Drugs and alcohol Use patterns among those seeking care in urban rehabilitation centres before and during early months of COVID-19 in Uganda.

Introduction: There is a rise in alcohol and other drug (AOD) abuse in the country but details of the practice are scanty. This paper provides characteristics of clients in the rehabilitation centres, their AOD related practices before and early months of COVID-19, and correlates of repeat treatment. Methods: The study was conducted in 10 rehabilitation centres in Kampala Metropolitan area. Characterization of AOD clients involved descriptive analysis while comparison of AOD related practices pre-and during COVID-19 lockdown was carried out using interrupted time series analysis. Modified Poisson regression model was used to analyse the repeat treatment. Results: The clients were mostly male (85%), single (57%) and had attained secondary education (84%). Nearly a third of them (29%) were unemployed while 68% were aged between 15-34 years. The commonest substances used were alcohol (52%), cannabis (19%), cocaine (13%) and opioids (8%). The commonest sources of substances were street dealers (52%) and friends (37%). COVID-19 did not change the pattern of AOD use except for Opioids. Repeat treatment was associated with being male, seeking care in private facilities, being casual labourer/self-employed. Conclusion: Intervention programs should target the educated, the unemployed, young men, their friends, street drug dealers and AOD hotspots.

Bifurcated Arterial Circulation for Hybrid Aortic Reconstruction: A Novel Technique.

Hybrid aortic procedures present many new challenges to the management of cardiopulmonary bypass (CPB). Reoperation or previous thoracic endovascular aortic repair (TEVAR) can further complicate these procedures, increasing the need for flexibility within the CPB system to execute multiple perfusion strategies as cases dictate. This technique describes the use of a bifurcated arterial circulation to provide both cerebral and lower body perfusion during a redo hybrid aortic arch reconstruction. The arterial line was divided into upper and lower body limbs, and connected to an 8-mm Dacron graft to the axillary artery, as well as a percutaneous 16-Fr. OptiSite femoral arterial cannula respectively. A 25-Fr. multi-stage femoral venous cannula was placed percutaneously as well. CPB was initiated utilizing both arterial cannulas with near-infrared spectroscopy and electroencephalogram to monitor the adequacy of cerebral perfusion. Moderate hypothermia of 26°C was induced and a CODA balloon (Cook Medical, Bloomington, IN) was deployed to occlude the proximal limb of a thoracic endovascular repair (TEVAR) graft; the common trunk of the debranched arch vessels was clamped proximally, allowing for simultaneous upper and lower body perfusion. Upon completion of the distal arch, the CODA balloon was removed and total body perfusion was reinitiated via central cannulation utilizing a sidearm on the arch graft.

Lean Flow: Optimizing Cardiopulmonary Bypass Equipment and Flow for Obese Patients-A Technique Article.

The goal of this chart review was to investigate the use of down-sized cardiopulmonary bypass (CPB) circuits for obese patients. The effects of transitioning from larger to smaller oxygenators, reservoirs, and arteriovenous tubing loops were evaluated through a retrospective review of 2,816 adult non-congenital procedure perfusion records. This technique report and case series is a continuation of our original prescriptive CPB circuit quality improvement project. An algorithm was derived to adjust body surface area (BSA) to lower body mass index (BMI) to provide down-sized extracorporeal circuit components capable of meeting the metabolic needs of the patient. As a result of using smaller circuits, decreased priming volumes led to significantly increased hemoglobin (HB) nadirs (p < .05) leading to significant decreases in homologous donor blood product exposures (p < .05). Patients with large BSAs were supported safely with smaller circuits by using lean body mass (LBM)-adjusted BSA and target blood flow algorithm. Based on this case series, large BMI patients may be safely supported with smaller circuits selected based on BSAs adjusted more toward LBM. Use of smaller circuits in high BMI patients led to higher HB nadirs and less donor blood components during the surgical procedure. Renal function and hospital stay were not affected by this approach.

Prescriptive patient extracorporeal circuit and oxygenator sizing reduces hemodilution and allogeneic blood product transfusion during adult cardiac surgery.

UNLABELLED: The goal of this cardiopulmonary bypass (CPB) quality improvement initiative was to maximize hemoglobin nadir concentration by minimizing hemodilution and, in turn, eliminating allogeneic blood product transfusion. The effects of transitioning from "one-size-fits-all" to "right-sized" oxygenators, reservoirs, and arterial-venous tubing loops were evaluated through a 2-year retrospective review of 3852 patient perfusion records. Using a sizing algorithm, derived from manufacturers' recommendations, we were able to create individualized "right-sized" extracorporeal circuits based on patient body surface area, cardiac index, and target blood flows. Use of this algorithm led to an increase in the percent of algorithm-recommended smaller oxygenators being used from 39% to 63% (p < .01) and an increase in average hemoglobin nadir from 8.38 to 8.76 g/dL (p < .01). Decreased priming volumes led to increased hemoglobin nadir and decreases in allogeneic blood transfusion (p = .048). Patients with similar body surface areas who previously were exposed to larger oxygenators, reservoirs, and arterial-venous loops were now supported with smaller circuits as a result of the use of the right-sized algorithm. Adjustments to the algorithm were made for unique patients and procedural situations including age, gender, and length and type of procedure. Larger heat exchanger surface area oxygenators were used for circulatory arrest procedures as a result of the need for increased heat exchange capability. Despite the generally higher costs of smaller circuits, reduced transfusion-related expenditures and decreased exposure risks justify the use of smaller circuit components. This quality improvement initiative demonstrated that as an integral part of a multidisciplinary, multimodal blood conservation effort, the use of the "right-sized" circuit algorithm can help to elevate hemoglobin nadir during CPB and eliminate allogeneic blood transfusions to patients undergoing CPB. KEYWORDS: cardiopulmonary bypass, oxygenator, perfusion index, extracorporeal circuit, hemodilution.