Glandular Fever Testing in Patients Presenting With Tonsillitis: A Retrospective Study.

BACKGROUND: Tonsillitis, the inflammation of the palatine tonsils, typically arises from infections and predominantly affects children of primary school age. Most cases stem from viral or bacterial infections. Glandular fever, a subtype, is primarily caused by the Epstein-Barr virus (EBV). This specific type of tonsillitis can lead to severe complications, including splenic rupture, encephalitis, chronic fatigue, and acute acalculous cholecystitis. As a result, early identification is vital to establish proper safety measures and prevent the onset of these potentially dangerous complications in patients. OBJECTIVES: This study aims to determine the number of missed glandular fever cases diagnosed as simple tonsillitis and raises considerations in managing these patients. METHODS: A 12-month retrospective single-centre cohort study was carried out in Lincoln County Hospital, Lincoln, England. A total of 185 patients diagnosed with tonsillitis were included, along with their presenting symptoms and investigations, including liver blood tests and glandular fever screening. RESULTS: Among the 185 patients, averaging 26 years old, 112 were screened for EBV infection, revealing 35 positive cases (31.3%). Notably, 74% of these positive cases (26 out of 35) displayed abnormal liver function test results. CONCLUSION: Applying the percentage of EBV-positive cases to the 73 unscreened patients results in a likelihood of 23 missed cases of EBV infection. These form 12% of the study group, indicating a significant potential missed number of cases. Given the associated risks and complications with EBV, we note the importance of screening to identify cases and apply relevant considerations in their management.

The Financial Burden Associated With Conservatively Managed Epistaxis.

AIM: Each year, approximately 25,000 patients present to NHS hospitals in the UK with epistaxis. This study aims to investigate the financial implications of epistaxis, focusing on cases managed conservatively. Specifically, the research explores the average cost of hospital bed stays, the length of hospitalization, and the impact of blood thinners on healthcare expenses.  Methods: A retrospective study spanning June 2022 to June 2023 collected data from electronic health records at our local district general hospital. Patients meeting inclusion criteria were analyzed for demographic information, duration of hospital stay, use of blood thinners, and outcomes. Statistical software (SAS and Excel) was used for data analysis. RESULTS: Out of 126 patients, conservatively managed epistaxis cases (n = 119) had an average age of 73.9 years, with 53.6% males. The mortality rate was 4.5%. The average hospital stay was 2.92 days. Approximately 57% of patients were taking blood thinners. The average cost of a hospital bed stay for epistaxis patients was £1,712.84, with a £259.69 difference between those on blood thinners and those not. CONCLUSION: Epistaxis imposes a significant financial burden on hospitals, with conservatively managed cases incurring substantial costs. Recognizing and addressing the financial implications of epistaxis is essential for healthcare providers and policymakers. Investment in preventative medicine and patient education can potentially reduce the incidence of epistaxis and alleviate the financial burden on healthcare systems.

Analysis of Variables Influencing Short-Term Complications in Geriatric Patients Undergoing Emergency General Surgery (EGS): A Retrospective Cohort Study.

BACKGROUND: Emergency general surgery (EGS) encompasses a wide range of acute surgical conditions that pose significant risks to patient life and well-being. Understanding the factors that contribute to short-term complications in geriatric patients undergoing EGS is crucial for improving patient outcomes. This retrospective single-center cohort study aimed to evaluate the impact of various variables on short-term complications in geriatric patients undergoing EGS. METHODS: A total of 212 patients aged 65 and above who underwent emergency abdominal surgery between 2017 and 2018 were included in the study. The analysis focused on several variables, including age, sex, body mass index (BMI), beta-blocker use, open abdomen treatment, blood transfusions, anticoagulant therapy, and vasopressor use. Univariate and multivariate analyses were conducted to assess the association between these variables and short-term complications. RESULTS: Among the analyzed variables, blood transfusions and vasopressor use demonstrated a statistically significant association with short-term complications. Patients who received blood transfusions had a significantly higher risk of complications, with an odds ratio (OR) of 3.01 (95% confidence interval, CI: 1.28-7.06, p-value = 0.011). Similarly, the use of vasopressors was strongly correlated with increased short-term complications, with an OR of 14.61 (95% CI: 4.86-43.89, p-value < 0.001). CONCLUSION: These findings emphasize the importance of minimizing blood transfusions and careful consideration of vasopressor use in geriatric patients undergoing EGS to reduce the risk of short-term complications. Further research is warranted to explore additional factors and optimize perioperative management strategies to improve outcomes in this vulnerable patient population.

Emergency General Surgery: Predicting Morbidity and Mortality in the Geriatric Population.

Introduction Numerous scoring systems have been created to predict the risk of morbidity and mortality in patients undergoing emergency general surgery (EGS). In this article, we compared the different scoring systems utilized at Humanitas Research Hospital and analyzed which one performed the best when assessing geriatric patients (>65 years of age). The scoring systems that were utilized were the APACHE II (Acute Physiology and Chronic Health Evaluation II), ASA (American Society of Anesthesiologists), ACS-NSQIP (American College of Surgeons-National Surgical Quality Improvement Program), Clinical Frailty Score, and the Clavien-Dindo classification as control. Materials and Methods We compiled a database consisting of all patients over the age of 65 who underwent EGS in a consecutive 24-month period between January 1, 2017 and December 31, 2018. We used the biostatistical program "Stata Version 15" to analyze our results. Results We found 213 patients who matched our inclusion criteria. Regarding death, we found that the ACS-NSQIP death calculator performed the best with an area under the curve of 0.9017 (odds ratio: 1.09; 95% confidence interval: 1.06-1.12). The APACHE II score had the lowest discriminator when predicting death. Considering short-term complications, the Clavien-Dindo classification scored highly, while both the APACHE II score and Clinical Frailty Score produced the lowest results. Conclusion The results obtained from our research showed that scoring systems and classifications produced different results depending on whether they were used to predict deaths or short-term complications among geriatric patients undergoing EGS.

Erratum: Addendum: Emergency General Surgery: Predicting Morbidity and Mortality in the Geriatric Population.

[This corrects the article DOI: 10.1055/s-0042-1756461.].

Diagnostic Performance of Point-of-Care Troponin I and Laboratory Troponin T in Patients Presenting to the ED with Chest Pain: A Comparative Study.

BACKGROUND: Chest pain is a common symptom in patients visiting the emergency department (ED). Diagnosing acute coronary syndrome is a challenging task for emergency physicians. Evaluation of chest pain depends on clinical symptoms and signs, ECG, and cardiac enzymes. Here, we aimed to compare the diagnostic performance of the point-of-care troponin I assay with laboratory HsTnT assay in patients presenting to the ED with chest pain. METHODS: A prospective study was done at the ED of Alkhor Hospital, Hamad Medical Corporation, between March 2016 and December 2016. Patients more than 18 years old who presented to the ED with chest pain were enrolled. Patients with renal failure, initial ECG showing ST-elevation MI, or arrhythmias, and hemodynamically unstable patients were excluded. A blood sample was collected at 0 and 3 hours post-admission for POC TnI and laboratory HsTnT assay. The sensitivity, specificity, PPV, NPV, and AUC were determined and compared. RESULTS: Out of 313 patients enrolled, ten were excluded. At 0 hour, the POC TnI assay had a lower sensitivity (72.5% versus 97.5%) and had almost equal specificity (99.24% versus 93.2%) when compared to lab HsTnT assay. At 3 hours post-admission, the sensitivity increased to 95% versus 100%, and specificity was 100% versus 94.3% when compared to lab HsTnT. The POC TnI assay had a higher PPV than HsTnT, whereas both assays showed a high NPV at 0 and 3 hours. CONCLUSION: Although the diagnostic performance of POC TnI was lower than that of Lab HsTnT at 0 hour, at 3 hours post-admission, the diagnostic performance was almost equal to that of HsTnT. Hence we conclude that chest pain in patients with a negative POC TnI at 3 hours post-admission is unlikely to be due to NSTEMI.