Duration Of Hospital Research Articles

Necessity of Using Drains in Thyroid Surgery: Systematic Review and Meta-Analysis

Thyroid surgery, characterized by its high risk due to the vascular nature of the thyroid gland, often leads to significant postoperative bleeding. This study assesses the efficacy of using drains to prevent complications such as hematomas, seromas, and bleeding, and their impact on infection rates and hospitalization duration post-thyroidectomy. Following the PRISMA guidelines, a systematic search was conducted across PubMed, Embase, and the Cochrane Library, including randomized controlled trials and published prospective studies on patients undergoing thyroidectomy by November 15, 2023. The analysis focused on postoperative complications and the length of hospital stay as primary outcomes. Thirty-five studies with 4283 participants (2162 with drains and 2121 without) were analyzed. The meta-analysis showed no significant reduction in hematomas, bleeding, or seroma formation in the drain group. However, drain usage was correlated with a higher infection rate (odds ratio 3.31; 95% confidence interval [CI] 1.92-5.70, p<0.001) and longer hospital stays (mean difference=1.38 days, 95% CI 1.00-1.76, p<0.001). The employment of drains in thyroid surgery does not significantly impact the prevention of typical surgical complications but is linked to increased infection risks and extended hospitalization. These findings challenge the conventional practice of utilizing drains in thyroidectomy, highlighting the necessity for a tailored approach based on individual patient assessments.

Advantages comparison of peritoneal drainage versus no drainage after laparoscopic appendectomy for complicated appendicitis: a meta-analysis.

Peritoneal drainage (PD) following laparoscopic appendectomy(LA) has long been considered beneficial for appendicitis patients, especially those with complicated appendicitis. However, recent research has raised doubts about the advantages of PD, as it not only fails to reduce postoperative complications but also prolongs the operative duration and hospital stay and incurs higher medical expenses. Given this controversy, we conducted a meta-analysis to determine whether drainage is necessary after LA for complicated appendicitis. This meta-analysis had registered in PROSPERO(ID: CRD42023472382). This study assessed current evidence regarding the efficacy, safety, and potential benefits of drainage versus no drainage following LA for complicated appendicitis. We conducted a comprehensive search of PubMed, Springer, and the Cochrane Library using the search terms "appendicitis", "laparoscopic appendectomy", and "drain" or "drainage" for studies published between January 1, 2000, and December 31, 2022. We employed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria for study inclusion and exclusion. Primary outcomes included postoperative intra-abdominal abscess, postoperative intestinal obstruction, postoperative stump leakage, wound infection and postoperative visual analog scale(VAS) score, while secondary outcomes consisted of operative time, postoperative recovery time and total hospitalization duration. Studies with at least two outcomes were considered for meta-synthesis. Depending on I2 values, fixed- or random effects models were used for data synthesis. Pooled odds ratios (OR) and weighted mean differences (WMD) were calculated for outcome comparisons between PD and no peritoneal drainage (NPD). Sensitivity analysis and meta-regression were performed to assess and investigate inter-study heterogeneity. After conducting our literature search and screening, twelve studies were analyzed, comprising 3374 cases. During the comparison of primary outcomes between PD and NPD, the incidence of wound infection and postoperative VAS score were significantly higher in the PD group(P < 0.05). While during the comparison of secondary outcomes, the operative duration, postoperative recovery time and hospitalization duration were significantly longer in the PD group than in the NPD group(P < 0.05). PD following LA for complicated appendicitis not only increases the incidence wound infection and aggravate patients' postoperative pain, but also prolongs the operative duration, postoperative recovery time and hospitalization duration. Therefore, routine PD after LA for acute complicated appendicitis is not recommended.

Enhanced Recovery After Surgery (ERAS) Protocol for Craniotomy Patients: A Systematic Review

Context: The enhanced recovery after surgery (ERAS) protocol is a multidisciplinary approach aimed at improving surgical outcomes, reducing complications, minimizing hospital stays, and lowering healthcare costs. Objectives: This study assesses the impact of the ERAS protocol on elective craniotomies, a routine procedure in neurosurgery. Methods: A comprehensive search across PubMed, Embase, Scopus, and Web of Science identified 562 articles. Following strict screening criteria, 54 studies were reviewed, and ultimately 10 studies meeting the inclusion criteria were selected for detailed analysis. Results: The review encompassed ten studies [one prospective, one systematic review, and eight randomized controlled trials (RCTs)] published between 2016 and 2023. Key components of the ERAS protocol included preoperative counseling, high-protein intestinal nutrition, preoperative fasting while avoiding carbohydrate intake within 2 hours of surgery, standardized anesthetic and analgesic regimens, and early postoperative initiation of enteral feeding. Postoperative outcomes showed fewer complications, early mobilization, and notably shorter hospital stays, all of which contributed to improved patient recovery. Conclusions: This review demonstrates that the ERAS protocol, when applied to elective craniotomies, is effective in enhancing postoperative recovery, improving functional outcomes, and reducing hospitalization duration.

Early outcomes of treatment selections for infrarenal abdominal aortic aneurysms: The first five year experience of a single center

Aim: We examined the criteria governing patient selection in contemporary practice in cases of infrarenal abdominal aortic aneurysm (AAA) treated electively or urgently in our Cardiovascular Surgery Clinic (CVSC). Material and Methods: From January 2019 to January 2024, we retrospectively evaluated infrarenal AAA patients treated either electively or urgently with Open Surgical Repair (OSR) or standard Endovascular Aortic Repair (EVAR) at our CVSC. The primary endpoints are distribution of AAA patients by treatment modality, early morbidity and mortality. The secondary endpoints were intensive care unit (ICU) duration and length of hospital stay (LOS). Results: A total of 332 patients received EVAR (Group 1), including 296 elective cases, while 90 patients underwent OSR (Group 2), with 66 being elective. Early mortality rates were significantly lower in the EVAR group (1.3% for elective and 27.8% for emergent) compared to the OSR group (6.1% for elective and 54.2% for ruptured cases, p=0.001). Major postoperative complications occurred in 12.5% of elective EVAR patients and 39.4% of elective OSR patients (p=0.001), while in ruptured cases, the rates were 11.1% and 58.3%, respectively (p=0.001). Comparisons of ICU duration and LOS also favored EVAR (p=0.001). Conclusion: EVAR offers a survival benefit in the early period compared to OSR. The choice of treatment should be tailored to the patient's comorbidities, preferences, and the vascular surgeon's expertise. Advanced aortic centers with hybrid operating rooms (HOR) and specialized CVSCs should aim for optimized patient outcomes and cost-effectiveness in our country.

Contemporary comparative surgical outcomes of type A aortic dissection in US and China: an analysis of the national inpatient sample database and a Chinese multi-institutional registry.

To investigate the contemporary comparative inpatient prognosis among US and Chinese patients with type A aortic dissection (TAAD). Data from Chinese multi-institutional TAAD registry and the US National Inpatient Sample databases were analyzed. We used multivariable logistic regression models to compare in-hospital mortality and perioperative complication rates between the US and China. Length of stay and overall costs were fitted with quantile regression models. Independent prognostic factors associated with post-operative survival were assessed via Cox proportional hazards models. Among 3,121 eligible TAAD patients, 1,073 were from China (25.0% female; mean ± SD age, 53.9 ± 12.4) and 2,048 were from the US (31.2% female; mean ± SE age, 59.8 ± 0.3). During the study period, the in-hospital mortality rates in China and the US were 15.5% and 13.3%, yet the difference was insignificant after adjustment (aOR, 1.16; 95% CI, 0.69-1.97). While there was no significant difference in overall perioperative complications (aOR, 1.07; 95% CI, 0.52-2.18), the patterns of complications differed between two cohorts. While Chinese TAAD patients experienced significantly longer duration of hospitalization (median difference, + 10.4 days; 95% CI, 9.2-11.5), the US TAAD cohort had significantly greater overall hospitalization costs (49.9; 95% CI, 55.4-44.5, in 1000 USD). Notwithstanding significant differences in demographic and clinical characteristics, TAAD patients from China and the US demonstrated comparable in-hospital mortality and overall perioperative complication rates. Future initiatives should focus on expanding surgical eligibility to the elderly Chinese TAAD patients and optimizing the duration of hospitalization without undermining meaningful clinical outcomes. KY20220425-05, April 5th 25 2022.

Direct Oral Anticoagulants Versus Warfarin in Patients With Isolated Heparin-Induced Thrombocytopenia or Heparin-Induced Thrombocytopenia With Thrombosis.

No existing studies compare oral anticoagulants to treat heparin-induced thrombocytopenia with or without thrombosis (HIT/HITT). This retrospective study evaluated thrombotic and bleeding outcomes in adults treated for HIT/HITT with a direct oral anticoagulant (DOAC) or warfarin between 2012 and 2023 within the Ochsner Health System. Patients with mechanical heart valves, valvular atrial fibrillation, antiphospholipid syndrome, active malignancy, or venous thromboembolism (VTE) within the previous 6 months were excluded. The primary outcome was a composite of new or progressive VTE or arterial thromboembolism. Secondary outcomes included major and clinically relevant non-major bleeding, duration of hospitalization, time to platelet recovery, and incidence of skin necrosis, gangrene, and amputation. Forty-nine patients receiving a DOAC and 30 patients receiving warfarin were included. Baseline characteristics were similar between cohorts. There were non-statistically significant increased rates of both the primary outcome (8.9% vs. 4.3%, p = 0.65) and the composite bleeding outcome (32.7% vs. 23.3%, p = 0.37) in the DOAC cohort. Larger, prospective studies are needed to confirm these findings.

Characteristics of cerebellar cognitive affective syndrome in patients with acute cerebellar stroke and its impact on outcome

Purpose To evaluate the cerebellar cognitive affective syndrome scale (CCAS-S) in patients with acute cerebellar stroke (ACS) and examine its relationship with the discharge destination. Methods Patients with first-time ACS admitted to our hospital between April 2021 and April 2023 were included. The CCAS-S, Mini-Mental State Examination (MMSE), and Scale for the Assessment and Rating of Ataxia (SARA) were evaluated 1 week after stroke onset, and Functional Independence Measure (FIM)/Barthel Index (BI) at discharge, duration of hospitalization, and discharge destination were evaluated. The Mann–Whitney U test was used to compare CCAS-S and variables. Results Thirteen consecutive patients with ACS and age-matched comparison groups were included. The MMSE was within the normal range in all patients; however, patients with stroke had a lower total CCAS-S score (median 72, IQR 66–80) and a higher number of failed tests (median 4, IQR 3–5) than comparison. Significant deficits were observed in semantic fluency (p = 0.008), category switching (p = 0001), and similarity (p = 009). Definite CCAS were diagnosed 10 patients, respectively. Patients discharged home showed better SARA and FIM/BI but similar CCAS-S compared to those discharged to rehabilitation hospitals. Conclusion In patients with ACS, it is the impairment of motor function, not CCAS, that affects discharge destination.

BN SO27 - Articulative Minimally Invasive Surgery and Placement of Anti-reflux Magnetic Surgical Appliance (LINX)

Abstract Background Gastro-oesophageal reflux disease (GORD) is a condition of prolonged retrograde flow of gastric contents into the oesophagus or structures beyond, causing symptoms such as heartburn and regurgitation.1 Laparoscopic Nissen Fundoplication (LNF) has been the surgical gold standard, however its side effects and technical challenges has limited its use to 1% of the GERD population.2 The use of a magnetic surgical appliance (LINX) has recently emerged as a promising treatment in overcoming the limitations of conventional LNF.3 Literature has shown patients aged less than 45 with satisfactory mean contraction amplitude (MAP) of 30mmHg and typical symptoms have favourable outcomes with LINX.3 Method This is a case of a 35-year-old patient presenting with typical reflux symptoms, with satisfactory MAP and high DeMeester score, patulous gastro-oesophageal junction and no hiatus hernia endoscopically. Steps for LINX placement are described in the video and we demonstrate the use of ArtiSential, an articulating laparoscopic instrument that provides better range of motion and angulation comparable to that of a robotic instrument. Results Using a magnetic surgical appliance (LINX) is superior to LNF through preservation of physiological belching and vomiting, reducing surgical time and duration of hospital stay while also scoring highly on quality of life and patient satisfaction.4 Conclusion We would recommend considering the placement of a LINX device in suitable patients as it provides good outcomes on par with LNF and to consider the use of an articulating instrument (ArtiSential) as it provides the surgeon better control and ease in placing a small device laparoscopically.

CLINICAL EFFECTIVENESS AND FEATURES OF THE POSTOPERATIVE PERIOD IN PATIENTS AFTER OSTEOSYNTHESIS OF THE MANDIBLE USING CELL TECHNOLOGIES

Due to a signifi cant increase in the frequency and complexity of maxillofacial injuries, one of the priorities in the development of modern surgical dentistry is the search for new eff ective methods of treating facial bone fractures. In recent decades, the attention of clinicians has been focused on biological treatment methods aimed at restoring bone defects using cell technologies and biological transplants.The aim of the study was to determine the eff ect of using osteoplastic materials based on multipotent adipose- derived mesenchymal stromal cells in dental patients in the surgical treatment of mandibular fractures.Materials and methods. The clinical material included 56 patients, 13 of whom underwent mandibular osteosynthesis with hydroxyapatite bone graft substitute (subgroup 1I), 25 of whom underwent surgery with a combination of multipotent adipose tissue mesenchymal stromal cells, hydroxyapatite bone graft substitute and platelet-rich plasma (subgroup 1B), and 18 of whom underwent spontaneous healing of the fracture line (subgroup 1C). Patients were clinically evaluated on a daily basis. Clinical parameters were assessed on days 1, 3, 5, 7, 10, 14 and 28 after surgery. The postoperative pain syndrome was assessed using the Numerical Rating Scale (NRS), considering the subjective signs of pain in the operated patients.The statistical processing of the study results was performed using the statistical analysis software for biomedical research ‘Microsoft Excel 21’ and ‘Statistica’ (licence number STA862D175437Q). In the statistical processing of the results, we used the variational analysis of series – calculation of the arithmetic mean and its standard error (Mim) – and assessed the signifi cance of diff erences in the results obtained in the comparison groups using the Student’s t-test method. p&lt;0.05 was considered a signifi cant diff erence. [17]. The study was conducted in accordance with the basic provisions of the «Rules of Ethical Principles for Scientifi c Medical Research Involving Human Subjects» approved by the Declaration of Helsinki (1964-2013), ICH GCP (1996), EEC Directive 609 (24.11.1986), Orders of the Ministry of Health of Ukraine ¹ 690 of 23.09.2009, ¹ 944 of 14.12.2009, ¹ 616 of 03.08.2012. The Commission on Biomedical Ethics of the Bukovinian State Medical University found no violations of ethical and moral standards in the conduct of the research (ProtocolNo. 6, 16.03.2023). Patients signed informed consent to participate in this study and all measures were taken to ensure their anonymity.The results. The comparative analysis of the clinical eff ectiveness of the use of various osteoplastic materials in the performance of osteosynthesis surgery of the lower law confi rmed the advantages of the use of bone tissue substitute based on hydroxyapatite and its combination with multipotent adipose tissue mesenchymal stromal cells before spontaneous augmentation. It is confi rmed by the data of subjective and objective symptoms of patients during the postoperative period.Conclusions. Our data show that osteoplastic material based on multipotent mesenchymal stromal cells of adipose tissue, bone substitute based on hydroxyapatite and platelet-rich blood plasma is a promising biological material. Its application improves the regenerative and reparative properties of bone tissue, facilitates the postoperative period and shortens the duration of hospitalization, promotes the development of innovative ways of reconstructive osteogenesis in modern maxillofacial surgery.

Davydov-Moore vaginoplasty in Mayer-Rokitansky-Küster-Hauser syndrome: sexual and surgical outcomes.

The aim of this study was to compare surgical and sexual outcomes after Davidov-Moore vaginoplasty in women with Mayer-Rokitansky-Küster-Hauser syndrome (MRKH). In the case-series study, we described seven women, at a median age of 22.6 ± and BMI 22.8 ± 2.3kg/m2. We measured peri- and postsurgical parameters, including surgery-related neovaginal length and sexual initiation time. Sexual outcomes were measured using the Female Sexual Function Index (FSFI) before and 6months after vaginoplasty. All surgical procedures were performed successfully, with one minor perioperative bleeding. The mean time of vaginoplasty was 82.1min and the mean duration of hospitalization was six days. After a 6-month follow-up, vaginal length was 8.1-times longer than before surgery (10 vs. 81mm). The time from the surgery to the initiation of vaginal intercourse was between 17 to 22weeks. The mean FSFI score indicated good results, with no women below 23 score, and was 4.3- times higher when compared with the pre-surgical one (6.7 vs 29.1). Contrary to the FSFI score before surgery, the post-surgical FSFI revealed higher scores in all six different domains: desire (2.5-times), arousal (4.1-times), lubrication (3.8-times), orgasm (3.4-times), satisfaction (3.3-times) and comfort (11-times). Laparoscopic Davydov-Moore vaginoplasty might be considered as a safe procedure with satisfactory anatomic and sexual outcomes. It should be considered as a treatment option for the creation of neovagina in women with MRKH.

AHP SO04 - ''Effectiveness of a surgical wound care bundle for reducing surgical site infection after emergency abdominal surgery''

Abstract Background Surgical site infection (SSI) imposes a considerable financial burden to both hospital and patient by increasing the hospital stay, utilization of resources and readmission rates. This study compared the effectiveness of surgical wound care bundle concept with traditional ongoing wound care for reduction of SSI after emergency abdominal surgery. Method This cross-sectional analytical study was carried out with a total of 120 patients who underwent emergency abdominal surgery were included after taking informed written consent and divided into two groups: Group-A (n=60, surgical wound care bundle) and Group-B (n=60, traditional ongoing care). A detailed history and thorough clinical examination were carried out in each patient. Data were collected in separated case-record form and analyzed by SPSS 24. Results Mean age of Group A and Group B was 44.88 ±11.2 years and 44.82±13.3 years accordingly (p=0.391) with male majority in both groups (70% in Group-A and 80% in Group-B, p&amp;lt;0.292). Both groups were statistically similar regarding comorbidities, baseline laboratory parameters and pre-operative diagnosis (p&amp;gt;0.05).Group-B patients had higher frequency of SSI development compared to Group-A(43.3% vs. 15%, p-0.001). Besides, patients having traditional ongoing care had longer hospital duration than surgical wound care bundle (10.1±2.7 vs. 6.9±1.9 days, p&amp;lt;0.01). Though not significant, 30-day readmission rate was also higher in Group-B than Group-A (16.7% vs. 5%, p=0.075). Conclusion Surgical wound care bundle reduce surgical site infections in patients with emergency surgery. However, further multicenter studies are warranted.

Nutritional status and daily habits as determinants of hospitalization duration in ovarian cancer patients undergoing chemotherapy.

Adequate nutrition in a hospital setting is essential for achieving optimal health outcomes in oncology patients. This study specifically investigated the interrelationships between nutritional status, daily habits, and hospital length of stay (LOS) in ovarian cancer patients undergoing chemotherapy. A prospective longitudinal study was conducted from August 2019 to January 2022 in a tertiary hospital. Throughout the study, nutritional status, biochemical indicators, diet, and physical activity were meticulously recorded at different stages of chemotherapy: before chemotherapy (T0), the first course (T1), third course (T2), and fifth course (T3). To determine the factors influencing LOS, a generalized estimation equation (GEE) was employed. A total of 460 patients completed the follow-up period. The findings revealed a decline in nutritional risk among patients by 9.90% at T1, 17.62% at T2 and 18.26% at T3 (χ2 = 79.220, P < 0.001). The proportion of people receiving enteral nutrition showed an upward trend (χ2 = 15.202, P < 0.001). Notably, the proportion of patients adhering to a healthier diet increased by 40.44% by the study's conclusion, while the number of patients abstaining from physical activity or engaging in solely low-intensity activities decreased by 21.08%. Moreover, as the chemotherapy cycle progressed, daily activity steps exhibited an upward trajectory (F = 5.986, P < 0.001), while the LOS experienced a significant reduction (F = 21.298, P < 0.001). This study identified hypoproteinemia (protein level < 34g/L), a high nutritional risk (NRS 2002 score ≥ 3), a short duration of sleep (≤ 7h/day), and a lower daily activity level as risk factors for LOS. Receiving enteral nutrition support is a protective factor for LOS. Significant improvements in nutritional status, diet, and physical activity have been observed among ovarian cancer patients during their chemotherapy cycles. Reduced nutritional risks, implementation of nutritional support, good physical activity, and adequate sleep were associated with a shorter LOS.

Assessment of Transcription Errors and their Effects on Medical Approach, Hospitalization Duration, and Financial Costs of Traumatic Patients: How Can We Prevent Them?

Background and aims: Transcription errors pose significant risks to patient well-being, potentially leading to morbidity, mortality, and financial burdens on healthcare systems and society. This study assessed the prevalence of transcription errors and their impacts on medical treatment approaches, hospitalization duration, and associated costs. Methods: Direct observation was used to evaluate and compare all patients’ medical records, identifying errors, costs, and hospitalization duration. Physician orders and patient applications were checked, with intervention and control groups categorized based on the presence or absence of errors, respectively. Data were analyzed using descriptive and quantitative methods such as the chi-square, student’s t-test, Mann-Whitney test, and ANCOVA, to assess statistical significance. Results: No significant differences were observed in gender (P=0.73) and age (P=0.89) between patients. Omission errors and incorrect dosage forms were the most common. Errors were more frequent in patients with underlying diseases (P&lt;0.001), with nurses frequently involved (P&lt;0.001). Errors were more prevalent in intensive care units (ICUs) (P=0.002) and during morning and night shifts (P&lt;0.001). A significant association was found between trauma severity and medication error occurrence (P&lt;0.001). Moreover, patients with transcription errors had higher medical expenses and extended hospital stays (P&lt;0.001). Conclusion: Effective preventive measures are crucial to avoid transcription errors and their adverse consequences. Recommendations include minimizing abbreviations, ensuring complete and explicit orders, rigorous training, double-checking, using technology such as Electronic Prescription and Physician Orders, maintaining a distraction-free, ergonomic work environment, and fostering open communication among healthcare providers and patients to enhance medication safety.

Dyspnea in COVID-associated lung disease

Introduction. Covid-associated lung disease has become one of the leading problems of the COVID-19 pandemic, and early diagnosis of complications is complicated. Assessment of dyspnoea as a significant symptom is important, but its diagnostic ability in this lesion is poorly understood.Aim. To study the features of dyspnoea in COVID-19-associated lung lesions and its diagnostic value.Materials and methods. The study included 134 patients with COVID-19-confirmed pneumonia. Demographic and anthropometric data, subjective condition, dyspnoea severity according to Borg scale, concomitant pathologies, multispiral computed tomography (MSCT) data, arterial blood gas composition, capnometry and spirometry data, as well as disease outcomes (transfer to ICU, support ventilation, fatal outcome) were analysed.Results. Dyspnoea was present in 43.3% of patients. Increased dyspnoea was associated with increased C-reactive protein (CRP), D-dimer, lung tissue damage (MSCT), decreased forced vital capacity (FVC), and increased alveolar-arterial gradient (P(A-a)O2). Dyspnoea correlated with duration of hospitalisation and need for oxygen therapy (OR = 1.307, p = 0.008). 57.4% of patients with hypoxaemia did not complain of dyspnoea, but their outcomes did not differ between patients with dyspnoea and hypoxaemia. 32.2% of patients without hypoxaemia complained of dyspnoea. These patients did not have a significant increase in FGEF by the time of discharge, and it remained lower than in patients without dyspnoea and hypoxaemia.Conclusion. Dyspnoea in COVID-19-associated lung disease is an important symptom correlating with clinical-functional, instrumental and laboratory characteristics of the disease. Comprehensive data analysis is necessary to identify patients requiring further observation.

Comparative evaluation of axillary and rectal temperatures across different gestational ages in newborns admitted to the neonatal intensive care unit: a cross-sectional study.

Maintaining normothermia is crucial for neonatal survival, especially in preterm infants prone to temperature instability. This study evaluates the correlation and variability between axillary and rectal temperatures at Neonatal Intensive Care (NICU) admission across gestational age ranges of 23-28, 29-32, 33-36, and ≥ 37 weeks, aiming to inform improved neonatal thermal management strategies. This cross-sectional study was conducted at King Abdulaziz Medical City, Riyadh, from October 2023 to April 2024, involving 160 infants. Admission temperatures were measured using digital thermometers. Data analysis included ANOVA/Kruskal-Wallis for continuous variables, Chi-square tests for categorical data, Bland-Altman method for agreement assessment, and Pearson correlation coefficients to evaluate temperature correlations. Mean axillary temperature increased from 36.4°C in the 23-28 weeks gestational group, to 36.5°C in the 29-32 weeks group, and to 36.7°C in the 33-36 weeks and ≥ 37 weeks groups, (p = 0.033). Rectal temperature increased from 36.5°C in the 23-28 weeks group, to 36.6°C in the 29-32 weeks group, and reached 36.8°C in both the 33-36 weeks and ≥ 37 weeks groups (p = 0.006). Notable differences between measurement methods were observed in the 33-36 and ≥ 37 weeks groups (p < 0.001), with less pronounced differences in the 23-28 and 29-32 weeks groups. While temperature differences between rectal and axillary measurements remained consistent across all groups at 0.1°C (p = 0.779), neonatal outcomes varied significantly across gestational age groups, with younger infants exhibiting lower survival rates (p < 0.001), higher incidences of hypoglycemia (p < 0.001) and sepsis (p < 0.001), and extended durations of ventilation (p < 0.001) and hospital stay (p < 0.001). Strong correlations between rectal and axillary temperature were found across all age ranges (Pearson coefficients: 0.953 for 23-28 weeks, 0.762 for 29-32 weeks, 0.910 for 33-36 weeks, and 0.761 for ≥ 37 weeks; all p < 0.001). Bland-Altman analysis indicated higher variability in agreement for younger preterm groups, showing limits of agreement ranging from - 0.5 to 0.65°C for 23-28 weeks and - 0.5 to 0.69°C for 29-32 weeks, improving in older groups with - 0.2 to 0.4°C for 33-36 weeks and similarly narrow ranges for ≥ 37 weeks. Both rectal and axillary temperatures showed variation across different age groups, exhibiting a substantial overall correlation. Notable differences between the two methods were observed in the 33-36 weeks and ≥ 37 weeks groups. Younger preterm infants demonstrated greater variability, with enhanced agreement observed in older infants.

Correlation Between Feeding Pattern and Duration of Hospital Stay in Pneumonia of Infants Below 6 Months of Age

&amp;lt;i&amp;gt;Introduction&amp;lt;/i&amp;gt;: Pneumonia is the most common respiratory disorder among infants and one of the leading causes of hospital admission. Various feeding patterns have multiple impacts on pneumonia and recovery from it. Breast milk provides some protective properties against respiratory tract and gastrointestinal illness to protect infants during the first year of life. This study aimed to find an association between feeding patterns and duration of hospital stay due to pneumonia in infants below 6 months of age. &amp;lt;i&amp;gt;Methodology&amp;lt;/i&amp;gt;: This cross-sectional study was conducted in the Department of Paediatrics, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh from February, 2019 to August, 2020. In our study, 200 infants below 6 months of age admitted with pneumonia in the Department of Paediatrics in Shaheed Suhrawardy Medical College Hospital, Dhaka were enrolled according to selection criteria. &amp;lt;i&amp;gt;Result&amp;lt;/i&amp;gt;: Maximum incidence was seen in the 3 to 4 months of age, e.g.40.0% &amp; 36.30% in girls and boys respectively, mean age of the pneumonia patient was 2.9±1.5 months. Out of 200 cases, 55.0% cases were male and 45.0% were female. Among all infants 93.75% of exclusively breastfed infants needed ≤10 days, and 27.88% of non-exclusive breastfed infants needed&amp;gt;10 days in the hospital for recovery from pneumonia. In both cases, the p-value was 0.001. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: Exclusive breastfed infants have shorter and non-exclusive breastfed infants have longer hospital stays due to pneumonia below 6 months of age.

Neoadjuvant chemotherapy with FLOT scheme in surgical treatment of gastric cancer: short- and long-term outcomes. A retrospective cohort study

Aim. To compare the results of surgical treatment of patients with gastric adenocarcinoma and esophagogastric junction cancer (EGJC) who received neoadjuvant chemotherapy (NCT) FLOT with primary operated patients. Materials and methods. A retrospective cohort study included 177 patients who underwent radical surgical treatment at the Burdenko Faculty Surgery Clinic of Sechenov University for gastric cancer (GC) and/or EGJC Sievert Type II–III in the period from January 2018 to December 2022. The main group consisted of patients (n=28) who received NCT FLOT. Patients in both groups did not statistically significantly differ in average age (p=0.110), ASA status (p=0.541), ECOG status 0–3 (p=0.12), localization (p=0.063), depth of invasion (p=0.099) and histological structure of the tumor (p=0.787). In the main group, more patients with lesion of the regional lymph nodes were expected (p0.001). According to the most significant indicators [postoperative complications, the presence of a "positive" edge of resection (R1), recurrence and/or progression of GC], we performed a quasi-randomization by the matching procedure, taking into account the selection of the nearest neighbors. Results. In 92.9% of patients in the main group and in 94.9% of the control group, R0 resection (p=0.750) was achieved. The number of removed lymph nodes was statistically significantly higher in the main group (average 26 vs 21; p=0.010). There was no difference in intraoperative blood loss (p=0.294) and hospital stay (p=0.992). The average duration of surgery in the main group was 319 minutes, compared to 250 minutes in the control group (p0.001). In the early postoperative period, the total number of complications (CD I–IV) was higher in the main group (p=0.031), however, there was no difference in the number of small (CD I–II; p=0.094) and significant (CD III–V; p=0.142) complications. Postoperative mortality in the first 30 days after surgical treatment was 3.6 and 2.5% in the main and control groups, respectively (p=0.764). The overall 6-month survival rate in the control group was 95.9% vs 90.9% in the main group, and the 12-month survival rate was 88.8% vs 75.7%, respectively. The reccurence-free 6-month survival rate in the control group was 96%, in the main group – 100%; the reccurence-free 12-month survival rate in the control group was 92.1%, in the NCT group – 93.3%. Conclusion. NCT FLOT in the treatment of GC and EGJC Sievert Type II–III does not increase the level of intraoperative blood loss, the number of postoperative complications and the duration of hospitalization. The 6-month and one-year survival rates did not differ in the two groups. Considering that the majority of patients in the NCT group belonged to the cN+ category, with an initially less favorable treatment prognosis, it can be assumed that comparable survival results were achieved thanks to NCT.

Evaluation of Door-to-Needle Stroke Patients With Thrombolytic Activation Code in Imam Reza Educational Center in Tabriz

Objectives: To investigate the therapeutic process and golden times for treating stroke patients receiving thrombolytic therapy at Imam Reza Hospital in Tabriz. Design: A cross-sectional descriptive study. Setting(s): The information for all patients entering the study was extracted from the stroke registry of the Neurosciences Research Center. Participants: Participants comprised all patients who were referred to Imam Reza Hospital emergency department (ED) in 2018, hospitalized as stroke patients, and had an indication for receiving thrombolytic therapy. Outcome measures: Data included demographic information, length of stay in the ED, time interval from the onset of symptom to ED arrival, time to CT scan, time to the start of thrombolytic therapy, outcomes (e.g., discharge, hospitalization, or death), and the use of tissue plasminogen activator (tPA) therapy. Results: A total of 140 patients were studied, with a mean and median age of 66.19±12.68 and 67.5 years, respectively. The mode age was 73 years, with the maximum age being 91 years and the minimum age being 34 years. Moreover, 82 (58.6%) of patients were male, and 58 (41.4%) were female. The mean time interval from ED arrival to the start of thrombolytic injection was 54.49±27.42 minutes, with a median and mode of 51 and 60 minutes, respectively. The minimum time was 17 minutes, and the maximum time was 218 minutes. The modified ranking scale (mRS) score at 7 days was significantly related to the National Institutes of Health Stroke Scale (NIHSS) at arrival, NIHSS 36 hours after treatment, NIHSS at 7 days after treatment, the incidence of intracerebral hemorrhage, and hospitalization duration (P≤0.001). Conclusions: Initiating thrombolytic injection within 60 minutes is feasible, and patients’ status 7 days after discharge has a significant relationship with NIHSS at arrival, NIHSS 36 hours post-treatment, and NIHSS 7 days post-treatment. Moreover, there is a significant correlation between mRS at 7 days and an interval of less than 60 minutes from ED arrival to the start of thrombolytic injection. In such cases, mRS is lower.

Clinical characteristics and associated factors of pediatric acute necrotizing encephalopathy: a retrospective study.

In the clinic, pediatric acute necrotizing encephalopathy (ANE) primarily affects children under five years of age and is characterized by severe brain damage and high mortality. However, some challenges remain regarding the diagnosis and treatment of ANE. In the present study, we analyzed the clinical characteristics and related factors of ANE with the aim of providing improved diagnostic and treatment strategies. Thirty-four pediatric ANE patients admitted to Zhejiang University School of Medicine Hospital between February 2019 and December 2023 were included in this study. To identify the factors associated with mortality, clinical, laboratory and imaging data were analyzed with independent-sample t tests, Mann‒Whitney U tests, Fisher's exact probability tests and receiver operating characteristic (ROC) curve analyses. In this cohort of 34 patients, the most common symptoms were fever, seizures, altered consciousness, vomiting, diarrhea and shock. The mortality rate was 55.9%. Laboratory tests revealed that patients who died had higher creatinine, lactate, activated partial thromboplastin time (APTT), thrombin time (TT), interleukin-6 (IL-6), interleukin-10 (IL-10), creatine kinase (CK), and D-dimer than survivors. Imaging examinations predominantly revealed symmetrical lesions in the thalamus. The fatal group displayed lower Glasgow Coma Scale (GCS) scores and severe complications. Other factors related to mortality included the arterial pH, GCS score and hospitalization duration. The most common symptoms of ANE are fever, seizures, altered consciousness, vomiting, diarrhea and shock, and ANE has a high mortality rate. The GCS score and arterial pH are critical biomarkers for assessing the severity of ANE.

Beyond diagnosis: maximizing the role of medical thoracoscopy in pleural disease treatment.

Medical thoracoscopy has been extensively utilized in the diagnosis of pleural disease, yet its potential therapeutic applications remain underutilized. This article presents a comprehensive overview of the various uses of medical thoracoscopy in managing pleural diseases. It has been employed to facilitate thoracic drainage and reduce hospitalization duration of patients with complicated parapneumonic effusions and empyema. Additionally, medical thoracoscopic occlusion therapy can be used for bronchoscopic closure and refractory pneumothorax. However, there is currently a lack of standardized protocols for utilizing medical thoracoscopy to reduce the volume of giant emphysematous bullae. Furthermore, medical thoracoscopy allows for pleurodesis or photodynamic therapy in patients with malignant pleural effusion. Nevertheless, further high-quality clinical research is needed to validate these findings.