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Vestnik ◽  
2021 ◽  
pp. 131-135
Author(s):  
Е.К. Дюсембеков ◽  
А.Р. Халимов ◽  
И.Т. Курмаев ◽  
А.В. Николаева ◽  
А.С. Жайлаубаева ◽  
...  

Проведено исследование 93 пациентов с ятрогенными повреждениями периферических нервов, 11,7% по отношению ко всем оперированным пациентам. Женщин было 51, мужчин 42. Пациенты трудоспособного возраста составили 88%. Позднее обращение за специализированной нейрохирургической помощью составило 53,7%. Чаще всех повреждался седалищный нерв - 29,1%, затем лучевой нерв - 22,6%. Наиболее частые причины ятрогенных осложнений - это операции на опорно-двигательном аппарате (79 - 84,9%). Представлены виды оперативных вмешательств, предложены меры по профилактике и своевременному специализированному лечению больных с ятрогенными повреждениями нервов. Research has been done of 93 patients with iatrogenic injuries of peripheral nerves. It amounted to 11,7 per cent of all patients, who received surgical treatment. In the absolute value, there were 51 men and 42 women in gender equivalent. The significant quantity of working age patients amounts to 88%. 53.7% - it is late referral to specialized neurosurgical care. The volume of sciatic nerve injuries was the largest and amounted to 29,1%, the next a radial nerve - 22,6%. Most common causes of harmful complications there are operations on the musculoskeletal system (79 - 84,9%).The article shows the types of surgery, preventive measures and timely specialized treatment of patients with iatrogenic nerve injuries were proposed


Author(s):  
Vandana R. Saravade ◽  
Munira Ansari ◽  
Ganesh Shinde

Background: Objectives to study the causes of maternal mortality and the complications leading to maternal death.Methods: A retrospective study of hospital records and death summaries of all maternal death over a period of 11 years from January 2008 to December 2018 was carried out at tertiary care hospital, Mumbai.Results: There were a total of 459 maternal death out of 36930 live birth giving maternal mortality rate mean maternal mortality ratio (MMR) of 1242 per 100000 live births. Unregistered and late referral account for maternal death. The majority of women were in 21-30 years age group in 20 to less than 37 weeks of pregnancy. The commonest cause of death was due to hepatitis infection 129 (28.1%), sepsis 52 (11.32%), PIH including eclampsia 46 (10.02%), cardiovascular diseases 33 (7.18%), haemorrhage 31 (6.75%), Kochs 31 (6.75%) and respiratory diseases 22 (4.79%).Conclusions: Maternal mortality can be reduced by identifying causes which are preventable and giving timely treatment.


Author(s):  
Kirti Gujarkar Mahatme ◽  
Pratibha Deshmukh ◽  
Priyanka Deshmukh ◽  
Shiliveri Sadhan Siddardha

Maternal mortality is one of the indicators of an efficiently working healthcare system. Eclampsia is one of the preventable causes of maternal mortality and thus it is important to identify the signs in the preeclampsia phase and treat it efficiently to prevent the mishap. Many times, the detection of eclampsia is delayed due to improper history, late referral, ignorance, and delay in transportation or hospitalization. This report presents a 22 yr. old pregnant female, who presented to the hospital and before considering her for admission and shifting to ward, she threw convulsions. This report emphasizes on successful and timely management of such cases and the precautions which help to reduce maternal and fetal mortality.


Author(s):  
Marco Meloni ◽  
Jose Luis Lazaro Martinez ◽  
Raju Ahluwalia ◽  
Benjamin Bouillet ◽  
Valentina Izzo ◽  
...  

Abstract Aim To investigate the effectiveness of fast-track pathway (FTP) in the management of diabetic foot ulceration (DFU) after 2 years of implementation. Methods The study group was composed of patients who referred to a specialized DF centre due to DFUs. Those were divided in two groups: early referral (ER) and late referral (LR) patients. According to FTP, ER were considered patients who referred after 2 weeks in the case of uncomplicated non-healing ulcers (superficial, not infected, not ischemic), within 4 days in the case of complicated ulcers (ischemic, deep, mild infection) and within 24 h in the case of severely complicated ulcers (abscess, wet gangrene, fever). Healing, healing time, minor and major amputation, hospitalization, and survival were evaluated. The follow-up was 6 months. Results Two hundred patients were recruited. The mean age was 70 ± 13 years, 62.5% were male, 91% were affected by type 2 diabetes with a mean duration of 18 ± 11 years. Within the group, 79.5% had ER while 20.5% had LR. ER patients showed increased rates of healing (89.9 vs. 41.5%, p = 0.001), reduced healing time (10 vs. 16 weeks, p = 0.0002), lower rates of minor (17.6 vs. 75.6%, p < 0.0001) and major amputation (0.6 vs. 36.6%, p < 0.0001), hospitalization (47.1 vs. 82.9%, p = 0.001), and mortality (4.4 vs. 19.5%, p = 0.02) in comparison to LR. At multivariate analysis, ER was an independent predictor of healing, while LR was an independent predictor for minor and major amputation and hospitalization. Conclusion After the FTP implementation, less cases of LR were reported in comparison to ER. ER was an independent predictor of positive outcomes such as healing, healing time, limb salvage, hospitalization, and survival.


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Vincenzo Antonio Panuccio ◽  
Giovanna Parlongo ◽  
Rocco Tripepi ◽  
Giovanni Luigi Tripepi ◽  
Paola Cianfrone ◽  
...  

Abstract Background and Aims Effective outpatient organization is essential in the management of patients with chronic kidney disease. Although peritoneal dialysis (PD) has many advantages it is still not popular. Method The aim of this study was to evaluate patient and center-related factors that affect the final choice of peritoneal dialysis (PD) versus hemodialysis (HD) in the Calabrian region (Italy). We analyzed 2 annual regional surveys performed by nephrologists (2017 and 2018) in incident dialysis patients. Collected factors included: early and late referral to the dialysis program, pre-dialysis participation in outpatient visits, first dialysis access [peritoneal catheter (PC), central venous catheter (CVC), arteriovenous fistula (AVF)], final dialysis treatment (HD or PD) and the care giver. Results The study sample included 296 incident patients (63% males) aged 66±15 years. Time to referral influenced the type of first dialysis access. Among patients with early referral, 35% initiated dialysis by a PC, 34% by AVF and 31% by CVC, while among those with late referral, only 5% started dialysis by a PC, 15% by AVF, and the majority (80%) by CVC (P&lt;0.001). Time to referral was also associated with pre-dialysis visits (34%, 33% and 34% versus 5%, 22% and 73%, respectively, P&lt;0.001). When evaluating clinical suitability for treatment modality, 54% of early referrals and 45% of late referrals were eligible for PD. The choice of dialytic modality was again related to time to referral: 38% with early referral chose PD compared to 15% of those with late referral (P&lt;0.001). Furthermore, in patients who participated in the pre-dialysis program, 38% started PD versus 11% of patients that did not participate (P&lt;0.001). The role of the caregiver remains uncertain. Conclusion These data confirm that a more attentive and dedicated organization of the pre-dialysis outpatient program would contribute to a greater expansion of the peritoneal dialysis program.


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Gaetano Alfano ◽  
Francesco Fontana ◽  
Cristina Bosica ◽  
Annachiara Ferrari ◽  
Giacomo Mori ◽  
...  

Abstract Background and Aims Telemedicine is a new modality of care delivery. Over the last months, it has been used to deliver health care to outpatients with chronic kidney disease (CKD) during COVID-19 pandemic. However, experience of telemedicine in patients with severe CKD is scarce and there are not reassuring data about its efficacy in improving patients’ outcome. To evaluate the efficacy and the outcome profile of telemedicine in people with severe CKD, we reviewed all data of outpatients with severe kidney impairment who underwent nephrological evaluation during the first wave of this pandemic. In particular, outcomes of the ambulatory activity (urgent-start dialysis, late referral and modalities of dialysis initiation) were compared to 2019 ambulatory activity. Method Outpatients with severe chronic kidney disease included in the ambulatory program called “Pre-Dialysis Program were enrolled in a retrospective study. We reviewed all electronic charts of patients who underwent nephrological follow-up from 9th March to June 21st, 2020 (15 weeks in total) at the University Hospital of Modena, Italy. Extension of the observation period to 30th September 2020 allowed us to determine the long-term effects of telemedicine on the rate of urgent-star dialysis, late referral, and modalities of dialysis initiation. Results During 15 weeks of follow-up, 186 nephrological visits were performed (Table) They were subdivided into telemedicine visits (56.5%) and in-person visits (43.5%). Overall, mean age of patients was 71.7±13.1 years with a prevalence of male (60.2%). Patients who received telemedicine visits had a statistically significant lower sCr (3.7±1.2 vs 4.5±1.5 mg/dl; P=0.0001) and higher eGFR level (14.7±6.02 vs 12.16±5.8 ml/min; P=0.002) than patients followed in the ambulatory setting. A high prevalence of patients with CKD stage 5 was monitored by in-person visits (P=0.0001). Patients followed by telemedicine had a clinical profile including a lower weight (P=0.007) and better control of metabolic acidosis (P=0.039) than the counterpart. Changes in domiciliary therapy occurred more frequently in patients monitored in the ambulatory setting (P=0.036). Statistically significant differences were encountered in the prescription of diuretics (P=0.002), sodium bicarbonate (P=0.043), antihypertensive drugs (P=0.001) and uric acid-lowering agents (P=0.046). During the 15-week period in 2019, 214 visits were performed (+13% compared to 2020). The vast majority of these visits were conducted in the hospital setting (210 out of 214; 98.2%). The severity of CKD was similar between patients, without statistically significant difference in the rate of patients in CKD stage III (P=0.7), stage IV (0.388) and stage V (P=0.593). Implementation of telemedicine to in-person visits during COVID-19 pandemic did not change the outcomes of patients. Short-term follow-up showed a similar rate in urgent-start dialysis (P=0.361), late referral (P=1), and HD (P=0.875) or PD initiation (P=0.661). Similar results were seen also at the end of the extended follow-up. Conclusion Implementation of telemedicine has been fundamental to maintain a high level of care in CKD patients during the COVID-19 pandemic. Telemedicine services in combination with in-person visits have contributed to the delivery of clinical monitoring in a group of patients with severe and progressive CKD. No differences have been identified in terms of rate of unplanned dialysis, late referral, and modality of dialysis initiation.


2021 ◽  
Vol 54 (02) ◽  
pp. 157-162
Author(s):  
Parag B. Sahasrabudhe ◽  
Mugdha D. Pradhan ◽  
Nikhil Panse ◽  
Ranjit Jagtap

Abstract Background Deep sternal wound infections (DSWI) following median sternotomy are initially treated by the cardiothoracic surgeons and are referred to a plastic surgical unit late in the course of time. Methods This is a retrospective review done in a tertiary care teaching institute from January 2005 to June 2018 and the data of 72 patients who had DSWI out of 4,214 patients who underwent median sternotomy for coronary artery bypass grafting (CABG) was collected with respect to the duration between CABG and presentation of DSWI as well as time of referral to a plastic surgery unit. We defined early referral as < or equal to 15 days from presentation and late referral as > 15 days. Both groups were compared with respect to multiple parameters as well as early and late postoperative course, postoperative complications, and mortality. Results The early group had 33 patients, while the late group had 39 patients. The number of procedures done by the cardiothoracic team before referral to the plastic surgery unit is significant (p = 0.002). The average duration from the presentation of DSWI to definitive surgery was found to be 16.58 days in the early group and 89.36 days in the late group. The rest of the variables that were compared in both the groups did not have significant differences. Conclusion There is no statistical difference between early and late referral to plastic surgery in terms of mortality and morbidity. Yet, early referrals could lead to highly significant reduction in total duration of hospital stay, wound healing, and costs. Early referral of post-CABG DSWIs to Plastic surgeons by the cardiothoracic surgeons is highly recommended.


Cureus ◽  
2021 ◽  
Author(s):  
Jia Ji Ng ◽  
Hui Yan Ong ◽  
Zara Nasseri ◽  
Mohd Imree Azmi ◽  
Asma Abdullah
Keyword(s):  

Author(s):  
Akram Kawsara ◽  
Fahad Alqahtani ◽  
Vuyisile T. Nkomo ◽  
Mackram F. Eleid ◽  
Sorin V. Pislaru ◽  
...  

Background Whether the poor outcomes of isolated tricuspid valve surgery are related to the operation itself or to certain patient characteristics including late referral is unknown. Methods and Results Adult patients who underwent isolated tricuspid valve surgery were identified in the Nationwide Readmissions Database (2016–2017). Patients who had redo tricuspid valve surgery, endocarditis, or congenital heart disease were excluded. Multivariable logistic regression was performed to identify contributors to postoperative mortality. A total of 1513 patients were included (mean age 55.7±16.6 years, 49.6% women). Surrogates of late referral were frequent: 41% of patients were admitted with decompensated heart failure, 44.3% had a nonelective surgery status, 16.8% had advanced liver disease, and 31% had an unplanned hospitalization in the prior 90 days. The operation was performed on day 0 to 1 of the hospitalization in only 50% of patients, and beyond day 10 in 22% of patients. In‐hospital mortality occurred in 8.7% of patients. Median length of stay was 14 days (7–35 days), and median cost was $87 223 ($43 122–$200 872). In multivariable logistic regression analysis, surrogates for late referrals (acute heart failure decompensation, nonelective surgery status, or advanced liver disease) were the strongest predictors of in‐hospital mortality (odds ratio [OR], 4.75; 95% CI, 2.74–8.25 [ P <0.001]). This was also consistent in a second model incorporating unplanned hospitalizations in the 90 days before surgery as a surrogate for late referral (OR, 5.50; 95% CI, 2.28–10.71 [ P <0.001]). Conclusions The poor outcomes of isolated tricuspid valve surgery may be largely explained by the late referral for intervention. Studies are needed to determine the role of early intervention for severe isolated tricuspid regurgitation.


2020 ◽  
Author(s):  
James Heaf ◽  
Maija Heiro ◽  
Aivars Petersons ◽  
Baiba Vernere ◽  
Johan V Povlsen ◽  
...  

Abstract Background In patients with end-stage kidney disease (ESKD), home dialysis offers socioeconomic and health benefits compared to in-centre dialysis but is generally underutilized. We hypothesized that pre-dialysis course and institutional factors affect choice of dialysis modality after dialysis initiation (DI). Methods The Peridialysis study is a multinational, multicentre prospective observational study assessing the causes and timing of DI and consequences of suboptimal DI. Clinical and biochemical data, details of the pre-dialytic course, reasons for DI and causes of choice of dialysis modality were registered. Results Among 1587 included patients, 516 (32.5%) were judged unsuitable for home dialysis due to contraindications (384; 24.2%) or no assessment (106; 6.7%; mainly due to late referral and/or suboptimal DI) or death (26; 1.6%). High age, comorbidity, late referral, suboptimal DI, acute illness, and rapid loss of renal function associated with unsuitability. Of the remaining 1071 patients, 700 (65.4%) chose peritoneal dialysis (61.7%) or home haemodialysis (3.6%), while 371 (34.6%) chose in-centre HD. Somatic differences between patients choosing home dialysis and in-centre dialysis were minor; factors linked to choice of in-centre dialysis were late referral, suboptimal DI, acute illness and absence of a “home dialysis first” institutional policy. Conclusions Given a personal choice with shared decision making, 65.4% of ESKD patients choose home dialysis. Our data indicate that the incidence of home dialysis potentially could be further increased to reducing the incidence of late referral and unplanned DI, and, in acutely ill patients, by implementing an educational program after improvement of their clinical condition.


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