Mean Duration Of Hospital Research Articles

Clinical epidemiology and treatment outcome of Hexaconazole poisoning – A prospective six year study

Background: Hexaconazole is a category 3/4 of poison as per the W.H.O Expert Group on Pesticide Residues. Hexaconazole is used to control infection by fungi in paddy and other crops. Apart from destroying the target species, it can also cause damage to humans. There have been discrete reports of instances of human poisoning due to hexaconazole. Methodology: A patient record-based cross-sectional study was carried out in Konaseema Institute of Medical Science & Research Foundation, Amalapuram, Andhra Pradesh, India during a period from March 2014 to April 2020 on 26 confirmed cases of hexaconazole poisoning. The clinic-demographic data, hematological, and biochemical parameters at the time of admission and at 72 hrs as well as the outcome were recorded and analyzed using descriptive statistics and paired t test. Result: The prevalence of hexaconazole poisoning was 4.79% of all poisoning cases. The major clinical presentation was gastrointestinal symptoms with vomiting being commonest. There was no significant change in the biochemical and hematological parameters. The mean duration of hospitalization was 4.93+1.39 days. The recovery rate was 100% without any major sequel. Conclusion: Poisoning due to hexaconazole is uncommon in comparison to poisoning by other pesticides in the agricultural community. The clinical manifestations of hexaconazole poisoning indicated that it is of non-serious nature and its recovery was without any sequel.

Epidemiological and clinical aspects of Guillain-Barré syndrome and its variants.

Guillain-Barré syndrome (GBS), an acute polyradiculoneuropathy that occurs because of an abnormal inflammatory response in the peripheral nervous system, is clinically characterized by acute flaccid paresis and areflexia with or without sensory symptoms. This syndrome can lead to disabling or even life-threatening sequelae. This study aimed to present the clinical and epidemiological aspects of GBS in patients admitted to a tertiary-level hospital in the Federal District between January 2013 and June 2019. In this observational, cross-sectional and retrospective study, medical records of patients diagnosed with acute inflammatory demyelinating polyradiculoneuropathy, acute motor axonal neuropathy or acute axonal motor-sensitive neuropathy based on electromyographic findings were included, and clinical data were collected retrospectively. A total of 100 patients (63 males and 37 females; ratio, 1.7:1) aged 2-86 years (mean, 36.4 years) were included. The mean annual incidence rate of GBS was 0.54 cases/100,000 inhabitants, with 52 and 49% of the cases occurring between October and March (rainy season) and between April and September (dry season), respectively. The proportions of patients showing each GBS variant were as follows: demyelinating forms, 57%; axonal forms, 39%; and undetermined, 4%. The mean duration of hospitalization was 8-15 days for most patients (38%). During hospitalization, 14% of the patients required mechanical ventilation and 20% experienced infectious complications. The findings indicate that there was an increase in the incidence of GBS during the rainy season. Moreover, we did not observe the typical bimodal distribution regarding age at onset.

627-P: Uncontrolled Hyperglycemia Predicts Ventilatory Support and Duration of Hospital Stay in People with Diabetes and COVID-19

Background: Despite growing evidence that diabetes is associated with worse COVID-19 outcomes, there remains little information on inpatient glycemic response among individuals with diabetes and uncontrolled hyperglycemia hospitalized with the novel coronavirus SARS-CoV-2. Methodology: This is a multicentric retrospective study aimed to explore the role of hyperglycaemia (uncontrolled HbA1c) in predicting length of hospital stay and ventilatory support in diabetic patients hospitalised for COVID-19. We excluded all patients with newly diagnosed diabetes within last 3 months and/or those who are only on lifestyle modification. Results: A total of 133 patient records admitted to three tertiary care hospitals between 15/05/2020 to 15/11/2020 were analysed retrospectively. The 62 patients requiring ventilatory support had a significantly higher HbA1c (9.49±2.73%) as compared to those without ventilatory support (8.09±1.32%), p=0.002. Multiple logistic regression also indicated that the HbA1c was an independent risk factor for ventilatory support in DM patients with COVID-19 (Odds Ratio [OR] = 1.310, 95% confidence interval [CI]: 1.063-1.615), p=0.011. The odds of requiring ventilatory support is 35% lower in patients with good glycemic control (HbA1c<7.5%) vs. those with HbA1c≥7.5% (OR-0.65, 95%CI 0.32-0.88). The mean duration of hospital stay was 10.5±3.45 days. Multiple linear regression analysis revealed HbA1c to predict the duration of hospital stay, p=0.001. For every 1% increase in HbA1c, the length of hospital stay was found to increase by 0.461 days. Conclusion: The present study demonstrated that a high level of HbA1c was an independent risk factor for ventilatory support and prolonged hospital stay in COVID-19 patients with DM. Disclosure S. Roy chaudhuri: None. A. Majumder: None. D. Sanyal: None. A. Biswas: None. K. Bhattacharjee: None.

MO895EVOLUTION AND PROGNOSIS OF HEMODYALISIS PATIENTS WITH MODERATE AND SEVERE COVID INFECTION: SINGLE HOSPITAL CENTRE EXPERIENCE

Background and AimsOne of the major challenges of our century seems to be the SARS-COV2 virus pandemic that has resulted, at least until now, in over 2 million deaths worldwide. Multiple observational studies showed that patients with chronic kidney disease and especially those on the hemodialysis program have an increased risk of severe morbidity and mortality caused by the novel coronavirus.Aim of studywas to determine the prognosis and mortality risk in hemodialysis patients hospitalized for symptomatic COVID-19 infection, using the ALAMA age score and the COVID-GRAM critical illness risk score.MethodProspective and retrospective study that included 74 patients undergoing chronic hemodialysis, hospitalized in the Constanta County Emergency Clinical Hospital between March 2020 - December 2020, confirmed with SARS-CoV 2 infection by RT-PCR testing.ResultsOut of the total number of 74 hospitalized patients (64.58% M, 35.41% F; mean age = 66.64 years), having moderate and severe forms of the disease. 56.25% needed conventional oxygen therapy, 22.9% non-invasive mechanical ventilation and 12.5% intubation and ventilation. All patients underwent specific treatment according to the national protocols, updated with the rapid changes and increasing informations regarding the disease management. The mean duration of hospitalization was 12.33 days. 94.7 % of patients had additional risk factors (diabetes mellitus-47.56%, arterial hypertension-87.3%, COPD – 7.8%, systemic aterosclerosis – 35.4%, immunosuppression – 11.6%, malignant tumors – 4.8% ). Mean ALAMA score was more than 85 years (p<0.01) and mean COVID-GRAM critical illness risk score was 202 (92.1% risk for critical illness). Fatal outcome affected 37.8% of the patients, mainly due to severe respiratory failure, myocarditis, arrhythmias and stroke.ConclusionHemodialysis patients with SARS-CoV 2 infection have an unfavorable evolution and a reserved prognosis with a high risk of death, depending especially on the need for ventilatory support. 6.25% of the patients followed had post-COVID syndrome (disseminated intravascular coagulation, severe bacterial infections, enterocolitis), but these long-term complications of the survivors will need further studies.

Using Dry Human Amniotic Membrane in Secondary Intention Wound Healing After Urological Cancer Surgery: The First Randomized Clinical Trial in Iran

Background: Wound healing is a complex process and in some patients, it is a long process. Due to the presence of various underlying diseases in patients with cancer, this process is delayed, and as a result, the rate of complications increases. Therefore, some materials are needed to accelerate wound healing. Nowadays efficacy of dry human amniotic membrane in burn wounds and chronic wounds is proven; however, no studies have been performed on the effect of this tissue in the treatment of surgical wounds. Objectives: This study aimed at evaluating the efficacy of dry human amniotic membrane in the secondary repair of urological cancer surgery wounds. Methods: In this randomized clinical trial from January 2018 to June 2020, 40 patients who underwent urological cancer surgery and secondary intention wound healing were selected and randomly divided into 2 groups of 20 patients. In the case group, the dry human amniotic membrane was used for dressing wounds, and in the control group, normal dressing without an amniotic membrane was performed. Complications such as infection, sepsis, and reoperation, as well as the duration of wound healing and hospitalization of patients at intervals of 1 week, 1, and 3 months, were compared between the 2 groups. Results: The 2 groups matched in terms of gender, age, and wound location. The mean duration of hospitalization and wound healing was significantly lower in the case group (P &lt; 0.05). The rate of complications was higher in the control group but was not significant. Conclusions: Dry human amniotic membranes due to the accelerated wound healing process and fewer complications could be a good choice for secondary healing of wounds after urological cancer surgery.

Safety and Efficacy of the Noncessation Method of Antithrombotic Agents after Emergency Endoscopic Hemostasis in Patients with Nonvariceal Upper Gastrointestinal Bleeding: A Multicenter Pilot Study.

Background and Aims The present study aimed to clarify the safety and efficacy of the noncessation method of antithrombotic agents after emergency endoscopic hemostasis in patients with nonvariceal upper gastrointestinal bleeding (UGIB). Methods In this multicenter, prospective, pilot study, we performed emergency endoscopic hemostasis for nonvariceal UGIB in patients taking antithrombotic agents and resumed the medications without a cessation period (group A). The clinical characteristics, types of antithrombotic agents, UGIB etiology, treatment outcome, and adverse events were evaluated. We used propensity score matching to compare treatment outcomes and adverse events with our previous cohort (group B) in whom antithrombotic agents were transiently discontinued after emergency endoscopic hemostasis. Results Forty-three consecutive patients were prospectively enrolled. The main antithrombotic agents were low-dose aspirin and direct oral anticoagulants; 11 patients (25.6%) were taking multiple antithrombotics. Peptic ulcers were the main cause of bleeding (95.4%). Endoscopic hemostasis was successful in all patients and the incidence of rebleeding within a month was 7.0%. Propensity score matching created 40 matched pairs. Endoscopic hemostasis was performed by soft coagulation significantly more frequently in group A than in group B (97.5% versus 60.0%, P < 0.001). Neither the rebleeding rate within a month nor thromboembolic event rate was different between the two groups. However, the mean duration of hospitalization was significantly shorter in group A than in group B (8.6 ± 5.2 d versus 14.4 ± 7.1 d, P < 0.001). Conclusions Antithrombotic agents possibly can be continued after successful emergency endoscopic hemostasis for nonvariceal UGIB.

AB0653 COURSE OF COVID-19 INFECTION IN A SERIES OF PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:Infection is a remarkable cause of morbidity and mortality in patients with SLE.Objectives:We aimed to determine the clinical course of COVID-19 infection in our patients with SLE and the factors affecting this courseMethods:SLE patients (2012 SLICC criteria) diagnosed with COVID-19 infection by a positive PCR test and/or typical findings of lung involvement in CT (computed tomography) imaging were included. Data regarding cumulative clinical and laboratory characteristics, histopathology results, autoantibody profiles, immunsuppressives and damage (SLICC damage index/SDI)) were retrieved from the existing database and revised. SLE Disease Activity Index (SLEDAI-2K) was determined at the time of infection.Results:Sixteen SLE patients with COVID-19 infection were identified. Most (87.5%) of these patients were female. Seventy % (n=11) had lupus nephritis. Twenty-five % had thrombotic antiphospholipid syndrome.PCR was positive in 70% (n=11) of the patients. Pulmonary parenchymal findings compatible with COVID-19 were observed in 56% (n=9) of those patients. Regarding complaints upon admission, 50% (n=8) had fever, 44% (n=7) cough, 44% (n=7) dyspnea, 19% (n=3) myalgia, 12.5% (n=2) headache, 12.5% (n=2) nausea /vomiting, 6% (n=1) diarrhea, and 6 % (n=1) had anosmia. Eight patients were hospitalized. Six of these patients needed oxygen therapy via nasal cannula. None needed a follow-up in the intensive care unit. The mean hospitalization duration was 14 ± 5 (8-25) days.Regarding disease activity at the time of infection, 9 had inactive disease with a SLEDAI-2K score of 0 whilst in 5 patients SLEDA-2K score was ≥4. The mean SLEDAI-2K score at the time of infection was 1.7 ± 2.3 (0-6). System/organwise, 1 patient with chronic thrombocytopenia presented with a worsening platelet count accompanied by serologic activity. This patient was a non-adherent to treatment who had stopped taking mycophenolic acid months before COVID19. Three patients 2 of whom had proliferative nephritis experienced nephritic flares.1 patient who had a history of cutaneous lupus and was in remission presented with oral ulcer, leukopenia and hypocomplementemia during infection. Of 16 patients, 7 had system damage at the time of infection. The mean SDI score of the patients was 1.4±1.8. Comparison of patients with and without damage revealed no significant differences in disease activity, symptoms associated with COVID, in the need for hospitalization, hospitalization duration, and the requirement for oxygen therapy. However,CT findings compatible with COVID19, were more common in patients with damage (87% vs.33%,p=0.04) and their mean CRP levels were higher at diagnosis (65 ± 47 vs.22 ± 48 mg/l;p=0.032).All patients received similar treatment for COVID-19 except active patients who required high dose steroids (2 with active renal, 1 with thrombocytopenia and 1 with oral ulcer, leukopenia and hypocomplementemia).The patient with thrombocytopenia also received intravenous immunoglobulin and 1 with cutaneous active disease received tocilizumab as she developed macrophage activation syndrome. Six patients (37.5%) had received rituximab (RTX) in the last 6 months before COVID. No significant difference, in terms of hospitalization and need for oxygen therapy due to COVID19 was found between patients who had received RTX vs who had not. No hypogammaglobulinemia was detected in patients who received RTX despite lower levels of IgG (998 ± 184 vs 1481± 51 mg/dl, p=0.02)Conclusion:Although half of the patients in our series of COVID19 infected SLE patients required hospitalization, there were no mortalities. More patients with damage (none pulmonary) displayed CT findings compatible with COVID19 and further follow up will reveal whether they will suffer from fibrotic lung disease. Patients can experience disease flares during COVID. But it is also important to consider that some manifestations such as thrombocytopenia may also be a sign of severe infection. Immunosupressive agents may not have a negative impact on the course of infection.*the first two authors contributed equallyDisclosure of Interests:None declared.

English

BACKGROUND Acute cholecystitis is a pathology of inflammatory origin, usually associated with cholelithiasis, with a high incidence in the world. Its treatment involves an important socioeconomic impact. There are two surgical therapeutic options: early laparoscopic cholecystectomy (ELC) done within 72 hours of onset of pain or delayed laparoscopic cholecystectomy (DLC) done after 6 weeks of conservative treatment. The present study intends to compare between the effectiveness of ELC vs DLC in the management of acute cholecystitis in a tertiary care setup. METHODS The study sample included 65 patients who were clearly documented and radiologically proven cases of acute calculous cholecystitis, met the inclusion criteria, admitted to the surgery department of MKCG MCH, Berhampur, between August 2018 and July 2020. Out of 65 patients, 33 and 32 patients were selected randomly for ELC and DLC respectively. In ELC group surgery was done within 72 hours of the onset of pain while in DLC group surgery was done after 6 weeks of initial conservative treatment. The study was conducted using a case record proforma, prepared in their local language. The questionnaire included timing of cholecystectomy, duration of antibiotic coverage, mean duration of hospital stay, number of intraoperative and postoperative complications, conversion to open cholecystectomy, and follow-up. The data was compiled and tabulated in MS ® Excel and statistically analysed using IBM ® SPSS 22.0. RESULTS The overall morbidity and mortality were less in ELC compared to DLC. The mean duration of surgery was less in ELC (47.36 minutes) compared to DLC (65.75 minutes). The mean duration of antibiotic coverage was lesser in ELC (3.58 days) compared to DLC (5.50 days).The mean hospital stay was less in ELC (4.67 days) to DLC (6.50 days). The overall morbidity and mortality were less in ELC. CONCLUSIONS ELC is considered to be a safe modality of treatment in patients with acute cholecystitis and leads to an economical treatment. KEYWORDS Acute Calculus Cholecystitis, Early Laparoscopic Cholecystectomy, Delayed Laparoscopic Cholecystectomy

Robot-assisted laparoscopic bladder diverticulum resection (RABDR)

Since October 2018, urinary bladder diverticulum resections at our Department of Urology have been carried out with robot assistance and with minimal invasivion, Paediatrical urological and robot-assisted minimally invasive urological surgery for the Bamberg Social Foundation were performed with the DaVinci robotic systemTM. The aim of the present study was to record the surgical results of our patients and to compare these if necessary with available data on optimal diagnostic and therapy. In this retrospective analysis, we included all patients who received RAHDR between October 2018 and March 2020. The primary endpoints were postoperative blood loss (postoperative haemoglobin decrease), the operation time (min), complications according to the Clavien-Dindo classification, length of hospital stay (days), postoperative residual urine, postoperative urine extravasation at the anastomosis of the bladder, postoperative quality of life and postoperative satisfaction with micturition. We reviewed a total of 11 patients, all of whom were male. Mean age was 64.8 years (52-82). Average BMI was 26.5 (19-37). 3 patients were ranked with ASA score III, 5 with II and 3 with I. The average residual urine value preoperatively was 183 ml (90-240). A cystogram to rule out extravasation was performed on day 6 postoperatively. The mean duration of surgery was 212 min (148-294) and the mean duration of hospitalisation was 7.6 days (6-10). The mean residual urinary value after surgery was 25 ml (10-60). The mean postoperative maximum of flow was measured at 27.7 ml/s (11-55). No contrast agent extravasation in the cystogram was detected in any of the patients. The complications according to Clavien were not measurable. The mean postoperative haemoglobin decrease was 1.61 g/dl (0-3. 2). In most cases, the removal of one or more bladder diverticula is possible using the minimally invasive robotic technique. Various surgeries such as YV-bladder neck plastic, prostate adenoma enucleation, bladder stone restoration, and inguinal herniotomy can be carried out simultaneously. A robot-assisted urinary bladder diverticulum resection is an effective and gentle procedure. However, it must be considered that it brings financial disadvantages due to the lack of adequate representation within the German DRG-system (Diagnosis Related Groups).

English

BACKGROUND Poisoning is a major healthcare issue in our country. There is a recent increase in trend of non-OP compound usage. We wanted to study the socio-demographic, and clinical profile in terms of outcome with different poisons. METHODS A total of 100 patients were included in this retrospective study conducted in tertiary care hospital in Northern Karnataka. Data was collected and analysed using pre-structured questionnaire regarding demographic details, mode of poisoning, precipitating factors, duration of hospitalization, and final outcome. Descriptive statistics and chi-square test were done to find the association between the two attributes. Odds ratio was also calculated. P &lt; 0.05 was considered to be statistically significant. RESULTS Mean age of the study population was 31.48 years. Majority of the study population was females (63 %, N = 63), homemakers or students (32 % each), illiterates (68 %) and married (62 %). Mode of poisoning was suicidal in 78 % of the patients. Among the compounds used for poisoning, non-OP compoundespecially pharmaceutical drugs accounted for 40 % of the cases. Mean duration of hospital stay was 5 days and 16 % had prolonged hospitalisation. Family fight, depression, and consumption of ethanol at the time of poisoning were the common precipitating factors. Mortality was 3 %. Homemakers and students (χ2 = 4.33, df = 1, OR = 3.33, 95 % CI = 1.02-10.7, P &lt; 0.05), unmarried individuals (χ2 = 5.31, df = 1, OR = 3.75, 95 % CI = 1.16 - 12.1, P &lt; 0.05) and teetotallers (χ2 = 18.94, df =1, OR=11, 95 % CI = 3.26 - 37, P &lt; 0.05) had higher proportion of non-OP compound consumption and this was statistically significant. CONCLUSIONS Educational awareness and regulation of drug availability over the counter, to prevent such emergencies, is essential. Awareness of good mental health and support systems has to be publicised to prevent the precipitating factors. KEYWORDS Poisoning, Drug Overdose, OP Compound, India

Efficacy of the implementation of the National Emergency X-Radiography Utilization Study II decision rule to clinical practice for paediatric head injury patients.

To investigate the usefulness of the National Emergency X-Radiography Utilization Study (NEXUS) II head trauma decision rule in clinical practice for paediatric patients in a tertiary university hospital serving as the only paediatric hospital in the area. We compared how doctors evaluated and examined patients with head injury during two time periods, before and after the introduction of NEXUS II decision rule. Multiple implementation strategies were used as follows: education, tutoring and written instructions for the use of NEXUS II. Two hundred and forty-four head injury patients visited the hospital before and 385 after the introduction of the NEXUS II decision rule. The number of hospital admissions (56%) and the mean duration of hospitalisation (2.5days) remained the same during the two periods. In the NEXUS II evaluated group, there was a decrease of 40% in the number of hospital admissions. NEXUS II was applied in only 62 (16%) cases. The number of head imaging procedures remained the same. No patients with a clinically significant head injury were missed with the NEXUS II evaluation. NEXUS II was ineffective as our implementation failed. When used, NEXUS II reduced expenses in our study population by decreasing the number of hospital admissions.

Clinical course of COVID-19 disease in immunosuppressed renal transplant patients

Background/aim We aimed to identify clinical settings of renal transplant patients with COVID-19.Materials and methodsIn this retrospective study, we included kidney transplant inpatients with laboratory confirmed COVID-19 who had been discharged or had died by October 1st, 2020. Characteristics of the patients, including basal and last outpatient biochemical parameters were recorded. Discontinuation or dosage reduction of immunosuppressives and other treatment information was documented.ResultsTwenty patients were included in this study, of whom 18 were discharged and 2 died in hospital. The mean duration of hospitalization and follow-up were 9.7 ± 6.4 days and 4.5 ± 2.0 months, respectively. Fourteen patients (70%) were male and mean age was 48.0 ± 10.3 years. At admission, all had immunosuppression withdrawn and were started on methylprednisolone 16 mg/day (50%) or dexamethasone (50%). Tacrolimus/m-TOR inhibitors were reduced by 50% and all antimetabolites were discontinued. Hemodialysis was needed for 10% of patients. Acute kidney injury was detected in 25% of the patients. With respect to hospitalization time and complications, there was no significant difference between patients who used dexamethasone and those who did not (P > 0.05). The discontinued immunosuppressives were resumed within 2 to 4 weeks after discharge according to the severity of disease. No rehospitalization or acute rejection was detected during the follow-up of the patients. ConclusionRenal transplant patients are considered a high risk group for COVID-19. It can be said that discontinuation or reducing dosages of immunosuppressives may be effective and safe in kidney transplant patients.

A study on predictors of severe dengue in pediatric patients in a tertiary care hospital in Telangana

Background: Dengue is an emerging arthropod borne disease with increasing incidence in recent years in several countries, especially India. Early recognition of progression of disease helps in triage and timely management of fluids to decrease mortality. Objective: The objective of the study was to identify the predictive factors for severe dengue in pediatric patients for hospitalization for close monitoring. Methods: This was a prospective observational study conducted in the department of pediatrics in a tertiary care hospital in Mahbubnagar from June 2019 to May 2020. One hundred and four children between the age group of 0 and 15 years with probable dengue symptoms who were willing to get admitted were included in the study cohort. Thorough history and clinical examination, basic laboratory investigations such as complete blood picture, hematocrit, liver function tests, renal function tests (RFTs), serum electrolytes, serum ferritin, and coagulation profile were done as needed. All the patients were grouped into two groups – non-severe dengue (dengue fever without warning signs and dengue fever with warning signs) and severe dengue as per the World Health Organization guidelines. All the variables were analyzed using SPSS software. Results: Out of 104 confirmed cases, majority of the admissions were in 5–10 years age group (51.9%). Male children were 61.5%. Mean duration of hospitalization was 4.79±2.96 days. Fever (97.1%) was the most common symptom followed by anorexia (86.5%) and lethargy (82.7%). Symptoms such as lethargy, vomiting, abdominal pain/epigastric tenderness, epistaxis, edema, and altered sensorium were more commonly associated with severe dengue. Hepatomegaly (53.9%) was the most common clinical sign followed by epigastric tenderness (58.7%). Hepatomegaly, splenomegaly, ascites, gallbladder edema, pleural effusion, low pulse pressure, hypotension, oliguria, and significant gastrointestinal bleeds were more common in severe dengue group. Platelet count &lt;50,000/mm3, increase in hematocrit more than 20% from baseline, raised transaminases, raised ferritin, decrease in serum sodium, decrease in serum albumin, abnormal coagulation profile, and abnormal RFTs were significantly associated with severe dengue. Mean platelet recovery time was 3–5 days. Conclusion: Dengue is a dynamic disease and progression of dengue with or without warning signs into severe dengue can be appropriately identified by close monitoring of certain clinical signs and symptoms.

Clinical Characteristics and Outcomes of COVID-19 in Children in Northern Iran.

Objective Since December 2019, the coronavirus disease 2019 (COVID-19) has been spread rapidly all over the world, infecting all age groups with this novel virus. In this manuscript, we report characteristics of children with COVID-19 in Mazandaran province, northern Iran. Method From 12 February to 28 July 2020, medical records of 100 children diagnosed with COVID-19 admitted to the hospitals of Mazandaran province were collected. Patients' age, gender, clinical symptoms, and signs, in addition to therapeutic management and outcomes, were reported. Results 57 (57%) boys and 43 girls with the mean age of 104.63 ± 79.14 months were evaluated. 20 patients (20%) were transferred to the PICU (pediatric intensive care unit), and 13 children experienced a severe form of the disease, pediatric inflammatory multisystem syndrome (PIMS). The mean duration of hospitalization was 5.3 ± 4.7 days. Fever (81%), respiratory (79%), gastrointestinal (47%), and neurologic complaints (29%) were experienced by the patients in addition to skin rash (14%). Sixty-two patients needed supplemental oxygen, and 6 of them underwent endotracheal intubation. Leukopenia was reported in 7, anemia in 24, and thrombocytopenia in 12 patients. 4 patients with underlying diseases including chronic renal failure, Down syndrome with cerebral palsy, and morbid obesity died. Conclusion COVID-19 can cause symptoms in children in two stages. In the first week, upper and lower respiratory symptoms can occur which has lower severity and prevalence compared to adults. But after 2-3 weeks following infection, symptoms of MIS-C or multisystem involvement can occur and COVID-19 should be considered. The most common indication for admission is fever, rash, and respiratory problems.

Cardiogenic shock due to acute coronary syndrome: characteristics and outcomes

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Among patients admitted to a catheterization laboratory with acute coronary syndrome (ACS), a minority present with cardiogenic shock (CS). Evidence for the best way to manage these patients are needed. Aims We aimed to assess patients’ characteristics and short and long-term outcomes of ACS presenting with CS. Methods We analysed all ACS cases with CS admitted during a ten-year period in a tertiary care centre. We defined CS as systolic blood pressure &amp;lt;90mmHg and signs of impaired organ perfusion with need for catecholamine therapy or presenting with cardiac arrest. At discharge, a standardized registry was performed in all cases, including clinical, electrocardiographic, echocardiographic and angiographic characteristics, and percutaneous coronary intervention (PCI) results. All patients were followed-up for two years for the occurrence of mortality (total and cardiovascular (CV)), CV hospitalizations and revascularization procedures. Results From 3283 patients admitted with ACS, 92 (2.8%) presented with CS. Mean age was 66.0 ± 12.8 years, with 64 (69.6%) males, and 60 (65.2%) presenting with ST-segment elevation myocardial infarction. These patients presented previous ACS in 12.0%, were smokers in 28.3% and had diabetes, dyslipidemia and hypertension in 23.9%, 37.0% and 45.7%, respectively. Angiographic characteristics are described in the table. Index-PCI was successful in 83.7% cases. Multivessel coronary artery disease (CAD) was presented in 56 patients (60.9%), of which 20 (21.7%) had 3-vessel disease. Of these 56 patients, complete revascularization in the index-procedure was attempted in 11 patients (19.6%), 10 of which successfully. Mean hospitalization duration of 16.4 ± 9.5 days with in-hospital mortality of 50.0%. Unsuccessful index-PCI (p = 0.002), culprit left main coronary artery (LCMA) (p = 0.044) and reduced left ventricular ejection fraction (LVEF) (p &amp;lt; 0,001) were significant in-hospital mortality predictors. At 12 and 24 months, survival after hospital release was 95.7% and 91.3%, respectively. At 24 months of follow-up, 40.0% had at least one CV hospitalization, 17.4% being related to a revascularization procedure (PCI 13.0%, coronary artery bypass surgery 4.4%). Conclusion CS was uncommon among ACS patients. Unsuccessful PCI, culprit LMCA and reduced LVEF were independent predictors of in-hospital mortality. Despite a very high in-hospital mortality, long-term outcome was favourable. Abstract Figure.

Antenatal Obstetric Hospitalization: Risk Factors and Pregnancy Outcomes in the University of Calabar University Teaching Hospital, Calabar – A Retrospective Review

BACKGROUND: Antenatal obstetrics hospitalization (AOH) may be indicated due to pregnancy complications that need close surveillance and possible intervention. AIM: The aim of this review was to assess the risk factors and the peripartum outcome of such women. METHODS: Retrospective study of records of pregnant women was done. The risk factors of interest included maternal demographic profile, obstetric factors, and medical comorbidities. Outcome of interest included discharge diagnoses, maternal death or morbidity, and perinatal outcome. Inferential statistics was used to assess significant relationship between variables. The level of significance was set at p ≤ 0.05. Analysis was done using SPSS version 22.0. RESULTS: The prevalence of AOH within the period under review was 2.8% among the 3686 women who delivered at UCTH. The mean maternal age was 29.24 ± 4.059 (SD) years. The mean body mass index (BMI) was 27.91 kg/m2 ± 3.704 (SD). The mean gestational age at admission was 33.03 weeks. The mean duration of hospitalization was 4.03 days. Seven (7.7%) of them had chronic medical comorbidities. The case fatality rate for preeclampsia/eclampsia was low for AOH with (12.5%) compared to 17.1% in none hospitalized women. The perinatal mortality rate was 66/1000 live births. The duration of hospitalization was positively related to the maternal BMI (p = 0.047). Booking status and duration of hospitalization did not significantly affect neonatal outcome/perinatal death (p = 0.905). CONCLUSION: AOH may reduce incidence of maternal death However, long-term study may be indicated to assess the trend and neonatal/infant survival.

Evaluation of patients hospitalized in a geriatrics clinic during normalization process of SARS CoV-2

Aim: The pandemic of Severe Acute Respiratory Syndrome-Coronavirus-2 was more severe and&#x0D; more fatal for elders and individuals who have chronic diseases. The treatment may be delayed due to&#x0D; the elders’ “fear of infection” in hospitals. This study aimed to evaluate the data of older patients who&#x0D; were admitted to the Geriatrics clinic in the normalization period.&#x0D; Materials and Methods: The data was retrieved between June-August 2020, retrospectively from the&#x0D; file database for older patients who were hospitalized in a geriatrics clinic of a university hospital.&#x0D; Results: 23 patients were included in the study and their mean age was 81.4±7.4 years. The most&#x0D; common symptoms at admission were changes in consciousness, weight loss, and malnutrition,&#x0D; respectively. The duration of symptoms was less than a month in 56.5% of patients, 1-3 months in&#x0D; 17.4% of patients, and more than 3 months in 26.1% of patients. The most common indications were&#x0D; delirium, urinary tract infection, and acute renal failure, respectively 73.9% of patients applied from the&#x0D; outpatient clinics and 26.1% from the emergency clinic. The mean hospitalization duration was 24.2 ±&#x0D; 17,2 days. 43.5% of patients had delirium and 21.7% had pressure ulcers during their hospitalization.&#x0D; Conclusion: The hospitalization indications had variations, outpatient hospitalizations were higher,&#x0D; and the duration of hospitalization was longer during normalization process of SARS CoV-2.&#x0D; Approximately, half of the patients had symptoms for more than a month and it is an important point to&#x0D; be investigated. In addition, geriatric syndromes such as delirium and pressure ulcer increased in this&#x0D; process

Thirty-Day Results of the Novel CGuard-Covered Stent in Patients Undergoing Carotid Artery Stenting

Objective: The aim of this study was to provide early-term evaluation, safety, and efficacy of the novel CGuard (Inspire MD, Tel Aviv, Israel) micromesh self-expanding stent with embolic protection system (EPS) during carotid artery stenting (CAS) procedure. Materials and Methods: All patients who underwent CAS with CGuard carotid stent system from January 2018 to September 2020 in a tertiary center were prospectively evaluated. Primary endpoints included technical success and perioperative neurological events (0–48 hours). Secondary endpoint was the rate of neurologic, cardiac events, and death (major adverse event or MAE) at 30 days. Patency of CGuard, peak systolic velocity (PSV), and end diastolic velocity (EDV) were evaluated at 30 days with duplex ultrasound. Results: A total of 103 patients underwent CAS procedure. Forty patients were symptomatic, and 63 patients were asymptomatic with stenosis greater than 70%. Technical success was 100%. Local anesthesia was applied in 94 patients (93%). Embolic protection devices were used in 6 patients (5.8%). Access site complications were 1.9%. Mean internal carotid artery stenosis diameter reduced from 79.47% to 14.68%. Two patients had transient ischemic attack (1.9%) and 1 patient experienced a cerebral hyperperfusion syndrome (CHS) perioperatively. External carotid artery (ECA) occlusion occurred in 1.9%. Four patients experienced jaw claudication (3.8%) postoperatively. Mean time of operation was 41 minutes. Mean duration of hospitalization was 3.1 days. The 30-day rate of MAE was 0%. CGuard patency was 100%, mean internal carotid PSV was reduced from 251.57 to 77.29 cm/s, and mean internal carotid EDV was reduced from 154.62 to 24.63 cm/s at 30 days. Conclusion: Our study shows that CGuard stent with EPS is an effective and safe device for treatment of carotid artery stenosis with acceptable low perioperative neurologic events, even with low embolic protection device usage. Larger multicenter and randomized studies are necessary to confirm its long-term efficacy.

THE OUTCOME OF LIMBERG FLAP RECONSTRUCTION PROCEDURE FOR PRIMARY NATAL CLEFT PILONIDAL SINUS DISEASE: FOUR YEARS’ EXPERIENCE AT A TEACHING HOSPITAL IN PAKISTAN

Background: Natal cleft pilonidal sinus disease is known for its high recurrence rate after surgery. Different surgical procedures are being used for its treatment and these vary from wide excision followed by healing with secondary intention to excision followed by reconstruction with a flap. Limberg flap reconstruction procedure has been used by many surgeons as their primary choice owing to its low recurrence rate and less postoperative complications.&#x0D; Objective: The objective of this study was to assess the outcome of Limberg flap reconstruction procedure in patients with primary natal cleft pilonidal sinus disease. &#x0D; Methods: This descriptive case series was conducted at Ghurki trust teaching hospital, Lahore, Pakistan, between January 2015 to December 2018. 110 consecutive patients with primary natal cleft pilonidal sinus disease were included in this study. Informed consent was taken from these patients and all patients underwent Limberg flap reconstruction procedure. The evaluated outcomes of this procedure included duration of hospital stay, postoperative pain, primary healing, surgical site Infection, seroma formation, flap necrosis and, recurrence. &#x0D; Results: The patients age ranged between 18 years to 60 years. The mean age was 26.6 ±8.6 years. 73 patients (66.36 %) were males and 23 patients (33.63%) were females. The duration of disease ranged between 1 month to 6 months with a mean of 3.7±1.7 months. The mean operating time was 47.50±5.14 minutes. The mean duration of hospital stay was 1.87±0.80 days. The mean postoperative pain score calculated by the visual analogue scale (VAS) twenty-four hours after the surgery was 3.45. 95 patients (86.36%) had complete primary healing without any complication. 9 patients (8.18%) had a surgical site infection and 6 patients (5.45 %) had seroma formation. No patient suffered from flap necrosis. 2 patients (1.81%) who had complete primary healing presented with recurrence of the disease within six months of the procedure with a period of one year of follow-up designated for every patient.&#x0D; Conclusion: Limberg flap reconstruction procedure is a safe and efficacious treatment option for primary natal cleft pilonidal sinus disease because it provides early complete primary healing in most patients, and shortens the duration of hospital stay thus reducing the cost of treatment. The pain scores fall in the moderate post-operative pain score category and the complication rates and the recurrence rates are very low.

Pattern of infectious diseases in northern Iran: An approach to internal medicine management.

Background:Despite the development of their prevention and treatment, infectious diseases cause high mortality, many disabilities and inadequate living conditions worldwide. The aim of this study was to evaluate the pattern of infectious diseases in northern Iran with an approach to internal medicine management.Methods:This cross-sectional research was conducted in 2019 on all 7095 infectious diseases patient records that referred to Ghaemshahr Razi Hospital, Mazandaran Province, Iran during 2012-2018. A checklist prepared by investigator was used to collect the data. The extracted data were coded and entered into SPSS 22 and analyzed using K2 and independent t-test at p<.05.Results:The mean age of the study patients was 29.7±26.4. 4372 (61%) of the cases were males and the mean duration of hospitalization was 41.6±33.5. Age was significantly correlated to infectious diseases (P=.001). Gastroenteritis was the most common infectious disease among the men and women with 2442 (60.5%) and 1594 (39.47%), respectively. Based on the Pearson's correlation test, the relationship between leptospirosis, brucellosis, pulmonary tuberculosis, shigellosis, sepsis and infectious mononucleosis with gender, habitation, admission mode, discharged mode and age was significant (p<.05).Conclusion:As the high frequent diseases were gastroenteritis, leptospirosis, brucellosis and sepsis and an increasing trend was in the prevalence of gastroenteritis, leptospirosis and lung tuberculosis, health system managers should consider training courses, preventive strategies, real-time interventions, increased hospital bed rate for patients with infectious diseases and so on.