Candidates For Surgery Research Articles

Determination of Allogeneic Transfusion after Injection of Injectable Iron in Patient's Candidates for Intertrochanteric Fracture Surgery

Background: The purpose of this study is to investigate the rate of allogeneic transfusion after the administration of intravenous iron in patients who are candidates for intertrochanteric fracture surgery. Methods: Patients who were candidates for intertrochanteric surgery referred to the orthopedic surgery and trauma department of Shahada Tajrish Hospital were included in the study after providing full explanations and obtaining written consent. The 80 patients were randomly divided into control group (No: 40) and intervention (No: 40). Patients in the intervention group were prescribed 600 mg of Venofer drug by ViforCo. This is while patients in the control group were not injected with Venofer before surgery. The results were evaluated using t-test and SPSS21 software. Results: Based on the results, the 1 hour after surgery, three indicators of systolic blood pressure, pulse rate, breathing rate, RBC showed a significant decrease in patients undergoing intervention (P<0.05). However, the oxygenation index showed a significant increase in the patients of this group (P>0.05). Meanwhile, in the period of 1 week after the surgery, we also see a significant decrease in the two indices of average hemoglobin and PTT time in the mentioned patients compared to the control subjects (P=0.030, P=0.037). The amount of blood consumed significantly lower in the patients of the intervention group than in the control group. Conclusion: The administration of injectable iron in patients with intertrochanteric fracture surgery candidates can improve some of the patients' clinical indicators in addition to a significant reduction in allogeneic blood transfusion

Enhancing the outcomes of bariatric surgery with inhibitory control training, electrical brain stimulation and psychosocial aftercare: a pilot study protocol

BackgroundNotwithstanding the documented short- and long-term weight loss and remission of physical and mental diseases following bariatric surgery, a significant proportion of patients fail to respond (fully) to treatment in terms of physical and mental health improvement. Mounting evidence links food-specific impulsivity, prefrontal cortex (PFC) hypoactivity and disrupted hormone secretion in bariatric surgery candidates to poorer post-surgical health outcomes. Neuromodulatory treatments like transcranial direct current stimulation (tDCS) uniquely target these neurobehavioral impairments. We present a pilot study protocol offering tDCS combined with an inhibitory control training and a structured psychosocial intervention to patients after bariatric surgery.MethodsA total of N = 20 patients are randomized to 6 sessions of verum or sham tDCS over the PFC, combined with an individualized food-specific inhibitory control training and a structured psychosocial intervention within 18 months after bariatric surgery (t0). Beyond acceptability, feasibility and satisfaction of the intervention, effects of verum versus sham tDCS on food-specific impulsivity and on secondary outcomes quality of life, general impulsivity and psychopathology, food-related cravings, eating disorder psychopathology, weight trajectory and endocrine markers are assessed 4 weeks (t1) and 3 months after the intervention (t2).DiscussionResults will provide information on the potential of combining tDCS with an inhibitory control training and a structured psychosocial intervention to enhance physical and mental outcomes after bariatric surgery. The present study may guide the development of future research with regard to tDCS as a brain-based intervention and of future post-surgical clinical programs, paving the way for randomized-controlled trials in larger samples.Trial registrationThe trial was prospectively registered on July 8, 2024, under the registration number DRKS00034620 in the German Clinical Trials Register (https://drks.de/search/de/trial/DRKS00034620).

Levator Veli Palatini Muscle Ratio Is a Clinically Significant Anatomic Predictor for Velopharyngeal Surgical Need.

Velopharyngeal insufficiency (VPI) poses challenges for normal speech production, often necessitating surgical intervention. Determining optimal candidates for surgery remains complex and requires a nuanced understanding of underlying anatomic factors contributing to VPI. This study aimed to identify anatomic predictors that drive surgical recommendations for VPI. Prospective observational cohort study. Pediatric tertiary care hospital. Magnetic resonance imaging data were acquired from 150 children (aged 4-17) to identify anatomic predictors of VPI and surgical need. Fourteen velopharyngeal variables were measured in the oblique coronal and midsagittal imaging planes. Calculations included differences in levator veli palatini (LVP) muscle angles of origin, mean extravelar length, differences between left and right extravelar segments, the VP Needs ratio, and a newly developed LVP ratio. Multivariate logistic regression models with k-fold cross validation were utilized to identify anatomic profiles predictive of VPI and receiving a surgical recommendation. The models demonstrated high accuracy, sensitivity, and specificity. Among anatomic variables, the LVP ratio emerged as the strongest determinant of surgical need (β = 11.256, p < .001). Notably, an increase in the LVP ratio of 0.10 is associated with a 3.08-fold increase in the likelihood of receiving a surgical recommendation. LVP ratios above 1.0 were significant for both VPI classification and surgical need. The LVP ratio significantly differentiates individuals with VPI and is predictive of surgical need for VPI management. Inclusion of the LVP ratio into clinical evaluations may refine patient stratification, enabling more precise surgical decision-making tailored to individual anatomic variations.

Analysis of Online Crowdfunding Among Patients Pursuing Metabolic and Bariatric Surgery in the United States.

Use of online crowdfunding to mitigate health-related cost burden is common in the US, but its usage among candidates for metabolic and bariatric surgery (MBS) is unknown. We aimed to identify GoFundMe campaigns fundraising for MBS and characterize sources of financial strain. We also aimed to determine factors associated with successful crowdfunding. We searched GoFundMe for campaigns fundraising for MBS. Data items were extracted by two investigators with disagreements resolved by a third. We assessed associations between these data items and category of money raised using ordered logistic regression. We identified 539 campaigns, of which 33.6% were raising funds for sleeve gastrectomy, 24.1% for Roux-en-Y gastric bypass, and 2.0% for biliopancreatic diversion with duodenal switch. Most campaigns were created by the patient (73.1%) who had health insurance (53.4%) and at least one obesity-associated disease (56.8%). Over half (53.6%) sought funds for a direct medical expense and 35.1% sought funds for a non-medical expense, which included lost wages (15.6%), food (10.8%), transportation (10.2%), childcare (7.1%), and/or housing (5.8%). The median requested was $8000 (IQR 10,440) and the median raised was $860 (IQR 3173). The majority (63.1%) of campaigns earned less than 25% of their requested amount. Campaigns that shared mental health-related disease (aOR 0.55, 95% CI 0.32-0.95) and non-surgical attempts to lose weight (aOR 0.59, 95% CI 0.37-0.94) had lower odds of raising a higher category of money compared to campaigns not disclosing these details. Patients pursuing MBS in the US use online crowdfunding to subsidize both medical and non-medical expenses, but the majority of campaigns are unsuccessful. Our study highlights unmet financial need among MBS candidates.

Modern possibilities of minimally invasive biliary drainage techniques for patients with malignant jaundice

Malignant biliary obstruction is a complex condition requiring a multimodal approach for both diagnosis and treatment. Most patients diagnosed with this disease are not candidates for radical surgery, as they come to us at advanced stages of the disease. Therefore, they need quality palliative care. Aim. Based on the data from scientific articles and literature, to highlight the possibilities of minimally invasive biliary drainage techniques in patients with malignant jaundice. The article analyzes the available sources of scientific literature and articles from the electronic resources PubMed, Google Scholar, UpToDate from 2019 to 2024. Minimally invasive methods of biliary drainage have demonstrated significant advantages over open surgeries, including a reduced risk of surgical complications, shorter rehabilitation period, and the ability to perform the procedure under local anesthesia. However, despite technological progress and accumulated clinical experience, a number of unresolved issues remain, in particular, related to choosing the optimal drainage method for a particular patient, and assessing the effectiveness and safety of a specific technique. Conclusions. The most controversial issue is the choice between endoscopic and percutaneous drainage methods. Some studies have shown that endoscopic drainage might be more effective in patients with tumors located in the distal bile ducts, while percutaneous drainage might be more appropriate in case of proximal obstructions. Therefore, the situation calls for additional studies to evaluate long-term results of different drainage techniques and the effectiveness of plastic, covered and uncovered metal stents in different clinical situations.

Computed Tomography Scan and Clinical-based Complete Response Prediction in Locally Advanced Rectal Cancer after Neoadjuvant Chemoradiotherapy: A Machine Learning Approach

Abstract Background: Treatment of locally advanced rectal cancer (LARC) involves neoadjuvant chemoradiotherapy (nCRT), followed by total mesorectal excision. Examining the response to treatment is one of the most important factors in the follow-up of patients; therefore, in this study, radiomics patterns derived from pretreatment computed tomography images in rectal cancer and its relationship with treatment response measurement criteria have been investigated. Methods: Fifty patients with rectal adenocarcinoma who were candidates for nCRT and surgery were included. The information obtained from the tumor surgical pathology report, including pathological T and N, the degree of tumor differentiation, lymphovascular invasion, and perineural invasion along with radiomics characteristics to each patient, was assessed. Modeling with disturbed forest model was used for radiomics data. For other variables, Shapiro–Wilk, Chi-Square, and Pearson Chi-square tests were used. Results: The participants of this study were 50 patients (23 males [46%] and 27 females [54%]). There was no significant difference in the rate of response to neoadjuvant treatment in between age and gender groups. According to the modeling based on combined clinical and radiomics data together, area under the curves for the nonresponders and complete respond group (responder group) was 0.97 and 0.99, respectively. Conclusion: Random forests modeling based on combined radiomics and clinical characteristics of the pretreatment tumor images has the ability to predict the response or non-response to neoadjuvant treatment in LARC to an acceptable extent.

Extended pelvic evisceration with lateral wall resection in malignant tumors

Patients with tumor involvement of lateral pelvic sidewall represent a peculiar category and were not assessed as the candidates for curative surgery up until recent years. The aim of the current review of literature is to display the working results of the most experienced surgical oncologists in pelvic surgery. We have analyzed issue-related articles, which were published from 1967 till 2023, considering the free margin status as a key prognostic factor. It is elucidated that R0 resection could be achieved in more than a half cases, 5 year overall survival ran up to 50 %, and postoperative mortality was less than 7 %. The majority of authors described high morbidity though (up to 82 %). Exenteration with laterally extended endopelvic resection could improve overall survival rate in patients with locally advanced pelvic malignancies granting sensible patient selection in expert medical care unit.

2024 critical review of the patient blood management (PBM) recommendations of the Spanish enhanced recovery after major surgery (via RICA)

The Spanish enhanced recovery in adult surgery strategy, the “RICA pathway”, was published in 2021 and includes 19 specific recommendations and more than 20 indirect recommendations for patient blood management (PBM).After reviewing these recommendations, and in the context of the new clinical evidence available, we propose the following updates:First: Detection and treatment of any preoperative anemia status in ALL patients who are candidates for major surgery with hematinic deficiencies.Second: Universal use of tranexamic acid in major surgery, bedside monitoring of intraoperative hemoglobin levels, restrictive transfusion criteria, and monitoring of patient well-being in terms of hydration, coagulability, normothermia and analgesia.Third: Restrictive transfusion criteria, single-unit blood transfusion and diagnosis/treatment of postoperative anemia.Real, universal implementation and integration of PBM in the RICA program is urgently needed.

Comparison of infusion of dexmedetomedine and magnesium sulfate on the stability of hemodynamic status during emergency orthopedic surgery: a randomized double-blind clinical trial

Objective: Preparing patients for emergency surgeries requires accurate consideration of their clinical condition and medical history to avoid potential hemodynamic instability and compromise the immune system. This study aims to compare the effects of dexmedetomidine and magnesium sulfate infusions in maintaining stable hemodynamics during emergency orthopedic surgery. Methods: The present study was conducted as a randomized and double-blind clinical trial with the participation of 80 patients who were candidates for an emergency orthopedic surgery during 2021. Magnesium sulfate was administered as an intravenous bolus at a loading dose of 50 mg/kg over 10 minutes, followed by a continuous infusion at a rate of 15-20 mg/kg/hour. Dexmedetomidine was administered as an intravenous bolus at a loading dose of 1 mcg/kg over 10 minutes, followed by a continuous infusion at a rate of 0.2-0.7 mcg/kg/hour, depending on patient response. These infusions were initiated 15 minutes before induction of anesthesia and continued until the end of surgery. All drugs (dexmedetomidine and magnesium sulfate) were diluted in a 50-cc syringe and infused. The hemodynamic status (diastolic blood pressure (DBP), systolic blood pressure (SBP) mean arterial pressure (MAP) and heart rate (HR)) of the patients between the two groups was recorded and finally compared with each other. Results: The hemodynamic status (DBP, SBP, MAP and HR) between the two groups at all (perioperative time) times were without significant statistical differences (P&gt;0.05). Conclusion: Both dexmedetomidine and magnesium sulfate are effective and safe options for achieving hemodynamic stability during emergency orthopedic surgery.

Differential correlations of refractive error, axial length, and axial length-to-corneal curvature ratio with anterior segment biometrics in myopic refractive surgery candidates

PurposeTo investigate the correlations of spherical equivalent (SE), axial length (AL), and AL to corneal curvature radius ratio (AL/CR) with anterior segment biometrics in candidates for myopic refractive surgery. MethodsAnterior segment biometrics of 2,478 myopic refractive surgery candidates measured by Pentacam were collected retrospectively. The anterior segment biometrics included anterior corneal curvature (ACC), posterior corneal curvature (PCC), white-to-white corneal diameter (WTW), central corneal thickness (CCT), corneal volume at 3 mm (CV), anterior corneal astigmatism (ACA), posterior corneal astigmatism (PCA), anterior corneal eccentricity (ACE), posterior corneal eccentricity (PCE), anterior corneal asphericity (ACAP), posterior corneal asphericity (PCAP), anterior chamber depth (ACD), and anterior chamber volume (ACV). The eyes were divided into four groups according to the AL: group 1, AL≤24 mm; group 2, 24mm<AL≤26 mm; group 3, 26mm<AL≤28 mm; group 4, AL≥28mm. The correlations between these biometrics with SE, AL, and AL/CR were assessed by Pearson or Spearman correlation tests. A correlation with a coefficient ≥0.3 and a p value <0.05 were considered significant. ResultsIn all AL groups, ACC was positively correlated with SE (r = 0.446 to 0.620) and negatively correlated with AL/CR (r = -0.704 to -0.894), whereas PCC was positively correlated with SE (r = 0.394 to 0.612) and negatively correlated with AL/CR (r = -0.606 to -0.787). WTW was positively correlated with SE (r = 0.304 to 0.474) in every group, and negatively correlated with AL/CR (r = -0.405 and -0.412) in group 1 and 4. ACA was positively correlated with AL (r = 0.310) and AL/CR (r = -0.333) in group 4. ACD was negatively correlated with AL (r = -0.304) in group 4, and positively correlated with AL/CR (r = -0.325) in group 2. ACV was positively correlated with SE (r = 0.344) in group 4, and positively correlated with AL (r = 0.303) in group 2. CCT, CV, PCA, ACE, PCE, ACAP, and PCAP was not significantly correlated with SE, AL, or AL/CR in any of group. ConclusionsDifferential correlations were observed between anterior segment biometrics and SE, AL, and AL/CR, suggesting that various myopia indicators have different effects on ocular structures. These findings may help identify the ocular structures that can be targeted of refractive surgery.

In Vivo Study of Organ and Tissue Stability According to the Types of Bioresorbable Bone Screws.

Biodegradable material, such as magnesium alloy or polylactic acid (PLA), is a promising candidate for orthopedic surgery. The alloying of metals and the addition of rare earths to increase mechanical strength are still questionable in terms of biosafety as absorbent materials. Therefore, the purpose of this study is to understand the effect of substances due to the degradation of various biodegradable substances on organs in the body or surrounding tissues. A total of eighty male Sprague-Dawley rats were selected for this study, and the animals were divided into four groups. Each of the three experimental groups was implanted with magnesium alloy, polymer, and titanium implants; the control group only drilled into the cortical bone. Serum assay, micro-CT, hematoxylin and eosin staining, immunoblotting, and real-time PCR were evaluated. There was no significant difference between the two groups of magnesium alloy and polymer in serum assay, but micro-CT analysis confirmed that magnesium alloy degrades faster than polymer, and histological examination showed a strong inflammatory response in the early stages, which was similarly observed in immunoblotting and real-time PCR. Our findings show that there was no toxicity due to the degradation of the biodegradable material, and the difference in each inflammatory response is thought to be determined by the rate of degradation in the body.

Laparotomy Versus Laparoscopy Cholecystectomy for Surgical Treatment in Patients with Gallstone Disease: A Comparative Cost-Effectiveness Analysis

Background: Due to the increasing costs of the healthcare system and limited financial resources, healthcare policymakers should adopt more cost-effective strategies. Objectives: This study aimed to compare the cost-effectiveness of laparotomy cholecystectomy with laparoscopy. Methods: This economic evaluation was conducted on patients with cholecystitis who were candidates for surgery in a private hospital in Ahvaz in 2021. Data collection tools consisted of four parts: (1) demographic information checklist; (2) clinical information checklist; (3) cost checklist; and (4) effectiveness assessment tool. SPSS22 and STATA14.2 were used for data analysis. One-way sensitivity analysis and Tornado diagrams were performed using Tree Age software. Results: The mean total effectiveness score in patients treated with laparoscopy was 83.44 (SD = 11.34), which was higher than those treated with laparotomy at 68.39 (SD = 13.61). This difference was statistically significant in all effectiveness criteria, except for postoperative infection rates and length of operation (P &lt; 0.001). The mean cost for patients undergoing laparoscopy was significantly higher than for those undergoing laparotomy ($481.43 vs. $459.49). However, overall, laparoscopic treatment (5.77) was more cost-effective than laparotomy (6.71). The laparoscopic procedure was approximately $1.47 per effectiveness unit cheaper than laparotomy, according to the ICER. One-way sensitivity analysis showed that the laparoscopic method remained more cost-effective, even when adjusting for cost and effectiveness components. Conclusions: Although laparoscopic cholecystectomy was more expensive than laparotomy cholecystectomy, it was generally more cost- effective. The results of this research may assist Iran’s healthcare policymakers and managers in promoting laparoscopic cholecystectomy in hospitals.

Assessing spatial memory using the Brown Location Test: Lateralizing seizures in a presurgical cohort of patients with temporal lobe epilepsy

ObjectiveWhilst the dominant temporal lobe has a well-established role in memory, the functions of its nondominant counterpart remain enigmatic. We compared the lateralizing ability of a promising spatial memory task (Brown Location Test, BLT) to other commonly used verbal and visual memory tasks in a sample of patients with unilateral temporal lobe epilepsy (TLE). MethodsNeuropsychological data from 48 TLE patients (right n = 28 and left n = 20) were compared on several verbal and nonverbal memory tasks. Univariate logistic regression analyses were used to examine the relationship between test scores and the odds of being categorised as right or left TLE, while multivariable logistic regression and decision tree analyses were used to establish the optimal combination of cognitive measures for lateralizing the epileptogenic zone (EZ). ResultsRelative to normative expectations, the right TLE group was specifically impaired on BLT measures, whereas the left TLE group was impaired on verbal and nonverbal memory tasks. The combination of BLT Delayed Recall and Delayed Recall on the Rey Auditory Verbal Learning Task (RAVLT) was identified as optimal for correctly predicting EZ laterality (AUC = 0.79). These two variables were also optimal predictors in the decision tree analysis, correctly predicting 79% of the overall sample (AUC = 0.83). ConclusionsOur findings support the BLT as a measure of right temporal lobe function. They demonstrate its superior sensitivity compared to another commonly used nonverbal memory test (i.e., Visual Reproduction; VR) and highlight the added lateralizing value of combining both verbal and nonverbal memory measures in the neuropsychological evaluation of epilepsy surgery candidates.

BS O05 - Prevalence and Patterns of Iron Deficiency in Patients Living with Obesity: Insights from Bariatric Surgery Candidates

Abstract Background Iron deficiency anaemia (IDA) is a recognised complication of obesity, and its associated co-morbidities. Iron deficiency has been implicated in immunologic dysfunction in obesity. However, the patterns of iron deficiency in people with obesity, independent of IDA, and its implications for patients with obesity remain unclear. This study aimed to investigate potential causes of iron deficiency, including relationship with glycaemic control and relationship with systemic inflammation. Relationship between iron deficiency and body mass index (BMI) was also considered. Method A retrospective review of a prospectively maintained database of consecutive patients undergoing bariatric surgery was performed. Pre-operative haematologic assessments were reviewed, and linear regression models were used to identify the associations of iron deficiency in patients with obesity. Statistical analysis was performed using SPSS. 384 consecutive patients over a 2-year time period were included in the analysis. 72.1% of patients were female and the mean age was 49.44±10.2. The mean weight of included patients was 144.1±31.02 kg, and the mean BMI was 50.66±9.61 kg/m2 Results ​2.45% of patients met the criteria for iron deficiency anaemia. However, 15.49 % had low serum iron(&amp;lt;9 mmol/L), 12.1% had low ferritin(&amp;lt;30mg/L), 1.38% had low transferrin(&amp;lt;2g/L), 15.17% had high Total Iron Binding Capacity(&amp;gt;71.6mmol/L), 37.93% had low transferrin saturation(&amp;lt;20%). High BMI was a significant predictor of low serum iron(β=-0.206, p=0.031). Dysregulated glycaemic metabolism(HbA1c and glucose) was not a significant predictor of iron deficiency. Baseline inflammation (elevated CRP) was associated with low serum iron(β=-0.320, p=&amp;lt;0.001) and low transferrin(β=-0.205, p=0.028). Conclusion Iron deficiency in patients with obesity is common, but not iron deficiency anaemia dependent. It does not appear to be linked to patients’ glycaemic regulation, as previously thought. Our findings suggest it may instead be attributable to the systemic inflammation caused by obesity.

SURG-09. IMPACT OF RESPONSIVE NEUROSTIMULATION IN PATIENTS WITH MESIAL TEMPORAL EPILEPSY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract BACKGROUND Brain-responsive neurostimulation, known as the RNS therapy, proves to be a safe and effective adjuvant therapy in decreasing seizure frequency among medically refractory adults with partial-onset seizures who are either seizure-prone post-surgery or are not eligible candidates for surgery. Nevertheless, previous publications have not presented outcomes specifically on subjects with Mesial temporal lobe epilepsy (MTLE). This meta-analysis aims to evaluate the effectiveness of RNS therapy in patients with medically refractory MTLE. METHODS A comprehensive search was conducted across the PubMed, Cochrane, and Scopus databases for studies evaluating the impact of RNS on seizure frequency in patients with mesial temporal epilepsy. Relevant studies published up to March 2024 were included. The statistical analysis assessed the mean seizure reduction, responder rate, and seizure freedom. RESULTS We applied a random-effects model to data from 7 cohort studies with 207 patients, which revealed a significant mean reduction in seizures among individuals who received RNS therapy (68.76%, 95%CI=57.16-80.37%, p-value&amp;lt;0.01). A sub-analysis of 5 studies involving 164 patients demonstrated a substantial response rate (67%, 95%CI= 47-88%, p-value&amp;lt;0.01). Furthermore, an analysis of 4 studies comprising 154 patients indicated a considerable proportion of patients achieved seizure freedom after treatment (Proportion=0.29, 95%CI=0.03-0.55, p-value=0.03). Notably, there was moderate to high heterogeneity across the studies. CONCLUSION This single-arm meta-analysis demonstrates that responsive neurostimulation could be an effective therapeutic option for patients with MTLE, significantly reducing seizure frequency and a high proportion of patients achieving seizure freedom. Further research, including randomized controlled trials with control groups, larger sample sizes, and longer follow-up periods, is warranted to validate these results and optimize patient outcomes. Keywords: neurostimulation; mesial temporal epilepsy; systematic review; meta-analysis.

Nutritional status of Saudi obese patients undergoing laparoscopic sleeve gastrectomy, one-year follow-up study.

Bariatric surgery has significantly increased globally as an effective treatment for severe obesity. Nutritional deficits are common among candidates for bariatric surgery, and follow-up of nutritional status is critically needed for post-surgery healthcare management. This observational prospective study was conducted at King Khalid University Hospital in Riyadh. Samples were collected pre- and post-laparoscopic sleeve gastrectomy (LSG), with the visit intervals divided into four visits: pre-surgery (0M), 3 months (3M), 6 months (6M) and 12 months (12M). Food intake and eating patterns significantly changed during the first year (P < 0·001). The mean energy intake at 3M post-surgery was 738·3 kcal, significantly lower than the pre-surgery energy intake of 2059 kcal. Then, it increased gradually at 6M and 12M to reach 1069 kcal (P < 0·00). The intake of Fe, vitamin B12 and vitamin D was below the dietary reference intake recommendations, as indicated by the 24-hour dietary recall. The prevalence of 25 (OH) vitamin D deficiency improved significantly from pre- to post-surgery (P < 0·001). Vitamin B12 deficiency was less reported pre-LSG and improved steadily towards a sufficient post-surgery status. However, 35·7 % of participants were deficient in Fe status, with 28·6% being female at higher levels than males. While protein supplementation decreased significantly over the 12M follow-up, the use of vitamin supplements dramatically increased at 3 and 6M before declining at 12M. Fe and vitamin B12 were the most popular supplements after vitamin D. This study confirms the necessity for individualised dietary plans and close monitoring of candidates' nutritional status before and after bariatric surgery.

The Complications after General Anesthesia between Female and Male Genders in the First 24 Hours after Surgery

Background During surgery, the body responds to injury. These physiological responses lead to an imbalance in the physiologic activity of the body. Objective This study aimed to compare the incidence of complications after general anesthesia between males and females in the first 24 hours postoperatively. Methods This is a cross-sectional study. The study population included 150 patients who were candidates for surgery in the age range of 18-55. The sampling method was simple and sequential, and the selection of samples continued to reach 75 in both male and female groups. The collected data were analyzed by SPSS v.18 software and descriptive statistics, chi-square and Repeated Measure tests. Finally, P &lt;0.05 was considered statistically significant. Results The incidence of some complications after general anesthesia was significantly higher in women than in men, including hypertension, tachycardia, tachypnea, restlessness, reduction of SaO2, hypotension, pain, vomiting, nausea, and drowsiness. Also, some complications were observed in women more than men, but they were not statistically significant, including voice violence, urinary retention, bradypnea, and shivering. Bradycardia was the only complication that was seen in men more than women but was not statistically significant. It was also observed that all complications after 24 hours significantly decreased in all patients. Conclusion It is suggested that in future studies, this type of study should be conducted with a larger sample size in different populations and compared with other types of anesthetics.

Smaller is better? Compact vs. Conventional gamma camera for sentinel lymph node localization in patients with breast cancer.

Sentinel lymph node biopsy (SLNB) has been recognized as "the gold standard" for axillary staging in early breast cancer patients with clinically negative lymph nodes, resulting in significant morbidity decrease and quality of life improvement. This study aims to validate the performance of a newly developed handheld portable gamma camera (PGC) produced by Imagensys (Italy), in detecting and locating sentinel lymph nodes (SLNs) during the preoperative and intraoperative phases in breast cancer patients compared to conventional lymphoscintigraphy. Adult female patients with histologically confirmed breast cancer, candidates for surgery and SLNB, were prospectively enrolled in this open-label, pre-marketing clinical trial. All patients underwent pre- operative assessment using both the PGC and conventional lymphoscintigraphy. The performance of the two devices was compared using the Poisson regression model for incidence rate ratios (IRRs). The intrinsic sensitivity of the devices was compared using the Wilcoxon Ranked Sign Test. The utility of PGC during intra-operative procedures was also evaluated. The manoeuvrability of the devices was evaluated using operator-satisfaction questioner. Sixty-eight patients (median age 50 years, BMI 21.4) were enrolled, including two patients with bilateral breast cancer, who underwent SLNB on both axillae. The PGC demonstrated superior preoperative lymph node detection rate (IRR 8.01, 95% CI 6.11-10.50; p < 0.0001) and intrinsic device sensitivity (mean counts per second 409 ± 286 vs. 255 ± 1173 for conventional device, p = 0.0003) compared to the conventional gamma camera. Intra-operative assessment with PGC was performed in 62 patients and no additional lymph nodes were visualised. However, the conventional gamma camera demonstrated superior manoeuvrability (p < 0.0001). The PGC handheld gamma camera showed promising results for preoperative SLN assessment in patients with breast cancer. The limited manoeuvrability may be related to the operator's experience leading to higher inter-operator variability. Appropriate training and frequent use of nuclear medicine and surgical equipment could overcome this limitation.

PSYCHOSOCIAL FACTORS AND CURRENT PRACTICES IN THE PSYCHOLOGICAL ASSESSMENT PROCESS FOR BARIATRIC SURGERY: A literature review

The psychological evaluation for bariatric surgery is mandatory, and its conduction by the psychologist must adhere to professional principles and guidelines, as well as specific legislation. Therefore, the study aimed to investigate the process of psychological evaluation for bariatric surgery and, additionally, to identify the psychological factors assessed and the instruments used in the process. This is a bibliographic research with data collection conducted between September and October 2023, in electronic databases such as Lilacs, Scielo, PubMed, and Pepsic, including full-text, open-access scientific articles published from 2018 to 2023. A total of 119 articles were found, of which 14 were selected for analysis. As a result, four categories were identified regarding psychological evaluation in bariatric surgery: 1) Importance of evaluation: involves expectations, support network, stress, and mental health; 2) Relevant psychosocial factors: such as social support and lifestyle; 3) Resources used: tools like BDI–II, BAI, ECAP, BAROS, EFS, IDATE, and LIS-A to assess emotional and cognitive aspects; 4) Challenges: highlight the complexity and the need for a multidisciplinary approach. Difficulties faced by psychologists in conducting these evaluations were also identified, requiring well-structured strategies and practices. Based on these findings, it is crucial that the responsible bodies—such as the Federal Council of Psychology—coordinate efforts, as the implementation of specific documents benefits psychologists and candidates for bariatric surgery by providing clear guidelines and standardizing procedures, making the professional practice more precise, safe, and accessible.

081. Radiofrequency Ablation for Retrosternal Thyroid Tumour: A Rare Case Report

Background: Retrosternal thyroid tumours, though uncommon, present complex diagnostic and therapeutic challenges due to their location behind the sternum. These tumours can cause significant symptoms, such as difficulty breathing and chest pressure, which can impact patient quality of life. Radiofrequency ablation (RFA) has emerged as a minimally invasive treatment option, offering potential benefits over conventional surgical methods for retrosternal thyroid tumor. Case: A 54-year-old male with a history of right thyroid isthmolobectomy presented with a rapidly growing left-sided neck mass, causing increasing chest pressure and shortness of breath. Imaging studies, including ultrasound and CT scans, revealed a large tumour extending retrosternally and compressing the trachea. The patient opted for RFA over surgery. A core biopsy confirmed a benign struma adenomatosa. RFA was performed using the moving shoot technique, resulting in effective tumor ablation. Follow-up imaging showed a significant reduction in tumor size and symptom relief. Conclusion: This case demonstrates that RFA is a safe and effective alternative to conventional surgery for retrosternal thyroid tumours. It provides substantial symptom relief and tumour reduction with fewer complications. RFA should be considered a valuable treatment option for patients who are not ideal candidates for surgery or who prefer less invasive approaches. Continued research and long-term studies are needed to confirm its broader efficacy.