Journal of Acute Disease

8-11

Authors: Farhan Haroon, Sajid Younus, Asif Peracha, Nouman Memon, Naveed Memon

Objective: To assess the utility and validation of the Surgical Apgar Score (SAS) in predicting postoperative complications of hip fractures. Methods: This prospective observational study included patients who received operations for hip fractures from 1st March 2017 to 30th June 2018 at the Department of Orthopedic Surgery, Liaquat National Hospital and Medical College. Patients were followed at the outpatient department, and complications and mortality were recorded through phone calls. The predictability of SAS for postoperative complications was assessed. Results: SAS≤4 was found as a significant predictor for postoperative pulmonary (P=0.008) and cardiac complications (P=0.042) as well as blood transfusion required to optimize postoperative hemoglobin (P=0.03) in the patients with hip fractures. Conclusions: SAS provides reliable feedback information about patients’ postoperative risk during the surgery. Hip fracture patients with scores≤4 should be monitored for major complications both during the hospital admission and after the discharge. KEYWORDS: Hip fractures; Surgical Apgar Score; Postoperative outcomes 1. Introduction The term “hip fracture” most commonly refers to the femoral neck and trochanteric fractures including intertrochanteric and subtrochanteric fractures or a combination of both. In the geriatric population, hip fractures usually occur due to minor trauma because of osteoporotic bones. Hip fracture is a major public health problem in the Asian population, which is usually associated with significant postoperative systemic complications and high mortality due to the burden of major surgery in a morbid patient[1]. For these postoperative complications, physicians need predictive tools to analyze the perioperative risk. Several algorithms have been employed for perioperative risk assessment, for example, the American Society of Anesthesiologists Physical Status Classification System (ASA classification)[2,3], the Physiologic and Operative Severity Score for Enumeration of Mortality and Morbidity[4] and Surgical Outcome Risk Tool[5]. According to Sakan et al., Surgical Apgar Score (SAS) has been shown as a proven independent predictor of major postoperative complications and mortality within 30 d after different types of surgery[6]. SAS is a simple and objective predictive tool, with three easily calculated variables, namely estimated blood loss, lowest heart rate, and lowest mean arterial pressure. These variables are derived after surgery from intraoperative anesthesia records[7]. Sakan et al. performed a retrospective study on the implementation of SAS on 43 hip fracture patients and concluded that the score≤4 was a significant predictor for the major postoperative complications within 30 d of surgery[6]. Gawande et al. performed a retrospective study on Apgar Scores for surgery on 303 patients and concluded that a 10-point score was significantly associated with major complications or death within 30 d after surgery[8]

17-22

Authors: Fatih Uzer1, Begum Uzer2, Fatma Mutlu Kukul Guven2, Idris Kirhan3, Nilay Coplu4

Objective: To investigate the chest radiography findings, hematological values and the risk factors of the mortality of coronavirus disease 2019 (COVID-19). Methods: Patients who were diagnosed with COVID-19 in a secondary-level state hospital in Turkey from March to April 2020 were included in the study. COVID-19 diagnosis was confirmed by reverse transcriptase-polymerase chain reaction. Initial routine blood tests and chest radiography findings were examined. The relationship between chest radiography findings and hematological values and risk factors of the mortality of COVID-19 were assessed. Results: In total, 94 patients with confirmed COVID-19 diagnosis were included in the study. Among them, 33 patients did not have lung involvement (RALE score of 0), and 42 had moderate lung involvement (RALE score of 1 to 4), and 19 had severe lung involvement (RALE score of 5 to 8). Patients with higher RALE scores were significantly elder (P=0.000) and had significantly lower lymphocyte count (P=0.032). Patients in need of intensive care had a lower mean number of platelets compared to patients who did not require intensive care (P=0.007). The receiver operating characteristic analysis revealed that RALE score (P=0.005), age (P=0.002), duration of symptoms (P=0.006), neutrophil-lymphocyte ratio (P=0.007), and lymphocyte percentage (P=0.012) were significantly associated with the risk of mortality. Conclusions: Patients with severe lung involvement have lower lymphocyte values and ratios. Age, RALE score, duration of symptoms, neutrophils/lymphocytes ratio, lymphocytes percentage are risk factors of mortality of COVID-19.

28-35

Authors: Johnson Oshiobugie Momoh1,2, Akinniyi Adediran Osuntoki2, Osaretin Albert Taiwo Ebuehi2, Olusola Ajibaye3

Objective: To evaluate the influence of –250G>A (rs2070895) polymorphism in hepatic lipase gene (LIPC) promoter on plasma lipid parameters of ischemic stroke patients. Methods: A total of 100 stroke patients and 100 control subjects matched for sex (59 men and 41 women) and age were selected. Hepatic lipase activity and lipid profiles were measured while lipoprotein ratios were calculated. Genotyping of the –250G>A promoter polymorphism of the LIPC was performed by the polymerase chain reaction and restriction fragment length polymorphism method combined with 2% gel electrophoresis and then confirmed by direct sequencing. The LIPC promoter gene sequencing data were compared with refseqNG011465.1 LIPC from GenBank. Results: The frequencies of GG, GA and AA genotypes of LIPC rs2070895 polymorphism were 39%, 45% and 16% for the control, 10%, 37% and 53% for the stroke subjects (P<0.0001), respectively. The frequencies of G and A alleles were 61.5% and 38.5% for the control, and 28.5% and 71.5% for the stroke subjects (P<0.0001). Our study shows that the mutant allele of the LIPC promoter was associated with dyslipidemia, lower hepatic lipase activity, and this variation contributed to the increased defective plasma highdensity lipoprotein-cholesterol (HDL-C), HDL2-C and HDL3-C concentration for both subjects. The control subjects had 6 single nucleotide polymorphism and 6 amino acid substitutions while the stroke subjects had 32 single nucleotide polymorphism and 20 amino acid substitutions. Conclusions: LIPC –250G>A polymorphism can influence plasma lipid profiles and lipoprotein ratios in patients with ischemic stroke.

39-41

Authors: Santosh Kumar Swain, Alok Das, Satyabrata Acharya, Nibi Shajahan, Rohit Agrawala

Rationale: Cavernous internal carotid artery (ICA) pseudoaneurysm caused by non-penetrating head trauma is a rare cause of massive epistaxis. The sudden onset of epistaxis due to such a fatal aneurysm protruding into the sphenoid sinus is extremely rare in clinical practice. The management is often challenging because of anatomical inaccessibility of the bleeding point. Patient’s concern: A 42-year-old man with a history of head trauma showing an ICA aneurysm eroding the sphenoid sinus followed by massive epistaxis. Diagnosis: A computerized tomography (CT) scan showed a fracture in the sphenoid sinus. CT angiogram revealed cavernous ICA pseudoaneurysm. Interventions: Endovascular coil embolization. Outcomes: The patient recovered well and was discharged without any neurological deficits Lessons: Cavernous ICA pseudoaneurysm may lead to a lifethreatening situation. If a patient has a history of head trauma, posttraumatic cavernous ICA pseudoaneurysm should be considered a differential diagnosis of massive epistaxis.

45-46

Authors: Vishal Mangal, Kaminder bir Kaur

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