Clinical and statistical characteristic of references at the third stage of ophthalmic care

AIM:to carry out a clinical and statistical analysis of patients references at the third stage of ophthalmic care in Azerbaijan Republic conditions. MATERIALS AND METHODS:Materials of the National Ophthalmology Center named after the Academician Zarifa Aliyeva are used. All the cases of primary references during 2019 are analyzed. RESULTS:The lowest proportion of unjustified references was among residents of republican subordination cities (1.3 0.1%), where the frequency of primary visits is low as well (1.28 0.04). The rate of unjustified references of regional centre city residents (4.8 0.1%), and of those of rural settlements (10.7 0.1%) were significantly different. There were significant differences concerning the rate of primary visits (2.32 0.026 and 2.56 0.024). The rate of primary visits between male and female populations also was significantly different (2.58 0.024 and 3.02 0.021,р 0.01). CONCLUSION:The rate of primary references at the third stage was 4.62 0.04 in Baku, 2.56 0.024 in rural settlements, 2.32 0.031 in regional centre cities, and 1.28 0.04 in republican subordination cities; it had significant gender specificities. Within primary visit causes, accommodation and refraction disorders (32.3 0.5%), ocular trauma and that of eye adnexa (19.7 0.4%) prevail.

«Complex» choledocholithiasis in practice of regional centre of endoscopic surgery

Objective. Estimation of rate of various causes of «complex» choledocholithiasis (CL) in practice of regional centre of endoscopic surgery. Materials and methods. The investigation was conducted on the base of Department of Surgery in Odessa Regional Clinical Hospital in 2019-2021 yrs. Experience of endoscopic operative interventions, performed in 198 patients with clinical signs of CL, was analyzed. Results. In 45 (22.7%) patients while ultrasonographic investigation a solitary calculus was revealed, while in the others –multiple calculi. Average value of the common biliary duct diameter have constituted (10.5 ± 0.8) mm. In all the patients distal localization of calculi was present, which coexisted in 31 (15.7%) with supraduodenal localization. In 1 woman-patient a valve calculus was revealed, which caused several accidents of biliary colic in anamnesis. Thus, multiple CL was present in majority of the patients. In 53 (26.8%) patients “complex” CL was diagnosed. While analyzing the causes rate of «complex” CL there was established its mostly frequent form (71.7%) occurring after previous multiple attempts of endoscopic interventions. Also frequent forms have appeared in technical complexities while approaching duodenal papilla magna (9.2%), cases of periampullar duodenal diverticulosis (5.8%) and tubular stenosis of common biliary duct (5.0%). Complete endoscopic papillosphincterotomy with the calculi extraction by one séance was performed in 27 (13.6%) patients. In 15 (7.6%) patients the procedure of a one-staged extraction of calculi failed as a consequence of the complications occurrence, presence of multiple big calculi. In these patients repeated seances of endoscopic papillosphincterotomy were done with extraction of calculi, which in 5 (2.5%) patients have demonstrated inefficacy, leading to performance of relithoextraction (up to 3 seances). Conclusion. Rate of “complex” CL constitutes 26.8%, its mostly frequent cause is previous multiple attempts of local endoscopic interventions. Rate of perioperative morbidity, while doing endoscopic interventions, do not exceed 15%, and mostly frequent complication is an acute pancreatitis. In part of the patients with “complex” CL it is expedient to apply laparoscopic and combined interventions.

The effect of COVID-19 First Lockdown on ENT emergencies: what happened and what can we learn?

ENT emergencies are heterogeneous and include infections, inflammatory and traumatic conditions. We observed what appeared to be a dramatic alteration in emergency presentations to our unit during the early phase of 1st COVID-19 Lockdown in 2020. Objective- This study compares pre COVID-19 presentations with 1st Lockdown presentations and examines the overall numbers; conditions encountered and draw conclusions which may influence future planning for ENT services. Setting-Records for emergency ENT presentations to a regional centre were examined for two comparable 61-day time periods. Design and Participants-Presentations for April and May 2019 (pre COVID-19) were compared to April and May 2020 (1st Lockdown). Records were compared with regards to overall numbers, demography, diagnosis and treatment. Admissions for COVID-19 related airway interventions and admissions/attendances for elective complications were excluded. Results and conclusion-In the pre COVID-19 group, 649 emergency presentations were recorded: 401 infection related cases, 90 epistaxis, and 158 non-infectious/traumatic cases. In the 1st Lockdown group, 254 emergency presentations were recorded: 121 infection related cases, 56 epistaxis and 77 non-infectious/ traumatic cases. Overall, there was a 61% reduction in emergency presentations during the 1st Lockdown. Infectious cases reduced by 70%, epistaxis reduced by 38% and non-infectious cases fell by 51%. All of these differences were statistically significant (p value <0.05). The infectious category showed the greatest reduction in presentations and within this category the greatest change was observed in Laryngeal infections (95%), facial cellulitis (84%) and Tonsil infections (73%).