ABSTRACT
Timing of tracheostomy in patients with COVID-19 has attracted substantial attention. Initial guidelines recommended delaying or avoiding tracheostomy due to the potential for particle aerosolization and theoretical risk to providers. However, early tracheostomy could improve patient outcomes and alleviate resource shortages. This study compares outcomes in a diverse population of hospitalized COVID-19 patients who underwent tracheostomy either "early" (within 14 d of intubation) or "late" (more than 14 d after intubation). DESIGN: International multi-institute retrospective cohort study. SETTING: Thirteen hospitals in Bolivia, Brazil, Spain, and the United States. PATIENTS: Hospitalized patients with COVID-19 undergoing early or late tracheostomy between March 1, 2020, and March 31, 2021. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: A total of 549 patients from 13 hospitals in four countries were included in the final analysis. Multivariable regression analysis showed that early tracheostomy was associated with a 12-day decrease in time on mechanical ventilation (95% CI, -16 to -8; p < 0.001). Further, ICU and hospital lengths of stay in patients undergoing early tracheostomy were 15 days (95% CI, -23 to -9 d; p < 0.001) and 22 days (95% CI, -31 to -12 d) shorter, respectively. In contrast, early tracheostomy patients experienced lower risk-adjusted survival at 30-day post-admission (hazard ratio, 3.0; 95% CI, 1.8-5.2). Differences in 90-day post-admission survival were not identified. CONCLUSIONS: COVID-19 patients undergoing tracheostomy within 14 days of intubation have reduced ventilator dependence as well as reduced lengths of stay. However, early tracheostomy patients experienced lower 30-day survival. Future efforts should identify patients most likely to benefit from early tracheostomy while accounting for location-specific capacity.
ABSTRACT
PURPOSE: COVID-19 is associated with high morbidity and mortality in patients undergoing surgery. Contrary to elective procedures, emergency operations should not be postponed. We aim to evaluate the profile and outcomes of COVID-19 patients who underwent emergency abdominal surgery. METHODS: We performed a retrospective analysis of perioperative data of COVID-19 patients undergoing emergency surgery from April 2020 to August 2020. RESULTS: Eighty-two patients were evaluated due to abdominal complaints, yielding 22 emergency surgeries. The mean APACHE II and SAPS were 18.7 and 68, respectively. Six patients had a PaO2/FiO2 lower than 200 and more than 50% of parenchymal compromise on chest tomography. The most common indications for emergency surgery were hernias (6; 27.2%). The median length of stay was 30 days, and only two patients required reoperation. Postoperatively, 10 (43.3%) patients needed mechanical ventilation for a mean of 6 days. The overall mortality rate was 31.8%. CONCLUSION: Both postoperative morbidity and mortality are high in COVID-19 patients with respiratory compromise and abdominal emergencies.
Subject(s)
Abdomen, Acute/surgery , COVID-19/complications , Pneumonia, Viral/complications , APACHE , Abdomen, Acute/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Brazil/epidemiology , COVID-19/mortality , Emergencies , Female , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Respiration, Artificial , Retrospective Studies , SARS-CoV-2ABSTRACT
The Forensic Anthropology and Forensic Dentistry, in one of its branches, aim to base skills making possible to estimate the age period for an individual, through factors such as tooth mineralization and bone development. This paper aims to report on two cases from Scientific Expertise Center - Renato Chaves, Belém- PA, where two individuals after committing crime, were referred to under 18s without supporting documents. Through data collected in the archives of the Scientific Expertise Center, an analysis of the mineralization of the teeth were made, highlighting the third molars by panoramic radiography; as well as the study of bone development of the hands and wrists of individuals through radiographs. After, the analysis was compared to surveys conducted by Nicodemos, Moraes and Médici-Filho, befitting the chronology of mineralization of permanent teeth among Brazilian citizens together with the work of Greulich-Pyle, Radiographic correlation concerning the chronology of the development of the hand and wrist. As a result of the analysis, it was obtained, for case 01, an estimated age of 17; and for case 02 the estimated age was between 18-19 years.
ABSTRACT
O presente estudo aborda um caso de uma adolescente de 16 anos, onde e analisado o fenomeno denominado por Bion, de ataques ao elo de ligacao.
Subject(s)
Psychology, Clinical , Adolescent , Psychoanalysis , Antisocial Personality Disorder , Psychology, Clinical , Adolescent , Psychoanalysis , Antisocial Personality DisorderABSTRACT
O presente estudo traz uma leitura sobre familia a partir dos conceitos propostos por Bion sobre grupos. Em especial, os grupos de supostos basicos.
