Prospective Observational Study
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BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Giziew Bawoke ◽  
Segni Kejela ◽  
Abebe Alemayehu ◽  
Girmaye Tamirat Bogale

Abstract Background Modified radical mastectomy is the procedure of choice in centers with little to no radiotherapy services. Studying the in-hospital outcome and complications associated with the procedure is important in low-income countries. Methods This is a multi-center prospective observational study involving all patients operated with modified radical mastectomy with curative intent. Results A total of 87 patients were studied with 10.3% of which were male and 54% were between the age of 30–49 years. Clinical stage IIB and IIIA were reported in 33 (37.9%) and 25 (28.7%) respectively and 62.1% had clinically positive lymph nodes at presentation. All of the studied patients underwent curative surgery, with an average lymph node dissection of 10.2 ± 0.83. Seroma rate was 17.2% and was significantly associated with diabetes (AOR: 6.2 (CI 1.5–8.7)) and neoadjuvant chemotherapy (AOR: 8.9 (CI 1.2–14.2)). Surgical site infection occurred in 14.9% and was significantly associated with Retroviral infections (AOR: 4.2 (CI 2.1–5.8)) and neoadjuvant chemotherapy (AOR: 1.8 (CI 1.3–3.9)). No in-hospital mortality occurred during the course of the study. Conclusion Seroma rate was lower than published studies while surgical site infections rate was higher. Neoadjuvant chemotherapy was associated with increase in seroma and surgical site infection rates. Additionally, diabetes increased the rate of seroma. Surgical site infections were higher in patients with retroviral infections.

2021 ◽  
Vol 124 ◽  
pp. 108317
Manisha Verma ◽  
Chandrakanta Kumar ◽  
Areesha Alam ◽  
Rashmi Kumar ◽  
Sciddhartha Koonwar ◽  

Milla Jousi ◽  
Marja Mäkinen ◽  
Johanna Kaartinen ◽  
Leena Meriläinen ◽  
Maaret Castrén

Abstract Background In the pre-hospital setting, non-urgent patients with non-specific chief complaints pose assessment challenges for the emergency medical systems (EMS). Severely ill patients should be identified among these patients, and unnecessary transport to the emergency department (ED) should be avoided. Unnecessary admissions burden EDs, deplete EMS resources and can even be harmful to patients, especially elderly patients. Therefore, tools for facilitating pre-hospital decision-making are needed. They could be based on vital signs or point-of-care laboratory biomarkers. In this study, we examined whether the biomarker soluble urokinase plasminogen activator receptor (suPAR), either alone or combined with C-reactive protein (CRP) and/or lactate, could predict discharge from the ED and act as a pre-hospital support tool for non-conveyance decision-making. Methods This was a prospective, observational study of adult patients with normal or near-normal vital signs transported by an EMS to an ED with a code referring to deteriorated general condition. The levels of suPAR, CRP and lactate in the patients’ pre-hospital blood samples were analysed. The values of hospitalized patients were compared to those of discharged patients to determine whether these biomarkers could predict direct discharge from the ED. Results A total of 109 patients (median age: 81 years) were included in the study. Of those, 52% were hospitalized and 48% were discharged from the ED. No statistically significant association was found between suPAR and the ED discharge vs hospitalization outcome (OR: 1.04, 95% CI 0.97–1.13, AUROC: 0.58, 95% CI 0.47–0.69). Adding CRP (AUROC: 0.64, 95% CI 0.54–0.75) or lactate (AUROC: 0.60, 95% CI 0.49–0.71) to the regression models did not improve their diagnostic accuracy. None of the patients with a suPAR value of less than 2 ng/ml were admitted to hospital, while 64% of the patients with a suPAR value of more than 6 ng/ml were hospitalized. Conclusion Pre-hospital suPAR measurements alone or combined with CRP and/or lactate measurements could not predict the ED discharge or hospital admission of 109 non-urgent EMS patients with non-specific chief complaints and normal or near-normal vital signs.

Mateusz Czyzycki ◽  
Elzbieta Klimiec‐Moskal ◽  
Adrian A. Chrobak ◽  
Joanna Pera ◽  
Agnieszka Slowik ◽  

2021 ◽  
Vol 3 (3) ◽  
pp. 72-76
Renu Rajguru ◽  
Anubhav Singh ◽  
Garima Rajguru ◽  
Dibya Jyoti Boruah

Facial aesthetic surgery requires a thorough preoperative analysis of face and identification of problems to frame a comprehensive surgical plan. The conceptions of an attractive face must be analyzed beforehand. Powell and Humphrey had defined facial angles and had formulated range which would be perceived as attractive. To compare the change in pre- and post-operative nasolabial, nasofrontal and nasofacial angles in patients undergoing Rhinoplasty. A prospective observational study was conducted from October 2014 to October 2019 in ENT department of a tertiary care hospital. Twenty-one patients undergoing Rhinoplasty and fulfilling the inclusion criteria were considered as study population. Their pre- and post-operative profile photographs were taken for morphometric analysis. The nasolabial, nasofrontal and nasofacial angles were measured and compared, before and one month after the surgery in profile pictures. A significant change in the nasolabial and nasofacial angles were seen following Rhinoplasty. The mean nasofrontal angle showed an increase following Rhinoplasty but was not found significant. Rhinoplasty results in significant change in nasofacial and nasolabial angles and in expert hands, is expected to restore the various facial angles to their acceptable range.

Yudai Yamamoto ◽  
Yunosuke Sato ◽  
Miri Takahashi ◽  
Hiroto Yamamoto ◽  
Mayumi Echizen ◽  

Abstract Purpose The Activator F (ActF) test on the TEG6s Platelet Mapping assay system is a means of quantifying blood viscoelasticity caused by fibrin network formation, triggered by reptilase and factor XIII, while platelets are inhibited. This unique methodology enables the measurement of blood viscoelasticity, even in highly heparinized blood. Here, we investigated whether fibrinogen concentration could be estimated using the ActF test in blood samples obtained during cardiopulmonary bypass (CPB) and after CPB in patients undergoing cardiovascular surgery. Methods We performed a single-center prospective observational study at a university hospital. Forty patients aged ≥ 18 years who underwent elective cardiovascular surgery with CPB were enrolled. Blood samples were drawn after the induction of anesthesia, after declamping of the aorta during CPB, and after the reversal of heparinization using protamine (after CPB). Coagulation profiles were evaluated using the Platelet Mapping assay and standard laboratory tests. Results There were strong correlations between the maximal amplitude of clot strength (MA) in the ActF test and fibrinogen concentration in samples drawn during CPB (R = 0.84, 95% confidence interval [CI] 0.72–0.91; P < 0.001) and after CPB (R = 0.83, 95% CI 0.70–0.91; P < 0.001). The areas under the receiver-operating characteristic curve for the ActF MA for fibrinogen concentrations < 150 mg/dL were 0.86 (95% CI 0.73–1.0) during CPB and 0.98 (95% CI 0.94–1.0) after CPB. Conclusion TEG6s Platelet Mapping ActF MA values strongly correlated with plasma fibrinogen concentration in highly heparinized blood during CPB and yielded highly accurate measurements of low fibrinogen concentrations.

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