Morbidity Rates Research Articles

Biodegradable Stents in the Treatment of Arterial Stenosis

Arterial diseases (ADs) are a significant health problem, with high mortality and morbidity rates. Endovascular interventions, such as balloon angioplasty (BA), bare-metal stents (BMSs), drug-eluting stents (DESs) and drug-coated balloons (DCBs), have made significant progress in their treatments. However, the issue has not been fully resolved, with restenosis remaining a major concern. In this context, bioresorbable vascular stents (BVSs) have emerged as a promising area of investigation. This manuscript includes articles that assess the use of BVSs. Studies have identified ongoing challenges, such as negative vascular remodeling and elastic recoil post-angioplasty, stent-related injury, and in-stent restenosis following BMS placement. While DESs have mitigated these issues to a considerable extent, their durable structures are unable to prevent late stent thrombosis and delay arterial recovery. BVSs, with their lower support strength and tendency towards thicker scaffolds, increase the risk of scaffold thrombosis. Despite inconsistent study results, the superiority of BVSs over DESs has not been demonstrated in randomized trials, and DES devices continue to be the preferred choice for most cases of arterial disease. Esprit BTK (Abbott Vascular) received approval from the US FDA for below-knee lesions in 2024, offering hope for the use of BVSs in other vascular conditions. Enhancing the design and thickness of BVS scaffolds may open up new possibilities. Large-scale and longer-term comparative studies are still required. This article aims to provide an overview of the use of biodegradable stents in the endovascular treatment of vascular stenosis.

Gut Microbiome Profiles in Colorectal Cancer Patients in Iraq

Colorectal cancer (CRC) is the third most commonly diagnosed cancer globally, and is a significant contributor to both morbidity and mortality rates. Emerging research has promptly highlighted the potential role of the gut microbiome in the development and progression of CRC. This study aims to investigate the differences in gut microbiota between CRC patients and healthy individuals in Iraq, using 16S rRNA metagenomic sequencing on Illumina NovaSeq (PE250-Seq). A total of 21 stool samples were analyzed: 12 from early-stage CRC patients and nine from healthy controls. Bacterial DNA was extracted, followed by 16S rRNA amplicon sequencing to profile the microbial communities. The results indicated significant differences between the fecal microbiome of the two groups. Remarkably, CRC patients exhibited a marked reduction in Bacteroidota and an increase in Verrucomicrobiota compared to healthy controls. At the genus level, Prevotella, Faecalibacterium, Roseburia, Barnesiella, Eubacterium Lachnospiraceae_UCG_004, and Lachnospira were significantly less abundant in CRC patients compared to the healthy individuals, while Actinomyces, Monoglobus, Desulfovibrio, Akkermansia, and Bacteroides were highly enriched. In addition, diversity analyses further indicated decreased α-diversity and distinct β-diversity patterns in the CRC patients, suggesting significant shifts in the gut microbial composition. These findings underscore the potential of microbiome-based diagnostics and therapeutic strategies, with microbial alterations serving as biomarkers for CRC diagnosis. Further research needs to focus on elucidating the causal relationships and therapeutic potential of these microbiome changes in CRC management.

Trends, seasonal variations and forecasting of chronic respiratory disease morbidity in charcoal producing areas, northwest Ethiopia: time series analysis

ObjectiveThis study analyzed the trend, seasonal variations and forecasting of chronic respiratory disease morbidity in charcoal producing areas, northwest Ethiopia, aiming to provide evidences in planning, designing strategies, and decision-makings for preparedness and resource allocation to prevent CRD and reduce public health burden in the future.Materials and methodsThe trend, seasonal variation, and forecasting for CRD were estimated using data collected from the three zones of Amhara region annual reports of DHIS2 records. Smoothing decomposition analysis was employed to demonstrate the trend and seasonal component of CRD. The ARIMA (2, 1, 2) (0, 0, 0) model was used to forecast CRD morbidity. The model's fitness was checked based on Bayesian information criteria. The stationarity of the data was assessed with a line chart and statistically with the Ljung-Box Q-test. SPSS version 27 was utilized for statistical analysis.ResultsThe annual morbidity rate of CRD has shown an increasing trend in both sexes over a seven-year period among people aged 15 years and older. Seasonal variation in CRD morbidity was observed. The smoothing decomposition analysis depicted that the seasonal component was attributed to 44.47% and 19.16% of excess CRD cases in the period between September to November, and June to August, respectively. A substantial difference among the three zones of the Amhara region in CRD morbidity rate was noted, with the highest observed in the Awi zone. Forecasting with the ARIMA model revealed that CRD-related morbidity will continue to increase from 2020 to 2030.ConclusionThe study revealed that the CRD morbidity rate has shown an increasing trend from 2013 to 2019. Seasonal variation in the CRD morbidity rate was observed, with the highest peak from September to November. The morbidity attributed to CRD will continue to increase for the next ten years (2020–2030). Therefore, this study could potentially play a groundbreaking role. Further study is warranted to understand the risk factors and facility readiness through a further understanding of seasonality and future trends.

Immediate skin-to-skin contact and postpartum hemorrhagic morbidity.

To examine rates of postpartum hemorrhagic (PPH) morbidity among patients who did and did not have immediate skin-to-skin contact (SSC). This study was a retrospective cohort of all non-anomalous, term singleton vaginal births at a Level IV center over 2 years. Exclusion criteria included COVID-19. Immediate SSC was defined as at least 60 min of direct contact initiated between parturient and neonate within 10 min of birth. The primary outcome was a composite of maternal morbidity related to PPH compared among those with and without immediate SSC. We used multivariable Poisson regression adjusted for possible confounders with robust error variance to determine the strength of the association. Of 8623 deliveries during the study period, 3520 (40.8%) deliveries were included; of which 2428 (55.5%) had immediate SSC and 1028 (31.0%) did not. Immediate SSC reduced the overall rate of composite morbidity (adjusted relative risk 0.78, 95% confidence interval 0.65-0.92), and rate of blood loss 1000 mL or greater, use of additional uterotonics, and use of mechanical tamponade. Blood loss and third stage of labor duration were significantly less for immediate SSC. Transfusion rate and hematocrit change after delivery, did not differ. Immediate SSC among term vaginal deliveries was associated with a significant reduction in PPH. Emphasis on early contact for maternal benefit may increase uptake of SSC and provide an accessible intervention for PPH in high- and low-resource settings.

Opioid-related harms and experiences of care among people in justice settings in New South Wales, Australia: evidence from the National Ambulance Surveillance System

BackgroundPeople in justice settings experience higher rates of psychiatric morbidity, including alcohol and drug use disorders, compared with the general population. However, our understanding of opioid-related harms in justice settings is limited. This study used ambulance data to examine opioid-related harms and experiences of care in New South Wales (NSW), Australia, during periods of incarceration or detention.MethodsThis mixed-methods study used data from the National Ambulance Surveillance System (NASS) for patients aged 18 and older with an opioid-related ambulance attendance between December 2020 and April 2023. People in justice settings were identified using ambulance billing codes and manual review of paramedic case notes. Descriptive statistics described the patterns and modalities of opioid-related harms in justice settings, and a qualitative thematic analysis of paramedic case notes was used to contextualise findings. Results Over the study period, 328 opioid-related ambulance attendances for people in justice settings were identified (51% heroin; 41% opioid agonist therapy (OAT) medication). Symptoms of opioid withdrawal were noted in 35% of attendances, most commonly for heroin (51%) and withdrawal from OAT medications (48%). Three interconnected themes were identified using qualitative analysis: trust and mistrust in justice settings, systemic barriers to providing OAT, and other harm reduction strategies, and experiences of withdrawal in justice settings.ConclusionOur study demonstrated the utility of ambulance data in identifying opioid-related harms for people in justice settings in NSW. Qualitative findings highlight current barriers to effective opioid care in justice settings and identify opportunities for intervention, including targeted harm reduction programs, as well as policies that promote continuity of care particularly during transitions in and out of justice settings.

Human platelet lysate: a potential therapeutic for intracerebral hemorrhage

Intracerebral hemorrhage (ICH) is a major public health challenge worldwide, and is associated with elevated rates of mortality, disability, and morbidity, especially in low- and middle-income nations. However, our knowledge of the detailed molecular processes involved in ICH remains insufficient, particularly those involved in the secondary injury stage, resulting in a lack of effective treatments for ICH. Human platelet lysates (HPL) are abundant in bioactive factors, and numerous studies have demonstrated their beneficial effects on neurological diseases, including their anti-neuroinflammatory ability, anti-oxidant effects, maintenance of blood–brain barrier integrity, and promotion of neurogenesis. In this review, we thoroughly explore the potential of HPL for treating ICH from three critical perspectives: the rationale for selecting HPL as a treatment for ICH, the mechanisms through which HPL contributes to ICH management, and the additional measures necessary for HPL as a treatment for ICH. We elucidate the role of platelets in ICH pathophysiology and highlight the limitations of the current treatment options and advancements in preclinical research on the application of HPL in neurological disorders. Furthermore, historical developments and preparation methods of HPL in the field of biomedicine are discussed. Additionally, we summarize the bioactive molecules present in HPL and their potential therapeutic effects in ICH. Finally, we outline the issues that must be addressed regarding utilizing HPL as a treatment modality for ICH.

Spectrum of Non-Traumatic Hollow Viscus Perforation in a Himalayan Population: A 3-Year Retrospective Study

Non-traumatic hollow viscus perforation (NT-HVP) is a common surgical emergency, often resulting in high morbidity and mortality rates. This study examines the epidemiology, aetiology, clinical presentations, and outcomes of NT-HVP among patients in the Himalayan region, by reviewing data from the Indira Gandhi Medical College (IGMC) Surgery Department, Shimla, between 2015 and 2018. A total of 274 cases were analysed. The most common cause of the problem was peptic ulcer disease and the study area had challenges like difficult terrain and limited access to healthcare. The findings aim to improve the understanding of NT-HVP in resource-limited settings and provide insights for better management strategies.

Syzygium aromaticum extract mediated, sustainable silver nanoparticle synergetic with heterocyclic antibiotic clarithromycin and their antimicrobial activities

Microorganisms are becoming resistant to drugs and antimicrobials, making it a significantly critical global issue. Nosocomial infections are resulting in alarmingly increasing rates of morbidity and mortality. Plant derived compounds hold numerous antimicrobial properties, making them a very capable source to counteract resistant microbial strains. Syzygium aromaticum (Clove) extract has been proven by studies to contain active ingredients that demonstrate antibacterial, antifungal, antioxidant, and insecticidal properties. It has also been used historically for its pain relief especially for tooth ache. Clove extract derived nanoparticle synthesis is a promising method of combining therapeutics with metals at nanoscale. Such nanostructured systems in combination with the heterocyclic antibiotic clarithromycin could potentiate the action of plant extracts, decrease drug side effects and improve antimicrobial activity. In this study, clove extract (C) was successfully used to synthesize silver nanoparticles (AgNP) to create AgNPC and AgNPCA (A = clarithromycin). The two compounds underwent different analytical methods consisting of SEM, EDS, DLS, UV-vis, FTIR and XRD. These nanoparticles were used against a variety of 10 pathogens and exhibited very good to intermediate antibacterial properties. AgNPC resulted in better antibacterial properties and smaller nanoparticle size. This study demonstrates the potential of clove extract mediated AgNP synthesis in combination with and without the antibiotic clarithromycin.

A Survey on Perception, Knowledge and Use of Contraceptives among Females in Ikot Abasi, Akwa Ibom State

The rate of unwanted pregnancies and maternal morbidity can be significantly reduced by the use of various forms of contraception. This study assesses the perception, knowledge and use of contraceptives among women in Ikot Abasi local government area of Akwa Ibom State. A pre-tested, structured interviewer-administered questionnaire was the tool for data collection and multi-staged sampling technique was used to select 512 females of reproductive age from the five clans of Ikot Abasi. The method of multinomial logistic regression was used to determine the contraceptive methods and determinants of contraceptive use while the Chi-Square test was applied to determine the perception of contraception. The results revealed that about 97% of the women have knowledge about contraceptives and their major source of information about contraceptives were from their friends/relatives which account for about (37%). Women in the age category 33 – 38, M.Sc/Ph.D level of education and income earners of more than ₦100,000 per month have a high relative risk ratio of contraceptive use of 3.90, 2.48 and 3.32 respectively. Finally, Age group, level of education, level of income per month and relationship status were discovered to be the main determinants of contraceptives use among women in Ikot Abasi.

The basis of bacteriological safety in the neonatal intensive care unit (literature review)

Background. According to world statistics, 7% of patients out of 100 in high-income countries and 15% of patients out of 100 in low- and middle-income countries develop infections related to medical care. As follows from the report of the World Health Organization, one in four cases of hospital sepsis that occurred in the intensive care unit is caused by hospital strains. On average, one in ten of these patients has a hospital-acquired infection that is fatal. The high-risk group includes patients in intensive care units, including newborns. In 2023, 28973 cases of neonatal infections (including intrauterine infection) were registered in medical organizations of the Russian Federation. The highest rates of neonatal morbidity were recorded in the Sverdlovsk Region (42.2%), the Trans-Baikal Territory (33.0%), the Novosibirsk Region (26.0%), the Chelyabinsk Region (22.4%), the Krasnoyarsk Territory (21.8%) and the Irkutsk Region (21.3%). Thus, infection prevention and control strategies aimed at both patients and their environment are of paramount importance in neonatal intensive care units.Objective. To summarize current relevant data on the prevention of hospital infections in neonatal intensive care units.Materials and methods. A literature review was conducted using the MEDLINE database (PubMed) as of December 2024 using keywords and a filter: randomized controlled trial, meta-analysis, systematic review.Results. This review summarizes the main data on the prevention of hospital infections in neonatal intensive care units. According to the literature, ensuring bacteriological safety in relation to the development of hospital infections depends on many factors: hand hygiene of medical personnel, organization of venous access control, disinfection of medical equipment and premises, compliance with the rules of asepsis and antiseptics when performing invasive manipulations, the introduction of modern approaches in the care of premature infants.Conclusion. There are many tasks in the intensive care unit that require innovative strategies to ensure the safe care of premature newborns. Joint efforts to standardize the processing of specialized equipment, maintain the cleanliness of the environment, comply with vascular access care protocols, adequate hand hygiene, and the active introduction of parents into newborn care are an integral part of the program aimed at preventing nosocomial infections. Active cooperation between the neonatal intensive care unit and the epidemiological service of the institution will allow us to develop a rational policy for risk management and monitoring of hospital infections.

Impact of Disease Etiology and Indication for Colectomy on Postoperative Outcomes: A NSQIP Colectomy-Targeted Database Study.

The ACS-NSQIP Colectomy-Targeted database provides valuable metrics on surgical outcomes by utilizing clinical data to enhance quality improvement efforts. However, the quality measures offered in the ACS-NSQIP semiannual report do not stratify for the indication for colectomy. We aim to compare postoperative outcomes in patients undergoing colectomy for colon cancer, infectious causes, and inflammatory bowel disease (IBD). A retrospective review of patients undergoing colectomy was performed using the ACS-NSQIP Colectomy-Targeted database from 2012-2022. Logistic regression models were used to compare the 30-day postoperative outcomes of patients who underwent colectomy for colon cancer, infectious causes, and IBD while adjusting for pre-operative risk factors. There were 158,560 patients who underwent colectomy for colon cancer, 90,827 patients for infectious causes, and 30,548 patients for IBD. In unadjusted analysis, patients undergoing colectomy for infectious causes had the highest rates of mortality (2.6%) and morbidity (27.6%). After adjusting for covariates, IBD patients undergoing colectomy had significantly higher odds of morbidity compared to those undergoing colectomy for colon cancer (OR 1.3, 95% CI [1.1, 1.4]) and infectious causes (OR 1.3, [1.2, 1.4]). Furthermore, IBD patients had significantly higher odds of experiencing venous thromboembolism, surgical site infections, prolonged ileus, and readmission within 30 days compared to both colon cancer and infectious causes patients. This study demonstrates that the indication for colectomy impacts postoperative outcomes. Reporting risk-adjusted outcomes based on the underlying disease etiology could lead to identifying high-risk patients, improving benchmarking outcomes, and developing targeted quality initiatives.

Health-related quality of life following cranioplasty: a cross-sectional cohort study – Cranio-PRO

Cranioplasty is an operation that aims to repair a defect in the skull. Indications commonly include Traumatic Brain Injury (TBI), tumours, and infections. It carries a high rate of postoperative morbidity. Due to underlying pathology and the nature of the operation patients’ Health-related Quality of life (QoL) can be severely affected. Patient reported outcomes (PROs) are poorly understood following cranioplasty. To investigate PROs following cranioplasty a cross-sectional cohort study of adults undergoing cranioplasty between 01/03/2010–30/08/2020 was conducted. If consent was provided, participants were sent five health reporting questionnaires: a study specific questionnaire, EuroQoL – 5D – 5L (EQ-5D-5L), RAND Short-Form 36 (SF-36), Hospital Anxiety and Depression Scale (HADS), and Derriford Appearance Scale (DAS-24). 239 eligible patients were contacted and 72 (30.8%) participated. Median [Range] age was 52.5 [23 – 95] of which 59.7% (n= 43) were male. 16.9% (n = 12) were categorised with borderline and 29.0% (n = 20) with extreme depression, 15.9% (n = 11) reported borderline and 35.2% (n = 25) extreme anxiety. 69.1% (n = 47) had problems with usual activities and 71.6% (n = 49) suffered from pain/discomfort. Median (Range) EQ-5D-5L visual analogue scale score for overall health was 70.0 (5–100). 76.0% (n = 53) reported feeling conscious or having negative feelings towards their appearance. When compared to normative UK population, physical functioning, overall health, and energy/fatigue were the most affected. After cranioplasty, patients may have reduced HRQoL. Signposting and referral to well-being services could benefit patients’ care. Adequately powered longitudinal studies are required to further elucidate change in PROs following cranioplasty.

Eosinophilic granulomatosis with polyangiitis; a distinctive presentation with myocarditis and autoimmune haemolytic anaemia: case report

BackgroundEosinophilic granulomatosis with polyangiitis (EGPA) is an extremely rare type of vasculitis characterized by inflammation within small blood vessels or tissues that may cause damage to the lungs, heart, kidneys, and other organs. Here, we present a rare case of EGPA with cardiac involvement that presented with acute heart failure.Clinical findingsA 44-year-old woman with a history of bronchial asthma and sinusitis presented with fever, shortness of breath, fatigue, unintentional weight loss, and polyarthritis. Physical examination revealed bilateral basal crepitation and mononeuritis multiplex.DiagnosisThe peripheral blood smear revealed red blood cells of different sizes and shapes (dimorphic features), more eosinophils, low hemoglobin, and higher lactate dehydrogenase (LDH) levels. Cardiac magnetic resonance imaging (CMR) revealed global hypokinesia and features suggestive of myocarditis. Echocardiography showed a low ejection fraction of 25%. Thus, the patient diagnosed with EPGA and myocarditis presented with acute heart failure.InterventionsThe patient was administered high-dose corticosteroids (intravenous bolus methylprednisolone 500 mg for three days, followed by 1 mg/kg of prednisolone) and cyclophosphamide 750 mg intravenously.OutcomeAfter one months, the patient showed a marked improvement in clinical and laboratory parameters. The ejection fraction improved to 30%–40%, the eosinophil count returned to normal, and the haemolytic anaemia resolved. The patient was sent home and shifted to mycophenolate mofetil 1 g twice a day as maintenance therapy.ConclusionPatients with EGPA have a higher morbidity and mortality rate when they have cardiac involvement. The pathophysiological mechanism of cardiac involvement in EGPA warrants consideration of immunosuppressive therapy in addition to standard heart failure treatment.

MRI-Based Multifunctional Nanoliposomes for Enhanced HCC Therapy and Diagnosis.

The morbidity and mortality rates of hepatocellular carcinoma (HCC) are high and continue to increase. The antitumor effects of single therapies are limited because of tumor heterogeneity and drug resistance, and the lack of real-time monitoring of tumor progression during the treatment process leads to poor therapeutic outcomes. Therefore, novel nanodelivery platforms combining tumor therapy and diagnosis have garnered extensive attention. In this study, we developed a multifunctional nanodelivery vector, LPSD-DOX/siRNA, which was loaded with oleic acid-modified superparamagnetic iron oxide nanoparticles (OA-SPION) and the antitumor drug doxorubicin (DOX), further modified by DOTAP to carry small interfering RNA targeting phosphatidylinositol proteoglycan-3 (Glypican-3, GPC3) (siRNA-GPC3). These components were utilized for the combined treatment of HCC and tumor monitoring with magnetic resonance imaging. LPSD-DOX/siRNA exhibited high drug loading, high gene transfection efficiency, and low toxicity. Pharmacokinetic and in vivo distribution experiments showed that LPSD-DOX/siRNA significantly prolonged the circulation time of DOX and enhanced drug accumulation at the tumor site. Magnetic resonance imaging demonstrated that LPSD-DOX/siRNA can serve as a T2 imaging contrast agent to enhance the imaging contrast between the tumor site and other tissues and facilitate the imaging monitoring of tumor tissues. Antitumor experiments revealed that the effects of DOX were promoted by inhibiting the expression of GPC3 protein in HepG2 cell-transplanted tumors, with increased tumor apoptosis. In conclusion, LPSD-DOX/siRNA serves as a promising strategy for combination therapy and monitoring of HCC, with significant potential in antitumor therapy.

Assessing Functional Outcomes in the Pediatric Neurocritical Care Population after Discharge: A Pilot Study.

Pediatric neurocritical care (PNCC) patients experience high rates of morbidity, but comprehensive follow-up is not universal. We sought to identify predictors of functional decline in these children to guide future resource allocation. We conducted a prospective observational study in a quaternary children's hospital pediatric intensive care unit (PICU) from July 2023 to December 2023. Patients (aged 3-17years) were admitted with a PNCC diagnosis, and their caregivers were enrolled. Outcomes were assessed through surveys using the Functional Status Scale (FSS) at time of consent (baseline) and the 2-month follow-up after PICU discharge. Follow-up surveys explored social, educational, and cognitive difficulties encountered after discharge. Functional decline was defined as any increase in FSS between baseline and follow-up, and severe morbidity was defined as an overall increase of 3 or more or an increase of 2 or more in one domain. Demographic and in-hospital variables were extracted from a clinical database to analyze with outcomes. A total 30 of 31 families consented, and 29 completed follow-up surveys. Out of those, 17 (58.6%) patients had a functional decline, 8 (27.6%) had a new severe morbidity, only 12 (41.4%) had returned to school, and 16 (55.2%) had new family hardships. Mechanical ventilation was a significant predictor of functional decline (odds ratio, 6.50, 95% CI, 1.26-33.58; P = .025). This study supplements reports of high morbidity after pediatric neurocritical illness. Targeting patients most at risk for functional decline, such as those receiving mechanical ventilation, can support efficient resource allocation for follow-up programs promoting health-related quality of life. Larger studies are needed to validate and expand on these findings.

Laparoscopic and Open Distal Pancreatectomy—An Initial Single-Institution Experience with a Propensity Score Matching Analysis

Laparoscopic distal pancreatectomy is a minimally invasive approach for the surgical treatment of neoplasms in the distal pancreas. This study aimed to compare this approach to the open procedure. A retrospective analysis of a prospectively maintained database of 400 pancreatectomies was performed. The laparoscopic distal pancreatectomy group (LDP) was compared to the open distal pancreatectomy group (ODP). A propensity score matching analysis (PSM) was performed. From 2016 to 2023, 108 distal pancreatectomies were carried out, 19 (17.6%) laparoscopically and 89 (82.4%) openly. The conversion rate was 13.6%. The severe morbidity rates were 28.1% in the ODP group, 47.4% in the LDP group, and 15.8% in the ODP-PSM group. The difference between the latter two was statistically significant (p = 0.034) due to the high rate of Clavien–Dindo grade 3a complications (42.1% versus 10.5%, p = 0.042) in the LDP group. The 90-day mortality rates were 3.3% in the ODP group and 5.3% in the other two groups. The LDP group had a shorter duration of intravenous narcotic analgesia (5 versus 7 days, p = 0.041). There was no difference in the R0 resection or postoperative pancreatic fistula rates. Our attention should be drawn to preventing postoperative complications because the oncological outcomes are already comparable with those of the open procedure, and postoperative pain management is promising.

Impact of Neoadjuvant Chemotherapy on Perioperative Morbidity in Combined Resection of Rectal Cancer and Liver Metastases.

Little is known about the relationship between neoadjuvant chemotherapy (NAC) and perioperative morbidity for patients undergoing combined resection of rectal cancer and sLM. The purpose of this study is to determine the impact of NAC on 30-day morbidity for patients who undergo combined resection of primary rectal cancer and sLM. A retrospective cohort study of patients undergoing combined resection of primary rectal cancer and sLM between 2016 and 2020 at participating NSQIP hospitals. Multivariate logistic regression models were used to assess the relationship between NAC and 30-day morbidity rates. Among 878 patients who underwent combined resection of primary rectal cancer and sLM, 672 (76.54%) received NAC. There were no significant differences in the rates of 30-day overall morbidity between patients who received NAC and those who did not (37.65% vs. 37.68%, p = 0.95). On adjusted analysis, there was no association between receipt of NAC and rates of overall morbidity (adjusted OR = 1.10, 95% CI 0.78-1.56, p = 0.95). The receipt of NAC does not appear to be associated with increased perioperative morbidity in patients undergoing combined resection of primary rectal cancer and sLM.

Reusable Tourniquets as Potential Transmitters of Infection: A Microbiological Analysis

Introduction: Healthcare-associated infections (HAIs) pose a significant global challenge, resulting in prolonged hospital stays, higher healthcare costs, and increased morbidity and mortality rates. Reusable medical equipment, such as tourniquets, represents a potential vector for infection transmission. Despite frequent use and close contact with patients’ skin, infection control protocols often overlook these devices. This study examines microbial contamination on the surface of reusable tourniquets in both emergency department and operating theatre settings. Methods: A cross-sectional study was conducted between March and September 2024 in Gdansk, Poland. Samples from tourniquets used in the emergency department and the operating theatre were collected after an indefinite period, 14 days, and 28 days. Bacterial contamination on the surfaces of the tourniquets was measured using Columbia agar blood medium and expressed as colony-forming units (CFUs) per cm2. Results: Significant bacterial loads were detected on reusable tourniquets, with contamination levels varying by location and duration of use. The average number of CFU/cm2 across all stages of this study was 545 CFU/cm2 for the emergency department and 101 CFU/cm2 for the operating theatre. Tourniquets used in the emergency department exhibited higher bacterial counts compared to those from the operating theatre, which showed a greater diversity of bacterial species. These findings underscore the need to revise infection control protocols for reusable tourniquets. Conclusion: This study provides critical data that may influence future policy changes aimed at reducing the risk of HAIs through the improved management of reusable medical devices.

Impact of Academic Medical Centers on Surgical Outcomes of Neighboring Non-Academic Medical Centers.

We aimed to investigate the geographic variation of Academic Medical Centers (AMCs) across different healthcare markets and the impact on surgical outcomes in nearby non-AMCs. Patients who underwent major surgery between 2016 and 2021 were identified from the Medicare Standard Analytic Files. Healthcare markets were delineated using Dartmouth Atlas hospital referral regions. Multivariable regression was used to examine the association between the presence of market-level AMCs and surgical outcomes in neighboring non-AMCs. A total of 388,431 Medicare beneficiaries underwent major surgery (CABG: n=97,346, 25.1%; AAA repair: n=67,000, 17.3%; pneumonectomy: n=30,500, 7.9%; pancreatectomy: n=5,341, 1.4%; colectomy: n=188,244, 48.5%) at 2,757 non-AMCs. Median age was 74 years (IQR: 70-80), and roughly one-half of patients was male (n=215,569, 55.5%). Notably, 43.1% of individuals underwent surgery in markets with low AMC presence, 48.0% in markets with moderate AMC presence, and 8.9% in markets with high AMC presence. On multivariable analysis, compared with low AMC markets, high AMC presence was associated with decreased risk of extended length-of-stay (-1.51%, 95% CI -2.03 to -1.00), postoperative complications (-1.20%, 95% CI -1.76 to -0.65), 90-day readmission (-2.39%, 95% CI -2.90 to -1.88), and mortality (-0.64% 95% CI -0.98 to -0.30) (all p<0.001). Moreover, high AMC market presence was associated with a 2.93% (-2.93%, 95% CI -3.17 to -2.68; p<0.001) decrease in expenditures for the index surgical procedure. High market presence of AMCs was associated with lower morbidity and mortality rates at nearby non-AMCs. The influence of AMCs on clinical outcomes likely extends beyond direct patient care, indicating spillover effects of AMCs on outcomes for patients in neighboring non-AMCs.

Specific plasma metabolite profile in intestinal Behçet’s syndrome

BackgroundIntestinal Behçet’s syndrome (IBS) has high morbidity and mortality rates with serious complications. However, there are few specific biomarkers for IBS. The purposes of this study were to investigate the distinctive metabolic changes in plasma samples between IBS patients and healthy people, active IBS and inactive IBS patients, and to identify candidate metabolic biomarkers which would be useful for diagnosing and predicting IBS.MethodsIn this study, we performed a global untargeted metabolomics approach in plasma samples from 30 IBS patients and 20 healthy subjects. P value < 0.05 and variable importance projection (VIP) values > 1 were considered to be statistically significant metabolites. Univariate receiver operating characteristic (ROC) curve analysis was plotted as a measure for assessing the clinical performance of metabolites, and area under curve (AUC) were assessed.ResultsA total of 147 differentially abundant metabolites (DAMs) were identified between IBS patients and normal control (NC) group. The potential pathways involved in the pathogenesis of IBS include linoleic acid metabolism; GABAergic synapse; biosynthesis of unsaturated fatty acids; valine, leucine and isoleucine biosynthesis; ovarian steroidogenesis; and others. In addition, a total of 103 significant metabolites were selected to distinguish active IBS from inactive IBS patients. Tyrosine metabolism, dopaminergic synapse and neuroactive ligand-receptor interaction were found to be closely related to the disease activity of IBS. Furthermore, three potential metabolites including quinate, stearidonic acid (SDA) and capric acid (CA) could significantly differ IBS patients from NC group. On the other hand, 1-methyladenosine (m1A), genipin, methylmalonic acid (MMA) and ascorbate could significantly differentiated active IBS from inactive IBS patients.ConclusionIn conclusion, this study demonstrated the characteristic plasma metabolic profiles between IBS group and NC group, as well as between active and inactive IBS patients by using an untargeted LC/MS metabolomics profiling approach. In this study, quinate, SDA and CA were identified as potential diagnostic biomarkers for IBS. Additionally, m1A, genipin, MMA and ascorbate could serve as potential biomarkers for evaluating IBS activity. These findings might provide potential valuable insights for developing therapeutic strategies to manage IBS in the future.