Mean Duration Of Hospital Research Articles

Video assisted thoracoscopy or laparoscopy for enucleation of esophageal leiomyoma: A seven-year single center experience of 75 cases

Leiomyoma is the most common benign tumor of the esophagus. Extra mucosal enucleation is the standard treatment. Herein we evaluated the feasibility and the outcomes of Minimally Invasive Surgery (MIS) using video-assisted thoracoscopic (VATS) or laparoscopic surgery (VALS) for esophageal leiomyoma enucleation. Retrospective study of patients who were treated via VATS or VALS for esophageal leiomyoma enucleation in "Hanoi Viet Duc Hospital" from 2010 to 2017 by the same operator. The operative approach, tumor size, complications and outcomes after surgery were recorded. Seventy-five patients were included. Mean age was 41.9 (range 20-68) years. The male/female sex ratio was 2.1:1. Fifty-five patients had clinical symptoms (73.3%). Tumors were identified in the upper third (12%), middle third (51%), and lower third (37%) of the esophagus. Mean tumor size was 3.7 (range 2-11) cm. VALS enucleation was performed in 23 patients who had leiomyoma located near the cardia (gastroesophageal junction or abdominal esophagus). The remaining 52 patients underwent right (n=42) or left VATS (n=10). Five patients (6.7%) sustained esophageal mucosa injury during dissection, repaired by MIS without late morbidity. A mini-incision (2 mini-laparotomies and 1 thoracotomy) was required in three patients (4%) due to large tumor size or mucosal injury. The mean operative time was 105min in VATS and 174min in VALS. No major perioperative surgical or medical complications were reported. The mean duration of hospital stay was 7.2 (range 5-12) days. MIS enucleation of esophageal leiomyoma is technically safe and associated with a high therapeutic success rate with low medico-surgical morbidity. VATS could be applied for almost all esophageal leiomyoma tumors; however, the VALS approach was preferred for tumors located near the gastroesophageal junction in order to create an anti-reflux valve after enucleation.

Efficacy, Safety of Baricitinib plus Remdesivir versus Standard Therapy (Remdesivir) in Patients with Severe COVID-19 Infection in Third Wave of Epidemics in Myanmar: Case Control Study

Background: Coronavirus disease 2019 (COVID-19) has been a major threat to health around the world as it causes significant morbidity and mortality. SARS-CoV-2 infection induces severe inflammation in lungs and multi-organs; therefore, the Janus kinase (JAK) inhibitor known as baricitinib was proposed as a treatment for COVID-19 because of its anti-inflammatory and potential antiviral effects. It may improve survival in patients with severe Covid-19 infection. The efficacy and safety of Baricitinib therapy in severe COVID-19 infection in Myanmar was not known clearly. Methods: A case control study was conducted in COVID-19 treatment centers in Myanmar- Yangon and Nay Pyi Taw, from June to October 2021. Baricitinib 4 mg daily for 14 days was given to the patients with severe COVID-19 infection as an add on therapy to Standard treatment group (Remdesivir). The primary outcome was survival status; survive or non-survive. The secondary outcome was duration of hospital stay, the requirement for oxygen therapy at Day 7 (improved or not), changes in chest radiograph at Day 14 (improved, same or worse), and changes in inflammatory markers (CPR and LDH). Patient data were stratified by age, sex, body weight, co-morbidities and immune status (immunocompromised or normal immune status). Data were collected by using standardized forms and analysis was done. Results: A total of 64 patients with severe COVID-19 infection were enrolled. Base line characteristics in both groups, Baricitinib group (n =32) and Standard treatment group (n = 32), were comparable. Nearly 53% of patients in Baricitinib group and 59% of patients in Standard treatment group survived; however, mean duration of hospital stay was shorter in Baricitinib group (15.53 ± 6.83 days versus 22.25 ± 11.17 days; p < 0.001). Improvement in oxygen supplementation, radiological changes and changes in inflammatory markers were not different in both groups. Minor side effects like giddiness, appetite loss and insomnia were noted in Baricitinib group. Conclusions: In treating patients with severe COVID-19 infection, the survival rate was not different between Baricitinib group (Baricitinib plus Remdesivir) and Standard treatment group (Remdesivir). In survivors, those in Baricitinib group had shorter duration of hospital stays; quick recovery time and accelerating improvement in clinical status

708 Serratia infections in burn care

IntroductionBurn wound infections, ventilator associated pneumonia, line sepsis and urinary tract infections are common in patients with major burn injuries, and remain prominent causes of morbidity and mortality. Within the spectrum of organisms responsible for infections, some are more common, while others might be relatively more virulent. This study sought to determine the impact of Serratia infections within the context of a verified regional burn centre.MethodsAll patients admitted with a diagnosis of burn injury who developed an infection with Serratia Marcescens in the six years between 1 January 2015 and 31 December 2020, from any site, were included in the study. Data collected included demographic details, mechanism and extent of the burn, as well as the clinical course and complications.ResultsTwenty two patients were included in the study, with a mean age of 46.5 years (range 27-70). Most had at least one significant co-morbidity. The mean burn size was 28% TBSA (range 2% - 71%), nine sustained inhalation injury and 13 required mechanical ventilation. Most patients underwent several surgeries (mean 3.4, range 1-9). The mean duration of hospital stay was 32.2 days (range 8-65), or 1.8 days per percentage burn (range 0.73 -4). For those who died, the mean number of days from admission to diagnosis of Serratia infection was 3.8 days (range 2-7), as against 10.11 days (range 1-27) for survivors. Eight of the first cultures were from sputum, 11 wounds, 4 blood cultures, and 1 from the urine. No significant resistant strains were identified, and all patients received timely and appropriate antibiotic therapy. Five of the patients died.ConclusionsPatients with major burn injuries are especially vulnerable to morbidity and mortality should they develop a systemic Serratia infection early in their hospital stay. Awareness of the natural history of these infectious episodes may improve the directed therapy required to improve outcomes.

Clinical characteristics and 30-day outcomes in patients with acute decompensated heart failure: Results from Indian College of Cardiology National Heart Failure Registry (ICCNHFR)

BackgroundAcute decompensated heart failure (ADHF) is a challenging medical emergency with high mortality and its prevalence is increasing in India. There is paucity of data on ADHF in the country. MethodsIndian College of Cardiology National Heart Failure Registry (ICCNHFR) is an on-going observational registry on ADHF contributed by 22 hospitals across India; and we present the in-hospital and 30-day outcomes of ADHF patients enrolled from August 2018 to July 2019. Major objective included capturing demographics, comorbid conditions, aetiology, prescription patterns and assessing clinical outcomes. ResultsOf 5269 patients (mean age: 61.90 ± 13.85 years) enrolled in this study, males were predominant (67.09%). Mean duration of hospitalization was 5.74 ± 4.74 days. Ischemic heart disease was the most common (75.44%) aetiology. Abnormal electrocardiogram readings were found in most patients (89.86%). LVEF of ˂40% was found in 68.29% of patients. In-hospital mortality rates were 6.98%. The 30-day cumulative mortality was 12.35% and 30-day rehospitalization rate was 7.98%. At discharge, all guideline-based medical therapy (GDMT) were prescribed only to 24.99% of patients and 23.72% adhered to the prescription until 30 days. Older age, high serum creatinine levels and poor LVEF contributed to high mortality and rehospitalization. ConclusionPatients with ADHF were younger and predominantly males. Usage of GDMT in ADHF patients was low (24.99%) and the in-hospital mortality was high. Older age, high serum creatinine levels, poor LVEF contributed for 30-day mortality and rehospitalization. This data on ADHF, could help in developing strategies to improve outcomes for HF patients in India.

Covid-19 among Multiple Sclerosis Patients and its Outcomes

Background: COVID-19 is a highly contagious disease and has resulted in 4533645 deaths until September first, 2021. Since Multiple sclerosis (MS) patients receive Immunosuppressive drugs there is a concern that these drugs will reduce the patient's immune system resistance against COVID19. Objectives: This study was performed to evaluate the epidemiology of COVID19 and it's impact on MS patients in our university hospital in Tehran, Iran. Materials & Methods: A cross-sectional study was conducted based on hospital-based registry data from May 2020 to March 2021. Among more than 500 registered MS patients in Imam Khomeini Hospital in Tehran who referred within the period of time of our study, 84 patients were reported of infection by SARS-COV2. The diagnosis of MS was confirmed by the McDonald criteria and the diagnosis of COVID-19 in MS patients was made by real time-PCR technique and chest computed tomography. Results: Out of 84 MS patients who were infected by SARS-COV2, 55(65.5%) were women and their mean age was 37.48 years. The most commonly used drugs by MS patients were Rituximab 20 (26.3%) and Dimethyl Fumarate 14(18.4%).Totally 9(10.8%) of the patients needed to be hospitalized due to COVID-19 with mean hospitalization duration of 5.88 days. A total of 1 (1.2%) death was reported. Discussion: In comparison to normal population, it seems that COVID-19 is not more serious in MS patients. Most of the MS patients with COVID-19 infection were not hospitalized and continued their medication during the course of the infection.

Open-label use of an aliphatic polyamine immunomodulator in patients hospitalized with COVID-19.

BackgroundEvidence-based therapies used to treat coronavirus disease (COVID-19) remain limited. Azoximer bromide (AZB; Polyoxidonium®) is an immunomodulating molecule frequently used in the Russian Federation. It offers demonstrable therapeutic benefit in upper respiratory tract infections. This study evaluated the safety and efficacy of AZB when used in combination with standard of care treatment in patients hospitalized with COVID-19.MethodsHospitalized patients with COVID-19 (n=81; nine sites) received AZB 12 mg intravenously once daily for 3 days then intramuscularly every other day until day 17. The primary endpoint included clinical status at day 15 versus baseline. Historical control data of 100 patients from a randomized, controlled, open-label trial conducted in China were included to serve as a direct control group.ResultsNotable clinical improvement, assessed by seven-point ordinal scale (OS) score and National Early Warning Score, was observed. Mean duration of hospitalization was 19.3 days. Indicators of pneumonia and lung function showed gradual recovery to normalization. No patients died but, by day 28, one patient still required respiratory support; this patient died on day 34. A higher proportion of patients receiving AZB required invasive or non-invasive ventilation (OS 5 or 6) at baseline compared with the historical control group. Improvement in mean OS score by day 14/15 was not notable in the control group (OS 3.99–3.87) but was clear in the AZB group (OS 4.36–2.90). Mean duration of hospitalization was similar in the control group (16.0 days); however, day 28 mortality was higher, at 25.0% (n=25).ConclusionAZB combined with standard of care was safe and well tolerated. An apparent clinical improvement could not be fully evaluated due to the lack of a direct control group; further assessment of AZB for the treatment of COVID-19 in a randomized, placebo-controlled study is warranted.

Liver involvement and mortality in COVID-19: A retrospective analysis from the CORACLE study group.

liver abnormalities are common in COVID-19 patients and associated with higher morbidity and mortality. We aimed to investigate clinical significance and effect on the mortality of abnormal liver function tests (ALFTs) in COVID-19 patients. we retrospectively evaluated in a multicentre study all patients admitted with confirmed diagnosis of COVID-19. 434 patients were included in this analysis. Among overall patients, 311 (71.6%) had normal baseline ALT levels. 123 patients showed overall abnormal liver function tests (ALFTs) at baseline [101 ALFTs <2x UNL and 22 ≥2 UNL]. Overall in-hospital mortality was 14% and mean duration of hospitalization was 10.5 days. Hypertension (50.5%), cardiovascular diseases (39.6%), diabetes (23%) were frequent comorbidities and 53.7% of patients had ARDS. At multivariate analysis, the presence of ARDS at baseline (OR=6.11; 95% CI: 3.03-12.32; p<0.000); cardiovascular diseases (OR=4; 95% CI: 2.05-7.81; p<0.000); dementia (OR=3.93; 95%CI:1.87-8.26; p<0.000) and no smoking (OR=4.6; 95% CI: 1.45-14.61; p=0.010) resulted significantly predictive of in-hospital mortality. The presence of ALFTs at baseline was not significantly associated with mortality (OR=3.44; 95% CI=0.81-14.58; p=0.094). ALFTs was frequently observed in COVID-19 patients, but the overall in-hospital mortality was mainly determined by the severity of illness, comorbidities and presence of ARDS.

Profile of Urology Patients at the Covid-19 Isolation Ward in Dr. Moewardi General Hospital Surakarta Periode June 2020 – May 2021 (A Retrospective Descriptive Study)

Objective: Coronavirus disease firstly discovered in December 2019, has caused many changes in patient management in the hospital, including in urology department. Several studies have demonstrated an increased rate of delayed care, with urology surgery having a delay of more than 8 weeks (Amota, O. et al., 2020). The medical workers are trying to reduce the spread rate by reducing of transmission (Amota, O. et al., 2020;and Sanyaolu, A. et al., 2020). The spread of this infectious disease is continuously increasing, hence the declaration of a pandemic (Cucinotta D). The COVID-19 status in the Solo city was updated to the red zone since the first year of the pandemic which makes the author interested in sharing information about COVID-19 in urology inpatients in the isolation ward (Tanggap Covid 19 Jawa Tengah, 2020). Materials and Methods: This study is a retrospective descriptive study that used secondary medical records data to determine the profile of urology patients in the COVID-19 isolation ward in dr. Moewardi General Hospital Surakarta for 1 year from May 2020 – June 2021. Results: This study found the urology patients in the COVID-19 ward were 26 patients, which was 4% of the total urology inpatients in the dr. Moewardi General Hospital in the first year of pandemic. Male patients consisted 85% of the total patients, with a mean age of over 50 years. The most frequent diagnosis was urinary retention. The mean duration of hospitalization was 2 weeks. The management in ward were urinary catheter insertion, closed cystostomy, prostate biopsy with local anesthesia, and emergency debridement surgery in isolated operating room. Delayed diagnostic procedures consisted of USG and BNO, while the delayed elective surgery consisted of cystoscopy, nephrectomy, direct visual urethrotomy (DVIU), and DJ stent insertion. Conclusions: The urology inpatients in the COVID-19 ward treated by multiple departments, in which the treatment of COVID-19 was prioritized before the definitive management from the urology department.

Effect of androgen receptor directed therapy in prostate cancer patients with COVID-19.

161 Background: TMPRSS2 is one of the two key enzymes that SARS-CoV-2 requires for its entry to the cell. TMPRSS2 is regulated by androgen receptor. It is well described Androgen Receptor Directed Therapy (ARDT) downregulates the expression of TMPRSS2. We hypothesized that the ARDT has a protective role in patients with prostate cancer (PCa) from poor outcome of COVID-19. Methods: A retrospective chart review of PCa patients with COVID-19 between March to October 2020 in the Yale-New Haven Health System was performed. Demographics, comorbidities, home medications, laboratory data, treatment, and clinical outcomes of COVID-19 were collected. ARDT was defined as the use of GnRH agonist, GnRH antagonist, or androgen receptor antagonist. This study was reviewed and approved by the Institutional Review Boards of Yale University. Results: A total of 146 (1.1%) prostate cancer cases were identified from the 13,642 cases of COVID-19. The clinical characteristics are summarized in the table. Twenty-five (17%) were on active ARDT and 121 (83%) not on ARDT (non-ARDT). The rates of hospitalization were the same: 52%, between the ARDT and non-ARDT group. Of those admitted, mean duration of hospitalization were 9.2 days (Range 1-25) and 14.9 days (Range: 2-47) in ARDT and non-ARDT groups, respectively (p=0.14). Rates of hospital stay &gt;30 days were 0% versus 14.3% (9/63) in ARDT and non-ARDT groups, respectively (p=0.15). Intubation rates were 0% versus 11% (7/63) for ARDT and non-ARDT groups, respectively (p=0.21). Mortality rates were 8% and 13.2%, in ARDT and non-ARDT groups, respectively (p=0.47). Conclusions: The prevalence of PCa was infrequent. Despite advanced stage of the cancer in ARDT group, there was a trend toward decreased severity of COVID-19 and mortality rates compared to non-ARDT group. Our data support further investigation on a protective role of hormone therapy in PCa patients with COVID-19.[Table: see text]

Outcomes of Seizures in Patients with Systemic Lupus Erythematosus in a Tertiary Government Hospital in the Philippines

Background. Seizures in patients with systemic lupus erythematosus (SLE) are uncommon but life-threatening; mortality rate is 25-29%. Seizure in a person with lupus may be due to lupus itself or other conditions. There are no published studies describing the causes and outcomes of seizures in Filipino patients with lupus.&#x0D; Objective. To describe the causes and outcomes of seizure in a cohort of patients with lupus seen at Philippine General Hospital.&#x0D; Methodology. We reviewed the medical records of patients with SLE) with a documented seizure and admitted between January 2016 and April 2019. History, physical examination and laboratory findings, and clinical course were obtained.&#x0D; Results. We included 29 patients with 31 seizure events. They were all women, mostly single, of low socio-economic status, and had poor functional capacity. Lupus was active in 77.4% (24/31), commonly with mucocutaneous or hematologic manifestations. Seizures were generalized in 87 % (27/31). Prior to seizure, one-third had headache, fever, and vomiting. There were no neurologic localizing signs. Twenty-four seizure events (77%) occurred among patients with active lupus; 16 (67%) was attributed to neuropsychiatric systemic lupus erythematosus (NPSLE) and eight (33%) to other causes: infection (tuberculous meningitis and septic encephalopathy), posterior reversible encephalopathy syndrome (PRES), uremia, arrhythmia, and eclampsia. Seven seizures in inactive lupus were not SLE-related. Mortality rate was 28%; infection was the most common cause. Seizure resolved in 97%. Mean duration of hospitalization was 26.7 days. Patients were discharged improved from 19 seizure events (18 patients); 14 had follow-up consultations, three were readmitted. There was no seizure recurrence within 30 days of discharge. There was improvement in functional capacity.&#x0D; Conclusion. The most common cause of seizure was NPSLE, followed by infection. Despite high rates of complete seizure resolution, poor outcomes were noted in almost half of the patients. Prolonged hospitalization was common. A high rate of mortality was observed. Infection was the most common cause of mortality.

Clinico-Radiological Profile and Outcome of Airway Foreign Body Aspiration in Children: A Single-Center Experience From a Tertiary Care Center in Eastern India.

BackgroundForeign body aspiration is one of the leading causes of childhood morbidity and mortality among older infants and toddler age groups. Missed and delayed diagnosis of foreign body aspiration can lead to increased incidence of complications. Early diagnosis can prevent life-threatening complications and morbidity. In this study, we aimed to evaluate the clinical and radiological details, types, localization of foreign bodies, complications, and outcomes in pediatric patients who presented to our hospital with foreign body aspiration.MethodologyWe conducted a retrospective analysis of hospital case records of children aged one month to 14 years who were admitted to the Department of Pediatrics between June 2018 and May 2020, with clinical suspicion of foreign body aspiration.ResultsA total of 22 children with a diagnosis of airway foreign body were included. The mean age of presentation was three years (SD: ±2.22), with a boy-to-girl ratio of 3.4:1. Cough (81.8%) and tachypnea (72.7%) were the most common clinical symptoms. The median duration between symptom onset and diagnosis was three (interquartile range: 6) days. Unilateral reduced breath sound (81.8%) was the most common clinical examination finding. The common site of impaction was the right main bronchus in 59.1% of cases. The foreign bodies retrieved during bronchoscopy were organic substances in 63.6% of cases, with peanuts being the most common (31.8%). Chest radiographs were normal in 36.3% of cases, and common abnormalities included hyperinflation, collapse, consolidation, and mediastinal shift. Mechanical ventilation was required in 54.5% of cases. The mean duration of hospitalization was five (SD: ±2.84) days. Complications such as pneumothorax were seen in one (4.5%) case. Mortality was seen in 4.54% of cases during the bronchoscopic procedures.ConclusionsForeign body aspiration was common in young male children, with cough being the common symptom. Normal X-rays of the chest were seen in one-third of cases. The common site of impaction was the right main bronchus, and organic substances such as peanuts were common foreign bodies retrieved. Strong clinical suspicion of foreign body aspiration should be kept in cases with acute onset of cough in young children. Prompt medical attention is needed to reduce the morbidity and mortality associated with foreign body aspiration.

Efficacy and safety of baricitinib plus standard of care for the treatment of critically ill hospitalised adults with COVID-19 on invasive mechanical ventilation or extracorporeal membrane oxygenation: an exploratory, randomised, placebo-controlled trial

BackgroundThe oral, selective Janus kinase 1/2 inhibitor baricitinib has shown efficacy in studies of hospitalised adults with COVID-19. COV-BARRIER (NCT04421027) was a multinational, phase 3, randomised, double-blind, placebo-controlled trial of baricitinib in patients with confirmed SARS-CoV-2 infection. We aimed to evaluate the efficacy and safety of baricitinib plus standard of care in critically ill hospitalised adults with COVID-19 requiring invasive mechanical ventilation or extracorporeal membrane oxygenation.MethodsThis exploratory trial followed the study design of COV-BARRIER in a critically ill cohort not included in the main phase 3 trial. The study was conducted across 18 hospitals in Argentina, Brazil, Mexico, and the USA. Participants (aged ≥18 years) hospitalised with laboratory-confirmed SARS-CoV-2 infection on baseline invasive mechanical ventilation or extracorporeal membrane oxygenation were randomly assigned (1:1) to baricitinib (4 mg) or placebo once daily for up to 14 days in combination with standard of care. Participants, study staff, and investigators were masked to study group assignment. Prespecified endpoints included all-cause mortality through days 28 and 60, number of ventilator-free days, duration of hospitalisation, and time to recovery through day 28. The efficacy analysis was done in the intention-to-treat population and the safety analysis was done in the safety population. This trial is registered with ClinicalTrials.gov, NCT04421027.FindingsBetween Dec 23, 2020, and April 10, 2021, 101 participants were enrolled into the exploratory trial and assigned to baricitinib (n=51) or placebo (n=50) plus standard of care. Standard of care included baseline systemic corticosteroid use in 87 (86%) participants. Treatment with baricitinib significantly reduced 28-day all-cause mortality compared with placebo (20 [39%] of 51 participants died in the baricitinib group vs 29 [58%] of 50 in the placebo group; hazard ratio [HR] 0·54 [95% CI 0·31–0·96]; p=0·030; 46% relative reduction; absolute risk reduction 19%). A significant reduction in 60-day mortality was also observed in the baricitinib group compared with the placebo group (23 [45%] events vs 31 [62%]; HR 0·56 [95% CI 0·33–0·97]; p=0·027; 44% relative reduction; absolute risk reduction 17%). In every six baricitinib-treated participants, one additional death was prevented compared with placebo at days 28 and 60. The number of ventilator-free days did not differ significantly between treatment groups (mean 8·1 days [SD 10·2] in the baricitinib group vs 5·5 days [8·4] in the placebo group; p=0·21). The mean duration of hospitalisation in baricitinib-treated participants was not significantly shorter than in placebo-treated participants (23·7 days [SD 7·1] vs 26·1 days [3·9]; p=0·050). The rates of infections, blood clots, and adverse cardiovascular events were similar between treatment groups.InterpretationIn critically ill hospitalised patients with COVID-19 who were receiving invasive mechanical ventilation or extracorporeal membrane oxygenation, treatment with baricitinib compared with placebo (in combination with standard of care, including corticosteroids) reduced mortality, which is consistent with the mortality reduction observed in less severely ill patients in the hospitalised primary COV-BARRIER study population. However, this was an exploratory trial with a relatively small sample size; therefore, further phase 3 trials are needed to confirm these findings.FundingEli Lilly and Company.

POS-952 COVID-19 and impact on patients and staff in Tanker Foundation

In terms of morbidity and mortality, the SARS COVID-19 infection had a tremendous impact on Indian healthcare. The illness has resulted in a high number of hospitalizations with well documented renal consequences. Moreover, because of this illness, patients with pre-existing conditions, such as chronic kidney disease, are more likely to have negative results. Here we present the results of COVID-19-positive, end-stage renal disease patients and the consequences of the pandemic on staff services in a charity-run haemodialysis centre. This observational study was conducted at Tanker Foundation. All patients undergoing dialysis (126) + the employees working at the haemodialysis units (107) were included in the study. Statistical analysis was performed using SPSS version 26 (IBM, New York). One hundred twenty-six patients received dialysis regularly in charity-run centres during the research period, and all of them tested positive at some point. 19 (17.7%) of the 107 employees tested positive for the virus. A total of 3 patients tested positive despite receiving both doses of vaccination. The mean age was 50.46 years, and most of them were men (78.5%). The most common co-morbidity was hypertension (95.2%), followed by diabetes (28.5%). Before being tested positive, patients had been on dialysis for an average of 49.6 months. Most of the patients were hospitalized (99.2%) after being diagnosed with Covid-19. The mean duration of hospitalization was 9.72 days. Of 126 patients on haemodialysis who tested positive for Covid-19, 31 (24.6%) patients expired. Compared to those who survived the illness, the Covid-19 positive patients who died were older (56.64 ± 13.15) vs 48.45 ± 11.5, p – 0.001) and had shorter dialysis vintage (mean 37.67 vs 54 days, p – 0.05). In conclusion, our investigation indicates the increased incidence of COVID-19 infection in populations undergoing haemodialysis. Out of 126 patients undergoing dialysis, all of them tested positive at some point, and the patients who died were older than those who survived (56.64 ± 13.15) vs 48.45 ± 11.5, p – 0.001). Despite nationwide lockdown and disruptions in transportation, we were able to continue our healthcare services at charitable haemodialysis centres without any interruption.

Abstract TP128: Do All Intracerebral Hemorrhage Need Intensive Care Unit Admission. The Influence Of Hospital Level Of Care

Background: Admission to intensive care unit has been the standard of care in many institutions. Level of care in intracerebral hemorrhage patients play an increasingly important role in outcome, but this relationship between level of care and outcome is unclear. Objective: To evaluate the outcomes of intracerebral patients admitted directly to step down unit. Methods: A single center review was performed when selected intracerebral hemorrhage patients were directly admitted to step down unit. The step down unit provided nursing evaluation every 04 hours without management of mechanical ventilation or intravenous infusions that required titration at hourly intervals or more frequently. Need for intubation, length of stay, and discharge disposition was evaluated. Results: A total of 84 (33.6%) patients among 250 patients with intracerebral hemorrhage were admitted to step down unit. Patients admitted to step down unit had higher admission Glasgow coma scale (median 13.7 versus 9.9, p=&lt;.0001) and were less likely to have hematoma volumes =&gt;30 cc (6% versus 53%, p=&lt;.0001) or intraventricular hemorrhage (16.3% versus 61%, p&lt;.0001). A total of 4 (4.8%) of 84 patients admitted to step down unit required intubation/ mechanical ventilation. The mean duration of hospitalization was significantly lower among patients admitted to step down unit compared with intensive care unit (5.6±5.7 versus 11.9±12.5 days, p &lt;.0001). The proportion of patients who were discharged home was significantly higher among those admitted to step down unit (45.2% versus 10.2%, p &lt;.0001). Conclusion: One third of the patients with intracerebral hemorrhage may not require intensive care unit admission. Step down unit admission may reduce the duration of hospitalization in patients with intracerebral hemorrhage.

A comparative study between endoscopic and microscopic type 1 tympanoplasty

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; The current study aims to compare type 1 microscopic tympanoplasty and endoscopic tympanoplasty and draws an evidence-based conclusion regarding the outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This randomized controlled clinical study consists of 60 patients, in which 30 cases allocated as group 1 underwent endoscopic myringoplasty, and 30 cases allocated as group 2 underwent conventional myringoplasty. Tympanic membrane (TM), pure tone audiometry (PTA) evaluated preoperatively and at 3 months postoperative follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Demographic distribution between the groups does not show a significant difference (χ2=6.67, p=0.16). There was no significant difference observed between TM perforation size between the groups (χ2=2.32, p=0.51). For the preoperative AB gap in group 1, the mean ABG was 28.20±2.67 and in group 2 was 28.20±0.80. The postoperative AB gap in group 1, the mean ABG was 17.40±3.01, and in group 2, the mean ABG was 19.67±2.93. The mean difference is 9.13, and it shows a statistically significant difference (p=0.001). The mean duration of surgery in group 1 was 130.83±34.84 and in group 2 was 168.33±16.88 min (p=0.001). In both groups, 90% have intact graft, and in 10% of patients’ residual perforation is present. The mean duration of hospitalization in group1 is 4.10±0.09 days and in group 2 is 4.97±0.18 days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; By using the endoscopic addition, minimal invasive tympanoplasty can made possible the similar graft success rate with minimal pain. Endoscopic tympanoplasty uses very less operative time than microscopic surgery.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

The Managements of Surgical Emergencies of Suspected and High-Risk Patients of COVID-19

Objective: In this study our main goal is to evaluate the managements of surgical emergencies of suspected and high-risk patients of COVID-19. Method: This observational study was conducted at Tertiary medical college and hospital from May 2020 to March 2021. Where 80 COVID-19 suspected patients of both genders with different ages (15- 65) who was admitted to OPD for surgical emergencies. Results: During the study, majority belong to 56-65years age group, 35% and most of them were male, 65%. According to distribution of patients according their emergency conditions, 35% cases were burst appendix, 30% cases perforation gas containing hollow viscus, 25% were Intestinal obstructions. Mean duration of hospital was 6.5±1.2 days and intussusception seen in 5 cases after surgery. Conclusions: In conclusion, the number of emergency surgeries decreased during the pandemic. Perhaps a new algorithm is required for emergencies in these unusual situations.

Use of a Trochanteric Fixation Nail-Advanced (TFNA) with cement augmentation for treatment of trochanteric fractures in patients greater than sixty five years of age.

Intramedullary nailing is the standard treatment of trochanteric fractures. Mechanical failure such as cut-out and cut-through are associated with high rates of revision surgery, functional impairment, and mortality. The aim of the study was to evaluate the rate of mechanical failure of the cement augmented screws of Trochanteric Fixation Nail-Advanced (TFNA) nails. A descriptive, retrospective, multi-operator, single-centre study was performed at our level 1 trauma centre between June 2019 and June 2020. Patients were included if they were > 65years of age, presented with a trochanteric fracture treated with an augmented TFNA nail with 6months of follow-up. The primary outcome was fixation failure rate (cut-out or cut-through) at three and sixpost-operative months. Secondary endpoints were intra-operative data, clinical scores, and radiographic analysis. Forty-five patients (38 women and 7 men) were analysed. The mean age was 82.84years (65-102, 9.50). There were no instances of mechanical failure in our series, after either three or sixmonths of follow-up. No patient exhibited cut-out or cut-through. The mean amount of cement injected was 4.72mL (3-6; 1.05). The mean length of surgery was 37.59min (25-55; 6.48), and the mean intra-operative radiation exposure was 91.47 cGycm2 (25.04-201.81; 51.40) for a mean duration of 43.11s (17-86; 16.81). The mean duration of hospitalisation was 6.38days (2-11; 2.27). Our clinical results suggest that cement-augmented TFNA screws can be successfully used in the management of trochanteric fractures in patients > 65years of age.

Epidemiology and Outcome of Candidemia in ICU, Mashhad, a 6-Year Multi-Center Study

Background and aim: candidemia is a state that usually happens in immunocompromised patients. Thus it is more prevalent in ICU patients. This status brings mortality and morbidity; however, the outcome is various in different ICU care settings. The aim of this study is to assess epidemiology of outcome of candidemia in ICU in Mashhad during a 6-year period. Method: in a cross-sectional study between 2012 and 2018 in different ICU centers affiliating with Mashhad University of Medical Sciences, data of candidemia patients were extracted from hospital information system. These data were demographic, past medical history, result of the culture, and antifungal treatment. Result: totally, 55 patients (22 men and 33 women) were included in the study. The mean age of the patients was 45.9±1.9 years. Furthermore, the mean duration of hospitalization and the mean duration of ICU care were 43 and 37 days, respectively. Five patients had a history of immunosuppressive treatment and four patients were prescribed antifungal treatment in their past medical history (all with fluconazole and none with Itraconazole). Eighteen patients received caspofungin, eleven Amphotericin B treatment, and two fluconazole with no significant difference in outcome of the patients regarding antifungal type. In case of coincident antibiotic treatment, Carbapenems were prescribed in 43 patients, Glycopeptides in 48 patients, 25 patients had Cephalosporin treatment, and 13 patients had Fluoroquinolone treatment with no significant difference regarding the antibiotic type. Conclusion: The mortality percent of candidemia in ICU was 69.1 within mean time of 37 days. Furthermore, there was no significant difference in outcome of the patients regarding using Caspofungin or Amphotericin. Timely initiation of antifungal regarding to the culture result may bring better outcomes.

Use of N-Acetylcysteine at high doses as an oral treatment for patients hospitalized with COVID-19.

Infection by SARS-CoV-2 causing coronavirus disease 2019 (COVID-19) can be associated with serious and life-threatening conditions, including acute respiratory distress syndrome (ARDS). Severity and mortality have been related to a cytokine storm, an imbalance of oxidative stress, and a pro-thrombotic state.We conducted an observational retrospective cohort study from a community-based large population of hospitalized COVID-19 PCR + patients admitted from March 01, 2020, to January 24, 2021, with integrated primary to tertiary care information in Castilla la Mancha, Spain. We explored the potential benefits of the antioxidant, anti-inflammatory and anti-thrombotic drug N-acetylcysteine (NAC) administered orally in high doses (600 mg every 8 h), added to standard of care in COVID-19 patients by using the free text information contained in their electronic health records (EHRs).Out of 19,208 patients with a diagnosis of COVID-19 hospitalized, we studied 2071 (10.8%) users of oral NAC at high doses. COVID-19 patients treated with NAC were older, predominantly male, and with more comorbidities such as hypertension, dyslipidemia, diabetes, and COPD when compared with those not on NAC (all p < 0.05). Despite greater baseline risk, use of NAC in COVID-19 patients was associated with significantly lower mortality (OR 0.56; 95%CI 0.47–0.67), a finding that remained significant in a multivariate analysis adjusting by baseline characteristics and concomitant use of corticosteroids. There were no significant differences with the use of NAC on the mean duration of hospitalization, admission to the intensive care unit or use of invasive mechanical ventilation. The observed association signaling to better relevant outcomes in COVID-19 patients treated with NAC at high doses should be further explored in other settings and populations and in randomized controlled trials.

Pneumothorax in Children: A Study of 47 Pediatric Cases at Mali Hospital 2017-2020

Objectives: Pediatric pneumothorax, whether primary or secondary (infection, trauma, or iatrogenic), is sometimes life-threatening. We tried to determine the clinical characteristics of pediatric pneumothorax in Mali. Materials and Methods: We collected all pediatric patients (0 - 15 years) admitted for pneumothorax in the pediatric department of the Mali Hospital from January 2017 to December 2020. Results: During this period, a total of 5569 children aged 0 - 15 years were hospitalized, of whom 47 had pneumothorax or 0.84%. Children under 5 years of age were the most affected (80%). Dyspnea was the most common reason for hospitalization (95.7%). The causes of pneumothorax were (in order): infectious causes dominated by bullous dystrophies (70.2%), traumatic (25.5%), and iatrogenic (4.2%). Pneumothorax was compressive in 42.6%. The frequency of anemia was 79.3%. Surgical drainage was performed in 87.2% and almost all (97.6%) were treated with amoxicillin/clavulanic acid. The mean duration of hospitalization was 10.06 days (range: 0 - 35 days): 74.5% were cured while 25.5% died. Conclusions: We reconfirmed that pneumothorax is a pediatric emergency. Children under 5 years of age are the most affected. The main etiologies are infectious bronchopneumonia. The prevention and treatment of respiratory infections, the implementation of good bacteriological diagnostic tools, and the use of surgical video-thoracoscopy will reduce its mortality rate.