Comparative study of the consequences of abdominal aortic aneurysm repair surgery using open and endovascular surgical methods.

BACKGROUND: Abdominal aortic aneurysm (AAA) is a life-threatening condition. Open surgery and endovascular repair are the options for treating AAA. This study aimed to compare the frequencies of in-hospital complications and outcomes in two groups of patients who underwent AAA repair surgery using either an open or an endovascular repair method. METHODS: This retrospective study was conducted on the records of 60 patients with AAA undergoing elective surgery repair using endovascular approaches or open surgery at Razi Hospital from 2010 to 2019. Patients' related information, including age, sex, changes in blood pressure, respiratory complications, renal complications, myocardial infarction, paraplegia, cloneischemia, lower limb ischemia, duration of hospital stay in intensive care unit and hospital, the dose of packed RBC, the dose of injectable narcotic analgesics, the need for vasopressor medication, duration of surgery, duration of postoperative oral feeding, and death during hospitalization were assessed. RESULTS: A total of 60 patients in two groups were studied. The mean age of patients was 72.4 ± 6.28 years, and most were male (86.7%). The incidence of renal complications (3.3%) and respiratory complications (0%), rate of decrease in arterial blood oxygen saturation, length of stay in ICU (median 2 vs. 4) and hospital (median 4.5 vs. 7), the need for vasopressor injection and the dose of packed RBC (median 0.4 vs. 3.33), the dose of narcotic analgesic injection (53.3%), duration of surgery (median 2.5 vs. 3), duration of postoperative oral feeding (median 23 vs. 54), and the incidence of death were significantly lower in the endoscopic surgery group. CONCLUSION: Endovascular surgery repairing the rupture of an AAA is associated with fewer postoperative complications and in-hospital death than open surgery.

Evaluation of patterns, cause and risk factors of burns in patients with seizure.

BACKGROUND: Burns following convulsion could be an important problem for patients with epilepsy. In the present study we aimed to identify the pattern and the cause of burns in these patients. METHODS: This is a cross-sectional study that was performed in 2017-2019 in Guilan on 40 patients with burns following seizure. The information in the records of patients were reviewed. We collected data including age, sex, marital status, occupation, place of residence, length of hospital stay, anatomy of the burn site, percentage of burn, degree of burns, cause of burns and disease outcome. RESULTS: The mean age of the patients was 42.2±2.99 years. Seven cases (17.5%) had burns due to fire, 5 cases (12.5%) due to gas explosion, 3 cases (7.5%) due to electrocution, 15 cases (37.5%) with hot water, 1 case (2.5%) with hot liquids, 5 cases (12.5%) with hot surface, 1 case (2.5%) with hot bath, 2 cases (5%) with hot food and 1 case (2.5%) with hot glue. The mean burning percentage of patients was 19.3±3.18%. The most common patterns of burns were observed as 7 (17.5%) upper limbs and 7 (17.5%) lower limbs. The mean duration of hospitalization was 5.05±0.69 days ranging from 1 to 18 days. 37 patients (92.5%) recovered partially and 3 patients (7.5%) died. CONCLUSION: Hot water, fire and hot surface are most common causes of burns and there were significant direct correlations between age with percentage of burns and duration of hospitalization. We believe further studies should evaluate the preventive strategies in this regard.

Changes in serum phosphorus level in patients with severe burns: A prospective study.

BACKGROUND: The second most abundant mineral in the body, phosphorus (P), is absorbed in the small intestine after ingestion enhanced by 1,25-dihydroxy vitamin D, and its excretion is exclusively regulated by the kidney. It is clinically significant, aside from its disturbance in burn ICU patient's P mechanism. The increasing rate of morbidity and mortality among the patients can be associated with severe hypophosphatemia. The current study aimed at investigating the changes in serum P levels in the early period after burns, the relationship between serum P level and TBSA (total body surface area) of burn, and the impact of hypophosphatemia on patients' clinical outcomes. MATERIAL AND METHODS: The current prospective, observational study was conducted on 137 patients hospitalized in the burn intensive unit (BICU) of Velayat Sub-specialty Burn and Plastic Surgery Center from December 2015 to May 2017. According to the TBSA percentage, the patients were divided into three groups. The level of serum P was determined in the 1st, 3rd, 5th, 7th, and 9th days of hospital stay and before discharge. To evaluate the trend of P changes in the sixtime-points, the average changes along with 95% confidence intervals (CI) were used for multivariate analysis of variance with repeated measures (repeated measures ANOVA). A P-value of 0.05 or less was considered statistically significant. The analyses were performed using SPSS software, version 19 (SPSS Inc.). RESULTS: Totally, 137 patients (70% male, mean age 32 ± 21years, and TBSA 32.6 ± 14%) were included in the study. The overall incidence of hypophosphatemia was 75.1%. Hypophosphatemia developed as early as 1.66 ± 0.136 (95%CI: 1.4-1.9) days after injury. The highest decrease in the serum P level was observed on the 3rd and 5th days after burn as 2.78 mg/dL and 2.85 mg/dL, respectively (P-value = 0.001). A correlation was observed between TBSA and serum P level. The mean serum P level decreased with increasing the percentage of burns. There was a correlation between serum P level and mortality; therefore, a decrease in serum P level increased the patient's mortality rate (P < 0.05). CONCLUSION: The current study highlighted that hypophosphatemia is often observed in patients with burn injuries during their hospitalization. It is potentially beneficial to identify patients at risk of hypophosphatemia. Therefore, it is suggested that P level be assessed regularly in patients with burn injuries for the timely initiation of P replacement therapy.

Significance of Cardiac Troponin I Elevation in Traumatic Brain Injury Patients.

BACKGROUND: Myocardial dysfunction is frequently described as an underlying cause of mortality in traumatic brain injury (TBI) known as brain-cardiac link. However the impact on prognosis of a disease remains uncertain. OBJECTIVES: The current study aimed at investigating the correlation between TBI and cardiac troponin I (cTnI) rise and in-hospital mortality rate among patients with TBI. METHODS: In the current prospective study TBI patients with abbreviated injury scale score (AIS) > 3 and Glasgow coma scale (GCS) score ≤ 8 with cTnI measurement within the first 24 hours of admission were evaluated. Chi-square, Kruskal-Wallis, Mann-Whitney U and Logistic Regression tests were used for data analysis. RESULTS: A total of 166 eligible patients were studied .The mean age of the cases was 37.64 ± 17.21 years, largely under 65 (93.4%) and male (86.7%).The most common injuries were cerebral contusion (35.1%), while motor vehicle crash (MVC) was the most common cause of injuries (83.73%); 59 % of the patients showed detectable cTnI concentrations within 24 hours of admission; 65.7% of the patients expired; they showed higher levels of cTnI compared to survivors that showed lower levels, 0.148 ± 0.074 vs 0.057 ± 0.055, respectively (P < 0.001). Moreover, a significant association was observed between mortality rate and lower admission GCS 3.49 ± 1.08 vs 6.79 ± 1.66, respectively (P < 0.001). CONCLUSIONS: Increased cTnI levels could be a predictor of mortality among patients with TBI. Its measurement and investigation for therapeutic strategies could lead to better management of these cases.