Prognostic Factors after Acute Subdural Hematoma

Background: Acute subdural hematoma is a lesion caused by traumatic brain injury. Computed topography, hematoma thickness and midline shift analysis are important factors in evaluating its prognosis. Aim: To evaluate the factors involved in prognosis of acute subdural hematoma. Study design: Retrospective study Place and duration of study: Department of Neurosurgery, Chandka Medical College Hospital, Larkana from 1st October 2020 to 30the June 2021. Methodology: One hundred patients from both genders and between age 18-55 years were enrolled. Clinical examination and radiological complete examination was done in each patient. Zumkeller Index (ZI) was calculated and Glasgow scoring was performed. Results: The mean age were 44.1±15.8 years with 87% males having major reasoning of head injury as a motor cycle accident. Traumatic brain injury was recorded as >3mm ZI in 10 cases. The mean midline shift was 12.4±6.06 mm with a significant difference between three categories. Conclusion: Midline shift and hematoma thickness are useful predictors of prognosis related to acute subdural hematoma. Keywords: Prognostic factor, Acute subdural hematoma, Computed tomography (CT)

Sonographic Measurement and Sex Variability of Portal Vein Using US scan in a sample of Sudanese Adults

Background: Measurements of the normal portal venous dimension in a specified population is so crucial. portal vein can be measured by several methods for assessing different parameters, Computed topography (CT) and sonographic imaging are common examples. The diagnosis of portal hypertension depends on the transverse portal vein diameter (normal diameter from 6-15 mm). The aim of this study is to establish baseline value for the portal vein diameter and assess the correlation with age, gender, weight, height and BMI in Sudanese populations.Methodology: This was a descriptive cross-sectional study that included a sample of Sudanese adults who were requested to have routine abdominal sonographic scanning due to reasons not related to liver or portal vein problems. The study was carried out at the Radiology Department of Qatar Alnada Hospital, Umbadda, Khartoum, Sudan 2020.Results: In this study, 376 participants were included of which more than half were females (56.1%, n=211), while 165(43.9%) were males. The mean age of the participants was 38.12 + 15.57 years. The mean portal vein diameter was 10.79 + 1.27 millimeters. From this study the portal vein diameter varied with age (p value = 0.000), weight (p value = 0.002), height (p value = 0.000) and gender (p value = 0.000). It is not related to BMI (p value = 0.3).Conclusion: This study has revealed that the portal vein diameter has positive correlation with age, gender, height, and weight of the person and has no correlation with the BMI.

Occurrence of Extra Roots in Permanent Mandibular Molars: A Cone Beam Computed Topography Study

Introduction: Permanent mandibular first and second molars may display extra roots namely radix entomolaris and radix paramolaris which may have implications in endodontic treatment outcome, if missed. Objective: To evaluate the occurrence of extra roots in permanent mandibular first and second molars in a sample of Nepalese population. Methods: This analytical cross-sectional study was done at Dhulikhel hospital. Convenience sampling technique was utilised for data collection of 773 CBCT images. Images from June 2018 to June 2020 were retrospectively screened for presence of fully erupted bilateral mandibular first and second molars. Presence of extra roots were recorded and laterality, gender, and racial variations were analysed by Fisher’s exact test and Chi-square test using SPSS v.20. Results: For mandibular first molars, out of 517 patients, 65 (11.38%) had radix entomolaris: 38 (13.2%) female and 27 (9.54%) male. Among 38 females; occurrence was 21 (7.3%) bilateral, 16 (5.56%) unilateral right and 1 (0.34%) unilateral left side. Likewise, among 27 males, the occurrence was 15 (5.3%) bilateral, 6 (2.1%) unilateral right and 6 (2.1%) unilateral left side. Regarding races, 50 (14.6%) were Mongoloids and 15 (6.6%) were Aryans. No radix paramolaris was found in mandibular first molars. For mandibular second molars, out of 623 patients, radix entomolaris and paramolaris were observed in 0.8% and 0.48% respectively. Conclusion: The overall occurrence of radix entomolaris in mandibular first and second molars was found to be 11.38% and 0.8%, respectively. Practitioners should be aware of these unusual variations to avoid iatrogenic mishap due to missed canal.

341 The Diagnosis and Management of Appendicitis During the COVID-19 Pandemic: The Pennine Acute Trust Experience

Introduction Appendicitis management has evolved recently with more reliance on Computed Topography (CT) and laparoscopic surgery being commonplace. In this project we looked at how the Coronavirus pandemic (COVID-19) had impacted the diagnosis, management and outcomes of patients with appendicitis in our unit. Method A retrospective review of patients diagnosed with appendicitis from 1st March – 30th April in 2019 and 2020. Data was collected on diagnosis, management and outcomes. Results In 2020, 91 patients were identified (mean 33, range 6-85, F:M 1:1.4). In 2019, 107 patients were identified (mean 32, range 7-69, M:F 1:1.1). There was no significant difference in patients’ symptom duration (p = 0.21), White Cell Count (p = 0.20) or C-Reactive Protein (p = 0.10). More CTs were performed in 2020 (56/91, 61.5%) than in 2019 (40/107, 37.4%). Less patients underwent appendicectomy in 2020 (75/91, 82.4%) than in 2019 (104/107, 97.2%). Open appendicectomies were performed in 64% (48/75) of those operated in 2020 compared with 12.2% (13/104) in 2019. There was no difference in hospital length of stay or re-admissions rates. Conclusions The diagnosis and management of appendicitis changed considerably at our trust during COVID-19 with more reliance on CT diagnosis and less use of laparoscopy. Despite this, outcomes remained unchanged.

721 Imaging for Suspected Bowel Obstruction in Pennine Acute Trust (PAT): A Comparison with the National Audit of Small Bowel Obstruction’s (NASBO) recommendations

Background NASBO recommends Computed Topography (CT) over plain abdominal X-ray (AXR) for the investigation of bowel obstruction (BO). AXR is routinely used within PAT for investigation of BO which may be exposing patients to unnecessary radiation and adding unnecessary cost to the service. Method A retrospective audit collected data on patients with CT confirmed BO between July 2019 and February 2020. This looked at the percentage of patients who had both CT and AXR to investigate BO. The cost of these AXRs and the percentage of these AXRs that were normal were also calculated. Results A search identified 141 patients with CT proven BO. 81/141(57.4%) patients had both AXR and CT as a part of their initial investigations. Of those patients 26/81(32.1%) had no AXR features suggestive of BO. Only 12/81(14.8%) of those patients had serial AXRs following initial imaging. The cost for one AXR is £34.15 which means £2766.15 was spent on potentially unnecessary AXRs within this period. Conclusions PAT is performing potentially unnecessary AXRs which is exposing patients to unnecessary radiation and costing the trust. Plain AXRs do not rule out BO. We have recommended an investigation flowchart to PAT A&E departments to reduce unnecessary AXRs being performed.

P122 The Diagnosis and Management of Appendicitis During the COVID-19 Pandemic: The Pennine Acute Trust Experience

Introduction Appendicitis management has evolved recently with more reliance on Computed Topography (CT) and laparoscopic surgery being commonplace. In this project we looked at how the Coronavirus pandemic (COVID-19) had impacted the diagnosis, management and outcomes of patients with appendicitis in our unit. Method A retrospective review of patients diagnosed with appendicitis from 1st March – 30th April in 2019 and 2020. Data was collected on diagnosis, management and outcomes. Results In 2020, 91 patients were identified (mean 33, range 6-85, F:M 1:1.4). In 2019, 107 patients were identified (mean 32, range 7-69, M:F 1:1.1). There was no significant difference in patients’ symptom duration (p = 0.21), White Cell Count (p = 0.20) or C-Reactive Protein (p = 0.10). More CTs were performed in 2020 (56/91, 61.5%) than in 2019 (40/107, 37.4%). Less patients underwent appendicectomy in 2020 (75/91, 82.4%) than in 2019 (104/107, 97.2%). Open appendicectomies were performed in 64% (48/75) of those operated in 2020 compared with 12.2% (13/104) in 2019. There was no difference in hospital length of stay or re-admissions rates. Conclusion The diagnosis and management of appendicitis changed considerably at our trust during COVID-19 with more reliance on CT diagnosis and less use of laparoscopy. Despite this, outcomes remained unchanged.