Safety and Efficacy of Various Intravenous Insulin Infusion Rates in Patients With and Without Diabetes Presenting With Hypertriglyceridemia

Background The use of IV insulin infusions in the acute management of hypertriglyceridemia has only been evaluated in small observational studies and case reports. Objective To evaluate the safety and efficacy of IV insulin infusions in the acute management of hypertriglyceridemia. Methods This was a retrospective chart review of adult patients who received an IV insulin infusion for the acute management of hypertriglyceridemia. The primary efficacy and safety outcomes were the number of patients who achieved a triglyceride level <500 mg/dL and experienced hypoglycemia (<70 mg/dL), respectively. A subgroup analysis was performed to compare outcomes between patients with and without diabetes, in addition to the IV insulin infusion rate received. Results In the total population (n = 51), there were no statistically significant differences between the insulin intensity groups in the number of patients who achieved TG levels <500 mg/dL. Compared to patients with a past medical history of diabetes, more patients without a past medical history of diabetes achieved triglyceride levels <500 mg/dL (14% vs 53%, respectively, P < 0.001). The number of hypoglycemic events observed in patients with and without a past medical history of diabetes were 5 (14%) and 4 (27%), respectively ( P = 0.023). Conclusion and Relevance Our findings suggest that patients who present with lower initial TG levels are more likely to achieve TG levels <500 mg/dL. To minimize the risk of hypoglycemia providers should consider prescribing a concomitant dextrose infusion and limiting IV insulin infusion rates ≤ 0.075 units/kg/h.

Acute Management of Deep Facial Burns

Introduction: Management of deep facial burns is a serious challenge for many reasons: a considerable anatomic and functional diversity is concentrated in a small space, a uniform treatment does not exist, late sequelae are frequent and may be severe, and the literature on the subject is ambiguous. Aim: To analyse management of deep facial burns. Patients and methods: A retrospective medical chart review was conducted for 569 patients with deep facial burns hospitalized between January 2005 and January 2015. Demographic data, type, depth and size of burns, chronology and type of surgical treatment, length of hospital stay, and type and incidence of late sequelae were analysed and compared. Results: Over 10 years, 596 patients with deep facial burns, 216 (36.24%) females and 380 (63.76%) males, aged from 5 months to 95 years (mean 39.5&plusmn;26 years) were treated. The most common burn agents were hot liquids and flames. The mean total body surface area (TBSA) burned was 17&plusmn;13.3%. Concomitant eye injury was detected in 63 (10.6%) patients. Priority was given to the early, meticulous, staged surgical approach aimed at sparing the survived tissues and rapid wound closure. Follow-up ranged from 3 months to 5 years. Late functional sequelae were documented for 50 (8.38%) patients and ocular sequelae - for 33 (5.54%) of them. There was no incidence of secondary corneal perforation or definitive loss of vision. Conclusions: Adequate and up-to-date acute management of deep facial burns based on early, judicious, surgical approach could limit initial damage and reduce late sequelae.

COMPARATIVE ASSESSMENT OF SURGICAL TREATMENT ACUTE INTRACRANIAL HEMATOMAS ACCORDING TO THE HOSPITAL

Представлены результаты хирургического лечения пациентов с острыми внутричерепными гематомами в различные периоды времени: 522 пострадавших были оперированы в период с 2011 по 2015 гг.; 498 пациентов были оперированы с 2016 по 2020 гг. В последний период экстренных нейрохирургических больных стали принимать дополнительно в трех стационарах, согласно районированию. Отмечено снижение числа пациентов, поступивших в фазе клинической декомпенсации, что можно объяснить сроками доставки в стационар с ближайших районов. Уменьшилась послеоперационная летальность до 17,3% (22,4% в первой группе). Среди умерших пациентов преобладают лица пенсионного возраста (46,5%). 59,3% погибших пациентов прожили менее трех суток. There is outcome surgical treatment of patients with acute intracranial hematomas at different times: 522 surgeries performed from 2011 to 2015; 498 ones underwent operation during 2016-2020. Recently, emergency neurosurgical procedures have been taking additionally in three hospitals in accordance with neighborhood. We can see decrease of patients with acute management of decompensation traumatic brain injury. This can be explained by their delivery to the nearest hospital. Postoperative mortality reduced to 17.3% (22.4% in the first group). Retirement patients predominate among the dead (46,5%). 59.3% of the mortality defined as less than three days.

Barriers to Optimal Acute Management of Stroke: Perspective of a Stroke Center in Mexico City

Background: Stroke is a leading cause of death and disability worldwide, particularly in low- and middle-income countries. We aimed to identify the main barriers to optimal acute management of stroke in a referral center.Methods: Demographic data was collected from patients assessed with acute stroke in the emergency department of the Instituto Nacional de Neurología y Neurocirugía (INNN) from January to June 2019. Additionally, a telephone interview was conducted with patients/primary caregiver to know which they considered the main reason for the delay in arrival at INNN since the onset of stroke.Results: 116 patients were assessed [age 65 ± 15 years, 67 (57.8%) men]. Patients consulted other facilities prior to arrival at INNN in 59 (50.9%) cases (range of hospitals visited 1–4), 83 (71.6%) arrived in a private car, with prenotification in only 4 (3.4%) of the total sample. The mean onset-to-door time was 17 h (45 min−10 days). Telephone interviews were done in 61 patients/primary caregivers, stating that they consider the multiple evaluations in other facilities [n = 26/61 (42.6%)] as the main reason for delay in arrival at the ED, followed by ignorance of stroke symptoms and treatment urgency [n = 21/61 (34.4%)].Conclusion: In this small, retrospective, single center study, the main prehospital barrier to optimal acute management of stroke in a developing country is multiple medical evaluations prior to the patient's transport to a specialized stroke hospital, who mostly arrived in a private car and without prenotification. These barriers can be overcome by strengthening public education and improving patient transfer networks and telemedicine.

Acute Management in Corrosive Ingestion

Corrosive ingestion is an important health problem and medical emergency worldwide. It occurs by accident or by intention. Acids cause coagulation necrosis, and alkalis cause liquefaction necrosis. In the acute period, stabilization of the patient is most important. Airway assessment and prompt management are a priority for severe cases. Caustic substance reflux into the esophagus resulting in further damage should be prevented. The initial evaluation should be performed by endoscopy and graded according to the Zargar classification. Computed tomography (CT) should be used to assess injury to the esophagus because CT is non-invasive. For Zargar 3b injuries, views from both endoscopy and CT scans should be considered. Post-corrosive esophageal stricture is a complication that responds poorly to treatment. Research and development for stricture prevention are ongoing, especially for Zargar 2b and 3a cases.