Pub Date : 2021-11-01DOI: 10.4103/2221-6189.330741
E. Birgi, H. Durmaz, Kürşat Güreşci, O. Ergun, G. Cıgsar, Burhan Kurtuluş, B. Hekimoğlu
Objectives: To present our experience in delivering endovascular therapies for emergent vascular traumas with various vascular structures. Methods: Between September 2013 and February 2018, patients who underwent endovascular intervention due to penetrating, blunt and iatrogenic arterial traumas were analyzed, retrospectively. Demographic data, trauma site, mechanism of injury, angiographic findings or arterial injury patterns, treatment methods, and outcomes were recorded. Results: A total of 30 patients were included. The mean age of patients was 39 years (range: 15-87 years). Arterial trauma locations were in the compressible area with a rate of 43% (n=13) and in the noncompressed area with a rate of 57% (n=17). Mechanisms of injuries were blunt [53% (n=16)], penetrating [17% (n=5)], and iatrogenic [30% (n=9)]. The most common indication for endovascular treatment was blunt noncompressible injury (n=12). Methods used for treatment were stent-graft (46%, n=14) and coil embolization (54%, n=16). Immediate success was obtained in all procedures. The mean follow-up duration was 5 months (range: 1-12 months). Conclusions: Endovascular treatments performed in traumatic arterial emergencies are effective and minimally invasive with very low complication rates even in hemodynamically unstable patients.
{"title":"Endovascular management of traumatic arterial emergencies: A single center retrospective study","authors":"E. Birgi, H. Durmaz, Kürşat Güreşci, O. Ergun, G. Cıgsar, Burhan Kurtuluş, B. Hekimoğlu","doi":"10.4103/2221-6189.330741","DOIUrl":"https://doi.org/10.4103/2221-6189.330741","url":null,"abstract":"Objectives: To present our experience in delivering endovascular therapies for emergent vascular traumas with various vascular structures. Methods: Between September 2013 and February 2018, patients who underwent endovascular intervention due to penetrating, blunt and iatrogenic arterial traumas were analyzed, retrospectively. Demographic data, trauma site, mechanism of injury, angiographic findings or arterial injury patterns, treatment methods, and outcomes were recorded. Results: A total of 30 patients were included. The mean age of patients was 39 years (range: 15-87 years). Arterial trauma locations were in the compressible area with a rate of 43% (n=13) and in the noncompressed area with a rate of 57% (n=17). Mechanisms of injuries were blunt [53% (n=16)], penetrating [17% (n=5)], and iatrogenic [30% (n=9)]. The most common indication for endovascular treatment was blunt noncompressible injury (n=12). Methods used for treatment were stent-graft (46%, n=14) and coil embolization (54%, n=16). Immediate success was obtained in all procedures. The mean follow-up duration was 5 months (range: 1-12 months). Conclusions: Endovascular treatments performed in traumatic arterial emergencies are effective and minimally invasive with very low complication rates even in hemodynamically unstable patients.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44828015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.4103/2221-6189.330747
Jyoti Aggarwal, A. Lamba, S. Gaba, Monica Gupta, S. Arora
Rationale: COVID-19 has a wide range of clinical presentations requiring a high index of suspicion for diagnosing patients presenting with extrapulmonary manifestations. Among them, patients with cardiovascular involvement have a high mortality. Patient’s concerns: A 50-year-old male patient with COVID-19 infection presented with multiple syncopal episodes, myalgia, and mild respiratory symptoms. Diagnosis: Mild COVID-19 infection with complete heart block. Interventions: Temporary pacing followed by permanent pacemaker insertion 10 days after the onset. Outcomes: The patient was managed as per COVID-19 protocol in an isolation ward, and his condition improved but remained pacemaker dependent until a repeat RT-PCR for COVID-19 tested negative, after which he was shifted back to the cardiac care unit for permanent pacemaker insertion. The patient was discharged after inflammatory markers were normal and clinical condition was completely stable. Lessons: COVID-19 has a wide range of clinical presentations, and extrapulmonary manifestations, especially, cardiovascular involvement can not be ignored.
{"title":"COVID-19 presenting as complete heart block: A case report","authors":"Jyoti Aggarwal, A. Lamba, S. Gaba, Monica Gupta, S. Arora","doi":"10.4103/2221-6189.330747","DOIUrl":"https://doi.org/10.4103/2221-6189.330747","url":null,"abstract":"Rationale: COVID-19 has a wide range of clinical presentations requiring a high index of suspicion for diagnosing patients presenting with extrapulmonary manifestations. Among them, patients with cardiovascular involvement have a high mortality. Patient’s concerns: A 50-year-old male patient with COVID-19 infection presented with multiple syncopal episodes, myalgia, and mild respiratory symptoms. Diagnosis: Mild COVID-19 infection with complete heart block. Interventions: Temporary pacing followed by permanent pacemaker insertion 10 days after the onset. Outcomes: The patient was managed as per COVID-19 protocol in an isolation ward, and his condition improved but remained pacemaker dependent until a repeat RT-PCR for COVID-19 tested negative, after which he was shifted back to the cardiac care unit for permanent pacemaker insertion. The patient was discharged after inflammatory markers were normal and clinical condition was completely stable. Lessons: COVID-19 has a wide range of clinical presentations, and extrapulmonary manifestations, especially, cardiovascular involvement can not be ignored.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43551164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.4103/2221-6189.330743
B. Çekmen, R. Koylu, N. Akilli, Y. Gunaydin, O. Koylu, Ş. Atiş, B. Cander
Objective: To evaluate the effect of serum ionized calcium levels on the prognosis of severe sepsis patients. Methods: This retrospective cross-sectional study included sepsis patients who were hospitalized in an intensive care unit between January 2011 and December 2014. The demographic and baseline data of the patients who died and survived were compared. The cutoff value of ionized calcium for in-hospital mortality was determined by the receiver operating characteristics curve (ROC). In-hospital mortalities and the survival rates were compared between patients with different ionized calcium levels. Besides, the risk factor of in-hospital mortality was determined. Results: This study included 145 patients with 113 patients who died in the hospital. The patients who died had significantly lower ionized calcium levels (U=2.25, P=0.034). A cut-off value of 0.93 mmol/L of ionized calcium was determined by the ROC curve. The patients with ionized calcium>0.93 mmol/L showed a significantly lower morality (χ2=9.90, P=0.002) and higher survival rate than with ≤0.93 mmol/L (log rank=6.20, P=0.010). Multivariate Cox regression revealed that ionized calcium ≤0.93 mmol/L was a risk factor of in-hospital mortality. Conclusions: Ionized calcium level≤0.93 mmol/L was an independent predictor of in-hospital mortality of severe sepsis.
{"title":"Ionized calcium level predicts in-hospital mortality of severe sepsis patients: A retrospective cross-sectional study","authors":"B. Çekmen, R. Koylu, N. Akilli, Y. Gunaydin, O. Koylu, Ş. Atiş, B. Cander","doi":"10.4103/2221-6189.330743","DOIUrl":"https://doi.org/10.4103/2221-6189.330743","url":null,"abstract":"Objective: To evaluate the effect of serum ionized calcium levels on the prognosis of severe sepsis patients. Methods: This retrospective cross-sectional study included sepsis patients who were hospitalized in an intensive care unit between January 2011 and December 2014. The demographic and baseline data of the patients who died and survived were compared. The cutoff value of ionized calcium for in-hospital mortality was determined by the receiver operating characteristics curve (ROC). In-hospital mortalities and the survival rates were compared between patients with different ionized calcium levels. Besides, the risk factor of in-hospital mortality was determined. Results: This study included 145 patients with 113 patients who died in the hospital. The patients who died had significantly lower ionized calcium levels (U=2.25, P=0.034). A cut-off value of 0.93 mmol/L of ionized calcium was determined by the ROC curve. The patients with ionized calcium>0.93 mmol/L showed a significantly lower morality (χ2=9.90, P=0.002) and higher survival rate than with ≤0.93 mmol/L (log rank=6.20, P=0.010). Multivariate Cox regression revealed that ionized calcium ≤0.93 mmol/L was a risk factor of in-hospital mortality. Conclusions: Ionized calcium level≤0.93 mmol/L was an independent predictor of in-hospital mortality of severe sepsis.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46285533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.4103/2221-6189.330739
J. Sutradhar, Bapi Sarkar
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has become a pandemic disease. It also increases the risk of co-infections. Mucormycosis is a severe fungal infectious disease and its causative agent, mucormycetes, belongs to an opportunist fungus Mucoraceae family. Mucormycosis in COVID-19 patients with mucormycosis presents an additional challenge worldwide. Mucormycosis shares certain risk factors and signs and symptoms with COVID-19. In this review, we summarize manifestations and risk factors of mucormycosis and COVID-19.
{"title":"Manifestations and risk factors of COVID-19 and mucormycosis: A mini-review","authors":"J. Sutradhar, Bapi Sarkar","doi":"10.4103/2221-6189.330739","DOIUrl":"https://doi.org/10.4103/2221-6189.330739","url":null,"abstract":"Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has become a pandemic disease. It also increases the risk of co-infections. Mucormycosis is a severe fungal infectious disease and its causative agent, mucormycetes, belongs to an opportunist fungus Mucoraceae family. Mucormycosis in COVID-19 patients with mucormycosis presents an additional challenge worldwide. Mucormycosis shares certain risk factors and signs and symptoms with COVID-19. In this review, we summarize manifestations and risk factors of mucormycosis and COVID-19.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70254259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.4103/2221-6189.330745
N. Katoch, Ajaykumar Gupta, R. Gulati, Vikas Kumar, Sharmendra Singh, Ketan Garg
Objectives: To determine COVID-19 mortality and its risk factors in hospitalized patients at of a tertiary care center in north India. Methods: A retrospective observational study was conducted of patients who were hospitalized from May 2020 to January 2021. The in-hospital mortality was assessed, and demographic variables and comorbidities between COVID-19 deaths and survivors were compared. Results: A total of 24 000 patients were admitted during the study period, among which 17 000 had shown positive results of the RT-PCR test for COVID-19. The total mortality was 329 patients (1.37%), among which 232 (70.52%) succumbed due to COVID-19, and 97 (29.48%) died due to other illnesses. The mean age of the patients was (64.09±16.99) years. The mean age was significantly higher in COVID-19 related deaths [(67.63±13.78) years] as compared to that of the survivors [(60.52±19.5) years] (P<0.001). Compared to COVID-19 survivors, there were more males (72.41% v.s. 61.5%) and less females (27.59% v.s. 38.5%) in COVID-19 related deaths (P=0.001). Comorbidities such as hypertension, diabetes mellitus, and chronic kidney disease showed a significant correlation with COVID-19 mortality with an adjusted odds ratio of 2.389 (95% CI: 1.465-2.982), 3.891 (95% CI: 2.059-5.392), and 6.358 (95% CI: 5.675-10.564), respectively. Conclusions: Elderly males with comorbidities have higher risk for mortality related to COVID-19. Ongoing vaccination drive is rightfully prioritised to serve the high-risk category first.
{"title":"COVID-19 mortality and its risk factors: A single-center observational study","authors":"N. Katoch, Ajaykumar Gupta, R. Gulati, Vikas Kumar, Sharmendra Singh, Ketan Garg","doi":"10.4103/2221-6189.330745","DOIUrl":"https://doi.org/10.4103/2221-6189.330745","url":null,"abstract":"Objectives: To determine COVID-19 mortality and its risk factors in hospitalized patients at of a tertiary care center in north India. Methods: A retrospective observational study was conducted of patients who were hospitalized from May 2020 to January 2021. The in-hospital mortality was assessed, and demographic variables and comorbidities between COVID-19 deaths and survivors were compared. Results: A total of 24 000 patients were admitted during the study period, among which 17 000 had shown positive results of the RT-PCR test for COVID-19. The total mortality was 329 patients (1.37%), among which 232 (70.52%) succumbed due to COVID-19, and 97 (29.48%) died due to other illnesses. The mean age of the patients was (64.09±16.99) years. The mean age was significantly higher in COVID-19 related deaths [(67.63±13.78) years] as compared to that of the survivors [(60.52±19.5) years] (P<0.001). Compared to COVID-19 survivors, there were more males (72.41% v.s. 61.5%) and less females (27.59% v.s. 38.5%) in COVID-19 related deaths (P=0.001). Comorbidities such as hypertension, diabetes mellitus, and chronic kidney disease showed a significant correlation with COVID-19 mortality with an adjusted odds ratio of 2.389 (95% CI: 1.465-2.982), 3.891 (95% CI: 2.059-5.392), and 6.358 (95% CI: 5.675-10.564), respectively. Conclusions: Elderly males with comorbidities have higher risk for mortality related to COVID-19. Ongoing vaccination drive is rightfully prioritised to serve the high-risk category first.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49243618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.4103/2221-6189.330740
H. Aydın, H. Doğan
Objective: To investigate the effect of the use of color codes for patient triage on physicians’ clinical decision. Methods: This prospective study was conducted among female patients aged 18-65 years who visited the emergency department (ED) with complaints of acute abdominal pain. A 3-level of triage system [red (very urgent), yellow (urgent) and green (less urgent)] was used in our ED. All patients were green level. Half of these patients remained at the green level (the green group), and the remaining patients were re-labeled as false yellow (the false yellow group) in the order of ED visits. Ordering tests, consultation requests, intravenous treatment, length of hospital stay, and cost were compared between the two groups of patients. Results: In total 393 patients were included with 198 patients in the green group and 195 in the false yellow group. There was no statistically significant difference between the two groups in age, temperature, systolic blood pressure, diastolic blood pressure, pulse and oxygen saturation (P>0.05). It was observed that more tests (P=0.001), consultations (P<0.001), and intravenous treatment were requested (P<0.001), and the duration of stay in the ED was longer (P<0.001) and cost (P<0.001) was higher in the false yellow group. Conclusions: Triage do affect the decisions of physicians on female patients with acute abdominal pain.
{"title":"Effect of triage on physicians’ clinical decision: A prospective, observational, single-center and cross-sectional study","authors":"H. Aydın, H. Doğan","doi":"10.4103/2221-6189.330740","DOIUrl":"https://doi.org/10.4103/2221-6189.330740","url":null,"abstract":"Objective: To investigate the effect of the use of color codes for patient triage on physicians’ clinical decision. Methods: This prospective study was conducted among female patients aged 18-65 years who visited the emergency department (ED) with complaints of acute abdominal pain. A 3-level of triage system [red (very urgent), yellow (urgent) and green (less urgent)] was used in our ED. All patients were green level. Half of these patients remained at the green level (the green group), and the remaining patients were re-labeled as false yellow (the false yellow group) in the order of ED visits. Ordering tests, consultation requests, intravenous treatment, length of hospital stay, and cost were compared between the two groups of patients. Results: In total 393 patients were included with 198 patients in the green group and 195 in the false yellow group. There was no statistically significant difference between the two groups in age, temperature, systolic blood pressure, diastolic blood pressure, pulse and oxygen saturation (P>0.05). It was observed that more tests (P=0.001), consultations (P<0.001), and intravenous treatment were requested (P<0.001), and the duration of stay in the ED was longer (P<0.001) and cost (P<0.001) was higher in the false yellow group. Conclusions: Triage do affect the decisions of physicians on female patients with acute abdominal pain.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43479865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.4103/2221-6189.330746
Shalendra Singh, Ankur Gupta, S. Nanda, P. Devidas, D. Dwivedi
Rationale: Dengue fever is a prevalent tropical infectious disease that has a broad panorama of presentations from mild febrile illness to life-threatening manifestations in the form of dengue hemorrhagic fever and dengue shock syndrome. Patient’s concerns: A 20-year-old male presented with a 2-day history of fever, multiple episodes of vomiting, and altered sensorium. Diagnosis: Dengue fever leading to acute hemorrhagic leukoencephalitis. Interventions: Multiple transfusions of single donor platelets, intravenous methylprednisolone, intravenous immunoglobulin, anti-seizure prophylaxis, and broad-spectrum antibiotics. Outcomes: Repeat brain magnetic resonance imaging showed resolution of lesions. The patient was subsequently discharged from the hospital in a healthy state. Lessons: This report helps us to gain a better understanding of the patient’s presentation, which will help to improve the timely recognition and prevention of this rare devastating presentation.
{"title":"Dengue fever leading to acute dengue hemorrhagic leukoencephalitis: A case report","authors":"Shalendra Singh, Ankur Gupta, S. Nanda, P. Devidas, D. Dwivedi","doi":"10.4103/2221-6189.330746","DOIUrl":"https://doi.org/10.4103/2221-6189.330746","url":null,"abstract":"Rationale: Dengue fever is a prevalent tropical infectious disease that has a broad panorama of presentations from mild febrile illness to life-threatening manifestations in the form of dengue hemorrhagic fever and dengue shock syndrome. Patient’s concerns: A 20-year-old male presented with a 2-day history of fever, multiple episodes of vomiting, and altered sensorium. Diagnosis: Dengue fever leading to acute hemorrhagic leukoencephalitis. Interventions: Multiple transfusions of single donor platelets, intravenous methylprednisolone, intravenous immunoglobulin, anti-seizure prophylaxis, and broad-spectrum antibiotics. Outcomes: Repeat brain magnetic resonance imaging showed resolution of lesions. The patient was subsequently discharged from the hospital in a healthy state. Lessons: This report helps us to gain a better understanding of the patient’s presentation, which will help to improve the timely recognition and prevention of this rare devastating presentation.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45114062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.4103/2221-6189.326911
M. Bilal, S. Jilani, I. Rafi, O. Shakeel, Wardah Jabeen
Objective: To determine the early outcomes of limb salvage surgery with mega prosthesis. Methods: This retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) from 1st January 2017 till 31st January 2020. Data like demographics, histopathology, functional and survival outcomes were retrieved from the Hospital Information System. Musculoskeletal Tumor Society (MSTS) score was used to evaluate the functional outcomes after the surgery. For survival analyses, Kaplan-Meier curve was applied. Prosthesis joint infection, amputation rate, metastasis, mortality rate, and recurrence were also recorded. Results: This study included 43 patients who underwent limb salvage surgery with endoprosthesis reconstruction at SKMCH&RC. The mean age at the time of diagnosis was (26.5±15.8) years. Patients with distal femoral replacement had the highest MSTS scores (81.45±9.70) while those with proximal humerus replacement has the lowest MSTS scores (56.8±11.2). There was a strong association between site of tumor and MSTS (F=3.30, P=0.017). We also found a correlation between surgical site infection and MSTS scores (r=0.484, P=0.001). Patients with recurrence also had significantly lower MSTS scores (P<0.05). The cumulative survival rate at the end of two-year follow-up was (71.4±17.1)% in proximal femur tumor patients, (88.0±7.8)% in distal femur tumor patients, and (50.0±3.5)% in proximal humerus tumor patients. Besides, patients with Ewing sarcoma had the highest survival rate (97.5±11.0)% while patients with chondrosarcoma had the lowest survival rate (77.8±13.9)%. Conclusions: Limb salvage surgery with mega-prosthesis can be performed with satisfactory functional and survival outcomes, but further studies are needed to compare it with other limb salvage methods. This study can be used as a reference for future studies.
{"title":"Early outcomes of limb salvage surgery with mega-prosthesis: A single center experience","authors":"M. Bilal, S. Jilani, I. Rafi, O. Shakeel, Wardah Jabeen","doi":"10.4103/2221-6189.326911","DOIUrl":"https://doi.org/10.4103/2221-6189.326911","url":null,"abstract":"Objective: To determine the early outcomes of limb salvage surgery with mega prosthesis. Methods: This retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) from 1st January 2017 till 31st January 2020. Data like demographics, histopathology, functional and survival outcomes were retrieved from the Hospital Information System. Musculoskeletal Tumor Society (MSTS) score was used to evaluate the functional outcomes after the surgery. For survival analyses, Kaplan-Meier curve was applied. Prosthesis joint infection, amputation rate, metastasis, mortality rate, and recurrence were also recorded. Results: This study included 43 patients who underwent limb salvage surgery with endoprosthesis reconstruction at SKMCH&RC. The mean age at the time of diagnosis was (26.5±15.8) years. Patients with distal femoral replacement had the highest MSTS scores (81.45±9.70) while those with proximal humerus replacement has the lowest MSTS scores (56.8±11.2). There was a strong association between site of tumor and MSTS (F=3.30, P=0.017). We also found a correlation between surgical site infection and MSTS scores (r=0.484, P=0.001). Patients with recurrence also had significantly lower MSTS scores (P<0.05). The cumulative survival rate at the end of two-year follow-up was (71.4±17.1)% in proximal femur tumor patients, (88.0±7.8)% in distal femur tumor patients, and (50.0±3.5)% in proximal humerus tumor patients. Besides, patients with Ewing sarcoma had the highest survival rate (97.5±11.0)% while patients with chondrosarcoma had the lowest survival rate (77.8±13.9)%. Conclusions: Limb salvage surgery with mega-prosthesis can be performed with satisfactory functional and survival outcomes, but further studies are needed to compare it with other limb salvage methods. This study can be used as a reference for future studies.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46163698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.4103/2221-6189.326907
M. Taghavi, A. Shokri, P. Niloofar, Salar Poorbarat, S. Mollazadeh, H. Milani
Objective: To derive the pooled estimate of chest computed tomography (CT) findings in coronavirus disease 2019 (COVID-19) patients. Methods: A comprehensive systematic search was conducted according to the PRISMA checklist from January 2020 to September 2020 in electronic databases including PubMed, Google Scholar, and Scopus based on search terms in title and texts. Original descriptive studies with epidemiological parameters of interest were included into the systematic review and meta-analysis. Results: Totally 54 articles comprised of 4 879 patients with a mean age of 49.05 years were eligible for this study. The pooled prevalence for abnormal CT images was 86.0%. Pooled prevalence for ground-glass opacity was 68.0%, 71.0% for bilateral abnormalities, 47.0% for mixed ground-glass opacity and consolidation and 29.0% for consolidation. In addition, 64.0% of lesions were peripheral, and 12.0% were central while 28.0% were both central and peripheral. Furthermore, 61.0% of lower lungs were involved, and 7.0% and 5.0% of the cases presented with pleural effusion and pericardial effusion, respectively. Besides, 11% of the cases showed lymphadenopathy, and 37% had air broncho gram sign. The pooled prevalence of other chest CT findings ranged from 8.0% to 65.0%. Conclusions: Chest CT can be used as predictive tools for the detection of COVID-19 disease along with clinical manifestations and the RT-PCR method.
{"title":"Chest CT features in COVID-19 patients: A systematic review and meta-analysis","authors":"M. Taghavi, A. Shokri, P. Niloofar, Salar Poorbarat, S. Mollazadeh, H. Milani","doi":"10.4103/2221-6189.326907","DOIUrl":"https://doi.org/10.4103/2221-6189.326907","url":null,"abstract":"Objective: To derive the pooled estimate of chest computed tomography (CT) findings in coronavirus disease 2019 (COVID-19) patients. Methods: A comprehensive systematic search was conducted according to the PRISMA checklist from January 2020 to September 2020 in electronic databases including PubMed, Google Scholar, and Scopus based on search terms in title and texts. Original descriptive studies with epidemiological parameters of interest were included into the systematic review and meta-analysis. Results: Totally 54 articles comprised of 4 879 patients with a mean age of 49.05 years were eligible for this study. The pooled prevalence for abnormal CT images was 86.0%. Pooled prevalence for ground-glass opacity was 68.0%, 71.0% for bilateral abnormalities, 47.0% for mixed ground-glass opacity and consolidation and 29.0% for consolidation. In addition, 64.0% of lesions were peripheral, and 12.0% were central while 28.0% were both central and peripheral. Furthermore, 61.0% of lower lungs were involved, and 7.0% and 5.0% of the cases presented with pleural effusion and pericardial effusion, respectively. Besides, 11% of the cases showed lymphadenopathy, and 37% had air broncho gram sign. The pooled prevalence of other chest CT findings ranged from 8.0% to 65.0%. Conclusions: Chest CT can be used as predictive tools for the detection of COVID-19 disease along with clinical manifestations and the RT-PCR method.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45063219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.4103/2221-6189.326908
Sonal K Ginoya, S. Parikh
Objective: To compare the value of HEART and TIMI scores in predicting major adverse cardiovascular events (MACEs) of patients with chest pain in the emergency department at a tertiary care hospital in Ahmedabad, a city in western India. Methods: A prospective study was conducted on chest pain patients from January to December 2019. All adult patients with non-traumatic chest pain presenting to the emergency department were included, and their HEART and TIMI scores were evaluated. The patients were followed up within 4 weeks for monitoring any major adverse cardiac events or death. The receiver-operating characteristics (ROC) curve was used to determine the value of HEART and TIMI scores in predicting MACEs. Besides, the specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of the two scores were assessed and compared. Results: A total of 350 patients were evaluated [mean age (55.03±16.6) years, 56.6% of males]. HEART score had the highest predictive value of MACEs with an area under the curve (AUC) of 0.98, followed by the TIMI score with an AUC of 0.92. HEART score had the highest specificity of 98.0% (95% CI: 96.4%-99.6%), the sensitivity of 75.0% (95% CI: 70.7%-79.3%), and PPV of 97.0% (95% CI: 94.1%-99.9%) and NPV of 82.5% (95% CI: 74.6%-90.4%) for low-risk patients. TIMI score had a specificity of 95.0% (95% CI: 92.4%-97.6%), sensitivity of 75.0% (95% CI: 69.4%-80.6%), PPV of 92.3% (95% CI: 88.1%-96.5%) and NPV of 82.3% (95% CI: 73.8%-90.8%) for low-risk patients. Conclusions: HEART score is an easier and more practical triage instrument to identify chest pain patients with low-risk for MACEs compared to TIMI score. Patients with high HEART scores have a higher risk of MACEs and require early therapeutic intervention and aggressive management.
{"title":"Performance of HEART and TIMI scores in predicting major adverse cardiovascular events (MACEs) of chest pain patients in the emergency department: A prospective observational study","authors":"Sonal K Ginoya, S. Parikh","doi":"10.4103/2221-6189.326908","DOIUrl":"https://doi.org/10.4103/2221-6189.326908","url":null,"abstract":"Objective: To compare the value of HEART and TIMI scores in predicting major adverse cardiovascular events (MACEs) of patients with chest pain in the emergency department at a tertiary care hospital in Ahmedabad, a city in western India. Methods: A prospective study was conducted on chest pain patients from January to December 2019. All adult patients with non-traumatic chest pain presenting to the emergency department were included, and their HEART and TIMI scores were evaluated. The patients were followed up within 4 weeks for monitoring any major adverse cardiac events or death. The receiver-operating characteristics (ROC) curve was used to determine the value of HEART and TIMI scores in predicting MACEs. Besides, the specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of the two scores were assessed and compared. Results: A total of 350 patients were evaluated [mean age (55.03±16.6) years, 56.6% of males]. HEART score had the highest predictive value of MACEs with an area under the curve (AUC) of 0.98, followed by the TIMI score with an AUC of 0.92. HEART score had the highest specificity of 98.0% (95% CI: 96.4%-99.6%), the sensitivity of 75.0% (95% CI: 70.7%-79.3%), and PPV of 97.0% (95% CI: 94.1%-99.9%) and NPV of 82.5% (95% CI: 74.6%-90.4%) for low-risk patients. TIMI score had a specificity of 95.0% (95% CI: 92.4%-97.6%), sensitivity of 75.0% (95% CI: 69.4%-80.6%), PPV of 92.3% (95% CI: 88.1%-96.5%) and NPV of 82.3% (95% CI: 73.8%-90.8%) for low-risk patients. Conclusions: HEART score is an easier and more practical triage instrument to identify chest pain patients with low-risk for MACEs compared to TIMI score. Patients with high HEART scores have a higher risk of MACEs and require early therapeutic intervention and aggressive management.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48170132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：