Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality / 대한뇌졸중학회지

Background@#and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. @*Methods@#We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). @*Results@#There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. @*Conclusions@#During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

Aneurysmal subarachnoid hemorrhage: outcome of aneurysm clipping versus coiling in anterior circulation aneurysm

Objective: To compare the neurological outcome of microsurgical clipping versus coiling in patients with anterior circulation aneurysm

Study Design: Comparative study

Place and Duration of Study: Department of Neurosurgery, Lahore General Hospital, Lahore, from January 2010 to December 2013

Methodology: Patients aged 14 - 60 years, with ruptured cerebral aneurysm of anterior circulation and World Federation of Neurosurgical Society [WFNS] grades 1, 2 and 3 were included. Patients more than 60 years, medically unfit patient and posterior circulation aneurysms and WFNS grades 4 and 5 were excluded. Aneurysm sac obliteration was done in randomized manner with microsurgical clipping or coiling. Postoperatively, the patients were assessed and followed-up upto one year for outcome parameters on the bases of WFNS grade and Modified Ranking Scale [mRS] as favourable [mRS 2]

Results: Among 140 subjects selected for study, 70 were included in group A, i.e. coiling and other 70 were in group B, i.e. clipping. The median age of patients in group A was 52.5 +/- 10 years and in group B was 51.00 +/- 10 years. Overall, 56 [40%] males, 28 [60%] males in each group; and 84 [60%] females, 42 [60%] in each group were included. The male to female ratio in this study was 1:1.5. In group A, i.e. coiling, 27 [38.6%] patients had no disability [grades 1 and 2], 25 [35.7%] were slightly disabled [grade 3] and 18 [25.7%] had moderate disability [grade 4]; whereas in group B, i.e. clipping group 23 [32.9%] patients had no disability [grades 1 and 2], 23 [32.9%] were slightly disabled [grade 3] and 24 [34.3%] had moderate disability [grade 4]. At one year follow-up, in group A, favourable outcome was achieved in 56 [80%] of patients compared to 48 [68.6%] in group B; whilst, 14 [20%] patients in group A and 22 [33.1%] in group B showed unfavourable outcome. Although mortality rate was higher in clipping [n=3, 4.3%] as compared to coiling [n=1, 1.4%], but was not statistically significant [p = 0.310]

Conclusion: Endovascular coiling of anterior circulation aneurysms is safe and as effective and successful as aneurysm clipping and is less invasive also

Skin closure in laparotomy; delayed versus primary closure performed for generalized peritonitis

The aim of this study was to record the outcome of healing in laparotomy wounds, managed by delayed versus primary skin closure in terms of hospital stay, major and minor wound infection. Quasi experimental study from September, 2006 to March, 2007. Surgical floor of Allied Hospital, [Punjab Medical College] Faisalabad. Detailed data of each patient including presentation, operative findings, procedure performed, post operative outcome was entered on a specially designed proforma. The main outcome measures found significant were major and minor wound infection, time of presentation and advancing age and hospital stay. Sixty patients underwent exploratory laparotomy through vertical abdominal incision during Sep.2006 to Mar.2007. Skin wound of the first thirty patients [group A] were left open and closed on 4th day while that of next thirty patients [group B] closed primarily. Out of sixty patients ten patients developed major wound infection leading to wound dehiscence [16.66%]. Four belonged to group A [13.33%] and six belonged to group B[20%] [p<0.05]. In advancing age the infection rate was significantly high in the same group [p<0.01]. Regarding hospital stay of patients of two groups the difference was statistically significant. Group A [mean=7.77, std. dev=2.029 and std. error of mean=0.370]. Group B [mean=10.30, std. dev=4.822 and std. error of mean=0.880]. Regarding age the difference was not statistically significant between two groups. Group A [mean 30.47, std. dev=10.099 and std error of mean=1.844]. The data was analyzed using SPSS 17 Chi-square test was used to test the significance between qualitative variable, p<0.05 was considered significance. No matter how advanced new wound closure techniques are, wound infection is the single most important factor for wound dehiscence and it can be decreased by using delayed skin closure technique and meticulous post-operative monitoring and care

Thyroid surgery complications: frequency of thyroid surgery complications and its association to the extent of procedure

Objectives: To Determine the frequency of thyroid surgery complications and its Association to the extent of procedure

Study Design: Cross sectional comparative study

Setting: Surgical and Radiological Department of District Head Quarters [DHQ] Hospital, Madina Teaching Hospital [MTH] and Allied Hospital Faisalabad

Duration: From December 2007 to December 2009

Subjects: 90 patients admitted with goiter due to benign diseases

Methods: In Group A, 30 patients underwent unilateral lobectomy. In Group B surgical procedure was Total Thyroidectomy. In Group C patients underwent Subtotal Thyroidectomy. Post operative complications were noted in each group and all three groups were compared

Results: we compared different complications like hemorrhage, respiratory distress, thyroid storm, and hypocalcaemia, injury to recurrent laryngeal or external laryngeal nerves or to cervical sympathetic chain, wound infection, and recurrence of goiter and hypocalcaemia. After excluding hypothyroidism as complication, [as all the patients in group B developed a hypothyroidism], in group A, one patient developed fore mentioned complications and in group B, ten patients developed complications. In group C complications noted in three patients were more as compared to group A but less as compared to group B

Conclusion: More extensive procedures are associated with greater number of complications in thyroid surgery

Enteric ileal perforation primary repair versus loop ileostomy

Objectives: The aim of this study was to record the outcome of enteric ileal perforation, managed by primary repair versus ileostomy in terms of post-operative complications, mortality rate and hospital stay

Design and Duration: Quasi experimental study from January, 2009 to August, 2010

Setting: Surgical Unit-V, District Headquarters [Teaching] Hospital, Punjab Medical College, Faisalabad

Methodology: During the period of study 46 patients of enteric ileal perforation were divided in two groups on consecutive sampling basis. Detailed data of each patient including presentation, operative findings, procedures performed, post-operative outcome and histopathology was entered on a specially designed proforma. The main outcome measures found significant were post-operative complications, hospital stay and mortality rate. The data was compiled and analyzed by using SPSS-1B

Results: 46 Patients of enteric ileal perforation were studied during the period of 20 months, divided equally in 2 groups, Group A [loop ileostomy] and Group B [primary repair]. An increased rate of post-operative complications was seen in Group B [primary repair] when compared with Group A [loop ileostomy] with 21.74% patients landed up in peritonitis secondary to leakage from primary repair and 17.39% ended up with controlled feacal fistula formation. Mortality rate was twice higher in Group B [primary repair] when compared with Group A [loop ileostomy]. A ratio of 1:2.75 days was observed between hospital stay of Group A [loop ileostomy] to Group B [primary repair]

Conclusion: Enteric ileal perforation still represents a disastrous complication of enteric fever and constitutes a good number of patients presenting in surgical emergency with acute abdomen. Exteriorization of perforation in the form of loop ileostomy is more appropriate option for such patients as compared to primary repair of the perforation when compared in terms of postoperative complications, hospital stay and mortality rate

Incidence of abdominal tuberculosis in 186 cases of acute abdomen presenting in our surgical emergency department

Among 186 cases of Acute Abdomen, determining the frequency of abdominal tuberculosis patients with their outcome. A prospective case study from January, 2009 to June 2010. Surgical Unit-V District Headquarters [Teaching] Hospital, Faisalabad. Detailed data of each patient including presentation, operative findings, procedure performed, post operative outcome and histopathology was entered on a specially designed Performa, compiled and analyzed. During the period of study, 186 patients presented in the surgical emergency with complaints of acute abdomen out of which 54 [29.03%] were of abdominal tuberculosis. Mean age of presentation was 27.3 years. Operative findings showed predominance of ileocaecal hypertrophic tuberculosis [tuberculous mass] in 18 [33.33%] patients, followed by tuberculous adhesions, ileal strictures and plastic gut.The surgical procedures were performed according to their intra-abdominal findings out of which right hemicolectomy with ileocolic end to end anastomosis in 18 [33.33%] patients remained the commenest procedure performed followed by segmental ileal resection anastomosis, ileostomy and stricturoplasty. 20 [37.04%] patients reported to have post-operative complications in which wound infection in 7 [12.96%] remained the highest occurring postoperative complication followed by intra-abdominal collection, anastomotic leakage and septicemia. Mortality rate among the patients of abdominal tuberculosis in this study remained 5.56%. Complicated abdominal tuberculosis is the most common pathology of acute abdomen. By proper management of pre-complicated abdominal tuberculosis, this disastrous stage of disease resulting in so morbidity and mortality can be reduced

Patterns of presentation, surgical management and outcome of patients with degloving injures

To describe the patterns of degloving injuries and to identify the outcome of different management techniques in patients with degloving injuries in patients presenting at Allied and Divisional headquarters hospital, Faisalabad. Prospective case study from January, 2008 to July 2008. Surgical floor of Allied and District Headquarters [Teaching] Hospitals, Faisalabad. Detailed data of each patient including presentation, operative findings, procedure performed, post operative outcome was entered on a specially designed Proforma, compiled and analyzed by using SPSS. Between February 2008 and July 2008, a total of 50 patients were included in the study. The etiological factors were road traffic accidents in 78% [39 patients], rotatory machine accidents 16% [8 patients] and domestic trauma in the remaining 6% [3 patients]. Degloving injury more commonly occurred in the lower limb 44% [22 patients], upper limb 16% [8 patients], scalp 22% [11 patients], penoscrotal 10% [5 patients] and miscellaneous group 8% [4 patient]. Associated skeletal fracture was seen in 3 [6%] patients. With increasing road traffic accidents, there is a marked increase in patients presenting to emergency department with degloving injuries. Early recognition and well planned surgical approach is all it takes to prevent complications and salvage a limb

Diagnostic value of transcranial doppler in the vasospasm secondary to middle cerebral artery aneurysmal haemorrhage

This study highlights the importance of transcranial dopper [TCD] study in suspected middle cerebral artery aneurysmal subarachnoid hemorrhage. Eight middle aged patients of either sex presented with acute history of severe headache to our department for Neuroradiological investigations. The TCD study on middle cerebral artery [MCA] was positive in all the cases, suggestive of vasospasm. In seven cases CT Scan brain and cerebral angiography showed middle cerebral aretery aneurysm with its segmental narrowing suggestive of vasospasm. In one, case neither CT scan nor cerebral angiography fully confirmed the middle cerebral artery aneurysm where as surgery correlated the TCD findings of vasospasm secondary to aneurysmal bleed. The TCD is an ideal and inexpensive method in suspected middle cerebral artery aneurysmal subarachnoid hemorrhage to have clue of the aneurysm and also to monitor vasospasm which may help in proper management