In the elderly population, trauma is a leading cause of utilization of healthcare, institutionalization, disability, and mortality. In this study, we will assess the injury patterns and the factors associated with the outcomes of blunt thoracic trauma in elderly individuals. Methods This prospective observational study was conducted in the Department of Thoracic Surgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan, from September 2019 to April 2020. The study included patients of both genders aged 60 years and above with blunt thoracic trauma. Patients with concomitant neurological injuries and penetrating trauma to the chest were excluded. Results There were a total of 80 patients in this study; majority were males (n = 66 [82.5%]). The mean age was 70.18 ± 8.3 years. Road traffic accident was the most common mode of injury (n = 45 [56.3%]) followed by fall (n = 32 [40%]). Hemothorax and hemopneumothorax were the most common primary diagnosis. Rib fractures were encountered in 72 (90%) patients. Mortality rate was 21.3% (n = 17). Factors significantly related to mortality were age ≥ 80 years (p = 0.00), tension pneumothorax (p = 0.036), pre-existing cardiopulmonary disease (p = 0.032), blood loss ≥ 500 mL (p = 0.004), flail chest (p = 0.018), and chest trauma score ≥ 5 (p = 0.001). Mean hospital stay in our study was 5.3 ± 3.4 days. Factors lengthening hospital stay by more than five days included lung contusion (p = 0.02), more than two rib fractures (p = 0.004), hemopneumothorax (p = 0.026), pneumonia (p = 0.003), acute respiratory distress syndrome (p = 0.003), and flail chest (p = 0.013). Conclusions Elderly patients with blunt thoracic trauma have higher mortality. Proactive evaluation of injuries using the chest trauma score in the elderly population helps in recognizing patients at high risk of mortality and helps in the timely management to prevent adverse outcomes.
Mazcuri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Objectives: In this study, we evaluated the differences in clinical and angiographic profiles of ST-segment elevation myocardial infarction (STEMI) patients with and without diabetes mellitus (DM) at a tertiary care cardiac hospital in Karachi, Pakistan. Methodology: This descriptive cross-sectional study was conducted at a tertiary care cardiac hospital in Karachi, Pakistan. The study included consecutive adult patients (≥ 18 years of age) diagnosed with STEMI undergoing primary percutaneous coronary intervention (PCI). Diabetic and non-diabetic patients were compared for clinical and angiographic profiles. Results: The study sample consisted of 43.8% (218) diabetic patients. The mean age was 59.03 ± 9.69 years vs. 49.54 ± 11.53 years; p<0.001, proportion of females was 35.3% (77) vs. 14.6% (41); p<0.001, Killip class III or IV was (17) vs. 2.5% (7), and hypertension was 83% (181) vs. 56.8% (159); p<0.001 among the diabetic and non-diabetic group, respectively. The frequency of multi-vessel disease was 50.9% (111) vs. 39.6% (111), the significant left main disease was 5% (11) vs. 2.5% (7), and initial TIMI III flow was 19.3% (42) vs. 25.4% (71) in diabetic and non-diabetic patients, respectively. Conclusion: In conclusion, diabetes in STEMI setting is associated with complex coronary artery diseases, more hemodynamic instability at presentation, and the presence of multiple co-morbid conditions.
Objective: To determine the role of VATS (Video Assisted Thoracoscopy) for evacuating retained / clotted haemothorax resulting in minimising the duration of chest tube drainage and length of hospital stay. Methods: From July 2019 to February 2020, 160 consecutive patients underwent VATS for retained or clotted haemothoraces at the Department of Thoracic Surgery, Jinnah Postgraduate Medical Centre. Institutional review board approval and consent from all patients taken. Outcome was measured as partial or complete lung expansion and relapse of collection. Results: There were 128 (80%) male and 32 (20%) female. 103 (64.37%) patients underwent VATS in first week (2-7) and 57 (35.63%) in second week (8-14 days). Of 103 patients who underwent VATS the first week, (71.9%) had complete lung expansion which was significantly higher compared to those who underwent VATS in second week (28,1%). Ninety-nine participants had chest tube removed in first week of VATS. Participants who underwent VATS in first week had shorter duration of stay (p=0.000). Conclusion: VATS is a safe, reliable and effective technique for the evacuation of retained haemothorax in haemodynamically stable patients. Early intervention within first week of injury not only is associated with better outcome but shorter duration of hospital stays. Keywords: VATS, blunt trauma, Clotted haemothoraces, Continuous...
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