Vellingwilliam4362

Results The frequency (percentage) of patients with STEMI in each Killip class from I to IV was 395 (81.4%), 46 (9.5%), 27 (5.6%), and 17 (3.5%), respectively, while the in-hospital mortality in each Killip class came out to be 39 (9.9%), 4 (8.7%), 25 (92.6%) and 17 (100%), respectively. The presence of diabetes, history of smoking, and body mass index (BMI) of more than 30 kg/m2 were significant contributors to mortality, along with higher Killip class and age of presentation. Conclusions It is concluded that the Killip classification system is a valid tool for risk stratification for patients after STEMI, especially in resource-limited countries.Background and objective Surgical site infections (SSI) are the most common healthcare-associated infections in low- and middle-income countries associated with substantial morbidity and mortality and impose heavy demands on healthcare resources. We aimed to study the microbiological profile of SSI pathogens and their antibiotic-resistant patterns in a tertiary care teaching hospital serving mostly rural population Methods A prospective, hospital-based cross-sectional study on pathogen profile and drug resistance was conducted from January 2015 to December 2016. Study subjects were the patients who developed signs of SSI after undergoing surgical procedures at three surgical wards (General Surgery, Orthopedics, and Obstetrics & Gynecology). The selection of the patients was based on CDC Module. Standard bacteriological methods were applied for isolation of pathogens and antibiotic-susceptibility testing based on CLSI (Clinical Laboratory Standard Institute) guidelines. Results Out of 518 enrolled subjects, 19d high resistance to the commonly used antibiotics thus leaving clinicians with few choices. This necessitates periodic surveillance of causative organisms and their antibiotic-susceptibility pattern to help in formulating hospital antibiotic policy. The antibiotic stewardship program is yet to be adopted in our hospital.Introduction Severe ischemia induces cerebral excitability imbalance before completion of infarct. To investigate the clinical availability of this imbalance with ischemic monitoring, paired-pulse somatosensory evoked potentials (SEPs) were performed in conjunction with conventional SEPs during carotid endarterectomy. Methods For carotid endarterectomy patients with hemodynamic deficits of the middle cerebral artery area (n = 34), the excitability imbalances (Q) were measured by paired-pulse SEPs, wherein the second response (A2) was divided by the first (A1; Q = A2/A1). Regional cerebral saturation (rSO2) was also measured. Occlusion was performed twice using shunting. Results Each carotid occlusion induced a significant decrease in mean A1 and rSO2, and an increase in mean Q values (p less then 0.001), which returned to the baseline level after occlusion. While neuronal imbalances were mostly transient, persistently increased Q values were observed in four cases (11.8%), all indicating postoperative abnormalities in diffusion-weighted magnetic resonance imaging (100%). Meanwhile, A1 detected the postoperative abnormality in only one case (25%). Preoperative Q values at the time of surgery were significantly higher in symptomatic patients having the upper limb deficits than those without (p less then 0.01), indicating persistent or permanent imbalances. Conclusion Paired-pulse SEPs reliably identified transient, persistent or permanent neuronal imbalances, depending on the ischemic severity. These preliminary results indicated that paired-pulse SEPs, in combination with conventional SEPs (A1), may offer better ischemic monitoring.Introduction Although there have been important developments in microsurgery in recent years, there is no current and comprehensive bibliometric study in the literature. In this study, we aimed to present a summary of the articles published on microsurgery between 1980 and 2019 with bibliometric analysis. Methods Articles published on microsurgery between 1980 and 2019 were withdrawn from the Web of Science database and analyzed by bibliometric methods. Citation analysis was performed to identify effective journals and articles. Keyword cluster and trends analyses were performed for a detailed analysis of the researched topics. Relationships between the article numbers of the countries and gross domestic product (GDP) and human development index (HDI) values were investigated using Spearman's correlation coefficient. A linear regression analysis was used to estimate the number of articles to be published in the future. Results A total of 3,537 publications related to microsurgery were found. Bibliometric analyses were performed in 2,063 articles (58.3%) of these publications. The most active countries in publishing were the United States (504), Germany (286), and Italy (154), respectively. A statistically significant correlation was found between the article numbers and the GDP and HDI sizes of the countries (r = 0.758, p less then 0.001, r = 0.659, p less then 0.001). Conclusion The economic size and development levels of the countries were an important factor in academic productivity in microsurgery. Undeveloped countries should be encouraged by performing multidisciplinary studies in this regard.Immune checkpoint inhibitors (ICIs) are novel humanized monoclonal antibodies that release the brakes on the immune system, resulting in the destruction of tumor cells. ICIs are approved for a variety of hematological and solid organ malignancies, and the list has been growing since the approval of ipilimumab in 2011. ICIs are associated with a variety of immune-related adverse events (irAEs). irAEs commonly affect the skin, the gastrointestinal (GI) tract, and the endocrine system. Acute kidney injury (AKI) due to ICIs (ICI-AKI) occurs in a minority of patients, and it is usually due to acute tubulointerstitial nephritis (ATIN). Treatment with corticosteroids is usually successful. There have been reports of electrolyte disorders due to ICIs, including hyponatremia, hypocalcemia, hypokalemia, and Fanconi syndrome. The diagnosis of electrolyte disorders requires vigilance and routine laboratory monitoring.Background The aim of this study was to evaluate the clinical and radiological results of patients with acute type III Rockwood acromioclavicular joint (ACJ) dislocation treated surgically by employing tension band wiring. Methods The study included 24 patients with traumatic type III ACJ dislocations according to the Rockwood classification. The clinical and radiological outcomes of patients were assessed at the final follow-up visit. Implant failure and reduction loss were assessed using radiographs, whereas the Constant-Murley scoring system was used to assess the patients clinically. Results The mean follow-up period was 3.5 ± 1.3 years (range 1-6 years). The mean age of the patients was 41.8 ± 11.7 years (range 19-64 years) and the mean length of hospital stay was 2.3 days (range 1-6 days). The fixation material was removed postoperatively at an average of 7.2 ± 9.9 months (range 3-40 months). At the end of the follow-up period, the mean Constant-Murley score was 72.5 ± 12.8 (range 50-90). The ACJ reduction was stable in 13 (54.2%) patients. Residual subluxation was detected in 11 (45.8%) patients. Distal clavicular osteolysis was noted in six (25%) patients. Acromioclavicular osteoarthritis was detected in five (20.8%) operated shoulders on follow-up radiographs. During the follow-up, Kirschner-wire migration and breakage occurred in four (16.6%) and seven (29.1%) patients, respectively. Conclusions This study showed that surgical treatment with the tension band wiring method provided functionally satisfactory results even if complications developed because of the presence of implants. Independent of age, we can recommend it as the primary treatment method for patients who do not have very high expectations regarding their shoulder function. Additionally, we think that reducing the duration of implant retention will reduce the incidence of complications.Introduction Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are two common treatment options used in patients suffering from coronary artery disease. check details Selection and favorability of one over the other depend on individual clinical scenarios. The purpose of this study is to compare outcomes after treatment with PCI and CABG. Methods This longitudinal observational study was conducted from April 2018 to July 2019 in a cardiovascular unit of a tertiary care hospital. Participants who were eligible for revascularization were randomized either to receive stent (PCI) or surgery (CABG). Patients were then followed up for 12 months for the development of all-cause mortality and major adverse cardiovascular events (MACEs). Results At 12 months, patients randomized to the PCI group had an increased risk of repeat revascularization (21.3% vs. 7.4%; p = 0.007), whereas a similar number of patients in both groups died (3.8% vs. 3.7%), suffered myocardial infarction (7.6% vs. 5.6%), or had a cerebrovascular accident (3.8% vs. 2.8%). Conclusions This study showed that PCI had an increased risk of repeat revascularization compared to CABG. However, both had comparable significance in the development of MACEs. Nevertheless, there is a need for further study to better assess the outcomes of either, especially in the long run.Common variable immunodeficiency (CVID) is a primary immunodeficiency that presents with a broad spectrum of clinical manifestations. We report the case of a 33-year-old man, initially referred to the outpatient internal medicine clinic for anemia. At the evaluation, the patient complained of diarrhea and unintentional weight loss for the last six months. He had no known medical conditions, but his previous medical history highlighted recurrent respiratory infections since childhood and also oral ulcers. The investigation identified iron-deficiency anemia caused by a malabsorption syndrome due to chronic giardiasis (Giardia lamblia cysts identified in fecal culture and Giardia lamblia trophozoites identified in the villi epithelium). Further investigation revealed bilateral bronchiectasis and splenomegaly. Suspecting CVID, a serum protein electrophoresis was performed, which showed a flattening of the gamma region, corresponding to a severe deficit of immunoglobulin (Ig) G, IgA, and IgM. A deficiency in the production of IgG in response to immunizations was confirmed, and the other causes of hypogammaglobulinemia were excluded. Therefore, a diagnosis of CVID was established. Malabsorption due to chronic giardiasis is a rare cause of iron deficiency anemia and an unusual presentation of CVID.Introduction COVID-19 has been a gravitating topic in the past months, yet much information about this new virus is to be unraveled. The uncertainties about the virus and its effects have affected a lot of daily life activities. One of these affected activities is emergency department (ED) visits and how this disease might have changed people's perspective on when to go to an emergency. This study aims to assess the effect of the COVID-19 pandemic on emergency department visits for neurological conditions. Methods A retrospective record review study was conducted at King Abdul-Aziz University Hospital (KAUH) during the month of July 2020. The study included visits of patients with common neurological conditions (headache, seizures, and weakness), during December 2019 - May 2020 at KAUH. Information obtained from the medical records included demographic data, date of visit, the reason for the visit, history of a similar episode, number of ED visits during the past year, priority given at the ED, length of hospitalization, diagnosis of COVID-19 at KAUH, known chronic diseases, and whether brain imaging was performed with which kind of imaging.