ABSTRACT
Background and objective Studies assessing the incidence of venous thromboembolic (VTE) events in the setting of massive balanced transfusions and/or tranexamic acid (TXA) infusion have yielded varied outcomes. In light of this, we conducted this study to examine the incidence of VTEs in trauma patients requiring blood products, and to identify the risk factors for VTE and mortality in this population. Methods We performed a retrospective analysis of trauma patients admitted to our level 1 trauma center from January 2013 to September 2023. Clinical characteristics were compared between patients who developed VTE and those who did not. A regression analysis of potential variables associated with the development of VTEs and mortality was performed. Results Among 1305 patients (mean age: 42.4 ± 18.8 years) receiving blood products within the initial 24 hours, 4.3% (56 patients) developed a VTE. Patients with VTE experienced prolonged ICU and hospital stays and ventilation duration (p<0.001). They were also noted to have delayed initiation of VTE prophylaxis (104.2 vs. 50.3 hours, p<.001). Prolonged ventilation >7 days was the sole significant factor associated with VTE in multivariate regression analysis [odds ratio (OR): 6.2, p=0.004]. Early TXA administration (within four hours) showed a higher association with VTE than TXA within 24 hours (OR: 2.1, p=0.07 vs. OR 1.6, p=0.22). Massive transfusion was found to increase VTE risk (OR: 2.65, p<0.001). Severe head and neck (OR: 6.0, p=0.002) and chest (OR: 3.8, p=0.01) injuries were key predictors of mortality, while TXA was not significantly associated with mortality in the multivariate model. Conclusions Our study revealed an elevated risk of VTE in patients requiring massive transfusion protocol (MTP, ≥6 units). Early TXA administration was neither associated with increased VTE risk in MTP patients nor increased mortality risk. Strategies directed at reducing the risk of VTE in massively transfused patients while maintaining the survival benefits of balanced resuscitation and TXA need to be devised.
ABSTRACT
Traumatic brain injury (TBI) is a major public health concern, often leading to significant behavioral and cognitive changes with subsequent impairment in daily functioning and personal interactions. The management of TBI involves a multidisciplinary approach. Neuropsychology has emerged as a critical discipline in assessing, diagnosing, treating, and rehabilitating individuals with TBI. Successful management also requires careful consideration of the patient's cognitive status. Therefore, clinicians must have a comprehensive understanding of the overall clinical picture of the patient at the cognitive and physical level. The primary aim of this research is to explore the role of neuropsychology in TBI management and rehabilitation thoroughly while providing an updated review of the literature. Various neuropsychological assessment tools used to evaluate cognitive functioning in individuals with TBI will be discussed in addition to their validity, reliability, and usefulness in identifying cognitive deficits and developing individualized treatment plans. The findings in this article will have significant implications on the clinical practice of neuropsychology in TBI patients, highlighting the importance of neuropsychological assessment in optimizing the management of this population. The need for increased awareness of neuropsychology among health care professionals, especially in the acute hospital setting, is growing along with the increase in diagnosis of TBI and its complications. Adequate understanding of the complex interplay between cognitive, emotional, and behavioral factors in TBI can inform the development of new interventions and treatment strategies, making it equally as important for patients and their families.
Subject(s)
Brain Injuries, Traumatic , Neuropsychology , Humans , Reproducibility of Results , Brain Injuries, Traumatic/complications , Brain Injuries, Traumatic/diagnosis , Brain Injuries, Traumatic/therapy , Neuropsychological Tests , CognitionABSTRACT
With the growth of interest in veterinary ethics, the teaching of ethics to veterinary students has become more important. This study collects comprehensive data about ethics education at veterinary faculties in Turkey to contribute to the international literature. A cross-sectional descriptive survey design is used to collect data via questionnaire. Of the 31 faculty members actively teaching ethics at 24 of the 29 veterinary faculties in Turkey (as of the end of 2021), 30 responded to the survey. By the end of 2021, ethics courses in 24 veterinary faculties in Turkey were conducted between the 7th and 10th semesters with similar content across the examined institutions. Of the 31 faculty members responsible for ethics education, 22 were ethicists. Theoretical lectures and multiple-choice tests were the most preferred methods for teaching and assessment. The most preferred learning outcome to be gained by students was ethical awareness. Integrity by ethicists and morality by faculty members from other departments were considered the most important virtues. The collected qualitative data regarding the strengths of ethics education and areas for improvement were varied and controversial. Ethics training should be an ongoing process throughout veterinary education. Applied ethics education should be comprehensively included in the curricula and carried out with the cooperation of faculty members working in clinical fields.
ABSTRACT
BACKGROUND: Wraparound referrals are a cornerstone of hospital-based violence intervention programs, which have proven to be an effective public health approach for mitigating violence and recidivism. We hypothesized that replacing a manual referral process with an electronic referral application would increase the number of generated referrals and improve compliance with follow-up visits. STUDY DESIGN: The population for this single center quantitative study was a convenience sample of firearm-injured patients. Data from 74 patients were collected using the electronic health record, the electronic referral application, and the trauma registry before and after the intervention. RESULTS: Post-implementation of the electronic referral application showed an increased number of generated referrals, increased emergency department and inpatient utilization of trauma recovery center services, and an increase in second follow-up visit compliance. CONCLUSION: This study demonstrated an increase in the number of referrals and greater likelihood of completion of post-injury follow-up visits after implementing the electronic referral system.
Subject(s)
Firearms , Wounds, Gunshot , Electronics , Hospitals , Humans , Referral and Consultation , Violence/prevention & controlABSTRACT
BACKGROUND: Ventilator-associated pneumonia (VAP) is considered the most common hospital acquired infection seen in critical care settings and leading cause of death in Intensive Care Units (ICU). The objective of this study was to assess whether specimen collection impacted diagnosis and if implementation of a VAP bundle would decrease rates at our center. METHODS: This single center study design is a retrospective chart review from 2017 to 2020 utilizing the electronic medical record. A pre-/postintervention comparison was performed following implementation of a unit wide VAP bundle and nursing education. Descriptive statistics and continuous variables were analyzed with independent group t -tests, and categorical variables were analyzed with chi-squared tests. RESULTS: Ventilator-associated pneumonia rates decreased in the postimplementation time (20.8%, n = 74 vs 12.2%, n = 15; P = .03). There were no significant differences in the patient profile of those who acquired VAP (ie, males 79.7% vs 86.7%, blunt injuries 63.5% vs 86.7% and severity scores 24.8 vs 25.1, pre vs postimplementation, respectively, all P-values greater than .05). DISCUSSION/CONCLUSIONS: Reduction in VAP rates were achieved by implementing a standardized, evidence based, prevention protocol. Further research is warranted as studies have noted that patients requiring mechanical ventilation are at greater risk for VAP than other ICU patients due to the nature of their injuries and increased risk of prolonged mechanical ventilation ≥ 21 days.
Subject(s)
Pneumonia, Ventilator-Associated , Male , Humans , Pneumonia, Ventilator-Associated/prevention & control , Retrospective Studies , Intensive Care Units , Critical Care/methods , DocumentationABSTRACT
Coccidiosis remains one of the major problems in poultry all over the world. Very limited data on anticoccidial drugs in wild pigeons is available. The current study was aimed to understand the comparative efficacy of sulfadimidine, amprolium and triquen in wild pigeons of Dir district, Pakistan suffering from coccidiosis. The faecal matter of wild pigeons were purchased from the local market for coccidian infection. Results revealed that 88.8% (16/18) were found infected with Eimeria spp. Three positive groups were treated with sulfadimidine (0.2mg/L), amprolium (25mg/L) and triquen. Sulfadimidine was most effective (45%) followed by amprolium (44.6%) while triquen (24.0%) showed less effectiveness against coccidiosis in pigeons. Number of oocysts were 79, 81 and 80 before treatment and 60, 44 and 44 after treatment with sulfadimidine, amprolium and triquen respectively. This study showed that sulphadimidine, amprolium and triquen could not significantly reduce the coccidiosis in pigeons. Further studies are required to clear the mechanism of anti-coccidial drugs in wild pigeons.
A coccidiose continua sendo um dos maiores problemas em aves de todo o mundo. Dados muito limitados sobre drogas anticoccidiais em pombos selvagens estão disponíveis. O presente estudo teve como objetivo compreender a eficácia comparativa da sulfadimidina, amprólio e triquenho em pombos selvagens do distrito de Dir, no Paquistão, que sofrem de coccidiose. A matéria fecal dos pombos selvagens foi comprada no mercado local para infecção por coccídios. Os resultados revelaram que 88,8% (16/18) foram encontrados infectados com Eimeria spp. Três grupos positivos foram tratados com sulfadimidina (0,2mg / L), amprólio (25mg / L) e triquenho. A sulfadimidina foi mais eficaz (45%), seguida pelo amprólio (44,6%), enquanto o triquenho (24,0%) apresentou menor efetividade contra a coccidiose em pombos. O número de oocistos foram 79, 81 e 80 antes do tratamento e 60, 44 e 44 após o tratamento com sulfadimidina, amprólio e triquenho, respectivamente. Este estudo mostrou que sulphadimidine, amprolium e triquen não poderiam reduzir significativamente a coccidiose em pombos. Mais estudos são necessários para limpar o mecanismo de drogas anticoccidiais em pombos selvagens.
Subject(s)
Animals , Amprolium , Coccidiosis/prevention & control , Coccidiosis/drug therapy , Coccidiosis/veterinary , Columbidae/parasitology , Sulfamethazine , Anti-Infective AgentsABSTRACT
Abstract Coccidiosis remains one of the major problems in poultry all over the world. Very limited data on anticoccidial drugs in wild pigeons is available. The current study was aimed to understand the comparative efficacy of sulfadimidine, amprolium and triquen in wild pigeons of Dir district, Pakistan suffering from coccidiosis. The faecal matter of wild pigeons were purchased from the local market for coccidian infection. Results revealed that 88.8% (16/18) were found infected with Eimeria spp. Three positive groups were treated with sulfadimidine (0.2mg/L), amprolium (25mg/L) and triquen. Sulfadimidine was most effective (45%) followed by amprolium (44.6%) while triquen (24.0%) showed less effectiveness against coccidiosis in pigeons. Number of oocysts were 79, 81 and 80 before treatment and 60, 44 and 44 after treatment with sulfadimidine, amprolium and triquen respectively. This study showed that sulphadimidine, amprolium and triquen could not significantly reduce the coccidiosis in pigeons. Further studies are required to clear the mechanism of anti-coccidial drugs in wild pigeons.
Resumo A coccidiose continua sendo um dos maiores problemas em aves de todo o mundo. Dados muito limitados sobre drogas anticoccidiais em pombos selvagens estão disponíveis. O presente estudo teve como objetivo compreender a eficácia comparativa da sulfadimidina, amprólio e triquenho em pombos selvagens do distrito de Dir, no Paquistão, que sofrem de coccidiose. A matéria fecal dos pombos selvagens foi comprada no mercado local para infecção por coccídios. Os resultados revelaram que 88,8% (16/18) foram encontrados infectados com Eimeria spp. Três grupos positivos foram tratados com sulfadimidina (0,2mg / L), amprólio (25mg / L) e triquenho. A sulfadimidina foi mais eficaz (45%), seguida pelo amprólio (44,6%), enquanto o triquenho (24,0%) apresentou menor efetividade contra a coccidiose em pombos. O número de oocistos foram 79, 81 e 80 antes do tratamento e 60, 44 e 44 após o tratamento com sulfadimidina, amprólio e triquenho, respectivamente. Este estudo mostrou que sulphadimidine, amprolium e triquen não poderiam reduzir significativamente a coccidiose em pombos. Mais estudos são necessários para limpar o mecanismo de drogas anticoccidiais em pombos selvagens.
ABSTRACT
Coccidiosis remains one of the major problems in poultry all over the world. Very limited data on anticoccidial drugs in wild pigeons is available. The current study was aimed to understand the comparative efficacy of sulfadimidine, amprolium and triquen in wild pigeons of Dir district, Pakistan suffering from coccidiosis. The faecal matter of wild pigeons were purchased from the local market for coccidian infection. Results revealed that 88.8% (16/18) were found infected with Eimeria spp. Three positive groups were treated with sulfadimidine (0.2mg/L), amprolium (25mg/L) and triquen. Sulfadimidine was most effective (45%) followed by amprolium (44.6%) while triquen (24.0%) showed less effectiveness against coccidiosis in pigeons. Number of oocysts were 79, 81 and 80 before treatment and 60, 44 and 44 after treatment with sulfadimidine, amprolium and triquen respectively. This study showed that sulphadimidine, amprolium and triquen could not significantly reduce the coccidiosis in pigeons. Further studies are required to clear the mechanism of anti-coccidial drugs in wild pigeons.
A coccidiose continua sendo um dos maiores problemas em aves de todo o mundo. Dados muito limitados sobre drogas anticoccidiais em pombos selvagens estão disponíveis. O presente estudo teve como objetivo compreender a eficácia comparativa da sulfadimidina, amprólio e triquenho em pombos selvagens do distrito de Dir, no Paquistão, que sofrem de coccidiose. A matéria fecal dos pombos selvagens foi comprada no mercado local para infecção por coccídios. Os resultados revelaram que 88,8% (16/18) foram encontrados infectados com Eimeria spp. Três grupos positivos foram tratados com sulfadimidina (0,2mg / L), amprólio (25mg / L) e triquenho. A sulfadimidina foi mais eficaz (45%), seguida pelo amprólio (44,6%), enquanto o triquenho (24,0%) apresentou menor efetividade contra a coccidiose em pombos. O número de oocistos foram 79, 81 e 80 antes do tratamento e 60, 44 e 44 após o tratamento com sulfadimidina, amprólio e triquenho, respectivamente. Este estudo mostrou que sulphadimidine, amprolium e triquen não poderiam reduzir significativamente a coccidiose em pombos. Mais estudos são necessários para limpar o mecanismo de drogas anticoccidiais em pombos selvagens.
Subject(s)
Animals , Coccidiosis/drug therapy , Coccidiosis/veterinary , Amprolium , Pakistan , Columbidae , Sulfamethazine , ChickensABSTRACT
Background and objective Cardiotocography (CTG) has been used more frequently in recent decades to reduce intrapartum fetal mortality rates. The purpose of this study was to determine whether pathological or non-reactive CTG could predict a low Apgar (Appearance, Pulse, Grimace, Activity, and Respiration) score. An abnormal trace would indicate a distressed fetus, whereas a normal trace would indicate a well-oxygenated fetus. Methods This study included a total of 470 women with a gestational period of more than 37 weeks. Based on the results of their CTGs, they were divided into three groups. An emergency cesarean section (CS) was performed if there was any sign of fetal distress on CTG. The Apgar scoring for newborns was recorded in the proforma following delivery. Results The study was carried out at two major tertiary-care hospitals in Pakistan. A reactive CTG was found in more than one-third (39.36%) of the 470 patients. An Apgar score above 8 was obtained by 34.26% of the newborns, while an Apgar score below 8 was obtained by more than half (63.40%). Only 2.34% of newborns had an Apgar score below 6. A third (30.64%) of the patients had grade-1 meconium-stained liquor (MSL), 24.89% had grade-2 MSL, 19.79% had grade-3 MSL, and 24.68% had no MSL. One-third (32.34%) of the neonates were admitted to the neonatal intensive care unit (NICU) shortly after birth. When CTG was pathological or non-reactive, the odds of securing a higher Apgar score decreased by 70.45% (OR: 0.30; 95% CI: 0.20-0.44; p<0.001). Conclusion The main conclusion drawn from this study's findings is that a pathological CTG is an indicator of a low Apgar score.
ABSTRACT
Coccidiosis remains one of the major problems in poultry all over the world. Very limited data on anticoccidial drugs in wild pigeons is available. The current study was aimed to understand the comparative efficacy of sulfadimidine, amprolium and triquen in wild pigeons of Dir district, Pakistan suffering from coccidiosis. The faecal matter of wild pigeons were purchased from the local market for coccidian infection. Results revealed that 88.8% (16/18) were found infected with Eimeria spp. Three positive groups were treated with sulfadimidine (0.2mg/L), amprolium (25mg/L) and triquen. Sulfadimidine was most effective (45%) followed by amprolium (44.6%) while triquen (24.0%) showed less effectiveness against coccidiosis in pigeons. Number of oocysts were 79, 81 and 80 before treatment and 60, 44 and 44 after treatment with sulfadimidine, amprolium and triquen respectively. This study showed that sulphadimidine, amprolium and triquen could not significantly reduce the coccidiosis in pigeons. Further studies are required to clear the mechanism of anti-coccidial drugs in wild pigeons.
Subject(s)
Amprolium , Coccidiosis , Animals , Chickens , Coccidiosis/drug therapy , Coccidiosis/veterinary , Columbidae , Pakistan , SulfamethazineABSTRACT
Nucleated red blood cells (NRBCs) have been studied in critically ill and injured patients as a predictor of increased in-hospital mortality and poor clinical outcomes. While prior studies have demonstrated the prognostic power of NRBCs in the critical patient, there has been a paucity of literature available describing their value as a prognostic indicator in the severely burned patient. This retrospective observational study was conducted from 2012 to 2017. Inclusion criteria for this study included all burn patients with total body surface area > 10% who were aged ≥ 15 years. Demographic and clinical data were collected from the electronic medical record system. Data analysis consisted of descriptive and comparative analysis using SPSS. Two hundred and nineteen patients (17.5%) met inclusion criteria with 51 (23.3%) patients positive for NRBCs. The presence of NRBCs had an increased mortality rate with an odds ratio of 6.0 (P = .001; 2.5, 14.5); was more likely to appear in older patients (P < .001); and was associated with increased hospital length of stay (P < .001), injury severity scores (P < .001), and complications. The presence of NRBCs even at the low concentrations reported in our study showed a 6-fold increase in the rate of mortality. With the current improvements in burn care leading to higher survival rates, the need to improve upon the numerous models that have been developed to predict mortality in severe burn patients is clear given the significantly increased risk of death that the presence of NRBCs portends.
Subject(s)
Burns/metabolism , Erythrocyte Count , Erythrocytes, Abnormal/metabolism , Adolescent , Adult , Aged , Blood Platelets/metabolism , Burns/mortality , Erythrocytes/metabolism , Female , Humans , Male , Middle Aged , Morbidity , Retrospective Studies , Risk FactorsABSTRACT
Since the SARS-CoV-2 (COVID-19) outbreak, health-care workers (HCWs) have had to create personal protective equipment (PPE) due to the worldwide demand and thus ensuing shortage. To address the dearth of available PPE, HCWs have quickly explored options to repurpose in-hospital equipment to provide alternative PPE to caregivers. We report the modification of a Stryker T5TM and Stryker Flyte® personal protection surgical helmets as a powered air-purifying respirator.
Subject(s)
COVID-19 , Respiratory Protective Devices , Head Protective Devices , Humans , Personal Protective Equipment , SARS-CoV-2ABSTRACT
The importance of communication skills in veterinary medicine has been increasing for a long time. The aim of this article is to investigate how theoretical training, role-playing, and standardized/simulated client (SC) methods improve senior (fifth-year) veterinary students' skills in breaking bad news. The study was carried out with 67 volunteer senior students. The research was designed from a pre-test and post-test control group pattern. All students encountered the SC. After pre-tests, theoretical training was given to Experimental Group A (EGA) and Experimental Group B (EGB). Then, only the students in EGA role-played together. Each student completed a checklist consisting of 10 basic items after pre-tests and post-tests. After post-tests, focus group interviews with open-ended questions were conducted. In the pairwise comparisons, EGA's and EGB's adjusted post-test mean scores were significantly higher than the control group's (p < .001). EGA's and EGB's post-test scores were found to be significantly higher than their pre-test scores. Women's empathy and eye contact scores were found to be statistically higher than men's scores. This study is the first of its kind in Turkey to use SCs and peer-to-peer learning with role-play simulations in training students about breaking bad news in veterinary medicine. These findings show that theoretical training and role-playing has an impact on senior veterinary students' skills in breaking bad news.
Subject(s)
Education, Veterinary , Animals , Communication , Female , Humans , Male , Physician-Patient Relations , Role Playing , Students , TurkeyABSTRACT
There is an ongoing global hepatitis C virus (HCV) epidemic mainly related to high-risk behaviour in persons who inject drugs (PWID) and in HIV-infected men who have sex with men (MSM) which continues to fuel the HCV epidemic. Treatment of HCV infection with direct antiviral therapy (DAA) has been very successful in the last decade. Main obstacles for HCV elimination are HCV reinfections observed in PWID and HIV-infected MSM. We present here an HIV-infected MSM patient who has been reinfected thrice with HCV. The virus which was investigated from his last reinfection episode reveals transmission of a newly acquired HCV protease inhibitor (PI) resistance, despite not having been exposed to HCV-PIs during his last DAA therapy.
Subject(s)
Antiviral Agents/therapeutic use , Coinfection/drug therapy , Drug Resistance, Viral , HIV Infections/complications , Hepatitis C, Chronic/complications , Epidemics , Europe , Genotype , HIV Infections/drug therapy , Hepacivirus/drug effects , Hepacivirus/genetics , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/epidemiology , Hepatitis C, Chronic/virology , Homosexuality, Male , Humans , Male , Protease Inhibitors/therapeutic use , Reinfection , Viral LoadABSTRACT
BACKGROUND: Isolated right atrial rupture (IRAR) from blunt chest trauma is rare. There are no physical exam findings and non-invasive testing specific to the condition, which result in diagnostic delays and poor outcomes. We present a case of IRAR along with a systematic review of similar cases in the literature. CASE REPORT: A 23-year-old male presented following a motor vehicle accident (MVA). He was bradycardic and hypotensive during transportation; and required intubation. There were contusions along the right chest wall with clear breath sounds, and no jugular venous distension, muffled heart sounds. Hemodynamic status progressively worsened, ultimately leading to his death. However, no external sources of bleeding or evidence of cardiac tamponade was found. METHODS: A search of PubMed, Ovid, and the Cochrane Library using: (Blunt OR Blunt trauma) AND (Laceration OR Rupture OR Tear) AND (Right Atrium OR Right Atrial). Articles were included if they were original articles describing cases of IRAR. RESULTS: Forty-five reports comprising seventy-five (n = 75) cases of IRAR. CONCLUSION: IRAR most commonly occurs following MVAs as the result of blunt chest trauma. Rupture occurs at four distinct sites and is most commonly at the right atrial appendage. IRAR is a diagnostic challenge and requires a high index of suspicion, as patients' hemodynamics can rapidly deteriorate. The presentations vary depending on multiple factors including rupture size, pericardial integrity, and concomitant injuries. Cardiac tamponade may have a protective effect by prompting the search for a bleeding source. A pericardial window can be diagnostic and therapeutic in IRAR. Outcomes are favourable with timely recognition and prompt surgical intervention.
Subject(s)
Atrial Appendage/injuries , Heart Injuries/diagnosis , Wounds, Nonpenetrating/complications , Accidents, Traffic , Fatal Outcome , Heart Injuries/etiology , Heart Injuries/physiopathology , Hemodynamics , Humans , Male , Young AdultABSTRACT
Because of its ideal band gap, high density and high electron mobility-lifetime product, cadmium zinc telluride (CdZnTe or CZT) is currently the best room-temperature compound-semiconductor X- and gamma-ray detector material. However, because of its innate poor thermo-physical properties and above unity segregation coefficient for Zn, the wide spread deployment of this material in large-volume CZT detectors is still limited by the high production cost. The underlying reason for the low yield of high-quality material is that CZT suffers from three major detrimental defects: compositional inhomogeneity, high concentrations of dislocation walls/sub-grain boundary networks and high concentrations of Te inclusions/precipitates. To mitigate all these disadvantages, we report for the first time the effects of the addition of selenium to the CZT matrix. The addition of Se was found to be very effective in arresting the formation of sub-grain boundaries and its networks, significantly reducing Zn segregation, improving compositional homogeneity and resulting in much lower concentrations of Te inclusions/precipitates. Growth of the new quaternary crystal Cd1-xZnxTe1-ySey (CZTS) by the Traveling Heater Method (THM) is reported in this paper. We have demonstrated the production of much higher yield according to its compositional homogeneity, with substantially lower sub-grain boundaries and their network, and a lower concentration of Te inclusions/precipitates.
ABSTRACT
The use of electronic cigarettes (ECs) has been on the rise with increased number of battery explosions causing burns. This study is a retrospective review of patients who presented with burns caused by EC explosions.Here, we present a case series of eight patients sustaining burns from EC explosions, within a year, to elucidate the pattern of such burns and to provide a treatment guideline.All of them were males. Five patients had partial-thickness burns and three had full-thickness burns. TBSA ranged from 4 to 16% (burns to lower extremity [n = 7], hand [n =3], scrotum/penis [n =2], chest [n = 1]). None had inhalation injuries. Two patients (29%) required skin grafting. EC explosion is predominantly attributed to its lithium-ion battery. Several types of injuries can occur, including chemical and thermal burns, inhalation injuries, metal poisoning, etc. There are currently no specific guidelines on the management of burns due to lithium-ion battery exposure. Herein, we recommend the following: Initial assessment of injuries should accompany the Advanced Trauma Life Support guidelines; serum levels of lithium, cobalt, and manganese should be checked and elevated levels should be monitored; patients should be monitored for signs of metal toxicity; wound should be extensively debrided and irrigated to remove any residual materials; and litmus test should be performed to check for alkali pH prior to irrigation with water or other aqueous solutions.
Subject(s)
Burns/etiology , Burns/surgery , Electric Power Supplies/adverse effects , Electronic Nicotine Delivery Systems , Explosions , Lithium , Adolescent , Adult , Humans , Male , Middle Aged , Skin TransplantationABSTRACT
Crimean Congo hemorrhagic fever (CCHF) is a viral zoonotic disease with high mortality rate. There are only a few studies on viral load in CCHF. In our study, we revealed the dynamics of viral load and its relationship with mortality in early phase of the disease. A total of 138 serum samples were collected from 23 patients. All patients had positive PCR for CCHF on admission. Serum samples were obtained daily from all patients for the first 6 days of hospitalization and stored at -80°C for viral load measurement. We found statistically significant difference between mean number of viremic serum samples of fatal and non-fatal patients. Furthermore, non-fatal cases' viral loads demonstrated statistically significant decreases over time; however, we could not observe a similar trend in viral loads of fatal cases. Limited number of studies on CCHF indicate that score of the contest between CCHF virus and immune system determines the survival in CCHF and viral load is found to be the most prognostic factor. In our study, we found that there is a notable decrease trend in viral loads of non-fatal patients over time and this clearance of CCHF virus is significantly related with survival.
Subject(s)
Hemorrhagic Fever Virus, Crimean-Congo/isolation & purification , Hemorrhagic Fever, Crimean/virology , Serum/virology , Viral Load , Adolescent , Adult , Aged , Female , Hemorrhagic Fever, Crimean/mortality , Hemorrhagic Fever, Crimean/pathology , Hospitalization , Humans , Male , Middle Aged , Polymerase Chain Reaction , Prognosis , Survival Analysis , Time Factors , Young AdultABSTRACT
BACKGROUND: Conventional coagulation tests do not provide an accurate representation of the complex nature of trauma induced coagulopathy. Thrombelastography provides a prompt global overview of all dynamic sequential aspects of trauma induced coagulopathy. The objective of this study was to evaluate the impact of using thrombelastography on blood products utilization, crystalloids utilization, hospital, and intensive care using length of stay, and cost savings. METHODS: We retrospectively reviewed 134 patients (May of 2012 to February of 2015) meeting Class I trauma activation. Outcome data was compared between two groups: patients prior to thrombelastography implementation (n = 87) and patients with thrombelastography guided trauma resuscitation (n = 47). Blood product usage was compared for three time periods: first 4 h, the next 20 h, and first 24 h. RESULTS: For the first 24 h of treatment, patients with thrombelastography guided trauma resuscitation had lower packed red blood cells (p = 0.0022) and fresh frozen plasma (p = 0.0474), but higher jumbo pack platelets (p = 0.0476) utilization when compared to the patients prior to thrombelastography implementation. There was no statistical significant difference in the utilization of crystalloids for any of the three time intervals. Patients with thrombelastography guided trauma resuscitation had a shorter hospital length of stay (p = 0.0011) and intensive care unit length of stay (p = 0.0059) than the patients prior to thrombelastography implementation. Cost savings in blood products transfusion were most pronounced in patients with penetrating injuries. DISCUSSION: Using visco-elastic tests to guide blood transfusion was first used for liver transplant patients and then applied to cardiovascular surgery and trauma. Similar to other studies, this study showed using visco-elastic tests for trauma patietns corresponded to an overall reduction in the use of packed red blood cells and fresh frozen plasma during the first 24 hours of resuscitation. In addition, this study showed using visco-elastic tests corresponded to a significant reduction in both hospital and intensive care unit length of stay. CONCLUSION: This study demonstrates that Thrombelastography guided trauma resuscitation decreases the overall transfusion requirements of packed red blood cells and fresh frozen plasma. However, given the nature of under-recognized jumbo pack platelets dysfunction in the conventional laboratory parameters, jumbo pack platelets utilization is higher when following Thrombelastography directed resuscitation. The utilization of Thrombelastography corresponded to a reduction in hospital length of stay, intensive care unit length of stay and cost of transfused blood products.
Subject(s)
Blood Coagulation Disorders/therapy , Blood Transfusion/methods , Critical Care/methods , Early Diagnosis , Resuscitation/methods , Thrombelastography/methods , Wounds and Injuries/complications , Adult , Blood Coagulation , Blood Coagulation Disorders/blood , Blood Coagulation Disorders/etiology , Female , Humans , Male , Retrospective Studies , Wounds and Injuries/blood , Wounds and Injuries/therapyABSTRACT
Pyosalpinx is a severe sequel of chronic pelvic inflammatory disease, whereby the fallopian tubes become filled with pus.1 2 Pyosalpinx often affects sexually active women and rarely is seen in celibate adolescent girls.3 We report a case of a 12-year-old girl with no prior sexual history who presented to our emergency department with complaints of severe right lower quadrant pain of 1-day duration. Ultrasonography and CT scan of the abdomen and pelvis revealed free fluid collections in the pelvis without visualisation of the appendix. A preoperative diagnosis of acute ruptured appendicitis was given and she was taken to the operating room. Peroperative findings included bilaterally distended, pus-filled pyosalpinges. A definitive diagnosis of bilateral pyosalpinx was then made. Two-week antibiotic therapy was successful but the patient returned with recurrent pyosalpinx and a pelvic abscess 9 weeks later.