Hospitalization Period Research Articles

Robotic pancreaticoduodenectomy after open Roux-en-Y biliary-enteric anastomosis: Technical insights (with video)

TechniqueRobotic pancreaticoduodenectomy (RPD) presents a formidable surgical challenge for patients with a prior history of bilioenteric anastomosis. However, there are no reports in the literature of robotic pancreaticoduodenectomy after open bilioenteric anastomosis. This article offers a detailed description of the surgical technique employed in performing RPD on a patient who previously underwent open Roux-en-Y biliary–enteric anastomosis, aiming to treat a duodenal tumor. ResultsThe patient underwent a successful surgery with a total operation time of 320 min and an estimated blood loss of approximately 150 ml. Following the procedure, the patient experienced an uncomplicated recovery and was discharged from the hospital after a 14-day hospitalization period. Postoperative pathology revealed a moderately differentiated adenocarcinoma of the duodenum invading the entire layer of the bowel wall. ConclusionsRPD is a safe and viable option for patients with a history of complex abdominal surgery.

A Systematic Review and Meta-Analysis of Supercapsular Percutaneously Assisted Total Hip Arthroplasty Versus Standard Posterior Approach for Femoral Neck Fracture in Elderly Patients.

This meta-analysis aimed to evaluate the efficacy and safety of the supercapsular percutaneously assisted total hip arthroplasty (SuperPATH) and the standard posterior approach in hip arthroplasty in treating femoral neck fractures in elderly patients. A systematic search was conducted for studies from 2012 to December 2022. Meta-analysis was conducted using Review Manager 5.3 on surgical time, intraoperative blood loss, Harris hip scores, and visual analog scale scores. A total of 26 studies involving 2,236 patients with femoral neck fractures were included. The SuperPATH group performed better than traditional posterior approach group in reducing intraoperative blood loss (in ml), shortening incision length (in cm), length of hospitalization period (in days) and improving Harris Hip score (HHS). The operation time took longer than the traditional posterior approach, with statistically significant differences. The VAS scores at 1 week and 3 months after surgery in the SuperPATH group were lower than those of the traditional posterior approach, with statistically significant differences. There was no statistical significance between the two groups in VAS scores 2 weeks and 1 month after surgery. The SuperPATH group resulted in better effects in reducing intraoperative blood loss (in ml), shortening incision length (in cm), length of hospitalization period (in days), and improving Harris hip score (HHS), which is conducive to the rapid postoperative recovery of patients.

Prophylactic barbiturate step-down infusion therapy has similar and favorable effects in elderly and non-elderly patients with severe traumatic brain injuries

With the aging population, the number of elderly patients with severe traumatic brain injury (sTBI) inevitably increases. The high mortality rate for sTBI in the elderly necessitates effective solutions. While we have previously reported the beneficial effects of a novel barbiturate therapy, a prophylactic step-down infusion of barbiturates (sdB), using thiamylal with normothermia (NOR) in patients with sTBI, its effects on elderly patients remain unclear. Therefore, we compared the efficacy and safety of sdB between elderly and non-elderly patients with sTBI.This study included 25 patients with sTBI who underwent sdB between January 2013 and March 2020. Patient characteristics were similar between elderly (≥75 years, n = 8) and non-elderly patients (<75 years, n = 17), except for the sex ratio. The hospitalization period tended to be longer for elderly patients. There were no differences in side effects or complications of sdB between the groups. The primary (favorable outcome at discharge and at 6–12 months) and secondary (composite death at discharge and at 6–12 months) endpoints were similar between the groups. Intracranial pressure and cerebral perfusion pressure were well controlled in the elderly patients.Our results suggest that sdB + NOR is as effective in elderly patients with sTBI as it is in non-elderly patients.

The Goldilocks Effect Of Hydration For Patients In A Sub-Acute Rehabilitation Setting: Too Warm, Too Cold Or Simply Not Nice

Abstract Background Older adults are considered at risk of becoming dehydrated. Risk of dehydration is increased during a hospital stay. Offering a range of preferred drinks frequently during the day can improve total fluid intake and minimise the risk of low intake dehydration. A survey of patient access to and consumption of water on an inpatient ward for older adult rehabilitation was undertaken. Methods A point prevalence survey was conducted on each patient on an inpatient ward for the following six situations: Results All inpatients (n=26, 15 female and 11 male) completed the survey for each of the six situations. 85% of patients surveyed had access to water (n=22). 85% of patients (n=22) surveyed were able to reach the water and 85% (n=22) could pour the water independently. 15% of patients surveyed (n=4) required assistance to drink (modified consistency (n=2) or physical assistance (n=2). Only 35% of patients (n=9) reported drinking the available water. Of the 17 patients who reported not drinking the water accessible to them, 59% (n=10) reported the water was too warm and 29% of patients (n=5) reported the water didn’t taste nice. Conclusion Low intake dehydration is associated with adverse outcomes in older adults. The root causes of low fluid intake need to be established in order to minimise the risk of dehydration during a period of hospitalisation. Further research is required to establish the root causes of low intake dehydration and development of quality improvement initiatives to minimise low intake dehydration in a hospital setting.

Isolated Severe Neutropenia in Adults, Evaluation of Underlying Causes and Outcomes, Real-World Data Collected over a 5-Year Period in a Tertiary Referral Hospital.

Background and Objectives: In clinical practice, neutropenia is frequently accompanied by other cytopenia; isolated non-chemotherapy-induced severe neutropenia is less frequent and its differential diagnosis can be challenging. In this real-world study with data collected over a 5-year period in a tertiary referral hospital, we primarily sought to identify underlying causes of isolated severe neutropenia (<0.5 × 109/L). Secondly, we aimed to analyze its management and outcomes. Materials and Methods: From 444,926 screened patients, after exclusion of patients with chemotherapy, radiotherapy, hematological neoplasms, additional cytopenia, and benign ethnic neutropenia, we identified and analyzed data from 70 patients (0.015%) with isolated severe neutropenia. We thus confirmed that the occurrence of isolated severe neutropenia is a rare event, even in a tertiary hospital. Results: The median age at diagnosis was 34 years (range 1-81) and 65% were female. Acute neutropenia was more frequently observed (n = 46/70, 65.7%); the main underlying causes in this group were drugs (n = 36/46, 78%) followed by infections (n = 10/46, 21.7%). We identified 24 (34.3%) patients with chronic neutropenia. The majority of them (n = 12/24, 50%) had an idiopathic form (CIN), 8/24 (33%) were autoimmune (AIN), and 4/24 (17%) were congenital. Conclusions: This study demonstrates the rarity and heterogeneity of isolated severe neutropenia and the steps to consider in its diagnostic work-up and management. Epidemiological characteristics, diagnostic work-up, and management including hospitalizations are described. Due to the high frequency of metamizole-induced neutropenia observed in this study, we want to raise awareness about its use, since this complication generates frequent hospitalizations even in young, otherwise healthy patients. Furthermore, recurrent infections in chronic forms of idiopathic neutropenia were quite common, suggesting a difference in phenotypes and need for therapy consideration depending on the clinical course.

Comparison of the quality of logistic regression models and a classification tree in predicting hospital mortality in elderly patients with non-ST-elevation myocardial infarction

Aim. Using the CHAID (Chi Squared Automatic Interaction Detection) method to develop a classification tree for predicting hospital mortality in patients with non-ST-elevation myocardial infarction (non-STEMI) aged 75 years and older and compare the quality of the constructed model with the logistic regression model.Material and methods. A retrospective analysis of the case histories of 119 sequentially enrolled patients aged ≥75 years who were hospitalized in a cardiology department due to non-STEMI in 2020-2021 was carried out. The construction of a predictive model of probability of dying was carried out using the logistic regression method. To assess the impact of various predictors affecting the probability of dying during the of hospitalization period in patients with non-STEMI, a classification tree was developed using the CHAID method. To compare the quality of logistic regression models and the classification tree, the areas under the ROC curve and confidence intervals were estimated.Results. Based on the construction of a binary logistic regression, it was found that the factors increasing hospital mortality were cardiogenic shock (CS): odds ratio (OR) 47.55; 4.00-589.16; p=0.002; new-onset atrial fibrillation: OR 6.45; 1.39-30.42; p=0.018; and the number of points on the GRACE scale: for each increase by 1 point: OR 1.03; 1,00-1,05; p=0.046. Similar data were obtained when analyzing the classification tree: in patients with CS, the predicted mortality was 91.7%. The probability of an unfavorable outcome based on the constructed classification tree was higher than the average in the analyzed sample in persons without CS, 2-3 degree atrioventricular blocks, and pulmonary edema, but with right bundle branch block on the electrocardiogram (25.0%) and in persons without CS and atrioventricular blockages of 2-3 degrees, but with pulmonary edema and a Q wave on the electrocardiogram (50.0%). Both methods of predicting hospital mortality are applicable. There were no statistically significant differences in the quality of both constructed models; the difference in the areas under the ROC curves was 0.043±0.268 with a 95% confidence interval of -0.055-0.141, p=0.387.Conclusion. Both developed methods can be used to determine the probability of dying in a hospital. Currently, the recruitment of patients into a prospective study of a similar design has begun and is continuing, during which validation of the constructed forecasting models is planned.

Can a Continuous Wound Infiltration System Replace Intravenous Patient-Controlled Analgesia for Postoperative Pain Management after a Single-Port Access Laparoscopy?

Background: The aim of this study was to determine whether continuous wound infiltration (CWI) can replace intravenous patient-controlled analgesia (IV PCA) and to investigate effective pain control strategies after a single-port access (SPA) laparoscopy for adnexal disease. Methods: A total of 470 patients (the CWI group [n = 109], the IV PCA group [n = 198], and the combined group [n = 163]) who underwent an SPA adnexal laparoscopy and who received CWI or IV PCA for postoperative pain management were retrospectively reviewed. The numeric rating scale (NRS) pain score at 6, 12, 24, and 48 h (h) after surgery and the total amount of fentanyl administered via IV PCA were collected. The incidence of postoperative nausea and vomiting (PONV) and the total amount of rescue antiemetic drugs administered were also evaluated. Results: The mean NRS pain scores at 6 h (combined vs. PCA vs. CWI, 3.08 vs. 3.44 vs. 3.96, p < 0.001), 12 h (2.10 vs. 2.65 vs. 2.82, p < 0.001), and 24 h (1.71 vs. 2.01 vs. 2.12, p < 0.001) after surgery were significantly lower in the combined group. CWI showed a similar pain-reduction effect after surgery compared to IV PCA, except for the acute phase (within 6 h after surgery). The incidence of PONV during the entire hospitalization period was significantly lower in the CWI group compared to the groups using IV PCA (p < 0.05). The combined group had a significantly lower incidence of PONV and use of rescue antiemetics than the IV PCA group (p < 0.05). The combined group required significantly less total PCA fentanyl compared to the IV PCA group (combined vs. PCA, 622.1 μg vs. 703.1 μg, p < 0.001). Conclusions: CWI is an effective alternative to IV PCA and has fewer side effects. Combined use of CWI and IV PCA may be an ideal pain management strategy, offering a strong pain-reduction effect and only moderate side effects.

A Routine Coronary Angiography before Carotid Endarterectomy as an Example of Interdisciplinary Work: The Immediate Results of the Surgery.

The aim: to evaluate the incidence of obstructive lesions of the coronary arteries during routine coronary angiography (CAG) before carotid endarterectomy (CEA) and the incidence of perioperative complications. Materials and Methods: We examined a continuous sample of 498 patients before CEA who underwent an invasive evaluation of the coronary bed during CAG. Depending on the hemodynamic significance of coronary artery lesions, the patients were divided into three groups: group I-obstructive coronary artery disease (≥70%) (n = 309, 62.0%); group II-non-obstructive lesions of the coronary arteries (<70%) (n = 118, 23.7%); group III-intact coronary arteries (n = 71, 14.3%). The groups were compared with each other according to the data of the preoperative examination (clinical and anamnestic parameters, laboratory data and results of echocardiography), as well as according to the immediate results of the operation. In the hospital period, adverse cardiovascular events were assessed: death, myocardial infarction (MI), stroke, arrhythmias, atrial fibrillation or flutter (AF/AFL) and combined endpoint. Results: The groups differed significantly in the presence of symptoms of angina pectoris, myocardial infarction and myocardial revascularization procedures in their medical history and in the presence of chronic ischemia of the lower extremities. However, in the group of intact coronary arteries, the symptoms of angina were in 14.1% of patients, and a history of myocardial infarction was in 12.7%. Myocardial revascularization before CEA or simultaneously with it was performed in 43.0% of patients. As a result, it was possible to reduce the number of perioperative cardiac complications (mortality 0.7%, perioperative myocardial infarction 1.96%). Conclusions: The high incidence of obstructive lesions in the coronary arteries in our patients and the minimum number of perioperative complications favor routine CAG before CEA.

Multisystem inflammatory syndrome in children treated with intravenous immunoglobulin monotherapy: a single-center retrospective study

BackgroundMultisystem inflammatory syndrome in children (MIS-C) is one of the complications of SARS-CoV-2 infection. This study aims to evaluate the clinical and laboratory characteristics, as well as treatment results, of MIS-C patients who received intravenous immunoglobulin (IVIG) monotherapy.MethodsThis retrospective study included patients diagnosed with MIS-C. Demographic data, organ involvements at the admission, laboratory evaluations for diagnosis, treatment, and follow-up were recorded. We evaluated outcomes by the length of the intensive care unit stay, the total hospitalization period, complications, and mortality.ResultsA total of 95 patients diagnosed with MIS-C were evaluated. The mean age was 118.8 (± 52.5) months. 76.8% of the patients had four or more organ systems involved. Seventy-nine patients (83%) were hospitalized in the pediatric intensive care unit (PICU) for a mean of 4.59 days. Seventy-seven (81%) patients received IVIG. A second dose of IVIG was administered to 66.3% of patients. All patients received vitamin D and C supplementation. Six patients who had cardiac involvement or cerebral infarction were treated with plasmapheresis. No patients received steroids. There was no mortality at the end of the follow-up.ConclusionsFavorable outcomes may be obtained with IVIG monotherapy in MIS-C patients. More clinical trials are needed to establish the role of supportive treatments like vitamin D and C in MIS-C management.

Comparison of the effect of chewing gum with routine method on ileus after burns: a randomized clinical trial

BackgroundChewing gum is a healthy, cheap, and familiar solution for patients with premature irritation of the stomach and intestines. This study compared the effect of chewing gum and the routine method on ileus after burns.MethodsThis study is a randomized clinical trial conducted in Valiasr Hospital in Arak, Markazi Province, in the center of Iran, from December 2021 to February 2023. After the diagnosis of intestinal ileus in 83 patients hospitalized in the burn department by a general surgeon, with the available sampling method, these patients were evaluated based on the inclusion and exclusion criteria of the study. As a result, 66 patients were selected and divided into groups A (33 patients in the intervention group: routine care + gum chewing) and B (33 patients in the control group: routine care) by random allocation method. For the intervention group, from entering the ward until the beginning of oral feeding, gum (without sugar) was chewed four times a day for 15 min, while control groups received the routine diet of the department. Both groups’ condition of the bowel sounds, time of passing gas, and stool were recorded. The statistical analyses were performed using SPSS version 16. The chi-squared, Fisher’s exact, Independent t-test, and Mann-Whitney U tests were utilized.ResultsThe results showed that the median bowel sound return time, time of the first gas discharge, earliest defecation time, and time to start the diet were significantly shorter in the intervention group than in the control group (P < 0.001).ConclusionThis study showed the effect of chewing gum without sugar in shortening the symptoms of intestinal ileus after burns. However, it was not effective in reducing the hospitalization period of patients. According to these results, it is recommended to add chewing gum to the routine care of people hospitalized due to burns.Trial registrationIranian Registry of Clinical Trials IRCT20180715040478N1, 2021-07-27.

Pin fixation is an effective method for fixation of bunion osteotomy with various procedures: a retrospective cohort study

BackgroundVarious fixation devices are available for bunion osteotomy. In this study, we evaluated the radiographic outcomes, postoperative complications, and recurrence rate in a series of hallux valgus deformities treated with various osteotomy procedures using a pin for the fixation of the osteotomy.MethodsTwo-hundred forty-seven patients with hallux valgus deformity managed with a Simple, Effective, Rapid and Inexpensive (SERI) osteotomy, distal chevron osteotomy, or proximal crescentic osteotomy and K-wire fixation were included. The mean follow-up of the patients was 53.9 ± 8.9 months. Radiographic evaluations included the assessment of the Hallux valgus angle (HVA), intermetatarsal angle (IMA), and union. Clinical evaluations included the assessment of the range of motion, pain in the first metatarsophalangeal joint, and patient satisfaction.ResultsIn the last visit, the mean improvement of HVA was 23.9 ± 9.1º (P < 0.001). The mean IMA improvement was 6.1 ± 6º (P < 0.001). The mean metatarsophalangeal flexion and extension were 33 ± 10.7º and 34.6 ± 9.2º, respectively. Postoperative complications included pin tract infection in eight (3.2%) patients, deep infection in five (2%) patients, and early pin complication in four (1.6%) patients. Recurrence was observed in five (2%) patients. Twenty-three (9.3%) patients had slight pain in the last follow-up. The mean surgical time was smaller in the SERI osteotomy (P < 0.001). The mean hospitalization period was longer in the proximal osteotomy group (P = 0.039). The mean metatarsophalangeal flexion and extension were significantly smaller in the distal chevron osteotomy (P = 0.046 and P = 0.037, respectively). 90% of patients were satisfied or very satisfied with the surgical outcomes.ConclusionK-wire fixation is a safe and effective device for the fixation of bunion osteotomy, and this effectiveness is even higher with SERI and proximal crescentic osteotomy.

Complex Infection-Control Measures with Disinfectant Switch Help the Successful Early Control of Carbapenem-Resistant Acinetobacter baumannii Outbreak in Intensive Care Unit.

A carbapenem-resistant Acinetobacter baumannii (CRAB) outbreak in an intensive care unit (ICU) was contained by an improved infection-control measure that included a disinfectant policy. In our retrospective cohort study, we describe the epidemiological investigations and infection-control measures during this outbreak. Descriptive analysis was used to summarize patient demographics, neurological diseases, surgical treatment, underlying diseases, infection, and outcomes. In December 2023, two CARB-positive patients were observed in the ICU, and four more patients became CRAB-positive in January. During this outbreak, there was an overlap of hospitalization periods among the CRAB-positive patients, and CRAB was isolated from the environment; the isolated CRAB strain was identical. Infection-control measures, including hand hygiene, contact precautions and isolation, surveillance, decolonization, environmental cleaning, and disinfection, were reviewed and modified. The aim of this study was to examine the molecular background of the effectiveness of the disinfectant shift used during successful outbreak control. Experiments were carried out to study the phenotypic sensitivity and genetic background of different disinfectant agents. A thorough analysis of the detected CRAB strain included whole-genome sequencing (WGS), investigation of the qacE and qacEΔ1 genes' relative expression by qPCR after exposure to different disinfectant solutions, as well as an analysis of biofilm formation. WGS analysis of the CRAB strain identified that an ST2 high-risk clone was responsible for the outbreak, which produced OXA-83 and ADC-30 beta-lactamases; in addition, qacE and qacEΔ1 genes were also detected, which confer resistance to disinfectants containing quaternary ammonium compounds (QACs). A qPCR analysis demonstrated that after exposure to different disinfectants, the gene expression levels of qacE and qacEΔ1 increased and correlated with concentrations of QACs of disinfectants. During the outbreak, the standard-of-care QAC-based disinfectant was changed to a mainly alcohol-based agent in the ICU, which contributed to the successful control of this outbreak, and no additional patients were identified with CRAB. We conclude that continuous surveillance and hand hygiene training combined with fast identification and reaction to new cases, as well as an in-depth analysis of multidrug-resistant outbreak strains and investigation of their disinfectant tolerance/resistance during an outbreak, are essential to effectively control the spread of nosocomial pathogens. The smart policy of disinfectant agent selection played a crucial role in controlling the outbreak and ensuring patient safety in the ICU.

The Partners of My Partners: Shared Collaborative Experience and Team Performance in Surgical Teams

When teams in organizations are assembled to perform contingent tasks, team members carry with them experiences of prior interaction with partners in different teams. Focal team members share collaborative experiences to the extent that they worked with common external prior partners. Extending current research on team effectiveness, we investigate how shared collaborative experience (SCE) affects team performance. Consistent with the established understanding of team processes as carrying both a teamwork and a taskwork component, we conceptualize SCE as having two distinct dimensions that we call SCE extent and SCE diversity. We posit that high SCE extent increases the ability of teams to refine their teamwork processes, increasing their performance through enhanced coordination and reflexivity. We argue that high SCE diversity hinders the ability of teams to form a shared understanding of task demands, thus undermining team performance. Furthermore, we investigate the contingent effect of task complexity on the relationship between SCE and performance. We argue that the benefits of implicit coordination and the drawbacks of experience diversity decrease as tasks become more complex and require more explicit coordination and wider repertoires of responses. These predictions find support in an analysis of 1343 robot-assisted surgery operations performed by 114 surgeons during a four-year period in a private university hospital. By explicitly recognizing how team members benefit from the network of their shared prior partners, our study contributes to developing a new approach to study the effectiveness of temporary teams in organizations.

Hypoalbuminaemia and its association with disease and clinical outcomes incats.

To report the incidence of feline hypoalbuminaemia and characterise the distribution of presenting disease categories and pathoaetiologies of hypoalbuminaemia in cats. The secondary aim was to evaluate the relationship between hypoalbuminaemia and clinical outcomes. Medical records of cats with hypoalbuminaemia (<28.0 g/L, reference interval: 28.0 to 39.0 g/L) presenting to a veterinary teaching hospital over 5 years were retrospectively reviewed. The severity of hypoalbuminaemia was further stratified into mild (24.0 to 27.9 g/L), moderate (20.0 to 23.9 g/L) and severe (≤19.9 g/L) groups. The median albumin and severity groups were compared between the determined disease categories, pathoaetiologies and clinical outcomes. The incidence of hypoalbuminaemia was 32.7% (533/1632). Gastrointestinal disease was the most common disease category associated with hypoalbuminaemia [154/533 (28.9%)], of which, 49.4% (76/154) of cats had gastrointestinal neoplasia. Neoplastic [159/533 (29.8%)] and inflammatory conditions [158/533 (29.6%)] were common pathoaetiologies noted. Statistically significant differences in the serum albumin between individual disease and pathoaetiological categories were found. Cats with moderate to severe hypoalbuminaemia had a statistically significantly longer hospitalisation period, cost of treatment and increased odds of death (odds ratio 2.4, 95% confidence interval: 1.3 to 4.6 and odds ratio 3.2, 95% confidence interval: 1.5 to 6.6, respectively). The incidence of feline hypoalbuminaemia in our study surpasses previous canine reports. Our findings support albumin as a negative acute phase protein in cats, with hypoalbuminaemia frequently associated with inflammatory disease. Hypoalbuminaemia also features prominently in cats with gastrointestinal neoplasia, indicating careful appraisal of the presence of protein-losing enteropathy is required in these cases. Finally, albumin is found to be a prognostic indicator in this study.

Effect of Nesting and Swaddling on Sleep Duration of Preterm Neonate Hospitalized at Tertiary Care Centre of Eastern Nepal

Background: All preterm neonates’ sleep is disturbed during hospitalization period due to various stressful environmental factors and human error and without focusing in individual developmental care. This impacts neonatal neurological development as well as normal growth resulting lifelong disabilities. Thus, modification of the environment by intervening developmental care could minimize the iatrogenic effect and neuro-developmental delay by decreasing stressful environment. This study was conducted to assess the effect of nesting and swaddling on sleep duration of preterm neonates during hospitalization at B.P.Koirala Instituted of Health sciences (BPKIHS). Methods: True experimental (post-test control design) study conducted among 36 preterm neonates, admitted in Nursery and Neonatal Unit of BPKIHS. The objective of this study was to assess the effect of nesting and swaddling on sleep duration. Consecutive sampling technique was used for total sample size then after random allocation is applied for creates the samples into two groups: experimental and control. Performa was used to collect socio-demographic characteristics. Sleep duration was recorded in self-administer observation form base on the observational behavior characteristics scoring of neonatal sleep by AASM (American Academy of sleep Medicine). As intervention, nesting and swaddling were performed in experimental group, then the sleep was video-recorded for 2 hours for each neonate. Finally, data were analyzed using descriptive and inferential statistics. Results: Among the enrolled neonates, there were 23 male (63.9%) and 13 female (36.1%) preterm. There was significant difference in sleep duration between experimental and control group. The mean ± SD of sleep duration was 59.22 ± 22.61 minute in experimental group and 39.50 ± 8.06 minute in control with p-value 0.001. The mean sleep duration was not associated with other selected study variables except the performed intervention. Conclusions: Nesting and Swaddling can be used as convenient and effective method to increase neonatal sleep duration or rest period.

Effectiveness and safety of intravenous labetalol in severe pre-eclampsia and eclampsia at a teaching institution in Chhattisgarh.

Severe hypertension in pregnancy deserves prompt recognition and urgent effective reduction in order to reduce the risk of complications such as eclampsia and HELLP syndrome and to achieve desirable neonatal outcomes. There is a need for effective and safe parenteral antihypertensive treatment. We studied the effectiveness and safety of intravenous labetalol use in severe hypertension in pregnancy and post-partum period in a teaching hospital in Chhattisgarh in 101 women. IV labetalol was given as bolus doses till the blood pressures were controlled. Neonatal outcomes were recorded, and adverse effects such as hypotension, hypoglycemia, and neonatal asphyxia were documented. Intravenous labetalol given as a single bolus of 20 mg was efficacious in controlling blood pressures in 93 out of 101 (93%) women, and the rest were controlled with 1 or 2 additional doses in 1-3 hours. No neonatal deaths happened beyond the 13 intrauterine fetal deaths at presentation. No women developed any episodes of hypotension, tachycardia of more than 100, or nausea or vomiting on labetalol. Intravenous labetalol, even as a single bolus dose, is highly efficacious and is free of any major adverse effects.

The Effect of Mask Use on Seasonal Virus Diversity in SARS CoV-2 Negative Patients Treated as Inpatients During the 2021-2022 and 2022-2023 Seasonal Flu Period.

The study aimed to explore the protective effect of mask use against respiratory tract viral agents during the pandemic. The study included patients with a COVID-19 negative test who were hospitalized in the pulmonary disease clinic with the diagnoses of asthma attack, chronic obstructive pulmonary disease (COPD) exacerbation, and pneumonia in two periods: during mandatory mask use (October 2021 - May 2022) and after the mask mandate was lifted (October 2022 - May 2023). Combined nose and throat swab samples taken from the patients were evaluated for viral agents by using the PCR test method. Viral agents isolated from the patients in the two periods were compared based on hospitalization diagnoses and periods. The study enrolled 1,335 patients, 483 female and 852 male. It was found that viral agents significantly increased during the period without a mask mandate compared to the period when the mask mandate was in effect (41.6% vs. 23.4%) (p < 0.001). During the period without mask mandate, influenza A, H1N1, and RSV/AB viruses significantly increased (p = 0.019, p = 0.003, p < 0.001, respectively). Our results indicated that mask use during the pandemic is protective against the transmission of respiratory tract viruses. Thus, it can be concluded that mask use is important not only in the coronavirus pandemic but also especially in influenza and RSV epidemics.

P104 MEDICAL TREATMENT IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION HOSPITALIZED AT RESEARCH INSTITUTE OF CARDIOLOGY DURING 1 YEAR (FROM SEPTEMBER 2022 TO SEPTEMBER 2023)

Objective: Patients with heart failure remain most challenging group of patients with cardiovascular diseases. Hospital period of these patients is important period of their life. Therefore evaluation of the level of in- hospital care and treatment options represents valuable information. Design and method: 477 patients (pts), 13% female,87% male with HFrEF hospitalized at Research Institute of Cardiology during 1 year (September 2022 – September 2023) represented study population. Consecutive patients’ data was extracted from the archive of Institute and evaluated. Results: Majority of pts had NYHA III-IV and mean ejection fraction (EF) of 35% (26-43%).Atrial fibrillation (AF) observed in 17,8% out of 477 pts. Myocardial infarction (MI) in anamnesis was in 82%. Systolic Blood Pressure (SBP) – mean 137 mm.Hg(min 80-max 240),Diastolic Blood Pressure(DBP) – mean 84 mm.Hg(min 50 – max 140).Arterial Hypertension(AH) had 61,4%. Type 2 Diabetes (T2D) – 51%.Chronic Kidney Disease had 22,9%.Pulmonary artery hypertension – 33%.Hb&lt;12 g/l had 22,4%.ACE inhibitors or ARB mainly in form of fix combination with thiazide diuretics received 34% out of 477pts. ARNI were used in 27,7% of pts.B-blockers-55%. MRA – 89%. SGLT2 inh – 17,4%.Loop diuretics-86,2%.Digoxin-28,8%.Amiodarone – 22,9%.Ivabradine – 6%. Lab, tests: К+ mean 4,4 (2,9-6,2). Na+, mean 140,4 (133- 155). NT-proBNP, mean 2246.39 pg/ml (10.0-30000.0). Conclusion: In significant number of patients with HFrEF hospitalized to Research Institute of Cardiology during the period from September 2022- September 2023 medical therapy was almost adequately adherent to modern international guidelines on management of heart failure. In some cases’ limitations for indication because of low blood pressure, low eGFR and high serum kalium level took place.

Magnesium sulfate enhances the effect of the peripheral analgesic cocktail in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials.

Although magnesium sulfate (MgSO4) is widely used as an analgesic adjuvant to peripheral analgesic cocktails, its efficacy in total knee arthroplasty (TKA) is still controversial. Therefore, we systematically reviewed and meta-analyzed the literature to assess the analgesic efficacy of MgSO4 as an adjuvant to the analgesic cocktail in TKA. The PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched. The meta-analysis was performed according to the PRISMA guidelines. Data were qualitatively synthesized or meta-analyzed using a random-effects model. Five randomized controlled trials involving 432 patients were included. Meta-analyses detected significant differences between the MgSO4 and control groups in the visual analog scale (VAS) pain scores (rest) at 6, 12, and 24 h postoperatively; VAS pain scores (motion) at 12, 24, and 48 h postoperatively; morphine consumption within 24 h, 24-48 h, and during the total hospitalization period; time to first rescue analgesia after TKA; and length of hospital stay. Regarding the functional recovery, the meta-analysis demonstrated significant differences between groups in terms of knee range of motion on postoperative day 1; daily mobilization distance on postoperative day 1; and daily mobilization distance. There was no significant intergroup difference in surgical complications. The findings suggest that MgSO4 is a promising adjunct to the analgesic cocktail, achieving significant improvements in pain scores and total opioid consumption during the early postoperative period after TKA.

What Factors Influence In-Hospital Mortality Following Aseptic Revision Total Hip Arthroplasty? A Single-Center Analysis of 13,203 Patients

BackgroundRevision total hip arthroplasty (rTHA) is associated with an extended surgical period, an increased hospitalization period, expanded blood loss, and high mortality rates. The purpose of the present study was to assess the risk factors that contribute to in-hospital mortality following aseptic rTHA. MethodsWe performed a retrospective examination of the medical records of all patients who underwent elective rTHA surgery at our tertiary referral arthroplasty center between March 1996 and March 2019. The study involved a group of 13,203 patients, including 70 who expired during hospitalization and 13,133 in the control group. Baseline characteristics, medical history, comorbidities, and surgery-related parameters of the patients were recorded. Logistic regression analyses were performed to examine the association between independent variables and in-hospital mortalities, which were presented as odds ratios (ORs) and confidence intervals (CIs). ResultsPatient factors associated with in-hospital mortality included hepatitis C (OR 75.5, 95% CI 3.5 to 1,625.2), chronic obstructive pulmonary disease (OR 30.7, 95% CI 6.5 to 145.7), rheumatoid arthritis (OR 28.9, 95% CI 3.8 to 218.5), history of myocardial infarction (OR 24.9, 95% CI 4.4 to 140.8), history of cerebrovascular disease (OR 23.1, 95% CI 3.8 to 142), congestive heart failure (OR 18.9, 95% CI 3.8 to 94.2), and diabetes mellitus (OR 10.2, 95% CI 2.4 to 42.6). Surgical factors included the history of multiple prior revisions (OR 1.75, 95% CI 1.1 to 2.7), postoperative blood transfusion (OR 2.8, 95% CI 1.1 to 7.3), and decreased preoperative hemoglobin (OR 2.3, 95% CI 1.7 to 3.1). ConclusionsSeveral patient-related and intraoperative factors significantly increased the risk of in-hospital mortality following aseptic rTHA. Vigilance and close perioperative monitoring are essential for patients undergoing this complex surgery. Level of EvidenceIII.