High Risk Of Complications Research Articles

Post-Discharge Outcomes of Elderly Patients Hospitalized for Inflammatory Bowel Disease Flare Complicated by Clostridioides difficile Infection.

Elderly hospitalized patients with inflammatory bowel disease (IBD) flare and concurrent Clostridioides difficile infection (CDI) are considered at high risk of IBD-related complications. We aimed to evaluate the short, intermediate, and long-term post-discharge complications among these patients. A retrospective multicenter cohort study assessing outcomes of elderly individuals (≥60 years) hospitalized for an IBD flare who were tested for CDI (either positive or negative) and discharged. The primary outcome was the 3-months post-discharge IBD-related complication rates defined as: steroid dependency, re-admissions (emergency department or hospitalization), IBD-related surgery, or mortality. We assessed post-discharge IBD-related complications within 6-months and mortality at 12-months among secondary outcomes. Risk factors for complication were assessed by multivariable logistic regression. In a cohort of 654 patients hospitalized for IBD (age 68.9 [interquartile range {IQR}]:63.9-75.2) years, 60.9% ulcerative colitis), 23.4% were CDI-positive. Post-discharge complication rates at 3 and 6-months, and 12-months mortality, did not differ significantly between CDI-positive and CDI-negative patients (32% vs. 33.1%, p=0.8; 40.5% vs. 42.5%, p=0.66; and 4.6% vs. 8%, p=0.153, respectively). The Charlson comorbidity index was the only significant risk factor for complications within 3-months (aOR 1.1), whereas mesalamine (5-aminosalicylic acid [5-ASA]) use was protective (aOR 0.6). An ulcerative colitis diagnosis was the sole risk factor for complication at 6-months (aOR 1.5). CDI did not significantly impact outcomes or interact with IBD type. In elderly IBD patients hospitalized for IBD flare and subsequently discharged, a concurrent CDI infection was not associated with post-discharge IBD-related complications or mortality up to 1-year.

Complications and 30-Day Readmission Rates After Lobectomy for Lung Cancer: A Single-Center Pre-enhanced Recovery After Surgery (ERAS) Assessment in Vietnam

Background: This study investigated complications and 30-day readmission rates following lobectomy for lung cancer in a pre-enhanced recovery after surgery (ERAS) program setting at the University Medical Center Ho Chi Minh City, aiming to identify key areas for improvement. Methods: A retrospective analysis was conducted on 99 patients who underwent lobectomy for lung cancer. Data on patient demographics, surgical details, and postoperative outcomes were collected. Complications were categorized using the Clavien-Dindo classification system, and statistical analyses were performed using STATA software. Results: Among the 99 surveyed patients, 53.5% were male, and 46.5% were female, with the majority being over 60 years old. The postoperative complication rate was 19.2% (30.9% reduction with multimodal pain relief, P = 0.001), and the 30-day readmission rate was 13.1% (19.4% reduction with physical therapy before surgery, P = 0.008). High-risk complication factors included open surgery (42.9%) compared to video-assisted thoracoscopic surgery (VATS) (11.8%) (P = 0.026) and vomiting after surgery (46.7%, P = 0.008). Conclusions: The findings underscore the necessity of integrating ERAS principles to enhance postoperative care and outcomes in lung cancer surgery. Implementing ERAS protocols could potentially reduce complications and readmissions, improving patient experiences and surgical efficacy. Future research will focus on applying these insights within the ERAS framework to optimize lobectomy outcomes.

Streptokinase or Alteplase for Acute Limb Ischemia? A Meta-Analysis

Background: Acute limb ischemia (ALI) is a vascular emergency that necessitates prompt and effective treatment to restore blood flow and prevent limb loss. Thrombolytic therapy, particularly with agents like streptokinase and alteplase, plays a pivotal role in ALI management. This meta-analysis and systematic review aimed to compare the efficacy and safety of streptokinase and alteplase in treating ALI. Methods: A comprehensive search of PubMed, Embase, Science Direct, and the Cochrane Library databases was conducted up to August 13, 2024, to identify relevant studies. The inclusion criteria encompassed clinical trials involving patients diagnosed with ALI who received either streptokinase or alteplase as the initial thrombolytic treatment. The quality of the included studies was rigorously assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) and the Methodological Index for Non-Randomized Studies (MINOR) criteria. A meta-analysis was performed using the Mantel-Haenszel random-effects model to calculate risk ratios (RRs) with their corresponding 95% confidence intervals (CIs). Results: The final analysis included 20 studies, encompassing both qualitative and quantitative assessments. A comparative analysis of streptokinase and alteplase for limb salvage at 30 days revealed a significant advantage in favor of alteplase, with a relative risk ratio (RR) of 0.78 (95% CI 0.69-0.88, I² = 0%). Furthermore, streptokinase was associated with a higher rate of primary amputation, with an RR of 2.54 (95% CI 1.50-4.32, I² = 0%) compared to alteplase. The use of streptokinase also correlated with a higher risk of complications, including major bleeding (RR 1.75, 95% CI 0.04-84.30, I² = 77%) and minor bleeding (RR 1.41, 95% CI 0.60-3.32, I² = 0%). Conclusion: The findings of this meta-analysis underscore the superior efficacy of alteplase in achieving limb salvage in ALI, coupled with a more favorable safety profile. The preferential use of alteplase in clinical practice is recommended, particularly in patients with severe ischemia. However, careful patient selection and close monitoring are crucial when streptokinase therapy is considered.

No difference in early outcomes comparing intramedullary versus extramedullary fibular fixation in operative ankle fractures

IntroductionThe purpose of this study was to compare postoperative complications and outcomes of minimally invasive intramedullary fixation (IMF) versus plate fixation (PF) in the treatment of distal fibular fractures. Materials and methodsA retrospective review was performed from identifying all consecutive ankle fracture patients aged ≥18-years-old surgically managed between August 2017 to September 2022 at a tertiary care center with minimum 6 months clinical follow-up. Patients were grouped into those receiving intramedullary versus extramedullary fibular fixation. The primary outcomes were relevant demographic factors (diabetes, osteoporosis, charlson comorbidity index [CCI]), surgical time, complication rates, reoperation rates. Secondary outcomes included time to definitive fracture fixation, fracture characteristics (AO/OTA and Lauge-Hansen classification), syndesmotic instability requiring fixation and discharge disposition. ResultsForty-one IMF patients (average age 55.3 ± 18.1yrs) and 162 PF patients (47.7 ± 17.4yrs) were identified and included in this study. Within the IMF group, 25 patients received IM nailing and 16 patients received percutaneous screw fixation. A greater proportion of IMF patients had diabetes (39 % vs 22 %, p < 0.001), osteoporosis (22 % vs 3 %, p < 0.001), and moderate or severe CCI (41 % vs 23 %, p = 0.017). Surgical time was significantly reduced when using IMF technique (80.4 ± 43.1 min vs 99.1 ± 43.1 min, p = 0.012). Overall complication rates or time to complication did not differ significantly between groups (p = 0.578 and p = 0.082, respectively); however, when sub-stratified, IMF patients trended towards experiencing fewer wound related complications versus PF patients (5 % vs 9 %, p = 0.291). No IMF patients experienced deep or superficial infections and only 2 (5 %) patients experienced wound dehiscence. Reoperation rates(15 % vs 10 %, p = 0.267) and time to fracture union (2.7 ± 2.2 mos vs 3.1 ± 2.0 mos, p = 0.301) did not differ significantly. At final follow-up (IMF: 15.0 ± 12.2 mos vs PF: 28.5 ± 19.5 mos), Olerud and Molander ankle score was significantly higher in IMF compared to PF (87.1 ± 14.2 vs 76.2 ± 22.6, p = 0.002). ConclusionPatients in the IMF group at baseline had several comorbid medical conditions that put them at high risk for wound related complications, however, postoperatively they demonstrated higher functional scores and similar complication rates compared to the PF group. It is important to note, however, while we expected a higher rate of wound issues with the PF group, there were no significant differences in infection rates. Either IMF and PF is reliable for fixation and outcomes, and thus with proper soft tissue, biologically friendly technique, either IMF or PF is a reliable choice in the fixation of fibula fractures. Level of evidenceIII, retrospective cohort comparison study.

Perceptions, Barriers and Facilitators Regarding Nutritional Care for Patients with Chronic Limb Threatening Ischemia: A Focus Group Study Among Healthcare Professionals

Nutrition and nutritional care are essential for optimal outcomes, and, therefore of importance for patients with chronic limb threatening ischemia (CLTI) given their high risk of complications. However, insight is lacking in how healthcare professionals directly involved in the care of patients with CLTI perceive nutritional care, as well as in the perceived barriers and facilitators regarding optimal nutritional care. In this qualitative study with a phenomenological approach, three online focus groups were conducted with various healthcare professionals directly involved in the care of patients with CLTI. Sample size was guided by information power. Focus group recordings were transcribed verbatim, and reflexive thematic analysis was performed. Seventeen healthcare professionals participated, including vascular surgeons, fellows in vascular surgery, a medical doctor and researcher, nurse specialized in wound care, general nurse, physical therapists, dietitians, and nutrition assistants. Four themes were generated: (1) nutritional care is crucial for optimal clinical outcomes and a healthy life, (2) insufficient attention to undernutrition and nutritional care by healthcare professionals, (3) patient-related factors challenge healthcare professionals in providing nutritional care, and (4) need for optimizing the organizational process related to nutritional care. Perceived barriers regarding nutritional care included knowledge deficits, nutritional care not being part of the healthcare professionals' routine, missing tools to identify undernutrition, patient-related factors, and time constraints. Facilitators regarding nutritional care included more scientific evidence regarding the effect of nutritional care on clinical outcomes and optimization of organizational processes related to nutritional care. Healthcare professionals perceive nutritional care as important for optimal outcomes, but nutritional care is not routinely implemented in the care of patients with CLTI. This lack of implementation of nutritional care may be due to the barriers perceived in various domains. The findings of this study stress the need to optimize nutritional care, with the aim of improving outcomes in the CLTI population.

Complications after Gonioscopy-Assisted Transluminal Trabeculotomy in glaucoma treatment - literature review.

Glaucoma is a disease that leads to optic nerve damage and irreversible loss of the visual field. Gonioscopy-assisted transluminal trabeculotomy (GATT) is a minimally invasive glaucoma surgery technique, where the surgeon opens the trabecular network and Schlemm's canal to improve the outflow of the aqueous humor. This method has shown efficacy in reducing intraocular pressure in patients with primary and secondary glaucoma. GATT has gained popularity due to its minimally invasive nature, compatibility with cataract surgery and relatively low cost. Despite its advantages, the procedure can be associated with many complications such as hyphema, intraocular pressure spikes and corneal edema. In rare cases, it can lead to Descemet's membrane detachment or cystoid macular edema. The success of GATT procedure mostly depends on the surgeon's skill and experience, but also on the patient's risk factors, including age and preoperative intraocular pressure levels. Further studies are required to understand long outcomes and identify the patients, who may be at higher risk of complications.

Cardiac Surgery-Associated Acute Kidney Injury in Cardiopulmonary Bypass: A Focus on Sex Differences and Preventive Strategies.

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a high-risk complication with well-recognized increased morbidity and mortality after cardiac surgery attributable in large part to cardiopulmonary bypass (CPB) associated factors contributing to AKI including hemodilution, hypothermia, hypotension and exposure to artificial surfaces. These conditions disrupt the renal microcirculation and activate local and systemic inflammatory responses to non-pulsatile flow, and low perfusion pressure. The underlying mechanisms of CSA-AKI in CPB are not fully understood, and the incidence of CSA-AKI remains high at around 30%. Furthermore, women appear to be more vulnerable than men to the renal injury associated with CPB even though the overall incidence of cardiovascular and kidney diseases is lower in premenopausal women. Nevertheless, estrogen elicits renoprotective effects in several ways including mitigating inflammation, promoting natriuresis and endothelial protection as shown in preclinical studies. However, women have higher rates of CSA-AKI and these are exacerbated in postmenopausal women. This leads to the conundrum of whether sex, age, and hormonal status differences influence CSA-AKI. In this review, we briefly discuss the pathophysiology of CSA-AKI in CPB, and sex differences in kidney functions with a focus on the possible role of estrogen-specific effects in CPB and also possible differences in CPB in women including greater hemodilution. Further, we review strategies to prevent CSA-AKI in CPB with a highlight for potential sex-specific strategies. Improving our understanding of the impact of sex and sex hormones on CSA-AKI initiation and development will allow us to better manage the CPB strategies delivered to all patients.

PROSPECTS FOR THE USE OF MESENCHYMAL STEM CELLS IN THE TREATMENT OF CONGENITAL EPIDERMOLYSIS BULLOSA

Epidermolysis bullosa (EB) is a hereditary orphan pathology caused by mutations in genes encoding structural cellular proteins necessary for the integrity of the skin and mucous membranes. As a result of minor mechanical stress, blisters with serous and/or hemorrhagic contents, long-term non-healing wounds and scars form on the skin. Such injuries have a high risk of infectious complications and often lead to disability of the patient. Current treatment methods are primarily palliative in nature and aimed at preventing complications, which emphasizes the relevance in new therapeutic strategies. Mesenchymal stem cells (MSCs) offer a promising therapeutic approach. MSCs are known for their multipotency, immunomodulatory properties, and ability to promote tissue repair, a potential treatment for epidermolysis bullosa. This literature review evaluates the therapeutic potential of MSCs in the treatment of VEB, highlighting key findings from recent studies.

MULTIMODAL (5-ALA, TRACTOGRAPHY AND ULTRASOUND GUIDED) AWAKE CRANIOTOMY FOR GLIOBLASTOMA: MAXIMISING SAFE SURGICAL RESECTION

Abstract AIMS Maximising the extent of surgical resection of glioblastoma is a key prognostic factor for survival. This must be balanced against avoiding neurological deficit, which may delay or preclude adjuvant treatments. This is a particular challenge in eloquent tumours. Optimal surgical adjuncts to enable maximal resection of glioblastomas in eloquent brain regions, remain unclear. We present the first series assessing the safety and efficacy of multimodality image-guided, awake resection of IDH-wildtype glioblastoma, combining 5-aminolevulinic acid (5-ALA), diffusion tractography (DTI) and intraoperative ultrasound (USS). METHOD We present a single centre retrospective series of 175 patients undergoing awake craniotomy for primary resection of glioblastomas, between January 2014 and January 2023. Awake craniotomy was considered if tumours were in or adjacent to eloquent areas. Key outcomes assessed included post-operative neurological complications (classified into transient, if persisting &amp;lt;3 months and completely resolved, or permanent if persisting &amp;gt;3 months), extent of resection (EOR) and overall survival (OS). RESULTS 175 patients (103M:72F) were included, with a mean age of 58.2 years. All cases used neuronavigation, whilst 5- ALA and DTI were used in 98.9% and 97.1% of patients respectively. Intraoperative USS was used 88/175 (50.3%). Gross total resection (&amp;gt;98%) was achieved in 101/175 patients (64.7%). 83/175 patients (47.4%) experienced a post-operative neurological deficit, which was temporary in 84.3% (70/83) of cases. When transient deficits occurred, these were most often speech related (49/70). Subgroup analysis found left temporal tumours were highest risk for transient dysphasia (59.2%), followed by left frontal (21.7%) and left parietal (16.0%). The median percentage EOR with USS was 100%, whilst without USS was 97.8% (Wilcox, p=0.0004). CONCLUSION Patients should be counselled about the high risk of transient neurological complications following awake surgery, particularly speech deficit. Multimodal image-guided surgery can maximise the extent of safe resection for glioblastoma.

Algorithm for Managing Patients Hospitalized in the Surgical Wards Due to COVID-19-Related Acute Abdominal Pathology

AIM OF THE STUDY. Was to improve the outcomes of treatment of patients with COVID-19-related acute abdominal pathology by developing and implementing an algorithm for the diagnosis and treatment of those patients.MATERIAL AND METHODS. The study involved 200 patients who were randomized into two groups. This research was retrospective, based on the analysis of the medical histories of patients hospitalized with clinical manifestations of acute abdominal pathology that developed against the background of COVID-19. All medical histories in emergency departments and centers of the Republic of Uzbekistan were analyzed in the period from the beginning of the declaration of the pandemic (March 2020) to July 2022 inclusive.RESULTS. In the context of an infectious disease pandemic (COVID–19 as an example), it is very important to develop an algorithm for managing patients with acute surgical pathology. This algorithm should include a diagnostic component with the purpose of timely diagnosis of acute surgical pathology and hospitalization in the surgical department. The next step is to identify patients with a high risk of perioperative complications and adverse outcomes. The final component of the algorithm is the correction of possible risk factors for adverse outcomes.CONCLUSION. The duration of hospitalization of patients who underwent surgery for acute abdominal pathology was significantly longer during the pandemic compared to that of in the post-pandemic period (10.35±7.01 vs. 5.83±3.85 days, p&lt;0.001), which may be due to both changes in the structure of the pathology and a larger number of complicated forms. The application of the developed algorithm will optimize the management of patients with COVID-19-related acute surgical pathology, guarantee rapid decision-making while minimizing the risk of infection, reduce the risk of complications and adverse outcomes.

Successful transcatheter aortic valve implantation in a high-risk nonagenarian in Sri Lanka

Severe calcific aortic stenosis with repeated heart failure hospital admissions carries a high mortality and morbidity in the elderly. Despite a calculated high risk of periprocedural complications, Sri Lanka's first transcatheter heart valve replacement in an over 90-year-old patient in such a clinical condition could be performed with no major in-hospital adverse cardiac or cerebral events. Improved quality of life with freedom from repeated hospitalizations is an important clinical achievement in this age group following transcatheter heart valve therapy.

Bado type III Monteggia fractures have a high injury- and treatment-related complication rate: a single center study of 73 fractures.

Monteggia fractures can be problematic injuries. The aim of this population-based study is to evaluate the risk of complications according to the Bado types, clinical outcome, and incidence. 72 children (median age 6, range 2-11 years) with 73 Monteggia fractures treated during 2014-2022 were identified from the institutional fracture register. Timing of diagnosis, complications, and method of treatment were registered. Outcomes were assessed at mean 4 years (1-9) follow-up in 68 (94%) children. The census population (< 16 years old) in Helsinki metropolitan area during the study period was assessed. Bado types I (n = 43) and III (n = 27) comprised all but 3 of the fractures. Diagnosis was made on admission in 57, and with a 1-8-day delay in 16 children. 8 children had sustained an associated nerve injury. 35 children were treated operatively, 7 after failed closed treatment. 4 reoperations were performed, including 3 ulnar osteotomies. The risk of complications (odds ratio [OR] 4.9, 95% confidence interval [CI] 1.7-14) and closed treatment failures (OR 12.3, CI 1.3-118) was higher in Bado type III than in type I injuries. 60 children attended for clinical follow-up, all had congruent radio-humeral joints and full range of elbow and forearm motion. Mean PedsQL was 94 (72-100) and QuickDash 3 (0-13). 8 additional children reported normal elbow functions by phone. The calculated mean annual incidence of Monteggia injuries was 2.9/100,000 children. Monteggia fractures are rare (2.9/100,000 yearly). Bado type III injuries are associated with a high risk of complications.

Long Term Physical and Mental Health Outcomes of Older Adults Following a Major Burn Injury: A Burn Model System Investigation.

Older adults are at a higher risk of complications after burn injuries since many physical and mental changes are compounded by increasing age. Few studies have targeted the long-term effects of burns on older adults. Therefore, this study will investigate the long-term physical and mental health outcomes in older adults. 3129 participants from the Burn Model System Database were divided into 3 cohorts based on their age at injury (18-54, 55-64, and 65+). Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were derived from the 12-item Short Form (SF-12) and the Veterans RAND 12-item (VR-12) health surveys and analyzed to measure recovery at preinjury, discharge, 2-year follow-up, and 5-year follow-up. ANOVA, T-score analysis, and linear mixed-effects models were utilized to assess for significant differences in outcome scores. PCS scores were significantly different between the 18-54 cohort and 65+ cohorts at the preinjury and 2-year time intervals (p<0.001 and p<0.001, respectively), but not at the 5-year follow up (P=0.28). MCS scores were significantly different between the 18-54 cohort and 65+ cohorts at all time intervals measured (p=0.001, p<0.001, P<0.001, and p=0.005 respectively), though the change in MCS scores over time were not significantly different between age cohorts across time (p=0.088). This supports that patients 65 years and older have a different physical function recovery trajectory when compared to patients under 64 years. These findings underscore the belief that for physical recovery after a burn injury, individualized physical rehabilitation plans will provide the most benefit for patients across all ages.

Bioethics at the bedside: considering the adolescent voice in withdrawal of life-sustaining therapy.

Durable mechanical circulatory devices are commonly used to support children and adolescents in end-stage heart failure. However, these patients remain at high risk of acute medical complications, which may lead to significant impairment in functional capacity, altered quality of life, or death. We explore the incorporation of adolescent directives into medical decision-making in this scenario through a clinical case vignette.

Malignant arterial hypertension in a child with nonspecific aortoarteritis

The article presents a clinical case of malignant renovascular hypertension in a child, resulting from non-specific aortoarteritis. The disease initially manifested with abdominal pain and convulsions, leading to hospitalization. During the hospital stay, blood pressure readings were elevated to 180/100 mmHg and higher. Over the course of a year, the patient underwent pathogenetic (immunosuppressive), combined (triple) antihypertensive treatment, and symptomatic therapy. Due to the malignant nature of the hypertension, progression of organ damage, a high risk of complications and mortality, and the ineffectiveness of conservative treatment, surgical interventions were performed. The first stage involved polyposition abdominal aortography and stent-graft implantation in the abdominal aorta. Despite restored blood flow in the abdominal aorta, blood pressure remained elevated over the following three months, even with ongoing antihypertensive therapy. As a result, a nephrectomy was performed at the second stage. Postoperatively, the patient’s blood pressure significantly decreased to 130/90–120/80 mmHg. Antihypertensive therapy was continued to reach lower target blood pressure values. Non-specific aortoarteritis remains a prognostically unfavorable condition, even after reconstructive surgery, owning to its autoimmune nature, which suggests ongoing arterial inflammation even during clinical remission. This necessitates lifelong monitoring by a rheumatologist.

Stroke-heart syndrome and early mortality in patients with acute ischaemic stroke using hierarchical cluster analysis: An individual patient data pooled analysis from the VISTA database.

The patient clinical phenotypes at particularly high risk for early cardiac complications after a recent acute ischaemic stroke (AIS), that is, stroke-heart syndrome (SHS), remain poorly defined. We utilised hierarchical cluster analysis to identify specific phenotypic profiles associated with this risk. We gathered data on patients with AIS from the Virtual International Stroke Trials Archive, a global repository of clinical trial data. We examined cardiac complications within 30 days post-stroke, including acute coronary syndrome, heart failure, arrhythmias and cardiorespiratory arrest. We employed hierarchical cluster analysis to define distinct phenotypic risk profiles. The incidence/risk of SHS and 90-day mortality were compared across these profiles. We included 12,482 patients (mean age 69 ± 12 years; 55% male), yielding five phenotypes: Profile 1 ('elderly and AF'), Profile 2 ('young and smoker'), Profile 3 ('young'), Profile 4 ('cardiac comorbidities') and Profile 5 ('hypertension with atherosclerotic comorbidities'). Profiles 4 and 1 exhibited the highest risk for SHS (adjusted HR (95% CI): 2.01 (1.70-2.38) and 1.26 (1.05-1.51), respectively, compared to Profile 3), while Profiles 5 and 2 showed moderate risk and Profile 3 had the lowest risk. Although Profiles 1 and 4 were at the highest risk for most SHS presentations, Profile 5 had the highest risk for cardiorespiratory arrest (adjusted HR (95% CI): 2.99 (1.22-7.34)). The 90-day mortality risk was stratified by phenotype, with the highest risk observed in Profiles 5, and 4. Hierarchical cluster analysis effectively identified phenotypes with the highest risk of SHS and early mortality in patients with AIS.

Detection of human strongyloidiasis among patients with a high risk of complications attending selected tertiary care hospitals in Colombo, Sri Lanka using molecular and serological diagnostic tools

BackgroundStrongyloidiasis a neglected tropical disease is known to cause severe disease among immunosuppressed and has not been studied extensively in Sri Lanka. Parasitological diagnostic approaches based on faecal microscopy and culture often fail to detect low-intensity infections. This study investigates the presence of strongyloidiasis among selected immunocompromised individuals using parasitological, molecular and serological techniques.MethodsAdult patients with immunocompromising conditions admitted to three tertiary care hospitals in Sri Lanka were recruited. A faecal sample and 2 ml of venous blood were collected. The faecal samples were subjected to direct faecal smear and cultures (agar plate, charcoal and Harada-Mori) and polymerase chain reaction (PCR) using species specific primers designed for Strongyloides stercoralis. The presence of Strongyloides IgG antibodies was tested in the collected serum samples using DRG Strongyloides IgG enzyme-linked immunosorbent assay (ELISA) kits. The PCR products of the positive samples were sequenced using Sanger sequencing method.ResultsA total of 260 patients were recruited to this study, out of which 160 provided faecal samples and 122 provided blood samples. Out of the 160 faecal samples, none were positive for strongyloidiasis by direct smear, charcoal and Harada-Mori cultures. Only one sample (0.6%) was positive by agar plate culture. Out of the 123 samples subjected to PCR, 14 (11.4%), including the culture positive patient, were positive for S. stercoralis. Sequencing results of the PCR products indicated 100% similarity to S. stercoralis. Out of the 122 serum samples subjected to ELISA, 20 (16.4%), including the culture positive patient, were positive for Strongyloides IgG antibodies. However, sociodemographic, exposure factors, clinical features were not significantly associated with the presence of strongyloidiasis infection.ConclusionsStrongyloidiasis is present among the immunocompromised population in Sri Lanka, even in the absence of a significant relationship with associated factors. It is advisable to screen such patients with highly sensitive tests such as PCR for early diagnosis and treatment.Graphical

Dose-Effect Relationship of Botulinum Toxin Type A in the Management of Strabismus: A Review.

Botulinum toxin type A (BTXA) is a well-accepted non-surgical therapy for strabismus. However, its dose and technique vary widely. We reviewed published evidence on the dose effect of BTXA in treating various types of strabismus.Articles on BTXA therapy outcomes were reviewed to study doses and brands of BTXA used and their efficacy for specific types of strabismus. Researchers indicated that greater dosages may be used safely without increasing the risk of complications.The review suggested a positive dose-response relationship of BTX to success but with a higher risk of complications. No single dose of BTX could be recommended for strabismus management.

Clinical associations of complement-activating collectins, collectin-10, collectin-11 and mannose-binding lectin in preterm neonates.

Premature and low-birthweight infants are at especially high risk of perinatal complications, including impaired thermoregulation, infections and respiratory distress. Such adverse effects and the need for invasive procedures are associated with high mortality among preterms. This study focused on the influence of the innate immune system and tested the levels of collectins, collectin-10 (CL-10), collectin-11 (CL-11) and mannose-binding lectin (MBL) in preterm neonates. Cord blood was collected from 535 preterms (born at gestational age ≤37 weeks). COLEC10 and COLEC11 polymorphisms were analyzed by real-time PCR and those of MBL2 by PCR/PCR-RFLP. The concentrations of collectins in sera from cord blood were determined with ELISA. Low concentrations of CL-10 in cord sera (<462 ng/ml corresponding to the 10th percentile) were significantly associated with births at GA ≤32 weeks. Median levels of both CL-10 and CL-11 were significantly lower in preterms with very low birthweight (<1500 g), low Apgar 1' score and those who needed prolonged hospitalisation. Lower median CL-10 was also observed in fetal growth restriction cases. An important finding was the decreased concentrations of CL-10, CL-11 and MBL in respiratory distress syndrome (RDS). For CL-10 and CL-11, that relationship was confined to infants born at GA ≥33 weeks and/or with body mass at birth ≥1500 g. Only CL-10 was found to influence susceptibility to early-onset infections. COLEC11 heterozygosity for the activity-decreasing polymorphism (rs7567833, +39618 A>G, His219Arg) was more common in preterm premature rupture of membranes (pPROM) cases, compared with corresponding reference groups. Furthermore, C/T or T/T genotypes at COLEC11 at rs3820897 (-9570 C>T) as well as MBL deficiency-associated MBL2 gene variants were more common in preterms diagnosed with RDS than among unaffected newborns. The complement-activating collectins investigated here could be important for maintaining homeostasis in preterm neonates. Despite similar structure and specificity, MBL, CL-10 and CL-11 manifest a different spectrum of clinical associations.

Patellar Tendon Ruptures after Total Knee Arthroplasty.

Patellar tendon (PT) rupture following total knee arthroplasty (TKA) is a rare, but devastating complication. These injuries occur most frequently in the acute period following TKA due to trauma to the knee. PT ruptures that disrupt the extensor mechanism create a marked functional deficit, impacting every facet of daily life. In complete ruptures of the PT, repair or reconstruction is typically indicated; however, complication rates following intervention remain high. Operative intervention remains the mainstay of treatment, with only certain specific situations where nonoperative intervention is appropriate. Operative techniques are chosen based on the acuity, location of disruption, and status of the residual soft tissues. Treatment options include repair with or without augmentation or reconstruction. Augmentation does reduce the high risk of complications, bringing rates down from 63 to 25%. Augmentation options include autografts, allografts, synthetic grafts, or synthetic meshes. Despite advancements, outcomes are unpredictable and complications are common, highlighting the need for further research to improve treatment protocols. This article provides an overview of PT ruptures following TKA, the various treatment options, and the recommendations of the M.M., R.D., G.S. for each common type of PT injury encountered.