ABSTRACT
Introduction: Patients with congenital bleeding disorders (CBD) have an increased bleeding tendency, which varies according to the factor deficiency and severity. In most cases, prolonged bleeding is observed after trauma, surgery and/or invasive procedures. Haemostatic treatment is needed to prevent bleeding complications and allow a good clinical outcome. Our aim is to evaluate the management of patients with CBD in minor procedures. Method(s): Retrospective study of patients with CBD who performed minor procedures over a 7-year period, through review of clinical files. Result(s): Between January 2015 and December 2021, 249 minor procedures were performed in 113 patients with CBD: 42 had diagnosis of Haemophilia A (HA) (15 severe without inhibitors;3 severe with inhibitors;4 moderate and 20 mild);12 had Haemophilia B (HB) (7 severe without inhibitors;2 moderate and 3 mild);5 were carriers of HA and 2 of HB. 35 had von Willebrand disease (VWD);15 had rare bleeding disorders (8 FVII deficiency;6 FXI deficiency;1 FX deficiency) and 2 had diagnosis of inherited platelet glycoprotein deficiencies (1 Glanzmann thrombasthenia and 1 Bernard Soulier syndrome). Most procedures were dental treatments (189);synoviorthesis/ infiltration/mesotherapy (17);endoscopies and colonoscopies (15);skin lesions excision (8);COVID-19 vaccination (5);sebaceous cyst excision (4);cardiac catheterization (3);ureteral stent removal (3);bone marrow biopsy (2);cystoscopy (2) and breast fibroadenoma excision (1). Prophylactic treatment was performed in 237 (95%) of the procedures, respectively FVIII concentrate factor (59);FIX concentrate factor (27);DDAVP (66);von Willebrand factor/factor VIII concentrates (44);bypassing agents (24);platelet (6);inactivated human plasma (9);tranexamic acid (47) and epsilon-aminocaproic acid (161). No side effects were reported. Discussion/Conclusion: Most patients that underwent minor procedures had Haemophilia and VDW(83%). The most common procedure was dental treatment (76%). Patients with CBD require attention and special care in dental practice. The haemostatic prophylactic treatment varies according to the specific haemostatic defect, severity and type of procedure. The treatment performed has been demonstrated safe and effective, with low incidences of haemorrhagic and treatment-related complications. These patients' treatment requires multidisciplinary teams and reference centres.
ABSTRACT
Background: In 2020, colorectal cancer (CRC) was the most diagnosed cancer and the 2nd leading cause of cancer related mortality in Portugal. Early detection and adequate treatment lead to improvements in mortality. Increasing participation in screening programs has been challenging and health authorities in Portugal reported that in 2018 only 40% of the target population had an up-to-date screening status. Not only screening but also access to specialized consultation and surgery seem to preclude timely treatment. The year 2020 brought forth another challenge as the SARS-CoV2 pandemic halted screening efforts and discouraged patients from seeking healthcare. We hypothesized that under these conditions an increase in colorectal obstruction and more advanced staging at diagnosis would be observed. Materials and Methods: We retrospectively identified the consecutive cases of malignant colorectal obstruction (MCO) that presented to the emergency department and demanded emergent surgery between January 1st 2017 and March 1st 2021. Recruitment was performed by reviewing operating room logbooks and electronic patient records. A total of 226 patients operated for colorectal obstruction were identified. Patients with benign disease or non-digestive primary were excluded and the 161 remaining cases were reviewed. Results: Median age of patients 72(29-97) years and female to male ratio of 1:1.3. Statistical analysis of complete years (2017-2020) observed an overall average of 39(±8.4) cases/year with no clear increasing trend. Previous CRC diagnosis had been established in 20.0%, 28.9%, 37.3% and 31.3% of cases in 2017, 2018, 2019 and 2020 respectively. Stage III or higher at pathological diagnosis was increasingly more frequent (62.9%, 76.3%, 76.5%, 81.3 %) but M status remained stable at an average of 42.7(±5.9)%. Surgical approach did not vary and in an average of 33.6(±2.7)% of patients, derivative surgery alone was indicated (palliation or bridge to therapy) and in 72.4(±1.0)% of patients, resection with ostomy was performed. Conclusions: The descriptive nature of this analysis hinders the accuracy of its conclusions but offers some insights. The incidence of MCO did not seem to vary, however our selection is biased as patients may have searched for emergent care in other hospitals. In the patients that evolve to obstruction, the delay in screening and treatment implementation seem to result in an increase in stage at surgery dependent on lymph node status as metastatic disease remained stable. It seems early to observe the effect of the pandemic on timely diagnosis and treatment, but it seems it contributed for a higher staging at diagnosis. It is possible we would find a similar effect on non-obstructive cases rather than an increase in MCO. A larger scope and prospective recruitment seem key to capturing this difference in outcomes.
ABSTRACT
OBJECTIVE: To compare the activity the Urology Department of a Portuguese Academic Hospital during the state of emergency and the equivalent period at the previous year. We compared the number of elective consultations and diagnostic urologic examinations, number and type of elective surgeries, as well as patients' demographic characteristics and main causes of presentation to Urology Emergency Department (ED) during the two mentioned periods MATERIALS AND METHODS: Data from 691 patients coming to emergency department were collected from institutional clinical software from March 18 th 2020 to May 2 nd 2020 - and from the same period the previous year. Data collected were age, sex, day of the presentation to Emergency Department, referral from other hospitals, triage color, reason of admission, diagnosis of discharge, and the need for emergency surgery or hospitalization. In order to identify associations between demographic and clinical variables with having been submitted to an emergency surgery (outcome), logistic regression models were applied. RESULTS: Multivariable analysis showed an association of sex with being submitted to surgery, 65.6% decrease in the odds for the male gender. The period (COVID versus non-COVID) did not show a significant association with surgery. CONCLUSION: Our department experienced a noticeable activity reduction. We also observe a reduction in urgent causes to attend the ED considered less serious. The percentage of cases requiring emergency surgery and hospitalization was higher during COVID-period.