ABSTRACT
Tranexamic acid (TXA) is an essential procoagulant drug used in various intra- and postoperative situations. Its efficacy and safety profile in obese cases undergoing laparoscopic sleeve gastrectomy (LSG) is still unresolved. Therefore, this meta-analysis evaluated and investigated the current intra- and postoperative effects and hazards of TXA on patients undergoing LSG. As for methodology, Web of Science, Cochrane Library, Scopus, and PubMed were thoroughly searched for relevant studies. Retrieved results were prepared for screening through Endnote, helping to identify eligible studies. Relevant patient characteristics and outcomes were extracted. The methodological quality of the relevant studies was appraised using the respected appraisal tool. Six studies of different designs were enrolled, comprising 753 cases that underwent LSG and administered TXA. Their mean BMI and age went from 37.3 to 56.25 kg/m2 and 33.5 to 43.25 years, respectively. Tranexamic acid significantly linked to reduction in intraoperative bleeding instances, operative blood loss, and operative duration, compared to placebo ((RR = 0.66, 95% CI [0.44, 0.98], P=0.04, I2 = 81%); (MD = -39.64, 95%CI [-75.49, -3.78], P=0.03, I2=94%); (MD=-5.84, 95%CI [-9.62, -2.05], P=0.003, I2=73%)). Tranexamic acid also significantly showed superiority regarding postoperative bleeding events and duration of hospitalization compared to the control group ((RR= 0.45, 95%CI [0.29, 0.69], P=0.0002, I2 =0%); (MD=-0.24, 95%CI [-0.32, -0.17], P< 0.0000, I2 =0%)). Moreover, follow-up of the enrolled patients for a minimum of three to six months resulted in no reported thromboembolic instances, suggesting a negligible risk for thromboembolism among patients undergoing LSG and receiving TXA. In conclusion, tranexamic acid demonstrates a robust safety and efficacy profile for its use in patients undergoing LSG, with no reported instances of thromboembolism. Variations in TXA administration regimens, bleeding definitions, procedural techniques, and potential confounding medications could not be accounted for, necessitating additional large-scale RCTs to address and bridge knowledge gaps.
ABSTRACT
Biliary cystadenomas are rare hepatic lesions originating from the biliary epithelium. We present the case of a 32-year-old female who presented with persistent right upper quadrant abdominal pain, prompting a thorough investigation. Mildly elevated liver enzymes were noted on laboratory testing. Imaging studies, including a contrast-enhanced CT scan, revealed a 14 cm multiloculated cystic lesion in the right lobe of the liver. A biliary cystadenoma was confirmed, leading to a collaborative decision for laparoscopic resection. Intraoperative findings and histopathological examination supported the diagnosis, and the patient had an uneventful recovery postoperatively. This case report underscores the clinical complexity of biliary cystadenomas and highlights the successful multidisciplinary management of a young patient through laparoscopic resection. The case contributes valuable insights into the diagnostic and therapeutic challenges associated with these uncommon hepatic lesions.
ABSTRACT
Background In the face of the ongoing global health crisis posed by COVID-19, it becomes imperative to understand the disease's dynamics, particularly in specific regions. This study provides a detailed examination of the factors influencing mechanical ventilation (MV) duration among COVID-19 patients in an intensive care setting, focusing on a diverse patient cohort from the Al Hassa region of Saudi Arabia. The primary aim of this study was to identify key demographic factors, clinical outcomes, and comorbidities that affect the duration of MV among ICU patients with COVID-19. This understanding is crucial for enhancing patient care and informing healthcare strategies in the context of the pandemic. Methods A retrospective cohort study was conducted involving patients diagnosed with COVID-19 and admitted to the ICU in the Al Hassa region. The total number of participants was 1,259. Using a systematic sampling method, these participants were chosen to create a representative sample that reflects the prevailing treatment protocols in ICUs across these hospitals. Data encompassed patient demographics, comorbidities, clinical outcomes, and MV duration. Statistical analyses were employed to explore the associations between these variables. Results Our findings reveal a total of 1,259 participants significant associations between MV duration and various factors, including nationality, legal status, travel history, and comorbidities like heart failure and immunocompromised status. These insights are instrumental in understanding the nuances of COVID-19 management in critical care. Conclusion The study provides valuable insights into the determinants of MV duration in severe COVID-19 cases, emphasizing the need for individualized patient care approaches. It highlights the complexity of managing COVID-19 in ICU settings and underscores the importance of tailored healthcare responses to this global health challenge, particularly in the Al Hassa region.
ABSTRACT
Bacterial meningitis in pediatric populations presents a formidable challenge, necessitating careful evaluation and swift intervention. The clinical spectrum of pediatric bacterial meningitis requires a clear understanding, considering its diverse presentations, risk factors, and evolving diagnostic and therapeutic approaches. We present the case of an eight-year-old male who presented with an acute onset of fever, severe headache, and vomiting following an upper respiratory tract infection. A physical examination revealed meningeal irritation signs, altered consciousness, and focal seizures. Laboratory results showed elevated inflammatory markers, and cerebrospinal fluid analysis indicated abnormalities. Initial imaging displayed sinus involvement, but the patient's condition deteriorated. Subsequent magnetic resonance imaging revealed subdural empyema and meningoencephalitis. Streptococcus pneumoniae was identified as the causative agent. Subsequently, tailored antibiotic therapy and urgent neurosurgical interventions were initiated. The patient recovered with the resolution of neurological deficits. This case underscores the complexity of pediatric bacterial meningitis and its potential complications, emphasizing the relationship between upper respiratory tract infections, sinus involvement, and meningitis development. A multidisciplinary approach, combining targeted antimicrobial therapy with neurosurgical intervention, proved crucial for optimal management and favorable outcomes. This detailed case report highlights the importance of early diagnosis and comprehensive management in pediatric bacterial meningitis cases.
