Current Issue : July-September Volume : 2025 Issue Number : 3 Articles : 5 Articles
Background: Liver function and the presence of portal hypertension, as well as the urgency and type of surgery, are prognostic factors in advanced chronic liver disease (ACLD) patients undergoing extrahepatic major surgeries. Emergent surgery in ACLD patients has 4–10 times higher mortality rates than elective surgery. However, perioperative management improvements have been made in recent years. Methods: This is a retrospective, observational, and unicentric study of 482 patients with ACLD who underwent major surgery from 2010 to 2019. We compared baseline characteristics and postoperative mortality according to the presence of ascites, the emergency, and the surgery period. Results: In total, 140 (29%) patients had ascites, and 191 (39.6%) underwent urgent surgeries. The 90-day mortality was 2.8-fold higher in patients with ascites [HR (95%CI) 2.8 (1.6–5.0); p = 0.001] and 3-fold higher in urgent surgeries [3.0 (1.6 − 5.5); p < 0.001)]. Urgent surgeries in patients with ascites revealed the highest mortality risk [6.3 (2.7–14.8); p < 0.001)], which persisted in current (2015–2019) surgeries [12.8 (2.9–56.5); p = 0.001)]. Portal hypertension was meaningful in patients undergoing abdominal surgery. Conclusions: ascites and emergent surgery increase the mortality risk of patients with ACLD despite the recent perioperative improvements....
Aim This study explores HICGs’ experience of disaster response during a terrorist-induced major incident major incident. Design A qualitative descriptive design with individual semi-structured interviews was used. Methods This was a qualitative study based on seven individual interviews. Participants were members of hospital incident command groups during a terror attack. The interviews were transcribed verbatim and analyzed using deductive content analysis. The SRQR checklist was used to report the findings. Results The data created from the interviews identified barriers and facilitators for hospital response as well as aligned with previously established categories: Expectations, prior experience, and uncertainty affect hospital incident command group response during a Major Incident and three categories, (I) Gaining situational awareness (containing two subcategories), (II) Transitioning to management (containing three subcategories) and (III) Experiences of hospital incident command group response (containing two subcategories). In addition, the results suggest that an exaggerated response may have led to unanticipated adverse events....
Background/Objectives: Obesity is a global health challenge linked to a higher risk of metabolic and cardiovascular complications. This study investigates the role of cardiovascular markers in predicting metabolic crises in obese patients, focusing on the prevalence and clinical implications of these markers. Methods: This retrospective cohort study included 433 patients presenting with metabolic crises at the Emergency Department of Timis, oara Municipal Emergency Hospital between 2019 and 2024. Patients were classified into obese (n = 161) and non-obese (n = 272) groups, with obesity further stratified into four grades based on body mass index (BMI). Cardiovascular markers, including NT-proBNP, troponin I, CRP, CK-MB, and D-dimer, alongside metabolic parameters, were analyzed. Results: Metabolic crises were significantly more prevalent in obese patients in all metabolic emergencies: hyperglycemia (27.9% vs. 11.0%, p < 0.001), electrolyte imbalance (23.6% vs. 9.2%, p < 0.001), and acute kidney injury (AKI) (12.4% vs. 5.5%, p = 0.01). NT-proBNP levels independently predicted AKI in obese patients (adjusted OR: 1.14 per 1000 pg/mL, 95% CI: 1.10–1.19, p < 0.001), with excellent discriminatory power (AUC: 0.88). Troponin I and D-dimer were higher in hyperglycemia and electrolyte imbalance, respectively, emphasizing the role of cardiac stress and pro-thrombotic states. Inflammatory markers such as CRP were significantly associated with metabolic disturbances, supporting the contribution of systemic inflammation. Comorbidities, particularly heart failure and atrial fibrillation, further increased the risk of metabolic crises. Conclusions: Cardiovascular markers suggest potential utility for early risk stratification of metabolic crises in obese patients. However, further studies are needed to validate their clinical applicability and to establish standardized approaches for integrating these biomarkers into routine practice, especially in patients with advanced obesity grades....
Background The 72-h emergency department (ED) revisit rate is a key quality indicator. While some revisits stem from medical errors or inadequate initial treatment, others are due to disease progression or a lack of accessible care. The development of a risk assessment tool could identify high-risk patients and improve resource management. Methods This study was conducted via an electronic health records system at a tertiary center in Taiwan. We derived a risk model via logistic regression and bootstrapping methods using a retrospective cohort of adults who underwent 72-h ED revisits between January 2019 and December 2020. The study population was divided into development (2019: 1224) and validation datasets (2020: 985). The primary outcome was high-risk return, defined as intensive care unit (ICU) admission or in-hospital mortality after 72-h ED return. Results On the basis of the odds ratio, eight variables were independently associated with high-risk ED returns and subsequently included in the HANDLE-24 score (hypertension; symptoms of acute coronary syndrome; dysnatremia; dyspnea; liver disease; triage level escalation; and revisits within 24 h). The area under the receiver operating characteristic curve was 0.816 (95% CI: 0.760–0.871, p < 0.001) in the development dataset and 0.804 (0.750–0.858) in the validation dataset. Patients can be divided into three risk categories on the basis of the HANDLE-24 score: low [0–8.5], moderate [9–11.5] and high [12–22] risk groups. The ability of our risk score to predict the rates of hospital admission, ICU admission and in-hospital mortality was significant according to the CochranArmitage trend test. Conclusion The HANDLE-24 score represents a simple tool that allows early risk stratification and suggests more aggressive therapeutic strategies for patients experiencing ED revisits. The risk of adverse outcomes in ED adults after revisiting can be swiftly assessed via easily available information....
Background/Objectives: Cerebrovascular events (CVEs) are a leading cause of intensive care unit (ICU) admissions from the emergency department, often associated with high morbidity and mortality rates. Identifying reliable, non-invasive predictors of mortality in these patients is critical for improving prognostic accuracy and guiding therapeutic strategies. This retrospective cohort study evaluates the predictive value of the optic nerve sheath diameter (ONSD), measured using magnetic resonance imaging (MRI), in determining mortality among ICU patients with CVEs. Methods: This singlecenter, retrospective observational study included 102 patients diagnosed with CVEs and admitted to the ICU at Gaziantep City Hospital between October 2023 and March 2024. This study adhered to the Declaration of Helsinki. Ethics approval was obtained from Gaziantep Islam Science and Technology University (Decision No. 394.36.08), and the requirement for informed consent was waived due to the retrospective design. The sample size was determined using G-Power 3.1.9.4. Results: A statistically significant positive correlation was observed between the ONSD and mortality (p = 0.002). Patients with higher ONSD values demonstrated an increased mortality risk, underscoring the potential prognostic value of ONSD measurements in this population. Conclusions: MRI-based ONSD measurement offers a non-invasive method for predicting mortality in ICU patients with CVEs. Its integration into routine diagnostic protocols could enhance clinical decisionmaking and patient outcomes. Further multicenter studies are warranted to validate these findings and standardize ONSD measurement techniques....
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