Risk Of Complications Research Articles

Different faces of Mycoplasma pneumoniae in children - cardiological and skin complications- case reports and literature review

Mycoplasma pneumoniae is one of the main pathogens responsible for atypical pneumonia, especially in children over the age of 5, where it accounts for about 40% of cases of extramedullary pneumonia. In addition to respiratory-related symptoms, it can lead to a variety of extrapulmonary manifestations associated with involvement of other organs. In this article, we present case reports of two pediatric patients with detected M. pneumoniae infection with associated cardiac and skin complications. The first case report describes an 11.5-year-old boy who was admitted to the Department of Pediatrics because of chest pain, fever and moist cough for several days, who was diagnosed with myocarditis during M. pneumoniae infection. The second case report describes a 17-year-old girl with a recent respiratory infection who was admitted to the hospital for pain, swelling, blistering of the lips and oral mucosa. Mycoplasma pneumoniae infection can lead to extrapulmonary complications in children, which can produce nonspecific symptoms, so clinical vigilance and early recognition are important to minimize the risk of complications.

IMPACT OF ADVANCED HEMODYNAMIC MONITORING ON MYOCARDIAL REVASCULARIZATION SURGERY IN HIGH-RISK PATIENTS

Coronary artery bypass grafting is a critical procedure for patients with advanced coronary disease, especially those classified as high risk due to comorbidities such as heart failure, hypertension and diabetes. Advanced hemodynamic monitoring has proved essential in this context, allowing continuous and accurate surveillance of cardiac and vascular parameters, which can reduce intra- and post-operative complications. This abstract aims to assess the impact of advanced hemodynamic monitoring during coronary artery bypass graft surgery in high-risk patients. The aim is to explore the advantages of this type of monitoring, the technologies used and the benefits in terms of clinical outcomes and reduction of complications. This is a literature review with a qualitative approach, carried out in the PubMed, SciELO, LILACS, BVS and Google Scholar databases. In order to optimize the search, descriptors such as Hemodynamic Monitoring, Cardiac Surgery, High Risk Patients and Fluid Management were used. For time delimitation, the research considered publications between the years 2019 and 2022, a period that reflects the latest advances in hemodynamic monitoring technologies in high-risk cardiac surgeries. Advanced hemodynamic monitoring includes the use of devices such as the pulmonary artery catheter and non-invasive bioimpedance systems, which provide real-time data on cardiac output, blood pressure, oxygen saturation and systemic vascular resistance. In high-risk patients, these devices allow for precise adjustments in the administration of fluids and vasoactive drugs, promoting better hemodynamic stability. Studies indicate that this approach reduces the incidence of serious complications, such as cardiogenic shock and arrhythmias, optimizing post-operative recovery. Therefore, advanced hemodynamic monitoring is a crucial tool in CABG surgeries, especially for high-risk patients. Its implementation improves intraoperative management, reducing the risk of complications and promoting better clinical outcomes. Therefore, its use should be considered an integral part of strategies for complex cardiac surgeries.

Inflammatory Signals Across the Spectrum: A Detailed Exploration of Acute Appendicitis Stages According to EAES 2015 Guidelines.

Background: In this retrospective study, we evaluate the diagnostic utility of C-reactive protein (CRP) and leucocyte count within the EAES 2015 guidelines for acute appendicitis (AA) in differentiating uncomplicated (UAA) from complicated AA (CAA). Methods: Conducted at a tertiary care center in Germany, the study included 285 patients over 18 years who were diagnosed with AA from January 2019 to December 2021. Patient data included demographics, inflammatory markers, and postoperative outcomes. Results: CRP levels (Md: 60.2 mg/dL vs. 10.5 mg/dL; p < 0.001) and leucocyte count (Md: 14.4 Gpt/L vs. 13.1 Gpt/L; p = 0.016) were higher in CAA. CRP had a medium diagnostic value for detecting CAA (AUC = 0.79), with a cutoff at 44.3 mg/L, making it more likely to develop CAA. Leucocyte count showed low predictive value for CAA (AUC = 0.59). CRP ≥ 44.3 mg/L was associated with a higher risk of postoperative complications (OR: 2.9; p = 0.002) and prolonged hospitalization (OR: 3.5; p < 0.001). Conclusions: CRP, within the context of the EAES classification, presents as a valuable diagnostic marker to distinguish CAA from UAA, with a higher risk of postoperative complications and hospitalization. Leucocyte count showed low diagnostic value for the identification of CAA.

Factors Influencing Outcomes of Diabetic Foot Management: Retrospective Study at Mwananyamala Regional Referral Hospital

Background: Diabetic foot ulcers (DFUs) contribute to significant morbidity and mortality worldwide, with the global prevalence of diabetes expected to rise to 12.2% by 2045, an increasing number of people are at risk for complications like DFUs, which affect 19% to 34% of diabetic patients. People with DFUs carry a 20% lifetime risk of limb amputation and mortality rate of 50% to 70%. In Tanzania DFUs account for 41.9% of major limb amputations and mortality rate of 54%. Methods: A retrospective observational study aimed to investigate the clinical factors, and treatment modalities that influence the management outcomes of diabetic foot among patients attending Mwananyamala Regional Referral Hospital (MRRH). The study reviewed existing patient records. Results: A total of 143 participants were enrolled in the study, of which 94 (65.73%) were female. The participants had a mean age of 57 ± 13.9 years. And approximately half (50.35%) were married. Nearly, all patients, 140 (97.90%), underwent surgical treatment, nearly half (41.96%) had DFU Wagner Class 3 while most of participants (69.93%) had hypertension. The mean hospital stay was 9.2 days. In binary logistic regression model output, marital status, level of education, working diagnosis, surgical management, patient progress and number of readmissions were identified as determinants of the outcome (P-value &lt; 0.05). Conclusion: This study identified key factors influencing diabetic foot outcomes, including gender, marital status, co-morbidities and ulcer grade. These findings underscore the importance of early diagnosis, targeted interventions, and comprehensive management to improve patient outcomes.

Early detection and management of congenital pulmonary airway malformation in a newborn with stable clinical course

Introduction: Congenital pulmonary airway malformation (CPAM) is a rare developmental lung anomaly characterized by cystic lung lesions, constituting about 25% of congenital pulmonary anomalies. It typically occurs sporadically and is not significantly associated with race, age, or other maternal factors. The prenatal course of CPAM can vary based on factors such as lesion size, mediastinal shift, and associated anomalies. While the overall prognosis is generally favorable in the absence of severe complications like hydrops fetalis, which can adversely affect outcomes, management strategies include corticosteroids, thoracoamniotic shunt (TAS), and, in severe cases, open fetal surgery or the EXIT procedure. Postnatal surgical excision usually offers a curative outcome with an excellent prognosis. Without surgical intervention, there are risks of recurrent infections and, rarely, malignant transformation. Effective prenatal detection significantly impacts clinical decision-making and neonatal outcomes, and the necessity and timing of surgery for asymptomatic infants remain subjects of ongoing debate, underscoring the need for personalized, multidisciplinary care. Case Report: A female infant, delivered at 38 weeks via Cesarean section, was diagnosed with CPAM following routine prenatal ultrasound. Presence of extensive cystic regions in the right lung confirmed the diagnosis and a CPAM volume ratio (CVR) of 0.37 indicated a low risk of severe complications. The pregnancy was largely uneventful, with maternal chronic hypertension managed by Nifedipine and mild intermittent asthma. Postnatal chest radiography corroborated the CPAM diagnosis, while an abdominal ultrasound investigated intrahepatic calcifications. Maternal screening for cytomegalovirus and toxoplasmosis yielded negative results, and postnatally, the infant also tested negative for both infections. The neonate, though asymptomatic and stable, required close monitoring in the neonatal intensive care unit to prevent potential respiratory compromise. Conclusion: Advances in prenatal imaging have greatly improved the early detection and management of CPAM, allowing for targeted neonatal care and strategic planning. This case highlights the importance of a multidisciplinary approach involving obstetricians, maternal-fetal medicine specialists, neonatologists, and pediatric thoracic surgeons in the effective management of CPAM. Early identification and diligent postnatal monitoring are essential for ensuring optimal outcomes and minimizing the risk of complications. The coordinated care and strategic decision-making exemplified in this case underscore the potential for enhanced neonatal health and long-term well-being through comprehensive management of congenital anomalies.

Outcomes of antenatal depression in women and the new-born: a retrospective cohort study.

To determine what effect maternal antenatal depression has on pregnancy and infant outcomes in the Lleida health region. Retrospective observational cohort study in pregnant women between 2012 and 2018 in the Lleida health region. Variables included age, body mass index, caesarean section, pre-eclampsia, birth weight, and Apgar score. We performed multivariate analysis, with linear regression coefficients and 95% confidence interval (CI). Antenatal depression was diagnosed in 2.54% pregnant women from a total sample of 17177. Depression is significantly associated with a higher risk pregnancy and low birth weight. Pre-eclampsia, 1-minute Apgar score, and caesarean section were not significantly associated with depression. Antenatal depression increases the risk of pregnancy complications. In addition, depression in the mother increases the probability of low birth weight.

The Association Between Preoperative Sarcopenia and Sarcopenic Obesity and the Occurrence of Postoperative Complications in Patients Undergoing Pancreaticoduodenectomy for Periampullary Malignancies-A Literature Review.

Sarcopenia and sarcopenic obesity, perceived as a reflection of cancer-induced cachexia, are often diagnosed in patients with periampullary malignancies. The pathophysiology of those conditions is multifactorial regarding the tumor microenvironment, immunological response, and the relationship to surrounding tissues. The PubMed and SCOPUS databases were systematically searched between November 2023 and December 2023. A total of 254 studies were primarily identified. Regarding the inclusion and exclusion criteria, 26 studies were finally included in the review. Evaluated papers disclosed that sarcopenia was significantly associated with a higher incidence of postoperative complications, including pancreatic fistula (POPF) type B and C, with the odds ratio (OR) ranging from 2.65 (95%CI 1.43-4.93, p = 0.002) to 4.30 (95%CI 1.15-16.01, p < 0.03). Sarcopenic patients also suffered more often from delayed gastric emptying (DGE) with an OR of 6.04 (95%CI 1.13-32.32, p = 0.036). Infectious complications, postoperative hemorrhage, and intra-abdominal abscesses occurred more often in sarcopenic patients. Surgical complications were also noted more frequently when sarcopenic obesity was present. Preoperative nutritional prehabilitation seems to reduce the risk of postoperative complications. However, more prospective studies are needed. Sarcopenia and sarcopenic obesity were associated with a higher incidence of multiple postoperative complications, including POPF (type B and C), DGE, hemorrhage, and infectious complications.

Development of acute kidney injury following repair of Stanford type A aortic dissection is associated with increased mortality and complications: a systematic review, meta-analysis, and meta-regression analysis.

Acute kidney injury (AKI) frequently complicates the repair of Stanford type A aortic dissection (TAAD). This systematic review, meta-analysis, and meta-regression analysis aimed to elucidate the prognostic impact of AKI in these patients. A literature search in PubMed, EMBASE, and Google Scholar identified relevant studies on the predictors and outcomes of AKI following TAAD repair. The primary endpoint was 30-day mortality; secondary endpoints included stroke, dialysis/continuous renal replacement therapy (CRRT), and other complications. Random-effects meta-analyses were used, with significance set at P < 0.05. Twenty-one studies (10 396 patients) were analyzed. AKI was associated with higher risks of 30-day mortality (risk ratio = 3.98), stroke (risk ratio = 2.05), dialysis/CRRT (risk ratio = 32.91), cardiovascular (risk ratio = 2.85) and respiratory complications (risk ratio = 2.13), sepsis (risk ratio = 4.92), and re-exploration for bleeding (risk ratio = 2.46). No significant differences were noted in sternal wound infection, tracheostomy, paraplegia, or hepatic failure. AKI significantly increases mortality, morbidity, hospital, and ICU stay duration in TAAD repair patients.

Endovascular therapy versus medical management in isolated posterior cerebral artery acute ischemic stroke: A multinational multicenter propensity score-weighted study.

Despite the proven effectiveness of endovascular therapy (EVT) in acute ischemic strokes (AIS) involving anterior circulation large vessel occlusions, isolated posterior cerebral artery (PCA) occlusions (iPCAo) remain underexplored in clinical trials. This study investigates the comparative effectiveness and safety of EVT against medical management (MM) in patients with iPCAo. This multinational, multicenter propensity score-weighted study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, involving 37 centers across North America, Asia, and Europe. We included iPCAo patients treated with either EVT or MM. The primary outcome was the modified Rankin Scale (mRS) at 90 days, with secondary outcomes including functional independence, mortality, and safety profiles such as hemorrhagic complications. A total of 177 patients were analyzed (88 MM and 89 EVT). EVT showed a statistically significant improvement in 90-day mRS scores (OR = 0.55, 95% CI = 0.30-1.00, p = 0.048), functional independence (OR = 2.52, 95% CI = 1.02-6.20, p = 0.045), and a reduction in 90-day mortality (OR = 0.12, 95% CI = 0.03-0.54, p = 0.006) compared to MM. Hemorrhagic complications were not significantly different between the groups. EVT for iPCAo is associated with better neurological outcomes and lower mortality compared to MM, without an increased risk of hemorrhagic complications. Nevertheless, these results should be interpreted with caution due to the study's observational design. The findings are hypothesis-generating and highlight the need for future randomized controlled trials to confirm these observations and establish definitive treatment guidelines for this patient population.

Neurosurgical Procedures in Patients Requiring Extracorporeal Membrane Oxygenation.

Extracorporeal membrane oxygenation (ECMO) is often withheld in patients with significant neurologic injury or recent neurosurgical intervention due to perceived futility. Studies of neurosurgical interventions before or during ECMO are limited to case reports or single-center series, limiting generalizability, and outcomes in this population are unknown. We therefore sought to report the outcomes of ECMO patients with acute neurosurgical interventions at four high-volume ECMO and comprehensive stroke centers. Retrospective case series. Four academic tertiary referral hospitals in the United States. Adults (n = 24) having undergone neurosurgical procedures before or during ECMO. None. We retrospectively reviewed adults at four institutions who had undergone neurosurgical procedures immediately before or during ECMO from 2015 to 2023. The primary outcome was survival to hospital discharge. Secondary outcomes included favorable neurologic outcome (Cerebral Performance Category 1 or 2) and neurosurgical complications. Twenty-four of 2957 ECMO patients (0.8%) were included. Primary indications for neurosurgical intervention included traumatic brain (n = 8) or spinal (n = 3) injury, spontaneous intracranial hemorrhage (n = 6), and acute ischemic stroke (n = 5). Procedures included extraventricular drain (EVD) and/or intracranial pressure monitor placement (n = 10), craniectomy/craniotomy (n = 5), endovascular thrombectomy (n = 4), and spinal surgery (n = 3). Fifteen patients (63%) survived to hospital discharge, of whom 12 (80%) were discharged with favorable neurologic outcomes. Survival to discharge was similar for venoarterial and venovenous ECMO patients (8/12 vs. 7/12; p = 0.67) and those who had neurosurgery before vs. during ECMO (8/13 vs. 7/11; p = 0.92). One patient (4%) experienced a neurosurgical complication, a nonlethal tract hemorrhage from EVD placement. Survival to discharge was similar for neurosurgical and nonneurosurgical ECMO patients at participating institutions (63% vs. 57%; p = 0.58). Patients with acute neurologic injury can feasibly undergo neurosurgery during ECMO or can undergo ECMO after recent neurosurgery. Larger studies are needed to fully understand risks for bleeding and other procedure-related complications.

Dietary Guidelines for Pregnant and Lactating Women, Adherence Levels, and Associated Factors: a Scoping Review.

This scoping review addresses gaps in the existing literature on dietary guidelines for pregnant and lactating women globally. The study delves into adherence levels, identifies influencing factors, and examines outcomes associated with these guidelines. Analysing food-based dietary guidelines (FBDGs) from around the world, the review reveals that half of the countries lack FBDGs, with only 15% providing tailored advice for pregnant and lactating women. Utilising data extracted from 47 articles across MEDLINE and EMBASE, the study highlights a scarcity of adherence studies, particularly in low- and middle-income countries (LMICs) and emphasises the lack of research during lactation. Overall adherence to dietary guidelines is low, with disparities in fruit, vegetable, whole grain, and fish consumption. Positive correlations with adherence include age, education, employment, social class, and certain medical histories, while negative correlations involve smoking, alcohol consumption, metropolitan residence, and elevated BMI. The study documented significant associations between adherence and reduced risks of gestational complications but calls for further exploration of intermediate nutritional outcomes like micronutrient deficiencies and child growth. Emphasising the urgency for globally standardised guidelines, especially in LMICs, this review provides a foundational call for prioritised studies and strategies to enhance dietary practices for pregnant and lactating women worldwide.

Innovative needle-assisted technique for intracorporeal anastomosis: Simplifying closure of common enterotomy in laparoscopic gastrointestinal surgery.

Intracorporeal anastomosis offers notable advantages over extracorporeal techniques, including reduced tissue manipulation leading to faster recovery and potentially lower risks of surgical site infections and complications. However, it also involves several challenges, such as increased operative time and the need for experienced assistants and multiple trocars. Our novel technique addresses these problems. We present a novel approach for closing common enterotomies during intracorporeal anastomosis by using a linear stapler. This technique involves the use of a 6-cm straight needle, which facilitates closure of the common enterotomy. The technique can be performed independently by a single surgeon without the need for additional trocars or assistants. This technique was applied for 20 patients undergoing laparoscopic gastrointestinal surgery between June 2023 and February 2024. The median age of the enrolled patients was 65years, with laparoscopic right hemicolectomy with intracorporeal ileocolostomy being the most common procedure (60% of cases). The median anastomosis time was 22.5min. No occurrence of anastomotic leakage was reported, and only one patient (5%) developed temporary postoperative bowel obstruction, which was managed conservatively. Our technique enables efficient and safe closure of common enterotomies during intracorporeal anastomosis, minimizing reliance on additional trocars and experienced assistants. It simplifies the procedure and ensures fullthickness stapling, potentially reducing the likelihood of complications. Because of its broad applicability across various laparoscopic surgeries, this technique offers substantial benefits and is worth recommending for intracorporeal anastomosis.

Efficacy and Safety of Sodium-Glucose Co-Transporter 2 Inhibitors for the Primary Prevention of Cardiovascular, Renal Events and Safety Outcomes in Patients with Systemic Lupus Erythematosus and Comorbid Type 2 Diabetes: A Population-based Target Trial Emulation.

Patients with systemic lupus erythematosus (SLE) were excluded from sodium-glucose co-transporter 2 inhibitors (SGLT2i) clinical trials. It is unknown whether the cardiorenal benefits of SGLT2i extend to patients with SLE and comorbid type 2 diabetes (T2D). We performed an emulated clinical trial in an insurance-based cohort in the U.S., evaluating SGLT2i versus dipeptidyl peptidase 4 inhibitors (DPP4i) for primary prevention of cardiovascular, renal, and other clinical outcomes among patients with both SLE patients and comorbid T2D. SGLT2i initiators were matched to DPP4i initiators using propensity scores (PS) based on clinical and demographic factors. Hazard ratios (HR with 95% confidence intervals) were calculated using Cox models. Outcomes among 2,165 patients starting SGLT2i and 2,165 PS-matched patients starting DPP4i were compared. Over 753.1 (±479.2) mean days, SGLT2i recipients had significantly lower risks of incident acute kidney injury (HR 0.49, 95% CI 0.39-0.63), chronic kidney disease (HR 0.61, 0.50-0.76), end-stage renal disease (HR 0.40, 0.20-0.80), heart failure (HR 0.72, 0.56-0.92), and emergency department visits (HR 0.90, 0.82-0.99). Risks of all-cause mortality (HR 0.89, 0.65-1.21), lupus nephritis (HR 0.67, 0.38-1.15), myocardial infarction (HR 0.81, 0.54-1.23), stroke (HR 1.03, 0.74-1.44), and hospitalizations (HR 0.76, 0.51-1.12) did not differ. Genital infection risk (HR 1.31, 1.07-1.61) was increased, but urinary tract infection risk (HR 0.90, 0.79-1.03) did not differ. No significant difference was observed for diabetic ketoacidosis risk (HR 1.065, 0.53-2.14) and fractures (HR 0.95, 0.66-1.36). In this emulated clinical trial, SGLT2i vs. DPP4i use was associated with significantly reduced risks of several cardiorenal complications among patients with both SLE and T2D.

IV Ciprofloxacin-Induced Phlebitis: Investigating the Impact of Pharmaceutical and Process-Related Factors on Patient Safety

Transient phlebitis is a rare but notable adverse reaction that can occur following intravenous administration of various medications, including ciprofloxacin, an antibiotic recognized for its broad-spectrum activity. This case report discusses a 48-year-old male patient with poorly controlled type 2 diabetes who developed phlebitis after receiving undiluted ciprofloxacin via a peripheral intravenous line. Symptoms emerged within 24 hours, characterized by swelling and redness at the injection site, prompting the discontinuation of the medication. Analysis revealed that improper dilution and rapid infusion rate were major factors contributing to the development of phlebitis. This underscores the importance of adhering to guidelines provided in product information leaflets for intravenous drug preparation and administration. The case emphasizes the critical need for healthcare professionals to follow recommended protocols to reduce the risk of infusion-related complications, especially in patients with underlying comorbidities.

Post-Discharge Outcomes of Elderly Patients Hospitalized for Inflammatory Bowel Disease Flare Complicated by Clostridioides difficile Infection.

Elderly hospitalized patients with inflammatory bowel disease (IBD) flare and concurrent Clostridioides difficile infection (CDI) are considered at high risk of IBD-related complications. We aimed to evaluate the short, intermediate, and long-term post-discharge complications among these patients. A retrospective multicenter cohort study assessing outcomes of elderly individuals (≥60 years) hospitalized for an IBD flare who were tested for CDI (either positive or negative) and discharged. The primary outcome was the 3-months post-discharge IBD-related complication rates defined as: steroid dependency, re-admissions (emergency department or hospitalization), IBD-related surgery, or mortality. We assessed post-discharge IBD-related complications within 6-months and mortality at 12-months among secondary outcomes. Risk factors for complication were assessed by multivariable logistic regression. In a cohort of 654 patients hospitalized for IBD (age 68.9 [interquartile range {IQR}]:63.9-75.2) years, 60.9% ulcerative colitis), 23.4% were CDI-positive. Post-discharge complication rates at 3 and 6-months, and 12-months mortality, did not differ significantly between CDI-positive and CDI-negative patients (32% vs. 33.1%, p=0.8; 40.5% vs. 42.5%, p=0.66; and 4.6% vs. 8%, p=0.153, respectively). The Charlson comorbidity index was the only significant risk factor for complications within 3-months (aOR 1.1), whereas mesalamine (5-aminosalicylic acid [5-ASA]) use was protective (aOR 0.6). An ulcerative colitis diagnosis was the sole risk factor for complication at 6-months (aOR 1.5). CDI did not significantly impact outcomes or interact with IBD type. In elderly IBD patients hospitalized for IBD flare and subsequently discharged, a concurrent CDI infection was not associated with post-discharge IBD-related complications or mortality up to 1-year.

First case report of a percutaneous coronary intervention with intracoronary lithotripsy in a heavily calcified and tortuous right coronary artery using the R-One+ robotic system

Abstract Background Advancement in interventional techniques has significantly improved the ability of percutaneous coronary intervention (PCI) to treat complex coronary artery disease. Despite these advancements, coronary artery calcification poses a substantial challenge during PCI, contributing to increased risks of procedural complications, prolonged procedure duration, an increase in radiation exposure dose for both patients and physicians. Recently, robotic PCI has emerged, allowing physicians to remotely control and deliver wires and catheters, leading to a notable reduction of the operator radiation exposure and a decrease in the risk of operator physical injuries such as back pain. Case summary We report the first robotic PCI with the R-One+™ robotic system using intracoronary lithotripsy for lesion preparation of two heavily calcified lesions in a tortuous right coronary artery of a 60-year old male patient followed by double drug-eluting stent implantation. Discussion Robotic PCI with the R-One+™ system can not only manage wires, balloons or stent systems but can also precisely position more bulky catheters such as intracoronary lithotripsy catheters to the target site even in the presence of a tortuous access.

Pneumaturia and Colonic Bleeding Post-Inguinal Herniorrhaphy: A Case Report

Introduction: A 51-year-old male was seen complaining of pneumaturia and bowel complaints, including blood per rectum. The patient related a history of an open left inguinal hernia repair utilizing a Kugel mesh ten years before. Case Presentation: Cystoscopy and colonoscopy demonstrated a hemorrhagic mass due to a prosthetic mesh protruding into the bladder and colon. Following colonoscopy and cystoscopy, a large inflammatory mass involving both the colon and urinary bladder was resected, which contained a rolled-up “tubular” mesh structure. After primary repair of the urinary bladder and placement of a Foley catheter, the sigmoid colon and mesh were resected, and the colonic anastomosis was completed. Outcome: Postoperatively, the patient progressed well with normal colon and bladder function after the removal of the Foley catheter. Discussion: Historically, the patient demonstrated the risk of major multiorgan surgical complications of a newer inguinal hernia repair technique, which may occur even a decade or more after the initial surgical correction and is, therefore, presented.

Infectious complications of Stevens-Johnson syndrome and toxic epidermal necrolysis: A systematic review and meta-analysis.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare severe cutaneous adverse reactions to medications characterized by keratinocyte necrosis leading to loss of protective barrier function and increased susceptibility to infection. Infection is a major cause of morbidity, and septicemia is the leading cause of mortality in this population. This systematic review and meta-analysis aimed to determine infectious complications' prevalence and risk factors in adults with SJS and TEN. This review was registered with the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) and conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Thirty-six articles describing results from 1446 cases were included. Skin infection was the most commonly diagnosed infection. The pooled prevalence of sepsis, respiratory tract infection, skin infection, and urinary tract infection was 27.3%, 21.5%, 37.5%, and 21.8%, respectively. Staphylococcus aureus was the most commonly identified organism. The overall quality of the studies was suboptimal, and the level of heterogeneity was high. The skin, bloodstream, respiratory, and urinary tracts are most commonly infected in the course of adult SJS and TEN. During hospitalization, clinicians should closely monitor and promptly investigate for these as well as several other infectious complications. More research is needed, with greater attention to the risk factors and causative organisms that cause these infections.

Implementation of digital remote postoperative monitoring in routine practice: a qualitative study of barriers and facilitators.

Remote monitoring can strengthen postoperative care in the community and minimise the burden of complications. However, implementation requires a clear understanding of how to sustainably integrate such complex interventions into existing care pathways. This study aimed to explore perceptions of potential facilitators and barriers to the implementation of digital remote postoperative monitoring from key stakeholders and derive recommendations for an implementable service. A qualitative implementation study was conducted of digital remote postoperative wound monitoring across two UK tertiary care hospitals. All enrolled patients undergoing general surgery, and all staff involved in postoperative care were eligible. Criterion-based purposeful sampling was used to select stakeholders for semi-structured interviews on their perspectives and experiences of digital remote postoperative monitoring. A theory-informed deductive-inductive qualitative analysis was conducted; drawing on normalisation process theory (NPT) to determine facilitators for and barriers to implementation within routine care. There were 28 semi-structured interviews conducted with patients (n = 14) and healthcare professionals (n = 14). Remote postoperative monitoring was perceived to fulfil an unmet need in facilitating the diagnosis and treatment of postoperative complications. Participants perceived clear benefit to both the delivery of health services, and patient outcomes and experience, but some were concerned that this may not be equally shared due to potential issues with accessibility. The COVID-19 pandemic demonstrated telemedicine services are feasible to deliver and acceptable to participants, with examples of nurse-led remote postoperative monitoring currently supported within local care pathways. However, there was a discrepancy between patients' expectations regarding digital health to provide more personalised care, and the capacity of healthcare staff to deliver on these. Without further investment into IT infrastructure and allocation of staff, healthcare staff felt remote postoperative monitoring should be prioritised only for patients at the highest risk of complications. The COVID-19 pandemic has sparked the digital transformation of international health systems, yet the potential of digital health interventions has yet to be realised. The benefits to stakeholders are clear, and if health systems seek to meet governmental policy and patient expectations, there needs to be greater organisational strategy and investment to ensure appropriate deployment and adoption into routine care. NCT05069103.

Prediction of complications after laparoscopic partial nephrectomy: feasibility of E‑PASS score.

With significant advancements in laparoscopic procedures and tools over the last decade, the partial nephrectomy (PN) surgical approach has gradually transformed from open to laparoscopic partial nephrectomy (LPN). Although numerous studies evaluating the postoperative complications of laparoscopic partial nephrectomy can be found in the literature, a scoring system that addresses both preoperative physical condition and intraoperative risk factors has not yet been established. The Estimation of Physiological Ability and Surgical Stress (E-PASS) score is a scoring system that considers both the patient's preoperative condition and intraoperative variables to predict the risk of postoperative complications in surgically treated patients. This study aimed to assess the applicability of the E-PASS scoring system for predicting postoperative complications following LPN. We analyzed data of 196 patients who underwent LPN between 2017 and 2024 by a single surgeon in this single-center retrospective study. Demographic data of the patients, parameters reflecting patients' preoperative physical condition, and intraoperative risk factors were recorded. Postoperative complications were classified using the Clavien-Dindo system. The E-PASS score and its sub-scores were calculated for each patient. Various degrees of complications developed in 46 patients (23.5%). Patients who developed complications had significantly higher mean age, performance scores, tumor sizes, length of hospital stay, and E-PASS values. The cutoff value of the E-PASS Comprehensive Risk Score (CRS) for predicting the development of postoperative complications was determined to be -0.1692 (AUC = 0.676; 95% CI 0.581-0.771; p < 0.001). According to the results of the multivariate analysis, the presence of E-PASS CRS > -0.1692 (OR 4.872; 95% CI 2.384-9.957; p < 0.001) and tumor size (OR 1.021; 95% CI 1-1.041; p = 0.047) was identified as independent risk factors predicting postoperative complications. Patients with a CRS higher than the cutoff value had a 4.87 times higher rate of postoperative complications after LPN. The E-PASS scoring model successfully predicts postoperative complications in patients undergoing LPN by utilizing preoperative data on the patient's physical condition and surgical risk factors. The E-PASS score and its sub-scores can serve as objective criteria to determine the risk of postoperative complications both preoperatively and immediately postoperatively.