Incidence Of Type Research Articles

VS 02 - HPB Inter-fascial Catheter with Local Anaesthetic Infusion in Hepato-biliary Surgery (HILA) – A Video Guide to Catheter Placement

Abstract Background Thoracic epidural analgesia (TEA) offers effective pain control after open hepato-biliary surgery, however it is associated with several limitations that delay post-operative recovery. Inter-fascial catheter with local anaesthetic infusion (IF) is an effective, safe and cost-saving alternative to thoracic epidural analgesia (TEA) following open liver and biliary surgery, with significant decrease in post-operative vasopressor requirements, and length of critical care and hospital stay. Method This video presentation outlines current clinical evidence with local data from Nottingham University Hospital, relevant clinical anatomy of the inter-fascial plane, intra-operative placement techniques, tips and tricks as well as troubleshooting in the event of a catheter related complication. Results The inter-fascial catheters can be placed in the transversus abdominis or posterior rectus plane based on the type of skin incision to achieve optimal post-operative pain control. It is associated with a low technical failure rate. Conclusion Inter-fascial catheter with local anaesthetic infusion is an effective, safe and cost-saving technique associated with significant decrease in post-operative vasopressor requirement, and length of critical care and hospital stay.

Evaluation of the Domino Effect Caused by Pool Fires in a Tank Farm

Major hazard installations (MHIs), such as oil refineries, petrochemical plants, and terminals, use large-capacity storage tanks for storing crude oil and by-products. Pool fire is one of the most common types of storage tank fire incidents. This technical article aims to investigate the domino effect resulting from a pool fire in a tank farm consisting of eight large floating-roof storage tanks, with a focus on four specific tanks. A crude oil storage tank was selected as the primary tank (source tank). Point source and plume solid models were used to estimate the thermal radiation. It has been noted that the thermal radiation from the source tank to the adjacent tank in the same dike exceeds the threshold heat radiation level and might result in a domino effect; however, the thermal radiation from the source tank alone does not reach the threshold level for the tanks in the other dike. Additionally, it was found that the thermal radiation from both the primary and secondary tanks just reaches the threshold level for the farther-away tank in the other dike. The domino effect occurs provided that the firefighting system is not activated and the emergency response team does not intervene within ten minutes.

Season-dependent characteristics of shock-related injuries in the Arctic zone of the Arkhangelsk region

Relevance. Studying the dynamics of injury rates, injury types and severity, as well as the treatment quality across various country regions, in particular the Arctic, is a prerequisite for managerial, healthcare, and strategic efficiency prior to and during hospital stay, taking into account the climate, geography, social and economic characteristics of every Russian Federation constituent.The objective is to analyse shock-related injuries in the Arctic zone of the Arkhangelsk region to understand season-related injury dynamics.Methods. Retrospective case series description parameters were used to study 140 patients with traumatic shock admitted to the Arkhangelsk Regional Clinical Hospital (ARCH) - a tier 1 trauma center. The analysed medical registration records included patient ambulance record and token (form 114/u), inpatient medical record (form 003/u), surgery logbook (form 008/u), patient radiographs, CT and nuclear MRI reports, as well as laboratory results. The study was conducted in accordance with ethical standards of the Declaration of Helsinki and European Community Directives (8/906 EC) and was approved by the local ethics committee of the Northern State Medical University of the Russian Ministry of Healthcare, Arkhangelsk (protocol no. 02/4-15 dated 04/08/2015). Statistical application package STATA ver.12 was used for statistical data processing.Results and discussion. The research demonstrated that the incidence of shock trauma is 4 times higher in men than in women. The vast majority of the injured are of working age. Seasonal distribution analysis per type of injuries and shock severity, including due to alcohol abuse, was carried out. The number of shock injuries is highest in winter, mainly due to road accidents which constitute 75.6 % of all injuries in winter. Throughout the year, over 50 % of shock injuries are combined injuries, that outperform isolated and multiple injuries in number. In particular, numerous combined injuries occur in winter with a responsible for almost 60 % among all other injuries. The majority the injured with shock-related trauma presented with stage 2 shock (49.3 %), whereas stage 1 and stage 3 shock was diagnosed in 27.9 % and in 21.4 % respectively. In winter, one in four patients with a shock-related injury presented with stage 3 shock. Alcohol-associated shock injuries are more numerous in summer (35.3 %), showing almost the same incidence as road traffic, domestic, and street injuries.Conclusion. The analysis of various types of injuries and season-related incidence of shock injuries in the Arctic territory of the Arkhangelsk region provides evidence to justify preventive measures to reduce the injury rates. Intensified efforts are required to minimise road traffic accidents in winter and combat alcohol abuse responsible for most injuries in summer. Since the vast majority of shock injuries occur in winter, in cold months ambulances must be equipped with local heating facilities, such as evacuation thermal bags with autonomous electric heating, thermal blankets, infusion warmers for blood transfusion and infusion sets.

Real-world data of perioperative complications in prepectoral implant-based breast reconstruction: a prospective cohort study.

To analyze complications and potential risk factors associated with immediate prepectoral direct-to-implant breast reconstruction (DTIBR). 295 patients (326 operated breasts) with DTIBR between March 2021 and December 2023 were included in this prospective study. Postoperative complications (postoperative bleeding, seroma, infection, necrosis, wound dehiscence, implant exchange/loss) were analyzed for potential risk factors by descriptive and logistic regression analyses. The implant was covered by TiLOOP® Bra Pocket in 227 breasts (69.6%), by "dual-plane" technique in 20 breasts (6.1%), by acellular dermal matrix (ADM) in 1 breast (0.3%). No additional support was used for 78 breasts (23.9%). The use of mesh did not increase the risk for complications. Major complications requiring surgical revision occurred due to postoperative bleeding in 22 (6.7%), seroma in 2 (0.6%), infection in 13 (4.0%), necrosis in 10 (3.1%), and wound dehiscence in 10 (3.1%) breasts. Thirteen (4.0%) implants were exchanged, and 5 (1.5%) were explanted without substitution. One patient had to switch to autologous reconstruction due to skin necrosis. The main reasons for the removal/exchange of implants were infections (11 breasts, 3.4%) and necrosis (4 breasts, 1.2%). The risk for necrosis, infection, and wound dehiscence was mainly associated with the type of incision, especially skin-reducing incisions, and body mass index (BMI) ≥ 30kg/m2. Severe complications occurred primarily in patients with a BMI ≥ 30kg/m2 and when skin-reducing surgical techniques were performed. This study was retrospectively registered at the German Clinical Trials Register (DRKS) on 20.06.2024. DRKS00034493. https://drks.de/search/de/trial/DRKS00034493 .

Ensuring accessibility and inclusion in the 1·1·2 emergency line. Mediation between life and death

In a Europe without borders, there is a quintessential emergency hotline that serves its citizens when their lives are at risk: 1·1·2. The Valencian Community (Spain) receives many visitors each year who, together with the migrant population, make use of this free public service in several languages. The main aim of this paper is to revise the legal framework that regulates the linguistic provisions in the Emergency Call Reception Centre (ECRC) to determine how accessibility and inclusion are guaranteed for speakers of foreign languages. In an attempt to analyse this reality, the aims of this descriptive and qualitative study are twofold. On the one hand, it examines the most common types of incidents received during the year 2021 (in English, French, and German); and, on the other hand, it focuses on how these calls are managed to ensure effective communication between the visitors that come from other countries and the authorities in the Valencian region.

Oblique or short incisions reduce the risk of saphenous nerve damage during hamstrings harvesting. A model for mapping nerve pathways at the harvest site.

INTRODUCTIONHamstring autografts are frequently used for ligament reconstruction surgery. Twelve to 84% of patients describe hypo or dysaesthesia secondary to injury of the saphenous nerve or one of its branches after hamstring harvesting. Type of incision (orientation and length) is subject of much debate to limit the risk of nerve damage. A cadaveric study was performed to determine which type of incision limits the risk of injury to the saphenous nerve or one of its branches, based on an anatomic model for mapping nerve pathways at the harvest site. METHODSAn anatomical study was performed on 20 knees from 12 embalmed bodies. Distance between saphenous nerve branches and 4 points of interest along the tibial crest was measured. Based on these measurements, a digital model of the saphenous nerve and its branches was created. A model of three common types of incision (vertical, horizontal and oblique) was overlaid. Each incision was modelled for three lengths (2, 3 and 4cm). Percentage of collision between nerve course model and incision model was then calculated to determine the risk of nerve damage for each type of incision. Based on the nerve course model, a “low collision risk” safe zone was identified. RESULTSNerve damage risk after an oblique incision was significantly lower than for a horizontal or vertical incision, for incision lengths of 3 and 4cm (p<0.05). For a specific incision orientation, the length of the incision did not affect the risk of nerve damage. A trapezoidal space close to the tibial crest and distal to the anterior tibial tuberosity appears to reduce risk of nerve damage. CONCLUSIONThis cadaveric study suggests that during hamstring harvesting, incisions shorter than 2cm reduce the risk of saphenous nerve’s branches injuries. For incisions longer than 2cm, using an oblique incision may reduce the risk compared to vertical or horizontal incisions. LEVEL OF EVIDENCELevel of evidence not applicable: Laboratory experiments

Refractive outcomes of Carlevale IOLs compared to Artisan iris-claw IOLs considering the type of incision.

To compare the refractive outcomes and the complications of implantation surgery by the Carlevale IOL to the Artisan iris-claw IOL. Retrospective comparative study of consecutive surgical cases between 2019 and 2021 in our tertiary centre in Paris, France. We included 142 eyes in the Artisan group and 63 in the Carlevale group. Post-operative astigmatism at one month was 2.3 ± 1.6 D in the Carlevale group, 3.3 ± 2.5 D in the Artisan group with corneal incisions, and 1.8 ± 1.4 D in the Artisan group with scleral incisions (p = 0.015). Surgery duration was higher (p = 0.007) with the Carlevale IOL (70.8 ± 31.3 min) than with the Artisan IOL (58.3 ± 23.2 min). The complication rates were similar at one month between the two groups (25.4% in Artisan, 27% in Carlevale). The mean follow-up was longer in the Artisan group (234.5 days vs. 77 days, p < 0.001). Artisan iris-claw IOL seems to induce higher astigmatism than Carlevale sutureless scleral-fixated IOL at one month when injected through a corneal incision, but not when injected through a scleral incision. Therefore cataract surgeons should avoid wide corneal incisions in implantation surgery whenever possible.

Influence of stearate dry coating on ibuprofen powder: What about the combustibility?

Dust explosion is one common type of process safety incident within the pharmaceutical industry. During powder processing, surface modification is widely used to increase dust flowability by alleviating inter-particle cohesion. However, it is currently unclear whether the addition of guest particles affects the combustibility of pharmaceutical powders. To investigate the explosion hazard of stearate-coated ibuprofen powder, this paper studied the ignition sensitivity and explosion severity of pure and coated ibuprofen by determining a series of explosion parameters in accordance with ASTM standards. The results indicated that the addition of stearate significantly reduced the minimum ignition energy of the mixture. Other parameters including the minimum ignition temperature, the minimum explosible concentration, the maximum explosion pressure, and the maximum rate of pressure rise were found to have less correlation with the improvement in dust flowability. Powder characterization through methods such as the Hausner ratio, scanning electron microscope, thermo-gravimetric analysis, and X-ray diffraction were employed to investigate chemical phase changes between coated mixtures and pure pharmaceuticals. The effects of improved dust flowability and dust dispersibility on the combustibility of ibuprofen dust were discussed to improve explosion-proof awareness in the pharmaceutical industry.

Minimally invasive intervention for gynecomastia excision: two case reports

Gynecomastia is characterized by abnormal and excessive development of breast tissue in male patients. Depending on the volume of the breasts and the amount of excess skin, it may be unilateral or bilateral. Surgery is considered the standard of care, with several techniques documented, including different types of incisions made in the periareolar or intra-areolar skin. The most common surgical technique is conventional open surgery, which utilizes a semicircular inferior periareolar incision. To achieve superior aesthetic outcomes, various alternatives to open surgery have been proposed, including vacuum-assisted excision, endoscopic mastectomy, and liposuction Herein, we present two cases involving male patients, aged 29 and 24, who reported bilateral breast enlargement. We used the same incision for both liposuction and glandular excision. Our patients underwent combined liposuction on two planes: subcutaneous and subglandular, accompanied by sharp parenchymal excision. These small incisions, measuring 1–1.5 cm, are discreetly placed within the inframammary fold across the breast width. The patients experienced an uneventful recovery without any complications.

Threats to the security of banking activities in modern Russian practice

Among other sectors of the Russian economy, the banking sector is one of the most dynamically developing. Consequently, its resistance to various shocks and possible threats will be one of the central points of support for the economic security of the state. Modern statistics show an increase in various types of incidents in the financial sector. Regular monitoring and detailed analysis of fraudulent schemes will minimize the possibility of criminal manipulation, thereby significantly reducing the number of risks and the amount of financial losses.The presented article provides a structural and geographical analysis of incidents in the financial sector recorded in 2023, and a sketch of the modern landscape of possible threats is compiled. The optimal approach to the formation of information and economic security of personal and financial data, in particular, and banking activities in general, involves comprehensive protection measures both from the point of view of the individual user and from the position of representatives of the banking community and the regulator.

Impact of enhanced recovery after surgery (ERAS) on surgical site infection and postoperative recovery outcomes: a retrospective study of 1276 cases

This retrospective observational study aimed to evaluate the incidence of surgical site infection (SSI) in the era of enhanced recovery after surgery (ERAS) and the effect of ERAS on postoperative outcomes. Totally 1,276 patients (565 in ERAS group and 711 in non-ERAS group) who underwent operations at the department of general surgery during 2017–2021 were included. Risk factors were identified via logistic regression analysis and meta-analysis of all relevant published studies was performed. Subsequently, propensity score matching was used to match different risk factors. Overall, 40 patients were diagnosed with SSI, and the pooled incidence of SSI was 3.13%. In total, 14 (2.48%) and 26 (3.66%) patients in the ERAS and non-ERAS groups, respectively, were diagnosed with SSI (P = 0.230). Among patients for whom the ERAS protocol was adopted, 7 independent risk factors of SSI were identified. After propensity score matching, in patients without SSI, the number of hospital days was significantly lower in the ERAS group than in the non-ERAS group (2 [2, 5] vs. 3 [2, 7], P = 0.005), whereas in patients with SSI, the number of hospital days was similar between the ERAS and non-ERAS groups. ERAS had no effect on the incidence of SSI but could significantly accelerate the discharge of uninfected patients. In the era of ERAS, SSI incidence was affected by the type of surgery; number of postoperative hospital days; type of incision; serum hemoglobin, total protein, and albumin levels; and antibiotic prophylaxis. Furthermore, these results will significantly affect the implementation of the ERAS protocol and optimal preoperative management.

Effect of incision location and type of fistula on postoperative urinary retention after radical surgery for anal fistula: a retrospective analysis

BackgroundPostoperative urinary retention (POUR) is a common complication characterized by fullness of the bladder without the ability to urinate. Its etiology in proctology surgery is multifactorial. This study aimed to identify the risk factors for POUR after radical surgery for anal fistula.MethodsWe retrospectively reviewed the clinical records of 511 patients who underwent radical surgery for anal fistula at the China-Japan Friendship Hospital from August 2022 to December 2023. Risk factors for POUR were analyzed by means of binary logistic regression analyses.ResultsPOUR occurred in 57 patients (11.2%) within 48 h post-surgery, and males were predominantly affected (84.4%). Independent risk factors included a history of urological disease (OR = 6.048; p < 0.001), incisions at position 1 (OR = 2.228; p = 0.046), high anal fistula (OR = 4.768; p < 0.001), VAS score ≥ 7 (OR = 2.805; p = 0.010), and GAD-7 score ≥ 5 (OR = 2.405; P = 0.024).ConclusionPOUR is a significant complication post-radical surgery for anal fistula, particularly among patients with urological disease, high anal fistula, and incisions at position 1. Surgeons should pay more attention to surgical methods for high anal fistulas and fistulas in the anterior rectum, and monitor postoperative bladder volume in high-risk patients. Enhanced postoperative pain and anxiety management can reduce the incidence of POUR and prevent long-term bladder damage.

Epidemiological study of human papillomavirus infection in 105,679 women in Wuhan, China

BackgroundQuality assessment of the prevalence and distribution of human papillomavirus (HPV) genotypes could support additional targeted HPV vaccinations. However, the characteristics of HPV infection in Wuhan city are limited in the past decade. We aimed to assess the epidemiology of HPV infection among women and provide a reference for the prevention and treatment of cervical cancer in this region.MethodsA retrospective study employing 105,679 women attending Wuhan Medical and Health Center for Women and Children for cervical cancer screening from January 2015 to December 2022 was conducted. The HPV genotype was detected by polymerase chain reaction (PCR) and diversion hybridization. The overall incidence and age-specific type distribution of HPV infection and the relationship between HPV infection and cervical cytology were analyzed.ResultsThe overall HPV infection rate was 16.87% in Wuhan city, and the prevalence rates of high-risk, low-risk and mixed high- and low-risk HPV infections were 13.64%, 1.77% and 1.46%, respectively. The five most prevalent genotypes were HPV52 (4.24%), HPV58 (2.42%), HPV16 (2.34%), HPV53 (1.87%), and HPV39 (1.66%). The prevalence of HPV in women exhibited a “two-peak” pattern, the peaks of which were observed in the < 21 years group (37.4%) and the 61–65 years group (41.72%). Logistic regression analysis revealed no significant difference in the rate of high-grade lesion positivity between single and multiple high-risk HPV infections. Among patients with a high-grade squamous intraepithelial lesion+ (HSIL+) ThinPrep cytologic test (TCT) diagnosis, HPV58 was the most common type, followed by HPV52, HPV16, HPV39 and HPV53.ConclusionsHPV types 52, 58, 16, 53, and 39 were the most common types in the general female population in Wuhan, and the prevalence of HPV infection varied among different age groups. This study provides a comprehensive overview of the epidemiological characteristics of HPV infection in women, which could support the development of targeted prevention and control strategies for cervical cancer in the region.

Paramedics’ anxiety and concerns around traumatic events: a Delphi study

Introduction: Trauma is a major problem in Saudi Arabia and a leading cause of mortality and morbidity. In 2018, road traffic injuries and trauma were the second-leading cause of death after ischaemic heart disease. There is a lack of research that explores the psychological effects on emergency medical service (EMS) professionals of providing prehospital care at trauma events. This study aims to identify which trauma cases cause the most anxiety and concern among EMS professionals. Methods: A study using a two-round Delphi method was undertaken online with EMS professionals working for the Saudi Red Crescent Authority. Results: In the initial round, one item—road traffic collision—achieved 70% consensus that it caused significant anxiety and concern; the second round did not achieve any consensus regarding other types of incident. Conclusion: Road traffic collisions are a leading cause of death and, based on the participants’ responses, they cause paramedics the most anxiety and concern of all case types.

Prospective Observational Study Of Surgical Site Infections In Obstetrics And Gynaecological Operations In Teaching Hospital

Background: Surgical site infections (SSI) are defined as infections occurring upto 30 days after surgery or (upto one year in patients receiving implants) and affecting either the incision or deep tissue at the operative site. SSIs are potential complications associated with any type of surgical procedure. Even though SSIs are among the most preventable hospital acquired infections, they still symbolize a significant burden in terms of patient’s morbidity and mortality leading to prolonged hospital stay and increase the patient susceptibility to other nosocomial infections affecting the financial condition of patients. Risk factors for SSIs are grouped as patient related, preoperative or pre pregnancy, intraoperative or intrapartum, and postoperative. SSI causes a substantial risk to patients and financial loses for health system because the multi-factorial causes achieving a measurable and sustained reduction in SSIs. In this context it becomes important to determine the prevalence of SSI, assess the magnitude of problem and provide a rationale to set priorities in infection control in the hospitals. Materials and Methods: The present prospective observational study was conducted on 200 patients in the Department of Obstetrics and gynaecology, at Dr B R Ambedkar Medical College and Hospital for a period of 12 months. Prior to the initiation of the study, Ethical and Research Committee clearance was obtained from Institutional Ethical Committee. Results: There was a significant statistical difference in the incidence of SSIs basing on the body mass index of subjects (pvalue:&lt;0.001). SSI incidence was high in morbidly obese subjects. There was a highly significant statistical difference in the incidence of SSIs basing on the history of previous surgeries of subjects (p-value: &lt;0.0001). SSI incidence was low in subjects with no history of previous surgeries. There was a highly significant statistical difference in the incidence of SSIs basing on the type of surgery (p-value: 0.48). SSI incidence was high in caesarean and low in tubectomy surgeries. There was a significant no statistical difference in the incidence of SSIs basing on the type of incision (p-value: 0.70). There was a highly significant statistical difference in the incidence of SSIs basing on the methods of skin closure (p-value: 0.002). SSI incidence was high in mattress method of skin closure and low in subcuticular method of skin closure. There was a highly significant statistical difference in the incidence of SSIs basing on the class of wound (p-value: 0.00001). SSI incidence was high in dirty wounds and low in clean wounds of skin closure. Conclusion: Although several preoperative risk factors (e.g., age, morbid obesity, ability to pursue a minimally invasive approach, type of gynaecologic surgery, type of incision, methods of skin closure, class of wound) may not be within the surgeon’s control, several evidence based interventions can limit the incidence of SSIs.

Analyzing steady-state equilibria and bifurcations in a time-delayed SIR epidemic model featuring Crowley-Martin incidence and Holling type II treatment rates

This article presents a time-delayed SIR epidemiological model that has been quantitatively examined. The model incorporates a logistic growth function for the susceptible population, a Crowley-Martin type incidence, and Holling type II treatment rates. We investigated two separate time delays. The first delay refers to the rate at which new infections occur, allowing us to evaluate the impact of the latent period. The second delay relates to the rate of treatment for those who have contracted the infection, which allows us to examine the consequences of postponed access to therapy. The investigation of the steady-state behavior of the model emphasizes two equilibria, namely, the infection-free equilibrium and the endemic equilibrium. The determination of critical values involves the use of the fundamental reproduction number, denoted R0, which serves as a predictive measure to determine the potential elimination of a disease within a specific population. Using the fundamental reproduction number, it can be shown that infection-free equilibrium exhibits local asymptotic stability when the value of R0 is less than 1. In contrast, when R0 exceeds 1, the infection-free equilibrium becomes unstable in the context of the time-delayed system. Furthermore, an analysis of the steady-state dynamics of the endemic equilibrium indicates the appearance of oscillations and periodic solutions with the Hopf bifurcation for all feasible combinations of two-time delays as the bifurcated parameter. In sensitivity analysis, a sensitivity index is utilized to evaluate the relative modification in the fundamental reproduction number caused by each parameter. In summary, numerical simulations are employed to offer empirical evidence for the theoretical findings.

Effect of the Green Cross method on patient safety culture in a postanaesthesia care unit: a longitudinal quasi-experimental study

BackgroundHospitals should adopt multiple methods to monitor incidents for a comprehensive review of the types of incidents that occur. Contrary to traditional incident reporting systems, the Green Cross (GC) method...

Cohen vs Pfannenstiel cesarean skin incision for body mass index ≥35 kg/m2: a randomized controlled trial

Background: Maternal obesity is recognized as a significant risk factor for adverse pregnancy outcomes, including increased cesarean delivery rates and heightened surgical complications. It is unclear if the Cohen or Pfannenstiel skin incisions at cesarean delivery are associated with different outcomes. Objective: To evaluate the impact of either Cohen or Pfannenstiel cesarean skin incision type on maternal morbidity. Study Design: Pregnant individuals with a BMI of ≥35 kg/m2, carrying either singleton or multiple gestations, were consented prenatally and in labor. Eligible participants who underwent a cesarean delivery between 24 and 41 weeks of gestation were randomized to either Pfannenstiel or Cohen skin incisions at Thomas Jefferson University Hospital from October 2016 to March 2020. The study aimed to recruit 284 participants based on a sample size calculation assuming a 50% reduction in wound complications with Cohen versus Pfannenstiel incisions (80% power, α=0.05), but recruitment was terminated early after 72 participants were randomized. The primary outcome was a composite maternal morbidity within six weeks, which consisted of the following: wound infection, hematoma, seroma, separation of skin ≥1 cm, readmission for wound complications, endometritis, and postpartum hemorrhage. Statistical analyses included bivariate tests, t-tests, and non-parametric analyses. Results: Of 331 pregnant individuals consented prenatally and in labor, 72 eventually underwent cesarean delivery and were randomized, 34 to Cohen and 38 to Pfannenstiel skin incisions. The mean BMI was >42 kg/m2, about two thirds of the patients had a pannus, 56% were Black, 47% had diabetes, and 56% hypertensive disorders. The primary outcome of composite maternal morbidity occurred in 47.1% in the Cohen and 36.8% in the Pfannenstiel groups (RR 1.24, 95% CI 0.71-2.08), and was also similar regardless of the presence of a pannus, or by degree of obesity. Surgical site infection, hematoma, seroma, wound separation/dehiscence, endometritis, and postpartum hemorrhage were each similar between Cohen and Pfannenstiel participants. Neonatal outcomes were also similar between the Cohen and Pfannenstiel groups, except that the Cohen group was found to have statistically significant lower Apgar score at 5 minutes and higher need for respiratory support compared to the Pfannenstiel group, possibly related to the trend for a longer time from skin incision to delivery. Physicians were found to be significantly less satisfied with the Cohen compared to the Pfannenstiel incision. Conclusion: In pregnant patients with BMI of ≥35 kg/m2, obstetrical providers can chose from either a Cohen or an Pfannenstiel skin incision, as they are associated in general with similar outcomes, except for lower Apgar scores and lower physician satisfaction associated with the Cohen incision. The findings of this study are limited by its early cessation for logistical reasons, leading to an underpowered analysis. It is crucial to acknowledge that these results must be interpreted cautiously due to the reduced sample size and the circumstances surrounding the study's termination. These data can inform future trial design and implementation as well as fuel individual patient level meta-analyses on this topic.

Audit of hypocalcemia as a clinical marker following total thyroidectomy: a retrospective chart review

Background: Surgical removal is one of the most important treatment options for the thyroid swellings. Metabolic derangement due to injury to parathyroid glands is one of the complication to be dealt with frequently. The aim of this study is to assess the incidence of postoperative hypocalcemia after total thyroidectomy and to analyze various pre-operative risk factors that lead to the same. Methods: A retrospective study was conducted on patients who underwent total thyroidectomy at department of ENT and head and neck surgery over a period of 2 years. The level of post-operative serum calcium was analyzed, to determine the incidence of hypocalcemia. In all the patients the following parameters were assessed – age, gender, pre and post-operative serum calcium and type of thyroid disease. Unpaired t test and Mann-Whitney U test was used for statistical analysis. Results: The total study population was 65. The mean age of the patients was 45.5 and 83% of the patients were female. The incidence of postoperative hypocalcemia was noted to be 37%. Pre-operative serum calcium (p&lt;0.0001) was found to be significant risk factor (p&lt;0.05) for prediction of post-operative hypocalcaemia. The same was not noted between variables like age, gender and type of thyroid disease and incidence of hypocalcemia. Conclusions: A thorough knowledge of normal anatomy of neck, possible anatomical variations and parathyroid physiology is of paramount importance to prevent complications during thyroid surgery. Early identification of hypocalcemia can be achieved only by stringent postoperative monitoring, which in turn will reduce morbidity to the patient.

Comparing Wise Pattern to Non-Wise Pattern Skin Sparing Mastectomy: A Critical Evaluation of Patient Demographics and Surgical Outcomes.

Multiple skin-sparing incisions are utilized in immediate post-mastectomy breast reconstruction; however, the Wise pattern incision (WPI) may have superior cosmetic outcomes for large ptotic breasts compared to non-Wise pattern incisions (NWPI). We evaluated patient demographics and surgical outcomes with WPI versus NWPI. An electronic medical record search was performed for patients at a single academic institution from 2019 to 2022 with ICD-10-CM diagnosis code "Z42.1: encounter for breast reconstruction following mastectomy." Retrospective chart review evaluated patient demographics, intraoperative factors, postoperative complications, and surgical cost. 288 patients were included; 58 had WPI and 230 had NWPI. Median BMI differed between WPI (30.5) and NWPI (26.4) (P < 0.001). 57% of WPI had preoperative grade 3 ptosis versus 23% of NWPI (P < 0.001). No difference was found in median operative times (WPI: 219 minutes, NWPI: 194 minutes, P = 0.38). Overall rates of postoperative complications differed between WPI (62%) and NWPI (45%) on univariate, but not multivariate, analysis. Median total surgery charge was higher for WPI (WPI: $36,223, NWPI: $31,185, P < 0.001), while implant cost was higher for NWPI (WPI: $2,700, NPWI: $8,040, P < 0.001). There was no significant difference in operative time, overall complication rate, or charge between incision types once adjusted for confounding factors. The higher complication rate in the WPI group was likely driven by higher BMI, a known risk factor for surgical complications regardless of approach. Surgeons can consider WPI as a noninferior option for patients with higher BMI and ptosis.