Impact of Preoperative Echocardiograms on In-Hospital Outcomes of Patients Undergoing Surgical Hip Fracture Repair and Their Clinical Appropriateness.

OBJECTIVES: Preoperative transthoracic echocardiograms (TTE) before hip fracture repairs are controversial. This study aimed to quantify the frequency of ordering TTE, the appropriateness of testing based on current guidelines, and the impact of TTE on in-hospital morbidity and mortality outcomes. METHODS: This retrospective chart review of adult patients admitted with hip fracture compared the length of stay (LOS), time to surgery, in-hospital mortality, and postoperative complications between TTE and non-TTE groups. TTE patients were risk stratified using the Revised Cardiac Risk Index (RCRI) to compare TTE indication according to current guidelines. RESULTS: Of the 490 patients included in this study, 15% received preoperative TTE. The median LOS of the TTE and non-TTE groups was 7.0 and 5.0 d, respectively, whereas the median time to surgery was 34 and 14 h, respectively. The odds of in-hospital mortality remained significantly higher in the TTE group after adjusting for RCRI but not when adjusted for the Charlson Comorbidity Index. Significantly more patients in the TTE groups had postoperative heart failure and up triage in the intensive care unit. Furthermore, 48% of patients with an RCRI score of 0 received preoperative TTE, with cardiac history as the most typical indication. TTE changed perioperative management in 9% of patients. CONCLUSIONS: Patients subjected to TTE before hip fracture surgery had a longer LOS and time to surgery, with higher mortality and intensive care unit up triage rates. TTE evaluations were typically conducted for inappropriate indications, which rarely made meaningful changes to patient management.

Diagnosis of hypercritical chronic pulmonary disorders using dense convolutional network through chest radiography.

Lung-related ailments are prevalent all over the world which majorly includes asthma, chronic obstructive pulmonary disease (COPD), tuberculosis, pneumonia, fibrosis, etc. and now COVID-19 is added to this list. Infection of COVID-19 poses respirational complications with other indications like cough, high fever, and pneumonia. WHO had identified cancer in the lungs as a fatal cancer type amongst others and thus, the timely detection of such cancer is pivotal for an individual's health. Since the elementary convolutional neural networks have not performed fairly well in identifying atypical image types hence, we recommend a novel and completely automated framework with a deep learning approach for the recognition and classification of chronic pulmonary disorders (CPD) and COVID-pneumonia using Thoracic or Chest X-Ray (CXR) images. A novel three-step, completely automated, approach is presented that first extracts the region of interest from CXR images for preprocessing, and they are then used to detects infected lungs X-rays from the Normal ones. Thereafter, the infected lung images are further classified into COVID-pneumonia, pneumonia, and other chronic pulmonary disorders (OCPD), which might be utilized in the current scenario to help the radiologist in substantiating their diagnosis and in starting well in time treatment of these deadly lung diseases. And finally, highlight the regions in the CXR which are indicative of severe chronic pulmonary disorders like COVID-19 and pneumonia. A detailed investigation of various pivotal parameters based on several experimental outcomes are made here. This paper presents an approach that detects the Normal lung X-rays from infected ones and the infected lung images are further classified into COVID-pneumonia, pneumonia, and other chronic pulmonary disorders with an utmost accuracy of 96.8%. Several other collective performance measurements validate the superiority of the presented model. The proposed framework shows effective results in classifying lung images into Normal, COVID-pneumonia, pneumonia, and other chronic pulmonary disorders (OCPD). This framework can be effectively utilized in this current pandemic scenario to help the radiologist in substantiating their diagnosis and in starting well in time treatment of these deadly lung diseases.

Thrombotic and Clinical Outcomes in Patients with Hematologic Malignancy and COVID-19.

BACKGROUND: Venous thromboembolism (VTE) is a common complication in acute COVID-19 and those with hematologic malignancy (HM) may be at an even higher risk. We performed a retrospective analysis of patients with history of HM and acute COVID-19 to evaluate thrombotic and clinical outcomes. METHODS: Patients with COVID-19 were identified by positive SARS-CoV-2 PCR test. Our primary endpoints were rate of VTE and CVA in patients with HM compared to the general population (GP). Secondary outcomes included composite thrombotic events (CVA + VTE), COVID-19 fatality, respiratory support, ICU admission rates, and length of ICU stay RESULTS: A total of 833 patients were evaluated, 709 in the GP cohort, 124 patients in the HM cohort. CVA was more prevalent in the HM cohort (5.4% vs. 1.6%, P = .011). Rates of VTE were numerically higher for the HM cohort (8.0% vs. 3.6%, P = .069). The composite thrombotic rate was increased in the HM cohort (13.4% vs. 5.2%, P = .005). Patients with HM had a higher inpatient fatality rate (35.5% vs. 11.3%, P < .001), required more respiratory support (74.6% vs. 46.5%, P < .001) and had a higher rate of ICU admission (31.9% vs. 12.1%, P = .001). CONCLUSION: Our data demonstrated an increased rate of composite thrombotic (CVA + VTE) outcomes, indicating HM patients with acute COVID-19 are at increased risk of thrombosis. Irrespective of disease status, HM patients also have significantly increased need for intensive care, respiratory support, and have higher fatality rates.

Basilic vein transposition: A viable alternative for multiple failed arteriovenous fistulas - A single center experience.

Primary use of the autogenous arteriovenous access is recommended by the National Kidney Foundation-Dialysis Outcomes Quality Initiative guidelines. In spite of troublesome comorbidities associated with basilic vein transposition (BVT), it is still the most preferred technique when autologous veins are not suitable to construct radio-cephalic fistula (RCF) and brachiocephalic fistula (BCF), arteriovenous fistula (AVF). The present study highlights our experience with BVT, with small incision technique, over a period of two years with excellent outcome. This retrospective study included all the patients who underwent BVT at our tertiary care center between March 2013 and March 2015. It was performed in patients with failed previous RCF or BCF or who had small caliber or thrombosed cephalic veins. The patients with minimum 3 mm basilic vein diameter on Doppler were only included in the study. A 3-cm horizontal incision was made in antecubital fossa to expose brachial artery and basilic vein. Multiple longitudinal separate second skin incisions (2-3 cm) were made to explore proximal part of basilic vein. Side branches of the vein were isolated and ligated. The divided basilic vein in antecubital fossa was brought over fascia through newly created subcutaneous tunnel followed by end-to-side anastomosis. A total of 18 (12 males and 6 females) underwent BVT in the two years period. The mean fistula maturation time was 42 ± 10 days. Maturation rate was 100%, and the postoperative flow rate was 290 ± 22 (mL/min). No bleeding, thrombosis, failure, pseudo aneurysm, or rupture occurred in our patients. Arm edema occurred in ix (33%) patients, infection in three (17%), and lymphorrhea in five (28%). The mean follow-up was six months. BVT is an alternative method with excellent initial maturation and functional patency rates requiring less extensive skin incision and surgical dissection. It is the most durable hemodialysis access procedure for those patients having multiple forearm AVF surgeries.

Nephron-sparing surgery in case of emphysematous pyelonephritis.

Emphysematous pyelonephritis is fatal necrotizing infection where life saving emergency nephrectomy is recommended for severe cases, but we performed nephron sparing surgery. Elderly diabetic female presented with left flank pain and fever for 15 days. On examination tender lump was palpable in left lumbar region. Investigations showed hyperglycemia, leucocytosis and creatinine 3.0 mg/dl. NCCT-KUB suggested class 3B-EPN. Following emergency pigtail, a repeat CT-scan suggested upper and lower pole destruction. In open drainage both poles debrided with sparing of middle pole. Follow-up CECT-KUB showed spared kidney with normal function. No literature for nephron sparing surgery in similar cases of EPN was found.

Total endoscopic management of a large bladder leiomyoma.

Leiomyoma of the urinary bladder is a very rare entity and represents < 0.5% of all bladder tumours, with only 250 cases reported worldwide to date. We report a case of leiomyoma of the bladder 55 -year-old female presented with chief complaints lower abdomen pain since 1 year associated with intermittency, burning, frequency and hesitancy in micturation. Bimanual examination of the patient revealed a mass on the right side near the bladder neck. USG suggested a well circumscribed polypoidal soft tissue lesion seen projecting in urinary bladder lumen and attached to the posterior wall and base of bladder with no internal vascularity. On cystoscopic examination, large smooth sessile growth arising from the right postero-lateral wall was noted with right ureteric orifice not visualized. Magnetic resonance imaging showed Large well defined rounded soft tisssue lesion close to anterior surface of the cervix and vagina which was Isointense to the skeletal muscles on T1 and T2 images with small focal irregular cystic areas of necrosis seen. It could be urinary bladder neoplasm or sub serosal cervical fibroid. Transurethral resection of tumor was performed. The pathologic diagnosis was leiomyoma of the bladder. We discuss the diagnosis and management of leiomyoma of the bladder and briefly review the literature.

Preoperative diagnosis of renal angiomyolipoma with fine needle aspiration cytology: a report of 3 cases.

BACKGROUND: Angiomyolipoma is a rare benign neoplasm, commonly involving the kidney. Preoperative diagnosis on fine needle aspiration cytology can confirm the diagnosis, reducing the chances of unnecessary surgery. CASES: We studied cases of renal angiomyolipoma (AML) presenting within 1 year with palpable renal masses confirmed on ultrasound to be of renal origin. Fine needle aspiration cytology (FNAC) smears showed a few cohesive syncytial fragments with adipocytes, spindle cells and isolated single cells with foamy cytoplasm; a diagnosis of AML was made. The diagnosis was confirmed on histopathology, which showed mature adipose tissue, tortuous and thick-walled blood vessels lacking elastic tissue lamina and bundles of smooth muscles that seemed to emanate from the blood vessels. CONCLUSION: A preoperative diagnosis of renal AML is of great importance for correct management. In fact, when the lesion is small and asymptomatic, a conservative approach may be considered. Partial nephrectomy is possible with masses < 5 cm. Preoperative FNAC along with computed tomographic findings and immunocytochemical analysis of FNAC smears with HNB-45 can confirm the diagnosis of AML, thus preventing unindicated nephrectomy.