General Complications Research Articles

Value of the Rapid Immunochromatographic Test for Diagnostic Guidance in the Diagnosis of Pharyngo-Tonsillitis Caused by Group A Hemolytic Beta Streptococcus (Abhs) In Southern Benin

Background: Group A beta-hemolytic streptococcus (ABHS) tonsillitis is an acute disease that is often benign but sometimes serious due to its locoregional and general complications. It is a frequent cause of consultation among general practitioners, ENT and paediatrics. The choice and interest of our work was motivated by the fact that one of the most important acute upper respiratory infections is tonsillitis with the risk of serious complications. This study aims to determine the sensitivity and specificity of RDOT in the diagnosis of ABHA tonsillitis in southern Benin. Methods: This was a prospective analytical and descriptive study carried out at the Vallée de Grâce Medical Clinic (CM VG) and at the Padre Pio Humanitarian Health Center (CSVH), at the Laboratory of Biology and Molecular Typing in Microbiology / UAC, in Benin over 12 months (July 2, 2022 and June 31, 2023). It included patients diagnosed with tonsillitis. All the patients included underwent a RDOT and a cytobacteriological examination of the throat swab (Gold Standard). We studied the following variables: age, sex, months, clinical signs, cytobacteriological examination of the throat swab and TROD results. Results: We recorded 272 tonsillitis cases. 60 cases of group A beta-hemolytic streptococcal (ABHS) tonsillitis are confirmed by bacterial culture. Group A beta-hemolytic streptococcal tonsillitis accounted for 22.06% of tonsillitis. 133 men (49%) and 139 women (51%) were registered. 32 men (53.33%) and 28 women (46.67%) had SBHA tonsillitis. The highest frequency of isolation of group A streptococcus was observed in the age group [0 to 5[years with 27 cases out of 60, i.e. a proportion of 45%. SBHA tonsillitis are more frequent in the months of December and August with the respective proportions of 16.67% and 10%. The SBHA TROD performed showed a Sensitivity of 95%, a Specificity of 94%, a positive predictive value of 92% and a negative predictive value of 98%. Conclusion: Streptococcal etiology represents 22.06% of tonsillitis in Benin. Our results reinforce the interest of RDOT and especially cytobacteriological examination in the etiological diagnosis of tonsillitis.

Mean-Variance Serum Sodium Associations with Diabetes Patients

Serum sodium (SNa) is a critically significant component of hyponatremia and bones, has firmly been established as a risk factor correlated with many diseases such as diabetes, heart, anaemia, etc and the incidence of fragility fractures. Note that the fragility fractures are a general complication in type 2 diabetes (T2D) patients, contributing to high rates of mortality and morbidity together with mounting public health costs. SNa is a fundamental component for normal physiological processes, and T2D patients may experience osmotic diuresis as a consequence of disease-related hyperglycemia, contributing to the excess excretion of sodium in the urine and resulting in hyponatremia. Dysnatremias [hyponatremia (<136 mmol/L) and hypernatremia (>145mmol/L)] can severely affect several physiologic organ systems and functions. Diabetes is correlated with many important electrolyte disorders, predominantly affecting magnesium, SNa, and potassium. However, the correlation/ association of SNa with diabetes patients is not clear. This can be confirmed based on the proper probabilistic model of SNa with diabetes status along with the other explanatory factors of the disease. On the other hand, this type of association can be obtained based on the models of fasting glucose/post glucose/random glucose/HbA1c level with SNa and other explanatory factors of the diabetes disease.

Early Postoperative Complications of One-Stage Substitution Urethroplasty with Oral Mucosa Graft: A Monocentric Retrospective Study

Introduction: We report early postoperative complications (PCs) (≤90 days) of one-stage oral mucosa graft (OMG) urethroplasty in treatment of acquired anterior urethral strictures. Material and Methods: In this study, we evaluated 530 males who underwent one-stage substitution urethroplasty (SU) between September 1996 and October 2020. Medical records were reviewed to identify and classify early PCs based on the Clavien-Dindo classification (CDC). We subdivided the PCs into three groups with different kinds of complications which allowed us a more detailed analysis concerning general surgical complications (GSCs), donor site morbidity (DSM) and complications specific for free graft urethroplasty (CSUs). The influence of patient demographics, stricture characteristics and operative procedure on the occurrence of PCs was analysed. Results: Early (90-day) PCs occurred in 90 (16.98%) patients, whereas only 19 patients (3.58%) experienced serious events (CDC grades III and IV). Early complications include 4.5% GSCs, 1.7% DSM and 10.8% CSUs. Only stricture length turned out to be an independent statistically significant risk factor for the occurrence of early PCs. There was a trend towards a higher rate of complications in patients with ASA III compared to ASA I. Conclusion: The incidence of severe early complications in patients undergoing one-stage SU with OMG is low.

The Impact of Standardized Emergency Care on Acute Stroke Treatment and Recovery Time

Objective: To investigate the clinical benefits derived from the implementation of standardized emergency care for patients experiencing acute strokes. Methods: One hundred cases of acute stroke were categorized based on the admission order, with 50 cases per group. The control group received routine emergency care, while the observation group received standardized emergency care. A comparison of the general observation indicators and complication rates of emergency care was conducted. Results: The observation group exhibited shorter pre-examination and assessment time, quicker physician reception time, faster emergency green channel treatment time, and reduced door-to-needle time compared to the control group (P < 0.05). Moreover, the emergency treatment success rate was higher, and the total number of complications was lower in the observation group than in the control group (P < 0.05). Conclusion: The implementation of standardized emergency care proves effective in reducing treatment and recovery times for acute stroke patients. It enhances the success rate of emergency treatment and diminishes the risk of associated complications. These findings underscore the significance of promoting standardized emergency care for acute stroke patients.

Engineering a highly selective leucine aminopeptidase near-infrared fluorescence probe for early diagnosis of diabetic nephropathy

Diabetic nephropathy (DN) is one of the most serious and general complications of diabetes, while schedules for prevention and treatment are unsatisfactory. Leucine aminopeptidase (LAP) as one of the biomarkers of DN is associated with glomerular and/or tubular injury. Imaging of LAP activity in DN disease model in vivo is thus beneficial for early diagnosis and prevention of DN, but such a strategy is still lacking. Herein, an enzyme-activated probe HD-LAP with a NIR fluorescence emission for specific detection of LAP activity in the DN model is designed and synthesized. HD-LAP has a significant fluorescence enhancement after reacted with LAP and shows a NIR fluorescence emission at 704 nm based on intramolecular charge transfer mechanism. Moreover, HD-LAP can be employed to image LAP activity in HK-2 and HepG2 cells. More importantly, HD-LAP is the first example to real-time image LAP in DN mice and clinical serum samples. These results demonstrated that HD-LAP is promising as a powerful tool for the research on LAP associated diabetic diseases in future.

Enhanced recovery and same-day discharge after brain tumor surgery under general anesthesia: initial experience with Hospital-at-Home-based postoperative follow-up.

The objective of this study was to describe the outcomes of outpatient oncological neurosurgery (OON) in a European clinical setting and to compare them with the conventional inpatient protocol. Patients who had undergone OON (either tumor removal or biopsy) at the authors' center since 2019 were analyzed. A matched cohort of patients was selected from patients undergoing tumor surgery in the same period. Collected data included patient demographics, postoperative progress, specific location of the target lesion, and the procedure performed. There were 18 patients in the case group and 59 patients in the control group. The outpatient surgeries had a same-day discharge rate of 89%, and all ambulatory patients successfully completed the Enhanced Recovery After Surgery program within 6.24 hours of the procedure. All ambulatory patients underwent Hospital-at-Home postoperative follow-up for an average of 4.12 days. Radiological complications were present in 11% of the case group and 8% of the control group. Postoperative neurological deficit occurred in 6% of the same-day discharge group and 3% of the control group. Among the patients in the control group, 3% suffered from postoperative seizures, whereas no seizures were observed in the case group. These differences were not statistically significant. General anesthesia-related complications were not observed in any of the patients. The authors' findings demonstrate that Enhanced Recovery After Surgery protocols and same-day discharge craniotomy for tumor resection and image-guided biopsy under general anesthesia, when patients are carefully selected, can be safely performed with excellent outcomes in a European clinical setting. The OON program proved to be a viable alternative to conventional hospitalization, showing comparable safety records and offering advantages in terms of patient recovery.

Single- and Multilevel Corpectomy and Vertebral body replacement for treatment of spinal infections. A retrospective single-center study of 100 cases

BackgroundThe optimal operative approach for treating spinal infections remains a subject of debate. Corpectomy and Vertebral Body Replacement (VBR) have emerged as common modalities, yet data on their feasibility and complication profiles are limited. MethodsThis retrospective single-center study examined 100 consecutive cases (2015–2022) that underwent VBR for spinal infection treatment. A comparison between Single-level-VBR and Multi-level-VBR was performed, evaluating patient profiles, revision rates, and outcomes. ResultsAmong 360 cases treated for spinal infections, 100 underwent VBR, located in all spinal regions. Average clinical and radiologic follow-up spanned 1.5 years. Single-level-VBR was performed in 60 cases, Two-level-VBR in 37, Three-level-VBR in 2, and Four-level-VBR in one case.Mean overall sagittal correction reached 10° (range 0–54°), varying by region. Revision surgery was required in 31 cases. Aseptic mechanical complications (8% pedicle screw loosening, 3% cage subsidence, 6% aseptic adjacent disc disease) were prominent reasons for revision. Longer posterior constructs (>4 levels) had significantly higher revision rates (p < 0.01). General complications (wound healing, hematoma) followed, along with infection relapse and adjacent disc infection (9%) and neurologic impairment (1%).Multilevel-VBR (≥2 levels) displayed no elevated cage subsidence rate compared to Single-level-VBR. Three deaths occurred (43–86 days post-op), all in the Multi-level-VBR group. ConclusionThis study, reporting the largest number of VBR cases for spinal infection treatment, affirmed VBR's effectiveness in sagittal imbalance correction. The overall survival was high, while reinfection rates matched other surgical studies. Anterior procedures have minimal implant related risks, but extended dorsal instrumentation elevates revision surgery likelihood.

Long-term prognosis of fatty-acid oxidation disorders in adults: Optimism despite the limited effective therapies available.

Fatty-acid oxidation disorders (FAODs) are recessive genetic diseases. We report here clinical and paraclinical data from a retrospective study of 44 adults with muscular FAODs from six French reference centers for neuromuscular or metabolic diseases. The study cohort consisted of 44 adult patients: 14 with carnitine palmitoyl transferase 2 deficiency (32%), nine with multiple acyl-CoA deficiency (20%), 13 with very long-chain acyl-CoA dehydrogenase deficiency (30%), three with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (7%), and five with short-chain acyl-CoA dehydrogenase deficiency (11%). Disease onset occurred during childhood in the majority of patients (59%), with a mean age at onset of 15 years (range = 0.5-35) and a mean of 12.6 years (range = 0-58) from disease onset to diagnosis. The principal symptoms were acute muscle manifestations (rhabdomyolysis, exercise intolerance, myalgia), sometimes associated with permanent muscle weakness. Episodes of rhabdomyolysis were frequent (84%), with a mean creatinine kinase level of 68,958 U/L (range = 660-300,000). General metabolic complications were observed in 58% of patients, respiratory manifestations in 18% of cases, and cardiological manifestations in 9% of cases. Fasting acylcarnitine profile was used to orient genetic explorations in 65% of cases. After a mean follow-up of 10 years, 33% of patients were asymptomatic and 56% continued to display symptoms after exercise. The frequency of rhabdomyolysis decreased after diagnosis in 64% of cases. A standardized register would complete this cohort description of muscular forms of FAODs with exhaustive data, making it possible to assess the efficacy of therapeutic protocols in real-life conditions and during the long-term follow-up of patients.

Maxillary Sinus Lift Procedures: An Overview of Current Techniques, Presurgical Evaluation, and Complications.

A maxillary sinus lift procedure is indicated if a dental implant needs to be placed in the posterior maxilla with limited bone available to accommodate a dental implant. Both open and closed sinus lifting procedures are reliable approaches for increasing the bone volume needed to support proper implant positioning. However, these methods can lead to several complications. In addition to the general complications commonly linked to oral surgery, such as swelling or hematoma, the primary complication in open sinus lifting is typically the perforation of the Schneiderian membrane during osteotomy. Detailed and extensive presurgical evaluation is crucial to minimize such complications. The objective of this study was to delineate contemporary trends in sinus lift surgery, with a specific emphasis on different techniques of sinus lift procedure, anatomical and surgical factors, presurgical evaluation, bone grafting, and the practical implications of these factors in implant dentistry cases involving a deficient posterior maxilla. In conclusion, while both osteotome and lateral window techniques can assist clinicians in addressing the complexities of implant placement in a deficient posterior maxilla, bone height before implantation remains a critical factor in determining the success and longevity of implants.

What determines complications and prognosis among patients subject to multivisceral resections for locally advanced gastric cancer?

BackgroundLocally advanced gastric cancer (GC) extending to the surrounding tissues may require a multivisceral resection (MVR) to provide the best chance of cure. However, little is known about how the extent of organ resection affects the risks and benefits of surgery.MethodsAn electronic database of patients treated between 1996 and 2020 in an academic surgical centre was reviewed. MVRs were defined as partial or total gastrectomy combined with splenectomy, distal pancreatectomy, or partial colectomy.ResultsSuspected intraoperative tumour invasion of perigastric organs (cT4b) was found in 298 of 1476 patients with non-metastatic GC, and 218 were subject to MVRs, including the spleen (n = 126), pancreas (n = 51), and colon (n = 41). MVRs were associated with higher proportions of surgical and general complications, but not mortality. A nomogram was developed to predict the risk of major postoperative morbidity (Clavien–Dindo’s grade ≥ 3a), and the highest odds ratio for major morbidity identified by logistic regression modelling was found for distal pancreatectomy (2.53, 95% CI 1.23–5.19, P = 0.012) and colectomy (2.29, 95% CI 1.04–5.09, P = 0.035). Margin-positive resections were identified by the Cox proportional hazards model as the most important risk factor for patients’ survival (hazard ratio 1.47, 95% CI 1.10–1.97). The extent of organ resection did not affect prognosis, but a MVR was the only factor reducing the risk of margin positivity (OR 0.44, 95% CI 0.21–0.87).ConclusionsThe risk of multivisceral resections is associated with the organ being removed, but only MVRs increase the odds of complete tumour clearance for locally advanced gastric cancer.

Early outcomes of open anterior versus posterior components separation with transversus abdominis release for large median incisional hernias: a retrospective stepwise analysis.

Complex incisional hernia is still a debatable topic, with increasing incidence and an increased local and systemic postoperative morbidity and mortality. The size of the defect is a risk factor for both difficult closure and 30-day readmission due to complications. The main option for closure such defect is a mesh augmented component separation technique. The goal was to evaluate 30-day wound events and general complications including 90days mortality. We present a retrospective study that includes patients from two different university hospitals who underwent open incisional hernia repair with anterior component or posterior component separation between January 2015 and December 2021. Only non-contaminated adult patients (over 18years old) with postoperative primary or recurrent median abdominal wall defects larger than 6cm and with complete fascial closure were included. Demographics (age, gender, Body Mass Index-BMI, American Society of Anesthesiologists Classification-ASA score), recurrence rank, and co-morbidities), operative details, patient outcomes complications were collected. A native abdomen/pelvis computerized tomography (CT) scan was performed preoperatively in all patients and the anatomy of the defect and volumetry (abdominal cavity volume, incisional hernia volume and peritoneal volume) were evaluated. One of the component separation technique was performed according to Carbonell's equation. Two hundred and two patients (101 from each group) were included. The patients with posterior component separation were more comorbid and with larger defects. The procedure was longer with 80min but overall length of hospital stay shorter (p < 0.001) for posterior component separation. Seroma, hematoma and skin necrosis were equally distributed for both group of patients and there was no direct relation to surgery (OR 0.887, 95% CI 0.370-2.125, p = 0.788; OR 1.50, 95% CI 0.677-3.33, p = 0.318 and OR 0.386, 95% CI 0.117-1.276, p = 0.119). Surgical Site Infection rate was increased for anterior component separation (p =0.004). Complex incisional hernia repair is a challenge given by a large amount of wound complications. Choosing between anterior and posterior component separation is still a source of significant debate. We were not able to depict significant different rates of complications between the procedures and we couldn't find any specific factor related to complications.

Short stem hip arthroplasty with the optimys prosthesis is a safe and effective option for obese patients: a mid-term follow-up multicenter study

IntroductionShort stems are a valuable option in young patients undergoing total hip arthroplasty (THA) because of their bone stock preserving properties facilitating revision hip arthroplasty. Although the effect of obesity on conventional THA is well studied, data about short stem THA in obese patients are lacking. Therefore, this study aimed to investigate the influence of obesity on complications, revisions, and outcome after short stem THA.Materials and methodsThis multicenter, observational cohort study included patients undergoing short stem THA with the optimys prosthesis. Follow-up examinations were performed at specific intervals up to 7 years postoperatively. Operation characteristics, general and specific complications, revisions, VAS rest pain, VAS load pain, VAS patient satisfaction, and Harris Hip Score (HHS) were recorded and statistically compared between obese (BMI ≥ 30 kg/m2) and non-obese (BMI < 30 kg/m2) patients.ResultsOf the 224 patients included with a mean follow-up of 87.2 months (range 81.9–104.0), 69 were assigned to the OB group and 155 to the non-OB group. A minimally invasive approach was significantly less often selected in obese patients (p = 0.049), whereas operating time and length of hospital stay were not significantly different. The rate of general and specific complications did not significantly differ between both groups. Survival of the optimys prosthesis was 99.1% at 7-year follow-up and one patient per group had to undergo revision surgery. VAS rest pain, load pain, and satisfaction improved from preoperatively to postoperatively in both groups without a significant difference between both groups. While the HHS was improved from preoperatively to postoperatively, obese patients showed a significantly lower HHS at the 7-year follow-up (p = 0.01) but still exhibited an excellent scoring above the PASS threshold.ConclusionShort stem THA with the optimys prosthesis is a safe and effective option also in obese patients with an excellent clinical outcome and a low complication rate.

Does intestinal anastomosis in resection of colon cancer have a significant impact onto early postoperative outcome and long-term survival?

To investigate the influence of anastomosis on the early postoperative and long-term oncological outcomes of patients with primary colon carcinoma (CA). All consecutive patients with the histologically diagnosed primary colon CA (design, prospective multicenter observational study) were registered with regard to patient-, diagnostic-, tumor (Tu) finding-, and treatment-related aspects using a computer-based registry with 60 items to characterize early postoperative and long-term oncological outcome. Basic data: From 2010 to 2016, data from a total of 14,466 patients were documented (mean age, 72.8 [range, 22-96] years; sex ratio, m:f=7,696:6,770).- 717/14,466 patients (4.96 %) were included in a matched-pair analysis. The majority of these patients underwent elective surgery (n=12,620 patients; 87.2 %) regardless of whether a bowel anastomosis or an ostomy was created. In emergency surgery, a bowel anastomosis was possible in a large proportion (n=1,332 patients [72.1 %]). In contrast, in 514 patients (27.9 %) who underwent emergency surgery, an ostomy was created. Interestingly, ostomy had to be created even less frequently in patients who had undergone planned surgery (n=366 [2.5 %]).- Early postoperative outcome: Cases of postoperative mortality were mainly due to general complications. Especially among the patients treated in an emergency situation without intestinal anastomosis, a high proportion died of their pre-existing condition (17.0 %). Patients who underwent ostomy creation or emergency surgery had a worse risk profile (incl. arterial hypertension, diabetes mellitus, and secondary cardiac or renal diseases) which led to the decision to operate without anastomosis. Furthermore, data show no matter which technique had been used, patients that had undergone surgical intervention without anastomosis were more likely to develop complications.- Long-term oncosurgical outcome: The most important factors influencing long-term survival were age, resection status, and tumor stage (according to TNM and UICC). The more advanced the tumor growth, the lower the long-term survival. Patients categorized with the same tumor stage, age,and risk factors had a better chance of survival, if they underwent elective surgical intervention and with intestinal anastomosis. Interestingly, the multivariable analysis showed that older patients and such with distant metastasis benefit from a discontinuity resection. The association of intraoperative and postoperative complications with increased postoperative mortality, as well as preexisting risk factors and perioperative complications is in line with findings of current studies. Furthermore, current studies also agree that older patients and such with reduced general condition benefit from discontinuity resection.

Hospital variations in failure to rescue after abdominal surgery: a nationwide, retrospective observational study

ObjectivesThis study aims to determine hospital variation and intensive care unit characteristics associated with failure to rescue after abdominal surgery in Norway.DesignA nationwide retrospective observational study.SettingAll 52 hospitals in Norway...

Incisional hernia repair following pancreatic surgery—open vs laparoscopic approach

IntroductionFor pancreatic procedures, transverse and midline or combined approaches are used. Having an increased morbidity after pancreatic surgery, these patients have an increased risk of developing an incisional hernia. In the following, we will analyze how the results of incisional hernia surgery after pancreatic surgery are presented in the Herniamed Registry.MethodsHospitals and surgeons from Germany, Austria and Switzerland can voluntarily enter all routinely performed hernia operations prospectively into the Herniamed Registry. All patients sign a special informed consent declaration that they agree to the documentation of their treatment in the Herniamed Registry. Perioperative complications (intraoperative complications, postoperative complications, complication-related reoperations and general complications) are recorded up to 30 days after surgery. After 1, 5, and 10 years, patients and primary care physicians are contacted and asked about any pain at rest, pain on exertion, chronic pain requiring treatment or recurrence. This retrospective analysis of prospectively collected data compares the outcomes of minimally invasive vs open techniques in incisional hernia repair after pancreatic surgery.ResultsRelative to the total number of all incisional hernia patients in the Herniamed Registry, the proportion after pancreatic surgery with 1-year follow-up was 0.64% (n = 461) patients. 95% of previous pancreatic surgeries were open. Minimally invasive incisional hernia repair was performed in 17.1% and open repair in 82.9% of cases. 23.2% of the defects were larger than 10 cm and 32.8% were located laterally or were a combination of lateral and medial defects. Among the few differences between the collectives, a significantly higher rate of defect closure (58.1% vs 25.3%; p < 0.001) and drainage (72.8% vs 13.9%; p < 0.001) was found in the open repairs, and larger meshes were seen in the minimally invasive procedures (340.6 cm2 vs 259.6 cm2; p < 0.001). No difference deemed a risk factor for chronic postoperative pain was seen in the rate of preoperative pain between the open and minimally invasive procedures (Appendix Table 4) No significant differences were found in either the perioperative complications or at 1-year follow-up.ConclusionsIncisional hernias after complex pancreatic surgery can be repaired safely and with a low recurrence rate in both open and minimally invasive techniques.

Clinical characteristics of bronchopulmonary dysplasia in very preterm infants.

With the development of perinatal and neonatal intensive care medicine, the survival rate of very premature infants increases year by year. However, the incidence of bronchopulmonary dysplasia (BPD) increases year by year, which seriously affects the survival prognosis of very premature infants. How to prevent and treat BPD effectively has become the focus of neonatologists. This study aims to provide ideas for the prevention and treatment of BPD in very preterm infants via analyzing the clinical characteristics of BPD. A total of 472 cases of very premature infants admitted to the Divison of Neonatology, Department of Pediatrics at the Second Xiangya Hospital of Central South University were retrospectively selected and assigned into a BPD group (n=147) and a non-BPD group (n=325) according to the diagnosis of BPD. Clinical data of each group were collected to find out the clinical characteristics of BPD in very preterm infants. Basic information, maternal pregnancy data, laboratory findings, nutritional support, respiratory support patterns and duration, and systemic complications were included. Compared with the non-BPD group, gestational age, birth weight, head circumference and body length in the BPD group were lower, the Apgar score in 1st min and 5th min and average body weight growth rate were lower (all P<0.05); the ratios of male, very low birth weight (VLBW), and extremely low birth weight (ELBW) in the BPD group were higher than those in the non-BPD group (all P<0.5); the incidence of maternal cervical insufficiency and the rate of using embryo transfer technology in the BPD group were higher than those in the non-BPD group, and the rate of using prenatal hormone in the BPD group was lower than that in the non-BPD group (all P<0.05). The positive rate of sputum culture in the BPD group was higher than that in the non-BPD group (P<0.05), and the white blood cell count, neutrophil ratio, and procalcitonin in the BPD group were higher than those in the non-BPD group (all P<0.05). The period of fasting, minimal feeding, total parenteral nutrition (TPN), and partial parenteral nutrition (PPN) in the BPD group were longer than those in the non-BPD group (all P<0.05). The duration of nasal catheter oxygen inhalation and mechanical ventilation in the BPD group was longer than that in the non-BPD group, and the rates of mechanical ventilation at Day 1, 3, 7, 14, 21 and 28 after birth were higher than those in the non-BPD group (all P<0.05). The incidence of respiratory distress syndrome, apnea of prematurity, respiratory failure, pneumonia, pulmonary hemorrhage, pleural effusion, persistent pulmonary hypertension, hemodynamic patent ductus arteriosus, cytomegalovirus infection, neonatal necrotic enterocolitis, cholestasis, anemia, abnormal blood system, hypothyroidism, retinopathy of prematurity, and internal environment disorders in the BPD group were significantly higher than those in non-BPD group (all P<0.05). There are significant differences between very premature infants with BPD and those without BPD in general information, maternal history, inflammatory indicators, nutritional support, respiratory support, comorbidities and complication rates. To ensure normal fetal development, reducing the inflammatory reaction of very premature infants, establishing enteral nutrition as early as possible, shortening the time of mechanical ventilation, and reducing the occurrence of complications are beneficial to decrease the incidence of BPD in very premature infants and improve the long-term prognosis of BPD.

Long-term anticoagulation treatment in proximal femoral fractures as obstacle to surgery in the 24h time window? : Results of an analysis of Quality Assurance data on 32,252 treatment courses with osteosynthesis

Both in Germany and internationally there is avehement controversy about the appropriate time for care of proximal femoral fractures in older patients. The effort to achieve high quality and uniform standards of care culminated in the German healthcare system in the strict requirement of delay-free surgery within 24 h. Until now, in view of their high vulnerability patients who were severely injured were too often operated on late with the reference to ageneral medical condition that could be improved preoperatively. In particular, the fear of complications due to apre-existing long-term anticoagulation treatment was repeatedly emphasized. The present study is dedicated to the question of whether adelay in surgery of anticoagulated patients with proximal femoral fractures already during the inpatient course has adetrimental effect on the complication statistics and the mortality of the patients. The extent to which external quality assurance data are suitable for rebutting any objections to an operation as soon as possible are examined. The study is based on treatment data from the external inpatient quality assurance procedure of the federal state of North Rhine-Westphalia from the years 2018-2020. Patients with aproximal femoral fracture were considered. This includes femoral neck fractures and fractures in the area of the pertrochanteric to subtrochanteric region. Only cases with joint-preserving fracture care were selected. The data sets were analyzed using suitable statistical software. More general complications and deaths have been observed in anticoagulated patients. The trend of delayed fracture treatment under anticoagulant medication continues to be clearly visible. Apositive association between longer preoperative waiting time and undesirable courses can be confirmed. With respect to fracture care when taking anticoagulants, it must be critically examined to what extent arapid normalization of the coagulation situation is necessary and this actually improves the chances of low complication courses. Should the elimination of the anticoagulant effect by substitution or antidote appear necessary, this should not prevent early care.

Immune system dysfunction in purulent inflammatory diseases of the maxillofacial area in pediatric patients

The issues of treatment of purulent inflammatory diseases of the maxillofacial region (PMMA) are quite urgent, due to increasing number of such patients. Their clinical course is getting worse, and the efficiency of antibiotic therapy is decreasing. Clinical outcomes of purulent maxillofacial pathology in children are complicated by potential severe local deformities at the growth areas of the jaw bones which are difficult to eliminate. The number of cases of prolonged and chronic inflammatory processes, development of local and general complications is increased. The reason for these complications may be an impaired susceptibility to infectious agents, which is determined by the state of the immune system. Therefore, our aim was to reveal some features of immune functions in children with purulent-inflammatory diseases of maxillofacial area.&#x0D; The study included a group of pediatric patients 8-17 years old with maxillofacial inflammatory diseases of the maxilla (the study group), and 13 conditionally healthy children (the comparison group). The contents of T cells (CD3+CD19-, CD3+CD4+, CD3+CD8+, CD3+CD4+/CD3+CD8+), and В cells (CD3-CD19+), NK (CD3-CD16+CD56+) was determined using Cytomics FC-500 (Beckman Coulter, USA);concentrations of serum IgA, IgM, IgG were determined by ELISA technique (Vector-Best, Russia). Phagocytic activity of neutrophilic granulocytes (NG) was evaluated as percentage of actively phagocytic NGs, capturing processes were assessed by appropriate phagocytic indices, and the digestive activity was evaluated against S. aureus (strain 209).&#x0D; Combined defects of immune response in children with maxillofacial hypertension were established: decrease of T lymphocytes contents along with decrease of T helpers and CTL ratio along with unchanged content of NK cells and B lymphocytes. Increase of IgA and IgG levels was also found. Defects of phagocytosis were revealed, primarily connected with the processes of completed phagocytosis and increased content of actively phagocytizing NG.&#x0D; Treatment of children suffering with purulent inflammatory diseases of maxillofacial region is still an urgent problem in dentistry. The revealed dysfunction of immune response to pathogens in the purulent maxillofacial disorders may explain a prolonged clinical course of inflammatory processes, thus determining a need for usage of immunotropic therapy in complex treatment schedules including operative aid as well as conventional drug and physiotherapeutic treatment aiming for increase of rehabilitation efficiency and prevention of postoperative complications in these patients.

Diabetic patient awareness and knowledge about the relationship between blood sugar level and oral health in the Qassim region: Survey based study

Abstract Introduction: People with uncontrolled diabetes are at significant risk of developing several oral health-related problems. Prevention and treatment of oral diseases in diabetic patients require persistent daily self-care at home and regular dental visits. Aim: The aim of this was to assess the level of knowledge and attitude of diabetic patients toward oral health in the Qassim region of Saudi Arabia. Materials and Methods: This cross-sectional, survey, and facility-based study was conducted at the Endocrine and Diabetic Center in Buraydah, Saudi Arabia. A simple random sampling technique was used and included male and female patients and excluding those with gestational diabetes. Each patient received a questionnaire containing four domains: sociodemographic data, oral health knowledge, general health knowledge, and oral health attitude. Results and Discussion: Statistical Package for the Social Sciences (SPSS) ran a detailed descriptive analysis. A sample size of 173 Saudi diabetic patients participated in this study (68 [39.3%] male and 105 [60.7%] female). Surprisingly, 75.7% did not know their diabetic type, 73.4% brush their teeth at least once daily, and 87.3% have never used interdental flossing. Just 38.2% knew diabetic patients were at a higher risk of developing oral disease. Furthermore, 19.7% have had their dentists educate them about the effect of diabetes on their oral health, and only 13.3% stated that their physicians had educated them about the relationship between diabetic status and oral health. It is paramount to ensure the role of dentists and physicians in educating patients, as most of the sample was unaware of the relationship between diabetes and oral health. Furthermore, interdental flossing is essential for dental home care and periodontium health. Most diabetic patients in this sample do not floss and must be educated about its importance. Conclusion: Integrated dental visits for diabetic patients, in coordination with their physician, may avoid further oral and general health complications.

Efficacy of Flap-based Posterior Trunk Reconstruction after Vertebrectomy and Radiation Therapy: A Retrospective Cohort Study.

Adjuvant radiation therapy following vertebrectomy is a major risk factor for local wound complications such as dehiscence, infection, and skin necrosis. In selected cases, well-vascularized coverage and modification of tension forces on the wound might reduce the risk of postoperative complications and reoperations. We aimed to demonstrate a reduction in general and specific complications in patients undergoing vertebral resection and flap coverage compared with vertebral resection alone. We retrospectively analyzed and collected data from patients diagnosed with a tumor involving the spine and requiring a total or partial posterior vertebrectomy between January 2012 and October 2022, referred to a single tertiary-level orthopedic and trauma center. We included only patients in whom primary closure of the wound was possible but judged to be under excessive tension. A total of 145 patients underwent partial or total vertebrectomy for oncological reasons at our tertiary-level trauma hospital. Among these, 73 patients were eventually included according to the inclusion and exclusion criteria: 53 in the orthopedic group and 20 in the orthoplastic group. Considering only patients undergoing radiation therapy, the orthoplastic group showed significantly lower rates of overall complications (33% versus 69%) than the orthopedic group. Primary flap coverage, especially in patients receiving RT, reduces the risk of postoperative complications and avoids a second reconstructive operation, consequently reducing patient discomfort, length of hospital stay, and healthcare costs.