ABSTRACT
Background:There is scarcity of essential medications, medical talent and health care facilities to treat covid-19, at remote places. This studyexplores various modalities in resource-limited settings for the management of COVID-19 patients.Methods: We retrospectively analysed data of 266 consecutive discharged and death Covid-19 patients from 26December 2020 to 29May 2021. All patients were admitted and received appropriate supportive care, regular clinical and laboratory monitoring.Results: Of total 266 patients the mean age of patients was 49.19 (SD 14.1) years and 185(69.54%) of them were males. 99(37%)cases were moderate, 83(31%)were severe cases remaining 84(32%)were mild cases. 16 (6.01%) patients expired and remaining 250 patients were subsequently discharged.Median duration of stay in the hospital was 9 (37) days. Of total 266 admitted patients� mortality rate was only 6.01%.Conclusions: We emphasize that even in healthcare facilities with limited resource, poor infrastructure and lack of ICU facilities, clinical observation-based managementt can help to reduce mortality considerably. Unique features of our study include; use of progesterone as an immunomodulator, use of dual antiviral agents, use of age-related lower limit of oxygen saturation.
ABSTRACT
Abstract Pelvic fractures occur in up to 25% of all severely injured trauma patients and its mortality is markedly high despite advances in resuscitation and modernization of surgical techniques due to its inherent blood loss and associated extra-pelvic injuries. Pelvic ring volume increases significantly from fractures and/or ligament disruptions which precludes its inherent ability to self-tamponade resulting in accumulation of hemorrhage in the retroperitoneal space which inevitably leads to hemodynamic instability and the lethal diamond. Pelvic hemorrhage is mainly venous (80%) from the pre-sacral/pre-peritoneal plexus and the remaining 20% is of arterial origin (branches of the internal iliac artery). This reality can be altered via a sequential management approach that is tailored to the specific reality of the treating facility which involves a collaborative effort between orthopedic, trauma and intensive care surgeons. We propose two different management algorithms that specifically address the availability of qualified staff and existing infrastructure: one for the fully equipped trauma center and another for the very common limited resource center.
Resumen Las fracturas de pelvis ocurren en más del 25% de los pacientes con trauma severo y su mortalidad es alta, a pesar de los avances en la resucitación hemodinámica y las técnicas quirúrgicas. Esta mortalidad se explica por la hemorragia inherente y las lesiones extra pélvicas asociadas, las fracturas o las disrupciones ligamentarias de la pelvis aumentan el volumen del espacio pélvico, y conlleva a que la hemorragia pélvica se acumule en el espacio retroperitoneal. En poco tiempo, esto conduce a la inestabilidad hemodinámica y el rombo de la muerte. La hemorragia pélvica es un 80% venosa proveniente de los plexos pre-sacro / pre-peritoneal. El restante 20% es arterial por sangrado de las ramas de la arteria iliaca interna. Esta realidad podría ser cambiada a través de un manejo secuencial enfocado según la disposición de recursos del centro de atención y de un trabajo colaborativo entre ortopedistas, cirujanos de trauma e intensivistas. Este articulo propone dos algoritmos de manejo que están enfocados según la disponibilidad de un equipo calificado e infraestructura existente: uno para un centro de trauma totalmente equipado, y el otro para un centro con recursos limitados.