Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

Summary Background In December 2019, the new virus infection coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged. Simple clinical risk scores may improve the management of COVID-19 patients. Therefore, the aim of this pilot study was to evaluate the quick Sequential Organ Failure Assessment (qSOFA) score, which is well established for other diseases, as an early risk assessment tool predicting a severe course of COVID-19. Methods We retrospectively analyzed data from adult COVID-19 patients hospitalized between March and July 2020. A critical disease progress was defined as admission to intensive care unit (ICU) or death. Results Of 64 COVID-19 patients, 33% (21/64) had a critical disease progression from which 13 patients had to be transferred to ICU. The COVID-19-associated mortality rate was 20%, increasing to 39% after ICU admission. All patients without a critical progress had a qSOFA score ≤ 1 at admission. Patients with a critical progress had in only 14% (3/21) and in 20% (3/15) of cases a qSOFA score ≥ 2 at admission (p = 0.023) or when measured directly before critical progression, respectively, while 95% (20/21) of patients with critical progress had an impairment oxygen saturation (SO2) at admission time requiring oxygen supplementation. Conclusion A low qSOFA score cannot be used to assume short-term stable or noncritical disease status in COVID-19.

Approximately 5.4 million people are bitten by snakes annually, with up to half of these victims experiencing signs of envenomation. This results in an estimated 138 000 deaths per year. [1] Only limited data exist on the long-term morbidity of snakebites, but one study suggested that between 5 900 and 14 600 amputations per year may be attributed to snakebites in sub-Saharan Africa (sSA) alone. [2] However, accuracy of epidemiological data is limited owing to under-reporting, patients' poor access to healthcare facilities and many victims attending traditional healers rather than health centres or hospitals. [1][2][3] The burden of snakebites is unevenly distributed across the globe, with 95% of cases encountered in low-and middle-income countries in Africa and Asia. [4,5] Even in those areas, the health effects of snakebites are disproportional, with the poorest of the poor generally experiencing poor outcomes. [6,7] Rural sSA is specifically vulnerable owing to limited availability of healthcare services. In 2017, the World Health Organization (WHO) recognised snakebite envenoming as a neglected tropical disease. [7] Accordingly, snakebite antivenoms are included in the WHO's list of essential medicines. [8] Common acute medical conditions arising from snakebites depend on the species, but include neurotoxicity, coagulation failure accompanied by shock or organ dysfunction, and local tissue destruction. [9] Multiple factors, including delayed presentation to healthcare facilities, adversely affect the management and outcome of snakebite victims. [2] Inadequate regulatory frameworks that result in ineffective or unsafe antivenom products being available, restricted access and high costs are crucial challenges limiting the use of antivenoms, particularly in sSA. [10,11] Supportive measures are often the only therapeutic options for patients presenting with snakebite envenoming in sSA.In this study, we report the intensive care unit (ICU) management and outcomes of 174 snakebite victims who were treated mainly with basic intensive-care interventions (e.g. mechanical ventilation) in a rural sSA hospital where adequate doses of antivenom were not available.

No abstract

No abstract