Injury patterns and emergency department mortality after unsuccessful suicide : a descriptive study of a consecutive case series

We hypothesized that trauma bay management and 24-hour emergency department (ED) mortality of patients that survived unsuccessful suicide attempts differ from other patients. Severely injured patients after an unsuccessful suicide attempt can be admitted to resuscitation rooms of any ED. To our knowledge, 24-hour mortality has not been investigated yet. We studied such patients admitted to the resuscitation room of a large ED. This consecutive case series included 64 patients who were evaluated in the resuscitation room because of an unsuccessful suicide attempt. Patient variables were recorded including method of suicide attempt, injuries, hemodynamic status, and treatment. Most patients were male [57 patients (89%)], and the most frequent methods were ingestion of harmful devices or substances [15 patients (23%)]; hanging [9 patients (14%)]; and strangulation [9 patients (14%)]. There were 2 patients who died in the ED: 1 from a self-inflicted gunshot to the head and the other from self-inflicted herbal poisoning. The frequency of emergency airway intervention was greater in patients after unsuccessful attempted suicide [18 patients, 28% (95% confidence interval [CI], 17.2%, 39%; endotracheal intubation, 17 patients; emergency tracheotomy, 1 patient] than all ED patients [1458 patients (16%); (95% CI, 14.9%, 16.4%; P = 0.005)]. Following attempted survived suicide, 24-hour ED mortality was 3% and 4% within the control group; the difference is insignificant (P = 0.9596). However, ED mortality showed a trend toward earlier death within the suicidal group. Resuscitation room mortality of patients that survived unsuccessful suicide does not differ from the general population of an ED resuscitation room

Bridging pre-surgical endocrine therapy for breast cancer during the COVID-19 pandemic: outcomes from the B-MaP-C study

Purpose: The B-MaP-C study investigated changes to breast cancer care that were necessitated by the COVID-19 pandemic. Here we present a follow-up analysis of those patients commenced on bridging endocrine therapy (BrET), whilst they were awaiting surgery due to reprioritisation of resources. Methods: This multicentre, multinational cohort study recruited 6045 patients from the UK, Spain and Portugal during the peak pandemic period (Feb–July 2020). Patients on BrET were followed up to investigate the duration of, and response to, BrET. This included changes in tumour size to reflect downstaging potential, and changes in cellular proliferation (Ki67), as a marker of prognosis. Results: 1094 patients were prescribed BrET, over a median period of 53 days (IQR 32–81 days). The majority of patients (95.6%) had strong ER expression (Allred score 7–8/8). Very few patients required expedited surgery, due to lack of response (1.2%) or due to lack of tolerance/compliance (0.8%). There were small reductions in median tumour size after 3 months’ treatment duration; median of 4 mm [IQR − 20, 4]. In a small subset of patients ( n = 47), a drop in cellular proliferation (Ki67) occurred in 26 patients (55%), from high (Ki67 ≥ 10%) to low (< 10%), with at least one month’s duration of BrET. Discussion: This study describes real-world usage of pre-operative endocrine therapy as necessitated by the pandemic. BrET was found to be tolerable and safe. The data support short-term (≤ 3 months) usage of pre-operative endocrine therapy. Longer-term use should be investigated in future trials

Another Pilonidal classification - PLLATIN

Introduction: Pilonidal disease is a troublesome disease of young adults, and associated with real discomfort for the patient. More than 40,000 operations are performed every year in Germany alone. Methods: Two classification systems are reviewed and novel approach presented. Results: PLLATIN classification is described: Proximity to anus; Length from distal to proximal sinus; LATeral openings distance from midline; Infection; Number of previous definitive surgery attempts. Conclusion: Classification systems require validation