Surgical management of continuous and mixed type of OPLL in cervical spine: Experience in tertiary level hospital.

Background: Ossification of the posterior longitudinal ligament (OPLL) is a chronically progressive disease of ectopic enchondral and membranous ossification of posterior longitudinal ligament (PLL). Controversy still persists over the superiority of various surgical approaches for cervical OPLL management. Purpose: To see the efficacy of expansive laminoplasty for the management of continuous and mixed type of cervical OPLL retrospectively. Methods: Records of 20 male and 8 female aged 36-72 years (mean, 56.64 years), who underwent surgical treatment posteriorly for continuous and mixed type OPLL by laminoplasty were obtained from the year 2004 - 2020. Clinical features along with imaging studies, which included X -ray/CT /MRI, were done for the diagnosis of OPLL. Multiple variables were studied, including demographics, surgical parameters, complications and functional outcomes. Results: They were followed on an average of 59.86 ± 20.95 months (range, 24 -108 months). The average operative duration was 95 ± 15.52 min (range: 70 - 140), and the intraoperative blood loss was 199.29 ± 33.55 ml. The cervical curvature index reduced to 8.81 ± 1.96 from 11.00 ± 2.49 and the VAS score decreased from 4.25 ± 0.75 to 2.43 ± 1.40. mJOA score improved from 8.64 ± 1.03 to 13.96 ± 1.26 on the last follow-up after surgery (p < 0.01), with average recovery rate of 65.5 %. Conclusions: The management for cervical myelopathy with multilevel stenosis due to continuous and mixed type of OPLL by Laminoplasty is safe and effective.

Effectiveness of ultrasound screening for placenta accreta spectrum using standard ultrasound criteria in a secondary care setting

Objectives: Ultrasound detection of placenta accreta spectrum (PAS) among women at risk is a key goal to reduce obstetric morbidity, but there is scarce information of its performance in real clinical settings. We report the effectiveness of a standardized ultrasound protocol to detect PAS in women with placenta previa in a secondary-level hospital. Methods: A retrospective analysis, including a cohort of 126 women with persistent placenta previa among 27,975 pregnancies between 2008 and 2020. All 126 women underwent standardized transabdominal and transvaginal ultrasound assessing 5 criteria: 1) loss of hypoechoic retroplacental zone and/or myometrial thinning <1 mm; 2) lacunar images with flow >15 cm/sec; 3) thick and bulging placenta; 4) thinning or interruption of the uterine-bladder serous interface; and 5) placental or uterovesical hypervascularity. The presence of at least one criterion was considered a high-risk for PAS. Diagnosis of PAS was confirmed during caesarean section and by histopathological analysis. Results: Among 126 women with placenta previa, 11 (8.7%) cases of PAS were diagnosed, of which 10 were detected prenatally by ultrasound. This resulted in a sensitivity of 90,9%, a specificity of 98,3%, a positive predictive value (PPV) of 83,3%, and negative predictive value (NPV) of 99,1%. Histopathological assessment showed six placenta increta (54.5%), four percreta (36.4%) and one accreta (9.1%). All 10 cases of invasive placenta presented more than three ultrasound criteria. Conclusions: Standardized ultrasound screening protocol in women at risk due to placenta previa in the third trimester was highly effective in detecting PAS in a secondary-level hospital setting.

Long-Term Outcomes in Patients on Life-Long Antibiotics: A Five-Year Cohort Study

Background: Little is known about the impacts at an individual level of long-term antibiotic consumption. We explored health outcomes of long-term antibiotic therapy prescribed to a cohort of patients to suppress infections deemed incurable. Methods: We conducted a 5-year longitudinal study of patients on long-term antibiotics at Monash Health, a metropolitan tertiary-level hospital network in Australia. Adults prescribed antibiotics for >12 months to suppress chronic infection or prevent recurrent infection were included. A retrospective review of medical records and a descriptive analysis was conducted. Results: Twenty-seven patients were followed up during the study period, from 29 patients originally identified in Monash Health in 2014. Seven of the 27 patients (26%) died from causes unrelated to the suppressed infection, six (22%) ceased long-term antibiotic therapy and two (7%) required treatment modification. Fifteen (56%) were colonised with multiresistant microorganisms, including vancomycin resistant Enterococci, methicillin resistant Staphylococcus aureus, and carbapenem resistant Enterobacteriaciae. Conclusions: This work highlights the potential pitfalls of long-term antibiotic therapy, and the frailty of this cohort, who are often ineligible for definitive curative therapy.

Infection by SARS CoV-2 in healthcare workers of a second level hospital

Background: From the first Covid-19 case in Playa del Carmen, 370 cases of infection have been reported in our staff until December 31, 2020. Material and Methods: Study in workers of the General Hospital who developed SARCOV-2 infection during the pandemic. A sample of 30 cases of both sexes with laboratory-confirmed infection was obtained. Descriptive statistics were used with measures of central tendency, dispersion and percentages. Results: In a sample of 30 workers there were 13 doctors, 6 nurses and 11 support workers. The age was obtained as a mean of 38.8 years and SD = 10.4. Only four risk factors were found. Of the 30 infected health workers, 27 were treated on an outpatient basis and three required hospitalization. Discussion: The main symptoms in health workers are alterations in the sensation of taste and smell, but unlike our study, was headache, fever and myalgia. Likewise, it has been observed that medical are the most affected, but in this study, it was support and the least affected was nursing personnel. There is no doubt that asymptomatic carriers are a serious disease transmission problem such that transmission between health workers by asymptomatic carriers is possible as was observed in this analysis. Keywords: COVID-19; SARS-CoV-2; Healthcare Workers; Nosocomial Transmission; Asymptomatic Carriers; Diagnostic Testing

Access to advanced-level hospital care: differences in prehospital times calculated using incident locations compared with patients’ usual residence

Studies estimate that 84% of the USA and New Zealand’s (NZ) resident populations have timely access (within 60 min) to advanced-level hospital care. Our aim was to assess whether usual residence (ie, home address) is a suitable proxy for location of injury incidence. In this observational study, injury fatalities registered in NZ’s Mortality Collection during 2008–2012 were linked to Coronial files. Estimated access times via emergency medical services were calculated using locations of incident and home. Using incident locations, 73% (n=4445/6104) had timely access to care compared with 77% when using home location. Access calculations using patients’ home locations overestimated timely access, especially for those injured in industrial/construction areas (18%; 95% CI 6% to 29%) and from drowning (14%; 95% CI 7% to 22%). When considering timely access to definitive care, using the location of the injury as the origin provides important information for health system planning.