Period Of Hospital Admission Research Articles

Survival benefit of IABP in pre- versus post-primary percutaneous coronary intervention in patients with cardiogenic shock

BackgroundCardiogenic shock (CS) remains a major cause of in-hospital mortality in the setting of acute myocardial infarction (AMI). However, little evidence is available regarding the optimal order of intra-aortic balloon counter-pulsation (IABP) insertion and primary percutaneous coronary intervention (PPCI). The aim of this study was to assess the hospital and short-term survival benefits of two different IABP insertion approaches, before versus after PPCI in patients with acute myocardial infarction and cardiogenic shock.ResultsTotal mortality was 80 patients representing 48.4% of the total 165 studied patients; 60 patients died during the hospital admission period, while the remaining 20 patients died post-discharge. In-hospital mortality was significantly higher in Post-PPCI–IABP group 40 (49.4%) versus Pre-PPCI–IABP group 20 (23.8%) (P = 0.001). Moreover, the mortality difference between the two groups was sustained over six-month follow-up period, where 15 patients (18.5%) died in the Post-PPCI–IABP group, while only 5 patients 6.0% died in the Pre-PPCI–IABP (P = 0.001).ConclusionsEarly IABP insertion before PPCI is associated with improved in-hospital and long-term survival when used for patients presenting with AMI complicated by hemodynamic instability.

An audit of ECG and blood test monitoring on new admissions to female adult psychiatry ward in a psychiatry hospital, North Yorkshire

Background: Numerous health reports have highlighted the poor physical health of individuals with mental health problems. To improve this situation, it is paramount that mental inpatients have their baseline ECG and blood tests done immediately, following admission to the psychiatric hospital, to inform their ongoing management.Aims: This audit aimed to identify the percentage of newly admitted patients to Esk Ward (Adult psychiatry female ward) at Cross LaneHospital, Scarborough with ECG and routine blood tests completed and the time frame within which the interventions were undertaken. It also sought to establish if the results of the interventions were documented in the patients’ electronic care records and that any reasons for refusal were elicited.Method: The clinical records of 20 consecutive patients admitted to the Unit between 08/07/2023 and 09/10/2023 were reviewed. An audit tool was designed and the patients’ clinical records were scrutinised concurrently during the admission to the Ward, to determine whether the interventions were completed and the timescales within which they were undertaken. It was also monitored if the ECG and blood results were interpreted appropriately and if any necessary follow-up actions were taken.Results: The audit showed that 90% of patients admitted to Esk Ward within the period under review underwent routine blood tests within 24 h of hospital admission. However, only 60% of patients underwent ECG within similar timescales although all patients subsequently underwent this intervention during the period of hospital admission. Reasons for initial refusal of the interventions were documented in the patients’ records and the results of the investigations were reviewed in a clinically appropriate fashion.Conclusion: Results of these investigations should be regularly reviewed and appropriate follow-up care relating to these findings falls predominantly on Consultant Psychiatrists and Junior Doctors on the inpatient team.

Gestational syphilis in a tertiary health service in Paraná, Brazil: A case-control study.

Approximately 10-12 million new syphilis infections occur annually worldwide, including in pregnant women. This study identified the factors associated with syphilis in pregnant women admitted to a tertiary maternity ward in the State of Paraná, Brazil. This is an ambispective, paired case-control study (1:2 ratio) conducted from September 2020 to October 2021. Pregnant patients (n = 93) admitted to the maternity ward, who were tested with the Venereal Disease Research Laboratory (VDRL) and rapid reagent test, were compared with 186 controls, matched by age and period of hospital admission. Sociodemographic, behavioral, prenatal, and maternity healthcare information was collected through interviews. The data were analyzed using binary logistic regression. Results showed that race/skin color other than white (OR: 2.12; 95%CI: 1.19-3.80; p < 0.001), having more than one sexual partner (OR: 3.69; 95%CI: 1.70-8.00; p = 0.001), being a former smoker (OR: 2.07; 95%CI: 1.07-4.01; p = 0.030) and a current smoker (OR: 4.31; 95%CI: 1.55-11.98; p = 0.005), as well as having a history of sexually transmitted infections (OR: 10.87; 95%CI: 4.04-29.27; p < 0.0.01) were risk factors for gestational syphilis. In summary, the study indicated that sociodemographic, behavioral, and healthcare-related variables were associated with gestational syphilis. Therefore, practitioners could benefit from incorporating these factors to deliver evidence-based treatment for gestational syphilis.

Bedside Pulmonary Rehabilitation – Mandatory and CostEffective Tools

Pulmonary rehabilitation has been advocated by a wide range of surgeries. Many studies show the clinical values of pulmonary rehabilitation, which could be applied before surgery and also in the period of post-surgery. Appropriate pulmonary rehabilitation can improve individuals› exercise tolerance, hospital admission period, and overall medical stability. Those who received pulmonary rehabilitation after major surgery were shown to gain increase in walking endurance and peak exercise capacity, and also decrease in dyspnoea and fatigue. We imply that pulmonary rehabilitation must be applied during hospitalization. Spirometric maneuvers like IRV, VC, and PEFR and their measurement has become an easier and more efficient tool in preventing postoperative lung complications in patients undergoing anesthesia.

A comparative study between the outcome of using LigaSure® versus suture ligation in thyroid surgery

Abstract Background: Thyroid surgery is one of the most performed operations; with the high vascularity of the thyroid gland and the importance of hemostasis to the surgical outcome, many surgeons have begun to use energy-based devices to perform thyroid surgical procedures, and numerous studies demonstrated the benefit of these devices. The aim was to compare the use of a vessel sealing device (LigaSure) with suture ligation in perioperative time, hypocalcemia, recurrent laryngeal nerve (RLN) damage, blood loss after surgery, hematoma formation, and period of the patient. Materials and Methods: In this study, 81 patients who underwent total thyroidectomy for different diseases, and divided into two groups corresponding to the hemostasis type: vessel sealing devices (LigaSure) group, and suture ligation group, these groups compared regarding operative time; hypocalcemia, RLN injury, blood loss after surgical procedure, hematoma formation, and period of hospital admissions. Results: The duration of surgery was more significant and shorter in the LigaSure® group 66.57 ± 8.93 min than suture ligation group 86.84 ± 17.5 min with P = 0.0001, with bleeding after surgery, was lesser in LigaSure® patients 52.76 ± 22.8 mL than suture ligation group 95.09 ± 39.91 mL with P = 0.0001; other outcomes (postoperative hematoma formation, injury to recurrent laryngeal nerve, hypocalcemia after surgery, and period of hospital admission), and there was no difference between the two groups mentioned above. Conclusion: The role of the LigaSure instrument in thyroidectomy surgery is to decrease the operative time duration and blood loss after surgery, with no effect on the incidence of recurrent laryngeal nerve damage, postoperative low serum calcium level, and hematoma formation.

Evaluation of health-related quality of life and its domains in pediatric patients with cancer

BackgroundHealth-related quality of life has emerged as a significant component in pediatric oncology research during the last several decades. Measures of health-related quality of life provide a thorough assessment of the child’s response to medical therapy, disease course, and adjustment outcomes in the context of pediatric oncology.MethodsThe aim of the present study was to assess the cancer-specific health-related quality of life in cancer pediatric patients and to evaluate the contribution of its domains and some of the anthropometric, sociodemographic, and treatment-related variables on the overall quality of life, by using the PedsQL™ 3.0 Cancer Module.ResultsThe study included 110 cases. The mean value of the PedsQL™ 3.0 Cancer Module score was 49.3 ± 12.0. The lowest mean score of quality of life was for the “procedure anxiety” (8.7 ± 23.9), followed by the “worry” domains (16.6 ± 28.5). Higher “frequency of hospital visits” was associated with increased feeling of pain and treatment anxiety yet decrease in suffering from nausea and vice versa. The longer period of hospital admission for more than half of the recommended treatment period was associated with reduced pain suffering on the expense of increase in feeling of worry as well as communication problems. The perceived physical appearance was better among those patients who spent a treatment period for 3–6 months when compared to those who spent a treatment period less than 3 months or more than 6 months. There was a highly significant association between all the eight-cancer-specific quality-of-life domains except the pain domain- and the overall quality-of-life log scores. Nausea problem followed by worry and cognitive problems was the most effective domains on the overall quality-of-life score.ConclusionCancer pediatric patients suffered low quality of life especially for anxiety procedure and worry domains with special consideration for the impact of nausea, worry, and cognitive problems on their perception of quality of life.

I don’t know where I’m going or where I come from. Self-disorders in schizophrenia.

IntroductionIn the early stages of schizophrenia the person experiences feelings of strangeness about themselves, difficulty in making sense of things and difficulty in interacting with their environment. Based on this, self-disorder assessment instruments have been developed and empirical studies have been conducted to assess people at risk of developing a schizophrenia spectrum disorder. These studies show that self-disorders are found in pre-psychotic stages and that their manifestation can predict the transition to schizophrenia spectrum disorders.ObjectivesWe present the case of a patient with multiple diagnoses and mainly dissociative symptoms who, after years of evolution, was diagnosed with schizophrenia.MethodsBibliographic review including the latest articles in Pubmed about self-disorders and schizophrenia.ResultsWe present the clinical case of a 51-year-old woman with a long history of follow-up in mental health consultations and with multiple hospital admissions to the psychiatric unit, with several diagnoses including: dissociative disorder, histrionic personality disorder, adaptive disorder unspecified psychotic disorder and, finally, schizophrenia. The patient during the first hospital admissions showed a clinical picture of intense anxiety, disorientation and claiming to be a different person. The patient related these episodes to stressors she had experienced, and they improved markedly after a short period of hospital admission. Later, psychotic symptoms appeared in the form of auditory and visual hallucinations and delusional ideation, mainly of harm, so that after several years of follow-up and study in mental health consultations and in the psychiatric day hospital, she was diagnosed with schizophrenia and treatment with antipsychotics was introduced, with a marked clinical improvement being observed.ConclusionsIt is important to take into account this type of symptoms (self-disorders), as they allow the identification of individuals in the early stages of the disorder and create the opportunity for early therapeutic interventions.Disclosure of InterestNone Declared

The delay in the diagnosis and treatment of newly diagnosed bladder cancer patients during COVID 19 pandemic.

To evaluate the newly diagnosed bladder cancer(BC) patients during the pandemic period and compare them with the corresponding last4 years. To document the time schedules of BC patient evaluation and define the possible delays and investigate the reasons. Newly diagnosed BC patients who underwent transurethral resection of bladder tumour in the last5 years were retrospectively included to study. The patients were divided into 5 groups. Group-1 was composed of patients diagnosed betweenMarch, 1,2016 -March-1,2017. The patients who were diagnosed in the further corresponding years formed group 2,3 and 4. The last group(Group-5) was composed of patients who were diagnosed during the pandemic period which was between March,1,2020 and March,1,2021. The clinicodemographic properties and diagnostic time schedules of the patients were compared between the groups. There were56 patients in Group-1,60 patients in Group-2,61 patients in Group-3,68 patients in Group-4, and 58 patients inGroup-5. The mean hospital admission period was102.5±179.0days during the pandemic period which ranged between24.5± 32.0 and38.3±69.1days before thepandemic.(p=0.002)The diagnosis-anesthesia period was significantly higher during the pandemic pandemic period.(p=0.034). The pandemic period has caused some delays in the diagnosis and treatment of BC patients. Telemonitoring systems may be useful to prevent the possible diagnostic and treatment delays for newly diagnosed BC patients.

Treatment of Pink Hand Syndrome (Pulsless Hand) Post Supracondylar Humeral Fractures in Pediatrics

Objectives: To review and present our experience at King Hussein Medical Centre, in the management of pink pulseless hand syndrome (PPHS ), and to analyse the results and outcome of the conservative watchful approach in the paediatric age group of patient presenting with PPHS, following Gartland type III humeral supracondylar fracture closed reduction and percutaneous pinning fixation (CRPP). Methods: This is a retrospective study, conducted at King Hussein Medical Centre, on patients aged 14 years and below (Paediatric age group) who sustained grade III Gartland supracondylar fracture of humerus (SCFH) and developed pulseless hands post fracture fixation, between the period of January 2016 and December 2021. Results: Among 533 patients with the age group of 14 years and below presented to the emergency department with SCFH, 196 patients had type III Gartland SCFH. Post CRPP, 125 (63.8%) had normal vascularity with intact pulses, 45 (22.9%) patients were found to have absent pulses with cold pale poorly perfused hands. Twenty six patients (13.3%) had absent pulses, but well perfused well perfused pink hands. During the admission, only two patients (6.7%) among the 24 patients experienced worsening of the perfusion in the involved extremity and underwent emergency exploration of the brachial artery restoration of hand perfusion successfully post operation. Twenty four (92.3%) patients had well perfused hands within 48 hours of in hospital admission period and were successfully discharged. Conclusion: Patients presenting with pink pulseless hand syndrome post fracture reduction and stabilization can be safely observed with in hospital admission and strict monitoring of perfusion of the involved hand with no significant sequel and with successful results.

Outcome of Laparoscopic versus Open Colorectal Cancer Surgery

Introduction: Since the first laparoscopic-assisted colon resection was introduced in 1991 by Jacobs et al., it has gradually become popular. Increasingly more colorectal surgeons admit that the laparoscopic technique leads to quicker functional recovery and improved short-term results when compared with the open approach. However, the laparoscopic technique has not previously been proven to gain significant benefits in colorectal surgeries. Recently, oncologic outcomes of colorectal cancer resection, in terms of lymph node harvest number and excision safety margin lengths, achieved under laparoscopy could be comparable to those obtained using the conventional open technique. However, the curability of colorectal cancer under the laparoscopic technique remains controversial because of the uncertainty about the overall recurrence rate. Objective: To study the outcome of colorectal surgeries in our department in order to compare laparoscopic surgery (LS) versus open surgery (OS) of colorectal cancer procedures in terms of operations duration, blood loss, intra and post-operative complications. Methods: Review of all colorectal cancer patients who underwent open and laparoscopic procedures between January 2014 and January 2020. Excluding patients, those have non-malignant tumors. Included in data collection are the patients’ demographic information, type of surgery, diagnostic test, complications, operative time, and hospital admission period. We will take the information from files of patients and our documentations during clinic visits. Results: A total of 101 patients underwent colorectal cancer surgery at King Salman Armed Forces Hospital from 1/1/2014 till 1/1/2020. Of these, 63 were male (62.3%). Of these colon cancer 68 cases (67%). The mean age was 47.2 years. Comorbidities included diabetes 13 (12%), hypertension 10 (9.9%), IHD 16 (15%), ESRD 4 (3.9%). Of these 41 were smokers (40.5%). Mean Body Mass Index (BMI) was 31.2 kg/m2. Mean hospital stay 7 ± 2 days for OS and 5 ± 2 for LS. Fifty nine patients (58.4%) underwent OS. 7 cases (6.9%) of LR had conversion. Conclusion: LS of colorectal cancer has better short-term results than OS but longer operative time.

Short-term functional changes after hospital discharge by COVID-19 through teleconsultation at a reference service in Northeast Brazil: A cross-sectional study.

Coronavirus infection disease 2019 (COVID‐19) was associated with a physical‐functional and emotional decline in patients with COVID‐19 hospital internment. Objective: Evaluate the main functional changes after hospital discharge after COVID‐19 by teleconsultation. A cross‐sectional study was carried out between April and July 2020, the peak period of new cases, hospital admission, and deaths by COVID‐19, in Recife‐Brazil. We included patients (n = 89) over 18 years with positive COVID‐19 RT‐PCR tests and hospitalized for more than 7 days. Functional aspects such as muscle pain, shortness of breath, cough, weight loss >5 kg, weakness/fatigue, daily living activities, balance, walking, lying down, sensitivity, anxiety/sadness, altered memory, or understanding were assessed. Besides this, the impact of hospital admission on daily activities and the quality of information obtained by teleconsultation were quantified. The mean age was 63.5 years (±14), and in the hospital, the mean internment was 18 days (±16). The main findings of this study showed four predominant functional alterations: weight loss greater than 5 kg (60.7%), muscle fatigue/weakness (53.9%), muscle/joint pain (43.8%), and anxiety/sadness (46.1%). Of the functions analyzed, 59.6% of patients reported dysfunctions in at least three of the alterations evaluated. There were several short‐term physical‐functional and emotional changes in adults after hospital discharge.

On-admission versus in-hospital thromboembolism due to COVID-19 infection. What is the particular characteristic of those with early thrombotic events?

Increasing evidence has declared a hypercoagulable state in the coronavirus 2019 infection (COVID-19), while the etiology has remained a question. For the first time, the current study has aimed to compare the contributors of thromboembolism among those whose primary manifestations of COVID-19 were thrombosis vs the patients with a thrombotic event during the period of hospitalization. This case-control study has been conducted on 267 COVID-19 patients, including 59, 48, and 160 ones with an on-admission, in-hospital, and without a thrombotic event, respectively. The events were defined as deep vein thrombosis (DVT), ischemic cerebrovascular accidents (CVA), pulmonary thromboembolism (PTE), or acute myocardial infarction (AMI). The demographic, physical examination, clinical and laboratory assessments of the groups were compared. The DVT (OR: 5.18; 95% CI: 1.01-26.7), AMI (OR: 11.1; 95% CI: 2.36-52.3), and arterial thrombosis (OR: 5.93; 95% CI: 0.63-55.8) were significantly associated with an on-admission thrombosis compared to those who presented in-hospital events. Lower levels of oxygen saturation were the only significant predictor index inversely associated with on-admission thrombosis compared to those with an event during the hospital admission period. PTE development was the most common in-hospital thrombotic event, whereas other thromboembolism types were remarkably more often among cases with on-admission events. Oxygen saturation was the only predictor of premature thrombosis that was inversely associated with outpatient events.

Integrating electronic health data records to develop and validate a predictive model of hospital-acquired acute kidney injury in non-critically ill patients.

ABSTRACTBackgroundModels developed to predict hospital-acquired acute kidney injury (HA-AKI) in non-critically ill patients have a low sensitivity, do not include dynamic changes of risk factors and do not allow the establishment of a time relationship between exposure to risk factors and AKI. We developed and externally validated a predictive model of HA-AKI integrating electronic health databases and recording the exposure to risk factors prior to the detection of AKI.MethodsThe study set was 36 852 non-critically ill hospitalized patients admitted from January to December 2017. Using stepwise logistic analyses, including demography, chronic comorbidities and exposure to risk factors prior to AKI detection, we developed a multivariate model to predict HA-AKI. This model was then externally validated in 21 545 non-critical patients admitted to the validation centre in the period from June 2017 to December 2018.ResultsThe incidence of AKI in the study set was 3.9%. Among chronic comorbidities, the highest odds ratios (ORs) were conferred by chronic kidney disease, urologic disease and liver disease. Among acute complications, the highest ORs were associated with acute respiratory failure, anaemia, systemic inflammatory response syndrome, circulatory shock and major surgery. The model showed an area under the curve (AUC) of 0.907 [95% confidence interval (CI) 0.902–0.908), a sensitivity of 82.7 (95% CI 80.7–84.6) and a specificity of 84.2 (95% CI 83.9–84.6) to predict HA-AKI, with an adequate goodness-of-fit for all risk categories (χ2 = 6.02, P = 0.64). In the validation set, the prevalence of AKI was 3.2%. The model showed an AUC of 0.905 (95% CI 0.904–0.910), a sensitivity of 81.2 (95% CI 79.2–83.1) and a specificity of 82.5 (95% CI 82.2–83) to predict HA-AKI and had an adequate goodness-of-fit for all risk categories (χ2 = 4.2, P = 0.83). An online tool (predaki.amalfianalytics.com) is available to calculate the risk of AKI in other hospital environments.ConclusionsBy using electronic health data records, our study provides a model that can be used in clinical practice to obtain an accurate dynamic and updated assessment of the individual risk of HA-AKI during the hospital admission period in non-critically ill patients.

Implementation of Specific Neurosurgical Protocol for Urgent Elective and Emergency Patients during the COVID-19 Pandemic in Croatia

Introduction: The COVID-19 pandemic was declared on January 30, 2020. The disease has rapidly disseminated throughout Europe, reaching Croatia from late February onward, representing a great burden to the national health care system. Our institution’s capacity for emergency neurosurgery was adjusted to assure adequate degree of protection for both the patients and medical workforce. Separate COVID-19-free pathways were ensured, while regular operative program has been attuned to the existing epidemiological condition. Aim: To explain the implementation of neurosurgical protocol for urgent elective and emergency traumatic brain injury patients during the COVID-19 pandemic based on our institutional experience. Methods: The time of pandemic was divided into 3 separate two-month periods. Patients, who suffered a traumatic brain injury and were not tested for corona virus, were considered COVID positive and were included in the analysis investigating the type and severity of injury, period of hospital admission and surgery, methods of surgery, and outcome. Results: A series consisted of 16 patients who were tested for COVID-19 at hospital admission, and under-went urgent/emergency surgery before the test results became known. Surgery was performed according to the specifically designed operative COVID-19 protocol. Skull fracture and traumatic intracranial hemorrhage were mainly observed. Moderate injury was recorded less frequently, particularly during the lock down, and post lock down summer. The majority of patients recuperated well, having good recovery. Conclusion: A specific operative protocol, employment of protective measures, and a separate operating theatre are mandatory for a safe and successful management of traumatic brain injury to evade transmission of the infection.

Palivizumab prophylaxis against respiratory syncytial virus infection in patients younger than 2 years of age with congenital heart disease.

BACKGROUND: Respiratory syncytial virus (RSV) is a viral pathogen that causes annual epidemics of lower respiratory tract infection with substantial morbidity and mortality in young children, especially those with congenital heart disease (CHD). Palivizumab is the only immunoprophylaxis therapy approved for RSV infection in infants with hemodynamically significant acyanotic or cyanotic CHD.OBJECTIVE: Identify the compliance rate with vaccination and study the effect of RSV vaccination on hospital admissions.DESIGN: Retrospective descriptive study.SETTING: Cardiac center.PATIENTS AND METHODS: Patient data was obtained from outpatient clinic records, inpatient records, and a surgical database for the period from October 2010 to March 2016. Infants with hemodynamically significant CHD, cyanotic CHD and moderate-to-severe pulmonary hypertension were included in the study. Palivizumab 15/mg/kg was given monthly starting from October, the usual beginning of the epidemic season, with five doses in the first season and six doses in the remaining season scheduled for administration. Patients were interviewed at every clinic visit for any side effects during the previous month, occurrence of any RSV infection and any hospital admission. Selection criteria included RSV vaccination and absence of RSV disease. Patients were excluded if they had RSV infection or a repaired cardiac lesion.MAIN OUTCOME MEASURES: Compliance rate, hospital admission frequency and period of stay.SAMPLE SIZE: 530 during six seasons of RSV epidemics.RESULTS: Fourteen patients (2.6%) developed RSV infection and 13 (2.5%) required hospital admission, but only one patient (0.1%) needed intensive care admission. There were no deaths related to RSV infection; however 11 patients died due to causes unrelated to RSV infection. The average compliance rate was 97%.CONCLUSION: Palivizumab was well tolerated and effective in the prophylaxis of severe RSV infection in children with CHD. As in other studies of palivizumab prophylaxis, we observed a reduction in hospital admissions.LIMITATIONS: Retrospective design.CONFLICT OF INTEREST: None.

Корреляции в патогенезе неразвивающейся беременности

Objective. To improve the quality of life and outcome by consecutive pregnancy in patients based on the analysis of correlations and differences in markers for the diagnosis by early pregnancy loss (EPL) in early gestation period (up to 12 weeks). Patients and methods. 100 patients aged 18 to 40 years diagnosed with early pregnancy loss (EPL) at 7–8 and 9–10 weeks of obstetric term were examined. The types of EPL were identified by ultrasound criteria; correlations and differences in the EPL mechanism during early pregnancy were determined. Time characteristics of the gestational sac (GS) development from conception to miscarriage and the duration of persistence of an empty sac in the uterine cavity before the diagnosis of EPL were recorded. Molecular genetic testing of the chorion in 42 women with EPL was performed by multi-locus quantitative fluorescent polymerase chain reaction (PCR). The method of manual vacuum aspiration under the control of hysteroscopy was developed, followed by the administration of antibacterial, antiviral, and immunomodulatory therapy with Viferon® rectal suppositories at a dose of 1,000,000 IU 1 suppository twice a day at 12-hour intervals for 10 days and Viferon® gel 36,000 IU on the vaginal region of the cervix at a dose of 2 mL twice a day for 7 days. Results. The period of hospital admission for patients with embryonic miscarriage (EM) as the type of EPL prevailed between 8 and 10 weeks, on the average – 9.5 weeks of obstetric term, in contrast to empty sac (ES, 7–8 weeks). The period of the GS development in ES ranged from 17 to 36 days (2.3 to 5.1 weeks); in EM – 4 to 9 weeks (26 to 69 days) in 96% of patients, and the embryo development was from 3–4 to 6–7 weeks from conception (21 to 49 days). There was a 1.2-week difference in the desynchronization of the development of GS and an embryo. A significant positive correlation between gestational age (before diagnosis) and β-hCG levels (26,348 ± 18,289 mIU/mL) in patients without bloody discharge at the time of hospitalization was observed. However, there was a desynchronization of lag in β-hCG levels by an average of 3 times (8661 ± 7701 mIU/mL) in the presence of bloody discharge, although the sizes of GS according to mean sac diameter (MSD) were comparable (28 ± 13 mm and 30 ± 11 mm). There was a complete lack of synchronization of the abnormal development of GS, an embryo, β-hCG levels, and the duration of GS persistence in the uterine cavity after miscarriage. The following correlations occurred in the pathogenesis of EPL: chromosomal abnormalities (45% in EM and 40% in ES), history of gynecological and viral diseases (49% in EM and 41% in ES). Correlational differences in the developmental period of GS according to MSD, an embryo, the period of persistence in the uterine cavity after miscarriage, the uterine size, and mean β-hCG levels (at week 8-10) in EM were at different gestation periods before the onset of manifestation of miscarriage. Conclusion. Determination of correlation dependencies and differences in the results of monitoring diagnostic markers of different types of EPL makes it possible to develop a personalized approach to the choice of gestational sac aspiration, antibacterial, antiviral, and immunomodulatory therapy with Viferon® (interferon α-2b with antioxidant complex) for a successful consecutive pregnancy and its outcome. Key words: anembryonic pregnancy, embryonic miscarriage, correlations, pathogenesis by early pregnancy loss, early pregnancy loss, persistence of empty sac, β-hCG

Compression stockings in addition to low-molecular-weight heparin to prevent venous thromboembolism in surgical inpatients requiring pharmacoprophylaxis: the GAPS non-inferiority RCT.

Patients admitted to hospital for surgery are at an increased risk of venous thromboembolism. Pharmaco-thromboprophylaxis and mechanical prophylaxis (usually graduated compression stockings or intermittent pneumatic compression) have been shown to reduce the incidence of venous thromboembolism. The evidence base supporting the National Institute for Health and Care Excellence's recommendation for the use of graduated compression stockings for venous thromboembolism prevention in the UK has recently been challenged. It is unclear if the risks and costs associated with graduated compression stockings are justified for deep-vein thrombosis prevention in moderate- and high-risk elective surgical inpatients receiving low-dose low-molecular-weight heparin pharmaco-thromboprophylaxis. The primary objective was to compare the venous thromboembolism rate in elective surgical inpatients at moderate or high risk of venous thromboembolism who were receiving either graduated compression stockings and low-dose low-molecular-weight heparin (standard care) or low-dose low-molecular-weight heparin alone (intervention). This was a pragmatic, multicentre, prospective, non-inferiority, randomised controlled trial. This took place in secondary care NHS hospitals in the UK. Patients aged ≥ 18 years who were assessed to be at moderate or high risk of venous thromboembolism according to the NHS England venous thromboembolism risk assessment tool (or the trust equivalent based on this form) and who were not contraindicated to low-molecular-weight heparin or graduated compression stockings were deemed eligible to take part. Participants were randomised 1 : 1 to either low-molecular-weight heparin or low-molecular-weight heparin and graduated compression stockings. The primary outcome measure was venous thromboembolism up to 90 days after surgery. A combined end point of duplex ultrasound-proven new lower-limb deep-vein thrombosis (symptomatic or asymptomatic) plus imaging-confirmed symptomatic pulmonary embolism. Secondary outcomes included quality of life, compliance with graduated compression stockings and low-molecular-weight heparin during admission, and all-cause mortality. A total of 1905 participants were randomised and 1858 were included in the intention-to-treat analysis. A primary outcome event occurred in 16 out of 937 (1.7%) patients in the low-molecular-weight heparin-alone arm compared with 13 out of 921 (1.4%) patients in the low-molecular-weight heparin plus graduated compression stockings arm. The risk difference between low-molecular-weight heparin and low-molecular-weight heparin plus graduated compression stockings was 0.30% (95% confidence interval -0.65% to 1.26%). As the 95% confidence interval did not cross the non-inferiority margin of 3.5% (p < 0.001 for non-inferiority), the results indicate that non-inferiority of low-molecular-weight heparin alone was shown. In total, 13% of patients did not receive a duplex ultrasound scan that could have detected further asymptomatic deep-vein thrombosis. However, missing scans were balanced between both trial arms. The subpopulation of those aged ≥ 65 years assessed as being at a moderate risk of venous thromboembolism was under-represented in the study; however, this reflects that this group is under-represented in the general population. For elective surgical patients at moderate or high risk of venous thromboembolism, administration of pharmaco-thromboprophylaxis alone is non-inferior to a combination of pharmaco-thromboprophylaxis and graduated compression stockings. These findings indicate that graduated compression stockings may be unnecessary for most elective surgical patients. Further studies are required to evaluate whether or not adjuvant graduated compression stockings have a role in patients receiving extended thromboprophylaxis, beyond the period of hospital admission, following elective surgery or in patients undergoing emergency surgical procedures. Current Controlled Trials ISRCTN13911492. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 69. See the NIHR Journals Library website for further project information.

Decrease in cardiac catheterization and MI during COVID pandemic

The consequences of severe acute viral respiratory syndrome (COVID 19) pandemic include collateral effects, one of which has been the significant reduction in routine hospital work. With widespread reports indicating reduction of cardiac procedures including MI presentation to hospitals, we aimed to analyze the local data over a 10-week period during lockdown in a tertiary cardiac centre Catheter Laboratory in England. MethodsWe conducted a retrospective review of the coronary catheterisation procedures and admissions with MI over the peak COVID-19 pandemic 10-week period (23rd March-30th May) in 2020, compared with the same 10-week period (25th March-2nd June) in 2019. ResultsIn 2019, 539 patients were admitted to the Cath lab for coronary catheterisation (M = 385:F = 154; mean age 65 years; STEMI = 186, NSTEMI = 192, elective = 161). In 2020, during peak period of COVID19 pandemic in England, a total of 278 patients were admitted for coronary catheterisation over the 10-week period (M = 201:F = 77; mean age 60.5 years; STEMI = 132, NSTEMI = 118, elective = 28). During peak COVID19 pandemic, this represents a 48.4% drop in all coronary catheterisations. The reduction in STEMI was 29% (54 less), in NSTEMI was 38.9% (74 less) and elective procedures dropped by 83% (133 less). ConclusionDuring peak COVID hospital admission period in England, we report a 48.5% reduction in coronary catheterisation in our tertiary hospital. These results are consistent with reports from other countries, and highlight the worrying potential consequences for these patients arising from delays in presentation with MI, and the challenges for restoring services post-pandemic.

Decrease in Cardiac Catheterization Laboratory Volume and MI During COVID Pandemic

Background: The consequences of severe acute viral respiratory syndrome (COVID 19) pandemic include collateral effects, one of which has been the significant reduction in routine hospital work. With widespread reports indicating reduction of cardiac procedures including MI presentation to hospitals, we aimed to analyse the local data over a 10-week period during lockdown in a tertiary cardiac centre Catheter Laboratory in England. Methods: We conducted a retrospective review of the coronary catheterisation procedures and admissions with MI over the peak COVID-19 pandemic 10-week period (23rd March-30th May) in 2020, compared with the same 10-week period (25th March-2nd June) in 2019. Results: In 2019, 539 patients were admitted to the Cath lab for coronary catheterisation (M=385:F=154; mean age 65 years; STEMI = 186, NSTEMI= 192, elective = 161). In 2020, during peak period of COVID19 pandemic in England, a total of 278 patients were admitted for coronary catheterisation over the 10-week period (M=201:F=77; mean age 60.5 years; STEMI = 132, NSTEMI=118, elective=28). During peak COVID19 pandemic, this represents a 48.4% drop in all coronary catheterisations. The reduction in STEMI was 29% (54 less), in NSTEMI was 38.9% (74 less) and elective procedures dropped by 83% (133 less). Conclusion: During peak COVID hospital admission period in England, we report a 48.5% reduction in coronary catheterisation in our tertiary hospital. These results are consistent with reports from other countries, and highlight the worrying potential consequences for these patients arising from delays in presentation with MI, and the challenges for restoring services post-pandemic.Funding Statement: None. No external or internal source of funding was used for this work.Declaration of Interests: None declared by all the authors.Ethics Approval Statement: Ethical approval was not required as this study constitutes a quality improvement in healthcare and did not involve human participants. Consent was therefore not required.

Association between number of medications and mortality in geriatric inpatients: a Danish nationwide register-based cohort study.

To explore the association between the number of medications and mortality in geriatric inpatients taking activities of daily living and comorbidities into account. A nationwide population-based cohort study was performed including all patients aged ≥ 65years admitted to geriatric departments in Denmark during 2005-2014. The outcome of interest was mortality. Activities of daily living using Barthel Index (BI) were measured at admission. National health registers were used to link data on an individual level extracting data on medications, and hospital diseases. Patients were followed to the end of study (31/12/2015), death, or emigration, which ever occurred first. Kaplan-Meier survival curves were used to estimate crude survival proportions. Univariable and multivariable analyses were performed using Cox regression. The multivariable analysis were adjusted for age, marital status, period of hospital admission, BMI, and BI (model 1), and additionally either number of diseases (model 2) or Charlson comorbidity index (model 3). We included 74,603 patients (62.8% women), with a median age of 83 (interquartile range [IQR] 77-88) years. Patients used a median of 6 (IQR 4-9) medications. Increasing number of medications was associated with increased overall, 30-day, and 1-year mortality in all three multivariable models for both men and women. For each extra medication, the mortality increased by 3% in women and 4% in men in the fully adjusted model. Increasing number of medications was associated with mortality in this nationwide cohort of geriatric inpatients. Our findings highlight the importance of polypharmacy in older patients with comorbidities.