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   Table of Contents - Current issue
April-June 2021
Volume 9 | Issue 2
Page Nos. 29-47

Online since Friday, May 13, 2022

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Factors associated with undertriage of trauma patients at level 1 trauma center p. 29
Ibrahim Al Babtain, Mohammed Alnasser, Abrar Bin Dohaim, Sahar Hammad Alomar
Background: Applying American College of Surgeons Trauma Team Activation (TTA) criteria could improve trauma system outcomes and minimize both overtriage and undertriage of trauma patients. However, a percentage of trauma patients might slip through the system and become undertriaged. Objective: The objective of the study is to investigate factors related to undertriage of trauma patients at level 1 trauma center. Design: This was a retrospective cohort study. Setting and Subjects: We included all trauma patients at a level 1 trauma center from January 1, 2016, to December 31, 2019. Methods and Main Outcome Measures: We compared those who received TTA after 5 min of their arrival to emergency department (ED) (undertriaged cohort) to those who received no TTA (properly triaged cohort) in terms of demographic, anatomical, and physiological factors as well as injury severity assessment. Results: A total of 3740 trauma patients were included; 3330 (89%) were appropriately triaged and needed no TTA while 410 (10.9%) were undertriaged. In multivariate logistic regression model, the following factors were significantly associated with undertriage: arriving to ED in weekends (odd ratio, 1.417, confidence interval [CI] 95%, 1.047–1.916), motorcycle accidents (odds ratio, 3.709, 95% CI, 1.422–9.671), pedestrian victims (odds ratio, 7.477, 95% CI, 3.048–18.341), heart rate <60 (odds ratio, 2.657, 95% CI, 1.083–6.522), systolic blood pressure 76–89 (odds ratio, 4.235, 95% CI, 1.596–11.235), and Glasgow coma scale 9–12 (odds ratio, 4.365, 95% CI, 2.747–6.936). Conclusion: This study displayed different factors predictive of delayed TTA. Recognizing these factors could improve patient outcomes. Limitations: Poor prehospital documentation and communication from emergency medical services and a large number of missing data.
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Hypocalcemia following thyroid surgery- A prospective study p. 34
Sidharth Sabu Cherian
Introduction: This was a prospective observational study of 18-month duration. The purpose of this study is to compare preoperative serum calcium levels with postoperative serum calcium levels and to analyze postthyroid surgery hypocalcemia with regard to prevalence, clinical presentation, and severity and to treat hypocalcemia if it occurs. In addition, we analyzed the correlation of postoperative hypocalcemia with relation to the type of surgery, diagnosis, duration of surgery, and the quantity of blood loss. This study was conducted on consecutive patients who underwent thyroid surgery in the Department of General Surgery of a tertiary hospital in Puducherry for 18 months from November 2014 to April 2016. The median age of the patients was 40 years. The sex ratio was 17:2 in favor of females. Out of 38 patients, 18 patients were diagnosed with multinodular goiter, 8 were follicular carcinoma thyroid, 5 were papillary carcinoma thyroid, 2 were medullary carcinoma thyroid, 4 were adenomatoid nodule, and 1 patient was diagnosed to have thyroid abscess. In addition, 31 patients underwent total thyroidectomy, 6 patients underwent hemithyroidectomy when 1 patient underwent incision and drainage for thyroid abscess. Results: 39% (n = 15) of the patients developed hypocalcemia postoperatively. 87% (n = 11) of the patients were symptomatic and required calcium correction. Two patients had delayed presentation of hypocalcemia on postoperative day 5. One patient who underwent hemithyroidectomy developed hypocalcemia in the postoperative period. Trousseau's sign was the most typical clinical feature seen in hypocalcemia patients. In the present study, no significant association of hypocalcemia with the female gender was noted, and we did not find any association of hypocalcemia with advancing age. We did not find any association between hypocalcemia and prolonged surgery duration or increased blood loss in the present study. In addition, we did not see any increase in the incidence of hypocalcemia in patients who underwent thyroidectomy combined with lymph node clearance. Conclusion: The rate of postoperative hypocalcemia following thyroid surgery in this study was 39%. It coincides with the incidence reported elsewhere in the world. Although the risk of hypocalcemia was associated with increased blood loss, prolonged surgery, and extent of surgery, it was not statistically significant. If a similar study is conducted on a larger scale, including a broader spectrum of the population, important factors that influence postoperative hypocalcemia may be recognized.
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Exposure and perception of general surgery residents' toward robotic-assisted surgeries in Riyadh, Saudi Arabia p. 40
Zeyad Yousef, Sarah Marie, Sultanah Bin Gheshayan
Introduction: Robotic surgery is one of the rapidly expanding technologies in the field of medicine. It has been implemented since 2000; and its use has expanded over the past years. Da Vinci system was first introduced to the Middle East in 2003 by Saudi Arabia; then over the following 15 years it was utilized by other gulf countries. With the expanding knowledge of this technology and the effectiveness of its utilization; formal training programs were introduced by many hospitals. However; there are no established credentialing standards or well-structured curriculum to provide this training in the gulf region. Method: This we aim to understand the perception of general surgery residents toward robotic surgery training in tertiary care centers in Riyadh; Saudi Arabia. An anonymous web based survey was conducted on general surgery residents enrolled in Saudi Commission for health specialties approved residency training hospitals in Riyadh. Results: 50% of GS residents were involved in robotic assisted surgery which was significantly associated with the presence of robotic machines in their training centers (P0.025). Sixty Percent of residents who were involved in RAS did not receive a formal training prior to their participation, barely even a brief introduction. Conclusion: exposure and education about RAS at early training years showed that residents have better technical performance during their fellowship training. However, it should not the main focus of the training.
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Textiloma mimicking an intra-abdominal tumor: A case report from a medicolegal point of view p. 45
Mohammed AlHarthi, Ibtihal Oudah AlGhamdi, Murad Aljiffry,
Textiloma is a pseudotumor arising from a nonabsorbable retained cotton matrix, incidentally left behind during surgery, which has triggered an inflammatory reaction. This study describes a case of intra-abdominal textiloma, which mimicked a small bowel tumor on preoperative assessment. A 24-year-old asymptomatic female patient, who had undergone open appendectomy at the age of 20, presented to our institution with incidental finding of a large solid mass in the small bowel, covered by the omentum. Abdominal computed tomography showed an enhanced tumoral mass occupying the right intraperitoneum. During the laparoscopic exploration, the tumor was identified attached to the small bowel loop; small bowel en bloc resection was performed. Pathology results were compatible with a piece of gauze surrounded by reactive changes adherent to the small bowel (textiloma). The patient had a good recovery, and postoperative follow-ups were uneventful. The case offers a medicolegal perspective of this not uncommon, yet avoidable, problem and assesses the difficulties of assigning the responsibility for its occurrence to surgical team members and operating room staff.
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