Duration Of Hospital Research Articles

7306 Impact of Hypoglycemia in Heart Failure: National Inpatient Sample Analysis

Abstract Disclosure: B. Neupane: None. S. Karki: None. A. Bhandari: None. U. Farooq: None. K. Rajamani: None. Introduction:Hypoglycemia is one of the frequently encountered phenomena in hospitalized patients, mainly with diabetes mellitus; however, it is sometimes seen in patients without diabetes mellitus. Risk factors like advanced age, comorbid diseases, aggressive hyperglycemia therapy, etc., can play a role in the contribution of hypoglycemia. Heart failure is a significant healthcare burden in the United States; mortality due to heart failure has been increasing, and the lifetime risk of heart failure has risen to 24%. There are limited studies investigating how hypoglycemia affects outcomes in heart failure. Methods: We conducted a retrospective analysis using a national inpatient sample from 2017 to 2020. For diseases/comorbidities, International Classification of Disease (ICD-10) codes were used. Data analysis was done using STATA. Multivariate regression analysis was used to calculate the adjusted odds ratio. The primary outcomes of the study were mortality, and secondary outcomes were length of stay (LOS), total cost of hospitalization, septic shock, pulmonary edema, acute respiratory failure (ARF), mechanical ventilation, acute respiratory distress syndrome (ARDS), and acute kidney injury (AKI). Results: There was a total of 21,258,175 patients with a diagnosis of heart failure. There were 158,175 patients with a diagnosis of hypoglycemia. There were significant outcomes in patients with hypoglycemia on rates of mortality (adjusted mean difference=3.64, 14.55% vs. 4.91%, p<0.001), LOS (adjusted mean difference =2.03, 8.50% vs. 6.22%, p<0.001), the total cost of hospital stays (adjusted mean difference=$21530, $103,773 vs. $77057, p<0.001), septic shock( aOR=4.05, 14.22% vs. 3.84%, p<0.001), ARF(aOR =1.75, 24.71% vs. 15.88%, p<0.001), mechanical ventilation (aOR=2.84, 14.84% vs. 5.21%, p<0.001), ARDS( aOR=2.15, 0.57% vs. 0.24%,p<0.001), and AKI(aOR=1.65, 41.38% vs. 29.89%,p<0.001) compared to patients without hypoglycemia. There were no significant outcomes in the rate of pulmonary edema (aOR=1.09, 0.54% vs.0.46%, p=0.24). Conclusion: Hypoglycemia increases mortality, duration of hospital stays, health care cost, and health care burden. Hypoglycemia nevertheless results in worse hospital outcomes and higher expenses as compared to non-hypoglycemia due to higher mortality rates, LOS, cost, and hospital outcomes. Blood sugar levels should be monitored frequently to minimize hospitalization complications and improve outcomes. Presentation: 6/1/2024

Evaluation of early and systematic ultrasound examination to determine postoperative dehiscence after small intestinal surgery (114 cases in dogs and cats).

To evaluate the feasibility and reliability of early ultrasound diagnosis for postsurgical bowel dehiscence and find the most reliable ultrasound criteria for dehiscence identification. Additionally, to determine the impact of early ultrasound detection of leakage in terms of survival and duration of hospitalization. Finally, to assess the need for systematized screening or checkup of the population at risk of dehiscence only. 31 cats and 83 dogs. A retrospective, records-based study was performed on 83 dogs and 31 cats (114 total) undergoing small intestinal surgery. Epidemiologic data, clinical signs, surgical procedures, pre- and postoperative ultrasound findings at 48 to 96 hours, hospitalization duration, complications, and general outcomes were recorded. Univariate and multivariate analyses were used to identify ultrasound findings associated with dehiscence. Dehiscence was suspected by ultrasound for 0 of 31 cats and 7 of 83 dogs (2 of 49 for enterotomy and 5 of 34 for enterectomy). Every suspected dehiscence was confirmed during revision surgery except one enterectomy revision, which was declined by the owner. Neither this case nor those without ultrasound evidence of dehiscence developed clinical signs of intestinal leakage. Direct visibility of wall discontinuity, presence of gas bubbles, and liquid in vicinity of the intestinal surgical site were statistically associated with early dehiscence. Survival rate after the second surgery was 83%. Median hospitalization time after the second surgery for dehiscence was 2 days (minimum, 2 days; maximum, 4 days). Postoperative ultrasound examination between 48 and 96 hours after intestinal surgery allows early and sensitive detection of intestinal dehiscence. Survival rate after revision surgery was significantly higher than that associated with septic peritonitis.

Nosocomial carbapenem-drug resistant Acinetobacter baumannii, related factors and clinical outcomes in Northeast Iran

Background and objectivesNosocomial infections, including drug-resistant Acinetobacter baumannii infections, continue to impact the health of hospitalized patients. This study sought to determine the prevalence of these infections and assess the associated risk factors and clinical outcomes in Gorgan, Iran.MethodsA retrospective cross-sectional study was conducted on 143 infected patients with Acinetobacter baumannii in two educational hospitals in Gorgan city, Iran between 2016 and 2018. Patient information including age, gender, reason and duration of hospitalization, background of diseases, type of sample culture, symptoms, laboratory findings, prescribed antibiotics, and antibiogram were collected and analyzed. The Logistic regression and survival statistical methods were used by software of SPSS 26.ResultsA total of 37 patients (25.87%) died during hospitalization. The less than one year and 45–65 years age groups demonstrated more deaths (29.7%; p-value < 0.001). Being single (not being married) was found to be a risk factor in increasing the chance of death among patients (OR = 2.154, 95% CI: 1.02–4.53; p = 0.048). Hospitalization in intensive care units (ICUs) was a risk factor for the death of patients (OR = 4.655, 95% CI: 7.6–83.2). The resistance to carbapenems was reported to be an important risk factor for the death of patients.ConclusionsAcinetobacter baumannii infections, particularly those resistant to carbapenems, are a significant risk for patients in ICUs and can lead to higher mortality rates.

An open comparative randomized prospective study: Direct trocar insertion vs Veress needle technique in laparoscopic surgeries.

Laparoscopy is a minimally invasive technique utilized for both diagnostic and surgical approaches. Minimally invasive procedures compared to laparotomy offer the advantages of reduced hospital stay, lower morbidity, decreased pain, and faster recovery. Common methods for laparoscopic entry include Veress needle insertion (VNI), direct optical trocar entry, direct trocar insertion (DTI), and the Hasson technique. This study aims to compare the efficacy and safety of VNI and DTI in laparoscopic gynecological surgeries. An open comparative randomized prospective study was conducted involving 200 women aged 18 to 70 years, scheduled for laparoscopic surgery at 2 tertiary centers. Participants were randomized into 2 groups: 1 using VNI and other using DTI. The groups were homogeneous regarding age, parity, and body mass index. The mean age of the VNI group is 45.22 ± 11.65 and the DTI group is 44.89 ± 10.5 (P = .833). There were no statistical significance in terms of the presence of chronic diseases and history of previous abdominal surgery between the groups (P = .802 and P = .510, respectively). Entry time to the abdomen, the decrease in hemoglobin values, and hospitalization length were found to be statistically significant between the entry methods (P < .001, P = .002, and P < .001, respectively). Entry time, the decrease in hemoglobin value, and hospitalization length were higher in the VNI group. In conclusion, although there is no definitive consensus on the optimal laparoscopic entry technique, direct trocar entry is an effective alternative to the Veress needle insertion technique. Direct trocar entry is associated with shorter entry times, fewer perioperative complications, less reduction in hemoglobin levels, and shorter hospitalization duration compared to VNI.

The effect of legal representation on clinical measures in involuntarily admitted psychiatric patients: a retrospective study

BackgroundMost western countries provide funded legal representation (LR) for involuntarily admitted psychiatric patients appearing before judicial committees. In 2004, an amendment to the Israeli Mental Health Act granted this right to involuntarily committed psychiatric patients. Psychiatrists then voiced concerns that LR may increase rates of premature discharge and compromise patients’ safety and well-being. These worries have not been sufficiently addressed to date. This study aimed to provide answers to their concerns.MethodsThis study included 3124 and 3434 inpatients involuntarily admitted to psychiatric facilities in 2000 and in 2010 (respectively), prior to and after the introduction of LR in Israel. Data were acquired from the Israeli National Psychiatric Hospitalization Registry. Clinical measures included percentage of discharges by the District Psychiatric Board (DPB), duration of involuntary hospitalization and rates of readmissions within thirty days and six months of discharge by treating psychiatrists (TP) or DPB.ResultsThe odds ratio (OR) of discharge by a DPB in 2010 (n = 221) compared to 2000 (n = 93) was 2.2 [95%CI 1.72–2.82]. The OR was similar for readmissions within thirty days or six months among patients discharged by TP and a DPB (OR = 1.08, p = 0.697 and OR = 0.92, p = 0.603, respectively) as well as between the two time points (p = 0.486 and p = 0.618). The duration of hospitalizations terminated by a DPB was significantly shorter than those terminated by TP, with no difference between the study time points. The mean hospitalization duration in 2010 was 21% shorter compared to 2000 among patients discharged by TP.ConclusionsThe number of DPB proceedings and the number of involuntarily hospitalized psychiatric patients discharged by DPBs increased considerably after the advent of state-funded legal representation in 2004. We found that this did not compromise beneficence and non-malfeasance of patient care. Our results emphasize the feasibility of affording even the most severely mentally ill patients the rights to due process. These findings may relieve concerns about state-funded LR procedures in involuntary psychiatric hospitalizations.

Septic Hip Arthritis in Children: A Comparison of Arthrocentesis and the Double Luminal Drainage Catheter

Background: Septic hip arthritis in children is an orthopaedic emergency. While the well-established surgical treatment is open arthrotomy, several minimally invasive techniques have been offered as alternatives in recent years. The purpose of this study was to compare the clinical outcome of a continuous double luminal drainage catheter (DLDC) with repeated arthrocentesis, in the treatment of septic hip arthritis in children. Methods: Medical records were retrospectively reviewed for all patients aged 1 to 18 years diagnosed with septic hip arthritis between 2005 and 2020 and treated with either DLDC or arthrocentesis. The clinical outcomes of 17 patients who fulfilled the inclusion criteria were compared. 8 were treated using DLDC, and 9 were treated by arthrocentesis. All patients had a follow-up period of 12 months after treatment. Results: In the DLDC group, the catheter was inserted continuously, with a median of 4 days. A single aspiration sufficed in 8 of 9 patients. The duration of hospitalization was significantly longer (P = 0.004) in the DLDC group (mean 21.6 SD 10.04 days), compared with the arthrocentesis group (mean 9.2 SD 1.7 days). The median time until patients returned to normal gait was 12 days (range 4 to 110) in the DLDC group, compared with 8 days (range 7 to 14) in the arthrocentesis group. None of the patients required open arthrotomy, and no infection recurrence was observed. Discussion: In conclusion, while both suggested minimally invasive techniques may be safe and efficient in the treatment of septic hip arthritis in children, arthrocentesis is associated with a shorter duration of hospitalization. However, continuous drainage with a DLDC may be a better modality for severe cases. Additional research is needed to determine specific indications, considering the widely accepted benchmark of open arthrotomy. Level of Evidence: III

Investigating colostomy-related morbidity in children following stoma formation and closure in a tertiary hospital, Abha, Saudi Arabia: a retrospective cohort study 2024

BackgroundOverall, stoma-related morbidity affects a reported 20–38% of pediatric patients. However, determining the true incidence of major stoma-related morbidity is challenging due to limited cohort sizes in existing studies. Thus, the aim of this study was to investigate colostomy related morbidity among children both after stoma formation and stoma closure.MethodologyThis is a retrospective cohort hospital-based study, conducted in an Abha maternity and children hospital, between August 1, 2018, and August 1, 2023, among 126 pediatric patients (aged 0–12 years) who underwent colostomy formation and subsequent closure during the study period. Data were collected from medical records. Data was analyzed using Statistical Package for Social Sciences (SPSS) v.26.ResultsThis study included a total of 126 children who underwent colostomy. (N = 37, 29.4%) of cases included in this study were emergency cases, while (N = 89, 70.6%) were elective. A variety of antibiotics were used for surgical prophylaxis, metronidazole (77%) and cefuroxime (62.7%) were the most prevalent. Oral feeding was started after 5–6 days in more than one third of cases (39.7%). Wound infection (N = 15, 11.9%) was the most reported post-operative complication, followed with bowel obstruction (N = 6, 4.8%). Emergency cases had a longer duration of hospital stay than elective cases; this difference was statistically significant (P = .04).ConclusionsMajority of patients reported no stoma related complications, while among those who reported complications, wound infection was the most reported complication, followed by bowel obstruction.

TAPP versus lichtenstein techniques for bilateral inguinal hernia repair: A systematic review and meta-analysis.

Inguinal hernia repair is one of the most common surgical procedures performed worldwide. However, very few studies report data on the laparoscopic advantages of bilateral inguinal hernia (BIH) repair over the open approach. Therefore, this meta-analysis was conducted to compare the effectiveness of the laparoscopic trans-abdominal pre-peritoneal (TAPP) technique with the open Lichtenstein repair technique (OLR) for the repair of BIH. A detailed literature search was conducted on PubMed, Google Scholar, and Cochrane Library for comparative studies between TAPP and OLR techniques for repair of BIH. RevMan Version 5.4 was used for data analysis. The Inverse Variance statistical method was used to analyze the primary outcomes and the Mantel-Haenszel statistical method was used to analyze the secondary outcomes. The effect measure was reported as a Risk Ratio. There was no significant difference in recurrence between the two groups. A significant difference was seen in duration of post-operative hospital stay, operative time, pain score on VAS criteria on post-operative Day 1, pain score on VAS criteria on post-operative Day 7, and complications, all in the favor of TAPP except for operative time which was in the favor of OLR. TAPP was found to be superior to OLR in terms of duration of post-operative hospital stay, pain scores on VAS criteria on post-operative days 1 and 7, and complications, whereas OLR was found superior only in terms of operative time. For recurrence, there was no significant difference between the two groups.

Treatment of Macrolide-resistant Mycoplasma pneumoniae Pneumonia in Children: A Meta-analysis of Macrolides Versus Tetracyclines.

The global prevalence of macrolide-resistant Mycoplasma pneumoniae (MRMP) pneumonia infections, particularly in children, is on the rise. It is imperative to assess the clinical efficacies of alternative antibiotics such as tetracyclines to ensure effective treatment, mitigate antibiotic resistance, enhance clinical outcomes, and minimize the spread of resistant strains among MRMP-infected children. The objective of this study was to compare the therapeutic efficacies of macrolides and tetracyclines in treating MRMP pneumonia in children. We systematically searched the literature to identify comparative studies that examined the clinical outcomes of macrolide and tetracycline antibiotics in children with MRMP pneumonia. We conducted a meta-analysis of the mean duration of fever, hospital stay duration, therapeutic efficacies, and time to defervescence to compare macrolides and tetracyclines. Eleven studies involving 1143 patients compared the clinical efficacies of macrolides and tetracyclines in children with MRMP pneumonia. The studies were conducted in China, Japan, and Korea, and the outcomes of febrile days, hospital stay duration, therapeutic efficacy, and time to defervescence were analyzed. The macrolides studied were azithromycin and clarithromycin, whereas the tetracyclines included minocycline and doxycycline. The pooled estimate of 5 studies showed that the mean duration of febrile days and hospital stay was longer in the macrolides group than tetracycline group [weighted mean difference = 1.64 days, 95% confidence interval (CI): 0.68-2.59, weighted mean difference = 1.22 days, 95% CI: 0.82-1.62, respectively]. The therapeutic efficacy was significantly lower in the macrolide group than in the tetracycline group (odds ratio: 0.33, 95% CI: 0.20-0.57). The clinical efficacy of tetracycline treatment was superior to that of macrolide treatment in children with MRMP pneumonia. However, further research is required to validate these findings and inform evidence-based clinical practice guidelines.

Assessment of ultrasound-guided tru-cut needle pleural biopsy in the diagnosis of unexplained exudative pleural effusion compared to medical thoracoscopy

Background Ultrasound-guided needle biopsy (USGNB) allows for precise and immediate viewing of pleural lesions, effusions, and needle placement without ionizing radiation. This study aimed to assess the efficacy of US-guided tru-cut needle pleural biopsy in diagnosing unexplained exudative pleural effusion compared to medical thoracoscopy (MT), focusing on safety, accuracy, time, and cost of the treatment. Patients and methods This observational cross-sectional research was conducted on 40 patients over 18 years old, of both sexes, with unexplained exudative pleural effusion. The patients were randomly separated into two equal groups. The girst group is USGNB and the second group is MT. Results Group II exhibited substantially greater costs, sedation levels, procedure duration, biopsy site discomfort, surgical emphysema, lung expansion failure, and psychological distress compared to group I (P&lt;0.05). There was no notable disparity between the two groups regarding radiological detection of pleural effusion, pleural fluid properties, procedural observations, histological results, and diagnostic effectiveness. The duration of hospitalization was considerably shorter in group I compared to group II, assessed from the day of the operation to the day of release (P=0.001). Conclusion USGNB is an important tool in the diagnosis of pleural effusion after failure of pleural fluid analysis, which is performed by a chest physician is an accurate, safer, lower in cost, and shorter in duration with fewer complications compared with MT.

Evaluation of the prevalence and influencing factors on poly-pharmacy among elderly patients - A review

ABSTRACT The evaluation of adverse effects caused by poly-pharmacy (PHP) in patients, especially in the elderly group, is very important. The purpose of the present study was to evaluate the prevalence and factors affecting PHP in elderly patients. This study was conducted as a narrative review. Related articles were downloaded using reliable international databases and specialized mesh terms. Finally, the results of 29 articles were extracted based on the authors’ names, study location, sample size, and key results. The findings of the study showed that the prevalence of PHP in the elderly was higher after discharge from the hospital than during hospitalization. In addition, the prevalence of PHP in the elderly who lived in care centers was higher than in those who lived at home. Based on the findings, there was a relationship between the source of obtaining information about drugs and the pattern of PHP consumption. The findings of the present study showed that PHP leads to serious complications in the elderly. Based on the results of the study, it can be concluded that some variables such as age, sex, health level, financial status, place of residence, type of disease, number of simultaneous diseases, hospitalization, duration of hospitalization, level of awareness of the elderly and their caregivers, the care place of elderly, and the number of visits of the elderly to the physician can be effective in the prevalence of PHP. Strategies such as choosing treatment goals for each patient in preventing unnecessary drug use, identifying at-risk groups, and periodically monitoring the benefits and side effects of drugs can be effective in reducing drug complications caused by PHP in the elderly.

Modified reconstruction approach after pancreaticoduodenectomy optimizes postoperative outcomes: Results from a multivariate cohort analysis.

Despite technical advances in recent decades and a decrease in hospital mortality (<5%), pancreaticoduodenectomy (PD) is still associated with major postoperative complications, even in high-volume centers. The present study aimed to assess the effect of a modified reconstruction technique on postoperative morbidity and mortality. A cohort study of all patients (n=218) undergoing PD between January 2010 and December 2019 was performed at Attikon University Hospital (Athens, Greece). Several variables were studied, including demographic data, past medical history, perioperative parameters, tumor markers and pathology, duration of hospitalization, postoperative complications, 30-day-survival, postoperative mortality and overall survival using multivariate logistic regression and survival analysis techniques. In this cohort, 123 patients [modified PD (mPD) group] underwent a modified reconstruction after a pylorus-preserving pancreaticoduodenectomy, which consisted of gastrojejunostomy and pancreaticojejunostomy on the same loop and an isolated hepaticojejunostomy on another loop. In the standard PD (StPD) group, 95 patients underwent standard reconstruction. The median age was 67 years, ranging from 25 to 89 years. Compared with in the StPD group, the mPD group had significantly lower rates of grade B and C pancreatic fistula (4.9% vs. 28.4%), delayed gastric emptying (7.3% vs. 42.1%), postoperative hemorrhage (3.3% vs. 20%), intensive care unit admission (8.1% vs. 18.9%), overall morbidity (Clavien-Dindo grade III-V: 14.7% vs. 42.0%), perioperative mortality (4.1% vs. 14.7%), and shorter hospitalization stay (11 days vs. 20 days). However, no difference was noted regarding median survival (35 months vs. 30 months). In this single-center series, a modified reconstruction after PD appears to be associated with improved postoperative outcomes. However, further evaluation in larger multi-center trials is required.

Semaglutide treatment for PRevention Of Toxicity in high-dosE Chemotherapy with autologous haematopoietic stem-cell Transplantation (PROTECT): study protocol for a randomised, double-blind, placebo-controlled, investigator-initiated study

IntroductionCancer treatment with high-dose chemotherapy damages the mucosal barrier of the gastrointestinal (GI) tract and is associated with severe toxicity involving mucositis, severe inflammation and organ dysfunction. Currently, there is...

Comparable long-term functional outcomes of subvastus and medial parapatellar approach in total knee arthroplasty: A 10-year follow-up study.

Surgeons usually use the medial parapatellar or subvastus approaches for total knee arthroplasty (TKA). The subvastus approach is rapidly gaining recognition to reduce damage to the extensional mechanism and recover faster after surgery. This study compares the long-term outcomes of the conventional medial parapatellar and subvastus approaches in primary TKA during a minimum 10-year follow-up. In a retrospective longitudinal follow-up study from 2008 to 2013, 60 eligible patients for primary TKA were included. The patients were divided into two groups: one undergoing TKA with the subvastus approach (n = 30) and the other with the conventional medial parapatellar approach (n = 30). Postoperatively, the patients were followed up for 10-15 years. Patients were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), and Visual Analogue Scale index for pain. The time required to perform an active straight leg raise (SLR) was significantly shorter in the subvastus group (p < 0.001) at early postoperation evaluation. Patients in the subvastus group had lower pain and better knee functional scores at the one-year follow-up (p < 0.05). There was no difference between the two groups regarding duration of hospitalisation, blood loss, operation time, length of the scar, and postoperative complications. Both approaches had similar long-term results regarding pain and functional scores of WOMAC (6.2 ± 1.2 vs. 6.3 ± 1.3, p-value = 0.69) and KSS scores (93.1 ± 6.8 vs. 95.0 ± 3.2, p-value = 0.42). The subvastus approach was associated with a shorter time to achieve active SLR, higher functional scores, and better pain relief at early postoperative evaluations. However, both techniques had similar long-term outcomes in terms of pain and functional scores, as measured by the WOMAC and KSS scales. II.

Laparoscopic myomectomy without uterine manipulator for maintaining endometrial cavity integrity

BackgroundPreserving the integrity of the endometrial cavity is crucial, particularly for preserving fertility during laparoscopic myomectomy (LM). This study aimed to compare the uterine breaching rate and clinical outcomes of LM performed with and without a uterine manipulator. MethodsData from women who underwent LM at our hospital between January 2020 and June 2023 were retrospectively analyzed. The primary outcomes included endometrial cavity breaching rate, conversion rate, abdominal port count, operative time, hospitalization duration, and blood loss. The secondary outcomes included adverse events such as postoperative anemia and emphysema. ResultsWe analyzed the data from 50 participants, comparing those with (n=30) and without (n=20) manipulators. No significant differences were observed in age, body mass index, surgical time, hospitalization, blood loss, or hemoglobin drop. However, the incidence of endometrial cavity breach was higher in the manipulator group (p=0.007). The manipulator group required fewer abdominal ports (p<0.001) than the manipulator group. Increased myoma size was associated with increased blood loss and surgical time. ConclusionsThe clinical outcomes of LM without a uterine manipulator were comparable to those of LM with a manipulator. The absence of a manipulator may aid in preserving the integrity of the endometrial cavity. An increase in myoma size was associated with longer surgical time and greater blood loss, while uterine manipulator use was linked to fewer trocars.

Reconstruction in early squamous cell carcinoma of the oral cavity—Do free flaps improve oncological outcome?

BackgroundOral squamous cell carcinoma (OSCC) ranks on position 14 in global cancer analysis and makes up to 38 % of all head and neck squamous cell carcinomas. While surgery is accepted as first-line treatment of early tumors, the reconstructive approach is not standardized. Therefore, we evaluated the concept of ablative tumor removal and microvascular reconstruction in terms of oncological safety and surgical morbidity for early OSCCs. Methods262 patients received ablative tumor surgery with neck dissection together with microvascular reconstruction between 2010 and 2020. General clinical data was analyzed descriptively with regard to surgery time, duration of tracheotomy and hospitalization. ResultsEstimated 5-year overall and progression-free survival was 85 % and 77 % respectively with no significant difference between stage I or II cancer patients. Tracheotomy was performed in 131 patients (50 %). 19 patients (7.3 %) were temporarily dependent to a gastric feeding tube. Flap loss occurred in 9 patients (3.4 %). DiscussionIn a standardized setting, mean surgery time could be reduced constantly. We propose consistent tumor ablation, combined with elective neck dissection and microvascular reconstruction in early oral squamous cell carcinoma. The presented concept leads to excellent oncological and functional results with acceptable morbidity and short surgery times.

Levosimendan in patients with low-cardiac-output syndrome after cardiac surgery: Substudy of the multicenter randomized CHEETAH trial

ObjectiveTo test the hypothesis that levosimendan administration to patients with low-cardiac-output syndrome after cardiac surgery is associated with improved long-term (5-year follow-up) outcome. DesignSingle-center subanalysis of the multicenter randomized CHEETAH trial. SettingCardiac surgery department of a tertiary hospital. ParticipantsA total of 134 adult patients requiring hemodynamic support for cardiac index <2.5 L/min/m2 after cardiac surgery with cardiopulmonary bypass (CPB). InterventionsPatients were randomized (1:1 ratio) to receive levosimendan (continuous infusion with starting dose of 0.05 μg/kg/min) or placebo, in addition to standard inotropic care. Measurements and Main ResultsThe primary endpoint was long-term mortality (1-5 years) after randomization. Secondary outcomes were the following: hemodynamic parameters, need for inotropic support (VIS), acute kidney injury (AKI), need for renal-replacement therapy, duration of mechanical ventilation, ICU and hospital stay, 30-day mortality. No significant between-group difference in long-term mortality (5-year) was observed (hazard ratio, 1.59; 95% CI, 0.81 to 3.11; P = 0.17). There were no significant differences in secondary outcomes, except for the difference in the mean pulmonary artery pressure at 4-6 hours after randomization, which was lower in the levosimendan group (24 [21.8, 28] mmHg versus placebo 26 [22.2, 33] mmHg, p = 0.019). ConclusionsAmong patients requiring hemodynamic support after cardiac surgery with CPB, perioperative levosimendan infusion does not affect long-term survival (1-5 years) compared with placebo. Levosimendan also had no effect on major clinical outcomes such as AKI, ICU stay, hospital stay, 30-day mortality.

Our experience of laparoscopic vesicovaginal fistula repair in a tertiary care center

Objective: Laparoscopic repair of vesicovaginal fistula (VVF) is gaining popularity day by day, but we have limited literature on it. This study is to evaluate the safety, feasibility, and outcomes of laparoscopic VVF repair in a tertiary care center in Eastern India. Subjects and Methods: This study is a single-center retrospective study in which 11 patients of supratrigonal VVF were evaluated who underwent laparoscopic repair. Preoperative workup included history, examination, computed tomography urography, cystoscopy, and vaginoscopy. After informed consent, laparoscopic VVF repair was done under general anesthesia. Duration of surgery, the need for conversion to open procedure, intraoperative bowel injury, the need for postoperative blood transfusion, postoperative hospital stay, postoperative urinary leak, and any incontinence after catheter removal were noted. Results: All the patients had primary supratrigonal fistula of approximate size in the range of 1.5–2.0 cm. All the included patients were operated on successfully by laparoscopic technique with a mean duration of surgery of 177.91 ± 6.14 min. The mean duration of postoperative hospital stay was 4.45 ± 0.52 days. There was no incidence of postoperative urine leak in any patient. After urethral catheter removal, all the patients voided well without any incontinence. Conclusions: Laparoscopic VVF repair is a safe and feasible option with satisfactory intraoperative and postoperative outcomes.

Study Of Incidence And Risk Factors In Surgical Site Infections Post LSCS At Tertiary Care Centre In Western Rajasthan

Background: Surgical site infection post LSCS leads to increasing patient morbidity and increase the duration of patient hospitalization, hospital costs and raise the burden on our healthcare system. The incidence of SSI after caesarean section ranges from 3% to 5%. Objective of current investigation was to study the incidence&amp;risk factors responsible for SSI in LSCS. Methods: This prospective study was done among pregnant women undergoing LSCS who developed SSI at department of Obstetrics and Gynaecology in Umaid Hospital, Jodhpur during June 2023 to August 2023. All patients were following up to 7thpostoperative day.SSI was defined by CDC criteria. Results: The incidence of SSI noted in present study was 2.5%. Almost 30.8% cases had BMI ≥25 kg/m2 , 55% multipara, 67.3% resided in rural area. Anemia, PROM, LSCS in emergency, multiple vaginal examination (&gt;5), prolonged labornoted in participants of SSI was 51.9%, 26.9%, 75, 34.6%, 38.4% respectively. Silk suture material was used in 71% of cases who developed SSI. Conclusions: Incidence of SSI in present is 2.5%. BMI, Anemia, PROM, LSCS in emergency, multiple vaginal examination (&gt;5), prolonged labor, silk suture material were noted higher among the participants who developed SSI. Keywords: Cesarean delivery, Incidence of SSI, Risk factor, Surgical site infection

Association of SARS-CoV-2 infection during late pregnancy with maternal and neonatal outcomes

BackgroundLimited data on the impact of the coronavirus disease 2019 (COVID-19) during pregnancy on newborn outcomes are available. This study aimed to characterize and compare the clinical outcomes of newborns from women with and without the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection during late pregnancy.MethodThis was a retrospective cohort study of women who were either infected or not infected with the SARS-CoV-2 virus during late pregnancy. The neonatal complications associated with COVID-19-positive pregnant women were investigated and analyzed.ResultsAmong 2063 pregnant women over 28 weeks of gestation, 1.2%, 3.3%, and 18.7% of patients with multiple pregnancies, abnormal fetal positions, and lack of maternal or neonatal follow-up data, respectively, were excluded. Patients who were COVID-19-negative (60.6%) and -positive (16.2%) remained for further analysis. SARS-CoV-2 infection was significantly associated with higher SARS-CoV-2 infection rates in newborns (0% vs. 1.49%, P < 0.01) and longer duration of hospital stay (6.39 ± 2.2 vs. 4.92 ± 1.6, P < 0.01). However, comparing neonatal complications, including Apgar score, preterm birth, low birth weight, cesarean section rate, newborn hearing, neonatal congenital heart defects, and height and weight compliance rate of 6-month-old children, between non-infected and infected participants did not reach statistical significance.ConclusionSARS-CoV-2 infection in late pregnancy has no significant impact on neonatal outcomes. After six months of follow-up of the neonates, we observed that SARS-CoV-2 infection in the third trimester of pregnancy did not affect their growth and development. Hopefully, these findings will guide management strategies and clinical practice.