Outcome of selective CT vs. pan-CT scan in elderly trauma patients: A retrospective cohort study in a level 1 trauma center / 中华创伤杂志(英文版)

PURPOSE@#There are currently no clear guidelines for use of pan- or selective CT in elderly trauma patients and this subject matter remains controversial. The aim of this study is to compare the outcome of elderly trauma patients in a level 1 trauma centre who required a pan- or selective CT scan on admission.@*METHODS@#The Trauma Audit Research Network database was reviewed to identify eligible patients (≥65 years) over a one-year period, from January 2018 to January 2019. Patients' demographics, mechanism of injury, injury severity score, length of hospital stay (LOS), mortality and type of CT scans done were recorded. The inclusion criteria were elderly patients ≥65 years involved in acute trauma setting (less than one day between incident and emergency department presentation and blunt mechanism of injury). Exclusion criteria were patients 60 days in pan-CT group compared to 64% in selective CT group (p < 0.0001). Performing pan-CT was also associated with lower need to repeat CT (p < 0.01). In patients with a single system injury, no differences were found in LOS or the need to repeat CT if either pan-CT or selective CT were requested.@*CONCLUSION@#We recommend doing pan-CT scan in all elderly patients with multiple system injuries as it decreases the LOS and the need for another CT during hospital stay. No difference in LOS or the need to repeat another CT if pan-CT or selective CT were requested initially in single system injuries. Although age and injury severity score are poor predictors for the need to do pan-CT, the mechanism of injury may be helpful.

Free radical scavenging activity of three different flowers-Hibiscus rosa-sinensis, Quisqualis indica and Senna surattensis

Objective To evaluate three flowers of Hibiscus rosa-sinensis (H. rosa-sinensis), Quisqualis indica (Q. indica) and Senna surattensis (S. surattensis) for their antioxidant activity by different methods in addition to total phenolic, flavonoid and pigment contents. Methods Antioxidant activity of water, ethanol and absolute ethanol extracts of three flowers; H. rosa-sinensis, Q. indica and S. surattensis was evaluated. The antioxidant activity was assessed by 1,1-diphenyl-2-picrylhydrazyl free radical scavenging activity, ferrous chelating activity, reducing power, nitric oxide scavenging activity, hydroxyl radical scavenging activity as well as total antioxidant capacity. Total flavonoids, total phenols and total pigments including chlorophylls and carotenoids were measured for the three flowers. Results The results showed that the highest total antioxidant capacity at concentration of 500 mg/L was found in S. surattensis as 0.479 ± 0.001. Scavenging activity of H. rosa-sinensis, Q. indica and S. surattensis flower extracts against 1,1-diphenyl-2-picrylhydrazyl radical showed the highest activity of (90.20 ± 0.29)% with 500 mg/L. Phytochemical screening of the three flowers extracts were carried out for alkaloids, flavonoids, saponins, tannins, steroids, glycosides, terpenoids, amino acid and mucilages. H. rosa-sinensis showed the total phenolic in water extract of (235.77 ± 14.31) mg/100 g, the other two flowers Q. indica and S. surattensis had the total phenolic in ethanol extracts of (937.70 ± 25.06) and (850.30 ± 13.81) mg/100 g, respectively. On the other hand total flavonoids were identified in absolute ethanol extracts in the three flowers [(32.83 ± 1.34), (49.24 ± 4.87) and (2.79 ± 0.23) mg/100 g, respectively]. Conclusions The extracts in the constituents of the three flowers could be used as additives as supplement fractions in foods.

Role of water soluble contrast agents in assigning patients to a non-operative course in adhesive small bowel obstruction

Adhesive small bowel obstruction [SBO] is a common surgical emergency. It is estimated that at least 60% of SBO are due to post-operative adhesions. Water soluble contrast agents [gastrografin] have been used to identify patients who might be treated non-operatively. This study aims to determine the role of gastrografin in adhesive intestinal obstruction patients. In this prospective study, 27 patients admitted between 1[st] August 2004 and 1[st] July 2006 with clinical signs suggestive of postoperative adhesive SBO met the inclusion criteria. After intravenous hydration, nasogastric tube insertion and complete suctioning of the gastric fluid, 100 ml of gastrograsfin was given and plain abdominal radiography was taken 6 hours and 24 hours if the contrast is not seen in the colon. Those in whom the contrast reached the colon in 24 hours were considered to have partial SBO and started oral intake. If gastrografin failed to reach the colon in 24 hours and the patient did not improve in the following 24 hours, laparotomy was performed. Conservative treatment was successful in 31 cases [91%] and 3 [9%] required operation. Patients treated conservatively had short hospital stay [mean=4 days] and tolerated oral feeding with no morbidity or mortality. Oral gastrografin helps in the management of patients with postoperative adhesive SBO

Recurrence of hepatitis C virus genotype-4 infection following orthotopic liver transplantation: natural history and predictors of outcome

There are few reports on hepatitis C virus genotype 4 [HCV-4] recurrences after orthotopic liver transplantation [OLT]. Therefore, we undertook a study to determine the epidemiological, clinical and virological characteristics of patients with biopsy-proven recurrent HCV infection and analyzed the factors that influence recurrent disease severity. We also compared disease recurrence and outcomes between HCV-4 and other genotypes. All patients who underwent OLT [locally or abroad] for HCV related hepatic cir-rhosis from 1991 to 2006 and had recurrent HCV infection were identified. Clinical, laboratory and pathological data before and after OLT were collected and analyzed. Of 116 patients who underwent OLT for hepatitis C, 46 [39.7%] patients satisfied the criteria of recur-rent hepatitis C. Twenty-nine [63%] patients were infected with HCV genotype 4. Mean [SD] for age was 54.9 [10.9] years. Nineteen of the HCV genotype 4 patients [65.5%] were males, 21 [72.4%] received deceased donor grafts, and 7 [24.1%] developed >1 acute rejection episodes. Pathologically, 7 [24.1%] and 4 [13.8%] patients had inflammation grade 3-4 and fibrosis stage 3-4, respectively. Follow-up biopsy in 9 [31%] HCV genotype 4 patients showed stable, worse and improved fibrosis stage in 5, 2 and 2 patients, respectively. Of the 7 patients in the recurrent HCV group who died, 6 were infected with genotype 4 and 4 of them died of HCV-related disease. This analysis suggests that HCV recurrence following OLT in HCV-4 patients is not significantly different from its recurrence for other genotypes

Intravitreal triamcinolone for the management of macular edema due to branch vein occlusion

To evaluate the efficacy of intravitreal triamcinolone acetonide in the management of persistent macular edema secondary to branch vein occlusion. 10 consecutive patient were selected with 3 - to 4 month history and persistent macular edema. These patients received a single intravitreal injection of 4 mg of triamcinolone acetonide [40 mg/ml]. The control group including 12 patients did not receive an intravitreal iunjection. The mean follow-up was 8-12 months. A single intravitreal injection of triamcinolone showed significant improvement in the visual acuity [P=0.005], with clinical and angiographic resolution of macular edema in 6 patients [60%] of the 10 patients in the treated group, while only 4 [33.3%] of the 12 patients in the observation group. A single intravitreal injection of triamcinolone acetonide can increased in terms of visual acuity and macular edema for non-ischemic branch vein occlusion