scholarly journals Reduction in ERCP volume for Acute Cholangitis and other Indications during COVID-19 Pandemic

2021 ◽  
pp. 01-04
Author(s):  
Swathi Paleti ◽  
Zain A. Sobani ◽  
Tarun Rustagi
Keyword(s):  
Seasonal Variation ◽  
Retrospective Review ◽  
Acute Cholangitis ◽  
Absolute Number ◽  
Similar Time ◽  
Endoscopic Procedures ◽  
Time Period

Introduction: The COVID-19 pandemic continues to significantly impact healthcare with Joint Gastrointestinal Societies recommending rescheduling elective and non-urgent endoscopic procedures. The aim of our study was to evaluate the trend of acute cholangitis requiring emergent ERCP and overall ERCP practice in the setting of the COVID 19 pandemic. Methods: A retrospective review of all ERCPs performed at our institution was performed during the study period (3/16/2020 to 4/15/2020) along with the preceding 2 months (1/1/2020 to 2/29/2020) and similar time period from the last 2 years (3/16/2019 to 4/15/2019 and 3/16/2018 to 4/15/2018) for comparison to account for any seasonal variation. Results: A reduction was noted in absolute number and proportion of ERCPs performed for acute cholangitis during the study period compared to preceding months (2 [6.45%] vs. average 10.5 [15.05%] cases/month; 81% reduction). We also found reduction in overall number of both inpatient and outpatient ERCPs during the study period (31 ERCPs/month to average 70 ERCPs/month; 55% reduction in ERCP volume). Conclusions: There was a reduction in the overall ERCP volume and number of ERCPs performed for acute cholangitis during the COVID-19 pandemic. Further larger studies are needed to validate this data and investigate its causes. Keywords: ERCP; COVID-19; SARS-2-Cov; Pandemic; Acute cholangitis; Trend; Biliary

PP28 Volunteer emergency responder response to the COVID-19 pandemic surge

2021 ◽  
Vol 38 (9) ◽  
pp. A12.2-A12
Author(s):  
Shadman Aziz ◽  
Aditi Nijhawan ◽  
Samantha Palfreyman-Jones ◽  
Chris Hartley-Sharpe
Keyword(s):  
Retrospective Review ◽  
Statistical Significance ◽  
Skill Training ◽  
Absolute Number ◽  
Ambulance Service ◽  
Valuable Resource ◽  
Front Line ◽  
Emergency Responder ◽  
Time Period ◽  
Life Threatening

BackgroundThe London Ambulance Service (LAS) runs an Emergency Responder (ER) scheme, where trained volunteers respond to 999 calls in blue-light rapid response vehicles (RRVs), alongside the statutory ambulance service response.The COVID-19 pandemic caused an unprecedented surge in call volume which, combined with reduced staffing of double-crewed ambulances (DCAs) due to illness, severely impaired the service’s ability to respond to calls.In response to this, as well as increasing volunteer RRV shifts, ERs were given additional up-skill training to work with regular ambulance service clinicians on DCAs, thus increasing the number of DCAs available to attend calls.This study aims to review the response to the COVID-19 pandemic provided by ERs.MethodA retrospective review was conducted of all ER shifts on volunteer RRVs and the service’s front-line DCAs. Data from the same time period (March 1 – April 30) was compared between 2019 (pre-pandemic period) and 2020 (pandemic period). The statistical significance of proportions was calculated using the χ2 test.ResultsThe absolute number of RRV hours volunteered by ERs increased by 34.2% (2,017 to 2,707), resulting in a 21.2% increase in RRV shifts (227 to 275) during the pandemic period. Furthermore, the proportion of C1 (life-threatening) incidents attended by ER RRVs doubled (32.4% vs 61.1%, p < 0.0001). In addition to RRV shifts, ERs volunteered 1,222 hours on DCAs during the pandemic, resulting in 125 additional DCA resources available. The combined total hours provided by ERs (RRV/DCA) increased by 94.8% (2,017 to 3,929).DiscussionVolunteer responders are a valuable resource during times of surge. In addition to volunteer RRV shifts, they have to the potential to assist ambulance service clinicians on DCAs. Future pandemic or winter-pressure plans should incorporate volunteer responders. This study predominantly looked at volunteer capacity, and further work is required to investigate patient-centred outcomes.

scholarly journals High-Risk Medication Use and Polypharmacy in Older Veterans Who Attempt Suicide

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 747-747
Author(s):  
Ruth Morin ◽  
Yixia Li ◽  
Michael Steinman ◽  
Ilse Wiechers ◽  
Amy Byers
Keyword(s):  
High Risk ◽  
Suicide Risk ◽  
Medication Use ◽  
Late Life ◽  
Health Concern ◽  
Prescription Medications ◽  
Similar Time ◽  
Medical Diagnoses ◽  
Risk Of Death ◽  
Time Period

Abstract Late-life veteran suicide is a public health concern, and may overlap with recent high-risk medication use. We identified use in the 6 months prior to attempt and assessed salient risk factors. 13,872 veterans aged 50 years and older that attempted suicide were compared with demographically-matched controls utilizing VHA healthcare in a similar time period. Medications potentially related to suicide risk were included. Other variables were psychiatric and medical diagnoses, fatality of attempt and means. Compared with controls, veterans who attempted were nearly 3 times more likely to have been prescribed benzodiazepines and opioids, even when controlling for other diagnoses. Those taking 3 or more high-risk medications were between 7 and 11 times more likely to attempt than controls, with a higher risk of death particularly by drug overdose. These findings begin to uncover the complex contribution of prescription medications and polypharmacy to late-life veteran suicide, with implications for prevention. Part of a symposium sponsored by the Aging, Alcohol and Addictions Interest Group.

scholarly journals Comparison of endoscopic activity before and during the covid pandemic at a tertiary care hospital in South Punjab

2021 ◽  
Author(s):  
Farooq Mohyud Din ◽  
Muhammad Asif Gul ◽  
Nouman Hameed ◽  
Rizwan Hameed ◽  
Yasir Zaidi ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Tertiary Care ◽  
Healthcare Delivery ◽  
Absolute Number ◽  
Care Hospital ◽  
Common Indication ◽  
Endoscopic Procedures ◽  
Significant Difference ◽  
Internal Hemorrhoids ◽  
One Year

Introduction: Coronavirus disease 2019 (COVID-19) has resulted in dramatic changes to healthcare delivery. Endoscopic activity has had frequent disruptions during this pandemic. The objective of the study was to see the influence of pandemic over the endoscopic activity. Methods: This retrospective analysis of endoscopic activity was undertaken at Nishtar Hospital Multan. Procedural analysis was done in the three months immediately after covid lockdown (1st April till 30th June 2020) and was compared to a similar period one year back. Results: Five hundred and fifty-four (68.5%) patients underwent endoscopic procedures during the three months of pre-COVID era, while this number reduced to half (n=255, 31.5%) patients during the covid pandemic. Even though the absolute number of Esophagogastroduodenoscopies (EGDs) reduced during the pandemic, patients were more likely to undergo EGDs during the COVID pandemic in contrast to the era before the pandemic (79% versus 66%, p = 0.002). The most common indication for EGD was upper gastrointestinal bleeding (UGIB). The percentage of EGDs done for UGIB rose from almost 60% to 80% during the covid pandemic (p < 0.001). The most common findings were esophageal varices and portal gastropathy (non-significant difference during and before the pandemic). Percentage of ERCPs done for obstructive jaundice doubled during the COVID pandemic (33% versus 65%, p = 0.002).The most common indication for sigmoidoscopy or colonoscopy was lower gastrointestinal bleeding. However, no significant difference was found before and during the covid pandemic (41.7% and 45.8% respectively, p=0.72). Internal hemorrhoids were the most common endoscopic finding. Colon cancer diagnosis reduced from 10% to undetected during the pandemic period. Conclusion: COVID pandemic resulted in a considerable reduction in all types of endoscopic procedures. The majority of procedures were done for emergency indications like gastrointestinal bleeding. Rates of cancer detection were significantly reduced. MeSH: Endoscopy, COVID-19, Gastroenterology

Geomorphic Systems of Green Lakes Valley

2001 ◽  
Author(s):  
Nel Caine
Keyword(s):  
Drainage Basin ◽  
Nitrogen Saturation ◽  
Ecosystem Processes ◽  
Colorado Front Range ◽  
Front Range ◽  
Similar Time ◽  
Time Period ◽  
Ecosystem Studies ◽  
Green Lakes Valley ◽  
Geomorphic Processes

There are at least three justifications for the examination of the geomorphology of the area in which ecosystem studies are conducted. First, the present landscape and the materials that make it up provide the substrate on which ecosystem development occurs and may impose constraints, such as where soil resources are limited, on that development. Second, the nature of the landscape and the geomorphic processes acting on it often define a large part of the disturbance regime within which ecosystem processes occur (Swanson et al. 1988). Third, the processes of weathering, erosion, sediment transport, and deposition that define geomorphic dynamics within the landscape are themselves ecosystem processes, for example, involving the supply of resources to organisms. In this last context, it is noteworthy that drainage basins (also called watersheds or catchments) were recognized as units of scientific study during a similar time period in both geomorphology and ecology (Slaymaker and Chorley 1964; Bormann and Likens 1967; Chorley 1969). The drainage basin concept, the contention that lakes and streams act to integrate ecological and geomorphic processes, remains important in both sciences and underlies the studies in Green Lakes Valley reviewed here. Over the past 30 years, Niwot Ridge and the adjacent catchment of Green Lakes Valley have been the subject of much research in geomorphology. Building on the studies of Outcalt and MacPhail (1965), White (1968), and Benedict (1970), work has emphasized the study of present-day processes and dynamics, especially of mass wasting in alpine areas. These topics have been reviewed by Caine (1974, 1986), Ives (1980), and Thorn and Loewenherz (1987). Studies of geomorphic processes have been conducted in parallel with work on Pleistocene (3 million to 10,000 yr BP) and Holocene (10,000 yr BP to present) environments in the Colorado Front Range (Madole 1972; Benedict 1973) that have been reviewed by White (1982). This chapter is intended to update those reviews in terms that complement the presentation of ecological phenomena such as nitrogen saturation in the alpine (chapter 5) as well as to refine observations and conclusions of earlier geomorphic studies.

Gallstones in Sickle Cell Disease: A Single Institution Experience

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4939-4939
Author(s):  
Thomas Coats ◽  
Kate Gardner ◽  
Swee Lay Thein
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Surgical Complications ◽  
Conflicts Of Interest ◽  
Acute Cholangitis ◽  
Biliary Tree ◽  
Ultrasound Scan ◽  
Cell Disease ◽  
Time Period ◽  
Elective Cholecystectomy

Abstract Background: There is an increased incidence of gallstones in patients with sickle cell disease (SCD), due to haemolysis. Complications of gallstones include cholecystitis, pancreatitis and cholangiopathy and gallstones can trigger an acute sickle cell crisis. It is not known whether patients with asymptomatic gallstones would benefit from elective cholecystectomy to avoid such complications. Method: Electronic patient records of all 767 adult SCD patients attending clinic at King’s College Hospital, London between 1st Jan 2003 and 31st Dec 2013 were retrospectively reviewed to identify cases of gallstones. Medical records and steady state blood values were analysed in all those patients with an ultrasound of the biliary tree during this time period. Results: Amongst the cohort of 767 patients with SCD, 481 (62.7%) were HbSS, 244 (31.8%) HbSC, 35 (4.6%) HbSB+, 6 (0.8%) HbSB0 and 1 (0.1%) HbSHFPH genotype. 43% were male. Mean age at the end of the study period was 36.6 +/- 12.5 years. 344 patients had an ultrasound scan of the biliary tree during the time period of the study. 38 of the 344 patients scanned had had a cholecystectomy prior to 2003. Of the remaining 306 patients with an ultrasound scan, 134 had gallstones identified within the gallbladder. The 134 patients with gallstones comprised 119 (88.8%) HbSS, 12 (9.0%) HbSC, 2 (1.5%) HbSB+ and 1 (0.7%) HbSB0. 39.6% were male. Mean age at the end of the study period was 35.4 +/- 12.2 years. Of the 134 patients with gallstones identified during the study, 35 developed serious complications directly relating to cholelithiasis (5 pancreatitis, 4 acute cholangitis, 8 choledocholithiasis and 18 isolated cholecystitis) and 8 of these patients required sphincterotomies +/- stone removal with endoscopic retrograde cholangio-pancreatogram. 34 of the 134 patients with gallstones went on to have a cholecystectomy during the 11 year study period. Of these 34, 3 had recorded surgical complications following cholecystectomy (2 bile leaks, 1 hepatic injury). All 3 cases had gallstone-related complications prior to the cholecystectomy. Discussion: Our findings of cholelithiasis in 134 of the 306 of sickle cell disease patients scanned, is similar to incidence reported in the literature. Notably, we documented a high incidence of complications associated with cholelithiasis. Furthermore, there were higher than expected rates of surgical complications in cholecystectomy undertaken following the development of a complication relating to gallstones. These findings make routine screening for cholelithiasis followed by elective cholecystectomy for positive cases an attractive approach. Disclosures No relevant conflicts of interest to declare.

scholarly journals High Rate of Early Posterior Capsule Opacification following Femtosecond Laser-Assisted Cataract Surgery

2016 ◽  
Vol 7 (3) ◽  
pp. 491-495 ◽  
Author(s):  
Benjamin Rostami ◽  
Jack Tian ◽  
Nicholas Jackson ◽  
Rustum Karanjia ◽  
Kenneth Lu
Keyword(s):  
Femtosecond Laser ◽  
Cataract Surgery ◽  
Postoperative Complication ◽  
Retrospective Review ◽  
Early Onset ◽  
Posterior Capsule Opacification ◽  
High Rate ◽  
Posterior Capsule ◽  
Time Period

Purpose: To compare the rates of rapid posterior capsule opacification (PCO) formation in the first 3 months following femtosecond laser-assisted cataract surgery (FLACS) to manual anterior capsulorhexis. Methods: Retrospective review of 29 cases of FLACS, comparing the rates of PCO in the first 3 months following surgery to 50 consecutive cases of manual anterior capsulorhexis. Results: Seven of the 29 FLACS cases developed PCO requiring capsulotomy at 3 months, while none of the control cases required a capsulotomy over the same time period (p < 0.05). Conclusion: There is an increased incidence of early-onset PCO following the use of femtosecond laser in cataract surgery that is otherwise unfounded in manual capsulorhexis. This suggests that the use of a femtosecond laser could increase the risk of this novel postoperative complication.

Acute epiglottitis: analysis of factors associated with airway intervention

2005 ◽  
Vol 119 (12) ◽  
pp. 967-972 ◽  
Author(s):  
Hideaki Katori ◽  
Mamoru Tsukuda
Keyword(s):  
Diabetes Mellitus ◽  
Seasonal Variation ◽  
Endotracheal Intubation ◽  
Retrospective Review ◽  
Vocal Fold ◽  
Clinical Course ◽  
Acute Epiglottitis ◽  
Airway Intervention ◽  
Factors Associated ◽  
Two Factors

We reviewed acute epiglottitis (AE) and identified factors associated with airway intervention. This report was a retrospective review of patients with AE and compared with factors associated with airway intervention. We reviewed 96 patients who were diagnosed with AE in our hospitals in Japan. Ninety-two (96 per cent) patients were adults, and no seasonal variation in the incidence of AE was encountered. Eight (8 per cent) patients had tracheostomy and endotracheal intubation had not been done. We found that symptoms of stridor and muffled voice, a rapid clinical course, and diabetes mellitus were the factors associated with airway intervention. Extremely severe swelling of the epiglottis such that only less than half of the posterior vocal fold (scope classification (SC): III) could be seen, and extension of the swelling to the arytenoids (SC: B) were the two factors that were strongly associated with airway intervention.

scholarly journals Genetics of Body Mass Stability and Risk for Chronic Disease: A 28-Year Longitudinal Study

2007 ◽  
Vol 10 (4) ◽  
pp. 537-545 ◽  
Author(s):  
Carol E. Franz ◽  
Michael D. Grant ◽  
Kristen C. Jacobson ◽  
William S. Kremen ◽  
Seth A. Eisen ◽  
...  
Keyword(s):  
Environmental Factors ◽  
Body Mass ◽  
Genetic Correlations ◽  
Phenotypic Correlation ◽  
Similar Time ◽  
Ww Ii ◽  
Lower Socioeconomic ◽  
Time Period ◽  
Adult Onset Diabetes ◽  
Genetic And Environmental Factors

AbstractWe examined the contributions of genetic and environmental factors to body mass index (BMI) over approximately 28 years. Participants were 693 male, predominantly middle-class, twins (355 monozygotic, 338 dizygotic) from the Vietnam Era Twin Registry. The phenotypic correlation between age 20 and age 48 BMI was 0.52; the genetic correlation was 0.60. Most of the remaining variance at both times was accounted for by nonshared environmental factors. Since genetic factors are not perfectly correlated, this indicates that other genes affect BMI at one or both time points, leaving room for further exploration of the genetics of body mass stability. Mean BMI increased significantly from 22.7 (normal) to 27.8 (overweight). Overweight BMI at age 20 predicted midlife adult onset diabetes (adjusted odds ratio = 4.62, 95% CI 1.91 to 11.18), but not hypertension. Depending on one's vantage point, the results indicate elements of both stability and change in BMI. Very similar phenotypic and genetic correlations were observed over a similar time period in a WW II twin sample, but without the substantial mean increase in BMI. It seems unlikely that different genes influence BMI in the two cohorts. Therefore, we argue that nonshared environmental factors are probably primarily responsible for the secular increase in midlife BMI. Our results also provide prospective evidence that early excess BMI may have serious long-term health consequences, and that this risk is not limited to minorities or adults of lower socioeconomic status.

Organochlorine pesticide residues in human milk in the United Kingdom 1997–8

1999 ◽  
Vol 18 (10) ◽  
pp. 602-606 ◽  
Author(s):  
C A Harris ◽  
S O'Hagan ◽  
G HJ Merson
Keyword(s):  
United Kingdom ◽  
Human Milk ◽  
Organochlorine Pesticide ◽  
Pesticide Residues ◽  
Similar Time ◽  
Milk Samples ◽  
The United Kingdom ◽  
Time Period ◽  
Organochlorine Pesticide Residues ◽  
The Uk

1 The concentrations of a range of organochlorine pesticide residues have been determined in 168 samples of human milk collected between January 1997 and May 1998 in the UK. 2 Of the 18 residues sought, only p,p′-DTT, p,p′-DDE, dieldrin, HCB, β-HCH and γ-HCH were detected. 3 The continuing trend of a reduction in the concentrations of these pesticide residues in human milk samples and in the percentage of human milk samples containing residues was seen. 4 Correlations between the concentrations of p,p′-DDE, dieldrin, HCB, β-HCH and γ-HCH and age were seen. 5 When compared to studies carried out in Europe over a similar time period, residues in this present study were shown to occur at similar or lower concentrations.

scholarly journals Three year experience of Upper Gastrointestinal Endoscopic procedures at a tertiary care hospital of South Punjab

2021 ◽  
Vol 15 (11) ◽  
pp. 3064-3065
Author(s):  
F Mohyud Din Ch. ◽  
M. Asif Gul ◽  
Rizwan Hameed ◽  
Muhammad Ilyas ◽  
Muhammad Zubair ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Common Finding ◽  
Care Hospital ◽  
Endoscopic Procedures ◽  
Upper Gi ◽  
Time Period ◽  
Keywords Endoscopy ◽  
Upper Gi Endoscopy ◽  
Complications Of Cirrhosis ◽  
Upper Gastrointestinal

Introduction: Endoscopy has become a necessity in diagnosing gastrointestinal (GI) disorders. The objective of our study was to evaluate the different indications and findings of upper GI endoscopy. Methods: This retrospective analysis was undertaken at department of Gastroenterology, Nishtar Hospital Multan. Records of all upper GI endoscopic procedures from 1st January 2018 till 31st December 2020 were evaluated. Results: A total 3299 upper GI endoscopic procedures were perfumed during the three-year time period. Mean age was 47 years. Majority of patients were males. Almost 48% of patients belonged to the middle-aged group. The most common indication was upper GI bleeding (57%), followed by dyspepsia (15%). The most common finding was esophageal varices (43%), followed by portal gastropathy (26%) and gastritis (16%). Conclusion: This study concludes that the majority of endoscopies are being undertaken as a result of complications of cirrhosis and portal hypertension. Keywords: Endoscopy, audit, indications, findings

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