General Surgery Research Articles

Comparative efficacy of autologous platelet rich plasma and conventional dressing in the management of chronic ulcers

Background: Chronic ulcers pose a major global healthcare challenge. The use of platelet-rich plasma (PRP) for treating these wounds has garnered interest because of its potential healing benefits. Objective were to determine the effect of autologous PRP therapy on the percentage of surface area reduction/healing in chronic ulcers. Methods: This randomized controlled trial was conducted at the department of general surgery of M.M. institute of medical sciences and research (M.M.I.M.S.R.) Mullana, Ambala from May 1, 2023, to April 30, 2024. Patients aged 18-80 years of either gender with chronic ulcers were enrolled. Patients were randomly allocated to the PRP group and control group. PRP group was administered autologous PRP once in two weeks for 6 weeks after debridement, while for the control group conventional saline dressings were done after debridement. Final assessment was done at 8 weeks. Results: Of the 60 patients, the mean age was 53.90±11.23 years. There were 49 (82%) males and 11 (18%) females. At 8 weeks, the PRP group achieved 83.78% (SD=2.99) reduction in surface area of ulcers, whereas the control group had a 57.78% (SD=1.32) reduction in surface area of ulcers, with a p=0.0000 indicating a significant difference. The small sample size and 56-day follow-up period are insufficient to assess long-term treatment effects. Conclusions: A better outcome of PRP was observed compared to conventional dressing in patients with chronic non-healing ulcers.

Perioperative Hypothermia in Surgical Patients: A Retrospective Cohort Analysis at a Busy District General Hospital.

Introduction Perioperative hypothermia is a common yet underreported complication of surgery. It results from various factors, including cold operating theaters, anesthetic effects, environmental exposure, exposed tissues, and the administration of cold intravenous or irrigation fluids. This study aims to determine the incidence of perioperative hypothermia in a district National Health Service hospital to assess the feasibility of a randomized controlled trial (RCT) for interventions to prevent hypothermia. Methods This retrospective study included the data of 200 elective surgical patients at North Manchester General Hospital from June 1, 2022, to August 1, 2022. Inclusion criteria were elective general surgery, urology, breast, and gynecology patients aged 18 to 60 years. Exclusion criteria included emergency cases and patients younger than 18 or older than 60. Temperature measurement data were collected from the anesthesia records of the patients at six phases: preoperative, pre-induction, intraoperative, post-procedure, recovery room, and post-recovery. Data collection included specialty, surgery duration, and the use of intraoperative fluid warmers. Statistical analysis was performed using StatsDirect software (StatsDirect Ltd, Wirral, UK). Results Among the 200 patients, the overall incidence of hypothermia was 4% preoperatively, 5% pre-induction, 12% intraoperatively, 11% postoperatively, 8% in recovery, and 6% post-recovery. Intraoperative hypothermia incidence was significant, given that active warming was applied to patients with preoperative hypothermia. Regression analysis showed no correlation between intraoperative temperature and the use of intraoperative fluid warmers. Pre-induction temperature was the most statistically significant predictor of intraoperative hypothermia. Conclusions This study highlights the need for active interventions to recognize and prevent perioperative hypothermia in elective surgical patients. Active pre-warming of patients, regardless of surgery type and duration, is feasible and potentially beneficial. Future research should include an RCT comparing active and passive warming strategies to evaluate their effectiveness in improving perioperative outcomes.

Bariatric and general surgical procedures in obese patients with a history of venous thromboembolism and concurrent anticoagulation therapy

Bariatric and general surgical procedures in obese patients with a history of venous thromboembolism and concurrent anticoagulation therapy

The cost of virtual interviews; more than just the money

PurposeThe COVID-19 pandemic resulted in travel restrictions to limit virus transmission, altering the residency interview process across the country. While the transition to virtual interviews has the potential benefit of convenience and cost savings, concerns remain about the impact on applicants’ ability to distinguish programs. We sought to understand individual applicant motivations when presented with the opportunity to interview in-person or virtually and the associated costs.MethodsAn anonymous, voluntary, mixed-methods survey was distributed to all US allopathic medical school general surgery applicants who applied to our program in the 2023 cycle. The primary outcome was identifying factors that impacted the decision to interview either in-person or virtually. Secondary outcomes included costs associated with the entire interview process, including travel for away rotations, in-person interviews, and program second looks.Results155 (21.3%) applicants completed the survey. The average number of interviews completed was 14.2 ± 6.25. Females completed more interviews than males (14.9, 12.6, p = 0.047). Respondents accepted a mean of 89% of virtual interviews offered. 73% of applicants selected to complete at least one interview in-person. Top reasons for electing in-person interviews were to gain a stronger impression of the program (64%), make a greater impression of the program (50%), and strength of interest in the program (64%). Top factors for choosing virtual interviews were decreased costs (64%), less travel time (53%), and the ability to complete more interviews (53%). 58% of applicants planned to visit at least one program in-person post-interview. The mean total cost of interviews was $122 for virtual and $358 for in-person. Travel for a “second look” visit cost $279. 53% of respondents completed an away rotation, spending an average of $1688 per away rotation.ConclusionWhen presented with the option, applicants chose to interview in-person because of a mutual feeling of portraying and receiving a stronger impression. Candidates chose virtual due to cost reduction and the ability to complete more interviews. The financial savings of virtual interviews should be examined in the context of increased applications, increased interviews, post-interview travel or "second look" experiences, and costs associated with away rotations. Future work is needed to elucidate the role of in-person contact or away rotations on the likelihood of an applicant to interview and match in a largely virtual interview era.

Reliability of a workplace-based assessment for the United States general surgical trainees’ intraoperative performance using multivariate generalizability theory: a psychometric study

The System for Improving and Measuring Procedure Learning (SIMPL), a smartphone-based operative assessment application, was developed to assess the intraoperative performance of surgical residents. This study aims to examine the reliability of the SIMPL assessment and determine the optimal number of procedures for a reliable assessment. In this retrospective observational study, we analyzed data collected between 2015 and 2023 from 4,616 residents across 94 General Surgery Residency programs in the United States that utilized the SIMPL smartphone application. We employed multivariate generalizability theory and initially conducted generalizability studies to estimate the variance components associated with procedures. We then performed decision studies to estimate the reliability coefficient and the minimum number of procedures required for a reproducible assessment. We estimated that the reliability of the assessment of surgical trainees' intraoperative autonomy and performance using SIMPL exceeded 0.70. Additionally, the optimal number of procedures required for a reproducible assessment was 10, 17, 15, and 17 for postgraduate year (PGY) 2, PGY 3, PGY 4, and PGY 5, respectively. Notably, the study highlighted that the assessment of residents in their senior years necessitated a larger number of procedures compared to those in their junior years. The study demonstrated that the SIMPL assessment is reliably effective for evaluating the intraoperative performance of surgical trainees. Adjusting the number of procedures based on the trainees' training stage enhances the assessment process's accuracy and effectiveness.

A Lifelong Commitment: The Story of Dr. Kisu Song and His Impact on Korean Healthcare.

Dr. Kisu Song, an allopathic medical doctor specializing in general surgery, significantly impacted South Korean medicine and healthcare through his lifelong dedication to serving rural communities. Born on December 25, 1939, during the Japanese colonial period, Dr. Song witnessed the tumultuous transformation of Korea from a colonized nation to a divided one. His early life was marked by the Japanese colonial period and the Korean War and its aftermath, which influenced his decision to pursue medicine over law, a choice guided by the pressing needs of his community and his father's legacy. This biography explores Dr. Song's journey from a young student in a war-torn country to a pioneering rural physician in South Korea. His contributions, particularly in underserved areas, exemplify his profound commitment to healthcare and community service.

A Pattern and Incidence Study of Complications after Emergency Laparotomy

Background and Objectives: The study of emergency laparotomies are being carried out prospectively at the Department of General Surgery at a tertiary care facility affiliated with the Parul Institute of Medical Science and Research (Parul Sevasharam Hospital). Methods: A tertiary care teaching hospital’s Department of General Surgery conducted a prospective study involving 100 emergency laparotomy cases from July 2020 to May 2021. Every patient underwent surgery using a midline vertical incision. The main aim of the study is to identify various complications occurring following emergency laparotomies and various factors influencing them. All patients followed up at least for a period of 6 months after surgery. Results: 60 patients developed one or more complications postoperatively, 19 (31.7%) patients had abdominal complications; 34 (56.7%) had wound complications; 12 (20%) had chest complications and 4 (6.7%) had limb complications Conclusion: Even with the availability of safe anaesthetic, broad range of antibiotics, and advanced experimental or investigational devices, the risk of complications and mortality from emergency laparotomies remains significant. Chest problems were associated with a higher postoperative mortality rate than wound, limb, or abdomen complications.

Hemoperitoneum: Frequency, Management and Prognostic Factors in the General Surgery Department Hospital National Ignace Deen, CHU de Conakry, Guinea

<i>Aim</i>: To report our experience in the management of haemoperitoneum in the general surgery department of the Ignace Deen National Hospital. <i>Patients and methods</i>: This was a retrospective descriptive and analytical study, covering a period of 5 years, from January 2017 to December 2021, carried out in the general surgery department of the Ignace Deen National Hospital. All records of patients admitted for hemoperitoneum were included. <i>Results</i>: During the five (5) years, 120 cases of hemoperitoneum were collected, representing 1.1% of all abdominal surgical emergencies. The mean age of the patients was 24 ± 16.83 years. The patients were predominantly male, with a sex ratio M/F: 1,05. The average admission time was 32.1 hours. Haemoperitoneum was traumatic in 58.33% of cases. Road traffic accidents accounted for 35.83% of cases. Treatment was surgical in 81 patients (69.23%). The main anatomopathological lesions found were: rupture of ectopic pregnancy (33.33%), rupture of the spleen (17.5%). The procedures performed were: salpingectomy (61.72%), splenectomy (23.45%). The prognostic factors were: age greater than 30 years, admission time greater than 48 hours, large haemoperitoneum. Post-operative management was straightforward in 92.50% of cases with a death rate of 4.17%. <i>Conclusion</i>: Hemoperitoneum is a frequent occurrence in the department. Treatment was surgical with hemostasis, salpingectomy and splenectomy. Prognostic factors were age, admission time and quantity of hemoperitoneum.

Pre-Operative Evaluation of Risk Factors for Difficult Laparoscopic Cholecystectomy

Cholelithiasis or the gallstone disease is the most common biliary pathology. 10-15% population of western world is estimated to be affected by gallstone disease, of which majority remains asymptomatic (>80%) and 1-2 % of these asymptomatic patients will develop symptoms needing surgery per year. In this prospective study, 77 patients years undergoing elective Laparoscopic Cholecystectomy (LC) and meeting all inclusion criteria in Department of General Surgery, Nepal Medical College and Teaching Hospital over period of 1 year. History, detailed clinical examination and laboratory investigations were performed as per the working proforma. Operative time and conversion to open cholecystectomy were recorded. The association between clinical, laboratory and sonographic factors with difficult laparoscopy were obtained. Data analysis was done using SPSS-17 version. Out of 77 patients, 63 were females. Body mass index (BMI) above 30 representing obese population were 33.2% with p value 0.0004. Also, 41.5% patients had history of acute cholecystitis while 12.9% patients had previous history of abdominal surgery and 70.1% patients had history of recurrent abdominal pain. Total of 19.4% patients had increased leucocyte count. On ultrasonography thickened GB wall of >3 mm was seen in 42.8%, distended GB was seen in 41.5%, stone size of >1 cm was seen in 70.1% patients and multiple stones were seen in 84.4%. Similarly, duration of surgery was >90 mins in 31.1% and 7.04% patients underwent conversion to open cholecystectomy both of which were considered difficult laparoscopy. Our study reveled that clinical factors like age, BMI, history of acute cholecystitis, previous history of recurrent abdominal pain and past history of abdominal surgery had significant association in prediction of difficult LC.

Anesthesia-related Complications in General Surgery: Strategies for Prevention and Management

Background: Anesthesia-related complications in general surgery remain a significant concern despite advances in anesthetic techniques. These complications can lead to increased morbidity and mortality if not effectively managed. This study aimed to evaluate the incidence, prevention, and management of anesthesia-related complications in a tertiary care hospital in Bangladesh. Methods: A prospective observational study was conducted on 60 patients who underwent general surgery at the Department of Anesthesia, Analgesia, and Intensive Care Medicine, BSMMU, Dhaka, from 2022 to 2023. Demographic data, anesthesia-related complications, preventive measures, and management strategies were recorded and analyzed. Results: Cardiovascular complications were the most common, with hypotension in 11.7% and arrhythmias in 6.7% of patients. Respiratory complications, including hypoxemia and bronchospasm, occurred in 13.3% and 5% of cases, respectively. Neurological complications, such as postoperative delirium, were observed in 10% of patients. Preventive strategies, including fluid preloading, bronchodilators, and antiemetic prophylaxis, were effective in reducing the incidence of complications. All cases of hypotension, hypoxemia, postoperative nausea and vomiting (PONV), and arrhythmias were successfully managed with standard interventions, achieving a 100% success rate. Conclusion: This study demonstrates that anesthesia-related complications can be effectively managed through vigilant perioperative care and established management protocols. Cardiovascular and respiratory complications were the most common, and prompt interventions such as fluid resuscitation, oxygen therapy, and pharmacological treatment ensured favorable outcomes. Future studies with larger sample sizes and multicenter settings are recommended to further validate these findings and optimize anesthesia practices in diverse healthcare environments.

Evaluating the Crossmatch-to-Transfusion Ratio as a Tool for Analyzing and Optimizing Blood Bank Resource Utilization: A Retrospective Observational Study.

Background Blood transfusion services are crucial for modern medical care, particularly for surgical interventions, chronic diseases, pregnancy complications, and malignancies. There is an increasing demand for blood products in India; hence,optimizing resource utilization in blood banks is essential. This study aims toevaluatethe crossmatch-to-transfusion (C/T) ratio as a tool for analyzing and optimizing the utilization of blood bank resources. The C/T ratioof the various clinical departments will also identify inefficiencies in blood ordering practiceand plan corrective actions. Methods A retrospective observational study was conducted at the Blood Center of Saveetha Medical College and Research Center. Data were collected over a three-month period from November 1, 2023, to January 31, 2024. Information was collected from crossmatch request forms, crossmatch registers, issue registers, and digital medical records. The study included all crossmatch requests received within the study period. The C/Tratio was calculated department-wise, and the departments with high C/T ratios were identified. Results In the study, 1,861 packed red blood cell (RBC) units were crossmatched, of which 797 units were issued. The overall hospital C/T ratio was 2.33, which indicates excessive blood ordering. The Department of Obstetrics and Gynaecology had the highest C/T ratio of 5.14, followed by Oncology (3.09), Urology (2.9), General Surgery (2.26), and Orthopaedics (2.08). These high ratios showed significant overorderingand underutilization of crossmatched blood units. Conclusion This study revealed that the C/T ratio in the hospital exceeded international standards, especially among surgical departments. This indicates a need for optimizing blood ordering practices to reduce unnecessary crossmatches, minimize wastage, and enhance resource management. Implementing strategies to correct the high C/T ratio and regular auditing can improve blood transfusion services and ensure efficient utilization of blood products.

A Clinical Audit of Pregnancy Testing in Females Presenting With Abdominal Pain to the General Surgery Department of a District General Hospital.

Introduction Guidelines state that all female patients of childbearing age presenting with acute abdominal pain to a surgical department must have a pregnancy test with either urinary or serum beta-human chorionic gonadotropin (𝜷-HCG) testing. This allows complete evaluation of the patient and consideration of a wider range of differential diagnoses, including those that must not be missed, such as a possible ectopic pregnancy. Additionally, management options for conditions unrelated to pregnancy may differ in pregnant women. This audit assessed adherence to guidelines for pregnancy testing in females presenting with abdominal pain to the general surgery department in a district general hospital and the impact of initiatives to improve compliance. Methods A retrospective audit to identify pregnancy test completion of all female patients aged between 11 and 55 years presenting to the general surgery department at a district general hospital with acute abdominal pain in August 2022 was conducted. A medical education session, posters, and discussion amongst multidisciplinary team members in a nursing huddle followed to raise awareness. A subsequent prospective audit was conducted in November 2022. Results In the initial audit conducted in August 2022, 55 female patients aged between 11 and 55 years presented to the surgical department with abdominal pain. Of these patients, pregnancy testing was only completed for 41.8% (n = 23). Following interventions, a second audit conducted in November 2022 found 30 female patients presenting with abdominal pain. In this cohort, pregnancy testing was completed for 80% of patients (n = 24). Conclusion This study highlights the need for regular clinical audits and multidisciplinary discussion in improving and maintaining high standards of patient care and ensuring pregnancy testing of all females of reproductive age presenting with abdominal pain to the general surgery department. Further consideration may be given to the incorporation of recording of pregnancy test status on electronic healthcare systems as part of admission and mandatory checklists.

Urgency and Outcomes of General Surgery Patients Admitted to the Emergency Department

Objective: This study aimed to evaluate the effectiveness of general surgery consultations initiated from the emergency department (ED) in a high-volume tertiary care hospital, focusing on patient outcomes and the impact of specialty recommendations. Material and Methods: A retrospective analysis was conducted over a six-month period, including 800 patients referred to the general surgery department from the ED. Data on patient demographics, presenting complaints, diagnoses, surgical interventions, and outcomes were collected. Additionally, the influence of the consultation source—whether initiated by the ED or recommended by another specialty—on patient management was assessed. Results: The mean age of the patients was 52.86 years. The most common presenting complaints were abdominal pain (37.5%), nausea/vomiting (14.2%), and trauma-related issues (12.7%). Acute appendicitis was the leading diagnosis (18.1%), frequently necessitating emergency surgery, while hernia (6.1%) and diverticulitis (4.1%) were more often managed with elective procedures. Consultations based on specialty recommendations (73.4%) were less likely to result in surgical intervention. Patients assessed solely by the ED were admitted to the surgical ward in 58.1% of cases, while 59.6% of patients referred following a specialty recommendation were transferred to non-surgical departments. The overall hospital admission rate was 50.7%, with a mortality rate of 4.6%. Conclusion: The study highlights the pivotal role of ED decision-making in managing general surgery patients, particularly in determining the need for surgical intervention. Optimising consultation criteria and reducing reliance on specialty recommendations may improve patient outcomes. The implementation of standardised consultation guidelines is recommended to enhance patient care and resource utilisation in emergency settings.

A needs assessment for simulation-based training in emergency urological skills in Ethiopia.

Urologic emergencies are common and complications from their management are high. Simulation-based education (SBE) is a highly effective training method, allowing trainees to learn both technical and nontechnical skills in a safe environment. Training in the management of urological emergencies is limited in many healthcare settings, so we performed a needs assessment for a urological emergencies SBE course in Ethiopia. This study presents data from a descriptive cross-sectional, survey-based survey of consultants and residents in the Ethiopian surgical community. The survey was disseminated using online Google Forms, through social media (WhatsApp), and to colleagues in the College of Surgeons of East, Central and Southern Africa (COSECSA) via email and social media. One hundred-seven results were received; two were discarded due to incomplete data. Fifty three of the respondents were general surgeons and 38 of the respondents were urologists. Sixty nine respondents strongly agreed that simulation-based training was important for first-year surgical residents, whereas twenty-five respondents agreed and nine respondents strongly disagreed; one respondent disagreed and one was neutral. Eighty seven respondents suggested a 3-day training course, whereas 17 respondents suggested a two-day course. More than 80 of the respondents rated training in the management of acute urinary retention, acute scrotum, urethral, and suprapubic catheterization as extreme or very important and 79 respondents wanted education about urologic trauma and Fournier's gangrene. Surgical and urology residents in Ethiopia have expressed a need for, and a strong interest in, simulation-based urological emergency training.

Effective Use and Cost-Evaluation of Erythrocyte Suspension in Surgical Branches of Tertiary Hospital

Blood has been accepted as the basic symbol of life from the past to the present. Transfusion is the transfer of blood and blood components to a patient due to various health problems. The present study aimed to evaluate the effective use and cost of erythrocyte suspension in surgical branches in a tertiary hospital. In this study, the use and cost-effective evaluation of erythrocyte suspension, a blood component, after surgical intervention in brain and nerve diseases surgery, orthopedics and traumatology, general surgery, gynecology and obstetrics, and organ transplantation clinics between 01/01/2023 and 12/31/2023 were retrospectively evaluated. Because blood products are provided as voluntary donations, their appropriate use will help reduce hospital and patient costs. We believe that strict compliance with national and international standards and guidelines, quality management, and good clinical practices, as well as ensuring continuity of training on these issues, will enable more efficient product acquisition and decrease blood component disposal in all blood services units.

The Effectiveness of Bariatric Surgery on Treating Infertility in Women-A Systematic Review and Meta-Analysis.

Background/Objectives: Obesity is a growing global health concern, which increases the risk of various diseases and has seen a rising prevalence over time. The global prevalence of obesity among adults has doubled over time. Obesity significantly impacts health by increasing the risk of a range of severe medical conditions. Cardiovascular diseases, such as heart attacks and strokes, are more prevalent in individuals with obesity due to factors like high blood pressure and abnormal cholesterol levels. This systematic review and meta-analysis sought to establish the effectiveness of bariatric surgery in treating infertility in women. Methods: This systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A broad electronic search was conducted through PubMed, Web Science, and Medline databases for studies published between April 2017 and October 2023. The search strategy used the following terms: bariatric surgery, metabolic surgery, bariatric surgical procedures, stomach stapling, infertility, and fertility issues. The data were analyzed using the Revman version 5.1.2 software. Results: The results of the study show that despite the heterogeneity found in the studies, irregular menstrual cycles were found to reduce significantly in patients who underwent bariatric surgery (p = 0.01), with an RR of 0.22, at a 95% CI (0.06, 0.74). With regards to infertility, the results indicate that bariatric surgery reduced the level of infertility among the patients significantly (p = 0.00001), with an RR of 0.55, at a 95% CI (0.45, 0.68). Further, the results show bariatric surgery reduced rate of miscarriages among patients (p = 0.01), with an RR of 0.51, at a 95% CI (0.30, 0.86). Moreover, bariatric surgery reduced the level of congenital malfunction, but the effect was not statistically significant (p = 0.16), with an RR of 0.39, at a 95% CI (0.10, 1.45). However, the overall effect of bariatric surgery on treating infertility was found to be significantly effective (p = 0.0001), with an RR of 0.54, at a 95% CI (0.43, 0.68). This implies that bariatric surgery helps in weight loss, which improves ovulatory dysfunction and irregular menstruation while boosting spontaneous conception. Conclusions: This study found that bariatric surgery helps infertile women of a reproductive age to lose weight, which improves ovulatory dysfunction and irregular menstruation while boosting spontaneous conception. On the other hand, the study noted that after bariatric surgery, spontaneous conception can occur because of a decreased rate of miscarriage, increased fertility, reduced levels of congenital malfunction, and the restoration of regular menstrual cycles. Therefore, this study highlights the need to offer adequate preconception care and counselling to women who are about to be pregnant, both before and after bariatric surgery. Further, based on the fact that this study focused on general bariatric surgery, future research should focus on specific types of bariatric surgery to establish the most effective type of bariatric surgery in treating infertility in women.

Influence of dental status on postoperative complications in major visceral surgical and organ transplantation procedures—the bellydent retrospective observational study

PurposeThe significance of dental status and oral hygiene on a range of medical conditions is well-recognised. However, the correlation between periodontitis, oral bacterial dysbiosis and visceral surgical outcomes is less well established. To this end, we study sought to determine the influence of dental health and oral hygiene on the rates of postoperative complications following major visceral and transplant surgery in an exploratory, single-center, retrospective, non-interventional study.MethodsOur retrospective non-interventional study was conducted at the Department of General, Visceral, and Transplant Surgery, University Hospital Heidelberg, Germany. Patients operated on between January 2018 and December 2019 were retrospectively enrolled in the study based on inclusion (minimum age of 18 years, surgery at our Department, intensive care / IMC treatment after major surgery, availability of patient-specific preoperative dental status assessment, documentation of postoperative complications) and exclusion criteria (minor patients or legally incapacitated patients, lack of intensive care or intermediate care (IMC) monitoring, incomplete documentation of preoperative dental status, intestinal surgery with potential intraoperative contamination of the site by intestinal microbes, pre-existing preoperative infection, absence of data regarding the primary endpoints of the study). The primary study endpoint was the incidence of postoperative complications. Secondary study endpoints were: 30-day mortality, length of hospital stay, duration of intensive care stay, Incidence of infectious complications, the microbial spectrum of infectious complication. A bacteriology examination was added whenever possible (if and only if the examination was safe for the patient)for infectious complications.ResultsThe final patient cohort consisted of 417 patients. While dental status did not show an influence (p = 0.73) on postoperative complications, BMI (p = 0.035), age (p = 0.049) and quick (p = 0.033) were shown to be significant prognostic factors. There was significant association between oral health and the rate of infectious complications for all surgical procedures (p = 0.034), excluding transplant surgery. However, this did not result in increased 30-day mortality rates, prolonged intensive care unit treatment or an increase in the length of hospital stay (LOS) for the cohort as a whole. In contrast there was a significant correlation between the presence of oral pathogens and postoperative complications for a group as a whole (p < 0.001) and the visceral surgery subgroup (p < 0.001). Whilst this was not the case in the cohort who underwent transplant surgery, there was a correlation between oral health and LOS in this subgroup (p = 0.040). Bacterial swabs supports the link between poor oral health and infectious morbidity.ConclusionsDental status was a significant predictor of postoperative infectious complications in this visceral surgery cohort. This study highlights the importance preoperative dental assessment and treatment prior to major surgery, particularly in the case of elective surgical procedures. Further research is required to determine the effect of oral health on surgical outcomes in order to inform future practice.Trial registrationTrial registered under the ethics-number S-082/2022 (Ethic Committee of the University Heidelberg).

Retrospective Analysis of Patients Aged 65 and Over who were Admitted to the General Surgery Clinic from the Emergency Department

Retrospective Analysis of Patients Aged 65 and Over who were Admitted to the General Surgery Clinic from the Emergency Department

Advancing Medical Education Using Virtual and Augmented Reality in Low- and Middle-Income Countries: A Systematic and Critical Review

This review critically examines the integration of Virtual Reality (VR) and Augmented Reality (AR) in medical training across Low- and Middle-Income Countries (LMICs), offering a novel perspective by combining quantitative analysis with qualitative insights from medical students in Egypt and Ghana. Through a systematic review process, 17 peer-reviewed studies published between 2010 and 2023 were analysed. Altogether, these studies involved a total of 887 participants. The analysis reveals a growing interest in VR and AR applications for medical training in LMICs with a peak in published articles in 2023, indicating an expanding research landscape. A unique contribution of this review is the integration of feedback from 35 medical students assessed through questionnaires, which demonstrates the perceived effectiveness of immersive technologies over traditional 2D illustrations in understanding complex medical concepts. Key findings highlight that VR and AR technologies in medical training within LMICs predominantly focus on surgical skills. The majority of studies focus on enhancing surgical training, particularly general surgery. This emphasis reflects the technology’s strong alignment with the needs of LMICs, where surgical skills training is often a priority. Despite the promising applications and expanding interest in VR and AR, significant challenges such as accessibility and device limitations remain, demonstrating the need for ongoing research and integration with traditional methods to fully leverage these technologies for effective medical education. Therefore, this review provides a comprehensive analysis of existing VR and AR applications, their evaluation methodologies, and student perspectives to address educational challenges and enhance healthcare outcomes in LMICs.

Comparison of Duration of Action in Spinal Anesthesia of 0.5% Bupivacaine and 0.5% Bupivacaine with Dexmedetomidine

Background: Spinal anesthesia is a common technique for surgeries below the navel, utilizing bupivacaine, a local anesthetic. Adding adjuncts like dexmedetomidine may enhance the efficacy and duration of the block.Objective: To compare the duration of action of 0.5% bupivacaine versus 0.5% bupivacaine with dexmedetomidine in spinal anesthesia.Methods: This quasi-experimental trial included 60 patients aged 20-60 years, ASA grade 1 or 2, undergoing general, plastic, orthopedic, or urological surgery at CMH Karachi. Patients were non-randomly assigned to Group B (0.5% bupivacaine, n=30) or Group BD (0.5% bupivacaine plus 5 mcg dexmedetomidine, n=30). Onset and duration of sensory and motor blocks, duration of analgesia, and adverse effects were recorded. Data were analyzed using SPSS version 25, with a p-value ≤ 0.05 considered significant.Results: Group BD showed faster onset of sensory block (7.08 ± 0.54 mins vs. 13.48 ± 0.73 mins, p &lt; 0.001) and motor block (10.32 ± 0.91 mins vs. 17.55 ± 0.69 mins, p &lt; 0.001). Duration of motor block was longer in Group BD (284.06 ± 5.64 mins vs. 133.93 ± 5.72 mins, p &lt; 0.001), as was duration of analgesia (218.07 ± 4.86 mins vs. 125.36 ± 5.42 mins, p &lt; 0.001).Conclusion: The addition of dexmedetomidine to 0.5% bupivacaine significantly enhances the onset and duration of spinal anesthesia with a comparable safety profile.