Management of Acute Appendicitis During the COVID-19 Pandemic is Significantly Different: A Retrospective Single UK Hospital Study.

INTRODUCTION: The COVID-19 pandemic has led to a change in the delivery of acute and emergency surgical services. With emphasis on reducing unnecessary operative intervention and performing more CT scans, there has been a shift in managing acute appendicitis conservatively. We evaluate the impact of this shift on the management of acute appendicitis. METHODS: A single UK centre retrospective study evaluating patients with suspected acute appendicitis pre-COVID-19 rota (18 March 2020) and post-COVID rota implementation. Data including demographics, inflammatory markers, imaging, mode of management and operative findings were collected. Logistic regression with SPSS was used to determine which factors were associated with conservative management and treated with antibiotics. RESULTS: A total of 161 patients were analysed, 82 pre-COVID19 and 79 post-COVID19. Of the pre-COVID-19 patients, 67.07% underwent appendicectomy while the rest were conservatively managed; 24.3% of these patients underwent a CT scan only. Post-COVID-19, 22.78% of patients underwent appendicectomy with a higher percentage of diagnostic CT scans performed, 43/79 (54.4%, p <0.001). The proportion of histologically normal appendicectomies was significantly reduced in the post-COVID-19 era (12.78% vs 0.00%; p-value 0.001). Logistic regression analysis showed a normal WCC to be associated with greater likelihood of conservative management. No conservatively managed patients returned to theatre in the 30-day follow-up period. CONCLUSION: Due to the restrictions imposed by the post-COVID-19 rota, a greater proportion of patients were managed conservatively with comparable patient outcomes. The approach also led to fewer negative appendicectomies owing to greater reliance on imaging.

A Study to See the Effect of Social Media Usage Among Healthcare Providers.

Purpose This study aimed to assess how healthcare professionals (HCPs) use social media to determine how it influences the quality of patient care. Materials and methods This is a cross-sectional study conducted over eight months, between August 2020 and March 2021 using a questionnaire and checked amongst investigators. Results One hundred fifty-eight participants had electronic devices and 145 (91.9%) used social media at work. 26.6% of these HCPs said they spent less than an hour on social media forums, 31% said they spent one to two hours, 28.5% said two to three hours, and 13.9% said they spent more than four hours. As compared to nurses (46%), consultants and pharmacists use social media at a much lower rate (1% for each group). Compared to junior doctors, a higher percentage of nurses (40%) said they were aware of a social media policy at their hospital (8%). A quarter of healthcare employees (20%) were unaware of their workplace policy, potentially exposing sensitive medical details to the public. More research is needed to assess the particular effects of these results on patient care quality and can help in providing literature informing applications encrypted and secure patient data. Conclusion According to our results, a large percentage of healthcare quality professionals used social media networks. A significant proportion of doctors and nurses use it to visit online medical forums for improving education. A large portion of surveyed sample was unaware of hospital policy on social media usage. Further education is required to improve the right use of social media in the hospital setting.

Intertrochanteric Hip Fractures And Vitamin D Deficiency; A Significant Association.

BACKGROUND: Intertrochanteric fractures are a common cause of disability, morbidity and mortality in aged population across the globe. The same population is also vulnerable to ill effects of vitamin D deficiency and presence of multiple comorbidities. Very few studies have been done in our part of the world to find the association of vitamin D deficiency with type of intertrochanteric fractures. METHODS: This cross-sectional study was conducted during July 2019 to June 2020 at tertiary care hospital in the megacity of Lahore, Pakistan. Demographic variables were recorded and anteroposterior and lateral views of plain radiographs were used to classify the fractures. History of chronic illness was taken and confirmed with available prescription. Vitamin D level was measured using standard laboratory techniques. Data was entered into IBM SPSS Statistics (version 25) software and analysed. RESULTS: Mean age for males was 65 years and for females 71 years. Boyd and Griffin type II fracture was most common injury (62%). 67% of our study population was suffering from some degree of vitamin D deficiency. Results have shown the significant association of vitamin D deficiency and severity of intertrochanteric fractures (p <0.05). There was no significant difference of degree of vitamin D deficiency and injury pattern among both genders. CONCLUSIONS: There is a strong association between degree of vitamin D deficiency and type of intertrochanteric fractures. Our study also highlighted the importance of mechanism of injury, age and presence of diabetes in association with these fractures.

Is spinal tuberculosis changing with changing time?

INTRODUCTION: Spinal tuberculosis is a chronic destructive disease with long-term morbidity. Patients are usually young especially from a poor socioeconomic background. Destruction of the intervertebral disk space and the adjacent vertebral bodies is the characteristic lesion. The dorsal spine is the most affected region with multi-level noncontiguous involvement being detected more frequently. Patients usually present with chronic back pain associated with spinal tenderness, paraplegia, spinal deformities, as well as with constitutional symptoms. Magnetic resonance imaging has proved to be more sensitive and specific for its diagnosis, but availability and affordability of this investigation remain a problem in developing countries. Anti-tuberculous drug therapy has revolutionized the treatment of this debilitating disease. Surgery is still required in selected cases especially with evolving neurological deficit, progressive deformity, intractable pain and lack of response to drug therapy. With early diagnosis and effective treatment, prognosis is generally good.Materials/Methods: After getting permission from the clinical governance department, We collected the retrospective data of 305 patients with diagnosed spinal tuberculosis, who underwent surgical intervention. RESULTS: There was no significant difference in incidence among males and females. Housewives were the most affected. Lower dorsal spinal was the commonest site involved but our study didn't confirm the incidence of multi-level disease process. Anterior decompression along with Cage fixation was most frequently performed procedure. CONCLUSION: Despite the availability of highly effective antituberculous drugs, advanced surgical procedure, the spinal tuberculosis still maintains its demographic profile. There has been no change in characteristics of spinal presentation of this chronic debilitating disease. Patients continue to suffer the same way as they were suffering decades ago.

Complications of interosseous infusion resulting in a diagnostic dilemma.

Successful revival of a patient with cardiac arrest need vigilant effort on behalf of whole team but sometimes missing a small thing can create disaster. Here we present a case of 58 years old obese lady who was revived from a cardiac arrest secondary to septic shock. Obstruction due to proximal ureteric stone was relieved with JJ stent insertion. She required renal replacement therapy and invasive ventilation. Fever and inflammatory blood markers improved and she woke up after 6 days in intensive care unit (ICU). She developed another episode of sepsis but this time it was her shoulder that was hurting. Initially it was thought to be an iatrogenic skeletal injury during aggressive cardiopulmonary resuscitation (CPR) but radiographs came out to be normal. Magnetic resonance imaging (MRI) created more confusion by showing septic arthritis with proximal humeral osteomyelitis and gas formation. MRI suggested that it might be the sequelae of an intraosseous line insertion. All documented records were silent regarding the intraosseous line insertion. Resuscitation team was contacted and inquired. They confirmed the insertion of intraosseous line insertion during initial resuscitation which was removed after securing peripheral vascular access and before transferring the patient to ICU but they forgot to document. Her shoulder joint was washed out and debrided arthroscopically. She made a safe recovery without any other problem.

Frequency of gall bladder carcinoma in patients with acute and chronic cholecystitis.

BACKGROUND: Gallbladder carcinoma is a relatively uncommon neoplasm which is more common in the seventh decade of life compared to that of cholelithiasis which is in the fourth decade. The objective of the study was to determine the frequency of carcinoma gall bladder in cases of acute and chronic cholecystitis particularly with reference to cholelithiasis. METHODS: This cross-sectional observational study was done in the department of Surgery at Fauji Foundation Hospital, Rawalpindi from 1st January, 2009 till 3 1st October, 2011. All 310 cholecystectomies performed during this period were included in this study. The specimens collected were macroscopically examined and sent for histopathology. All the reports were reviewed and the results recorded. RESULTS: Out of 310 cases, 27 (8.7%) had acute cholecystitis and 280 (91.2%) were chronic cholecystitis. 3 specimens got autolysed and therefore excluded from the study. 290 cases had cholelithiasis. 2 out of 290 calculous cases were found to have coexistent carcinoma gall bladder proven on histopathology. CONCLUSION: Frequency of carcinoma gallbladder associated with cholelithiasis discovered incidentally after cholecystectomy is very low in our patients.