ObjectivesTo describe the effect of the COVID-19 lockdown in Jordan (21 March 2020–21 May 2020) on the incidence and patterns of toxic exposures and poisoning as compared with the same period from the previous year (21 March 2019–21 May 2019).DesignA retrospective descriptive study.MethodsCall data sourced from Pharmacy One Poison Center from the lockdown period (21 March 2020–21 May 2020) and the same period during 2019 (21 March 2019–21 May 2019) were revised. In addition, a database was established and analysed.ResultsWe noticed that not only did calls increased, but there was also a noticeable change in call patterns. Calls increased by 91% (544 vs 285 calls) during the lockdown period. Drugs were the most common among types of exposure, and the most prevalent route of exposure was ingestion. There was a notable increase in ocular exposure by 550% (13 vs 2 cases). The majority of exposures were at home and there were no occupational exposures. We found an increase in household cleaner exposure among males and an increase in alcohol exposure in females. Children aged below 5 years are the most affected. Even though there is an increase in the total number of cases, severe cases decreased.ConclusionThe lockdown effect on rates of toxic exposures was prominent, whether through the increase in calls or the change in patterns. As people spent more time at home, their exposure to toxic agents increased. Furthermore, cleaning recommendations led to the misuse of cleaning and disinfectant products, increasing exposures related to abating the COVID-19 infection.

ObjectiveThe Emergency Surgery Score (ESS) is a predictive tool used to assess morbidity and mortality rates in patients undergoing emergent surgery. This study explores the ESS’s predictive ability and reliability in the Jordanian surgical population.DesignA retrospective validation study.SettingA tertiary hospital in Jordan.ParticipantsA database was created including patients who underwent emergent surgery in King Abdullah University Hospital from January 2017 to June 2021.Primary and secondary outcome measuresRelevant preoperative, intraoperative and postoperative variables were retrospectively and systematically gathered, and the ESS was calculated for each patient accordingly. In addition, a multivariable logistic regression analysis was performed to assess the correlations between the ESS and postoperative mortality and morbidity along with intensive care unit (ICU) admissions.ResultsOut of total of 1452 patients evaluated, 1322 patients were enrolled based on inclusion and exclusion criteria. The mean age of the population was 47.9 years old. 91.9% of the patients were admitted to the surgical ward through the emergency department, while the rest were referred from inpatient and outpatient facilities. The mortality and postoperative complication rates were 3.9% and 13.5%, respectively. Mortality rates increased as the ESS score gradually increased, and the ESS was evaluated as a strong predictor with a c-statistic value of 0.842 (95% CI 0.743 to 0.896). The postoperative complication and ICU admission rate also increased with reciprocal rises in the ESS. They were also evaluated as accurate predictors with a c-statistic value of 0.724 (95% CI 0.682 to 0.765) and a c-statistic value of 0.825 (95% CI 0.784 to 0.866), respectively.ConclusionThe ESS is a robust, accurate predictor of postoperative mortality and morbidity of emergency general surgery patients. Furthermore, it is an all-important tool to enhance emergency general surgery practices, in terms of mitigating risk, quality of care measures and patient counselling.

Purpose The burden of the coronavirus disease of 2019 (COVID-19) pandemic on the healthcare sector has been overwhelming, leading to drastic changes in access to healthcare for the public. We aimed to establish the impact of implemented government partial and complete lockdown policies on the volume of surgical patient admissions at a tertiary referral center during the pandemic. Methods A database was retrospectively created from records of patients admitted to the surgical ward through the emergency department. Three 6-week periods were examined: The complete lockdown period (CLP), which included a ban on the use of cars with the exception of health service providers and essential sector workers; A pre-COVID period (PCP) 1 year earlier (no lockdown); and a partial lockdown period (PLP) that involved a comprehensive curfew and implementing social distancing regulations and wear of personal protective equipment (e.g., masks) in public places. Results The number of patients admitted to the surgery ward was significantly higher in the PCP cohort compared to the CLP and PLP cohorts (p = 0.009), with a 42.1% and 37% decline in patients’ admissions, respectively. Admission rates for patients with biliary pathologies and vascular thrombotic events increased. 30-day mortality rates did not differ significantly between the three periods (p = 0.378). Conclusions While COVID-19 lockdown regulations had a significant impact on patient admission rates, surgical outcomes were not affected and the standards of care were maintained. Future protocols should strive to improve access to healthcare to avoid complications caused by delayed diagnosis and treatment.

Purpose Lung deflation may reduce the risk of pneumothorax based on the assumption that the distance between the subclavian vein and the lung pleura would increase as well as the diameter of the vein. We aim to provide evidence to support the suggested desideratum of deflation in adults. Methods A prospective database was created that included patients who underwent subclavian vein catheterization for monitoring and therapeutic reasons from January 2014 to January 2020. Measurements using ultrasonography of the diameter of the subclavian vein were taken while the patient’s breathing was controlled by a ventilator and then repeated after disconnecting the mechanical ventilation and opening the pressure relief valve. Results A total of 123 patients were enrolled, with an average age of 41.9 years. The subclavian vein diameter was measured during controlled breathing with a mean average of 8.1 ± 0.6mm in males and 7.1 ± 0.5mm in females. The average increase after lung deflation with the pressure relief valve closed was 8.0± 5.1mm in males and 13.9 ± 5.4mm in females. An increase was noticed after opening a pressure valve, and the means were 5.5 ± 2.8mm in males and 5.1 ± 3.3mm in females. The catheter malposition rate was 0.8% Conclusion The benefit of interrupting mechanical ventilation and lung deflation lies within possibly avoiding pneumothorax as a complication of subclavian vein catheterization. These findings support the need for evidence regarding the curtailment of pneumothorax incidence in spontaneously breathing patients and the suggested increase in first-time punctures and success rates.