Surgery
Vishnu Vardhan P. Reddy; Srujan Dharap; Reyaz Ahmad; Ajeet Pratap Maurya; Meena Kumari; Bharati Pandya
Volume 10, Issue 1 , January 2024, , Pages 7-16
Abstract
Objective: COVID-19 caused one of the most prolonged global pandemics, disturbing the routine of hospital protocols beyond measure, especially affecting surgical specialties, emergencies, and cancer care.Methods: This observational study was conducted on 129 patients of pediatric and adult age groups ...
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Objective: COVID-19 caused one of the most prolonged global pandemics, disturbing the routine of hospital protocols beyond measure, especially affecting surgical specialties, emergencies, and cancer care.Methods: This observational study was conducted on 129 patients of pediatric and adult age groups who presented with abdominal emergencies from March 1, 2020 to March 31, 2022 and were recruited for the study from the department of General Surgery, All India Institute of Medical Sciences, Bhopa. The analysis done using the chi-square or Fisher’s exact test. P values < 0.05 were considered significant. The outcomes were compared with the pre-existing standard protocols using SPSS.Results: Among the 129 patients, 104 were COVID-19-negative and 15 were COVID-19-positive, and in 10 cases, the results were inconclusive. The abdominal presentations observed in the study were as follows: two patients with hemorrhagic and five with septic shock. Emergency surgeries were done in 80 (62.1%) patients, and conservative approaches were used in 49 (37.9%) patients; of the 80 patients who underwent operation, 30 (37.5%) required deviation from standard established protocols. The ICU admitted a larger number of COVID-19-positive patients as compared to COVID-19-negative patients [8 (57%) vs. 24 (25%)] who needed operations, and 18 (13.9%) patients were treated conservatively in the ICU. Mortality was higher in COVID-19-positive as compared to COVID-19-negative patients [4 (28%) vs. 9 (8%)].Conclusion: The present study demonstrated the definite negative impact of COVID-19 on emergencies but provided useful lessons for emergency surgeons. A high standard of care, such as evaluating if a procedure can be postponed till the patient is less infectious or at a lesser risk of morbidity and mortality, is warranted during COVID-19 or similar pandemics. Ensuring adequate safety measures in the operating theatre is essential. We recommend a careful and judicious evaluation of every surgical indication.
Surgery
Rouzbeh Rajaei Ghafouri; Saeed Shahbazi; Changiz Gholipour; Samad Shams Vahdati; Manouchehr khoshbaten; Amir Ghaffarzad; Respina Jalilian
Volume 2, Issue 2 , July 2016, , Pages 46-49
Abstract
Objective: Acute mesenteric ischemia (IMA) is a vascular emergency with broad variability of clinical presentations and non-specific laboratory findings. Therefore, there is a significant need for reliable serological markers of ischemia. Various laboratory studies may be performed for suspected AMI, ...
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Objective: Acute mesenteric ischemia (IMA) is a vascular emergency with broad variability of clinical presentations and non-specific laboratory findings. Therefore, there is a significant need for reliable serological markers of ischemia. Various laboratory studies may be performed for suspected AMI, but in general, such studies will not establish the diagnosis.Methods: In a prospective, non-interventional study, from October 2012 to October 2013, we investigated 70 patients with probable diagnosis of AMI. Blood samples were taken from patients and analyzed for complete blood count (CBC), prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), urea, creatinine (Cr), sodium (Na), potassium (K), D-dimer, lactate, amylase, PH, partial pressure of carbon dioxide (PCO2), and bicarbonate (HCO3). Finally the results were compared with AMI diagnosis confirmed by computed tomography (CT) angiography.Results: Seventy patients with acute severe abdominal pain were studied. Thirty-nine patients (55.7%) were male and 31 patients (44.3%) were female. The average age was 68.01 ± 14.67 (±SD). Based on CT-angiography results, 27 (38.6%) patients had AMI and 43 (61.4%) patients did not have AMI. Chi-squire test showed P values of 0.606 and 0.986 for relations between sex and risk factors with AMI correspondingly. One-sample Kolmogorov-Smirnov revealed white blood cell (WBC), hemoglobin (Hb), platelets (Plt), urea, Cr, Na, K, PCO2 and HCO3 as normally distributed parameters (P > 0.05). Moreover PT, PTT, INR, D-dimer, lactate, amylase, and PH were non-normally distributed (P < 0.05).Conclusion: We found a significant relation between increased serum lactate level and definitive AMI diagnosis. We recommend rising serum lactate as a finding in AMI.