Objective: To describe the experience with upper gastrointestinal bleeding (UGIB) in two major Latin American hospitals, its main causes, treatment and prognosis, while exploring some risk factors associated with death. Design: Prospective cohort study. Patients and Methods: We included 464 patients older than 15 years of age from two reference centers. We studied some demographic variables, history, clinical presentation, treatment and mortality. We explored the association between those variables and death. Results: The mean age was 57.9 years, and the male: female ratio was 1.4:1. Three hundred and fifty-nine patients (77.4%) were seen for gastrointestinal bleeding (outpatient bleeding) and 105 patients (22.6%) were inpatients seen for UGIB. A total of 71.6% of patients admitted with the diagnosis of upper GI bleeding underwent upper GI endoscopy (EGD) within 24 hours. The main causes of bleeding were peptic ulcer (190 patients, 40.9%), erosive disease (162 patients, 34.9%) and variceal bleeding (47 patients, 10.1%). Forty-four patients died (9.5%). Patients who presented with bleeding due to other causes during hospitalization had a higher mortality risk than those whose complaints were related to gastrointestinal bleeding (RR 2.4, 95% CI 1.2-4.6). An increasing number of comorbidities, such as those described in the Rockall score, were also associated with a higher risk of mortality (RR 2.5, 95% CI 1.1-5.4). Conclusion: Intrahospital upper GI bleeding and the presence of comorbidities are risk factors for a fatal outcome. Identifying patients with a higher risk would help improve the management of patients with UGIB.
Background. Additional studies on clinical outcomes to determine the optimal time delay from injection of local anesthesia to skin incision for WALANT surgeries are needed. The authors aimed to propose the optimal time delay from local injection to skin incision for WALANT surgeries of the hand and wrist by analyzing intraoperative blood loss, postoperative pain scores, and complication rates. Methods. Thirty-four patients were consecutively recruited and allocated by either 7-min or 30-min delay for skin incision from local injection of epinephrine with lidocaine. Intraoperative bleeding and postoperative pain scores were analyzed between both groups by Mann–Whitney U-test, while complication rates were compared using Fisher’s exact test. Results. The present study did not find significant differences in mean intraoperative blood loss (8 ± 5.8 mL vs. 5 ± 2.2 mL, p=0.074), complication rates (18% vs. 0%, p=0.227), and mean pain scores (1.2 ± 0.5 vs. 1.4 ± 0.5, p=0.307) between the 7-min and 30-min groups. Conclusion. The authors conclude that a waiting time of 7 min from the injection of local anesthesia is sufficient to achieve comparable clinical outcomes for minor hand and wrist surgeries under WALANT.
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