Intensive Care Admission Rates Research Articles

Comparison of composite adverse perinatal outcomes in early- and late-onset intrahepatic cholestasis of pregnancy

Comparison of composite adverse perinatal outcomes in early- and late-onset intrahepatic cholestasis of pregnancy

Risk of Invasive Meningococcal Disease in Preterm Infants.

Invasive meningococcal disease (IMD) is most common in the first year of life. We hypothesized that preterm infants may have a higher risk of IMD and more severe disease than term infants. We compared the incidence, demographics, clinical presentation, and outcomes of IMD in preterm compared with term infants during the first 5 years after implementation of a national meningococcal group B vaccine (4CMenB) for infants in England. The UK Health Security Agency conducts enhanced national IMD surveillance with detailed follow-up of all confirmed cases in England. Infants aged <1 year (uncorrected for gestational age) with IMD confirmed between 1 September 2015 and 31 August 2020 were included. There were 393 infant IMD cases (incidence, 12.4/100 000 live births). Among 363 (92.4%) of the infants with known gestational age, the IMD incidence was higher in preterm (<37 weeks' gestation) than in term infants (18.3/100 000 vs 10.9/100 000; incidence rate ratio [IRR], 1.68 [95% confidence interval, 1.23-2.29]; P = .001). The IMD incidence was highest in those born at <32 weeks' gestation (32.9/100 000; incidence rate ratio for <32 weeks' gestation vs term, 3.01 [95% confidence interval, 1.73-5.24]; P ≤ .001). There were no differences in demographics, clinical presentation, rate of intensive care admission, or case-fatality rate, but preterm infants were more likely than term infants to have ≥1 reported sequela (14 of 39 [35.9%] vs 51 of 268 [19.0%]; P = .02). Preterm infants had a higher incidence of IMD than term infants and the IMD incidence was highest in infants born at <32 weeks' gestation. Preterm infants also had a higher risk of IMD sequelae.

COVID-19 Outcomes in Patients with Hematologic Malignancies in the Era of COVID-19 Vaccination and the Omicron Variant.

A greater understanding of clinical trends in COVID-19 outcomes among patients with hematologic malignancies (HM) over the course of the pandemic, particularly the Omicron era, is needed. This ongoing, observational, and registry-based study with prospective data collection evaluated COVID-19 clinical severity and mortality in 1818 adult HM patients diagnosed with COVID-19 between 27 February 2020 and 1 October 2022, at 31 centers in the Madrid region of Spain. Of these, 1281 (70.5%) and 537 (29.5%) were reported in the pre-Omicron and Omicron periods, respectively. Overall, patients aged ≥70 years (odds ratio 2.16, 95% CI 1.64-2.87), with >1 comorbidity (2.44, 1.85-3.21), or with an underlying HM of chronic lymphocytic leukemia (1.64, 1.19-2.27), had greater odds of severe/critical COVID-19; odds were lower during the Omicron BA.1/BA.2 (0.28, 0.2-0.37) or BA.4/BA.5 (0.13, 0.08-0.19) periods and among patients vaccinated with one or two (0.51, 0.34-0.75) or three or four (0.22, 0.16-0.29) doses. The hospitalization rate (75.3% [963/1279], 35.7% [191/535]), rate of intensive care admission (30.0% [289/963], 14.7% [28/191]), and mortality rate overall (31.9% [409/1281], 9.9% [53/536]) and in hospitalized patients (41.3% [398/963], 22.0% [42/191]) decreased from the pre-Omicron to Omicron period. Age ≥70 years was the only factor associated with higher mortality risk in both the pre-Omicron (hazard ratio 2.57, 95% CI 2.03-3.25) and Omicron (3.19, 95% CI 1.59-6.42) periods. Receipt of prior stem cell transplantation, COVID-19 vaccination(s), and treatment with nirmatrelvir/ritonavir or remdesivir were associated with greater survival rates. In conclusion, COVID-19 mortality in HM patients has decreased considerably in the Omicron period; however, mortality in hospitalized HM patients remains high. Specific studies should be undertaken to test new treatments and preventive interventions in HM patients.

The Effect of Urea/Albumin Ratio on Mortality in the Geriatric Patients Admitted in the Intensive Care Unit.

To analyse the effect of urea albumin ratio on mortality in intensive care patients aged over 65 years. An observational study. Place and Duration of the Study: Health Sciences University, Ankara Training and Research Hospital, Emergency Critical Intensive Care Unit, from October 2021 to March 2022. Patients over 65 years of age admitted in the intensive care unit were included in this study, and the laboratory and clinical data were recorded within the first 24 hours after the admission of the patient. The urea : albumin ratio was calculated using serum urea and albumin concentrations. All the patients were monitored during intensive care admission and mortality rates were recorded; additionally 1-month mortalities of the patients were also recorded. The data of the survivors and non-survivors were compared. There were 362 patients with mean age of 79.00±8.40 years; 53.9% were females. The median urea : albumin ratio was found to be 22.8 mg/gr. The area under curve, sensitivity and specificity values were found to be 0.631, 68%, and 56% at a cut-off value of 22.1 mg/gr for urea : albumin ratio, respectively. In addition, urea : albumin ratio >22.1mg/gr was found to be significant in univariate regression analysis (p<0.001) and multivariate regression analysis (p<0.002) for the predictive value of 1-month mortality. Urea : albumin ratio is a simple and potentially useful prognostic factor in the geriatric patient population admitted in the intensive care unit. Geriatrics intensive care unit, Urea:albumin ratio, Mortality (MeSH database).

Delayed surgical treatment of geriatric hip fractures increases the need for intensive care unit, morbidity and mortality rates

Objective: The aim of this study was to present the intensive care admission, morbidity and mortality rates of older adults with hip&#x0D; fractures who could not be operated in the first 48 hours after admission, which is the recommended time in literature.&#x0D; Patients and Methods: Patients aged &gt;60 years of age with a hip fracture who were operated on in our clinic between January 2012&#x0D; and June 2021 were identified. The patients were evaluated in 3 groups according to preoperative waiting time, as Group 1: 2-10 days,&#x0D; Group 2: 11-20 days, and Group 3: ≥21 days.&#x0D; Results: Mortality within 1 year was found to be 20% in Group 1, 31% in Group 2, and 50% in Group 3 (P=0.001). Preoperative waiting&#x0D; time did not affect complications related to surgery infection (P=0.890), implant failure (P=0.129) but surgeons had to deal with&#x0D; decubitus ulcer (P=0.016) and urinary tract infection (P=0.001). Patients with a long preoperative waiting time required preoperative&#x0D; intensive care (P=0.003).&#x0D; Conclusion: The study results demonstrate that as the preoperative waiting period increases, the mortality rate also increases, the need&#x0D; for intensive care before and after the operation increases, and there is increased morbidity due to a long hospital stay.

Effect of progesterone on preventing preterm birth and adverse perinatal outcomes in women in the risk group: A prospective clinical trial

Background and Objective: Preterm labor is a significant reason for perinatal mortality and morbidity. This study was conducted to determine the effect of two regimens of progesterone to avoid preterm labor and the adverse perinatal outcomes in the two groups. Methods: A prospective clinical trial was performed in Maternity Teaching Hospital and Hawler Private Hospital in Erbil city, Kurdistan region, Iraq over a one-year period from 1 May 2019 until 1 May 2020. The study sample was 200 pregnant women with a short cervix and a risk of preterm birth; the sample was divided into two groups. Group I of 100 pregnant women received 400 mg progesterone vaginally once daily, and group II of 100 pregnant women received it twice daily, started from 16 weeks of gestation up to the time of delivery in both groups. Results: The rate of term pregnancy (? 37 weeks) was 87% among women in group II and 55% in women in group I. Accordingly, the rate of neonatal intensive care admission was significantly higher in group I than in group II (30% and 11%, respectively). The rate of respiratory distress syndrome was also significantly higher in group I (31%) than in group II (7%). Conclusion: The administration of progesterone 400 mg vaginally twice a day appears to be more effective than progesterone 400 mg vaginally once a day in preventing preterm birth and reducing the risk of adverse neonatal complications.

Caesarean Section for Placenta Previa: A Retrospective Cohort Study of Anaesthesia Techniques.

Placenta previa is associated with maternal and neonatal morbidity and mortality. This study aims to add to the limited literature from the developing world on the association of different anaesthetic techniques with blood loss, the need for blood transfusion, and maternal/ neonatal outcomes among women undergoing caesarean section with placenta previa.This retrospective study was conducted at Aga University Hospital, Karachi, Pakistan. The patient population included parturients undergoing caesarean section for placenta previa from January 1, 2006, through December 31, 2019.Out of 276 consecutive cases of placenta previa progressing to caesarean section during the study period, 36.24% were performed under regional anaesthesia and 63.76% under general anaesthesia. When compared to general anaesthesia, significantly less regional anaesthesia was used for emergency caesarean section (26% vs. 38.6%, P = .033) and for grade IV placenta previa (50% vs. 68.8%, P = .013). Blood loss was found to be significantly low with regional anaesthesia (P = .005) and posterior placenta (P = .042), while it was found to be high in grade IV placenta previa (P = .024). The odds of requiring blood transfusion were low in regional anaesthesia (odds ratio = 0.122; 95% CI = 0.041-0.36, P = .0005) and posterior placenta (odds ratio = 0.402; 95% CI = 0.201-0.804, P = .010), while they were high in grade IV placenta previa (odds ratio: 4.13; 95% CI = 0.90-19.80, P = .0681). The rate of neonatal deaths and intensive care admission was significantly lower in regional anaesthesia than in general anaesthesia (7% vs. 3% and 9% vs. 3%). The maternal mortality was zero; however, intensive care admission was less in regional anaesthesia compared to general anaesthesia (<1% vs. 4%).Our data demonstrated less blood loss, need for blood transfusion, and better maternal and neonatal outcomes with regional anaesthesia for caesarean section in women with placenta previa.

Factors associated with the evolution of COVID-19 in pregnant women: a Brazilian population-based study.

To assess the evolution of COVID-19 among Brazilian pregnant women, identifying sociodemographic and clinical predictors related to admission to ICU - Intensive Care Unit and death. Cross-sectional, population-based study, carried out with a secondary database, based on data from the Influenza Epidemiological Surveillance Information System. Descriptive analysis was performed, followed by multiple linear regression with Poisson response, adopting critical p < 0.05. Intensive care admission rates of 28.2% and death rates of 9.5% were identified. Region of residence, gestational trimester, number of comorbidities and respiratory signs and symptoms were associated with the risk of admission to intensive care. Age over 34 years, comorbidities, oxygen saturation equal to or less than 95%, admission to intensive care and ventilatory support, invasive or not, increased the risk of death. Sociodemographic and clinical predictors showed an association with hospitalization in intensive care and death of pregnant women with COVID-19.

Epidemiology and outcomes of culture-positive bloodstream pathogens prior to and during the SARS-CoV-2 pandemic: a multicenter evaluation

BackgroundBloodstream infections (BSIs) are an important cause of morbidity and mortality in hospitalized patients. We evaluate incidence of community- and hospital-onset BSI rates and outcomes before and during the SARS-CoV-2 pandemic.MethodsWe conducted a retrospective cohort study evaluating patients who were hospitalized for ≥ 1 day with discharge or death between June 1, 2019, and September 4, 2021, across 271 US health care facilities. Community- and hospital-onset BSI and related outcomes before and during the SARS-CoV-2 pandemic, including intensive care admission rates, and overall and ICU-specific length of stay (LOS) was evaluated. Bivariate correlations were calculated between the pre-pandemic and pandemic periods overall and by SARS-CoV-2 testing status.ResultsOf 5,239,692 patient admissions, there were 20,113 community-onset BSIs before the pandemic (11.2/1000 admissions) and 39,740 (11.5/1000 admissions) during the pandemic (P ≤ 0.0062). Corresponding rates of hospital-onset BSI were 2,771 (1.6/1000 admissions) and 6,864 (2.0/1000 admissions; P < 0.0062). Compared to the pre-pandemic period, rates of community-onset BSI were higher in patients who tested negative for SARS-CoV-2 (15.8/1000 admissions), compared with 9.6/1000 BSI admissions among SARS-CoV-2-positive patients. Compared with patients in the pre-pandemic period, SARS-CoV-2-positive patients with community-onset BSI experienced greater ICU admission rates (36.6% vs 32.8%; P < 0.01), greater ventilator use (10.7% vs 4.7%; P < 0.001), and longer LOS (12.2 d vs 9.1 d; P < 0.001). Rates of hospital-onset BSI were higher in the pandemic vs the pre-pandemic period (2.0 vs 1.5/1000; P < 0.001), with rates as high a 7.3/1000 admissions among SARS-CoV-2-positive patients. Compared to the pre-pandemic period, SARS-CoV-2-positive patients with hospital-onset BSI had higher rates of ICU admission (72.9% vs 55.4%; P < 0.001), LOS (34.8 d vs 25.5 d; P < 0.001), and ventilator use (52.9% vs 21.5%; P < 0.001). Enterococcus species, Staphylococcus aureus, Klebsiella pneumoniae, and Candida albicans were more frequently detected in the pandemic period.Conclusions and relevanceThis nationally representative study found an increased risk of both community-onset and hospital-onset BSI during the SARS-CoV-2 pandemic period, with the largest increased risk in hospital-onset BSI among SARS-CoV-2-positive patients. SARS-CoV-2 positivity was associated with worse outcomes.

Evaluation of Nursing Home Residents Applying to The Emergency Service

Background: Emergency deparment (ED) has an important role at the care of nursing home residents and acts facilitator role at the acute care, admission to the hospital, unexpected injuries and hospitals. Our research is aiming the evaluation of the demographic and clinical features of the nursing home patients applying to ED. &#x0D; Materials and methods: The nursing home residents who are aged 18 and over 18 applying to ED at the date between 15.04.2014-15.05.2015 are included to this respective study. In the study, demographic information of the patients and diagnosis and treatment information in the emergency room were evaluated. &#x0D; Results: 51 (52%) of the patients are male. The average age of them is 73. The most frequent disease observed in their medical history is Alzheimer’s disease. The physical examinations of the patients resulted that they have cachexia and dehydration. The oftenest diagnosises detected are lung disease (23.5%), infection (22.4%) and malnutrition (22.4%). It has been also detected that 45% of them admitted to hospital and 3.1% of them are to die. The rate of intensive care admission is 64% while the service admission rate is 36%. &#x0D; Conclusion: The rate of the admission of the nursing home residents to ER and especially to intensive care units is quite high. To ameliorate this condition, training and supervision of the nursing home workers should be made more carefully and often. Since we do not have sociodemographic and clinical data about the nursing home residents applying to ED, more study must be made about this area.

Non-Invasive Ventilation in the Prehospital Emergency Setting: A Systematic Review and Meta-Analysis

Introduction Noninvasive ventilation is a well-established treatment for acute respiratory failure, being increasingly applied in the prehospital setting. This systematic review and meta-analysis aims to investigate whether early prehospital initiation of noninvasive ventilation reduces mortality compared to standard oxygen therapy. Methods We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to February 7th, 2022, for studies comparing prehospital noninvasive ventilation performed by emergency medical services versus standard oxygen therapy in patients with acute respiratory failure. The primary outcome was mortality at the longest follow-up available. Results We included ten randomized studies and two quasi-randomized studies for a total of 1485 patients. Prehospital treatment with noninvasive ventilation compared with standard oxygen therapy did not significantly reduce mortality at the longest follow-up available (107/810 [13%] vs 114/772 [15%]; RR = 0.89; 95% CI, 0.70–1.13; P = 0.34; I2=24%). The endotracheal intubation rate was reduced when receiving prehospital noninvasive ventilation (38/776 [4.9%] vs 81/743 [11%]; RR = 0.44; 95% CI, 0.31–0.63; P < 0.001; I2=0%; number needed to treat 17). The intensive care admission rate (114/532 [21%] vs 129/507 [25%]; RR = 0.85; 95% CI, 0.69–1.04; P = 0.11; I2=0%) and length of hospital stay (mean difference=-1.29 days; 95% CI, −3.35–0.77; P = 0.21; I2=82%) were similar between groups. Conclusions Adults with acute respiratory failure treated in the prehospital setting with noninvasive ventilation had a lower risk of intubation than those managed with standard oxygen therapy, with similar risk of death, intensive care admission, and length of hospital stay. Review registration PROSPERO CRD42021284947

Komorbiditesi Olan COVID-19 Hastalarının Laboratuvar Bulguları, Hastanede Yatış ve Ölüm Oranlarının İncelenmesi

Objective: The purpose of the present study was to investigate the laboratory findings in terms of comorbidity, taking into account the length of hospital stay and death rates of COVID-19 patients.Method: Forty-four patients with COVID-19 hospitalized in intensive care unit and 71 patients hospitalized in the ward were included in this study. Whole blood parameters, C-Reactive Protein (CRP), Procalcitonin, Ferritin, Erythrocyte Sedimentation Rate (ESR), Troponin-I, Creatine, Prothrombin time (PT), Activated partial thromboplastin time (aPTT) International normalized ratio (INR) and D-Dimer results of the patients between hospitalization day and death rate correlation analysis was performed. In addition, the effects of these parameters on comorbid diseases were evaluated.Results: PT, INR, CRP, Ferritin, Procalcitonin, ESR, D-Dimer, Troponin-I, White blood cell, Neutrophil, Monocyte Lymphocyte Ratio, Neutrophil Lymphocyte Ratio levels of the patients were positively correlated with hospitalization day and death rate, while Lymphocyte levels showed a negative correlation. It also showed a positive correlation with ex rate and Monocyte, Creatine and Platelet levels.Conclusion: It was determined that patients with Chronic Obstructive Pulmonary Disease, Pneumonia comorbidities and Cardiovascular Disease had higher hospitalization days and intensive care unit admission rates than patients without comorbidity. In addition, patients with Diabetes, Cancer and Chronic Kidney Failure were found to have higher rates of intensive care admission compared to patients without comorbidity.

The fetal and maternal outcomes related to previous number of cesarean sections and uterus sparing surgery in women with abnormal placentation

Objectives. We aimed to study the number of previous cesarean sections in cases diagnosed with placenta previa (PP) and placenta accreta spectrum (PAS), and maternal and fetal results in cases where we performed uterus-sparing surgery. Materials and Methods. PAS patients diagnosed with PP (PPAS) were included in this retrospective study. Postoperative hemogram values, blood transfusion amounts, hospitalization days, intraoperative and postoperative complication rates of all patients, APGAR scores (5-minute), mortality rates and birth weights were registered for all newborns on admission to the intensive care unit. Results. A total of 122 pregnant women were included in the study. In the comparison of hospitalization rates, there was a significant difference between CS ≤1 and CS =2 (p=0.01). When postoperative hemoglobin values were compared, there was significant difference between CS ≤1 and CS ≥3 (p&lt;0.01). Neonatal intensive care admission rates increase as the number of CS increases. Conclusions. Uterus-sparing surgery in experienced clinics seems to be applicable, even if maternal and fetal morbidity increases. We suggest to consider CS numbers in PPAS group for fetal and maternal wellness while doing surgical planning.

Comparison of Severe Viral Pneumonia Caused by SARS-CoV-2 and Other Respiratory Viruses Among Malaysian Children During the COVID-19 Pandemic.

ObjectivesWe described the etiology of severe pneumonia in children during the height of the COVID-19 pandemic in Malaysia and compared the clinical features of severe SARS-CoV-2 to other respiratory viruses.MethodsThis retrospective study included all children aged 12 years and below hospitalized with severe pneumonia in Negeri Sembilan, Malaysia, between 1 April 2021 and 31 October 2021. We extracted demographic and clinical data and used logistic regression to examine risk factors associated with severe SARS-CoV-2 or other viral pneumonia.ResultsA total of 111 children were included. The median age was 15 months. Human rhinovirus/enterovirus, SARS-CoV-2 and respiratory syncytial virus were the most common etiology of severe pneumonia. Codetection of >1 viral pathogen was present in 14 (12.6%) patients. Children with severe COVID-19 presented early in the course of illness and had lower rates of pediatric intensive care admission. The presence of sick contact with an adult was a predictor for SARS-CoV-2, whereas adventitious breath sounds were predictive of other respiratory viruses.ConclusionsThe etiology of severe pneumonia in children evolved with the epidemic curve of COVID-19 and school closures. Children with severe pneumonia due to SARS-CoV-2 experienced a milder clinical course when compared to other respiratory viruses.

Trial of labor of vertex-nonvertex twins following a previous cesarean delivery

Maternal and neonatal outcomes of trial of labor after cesarean delivery of twins are similar to those of singleton trials of labor after cesarean delivery. However, previous studies did not stratify outcomes by second-twin presentation on admission to labor. To examine maternal and neonatal outcomes following trial of labor after cesarean delivery in twins with vertex-nonvertex presentation. A retrospective multicenter study was conducted including data on deliveries occurring between the years 2005 and 2020. We included trials of labor after a previous cesarean delivery (at ≥320/7 weeks' gestation) of twin gestations with a vertex-presenting first twin on admission to labor. The exposed group was defined as deliveries with a nonvertex second twin at admission to labor, whereas the comparison group included deliveries with a vertex second twin at admission. Only parturients who attempted vaginal delivery were included. Cases of prelabor fetal death of either twin or major fetal anomalies were excluded. The primary outcome was uterine rupture. A total of 236 twin trials of labor after cesarean delivery were included, of which 128 involved nonvertex second twins and 108 a second vertex twin. Uterine rupture rates were comparable between the groups (1/128 [0.9%] vs 1/108 [0.8%]; P=1.000). Successful trial of labor after cesarean delivery of both twins occurred in 76.6% of the exposed group vs 81.5% of the comparison group, whereas cesarean delivery of both twins was performed in 21.9% of the exposed group vs 17.6% of the comparison group (P=.418; odds ratio, 1.32; confidence interval, 0.7-2.5). Two cases of cesarean delivery of the second twin occurred in the exposed group and 1 in the comparison group (1.6% vs 0.9%, respectively, P=1.000). There was no difference between the groups in maternal outcomes, including rates of postpartum hemorrhage, blood transfusion, placental abruption, thromboembolic events, and maternal fever. Neonatal outcomes were also comparable between the groups, including rates of intensive care admission and low (≤7) 5-minute Apgar scores. Our data show thattrial of labor after cesarean delivery of noncephalic second twins holds favorable maternal and neonatal outcomes, comparable with those of vertex-vertex trials of labor after cesarean delivery.Second-twin noncephalic presentation should not discourage parturients and caregivers from considering trial of labor after cesarean delivery if desired.

IDF21-0046 Higher rates of DKA and intensive care admission among children newly diagnosed with T1D during the COVID 19 pandemic

Background: The COVID-19 pandemic might have a multifaceted effect on children with Type 1 Diabetes (T1D), either directly through infection itself or indirectly due to measures implemented by health authorities to control the pandemic. Aim: To compare data on children newly diagnosed with T1D in Kuwait during the COVID-19 pandemic to the pre-pandemic period. Method: We analyzed data on children aged 12 years or less registered in the Childhood-Onset Diabetes electronic Registry (CODeR) in Kuwait. Data were incidence rate (IR), Diabetic ketoacidosis (DKA) and its severity and admission to the Pediatric Intensive Care unit (PICU). Results: The IR of T1D was 40.2 per 100,000 (95%CI; 36.0-44.8) during the COVID-19 pandemic period and was not statistically different from pre-pandemic. A higher proportion of incident T1D cases presented with DKA and were admitted to the PICU during the pandemic (52.2% vs 37.8%: p<0.001, 19.8% vs 10.9%; p=0.002 respectively). The COVID-19 pandemic was positively associated with presentation of DKA and admission to PICU (AOR=1.73; 95% CI, 1.13-2.65; p=0.021, AOR=2.04; 95% CI, 1.13-3.67; p=0.018 respectively). Children of families with a positive history for diabetes were less likely to present with DKA and get admitted to the PICU during the COVID-19 pandemic (AOR=0.38; 95% CI, 0.20-0.74; p=0.004, AOR=0.22; 95% CI, 0.08-0.61; p=0.004, respectively). Discussion: High rates of DKA at presentation and admission to PICU in incident T1D cases during the COVID-19 pandemic warrant further studies and effective mitigation efforts through increasing awareness, early detection, and timely intervention.

The clinical significance of antiphospholipid antibodies in COVID-19 infection.

One of the factors that may aggravate the clinical presentation in COVID-19 is the increased level of antiphospholipid antibodies (aPLs) and thrombotic events that can be seen with the disease. In our retrospective study, we aimed to evaluate the effect of aPLs on the clinical findings in patients with a diagnosis of COVID-19. Seventy-three patients diagnosed with COVID-19 and examined for aPLs were included in the study. Patients were divided into two groups according to the test results of aPLs. Clinical and laboratory parameters were compared in both groups to reveal whether there was any difference between the groups. There were 15 patients with a positive aPLs test. Dyspnea, nausea, vomiting, myalgia, and abdominal pain were significantly higher in the aPLs positive group than those with negative aPLs. The duration of hospital stays and the need for oxygen therapy of the patients in the aPLs positive group were significantly higher than the aPLs negative group. However, no difference was found between the two groups in terms of mechanical ventilation need, intensive care admission rate, thrombosis and mortality. In terms of laboratory findings, those with positive aPLs have higher median C-reactive protein (CRP) and ferritin values than those with negative aPLs. In our study group, we could not find a relationship between aPLs positivity and critical complications. According to our hypothesis, it may not be necessary to routinely examine aPLs in patients with a diagnosis of COVID-19 to determine the risk of thromboembolic complications.

Incidence Rate of ALI in COVID-19 Patients

Background: With the outbreak of COVID19, acute lung injury has been detected as the main etiology for intensive care admission and high mortality rate. Among the infected population, there is some percentage of those who tend to develop acute respiratory distress syndrome and respiratory failure. Thus, the intensivist and anesthesiologist must be aware of the of incidence rate of ARDS, risk factors, and try to take measures to reduce its incidence.&#x0D; To define the rate of incidence of acute lung injury and ARDS among COVID 19 patient.&#x0D; Methods: We performed a narrative review via searching in three databases PubMed, Google Scholar and Embase for all studies that mentioned the incidence of acute lung injury among infected patients with COVID19, manual searching also completed. All the selected reviews were limited to the English language and data also.&#x0D; Results: Five searches referred to the exact number of patients and the percentage rate of incidence of ARDS related to COVID 19 infection, other articles are merely reviews and case reports.&#x0D; Conclusion: Incidence of acute lung injury among COVID19 patient was highly reported, and some percentage of these cases tend to develop ARDS especially in those who have preexisting diseases and obesity.

Appendicitis in Far North Queensland: a new take on an old story.

Appendicitis is a leading cause of surgical hospital admission. To date, there have been no published epidemiological studies describing appendicitis in tropical and remote Australia and none specifically documenting appendicitis in Indigenous Australians. This descriptive study used available state data to investigate appendicitis across Far North Queensland (FNQ). Queensland Health hospital admission data for FNQ was analysed to explore appendicitis epidemiology and outcomes in FNQ, 2012-2018. Population data for the same time period provided rates. Over the study period, 3458 hospital presentations for appendicitis were available for analysis. Mean incidence was 178 per 100 000/yr. Median age was 27 years with 50.1% female patients. The annual rate of appendicitis was higher in the Indigenous population. Most patients had a laparoscopic procedure with a low rate of conversion to open surgery (2.6%). More than 80% of patients were discharged from hospital in less than 3 days. Intensive care (ICU) admission rate was low overall (1.1%) although higher for Indigenous people (2.4%). Following discharge, the hospital re-admission rate was 3.8% and all-cause mortality was 0.03%. The incidence of appendicitis in FNQ is higher than that reported in the rest of Australia in both Indigenous and non-Indigenous populations. Despite logistical challenges of health care, clinical outcomes are in line with best practice across the country. Clinicians in FNQ should maintain a high index of suspicion for diagnosing appendicitis in rural and remote settings.

A Review of Phenobarbital for Alcohol Withdrawal Syndrome

Background: Alcohol use disorder represents a serious health problem worldwide which is increasing in pervasiveness. Alcohol withdrawal syndrome is a common clinical problem encountered in emergency departments and inpatient settings, including intensive care units. While benzodiazepines are the most widely used class of medication for the treatment of alcohol withdrawal, in recent years, there is renewed interest in using phenobarbital, a barbiturate, in the treatment of refractory alcohol withdrawal. Objective: This review provides an overview of phenobarbital in the treatment of alcohol withdrawal, as well as clinical outcomes in patients, while also outlining some of the limitations of existing studies in comparing phenobarbital to benzodiazepines. Methods: PubMed, Ovid MEDLINE, and Cochrane databases were searched using the terms phenobarbital, barbiturates, and alcohol withdrawal syndrome. Prospective and retrospective trials comparing phenobarbital with benzodiazepines to treat alcohol withdrawal in English were included. Results: Two prospective randomized controlled and eleven retrospective cohort trials were identified. Phenobarbital is safe alone and as an adjunct to benzodiazepine in the emergency department, intensive care units, general medical units and acute trauma surgery service. In a randomized controlled trial, one dose of phenobarbital in the emergency department significantly reduced the intensive care admission rate. There is some evidence that phenobarbital may be effective in the treatment of benzodiazepine- refractory alcohol withdrawal. Conclusion: Although existing knowledge and practice regarding phenobarbital for the treatment of alcohol withdrawal are increasing, there currently remains limited evidence in support of phenobarbital over benzodiazepines in superior efficacy and outcomes.