02, 11.17), and effect size 0.6. Secondary endpoints were statistically similar. Critically ill medical patients who require an insulin infusion have a reduced insulin requirement when fed intermittently, whereas dysglycemia metrics are not adversely affected. A larger clinical study is required to confirm these findings. Critically ill medical patients who require an insulin infusion have a reduced insulin requirement when fed intermittently, whereas dysglycemia metrics are not adversely affected. A larger clinical study is required to confirm these findings. Critically ill patients with liver disease commonly present to the intensive care unit (ICU) with need for prolonged ventilation, difficult weaning, and refractory coagulopathy. These patients experience both bleeding and thrombotic complications with a precariously balanced state of coagulopathy. The purpose of this study was to assess the bleeding complications of tracheostomy in critically ill patients with liver disease. A retrospective study was conducted in liver ICU of a tertiary teaching institute. Medical records were analyzed to assess postprocedure complication rate among 73 critically ill liver disease patients who had undergone tracheostomy during the period of October 2017 to September 2018. Ten out of 73 patients (13%) required transfusion of blood products after 12 h of procedure, despite thromboelastography (TEG)-based correction prior to procedure. Of these, 7 patients (9%) underwent surgical tracheostomy (ST) and three patients (4%) underwent percutaneous tracheostomy. Statistically no significant difference in bleeding was seen among the two groups, but a rising trend was seen with the ST group ( = 0.52). None of the patients experienced procedure-related pneumothorax and subcutaneous emphysema, as observed in the chest X-ray. We conclude that coagulopathy should not be deterrence for the performance of tracheostomy in critically ill patients with liver disease. Adequate clotting support guided by the global tests of coagulation, such as TEG, ensures lesser incidence of bleeding. We conclude that coagulopathy should not be deterrence for the performance of tracheostomy in critically ill patients with liver disease. Adequate clotting support guided by the global tests of coagulation, such as TEG, ensures lesser incidence of bleeding. The need to evacuate the chest after a penetrating wound was first recognized in the 18 century. Most thoracic injuries are treated with tube thoracostomy (TT) which refers to the insertion of a TT into the pleural cavity to drain air, blood, pus, or other fluids. However, TT has been challenged in the trauma care due to insertional, positional, or infective complications. A retrospective study of all trauma patients who had TT insertion from 2008 to 2014 was conducted based on the trauma registry data to describe patient characteristics, injury characteristics, management, and outcomes. The complication incidences per TT before (2008) and after (2009-2014) the implementation of standard protocol were compared. During the study period, 804 patients were managed with 1004 TT procedures. The mean age was 34 years, and majority (91%) was males. Motor vehicle crash (43%) was the main mechanism of injury. Mean injury severity score was 22. The rib fractures (68%) were more frequent followed by pneumothorax (49%). Nearly 72% of patients received antibiotic coverage before insertion. https://www.selleckchem.com/products/az20.html The complications developed per TT reduced over the years from 2008 to 2014 (12.6% to 4.4%). The average complication per TT after the protocol implementation (2009-2014) reduced by 7% when compared to the duration before implementation (2008). The present study shows that standardized management of trauma patients who undergo TT results in a reduction in complications, helps improve patient flow, and ensures the proper management of resources in our high-volume trauma center. The present study shows that standardized management of trauma patients who undergo TT results in a reduction in complications, helps improve patient flow, and ensures the proper management of resources in our high-volume trauma center. Epidemiological analysis of traffic accidents can provide information for future plans to lower the cost and burden of road traffic accidents (RTAs). This study was aimed to determine the epidemiological characteristics of patients with RTAs. We conducted a retrospective cross-sectional study of RTA patients presenting in 2016 to the Emergency Department at Shahid Bahonar Medical Education Center in Kerman, Iran. A checklist including variables such as age, sex, month, in which the patient referred, final outcome, overall cost and the site of injury used to collect data. The diagnostic criteria were in accordance to ICD 10. Of the total of 3277 patients who were studied, 2713 (82.78%) were men and 564 (16.66%) were women. Most of the accidents occurred at the age group of 16-30 years and the average cost of treatment in the hospital was 2152.45 USD. The most affected area was the lower limb. The majority of accidents occurred in spring and summer. The mortality rate was (2.74%). Injuries and deaths due to RTAs are a major public health problem, especially in young age groups. Therefore, more preventive programs targeting young adults should be considered to reduce the burden of RTAs. Injuries and deaths due to RTAs are a major public health problem, especially in young age groups. Therefore, more preventive programs targeting young adults should be considered to reduce the burden of RTAs. Head injuries are the leading cause of traumatic morbidity and mortality. Timely proper management can reduce the mortality rate. This study aimed to examine the effects of a fast-track system on reducing head injury mortality using the data in Southern Thailand. A retrospective study of data from the medical records of severe head injury patients admitted to Hatyai Hospital from October 2012 to May 2017. The records of subjects were selected for participants aged more than 11 years, having Glasgow Coma Score (GCS) <9, no injuries in other organs, and neither hypoxemia nor hypotension. A total of 193 participants fulfilling these criteria were analyzed. Of these, 108 participants were managed in the fast track. The fast-track group was compared with normal track participants by using logistic regression after preliminary analysis to identify the risk factors using the Chi-squared tests. After adjustment for confounders, namely acute subdural hematoma, linear skull fracture and diffuse brain injury, and mortality in the fast-track group (13%) was significantly lower than that in the nonfast track group (22.