None/trace aortic regurgitation occurred in 76.5%, mild AR in 20.5% and moderate AR in 3%. The permanent pacemaker implantation rate was 8.5% and 30-day all-cause death occurred in 3.0% of cases. TAVI with the Myval THV in selected BAV anatomy is associated with favorable short-term hemodynamic and clinical outcomes.Bicuspid aortic valve (BAV) is the most common valvular congenital anomaly and is apparent in nearly 50% of candidates for AV replacement. While transcatheter aortic valve implantation (TAVI) is a recommended treatment for patients with symptomatic severe aortic stenosis (AS) at all surgical risk levels, experience with TAVI in severe bicuspid AS is limited. TAVI in BAV is still a challenge due to its association with multiple and complex anatomical considerations. A retrospective study has been conducted to investigate TAVI’s procedural and 30-day outcomes using the Myval transcatheter heart valve (THV)  in patients with severe bicuspid AS. Data were collected on 68 patients with severe bicuspid AS who underwent TAVI with the Myval THV. Baseline characteristics, procedural, 30-day echocardiographic and clinical outcomes were collected. The mean age and STS PROM score were 72.6 ± 9.4 and 3.54 ± 2.1. Procedures were performed via the transfemoral route in 98.5%. Major vascular complications (1.5%) and life-threatening bleeding (1.5%) occurred infrequently. No patient had coronary obstruction, second valve implantation or conversion to surgery. On 30-day echocardiography, the mean transvalvular gradient and effective orifice area were 9.8 ± 4.5 mmHg and 1.8 ± 0.4 cm Bicuspid aortic valve (BAV) is the most common valvular congenital anomaly occurring in up to 1.5% of the general population . FurtherThe recent ACC/AHA and ESC guidelines have recommended transcatheter aortic valve implantation (TAVI) as a viable and alternative treatment to surgical aortic valve replacement (SAVR) for selected patients with severe AS. Importantly, neither guideline included patients with BAV in their specific recommendations ,5.BAV is a heterogenous valvulo-aortopathy disorder associated with valve leaflet dysfunction and/or aortic dilatation . AnatomiAlthough BAV has been considered as unfavorable valve anatomy for TAVI ,5 and thThe selection of the most appropriate THV device and size is challenging in BAV due to the unpredictable baseline anatomy. In a recent paper by Kawashima et al. , operaton = 7), Denmark (n = 2), Italy (n = 2), and Croatia (n = 1). A list of participating centers, collaborators and numbers of patients included is provided in Data of patients confirmed to have BAV and selected for TAVI were collected retrospectively from 12 centers in India  or a CT Core Lab . Clinical and procedural data, in addition to 30-day clinical outcomes, including site-reported echocardiographic assessment reported by the participating centers, were collected by the CORRIB Core Laboratory . This registry was conducted as an academic collaboration among the participating centers without sponsoring from the industry.Preprocedural MSCT analysis was performed either at the participating centers  . The lef2.Statistical analysis® SPSS® Statistics version 27 .Continuous variables were presented as mean and standard deviation (SD) after conduction of the Shapiro–Wilk test for normality. Categorical variables were presented as frequencies and percentages. Analysis was performed using the IBMThe study comprised 68 patients with severe bicuspid AS who underwent TAVI using the Myval THV system. Patients’ mean age was 72.6 ± 9.4 years,  and mostTAVI was performed through femoral access in 67 (98.5%) patients. The Python 14-F expandable introducer sheath was used in 67 (98.5%) patients. TAVI was performed with local anesthesia and/or moderate sedation in all cases. Preimplantation balloon dilatation was used in 49 (72%) patients and postimplantation was performed only in 8 (12%) patients . Eight dVARC-3 technical success was achieved in 97% of patients. No procedural death and no need for second valve implantation or conversion to surgery were observed. Life-threatening bleeding occurred in one (1.5%) patient and an access-related complication occurred in another single (1.5%) case . VARC-3 2. The total aortic regurgitation (AR) post-TAVI was non/trace AR in 52 (76.5%), mild AR in 14 (20.5%), moderate in 2 (3.0%), and there were no cases of severe AR , with low surgical risk (STS PROM score 3.5 ± 2.1%), reflecting the typical prevalence of BAV. There was 3% mortality in the first 30 days and no disabling stroke. The device success rate was achieved in 93% of patients, with no cases of device migration, embolization, aortic root injury or need for second valve implantation. The low rate of significant post-TAVI AR in this registry is similar to the Myval performance in patients with severe AS and tricuspid anatomy ,11,19.The selection of surgical or transcatheter intervention in patients with severe bicuspid AS represents an emerging clinical challenge. On one hand, many patients would prefer to opt for TAVI, however no prospective randomized data have compared this approach to SAVR, which has well-established evidence in such groups. Recent guidelines suggest that SAVR should be the treatment of choice in younger and lower-risk patients with severe bicuspid AS ,5, but tBAV anatomy is challenging for TAVI due to valve-opening asymmetry, the fused raphe, differential sinuses’ depths and dimensions, significant calcifications, and associated aortopathy, in addition to the likely associated abnormal coronary origin. These anatomic constraints can potentially result in an asymmetric expansion of the implanted device, resulting in the requirement for aggressive postdilatation to treat residual gradients or paravalvular leak. Furthermore, the long-term mal expansion can lead to flow abnormalities, with the potential for device thrombosis and early structural valve deterioration, which ultimately may affect device durability ,22.The calcification severity is another major challenge for TAVI in bicuspid anatomy. Yoon et al. studied the two-year outcome of TAVI in low-surgical-risk patients with BAV. The authors reported a 4-fold increase in mortality in patients who had severe calcifications involving both leaflets and raphe, compared to patients with only leaflet calcification .The experience of TAVI in BAV with the BEV, SEV, and mechanical expandable valves showed various outcomes, particularly in mortality, stroke, the need for permanent PMI, and AR severity .The clinical outcomes of TAVI using the Myval BEV in BAV in this small registry are similar to those reported from contemporary BEV and SEV by Yoon et al.  with resFurthermore, the hemodynamic performance parameters of the Myval BEV are also comparable to those reported by Yoon et al. and by Makkar et al.—EOA is 1.8 ± 0.4 vs. 1.7 ± 0.5 and 1.9 ± 0.6, respectively, the mean pressure gradient is 9.8 ± 4.5 vs. 10.6 ± 5.0 and 12.7 ± 5.4 mmHg, respectively, and there was moderate or more AR . Regarding the recent guidelines’ definition ,16, PPM Life-threatening bleeding was seen only in one (1.5%) patient in the form of severe pericardial effusion (tamponade), and it was due to injury from the pacing lead, but the patient become stable after pericardiocentesis and did not require any reintervention.To date, the postprocedural complications of TAVI in bicuspid AS using different prostheses have been low in several series ,24,25. TWithout a dedicated RCT exploring the safety and efficacy of TAVI in BAV anatomy, current evidence remains “hypothesis-generating”. However, there is accumulating evidence that TAVI in BAV using selected and appropriately sized devices in a selected population is safe .Limitations of this registry include its retrospective nature. In addition, detailed anatomical characteristics  were not collected systematically. Additionally, the data were site-reported with the unavoidable variability of reports between sites in absence of an independent Core Lab analysis and independent clinical event adjudication. The missing data in this registry are listed in TAVI using the balloon-expandable Myval THV was associated with favorable short-term hemodynamic and clinical outcomes in selected patients with severe bicuspid AS. These findings should be confirmed in a prospective, randomized controlled and adequately powered study.


Non-traumatic subarachnoid hemorrhage (SAH) is an emergency usually caused by the rupture of a saccular intracranial aneurysm. Endovascular treatment (EVT) is now considered as the first therapeutic option. The aim of our study is to evaluate, over a 14-year period in a single center, the result of EVT of ruptured intracranial aneurysms.From the retrospective analysis of our prospectively maintained database, we collected data of 457 patients successfully treated by endovascular approach for a SAH. Descriptive statistics and percentages were used to report clinical and anatomical outcomes, procedure-related complications, post procedural events, morbidity and mortality.EVT was unsuccessful in eleven patients but effective in 457 patients with two patients who experienced a rebleeding (0.4%). In 6.3% of cases, a second EVT was necessary. The final aneurysm occlusion was complete (65.7%), with a neck remnant (28.2%) or incomplete (6.1%). Procedure-related complications occurred in 5.9% of patients and were associated with five clinical worsening and one death. Overall EVT-related morbidity and mortality were thus of 1.3% and 0.4% respectively. At discharge, 71% of patients had a good recovery (mRS 0–2), 11.2% had a poor outcome (mRS 3–5), and 17.8% died.This study seems to prove that high-volume centers with experienced interventional neuroradiologists carry low rates of technical failure and complication from EVT of ruptured intracranial aneurysm. Non-traumatic subarachnoid hemorrhage (SAH) is a major life-threatening emergency. In 80% of cases, it is caused by the rupture of a saccular intracranial aneurysm (sIA). Other common causes are dissecting aneurysms, cerebral arteriovenous malformations and vasculitis 23.2The hallmark symptom is a sudden and severe headache. Associated signs include nausea, vomiting, photophobia, neck stiffness, focal neurologic deficits, seizure or depressed consciousness 24. The i24SAH may cause acute hydrocephalus and brain edema. Later complications include vasospasm and delayed cerebral ischemia that are associated with serious damages even after the aneurysm treatment 25.2Aneurysmal SAH are most often treated within 24 – 72 hours 45. Neuro4345678The aim of our study is to evaluate, over a 14-year period in a single high-volume center, the results of EVT of ruptured intracranial aneurysm.This study was approved by our institutional ethical committee (n°P2019/152). Our prospectively maintained database was retrospectively analyzed to identify, between April 2004 and June 2018, all patients treated only by endovascular approach for a ruptured IA.Available data were collected from the admission date in different institutions to collect the first bleeding time. The outcomes of our patients were followed until they were discharged from our hospital, or another medical institution and no clinical results were collected beyond three months of follow-up after EVT.Figure 1, the majority of patients were treated within the first days following the SAH (median = day 1 and interquartile range = 2 days).All EVT were performed by an INR from our institution. As it is reflected in Placement of an external ventricular drainage (EVD) was decided by our neurovascular team. Patients were then monitored in our intensive care unit until the overall stabilization of their condition.The sample was analyzed by descriptive statistics. Quantitative data were expressed in mean values ± standard deviation (SD) or medians and 95% confidence intervals (CI) or interquartile range, accordingly, after verification of normality of distributions by the Kolmogorov-Smirnov test. Qualitative data were expressed by the way of percentages.Four hundred sixty-eight patients were identified. In eleven patients, there was a failure of EVT (2.4%). These patients were excluded from the present analysis and are detailed in Appendix.Table 1.Our final cohort includes 457 patients successfully treated by endovascular approach. Patient characteristics are detailed in Table 2.Imaging characteristics of 457 patients successfully treated by endovascular approach are detailed in Figure 2 shows the endovascular technique used for EVT. In 6.3% of the cases (n = 29/457), a second EVT was necessary to completely exclude the aneurysm or the arterial dissection. Figure 3 shows the second endovascular method.Regarding aneurysm or arterial dissection occlusion, EVT achieved a complete occlusion in 65.7% of the cases. There was a neck remnant in 28.2% and an incomplete occlusion in 6.1% of the cases.Procedure-related complications occurred in 27 cases (5.9%) in 26 patients.Complications included 9 thromboembolic events (2%), 6 aneurysm perforations (1.3%), 5 vasospasms (1.1%), 2 coil migrations (0.4%), 4 arterial dissections (0.9%), one WEB device migration (0.2%). These complications were associated with clinical consequences in 6 patients with 5 worsening of neurological exam and 1 death. Immediate EVT-related morbidity and mortality were thus 1.1% and 0.2% respectively.Figure 4.Immediate clinical outcomes were collected within 24 hours after EVT and are detailed in Table 3.Clinical complications occurred in 246/457 (53.8%) patients. These events are detailed in Aneurysm rebleeding occurred in 2/457 patients (0.4%):th day after SAH. A vasospasm was identified before EVT and the occlusion of the sIA was incomplete. The next day, a rebleeding occurred and an EVD was needed with a second EVT by stenting and coiling. The patient kept a moderate disability at discharge and a neck remnant regarding the occlusion of the sIA- A 34-year-old woman with a WFNS grade 3 and a large MCA sIA was treated by coiling on the 8nd day after SAH. The patient presented then a major vasospasm and hydrocephalus that had worsened his clinical situation. The rebleeding occurred ten days after the EVT and left him in a brain-dead state.- A 66-year-old man with a WFNS grade 4 and a posterior cerebral artery dissection was treated by stenting on the 2Overall EVT-related morbidity and mortality were thus 1.3% and 0.4% respectively.There were 37 ventriculitis and 2 meningitis among 192 EVDs placed. Overall EVD-related infections were thus 20.3%.Figure 5.Modified Rankin Scale (mRS) at discharge is shown in Figure 6 shows the comparison between GOS immediately after EVT  and GOS at discharge (lighter grey).Table 4.The report of the clinical results (mRS) at discharge according to the initial WFNS grade is detailed in Our WFNS grades correspond to the ARETA trial and the CLARITY studies and show a similar population with most patients with a favorable grade at admission 11.In this study, the proportion of saccular intracranial aneurysms 90.6%) and arterial dissection 7.2%) is probably higher because we have excluded etiologies that did not require an EVT. The most common sites of ruptured aneurysms are the ACom, the Pcom and the MCA with often unique aneurysm which are in line with our results. The median size of ruptured aneurysms is around 6 mm and most of intracaranial aneurysms are smaller than 1 cm (around 80–90% of cases) like in our study which highlights the rupture risk even with small aneurysms [% is prob% and art791011141516Our results show high use of intracranial stents and vascular occlusion. It can be explained by several factors: (1) a high percentage (9.4%) of dissections and fusiform aneurysms; (2) stents are more often used for larger aneurysms (18.4% in our study) and/or wide neck aneurysms .Occlusion rates reported in our series were like the CLARITY and Park et al. studies 691018192021.181920In our study, the rates of intraoperative complications, EVT-related morbidity and mortality are lower than in the literature 2122.21Regarding thromboembolic events (2% in our study), the range in the literature is between 2.5% and 28.0% 212223. G212222The rate of intraoperative rupture in our study was 1.3% which is lower to the reported rates found in literature 4.4–7.6%) 2123. Pra21.4–7.6% 2131921In our series, delayed cerebral ischemia (DCI) occurred in 166 patients (36.3%) and was the most frequent complication. Our results are thus in accordance with the literature.The incidence of acute re-rupture after coiling embolization of ruptured saccular intracranial aneurysms is between 1.0% to 3.6% 25. Disse1621The ISAT study showed 74.6% of modified Rankin Scales (mRS) between 0 – 2 and 25.4% of mRS between 3 – 6 which are like our results even if we have more patients without any symptom (42%) and more fatalities 17.8%) compared to ISAT (20% and 7.5% respectively) [7% compareFigure 6, a significant proportion of patients at discharge are in a worse clinical condition than immediately after EVT. Post-procedural events like DCI, intracranial hypertension or epileptic seizure may explain this worsening.As illustrated in Our monocentric retrospective study has several limitations despite the fact that our database was prospectively maintained. Some data could have been collected to provide interesting information such as the aneurysm neck size, patient risk factors, the severity of the bleeding on CT scan, the detailed presentation of SAH. On the other hand, mid- and long-term results were not evaluated in the present study. Aneurysm recanalization and late rebleeding are significant issues and could be part of a complementary study to evaluate long-term results of EVT of ruptured IA 121725. F1217This study shows that EVT is safe and effective for patients with ruptured intracranial aneurysms, especially when high practitioner experience and high-volume centers are available. However, even if SAH management has improved over the years, associated complications still lead to significant neurological impairment in some patients. Further research on these topics is mandatory to improve the clinical course of these patients.


COVID-19 disease, caused by the SARS-CoV-2 virus, continues to cause high hospitalization and death rates. Vaccination campaigns have been key to controlling the pandemic, but vaccine hesitancy is on the rise. This study investigated the general population’s attitude to vaccination in Veneto  in January 2021 as part of a study on the prevalence of SARS-CoV-2 infection. An ad hoc questionnaire collected 4467 respondents’ sociodemographic data and propensity to be vaccinated, and findings were analyzed using logistic multivariable regression. The 48.9% of respondents were male, and the mean age was 46.8 ± 16.0 years. Asked whether they would get vaccinated against COVID-19, 84.3% said yes, 5.0% were uncertain, and 10.7% said no. Vaccine acceptance was higher in males than in females (85.8% vs. 82.8%), in people 70+ years old (92.3%), and among people with more than 14 years of schooling (89.6%). Multivariable analysis with adjOR (95% CI) showed a significantly greater vaccine reluctance in females (0.68 (0.57–0.81)), people 30–49 or 50–69 years old (0.69 (0.54–0.87)), and (0.76 (0.58–0.99)); and those with <9 or 9–13 years of schooling (0.62 (0.46–0.82)), and (0.72 (0.57–0.91)). As people refusing vaccination undeniably hinder efforts to control the pandemic, specific strategies are needed to overcome their doubts. The COVID-19 pandemic caused by the SARS-CoV-2 virus has prompted a huge number of hospitalization and many deaths. As of 21 December 2021, the World Health Organization (WHO) estimated that there had been 274,628,461 confirmed cases of COVID-19 around the world, and the number of deaths had reached 5,358,978 .In Italy, the vaccination campaign against SARS-CoV-2 began in January 2021, initially focusing on health workers and then the elderly and very frail. By mid-December 2021, about 73.6% of adults aged 18 and over) in Italy had completed the vaccination cycle against COVID-19, so more than a quarter (26.4%) of the Italian adult population was still without full coverage . This si and overVaccine hesitancy is currently a rapidly growing phenomenon, so urgent action is needed to increase people’s confidence in the vaccine in order to get more and more people vaccinated and reduce the global impact of the pandemic. Governments and institutions should make a concerted effort to improve communication strategies, nurture confidence in the health system, and achieve greater adherence to the vaccination campaign.Vaccination campaigns are usually based on multifaceted strategies to increase vaccination coverage, including education/promotion, incentives, organization, and policies. In recent months many governments, including the Italian, have been considering introducing mandatory vaccination policies to increase vaccination coverage among individuals strongly opposed to vaccination against COVID-19. Previous studies have shown that mandatory vaccination policies are effective in achieving the greatest overall vaccination coverage . In VeneThe aim of this study was to run a survey to investigate the general public’s point of view regarding the vaccination against COVID-19 in view of the campaign’s extension to the population as a whole. Gaining a better idea of people’s different attitudes in relation to their demographic and individual variables could inform vaccination strategies and campaigns to more specifically target the vaccine-hesitant population and thus reduce the proportion of the population refusing vaccination.Data were collected as part of a study on the prevalence of SARS-CoV-2 infection in the general population of the Veneto region , which had an average population of 4.8 million , with a mean age of 45.4 years, and 51.0% were female. The population’s employment rate was 65.9% , and aboFrom 8 to 27 January 2021, individuals were recruited on a voluntary basis and had a third-generation rapid antigen test. Participants were drawn from among workers and customers at supermarkets and shopping centers (SSC), Italian Red Cross (IRC) voluntary workers, employees of local authorities (LA), and the Italian Economy and Finance Ministry (MMEF). To be included in the study, they had to be at least 18 years old.All participants completed an ad hoc questionnaire , providiThe Veneto Regional Authority has developed a centralized regional platform, where the results of all molecular and antigen tests performed to identify SARS-CoV-2 are recorded. For each participant in our study sample, a unique anonymous identification code was generated and used to identify all swabs performed by the same individual prior to their enrollment . The stut-test (for unpaired data), as appropriate. Age was summarized in terms of medians and interquartile ranges (IQR).The data were analyzed using the chi-square test and Student’s p value of less than 0.05 was considered statistically significant.Answers to the question “Would you get vaccinated against COVID-19?” were dichotomized, grouping respondents answering “I don’t know” with those answering “No” and defined as “reluctant”, and a multivariable logistic regression was performed to assess participants’ reluctance to undergo COVID-19 vaccination from which adjusted odds ratios (adjORs) and corresponding 95% confidence intervals (95% CI) were calculated. The covariates included in the model were demographic and individual variables, such as sex, age, occupation, education level, routine behavior, and lifestyle. Statistical analyses were performed using SPSS Statistics, version 27.0. A The sample size was obtained using a prior prevalence for SARS-CoV-2 of 0.4%, a marginal error of 0.2%, and a type 1 error of 5%, two-sided: a minimum sample of 3800 people was needed. The sample size was calculated using EpiInfo Software.Between 8 and 27 January 2021, a total of 4467 members of the general population  underwent a third-generation rapid antigen test for SARS-CoV-2 and answered our questionnaire. In response to the question “Would you get vaccinated against COVID-19?”, 3765 (84.3%) were favorable, 223 (5.0%) were uncertain, and 479 (10.7%) were opposed .p < 0.001). The 30- to 49-year-olds were the age group least inclined to get vaccinated, with higher proportions of opposed (14.4%) or uncertain (5.2%). The age groups most favorable to vaccination were over 70 years old (92.3%) or 50–69 (86.7%). As concerns sex, the percentage of favorable respondents was the same among males and females (10.7%), while the percentage of the uncertain was lower for males (3.5%) than for females (6.4%) . The opposed group was significantly younger (42.4 ± 13.8 years) than the uncertain group (47.4 ± 16.2 years) or favorable group (46.9 ± 16.4) (s (6.4%) .p < 0.001). The customers accounted for 20.3% of the opposed group and 35.2% of the favorable group (p < 0.001)  participants were recruited at supermarkets and shopping centers (1481 customers and 1056 workers). These workers accounted for 51.1% of the opposed group and 19.8% of the favorable group (< 0.001) . When pr< 0.001) .p < 0.000) (Excluding 99 participants (2.2% of the whole sample) who did not indicate their years of schooling, it emerged that people with <14 years of education made up 72.3% of the favorable group, whereas they accounted for significantly higher percentages of the uncertain and opposed groups , (< 0.000) . Figure When we examined the number of participants’ daily contacts, the people with more than five contacts a day accounted for 70.1% and 62.3% of the opposed and uncertain groups, respectively. The people who reported going out more than once a day made up 78.3% of the opposed group and 70.9% of the uncertain group . Figure p < 0.001)  or opposed (5.8%) groups (< 0.001) . Among t< 0.001) .Of the sample as a whole, 37.8% had previously been tested for SARS-CoV-2, and 1.7% reported having previously tested positive for the virus .The multivariable analysis (adjOR (95% CI)) showed that, among the individuals more reluctant to undergo COVID-19 vaccination, there were more females (1.47 (1.24–1.75)) and people aged 30–49 (1.45 (1.14–1.85)) or 50–69 (1.32 (1.01–1.71)), compared with people <30 years old. Taking local authority employees for reference, workers at supermarkets and shopping centers were more reluctant (2.13 (1.67–2.71)), while customers were more in favor of vaccination (0.74 (0.56–0.96)). Regarding the influence of education, the multivariable analysis showed that people with <9 years (1.63 (1.22–2.16)) or 9–13 years (1.39 (1.09–1.77)) of schooling were more vaccine reluctant than those with 14+ of formal education. People who went out more than once a day (1.33 (1.01–1.76)) and those who went out 0–1 time a week (1.78 (1.25–2.53)) and people who had not been vaccinated against seasonal flu (6.14 (4.43–8.53)) were more vaccine reluctant. No associations emerged between people’s propensity to be vaccinated and the number of their daily contacts or any previous screening or testing positive for SARS-CoV-2 .This study examined the willingness to be vaccinated against COVID-19 in a sample of the general population in northeast Italy. The aim was to identify predictors of COVID-19 vaccine reluctance with a view to informing strategies to improve the overall vaccination coverage and thereby reduce the impact of the pandemic on public health.It is important to emphasize that vaccination propensity was high in this study population, with 84.3% of the sample as a whole in favor of vaccination. This finding is of interest considering that it was obtained from the population at a time when the vaccines had only just become available, and only for selected categories of the population, such as healthcare workers and frail patients . ConsideThat said, 15.7% of the sample was reluctant to be vaccinated, and 10.7% of participants claimed to be against vaccination. Many governments, including the Italian, are considering introducing mandatory vaccination as an extreme strategy to improve adherence, to increase vaccination coverage even among individuals strongly opposed to vaccination against COVID-19. Previous studies have shown that making vaccination mandatory may induce the hesitant population to be vaccinated to avoid incurring sanctions and may also be interpreted by citizens as a sign that a vaccine is safe .Our results showed that women were significantly less inclined to get vaccinated against COVID-19, in line with previous reports of a positive association between male sex and attitude to COVID-19 vaccination ,23. SeveStudies that considered the link between age and intention to get vaccinated against COVID-19 generated different findings . Age is We also examined the acceptance of the COVID-19 vaccine by the type of participant enrolled in our sample. Taking local authority employees for reference, it emerged that supermarket and shopping center employees were less inclined to get vaccinated, and customers of large retailers were more likely to do so. Our results concerning supermarket and shopping center employees are consistent with several studies reporting a lower propensity to be vaccinated among people not working in the healthcare sector ,31. ThisOur data also confirmed the association between education level and vaccine acceptance reported in several scientific articles; people with fewer years of formal education were less likely to get vaccinated ,35. GreaOur study also showed that vaccine hesitancy featured among people who went out more than once a day and also among those who seldom left their homes (less than once a week). In both cases, this could be due to misconceptions regarding the risk associated with COVID-19. People going out more than once a day were probably not very concerned about the virus and therefore judged vaccination unnecessary. Those going out less than once a week may have felt less exposed to the risk than the rest of the population and therefore believed that there was little advantage in getting vaccinated. In both cases, this would suggest that these people underestimate COVID-19. Several published studies investigated the association between vaccine hesitancy and the perception of the risk posed by the disease . PerceivOur findings also confirmed a positive association between previous seasonal flu vaccinations and the acceptance of COVID-19 vaccination. This is presumably because people who get vaccinated against the flu every year have confidence in vaccination campaigns, are more aware of the importance of prevention in public health, and take more care of their own health than people who do not get vaccinated.Our study has several limitations. The composition of the study population may not represent the true picture of the Veneto population; the sample was drawn from specific social categories . Our findings also come from a COVID-19 cross-sectional study, for which individuals were recruited on a voluntary basis, and this may have (i) biased the estimation of vaccination adherence emerging from the questionnaire by comparison with that of the real population and (ii) only provided a snapshot of the population’s response during a limited period of time. People’s intention to be vaccinated against COVID-19 may change in the future, and another limitation related to this study’s design lies in the lack of in-depth information on issues such as the reasons for people’s reluctance to be vaccinated.Despite the above limitations, the considerable sample size involved means that our study provides some useful information regarding the demographic and individual variables associated with the vaccine-hesitant population.COVID-19 vaccine reluctance is an increasingly important public health issue and an undeniable obstacle to the achievement of the immunization rates needed to overcome the pandemic. In our sample, the identikit of people unwilling to get vaccinated against COVID-19 had the following characteristics: female, 30–69 years old, and with <14 years of formal education.


The sex ratio  was 2.5. The mean delay of diagnosis was 53.5 months. Oral aphthosis was constant. The frequency of the manifestations was: genital aphtosis 71.5%, pseudofolliculitis 84.6%, erythema nodosum 11.5%, positive pathergy test 50%, ocular disease 36.9%, venous thrombosis 30%, arterial disease 4.6%, joint damage 30.8%, neurological disease 19.2% and digestive disease 0.8%. The male gender was significantly associated with ocular involvement (p =0.02), venous disease (p =0.01) and occurrence of relapses (p =0.01). The mean follow up was 68.5 ± 77.3 months. The poor survival prognostic factors were male gender, ocular involvement, venous disease, cardiovascular disease, a duration of follow up ≤12 months and a diagnostic delay ≤ 24 months.  Behçet’s disease (BD) is a systemic vasculitis characterized by buccal and/or genital aphthosis with or without systemic manifestations. Its prognosis depends on clinical forms. Although BD seems to be the most common form of vasculitis in Tunisia , no reprType of the study: this study is a single-center, retrospective, descriptive and longitudinal study. We retained all patients with BD admitted to an Internal Medicine Department in Tunisia over a period of 26 years.Inclusion criteria: we retained all patients with confirmed BD responding to the International Criteria for BD [aphtosis of the mouth (two points); b) genital aphtosis (two points); c) skin damage (one point): pseudofolliculitis, erythema nodosum, papulo-pustular lesions and/or acneiform nodules not explained by corticosteroids and cutaneous aphtosis. d) Positive pathergic test (one point): it was considered positive if an aseptic papuleor pustule (superior than 2 mm) was objectified at the point of the bite. e) Eye damage (two points): in case of ocular abnormalities in ophthalmic examination, ophthalmological exploration was supplemented with retinal fluoresce in angiography. Visual field, visual evoked potentials and/or the ocular echography were practiced according to the clinical context.a for BD . A positmajor ocular lesions: uveal involvement  and/or retinal vasculitis (RV). Minor ocular lesions: conjunctival ulcerations, keratoconjunctivitis, episcleritis and / or scleritis.We included: Complications and ocular sequelaeVascular involvement (One point): it was confirmed by the imaging data. We included venous thrombosis: superficial vein thrombosis, deep vein thrombosis (DVT), pulmonary embolism (PE) and /or cerebral venous thrombosis (CVT). Arterial injury: thrombosis and/or arterial aneurysms.Neurological impairment (one point): retained in front of somatic neurological examination, neuroimaging and / or cerebro-spinal fluid.non-parenchymal lesions: they included CTV, arterial thrombosis and/or cerebral arterial aneurysms; neurological sequelae: objective neurological disorders persisting during the evolution and that could be a source of neurological handicap.We included: a) parenchymatous lesions retained on the cerebro-medullary magnetic resonance imagery sequences by hypo-signal lesions in T1 sequence and in hyper-signal in T2 and T2 flair sequence; b) Non inclusion criteria: we have not included the patients with confirmed BD but had never been hospitalized for BD and the patients to whom the diagnosis was rejected during the evolution and whose medical files were lost and/or unworkable.Modalities of evaluation: we defined different modalities of evaluation: a) a patient lost sight of was defined by a follow-up period necessarily longer than a month. b) A patient lost sight of out of hand was defined by a duration of follow-up obligatorily lower than one month. c) An improvement or remission was defined by subjective and/or objective good evolution of the clinical signs with a complete and/ or partial remission. d) A complete remission was defined by a complete resolution with disappearance of any sign of the disease, in the absence of any relapse during the follow-up period. e) A partial remission was defined by a significant but incomplete decrease in the signs of the disease, while maintaining a risk of subsequent relapse during the observation period. f) A relapse was defined by the reappearance of clinical signs after a favourable evolution. g) A stabilization was defined by a stability that no longer progressed toward improvement or worsening with a risk of relapse during the follow-up period. h) An aggravation was defined by an exacerbation of clinical lesions with appearance of complications.Statistical analysis: all data were analysed by the software SPSS 19.0. Statistical analysis contained absolute frequencies and relative frequencies. We calculated averages, medians and standard deviations and we determined the extreme values for the quantitative variables. For the analytic study, the comparison between two averages was made with the Student test for independent series, and by the non-parametric test of Mann and Whitney in case of low effectives. The comparison in percentages on independent series were made by the chi-Square test of Pearson and in case of significance of chi-square test and its non-validity, with exact bilateral Fisher test. The study of the binding was carried out by the Kaplan Meier method. Survival prognostic factors was performed in univaried analysis by comparing survival curves with Log rank test. In all statistical tests, the level of significance is 0.05.Epidemiological characteristics: we included 130 patients. Disease incidence was of five new cases per year. Patients were Tunisian in 97.7% of the cases and Algerian in two cases. The mean age at first disease manifestation was 30.3 years ± 8.8 (extremes 12-58 years). The mean age at diagnosis was 34.6 years ± 9.4 (extremes 15-65 years). Five patients were aged less than 16 years. Sex ratio (M/F) was 2.5.Onset disease: buccal aphthosis was inaugural in 55.4% of the cases. Genital and buccal aphthoses were associated in 25.4% of the cases. Severe organ involvement was revealed in 27 BD cases (20.8%). Mean diagnosis delay was 53.5 months ± 65.2. Mean diagnosis delay for 72 patients with inaugural buccal aphthosis was 58.1 months ± 79.6 and 49.5 months ± 60.5 for other patients.Cutaneous mucosal manifestations: buccal aphthosis was constantly observed among patients. Evolutive genital aphthosis was observed in 71.5% of the cases. Genital scars were noted in 45.4% of patients. Two patients had peri-analaphthosis. Skin hypersensitivity was noted in 46.9% of the cases. Pathergy test was performed in 87.7% of cases and was positive in 50% of the cases. Skin damages were observed in 87.7% of the cases. Pseudofolliculitis and erythema nodosum (EN) were observed in 84.6% and 11.5% of the cases, respectively.Ocular manifestations: they were observed in 36.9% of the cases and inaugural in 10.8% of the cases. Ocular involvement was discovered in 6.2% of the cases. Complications and sequelae were diagnosed in respectively 47.9% and 6.2% of the cases. Patients were definitely blind at the moment of diagnosis in 8.3% of the cases. Uveal involvement was the most frequent lesion (77.1%) followed by retinal vasculatis (62.5%). Hyalitis was diagnosed in 15 patients (31.3%) and was associated to posterior uveitis in six cases. Seven patients (14.6%) had retinal hemorrhage.Vascular manifestations: they were noted in 31.5% of cases. It was about 35 cases of venous manifestations in 35 cases, arterial manifestations in two cases and both in four cases. Deep venous thrombosis(DVT) was the most frequent vascular manifestations (78%).Venous manifestations: venous impairment was observed in 95.1% of vascular manifestations and 30% of BD patients. It revealed the diagnosis in 20.7% of the cases. Venous manifestation appeared during BD evolution in 9.2% of cases with a mean delay of 45.8 months ± 45.9. There were DVT in 32 cases and superficial vein thrombosis in 32 cases. The locations of DVT were the lower limbs (84.4%), the vena cava (28.1%), the upper limbs (9.4%), pulmonary embolism (PE) (9.4%), cerebral venous thrombosis (6.2%) and Budd Chiari syndrome (3.1%).Arterial impairment: it was observed in 14.6% of vascular manifestations and 4.6% of patient with BD and revealed BD in three cases. All patients were male. Arterial manifestations were as follows: isolated arterial aneurysms (n=1), isolated arterial thrombosis (n=4), and both manifestations (n=4). Pulmonary artery was the most frequent disease localization (n=5).Neurological manifestations: central nervous system disorders was reported in 19.2% and was inaugural in two cases. They were caused by parenchymatal lesions (88%). Psychiatric manifestations were observed in 36% of the cases with neuro-BD (6.9% of patients with BD).Cardiac manifestations: they were inaugural in one case. Three patients had pericardial effusion and coronary involvement.Other manifestations: joint damage and digestive disease were diagnosed in respectively 30.8% and 0.8% cases.Biology: biological inflammatory disorders were observed in 77 patients (59.2%). HLA typing was performed in 47 patients (32.2%) and was positive in 48.9% of the cases. Only one patient had a combined deficiency of proteins S and C.Therapeutic means in Behcet´s disease: the different therapies used for BD are summarized in Anticoagulant therapy and platelet aggregation inhibitors: all patients with DVT and /or arterial thrombosis were treated with anticoagulant therapies. The mean period of treatment was 60.9 months with extremes 2 to 218. Two patients had hemorrhagic complications secondary to vitamin K overdose.Evolution modalities: twenty-two patients (16.9%) were lost sight of the out of hand. The mean follow-up was 68.5 ± 77.3 months (5.7 years), and extremes were 6 days to 26 years. Among 130 patients, 48.5% noted an improvement. It was about vascular manifestations (53.6%), cutaneous and mucosal manifestations (46.9%) and ocular manifestations (25%). Complete and partial remission were observed in respectively 26.2% and 22.3%. Disease stabilization and a worsening were observed in respectively 28.5 and 4.6%. The mortality rate in our study was 1.5%. A fatal vasculo-BD occurred in two cases. The relapse was observed in 42.3%. The mean number of relapses per patient during BD evolution was 7 ± 6. The maximum number of relapses was 14. The mean period between BD diagnosis and first disease relapse was 34 months ± 53. Definitive sequelae were observed in 10% of cases (n=13) and were mainly secondary to ocular and neurological involvement.Gender: women developed significantly more frequently EN (p=0.03) than men. Male gender was significantly associated with ocular involvement (p=0.02), venous manifestations (p=0.01), corticosteroid treatment (p=0.007), immunosuppressive therapy (p=0.01), anticoagulation (p=0.009) and relapses (p=0.001). Age: no difference in epidemiological, clinical, biological, diseaseevolution and prognosis in terms of age was observed among patients. b) Types of manifestations: patients with ocular involvement developed less frequent biological inflammatory disorders (p=0.001) and vascular manifestations (p=0.016). Remission is rarely observed compared with patients without ocular BD (p=0.001). Biological inflammatory disorders were more frequently observed in patients with angio-BD (p=0.003). Patients with articular manifestations develop significantly less relapses than patient with other organ involvement. (p=0.007). HLA profile: no difference in the type of manifestations and HLAB51 profile was observed among the patients. d) Prognostic factors: two cases of death were noted in our series. We were unable to identify prognostic factors of mortality. We studied the survival events of patients without relapses and survival events without aggravation and thus released the prognostic factors of survival that can influence the evolutionary profile and the survival of these patients. We compared the two subgroups of patients: 1) group1 (n = 74): patients who had no relapses or worsening of the disease (n=51) and patients who had only isolated mucocutaneous relapses (n=23); group 2 (n = 29): patients who have relapsed ocular, vascular, articular, and neurological manifestations and patients who have had a worsening of their disease. According to Kaplan Meier analysis, one- three- five-10-and 20 years the survival rates with-neither relapses nor worsening were observed in respectively 84%, 70%, 67%, 61% and 61% of the cases. The disease was stabilized after 8 years of evolution (volution . These pOur study was conducted during a long period of 26 years. A few works have been focused on BD characteristics and survival factor prognosis without relapse nor worsening. A better knowledge of different manifestations and prognosis factors of BD, are a key for early diagnosis and better management to improve the function and prognosis and guarantee a better quality of life for North African patients. However, retrospective and single center characteristics were the limitations of this study. Selection biais can also explain the important prevalence of multisystemic forms. BD seems to be the most frequent vasculitis in Tunisia . In a NoCutaneous-mucosal manifestations were inaugural in many studies , 13, andCentral nervous system involvement in BD is characterized by diffuse involvement with brain stem predilection observed in 21.4% to 70%of the cases. Hemispherical and medullary localizations were observed in respectively 14% to 19.8% and in 2.6% to 14% of the cases , 23. Theet al. [Cardiac manifestations incidence was comparable to the literature , 12. Caret al. . Pericaret al. , 27. Theet al. , 29. In et al. . Howeveret al. .BD has an important polymorphism and a relatively high incidence in the Maghreb. Poor survival prognostic factors are male gender, ocular involvement, venous disease, cardiovascular disease, a duration of follow up ≤12 months and a diagnostic delay ≤24 month. Behind the therapeutical progress, prognosis improvement is very important by shortening the diagnosis delay, multidisciplinary staff participation, and intensive treatment of the functional involvement and regular monitoring of patients. Education is important for the treatment of BD to guarantee patients´ compliance.BD is an inflammatory, systemic, chronic disease that evolves by relapses;The clinical presentation is polymorphic and associated with a bucco-genital aphthosis with various systemic manifestations. The positive diagnosis is often difficult especially in the absence of aphthosis;The therapeutic management remains controversial, due to the scarcity of therapeutic trials and the absence of standardized criteria for measuring the evolution. Its evolution is unpredictable. Its prognosis varies according to its clinical presentation. The neurological and ocular manifestations are responsible for a progressive deterioration of the functional prognosis. The vascular and digestive disorders condition the vital prognosis.The male gender is significantly associated with ocular involvement, venous disease and occurrence of relapses;The poor survival prognostic factors are male gender, ocular involvement, venous disease, cardiovascular disease, a duration of follow up ≤12 months and a diagnostic delay ≤24 months.


Intestinal obstruction is defined as a blockage or partial blockage of the passage of the intestinal contents. It is a potentially risky surgical emergency associated with high morbidity and mortality. Its pattern differs from country to country and even from place to place within a country. Therefore, this study aimed to find out the magnitude, pattern and management outcome of intestinal obstruction in Arba Minch General Hospital.A retrospective cross-sectional study was conducted in Arba Minch General hospital from January 09, 2015, to November 09, 2018. The data collection period was from December 15, 2018, to February 09, 2019. A simple random technique was applied to select 801 study participants. Then, the required data entered into Epi Info version 7.2.1.0 and exported to the statistical package for the social sciences software package version 20 for analysis. The binary logistic regression analysis has been done to determine crude statistical associations between independent variables and dependent variables. Linearity, Multivariate normality and multicollinearity were checked between independent and dependent variables by using scatter plot and Q–Q plot respectively. Variables with a p-value of less than 0.25 in the binary logistic regression analysis were entered into multivariable logistic regression. Statistical significance factors were identified based on a p-value of < 0.05 and with a 95% confidence interval.This study revealed that the overall magnitude of intestinal obstruction was 40.60% with 95% CI (34.95–45.95). The magnitude of unfavorable management outcomes and deaths during the study period were 22.3% with 95% CI (18.00–27.00) and 7.1% with 95% CI (4.00–10.00) respectively. Persistent tachycardia 10.3 (3.28–32.42), Dehydration 13.7 (3.34–56.56), elevated serum creatinine 10.2 (1.89–54.94), gangrenous small bowel volvulus 2.7 (1.27–5.84), ischemic bowel 3.4 (1.17–9.81) and perforated bowl 7.68 (2.96–19.93) were significantly associated with the management outcome of intestinal obstruction.Intestinal obstruction was the most common among all acute abdomen cases and its management outcome highly associated with dehydration. Adequate early preoperative resuscitation and proper post-operative care with appropriate surgical techniques and wound care with sterile techniques would help to reduce further mortality. This could be achieved by increasing public awareness of health-seeking behavior. Moreover, health facilities capable of handling patients with small bowel obstruction should be available within the reach of the community. Intestinal obstruction (IO) is defined as a blockage or partial blockage of the passage of the intestinal contents. It is a potentially risky surgical emergency associated with high morbidity and mortality . It is aIn a global based report of the world health organization, about 3.2 million cases of bowel obstruction occurred in 2015 which resulted in 264,000 deaths . In mostStudies conducted in Ethiopia showed that the death rate after the management of intestinal obstruction cases were 13.6%, 9.2%, and 2.5% in South, East and Central Ethiopia respectively –14. In sAetiologies of bowel obstruction include sigmoid volvulus, small bowel volvulus, adhesions, hernias, inflammatory bowel disease, appendicitis, tumors, diverticulitis, ischemic bowel, tuberculosis and intussusception . The cauAnalysis of cases based on the specific causes of the acute abdomen has great value for early diagnosis and prompt treatment in clinical practice . DespiteA hospital-based retrospective cross-sectional study was conducted in Arba Minch General Hospital from January 09, 2015, to November 09, 2018. All patients with the diagnosis of non-traumatic acute abdomen cases who were admitted to the surgical ward of Arba Minch General hospital were included and patients who went home before completion of treatment, with lost cards and cards with incomplete data were excluded.The sample size was determined by the single population proportion formula. The assumptions considered to calculate the sample size were from the previous study in Ethiopia using a prevalence of 21.8% . ConsideA total of 5590 total surgical admissions were found during the study period. Among these, 1303 of them were admitted with conditions attributed to non-traumatic acute abdomen. During the procedure, the medical record numbers were sorted from smallest to largest code (1–1303). The required sample size was obtained by using a simple random sampling technique. So, 801 cards were selected randomly from 1303 cards. But, among the sample size, only 761 cards were found with complete data. Cards/Medical records with incomplete data were excluded from the study.Management outcome of IO (favorable or unfavorable).Socio-demographic characteristics , patient history , Physical examination findings , intraoperative findings , intraoperative procedure .The data were collected by using a structured checklist. The checklist was adapted from previous studies to enable us to collect important information. A checklist was developed in the English language to collect important information such as age, sex, ethnicity, admission clinical diagnosis, intraoperative findings, intra-operative procedures, duration of the presentation, causes of IO, postoperative complications and management outcome. For data collection, two clinical nurses were recruited.Acute abdomen: a patient’s case which is labeled in their discharge diagnosis as one of the patterns of acute abdomen. Intestinal obstruction: a patient with acute abdomen who has abdominal pain, abdominal distension, vomiting, not passing gas and feces (obstipation) completely, not passing feces (constipation), with imaging diagnosis having obstructed dilated bowel loops and labeled in their discharge diagnosis note as intestinal obstruction. Management outcome: the condition of the patient after treatment has been carried out, after conservative or operative procedure that means whether discharged alive or died in the hospital or end up with complications. Favorable management outcome: discharged live and with no complication after management. Unfavorable management outcome: defined as a patient with intestinal obstruction developing one or more postoperative complications  and/or death.Data were cleaned, coded and entered into Epi-info version 7.2.1.0 and was exported to SPSS version 20 for analysis. Descriptive statistics were conducted and results have been presented using frequency tables, graphs and percentages. The binary logistic regression analysis has been done to determine crude statistical associations between independent variables and dependent variables. Linearity between independent and dependent variables was checked by scatter plot. Multivariate normality between variables was checked by a Q–Q plot. And, multicollinearity was checked. Variables with a p-value of less than 0.25 in the binary logistic regression analysis were considered as a candidate to be entered into multivariable logistic regression. Multivariable analyses have isolated independent predictors of IO management outcome. Statistical significance factors were identified based on a p-value of < 0.05 with a 95% confidence interval.From the total study participants of 801, only 761 cards have complete data with a response rate of 95.12% where 507 (66.6%) cases were male, 478 (62.80%) were from a rural area (out of Arba Minch city) and 680 (85.42%) were less than 50 years old age. Among these 309 (40.60%) cases were found to have an intestinal obstruction which is the most common condition followed by Appendicitis 207 (27.20%), Hernia 200 (26.28%), ill determined acute abdomen conditions 9 (1.18%), urologic emergencies 8 (1.05%), peritonitis 7 (0.91%), intussusceptions, 6 (0.79%), cholecystitis 6 (0.78%), acute pancreatitis 5 (0.65%) and PPUD 4 (0.52%) respectively. Most of the cases from each were males  of them were males and 61 (19.74%) of them were females. The male:female ratio was 4:1. Among these, 243 (78.6%) of them were from a rural area (out of Arba Minch city), 64 (20.7%) of them were from urban (Arba Minch city) and 2 (0.6%) were with no information of residence. The age of patients ranged from 2 months to 100 years with a mean and standard deviation of (40.68 ± 17.88). Among these study participants, 195 (63.1%) were Protestants and 249 (80.9%) were Gamo in ethnicity  among non-traumatic acute abdominal cases. Of the total 309 intestinal obstructions, 302 (97.7%) of them were mechanical intestinal obstructions and the remaining 7 (2.3%) were a dynamic ileus/functional intestinal obstruction. According to the site of obstruction, 198 (64.1%) were small bowel obstructions, 108 (35.0%) were large bowel obstructions and the rest 3 (1.0%) of them were undetermined.The common clinical presentations were abdominal pain (95.8%), abdominal distension (88.0%), obstipation (78.3%), constipation (69.6%), vomiting (62.1%), rectal bleeding (2.6%) and history of abdominal surgery (7.1%). Dehydration, Persistent tachycardia, fever and shock were also seen in 5.8%, 10.7%, 12.6% and 2.6% of patients respectively. Hypertension, known cardiac disease, diabetic, CLD and CKD found in 4.9%, 1.3%, 1.9%, 1.3% and 1.3% of patients respectively. By laboratory diagnoses: hypokalaemia, leucocytosis, elevated serum urea, hyperkalaemia and elevated serum creatinine were found in 1.0%, 21.0%, 2.6%, 0. 3% and 3.9% of patients respectively.The time of arrival since the onset of disease was greater than 24 h for 253 (81.9%) of patients and less than or equal to 24 h for 56 (18.1%) of patients. The total hospital stays recorded was > 7 days for 170 (55.0%), < 7 days for 134 (43.41%) and equal to 7 days for 5 (1.6%) of patients. 63 (20.4%) of patients were managed only conservatively and 246 (79.6%) were managed surgically.From the operative procedure undertaken resection and anastomosis 118 38.2%) were the most common procedure done  were the most common complications. Surgical site infections 25 (8.1%), acute respiratory diseases 12 (3.9%), enter cutaneous fistula 9 (2.9%), anastomotic leakage 7 (2.3%) and wound dehiscence 4 (1.3%) were the remaining common complication types found respectively . However, only dehydration, persistent tachycardia, elevated serum creatinine, gangrenous small bowel volvulus, ischemic bowl and perforated bowl were significantly associated with the management outcome of intestinal obstruction in multivariable logistic regression Table .Table 4FThe magnitude of intestinal obstruction in this study is 40.45% at 95%, CI (34.95–45.95) which is consistent with a result of a study at Gonder University Hospital (43.4%) . But it The majority of intestinal obstruction cases were small bowel obstruction (64.1%) which is similar to the studies conducted in eastern and central Ethiopia , 22, 24.The commonest causes of intestinal obstruction found from intraoperative findings were small bowel volvulus 45.30%, sigmoid volvulus 21.35%, adhesion and bands 12.0% and intussusceptions 4.9%. This result is similar to studies conducted in Gelemso and Chiro General Hospital . But, diThe magnitude of post-management complication in this study is 22.0% with 95% CI (18.0–27.0). This result is consistent with the studies conducted in Nigeria (20.77%), Kenya (23.6%) and Adama 24.6%) in Adama , 25, 26..6% in AdSepsis and septic shock was the most common pattern of complication after management in the current study. This is different from the study in Gelemso General Hospital which found surgical site infection as the most common complication and Jogla General Hospital which found pneumonia as the most common complication type and septic shock next to it , 22. ThiIn this study, patients without dehydration were 13.73 times more likely to have favorable management outcome, [AOR with 95% CI (13.73 (3.34–56.56))], than those with dehydration which is similar to the study conducted in Nigeria.Persistent tachycardia is significantly associated with management outcome of intestinal obstruction, [AOR with 95% CI (10.31 (3.28–32.42))], in which patients without persistent tachycardia are 10.31 times more likely to have favorable management outcome than those with persistent tachycardia which is supported by a study conducted in Nigeria .Elevated serum creatinine is significantly associated with management outcome of intestinal obstruction, [AOR with 95% CI (10.19 (1.89–54.94))], in which patients without elevated serum creatinine are 10.19 times more likely to have favorable management outcome when compared with those patients who have elevated serum creatinine. This may be due to the fact that in patients with renal function impairment creatinine levels may increase .Perforated bowel, ischemic bowl and gangrenous small bowel volvulus are also significantly associated with management outcome of intestinal,  respectively, in which patients without perforated bowl, ischemic bowl and gangrenous small bowel volvulus are 7.68, 3.39 and 2.72 times more likely to have favorable management outcome than their counterparts respectively. This result is similar to study findings conducted in East Ethiopia , 24.Since this study was from secondary data, Limitations were incomplete documentation, missing charts and difficulty interpreting information found in patients' cards.In conclusion, intestinal obstruction was the most common pattern of non-traumatic acute abdomen conditions during the study period. Males were affected more than females. Intestinal obstruction was more common in rural residents. Small intestinal obstruction was more dominant than large bowel obstruction. Small bowel volvulus, sigmoid volvulus and adhesion and bands were the commonest patterns of intestinal obstruction respectively. Resection and anastomosis, derotation and adhesion removal were commonest procedures done respectively. Dehydration, persistent tachycardia, elevated serum creatinine, gangrenous SBV, ischemic bowl and perforated bowl were significantly associated with the management outcome of intestinal obstruction. Therefore, designing a strategy addressing these factors would be helpful to decrease the likelihood of unfavorable surgical management outcomes for the patients attending hospital with IO.Based on our findings we suggest that health professionals in the hospital should increase public awareness on IO by providing appropriate health information.Physicians should diagnose and intervene on time before the intestine develops a complication.Health professionals should give attention to appropriate surgical techniques and wound care with sterile techniques to decrease surgical site infection which is the most common complication.Cardroom staff should improve record-keeping in the hospital because some medical records were incomplete.Further research using a prospective study design is recommended as a way to overcome the limitations of secondary data in the current retrospective research that preclude generalization to the whole population.


Background: The nursing profession is predisposed toward depressed mood and depressive symptoms. The multidirectionality and intensity of stressors in the nurses' occupational environment are of great significance in this respect. The study aimed to evaluate the impact of selected sociodemographic factors on depressive symptoms among cardiac nurses.Methods: This cross-sectional study included 336 cardiac nurses (302 women and 34 men) and was conducted between December 2019 and September 2020 in four hospital cardiac units in Wroclaw, Poland. Sociodemographic data were collected using a self-developed survey. The following standardized instruments were used for the study outcomes: Patient Health Questionnaire-9 (PHQ-9) and Beck Depression Inventory (BDI).Results: The study among cardiac nurses showed mild depression in 11.61%, moderate depression in 5.06%, and severe depression in 2.68%. Linear regression models showed that significant (p < 0.05) predictors of the PHQ-9 score included (1) higher occupational education (bachelor's degree), graduation “only” from medical high school or “other” education; (2) work experience of 16–20 years; (3) living in a relationship; (4) living in a rural area. Linear regression models showed that significant (p < 0.05) predictors of the BDI score included (1) higher occupational education (bachelor's degree); (2) graduation “only” from medical high school or “other” education; (3) living in a relationship.Conclusions: Depressive symptoms are a significant problem among Polish cardiac nurses. The prevalence of depressive symptoms is affected by the education level, employment form, marital status, and place of residence. Depression and mood disorders are serious health problems, especially in developed countries. It is estimated that 12.9% of the worldwide population is affected by depression, with the highest percentage in South America (20.6%) and the lowest in Australia (7.3%)  aged between 20–60 years and was conducted between December 2019 and September 2020 in four hospital cardiac units in Wroclaw, Poland. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were followed in the design and reporting of this study 2 (p) (q)}/d2, where prevalence rate for assessment of depression among nurses was considered 40% . All nurses gave their written informed consent before participating in the study. The study was conducted following the Declaration of Helsinki and Good Clinical Practice guidelines.The analysis of quantitative variables  was conducted by calculating the mean, standard deviation, median, quartiles, minimum and maximum values. The analysis of qualitative variables  was conducted by calculating the number and percentage of occurrences of each value. Univariate and multivariate analyses of the effect of multiple variables on the quantitative variable were conducted using linear regression. The results are presented as values of the regression model's parameters with a 95% confidence interval. A significance level of 0.05 was adopted in the analysis. The analysis was conducted using the R program, version 4.0.3  women and 34 (10.12%) men, were included in the study. There were 16.67% nurses from the age group of 20–30, 42.43% nurses from the age group of 31–40, 33.33% nurses from the age group of 41–50, and 28.57% from the group of 51–60. The master's degree in nursing was held by 25% nurses, a bachelor's degree by 30.36% nurses, while as many as 30.95% nurses graduated from medical high school. As many as 54.68% of nurses had the greatest seniority that is more than 20 years. Moreover, the majority of the respondents (52.68%) had one job. Most surveyed nurses, 72.02%, were employed under an employment contract. The most typical monthly amount of working time was 101–180 h, and it concerned 57.74% of nurses. Typical working conditions included teamwork (75.60%) and shift work in the form of 12-h duty shifts (75.0%). The vast majority of respondents were in a relationship (69.94%) and lived in a city > 100,000 residents (63.69%) .The PHQ-9 questionnaire assesses the severity of depression in a respondent. The tool has standards that ensure the interpretation of scores. A total of 141 out of 336 survey participants (41.96%) had no depressive symptoms, 117 respondents (34.82%) suffered from mild depression, 53 (15.77%) had moderate depression, 17 (5.06%) had moderately severe depression, and 8 (2.38%) suffered from severe depression .The BDI provides an assessment of the severity of depressive symptoms in an individual completing the questionnaire. In addition, the BDI has standards that enable the interpretation of the obtained score .No depression was found in 271 out of 336 survey participants (80.65%), mild depression in 39 respondents (11.61%), moderate depression in 17 respondents (5.06%), and severe depression in 9 respondents (2.68%) .p < 0.05) predictors of the PHQ-9 score include (1) higher vocational education (bachelor's degree): the regression parameter is 1.873 thus it elevates the PHQ-9 score by 1.873 pts on average compared to a master's degree; (2) graduation “only” from medical high school or “other” education: the regression parameter is 1.557 thus it elevates the PHQ-9 score by 1.557 pts on average compared to a master's degree; (3) job seniority of 16–20 years: the regression parameter is −3.21 thus it lowers the PHQ-9 score by 3.21 pts on average compared to job seniority <5 years; (4) living in a relationship: the regression parameter is −2.338 thus it lowers the PHQ-9 score by 2.338 pts on average compared to being single or widowed; (5) living in a rural area: the regression parameter is −1.7, thus it lowers the PHQ-9 score by 1.7 pts on average compared to living in a city >100,000 residents  showed that significant (esidents .p < 0.05) independent predictors of the PHQ-9 score include (1) higher vocational education (bachelor's degree): the regression parameter is 2.173 thus it elevates the PHQ-9 score by 2.173 pts on average compared to master's degree education; (2) graduation “only” from medical high school or “other” education: the regression parameter is 2.301 thus it elevates the PHQ-9 score by 2.301 pts on average compared to a master's degree; (3) job seniority of 16–20 years: the regression parameter is −5.96 thus it lowers the PHQ-9 score by 5.96 pts on average compared to job seniority <5 years; (4) job seniority >20 years: the regression parameter is −4.563 thus it lowers the PHQ-9 score by 4.563 pts on average compared to job seniority <5 years; (5) living in a relationship: the regression parameter is −1.833 thus it lowers the PHQ-9 score by 1.833 pts on average compared to being single or widowed (The multivariate linear regression model showed that significant ( widowed .p < 0.05) predictors of the BDI score include (1) higher vocational education (bachelor's degree): the regression parameter is 3.151; thus, it elevates the BDI score by 3.151 pts on average compared to a master's degree; (2) graduation “only” from medical high school or “other” education: the regression parameter is 4.031 thus so it elevates the BDI score by 4.031 pts on average compared to a master's degree; (3) living in a relationship: the regression parameter is −3.551 thus it lowers the BDI score by 3.551 pts on average compared to being single or widowed  showed that significant ( widowed .p < 0.05) independent predictors of the BDI score include (1) higher vocational education (bachelor's degree): the regression parameter is 3.083 thus it elevates the BDI score by 3.083 pts on average compared to a master's degree; (2) graduation “only” from medical vocational school: the regression parameter is 3.723 thus it elevates the BDI score by 3.723 pts on average compared to a master's degree; (3) graduation “only” medical high school or “other” education: the regression parameter is 4.503 thus it elevates the BDI score by 4.503 pts on average compared to a master's degree; (4) a form of employment other than an employment contract (solo trader or employment contract combined with another contract): the regression parameter is −3.314 thus it lowers the BDI score by 3.314 pts on average compared to an employment contract; (5) living in a relationship: the regression parameter is −3.42 thus it lowers the BDI score by 3.42 pts on average compared to being single or widowed; (6) living in a rural area: the regression parameter is −2.76 thus it lowers the BDI score by 2.76 pts on average compared to living in a city >100,000 residents  and living alone, while it is positively affected by more seniority (over 16 years) and living in a rural area.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Bioethics Committee of the Wroclaw Medical University, Poland . The patients/participants provided their written informed consent to participate in this study.AL contributed to study conception and design, data acquisition, analysis and interpretation of data, and drafting of the manuscript. IU contributed to study conception and design, analysis and interpretation of data, and critical revision of the manuscript. All authors approved the final version of the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


We estimate PM2.5 exposure and health impacts for the entire continental US from current and future western US wildfire activity projected for a range of future climate scenarios through the 21st century. We use a simulation approach to estimate wildfire activity, area burned, fine particulate emissions, air quality concentrations, health effects, and economic valuation of health effects, using established and novel methodologies. We find that climatic factors increase wildfire pollutant emissions by an average of 0.40% per year over the 2006–2100 period under Representative Concentration Pathway (RCP) 4.5 (lower emissions scenarios) and 0.71% per year for RCP8.5. As a consequence, spatially weighted wildfire PM2.5 concentrations more than double for some climate model projections by the end of the 21st century. PM2.5 exposure changes, combined with population projections, result in a wildfire PM2.5-related premature mortality excess burden in the 2090 RCP8.5 scenario that is roughly 3.5 times larger than in the baseline period. The combined effect of increased wildfire activity, population growth, and increase in the valuation of avoided risk of premature mortality over time results in a large increase in total economic impact of wildfire-related PM2.5 mortality and morbidity in the continental US, from roughly $7 billion per year in the baseline period to roughly $36 billion per year in 2090 for RCP4.5, and $43 billion per year in RCP8.5. The climate effect alone accounts for a roughly 60% increase in wildfire PM2.5-related premature mortality in the RCP8.5 scenario, relative to baseline conditions.Wildfire activity in the western United States (US) has been increasing, a trend that has been correlated with changing patterns of temperature and precipitation associated with climate change. Health effects associated with exposure to wildfire smoke and fine particulate matter (PM Recen2 μg m−3 .Climate change affects wildfire activity by modifying patterns of temperature and precipitation, which can increase the number and length of low moisture periods in air, soil, and biomass , 12–14. As wildfire activity increases, the effects of wildfire emissions on local and downwind communities will also intensify , 18–20. 2.5 exposure from wildfire smoke in the western US. Specifically, we examine the health burden of projected future wildfire activity on P2.5-attributable premature mortality and a range of morbidity outcomes, including hospital admissions, ED visits, asthma exacerbations, and upper and lower respiratory symptoms (see stacks.iop.org/ERL/16/035019/mmedia)). We use methods compatible with the US Environmental Protection Agency’s (US EPA) Climate Change Impacts and Risk Analysis (CIRA) framework, developed as an input to the US Global Change Research Program’s National Climate Assessment, to achieve two distinct objectives: (a) to allow comparison of the results with the economic impacts of climate change on other sectors in the US; and (b) to assess wildfire impacts across two future climate forcing scenarios simulated in five climate models [2.5 beyond that estimated here [Here we build on this earlier work to provide a comprehensive analysis of the present and potential future health burden associated with PMe models , 28. Assted here .2.2.5 and associated mortality and morbidity in the US under two climate scenarios and five GCMs throughout the 21st century. The two climate scenarios are Representative Concentration Pathway (RCP) 8.5, a higher GHGs scenario, and RCP4.5, a lower scenario. We do not assign probabilities to the relative likelihood that one of these scenarios may describe better the pathway of future emissions. We employ spatially downscaled climate projections from the Localized Constructed Analogs dataset for five Earth system models participating in the Coupled Model Intercomparison Project Phase 5: CanESM2, CCSM4, GISS-E2-R, HadGEM2-ES, and MIROC5, consistent with the CIRA framework  quantify wildfire-attributable PM2.5 mortality and morbidity  [et al (1994), and the spatial delineation of the western US from Yue et al [We estimate fire activity and associated emissions using previously published regression models for the western US that relate historical annual area burned with meteorological variables and fire indexes . Yue et ue et al . Ecoregiet al. We then calculated the total fuel load for each grid cell using the US. Forest Service × 1 km fuelbed map used by Yue et al  [et al [et al [For each year, climate scenario, and GCM, we calculated the quantity and spatial distribution of wildfire-related BC and OC emissions following the process described by Yue r et al) , 31. Sim) [et al  (include) [et al . Total b) [et al . Similarl [et al , we did 2.2.http://acmg.seas.harvard.edu/geos/) to simulate impacts on PM2.5 concentrations, again repeating this process for each year, climate scenario, and GCM. We use the model at 0.5° × 0.625° resolution with 47 vertical levels (1013.25–0.01 hPa) over North America . Boundary conditions for the nested North American domain are provided by a global simulation at 2° ×2.5° spatial resolution. We spin up the model for one month before any simulations to remove the effects of initial conditions.We input our estimated wildfire BC and OC emissions for the western US, and non-wildfire anthropogenic emissions as indicated below, into the GEOS-Chem chemical transport model  from the NASA Modeling and Assimilation Office. Emissions of PMstern US . To isol US [2.5 .2.5 concentrations simulated in the future years versus the present-day for each GCM separately. Our approach first simulates PM2.5 in the baseline excluding wildfire emissions; we then add wildfire emissions for the baseline period to simulate total baseline PM2.5; and finally we simulate future PM2.5 for each GCM/climate scenario combination for each of the two future eras (2050 and 2090), holding non-fire emissions constant at baseline levels. In this way we isolate the impact of wildfire emissions in both the baseline and future periods, and therefore discern the incremental impact of climate change on both future emissions and PM2.5.We isolate the influence of climate-driven wildfire emission changes by comparing gridded PM2.3.2.5-associated health impacts and economic values using the US EPA’s Environmental Benefits Mapping and Analysis Program—Community Edition (BenMAP—CE) version 1.5.1.0 [2.5-attributable health impacts are provided below:i signifies a specific health endpoint, k signifies a 0.5° × 0.625° GEOS-Chem grid cell in the western US, and a represents a population subgroup spanning 5 years of age. In yika represents the wildfire-attributable PM2.5 health impacts for health endpoint i in grid cell k for population subgroup a; Incidenceika is the baseline incidence of health endpoint i in grid cell k for population subgroup a; βi is the effect estimate relating a change in PM2.5 concentration to a change in the risk of health impact i; WildfirePM2.5k is the annual mean wildfire-attributable PM2.5 concentration in grid cell k, and Populationka is the population subgroup in grid cell k. To calculate total wildfire attributable PM2.5 health impacts for a particular health endpoint during the baseline, 2050, or 2090 eras, health impacts are aggregated across all grid cells and all population subgroups as shown in yi signifies the total additional wildfire-attributable health impacts for a given health endpoint during the baseline, 2050, or 2090 eras when compared to the baseline without wildfires. We follow the US EPA methodology for estimating health risks from PM2.5 using concentration-response functions for total, not source-specific, PM2.5 mass. Thus, we apply total PM2.5 based health impact functions to the fine particles emitted as a result of wildfires; however, we limit our analysis of health impacts to those specific endpoints that have to date been associated with wildfire PM2.5  model , 38. Thi2.4.We estimate the economic value of projected health impacts based on recommendations in federal guidance for economic analyses  and valuFor mortality endpoints, the EPA’s Guidelines for Preparing Economic Analyses  recommen3.p < 0.001). We find large interannual variability in wildfire BC and OC emissions driven by variability in precipitation and soil moisture inputs. Comparing between GCMs, we find that the estimated wildfire emissions increase is more moderate using simulated climate variables from a cooler climate model (GISS-E2-R), with virtually no change in emissions in both the 2050 and 2090 eras for RCP4.5, but increases of 8% in the 2050 era and 17% in the 2090 era relative to the 1996–2005 reference period for RCP8.5. The four other GCMs produce larger increases in emissions. HADGEM2-ES results have the largest magnitude change in emissions, with wildfire BC and OC emissions increasing from 2000 by over a third in the 2050 period for RCP4.5, and more than doubling for the 2090 period for RCP8.5. The results across GCMs largely correspond to variation in individual GCM projections of temperature and precipitation over the western U for our time period, and clearly illustrate the importance of using a wide range of plausible climate drivers when estimating future fire activity and emissions.Overall, our estimates of fire activity capture a substantial amount of interannual variability in area burned that can be attributed to climatic variation, though they generally underestimate peak years across all ecoregions . Underes2.5 concentrations for RCP8.5 in 2090 for all five GCMs. Spatially weighted PM2.5 concentrations from the CONUS GEOS-Chem results across all models, RCPs, and time periods are provided in the μg m−3 in 2090 relative to the baseline period. Compared to the baseline period value, western wildfire PM2.5 increases in most GCM/RCP/era combinations, more than doubling for the HADGEM2-ES/RCP8.5/2090 projection scenario. For all GCMs, the largest changes occur in the Nevada Mountain/Semi-Desert and Coastal California regions, and extend southward to Southern California along the Sierra Mountain range. Results in the 2.5 concentrations) relative to RCP8.5, across nearly the entire western U.S . The overall result is a large increase in total health and health-related economic impact of wildfire-related PMn RCP8.5 . The tot4.2.5 from western US wildfires under plausible scenarios of future changes in climate. The increase is consistent across alternative projections of future climate and across multiple climate models, though the effect varies in magnitude and location across these futures. The increase in wildfire-related PM2.5 mortality and morbidity grows over time and is larger for the higher GHG scenario (RCP8.5) compared to the lower emission scenario (RCP4.5).Our results show the potential for a substantial increase in air pollution-related health impacts associated with exposure to PM2.5-related mortality could increase by 3.7 times and 4.2 times in 2090 under RCP4.5 and RCP8.5, respectively, translating to $29 and $36 billion in annual total excess economic damages. An estimated 40% (for RCP4.5) and 60% (for RCP8.5) of the mortality increase is attributable to climate change, with the rest driven by population growth, change in population age structure, and mortality rate changes. Compared with other climate health impacts estimated in the CIRA framework, in 2090 under RCP8.5, these projected economic damages from increased wildfire PM2.5 mortality are larger than the climate-attributable impacts of West Nile Virus and hazardous algal blooms, smaller than those for extreme heat mortality and labor productivity, and comparable to those for southwestern US fugitive dust impacts . For exet al (2018) found that the baseline (2012) health burden for fire activity in the US is six times higher than our estimates, but that work includes the effect of prescribed fires, which predominate in the populous southeast region, and the effect of eastern U.S wildfires [et al [2.5 concentration estimates, Li et al (2020) applied the GEOS-Chem model to western wildfires and found fine PM increases of 53% for RCP4.5 and a doubling under RCP8.5 by 2100.These findings are consistent with other studies in the literature, though they generally show a smaller impact of wildfires, which can be attributed to differences in analysis scope and methodology. Fann ildfires , both ofs [et al . In addiet al (2013) found higher estimates of both area burned and emissions . Local scale estimates of wind speed could be important to area burned estimates . Howevein et al . Anotheret al (2018) conducted a global scale analysis of wildfire impacts on PM2.5 that showed higher estimates of area burned, larger effects on PM2.5, and a larger health burden for the western US than results in our study [et al use a single Earth system model (CESM) as opposed to our multi-model ensemble of five GCMs—CESM for the; (b) Ford et al use a coarser grid resolution (0.9° × 1.25°) similar to Yue et al; (3) we hold meteorology constant over time as an input to the GEOS-Chem air quality modeling, while Ford et al use time-varying meteorology; and (4) Ford et al consider changes in forest cover associated with forecast economic activity, which generally increases forest cover in the western US Although the combined directional effects of these methodological differences on results are unknown, in totality their effect is that our estimates are lower. The forecast changes in forest cover in Ford et al, a feature not included in our study, appears to have a large impact on their results. However, neither Ford et al nor we consider changes in vegetation type. Some wildfire studies using dynamic vegetation models [Ford ur study . We attrn models  suggest n models .2.5 concentrations likely leads to underestimated impacts on wildfire-related PM2.5 due to a shorter lifetime of PM2.5 than might be expected in the future in areas projected to experience reductions in precipitation [2.5 concentrations. Results of a parallel effort using a different air quality model, but otherwise similar methods and inputs with the exception of climate-driven wildfire emissions, show that changes in meteorology alone could increase population-weighted PM2.5 exposure in CONUS by 0.08–0.18 μg m−3 by mid-century, and 0.13–0.65 μg m−3 by end century, leading to an additional 15 000–21 000 annual PM2.5-attributable premature deaths by the end of the century [2.5 concentrations may remain uncertain or at least highly context-specific, so future research that integrates forecast meteorology with changes in wildfire emissions attributable to climate change remains a high priority [Regarding time-varying meteorology, in our study running GEOS-Chem with future meteorology was not possible since the model was not configured to use outputs from global climate models. Recent evidence suggests, however, that our use of present-day meteorological fields when simulating wildfire emissions effects on PMpitation , 43, 44. century . Other lpriority .2.5, but increasingly the mixture of air pollutants that constitute wildfire smoke has been implicated in health burden, particularly short-term effects associated with pollutants other than PM2.5 (e.g. air toxics) [et al (2017) find that the annualized economic burden from wildfire is between $71.1 billion to $347.8 billion (2016 US$) [There are also other reasons to suggest that our results underestimate the full air pollution-related health burden of wildfire. We focus on the annual average concentration of PM toxics) , 23. In  toxics) –48. In t016 US$) . Table 25.2.5 on premature mortality, and various forms of morbidity, in communities near the source of wildfire smoke but also extending to areas far downwind , using Supplementary Material