Management Of Disease Research Articles

Artificial intelligence-clinical decision support system for enhanced infectious disease management: Accelerating ceftazidime-avibactam resistance detection in Klebsiella pneumoniae

BackgroundEffective and rapid diagnostic strategies are required to manage antibiotic resistance in Klebsiella pneumonia (KP). This study aimed to design an artificial intelligence-clinical decision support system (AI-CDSS) using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and machine learning for the rapid detection of ceftazidime-avibactam (CZA) resistance in KP to improve clinical decision-making processes. MethodsOut of 107,721 bacterial samples, 675 specimens of KP with suspected multi-drug resistance were selected. These specimens were collected from a tertiary hospital and four secondary hospitals between 2022 and 2023 to evaluate CZA resistance. We used MALDI-TOF MS and machine learning to develop an AI-CDSS with enhanced speed of resistance detection. ResultsMachine learning models, especially light gradient boosting machines (LGBM), exhibited an area under the curve (AUC) of 0.95, indicating high accuracy. The predictive models formed the core of our newly developed AI-CDSS, enabling clinical decisions quicker than traditional methods using culture and antibiotic susceptibility testing by a day. ConclusionsThe study confirms that MALDI-TOF MS, integrated with machine learning, can swiftly detect CZA resistance. Incorporating this insight into an AI-CDSS could transform clinical workflows, giving healthcare professionals immediate, crucial insights for shaping treatment plans. This approach promises to be a template for future anti-resistance strategies, emphasizing the vital importance of advanced diagnostics in enhancing public health outcomes.

Potassium dynamics in sickle cell anemia: clinical implications and pathophysiological insights

Potassium dynamics are critical in the pathophysiology of sickle cell anemia (SCA), a genetic disorder characterized by the presence of abnormally shaped red blood cells that lead to various complications such as vaso-occlusive crises and hemolytic anemia. This review focuses on the clinical implications and pathophysiological insights of potassium regulation in SCA, highlighting its impact on disease progression and potential therapeutic strategies. The dysregulation of potassium transport in SCA leads to significant K+ efflux and cellular dehydration, exacerbating the sickling process. Dehydrated sickle cells, due to potassium loss, become more rigid and prone to causing blockages in small blood vessels, leading to painful vaso-occlusive crises and ischemia. Furthermore, chronic hemolysis in SCA, aggravated by potassium imbalance, contributes to severe anemia and systemic complications. These insights underscore the importance of maintaining potassium homeostasis to mitigate disease severity and improve patient outcomes. Therapeutic strategies targeting potassium regulation show promise in managing SCA. Inhibitors of the Gardos channel, such as senicapoc, have demonstrated potential in reducing sickling and hemolysis. Additionally, hydration therapy plays a crucial role in maintaining electrolyte balance and preventing RBC dehydration. A comprehensive approach that includes monitoring and correcting electrolyte imbalances, along with standard treatments like hydroxyurea and blood transfusions, is essential for effective disease management.

Screening the efficacy of platinum-based nanomaterial synthesized from Allium sativum to control plant pathogens

Emerging challenge posed by multidrug-resistant Bacillus spp. phytopathogens on agriculture and their commodities exerts pressure on global food security. This mandates the search for other alternatives to existing antibiotics. This study reports a novel method of green synthesis of platinum nanoparticles (PtHGNM) using aqueous extract of Himalayan garlic (Allium sativum). Physicochemical characterization techniques including UV-visible spectrometry, FT-IR, XRD, DLS, zeta potential, and FESEM-EDAX disclosed the biogenic fabrication of a stable and amorphic nano platinum material. This nanoparticle exhibited high bactericidal efficacy and effectively inhibited biofilm formation by the model plant-borne pathogens used in this study. We estimated the membrane integrity, oxidative enzymes and stress parameters of bacteria to elucidate the underlying mechanism of action of PtHGNM. This research uncovered the potential of biogenic nanoparticles for sustainable plant disease management and paved the way for further analysis of its properties and mechanism of its action.

First Report of Chili Anthracnose Caused by Colletotrichum sojae in South Korea.

Chili (Capsicum annuum L.) is an economically important crop worldwide, valued for its culinary uses. In South Korea, anthracnose caused by Colletotrichum spp. including C. truncatum, C. gloeosporioides, C. coccodes, C. acutatum, and C. scovillei incurs on substantial economic loss (Kim et al. 2008; Oo and Oh 2020). In August 2022, somewhat different types of symptoms that was not typical on chilli fruits were observed in a field in Yereonggwang (GPS: 35.2579° N, 126.4742° E), South Korea. The disease symptoms appeared as sunken, necrotic lesions with dense black spore masses forming in concentric rings. The estimated disease incidence the 0.2 ha field showing up to 1% of fruits affected. To isolate the pathogen, six symptomatic chilli fruits were collected. Small pieces (5 mm²) were cut from the margins of the lesions, surface-sterilized in 70% ethanol for 30 sec, followed by 1% sodium hypochlorite for 1 minute, and then rinsed three times in sterile distilled water. The tissue pieces were placed on potato dextrose agar (PDA) plates and incubated at 25°C in the dark. After 3 to 5 days, emerging fungal colonies were sub-cultured to obtain pure isolates. A total of five isolates were obtained and initially identified as Colletotrichum spp. based on morphological characteristics. Seven-day old colonies were initially white, turning light orange with age on PDA. Setae (observed on lesion) were dark brown, verruculose and septate. Conidia were cylindrical, hyaline, and measured 14.8 to 19.9 × 4.2 to 6.5 µm (mean 16.7 × 5.6 μm, n = 70) in size; appressoria were brown to dark brown and irregularly shaped. These morphological characteristics of the isolates agree with those reported for the morphology of C. sojae by Damm et al. (2019). To confirm the identity of the isolates, DNA was extracted and specific gene regions were amplified and sequenced using the following primer sets: ITS (ITS1 and ITS4), GAPDH (GDF1 and GDR1), ACT (ACT-512F and ACT-783R), TUB (T1 and Bt2b), HIS3 (CYLH3F and CYLH3R), and CHS-1 (CHS-79F and CHS-345R). The resulting sequences were deposited in the NCBI GenBank with accession numbers (LC830742 to LC830766). Maximum likelihood phylogenetic analysis using combine sequences of ITS, GAPDH, ACT, TUB, HIS3 and CHS-1 in MEGA X confirmed the isolates as C. sojae, marking the first report of this pathogen on chilli in South Korea, previously known to infect soybean. Pathogenicity tests were conducted on wound and nonwounded healthy and mature-green chili fruits (cv. Bicksita) to confirm the pathogenicity of the isolated C. sojae. The fruits were surface-sterilized using 70% ethanol and then rinsed with sterile distilled water. The fruits were wounded using a sterile needle to facilitate infection. A conidial suspension (1x106 conidia/mL) was prepared from 7-day-old PDA cultures. Each fruit was inoculated by placing a 10 µL drop of the conidial suspension onto the wounded and nonwounded sites (4 to 5) of the wound and unwound fruits, respectively. Control fruits were inoculated with sterile water. A total of 40 fruits per treatment were used and the experiment repeated twice. The fruits were placed in plastic box lined with moist paper towels to maintain high humidity and incubated at 25°C. Anthracnose symptoms developed on the inoculated fruits within 7 days, while control and unwounded fruits remained symptom-free. Colletotrichum sojae was successfully reisolated from the symptomatic fruits, fulfilling Koch's postulates and confirming its role as the causal agent of the disease. Colletotrichum sojae is known to infect Fabaceae species worldwide such as Glycine max, Medicago sativa, Phaseolus vulgaris, Atractylodes ovata and Vigna unguiculata (Damm et al. 2019; Talhinhas and Baroncelli 2021), Atractylodes ovata in South Korea (Hassan et al. 2021) and chili pepper in China (Zhanget al. 2023). The first report of C. sojae causing chili anthracnose in South Korea represents a new challenge for chili growers. Integrated disease management strategies need to be developed and implemented to mitigate its impact.

Preferences for diagnostic pathways and treatment choice in systemic lupus erythematosus: a patient-based discrete choice experiment.

Starting from the unmet need of early diagnosis and treatment in systemic lupus erythematosus (SLE), the study aims to explore patient preferences in diagnostic pathways and treatment modalities. It seeks to integrate clinical priorities with patient perspectives, providing an optimal approach to SLE treatment that remains uncertain. A discrete choice experiment (DCE) has been conducted to investigate whether patient preferences align while maintaining consistent attributes and levels, providing a direct assessment of relative preferences and hypothetical treatment approaches in SLE. DCE results demonstrated that obtaining an early diagnosis is the most crucial attribute for patients. Additionally, a multidisciplinary care team, capable of enhancing clinical outcomes and patient satisfaction, is essential, along with a clinical centre conveniently located within 30 minutes of the patient's home. Lastly, patients prefer the opportunity to reduce glucocorticoid to a dosage ≤5 mg/day, and eventually discontinue, aligning with the new EULAR recommendations, and favour oral and subcutaneous routes of administration for new course of treatment. Patient preferences contribute to enhancing the care pathway for SLE by optimising disease management, with a focus on multidisciplinarity and psychological support.

Application of Asteraceae biomass and biofertilizers to improve potato crop health by controlling black scurf disease

Potato (Solanum tuberosum L.) cultivation in Pakistan faces challenges, with black scurf disease caused by Rhizoctonia solani Kühn being a significant concern. Conventional methods like chemical fungicides partially control it, but an effective solution is lacking. This study explores the potential of biofertilizers and soil amendments from Asteraceae weed biomass to manage the disease. Two potato varieties, Karoda and Sante, were chosen, and two biofertilizers, Fertibio and Feng Shou, were tested alone or with Xanthium strumarium biomass. Disease pressure was highest in the positive control, with significant reduction by chemical fungicide. X. strumarium biomass also decreased disease incidence significantly. Fertibio showed better efficacy than Feng Shou. Physiological and biochemical attributes of plants improved with biofertilizer and biomass application. Tuber weight, photosynthetic pigments, total protein content, and antioxidant enzymes (CAT, POX, and PPO) were positively correlated. Combined application of Fertibio and S. marianum biomass effectively managed black scurf disease. These eco-friendly alternatives could enhance disease management and yield. Future research should explore their cost-effectiveness, commercialization, and safety.

Potential impact of climatic factors on malaria in Rwanda between 2012 and 2021: a time-series analysis

BackgroundMalaria remains an important public health problem, particularly in sub-Saharan Africa. In Rwanda, where malaria ranks among the leading causes of mortality and morbidity, disease transmission is influenced by climatic factors. However, there is a paucity of studies investigating the link between climate change and malaria dynamics, which hinders the development of effective national malaria response strategies. Addressing this critical gap, this study analyses how climatic factors influence malaria transmission across Rwanda, thereby informing tailored interventions and enhancing disease management frameworks.MethodsThe study analysed the potential impact of temperature and cumulative rainfall on malaria incidence in Rwanda from 2012 to 2021 using meteorological data from the Rwanda Meteorological Agency and malaria case records from the Rwanda Health Management and Information System. The analysis was performed in two stages. First, district-specific generalized linear models with a quasi-Poisson distribution were applied, which were enhanced by distributed lag non-linear models to explore non-linear and lagged effects. Second, random effects multivariate meta-analysis was employed to pool the estimates and to refine them through best linear unbiased predictions.ResultsA 1-month lag with specific temperature and rainfall thresholds influenced malaria incidence across Rwanda. Average temperature of 18.5 °C was associated with higher malaria risk, while temperature above 23.9 °C reduced the risk. Rainfall demonstrated a dual effect on malaria risk: conditions of low (below 73 mm per month) and high (above 223 mm per month) precipitation correlated with lower risk, while moderate rainfall (87 to 223 mm per month) correlated with higher risk. Seasonal patterns showed increased malaria risk during the major rainy season, while the short dry season presented lower risk.ConclusionThe study underscores the influence of temperature and rainfall on malaria transmission in Rwanda and calls for tailored interventions that are specific to location and season. The findings are crucial for informing policy that enhance preparedness and contribute to malaria elimination efforts. Future research should explore additional ecological and socioeconomic factors and their differential contribution to malaria transmission.

Macroalgal Diseases: Exploring Biology, Pathogenesis, and Management Strategies

The global seaweed market is expected to reach USD 17.8 billion by 2032, fuelled by growing demand for sustainable and healthy food solutions and expanding applications in agriculture and aquaculture. However, this rapid growth poses significant challenges, particularly in managing diseases that often establish themselves in intensive macroalgal culture facilities. Red rot disease, Olpidiopsis, and green spot disease often affect marine macroalgae species of high commercial interest, as seen in Pyropia/Porphyra as has already happened for “ice-ice” malaise on Kappaphycus, causing huge economic losses. These diseases are caused by infectious agents that find their place in extreme environmental conditions, such as those characterized by sudden changes in temperature and pollution. Despite technological advances aimed at monitoring the well-being of cultivated seaweed, discrepancies between regions’ technological capabilities and species vulnerability exacerbate management difficulties. This review provides an overview of diseases prevalent among marine algae, their impact on aquaculture, and the effectiveness of currently adopted treatments. This study highlights the need to improve disease management strategies and highlights the importance of understanding host–pathogen interactions in order to mitigate future epidemics.

Palliative care in terminally ill advanced chronic liver disease patients.

While mortality rates from advanced chronic liver disease (ACLD) are rapidly increasing, patients with an advanced disease stage have acomparable or even higher symptom burden than those with other life-limiting diseases. Although evidence is limited there is increasing recognition of the need to improve care for patients with ACLD; however, there are many limiting factors to providing good palliative care for these patients, including unpredictable disease progression, the misconception of palliative care and end of life care as being equivalent, alack of confidence in prescribing medication and alack of time and resources. Health professionals working with these patients need to develop the skills to ensure effective palliative care, while referral to specialized palliative care centers should be reserved for patients with complex needs. Basic palliative care, along with active disease management, is best delivered by the treating hepatologists. This includes discussions about disease progression and advance care planning, alongside the active management of disease complications. Liver disease is closely associated with significant social, psychological, and financial burdens for patients and their caregivers. Strategies to engage the discussion in multidisciplinary teams early in disease progression help to ensure addressing these issues proactively. This review summarizes the evidence on palliative care for patients with ACLD, provides examples of current best practice and offers suggestions on how disease-modifying and palliative care can coexist, to ensure that patients do not miss opportunities for quality of life improving interventions.

Development and validation of a 66K SNP array for the hard clam (Mercenaria mercenaria)

BackgroundThe hard clam (Mercenaria mercenaria), a marine bivalve distributed along the U.S. eastern seaboard, supports a significant shellfish industry. Overharvest in the 1970s and 1980s led to a reduction in landings. While the transition of industry from wild harvest to aquaculture since that time has enhanced production, it has also exacerbated challenges such as disease outbreaks. In this study, we developed and validated a 66K SNP array designed to advance genetic studies and improve breeding programs in the hard clam, focusing particularly on the development of markers that could be useful in understanding disease resistance and environmental adaptability.ResultsWhole-genome resequencing of 84 individual clam samples and 277 pooled clam libraries yielded over 305 million SNPs, which were filtered down to a set of 370,456 SNPs that were used as input for the design of a 66K SNP array. This medium-density array features 66,543 probes targeting coding and non-coding regions, including 70 mitochondrial SNPs, to capture the extensive genetic diversity within the species. The SNPs were distributed evenly throughout the clam genome, with an average interval of 25,641 bp between SNPs. The array incorporates markers for detecting the clam pathogen Mucochytrium quahogii (formerly QPX), enhancing its utility in disease management. Performance evaluation on 1,904 samples demonstrated a 72.7% pass rate with stringent quality control. Concordance testing affirmed the array's repeatability, with an average agreement of allele calls of 99.64% across multiple tissue types, highlighting its reliability. The tissue-specific analysis demonstrated that some tissue types yield better genotyping results than others. Importantly, the array, including its embedded mitochondrial markers, effectively elucidated complex genetic relationships across different clam groups, both wild populations and aquacultured stocks, showcasing its utility for detailed population genetics studies.ConclusionsThe 66K SNP array is a powerful and robust genotyping tool that offers unprecedented insights into the species’ genomic architecture and population dynamics and that can greatly facilitate hard clam selective breeding. It represents an important resource that has the potential to transform clam aquaculture, thereby promoting industry sustainability and ecological and economic resilience.

Disease Management in Regenerative Cropping in the Context of Climate Change and Regulatory Restrictions.

Regenerative agriculture as a term and concept has gained much traction over recent years. Many farmers are convinced that by adopting these principles they will be able to address the triple crisis of biodiversity loss, climate change, and food security. However, the impact of regenerative agriculture practices on crop pathogens and their management has received little attention from the scientific community. Significant changes to cropping systems may result in certain diseases presenting more or less of a threat. Shifts in major diseases may have significant implications regarding optimal integrated pest management (IPM) strategies that aim to improve profitability and productivity in an environmentally sensitive manner. In particular, many aspects of regenerative agriculture change risk levels and risk management in ways that are central to effective IPM. This review outlines some of the challenges, gaps, and opportunities in our understanding of appropriate approaches for managing crop diseases in regenerative cropping systems.

Expert System Software Framework for Nutritional Analysis and Diet-Related Disease

Nigeria faces a serious health crisis with diet-related diseases, which calls for creative ways to improve nutritional results and public knowledge. In addressing the challenges, this study introduces an Expert System Software Framework for Nutritional Analysis and Diet-Related Diseases, leveraging advanced technologies to address healthcare and nutrition challenges. Developed through rigorous research, the framework offers dynamic capabilities, personalized recommendations, and a user-friendly interface. Key features include customized algorithms, blockchain authentication for security, dynamic scheduling, and robust administrative tools. It fills critical gaps by providing insights into nutritional contents and health impacts of foods, supporting informed decision-making and proactive management of diet-related disorders. The performance evaluation demonstrates a high accuracy rate of 91.7%, ensuring reliability in dietary recommendations. Future directions include integrating wearable technology and AI to provide real-time health data for personalized dietary recommendations. This framework sets a new standard in nutritional analysis and disease management, contributing to advancements in healthcare and nutrition. Its recommendations for sustained engagement, collaboration with medical professionals, and global expansion aim to improve user outcomes and quality of life beyond the Nigerian setting.

Malaria diagnostics: from traditional techniques to cutting-edge solutions

Recent advancements in malaria diagnostics have revolutionized the detection and management of this deadly disease. From traditional microscopy to rapid diagnostic tests and currently, to cutting-edge molecular techniques, such as isothermal amplification and different types of polymerase chain reactions, significant progress has been witnessed in enhancing the sensitivity, specificity, and accessibility of diagnostic tools. These innovations have enabled rapid and more accurate detection of malarial parasites, especially in regions with limited healthcare infrastructure. Furthermore, integrating information technology- and artificial intelligence-based applications with point of care devices has facilitated realtime data collection and decision-making, ultimately aiding global efforts toward malaria elimination. Although conventional techniques are still employed at field sites, challenges such as high sensitivity, species specificity, cost-effectiveness, scalability, and the emergence of drug-resistant strains persist. These challenges underscore the need for continuous research and development of novel malaria diagnostics.

ThP6.19 - Surgical Management in Sacrococcygeal Pilonidal Sinus Disease Depending on The Suggested Staging System

Abstract Background The ideal management of the PNS has not been established yet. However; The optimal method should cover rapid recovery and return to normal daily activities, low recurrence rate, be technically applicable with reasonable cost. Aim to evaluate outcomes with the use of a stage-based treatment approach. Method A cohort prospective analytical study was conducted at Basrah Teaching Hospital-Iraq, a total of 71 patients were operated based on the proposed staging system in the period between December 2018 to April 2022, the staging system (Stage I–IV) was defined by using the morphological extent. the collected data includes demographic, perioperative data, short and long-term outcomes. Results Stage IV had the highest abscess drainage, drain insertion, and hospital stay. Concerning the short and long-term complications, the following frequencies were observed: Collection (9.85%), Infection (8.45%), and Dehiscence (4.22%), the collection and dehiscence were highest among stage R while the lowest rate of collection and infection was among stage III cases (6.67%, 6.67%) accordingly. Primary healing was recorded (91.5%) among the overall included patients with the higher rates of stage II-a (100.0%) with the lowest being among stage R (71.4%). Stage IV patients experienced the longest time for functional recovery and wound healing (14.25± 7.13, 13.25± 7.27) accordingly. The Recurrence rate was (2.81%) commonly observed among stage II-a (16.67%). Conclusion PNS is a recognizable condition in our locality and presents in different stages, thus this proposed staging system categorizes its extent and is a valuable tool in tailoring surgical approaches to each stage, Furthermore, it provides a common language for the surgeon to communicate about the disease.

Formulation and characterization of nanoemulsion biopesticide from Balanite aegyptiaca seed kernel extract

Consumers’ growing awareness and desire for food free of pesticide residues led to the incubation of this research work. The study aimed at developing a nanoemulsion formulation of Balanite aegyptiaca seed kernel extract for use as a biopesticide. A preliminary study was carried out on the solubility and miscibility of surfactant, carrier, and deionized water utilizing the low-energy spontaneous emulsification method. Information from the study was then used to plot a ternary phase diagram (TPD) showing both the isotropic zone and the anisotropic zones, from which a point with a surfactant, oil, and water ratio (20:20:60) was selected from the isotropic zone for the formulation. The developed nanoemulsion was tested for stability and thermostability, and both results revealed the system was stable. Similarly, the physiochemical properties of the developed nanoemulsion system were characterized, and the results showed that the system revealed the following properties: mean particle size of 173.2±21.6, polydispersity index (PDI) of 0.403±0.038, surface tension of 32.53±0.71, viscosity of 37.33±0.67 mPas, and a pH of 4.92±0.02. The formulation appears homogeneous, clear, and transparent, which further indicates it’s a nanoemulsion formulation. Therefore, the nanoemulsion formulation of B. aegyptiaca seed kernel can serve as a safe and environmentally friendly substitute for synthetic pesticides in the management of plant diseases.

Navigating the Maze: A Mini-Guide for the Management and Therapy of Metabolic Dysfunction-associated Steatotic Liver Disease

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), formerly known as Nonalcoholic Fatty Liver Disease (NAFLD), poses a significant global health challenge with a prevalence of 30% worldwide. Alarming projections anticipate a substantial increase in MASLD cases, highlighting the urgent need for preparedness and effective policies. The pathophysiology of MASLD involves a complex interplay of metabolic, genetic and lifestyle factors. Although liver biopsy remains the gold standard for the diagnosis of MASLD, non-invasive methods such as abdominal ultrasound, transient elastography with controlled attenuation parameter, shear wave elastography, and non-invasive serum fibrosis scores have been developed and validated. Effective risk stratification in primary care with non-invasive fibrosis scores, such as fibrosis 4 (FIB-4) index and NAFLD fibrosis score (NFS), optimizes healthcare resource utilization, ensuring appropriate referrals for high-risk patients while minimizing unnecessary referrals. Lifestyle intervention, including diet and physical activity, remains the primary therapy for MASLD. Notably, with the FDA approval of resmetirom, the first authorized medication for fibrotic metabolic dysfunction-associated steatohepatitis (MASH), and several antifibrotic agents under investigation, the therapeutic landscape for MASLD is rapidly evolving. Despite its increasing prevalence, morbidity and mortality, MASLD is frequently underdiagnosed in primary care. In this review, we aim to provide primary care physicians an update on the diagnosis, management and treatment of MASLD.

To biopsy or not to biopsy a teenager with idiopathic nephrotic syndrome? Biopsy first.

Kidney biopsy plays a crucial role in the diagnosis and management of several glomerular diseases. While it is generally considered a routine and safe procedure in children, it should be conducted with the primary objective of addressing the following question:do the prognosis and treatments vary based on the findings of kidney biopsy? In children presenting with idiopathic nephrotic syndrome (INS), guidelines suggest to consider kidney biopsy for individuals older than 12years, primarily due to the possible increased incidence of different glomerulonephritis compared to younger patients, who predominantly manifest with minimal change disease. However, these guidelines also advocate for uniform therapeutic strategies, typically steroids, irrespective of the age or histological findings. Whether the age of more than 12years may be a recommendation for performing kidney biopsy at presentation of INS is debatable. Instead, kidney biopsy could be reserved for steroid-resistant cases. On the other hand, when kidney biopsy is performed in INS, particularly in focal segmental glomerulosclerosis, histology may reveal additional lesions, that are strongly associated with a poorer response to treatment and worse clinical outcomes. Therefore, current guidelines on treatments of nephrotic syndrome may appear overly restrictive, despite the relevant findings provided by kidney biopsy. Therefore, in the present manuscript, which is part of a pro-con debate on the management of nephrotic syndrome in adolescents, we emphasize the potential role of performing a kidney biopsy before initiating corticosteroid treatment.

Current Advances in Diagnosis, Therapeutics, and Surgical Interventions for the Management of Refractory Gastroesophageal Reflux Disease (GERD): An Update

Current Advances in Diagnosis, Therapeutics, and Surgical Interventions for the Management of Refractory Gastroesophageal Reflux Disease (GERD): An Update

ThP5.1 - The Influence of the COVID-19 Pandemic on the Complexity of Laparoscopic Cholecystectomy

Abstract Aim The operative difficulty of Laparoscopic Cholecystectomy (LC) varies widely. This can affect the operative time, complications, post-operative course and ultimately patient outcomes. The COVID-19 pandemic caused substantial delays in the definitive management of gallstone disease. The aim of the present study was to compare the intraoperative difficulty grading of post COVID-19 pandemic LCs with previously published data. Methods This comparative study analyses a prospectively maintained database of all LCs performed by two biliary surgeons in a single centre between August 2022 to January 2024. Clinical and intra-operative findings including operative difficulty grading using the Nassar scale were recorded. This data was then compared to the previously published data from a single surgeon spanning 29 years (n=5,391). Results 149 patients were included; the median age was 56 years (IQR 45-66). 88 (51.1%) were female. 71 (47.7%) LC’s were completed as part of an emergency admission. The median Scottish Index of Multiple Deprivation was 5 (IQR 3-7). 45 (30.2%) underwent LC alone, 63 (42.2%) also received an operative cholangiography and 41 (27.5%) underwent common bile duct exploration. Grade 1 LC (4.8% vs 33.2%, p<0.001) were significantly less prevalent than grade 4 LC (37.4% vs 14.2%, p<0.001) in the post pandemic period when compared to the previous published data. Conclusion The present study suggests that LCs are more challenging post pandemic. The contributing factors are likely diverse, but extended waiting times and multiple emergency admissions leading to delays in definitive management are presumed to play significant role. Urgent attention is warranted to establish biliary pathways that guarantee timely and definitive management of gallstones for patients.

ThP5.11 - Reducing Gallstone Related Patient Episodes Through Index Admission Management: A Multicentre Retrospective Study

Abstract Aim Gallstones represent a significant portion of acute general surgical admissions, with widespread management practices across the UK. Our objective was to assess the effects of implementing proactive management strategies for symptomatic gallstones and their complications on admissions related to gallstone. Methods A retrospective multicentre study of three acute general surgical units within a single health board with similar population coverage between 2014 and 2018. In site A, the standard of care was definitive management of gallstone disease in the index admission; whereas in site B & C this was not the case. All gallstone related presentations were included. The data was extracted from the health board coding data. Number of biliary related admissions compared between the three sites. Results 3,790 episodes were identified. Biliary colic was the most common (54.9%) reason for presentation followed by acute cholecystitis (22.7%), acute pancreatitis (16.2%) and ascending cholangitis (6.2%). For biliary colic: site A had 361 presentations, site B had 853 presentations and site C had 867 presentations. The occurrences of more than one admission were 22.7%, 36.3%, and 42.3% for Site A, B, and C, respectively. Overall, site A had 796 biliary presentations; compared to 1497 each at site B and C. Conclusion Implementing definitive surgical interventions during the index admission for biliary-related cases offers a substantial reduction in re-admission rates, leading to an overall decrease in hospital attendance. This not only yields significant cost benefits for the health board but also enhances the quality of life for patients.