Mean Duration Of Hospital Research Articles

Davydov-Moore vaginoplasty in Mayer-Rokitansky-Küster-Hauser syndrome: sexual and surgical outcomes.

The aim of this study was to compare surgical and sexual outcomes after Davidov-Moore vaginoplasty in women with Mayer-Rokitansky-Küster-Hauser syndrome (MRKH). In the case-series study, we described seven women, at a median age of 22.6 ± and BMI 22.8 ± 2.3kg/m2. We measured peri- and postsurgical parameters, including surgery-related neovaginal length and sexual initiation time. Sexual outcomes were measured using the Female Sexual Function Index (FSFI) before and 6months after vaginoplasty. All surgical procedures were performed successfully, with one minor perioperative bleeding. The mean time of vaginoplasty was 82.1min and the mean duration of hospitalization was six days. After a 6-month follow-up, vaginal length was 8.1-times longer than before surgery (10 vs. 81mm). The time from the surgery to the initiation of vaginal intercourse was between 17 to 22weeks. The mean FSFI score indicated good results, with no women below 23 score, and was 4.3- times higher when compared with the pre-surgical one (6.7 vs 29.1). Contrary to the FSFI score before surgery, the post-surgical FSFI revealed higher scores in all six different domains: desire (2.5-times), arousal (4.1-times), lubrication (3.8-times), orgasm (3.4-times), satisfaction (3.3-times) and comfort (11-times). Laparoscopic Davydov-Moore vaginoplasty might be considered as a safe procedure with satisfactory anatomic and sexual outcomes. It should be considered as a treatment option for the creation of neovagina in women with MRKH.

Expandable Intravertebral Titanium Implants for Thoracolumbar Burst Fractures Without Neurological Deficits

Objective: A thoracolumbar burst fracture (TLBF) is defined as the failure of the anterior and middle columns of the vertebra due to high-energy trauma, such as motor vehicle collisions and falls from heights. Debate has continued for decades regarding the standard treatment, especially for TLBFs without neurological deficits (TLBF-WONDs). The aim of this study was to understand the role of expandable intravertebral titanium implants (EITIs) in treating TLBF-WONDs.Methods: We included patients aged 18–65 years who presented at our hospital Emergency Department with severe back pain (visual analogue scale [VAS] score ≥ 8), were neurologically intact, were diagnosed with TLBF-WOND by either computed tomography or magnetic resonance imaging, underwent percutaneous bilateral transpedicular EITI implantation, and were followed-up for ≥12 months. Radiological and clinical outcomes were analyzed.Results: Thirty patients satisfied the study inclusion criteria, including 9 men and 21 women, with an average age of 48.2 years. Thirteen A3 and 17 A4 burst fractures were included. The mean duration of hospitalization was 3.3 days. The mean follow-up period was 4.4 years. All patients exhibited significant improvements in radiographical (anterior, middle, and posterior vertebral heights); vertebral kyphotic angle (p<0.001); and functional outcomes (VAS and Oswestry Disability Index scores, p<0.001). One case of cement leakage into the paraspinal muscle was observed; however, no major complications occurred.Conclusion: Percutaneous bilateral transpedicular EITI placement with cement augmentation under local anesthesia may be an effective strategy for the treatment of high-energy traumatic TLBFs with neurological integrity.

The effect of legal representation on clinical measures in involuntarily admitted psychiatric patients: a retrospective study

BackgroundMost western countries provide funded legal representation (LR) for involuntarily admitted psychiatric patients appearing before judicial committees. In 2004, an amendment to the Israeli Mental Health Act granted this right to involuntarily committed psychiatric patients. Psychiatrists then voiced concerns that LR may increase rates of premature discharge and compromise patients’ safety and well-being. These worries have not been sufficiently addressed to date. This study aimed to provide answers to their concerns.MethodsThis study included 3124 and 3434 inpatients involuntarily admitted to psychiatric facilities in 2000 and in 2010 (respectively), prior to and after the introduction of LR in Israel. Data were acquired from the Israeli National Psychiatric Hospitalization Registry. Clinical measures included percentage of discharges by the District Psychiatric Board (DPB), duration of involuntary hospitalization and rates of readmissions within thirty days and six months of discharge by treating psychiatrists (TP) or DPB.ResultsThe odds ratio (OR) of discharge by a DPB in 2010 (n = 221) compared to 2000 (n = 93) was 2.2 [95%CI 1.72–2.82]. The OR was similar for readmissions within thirty days or six months among patients discharged by TP and a DPB (OR = 1.08, p = 0.697 and OR = 0.92, p = 0.603, respectively) as well as between the two time points (p = 0.486 and p = 0.618). The duration of hospitalizations terminated by a DPB was significantly shorter than those terminated by TP, with no difference between the study time points. The mean hospitalization duration in 2010 was 21% shorter compared to 2000 among patients discharged by TP.ConclusionsThe number of DPB proceedings and the number of involuntarily hospitalized psychiatric patients discharged by DPBs increased considerably after the advent of state-funded legal representation in 2004. We found that this did not compromise beneficence and non-malfeasance of patient care. Our results emphasize the feasibility of affording even the most severely mentally ill patients the rights to due process. These findings may relieve concerns about state-funded LR procedures in involuntary psychiatric hospitalizations.

Total coronary revascularization via left anterior thoracotomy: Comparison of early- and mid-term results with conventional surgery

Background: This study aimed to evaluate the efficacy and safety of total coronary revascularization via left anterior thoracotomy (TCRAT) by comparing it to conventional coronary artery bypass grafting (CABG) with median sternotomy. Methods: In this retrospective study, 108 patients (95 males, 13 females; mean age: 57.1±8.8; range, 41 to 75 years) who underwent TCRAT (Group 1) and 154 patients (126 males, 28 females; mean age: 61.2±9.8; range, 31 to 79) who underwent conventional CABG (Group 2) between February 1, 2021, and September 1, 2022, were evaluated. The operations were performed by the same surgical team. Preoperative, operative, and postoperative data of patients and mid-term follow-up data were analyzed. Results: Mean cardiopulmonary bypass and cross-clamp times, respectively, were 167.70±68.93 and 77.03±38.18 min in Group 1 and 106.64±38.27 and 62.21±24.06 min in Group 2 (p<0.001). During the postoperative period, the all-cause mortality rate was 5.8% (n=9) in Group 2, while it was 0.9% (n=1) in Group 1; there was a statistically significant difference between the two groups (p=0.037). Nevertheless, the mean preoperative EuroSCORE (European System for Cardiac Operative Risk Evaluation) II was 2.59±2.3 in Group 2, which was significantly higher than the mean EuroSCORE II of Group 1 (1.37±1.5; p<0.001). The mean hospitalization duration for Group 2 was 6.99±3.37 days, and the mean hospitalization duration for Group 1 was 6.77±4.24 days. Duration of hospitalization was statistically significantly shorter in Group 1 (p=0.047). In addition, the mean perioperative number of erythrocyte suspension transfusions in Group 1 was 1.51±1.74, while it was 1.86±1.75 in Group 2. Significantly fewer erythrocyte suspension transfusions were performed in Group 1 (p=0.033). Conclusion: The findings of our study indicate that TCRAT is a safe and viable technique when performed on a select patient group compared to the conventional method.

Impact of Cannabis Use on the Length of Hospitalization of Schizophrenic Patients

Background: Cannabis is the most widely used illicit substance worldwide, with its prevalence increasing notably among individuals with schizophrenia. This population of patients often require multiple and prolonged hospitalizations for optimal symptom control. Previous studies have suggested an association between cannabis use and prolonged hospitalization, but this link has not been explored in the Moroccan population. Objective: This study aims to explore the association between cannabis use and the length of hospitalization in patients with schizophrenia. Methods: We conducted a descriptive and analytical cross-sectional study on a cohort of 135 schizophrenic patients hospitalized at Ar-razi Psychiatric Hospital in Salé between July 2023 and February 2024. The sample was divided into two groups: cannabis users (60%) and non-users (40%). The length of hospitalization was compared in univariate and multivariate analyses. Results: The mean hospitalization duration was significantly longer for cannabis users (56.4 ± 22.3 days) compared to non-users (33.5 ± 14.2 days) (p < 0.001). A univariate regression model revealed that cannabis use was associated with a 25-day prolongation in hospital stay (OR: 24.8, 95% CI: 17.5 – 32.2, p < 0.001). Other socio-demographic factors did not show a notable effect on hospitalization duration. Conclusion: Cannabis use may be a significant factor in prolonging hospitalization in patients with schizophrenia. Further studies with larger samples and objective assessments of cannabis use, are recommended.

Epidemiological analysis of a 10-year retrospective study of pediatric trauma in intensive care

Pediatric trauma plays a crucial role in pediatric mortality, with traffic injuries and falls frequently cited as leading causes of significant injuries among children. A comprehensive investigation, including geographical factors, is essential for developing effective strategies to prevent injuries and alleviate the burden of pediatric trauma. This study involved a retrospective analysis of clinical data from pediatric patients admitted to our hospital’s intensive care unit (ICU) due to trauma over a 10-year period. Comprehensive analyses were conducted to elucidate trends, demographics, injury patterns, and risk factors associated with these admissions. This retrospective study included 951 pediatric patients (mean age: 4.79 ± 3.24 years; mean weight: 18.45 ± 9.02 kg; median time to ICU admission post-injury: 10.86 ± 14.95 h). Among these patients, 422 (44.4%) underwent emergency surgery, and 466 (49%) required mechanical ventilation support, with a mean duration of 70.19 ± 146.62 h. The mean duration of ICU stay was 6.24 ± 8.01 days, and the overall mean hospitalization duration was 16.08 ± 15.56 days. The predominant cause of unintentional injury was traffic accidents (47.9%), followed by falls (42.5%) and burns/scalds (5.3%). Most incidents involved children aged 0–6 years (70.7%), with males comprising 60.0% of patients. Injury incidents predominantly occurred between 12 and 6 PM (44.5%) and on non-workdays (37.6%). The most common locations where injuries occurred were roadsides (49%) and rural areas (64.35%). Single-site injuries (58.78%) were more prevalent than multiple-site injuries (41.22%), and head injuries were the most common among single-site injuries (81.57%). At ICU admission, the mean injury severity score was 18.49 ± 8.86. Following active intervention, 871 patients (91.59%) showed improvement, while 80 (8.41%) succumbed to their injuries. Traffic injuries remain the primary cause of pediatric trauma leading to ICU admission, underscoring the importance of using appropriate child restraint systems and protective gear as fundamental preventive measures. The increased incidence of injuries among children aged < 6 years and those residing in rural areas highlights the need for targeted preventive strategies, necessitating tailored interventions and public policy formulations that address these high-risk populations.

Association of Fragmented QRS Complex with Short Term Outcome in Patients with Acute ST-Elevation Myocardial Infarction

Background: Acute ST-elevated myocardial infarction is a life-threatening condition. Presence of fragmented QRS (fQRS) after acute STEMI is associated with alteration of myocardial activation due to myocardial scar and myocardial fibrosis. Previous studies have suggested that fQRS in acute STEMI is associated with increased mortality, morbidity, sudden cardiac death and recurrent adverse cardiovascular events. The study was designed to assess the association of fQRS complex with short-term outcome (in hospital and 30 days follow up) in patients with acute ST elevation myocardial infarction. Methods: This prospective cohort study was conducted in the Department of Cardiology, Dhaka Medical College Hospital among the STEMI patients who were thrombolysed. All patients underwent serial ECG at admission, within first 12 hours, at 24 hours and at 48 hours for detecting the presence of fQRS complex. Patients showing fQRS involving infarct territory within 48 h of admission were included in the “fQRS group” and those who did not develop fQRS within 48 h of admission were included in the “without fQRS” group. 114 patients had fQRS complex and 104 patients were without fQRS in their ECG. In-hospital outcomes such as: death, heart failure, significant arrhythmias (VT, VF AF, SVT, 20 AV block, CHB), cardiogenic shock were recorded. Among the study patients, sixteen patients were lost to follow up in 30 days of index hospitalization. Finally, 202 patients were tracked for follow up regarding death or re hospitalization information by personal contact or over telephone. Statistical analysis was performed using the statistical package for social science (SPSS) 21.0 software for windows. Results: Appearance of fQRS complex occurred at admission, within first 12 hours, 24 hours and 48 hours in 53.5%, 23.7%, 14.9% and 7.9% cases respectively. During index hospitalization, development of cardiogenic shock (27.19% vs 11.54%), heart failure (23.68% vs 9.62%) and significant arrhythmias were significantly higher in fQRS group (42.10% vs 11.53%, p&lt;0.05). Although mean duration of hospitalization was similar in both groups (p&gt;0.05), but in-hospital mortality was higher in fQRS group (11.40% vs 3.85%, p&lt;0.05). Rate of re-hospitalization was significantly higher in patients with fQRS complex (21.69% vs 7.29% p&lt;0.05). Overall mortality within 30 days of index hospitalization follow-up also differs significantly in presence of fQRS complex (19.81% vs 5.2%; p =0.006). Conclusion: Presence of fQRS complex is associated with adverse short-term outcome in patients with acute ST elevation myocardial infarction. Hence, these patients need more aggressive and early invasive treatment to reduce morbidity and mortality. Bangladesh Heart Journal 2024; 39(2); 93-101

Analysis of patients with acute surgical abdomen due to trauma and evaluation of factors affecting mortality and the impact of COVID-19 pandemic process on patient admissions

Objective: To analyze the patients who developed acute surgical abdomen due to trauma, to evaluate the factors affecting mortality and to examine the impact of the COVID-19 pandemic process on patient admissions. Materials and Methods: The study was conducted retrospectively by analyzing the patients who applied to the emergency department of a secondary healthcare institution between 01.01.2019-31.12.2023 (5 years) and developed an emergency surgical abdomen secondary to trauma and were hospitalized and treated. All age groups were included in the study. Demographic data, type of trauma, type of treatment, site of injury, laboratory data, length of hospitalization and mortality status were analyzed. Comparative analysis of the injured regions according to the type of trauma was performed. Data of patients who were discharged and those who died were compared. Data collection was performed through hospital electronic data. Results: 123 patients were evaluated in the study. 78.9% (n=97) of the patients were male. The mean age was 36.43±14.81 years and the most common age range was 21-40 years (60.2%, n=74). At the time of presentation to the emergency department, the most common Glasgow Coma Score was 11-15 (83%, n=102). The most common reason for presentation was traffic accident (40.7%, n=50). Post-traumatic injuries to more than one organ or region in the abdomen were most common (28.5%, n=35). Surgical procedures were performed in 65.9% (n=81) of the patients. The mean duration of hospitalization was 7.14±5.40 days. Hemoglobin and platelet levels were found to be significantly lower at the time of admission in the patients who died (p

Modified Chevrel Technique: A Lifesaver for Surgeons.

Background and Objectives: Ventral hernias (VH) pose significant challenges for surgeons due to the risk of recurrence, complexities in aligning abdominal muscles, and selecting the most suitable layer for mesh augmentation. This study aims to evaluate the effectiveness of utilizing the anterior rectus fascia as a turnover flap in conjunction with onlay mesh reinforcement, a procedure known as the modified Chevrel technique (MCT). Materials and Methods: We conducted a retrospective analysis of patients who were operated on using MCT for abdominal hernias between January 2013 and December 2019. Data were extracted from our hospital's electronic database. Recurrence rates, as well as the rates of surgical site occurrences (SSO), surgical site infections (SSI), and surgical site occurrences requiring procedural intervention (SSOPI), were analyzed based on patients' comorbidities and demographic characteristics. Results: The median follow-up period was 42.9 months (range: 14-96), and the recurrence rate was 4% (n = 3). Among the recurrent cases, three patients had chronic obstructive pulmonary disease, representing a statistically significant association (p = 0.02). Although all patients with recurrence were obese, this association did not reach statistical significance (p > 0.05). The mean hospitalization duration was 17.6 days (range: 6-29). SSO, SSI, and SSOPI rates were 39 (52%), 12 (16%), and 32 (42%), respectively. Conclusions: Managing VH remains a surgical challenge, emphasizing the importance of achieving effective abdominal closure for both functional and cosmetic outcomes. MCT presents a relatively simple approach compared to techniques like transversus abdominis release (TAR) and anterior component separation (ACS), with acceptable rates of SSO, SSOPI, SSI, and recurrence.

Evaluation of Candidemia Cases Developed in the Intensive Care Unit: A Ten-Year Analysis

Objective: Fungal infections have been a major health problem for many years. They constitute a major cause of increased mortality and morbidity, especially in immunocompromised patients and intensive care unit (ICU) patients. In this study, we aimed to evaluate the epidemiologic characteristics, mortality and causative agent distribution of cases of healthcare-associated candidemia (HCA) in intensive care units of our hospital and to contribute to the literature. Methods: Our study included patients diagnosed with healthcare-associated candidemia who were hospitalized in 3rd level ICUs with various complaints between November 2011 and August 2021 in Meram State Hospital. Results: In our study, the mean age of patients who developed candida infection during intensive care unit hospitalization was 67.2±20.5 years. Of these patients, 59.5% (n:103) were men and 40.5% (n:70) women. Mean duration of hospitalization in the intensive care unit was 38.2±29.5 (min:1, max:231) days. Grouping of candida related HCAIs developed in patients according to Centers for Disease Control and Prevention (CDC) criteria shows that the most common candida related healthcare-associated infection (HCAI) was central line-associated bloodstream infection (CLABSI) at 52% and the second most common was laboratory-confirmed bloodstream infection (LCBI) at 31.2%. Cumulatively, candidemia are significantly higher to other candida related HCAIs. Conclusion: To prevent and empirically treat candidemia, which has a very high mortality rate, the causative agent distribution of the center should be well understood. Large-scale, high-quality studies using various biomarkers in addition to clinical findings for the correct antifungal selection and to reduce mortality due to invasive candidiasis in line with these selections are warranted.

The Effects of Subcutaneous Rapid-Acting Insulin Aspart in the Treatment of Mild and Moderate Diabetic Ketoacidosis in Children: A Prospective Study.

Background and objectives The traditional treatment approach to diabetic ketoacidosis (DKA) involves the replacement of fluid and electrolyte deficits and a continuous intravenous infusion of regular insulin. Several clinical trials supported the administration of subcutaneous rapid-acting insulin analogs in the management of uncomplicated DKA. This study aimed to determine the effects/safety of subcutaneous rapid-acting insulin aspart injections in treating uncomplicated mild and moderate DKA in children. Methods In this prospective study in 2022, 25 children with mild/or moderate DKA were enrolled. The main outcome measure was median time (hours) for the resolution of ketoacidosis. Data recorded were as follows: clinical characteristics, severity of ketoacidosis and dehydration, blood glucose, sodium, potassium, creatinine, urine ketones, hospitalization's duration, and complications. Based on the degree of dehydration, fluid deficit was replaced by sodium chloride 0.45%. Insulin aspart 0.15 units/kg subcutaneous injections were given every 2 hours in the hospital outside ICU. Blood glucose was measured hourly and blood gases every 2 hours. Ketoacidosis was considered resolved when the patient did not have nausea/vomiting, was conscious, and could eat, and blood glucose was <250 mg/dL, pH was >7.30, and/or HCO3 was >15 mmol/L. Results Of 25 DKA patients (mean age 11.06±3.89, range 4-17 years, 60% girls), 16 cases (64%) had established type 1 diabetes. Overall, 13 (52%) cases had mild ketoacidosis (average pH=7.25), and 12 (48%) cases had moderate ketoacidosis (average pH=7.15). The mean time to resolution of ketoacidosis was 11.24 hours. All but one patient met DKA recovery criteria without complications. Mild cases compared to moderate cases of DKA had a shorter duration to resolution of DKA (p = 0.04). Mean duration of hospitalization was 2.3 days. No electrolyte disturbances, hypoglycemia events, readmission or mortality, or other adverse effects were observed. Conclusion In children with mild and moderate DKA, subcutaneous rapid-acting insulin aspart administration was an effective, safe, and convenient treatment.

Posterior Fossa Craniotomy: Retrospective Analysis of 85 Patients

Aim: Craniectomy procedures were traditionally performed in posterior fossa surgeries. However, craniotomy procedure has also been started to be performed routinely in recent years. In this study, we aimed to evaluate the patients who underwent posterior fossa craniotomy procedures. Methods: The records of 85 patients who underwent posterior fossa craniotomy for various pathologies between 2016-2021 were retrospectively reviewed. Results: The mean age of the patients was 36.1 (2-82 years interval). There were 43 female patients (50.5%) and 42 male patients (49.5%). The pathologies was tumoral in 63 patients and non-tumoral in 22 patients. The symptoms of the patients identified were headache (84.5%), cerebellar symptoms (68%), deterioration of consciousness (54%), nause (48%), cranial nerve dysfunction (34%) and hemiparesis (18.5%). At admission, hydrocephaly was present in 22 patients. Ventriculoperitoneal shunt was applied to 12 of these patients. The duramater of the 68 patients were closed with primary suturation while 17 patients underwent duraplasty with fascia graft. Craniotomy flaps were fixed with only silk in 75 patients and miniplates in 10 patients. Two of the patients had pseudomeningocele and 1 had cerebrospinal fluid leak from the wound. The mortality rate was 3.5%. The mean duration of hospitalization was 7.6 days (2-54 days interval). Conclusion: Posterior fossa craniotomy technique has recently become widespread and begun to replace traditional craniectomy technique. It was facilitated by using high-speed drill with the advancement in technology. Posterior fossa craniotomy is a prominent technique with the low complication rates and high patient comfort in the postoperative period.

Journey of Guillain Barre syndrome from the pre-pandemic era to the pandemic era: A 4-year retrospective study.

To study demographic and clinical profiles of Guillain Barre syndrome (GBS) in the pre-pandemic and coronavirus disease 2019 (COVID-19) pandemic era and to compare the GBS incidence, severity, and its outcome in the pre-pandemic and pandemic eras. This is a 4-year retrospective study done in a tertiary care hospital in Delhi, India, between March 2018 and March 2022. Patients were divided into the pre-pandemic era and pandemic era (2 years before and 2 years after March 2020). The number of patients (N) was 25 in the pandemic/vaccine era, while N = 49 in the pre-pandemic era. The mean duration of hospitalization was significantly higher (P = 0.03) during the pandemic era (10.68 ± 6.67 days) compared to the pre-pandemic era (7.59 ± 3.55 days). There was no statistical difference in age (P = 0.56), gender (P = 0.70), GBS variants (P = 0.40), clinical spectrum, antecedent infection (P = 0.91), Hughes Disability Score on admission and discharge (P = 0.93 and P = 0.52, respectively), respiratory involvement requiring a ventilator (P = 0.19), and mortality (P = 0.26) in both the eras. Our study showed no association of the incidence of GBS with the ongoing COVID-19 pandemic. The mean hospitalization days were significantly increased during COVID-19 in view of associated respiratory involvement. The commonly held hypothesis of the increase in GBS cases during the pandemic/vaccine era has not been observed in our study.

Unloading the left ventricle in VA-ECMO: a comparative analysis of outcomes

Abstract Funding Acknowledgements None. Introduction Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) has radically changed the way we see and treat cardiogenic shock, despite the challenges it presents. The retrograde delivery of oxygenated blood to the aorta via the arterial cannula imposes increased afterload on an already strained left ventricle (LV). Unloading techniques aim to reduce the preload and afterload caused by VA-ECMO on the LV. Purpose Our study aims to compare the clinical outcomes of patients on VA-ECMO where additional invasive techniques were employed to unload the LV, against those without unloading strategies. Methods Patients treated with VA-ECMO in our hospital since 2012 were categorized into two groups: the Venting Group (VG) that received LV unloading interventions and the Non-Venting Group (NVG) without such interventions. We collected comprehensive clinical data, including demographics, baseline characteristics, ECMO-related parameters, in-hospital complications, and patient outcomes. Statistical analyses involved chi-square tests for categorical variables and independent samples t-tests for continuous variables to assess the impact of unloading strategies on patient outcomes. Results Our hospital treated 100 patients with VA-ECMO (mean age 58.4 ± 11.9 years, 60% male). Approximately 39% of patients received LV unloading support. The choice of unloading device was guided by our center's expertise. Most commonly, Intra-Aortic Balloon Pump (IABP) was used (61.5%), followed by Impella CP (23.1%), percutaneous atrial septostomy (2.6%) and surgical LV venting (12.8%). Unloading techniques were implemented either concurrently with VA-ECMO cannulation (58.9%), before (17.9%), or after its insertion (23.2%). Most patients (68%) received inotropic drugs, predominantly dobutamine. The mean duration of venting device use was 4.2 ± 3.8 days. Airway bleeding (3.3% NVG vs. 17.9% VG, p=0.032) and thromboembolic complications (19.7% NVG vs. 41.0% VG, p=0.036) were significantly more prevalent in the VG. There were no significant differences in the others reported ECMO-related complications. No significant differences were observed in the mean duration of support with VA-ECMO (3 days NVG vs. 4 days VG, p=0.147) or in the mean duration of hospitalization (13 days NVG vs. 12 VG, p=0.619) between the two groups. The 30-day survival rates were 42% (95% CI, 0.30-0.59) in NVG and 29% (95% CI, 0.18-0.49) in VG, which did not display statistical significance, p=0.24 [Figure 1]. Conclusions In our cohort, incorporating unloading devices alongside VA-ECMO did not yield major differences in survival rates, yet led to a considerable increase in airway bleeding and thromboembolic complications. The precocity of unloading device implantation occurred either as an initial strategy or to prevent increased afterload in hearts with limited contractile reserve.Characteristics and Clinical OutcomesSurviving Curves VG vs. NVG

The Effect of a Light-Dark Cycle on Premature Infants in the Neonatal Intensive Care Unit: A Randomized Controlled Study

PurposeTo investigate potential differences in discharge time, feeding methods and amounts, daily weight gain, vital signs, pain, and comfort levels among preterm infants born at 28–32 weeks' gestation who were hospitalized in the neonatal intensive care unit during long-term follow-up while implementing a light-dark cycle. Design and methodsThis is a randomized controlled study conducted with the support of a day-night cycle in premature infants born at 28–32 weeks' gestation and admitted to the neonatal intensive care unit of a teaching and research hospital affiliated with the Ministry of Health. The study compared the follow-up results from hospitalization to discharge over a period of 8 weeks. Results50% of premature infants admitted to the unit are multiple pregnancies. There was no significant difference in discharge weight, comfort level, pain level, vital signs of the infants included in the study (p > 0.05). The optimal development of infant feeding patterns was examinedand it was observed that the study group had significantly improved before the control group in terms of the time to switch to full enteral feeding and oral feeding (p < 0,05). The daily weight gain of the babies was examined, it was seen that the weight gain was higher in the study group compared to the control group (p < 0,05). The mean duration of hospitalization was compared, it was seen that the babies in the study group were discharged significantly earlier (p < 0,05). ConclusionThe study compared the long-term outcomes of premature babies hospitalized in neonatal intensive care and babies exposed to a light-dark cycle and regularly monitored in standard care. The results showed that the babies in the study group had higher daily weight gain and were discharged earlier than the control group. There were also no statistically significant differences in comfort and pain scores, vital signs or oxygen saturation between the study and control groups. Practice implicationsA light-dark cycle was found to be a feasible and promising intervention for infants at 28–32 weeks' gestation. It was a nurse-led management of care that could be integrated into the usual care of 28–32-week-old babies in neonatal units.

The Effect of the COVID-19 Pandemic on Odontogenic Cervicofacial Infections in a Single Center in Greece.

Odontogenic cervicofacial infections are still an ongoing problem, requiring immediate hospital admittance and management. The aim of this studyis to reflect the number of patients with cervicofacial infections who were admitted during the coronavirus disease 2019 (COVID-19) pandemic period in a single, point of reference center in Northern Greeceas well as analyze the quantitative and qualitative parameters of patient characteristics and management data. This was a retrospective cohort study that included all the patients with cervicofacial infections who were admitted to our unit during the COVID-19 pandemic, specificallybetween 2020 and 2021. For comparative reasons, patients admitted with cervicofacial infections between 2019 and 2020 (pre-COVID period) were analyzed. In total, 341 patients fulfilled the criteria for this study. Specifically, the number of admitted patients was 151 in the pre-COVID era instead of 190 patients in the pandemic. The mean age of the patients was 45.3 years, with a slight male predominance (54.7% males to 45.3%). The mean duration of hospitalization was 2.5 days in the pre-COVID period instead of 3.42 days in the pandemic. Interestingly, in the pandemic, eight times more patients were admitted to the ICU post-operatively, in contrast to the pre-COVID period (23 vs 3 patients). Also in the COVID period, almost 54.9% of the patients presented with fever and 49.6% with trismus. Moreover, the submandibular space involvement was the most common space of infection in both COVID and pre-COVID groups with (58.9% and 49.7%) respectively.In one-third of all cases, a post-extraction infection of a third molar was the main cause of abscess. Cervicofacial infections during the COVID-19 pandemic appeared with more severe symptoms and resulted in an increased number of patients who needed admittance to the intensive care unit, in contrast to the pre-COVID era. Also, the mean length of stay was increased for a day at the same period. This study could be used as an example for further research, in case of similar pandemic situations in the future.

Can local infiltration analgesia supplemented with tranexamic acid reduce blood loss during total knee arthroplasty?

PurposeThe aim of this study was to investigate the efficacy of TXA supplemented with local infiltration analgesia (LIA) for reducing blood loss in patients undergoing total knee replacement.MaterialsA retrospective study of 530 individuals with a mean age of 71.44 years was performed after posterior stabilized total knee arthroplasty. Patients were divided into three groups according to the method of bleeding control: I - patients without an additional bleeding protocol (control group); II - patients receiving IV TXA (TXA group); and III - patients receiving the exact TXA protocol plus intraoperative local infiltration analgesia (TXA + LIA group). Blood loss was measured according to the maximal decrease in Hb compared to the preoperative Hb level.ResultsThe mean hospitalization duration was 7.02 (SD 1.34) days in the control group, 6.08 (SD 1.06) days in the TXA group, and 5.56 (SD 0.79) in the TXA + LIA group. The most significant decrease in haemoglobin was found in the control group, which was an average of 30.08%. The average decrease in haemoglobin was 25.17% (p < 0.001) in the TXA group and 23.67% (p < 0.001) in the TXA + LIA group. A decrease in the rate of allogeneic blood transfusions was observed: 24.4% in the control group, 9.9% in the TXA group, and 8% in the TXA + LIA group (p < 0.01).ConclusionsCompared to the separate administration of tranexamic acid, the combination of perioperative administration with local infiltration analgesia significantly reduced blood loss in patients after total knee replacement.

Characterization of the Benefits and Risks of Therapeutic Anticoagulation in Patients Admitted with Severe COVID-19 (CRITAC).

Severe COVID-19 is associated with increased rates of thrombotic complications. Recent provincial recommendations in British Columbia have suggested providing thromboprophylaxis with therapeutic anticoagulation for hospital inpatients with severe COVID-19 who do not have a high risk of bleeding. To characterize the rates of major bleeding, thrombotic events, complications from COVID-19, and adverse effects among patients with severe COVID-19 treated with therapeutic anticoagulation. This retrospective chart review involved patients with laboratory-confirmed COVID-19 who were admitted to 3 sites within a local health authority between April 1 and December 31, 2021, and received therapeutic anticoagulation for thromboprophylaxis. After screening of 1036 patients, 72 patients were included in the study. The mean age of participants was 54 years, 63% (n = 45) were male, and 92% (n = 66) were receiving supplemental oxygen by nasal prongs on admission. The primary outcome, major bleeding, was experienced by 1 patient (1%). Increasing oxygen requirements resulting in progression to high-flow nasal cannula occurred in 11 patients (15%), and 5 patients (7%) required admission to the intensive care unit. One patient (1%) experienced a thrombotic event, and 1 patient (1%) had a minor bleed. The mean duration of hospitalization was 10 (standard deviation 10.8) days. One death occurred during the study period, and no cases of heparin-induced thrombocytopenia were observed. In this study of hospital inpatients with severe COVID-19 who were deemed to be at low risk of bleeding and who received therapeutic anticoagulation, there were low rates of both major bleeding and thrombotic events.

ST elevation acute myocardial infarction in young versus elderly: An observational study

ABSTRACT Background: ST elevation acute myocardial infarction (AMI) is usually associated with marked morbidity and mortality, affecting both young and elderly populations. Aims: To compare the differences in clinical presentation, treatment, outcome, and comorbidity in elderly and young patients of ST elevation myocardial infarction (STEMI). Methods: A prospective study was conducted on 60 patients divided equally into two groups – above 60 years (Group A) and 60 years or below (Group B). The various parameters including clinical presentation, time of onset, type of AMI, medication, complications, and outcome were assessed. They were followed up for 1 month. Results: The proportion of males and females (M:F) was equal in Group A, and the M:F ratio was 2.75 in Group B. The mean duration of hospitalization was longer in elderly. Hypertension was the most common comorbid condition. About half of the elderly cohort had previous history of angina pectoris, and about one third had prior attacks of MI. Overall, a higher number of younger cohorts were thrombolyzed with streptokinase. Conclusion: Our study showed that there were noteworthy differences in clinical presentation, management, and outcome between elderly and young AMI patients. Early recognition of atypical features among elderly can lead to effective strategies and timely management.

Foreign body aspiration in children: our pediatric tertiary care experience.

Inhalation of a foreign body is a real emergency in pediatric age and requires prompt diagnosis and treatment to reduce mortality. The objective of this study is to analyze clinical and radiological details, types, and localization of foreign bodies in patients conducted or to our hospital with suspected inhalation. We conducted a retrospective analysis of all cases of foreign body inhalation admitted to our Pediatric Emergency Room between January 2009 and June 2022. 171 patients were included in the study. In 83 patients, the FB was detected. The mean age of presentation was 2.3years (SD: ± 2). Cough (73%) and unilateral reduced breath sound (51%) were the most common clinical symptom and clinical sign. The most frequent localization was the right main bronchus (43%). The foreign bodies retrieved were vegetable (83%), of which peanut was the most common. Chest radiographs were normal in 25%. The mean duration of hospitalization was 5days (± 2.9). Complications such as pneumothorax were seen in two cases. Foreign body inhalation represents a true pediatric emergency and still a challenge in clinical practice. The best way to manage it is an early diagnosis and removal by fully trained staff.