Acceptance Rate Research Articles

Intra‐ and Postoperative Complications in 4565 vNOTES Hysterectomies: International Registry Cohort Study

ABSTRACTObjectiveTo present the rates of intra‐ and postoperative complications and conversions in a large cohort of unselected vNOTES hysterectomies, performed by surgeons with different levels of expertise.DesignInternational register‐based cohort study.SettingHysterectomies in the iNOTESs registry, 2015 to January 2024, performed by 201 surgeons from multiple countries.Population4565 patients undergoing vNOTES hysterectomy.MethodsDescriptive data are presented in frequencies (n) and percent (%).Main Outcome MeasureIntra‐ and postoperative complications. Conversions.ResultsIntraoperative and postoperative complication rates were 3.2% (n = 144) and 2.5% (n = 115), respectively. Conversions occurred in 1.6% (n = 72), of which 10 (0.2%) to laparotomy, and 82% of the conversions occurred within the first 50 cases of the surgeon's learning curve. The most common intraoperative complication was cystotomy, occurring in 1.3%, and almost half were performed by inexperienced surgeons. Other intraoperative organ injuries occurred in 20 cases (0.44%). Postoperatively, the most common complications were haemorrhage (n = 28), vault complications (n = 26) including 11 infected vault hematomas, cystitis (n = 18) and non‐specific infections (n = 14). The vNOTES hysterectomies were performed by 201 surgeons, of which 9.5% had performed more than 50 vNOTES cases, representing 70% of the registered cases in the registry. The remaining 30% of the hysterectomies mainly represent learning curve data from 90% of the included surgeons. The complication rate decreased with increasing surgical experience.ConclusionsThe largest study population of vNOTES hysterectomies is presented, including both learning curve data and data from experienced surgeons, with acceptable rates of intra‐ and postoperative complications. No implication was found of vNOTES being inferior to other minimally invasive methods.

Multispectral multiplexed confocal FLIM for live cell imaging

Abstract Spectrally resolved fluorescence lifetime imaging with high spatial precision offers comprehensive information on species localization and behavior. It is challenging to resolve weak fluorescence signals in multiple dimensions (spatial, spectral, and temporal) at high frame rates, especially in dynamic live cell processes, as photobleaching and phototoxicity limit acceptable photon count rates. We developed a multiplexed confocal FLIM technique, which uses a prism-based imaging spectrometer to separate a 10x10 array of confocal foci into their spectral components. This allows the sampling of the spectra by a time-resolved image sensor to produce a multispectral time-resolved data set used for generating multispectral lifetime images. This system captures 300x300 pixel fluorescence lifetime images containing 12 unique spectral bands covering a 450-700 nm spectral range in 1.8 seconds of exposure. Its performance was demonstrated in fixed stained samples and in multispectral imaging of FLIM-FRET in live cells.

Outcomes of Left Main Chronic Total Occlusion Percutaneous Coronary Interventions.

Percutaneous coronary intervention (PCI) of left main (LM) chronic total occlusions (CTO) has received limited study. We compared the clinical and procedural characteristics and outcomes of patients who underwent LM versus non-LM CTO PCI at 41 US and non-US centers between 2012 and 2024. During the study period 85 of 15,254 CTO PCIs (0.6%) performed in 14,969 patients were LM CTO PCIs. LM CTO PCI patients were older, had higher rates of dyslipidemia and heart failure and most (88.8%) had prior coronary artery bypass graft surgery (CABG). They were more likely to have moderately or severely calcified lesions (80.7% vs. 45.7%, p < 0.001) and had higher J-CTO (2.76 ± 1.17 vs. 2.37 ± 1.26, p = 0.008), PROGRESS-CTO MACE (3.56 vs. 2.57, p < 0.001), Mortality (2.45 vs. 1.68, p < 0.001), Pericardiocentesis (2.74 vs. 1.87, p < 0.001), Acute MI (1.72 vs. 0.89, p < 0.001) and Perforation (3.21 vs. 2.19, p < 0.001) scores. There was no difference in technical success (80.5% vs. 87.2%, p = 0.086) or major cardiovascular adverse events (MACE) (2.4% vs. 2.0%, p = 0.700). LM CTO PCI patients with and without prior CABG surgery had similar technical success and MACE. The retrograde approach in prior CABG patients was more likely to be performed through saphenous vein grafts. LM CTO PCI is infrequently performed, is associated with high comorbidity burden and angiographic complexity but can be performed with high success and acceptable complication rates.

Nonfinancial Barriers to Prosthetic Use Following Upper-Limb Amputation: A Prospective Observational Study in India

ABSTRACT Introduction Upper-limb traumatic amputation is a common and poorly managed situation. Despite the huge burden, no study from the developing countries has evaluated rates of prosthesis acceptance and reasons for rejecting prostheses. Materials and Methods This was a longitudinal prospective observational study with a consecutive sampling technique. Participants were assessed after a period of 6 months of isolated upper-limb amputation. Patients were evaluated for reasons of nonfitment of upper-limb prosthesis despite their willingness to be fitted with an appropriate prosthesis. We conducted semistructured interviews to identify the potential hindrances. Results A total of 44 patients were recruited, out of which 38 did not get the prosthesis. A total of 57.8% reported a nonfinancial reason for prosthesis nonfitment. Nonfinancial is further classified into medical and nonmedical categories as per verbatim remarks by the patient. Among the nonmedical reasons, the most common reason was apprehension toward the use of the prosthesis, followed by satisfaction without the prosthesis and the weight of the prosthesis. In terms of medical reasons, the most common reason was persistent phantom limb pain, followed by residual limb infection. Conclusions Identification of “potentially correctable” hindrances to prosthesis acceptance is an essential step in the rehabilitation of persons with limb loss. All efforts should be made toward these hindrances so that persons with limb difference can be better rehabilitated. Clinical Relevance Given that some persons with limb difference need to be fitted with prostheses for optimal rehabilitation and to return as an able contributor to society, the identification of hindrances to prosthesis fitting is imperative to make further inroads toward improving prosthesis acceptance rate.

Baseline characteristics, management patterns and outcome in patients with pulmonary embolism and malignancy: Insights from a single-centre study.

Acute pulmonary embolism (PE) is one of the main causes of death in patients with active cancer. In this study, we evaluated the impact of malignancy on the treatment choices, and short- and long-term clinical outcomes in patients with acute PE. In this study, 872 acute PE patients (age 61.6 ± 16.8 years, female 57.5 %) from different risk and treatment categories were retrospectively analyzed and divided into two groups according to the presence of active malignancy. Active malignancy was documented in 129 (14.8 %) out of the 872 patients. Ultrasound-assisted-thrombolysis (USAT), rheolytic-thrombectomy (RT), systemic-thrombolysis (ST) and anticoagulation-alone therapies were noted in 27.3 %, 16.6 %, 6.4 % and 49.7 % of overall PE patients. RT and anticoagulation therapies were more frequent in patients with malignancy whereas ST and USAT were more frequently used in the other group. Regardless of the presence of malignancy and the treatment modality chosen, significant improvements were achieved in all treatment targets (p < 0.001 for all). Bleeding rates were similar in both groups, while in-hospital and long-term mortality was higher in the malignancy cohort. Active malignancy was found to be an independent predictor for composite of 60-day mortality and PE-related rehospitalization (adjusted OR: 2.43; 95 % CI: 1.32-4.47, p = 0.04) and long-term mortality (adjusted HR: 2.25, 95 % CI: 1.29-3.91, p = 0.004). Concomitant malignancy adversely affects both short- and long-term outcomes in patients with acute PE. Although these patients are more vulnerable, it is possible to achieve satisfactory treatment success with acceptable bleeding rates with the inclusion of catheter-based methods as treatment option.

Outcomes of adjuvant radiation treatment following subtotal resection of world health organization grade II meningiomas.

Existing literature on adjuvant radiation after subtotal resection (STR) of WHO II meningiomas is limited by heterogenous patient cohorts, combining adjuvant and salvage radiation, gross total resection (GTR) and STR, primary radiation treatment vs. re-treatment, or grade II and III meningiomas, all of which have different expected outcomes. Tumor control estimates in a large homogenous patient cohort are needed to accurately counsel patients. A retrospective review of patients that had immediate post-operative imaging-confirmed residual WHO grade II meningioma followed by either adjuvant intensity-modulated radiation therapy (IMRT) or stereotactic radiosurgery (SRS) between 1996 and 2020 was conducted. Kaplan-Meier survival analysis and log-rank test was used to assess progression-free survival (PFS). Thirty-nine patients met inclusion criteria (IMRT = 32; SRS = 7). Overall, the 3-, 5-, and 10-year PFS was 81.1%, 61.2%, and 44.6%, respectively. Median follow-up time was 37 months. When comparing IMRT and SRS cohorts, baseline characteristics did not differ significantly between groups, but significantly larger residual tumor volumes were treated with IMRT (22.2 cm3 vs. 6.3 cm3, p = 0.004). PFS was not significantly different between IMRT and SRS at 3 years (81.1% vs. 80.0%) or 5 years (65.5% vs. 40%) (p = 0.19). There was no significant difference in radiation necrosis between groups (IMRT = 3/32 patients vs. SRS = 0/7 patients, p = 0.32). Our homogenous patient cohort displayed acceptable control rates at 3 years using SRS or IMRT as adjuvant therapy. No significant difference in PFS or radiation necrosis was noted between patients treated with adjuvant IMRT versus SRS.

HPB SO54 - Outcomes of Isolated Bile Duct Resection for Cholangiocarcinoma; More Than 15 Years Experience in a Single Tertiary HPB Centre

Abstract Background Cholangiocarcinoma of the extrahepatic biliary tree usually requires a major resection to achieve clear margins with adequate lymphadenectomy. For perihilar tumours this involves extended liver resection with bile duct resection whilst distal tumours require pancreaticoduodenectomy. Occasionally a combination of both (hepato-pancreaticoduodenectomy) is required. These procedures are associated with high morbidity and mortality. In a small number of patients, cholangiocarcinoma is confined to the extrahepatic bile duct with no involvement of the liver or pancreas and a bile duct resection alone is an option. We reviewed the outcomes of patients who underwent bile duct resection for cholangiocarcinoma in our unit. Method We identified all patients who underwent bile duct resection and hepaticojejunostomy for cholangiocarcinoma between June 2007 and June 2023 in our centre from a prospectively maintained database. Patient demographics, complications, histology, resection margin status, follow-up, recurrence, and survival were recorded. Time to recurrence and overall survival were analysed using Kaplan Meier analysis. Results Thirteen patients underwent bile duct resection and hepaticojejunostomy for cholangiocarcinoma. 12 (92%) were male and the median (range) age was 72 (41-82). No patients received neoadjuvant treatment. 3 (23%) patients developed postoperative complications with 1 (7.7%) perioperative mortality. R0 margin was achieved in 6 (46%). The median (range) postoperative stay was 7 (5-25) days. 8 (61.5%) patients received adjuvant chemotherapy. 7 patients (53.8%) developed recurrent disease at a median of 12 (IQR 8-54) months following surgery. The most common sites of recurrence were the liver (23.1%) followed by local recurrence (15.4%). The median survival was 38 (IQR 20-95) months. Conclusion Extrahepatic bile duct resection with hepaticojejunostomy is an option for patients with cholangiocarcinoma of the extrahepatic bile duct without macroscopic involvement of the liver or pancreas. In our series this procedure was associated with a low morbidity and perioperative mortality with acceptable recurrence rates and overall survival despite only modest R0 resection rates. Isolated bile duct resection with hepaticojejunostomy should be considered for tumours without macroscopic involvement of the liver or pancreas, especially in patients of borderline fitness for a more extensive resection.

Outcome of Ultrasonography-Guided Percutaneous Nephrolithotomy for the Management of Pediatric Urolithiasis.

Objectives: This study aims to assess the outcomes of ultrasonography (US)-guided minimally invasive percutaneous nephrolithotomy (PCNL) in the treatment of pediatric urolithiasis. Methods: A retrospective analysis was conducted on 176 patients with pediatric renal and upper ureteral lithotripsy who underwent PCNL between August 2006 and July 2022. The cohort comprised 110 men and 66 women, with ages ranging from 6 months to 16 years. Postoperative stone clearance was evaluated using kidney, ureter, and bladder radiograph or US, categorizing stones less than 4 mm as clear. Postoperative complications were graded according to the Clavien-Dindo classification, with grades I and II considered minor and III and IV classified as major. Results: Among the patients, 152 underwent unilateral renal operation, whereas 24 underwent bilateral renal operation. The average operation duration was 67.41 minutes (range: 15-195 minutes). The mean duration of nephrostomy tube removal was 3.79 days, and the mean postsurgical hospital stay was 5.97 days. A total of 146 patients experienced a decrease in hemoglobin concentration post operation, with an average drop of 10.57 g/dL (range: 0.5-37.8 g/dL). Initial stone-free rate (SFR) was achieved in 85.5% (171/200) of cases, and the final SFR was 92.50% (185/200). The postoperative rate of minor complications was 8.54% (17/199), whereas major complications occurred in 12.06% (24/199) of cases. During the 6-month to 11-year follow-up period, 19 patients presented with combined stones, and of these 4 presented with ipsilateral stone recurrence who underwent PCNL treatment. Calcium oxalate was identified as the most common stone component. Conclusions: US-guided minimally invasive PCNL demonstrated excellent SFR and an acceptable complication rate in the management of pediatric urolithiasis. Furthermore, it offers the advantage of minimizing potential risks associated with radiation exposure during the procedure.

Public acceptance of coercive measures in Nigerian mental health care.

For the first time, Nigeria has enacted a new mental health law that regulates the use of coercive measures in mental health care. The study aimed to investigate the extent to which the Nigerian public accepts the use of coercive measures in the treatment of people with mental health conditions and to understand the impact of stigma and other sociodemographic characteristics. A cross-sectional survey was conducted among 615 adult respondents from Nigeria's six geopolitical zones. The study instrument included a case-specific vignette, a social distance scale, and a brief sociodemographic form. Descriptive and inferential statistics were conducted with SPSS v.25 software. More than half of the study respondents agreed that the vignette character should be forced to go to the hospital if he refuses to go (65%, n = 400), and he should be forced to take medications at the psychiatric hospital (55.1%, n = 339). The least accepted coercive measure was Isolation (28.8%, n = 177). There were significant associations between social distance and the acceptance of involuntary admissions, forced medication, mechanical restraints, and isolation (p < .05). Social distance score was highest among respondents who agreed that the vignette character should be isolated (24.023 ± 5.503; F = 24.672, p < .001). The study highlights variations in public attitudes toward coercive psychiatric measures, within the Nigerian context compared to other countries. The lower acceptance rates for isolation as a coercive measure underscore the cultural importance of social interaction in Nigeria. The relatively recent implementation of Nigeria's Mental Health Act also suggests a potential gap in public knowledge regarding the criteria for coercive measures. Future research should aim to include diverse populations and consider longitudinal approaches to assess changes in public attitudes as awareness of mental health legislation increases.

Development of a Novel Gluten-Free Cookie Premix Enriched with Natural Flours Using an Extreme Vertices Design: Physical, Sensory, Rheological, and Antioxidant Characteristics

This work aimed to develop novel alternative gluten-free premixes for use in the production of cookies by optimizing the formulation of three different starches (corn, potato, and tapioca starch) in a rice/corn formula and then enriching the optimized formula with various natural flours (acorn, soy, chestnut, chickpea, millet, and quinoa). An extreme vertices mixture design was used to optimize the mixing sub-part consisting of 30% (w/w) of starches. The enriched gluten-free cookies were characterized by physical, rheological, antioxidant, color, and sensory properties. An optimum was obtained by mixing 18.5084 g of corn starch, 6 g of potato starch, and 5.4916 g of tapioca starch. The enrichment results indicated that soy-enriched gluten-free cookies have a high specific volume (2.428 cm3/g) with the highest spread ratio (12.25) compared to other cookies. The rheological properties of enriched gluten-free doughs indicated a higher value of the consistency coefficient (K) of soy-enriched gluten-free cookies. The antioxidant characteristics were enhanced by replacing corn with several types of flours, with higher TPC for acorn (2.83 mg GAE/g dw) and soy-enriched cookies (2.49 mg GAE/g dw) with better antioxidant activities (DPPH, ABTS, and RED). The tasters gave all the cookies favorable ratings for overall acceptability. With an average rating of 7.09, cookies enhanced with chickpea flour have a high acceptability compared to the other cookies. Considering all the tested parameters, PCA analysis clustered millet, corn, quinoa, and chestnut gluten-free enriched cookies into the same group. However, acorn and soy cookies were placed in a separate group, and chickpea-enriched cookies were classified separately.

Diagnostic value and safety of transbronchial cryobiopsy in postoperative complications after lung transplantation

Objective: To compare the diagnostic rate and safety of postoperative complications between transbronchial cryobiopsy (TBCB) and transbronchial lung biopsy (TBLB) in patients with lung transplantation. Methods: A retrospective analysis of patients who underwent TBCB or TBLB in the Department of Lung Transplantation in China-Japan Friendship Hospital from June 2017 to June 2024 was conducted to determine the postoperative complications and analyze clinical characteristics, procedures, diagnostic rates and safety. Results: Thirty-five and 153 patients with lung transplantation received TBCB and TBLB, respectively. Patients who received TBCB had lower preoperative oxygenation index (t'=2.4, P<0.01). Meanwhile, the pathological diagnosis rate (85.7% vs. 45.7%, χ²=18.27, P<0.01) and clinical diagnosis rate (94.2% vs. 69.9%, χ²=8.80, P<0.01) of patients who received TBCB were significantly higher than those who received TBLB. There was no significant difference in the incidence of severe bleeding (2.9% vs. 0.7%, χ²=1.3, P=0.86) and pneumothorax (0 vs. 3.9%, χ²=0.43, P=0.24) between patients receiving TBCB and TBLB. The most common complications after lung transplantation in the group of TBCB were chronic lung allograft dysfunction (45.4%, 15/33), antibody mediated rejection (18.2%, 6/33) and organizing pneumonia (12.2%, 4/33). While antibody mediated rejection (29.9%, 32/107), chronic lung allograft dysfunction (16.8%, 18/107), and pneumonia (16.8%, 18/107) were more frequent in the patients who received TBLB. Conclusions: TBCB has a high diagnostic value for postoperative complications after lung transplantation, with an acceptable complication rate of bleeding and pneumothorax.

Knowledge, fear and acceptance rate of spinal anesthesia among pregnant women scheduled for cesarean section: a cross-sectional study from a tertiary care hospital in Karachi.

Worldwide, the cesarean section (c-section) rate is rising. Globally, regional anesthesia in the form of spinal anesthesia (SA) is considered the first choice in uncomplicated c-section cases for safe maternal and neonatal outcomes. This study aimed to ascertain knowledge, acceptance, and fears of SA among patients scheduled for c-section in a tertiary care hospital. This cross-sectional study was performed in the Anesthesia Department, Hamdard University Hospital, Karachi, from April to September 2023. Knowledge was assessed using a self-designed questionnaire with a total of 7 questions. Data was entered in SPSS version 26 to perform statistical analysis. A total of 303 females were enrolled, with a mean age of 26.5 ± 4.5 years and a median gestational age of 37 (IQR = 36-37) weeks. 93.7% of women agreed to receive SA. 63% heard the term regional anesthesia before, 12.2% heard about general anesthesia, and 17.5% heard about SA. 23.4% of participants scored 7 out of 7, 39.9% had a score of 6 out of 7, and 36.6% had a score of ≤ 5. Among 129 (42.6%) females having fear, the commonest fear was limiting lower limb functions post-surgery (93.8%), followed by post-operative vaginal pain (91.5%), intra-operative pain (80.6%), post-operative backache (76.7%), having visuals of surgery (72.9%), back injury (56.6%), headache (46.5%), nausea/vomiting (31%), and being nude (24%). The present study analyzed that although the majority of female agreed to receive spinal anesthesia, they had a fear of it. Knowledge of spinal anesthesia was not remarkable among the study population. Proper education regarding anesthesia should be given to patients to overcome fears related to spinal anesthesia. Not applicable.

Predictors of In-hospital and Short-term Outcomes of Thoracic Endovascular Aortic Repair for Aortic Aneurysm and Aortic Syndrome: A Single-Center Experience

BACKGROUND: Endovascular technique has replaced open repair as primary treatment for different aortic disease indications and was associated with low perioperative mortality and acceptable short-, mid-, and long-term survival. Locally, thoracic endovascular aortic repair (TEVAR) was not widely practiced until year 2017. This study aims to determine the predictors of in-hospital and short-term outcomes of patients who underwent TEVAR for aortic aneurysm and aortic syndrome in a single center and how it compares with local and international data. METHODS: This study is a retrospective analysis of 52 adult patients who underwent TEVAR for the treatment of aortic aneurysm and aortic syndrome. Demographic and clinical data, diagnostic imaging, and procedural details were obtained via inpatient charts at the medical records section and hospital system database archiving. Outcomes at 30 days and 1 year postprocedure were obtained through telephone follow-up after attaining verbal consent. Gathered data were analyzed as to association of different variables with or without the presence of complications. Outcomes reported included in-hospital mortality rate, presence of major adverse events (MAEs), 30-day and 1-year survival rates, and rate of freedom from reintervention. RESULTS: The overall in-hospital mortality was 7.69% (n = 4/52), and complication rate was 32% (n = 20/52), with a survival rate of 92.31% and 87.76% at 30 days and 1 year, respectively. The rates of overall freedom from reintervention were 83.33% and 100% at 30 days and 1 year, respectively. The independent predictors for in-hospital mortality and development of MAEs were increasing weight (odds ratio [OR], 1.0588; 95% confidence interval [CI], 1.003–1.208), preexisting chronic kidney disease (OR, 10.33; 95% CI, 1.1069–96.462), and TEVAR with debranching done as a single procedure (OR, 3.6667; 95% CI, 1.1154–12.054), whereas an estimated glomerular filtration rate of 49.05 ± 19.25 (OR, 0.9402; 95% CI, 0.9019–0.9801) and TEVAR with debranching done as a staged procedure (OR, 0.1624; 95% CI, 0.0321–0.8225) statistically decrease the risk for development of in-hospital mortality and MAEs (P = 0.001 and P = 0.028, respectively). CONCLUSIONS: In this single-center study, indications for TEVAR were fusiform and saccular aneurysm, high-risk intramural hematoma and penetrating aortic ulcer, complicated acute type B dissection, chronic complicated type B dissection with high-risk feature, and aortic rupture. The outcome of this study shows comparable results with other international studies with an acceptable in-hospital mortality rate, complication rate, short-term survival rate, and rate freedom from reintervention at 30 days and 1 year. Increasing weight, preexisting chronic kidney disease, and TEVAR with debranching done as a single setting are independent predictors for developing in-hospital mortality and MAEs, whereas a normal estimated glomerular filtration rate and TEVAR with debranching done as a staged procedure decrease the risk; hence, careful planning and scheduling of procedure among elective and amenable cases could further reduce complication rates of future TEVAR procedures.

Three-Year Clinical and Hemodynamic Evaluation of the Hydra Self-Expanding Transcatheter Aortic Valve in Patients With Severe Aortic Stenosis.

The Hydra CE study revealed 1-year favorable efficacy of TAVR, showing a large effective orifice area (EOA), low gradient, and acceptable complication rates. We evaluated the 3-year clinical and hemodynamic outcomes of Hydra self-expanding transcatheter aortic valve (manufactured by Vascular Innovations Co Ltd, Nonthaburi, Thailand; a subsidiary of Sahajanand Medical Technologies Limited, India) in patients with symptomatic severe aortic stenosis at high or extremely high surgical risk. The Hydra CE study was a prospective, multicenter, single-arm study. A total of 157 patients were enrolled in the study, out of whom 54 patients from two centers (Lithuania and Poland) had provided consent for long-term follow-up at recruitment, with a planned 5-year follow-up period. The primary endpoint was all-cause mortality, and patients were followed up for up to 3 years, with an assessment of clinical and echocardiographic outcomes. Among the 54 patients, the average age was 81.0 ± 4.1 years. The mean STS score was 3.2 ± 2.0%. At 3 years, all-cause mortality had occurred in 14.8% of patients, including 3.7% cardiovascular deaths and 1.9% device-related deaths. There was a progressive enhancement in EOA that is, 0.68 ± 0.15 cm2 at baseline to 1.97 ± 0.52 cm2 at 3 years (p < 0.001) as well as significant improvement in the mean aortic valve gradient that is, 53.4 ± 14.24 mmHg at baseline to 8.6 ± 2.80 mmHg at 3 years (p < 0.001). New permanent pacemaker implantation rates up to 3-year follow-up was 12.9%. The 3-year results of the Hydra CE study demonstrated consistent improvements in hemodynamics over time. The study also revealed favorable safety and efficacy trends, along with low occurrences of new permanent pacemaker implantations and paravalvular leaks.

High acceptability of point-of-care HIV testing at the colposcopy outpatient clinic in hospitals in the Netherlands.

Cervical cancer and its precursor are labeled as HIV indicator conditions, justifying the recommendation of HIV testing for all patients. This study aimed to assess the acceptance and patients' and gynecologists' perceptions on HIV testing in patients with cervical dysplasia at the colposcopy outpatient clinic in hospitals in the Netherlands. A cross-sectional study was conducted between May 2021 and February 2023 to implement point-of-care HIV testing in five hospitals in the Rotterdam region, the Netherlands. We included patients aged 18 years and older, without documented HIV, presenting with cervical dysplasia. The primary outcome was the HIV test acceptance rate. Secondary outcomes were the HIV positivity rate and the association between dysplasia severity and test acceptance. We also assessed patients' and gynecologists' perspectives on this testing strategy with a questionnaire. Of 563 patients, 523 accepted HIV testing, resulting in a test acceptance rate of 92.9% (95% confidence interval, 90.45%-94.88%). Testing rates were consistent among participating hospitals (91.6%-100.0%) None of the patients tested positive for HIV. Severity of dysplasia was not associated with test acceptance (P = 0.768). Most patients (n = 500, 96.0%) reported good or higher experience with this testing strategy. The main barriers for gynecologists to offer HIV testing were lack of time (n = 22, 33.9%) and fear to offend a patient (n = 7, 12.5%). Less than half (n = 19, 39.3%) of gynecologists believed an HIV test should be offered to all patients with cervical dysplasia. Point-of-care HIV testing at colposcopy outpatient clinics was well accepted by patients. The data indicate that the primary barrier lies with the physicians to offer such testing.

Outcomes of Congenital Heart Diseases in Duhok, Kurdistan Region of Iraq

Background: Congenital heart diseases (CHD) are the most common birth defects worldwide, significantly impacting morbidity and mortality, especially in low- and middle-income countries where early diagnosis and access to surgical care are limited. In Iraq, congenital heart surgeries are relatively new, and few studies have investigated CHD outcomes in this context. Aim: This study aimed to evaluate the prevalence, distribution, and surgical outcomes of congenital heart diseases among patients treated at the Azadi Heart Center in Duhok, Kurdistan Region of Iraq. Patients and Methods: A retrospective, cross-sectional study was conducted involving 111 patients aged 1-69 years with CHD who underwent surgery at the Azadi Heart Center between March 2019 and March 2024. Data were collected on demographic characteristics, clinical profiles, surgical details, and postoperative complications, including mortality rates. Statistical analysis was performed using Microsoft Excel, with data presented as means, standard deviations, frequencies, and percentages. Results: The average age of patients in the study was 13 years (±16), with congenital heart disease (CHD) being most common among children, who made up 80.18% of cases. Male patients accounted for 54.95%. The most frequent CHD types observed were Tetralogy of Fallot (25%), isolated Ventricular Septal Defect (20%), and Atrial Septal Defect (10%). The surgeries were highly successful, with a 95.5% success rate. However, some patients experienced postoperative complications, such as pneumonia (11.71%), arrhythmias (10.96%), and surgical site infections (5.41%). The overall mortality rate was 10.81%, with infections being a leading cause of death after surgery. Conclusions: CHD is prevalent among young patients in Duhok, with favorable surgical outcomes and acceptable complication rates. These findings highlight the need for early detection, enhanced surgical resources, and continued surveillance to improve outcomes for CHD patients in Iraq.

Exploring Edible Insects: From Sustainable Nutrition to Pasta and Noodle Applications—A Critical Review

Edible insects provide an alternative source of high-quality proteins, essential lipids, minerals, and vitamins. However, they lack the acceptability and consumption rates of more common staple foods. In contrast, pasta and noodles are globally appreciated foods that are consumed across various cultures. These products contribute greatly to the population’s energy intake but generally lack essential nutrients. Recently, edible insects have gained in popularity due to their numerous benefits, both environmental and nutritional. Current research indicates that incorporating edible insect ingredients into pasta and noodle formulations enhances their nutritional quality by increasing protein and fiber content and reducing carbohydrates. However, adding new ingredients to enrich common foods often carries technological and sensory challenges, such as changes in processing parameters, texture, flavor, and appearance. Technology assessment, scientific research, information campaigns, and public policies can help overcome these issues. This review aims to summarize the benefits of entomophagy (the consumption of insects as food) for sustainability, nutrition, and health; highlight the potential of pasta and noodles as carriers of nutritious and bioactive ingredients, including insects; and critically address the advancements in insect-enriched pasta and noodle technology, identifying current challenges, knowledge gaps, and opportunities.

Comparative analysis of 333 proGAV® and proGAV 2.0® adjustable valves in pediatric hydrocephalus treatment: survival and complication rate assessment

ObjectiveProGAV and ProGAV2.0 adjustable valves are extensively used for treating hydrocephalus in pediatric patients. This study aims to conduct a comprehensive comparison between these two valves concerning their survival and complication rates.MethodsThis retrospective study included all pediatric patients who underwent ProGAV or ProGAV2.0 valve implantation at our neurosurgical clinic from August 2008 to August 2020. A comparative analysis was performed considering age, gender, follow-up duration, complication and survival rates, adjustments, spontaneous adjustments, and adjustment difficulty rates. All valves were followed up for a maximum of 3 years.ResultsInclusion involved 333 cases (mean age of 5.4 ± 5.1 years; 54.1% males), comprising 173 cases (52.0%) with ProGAV valve implantation and 160 cases (48.0%) with ProGAV 2.0. Early complications within the first month post-implantation were observed in 51 cases (15.3%). No significant differences were noted in valve implantation indications, age distribution, or survival duration (27.1 vs. 27.8 months, p = 0.629) between the two groups. Predominant indications for implantation were post-hemorrhagic hydrocephalus and aqueduct stenosis for both valve types. Notably, both valves showed non-significantly different explantation rates during the first three years after implantation (34.7% vs. 29.7%, p < 0.289). However, there was a significantly higher early post-implantation complication rate (22% vs. 9.4%, p = 0.002), and a significantly increased association with difficulties in valve adjustments and spontaneous adjustments (p = 0.041 and 0.011, respectively). ProGAV2.0 cases displayed notably enhanced clinical and radiological improvement within the initial 6 months after implantation (p = 0.001 and p = 0.038). Younger children (< 2 years of age) also experienced significantly more valve adjustment difficulties (p = 0.049) and had higher rates of valve explantation (p < 0.001).ConclusionThe findings of this study highlight the superior performance of the ProGAV2.0 valve in terms of complication rate and maladjustment rate when employed in the treatment of pediatric hydrocephalus. Both valves demonstrated an acceptable survival rate with 65.3% for ProGAV and 71.3% for ProGAV2.0 within three years of implantation.

Quantitative evaluation of clinical pharmacy activities following implementation of an enhanced weekend service at a teaching hospital

Abstract Introduction Improving equity of staffing across seven-days is a strategic priority for the National Health Service (NHS).1 Development of enhanced weekend clinical pharmacy services presents opportunity to improve admission and discharge medicines reconciliation (MR), reduce medication error and increase patient counselling.2 At the study site, an enhanced weekend clinical pharmacy service was implemented in October 2021. The service was delivered 9am-5pm to all clinical specialities across 54 wards. Defined minimum staffing was 13 pharmacists and 2 medicines management pharmacy technicians (MMPT). Service specification included: clinical screen and order of medications; admission MR, review of high-risk patients (critical care patients and those prioritised by the weekday team); and discharge activities including patient counselling. Aim To evaluate provision of the enhanced weekend clinical pharmacy service post-implementation by quantification of shift fill and clinical pharmacy professional activities. Methods A quantitative study was conducted over two separate weekends one month and six months post-implementation (13th-14th November 2021 and 9-10th April 2022). Pharmacy professionals collected data using a paper activity tool validated for use at the study site. Interventions included rectification of medication error, medicines optimisation or consult. Data were collated in Microsoft Excel immediately after each study weekend. Simple descriptive statistics were performed in Microsoft Excel. The study was registered with KCH Pharmacy Research and Audit Group (07/2021), deemed service evaluation and ethics approval waived. Results Pharmacy professionals reviewed 1,056 patients over 3,645 occupied bed-days. Services were delivered by 13 pharmacists and 1 MMPT on weekend 1, 12 pharmacists and 1 MMPT on weekend 2. Data were collected for all wards on weekend 1; on weekend 2 activity data was not collected for five surgical wards (Saturday and Sunday), four post-acute medical wards (Saturday) and the acute medical unit (Sunday). Admission MR was conducted for 77% (317/412) of newly-admitted patients. Pharmacists recommended prescription amendment for 68% (217/317) of patients receiving admissions MR; affecting 517 medicines. The recorded intervention rate per patient reviewed was 0.64 (680/1056). Pharmacy professionals responded to 211 queries from healthcare professionals (HCPs), undertook 90 incidences of pro-active HCP education and counselled 92 patients/carers. Pharmacists prepared discharge medication lists or clinically screened discharge prescriptions for 205 patients. A total of 952 non-stock medicines were ordered and 313 patients own medicines checked for suitability for reuse. Discussion / Conclusion These findings add to existing evidence for seven-day clinical pharmacy services. Defined minimum staffing was not fulfilled with 90% shift fill rate. Clear benefit was demonstrated in terms of admission MR and resultant intervention, HCP education, discharge and counselling activities. The percentage of patients with a recommended prescription amendment following admission MR matched findings from a separate service evaluation during February 2021 of an enhanced weekend service introduced at our study site during the COVID-19 pandemic (68%).3 The intervention rate for reviewed patients was also comparable (0.64 compared with 0.57 during COVID-19).3 Limitations include the relatively short period of data collection at a single-site which limits generalisability of findings. There were some gaps in data collection and acceptance rate of interventions was not collected.

Acceptance of Human Papillomavirus (HPV) vaccine among the parents of eligible daughters (9-15 years) in Bangladesh: A nationwide study using Health Belief Model.

To align with the 2030 vision of the World Health Organization (WHO) to ensure 90% of girls receive the HPV vaccine before turning 15, Bangladesh has recently started the (HPV) vaccine campaign nationwide. Therefore, our study aimed to assess the level of its acceptance among parents of eligible daughters in Bangladesh. This nationwide cross-sectional study was conducted among the self-identified parents of daughters in the age group of 9-15 years between June 28 and August 2, 2023. A total of 2,151 parents were conveniently selected from all eight divisions of Bangladesh. Data was collected through face-to-face interviews using a semi-structured questionnaire. The Health Belief Model was used to appraise respondents' beliefs concerning HPV and its vaccination. Adjusted odds ratios (AOR) with a corresponding 95% confidence interval (CI), and a p-value of <0.05 was considered statistically significant. R Studio (Version 2023.09.0+463) was used as an interface for data analysis, while R (the programming language) was used for statistical computations. The mean age of the study participants was 38.18 (±5.86) years. The overall acceptance rate of the HPV vaccine was 86.61% (95%CI: 85.09-88.02). The vaccine acceptance level was positively associated with all the domains of the HBM (p<0.001), except in the perceived barrier domain (p = 0.489). After adjustment for other factors, it was found that higher age was associated with a decreased acceptance (AOR: 0.92; 95% CI: 0.89-0.95). The urban residents exhibited 42% lower odds of vaccine acceptance than rural (AOR: 0.58; 95% CI: 0.36-0.92). Similarly, participants of the middle-income group had 44% lower odds than the lower-income group (AOR: 0.56; 95% CI: 0.32-0.97). Our study found a reasonably good level of acceptance of the HPV vaccine among the parents of eligible daughters. Multiple factors such as younger age, urban residence, belonging to the middle income group, history of regular routine health check-ups, knowledge of cervical cancer, positive perception about benefits of the vaccine, and positive cues to actions were associated with HPV vaccine acceptance.