Search

Yassin Abdelrahim Abdalla,1 Arwa Mustafa Kamil,2 Samya Abbas Abdelrazig Mohamed,3 Ahmed Hashim Ahmed Mohamed,4 Eman Khalifa,5 Mohamed Hamid Abdelsalam Mohamed,2 Eilaf Eltayeb Abdalla Abdelgadir,6 Muawiya Dabora,7 Mohammed Salah Eldin Mohammed Elshikh Awoda8 1Internal Medicine Department, Faculty of Medicine and Health Science, Omdurman Islamic University, Khartoum, Sudan; 2MBBS, Alzaiem Alazhari University, Khartoum, Sudan; 3MBBS, Al Gezira University, Wadmedani, Sudan; 4MBBS, National Ribat University, Khartoum, Sudan; 5MBBS, University of Khartoum, Khartoum, Sudan; 6MBBS, Alneelain University, Khartoum, Sudan; 7Department of Surgery, Alshuhada Teaching Hospital, Khrtoum, Sudan; 8Surgery Department, National Ribat University, Khartoum, SudanCorrespondence: Yassin Abdelrahim Abdalla, Email yasinabdo96@gmail.comBackground: Hospital-acquired thrombosis (HAT) is associated with significant morbidity, mortality, and financial burden globally. Following trusted guidelines for VTE prevention has shown effective, safe, and satisfactory results. This prompts national collaborative efforts to maintain a consensus approach for the safe risk assessment of inpatients and the prescription of thromboprophylaxis.Objective: This study aimed to detect and estimate deviations from international thromboprophylaxis protocols. The study also aimed to raise the quality of practice and adherence to evidence-based protocols in Alshuhada Teaching Hospital.Methods: A cross-sectional audit of general surgical inpatients was performed from October 2021 to May 2022. The first cycle was from 1/10/2021 to 21/10/2021, and the second cycle was from 13/5/2022 to 31/5/2022. The target population was adults aged > 18 years. Data were collected via an online checklist on two separate occasions. The criteria were based on the NICE guideline for venous thromboembolism in individuals aged over 16 years: “Reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism NG89”.Results: Forty-five surgical inpatients were included in this study: 20 in the first cycle and 25 in the second cycle. The first-cycle report showed that only 25% of VTE candidates received this regimen. In the second cycle, practice significantly improved, with 92% of admitted patients having their risk assessment tool completed within 24 h of admission. 79% of VTE prophylaxis candidates were prescribed adequate pharmacological prophylaxis within 14 h of admission.Conclusion: The rate of adequate thromboprophylaxis for inpatients undergoing surgery was very low before clinicians received education on VTE prevention, whereas was evidently high after they had received them. The cause of non-adherence in the pre-intervention phase was a lack of adequate knowledge regarding the magnitude and burden of HAT and the importance of thromboprophylaxis, which has a potential role in preventing the majority of HAT.Keywords: hospital acquired thrombosis, deep vein thrombosis, pulmonary embolism, venous thromboembolism

Background: Synovial sarcoma (SyS) is a rare malignancy that is typically located on the limbs and occurs predominantly in adolescents. A study in a large population for SyS comparing subtypes has not yet been reported. Methods: National Cancer Institute’s Surveillance, Epidemiology, and End Results database was queried for patients diagnosed with SyS between January 1975 and December 2016. Patients were classified demographically according to gender, age, race/ethnicity, and marital status, and they were also classified by tumors, subtypes, localization, grade, year of diagnosis, laterality, type of treatment, and follow-up results. Results: A total of 3228 patients were included, with a mean age of 39.3 ± 18.8 (range: 1–94), of which 1521 (47.1%) were females and 1707 (52.9%) were males. According to its subtypes, 47.2% were SyS not otherwise specified, 32.3% were spindle cell, 19.9% were biphasic, and 0.6% were epithelioid type. The overall survival period is 138.0 (95% confidence interval: 113.2–162.8) months. Survival duration was found to be significantly different between groups according to gender (log-rank test; p < 0.001), age groups (log-rank test; p < 0.001), race (log-rank test; p = 0.001), marital status (log-rank test; p < 0.001), tumor subtypes (log-rank test; p < 0.001), tumor location (log-rank test; p < 0.001), tumor laterality (log-rank test; p < 0.001), date of diagnosis (log-rank test; p = 0.025), tumor grade (log-rank test; p < 0.001), historic stage (log-rank test; p < 0.001), state of chemotherapy (log-rank test; p < 0.001), state of radiotherapy (log-rank test; p < 0.001), presence of metastasis (log-rank test; p < 0.001), and total number of malignant tumors (log-rank test; p < 0.001). Conclusion: Male gender, being colored individual, being over 35 years at the time of diagnosis, epithelioid type, non-head and neck region localization is associated with poor prognosis. While radiotherapy improves survival, benefit of chemotherapy is unclear. Level of Evidence: III retrospective analysis.

Introduction: The Coronavirus-19 (COVID-19) pandemic has led to a 50-70% reduction in acute non-COVID-19 presentations to emergency departments globally., Aim: To determine the impact of COVID-19 on incidence, severity, and outcomes of acute surgical admissions in an Irish University teaching hospital., Methods: Descriptive data concerning patients presenting with acute appendicitis, diverticulitis, and cholecystitis were analysed and compared from March-May 2020 to March-May 2019., Results: Acute surgical admissions decreased in March from 191 (2020) to 55 (2019) (55%), before increasing by 28% in April (2019: 119, 2020: 153). Admissions due to acute cholecystitis reduced by 33% (2019: 33, 2020: 22), with increased severity at presentation (P = 0.079) and higher 30-day readmission rates (P = 0.056) reported. Acute appendicitis presentations decreased by 44% (2019: 78, 2020: 43, P = 0.019), with an increase in severity (P < 0.001), conservative management (P < 0.001), and post-operative complications (P = 0.029) in 2020 compared to the same period in 2019., Conclusion: COVID-19 has potentiated a significant reduction in acute surgical presentations to our hospital. Patients presenting with acute appendicitis during the pandemic had more severe disease, were more likely to have complications, and were significantly more likely to be managed conservatively when compared to historical data., (© 2021. The Author(s).)