Median Hospital Research Articles

Factors associated with breastfeeding one month after discharge in very low weight premature infants hospitalized at birth

To determine the factors associated with BF cessation in preterm infants one month after discharge from a neonatology unit. Historical cohort of 218 newborns from the Very Low Birth Weight Newborn Follow-up Program of the Hospital Base Valdivia, hospitalized between January 2016 and June 2022 and who maintained BF at discharge. Biodemographic and clinical data were collected from available records and their relationship with BF cessation was evaluated one month after discharge. One month after discharge, 35.8% of the infants abandoned BF (N = 78). The bivariate analysis highlighted a significantly lower median gestational age and lower mean birth weight in those who abandoned BF. Neonates born to married mothers, with a shorter median hospital stay and without requiring invasive mechanical ventilation had a lower proportion of BF abandonment. In the adjusted analysis, the educational level of maternal higher education was significantly associated with a lower probability of abandoning BF (adjusted OR: 0.3; 95% CI 0.11 - 0.85). One month after discharge, over a third of the children stopped BF which was significantly associated with the mother's educational level. Support and educational interventions during hospitalization must consider the mother's educational background.

A Study of Hydroelectrolytic and Acid-Base Disturbances in MIS-C Patients: A Perspective on Antidiuretic Hormone Secretion.

COVID-19-associated multisystem inflammatory syndrome in children (MIS-C) is a rare autoimmune disorder characterized by a range of polymorphic manifestations, similar to but distinct from other well-known inflammatory syndromes in children. We conducted a retrospective-descriptive study in which we summarized the clinical presentation of, biomarker variations in, and complications occurring in patients diagnosed with MIS-C, admitted to the Emergency Clinical Hospital for Children "Sf. Ioan", Galati, between July 2020 and June 2024. A total of 36 children met the MIS-C classification criteria according to the WHO-approved case definitions. A total of 41.7% (n = 15) were male and 58.3% (n = 21) were female. The median age of the study group was 4 years (IQR: 1.75-9.25 years). Surgical involvement was suspected in 16.7% (n = 6) of the patients, while 52.8% (n = 19) required intensive care. Clinically, fever was the most common symptom present in 89% (n = 32) of the cases. Gastrointestinal disorders were also common, with 50% (n = 18) presenting with inappetence, 42% (n = 15) with vomiting, and 39% (n = 14) with abdominal pain from admission, which worsened over time. Paraclinically, all patients exhibited signs of inflammation, and 86.1% (n = 31) had hydroelectrolytic and acid-base imbalances. The median hospital stay was 10 days (IQR: 7-12 days), with a stagnant clinical course in most cases. The inflammatory mechanisms in MIS-C, which can affect the secretion of antidiuretic hormone (ADH), were correlated with hydroelectrolytic disturbances and may lead to severe complications. For this reason, it is imperative to evaluate hydroelectrolytic disorders in the context of MIS-C and use diagnostic and prognostic biomarkers to develop effective therapeutic management strategies, ultimately improving the quality of life of affected children.

Early injection laryngoplasty for acute unilateral vocal fold paralysis after thoracic aortic surgery

ObjectiveUnilateral vocal fold paralysis (UVFP) following open thoracic aortic surgery increases pulmonary complications and hospital stays. An intervention protocol with early injection laryngoplasty (IL) and swallowing maneuvers was developed for acute UVFP following thoracic aortic surgery. This study aimed to compare the incidence of complications and length of medical care between the non-VFP and the IL-UVFP group managed under this protocol. MethodsPatients who underwent open thoracic aortic surgery from March 2020 to February 2023 were included, excluding those with preoperative VFP or postoperative bilateral VFP. Under the protocol, patients with UVFP and incomplete glottic closure received IL and swallowing maneuvers within one week after diagnosis, while those without a glottic gap started a soft diet along with swallowing maneuvers. Postoperative complications, including reintubation, ICU re-transfer, pneumonia, stroke, delirium, wound infection, and bleeding, as well as hospital and ICU stay, were assessed. ResultsOf the 355 patients included in the study, 51 (14.4%) developed postoperative UVFP, while 304 (85.6%) had normal VF function. In the UVFP group, 42 patients underwent IL, while 9 patients without a glottic gap did not undergo IL. The incidence of complications and length of medical care were analyzed in the non-VFP and the IL-UVFP groups. The IL-UVFP group had a longer median hospital stay compared to the non-VFP group (20.5 vs. 16.0 days), though this difference was not statistically significant (P = .0681). ICU stay (P = .5396) and ICU re-transfer rates (P = 1.00) were also comparable between the groups. There was no significant difference in the incidence of pneumonia between the IL-UVFP group (4.8%) and the non-VFP group (9.5%) (P = .4003). Additionally, no significant differences were observed in the incidence of stroke, delirium, wound infection, or bleeding between the groups. No IL-related complications were reported. ConclusionsThe protocol with early IL appears to help reduce complication rates in acute UVFP patients following thoracic aortic surgery to levels comparable to those in patients without VFP. This protocol could serve as a guideline for otolaryngologists in managing UVFP patients. Level of evidence2b/Individual cohort study.

Evaluation of Plasma-Lyte Versus Lactated Ringer's in Surgical Intensive Care Unit Trauma Patients as Fluid Resuscitation.

In critically ill patients, fluid resuscitation with balanced crystalloids close to plasma osmolarity have a lower risk of electrolyte imbalances and demonstrated better clinical outcomes compared to normal saline (NS). While lactated ringer's (LR) has shown benefit over NS, plasma-lyte (PL) with a higher osmolarity and different electrolyte formulation is hypothesized to be superior. We performed a retrospective observational cohort study over 37 months at a tertiary hospital. Inclusion criteria were hospitalization in the surgical intensive care unit (SICU), trauma indication, ≥18 years old, and received either PL or LR. All PL administrations and every fifth patient with LR as resuscitation were included in order to match the sample size in each group. Primary outcomes were SICU length of stay (LOS), hospital LOS, and mortality. Secondary outcomes were biomarker changes from baseline. There were 113 patients in both PL and LR groups. The PL arm had higher APACHE II scores (16 vs 13, P = .033) and were more likely ventilated (39.3% vs 20.4%, P = .002) compared to LR. Median hospital LOS (12.0 vs 8.0, P < .001) and SICU LOS (6.0 vs 3.0, P < .001) are significantly longer in PL group compared to the LR group. However, there was no difference in in-hospital mortality (5.3% vs 3.5% P = .519) and SICU mortality (9.7% vs 5.3%, P > .208) between PL and LR. Overall, PL use was associated with prolonged hospital and SICU LOS. PL use did not demonstrate mortality benefit. However, patients were more critically ill in PL group based on higher APACHE II scores and higher rates of mechanical ventilation, which could be contributing to these unfavorable outcomes.

Health outcomes and economic burden among patients with a COVID-19-associated hospitalization in the United States during the predominance of the XBB and JN.1 omicron lineages

Objective Conduct a comprehensive analysis of the health and economic outcomes of patients with a COVID-19-associated hospitalization in the US during the predominance of the XBB and JN.1 Omicron lineages. Methods This analysis used data from the PINC AI Healthcare Database (PHD) for all patients with a hospital admission date occurring between February 4, 2023, and February 29, 2024 with an ICD-10-CM code U07.1 “COVID-19” in any position. The data were used to estimate the mean and median length of stay (LOS), mean and median hospitalization cost, and proportion of patients that died in the hospital, by age and level of care (normal ward, intensive care [ICU], invasive mechanical ventilation [IMV]). Results LOS, hospitalization costs, and inpatient mortality increased with both the level of care and age. Patients not receiving ICU care had the shortest LOS, lowest inpatient mortality, and lowest hospitalization costs. LOS, hospitalization costs, and inpatient mortality were higher for those receiving ICU care and highest for those receiving IMV in the ICU. Within each level of care (normal ward, ICU without IMV, and ICU with IMV), the LOS, inpatient mortality, and hospitalization cost generally increased with age, indicating that older adults with COVID-19 required a longer recovery period, have a higher likelihood of death, and accrue higher costs. However, the proportion of pediatric patients with an ICU admission and/or IMV usage remained high. Limitations The PHD data may not be representative of all hospitalized patients in the US. Conclusions These findings suggest that COVID-19 continues to have severe and costly consequences in all age groups, but particularly for older adults including long LOS, ICU admission, need for IMV, mortality, and high hospital costs.

Opioid use patterns following discharge from elective colorectal surgery: a prospective cohort study.

Opioid overprescription after colorectal surgery can lead to adverse events, persistent opioid use, and diversion of unused pills. This study aims to assess the extent to which opioids prescribed at discharge after elective colorectal surgery are consumed by patients. This prospective cohort study included adult patients (≥ 18yo) undergoing elective colorectal surgery at two academic hospitals in Montreal, Canada. Patients completed preoperative questionnaires and data concerning demographics, surgical details, and perioperative care characteristics (including discharge prescriptions) were extracted from electronic medical records. Self-reported opioid consumption was assessed weekly up to 1-month post-discharge. The total number of opioid pills prescribed and consumed after discharge were compared using the Wilcoxon signed-rank test. Negative binomial regression was used to identify predictors of opioid consumption. We analyzed 344 patients (58 ± 15years, 47% female, 65% laparoscopic, 31% rectal resection, median hospital stay 3days [IQR 1-5], 18% same-day discharge). Most patients received a TAP block (67%). Analgesia prescription at discharge included acetaminophen (92%), NSAIDs (38%), and opioids (92%). The quantity of opioids prescribed at discharge (median 13 pills [IQR 7-20]) was significantly higher than patient-reported consumption at one month (median 0 pills [IQR 0-7]) (p < 0.001). Overall, 51% of patients did not consume any opioids post-discharge, and 63% of the prescribed pills were not used. Increased opioid consumption was associated with younger age (IRR 0.99 [95%CI 0.98-0.99]), higher preoperative anxiety (1.02 [95%CI 1.00-1.04]), rectal resections (IRR 1.45 [95%CI 1.09-1.94]), and number of pills prescribed (1.02 [95%CI 1.01-1.03]). A considerable number of opioid pills prescribed at discharge after elective colorectal surgery are left unused by patients. Certain patient and care characteristics were associated with increased opioid consumption. Our findings indicate that post-discharge analgesia with minimal or no opioids may be feasible and warrants further investigation.

Demographic-based disparities in outcomes for adults with central line-associated bloodstream infections in the United States: a National Inpatient Sample database study (2016-2020).

Central line-associated bloodstream infections (CLABSI) are prevalent and preventable hospital-acquired infections associated with high morbidity and costs. Disparities based on race, ethnicity, and hospital factors remain underexplored. This study compares cost, length of stay, and mortality for adults with CLABSI by race-ethnicity, hospital location-teaching status, and geographic region in the United States using data from the National Inpatient Sample (NIS) database from 2016 to 2020. The hospitalization cohort included adults diagnosed with CLABSI, excluding those with primary CLABSI diagnoses, cancer, immunosuppressed states, or neonatal conditions. Primary outcomes were in-hospital mortality, length of stay, and hospital costs, adjusted to mid-year 2020 US dollars. Independent variables included race-ethnicity, hospital location-teaching status, and geographic region. All analyses accounted for NIS sampling design. From 2016 to 2020, there were approximately 19,835 CLABSI hospitalizations. The overall in-hospital mortality rate was 9.1%, with a median hospital stay of 16.9 days and median cost of $44,810. Hispanic patients experienced significantly higher mortality, longer length of stay, and higher costs compared to non-Hispanic Black and White patients. Urban teaching hospitals had longer stays and higher costs than rural and urban non-teaching hospitals. Regionally, the Northeast and West had higher costs and longer stays than the Midwest and South, but mortality rates did not differ significantly. This study highlights significant disparities in CLABSI outcomes based on demographic factors. Addressing these disparities is crucial for improving CLABSI management and healthcare equity. Further research should explore the underlying causes of these differences to inform targeted interventions.

Prospective Outcomes of Standardized Non-operative Management of Pancreatic Trauma With Ductal Injury in Children: Less is More

BackgroundTraumatic pancreatic laceration with ductal injury in children can be managed non-operatively (NOM); however, variable management affects outcomes. We hypothesized that a standardized management approach with early feeding and limited resource utilization is safe and improves outcomes. MethodProspective, multicenter study of 13 pediatric trauma centers (2018–2022). Children with blunt pancreatic trauma with ductal injury were managed per a standard NOM pathway. Outcomes were compared to a historical NOM cohort with variable management. ResultsOf 22 patients, the median age was 7.5 years (range 1–14 years). Low-fat diet was started at median 4 days [IQR 2–7] and median hospital stay was 8 days [IQR 4–10]. One patient failed NOM and underwent distal pancreatectomy. Of the rest, most (17/21, 81%) had early recovery and discharged in median 6 days [IQR 4–8.25] while 4 (19%) had prolonged recovery (median stay 24 days, IQR 19.8–30.5) and higher peri-pancreatic cyst development (early 23.5% vs prolonged 75%,p = 0.05). Pancreatic ascites at presentation correlated with cyst development (p < 0.0001). Endoscopic stent (optional) was placed in 33% and did not prevent cyst development. Delayed exocrine pancreatic insufficiency was noted in 1 patient. Compared to the historic cohort (32 patients), TPN use was lower (pre-protocol 56% vs post 23%, p = 0.02), days to diet was shorter (pre-protocol 7 vs post 4; p = 0.03), and cyst development was lower (pre-protocol 81% vs post 33%, p < 0.001). ConclusionChildren with traumatic pancreatic ductal injury can be safely managed per the PTS NOM clinical pathway and most recover rapidly. Pancreatic ascites may predict pseudocyst formation. Levels of EvidenceIV. Study type: therapeutic, comparative.

Prognosis of Acute HEV Infection in Patients With Liver Cirrhosis: A Retrospective Study of 628 Chinese Patients.

Acute hepatitis E virus infection is a serious global health problem, which a significant cause of morbidity and mortality. The aim of the present study was to characterise the clinical features and therapeutic response of patients with acute HEV infection and identify risk factors for poor prognosis. In a retrospective study from 01 January 2014 to 01 Januray 2022, we collected baseline data from all patients eligible for acute hepatitis E virus (HEV) infection and followed up with all patients via interviews and medical records. We explored the clinical feature of Chinese patients with acute HEV infection. The follow-up data of patients were used to identify risk factors for poor prognosis. In total, 628 acute hepatitis E (AHE) patients fulfilled the inclusion criteria and did not meet the exclusion criteria. Among them, 452 were males and 176 were females (M:F = 2.57:1). The median age at diagnosis was 57.0 years (interquartile range: 46-64 years). The median baseline serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBIL) were elevated in this cohort (642.3 U/L, 216.2 U/L, 104.1 μmol/L, respectively). The median hospitalisation duration was 16 days. Compared with patients without other liver diseases, patients with liver cirrhosis show lower baseline ALT and AST level, poorer coagulation indices and higher MELD scores. According to multivariate analysis, liver cirrhosis, high MELD score, low albumin concentration was found to be independent predictors of poor prognosis in patients with AHE. Our study used a lager sample size to validate that some demographic and serological features were quite different between patients with/without CLDs. Liver cirrhosis was a significant independent predictor of poor prognosis in acute HEV hepatitis.

Assessment of the frequency and risk factors of gastrointestinal bleeding after cardiopulmonary bypass in paediatric cases.

Gastrointestinal bleeding is a potential complication in paediatric patients undergoing cardiopulmonary bypass, as it develops secondary to low gastrointestinal perfusion. This study aimed to examine the incidence of gastrointestinal bleeding and identify its risk factors in these patients. This retrospective study was undertaken to examine the demographic features, clinical findings, and operative data of paediatric patients under years old who had undergone congenital heart surgery with cardiopulmonary bypass between November 1, 2021, and November 1, 2023. The study aimed to investigate the incidence of gastrointestinal bleeding associated with cardiopulmonary bypass and to identify potential risk factors for gastrointestinal bleeding. The obtained results were statistically evaluated. The study period included 1100 patients who underwent congenital heart surgery with cardiopulmonary bypass. Fifty-two percent of the total participants were male. The median weight of the patients was 4.4 kg, with an interquartile range of 3.5-5.8 kg. The patients were categorised by age, revealing that 62% were newborns, 24% were infants, and 14% were children. Forty-four (4.2%) of the total number of patients experienced gastrointestinal bleeding. Newborns had a significantly higher incidence of bleeding (6% or 34 patients) compared to infants (3% or 8 patients) and children (1.5% or 2 patients) (p < 0.05). Patients who experienced gastrointestinal bleeding had a longer median hospital stay of 24 days compared to those who did not, with a median hospital stay of 14 days. Moreover, patients who suffered from bleeding had a significantly higher mortality rate (30%) in comparison to those who did not (9.9%) (p < 0.05). The incidence of gastrointestinal bleeding was found to be associated with several risk factors, such as low operative age and weight, high surgical score, presence of low cardiac output syndrome, extracorporeal membrane oxygenation (ECMO) usage, high lactate levels, and low platelet count. Gastrointestinal bleeding is a potential complication for patients who undergo cardiopulmonary bypass. It is particularly relevant for newborns who have undergone prolonged surgery, have a high surgical complexity score, exhibit high lactate levels, display low cardiac output, utilise ECMO, and possess low platelet counts. In such cases, there may be a heightened incidence of gastrointestinal bleeding. It is important to consider this possibility in order to ensure the best possible patient outcomes.

6431 Comparison of Diagnostic Scoring Systems for Myxedema Coma

Abstract Disclosure: K.S. Wei: None. A. Joyo: None. A.N. Lim: None. T.E. Angell: None. Introduction: Myxedema coma (MC) is a rare condition of severe hypothyroidism with high mortality. Diagnostic scoring systems exist, such as criteria by Popoveniuc et al. (2014) and Chiong et al. (2015), which both include categories of: “highly likely MC” (hlMC), “suggestive of MC” (sMC), and “unlikely MC” (uMC). Because few data support their clinical utility, we performed an analysis comparing these diagnostic criteria and associations with mortality and hospital measures. Methods: Patients with MC were included from a retrospective cohort of hospitalized adult patients with TSH greater than or equal to 10 mIU/L and free thyroxine (fT4) below the lower reference limit. Initial clinical diagnosis of MC was generally based on: hypothyroidism, precipitating illness, hypothermia, and altered mentation. Data collection included patient characteristics, mortality, ICU admission, and hospital length of stay (LOS). Patients were post-hoc categorized based on criteria of Popoveniuc and Chiong. Results: Of 386 initial patients, 25 patients had a clinical diagnosis of MC (median age = 60.1 years [IQR: 53.6-70.0]; 10/25 [40%] female). Median TSH was 58 mIU/L (IQR: 33.8-93.3) and median fT4 was 0.48 ng/dL (IQR: 0.16-0.68). All patients received IV levothyroxine and supportive care. Using Popoveniuc, 20/25 (80%) patients were hlMC and 5/25 (20%) were sMC. In contrast, using Chiong, 11/25 (44%) were hlMC, while 14/25 (56%) were sMC. No patient was considered uMC by either system. 10/25 (40%) patients were hlMC in both systems. 10/25 (40%) were hlMC in Popoveniuc but not Chiong, while only 1/25 (4%) was hlMC in Chiong but not Popoveniuc. Finally, 4/25 (16%) were not hlMC in either system. Mortality occurred in 3/25 (12%) patients, 2 of which were hlMC in Popoveniuc but not Chiong. There was a trend toward longer median hospital LOS in patients identified as hlMC vs not hlMC using Popoveniuc (11 days [IQR: 5.3-37.0] vs. 3.0 days [IQR: 2.0-17.5], p=0.07) but no statistically significant differences in hospital LOS were noted. There were no significant differences in ICU admission or LOS. Conclusion: Existing diagnostic scoring criteria of MC identified most patients but differed in their categorizations. Some cases of clinically diagnosed MC were not identified as hlMC by either scoring criteria. Criteria by Popoveniuc et al. appears to better capture patients most at risk for mortality and prolonged hospitalization. Presentation: 6/2/2024

Evaluation of early and systematic ultrasound examination to determine postoperative dehiscence after small intestinal surgery (114 cases in dogs and cats).

To evaluate the feasibility and reliability of early ultrasound diagnosis for postsurgical bowel dehiscence and find the most reliable ultrasound criteria for dehiscence identification. Additionally, to determine the impact of early ultrasound detection of leakage in terms of survival and duration of hospitalization. Finally, to assess the need for systematized screening or checkup of the population at risk of dehiscence only. 31 cats and 83 dogs. A retrospective, records-based study was performed on 83 dogs and 31 cats (114 total) undergoing small intestinal surgery. Epidemiologic data, clinical signs, surgical procedures, pre- and postoperative ultrasound findings at 48 to 96 hours, hospitalization duration, complications, and general outcomes were recorded. Univariate and multivariate analyses were used to identify ultrasound findings associated with dehiscence. Dehiscence was suspected by ultrasound for 0 of 31 cats and 7 of 83 dogs (2 of 49 for enterotomy and 5 of 34 for enterectomy). Every suspected dehiscence was confirmed during revision surgery except one enterectomy revision, which was declined by the owner. Neither this case nor those without ultrasound evidence of dehiscence developed clinical signs of intestinal leakage. Direct visibility of wall discontinuity, presence of gas bubbles, and liquid in vicinity of the intestinal surgical site were statistically associated with early dehiscence. Survival rate after the second surgery was 83%. Median hospitalization time after the second surgery for dehiscence was 2 days (minimum, 2 days; maximum, 4 days). Postoperative ultrasound examination between 48 and 96 hours after intestinal surgery allows early and sensitive detection of intestinal dehiscence. Survival rate after revision surgery was significantly higher than that associated with septic peritonitis.

Wide exposure VS. stab surgical incisions in necrotizing fasciitis of the head and neck: a retrospective analysis of 22 cases.

Necrotizing fasciitis of the head and neck is a rare, rapidly progressing bacterial infection with high mortality. Traditional surgical management involves wide exposure incisions, but minimally invasive stab incisions have emerged as a potential alternative. This study aimed to compare outcomes between wide exposure and stab surgical incisions in the management of head and neck necrotizing fasciitis. A retrospective analysis was conducted on 22 patients treated for necrotizing fasciitis of the head and neck between January 2006 and January 2023. Patients were divided into two groups based on the surgical approach: wide exposure incisions (N = 15) and stab surgical incisions (N = 7). Data on mortality, hospital stay, hypertrophic scarring, neck contractures, and tracheostomy tube dependence were collected. The overall mortality rate was 9.1%, with 6.7% in the wide exposure group and 14.3% in the stab surgical incision group (p > 0.05). Hypertrophic scarring occurred in 59.1% of patients, all of whom underwent wide exposure incisions. Neck contractures were observed in 9.1% of cases, also in the wide exposure group. Tracheostomy was performed in 63.6% of patients, with successful decannulation achieved in 91.7%. The median hospital stay was longer in the stab surgical incision group (p < 0.05), partly due to the need for revision surgeries. Wide exposure incisions remain the standard treatment for necrotizing fasciitis of the head and neck due to their effectiveness in managing extensive tissue necrosis. However, stab surgical incisions offer the advantage of reduced morbidity and functional impairment. These benefits are offset by a slightly higher mortality rate and the potential need for additional interventions. Stab incisions may be a viable option in carefully selected patients, particularly those without extensive comorbidities or advanced disease.

Structured learning and mentoring: shortening the learning curve in laparoscopic common bile duct exploration.

Technological advances have made the laparoscopy procedure popular for simultaneous cholecystectomy and bile duct exploration. We aimed to assess the implementation of a structured mentorship program for training in laparoscopic common bile duct exploration (LCBDE). We explored the effectiveness thereof in facilitating the learning of LCBDE as a single-stage treatment of common bile duct stones (CBD) with gallbladder in situ. The surgical databases of a mentor (experienced in LCBDE) and a mentee (new to LCBDE) were analyzed. The analysis retrospectively compared the mentor's first 100 cases (MF) with the mentee's first 100 (MEF) cases, and the mentor's last 100 cases (ML) with the mentee's initial cases. Data included demographics, technical details, and postoperative outcomes. A total of 300 patients underwent LCBDE. For MF vs. MEF (both n = 100), MF had a lower transcystic approach rate (5% vs. 70%; p < 0.001) than MEF. Postoperative median hospital stay was significantly shorter in the MEF group compared to the MF group (2 vs 5, p < 0.001). No mortality or significant complications were observed in either group. For ML (n = 100) vs. MEF, the ML group had a higher transcystic rate (87% vs. 70%; p = 0.005). No differences in mortality or conversion were observed between the groups. Bile leak was lower in the ML (3% vs. 6%, p = 0.498) group than the MEF group. Postoperative median hospital stay did not significantly differ between the ML and MEF group (1 vs 2days, p = 0.952). Structured mentorship significantly influenced the successful adoption of LCBDE by the mentee, shortening the learning curve to provide outcomes in the first 100 cases, comparable to highly experienced centers. These results support the implementation of structured training and continuous mentoring to facilitate the learning curve of laparoscopic bile duct exploration.

Clinical Profile of Thoracoscopic Bullectomy in Treatment of Pneumothorax.

In pneumothorax patients requiring surgery for various indications, thoracotomy was the traditional approach until the advent of video-assisted thoracoscopic surgery. In the last decade, role of thoracoscopy in the surgical management of pneumothorax has been consolidated and established. In this study, we aim to report our experience of thoracoscopy in the surgical management of pneumothorax. A descriptive review of prospectively maintained data on all the patients undergoing thoracoscopic bullectomy for pneumothorax was done. Over the period of 9 years, a total of 120 patients underwent thoracoscopic bullectomy. Among them, 95 entered final analysis. Most common age group was 21-40 years, with male predominance (80%); most common diagnosis was primary pneumothorax (67%), first episode (74%), and on the right (65%) side; commonest symptom was shortness of breath (84%) of a median duration of 7 days. A chest tube was placed in 96% of patients before the operation. Commonest radiological finding was multiple bullae (45%) in the apical region (71%). Majority of patients underwent surgery via 3 ports, and a single bulla in the apical region was the most common intraoperative finding. Among the postoperative complications which occurred in 17%, an air leak was present in 9%. The median intensive care stay was 23 hours, the median chest tube duration was 3 days, and the median hospital stay was 9 days. Thoracoscopy can be used as a safe, feasible, and effective procedure in patients presenting with pneumothorax with minimal postoperative complications.

Conversion of one-anastomosis gastric bypass to Roux-En-Y gastric bypass: mid-term results from the United Arab Emirates.

One-Anastomosis Gastric Bypass (OAGB) is becoming popular, but some patients may need to convert to Roux-en-Y Gastric Bypass (RYGB) due weight-related difficulties or postoperative complications. The data on conversions is currently limited to 30-day or short-term follow-up studies. As such, the objective of this study was to evaluate the indications and mid-term outcomes for OAGB conversions to RYGB at a tertiary referral center in the United Arab Emirates. A retrospective analysis was conducted on patients who underwent conversion from OAGB to RYGB between February 2016 and May 2023. Demographic information, indications for conversion, intraoperative details, and mid-term outcomes were collected and analyzed. Sixty-four patients underwent conversion from previous OAGB to RYGB. The cohort was 73.4% female (n = 47) with a mean age of 40.8years. Indications for conversion included acid reflux (n = 28, 43.7%), intractable nausea/vomiting (n = 20, 31.2%), protein-calorie malnutrition (n = 7, 10.9%), anastomotic ulcer (n = 6, 9.3%) and weight recidivism (n = 3, 4.7%). The mean operative time was 238 ± 78.3min. During the procedure, three intraoperative complications occurred: two cases of bleeding and one case of bowel perforation; all successfully addressed during surgery. The median hospital stay was 3 ± 15.8days. Three patients (4.6%) experienced major postoperative complications comprising 2 anastomotic leaks and 1 small bowel obstruction. The mean follow-up time was 26.2 ± 19.7months, with 96.2% of patients reporting resolution of symptoms. There were no mortalities. Acid reflux is representing 43.7% of the indications for conversion from OAGB to RYGB. The symptom resolution rate holds significance, standing at a remarkable 96.8%. Despite surgical technique advancements, the complication rate after conversions remains significant at 4.6%, with no mortality reported. OAGB patients should be informed about these risks prior to undergoing conversions from OAGB to RYGB.

Depressive Symptoms in Medicated Patients with Schizophrenia: An Egyptian Sample

Abstract Background Schizophrenia is a psychotic disorder. Persons with schizophrenia may experience hallucinations, delusions, disorganized behaviors, negative symptoms and disturbance in social functioning. Schizophrenia consists of a range of features. Patients may display improper affect and delusions and as a result, fear and worry may follow. The incidence of depressive episodes is common in schizophrenia, with a common symptomatology. Consequently, the diagnosis of their comorbidity is challenging for both clinicians and researchers. Within this context, the presence of comorbid depression negatively affects quality of life, underlies psycho pathology and the brutality of associated medical conditions 10. In addition, pharmacotherapy of schizophrenic patients with depression is different from that of patients with schizophrenia alone. Objective This study aims to To measure the intensity of suicidal ideations in the patients diagnosed with schizophrenia and co-morbid depression and to compare the severity of depression and suicidal symptoms in patients diagnosed with schizophrenia and co-morbid depression who are compliant on treatment regarding taking with conventional or atypical antipsychotics. Patients and Methods Between November 2022 and March 2023 in Ain Shams University, 92 patients attending the General Psychiatry outpatient clinics at Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University Hospitals (all aged 18–65 years) were interviewed using semi-structured designed questionnaire to assess psychiatric, medical history, medication history, SCID I for diagnosis of schizophrenia and depression according to the DSM-IV, The Hamilton Depression Rating Scale (HAM-D) for assessing the presence and severity of depressive symptoms, Beck’s suicidal ideation scale (BSI) for detecting and measuring the current intensity of the patients’ specific attitudes, behaviors, plans to commit suicide, Morisky 8-Item Medication Adherence Scale (MMAS) and Socioeconomic status scale (SES). Results On descriptive analysis between children and adolescents presenting with psychiatric and neurologic complaints The Hamilton depression scale showed significant difference as, median Hamilton depression scale in patients who consumed typical medication 8 with IQR = 5.75 was higher than median Hamilton depression scale in patients who consumed atypical medication 5 with IQR = 3, p-value = 0.002. Meanwhile, Number of previous hospitalizations showed significant association as, median previous hospitalizations in patients who consumed atypical medication 2 with IQR = 2 was higher than median previous hospitalizations in patients who consumed typical medication 1 with IQR = 1, p-value = 0.026. Conclusion In conclusion, the present study suggests that patients with schizophrenia who have not been diagnosed with depression frequently have clinical symptoms of depression, with the possible exception of a contribution from negative symptoms. However, depressive symptoms may be more common in schizophrenic patients treated with typical antipsychotic drugs than in schizophrenic patients treated with atypical.

Surgical Strategies and Perioperative Outcomes of Robot-Assisted Vena Cava Reconstruction.

This study aimed to describe robot-assisted vena cava reconstruction by summarising surgical strategies and perioperative outcomes. A retrospective review was performed on all robotic surgeries involving dissection and repair of the inferior vena cava (IVC) at our institution. Patient characteristics, operative reports, and follow-up visits were analysed. Thirty-nine patients underwent robot assisted surgery of the vena cava from 2016 to 2023. The median postoperative hospital stay of all patients was 7days, and the median estimated blood loss (EBL) was 550mL. The median IVC clamping time was 23min, and IVC wall invasion was pathologically identified in five cases. No patients had liver or kidney dysfunction at the last follow-up. Our initial experiences demonstrate that it is safe and feasible for experienced surgeons to perform robot-assisted vena cava reconstruction in highly selected patients.

Factores predictivos del ingreso hospitalario y sociosanitario en la fijación de fracturas de tobillo por trauma de baja energía

IntroductionAnkle fractures are increasingly common in frail patients, with hospitalization being the principal cost driver, particularly for the elderly who often need referral to nursing facilities. This study aims to identify factors affecting resource utilization per admission (hospital and nursing) in the fixation of low-energy ankle fractures. Materials and methodsThis retrospective cohort study examined patients undergoing fixation for low-energy ankle fractures. The primary outcome was the length of hospitalization. Secondary outcomes included delays in fixation and the need for referral to a nursing institution. Multiple linear and logistic regression models were used to determine predictors related to patient demographics, injury characteristics, and treatment. ResultsWe analyzed 651 patients with a median age of 58years. The median hospitalization duration was 9days, primarily before surgery. Extended hospitalization was associated with antithrombotic treatment (b=4.08), fracture-dislocation (2.26), skin compromise (7.56), complications (9.90), and discharge to a nursing center (5.56). Referral to a nursing facility occurred in 17.2%, associated with older age (OR=1.10) and an ASA score ≥III (6.96). ConclusionsProlonged hospitalization was mainly due to surgical delays and was related to fracture-dislocations, skin compromise, and complications. Older and comorbid patients were more likely to need nursing facilities, and delays in these facilities’ availability contributed to extended hospital stays.

Feasibility of video-assisted thoracoscopic surgery as a redo chest approach for lung resection in patients with a history of surgical procedures on the same side.

Thoracic surgeons are increasingly facing situations for which patients are eligible for iterative thoracic surgery. With growing experience in minimally invasive thoracic surgery, the question of the safety and feasibility of minimally invasive redo procedure is rising. Our study aims to report the results of video-assisted thoracoscopic surgery (VATS) as surgical approach for reintervention after a previous ipsilateral intrathoracic surgery. This retrospective monocentric observational study required review of medical files of patients undergoing minimally invasive ipsilateral redo surgery between 2018 and 2023. Operative data, morbidity, and mortality were studied. Thirty-eight patients underwent redo-VATS for pulmonary resection. Of these, 22 (57.9%) were males, with a mean age of 66±12.2 years. Primary procedures included lung cancer resection (n=32, 84%) [lobectomy (n=8, 21.1%), segmentectomy (n=4, 10.5%), wedge resection (n=20, 52.6%)], lung transplantation (n=2, 5.3%), esophagectomy (n=1, 2.6%), thoracic aortic bypass (n=1, 2.6%), empyema (n=1, 2.6%), and chemical pleurodesis (n=1, 2.6%). The median duration between surgeries was 30 (range, 2-99) months. Redo-VATS resection included lobectomy (n=21, 55.3%), segmentectomy (n=3, 7.9%), and wedge resection (n=14, 36.8%). The median operating time was 153 (range, 30-287) min. Intraoperative blood loss was less than 200 mL in 34 (89.5%) cases. The conversion rate was 13.2% secondary to pulmonary artery injuries (n=2) and difficulties in dissection and exposure (n=3). Thirty-day mortality was 0%. Median chest drainage time was 3 (range, 1-37) days, median hospital stay was 5 (range, 3-24) days. redo-VATS lung tumor resection has been demonstrated as a safe and feasible approach with an acceptable conversion risk and morbidity. These encouraging results should question the indication for a systematic open surgical approach in this situation.