General Complications Research Articles

Fresh Frozen, In-Alcohol, or Autologous Costal Cartilage? Analysis of Complications in Over 650 Revision Rhinoplasties.

When there is insufficient autologous septal cartilage for graft sculpting in revision rhinoplasty, valid alternatives need to be found. Both autologous and homologous costal cartilage usage has been described in the literature. As there is no universally accepted consensus on cartilage choice, experience with different types of cartilage assumes significant importance in the rhinoplasty learning process. This multicenter prospective study outlined an overview of the authors' experience regarding short-term and long-term complications following revision rhinoplasty procedures in which either fresh frozen (FFCC), in-alcohol (IACC), or autologous costal cartilage (ACC) was used. A total of 671 patients undergoing revision rhinoplasty between June 2015 and September 2020 were divided into 3 groups according to the type of cartilage used (Group 1, 212 patients with FFCC; Group 2, 239 patients with IACC; Group 3, 202 patients with ACC). Sociodemographic and clinical characteristics and short- and long-term complications were described and discussed. A statistical analysis investigating a possible significance of the differences in complication rates was conducted. The data obtained indicated a short-term general complication rate of 5.05%, and a long-term complication rate of 7.04%. A statistically significant difference was identified in cartilage warping rate between the homologous cartilages in comparison to ACC. FFCC, IACC, and ACC can be safely used in revision rhinoplasty with no statistically significant differences regarding short- and long-term complication rates. Cartilage warping rate is significantly higher for ACC compared with FFCC and IACC.

Diagnóstico y tratamiento de la miocarditis y la miocardiopatía inflamatoria. Documento de consenso SEC-GT de miocarditis

Myocarditis is defined as myocardial inflammation and its etiology is highly diverse, including infectious agents, drugs, and autoimmune diseases. The clinical presentation also varies widely, extending beyond the classic clinical picture of acute chest pain, and includes cases of cardiomyopathy of unknown cause whose etiology may be inflammatory. Because certain patients may benefit from targeted treatments, the search for the etiology should begin when myocarditis is first suspected. There remain several areas of uncertainty in the diagnosis and treatment of this disease. Consequently, this consensus document aims to provide clear recommendations for its diagnosis and treatment. Hence, a diagnostic algorithm is proposed, specifying when non-invasive diagnosis with cardiac MR is appropriate vs a noninvasive approach with endomyocardial biopsy. In addition, more novel aspects are discussed, such as when to suspect an underlying genetic etiology. The recommendations cover the management of myocarditis and inflammatory cardiomyopathy, both for general complications and specific clinical entities.

Dental Care for Cancer Patients in the Prevention of Complications of Chemotherapy and Head and Neck Radiation Therapy

Oncological diseases occupy one of the first places in the structure of disability and mortality of the population. The main methods of treating patients with malignant tumors in the maxillofacial area are surgical method, radiation therapy and chemotherapy. Treatment with only one of the listed methods It is rarely performed, mainly at the stage of cancer in situ or stage I of the disease. The treatment depends on the clinical and morphological characteristics of the tumor and requires the use of all methods simultaneously or in a certain sequence. Radiation and chemotherapy treatments not only have systemic side effects, but also side effects in the treatment area. Against the background of antitumor treatment, there is an exacerbation of concomitant chronic diseases, including odontogenic ones. Pathological changes appear on the mucous membrane oral cavity, on the skin, in the subcutaneous tissue, in the salivary glands and in the bone marrow of the jaw bones. The degree of damage to these structures during tumor treatment depends on their initial condition. At the same time, the initial condition of the oral cavity affects the quality of antitumor treatment. Poor oral hygiene and chronic odontogenic lesions can cause the development of episodic fevers and other general complications. All this requires stopping or changes in the tactics of antitumor treatment, which reduces its radicalism. It becomes obvious that sanitation of the oral cavity, carried out before treatment by an oncologist, will avoid or reduce the frequency complications in the maxillofacial area, improve the quality of life of an oncology patient. Dental care for such a patient has features and requires an individual approach. The purpose of this study was to review the literature on the main oral tissue complications arising from chemotherapy and radiation therapy in the head and neck region. In Google Scholar, Medline, Scopus, Web of Sciences, PubMed a systematic review was conducted. Search keywords terms included head and neck cancer, dental care, prevention of complications of cancer, oral tissue lesions manifestationin, chemotherapy, head and neck radiation therapy. Conducted a preliminary search and reviewed 132 titles and abstracts in this literary review included 48 article. This article analyzes the main complications of oral tissues resulting from chemotherapy and radiation therapy in the head and neck area and provides practical recommendations for the management and prevention of complications in this category of patients.

Retinal Changes in Patients With Covid-19 and Different Expressiveness of Metabolic Changes.

To study the relationship between the severity of COVID-induced metabolic changes and the structure and frequency of retinal changes, according to funduscopy data in patients with different clinical courses of COVID-19. 117 patients with COVID-19 were examined. While examining patients, severity of the course of COVID-19, the expressiveness of changes in the metabolic status were determined; fundus image registration was performed with portable fundus cameras Pictor Plus Fundus Camera and VistaView (Volk Optical). As a result of the research, retinal changes were found in 49 (41.9 %) patients with COVID-19. In 8 (16.3 %) cases, clinically significant (vitreous hemorrhage, prethrombosis of the central retinal vein or branches of the central retinal vein, thrombosis of the central retinal vein or branches of the central retinal vein) COVID-induced retinal and ophthalmological changes were observed, which caused a decrease in visual acuity. In 41 (83.7 %) cases, clinically insignificant changes (cotton wool spots, narrowed retinal vessels, intraretinal and petechial hemorrhages, tortuosity and dilatation of retinal venules) COVID-induced retinal changes were observed. Clinically significant retinal changes occur in patients with a statistically significantly higher level of D-dimer and a greater percentage of lung parenchyma lesion than in the group of patients with clinically insignificant retinal changes (p < 0.05). The structure of retinal changes in patients with COVID-19 correlates with the severity of the clinical course of the disease and changes in the metabolic status of patients. Metabolic changes are correlated with retinal changes and can be predictive for preventing general vascular complications in COVID-19.

A REVIEW OF MAGGOT DEBRIDEMENT THERAPY IN DIABETIC FOOT ULCER

the protocol for treating diabetic foot ulcers which occur in at least 15% of patients with diabetes and precede 84% of leg amputations. Debridement may be surgical or non-surgical. Surgical debridement is carried out using sharp instruments. It has some complications like perioperative bleeding and general complications of anaesthesia. It demands skilled surgeon. Non-surgical debridement includes autolytic, enzymatic, mechanical and biological debridement. All the methods have their own advantages and disadvantages. Biological debridement is a technique based on the use of maggots to remove necrotic tissues from chronic wound. Maggots or larvae of flies are applied on the infected wound. Maggots excrete the enzyme which degrade and liquefy necrotic tissue and later on ingest this from the wound. It is relatively painless procedure as compared to the surgical debridement. This technique has been granted FDA approval in US since 2004. All classical and contemporary literature especially PubMed database regarding maggot debridement therapy and diabetic foot ulcer is scrutinised for the review. It was found that Maggot debridement therapy (MDT) is the better technique as compared to other non-surgical debridement methods for management of diabetic foot ulcer. Sushruta the father of surgery was the first to introduce the maggot therapy in context to kaphaja arbuda (a type of tumour). It is the need of time to conserve this basic principle as a non-surgical method for debridement.

Perioperative corticosteroids for reducing postoperative complications following esophagectomy: an updated systematic review and meta-analysis

BackgroundThis updated systematic review and meta-analysis aims to evaluate the efficacy and safety of perioperative corticosteroid administration versus placebo for esophageal cancer patients following scheduled esophagectomy.MethodsWe searched databases through June 30, 2023. We included articles on randomized controlled trials (RCTs) comparing perioperative corticosteroid administration with placebo in esophageal cancer patients with esophagectomy. The outcomes were the death rate during hospitalization, length of hospital stay, and short-term complications. Risk ratios (RRs) and corresponding 95% confidence interval (CIs) for each estimated effect size were applied for dichotomous outcomes, and the mean difference (MD) and corresponding 95% CIs for each estimated effect size were applied for continuous outcomes. We used GRADE to evaluate the quality of each of the outcome and the level of recommendations.ResultsNine RCTs with 508 participants were included in this study. Severe outcomes, including the length of hospital stay, leakage, mortality during the hospitalization period in the corticosteroid group was comparable to that in the control group, but positive effects of corticosteroid administration were observed on the length of intensive care unit stay (MD -3.1, 95% CI − 5.43 to − 0.77), cardiovascular disorders (RR 0.44, 95% CI 0.21–0.94) and other general complications (RR 0.49, 95% CI 0.29–0.85).ConclusionsPeri-operative intravenous corticosteroid administration may reduce cardiovascular disorders, other general complications and the length of ICU stay without carrying severe outcomes. More high quality RCTs are warranted to further investigate the effects of corticosteroids on postoperative mortality and complications for esophageal cancer patients with esophagectomy.Systematic review registrationCochrane, registration number: 196.

Clinical predictors of postoperative complications in the context of enhanced recovery (ERAS) in patients with esophageal and gastric cancer

The overall frequency of postoperative complications in patients with esophageal and gastric cancer diverges between studies. We evaluated the frequency and assessed the relationship between complications and demographic and clinical features. For this observational study, data were extracted from the ERAS Registry managed by the University of Verona, Italy. Patients were evaluated and compared for postoperative complications according to the consensus-based classification and the Clavien–Dindo scale. The study population was 877 patients: 346 (39.5%) with esophageal and 531 (60.5%) with gastric cancer; 492 (56.2%) reported one or more postoperative complications, 213 (61.6%) of those with esophageal and 279 (52.5%) of those with gastric cancer. When stratified by consensus-based classification, patients with esophageal cancer reported general postoperative complications more frequently (p < 0.001) than those with gastric cancer, but there was no difference in postoperative surgical complications between the two groups. Multiple logistic regression models revealed an association between postoperative complications and the Charlson Comorbidity Index (adjusted odds ratio [OR] 1.22; 95% confidence interval [CI] 1.08–1.36), operation time (adjusted OR, 1.08; 95% CI 1.00–1.15), and days to solid diet intake (adjusted OR, 1.39; 95% CI 1.20–1.59). Complications in patients with esophageal and gastric cancer are frequent, even in those treated according to ERAS principles, and are often associated with comorbidities, longer operative time, and longer time to solid diet intake.

VagiBIOM Lactobacillus suppository improves vaginal health index in perimenopausal women with bacterial vaginosis: a randomized control trial

Bacterial vaginosis (BV) can cause vaginal dysbiosis that may influence general vaginal health and pregnancy complications. Balancing vaginal microbiome using Lactobacillus spp. may be a new way to prevent and treat mild BV. We conducted a randomized, double-blind, placebo-controlled pilot study aimed at evaluating the effect of the product VagiBIOM, a multi-Lactobacillus vaginal suppository, on peri- and premenopausal women with BV in restoring vaginal pH and overall vaginal health by resetting the vaginal microbiome composition. Sixty-six peri- and premenopausal women with BV symptoms were randomized with a 2:1 ratio to be treated with VagiBIOM or placebo suppositories. Vaginal pH, VAS itching score, total Nugent score, and vaginal health index (VHI) were measured. Vaginal microbiome changes before and after the treatment were analyzed by 16S rRNA sequencing and bioinformatics analysis. After 4 weeks of intervention with VagiBIOM or a placebo, the mean score for vaginal pH, VAS itching, and total Nugent score was significantly decreased from the baseline. Compared to the baseline scores, the VHI scores improved significantly following 28-day intervention (p < 0.001). Our results revealed two Lactobacillus species, L. hamsteri, and L. helveticus, as indicator species occurring differentially in the VagiBIOM-treated group. Furthermore, the regression and species network analyses revealed significant bacterial associations after VagiBIOM treatment. Lactobacillus hamsteri was positively associated with the Nugent score and negatively associated with vaginal pH. L. iners and L. salivarius were positively and inversely associated with VHI. As is typical, Bacteroides fragilis was positively associated with vaginal pH and negatively associated with the Nugent score. Interestingly, the Lactobacillus spp. diversity improved after VagiBIOM treatment. The VagiBIOM suppository treatment for peri- and premenopausal women with BV significantly relieved vaginal itching by decreasing vaginal pH and Nugent scores and improving the overall VHI after 4 weeks’ intervention. This effect was primarily the result of VagiBIOM improving vaginal Lactobacillus diversity.Trial Registration ClinicalTrials.gov registration: NCT05060029, first registration 09/28/2021: Title: A Pilot Study to Evaluate the Efficacy and Safety of Lactobacillus Species Suppositories on Vaginal Health and pH.

Complication Patterns of Loop Ileostomy

Background: Loop ileostomy is a temporary diversion of small intestinal contents towards exterior through anterior abdominal wall. Though it is a good procedure for a better outcome of primary surgery it has itself many complications. Objective: To determine the clinical spectrum of loop ileostomy complications. Materials and method: This prospective study was conducted from January, 2017 to December, 2017. Consecutive 30 patients requiring loop ileostomy were enrolled in the study by purposive sampling and were categorized into Group A requiring emergency surgery and Group B planned for elective surgery. Data regarding sociodemographic, clinical, surgical and outcome profile were recorded in a pre-structured, interview and observation based, peer reviewed data collection sheet. Data were compiled, edited and analyzed with SPSS version 23. Data were presented as mean and standard deviation, frequency percentage and median with range. Results: The mean age of the patients were 32.79±5.19 years (age range: 20-43 years) and 49.16±6.17 years (age range: 28-76 years) in Group A and Group B respectively with sex ratio of male to female of 4:1 and 3:1. Out of 10 patients in Group A, 4(40%) patients underwent resection anastomosis with ileostomy and primary repair with loop ileostomy whereas 2(20%) patients underwent exteriorization of multiple perforation site. In Group B among 20 patients, 9(45%) underwent low anterior resection with loop ileostomy and 5(25%) patients underwent left hemicolectomy with loop ileostomy. Out of 10 patients in Group A, 5(50%) patients each suffered from skin excoriation and major wound infection. On the contrary, among 20 patients in Group B, 11(55%) and 4(20%) patients suffered from skin excoriation and stomal obstruction. Only skin excoriation was evident as statistically significantly higher in Group B than in Group A (p 0.03). Among the general complications, electrolyte imbalance (60% vs 40% in Group A and B respectively) and respiratory tract infection (10% each in Group A and B) were evident. Conclusion: Skin discoloration, skin edema, major and minor wound infection, prolapse, skin excoriation and stomal obstruction are the different spectrum of loop ileostomy complications in our perspective. Among them skin excoriation is much higher in routine cases than emergency surgery. Delta Med Col J. Jan 2021;9(1):17-22

No difference between split-thickness and full-thickness skin grafts for surgical repair in adult acquired buried penis regarding surgical and functional outcomes: a comparative retrospective analysis.

Adult Acquired Buried Penis (AABP) is a pathological condition necessitating surgical correction, ranging from simple to complex procedures involving the utilization of full-thickness (FTSG) or split-thickness (STSG) skin grafts especially in cases of substantial viable penile skin loss. In this retrospective study, we aimed to compare the surgical, functional, and patient-reported outcomes (PROs) of graft types that were utilized to treat AABP among 39 patients at a single center between November 2017 and May 2023. Among these patients, 22 needed skin grafts, with 9 undergoing FTSG and the remainder receiving STSG. Lichen Sclerosus (LS) was the primary cause (54.6%) of AABP requiring skin grafts. Patients primarily presented with voiding (63.6%) and sexual (27.3%) dysfunction. The STSG group had a lower mean age (64.7 ± 11.6) than the FTSG group (66.7 ± 11.6; P = 0.015), with no significant differences in BMI (p = 0.643). Complex repairs (Santucci grade ≥3) were performed in 81.0% of cases, with 88.9% in the FTSG group and 75.0% in the STSG group. Operative times were similar (160.2 ± 31.7 vs 161.5 ± 50.3, p = 0.945). No significant differences in preoperative penis length were found between the FTSG and STSG groups (P = 0.918). Postoperative complications occurred in 36.4% of patients, with severe complications (Clavien grade ≥3) in 9.1%. General postoperative complications and recurrence rates did not significantly differ between groups (P = 0.397 and 0.375; respectively). Functional outcomes, evaluated using the International Index of Erectile Function and the International Prostate Symptom Score, improved significantly in both groups after surgical procedures (P < 0.001 for all). Patient-reported satisfaction for the operation was 81.3% calculated by ad-hoc questionnaire. In conclusion, no discernible differences in outcomes were observed between STSG and FTSG. Larger comparative studies with extended follow-up periods and validated questionnaires are warranted for confirmation. Physicians should consider specialized centers for AABP surgical repair due to its intricacies.

External Fixation as a Primary and Definitive Treatment for Complex Tibial Diaphyseal Fractures: An Underutilized and Efficacious Approach.

External fixation is one of the most often utilized treatment options for complicated tibial diaphyseal fractures (TDF). The purpose of this study was to assess the efficacy of unilateral external fixators as primary and definitive therapy for complex TDF in a resource-limited setting. A retrospective study between June 2016 and March 2021 included 110 subjects with TDF who were treated with an external fixator as definitive fixation in hospitals affiliated with Ibb University. The patient's demographic characteristics, complications, and outcomes were gathered and analyzed. Factors associated with pin site infection were also investigated. The mean age was 42.1 ± 10.1 years, with 92.7% being male. Rural residents accounted for 22.7%. Smoking and diabetes mellitus were present in 27.3% and 30.0%, respectively. General complications occurred in 12.0%, with pulmonary embolism being the most common at 4.5%. Orthopedic complications included pin-track infections in 27.3% (30) and osteomyelitis in 1.8% (2). Pin site infections required medical treatment in 21 cases and external fixator changes in five. Two cases each needed several debridements for osteomyelitis and soft tissue. Full union occurred in 79.1% (87) over 23.1 ± 3.2 weeks and final alignment in 97.3% (107) over 34.8 ± 4.8 weeks. Malunions occurred in 1.8% (2), and one case had hypertrophic nonunion. Factors like rural residency, smoking, diabetes, open fractures, worst fracture grade (Gustilo and Anderson type C), and general complications occurrence significantly correlated with pin site infection (all p-values < 0.05). A unilateral external fixator as a primary and definitive treatment is a viable, simple, and effective option for TDF with a high success rate even in a resource-limited setting. In this study, residents in rural areas, smoking, diabetes, open fracture, worst fracture grade, and general complication occurrence were associated with pin site infection occurrence.

The Outcome of Laparoscopic Versus Open Appendectomy in Childhood.

Appendectomy in children is performed either lapa - roscopically (LA) or by open surgery (OA). We studied whether, and how, the outcome is affected by the technique used and by the intraoperative conversion of LA to OA. We analyzed routine data from children and adolescents in three age groups (1-5 years, 6-12 years, and 13-17 years) who were insured by the AOK statutory health insurance carrier in Germany and who underwent appendectomy in the period 2017-2019. General surgical complications and reoperations within 90 days were assessed with relevant indicators. Associations between the surgical technique and these indicators were studied with logistic regression. Of the 21 541 patients included in the study, general surgical complications were observed in 2.1% and reoperations in 1.8% overall. Broken down by age group, the corresponding figures were 5.4% and 4.4% (age 1 to 5), 2.5% and 1.8% (age 6 to 12), and 1.5% and 1.6% (age 13 to 17). The main risk factors for complications and reoperations were acute complicated appendicitis and conversion from LA to OA. Regression analysis revealed similar outcomes with OA compared to LA in the 1-to-5 age group, (odds ratios and 95% confidence intervals: 1.1 [0.6; 2.1] for general surgical complications and 1.5 [0.8; 2.7] for reoperations), but worse outcomes with OA in the other two age groups (age 6 to 12: 1.9 [1.2; 2.9] and 2.1 [1.5; 2.9]; age 13 to 17: 1.7 [1.0; 2.9] and 2.2 [1.4; 3.6]). When conversions were assigned to the LA group, the odds ratio (OA compared to LA) for reoperation across all age groups was 3.5 [2.8; 4.4] in patients with acute uncomplicated appendicitis and 4.2 [3.4; 5.3] in patients with complicated appendicitis. Complicated appendicitis also increased the rate of general surgical complications and the length of stay in hospital. Among children in the two older age groups, LA was followed by fewer general surgical complications and reoperations than OA. These differences were less pronounced when conversions were counted as belonging to the LA group. Children aged 1-5 appear to benefit the least from the lapa - roscopic technique.

A review of comprehensive genomic profiling testing in a Japanese single institution.

740 Background: In Japan, comprehensive genomic profiling (CGP) testing, including OncoGuide and FoundationOne CDx (F-1), were approved in June 2019 for patients with advanced solid tumors. Here, we report the landscape of CGP testing in our hospital. Methods: This study was conducted with a retrospective design to evaluate the clinico-genomic characteristics of patients who underwent CGP testing. OncoGuide is a panel using matched tumor tissue and blood sample, containing 124 genes, developed by the National Cancer Center. F1 is a tumor-only panel, containing 324 genes, developed by Foundation Medicine Industry. Results: Of the 460 patients enrolled in this study, 376 and 84 underwent F-1 and OncoGuide, respectively. The most common primary tumor was colorectal cancer (93 pts), followed by malignant melanoma (33 pts) and pancreatic cancer (33 pts). Actionable gene alteration was detected in 304 patients (66.1%). The detected actionable genes were TP53 (55.9%), APC (27.8%), KRAS (22.6%), and BRAF (8.5%) in colorectal cancer, BRAF (10.1%), CDKN2A (30.2%), CDKN2B (9.4%), and TERT (33.3%) in malignant melanoma, and KRAS (18.8%), TP53 (54.3%), and CDKN2A (21.8%) in pancreatic cancer. The mean time from sample shipment to result receipt was 42.5 days. As a result of CGP testing, candidate anticancer drugs were found in 304 patients: however, 108 patients were not treated due to poor general condition, complications, or age, which limited access to clinical trials. In germline findings, a pathogenic germline variant of BRCA2 was detected in one patient in OncoGuide, and presumed germline pathogenic variants of MLH1, BRCA2, and PTEN were detected in 1, 13, 26 patients in F-1. Conclusions: In Japan, CGP testing found candidate anticancer drugs, however it requires a significant amount of time to receive treatment because of limiting access to ongoing clinical trials and being typically performed after standard chemotherapy. Therefore, improving access to clinical trials, including determining the timing of testing and selecting appropriate cases, was critical.

Prevention and Care of Oral Manifestations in Cancer Patients Receiving Chemotherapy and Head and Neck Radiation Therapy. Systematic Review

Purpose: The purpose of this systematic review was to evaluate current evidence to prevent and care of oral manifestations chemotherapy and head and neck radiation therapy. Methods: Study selected if they met the following criteria: design - random allocation of participants; participants - anyone with cancer receiving chemotherapy or radiotherapy treatment for cancer; interventions - agents prescribed to prevent oral complication. Search keywords terms included head and neck cancer, dental care, prevention of complications of cancer, oral tissue lesions manifestationin, chemotherapy, head and neck radiation therapy, length of hospitalisation, cost and patient quality of life. Results: Conducted a preliminary search and reviewed 132 titles and abstracts in this review and 48 full-text articles were selected of high methodological quality. This systematic review analyzes the main complications of oral tissues resulting from chemotherapy and radiation therapy in the head and neck area and provides practical recommendations for the management and prevention of complications in this category of patients. The main methods of treating patients with malignant tumors in the maxillofacial area are surgical method, radiation therapy and chemotherapy. The treatment depends on the clinical and morphological characteristics of the tumor and requires the use of all methods simultaneously or in a certain sequence. Radiation and chemotherapy treatments not only have systemic side effects, but also side effects in the treatment area. Against the background of antitumor treatment, there is an exacerbation of concomitant chronic diseases, including odontogenic ones. Pathological changes appear on the mucous membrane oral cavity, on the skin, in the subcutaneous tissue, in the salivary glands and in the bone marrow of the jaw bones. Poor oral hygiene and chronic odontogenic lesions can cause the development of episodic fevers and other general complications. All this requires stopping or changes in the tactics of antitumor treatment, which reduces its radicalism. Conclusion: The current systematic review demonstrated that regular extensive oral health education, sanitation of the oral cavity, carried out before treatment by an oncologist, will avoid or reduce the frequency complications in the maxillofacial area, improve the quality of life of an oncology patient. Dental care for such a patient has features and requires an individual approach.

MANUAL VACUUM ASPIRATION VERSUS DILTATION AND CURETTGE TERMINATION OF FIRST TRIMESTER ABORTION AMONG WOMEN ADMITTED AL-SADAQA TEATCHING HOSPITAL, ADEN JAN1st DECEMBER 31st 2020

Early pregnancy failure is a medical complication and major health problem across the globe. The aim of this study is to compare manual vacuum aspiration (MVA) and dilatation and curettage (D&amp;C) for first trimester abortion, in terms of the efficiency of eliminating retain product of conceptus, frequency of complications, duration of the procedure, and duration of patients' hospitalization. This is a prospective comparative descriptive study performed at Al-Sadaqa Teaching Hospital. Over a period from 1st Jan 2020 to 31st December 2020, a total of 143 women, these patients either MVA group (n=72) or D&amp;C group (n=71). Presented with spontaneous abortion and gestational age less than 12 weeks, patent cervix, and no signs of septic abortion, hemoglobin ≥9 g/dl and no bleeding disorder. Data was collected on prescribed questionnaire. The total number of abortion 637 in compare to 259 (40.7%) patient with first trimester abortion, 143 patients was included in this study, MVA group (n =72) and D&amp;C group (n=71). The distribution in respect to the age, parity &amp; gestational age was similar in both groups. The mean duration of procedure was significantly higher (P&lt;0.05) in D&amp;C group compared to MVA group. The duration of hospital stay was significantly lower (P&lt;0.05) in MVA group compared to D&amp;C group. MVA group showed the least incidence of complications regarding the amount of blood loss, and cervical laceration. Complete evacuation was achieved in 95.8% in MVA vs. 98.6% in D&amp;C group with no statically significant (P=0.304). MVA is as effective as popular dilatation and curettage for treatment of early pregnancy failure while it need less time consuming, requires a shorter hospital stay and subsequently costs less. It does not require general anesthesia and complication rate is less than dilatation and curettage. So it can be easily accessible to the woman of both rural and urban societies belonging to any socioeconomic strata especially where high tech equipment and power supply are not available.

Medical errors and adverse events in israel during the COVID-19 pandemic

The pandemic has suddenly challenged many healthcare systems. These systems needed more time to adapt and adjust their patient safety, risk management, and quality improvement programs to the new situation. This study aimed to characterize the pandemic's impact on reporting medical adverse events compared to periods before the pandemic outbreak in Israel. This retrospective cohort study is based on an adverse event reporting database reported to the Israeli Ministry of Health. We analyzed the number and type of adverse events reported to the Ministry of Health in the years before the COVID-19 pandemic (pre-pandemic period 2018–2019) in comparison to the same type of events reported during the pandemic (pandemic period 2020–2021). We found significant differences in reporting of adverse medical events compared to the pre-pandemic period. The following types of events were reported significantly more: medical and surgical procedures, unexpected deaths in general hospitals, complications or deaths of the mother in-hospital and home birth, more severe complications, and stillbirth of born children, and higher escape rate from psychiatric hospitals. A significant decrease was observed in errors in the operation process and device malfunctions. The overall rate of reporting adverse events was higher during the pandemic than pre-pandemic. Reporting of specific types of adverse events increased compared to the pre-pandemic period, though some were reported less. It may be beneficial to try to understand what specific variables played a significant role in affecting those changes. This understanding may help the healthcare system prepare to cope better with future medical crises.

Factors associated with oropharyngeal dysphagia in individuals with cardiovascular disease and COVID-19.

Oropharyngeal dysphagia (OD) is one of the possible outcomes in patients hospitalized with COVID-19 and also in the population hospitalized for the treatment of cardiovascular disease. Thus, knowing the predictive risk factors for OD may help with referral and early intervention. This study aimed to verify the association of different factors with OD in hospitalized individuals with cardiovascular disease and COVID-19. Cross-sectional clinical study approved by the Research Ethics Committee (4,521,771). Clinical evaluation of swallowing was carried out in 72 adult patients with cardiovascular disease and COVID-19 hospitalized from April to September 2020. Individuals under 18 years of age and without previous cardiovascular disease were excluded. The presence of general clinical and/or neurological complications, pronation, stay in the intensive care unit (ICU), orotracheal intubation (OTI), tracheostomy tube, oxygen support and age were considered as predictive risk factors for oropharyngeal dysphagia. Fisher's exact test, Mann Whitney test and logistic regression model were used for analysis. General clinical complications (p=0.001), pronation (p=0.003), ICU stay (p=0.043), in addition to the need for oxygen supplementation (p=0.023) and age (p= 0 .037) were statistically significant factors associated. The pronation (0.013) and age (0.038) were independently associated with dysphagia. OTI (p=0.208), tracheostomy (p=0.707) and the presence of previous cerebrovascular accidents (p=0.493) were not statistically significant. In this study, age and prone position were factors independently associated with oropharyngeal dysphagia, complications such as the need for oxygen supplementation, in addition to the need for ICU admission, were also associated factors in the population.

Incidence of Cardiovascular Complications in Pediatric Patients Treated with Anthracyclines at a Brazilian Cancer Center.

The introduction of anthracyclines in the treatment of children and adolescents with cancer has promoted a significant increase in survival, but also in morbidity and mortality rates due to cardiovascular (CV) complications. To determine the cardiovascular profile of pediatric patients treated with anthracyclines at a cancer center in Brazil and the incidence of CV complications. The following data were collected from the medical records of patients of both sexes, aged younger than 19 years - frequency and form of clinical presentation of general CV complications (G1) and CV complications related to ventricular dysfunction (G2) - and correlated with risk factors, age range and vital status, cardiovascular and cardioprotective medications. A p<0.05 was considered statistically significant. A total of 326 patients were included, 214 (65.6%) were younger than 10 years and 192 (58.9%) of male sex. G1 complications occurred in 141 (43.3%) patients, and the most frequent was systemic arterial hypertension; G2 complications occurred in 84 patients (25.8%). Cumulative dose (CD) of anthracyclines > 250mg/m2 was used in 26.7% of patients and the association of G2 complications with this CD was not statistically significant (p=0.305; OR=1.330 and [95% CI = 0.770- 2.296]). The most used cardiac medications were diuretics (34.7% of patients). In accordance with literature, the study showed a high incidence of CV complications in the treatment of children and adolescents with cancer, with general CV complications as the most prevalent.

Incidência de Complicações Cardiovasculares em Pacientes Pediátricos Tratados com Antraciclinas em um Centro Oncológico Brasileiro

Abstract Background: The introduction of anthracyclines in the treatment of children and adolescents with cancer has promoted a significant increase in survival, but also in morbidity and mortality rates due to cardiovascular (CV) complications. Objectives: To determine the cardiovascular profile of pediatric patients treated with anthracyclines at a cancer center in Brazil and the incidence of CV complications. Methods: The following data were collected from the medical records of patients of both sexes, aged younger than 19 years – frequency and form of clinical presentation of general CV complications (G1) and CV complications related to ventricular dysfunction (G2) – and correlated with risk factors, age range and vital status, cardiovascular and cardioprotective medications. A p&lt;0.05 was considered statistically significant. Results: A total of 326 patients were included, 214 (65.6%) were younger than 10 years and 192 (58.9%) of male sex. G1 complications occurred in 141 (43.3%) patients, and the most frequent was systemic arterial hypertension; G2 complications occurred in 84 patients (25.8%). Cumulative dose (CD) of anthracyclines &gt; 250mg/m2 was used in 26.7% of patients and the association of G2 complications with this CD was not statistically significant (p=0.305; OR=1.330 and [95% CI = 0.770- 2.296]). The most used cardiac medications were diuretics (34.7% of patients). Conclusions: In accordance with literature, the study showed a high incidence of CV complications in the treatment of children and adolescents with cancer, with general CV complications as the most prevalent.

Incidence of COVID-19 in general surgery emergency and complications associated in different types of management

Background COVID-19 disease causes complications that are classified according to likelihood to high such as venous thromboembolism, acute kidney injury, and postintensive care syndrome. Other complications are low in likelihood such as cytokine release syndrome, pancreatic injury, gastrointestinal complications, and pregnancy-related complications. Mortality and morbidity are really high when it is combined with surgical intervention especially under general anesthesia. Objectives To evaluate the incidence of COVID-19 in general surgery emergency and complications associated in different types of management. Patient and method This is a retrospective study from June 2020 to January 2021 including all COVID-19 positive cases admitted in general surgery department during previously mentioned period. Before September 2020, screening for COVID was based on swab for only clinically suspected COVID-positive patients. Starting from September 2020, routine swab to all admitted patients was done. All data collected about included cases in study underwent statistical analysis to get results. Results In this study, incidence of COVID-19 is 1.35%, mortality incidence is 26.4% (about 92.9% of mortality cases underwent surgery) and morbidity incidence is 30.2%. About 74% (73.6%) of positive cases improved and discharged. Management of cases is according to guidelines of management to each disease and decision of ER consultant. About 77.4% of cases are managed surgically; about 70.7% of cases operated upon underwent exploration. However, 60.4% of cases are admitted with sepsis and septic shock. Asymptomatic cases for COVID during admission are 26.4%. Conclusion Incidence of COVID-19 in acute general surgery emergency in Kasr Al-Ainy is not that high. However, cases operated upon in the era of COVID are associated with high incidence of mortality. Cases are presented to our institute late, which might be an effect of lock down.