Recent randomized controlled trials (RCTs) challenge the routine practice of keeping patients NPO ("nil per os") after midnight before diagnostic cardiac catheterization. Shorter fasting durations improve patient experience without increasing risks; however, systematic uptake into routine practice remains limited. At a high-volume cardiac care centre, patients were still being required to fast from midnight, despite emerging evidence. To assess the feasibility of shifting long‑standing practice patterns, we established a >70% adherence target for uptake of a shortened fasting protocol. A structured quality improvement initiative using sequential Plan-Do-Study-Act (PDSA) cycles modified pre-procedural fasting protocols to permit a light meal up to 2 hours before cardiac catheterization and clear fluids until the procedure (i.e., intervention). Patient experience surveys were administered to intervention and control groups in 2 PDSA cycles, followed by a post-implementation intervention group. The primary outcome was adherence to shortened fasting protocols (>70% target). Secondary outcomes included patient comfort, satisfaction, safety events, and sustained uptake. Cycle 1 included 97 outpatients (37 control, 60 intervention), cycle 2 included 84 inpatients (40 control, 44 intervention), and 45 patients were in the post-implementation group. Target adherence was met (77% in cycle 1, 82% in cycle 2, and 79% at post-implementation). Patients in the intervention groups reported lower hunger (cycle 1 outpatients) and lower nausea (cycle 2 inpatients), while satisfaction scores remained consistently high across all groups. No aspiration, intubation, or escalation to higher-level care was observed. Shortening fasting requirements to 2 hours before cardiac catheterization was feasible to implement in a high‑volume cardiac centre.

Recovery centered perinatal care: A retrospective cohort study evaluating a scalable prenatal care model to improve outcomes for birthing people with opioid use disorder and their newborns.

Impact of firework restrictions on emergency plastic surgery cases: A five-year comparison of restricted vs. non-restricted New Year's Days and Easter Sunday (2021-2025).

A two-stage PDS sheet repair technique for extremely wide cleft palates; A review from two UK regional cleft centres.

Early childhood education and care (ECEC) centres are an ideal setting to promote key healthy eating and active living (HEAL) practices. Redesigning messages around such practices to be digital could help engage ECEC educators and assist with long-term implementation and reach. The aim of this study was to evaluate the potential impact of a HEAL-focused video initiative (Small Bites for Big Steps) on precursors to behaviour change including educators' self-efficacy, perceived behavioural control and behavioural intentions and the acceptability of the videos. A pilot randomised controlled trial was conducted with early childhood educators (56% aged 25-44 years, 98% female). Participants randomised to the intervention group received on average 3-4 weekly videos promoting HEAL practices, whilst participants in the control group maintained usual practice. Educators' self-efficacy, perceived behavioural control, and behavioural intention were assessed using questionnaires at baseline and post-intervention (9 weeks). Data were analysed using Mann Whitney U tests in SPSS and thematic analysis. Acceptability data were collected using questionnaires, focus groups, interviews, and Vimeo analytics. One hundred and six educators from 16 ECEC services were recruited. Exploratory efficacy analysis found significant improvements from baseline to post-intervention between groups for healthy eating/drinking perceived behavioural control. At post-intervention, there was a significant difference between intervention and control groups for healthy eating/drinking behavioural intention, physical activity behavioural intention, and overall behavioural intention. No significant between group differences were observed for changes in perceived behavioural control relating to physical activity or for any self-efficacy measures. Educators valued the content, length and approach of the videos. Limitations identified from the qualitative data included technical difficulties and cultural appropriateness. This video-based intervention positively influenced educators' perceived behavioural control and behavioural intentions, key precursors to behaviour change. The video suite was acceptable to educators. SO WHAT?: Redesigning HEAL messages into video resources may support ECEC educators to promote and implement these practices to young children and their families/carers.

The online version contains supplementary material available at 10.1007/s12288-025-02137-1.

Despite the high prevalence of tuberculosis (TB) in developing countries, tubercular reactivation or new infections are rarely observed in patients with acute leukemia or after hematopoietic stem cell transplant (HSCT). We describe 9 pediatric oncology or post-HSCT patients with TB. The median age was 9 years (range: 1 to 15y). All leukemia patients (n=8) developed TB during or immediately after induction chemotherapy. The most common symptoms were fever and cough. Co-infection with other microorganisms was observed in 6 cases. Management included first-line antitubercular therapy (ATT) for 4 cases and second-line ATT for 5 patients, with a switch back to first-line ATT as soon as possible. ATT-induced hepatitis was observed in 3 cases. Tuberculosis led to chemotherapy treatment interruption in all cases, with a median duration of 16 days (range: 7 to 28d). All children responded well to ATT, with defervescence, resolution of effusion, resolution of cough, and radiologic improvement. The study highlights the clinical mimics, diagnostic difficulties, and treatment-related challenges with modifications needed for both TB and cancer when they occur together.

Elective pediatric upper airway procedures are generally safe; however, some patients require unplanned pediatric intensive care unit admission, increasing care complexity. To identify perioperative risk factors associated with unplanned pediatric intensive care unit admission following elective pediatric upper airway surgery. We performed a retrospective case-control study at a single tertiary care center, identifying all unplanned pediatric intensive care unit admissions between January 2017 and June 2022. Among 151 such admissions, 29 followed elective upper airway surgery; of these, 22 cases were successfully matched on procedure type, age, and date of surgery in a 1:2 ratio to controls without unplanned pediatric intensive care unit admission based on procedure type, age, and date of surgery. Demographic, clinical, and perioperative variables were compared between cases and controls. The unplanned pediatric intensive care unit admission (n = 22) and control (n = 44) groups were comparable with respect to age and weight; however, median apnea-hypopnea index was higher in the unplanned pediatric intensive care unit cohort (12.7 [IQR 7.9-33.7] vs. 6.6 [IQR 3.7-25.2] events/h; p = 0.033). In unadjusted conditional logistic regression analyses, American Society of Anesthesiologists physical status > 2 was associated with increased odds of unplanned pediatric intensive care unit admission (OR 7.92, 95% CI 2.25-27.92; p = 0.001), as were prior neonatal intensive care unit admission (OR 23.19, 95% CI 3.03-177.38; p = 0.003), chronic lung disease (OR 14.00, 95% CI 1.72-113.79; p = 0.014), and longer operative duration (OR 1.03 per minute, 95% CI 1.003-1.058; p = 0.032). Apnea-hypopnea index, analyzed using multiple imputed values, was not significant (OR 1.03 per unit increase, 95% CI 0.996-1.069; p = 0.082). In a multivariable conditional logistic regression model, only prior neonatal intensive care unit admission remained independently associated with unplanned pediatric intensive care unit admission (adjusted OR 14.65, 95% CI 1.23-175.05; p = 0.034). Several clinical factors were seen to be associated with increased risk of unplanned pediatric intensive care unit admission after upper airway surgery including American Society of Anesthesiologists physical status > 2, chronic lung disease, prior neonatal intensive care unit admission, and longer operative duration. Controlling for these clinical factors, prior neonatal intensive care unit admission best predicted the need for unplanned pediatric intensive care unit admission. Recognition of these risk factors may help inform perioperative risk stratification and postoperative resource planning.

Commentary: Evolving trends in contact lens practice in India - Insights from a decade-long experience at a tertiary eye care center.

Alopecia areata (AA) is a chronic, immune-mediated disorder characterized by nonscarring hair loss. Emerging evidence suggests that AA is associated with systemic inflammation, metabolic dysregulation, and coagulation abnormalities. However, data on these associations in the Indian population remain limited. To evaluate coagulation parameters, metabolic profiles, and inflammatory markers in Indian patients with AA and assess their correlation with disease severity. A case-control study was conducted at a tertiary care center in North India, including 110 AA patients and 110 age- and sex-matched healthy controls. Coagulation parameters (D-dimer, fibrinogen, prothrombin time, and activated partial thromboplastin time), metabolic markers [fasting blood glucose, lipid profile, body mass index (BMI)], and inflammatory markers [C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)] were analyzed. Disease severity was assessed using the Severity of Alopecia Tool (SALT) score. Correlation and multivariate regression analyses were performed to identify predictors of severe AA. AA patients exhibited significantly elevated D-dimer ( P < 0.001) and fibrinogen levels ( P < 0.001) compared to controls, indicating a hypercoagulable state. The prothrombin time was also prolonged ( P = 0.03). Metabolic abnormalities, including higher fasting blood glucose ( P < 0.001) and total cholesterol ( P = 0.008), were observed. Inflammatory markers (CRP and ESR) were significantly elevated in AA patients. A strong positive correlation was found between SALT scores and D-dimer levels (r = 0.64, P < 0.001). Multivariate regression analysis identified D-dimer (95% CI: 1.58-4.20), fibrinogen (95% CI: 1.41-3.11), CRP (95% CI: 1.23-2.97), and BMI (95% CI: 1.18-2.46) as independent predictors of severe AA. Cross-sectional study design and lack of longitudinal follow-up. Indian AA patients exhibit significant coagulation abnormalities, metabolic dysregulation, and systemic inflammation, with these factors correlating with disease severity. These findings suggest that AA extends beyond a localized dermatological disorder and may have systemic implications. These associations imply a link rather than causality due to the cross-sectional nature of the study. Further research is warranted to explore the role of targeted therapies in mitigating these risks.

Annual Summative Feedback Letters are Associated With Improved End-of-Rotation Surgical Faculty Ratings.

Outcomes Following Definitive Chemoradiation in Locally Advanced Laryngeal and Hypopharyngeal Cancers: Experience From a Tertiary Care Centre.

The combined use of Veno-venous extracorporeal membrane oxygenation (VV-ECMO) and damage-control laparotomy/open abdomen (DCL/OA) is not well described in the literature. We hypothesized that the mortality with concurrent VV-ECMO and DCL/OA would not be statistically different from that reported for either intervention alone. Patients managed with a DCL/OA and VV-ECMO from March 2014 through March 2022 were retrospectively reviewed from a prospectively collected database at a single quaternary care center. The primary outcome was in-hospital mortality. Survivor and nonsurvivor cohorts were compared using univariate and bivariate analyses with a priori significance at p ≤ 0.05. A multivariable regression analyses was performed to identify independent predictors of mortality. Fifty-two patients were managed with VV-ECMO and concurrent DCL/OA. The majority of patients were male (58%), with a mean (SD) age of 41 (14) years. The primary indication for VV-ECMO was acute respiratory distress syndrome/pneumonia (83%). The primary indications for DCL/OA were abdominal compartment syndrome (37%) and trauma (19%). Sixty percent of the patients underwent VV-ECMO cannulation after DCL/OA. Survival at hospital discharge was 58%. Survivors had a lower mean Sequential Organ Failure Assessment score (12 vs. 14, p = 0.02), higher mean Respiratory ECMO Survival Prediction score (3.5 vs. 1.1, p = 0.004), lower mean preoperative lactic acid level (4 vs. 7, p = 0.04) and were more likely to receive anticoagulation while on VV-ECMO (70% vs. 30%, p = 0.012) than nonsurvivors. Postdischarge, survival rates at 3, 6, 9, and 12 months were 90%, 72%, 69%, and 62%, respectively. After adjusting for confounders, the use of anticoagulation (odds ratio, 0.08; 95% confidence interval, 0.01-0.42) and a higher Respiratory ECMO Survival Prediction score (odds ratio, 0.71; 95% confidence interval, 0.53-0.95) were associated with decreased mortality. Relatively favorable outcomes are often achieved in acute care surgery patients treated with concomitant VV-ECMO and DCL/OA. Veno-venous extracorporeal membrane oxygenation should not be considered a contraindication to DCL/OA and vice versa. ( J Trauma Acute Care Surg . 2026;101: 136-144. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). Retrospective Cohort Study; Level III.

Thalassemia is a heterogeneous group of inherited hemoglobin disorders broadly classified into transfusion-dependent thalassemia (TDT) and non-transfusion-dependent thalassemia (NTDT). Chronic transfusion therapy in TDT often leads to complications, including iron overload and alloimmunization. Thalidomide, known for its immunomodulatory and fetal hemoglobin (HbF)-inducing properties, has shown promise in improving hematologic parameters in thalassemia. This study aimed to evaluate the efficacy and safety of thalidomide in patients with TDT and NTDT. A prospective, non-randomized study was conducted over two years at a tertiary care center in Eastern India. A total of 61 patients (25 TDT and 36 NTDT), aged 2-50years, received thalidomide at 2-3mg/kg/day for 24weeks. Clinical and laboratory parameters, including hemoglobin levels, serum ferritin, HbF, organomegaly, and transfusion requirements, were assessed at baseline and post-treatment. Thalidomide therapy resulted in a significant rise in hemoglobin and HbF levels in both TDT and NTDT groups (p < 0.05). Serum ferritin levels, spleen and liver sizes, and transfusion needs were significantly reduced. By six months, 40% of TDT patients became transfusion-independent, while 80.5% of NTDT patients achieved a major hematologic response. Adverse effects were mild and included constipation, rash, and neutropenia. Thalidomide appears to be an effective and well-tolerated treatment in TDT and NTDT, offering benefits such as improved hemoglobin levels and reduced transfusion burden. Larger, randomized trials are warranted to confirm long-term safety and efficacy.

The global incidence of thyroid cancer has risen over recent decades, largely attributed to increased detection of thyroid nodules. This trend has raised concerns regarding overdiagnosis and overtreatment. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) plays a pivotal role in preoperative risk stratification, yet clinical decision-making remains challenging in indeterminate categories (Bethesda III-V), particularly in resource-limited settings where molecular testing is unavailable. To determine the risk of malignancy (ROM) for each TBSRTC category among patients who underwent thyroid surgery over a 10-year period at a tertiary care center in India, and to compare these rates with the 2023 TBSRTC risk estimates. This retrospective study analyzed fine-needle aspiration cytology and histopathology data for all patients who underwent thyroid surgeries conducted between 2014 and 2024. ROM across TBSRTC categories was calculated and compared with established TBSRTC risk estimates. A 100% malignancy rate was observed in TBSRTC VI category, supporting the reliability of surgical decisions in this group. However, significantly higher malignancy rates were found in TBSRTC categories III (58.7%), IV (82.7%), and V (100%) compared to TBSRTC estimates (22%, 30%, and 74%, respectively). TBSRTC III nuclear had a significantly higher malignancy rate (70.0%) than TBSRTC III other (40.57%). Institution specific malignancy data enhances the clinical utility of TBSRTC and improves patient counseling, particularly in settings where molecular diagnostics are not feasible.

Surgeons traditionally place the synthetic midurethral sling (MUS) after completing the apical suspension procedure during surgical procedures for pelvic organ prolapse (POP) and stress urinary incontinence (SUI). We hypothesize it may be more efficient to perform the MUS procedure at the beginning of the case without compromising MUS treatment success. The objective of this study was to determine whether MUS timing affects SUI treatment outcomes 3 months after surgery. A retrospective cohort study was performed of patients who had minimally invasive sacrocolpopexy (SCP) at a single tertiary care center between June 2023 and June 2024. As routine practice, 4 surgeons place MUS before and 4 place MUS after completion of the SCP. Surgical cases were categorized into "MUS pre-SCP" and "MUS post-SCP". SUI treatment failure was defined as (1) patient report of persistent or de novo SUI, (2) positive cough stress test result, and/or (3) retreatment for SUI (including pelvic floor physical therapy, pessary, or surgery). Sixty-six participants had MUS placed before the SCP (MUS pre-SCP), and 111 had MUS placed after completing the SCP (MUS post-SCP). The MUS pre-SCP group was more likely to have advanced stage 3/4 POP ( P < 0.001). The MUS pre-SCP group was more likely to have had a concomitant hysterectomy ( P = 0.01), total hysterectomy ( P < 0.001), single-port robotic procedure ( P <0.001), and shorter operative times ( P < 0.001). Overall, SUI treatment failure was similar between MUS pre-SCP and post-SCP cohorts ( P = 0.54). Placing an MUS before minimally invasive SCP did not affect SUI treatment outcomes at 3 months and was associated with shorter operative time.

Diabetes Mellitus (DM) is frequently complicated by Diabetic Foot Ulcers (DFUs), which contribute to high morbidity, mortality, and healthcare costs. Regular foot care and clinic follow-up can reduce the incidence of DFUs and related complications, yet adherence to these practices remains poorly described in Sudan. To assess compliance with foot care practices and identify factors associated with compliance and barriers to regular foot care clinic attendance among patients with diabetes attending the Jabber Abo Aliz Diabetes Care Center in Khartoum, Sudan. A cross-sectional descriptive study was conducted from December 2021 to February 2022 involving 120 patients with DM attending foot care clinics. Data were collected using structured questionnaires covering demographic and clinical characteristics, foot care behaviours, and perceived barriers. Compliance was measured using a Likert-based scoring system, with scores ≥ 9/17 classified as compliant. Data were analysed using SPSS version 21.0, applying Chi-square tests and ANOVA where appropriate, with statistical significance set at p < 0.05. Among 120 participants (55% female; mean age 49 ± 11 years), 70% were classified as compliant with foot care. Compliance was significantly associated with female gender (p = 0.043), age < 40 years (p = 0.034), urban residence (p = 0.037), higher socioeconomic status (p = 0.002), and good glycemic control (HbA1c ≤ 7%; p = 0.001). Duration of DM showed no significant association (p = 0.184). Transportation and distance were the most reported barriers to clinic attendance (30%). Most patients attending foot care clinics demonstrated good adherence to foot care practices, particularly those with favourable socioeconomic and clinical profiles. However, geographic and economic barriers continue to limit regular attendance. Strengthening outreach strategies, reducing access barriers, and integrating foot care education into routine diabetes management could improve outcomes and reduce DFU-related complications in Sudan.

Delayed union of long bone fractures presents a significant clinical challenge, often leading to prolonged morbidity and functional limitation. Teriparatide, a recombinant human parathyroid hormone (PTH 1-34), has shown promise as a biological enhancer of bone healing. This study aims to evaluate the efficacy and safety of teriparatide in promoting fracture healing in patients with delayed union. A prospective interventional study was conducted on 48 adult patients (mean age: 42.6 ± 11.2 years) with delayed union of long bone fractures (tibia, femur, humerus, and radius/ulna) between 3 and 9 months postinjury. All patients received daily subcutaneous teriparatide (20 μg) for 3 months, along with calcium and vitamin D supplementation. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and weight-bearing ability; radiological healing was assessed using the Radiographic Union Score for Tibial fractures (RUST) and cortical bridging on serial radiographs at 0, 6, and 12 weeks. The mean VAS score significantly reduced from 7.8 ± 1.1 at baseline to 2.1 ± 0.9 at 12 weeks (P < 0.001). Radiological union was observed in 81.2% of patients at 12 weeks, with the mean RUST score improving from 5.2 ± 1.3 to 10.3 ± 1.2 (P < 0.001). Clinical union was achieved in 87.5% of patients, and 91.7% regained full weight-bearing ability. Metaphyseal fractures and fractures with stable fixation showed better outcomes. No major adverse events were reported. Teriparatide is a safe, well-tolerated, and effective adjunct in managing delayed union of long bone fractures. It accelerates both clinical and radiological healing, reducing the need for surgical reintervention. These findings support its inclusion in the orthopedic treatment armamentarium for biologically enhancing fracture repair in selected cases.

The number of pregnant women with adult congenital heart disease (ACHD) is increasing, posing growing challenges for obstetric anaesthesia. This study analysed anaesthetic strategies and postoperative care in ACHD patients treated at atertiary care centre. This retrospective single-centre study included ACHD patients who received anaesthesia for delivery, caesarean section or obstetric surgery between 2004 and 2023. Acomparison group of obstetric patients without congenital heart disease was selected based on baseline characteristics. Atotal of 391 cases were included (131 ACHD, 260 comparison group). Most patients were classified as mWHOI (44.2%) orII (23.8%), with 20.5% mWHO II-III and 11.5% mWHO III and IV. Spinal and epidural anaesthesia were used more frequently in lower mWHO classes (p = 0.017). All mWHOIV patients required general anaesthesia provided by ACHD-experienced anaesthetists. ACHD patients more frequently required postoperative ICU or IMCU care (6.6% vs.1.6%, p = 0.02; 13.9% vs.3.7%, p < 0.001). Anaesthesiologic complication rates were low in both groups. Obstetric anaesthesia was feasible with low complication rates, even in severe ACHD, when management was individualised and interdisciplinary. All anaesthetic procedures proved to be feasible when adapted to the risk profile.

Palpitation is one of the commonest presenting complaints to the hospital. The underlying problem may or may not be cardiac. Symptoms may not be present at the time of hospital presentation, and the patient's resting electrocardiogram (ECG) may be normal. In such cases, Holter ECG becomes a valuable tool for evaluating these patients. This 12-year retrospective cross-sectional study determined the prevalence of arrhythmias and conduction abnormalities among patients who presented to a specialist cardiac clinic with palpitations and underwent 24-h Holter ECG monitoring between 2010 and 2022. Data were summarized using descriptive statistics. Also, binary logistic regression models, adjusted for age, sex and comorbidity, were used to examine associations between clinical characteristics and Holter ECG outcomes. A total of 495 patients were included in the study. Overall, 223 (45.1%) had significant arrhythmia. Frequent ectopic beats were present in 159 (32.0%). Supraventricular ectopic beats and ventricular ectopic beats of any frequency were present in 483 (97.6%) and 402 (81.2%), respectively. Other arrhythmias included non-sustained ventricular tachycardia (5.5%), atrial fibrillation (1.8%), Mobitz II atrioventricular block (2.2%), sinus pause (> 2 s, 14.9%), and sinoatrial node block/arrest (2.8%). Significant arrhythmias were more likely with advancing age (adjusted odds ratio (aOR) = 11.022, 95% confidence interval (CI): 1.008-1.036, p = 0.002), whilst frequent ectopic beats were also more likely with advancing age (aOR 1.017, CI 1.002-1.031, p = 0.026) and with the presence of heart failure (aOR = 1.917, 95% CI = 1.048-3.506, p = 0.035). Holter ECG is a valuable tool for evaluating patients with palpitations. Nearly half of the patients showed significant arrhythmia on Holter ECG monitoring.