ABSTRACT
In this case report, a 75-year-old unvaccinated female patient presented with hypoxaemia, and she was admitted to an intensive care unit. After four days her left hand was discoloured blue, and fibrin D-dimer was elevated. An angiogram showed occlusion in the arteria radialis at the level of the bifurcature. Thrombolysis had no effect, and the patient's left arm was amputated above elbow level. COVID-19 is still a present problem worldwide, and it is important to be alert and aware of the risk of serious thromboembolic complications when treating unvaccinated patients.
ABSTRACT
Aim: A comparative analysis of short term outcome of colorectal resections undertaken before and during COVID-19 pandemic. Method(s): A retrospective analysis of prospective database of colorectal cancer resections pre and post COVID-19 (2019 vs 2020) in a DGH. The cohort had 106 patients (60 in 2019;46 in 2020). Outcome parameters analysed were, Length of stay (LOS), stoma formation, resection margin, Clavien-dindo classification of complications, 30 day re-admission rate and 30 day mortality. Demographic data included age, gender and type of resection Results: A total of 60 resections were performed in 2019, 53% being female and median age 68 years In 2020 there were 46 resections, median age 70.5yrs and 43% female. In 2019 15/60 (25%) of resections were performed as an emergency and in 2020 10/46 (22%) (P = 0.65). Median LOS was 8 days in 2019 and 7 in 2020 (P = 0.25). 5/60 patients were readmitted within 30days in 2019 and 9/46 in 2020 (P = 0.045*). In both arms 30 day mortality was 0. In 2019 8 patients suffered Clavien-dindo complications rated at 2 or greater and 11 in 2020 (P = 0.08). Stomas were formed in 26/60 in 2019 and 28/46 in 2020 (P = 0.037*). Finally in 2019 7/60 resections had R1 resection and 4/46 in 2020 (P = 0.62). Conclusion(s): The analysis found no signifcant difference in short term outcome of the two periods including length of stay or days in ICU. Comparatively little statistical difference was found between the two years despite COVID-19. The only parameters notably different were the stoma rate rising from 43% to 61%, and 30 day readmission rate increasing from 8% to 20%. This data-set is too small to infer if problems related to stoma care were responsible. This analysis would suggest that there was not a significant difference in occupancy of ICU beds despite increasing stoma formation at a local level. Many of these patients will need reversal and the pandemic is likely to continue, therefore should stomas be formed as readily? Larger multicentre audit may validate such observations.
ABSTRACT
PURPOSE: In low and middle-income countries, mechanical ventilators or commercially available devices used to offer continuous positive airway pressure are not readily affordable and available. In Ghana, nearly 10% of critically ill patients presenting to the emergency department require ventilator support. DESCRIPTION: We designed, built, and tested a simple expiratory positive airway pressure (EPAP) device to provide adult respiratory support in low resource environments with or without supplemental oxygen and without the need for electricity. EVALUATION: Laboratory tests demonstrated that the device is capable of delivering EPAP at levels expected to provide significant assistance to some patients. We present the first 2 cases where the use of this simple EPAP device provided critical respiratory support during weaning of patients from mechanical ventilation. CONCLUSIONS: A low-cost 3-dimensional printable adult respiratory support device could provide substantial benefit to patients suffering from respiratory distress through the delivery of appropriate levels of EPAP in a low-resource setting with limited infrastructure. Further clinical validation is needed for broader application in low-resource settings.