Evaluation of an adjusted MEWS (Modified Early Warning Score) for COVID-19 patients to identify risk of ICU admission or death in the Kingdom of Bahrain

Background: While most COVID-19 cases have uncomplicated infection, a small proportion has the potential to develop life-threatening disease, as such development of a prediction tool using patients baseline characteristics at the time of diagnosis should aid in early identification of high-risk groups and devise pertinent management. Hence, we set up this retrospective study to determine preadmission triaging tool to predict the development of severe COVID-19 in the Kingdom of Bahrain Materials and methods: A retrospective study was conducted from 1 September 2020 to 30 November 2020 with enrolment of all SARS-CoV-2 PCR-confirmed persons aged ≥ 14 years who attended Al-Shamil Field Hospital (SFH) in the Kingdom of Bahrain for triaging and assessment with recording of the following parameters: systolic blood pressure, heart rate, respiratory rate, temperature, the alert, verbal, pain, unresponsive neurological score, age, oxygen saturation, comorbidities, Body Mass Index (BMI), duration of symptoms and living with immunocompromised populations to develop our local adjusted MEWS as predictor for ICU admission & for consideration of suitable isolation at home.Follow up data of all patients was obtained from the electronic medical records system including CXR findings, treatments/medications received, need of oxygen supplements /intubation, needs of ICU care, and the outcome (death /discharged alive)IBM SPSS statistic version 21 program was used for data analysis. Results: Our study showed that using the locally developed adjusted MEWS score, there was an significant association between high value of this adjusted MEWS score and abnormal radiographic finding (49.7 % Vs. 17 % for patients with high score Vs. those with low score respectively). Out of the 181 patients with high scores on adjusted MEWS; 38.7 % required oxygen via nasal cannula, 14.4 % required face mask and 8.3 % non-rebreather mask; this proportion was significantly higher than their counterpart patients who score low on adjusted MEWS (20.9 %, 7.7 %, 4.8 %respectively) with statistically significance difference between the two groups (p value of 0.00, 0.00,.004 respectively)Requirement of ICU admission was significantly higher among patients with high score in comparison to those with low score (14.4 % vs. 3 %) with significant p value (0.00)But higher score value was not associated significantly with increase mortality rate among COVID patients. Conclusion: Development of our new Adjusted MEWS score system by adding the additional elements of age, oxygen saturation, comorbidities, Body Mass Index (BMI) and duration of symptoms found to be very useful predictor tool for preadmission triaging of COVID patients based on their risk assessment to help clinician to decide on the appropriate placement to different level of isolation facilities

Adrenocortical Oncocytic Carcinoma and Papillary Thyroid Carcinoma Incidentally Detected in an Asymptomatic Patient by F-18 FDG PET/CT

F-18 FDG is the most widely used tracer in molecular imaging and it isapplied for many purposes mainly in malignant diseases. Incidental findingare common in FDG-PET/CT imaging and includes benign and malignantlesions. Among the rare tumors , adrenal oncocytomas are uncommonfindings and incidental findings of thyroid malignancies are not rare.Oncocytoma is a rare adrenocortical tumor and majority of bulky adrenaltumors are benign with uncertain incident of malignancy. In this study,we are reporting a 37-year-old man with two incidental malignanciesdetected by FDG-PET-CT. He has no symptoms has no blood and hormonalabnormalities.The scan demonstrated intense heterogeneous FDG uptake within thebulky oval shaped lesion in the left adrenal gland. Accordingly, openadrenalectomy was performed and diagnosis of adrenocortical carcinomaoncocytic type was established. Furthermore, a focal FDG uptake wasidentified in the right thyroid lobe and histopathology findings wereconsistent with well-differentiated papillary thyroid cancer. FDG playsa great role in identifying primary rare lesions and also detection ofincidental findings at unexpected sites

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)