Journal of Critical Care & Emergency Medicine
Journal of Critical Care & Emergency Medicine is an open access peer-reviewed journal from the publishers of Scientific Research and Community (SRC) which publishes articles in the form of written, video and power-point presentations from the arena of Critical Care & Emergency Medicine. The journal focuses to build up accessing the complete content of articles freely from online for reader’s perusal. Article acceptance will be in the form of Research, Review, Case Reports, Analysis, Magazines, Editorials, Opinion, Communications, Mini-Review, Short Communications, Picturized, Book Review, Video Type and Power Point Presentations (PPTs). You can submit your articles through online https://www.onlinescientificresearch.com/submit-online (or) can send through an e-mail with attachment for: emergencymedicine@onlinescientificresearch.info
Acute Compartment Syndrome is a rare but potentially devastating condition that demands immediate intervention. Failure to diagnose and manage compartment syndrome promptly is associated with long term disability and litigation. Ongoing research looks set to introduce new techniques for compartment pressure monitoring and both the diagnosis and treatment of the condition are now the subject of national guidelines. In writing this, clinical review, we performed a Pub Med and Med Line Search using the words Compartment Syndrome and cited key papers historical papers in the field.
Copyright (c) 2026 Journal of Critical Care & Emergency Medicine
Clinical Management Strategies for Lymphedema Secondary to Breast Cancer Treatment in Selected Hospitals in Western Region,Kenya
Background: Globally breast cancer remains the most diagnosed cancer with approximately 2.3 million cases in both sexes, about, 28% to 38% develop lymphedema following breast cancer treatment affecting one in five patients, when severe, Lymphedema significantly impact the person’s ability to perform tasks and without treatment the condition progresses to serious complications. In Sub-Saharan Africa reported comorbidities associated with lymphedema showed it is on the increase. Kenya has no data on the prevalence of lymphedema, although reports exist on different types of lymphedema treatment. In western Kenya, no studies have examined lymphedema. This study evaluated clinical management strategies for lymphedema secondary to breast cancer treatment in selected hospitals in the Western Region of Kenya. Material and Methods: This was a cross sectional analytic study. Simple random sampling was used to select health care facilities offering cancer screening and treatment. HealthCare providers were randomly selected from five health facilities depending on the number required at each health facility. 192 health care providers were selected to participate in the study. Data collection was by structured questionnaires, observation checklist and focus group discussion, analysed by SPSS version 23.1 and Qualitative data thematically analysed guided by questions on knowledge, skills and management strategies. Results: The results showed healthcare providers knowledge ranging from low to average with deficit in important areas of practice such as skincare (OR=0.56, p=0.01). stocking pressure (OR=1.841, P=0.004, positive stemmer’s sign test (OR=2.217, p=0.001) with over 50% getting incorrect answers. Good history and assessment Skills were demonstrated (0R=1.6;CI;1.0-24;P=0.037) but patient education was poorly done. Findings from focus group discussion showed deficit in knowledge by failure to clearly define lymphedema. Conclusion: Structured education of lymphedema is needed to increase the knowledge of healthcare providers and improving knowledge may fill the gaps in knowledge and demonstrate good practical skills in patient management.
The Relationship Between Knowledge and Attitudes of Reproductive-Age Women in Choosing Contraceptive Pills at the IndependentPractice of Midwife “WA” Sidakarya in 2024
Understanding the relationship between knowledge and attitudes is crucial for making informed and effective contraceptive decisions, preventing unplanned pregnancies, and complications resulting from inappropriate contraceptive use. This study aims to explore the relationship between knowledge and attitudes of reproductiveage women in selecting contraceptive pills at the Independent Practice of Midwife WA Sidakarya in 2024. The research employs a correlational analysis design with a cross-sectional approach to investigate this relationship. Primary data were collected through questionnaire responses from 51 participants. The study findings indicate varying levels of knowledge about contraceptive pills among women aged 20-24 years, with a significant 71% correlation
Impact of Supply Chain Management Practices on Surgical Outcomes at Mpilo Central Hospital
Background: Efficient Supply Chain Management (SCM) is critical for ensuring timely and safe surgical care, particularly in resource-constrained settings. This study investigated the impact of SCM practices, including inventory management, procurement efficiency, demand planning, and logistics and distribution, on surgical outcomes at Mpilo Central Hospital, Zimbabwe. Methods: A cross-sectional survey was conducted among 83 healthcare professionals, including surgeons, nurses, anesthetists, and inventory managers, achieving a 92% response rate. Data were analyzed using descriptive statistics, chi-square tests, ANOVA, and Partial Least Squares Structural Equation Modelling (PLS-SEM) to examine relationships between SCM practices and surgical outcomes. Reliability of the survey instrument was confirmed with a Cronbach’s alpha of 0.705. Results: Respondents reported significant challenges in SCM: 91% indicated that surgical delays were due to missing supplies, and 95% reported surgery cancellations resulting from supply shortages. Poor inventory management, procurement inefficiencies, inadequate demand planning, and ineffective logistics were all negatively associated with surgical outcomes. Chi-square analyses revealed significant associations between demographic variables (age, length of employment, and department) and perceptions of SCM impact. PLS-SEM confirmed that inventory management (β = -0.175, p = 0.0195), procurement efficiency (β = -0.192, p = 0.015), and logistics and distribution (β = -0.121, p = 0.04) significantly influenced surgical outcomes, whereas demand planning was not statistically significant (β = -0.00674, p = 0.959). Conclusion: Deficiencies in SCM practices at Mpilo Central Hospital negatively impact surgical outcomes, contributing to delays, cancellations, and compromised patient care. Strengthening inventory control, procurement processes, and logistics systems, alongside targeted training and resource allocation, is essential to enhance surgical efficiency and patient outcomes in similar low-resource settings.
Deliberate Simulation Training with a Geriatric Focus
The global increase in older adults poses immense challenges for both the healthcare system and social perspectives. They often have multiple long-term health-related issues, complex healthcare needs requiring tailored and anticipatory approaches. In this paper, we share our deliberate focus on geriatric simulation for training our healthcare providers and staff. This is with the intent to deliver patient-centred care for these older patients, who are both fragile and vulnerable. They also come with a multitude of medical conditions and co-morbidities which need to be managed in a customized fashion. These older persons are extremely dynamic in their needs and have atypical as well as complex presentations, which will differ from the younger patients. Incorporating simulation-based education into the geriatric curriculum for Emergency Department staffs not only enhances clinical competence, interprofessional coordination, and decision-making in the acute care of older adults; it also aligns with the preparation to face the super-aged society Singapore is transforming into.
From Hierarchy to Integration: The ‘Hierarchy of Intervention Effectiveness’ to the ‘Framework for Effective Integration and Adoption’
At work and in organizations, hierarchy often does not apply equally. Education and training is never a “one-size-fit-all”. The boundaries between systems-focused and people-focused interventions are becoming increasingly blurred today. The Hierarchy of Intervention Effectiveness (HIE) popularized by Lucian Leape and illustrated by Cassie McDaniel represents a risk management theory, with hierarchical ranks given to interventions; depicting that systems-focused interventions are more impactful and effective than human-focused ones. We are proposing that the HIE be evolved to “The Framework for Effective Integration and Adoption”, for a variety of reasons, discussed in this paper. It aligns with the state of education and training today against the background of technological advancements.
Reducing NSAID Prescriptions in Patients Receiving ACE Inhibitors/ARBs and Diuretics: A Quality Improvement Initiative
Background: Concurrent prescribing of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) to patients taking an ACE inhibitor or Angiotensin Receptor Blocker (ARB) together with a diuretic (“triple whammy”) increases Acute Kidney Injury (AKI) risk. This Quality Improvement (QI) initiative sought to reduce avoidable NSAID prescribing among high-risk patients in primary care. Objective: To reduce NSAID prescriptions by 50% among adults concurrently receiving ACEI/ARB and a diuretic over a 3-month period (May–July 2024). Methods: Using the Institute for Healthcare Improvement Model for Improvement, we implemented prescriber education, pharmacist counseling, and monthly electronic medical record (EMR) audits. The primary outcome was the monthly proportion of high-risk patients receiving an NSAID; 95% Confidence Intervals (CI) were calculated and a chi-square test assessed change across months. Results: NSAID prescribing decreased from 31.0% (9/29) in May to 21.7% (5/23) in June and 14.3% (3/21) in July. This represented a 54.0% relative reduction. Chi-square test of independence: χ²=1.96, p=0.376. Two-proportion (May vs July) z-test: z=1.37, p=0.171. Balancing measures included qualitative patient feedback on pain control. Conclusions: A structured QI approach integrating prescriber education, pharmacist counseling, and EMR audit feedback achieved a substantial reduction in NSAID prescribing among patients at elevated AKI risk.
Reimagining the Delivery of Emergency Medicine
Introduction: Emergency departments are experiencing higher volumes of patients, where overcrowding and boarding have become a normal everyday occurrence. These barriers force hospitals and specifically emergency departments to think differently when it comes to caring for patients. The old split flow model of care is no longer sufficient to move patients safely, effectively, and timely through the continuum of emergency care. This project focuses on innovating emergency department throughput and identifies new road maps to decrease the time a patient spends in the emergency department. Methods: A multi-disciplinary team was created including nurses, physicians, patient care assistants, transporters, radiology, and patient liaisons. The team was tasked to completely reimagine a new innovative emergency care model. Go-live would be in 60 days. The challenge was to create superior emergency department throughput strategies that did not rely on the hospital having capacity. Post-implementation metrics were measured for eight months. Results: Vast improvement was noted in nearly every emergency department metric upon go-live. Length of stay decreased by nearly 25%, left without being seen decreased to nearly 0%, left before treatment complete decreased to below 1%, and patient satisfaction more than doubled. Conclusion: Using data analysis as the foundation for creating an innovative emergency care model was able to improve throughput inefficiencies experienced with the previous split flow model at an overcrowded urban hospital. Contribution to Emergency Nursing Practice: This quality improvement project developed a new care delivery model for emergency departments which are experiencing overcrowding related throughput inefficiencies. • Key implications for emergency nursing practice found in this article are that interdisciplinary collaboration is key to improving emergency department throughput. • This article places an emphasis on utilizing data analysis to drive emergency department throughput decision making.
Rethinking Vascular Access in the Emergency Department
Many studies have concluded that implementing a vascular access program in inpatient units can reduce central line rates. However, there are limited studies on the effects of implementing these programs within the emergency department, where efforts to reduce central line rates should begin. This quality improvement project examined the effects of an ultrasound-guided peripheral access program in the emergency department has on inpatient central line rates. An ultrasound-guided peripheral IV access program was implemented at a community hospital with an annual volume of 40,000 patients. Eight Emergency Department (ED) nurse champions were trained in various ultrasound-guided peripheral IV insertions. Central line data were compared for 8 weeks pre- and post-intervention. The study site experienced a 39% reduction in the total number of inpatient central lines inserted during project implementation despite a 12% increase in the average daily hospital census. The project implementation resulted in a 46% reduction in the total number of patient days per central line. The study concluded that implementing an ultrasound-guided peripheral vascular access program in the ED was able to reduce inpatient central line use.
When Time is of the Essence: Comparing Infusion Rates by Gravity, “Push-Pull” Technique and Pressure Bag Delivery
Background: Rapid infusion is a fundamental component of resuscitation in trauma, conditions such as shock, perioperative bleeding and sepsis. The ability to deliver fluids and blood products swiftly and safely often determines the outcome of critical cases. Rapid fluid administration will help to restore volume, augment cardiac output and reverse shock. It represents one of the early interventions that can help reduce mortality and morbidity. In most emergency situations, peripheral intravenous (IV) access provides the fastest and most practical route for initial resuscitation when central access or automated rapid infusers are not yet available. However, infusion rate through a peripheral line is affected by multiple mechanical and physical factors, such as bag height, tubing length, cannula gauge, external pressure, and fluid viscosity. Objective: To compare the flow rates via three peripheral infusion techniques gravity flow, pressure-bag assistance, and push–pull syringe method, using both normal saline and simulated blood at two pole heights (1.85 m and 1.50 m). Methods: Thirty-six bench-simulation trials were conducted in a controlled laboratory using an 18-gauge cannula, standard transfusion tubing, and a mannequin arm. Each combination of method, pole height, and fluid type was tested in triplicate (250 mL per run). Mean infusion times (seconds) and flow rates (mL/min) were recorded. Results: Pressure-bag infusion produced the highest flow rate (118 ± 27 mL/min), significantly outperforming gravity (36 ± 7 mL/min) and push–pull syringe techniques (31 ± 2 mL/min) (p < 0.001). Raising the pole from 1.50 m to 1.85 m increased flow by 14–25%, depending on method. Saline infused faster than simulated blood (mean +23 mL/min, p < 0.05). The fastest combination was Pressure Bag + High Pole + Saline (139.7 mL/min), and the slowest was Gravity + Low Pole + Blood (26.7 mL/min). Conclusion: External pressure and greater hydrostatic height substantially enhance infusion speed. Pressure-bag assistance offers a simple, effective solution when rapid infusion is required, particularly in emergency or low-resource settings.
Copyright (c) 2025 Journal of Critical Care & Emergency Medicine
Evaluation of Brain-Derived Neurotrophic Factor Nano Therapies to Treat Alzheimer’s Diseases
Alzheimer’s disease is a neurodegenerative disorder affecting millions across the world. It is caused by the progressive build-up of Amyloid-β plaques and tau tangles resulting in inflammation in neurons, followed by apoptosis. This paper aims to synthesize the findings of various researchers on Alzheimer’s Diseases to shed light on a treatment using molecules that promote the survival and proliferation of neurons - neurotrophic factors. Each family of neurotrophic factors has different functions and after evaluating each one, brain-derived neurotrophic factor (BDNF) was shown to have the most potential in treating Alzheimer’s disease. Nano therapy was considered as a carrier for BDNF to cross the blood-brain barrier. PolyPGLA was found to be the most effective nanocarrier for BDNF
Copyright (c) 2023 Journal of Critical Care & Emergency Medicine
Rare Diseases and the Unseen Burden: A Patient-Centered Perspective
Background: Rare diseases affect millions worldwide and pose substantial challenges to patients, healthcare providers, and researchers. Definitions of rarity vary geographically, complicating coordinated global responses. Patients often face prolonged diagnostic delays, limited treatment options, and significant social barriers. Main Body: This perspective explores the multi-dimensional burden faced by rare disease patients, highlighting key issues such as diagnostic odysseys marked by misdiagnoses and emotional distress. Treatment availability is constrained by high costs and lack of approved therapies, especially in low- and middle-income countries. Clinical trials, central to advancing therapies, remain difficult to access for many due to geographic and logistical barriers. Decentralized Clinical Trials (DCTs) emerge as a promising innovation, leveraging telemedicine and remote monitoring to increase inclusivity and trial participation. Beyond medical challenges, patients and caregivers experience social isolation, stigma, and significant psychosocial strain. Addressing these gaps requires coordinated efforts to raise awareness, improve healthcare infrastructure, foster patient-centric and decentralized research models, and implement supportive policies promoting equitable access to care. Conclusion: The rare disease community urgently needs integrated action combining early diagnosis, expanded therapeutic research, inclusive clinical trial designs, and social support mechanisms. Amplifying patient voices and fostering partnerships in research and policy are critical to developing effective, meaningful solutions. This comprehensive approach promises to transform the rare disease landscape, ensuring no patient remains unseen or underserved.
Behavior of Perfusion Variables in Adult Patients Undergoing Cardiac Surgery in the Hospital Cardiovascular Del Niño De Cundinamarca Descriptive Cohort
Introduction: Blood lactate levels during extracorporeal circulation (ECC) have been the method used to monitor the state of microcirculation. New studies recommend the central venous oxygen saturation (SvcO2) and the central venous - arterial difference of CO2 (Cv-aCO2 ) as innovative tools to evaluate such state in this group of patients. Aim: To describe the levels of tissue perfusion biomarkers (SvcO2, Cv-aCO2 and lactate) of adult patients undergoing ECC cardiac surgery, at the Hospital Cardiovascular del Niño, from April 1 to July 31, 2019. Methodology: Historical descriptive cohort study. A review of the medical records of adult patients undergoing cardiac surgery of any etiology under ECC was carried out, evaluating the variables to be studied intraoperatively and postoperatively at 6, 12 and 24 hours in the Intensive Care Unit. Descriptive statistics were used. Results: 54 patients undergoing different types of cardiac surgery with ECC were included. The most frequent one was myocardial revascularization in 24 patients (44,4%). The duration of ECC in 30 cases (55,5%) ranged between 60-120 minutes. During the intraoperative period, a progressive rise in the medians of the Lactate variables was observed, being greater towards the end of the ECC and being reestablished outside the ECC and in the first 24 hours of ICU stay. Conclusions: This study allowed the integration of 3 tissue perfusion variables and findings that are relevant from the clinical perspective for the perioperative management of patients undergoing cardiac surgery in ECC.
Venous-toArterial Carbon Dioxide Difference
Prevalence, Severity, and Persistence of Chemotherapy-Induced Peripheral Neuropathy in Early-Stage Breast Cancer Patients Treated with Paclitaxel: an Observational Study in a Referral Hospital in Latin America
Chemotherapy-induced peripheral neuropathy (CIPN) is one of the main adverse effects of antitumor treatment. The aim of our study was to examine the prevalence and severity of CIPN in breast cancer patients treated with paclitaxel. The association with specific patient-, tumour- and treatment-related variables was also explored. Thus, 45 patients with early-stage breast cancer were evaluated at a referral hospital in Argentina. Patient-reported CIPN-related symptoms were assessed using an abbreviated version of EORTC QLQ-CIPN20 questionnaire. Additional variables analyzed included age, weight, body mass index, tumor phenotype, and chemotherapy regimen. The study population included women aged 25-71 years. Most tumors were ER/PR-positive, and the most frequently used chemotherapy regimen was adjuvant anthracycline-based therapy. The prevalence of clinical CIPN, defined by the presence of at least one symptom experienced ‘quite a bit’ or ‘very much’, was 62%. In contrast, clinical records showed a prevalence of 24%. No significant associations were observed between patient-, tumor- or treatment-related variables and CIPN development. Among patients with neuropathy, mean CIPN score was 26,25. Of these patients, 50% presented both sensory and motor symptoms, 29% only motor and 18% only sensory symptoms. Two years after finishing chemotherapy, 46% of CIPN-patients still experienced at least one symptom. All patients with persistent symptoms had experienced motor disturbances during chemotherapy, with significantly higher motor scores. Our results indicate a high prevalence of CIPN-related symptoms during and after paclitaxel administration in our population. The presence and/or the severity of motor symptoms during chemotherapy could be postulated as possible predictors of CIPN persistence. Clinical underreporting and symptom persistence emphasize the need to incorporate patient-reported measures into clinical practice to better detect symptoms and guide interventions to improve patient’s quality of life.
Chemotherapy-Induced Peripheral Neuropathy
Sympathetic Crashing Acute Pulmonary Edema (SCAPE): A Race Against Time in the Emergency Department
Sympathetic Crashing Acute Pulmonary Edema (SCAPE) represents the extreme end of the heart failure spectrum, characterised by hemodynamic instability and severe respiratory distress. Prompt recognition and intervention are crucial to reducing morbidity and mortality in patients with SCAPE. High-Dose Nitroglycerin (HDN) and Non-Invasive Ventilation (NIV) are pivotal in managing these cases. We present a case of a 56-year-old man who presented to our Emergency Department (ED) with SCAPE. He was successfully managed with HDN at a dosage of 100 µg/min and positive pressure ventilation. This case underscores the importance of early recognition and aggressive intervention in SCAPE, highlighting the effectiveness of HDN and NIV in stabilising hemodynamics and improving outcomes.
Sympathetic Crashing Acute Pulmonary Edema (SCAPE)
Blunt Abdominal Trauma with an open Book Pelvic Fracture and a retrohepatic caval injury in a patient with cirrhosis
A 42-year-old male was involved in a high-speed motor vehicle collision. He was intubated at the scene and transported to a Level 2 trauma center.
Utilization of Immediate Energy Resources in Critical Care, Emphasis on Phosphocreatine
Modern societies heavily rely on sophisticated energy resources, likewise human baseline daily and stress related activity commencing on the molecular and cellular level is essentially dependent on properly functioning energy producing, rebooting and storage conditions. Adenosine triphosphate (ATP) assumes the role of universal energy currency stored in high energy phosphate bounds, with immediate availability for biochemical processes requiring fuel resources. The intrinsic resources for ATP are mitochondria providing synthesis from ADP mediated by ATPase, and ATP is recycled in significant amounts from high ATP containing organs, like muscles. ICU patients are characterized by low ATP reserves. The reasons are conceivably multifactorial, including increased requirements, mitochondrial damage, catabolism and muscle breakdown, leading to impaired availability and increased demand. Phosphocreatine (PCr) provides the high energy substrate to promote regeneration of ATP rendering an immediate energy resource bypassing the largely oxygen dependent oxidative phosphorylation. Currently, phosphocreatine substitution is available therapeutically, offering a transient supportive tool to the organism during conditions when demand is enhanced, production may suffer and endogenous resources of creatine or phosphocreatine are relatively low. Exogenous phosphocreatine supplementation may be beneficial during critical care illness, when energy resource processing and utilization may be dampened by ischemic and inflammatory pathological processes. The significance of supplementary immediate energy substitution is demonstrated on case reports during inflammatory conditions.
Treatment by Ozone and a Parasympathomimetic Drug in Liposome Cream on Knee after Surgery or Trauma
Verify the pain relief by applying a parasympathomimetic drug in liposomes cream distributed supra cute males, in-group of patients suffering from painful knee, after surgery or trauma. This study was carried out in double blind. Material and Methods: From 2022 to 2023, the authors, on double blind method, of which 34 females and 84 males, average age, studied 118 patients 49 years old, suffering from painful knee, after surgery or trauma. by application of a parasympathomimetic drug diluted in liposomes cream, at a dose of 20 mg in 150 ml of cream, for 20 session, after ozone by 10 ml for each treatment. For each patient, the intensity of pain was assessed by the visual analogue scale (VAS) and the assessment of functional impotence with the 5 levels of the semantic scale: A = Absent AA = Almost Absent M =Mild R = Remarkable T = Total Detection occurred at T0’, T10’, T20’, T60’ after each medicated session. Results: Of118 patients, 34 females and 84 males, therefore 85,00% of the total obtained a good pain control with restoration of functional activity (See poster’s graphic).
Dual Burden: Radiologically Confirmed Neurocysticercosis Complicated by Infective Endocarditis in a Young Patient: Case Report
We report the case of a 17-year-old male who presented with progressive headache, fever, vomiting, and neck stiffness. On admission, he was febrile, tachycardic, tachypneic, hypoxic, and severely anemic, with conjunctival hemorrhages and new cardiac murmurs. Neurologically, he had reduced consciousness, left-sided weakness, hypertonia, and meningeal signs. Echocardiography revealed large vegetations on the aortic and mitral valves with moderate regurgitations and pulmonary hypertension, confirming native-valve infective endocarditis. Neuroimaging demonstrated a left parietal mass extending from the choroid plexus with multiple subarachnoid and scalp cystic lesions, consistent with racemose neurocysticercosis, complicated by severe vasogenic edema, obstructive hydrocephalus, subfalcine herniation, and intraparenchymal hemorrhages. The patient underwent burr-hole decompression (yielding mainly blood) and was treated with albendazole, praziquantel, corticosteroids, and antiepileptics for neurocysticercosis, alongside intravenous vancomycin and ceftriaxone for six weeks for infective endocarditis. This case highlights the rare coexistence of infective endocarditis and racemose neurocysticercosis with intracerebral hemorrhage, underscoring the importance of multidisciplinary care in managing overlapping infectious and neurological pathologies.
Comparison of Hematological Indices in Patients before and After Coronary Artery Bypass Grafting (CABG)
Subject: Clinically, a reduction in hematocrit (Hct) or hemoglobin (Hb) levels is a notable condition commonly observed in patients undergoing coronary artery bypass grafting (CABG). Postoperative anemia is a risk factor for mortality in patients undergoing CABG, affecting both the early and late stages of recovery. However, the underlying mechanisms remain incompletely elucidated. We aimed to investigate the relation between the hematologic indices with two surgery methods (on-pump & off-pump). Methods: Fifty consecutive CABG cases were randomly assigned to group I (On-pump, n= 24) and group II (Off-pump, n = 26). General clinical and surgery parameters, hematologic incidence were measured in two blood samples, the first sample was taken from each patient on the morning of the day of surgery after 12-hr fasting, and the second sample on the first postoperative day at 24-hr after surgery. Statistically assessing serum levels pre- and post-CABG and comparing between the two groups was analyzed and the correlation between parameters was evaluated. Result: In the baseline, there were significant differences between the on-pump and off-pump groups regarding heart rate (HR) (p = 0.002). Investigation after surgery showed that the difference in HR and urea levels in pre- and post-CABG was significant when compared between the two groups. A significant difference was observed in the white blood cell, it became less after the operation. The decrease in platelet and PT level in patients who underwent the on-pump and off-pump surgery (diff = -23.5 and diff = -0.62, respectively) was shown and this difference remained significant between the two groups. Conclusion: We achieve the on-pump method places greater stress on blood cells, resulting in reduced levels of white blood cell in patient outcomes. It can be suggested that it should be adjusted for patients undergoing both on-pump and off-pump surgeries.
Using the ERAS Concept as an Evolution of the Fast Track Surgery Program for Safe Elective Surgical Treatment of Primary Progressive Chronic Vein Disease During Pregnancy
Objective: To date, therapeutic tactics for primary symptomatic chronic disease of sphere and/or non-sphere veins during pregnancy remain the subject of discussion. There are no generally accepted approaches to the choice of therapy methods, especially indications for planned surgical treatment. Material and Methods: Surgical treatment of 457 pregnant women in the second and third trimesters with primary symptomatic chronic disease of saphenous (large and / or small saphenous veins) of clinical class C2-4s, Er, As, p, Rg (according to the classification of the basis of CEAP, 2002) and / or non-saphene veins (varicose veins of the inguinal canal, and/or vulva, and perineum) was carried out in a planned manner according to the ERAS program. The most important thing in this program is a multidisciplinary approach to the observation of pregnant women, hospitalization of them in a specialized obstetric hospital on the day of surgery, the use of perinatal psychotherapy to prepare the pregnant woman and fetus for surgery, performed by a vascular surgeon - the so-called “obstetric vascular surgeon”. Results: As a result of the study, all operated patients noted that the use of the ideology of the ERAS program for planned surgical treatment of pregnant women with primary symptomatic chronic disease of saphene and/or non-saphene veins required the implementation of general and adaptation of some of its components to this contingent of patients, scrupulous adherence to them at all stages (before, during and after) of surgery. These factors contributed to the achievement of clinical effectiveness planned surgical treatment 97% in the absolute absence of complications from the fetus and mother in all operated patients, protected against premature birth, caused a decrease in the number and severity of postoperative complications from postoperative wounds, which did not require additional treatment, did not affect the development of the fetus, the course of pregnancy. Conclusion: This ensured the safety of childbirth and the postpartum period, formed comfortable conditions for the course of pregnancy in the postoperative period with a reduction in the period of stay in the hospital and the patient’s return to a normal lifestyle as soon as possible. All operated patients did not need medical support in the postoperative and postpartum periods, except for the use of elastic knitwear of compression class 2 (stockings or knee-highs) during physical exertion.
NonObstetric Elective Surgical Interventions
The Health and Nutritional Benefits of Fruits and Vegetables to Reduce the Risk of Obesity and High Blood Lipids
Background: Vegetables and fruits are an important part of a healthy diet and help with growth and support body functions and physical, mental, and social well-being at all ages. They can also help prevent all forms of malnutrition, such as undernutrition, micronutrient deficiencies, obesity, and overweight, and reduce the risk of non-communicable diseases. World Health Organization consumption of at least 400 grams of fruits and vegetables per day, or five servings of 80 grams each, and the reasons for the sad fact that most people do not eat enough of them to maintain a healthy life for the sake of obesity treatment and weight reduction. Objectives: The aim of the study was to investigate the effects of increasing fruit and vegetable intake rich in antioxidants and vitamins on people at risk of obesity and high levels of blood fat and to provide education about its benefits and the amount of daily rations. Methods: This a descriptive cross-sectional study, 160 obese women underwent to Aspetar ospital in Misurata city during The period (October–December 2022) and they were divided into two groups of 80 women per group. The first group was presented with a weight-loss diet devoid of vegetables and fruits. The second group was given a weight-loss diet rich in vegetables, including cucumber, lettuce, tomato, and fruits (kiwi, apple, and orange). For three consecutive months. Results: The findings were a decrease in weight with an average of 8 kg per woman for the first group and 15 kg per woman for the second group, and the average cholesterol and triglycerides were 280 mg/100 dL of blood and 230 mg/100 dL of blood, respectively, for the women of the first group. While it was 150 mg/100 dL blood and 90 mg/100 dL blood for the women of the second group, with some daily light exercise for all women in the two groups. Conclusion: This study indicates that consumption of three to five portions/day of fruit and vegetables is highly associated with prevention and a low risk of obesity, high blood fat, cholesterol, and cardiovascular disease. Therefore, we recommend relying on eating vegetables and fruits daily to reduce weight and blood fats, improve health, and nourish the body.
Approach to Thrombocytopenia in Critical Care
Thrombocytopenia is one of the most frequently encountered haematological abnormalities in critically ill patients, with reported incidence ranging from 13–65% [1]. It is defined as a platelet count <150,000/µL or a decline of >50% from baseline. The condition may develop due to multiple, often overlapping mechanisms, and its presence in ICU patients correlates with increased morbidity, mortality, and prolonged ICU stay.
Using Ultrasound Cyclo-Plasty as A Preventive Glaucoma Treatment for Eyes Undergoing Boston Keratoprosthesis Type I Implantation
Purpose: To study the benefit of performing Ultrasound Cyclo-Plasty (UCP) using High-Intensity Focused Ultrasound (HIFU) as a glaucoma treatment in eyes undergoing Boston kerato-prosthesis type I and to evaluate the control of intraocular pressure and glaucoma progression postoperatively. Methods: This is a retrospective study review of cases that underwent Boston Kerato-prosthesis type 1 implantation with UCP treatment at the same time in Ocular Hypertension (OHT), glaucoma suspects or glaucoma patients. Results: Fourteen patients (14) underwent a BKpro implant combined with UCP procedure. Mean age 53,2 ± 20 years (range 26 to 81 years). 10 males and 4 females, 5 right eyes and 9 left eyes. The average duration of follow-up was 36 months (range 6 to 70 months). Mean IOP was reduced from 21.7 ± 6.6 mm Hg to 15.86 ±4.02 which was sustained in longer follow up periods 15.1 ± 4.3. at the last visit, corresponding to a mean IOP reduction of 23%. Only two patients required further glaucoma surgical intervention. Vision improved to better than 20/80 in five patients, better than 20/200 in two and four remained unchanged in the 20/200-20/400 vision group and two patients had worsening of vision. Conclusions: For a mean follow-up of 3 years and ranging up to more than 5 years, the glaucoma progression or the conversion from Glaucoma Suspect (OHT) into a Glaucoma according to our criteria and definition, was only seen in 1 case (7,14%). The complications cannot be associated with the UCP treatment and might be related to the BKpro + UCP surgery itself. UCP, in combination of BKpro, seems to be a safe procedure to slow down the progression of glaucoma in cases undergoing BKpro.
High-Intensity Focused Ultrasound Ablation
Asthma is a chronic condition that affects the airways. It causes wheezing and breathing difficulties. There are different types, such as childhood, adult-onset, seasonal, and workplace-related asthma.
Case Report: Understanding Malignant Coronary Artery Anomalies
Background: The right coronary artery (RCA) plays a crucial role in providing innervation to the right ventricle and right atrium, including key nodes involved in heart rhythm regulation. Anomalous origin of the RCA, particularly from the left coronary sinus, termed malignant RCA, is a rare congenital condition. Similarly, abnormalities involving the left circumflex artery (LCX), which supplies blood to the lateral and posterior walls of the left ventricle, can also pose significant clinical risks, particularly in cases where the LCX is anomalously connected or obstructed. Given the rarity of these conditions, we report three cases of hospitalized adults with malignant courses of their coronary arteries (two RCAs and one LCX). Case report Case 1: A 53-year-old male with diabetes presented with severe chest pain persisting for 3 days. Diagnostic tests revealed ST segment elevation in inferior leads on electrocardiogram (ECG) and elevated troponin T levels. Coronary angiography revealed an anomalous RCA origin, along with significant occlusion and stenosis in other coronary arteries, indicating a malignant course. The patient underwent coronary revascularization and was scheduled for coronary artery bypass grafting (CABG). Case 2: A 69-year-old female with multiple comorbidities, including diabetes and hypertension, presented with continuous chest pain. ECG indicated left bundle branch block (LBBB), and troponin T levels were elevated. Imaging confirmed a malignant course of the RCA with calcification atheromatous plaque. Despite diagnosis, the patient declined intervention. Case 3: A 76-year-old male presented with chest pain following a road traffic accident where he sustained impact to his chest. Initial tests showed an abnormal ECG and elevated troponin, prompting further investigation. Imaging revealed a sternal fracture and pericardial fluid but no major cardiac events. A coronary CT scan uncovered several significant coronary artery abnormalities, including a calcified obtuse marginal artery, a hypoplastic aberrant left anterior descending artery, and an abnormal left circumflex artery. Conclusion: These cases highlight the clinical challenges posed by anomalous coronary arteries and underscore the importance of timely diagnosis and management. Treatment strategies should be tailored considering individual patient factors and preferences, with a focus on optimizing outcomes and improving quality of life.
Rectal Artery Embolization for Acute Uncontrollable Rectal Bleeding: Case Series and Systematic Literature Review
Purpose: The article aims to evaluate the possibilities of transcatheter arterial embolization (TAE) as a method of hemostasis in inoperable, life-threatening rectal cancer bleeding by embolizing rectal arteries related to the tumor. Materials and Methods: Using PubMed, Embase, Web of Science, and Cochrane Library, a systematic literature review following the PRISMA 2020 guidelines was performed on October 26, 2023. The search focused exclusively on patients with bleeding rectal cancer controlled by TAE. In addition, in alignment with the PROCESS 2016 guidelines, we describe three patients who underwent transcatheter embolization of the rectal arteries for rectal cancer bleeding from Surgery Department No.2, admitted to the Municipal Saint Trinity Hospital, in Moldova, Chisinau, over the period 2020-2023. Results: Out of 4,958 articles identified, 89 were included for analysis, and only nine were relevant to the topic addressed. In total, 33 cases of rectal cancer bleeding controlled by the rectal artery embolization (RAE) approach were found. Technical success was achieved in 32 out of 33 patients. Technical failure was encountered in one patient due to a practical shortfall in advancing the microcatheter to the source of bleeding. The most frequently embolized artery was the superior rectal artery (in 22 patients). Bleeding control was achieved in 24 patients from the first attempt. Recurrent bleeding was observed in nine patients who successfully responded to repeated RAE. There was no evidence of bowel infarction, and the procedure was well tolerated, in general. Conclusions: The present review and case presentation of patients who underwent endovascular approaches to treat rectal cancer bleeding showed that rectal artery embolization is a safe and feasible procedure, with a high technical success rate.
Ethical and Clinical Challenges in Managing Brain Death During Pregnancy
Introduction: Diagnosis of brain death in a pregnant patient is highly challenging both ethically and clinically when the usual medical criteria for brain death cannot be utilized completely because of pregnancy-related restrictions. The situation is compounded by the requirement to weigh the medical limitations posed by the patient’s critical status. Pregnancy itself can interfere with some diagnostic tests, making it difficult to conclude brain death, this case is reported which aims to discuss the ethical challenges and clinical intricacies in diagnosing brain death when critical diagnostic tests are restrained or limited. Case Report: A 31-year-old pregnant patient at her12 weeks gestation was admitted. We reported her history of headache, vomiting and acute loss of consciousness. Presenting with GCS 3/15 on arrival, unequal, non-reactive pupils on physical examination, she was intubated. Imaging scans revealed a thalamic hematoma on the left side as well as extensive brain edema and signs of herniation of the brain. decompressive craniectomy was carried out to lower intracranial pressure. Due to the patient’s pregnancy, an apnea test was not feaasible, The patient also had a craniectomy which made it impossible to use an EEG to determine brain function. Conclusion: Presented case illustrates ethical and clinical dilemma of establishing a diagnosis of brain death in a pregnant woman when pregnancy-related constraints hamper use of routine tests. Inability to perform critical tests like the apnea test and EEG show complexity of making an irreversibility diagnosis while weighing the risk of harm to both maternal and fetal health.
Approach to Hyperglycemia and Its Crises
Hyperglycemia may be simple due to uncontrolled or newly discovered DM, but may also be due an underlying serious condition like infection, stroke or even MI. Also hyperglycemia may be complemented with hyperglycemic crises, namely Diabetic Keto-Acidosis (DKA) and Hyperglycemic Hyperosmolar State (HHS).
Outcomes of Transcatheter Balloon Valvuloplasty for Mitral Valve
Objective: To evaluate the effectiveness of transcatheter balloon valvuloplasty (TBV) in patients with mitral valve stenosis by assessing post-procedural expansion of the mitral valve area. Materials and Methods: From March 2023 to March 2024, 16 patients diagnosed with mitral valve stenosis were evaluated at the International Cardiology Center. Among them, 15 patients underwent TBV. The study included patients aged 37 to 69 years with no prior history of TBV. The cohort comprised 11 females (68.75%) and 5 males (31.25%). Diabetes mellitus was present in 3 patients (18.75%). Results: TBV was successfully performed in all 15 patients, achieving a 100% procedural success rate. The mitral valve area increased from 1.20 ± 0.4 cm² to 2.90 ± 0.9 cm² post-procedure. Sinus rhythm was restored in 6 of 7 patients undergoing cardioversion. No in-hospital mortality or major complications occurred within the 30-day follow-up period. Conclusion: TBV is an effective minimally invasive alternative to surgical valve replacement, providing significant improvements in hemodynamic parameters and clinical outcomes.