Background A community lockdown has a profound impact on its citizens. Our objective was to identify changes in trauma patient demographics, volume, and pattern of injury following the COVID-19 lockdown. Methods A retrospective review was conducted at a Level-1 Trauma Center from 2017 to 2020. Results A downward trend in volume is seen December–April in 2020 (R 2 = 0.9907). February through April showed an upward trend in 2018 and 2019 (R 2= 0.80 and R 2 = 0.90 respectively), but a downward trend in 2020 (R 2 = 0.97). In April 2020, there was 41.6% decrease in total volume, a 47.4% decrease in blunt injury and no decrease in penetrating injury. In contrast to previous months, in April the majority of injuries occurred in home zip codes. Conclusions A community lockdown decreased the number of blunt trauma, however despite social distancing, did not decrease penetrating injury. Injuries were more likely to occur in home zip codes.

Introduction Burns are global public health problem. Micronutrients play an essential role in defense mechanisms and immunity. Vitamin C has fostered a growing interest. We reviewed current evidence regarding the effects of Vitamin C on management of burn patients and aims to understand its benefits and risks. Methods A narrative review was performed from January 2000 through September 2020 via PubMed by searching the terms “vitamin C”, “ascorbic acid” and “burns”. The search yielded a total of 170 journal articles. The following were excluded: commentaries, experimental research and studies on non-human subjects. Ultimately, 20 articles qualified for review. Results A total of 924 patients were studied. The literature collectively endorsed a difference in patient outcomes when vitamin C is administered on the first day of admission. The average age across the studies was 15–45 years old. Only 10% of studies included vulnerable age groups (2–15 years old). The Mean Total Body Surface Area (TBSA) of patients was 31%. Most of the studies excluded patients with co-morbidities. The benefits of vitamin C in various aspects of burn management were documented in 70% of studies. Patients who were given vitamin C exhibited a decrease in fluid requirement in 42% of the studies when compared to controls. Additionally, a decrease in wound healing time was reported in 35% of studies, a decreased rate of post-burn infections was reported in 28%, and 14% of studies state that patients given vitamin C had reduced edema. The effect of vitamin C dosing methods on outcomes was also examined. It was reported by 14% of Studies that low-dose Vitamin C infusion does not improve outcomes, while 50% of studies that used high-dose infusion revealed improved results. Additionally, when comparing oral route of administration 20 % of studies used high-dose with favorable results. In regards to risk, oxalate nephropathy, acute kidney injury, and renal failure was documented by six studies. Conclusions Our review concludes that there is decreased fluid requirement, improvement in edema, healing time and post burn infections when high-dose vitamin C (66mg/kg/hr) is given to adults on first day of admission and continuously infused for 24 hours in 1st and 2nd degree burn involving 10 to 40% TBSA. However, there is an associated risk of acute kidney injury and renal failure.

No abstract

INTRODUCTION:Complications following laparoscopic or open hysterectomy for endometrial malignancy were compared.METHODS: NSQIP databank was queried between 2016-2018. Women older than 50 years who underwent hysterectomy for endometrial malignancies were included. Patients with disseminated cancer and pre-existing cardio-pulmonary disorders were excluded. The primary outcome was cardiac complications. Secondary outcomes were hospital length of stay (HLOS), postoperative complications and mortality.

Score (TRISS), Injury Severity Score (ISS), Shock Index (SI), and NISS. Receiver operating characteristic curves (ROC) were used to evaluate the sensitivity and specificity of trauma scores for predicting mortality.RESULTS: A total of 738 patients were included (mean age: 35.7AE15.6 years). ROC curves demonstrated that NISS (AUC¼0.83, 95%CI: 0.79-0.87, p<0.001) were the best predictor of mortality, followed by TRISS (AUC¼0.80, 95%CI: 0.73-0.87, p<0.001) and GCS (AUC¼0.80, 95%CI: 0.74-0.85, p<0.001), ISS (AUC¼0.76, 95%CI: 0.71-0.81, p<0.001), RTS (AUC¼0.71, 95%CI: 0.62-0.81, p<0.001), and SI (AUC¼0.63, 95%CI: 0.57-0.70, p<0.001). NISS was superior in predicting mortality for penetrating trauma (AUC¼0.86AE0.02, p<0.001) compared to blunt trauma (AUC¼0.73AE0.04, p<0.001).CONCLUSION: NISS was the best scoring index for predicting mortality in trauma patients, especially for penetrating trauma. Clinicians should consider incorporating other trauma scores, especially NISS, in determining injury severity and the likelihood of mortality. These scores can help physicians determine the best course of action in patient management.