15 research outputs found
Introduction and evolution of dengue virus type 2 in Pakistan: a phylogeographic analysis
Outcomes of obese patients hospitalized with COVID-19: the impact of prior bariatric surgery.
The impact of the novel coronavirus pandemic on gastrointestinal operative volume in the United States
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Outcomes of obese patients hospitalized with COVID-19: the impact of prior bariatric surgery
BackgroundObesity and several obesity-related co-morbidities are risk factors for severe COVID-19 disease. Because bariatric surgery successfully treats obesity-related conditions, we hypothesized that prior bariatric surgery may be associated with less severe COVID-19 disease.ObjectivesTo examine the association between prior bariatric surgery and outcomes in patients with obesity admitted with COVID-19.SettingUnited States METHODS: The Vizient database was used to obtain demographic and outcomes data for adults with obesity admitted with COVID-19 from May 2020 to January 2021. Patients were divided into 2 groups: those with and those without prior bariatric surgery. The primary outcome was in-hospital mortality. Secondary outcomes were mortality by age, sex, race/ethnicity, and co-morbidity; intubation rate; hemodialysis rate; and length of stay. Because the database only provides aggregate data and not patient-level data, multivariate analysis could not be performed.ResultsAmong the 124,699 patients with obesity admitted with COVID-19, 2,607 had previous bariatric surgery and 122,092 did not. The proportion of patients ≥65 years of age was higher in the non-bariatric surgery group (36.0% versus 27.6%, P < .0001). Compared with patients without prior bariatric surgery, patients with prior bariatric surgery had lower in-hospital mortality (7.8 versus 11.2%, P < .0001) and intubation rates (18.5% versus 23.6%, P = .0009). Hemodialysis rate (7.2% versus 6.9%, P = .5) and length of stay (8.8 versus 9.6 days, P = .8) were similar between groups. Mortality was significantly lower in the bariatric surgery group for patients 18-64 years of age (5.9% versus 7.4%, P = .01) and ≥65 years of age (12.9% versus 17.9%, P = .0006).ConclusionsThis retrospective cohort study found that inpatients with obesity and COVID-19 who had prior bariatric surgery had improved outcomes compared with a similar cohort without prior bariatric surgery. Further studies should examine mechanisms for the association between bariatric surgery and less severe COVID-19
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The impact of the novel coronavirus pandemic on gastrointestinal operative volume in the United States.
BackgroundIn March 2020, the Surgeon General recommended limiting elective procedures to prepare for the COVID-19 surge. We hypothesize a consequence of COVID-19 is reduced operative volume across the country. We aim to examine changes in volume of common gastrointestinal operations during COVID-19, including elective, urgent/emergent, and cancer operations. We also evaluate if hospitals with more COVID-19 admissions were most impacted.MethodsThe Vizient database was used to determine monthly operative volume from November 2019 to June 2020 for elective operations (hiatal hernia repairs, bariatric surgery), urgent operations (cholecystectomies, appendectomies, inguinal hernia repairs), and cancer operations (colectomies, gastrectomies, esophagectomies). COVID-19 admissions per hospital were also determined. November 2019-January 2020 was defined as "pre-COVID." The monthly reduction in volume from pre-COVID was calculated for each operation. The top quartile (25%) of hospitals with the most COVID admissions were also evaluated separately from hospitals with fewer COVID cases. Data were analyzed using analysis of variance.ResultsData from 559 hospitals were analyzed. The volumes of all operations evaluated were significantly reduced during the pandemic except gastrectomies and esophagectomies for cancer. The greatest reduction in all operations was in April. In April, the volume of bariatric surgery reduced by 98% (P < 0.001), hiatal hernia repairs by 96% (P < 0.001), urgent cholecystectomies by 42% (P < 0.001), urgent inguinal hernia repairs by 40% (P < 0.001), urgent appendectomies by 24% (P < 0.001), and colectomies for cancer by 39% (P < 0.001). Hospitals with the most COVID-19 admissions had greater reductions in all operations than hospitals with fewer COVID cases.ConclusionsThe coronavirus pandemic led to a significant reduction in volume of all gastrointestinal operations evaluated except gastrectomies and esophagectomies. While elective, non-cancer operations were most affected, urgent and some cancer operations also declined significantly. As COVID-19 continues to surge, Americans may suffer continued limited access to surgical care and a significant operative backlog may be forthcoming
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Intracystic Hemorrhage Complicating Polycystic Liver Disease in a 90-Year-Old Woman.
Nonparasitic hepatic cysts are common benign tumors that are often asymptomatic and incidentally discovered on imaging. Intracystic hemorrhage is a rare complication of hepatic cysts. We review the literature and discuss a case of intracystic hemorrhage in a 90-year-old woman with polycystic liver disease. The patient underwent cyst aspiration and percutaneous drain placement with subsequent resolution of symptoms. To our knowledge, we report the oldest patient to present with hemorrhage into a hepatic cyst. This case presents unique challenges in management, both because of the patient's age and because of her polycystic liver disease
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Outcomes of Colectomy and Proctectomy According to Surgeon Training: General vs Colorectal Surgeons.
BackgroundColectomies and proctectomies are commonly performed by both general surgeons (GS) and colorectal surgeons (CRS). The aim of our study was to examine the outcomes of elective colectomy, urgent colectomy, and elective proctectomy according to surgeon training.Study designData were obtained from the Vizient database for adults who underwent elective colectomy, urgent colectomy, and elective proctectomy from 2020-2022. Operations performed in the setting of trauma and patients within the database's highest relative expected mortality risk group were excluded. Outcomes were compared according to surgeon's specialty: GS vs. CRS. The primary outcome was in-hospital mortality. The secondary outcome was in-hospital complication rate. Data were analyzed using multivariate logistic regression.ResultsOf 149,516 elective colectomies, 75,711(50.6%) were performed by GS and 73,805(49.4%) by CRS. Compared to elective colectomies performed by CRS, elective colectomies performed by GS had higher rates of complications(4.9% vs. 3.9%, OR1.23, 95%CI 1.17-1.29,p<.01) and mortality(0.5% vs. 0.2%, OR2.06, 95%CI 1.72-2.47,p<.01). Of 71,718 urgent colectomies, 54,680(76.2%) were performed by GS, while 17,038(23.8%) were performed by CRS. Compared to urgent colectomies performed by CRS, urgent colectomies performed by GS were associated with higher rates of complications(12.1% vs. 10.4%, OR1.14, 95%CI 1.08-1.20,p<.01) and mortality (5.1% vs. 2.3%, OR2.08, 95%CI 1.93-2.23,p<.01). Of 43,749 elective proctectomies, 28,458(65.0%) were performed by CRS and 15,291(35.0%) by GS. Compared to proctectomies performed by CRS, those performed by GS were associated with higher rates of complications (5.3% vs. 4.4%, OR1.16, 95%CI 1.06-1.27,p<.01) and mortality(0.3% vs. 0.2%, OR1.49, 95%CI 1.02-2.20,p=.04).ConclusionsIn this nationwide study, colectomies and proctectomies performed by CRS were associated with improved outcomes compared to GS. Hospitals without a CRS on staff should consider prioritizing recruiting CRS specialists
Procedural simulation: medical student preference and value of three task trainers for ultrasound guided regional anesthesia.
BACKGROUND:Ultrasound guided regional anesthesia is widely taught using task trainer models. Commercially available models are often used; however, they can be cost prohibitive. Therefore, alternative "homemade" models with similar fidelity are often used. We hypothesize that professional task trainers will be preferred over homemade models. The purpose of this study is to determine realism, durability and cleanliness of three different task trainers for ultrasound guided nerve blocks. METHODS:This was a prospective observational study using a convenience sample of medical student participants in an ultrasound guided nerve block training session on January 24th, 2015. Participants were asked to perform simulated nerve blocks on three different task trainers including, 1 commercial and 2 homemade. A questionnaire was then given to all participants to rate their experiences both with and without the knowledge on the cost of the simulator device. RESULTS:Data was collected from 25 participants. The Blue Phantom model was found to have the highest fidelity. Initially, 10 (40%) of the participants preferred the Blue Phantom model, while 10 (40%) preferred the homemade gelatin model and 5 (20%) preferred the homemade tofu model. After cost awareness, the majority, 18 (72%) preferred the gelatin model. CONCLUSION:The Blue Phantom model was thought to have the highest fidelity, but after cost consideration the homemade gelatin model was preferred