Predictors of pleural decompression in blunt traumatic occult hemothorax: A retrospective study

Background: The increased use of computed tomography (CT) results in higher occult hemothorax detection in blunt chest trauma. The indication for pleural decompression is not well defined. This research aims to study the overall factors determining pleural decompression. Methods: All blunt chest injury patients were retrospectively reviewed from the institutional trauma registry. Patients who underwent chest or whole-abdomen CT within 24 h were reviewed by a radiologist to identify initial occult hemothorax defined as a negative chest X-ray with the presence of hemothorax in the CT. The data included demographic data, mechanism of injury, complications, treatments, and characteristics of the hemothorax from the CT. Results: Six hundred and eighty-six blunt chest injury patients were reviewed over a period of 30 months. Eighty-one (24.9) patients had occult hemothorax. The mean time from injury to CT was 5.7 h. Most patients (87.6) were male. Most patients (70.2) suffered from traffic collisions and 84.4 had rib fractures. Pleural decompression was performed in 25 patients who had significantly thicker hemothorax (1.1 cm vs. 0.8 cm,P P P 1.1 cm was associated with increased risk of pleural decompression (odds ratio OR: 5.51, 95% confidence interval CI: 1.42 /21.42) and occult pneumothorax (OR: 6.93, 95% CI: 1.56/30.77). Conclusions: Drainage of occult hemothorax after blunt chest trauma was significantly associated with concomitant occult pneumothorax, lung contusion, and hemothorax thicker than 1.1 cm

Noise Exposure Assessment in a Dental School

Objectives: This cross-sectional study was performed in the Dental School of Prince of Songkla University to ascertain noise exposure of dentists, dental assistants, and laboratory technicians. A noise spectral analysis was taken to illustrate the spectra of dental devices.Methods: A noise evaluation was performed to measure the noise level at dental clinics and one dental laboratory from May to December 2010. Noise spectral data of dental devices were taken during dental practices at the dental services clinic and at the dental laboratory. A noise dosimeter was set following the Occupational Safety and Health Administration criteria and then attached to the subjects’ collar to record personal noise dose exposure during working periods.Results: The peaks of the noise spectrum of dental instruments were at 1,000, 4,000, and 8,000 Hz which depended on the type of instrument. The differences in working areas and job positions had an influence on the level of noise exposure (p < 0.01). Noise measurement in the personal hearing zone found that the laboratory technicians were exposed to the highest impulsive noise levels (137.1 dBC). The dentists and dental assistants who worked at a pedodontic clinic had the highest percent noise dose (4.60 ± 3.59%). In the working areas, the 8-hour time-weighted average of noise levels ranged between 49.7-58.1 dBA while the noisiest working area was the dental laboratory.Conclusion: Dental personnel are exposed to noise intensities lower than occupational exposure limits. Therefore, these dental personnel may not experience a noise-induced hearing loss

Implementation of Triage System and Shortening Patient Journey Time to Prevent COVID-19 Transmission in a University Hospital during a Pandemic

To explore the characteristics of the patient under investigation (PUI), and the routes and the patient journey time in our outpatient service, we examined the demographic data, presenting symptoms, risks of contact with COVID-19 cases, and the results of real-time polymerase chain reaction (PCR) tests in PUI cases from March to May 2020. The contact time, transfer time and total journey time of patient journey routes in our hospital were also explored. The results were shown in numbers, percentages and medians (interquartile range, IQR). A total of 334 PUI cases were identified from our triage system. The median (IQR) age was 35 (27, 47) years. Cough was the most common presenting symptom (56.2%), while fever (≥37.5 °C) was found in only 19.8% of the cases. The median (IQR) time of onset of the presenting symptoms was 3 (1, 5) days. The most common risk of contact with COVID-19 cases found during the triage was living in or returning from an outbreak area. Fifteen (4.5%) of the PUI cases had positive real-time PCR tests. The contact time and transfer time were longest in the PUI ward and from the Emergency Department (ED) to the PUI ward, respectively. Plans and actions to shorten the transfer time between the ED and the PUI ward and the total journey time should be developed

Validation of original, expanded Baveno VI, and stepwise &amp; platelet-MELD criteria to rule out varices needing treatment in compensated cirrhosis from various etiologies

Introduction and objectives: The Baveno VI criteria to rule out varices needing treatment (VNT) was introduced in 2015. Soon after, the expanded Baveno VI and stepwise platelet-MELD criteria were proposed to be equal/more accurate in ruling out VNT; however, neither has been widely validated. We aimed to validate all 3 criteria in compensated cirrhosis from assorted causes. Materials and methods: We conducted a cross-sectional study including all adult compensated cirrhotic patients who underwent endoscopic surveillance at our center from 2014 to 2018 and had transient elastography (TE), and laboratory data for criteria calculation within 6 months of endoscopies. Exclusion criteria were previous decompensation, unreliable/invalid TE results, and liver cancer. The diagnostic performances of all criteria were evaluated. Results: A total of 128 patients were included. The major cirrhosis etiologies were hepatitis C and B (37.5% and 32.8%, respectively). VNT was observed in 7.8%. All criteria yielded high negative predictive values (NPVs) > 95%, missed VNT was observed in 2%, 2.7%, and 2.8% in the original, expanded Baveno VI, and platelet-MELD criteria, respectively. The expanded Baveno VI and the platelet-MELD criteria yielded significantly better specificities and could spare more endoscopies than the original Baveno VI criteria. Conclusions: All 3 criteria showed satisfactorily high NPVs in ruling out VNT in compensated cirrhosis from various causes. The expanded Baveno VI and the platelet-MELD criteria could spare more endoscopies than the original Baveno VI criteria. From a public health standpoint, the platelet-MELD criteria might be useful in a resource-limited setting where TE is not widely available

A Single Center Study on the Risks of Peri-Intervention Stroke in Thoracic Endovascular Aortic Repair (TEVAR) and Endovascular Abdominal Aortic Repair (EVAR)

(1) Background: The risk factors of peri-intervention stroke (PIS) in thoracic endovascular aortic repair (TEVAR) and endovascular abdominal aortic repair (EVAR) are different. This study aimed to compare the risks of PIS in both interventions. (2) Methods: Patients who had suffered a PIS related to TEVAR or EVAR from January 2008 to June 2015 in Songklanagarind Hospital were selected as the cases, while patients who had not suffered PIS were randomly selected to create a 1:4 case: control ratio for analysis. The associations between the factors from pre- to post-intervention and PISs in TEVAR or EVAR cases were analyzed by univariable analysis (p p p p = 0.010) and post-intervention hyperglycemia (18.60 (1.60–216.06), p = 0.001) in the EVAR-related PIS. There were no differences in the rate of PIS among the operators, intervention techniques, and status of the interventions performed. (4) Conclusion: The risks of PIS in TEVAR or EVAR in our center were different and possibly independent of the operator expertise and intervention techniques

Integrative Effects between a Bubble and Seal Program and Workers&rsquo; Compliance to Health Advice on Successful COVID-19 Transmission Control in a Factory in Southern Thailand

Applying health measures to prevent COVID-19 transmission caused disruption of businesses. A practical plan to balance public health and business sustainability during the pandemic was needed. Herein, we describe a &ldquo;Bubble and Seal&rdquo; (B&amp;S) program implemented in a frozen seafood factory in southern Thailand. We enrolled 1539 workers who lived in the factory dormitories. First, the workers who had a high fatality risk were triaged by RT-PCR tests, quarantined and treated if they had COVID-19. Newly diagnosed or suspected COVID-19 workers underwent the same practices. The non-quarantined workers were regulated to work and live in their groups without contact across the groups. Workers&rsquo; personal hygiene and preventive measures were strongly stressed. Between the 6th and 9th weeks of the program, the post-COVID-19 infection status (PCIS) of all participants was evaluated by mass COVID-19 antibody or RT-PCR tests. Finally, 91.8% of the workers showed positive PCIS, which was above the number required for program exit. Although no workers had received a vaccination, there was only one case of severe COVID-19 pneumonia, and no evidence of COVID-19 spreading to the surrounding communities. Implementation of the B&amp;S program and workers&rsquo; adherence to health advice was the key to this success