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A retrospective study of burns patients at a major government referral hospital in Freetown, Sierra Leone
Vol. 215, No. 3S, September 2012
and phospho-FAK. While down-regulation of MACC1 induced the opposite effects, and it also increased the response of HCC cells to apoptotic stimuli and sensitized doxorubicin and etoposide chemotherapy. Microarray analysis revealed that MACC1 modulated the expression of multiple genes involved in tumor metastasis. The patients with MACC1high or FAKhigh in HCCs showed a significantly shorter overall survival and higher cumulative recurrence rates after liver transplantation (LT), compared with MACC1low or FAKlow group. Multivariate analysis indicated that MACC1 alone or combination of MACC1/FAK was an independent prognostic factor for overall survival and cumulative recurrence. CONCLUSIONS: MACC1 is a critical oncogene in controlling HCC metastasis, and MACC1 or combination of MACC1/FAK could serve as a novel biomarker in predicting the prognosis of HCC after LT.
A retrospective study of burns patients at a major government referral hospital in Freetown, Sierra Leone Jennifer Jackson-Cole, MD, Dudley Pratt, MD, Marta Forde, MD, Joseph Bangura, MD, Reinou S Groen, MD, Adam L Kushner, MD, FACS, MPH, Thaim B Kamara, MD Connaught Hospital, Freetown, Sierra Leone Surgeons OverSeas (SOS), New York, NY, Columbia University, New York, NY INTRODUCTION: Connaught Hospital in Freetown is the major government surgical and medical referral hospital in Sierra Leone. Burns cases are managed in the general surgical wards and are considered a significant burden for patients and contribute to a high workload for the hospital staff. METHODS: A retrospective descriptive review of patient charts was undertaken. All medical files available from patients who presented to Connaught Hospital with a diagnosis of burns between Jan 2007 to Dec 2011 were included. Demographics, etiology, thickness, location and complications were recorded. RESULTS: A total of 436 burn cases were recorded. The sex ratio m:f was 1:0.79. Age ranged from 3 months to 68 years, with a mean of 26.4 (SD 15.3). Thermal injury, mainly hot liquid, was noted in 342 patients (73.9%). Of the open-fire burns, kerosene lamps accounted for 15.2%. Burns with partial thickness were sustained in 57.3% of cases, and the anterior trunk and the right upper-limb were most affected. Sepsis (3.5%) and contracture (2.8%) were the commonest complications documented. Eighty-four burn patients (3.9%) left the hospital against medical advice and the mortality rate was 10%. CONCLUSIONS: Burns are a common cause of hospitalization in Sierra Leone. Most cases are thermal and occur in males. High mortality mandates that more resources be devoted to developing specialized burn services in addition to patient education. Although there were more male than female burn patients, additional research is need to determine if males are more prone to burns or if there are barriers to access for female patients.
Abstracts
S67
Severe vitamin D deficiency is associated with worsened outcomes in surgical patients with ventilated-associated pneumonia Leslie Ray Matthews, MD, FACS, Kenneth Wilson, MD, FACS, Yusuf Ahmed, MD, MPH, Diane Griggs, NP, Ed Childs, MD, FACS, Omar Danner, MD, FACS Morehouse School of Medicine, Atlanat, GA INTRODUCTION: Vitamin-D deficiency adversely affects immune function in critically-ill patients. This study investigates the impact of vitamin-D deficiency in surgical intensive care unit (SICU) patients with ventilated-associated pneumonia (VAP). We hypothesize that severe vitamin-D deficiency increases the incidence, length of stay (LOS), hospital costs, and mortality rate in critically-ill patients with VAP. METHODS: We performed a prospective assessment of the vitamin-D status of 565 patients admitted to our SICU between August 2009 and February 2012. We assess the surgical outcomes in this patient population that developed VAP. Vitamin D deficiency was defined as follows: severe, less than 13; moderate 14-26; mild 27-39; and normal 40 ng/mL. RESULTS: Of the 565 patients, 403 (71.3%) were male, and 162 (28.7%) were female, 388 (68.7%) were African-Americans and 177 (31.3 %) were Caucasian. 46.8% were severe vitamin D deficient, 42.3% had moderate deficiency, and 8.8% mildly deficiency to normal. The incidence of VAP was 20.7% overall. The severe group comprised 61.3% versus 38.7% in the non-severe (moderately & mildly deficiency) VAP population (p value, 0.020). Mean SICU LOS for severely deficient group was 11.90 days versus 7.16 days (⬍0.001). Average ICU cost was $45,689.67 for severe group with VAP versus $27,627.45 (p⬍ 0.001). Mortality rate for severe vitamin D deficient group with VAP was 12.7% versus 8.6%, (p⫽ 0.090), trending towards higher mortality. CONCLUSIONS: Severe vitamin-D deficiency increases VAP-associated incidence, LOS, and total hospital costs in SICU patients. Therefore, vitamin D deficiency should be assessed and corrected in critically-ill SICU patients expeditiously.
Lack of emergency department and primary care genitourinary physical examination before urologic consultation - a quality of care issue Adam W Ylitalo, DO, Kelly R Ylitalo, MPH, PhD, Richard A Santucci, MD, FACS Detroit Medical Center, Detroit, MI INTRODUCTION: A well-performed physical exam along with solid history-taking is the foundation of medical evaluation. Many urological diagnoses may be obtained from this information alone; however, the genitourinary physical exam is often poorly executed or missing during an initial patient evaluation. METHODS: For six weeks between July and August 2010, 420 consecutive patients evaluated by the urology consultation service had medical charts reviewed retrospectively, with the frequency of genitourinary physical exam performed by the emergency department or primary hospital team recorded.
and phospho-FAK. While down-regulation of MACC1 induced the opposite effects, and it also increased the response of HCC cells to apoptotic stimuli and sensitized doxorubicin and etoposide chemotherapy. Microarray analysis revealed that MACC1 modulated the expression of multiple genes involved in tumor metastasis. The patients with MACC1high or FAKhigh in HCCs showed a significantly shorter overall survival and higher cumulative recurrence rates after liver transplantation (LT), compared with MACC1low or FAKlow group. Multivariate analysis indicated that MACC1 alone or combination of MACC1/FAK was an independent prognostic factor for overall survival and cumulative recurrence. CONCLUSIONS: MACC1 is a critical oncogene in controlling HCC metastasis, and MACC1 or combination of MACC1/FAK could serve as a novel biomarker in predicting the prognosis of HCC after LT.
A retrospective study of burns patients at a major government referral hospital in Freetown, Sierra Leone Jennifer Jackson-Cole, MD, Dudley Pratt, MD, Marta Forde, MD, Joseph Bangura, MD, Reinou S Groen, MD, Adam L Kushner, MD, FACS, MPH, Thaim B Kamara, MD Connaught Hospital, Freetown, Sierra Leone Surgeons OverSeas (SOS), New York, NY, Columbia University, New York, NY INTRODUCTION: Connaught Hospital in Freetown is the major government surgical and medical referral hospital in Sierra Leone. Burns cases are managed in the general surgical wards and are considered a significant burden for patients and contribute to a high workload for the hospital staff. METHODS: A retrospective descriptive review of patient charts was undertaken. All medical files available from patients who presented to Connaught Hospital with a diagnosis of burns between Jan 2007 to Dec 2011 were included. Demographics, etiology, thickness, location and complications were recorded. RESULTS: A total of 436 burn cases were recorded. The sex ratio m:f was 1:0.79. Age ranged from 3 months to 68 years, with a mean of 26.4 (SD 15.3). Thermal injury, mainly hot liquid, was noted in 342 patients (73.9%). Of the open-fire burns, kerosene lamps accounted for 15.2%. Burns with partial thickness were sustained in 57.3% of cases, and the anterior trunk and the right upper-limb were most affected. Sepsis (3.5%) and contracture (2.8%) were the commonest complications documented. Eighty-four burn patients (3.9%) left the hospital against medical advice and the mortality rate was 10%. CONCLUSIONS: Burns are a common cause of hospitalization in Sierra Leone. Most cases are thermal and occur in males. High mortality mandates that more resources be devoted to developing specialized burn services in addition to patient education. Although there were more male than female burn patients, additional research is need to determine if males are more prone to burns or if there are barriers to access for female patients.
Abstracts
S67
Severe vitamin D deficiency is associated with worsened outcomes in surgical patients with ventilated-associated pneumonia Leslie Ray Matthews, MD, FACS, Kenneth Wilson, MD, FACS, Yusuf Ahmed, MD, MPH, Diane Griggs, NP, Ed Childs, MD, FACS, Omar Danner, MD, FACS Morehouse School of Medicine, Atlanat, GA INTRODUCTION: Vitamin-D deficiency adversely affects immune function in critically-ill patients. This study investigates the impact of vitamin-D deficiency in surgical intensive care unit (SICU) patients with ventilated-associated pneumonia (VAP). We hypothesize that severe vitamin-D deficiency increases the incidence, length of stay (LOS), hospital costs, and mortality rate in critically-ill patients with VAP. METHODS: We performed a prospective assessment of the vitamin-D status of 565 patients admitted to our SICU between August 2009 and February 2012. We assess the surgical outcomes in this patient population that developed VAP. Vitamin D deficiency was defined as follows: severe, less than 13; moderate 14-26; mild 27-39; and normal 40 ng/mL. RESULTS: Of the 565 patients, 403 (71.3%) were male, and 162 (28.7%) were female, 388 (68.7%) were African-Americans and 177 (31.3 %) were Caucasian. 46.8% were severe vitamin D deficient, 42.3% had moderate deficiency, and 8.8% mildly deficiency to normal. The incidence of VAP was 20.7% overall. The severe group comprised 61.3% versus 38.7% in the non-severe (moderately & mildly deficiency) VAP population (p value, 0.020). Mean SICU LOS for severely deficient group was 11.90 days versus 7.16 days (⬍0.001). Average ICU cost was $45,689.67 for severe group with VAP versus $27,627.45 (p⬍ 0.001). Mortality rate for severe vitamin D deficient group with VAP was 12.7% versus 8.6%, (p⫽ 0.090), trending towards higher mortality. CONCLUSIONS: Severe vitamin-D deficiency increases VAP-associated incidence, LOS, and total hospital costs in SICU patients. Therefore, vitamin D deficiency should be assessed and corrected in critically-ill SICU patients expeditiously.
Lack of emergency department and primary care genitourinary physical examination before urologic consultation - a quality of care issue Adam W Ylitalo, DO, Kelly R Ylitalo, MPH, PhD, Richard A Santucci, MD, FACS Detroit Medical Center, Detroit, MI INTRODUCTION: A well-performed physical exam along with solid history-taking is the foundation of medical evaluation. Many urological diagnoses may be obtained from this information alone; however, the genitourinary physical exam is often poorly executed or missing during an initial patient evaluation. METHODS: For six weeks between July and August 2010, 420 consecutive patients evaluated by the urology consultation service had medical charts reviewed retrospectively, with the frequency of genitourinary physical exam performed by the emergency department or primary hospital team recorded.