17 results on '"ICU, Intensive care unit"'
Search Results
2. Psychological impact of the COVID-19 pandemic on waitlisted pre-bariatric surgery patients in Saudi Arabia: A cross-sectional study.
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Magliah SF, Alzahrani AM, Sabban MF, Abulaban BA, Turkistani HA, Magliah HF, and Jaber TM
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Background: During the COVID-19 pandemic, the number of bariatric surgeries was decreased to ensure patient safety. This study aimed to evaluate the effect of such delays on the psychological status and weight management behaviors of waitlisted pre-bariatric surgery patients in Jeddah, Saudi Arabia., Materials and Methods: A web-based cross-sectional survey was conducted. Results were then evaluated with simple descriptive statistics and inferential analyses through the Chi-square test, one-way ANOVA, and the general linear regression model., Results: Of 437 patients, 208 successfully completed the survey. Approximately half of the participants reported weight change (46.6%, n = 97), while other weight management behaviors remained unchanged. The mean Patient Health Questionnaire-9 (PHQ-9) total score of the respondents was 8.29 ± 6.3, indicating mild depression. Higher PHQ-9 scores were associated with being a student, unhealthy dietary habits, physical inactivity, worsened psychological status, and weight gain. Among these factors, being a student was the strongest predictor of the total PHQ-9 score., Conclusion: The COVID-19 pandemic significantly affected the psychological status of patients with obesity on the bariatric surgery waitlist. Since delays in bariatric surgeries could worsen patients' psychological status, as substantiated in this study, the provision of virtual care through telemedicine and the development of policies for reintroducing bariatric surgeries for future lockdowns are highly recommended., Competing Interests: The authors declare no conflicting interest for this study., (© 2022 The Authors.)
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- 2022
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3. Neutrophil to lymphocyte ratio and in-hospital mortality among patients with SARS-CoV-2: A retrospective study.
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Al-Mazedi MS, Rajan R, Al-Jarallah M, Dashti R, Al Saber A, Pan J, Zhanna KD, Abdelnaby H, Aboelhassan W, Almutairi F, Alotaibi N, Al Saleh M, AlNasrallah N, Al-Bader B, Malhas H, Ramadhan M, Brady PA, Al-Zakwani I, Setiya P, Abdullah M, Alroomi M, and Tse G
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The goal of this study was to investigate in-hospital mortality in patients suffering from acute respiratory syndrome coronavirus 2 (SARS-CoV-2) relative to the neutrophil to lymphocyte ratio (NLR) and to determine if there are gender disparities in outcome. Between February 26 and September 8, 2020, patients having SARS-CoV-2 infection were enrolled in this retrospective cohort research, which was categorized by NLR levels ≥9 and < 9. In total, 6893 patients were involved included of whom6591 had NLR <9, and 302 had NLR ≥9. The age of most of the patients in the NLR<9 group was 50 years, on the other hand, the age of most of the NLR ≥9 group patients was between 50 and 70 years. The majority of patients in both groups were male 2211 (66.1%). The ICU admission time and mortality rate for the patients with NLR ≥9 was significantly higher compared to patients with NLR <9. Logistic regression's outcome indicated that NLR ≥9 (odds ratio (OR), 24.9; 95% confidence interval (CI): 15.5-40.0; p < 0.001), male sex (OR, 3.5; 95% CI: 2.0-5.9; p < 0.001) and haemoglobin (HB) (OR, 0.95; 95% CI; 0.94-0.96; p < 0.001) predicted in-hospital mortality significantly. Additionally, Cox proportional hazards analysis (B = 4.04, SE = 0.18, HR = 56.89, p < 0.001) and Kaplan-Meier survival probability plots also indicated that NLR>9 had a significant effect on mortality. NLR ≥9 is an independent predictor of mortality(in-hospital) among SARS-CoV-2 patients., Competing Interests: Nothing to disclose., (© 2022 The Authors.)
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- 2022
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4. Suggested organism entry portal of necrotizing fasciitis with complete DNA from fascia, blood, and pharyngeal ulcers: A case report.
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Murata S, Toyoshima C, Suzuki S, and Sato N
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Introduction and Importance: In approximately 50% of patients with necrotizing fasciitis, infection begins deep in the soft tissues. A history of trauma is often absent. The mechanism of spread has not been elucidated. We report a case of type II necrotizing fasciitis in which the streptococcal strain was identical to isolates from other locations in the same patient., Case Presentation: A 42-year-old man presented with left leg pain. Two days prior, he had a non-penetrating injury to the left thigh while playing futsal. Workup revealed swelling of the left gastrocnemius. He was admitted to orthopaedics. On the third hospital day, he was referred to our department for hypotension, impending respiratory failure, and decreased sensorium, and subsequently admitted to the ICU. A biopsy was done on the left gastrocnemius fascia. He was diagnosed with necrotizing fasciitis. On the seventh hospital day, left hip amputation and extensive debridement of the trunk were done. Patient improved and eventually recovered., Clinical Discussion: Group A streptococcus was isolated in from the fascia, blood, and pharyngeal ulcer. Pulsed field gel electrophoresis showed all isolates to be genetically identical. An oral route of infection was considered., Conclusions: This is the first report in which etiologic agent of necrotizing fasciitis is genetically identical with isolates from other parts in the absence of trauma., Competing Interests: The authors declare no competing or conflict of interest., (© 2022 The Authors.)
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- 2022
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5. Zika, Nipah and Kala-azar: Emerging lethal infectious diseases amid COVID-19 as an escalating public health threat in South India.
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Uday U, Tadi LJ, Islam Z, Mohanan P, Ghazanfar S, Babar MS, and Ismail S
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As of 6 June 2022, a sum 25,782 of active cases and 524,701 deaths due to Coronavirus disease-19 (COVID-19) have been recorded in India. Stewing in the flares of the pandemic, Kerala is entwined in the wrath of multiple emerging infectious diseases. India, a home to 1.3 billion people, recently faced a devastating second wave of COVID-19 during May of 2021, with a ruckus of chronic shortage of medicine, oxygen supplies, ventilators, besides, being challenged by secondary infections and chronic health ailments. The state of Kerala, alone contributes to 50% COVID-19 caseload, besides, recent simultaneous outbreaks of Zika Virus Disease (ZVD), Nipah Virus Disease (NiVD) and Kala-azar (black fever) on July 8, September 5 and 8, 2021 respectively. Syndemicity and a high case fatality rates of these highly contagious diseases coupled with post infection sequelae, overwhelm the already fragile healthcare system. Thus, these lethal infectious diseases along with an anticipated third wave of COVID-19 pose a serious public health threat in and around South India. With this narrative review, we aim to discuss the challenges that the emergence of intersecting outbreaks of Zika, Nipah, Kala-azar presents with, in the nation, amidst the global pandemic of COVID-19 and provide recommendations so as to help alleviate the situation. The syndemicity of COVID-19 with other infectious diseases, calls for adequate surveillance and monitoring of diseases' outbreaks. To avoid the worst situations like pandemic, the health ministry, public and private health stakeholders in India should strengthen the public healthcare delivery system and providence of quick medical facilities to control the rate of mortality and morbidity during outbreaks., Competing Interests: None., (© 2022 The Authors.)
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- 2022
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6. Mediastinal lymphadenopathy: A serious complication in COVID-19 patients.
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Khatri G, Priya, Saleem MB, Kumar A, and Hasan MM
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Competing Interests: The authors declare that there is no conflict of interest.
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- 2022
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7. Knowledge of intensive care nurses' towards prevention of ventilator-associated pneumonia in North West Ethiopia referral hospitals, 2021: A multicenter, cross-sectional study.
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Getahun AB, Belsti Y, Getnet M, Bitew DA, Gela YY, Belay DG, Terefe B, Akalu Y, and Diress M
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Introduction: Ventilator-associated pneumonia is a common nosocomial infection that occurs in critically ill patients who are on intubation and mechanical ventilation. Nurses' lack of knowledge may be a barrier to adherence to evidence-based guidelines for preventing ventilator-associated pneumonia. This study aimed to assess the knowledge of intensive care nurses' towards the prevention of ventilator-associated pneumonia., Methods: A multicenter cross-sectional study was conducted among nurses working in the intensive care unit from April to July 2021. A pre-tested and structured questionnaire was used to collect data. All intensive care nurses working in the study area were included in the study. Data was entered into Epi-data 4.1 version (EpiData Association, Denmark) and transferred to STATA version 14 (College Station, Texas 77845-4512 USA) statistical software for analysis. Both bi-variable and multivariable binary logistic regression analysis was used to identify factors associated with knowledge of intensive care unit nurse. Variables with a p-value less than <0.2 in the bi-variable analysis were fitted into the multivariable logistic regression analysis. Both Crude and Adjusted Odds Ratio with the corresponding 95% Confidence Interval was calculated to show the strength of association. In multivariable analysis, variables with a p-value of <0.05 were considered statistically significant., Result: A total of 213 intensive care nurses were included in the study, with a response rate of 204(95.77%). The mean knowledge score of intensive care nurses regarding the prevention of ventilator-associated pneumonia out of 20 questions is (10.1 ± 2.41). There are 98 (48.04%) of the participants have been found to have good knowledge and 106 (51.96%) of them are rendered poor knowledge about the overall knowledge related to the prevention of ventilator-associated pneumonia. Higher academic qualifications and taking intensive care unit training were significantly associated with good knowledge of ventilator-associated pneumonia prevention in multi-variable logistic regression., Conclusion: Our study indicates that the knowledge of intensive care nurses about ventilator-associated pneumonia prevention is not sufficient. Higher academic qualifications and taking intensive care unit training are significantly associated with a good level of knowledge. Therefore it shows the necessity for thorough training and education., Competing Interests: There is no conflict of interest., (© 2022 The Authors.)
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- 2022
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8. Characteristics and outcome of infants born to mothers with SARS-CoV-2 infection during the first three waves of COVID-19 pandemic in northern Iran: A prospective cross-sectional study.
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Farhadi R, Ghaffari V, Mehrpisheh S, Moosazadeh M, Haghshenas M, and Ebadi A
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Background: Despite the rapid increase in knowledge about coronavirus disease 2019 (COVID-19), there is limited data on vertical transmission, viral loads in mother-neonate pairs, and health outcomes. We aimed to describe the characteristics, viral loads, and short-and mid-term outcomes of neonates born to mothers with confirmed COVID-19 infection in northern Iran., Materials and Methods: In a cross-sectional study, we prospectively collected and analyzed the clinical features, reverse transcription-polymerase chain reaction (RT-PCR) results, viral loads, and outcomes of 60 neonates delivered by 58 SARS-CoV-2 infected pregnant women in maternity hospitals of Mazandaran University of Medical Sciences (northern Iran) during first three waves of the pandemic from March 1 to December 31, 2020. We assessed neonates' short and mid-term outcomes up to 24 months after the pandemic. We also described the timing of mother-to-infant transmission based on the classification presented by the World Health Organization., Results: Of the 17767 deliveries, 58 mothers had confirmed and probable COVID-19 infection. Twenty (33.3%) neonates were positive for SARS-CoV-2, two of whom had possible in utero transmission. Twenty-five (41.2%) neonates were preterm, most of whom were born during the first and second waves in which mothers were critically ill. 19 (31.7%) patients needed resuscitation in the delivery room. 34 (56.7%) neonates were isolated in the neonatal intensive care unit. We observed a significant relationship between the maternal and neonatal viral load (correlation coefficient = 0.983, P = 0.00). No neonatal death was observed and all babies had a good outcome., Conclusions: The results showed that vertical transmission of SARS-CoV-2 is possible but rare. Regional factors and severity of mother's disease may influence the clinical course of neonates. With increasing experience, proper observance of health precautions, and rapid development of evidence-based response systems for regional and global disasters, the transmission rate of SARS-CoV-2 from mother to newborn is reduced., Competing Interests: The authors declare that they have no competing interests., (© 2022 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)
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- 2022
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9. Early bilateral pulmonary embolism in a polytrauma patient: About a case report.
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Haddad IAE, Mouhib AE, Hattab O, Assamti M, Mojahid A, Bkiyer H, Nasri S, Skiker I, Ouafi E, and Housni B
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Introduction: and importance: Venous thromboembolism (VTE) is a well-known complication in polytrauma patients, associated with a high rate of mortality and morbidity. Generally pulmonary embolism (PE) is most common between the fifth and seventh days following a significant trauma, and it is uncommon before the fourth day. Their management remains a challenge to physicians given the nature and risk of blood loss from the accompanying injuries must be considered while using anticoagulant therapy., Case Presentation: Here we present a case of acute pulmonary embolism in a previously healthy young woman that developed two days after a traumatic brain injury (TBI) and varying degrees of additional blunt thoracic trauma. An angio CT scan was used to make the diagnosis, and the patient was given anticoagulant medication with close monitoring and satisfactory outcomes., Conclusion: Evidence suggests that early after trauma, a considerable number of trauma patients are hypercoagulable. In patients with unexplained dyspnea/hypoxia, clinicians should maintain a high index of suspicion and explore PE early after injury. In the case of traumatic brain injury patients with cerebral contusions, intraparenchymal haemorrhages, or subdural/extradural haemorrhages, the existence of post-traumatic PE adds to the problems., Competing Interests: None., (© 2022 The Author(s).)
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- 2022
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10. Patients' knowledge and perception of anesthesia and the anesthetists: Cross-sectional study.
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Arefayne NR, Getahun AB, Melkie TB, Endalew NS, and Nigatu YA
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Background: Anesthesiology was misconceived as a behind the screen specialty. Despite significant advancements in its scope, anesthesia remains have a poor public image, clients are not even aware of an anesthetist as a medically qualified health professional, particularly in underdeveloped countries. There has been very little study done on the public's awareness of anesthesia in Ethiopia. This study was conducted to assess the level of patients' knowledge and perception of anesthesia and the anesthetists., Methods: Institution-based, cross-sectional study was conducted from January to May 2021, at the University of Gondar comprehensive specialized hospital, Ethiopia. Consenting participants were asked to answer a standard questionnaire in a personal interview to assess their knowledge about anesthesia and the anesthetist. Descriptive statistic was used to explain the study participants with study variables and to describe their perception about anesthesia and anesthetists. Binary logistic regression analysis was performed to identify the association between the level of knowledge and independent variables. The strength of the association between the independent variables and the level of knowledge was presented by an adjusted odds ratio and 95% Confidence Interval., Results: A total of 307 study participants were included in this study with a response rate of 100%. Of these 113 (36.8) were males and 194 (63.2) were females. Two hundred twenty (71.7%) study participants answered less than half of the questions correctly and had a poor level of knowledge the rest 87 (28.3%) had a good level of knowledge and the mean knowledge score was1.72 ± 0.45. Previous anesthesia exposure (p value = 0.001) and occupation (p value = 0.022) of participants had statistically significant association with the level of knowledge., Conclusion: and recommendation: We have found that patients had very limited (poor) knowledge and perception regarding anesthesia and the role of anesthetists. Anesthetists should do a complete pre-anesthetic assessment which helps them to achieve good patient recognition., Competing Interests: There is no conflict of interest., (© 2022 The Authors.)
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- 2022
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11. Pulmonary barotrauma in COVID-19: A systematic review and meta-analysis.
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Shrestha DB, Sedhai YR, Budhathoki P, Adhikari A, Pokharel N, Dhakal R, Kafle S, Yadullahi Mir WA, Acharya R, Kashiouris MG, and Parker MS
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Background: An ever-increasing number of studies have reported an increased incidence of spontaneous pulmonary barotrauma such as pneumothorax, pneumomediastinum, and subcutaneous emphysema in patients with COVID-19. We conducted this systematic review and meta-analysis to assess the value and significance of the available data., Methods: A thorough systematic search was conducted to identify studies of barotrauma in hospitalized patients with COVID-19. Data analysis of case reports was done using a statistical package for the social sciences (SPSS) version 22, and meta-analysis was performed using CMA-3., Results: We identified a total of 4488 studies after thorough database searching.118 case reports and series, and 15 observational studies were included in the qualitative analysis. Fifteen studies were included in the quantitative analysis. The observational studies reported barotrauma in 4.2% (2.4-7.3%) among hospitalized patients; 15.6% (11-21.8%) among critically ill patients; and 18.4% (13-25.3%) in patients receiving invasive mechanical ventilation, showing a linear relationship of barotrauma with the severity of the disease. In addition, barotrauma was associated with a longer length of hospital stay, more extended ICU stay, and higher in-hospital mortality. Also, a slightly higher odds of barotrauma was seen in COVID-19 ARDS compared with non-COVID-19 ARDS., Conclusion: COVID-19 pneumonia is associated with a higher incidence of barotrauma. It presents unique challenges for invasive and non-invasive ventilation management. Further studies are required to unravel the underlying pathophysiology and develop safer management strategies., Competing Interests: The authors declare that they have no competing interests., (© 2022 The Authors.)
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- 2022
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12. Radical extrapleural pneumonectomy with bronchial fistula by pulmonary function test evaluation technique.
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Marzban-Rad S, Bozorgmehr R, Sattari P, Azimi G, and Azimi A
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Introduction: and importance: Pulmonary Function Tests (PFTS) is an important tool in the assessment of pulmonary pathologies and preoperative evaluation. Case presentation : A 54-year-old man with history of massive pleurisy in the left thorax, treated by placing chest tube and drainage of bloody effusion, was readmitted for epithelioid mesothelioma. He was then presented with pneumothorax due by a refractory bronchial fistula while having a plural catheter. Based on the consultation, the whole-body bone scan was conducted, and findings demonstrated epithelioid mesothelioma (stage 1) with the refractory fistula for which the patient was candidate for thoracic surgery. Decreased lung capacity was seen by Pulmonary Function Testing - PFTS., Clinical Discussion: The novel PFTS Evaluation Technique was designed to measure the true pulmonary capacities in order to evaluate the pulmonary post-operative tolerance. In this technique the chest tube was placed for 4 weeks until the patient reaches mediastinal fixation then the measurements by PFTS were carried out in two steps. First, using an open chest tube and second, using a clamped chest tube. In both steps, the pulmonary capacities were measured and provided to the pulmonologist for consultation., Conclusion: In this case, after acquiring the approval of the specialist depended on PFTS after PFTS Evaluation Technique, the radical extra pleural pneumonectomy surgery was conducted, and the patient was discharged with a good general appearance and treated fistula., Competing Interests: The authors deny any conflict of interest in any terms or by any means during the study., (© 2021 The Authors.)
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- 2021
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13. Survival and predictors of mortality among patients admitted to the intensive care units in southern Ethiopia: A multi-center cohort study.
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Abate SM, Assen S, Yinges M, and Basu B
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Background: The burden of life-threatening conditions requiring intensive care units has grown substantially in low-income countries related to an emerging pandemic, urbanization, and hospital expansion. The rate of ICU mortality varied from region to region in Ethiopia. However, the body of evidence on ICU mortality and its predictors is uncertain. This study was designed to investigate the pattern of disease and predictors of mortality in Southern Ethiopia., Methods: After obtaining ethical clearance from the Institutional Review Board (IRB), a multi-center cohort study was conducted among three teaching referral hospital ICUs in Ethiopia from June 2018 to May 2020. Five hundred and seventeen Adult ICU patients were selected. Data were entered in Statistical Package for Social Sciences version 22 and STATA version 16 for analysis. Descriptive statistics were run to see the overall distribution of the variables. Chi-square test and odds ratio were determined to identify the association between independent and dependent variables. Multivariate analysis was conducted to control possible confounders and identify independent predictors of ICU mortality., Results: The mean (±SD) of the patients admitted in ICU was 34.25(±5.25). The overall ICU mortality rate was 46.8%. The study identified different independent predictors of mortality. Patients with cardiac arrest were approximately 12 times more likely to die as compared to those who didn't, AOR = 11.9(95% CI:6.1 to 23.2)., Conclusion: The overall mortality rate in ICU was very high as compared to other studies in Ethiopia as well as globally which entails a rigorous activity from different stakeholders., Competing Interests: The authors declare that there are no competing interests., (© 2021 The Authors.)
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- 2021
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14. Indwelling catheters increase altered mental status and urinary tract infection risk: A retrospective Cohort Study.
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Fukushima T, Shoji K, Tanaka A, Aoyagi Y, Okui S, Sekiguchi M, Shiba A, Hiroe T, and Mio Y
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Background: Although indwelling urinary catheters (IUCs) are used intraoperatively and may cause complications ( e.g. , delirium), only few robust studies have investigated the association between intraoperative IUC use and complications. We hypothesized that IUC use might increase the postoperative incidence of altered mental status and/or urinary catheter infection., Materials and Methods: In this retrospective single-center cohort study, we analyzed the data of adult patients undergoing surgery at our facility between January 2013 and December 2018. The primary endpoint was altered mental status and/or incidence of urinary catheter infections. The patients were divided into IUC and control groups. A multivariable logistic regression model was used to identify the predictors of postoperative complications, and a multivariable Cox proportional hazards regression model was used to analyze hospital discharge in unmatched and inverse propensity-weighted patients., Results: Of the 14,284 patients that were reviewed, we analyzed 5112 patients (control group, 44.0%; IUC group, 56.0%). Almost all procedures comprised less invasive surgeries. The prevalence of postoperative altered mental status and postoperative urinary catheter infection were 3.56% and 0.04%, respectively. After inverse propensity weighting, all baseline characteristics were similar between the two groups. However, patients with IUCs had a higher risk of postoperative complications (adjusted odds ratio, 1.97; 95% confidence interval [CI], 1.50-2.59) and prolonged hospital stays (hazard ratio, 0.84; 95% CI, 0.80-0.89)., Conclusion: In patients undergoing less invasive surgery, IUCs may be associated with a relatively high risk of altered mental status or urinary catheter infection. These data may facilitate preoperative discussions regarding the perioperative use of IUCs., Competing Interests: The authors disclose no conflicts of interest., (© 2021 The Authors.)
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- 2021
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15. Liver transplantation in a patient with complete portal vein thrombosis, is there a surgical way out? A case report.
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Manzia TM, Fazzolari L, Manuelli M, Pellicciaro M, Baiocchi L, and Tisone G
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Introduction: Due to the complexity of the surgical procedure portal vein thrombosis (PVT) has long been considered an absolute contraindication to liver transplantation (LT). The presence of a large splenorenal shunt (SRS) could make portal anastomosis a valid option., Presentation of Case: We report the case of a 37-year-old female patient with Grade III PVT and a large SRS, who underwent orthotopic LT. Liver was implanted using a 1992-Belghiti piggyback technique and portal anastomosis was performed using the large spleno-renal shunt. We observed good graft reperfusion and postoperative Doppler ultrasound showed normal portal vein flow. She was discharged on postoperative day 7, with an excellent graft function. At six months follow-up, patient is alive with normal hepatic vascularization., Discussion: Due to paucity of reports, there is currently no consensus on the indication to LT and/or surgical technique. In the present case, once the transplant benefit was evaluated, the Grade III PVT was not considered a contraindication to LT., Conclusion: The presence of a Grade III PVT associated with a large SRS should not be considered a contraindication for LT, and the use of the shunt vein should be considered a feasible option to perform portal anastomosis.
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- 2016
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16. The use of finger-stick blood to assess lactate in critically ill surgical patients.
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Sabat J, Gould S, Gillego E, Hariprashad A, Wiest C, Almonte S, Lucido DJ, Gave A, Leitman IM, and Eiref SD
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Background: Using finger-stick capillary blood to assess lactate from the microcirculation may have utility in treating critically ill patients. Our goals were to determine how finger-stick capillary lactate correlates with arterial lactate levels in patients from the surgical intensive care unit, and to compare how capillary and arterial lactate trend over time in patients undergoing resuscitation for shock., Methods: Capillary whole blood specimens were obtained from finger-sticks using a lancet, and assessed for lactate via a handheld point-of-care device as part of an "investigational use only" study. Comparison was made to arterial blood specimens that were assessed for lactate by standard laboratory reference methods., Results: 40 patients (mean age 68, mean APACHEII 18, vasopressor use 62%) were included. The correlation between capillary and arterial lactate levels was 0.94 (p < 0.001). Capillary lactate measured slightly higher on average than paired arterial values, with a mean difference 0.99 mmol/L. In patients being resuscitated for septic and hemorrhagic shock, capillary and arterial lactate trended closely over time: rising, peaking, and falling in tandem. Clearance of capillary and arterial lactate mirrored clinical improvement, normalizing in all patients except two that expired., Conclusion: Finger-stick capillary lactate both correlates and trends closely with arterial lactate in critically ill surgical patients, undergoing resuscitation for shock.
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- 2016
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17. Early combined parenteral and enteral nutrition for pancreaticoduodenectomy - Retrospective cohort analysis.
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Probst P, Keller D, Steimer J, Gmür E, Haller A, Imoberdorf R, Rühlin M, Gelpke H, and Breitenstein S
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Background: Suggested guidelines for nutritional support after pancreaticoduodenectomy are still controversial. Recent evidence suggests that combining enteral nutrition (EN) with parenteral nutrition (PN) improves outcome. For ten years, patients have been treated with Early Combined Parenteral and Enteral Nutrition (ECPEN) after PD. The aim of this study was to report on rationale, safety, effectiveness and outcome associated with this method., Methods: Consecutive PD performed between 2003 and 2012 were analyzed retrospectively. Early EN and PN was standardized and started immediately after surgery. EN was increased to 40 ml/h (1 kcal/ml) over 24 h, while PN was supplemented based on a daily energy target of 25 kcal/kg. Standard enteral and parenteral products were used., Results: Sixty-nine patients were nutritionally supplemented according to ECPEN. The median coverage of kcal per patients related to the total caloric requirements during the entire hospitalization (nutrition balance) was 93.4% (range: 100%-69.3%). The nutritional balance in patients with needle catheter jejunostomy (NCJ) was significantly higher than in the group with nasojejunal tube (97.1% vs. 91.6%; p < 0.0001). Mortality rate was 5.8%, while major complications (Clavien-Dindo 3-5) occurred in 21.7% of patients. Neither the presence of preoperative malnutrition nor the application of preoperative immunonutrition was associated with postoperative clinical outcome., Conclusion: This is the first European study of ECPEN after PD. ECPEN is safe and, especially in combination with NCJ, provides comprehensive coverage of caloric requirements during the postoperative phase. Clinical controlled trials are needed to investigate potential benefits of complete energy supplementation during the early postoperative phase after PD.
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- 2016
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