Pub Date : 2022-09-01DOI: 10.4103/2221-6189.357456
H. Modir, Esmail Moshiri, Mehran Azami, M. Zad, A. Hashiani
Objective: To compare the effect of ketamine, lidocaine, acetaminophen, and dexmedetomidine combined with morphine patient-controlled analgesia for opium addicts after tibial fracture surgery. Methods: This double-blind clinical trial included opium-addicted patients undergoing tibia fracture surgery. Patients were recruited and randomized to four different groups including the ketamine group, the lidocaine group, the acetaminophen group, and the dexmedetomidine group. The hemodynamic parameters such as heart rate (HR), mean arterial pressure, and arterial SaO2, alongside visual analog scale pain scores, sedation assessed by Ramsay score, nausea and vomiting, and opioid use were recorded and compared among the four groups. Results: This study included 140 patients, aged 37 (32, 41) years, with 92 males and 48 females, and each group had 35 patients. Dexmedetomidine-sedated subjects had the lowest blood pressure from 1 to 24 h after surgery, decreased HR at 12 and 24 h after surgery, and more satisfactory sedation (P<0.05). Notwithstanding no significant difference was noted in the pain scores, or nausea and vomiting among the groups (P>0.05). Conclusions: Dexmedetomidine has a better sedation effect compared to ketamine, lidocaine, and acetaminophen for pain control, but the final choice hinges on the patients’ physical condition and the anesthesiologist′s preference. Clinical registarion: It is registered in Iranian Registry Clinical Trial by code IRCT20141209020258N146.
目的:比较氯胺酮、利多卡因、对乙酰氨基酚、右美托咪定联合吗啡对胫骨骨折术后鸦片依赖者自控镇痛的效果。方法:双盲临床试验纳入接受胫骨骨折手术的阿片成瘾患者。招募患者并随机分为氯胺酮组、利多卡因组、对乙酰氨基酚组和右美托咪定组。记录四组患者的血流动力学参数，如心率(HR)、平均动脉压、动脉SaO2、视觉模拟疼痛评分、拉姆齐评分(Ramsay score)评定的镇静程度、恶心呕吐和阿片类药物使用情况。结果:本研究纳入140例患者，年龄37(32,41)岁，其中男性92例，女性48例，每组35例。右美托咪定镇静组患者术后1 ~ 24 h血压最低，术后12、24 h HR降低，镇静效果更满意(P0.05)。结论:右美托咪定在镇痛作用上优于氯胺酮、利多卡因和对乙酰氨基酚，但最终的选择取决于患者的身体状况和麻醉医师的偏好。临床注册:在伊朗注册中心临床试验注册，注册代码为IRCT20141209020258N146。
{"title":"Comparative efficacy of ketamine, lidocaine, acetaminophen, and dexmedetomidine combined with morphine patient-controlled analgesia in treating opium-addicted patients undergoing tibia fracture surgery: A randomized clinical trial","authors":"H. Modir, Esmail Moshiri, Mehran Azami, M. Zad, A. Hashiani","doi":"10.4103/2221-6189.357456","DOIUrl":"https://doi.org/10.4103/2221-6189.357456","url":null,"abstract":"Objective: To compare the effect of ketamine, lidocaine, acetaminophen, and dexmedetomidine combined with morphine patient-controlled analgesia for opium addicts after tibial fracture surgery. Methods: This double-blind clinical trial included opium-addicted patients undergoing tibia fracture surgery. Patients were recruited and randomized to four different groups including the ketamine group, the lidocaine group, the acetaminophen group, and the dexmedetomidine group. The hemodynamic parameters such as heart rate (HR), mean arterial pressure, and arterial SaO2, alongside visual analog scale pain scores, sedation assessed by Ramsay score, nausea and vomiting, and opioid use were recorded and compared among the four groups. Results: This study included 140 patients, aged 37 (32, 41) years, with 92 males and 48 females, and each group had 35 patients. Dexmedetomidine-sedated subjects had the lowest blood pressure from 1 to 24 h after surgery, decreased HR at 12 and 24 h after surgery, and more satisfactory sedation (P<0.05). Notwithstanding no significant difference was noted in the pain scores, or nausea and vomiting among the groups (P>0.05). Conclusions: Dexmedetomidine has a better sedation effect compared to ketamine, lidocaine, and acetaminophen for pain control, but the final choice hinges on the patients’ physical condition and the anesthesiologist′s preference. Clinical registarion: It is registered in Iranian Registry Clinical Trial by code IRCT20141209020258N146.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45065879","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 : 2022-09-01DOI: 10.4103/2221-6189.357460
A. Gokoglu, H. Gozdas, S. Ozen, S. Gokoglu
Rationale: There are many cases of daily reported dog bite injuries around the world. However, craniofacial fractures owing to dog bites are quite rare. They are frequently seen in the pediatric age group. Here, we report the successful management of a pediatric patient with depression skull fracture due to a dog bite injury. Patient’s concerns: A 3-year-old boy was admitted to the emergency department with a complicated skull fracture due to a dog bite injury. In physical examination, the patient was neurologically intact. He had hemorrhagic scalp wounds. Cerebrospinal fluid was leaking on the right temporal and frontal sides. Diagnosis: Cranial computed tomography revealed pneumocephalus, brain edema, and compound fracture associated with right frontal concussion. Intervention: After decompressive craniectomy, duraplasty was performed by placing a galea graft. Depressed fractures were removed and subdural bleeding control was provided. Outcomes: Perioperative and postoperative periods were uneventful. Lessons: Emergency medicine physicians should control possible underlying fracture lines in pediatric head trauma caused by dog bites.
{"title":"Successful management of depression skull fracture in a boy with dog bite injury: A case report","authors":"A. Gokoglu, H. Gozdas, S. Ozen, S. Gokoglu","doi":"10.4103/2221-6189.357460","DOIUrl":"https://doi.org/10.4103/2221-6189.357460","url":null,"abstract":"Rationale: There are many cases of daily reported dog bite injuries around the world. However, craniofacial fractures owing to dog bites are quite rare. They are frequently seen in the pediatric age group. Here, we report the successful management of a pediatric patient with depression skull fracture due to a dog bite injury. Patient’s concerns: A 3-year-old boy was admitted to the emergency department with a complicated skull fracture due to a dog bite injury. In physical examination, the patient was neurologically intact. He had hemorrhagic scalp wounds. Cerebrospinal fluid was leaking on the right temporal and frontal sides. Diagnosis: Cranial computed tomography revealed pneumocephalus, brain edema, and compound fracture associated with right frontal concussion. Intervention: After decompressive craniectomy, duraplasty was performed by placing a galea graft. Depressed fractures were removed and subdural bleeding control was provided. Outcomes: Perioperative and postoperative periods were uneventful. Lessons: Emergency medicine physicians should control possible underlying fracture lines in pediatric head trauma caused by dog bites.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43468194","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 : 2022-09-01DOI: 10.4103/2221-6189.357457
Priyanka Rajmohan, Unnikrishnan Gopinathan, Nada Parvin Ashraf Saudha, M. Jose, L. Raphael, Joe Thomas
Objective: To determine the real-world effectiveness of the ChAdOx1 nCoV-19 coronavirus vaccine in preventing severe disease and mortality due to COVID-19. Methods: A case-case design was used to estimate the effect of the ChAdOx1 nCoV-19 coronavirus vaccine on severe SARS-CoV-2 outcomes in individuals aged 40 years and above. Cases (n=200) were COVID-19 patients admitted to intensive care unit (ICU) or who died. Controls (n=223) were those with mild COVID-19, fit for home isolation. The logistic regression model was used to estimate adjusted vaccine effectiveness for full vaccination (two doses ≥14 d) and partial vaccination status (one dose ≥14 d or two doses <14 d). Results: The proportion of fully vaccinated individuals was significantly lower among cases (12, 6.0%) compared to controls (30, 13.5%). The adjusted effectiveness of a full dose of ChAdOx1 nCoV-19 coronavirus vaccine in preventing ICU admission or death was 81.9% (95% CI: 61.3%-91.6%, P=0.001). Subgroup analysis restricted to age group, sex, and comorbidities found that ChAdOx1 nCoV-19 coronavirus vaccine had a significant positive effect in all subgroups and categories. Conclusion: COVID-19 vaccination reduces ICU admissions or death. Therefore, increased vaccine uptake may reduce the severity of the pandemic, more so in the elderly and those with comorbidities.
{"title":"Effectiveness of ChAdOx1 nCoV-19 coronavius vaccine in preventing severe disease and mortality during the second wave of pandemic: A case-case analysis from a tertiary care center in South India","authors":"Priyanka Rajmohan, Unnikrishnan Gopinathan, Nada Parvin Ashraf Saudha, M. Jose, L. Raphael, Joe Thomas","doi":"10.4103/2221-6189.357457","DOIUrl":"https://doi.org/10.4103/2221-6189.357457","url":null,"abstract":"Objective: To determine the real-world effectiveness of the ChAdOx1 nCoV-19 coronavirus vaccine in preventing severe disease and mortality due to COVID-19. Methods: A case-case design was used to estimate the effect of the ChAdOx1 nCoV-19 coronavirus vaccine on severe SARS-CoV-2 outcomes in individuals aged 40 years and above. Cases (n=200) were COVID-19 patients admitted to intensive care unit (ICU) or who died. Controls (n=223) were those with mild COVID-19, fit for home isolation. The logistic regression model was used to estimate adjusted vaccine effectiveness for full vaccination (two doses ≥14 d) and partial vaccination status (one dose ≥14 d or two doses <14 d). Results: The proportion of fully vaccinated individuals was significantly lower among cases (12, 6.0%) compared to controls (30, 13.5%). The adjusted effectiveness of a full dose of ChAdOx1 nCoV-19 coronavirus vaccine in preventing ICU admission or death was 81.9% (95% CI: 61.3%-91.6%, P=0.001). Subgroup analysis restricted to age group, sex, and comorbidities found that ChAdOx1 nCoV-19 coronavirus vaccine had a significant positive effect in all subgroups and categories. Conclusion: COVID-19 vaccination reduces ICU admissions or death. Therefore, increased vaccine uptake may reduce the severity of the pandemic, more so in the elderly and those with comorbidities.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46741740","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 : 2022-09-01DOI: 10.4103/2221-6189.357459
Abhyuday Kumar, A. Valiyaparambath, Neeraj Kumar, Amarjeet Kumar, Ajeet Kumar
Rationale: The gastrointestinal manifestations of COVID-19 include anorexia, nausea, vomiting, abdominal pain, and diarrhea. However, pancreatitis as the presentation of COVID-19 is rarely reported. Patient’s Concern: A 63-year-old COVID-19 patient presented with complaints of abdominal pain and difficulty breathing for 5 d. Diagnosis: Contrast-enhanced computed tomography of the abdomen suggested acute interstitial pancreatitis without any biliary tract obstruction. Interventions: The patient was resuscitated with intravenous fluids based on dynamic parameters of fluid responsiveness. The patient was started on enteral feeding, analgesics, antibiotics, dexamethasone, low molecular weight heparin, and supportive therapy. Outcomes: The patient developed severe acute respiratory distress syndrome and died 6 days after admission. Lessons: Management of COVID-19 in the presence of pancreatitis is challenging. Adequate early fluid resuscitation is an important aspect of medical management for COVID-19 patients with pancreatitis and restrictive strategies must be followed. Increased liver enzymes and renal dysfunction in acute pancreatitis can also limit the use of specific therapies like remdesivir. Dexamethasone, even though it has shown a beneficial effect in treating COVID-19, can have an additive effect in causing hyperglycemia in these cases. Clinicians should be aware of this atypical presentation of COVID-19 with pancreatitis and adjust their management strategies, keeping in mind the considerations for both diseases.
{"title":"COVID-19 presentation as acute pancreatitis: A case report","authors":"Abhyuday Kumar, A. Valiyaparambath, Neeraj Kumar, Amarjeet Kumar, Ajeet Kumar","doi":"10.4103/2221-6189.357459","DOIUrl":"https://doi.org/10.4103/2221-6189.357459","url":null,"abstract":"Rationale: The gastrointestinal manifestations of COVID-19 include anorexia, nausea, vomiting, abdominal pain, and diarrhea. However, pancreatitis as the presentation of COVID-19 is rarely reported. Patient’s Concern: A 63-year-old COVID-19 patient presented with complaints of abdominal pain and difficulty breathing for 5 d. Diagnosis: Contrast-enhanced computed tomography of the abdomen suggested acute interstitial pancreatitis without any biliary tract obstruction. Interventions: The patient was resuscitated with intravenous fluids based on dynamic parameters of fluid responsiveness. The patient was started on enteral feeding, analgesics, antibiotics, dexamethasone, low molecular weight heparin, and supportive therapy. Outcomes: The patient developed severe acute respiratory distress syndrome and died 6 days after admission. Lessons: Management of COVID-19 in the presence of pancreatitis is challenging. Adequate early fluid resuscitation is an important aspect of medical management for COVID-19 patients with pancreatitis and restrictive strategies must be followed. Increased liver enzymes and renal dysfunction in acute pancreatitis can also limit the use of specific therapies like remdesivir. Dexamethasone, even though it has shown a beneficial effect in treating COVID-19, can have an additive effect in causing hyperglycemia in these cases. Clinicians should be aware of this atypical presentation of COVID-19 with pancreatitis and adjust their management strategies, keeping in mind the considerations for both diseases.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46953594","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 : 2022-09-01DOI: 10.4103/2221-6189.357458
Furkan Tontu, S. Aşar, Beyza Oren Bilgin
Objective: To investigate the effect of the variability of Nas, Cls, Ks, lactate values and sodium effect (NaEffect), chloride effect (ClEffect), non-lactate strong ion difference (SIDnl) values calculated according to Stewart’s approach on predicting intensive care unit (ICU) mortality. Methods: The study was conducted on 1539 patients, retrospectively. Serum Na (Nas), serum Cl (Cls), serum K (Ks), serum Ca (Cas), serum Mg (Mgs), lactate, pH values and SIDnl, NaEffect, ClEffect, APACHE II (first, last), and SOFA (first, last) scores were recorded. Radiometer ABL 800 (Denmark) was used for blood gas analysis. The variability of each parameter was calculated. The effect of variability of each parameter on 30-day ICU mortality was analyzed. Results: The variability of lactate (P<0.001, OR=0.580, 95% CI=0.505-0.652), pH (P=0.001, OR=0.004, 95% CI=0.000-0.104), NaEffect (P<0.001, OR=0.550, 95% CI=0.378-0.592), Ks (P<0.001, OR=0.385, 95% CI=0.244-0.565) values were protective factors of ICU mortality and Cls value was a risk factor (P=0.004, OR=1.095, 95% CI=1.024-1.164). Variability of ClEffect, SIDnl values did not affect ICU mortality. Conclusions: The variability of electrolytes is important. Electrolyte, effects, and lactate variability can guide treatment and fluid applications in ICU.
{"title":"Effect of pH, lactate, electrolyte, and strong ion difference variability on prediction of intensive care unit mortality: A retrospective study","authors":"Furkan Tontu, S. Aşar, Beyza Oren Bilgin","doi":"10.4103/2221-6189.357458","DOIUrl":"https://doi.org/10.4103/2221-6189.357458","url":null,"abstract":"Objective: To investigate the effect of the variability of Nas, Cls, Ks, lactate values and sodium effect (NaEffect), chloride effect (ClEffect), non-lactate strong ion difference (SIDnl) values calculated according to Stewart’s approach on predicting intensive care unit (ICU) mortality. Methods: The study was conducted on 1539 patients, retrospectively. Serum Na (Nas), serum Cl (Cls), serum K (Ks), serum Ca (Cas), serum Mg (Mgs), lactate, pH values and SIDnl, NaEffect, ClEffect, APACHE II (first, last), and SOFA (first, last) scores were recorded. Radiometer ABL 800 (Denmark) was used for blood gas analysis. The variability of each parameter was calculated. The effect of variability of each parameter on 30-day ICU mortality was analyzed. Results: The variability of lactate (P<0.001, OR=0.580, 95% CI=0.505-0.652), pH (P=0.001, OR=0.004, 95% CI=0.000-0.104), NaEffect (P<0.001, OR=0.550, 95% CI=0.378-0.592), Ks (P<0.001, OR=0.385, 95% CI=0.244-0.565) values were protective factors of ICU mortality and Cls value was a risk factor (P=0.004, OR=1.095, 95% CI=1.024-1.164). Variability of ClEffect, SIDnl values did not affect ICU mortality. Conclusions: The variability of electrolytes is important. Electrolyte, effects, and lactate variability can guide treatment and fluid applications in ICU.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47321948","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 : 2022-09-01DOI: 10.4103/2221-6189.357462
Eunizar Omar, Yasheen Persand
Rationale: As an uncommon manifestation of congestive heart failure, congestive hepatopathy requires an early diagnosis in order to render appropriate care. Misdiagnosis as intraabdominal sepsis may lead to erroneous initial intervention, such as fluid boluses, that can potentially tip an already sick patient with poor reserves over into an extreme state. Patient’s Concern: A 65-year-old man was brought to the emergency department for excruciating abdominal pain, vomiting and jaundice. He also had lower limb pitting edema and was hypotensive en route. Diagnosis: Congestive hepatopathy. Interventions: Intravenous furosemide and fluid restriction. Outcomes: The patient declined admission to the cardiology ward and discharged himself against medical advice after his condition was improved in the emergency department. Lessons: It is important to pay attention to acute abdominal pain induced by extraabdominal pathologies. In this case of acute decompensated congestive heart failure, early recognition of the cause makes a difference to the management.
{"title":"Congestive heart failure masquerading as acute abdomen: A case report","authors":"Eunizar Omar, Yasheen Persand","doi":"10.4103/2221-6189.357462","DOIUrl":"https://doi.org/10.4103/2221-6189.357462","url":null,"abstract":"Rationale: As an uncommon manifestation of congestive heart failure, congestive hepatopathy requires an early diagnosis in order to render appropriate care. Misdiagnosis as intraabdominal sepsis may lead to erroneous initial intervention, such as fluid boluses, that can potentially tip an already sick patient with poor reserves over into an extreme state. Patient’s Concern: A 65-year-old man was brought to the emergency department for excruciating abdominal pain, vomiting and jaundice. He also had lower limb pitting edema and was hypotensive en route. Diagnosis: Congestive hepatopathy. Interventions: Intravenous furosemide and fluid restriction. Outcomes: The patient declined admission to the cardiology ward and discharged himself against medical advice after his condition was improved in the emergency department. Lessons: It is important to pay attention to acute abdominal pain induced by extraabdominal pathologies. In this case of acute decompensated congestive heart failure, early recognition of the cause makes a difference to the management.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43526656","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 : 2022-09-01DOI: 10.4103/2221-6189.357461
Shenoy Mala, B. Ahmed
Rationale: Symmetrical peripheral gangrene is a rare acute condition triggered by several medical conditions. It needs to be recognized early and treated as an emergency. Patient’s Concern: A 40-year-old patient without any comorbidities presented with sudden onset of pain, swelling, blistering and bluish discoloration of the fingers and toes associated with fever and constitutional symptoms. Later the fingers and toes turned dark and they were cold to touch. Diagnosis: Diagnosis of symmetrical peripheral gangrene was made and investigated. Blood culture isolated Escherichia coli indicating a possible role in the causation of symmetrical peripheral gangrene. Interventions: Patient was managed with antibiotics and anticoagulants along with supportive care. Outcomes: There was improvement in patient’s general condition along with development of gangrene demarcation line of the fingers and toes. Lessons: Awareness of this condition is needed and an early management is recommended including recognizing the cause and supportive therapy to prevent complications.
{"title":"Symmetrical peripheral gangrene triggered by Escherichia coli sepsis","authors":"Shenoy Mala, B. Ahmed","doi":"10.4103/2221-6189.357461","DOIUrl":"https://doi.org/10.4103/2221-6189.357461","url":null,"abstract":"Rationale: Symmetrical peripheral gangrene is a rare acute condition triggered by several medical conditions. It needs to be recognized early and treated as an emergency. Patient’s Concern: A 40-year-old patient without any comorbidities presented with sudden onset of pain, swelling, blistering and bluish discoloration of the fingers and toes associated with fever and constitutional symptoms. Later the fingers and toes turned dark and they were cold to touch. Diagnosis: Diagnosis of symmetrical peripheral gangrene was made and investigated. Blood culture isolated Escherichia coli indicating a possible role in the causation of symmetrical peripheral gangrene. Interventions: Patient was managed with antibiotics and anticoagulants along with supportive care. Outcomes: There was improvement in patient’s general condition along with development of gangrene demarcation line of the fingers and toes. Lessons: Awareness of this condition is needed and an early management is recommended including recognizing the cause and supportive therapy to prevent complications.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42691283","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 : 2022-08-01DOI: 10.37766/inplasy2022.8.0005
Abhijit S. Nair, Hamed Humayid Mohammed Al Aamri
Objective: To compare the benefits of enhanced recovery after surgery (ERAS) pathways with traditional pathways for adult patients undergoing laparoscopic appendectomy. Methods: We looked for publications using the keywords “Enhanced Recovery After Surgery,” “Fast-track Surgery,” “Laparoscopic Appendectomy,” and “Laparoscopic Appendicectomy” in PubMed/Medline, Embase, and the Cochrane library. Operative time, lesser length of stay, oral intake timing, readmission rate, pain/satisfaction levels, readmission rate, and surgical site infections were recorded and analyzed. Results: A total of 95 articles from registers and 161 articles from databases were identified. Three eligible studies were included. The ERAS pathways had a lesser length of stay [Z=2.06, MD= -1.05, 95% CI=(-2.04, -0.05), P=0.04] and an earlier start to postoperative feeds [Z=6.22, MD= -267.49, 95% CI=(-351.80, -183.19), P<001]. Conclusions: ERAS pathways have a shorter length of stay and earlier postoperative feed initiation for adult patients undergoing laparoscopic appendectomy compared with standard care. Both approaches have similar operative time, surgical site infection incidence, and readmission rate. Clinical registration: This review is registered with INPLASY202280005.
{"title":"Enhanced recovery after surgery pathways for patients undergoing laparoscopic appendectomy: A systematic review and meta-analysis","authors":"Abhijit S. Nair, Hamed Humayid Mohammed Al Aamri","doi":"10.37766/inplasy2022.8.0005","DOIUrl":"https://doi.org/10.37766/inplasy2022.8.0005","url":null,"abstract":"Objective: To compare the benefits of enhanced recovery after surgery (ERAS) pathways with traditional pathways for adult patients undergoing laparoscopic appendectomy. Methods: We looked for publications using the keywords “Enhanced Recovery After Surgery,” “Fast-track Surgery,” “Laparoscopic Appendectomy,” and “Laparoscopic Appendicectomy” in PubMed/Medline, Embase, and the Cochrane library. Operative time, lesser length of stay, oral intake timing, readmission rate, pain/satisfaction levels, readmission rate, and surgical site infections were recorded and analyzed. Results: A total of 95 articles from registers and 161 articles from databases were identified. Three eligible studies were included. The ERAS pathways had a lesser length of stay [Z=2.06, MD= -1.05, 95% CI=(-2.04, -0.05), P=0.04] and an earlier start to postoperative feeds [Z=6.22, MD= -267.49, 95% CI=(-351.80, -183.19), P<001]. Conclusions: ERAS pathways have a shorter length of stay and earlier postoperative feed initiation for adult patients undergoing laparoscopic appendectomy compared with standard care. Both approaches have similar operative time, surgical site infection incidence, and readmission rate. Clinical registration: This review is registered with INPLASY202280005.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44737850","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 : 2022-07-01DOI: 10.4103/2221-6189.355309
A. El-Gilany, E. Sameh, H. Abou-ElWafa
This narrative review aims to highlight some of the factors contributing to challenges faced by many countries in controlling the spread of COVID-19 pandemic that continues to rage around the world, especially after stoppage of official prevention and control activities. A literature search was conducted on PubMed, and Google using search terms “COVID-19”, “challenges”, “prevention”, and “control” in different combinations. COVID-19 prevention and control challenges are related to health-system, vaccines, administration, and society culture. Controlling the spread of COVID-19 necessitates cooperation between community leaders, healthcare professionals, religious leaders, and the public.
{"title":"Challenges of COVID–19 prevention and control: A narrative review","authors":"A. El-Gilany, E. Sameh, H. Abou-ElWafa","doi":"10.4103/2221-6189.355309","DOIUrl":"https://doi.org/10.4103/2221-6189.355309","url":null,"abstract":"This narrative review aims to highlight some of the factors contributing to challenges faced by many countries in controlling the spread of COVID-19 pandemic that continues to rage around the world, especially after stoppage of official prevention and control activities. A literature search was conducted on PubMed, and Google using search terms “COVID-19”, “challenges”, “prevention”, and “control” in different combinations. COVID-19 prevention and control challenges are related to health-system, vaccines, administration, and society culture. Controlling the spread of COVID-19 necessitates cooperation between community leaders, healthcare professionals, religious leaders, and the public.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48838957","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 : 2022-07-01DOI: 10.4103/2221-6189.355312
L. Gauri, Ketan Bhatnagar, P. Sameja, H. Nehara, K. Saini, R. Dutt, Bhupen Bhatnagar, Mohit Khokhar, Vikas Kumar, Anjali Garg
Objective: To explore predictive hematological parameters on admission which are associated with mortality in NS1 positive dengue shock syndrome patients. Methods: Demographic characteristics, hematological parameters, and the outcome of NS1 positive dengue shock syndrome patients without any comorbidity and coexisting infections were collected from the Intensive Care Unit and the results were compared between the survivor and non-survivor groups. Results: The mean age was (30.77±11.48) years and 56 (56.6%) patients were males. Out of the total 99 patients, 72 (72.27%) patients were successfully discharged and 27 (27.27%) patients eventually succumbed to death. The most common hematological finding was thrombocytopenia (95.95%), followed by anemia (52.52%) and decreased mean platelet volume (37.37%). After controlling other variables, logistic regression analysis showed that absolute neutrophil count and mean platelet volume were associated with mortality. Conclusions: Total leucocyte count, absolute neutrophil count, and total platelet count are significantly higher, and mean platelet volume is significantly lower in the non-survivor group as compared to the survivor group. Absolute neutrophil count and mean platelet volume are predictors associated with mortality.
{"title":"Hematological indices as predictors of mortality in dengue shock syndrome: A retrospective study","authors":"L. Gauri, Ketan Bhatnagar, P. Sameja, H. Nehara, K. Saini, R. Dutt, Bhupen Bhatnagar, Mohit Khokhar, Vikas Kumar, Anjali Garg","doi":"10.4103/2221-6189.355312","DOIUrl":"https://doi.org/10.4103/2221-6189.355312","url":null,"abstract":"Objective: To explore predictive hematological parameters on admission which are associated with mortality in NS1 positive dengue shock syndrome patients. Methods: Demographic characteristics, hematological parameters, and the outcome of NS1 positive dengue shock syndrome patients without any comorbidity and coexisting infections were collected from the Intensive Care Unit and the results were compared between the survivor and non-survivor groups. Results: The mean age was (30.77±11.48) years and 56 (56.6%) patients were males. Out of the total 99 patients, 72 (72.27%) patients were successfully discharged and 27 (27.27%) patients eventually succumbed to death. The most common hematological finding was thrombocytopenia (95.95%), followed by anemia (52.52%) and decreased mean platelet volume (37.37%). After controlling other variables, logistic regression analysis showed that absolute neutrophil count and mean platelet volume were associated with mortality. Conclusions: Total leucocyte count, absolute neutrophil count, and total platelet count are significantly higher, and mean platelet volume is significantly lower in the non-survivor group as compared to the survivor group. Absolute neutrophil count and mean platelet volume are predictors associated with mortality.","PeriodicalId":45984,"journal":{"name":"Journal of Acute Disease","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42924708","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}
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