Morbidity Rates Research Articles

Metabolomics and proteomics reveal the inhibitory effect of Lactobacillus crispatus on cervical cancer

Cervical cancer remains a significant global health issue due to its high morbidity and mortality rates. Recently, Lactobacillus crispatus has been recognized for its crucial role in maintaining cervical health. While some studies have explored the use of L. crispatus to mitigate cervical cancer, the underlying mechanisms remain largely unknown. In this study, we employed non-targeted proteomics and metabolomics to investigate how L. crispatus affects the growth of cervical cancer cells (SiHa) and normal cervical cells (Ect1/E6E7). Our findings indicated that the inhibitory effect of L. crispatus on SiHa cells was associated with various biological processes, notably the ferroptosis pathway. Specifically, L. crispatus was found to regulate the expression of proteins such as HMOX1, SLC39A14, VDAC2, ACSL4, and LPCAT3 by SiHa cells, which are closely related to ferroptosis. Additionally, it activated the tricarboxylic acid (TCA) cycle in SiHa cells, leading to increased levels of reactive oxygen species (ROS) and lipid peroxides (LPO). These results revealed the therapeutic potential of L. crispatus in targeting the ferroptosis pathway for cervical cancer treatment, opening new avenues for research and therapy in cervical cancer.

The Influence of Pulmonary Arterial Hypertension In Pregnancy: A Review.

Pulmonary arterial hypertension (PAH) is a severe condition characterized by increased pulmonary vascular resistance and right ventricular failure. This review examines the intersection of PAH and pregnancy, highlighting the significant physiological, hemodynamic, and hormonal changes that exacerbate PAH during gestation. Pregnancy is contraindicated in PAH patients due to high maternal and fetal morbidity and mortality rates. However, some patients choose to continue their pregnancies, necessitating a comprehensive understanding of the implications and management strategies. Effective management of PAH in pregnant patients involves individualized treatment plans. Prepartum management focuses on optimizing therapy and monitoring hemodynamic status. Prostacyclin analogs and phosphodiesterase inhibitors are commonly used, though their safety profiles require further investigation. Intrapartum management prioritizes preventing right ventricular failure, utilizing therapies such as intravenous epoprostenol, inhaled iloprost, and inhaled nitric oxide. Managing PAH in pregnancy requires careful planning, continuous monitoring, and tailored therapeutic strategies to navigate the complex interplay of physiological changes and mitigate risks. Future research should focus on elucidating the pathophysiology of PAH during pregnancy and developing safer, more effective treatments to improve maternal and fetal outcomes.

Exploring the Mechanisms and Therapeutic Approaches of Mitochondrial Dysfunction in Alzheimer's Disease: An Educational Literature Review.

Alzheimer's disease (AD) presents a significant challenge to global health. It is characterized by progressive cognitive deterioration and increased rates of morbidity and mortality among older adults. Among the various pathophysiologies of AD, mitochondrial dysfunction, encompassing conditions such as increased reactive oxygen production, dysregulated calcium homeostasis, and impaired mitochondrial dynamics, plays a pivotal role. This review comprehensively investigates the mechanisms of mitochondrial dysfunction in AD, focusing on aspects such as glucose metabolism impairment, mitochondrial bioenergetics, calcium signaling, protein tau and amyloid-beta-associated synapse dysfunction, mitophagy, aging, inflammation, mitochondrial DNA, mitochondria-localized microRNAs, genetics, hormones, and the electron transport chain and Krebs cycle. While lecanemab is the only FDA-approved medication to treat AD, we explore various therapeutic modalities for mitigating mitochondrial dysfunction in AD, including antioxidant drugs, antidiabetic agents, acetylcholinesterase inhibitors (FDA-approved to manage symptoms), nutritional supplements, natural products, phenylpropanoids, vaccines, exercise, and other potential treatments.

Anti-inflammatory Effect of Symplocos prunifolia Extract in an In Vitro Model of Acute Pneumonia.

Acute pneumonia is a respiratory disease characterized by inflammation within the lung tissue, exhibiting higher morbidity rates and mortality rates among immunocompromised children and older adults. Symplocos species have been traditionally used as herbal remedies for conditions like dysentery, skin ulcers, diarrhea, and dyspepsia. Contemporary research has employed various Symplocos species in the study of diverse diseases. However, the exact efficacy and mechanisms of action of Symplocos Prunifolia remain unknown. Therefore, this study investigated the anti-inflammatory mechanism of S. prunifolia extract (SPE) in A549 and RAW264.7 cells stimulated by lipopolysaccharide (LPS). SPE significantly reduced nitric oxide (NO) production and the protein expression levels of like inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) in LPS-stimulated RAW 264.7 cells. Furthermore, it reduced the protein expression levels of iNOS, COX-2 and the levels of pro-inflammatory cytokines in LPS-stimulated A549 cells. The mechanism underlying the anti-inflammatory effect of SPE was associated with the inhibition of LPS stimulated the phosphoinositide-3-kinase/protein kinase B (PI3K/Akt) and Mitogen-activated protein kinase (MAPK) phosphorylation. Moreover, we confirmed that SPE decreased the nuclear translocation of nuclear factor-κB (NF-κB)/p65 stimulated by LPS. In conclusion, these results demonstrate that SPE alleviates inflammatory responses by deactivating the PI3K/Akt, MAPK, and NF-κB signaling pathways. Our findings suggest that SPE is a potential candidate for acute pneumonia prevention.

Neurological Manifestations and Complications of Neonatal Meningitis: A Systematic Review and Meta-analysis

Background: Neonatal meningitis has significant worldwide morbidity and mortality rates. Nevertheless, the clinical manifestations of neonatal meningitis are subtle and nonspecific which can pose challenges in terms of timely diagnosis and intervention. This meta-analysis aims to the prevalence of neurological manifestations and complications associated with neonatal meningitis in term and preterm neonates. Methods: A systematic literature search was conducted in PubMed, SCOPUS, and Ovid SP to identify relevant studies. Pooled prevalence of neurological manifestations and complications with a 95% confidence interval (CI) were calculated using the random-effects generic inverse variance model. Statistical analysis was performed using Review Manager v5.4 and R programming. Results: A total of 25 studies with 2252 patients evaluated for neurological symptoms and 1822 patients evaluated for neurological complications were included in this meta-analysis. The overall prevalence of neurological manifestations in neonatal meningitis was 23% (95% CI, 20% to 26%). The overall prevalence of neurological complications in neonatal meningitis was 8% (95% CI, 6% to 9%). Conclusion: Our meta-analysis revealed a low prevalence of neurological manifestations and complications in neonatal meningitis. Although neurological complications occur less frequently, the complications are significantly associated with higher mortality and morbidity rates.

Clustering of cantons in Costa Rica based on interest variables during the beta variant of Covid-19

The study of case behavior and the analysis of bioindicators are relevant and important for decision-making by health authorities worldwide, related to the Covid-19 pandemic. Thus, numerous investigations have been carried out around the world to understand this phenomenon, its variants, and its primary impacts on population health. In this study, a cluster analysis was conducted based on the variables of mortality rate, morbidity rate, and fatality rate, along with cantonal geographical density, for the period of the beta variant in Costa Rica, corresponding to the months from February to June 2021. Therefore, a total of three methods were chosen to obtain groups: k-means, k-medoids, and fuzzy methods; as well as two types of distances: Euclidean and Manhattan. Additionally, the sum of squares within groups and the Dunn index were used to validate the formation of the clusters. It was identified that the method and distance that formed the most compact cantonal clusters with lower intragroup variability were k-medoids and Manhattan, respectively, due to their greater robustness against extreme values. Among the formed groups, cluster 1 has a moderate impact of the pandemic during the specified variant, while groups 2 and 3 have low and high impacts, respectively. Moreover, groups 1 and 2 are predominantly composed of cantons outside the Greater Metropolitan Area, in contrast to the third group. This analysis provides valuable insights for health authorities in understanding the impacts of the Covid-19 pandemic in Costa Rican regions and aids in the development of targeted strategies for effective management.

FP7.18 - Early Operative Risk Assessment Using Modified Mannheim Peritonitis Index in Patients with Generalised Peritonitis at a Tertiary Hospital in Abuja, Nigeria

Abstract Aim This study assessed the usefulness of a modified Mannheim Peritonitis Index (MPI) as a risk stratification tool in predicting surgical outcomes in the management of patients with generalized peritonitis in Abuja, Nigeria. Methods This is a prospective study of consecutive adult patients managed for generalized peritonitis at a tertiary hospital in Abuja Nigeria within a one-year duration. The MPI was modified using respiratory rate and SpO2. Patient characteristics and outcome of treatment obtained were entered into a structured proforma, checked and analysed using the SPSS, version 25. The threshold score of the modified MPI, as well as the accuracy, sensitivity, and specificity, were derived from the receiver-operator characteristic (ROC) curve analysis and its coordinates. Results There were 49 patients with generalised peritonitis during the study period with a male-to-female ratio of 2.5:1. The commonest cause of peritonitis in this study was penetrating abdominal injury (30.6%) followed by complicated appendicitis (24.5%). This study's mortality and morbidity rates were 14.3% and 63.3%, respectively. On the ROC curve, the modified MPI best predict mortality at a threshold score point of ≥26 (Accuracy of 79.4%, sensitivity of 85.7% specificity of 61.9%, P-value = 0.013), and morbidity at a threshold score of ≥23 (Accuracy 78.4%, sensitivity of 77.4%, specificity of 72.2%, P-value = 0.001). Conclusion The modified MPI can be used as a risk assessment tool in predicting postoperative outcomes in adult patients operated for generalised peritonitis within 30 days of operative intervention at Abuja. This modification can be useful in low-resource centres with limited access to arterial blood gas analysers.

Azathioprine Induced Acute Pancreatitis in a Patient with Lichenoid Dermatitis

Acute pancreatitis (AP) is an inflammatory condition, characterized by elevated levels of amylase and lipase, with manifestation of acute abdominal pain and acute with high mortality and morbidity rates. The most common causes of AP other than gallbladder stones and alcohol include hypercalcemia, infections, hypercalcemia, and drugs. One such drug associated with AP is azathioprine. Azathioprine for dermatologic lesions are used as steroid sparing immunomodulatory agents. Here in, we report such an unusual case of azathioprine induced acute pancreatitis.

A Long-term Retrospective Epidemiological Analysis of the Incidence of Rotavirus Infection in the Altai Krai for 2001–2023

Relevance. The urgency of the problem of rotavirus infection, primarily among children, is due to the steady preservation of leading places in the structure of childhood morbidity. Despite the existing preventive measures, the incidence of rotavirus infection has been steadily increasing over the past 10 years. Vaccination coverage in our country in recent years has not exceeded 10-12% of the target cohort, which in general cannot have a significant impact on the incidence of rotavirus infection and requires special attention. Aim. To assess the epidemiologic situation on the incidence of rotavirus infection in Altai Krai in 2001–2023. Materials and methods. A retrospective epidemiological analysis of the incidence of rotavirus infection in the Altai Krai was carried out using data from statistical reporting forms No. 2 of the Federal State Statistical Observation «Information on infectious and parasitic diseases» in the Altai Krai in 2001–2023. Results. A long-term retrospective epidemiological analysis of rotavirus infection incidence was carried out. It was noted: an increase in the share of rotavirus infection in the structure of acute intestinal infections; a tendency for an increase in morbidity rates in the Altai Krai; the average long-term morbidity rate among children 0–17 years old exceeded that among adults by 67 times; in the structure of cases, the main proportion was children 1–2 years old; the greatest contribution to the formation of morbidity was made by unorganized children (75%) vaccination had no effect on morbidity, since vaccine coverage of Altay Krai population does not exceed 0.1%. Conclusion. The reasons for close monitoring of rotavirus infection and improvement of preventive measures, including vaccine prophylaxis, are substantiated

FP2.7 - Results of Lower Rectum Cancer Treatment

Abstract Objective The objective of this study is to evaluate oncological outcomes, specifically, the rate of locoregional recurrences in lower third rectum cancers treated with concurrent radio-chemotherapy and radical surgery. Methods Locoregional and metastatic recurrences were analyzed based on the initial tumor stage, response to neoadjuvant treatment, and the type of surgery. We utilized the biomedical statistics software SPSS24 and Microsoft Excel. Statistical analysis was performed using the chi-square test, with the calculation of the P-value (Pearson's test). Results During the period from 2000 to December 2021, 638 consecutive resections for lower third rectum cancer were conducted. One hundred and sixty-one patients (25.23%) underwent abdominoperineal amputation (AAP), while 477 (74.76%) underwent conservative surgery. There were 389 men and 249 women, with an average age of 51 years (ranging from 20 to 88). Thirty of our patients were classified as T1, 163 as T2, 420 as T3, and 25 as T4. One hundred and thirty-five patients (21%) received preoperative radiotherapy, and four hundred and eighty-six (76%) underwent concurrent preoperative radio-chemotherapy. Two hundred and six patients (43%) had an ultralow colorectal anastomosis, and 252 (52.8%) had a coloanal anastomosis. Local resection was performed in nineteen patients. The mortality rate was 0.78%, and the morbidity rate was 34%, including twenty-seven anastomotic fistulas (5.6%). Forty-one local recurrences were observed (6.4%). Conclusion During surgery for lower rectal cancer, the surgeon's primary concern is to achieve a valid oncological resection, preserve sphincter function, and ensure patients a recurrence-free survival.

ThP4.9 - The role of preoperative nutritional assessment in postoperative outcomes of hepato-pancreato-biliary patients: A bicenter prospective observational study

Abstract Aims Preoperative nutritional status of patients who undergo surgery due to hepato-pancreato-biliary (HPB) cancer has been considered as a prognostic factor of their postoperative course. The aim of the present study was to investigate the association of preoperative nutritional assessment with the postoperative morbidity and mortality in such patients. Methods Patients undergoing surgery due to HPB cancer from March 2022 until March 2023 at two university surgical departments were included in the present study. Patients’ demographics and postoperative parameters, such as complications’ severity according to Clavien-Dindo classification and mortality, along with malignancy stage were reported. Preoperative nutritional assessment was conducted according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and the Controlling Nutritional Status (CONUT) score. The present study was registered in ClinicalTrials.gov (NCT05795374). Results The present study included 66 patients with a mean age of 63 ± 12 years old. The high risk of malnutrition according to the GLIM criteria was associated with major (Clavien-Dindo≥3) postoperative complications (74% vs 32%, p=0.026) and increased 30-day mortality (80% vs 23%, p=0.021). Moreover, malnutrition according to the CONUT tool was correlated to increased 30-day mortality (66% vs 45%, p=0.016). Conclusions Preoperative malnutrition seems to be associated with higher rates of postoperative mortality and major morbidity in patients undergoing surgery due to HPB cancer.

Association of in vitro fertilization with severe maternal morbidity in low-risk patients without comorbidities

To determine whether an association exists between in vitro fertility (IVF) and severe maternal morbidity among low-risk pregnant patients. Retrospective cohort study SUBJECTS: Low-risk pregnant patients who delivered between 1/2019 and 12/2022. Low-risk was defined as having an Obstetric Comorbidity Index (OB-CMI) score of 0. IVF MAIN OUTCOME MEASURES: The primary outcome (dependent variable) was any severe maternal morbidity. The secondary outcome was the need for a cesarean delivery. A modified Poisson regression with robust error variance was used to model the probability of severe maternal morbidity as a function of IVF. Risk ratios (RR) and their associated 95% confidence intervals (CI) were computed. An alpha value of 0.05 was considered statistically significant. A total of 39,668 pregnancies were included for analysis, and 454 (1.1%) were conceived by IVF. The overall severe maternal morbidity rate was 2.4% (n=949), with the most common indicator being blood transfusion. Overall cesarean delivery rate was 18.8% (n=7,459). On modified Poisson regression, IVF-conceived pregnancies were associated with 2.56 times the risk of severe maternal morbidity (95% CI 1.73 - 3.79) and 1.54 times the risk of having a cesarean delivery (95% CI, 1.37-1.74) compared to non-IVF pregnancies. IVF is associated with higher rates of severe maternal morbidity, primarily the need for a blood transfusion, and cesarean delivery in low-risk pregnancies without major comorbidities. Recognizing this association allows healthcare providers to implement proactive measures for better monitoring and tailored postpartum care.

SP4.1 - Incidence of recurrent bile duct stones following 6140 laparoscopic cholecystectomies and bile duct explorations: management and evaluation of risk factors

Abstract Aim To evaluate the rate of bile duct stone recurrence and possible risk factors in patients undergoing laparoscopic cholecystectomy (LC) and bile duct exploration (LCBDE) on a unit adopting routine cholangiography and LCBDE. Methods A prospective database of LC and LCBDE with confirmed ductal clearance spanning 30 years was reviewed. Those returning with clinical and laboratory suspicion of recurrence were included whether or not MRCP confirmation was obtained or intervention required. Apart from annual follow up electronic records were examined in 2020 and 2023 to capture unreported episodes. Results 1447 patients underwent LCBDE. 56 (3.8%) had suspected recurrence after a mean of 36.6 months (5-144). Mean age was 67.6 years and 57.1% were females. 12 (21.4%) settled on conservative management, including Glucagon administration, and MRCP was negative. 44 patients (78.6%) had 59 confirmed recurrence episodes; 53 needing 63 ERCPs and 6 settling conservatively. 12/44 (21.4%) had repeat recurrences. Only one biliary-enteric anastomosis was required. Only 11 of 4693 LC (0.23%) had recurrent stones (5 repeatedly) after a median interval of 30 months (5-120). 19 recurrence episodes occurred during which 13 settled spontaneously and 6 needed 9 ERCPs. In spite of average rates of ERCP morbidity no biliary related deaths resulted from stone recurrence. Compared to the rest of LCBDEs those with recurrence were more male, older, with more dilated CBD on USS & required more choledochotomies for larger stones. Conclusions CBDS recurrence occurs in 3.8% after LCBDE with 3% confirmed and requiring intervention, significantly lower than after sphincterotomy. Glucagon may help small stones pass. 21.4% have repeat recurrences justifying stone dissolution agents. Identifying recurrence risk factors require further studies.

FP2.8 - Emergency CRC Resections: A single centre cohort Study

Abstract Aims According to NBOCA, 20% of cases of CRC’s are emergencies, associated with high rates of post-operative morbidity and death (11.3 % within 90 days, NBOCA annual report 2023). Emergency CRC commonly presents as obstruction and perforation, less commonly with other constitutional symptoms. Aim of study is to assess surgical outcomes in emergency malignant CRC resections. Methods Cohort study carried out from Jan'2008 to Jan'2023. Descriptive demography & post-operative surgical outcomes were analysed in all emergency CRC resections. All elective CRC resections were recruited as controls. Results Em CRC (n = 365) Elective CRC (n = 1349) Mann Whitney U test (p value) Age(yrs) 70.0 70.5 NS Sex(M:F) 193 : 172 764 : 585 NS ASA(median) 3 2 < 0.0001 BMI(kg/m2) 25.7 26.7 < 0.0005 Op time(mins) 134.1 186.1 < 0.0001 LOS(days) 11 7 < 0.0001 Complications (n) Leaks 7 59 NS Ileus 68 207 NS HAP 53 132 NS Anaemia (Tx) 8 47 NS Wound infections 41 115 NS Collections 29 67 NS Sepsis 31 55 NS Mortality (n) 30 day 32 26 NS 60 day 46 38 < 0.01 90 day 54 44 < 0.005 TNM stage (n) 0 10 16 1 20 351 2 107 456 3 158 446 4 45 52 Survival rates 1st year 71.1 92.3 5th year 48.3 77.1 10th year 41.1 68.5 Logrank p < 0.05 15th year 39.5 65.1 Conclusions Emergency CRC patients had a worse pre-operative functional limitation (ASA 3), prolonged hospitalization, greater 90-day mortality rate, thus poorer survival. Despite national bowel cancer screening initiatives, emergency CRC presentations remain a challenge. Our study supports prompt diagnosis and early surgical intervention.

Association between serum alkaline phosphatase and clinical prognosis in patients with acute liver failure following cardiac arrest: a retrospective cohort study

BackgroundAcute liver failure (ALF) following cardiac arrest (CA) poses a significant healthcare challenge, characterized by high morbidity and mortality rates. This study aims to assess the correlation between serum alkaline phosphatase (ALP) levels and poor outcomes in patients with ALF following CA.MethodsA retrospective analysis was conducted utilizing data from the Dryad digital repository. The primary outcomes examined were intensive care unit (ICU) mortality, hospital mortality, and unfavorable neurological outcome. Multivariable logistic regression analysis was employed to assess the relationship between serum ALP levels and clinical prognosis. The predictive value was evaluated using receiver operator characteristic (ROC) curve analysis. Two prediction models were developed, and model comparison was performed using the likelihood ratio test (LRT) and the Akaike Information Criterion (AIC).ResultsA total of 194 patients were included in the analysis (72.2% male). Multivariate logistic regression analysis revealed that a one-standard deviation increase of ln-transformed ALP were independently associated with poorer prognosis: ICU mortality (odds ratios (OR) = 2.49, 95% confidence interval (CI) 1.31–4.74, P = 0.005), hospital mortality (OR = 2.21, 95% CI 1.18–4.16, P = 0.014), and unfavorable neurological outcome (OR = 2.40, 95% CI 1.25–4.60, P = 0.009). The area under the ROC curve for clinical prognosis was 0.644, 0.642, and 0.639, respectively. Additionally, LRT analyses indicated that the ALP-combined model exhibited better predictive efficacy than the model without ALP.ConclusionsElevated serum ALP levels upon admission were significantly associated with poorer prognosis of ALF following CA, suggesting its potential as a valuable marker for predicting prognosis in this patient population.

ThP4.11 - Preoperative respiratory disease and outcomes of pancreatoduodenectomy performed for malignancy

Abstract Background Despite improvements to morbidity and mortality rates in recent decades, pancreatoduodenectomy for malignancy (PD) remains a high-risk operation. Patients with pre-existing respiratory disease are likely to be at increased risk of developing postoperative complications but few prior studies have investigated this. This may be as few patients with significant respiratory pathology are considered appropriate surgical candidates. This study aimed to compare PD outcomes in patients with a prior respiratory condition to those without. The outcomes of interest were median length of stay (LoS), 30-day readmission, 90-day mortality, unplanned return to theatre rate and five-year survival. Methods Data was extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes of PD performed for pancreatic head malignancy (29 centres in 8 countries, n=1484). Pre-existing respiratory disease included a prior diagnosis of: asthma, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, pulmonary embolism, asbestosis, obstructive sleep apnoea, pleural effusion, tuberculosis, pulmonary sarcoidosis, pneumoconiosis or hypersensitivity pneumonitis. The Mann-Whitney U test and Fisher exact test were used to compare the two groups. Results Out of a total of 1484 cases, 142 patients (9.6%) had a pre existing respiratory comorbidity. Asthma and COPD both affected 4.2% of patients. All other included pathologies affected less than one percent of patients. 30-day readmission (8.5% vs 9.1%, p=0.1), 90-day mortality (1.4% vs 3.7%, p=0.2), and unplanned return to theatre rate (3.5% vs 5.1%, p=0.5) were similar between the two groups, however, median LoS was significantly longer in those with a prior respiratory disease (14 vs 13 days, p<0.0001). Five-year survival was also higher in those without respiratory disease but this was not statistically significant (24.6% vs 32.5%, p=0.06). Conclusion In our multicentre study of patients with confirmed malignancy, PD patients with a preoperative respiratory disease had significantly longer length of stay. There was a trend towards lower 5-year survival.

Barriers to a Healthy Lifestyle Among Obese Patients Attending Primary Care Clinics in Al-Ahsa, Saudi Arabia.

Obesity is a significant public health issue in Saudi Arabia, contributing to high morbidity and mortality rates. This study aimed to identify the barriers preventing obese patients from adhering to healthy diets and regular exercise while following a health coach in primary healthcare centers in Al-Ahsa. A cross-sectional study of 283 obese adults revealed that major barriers included lack of energy, willpower, and time for exercise, as well as lack of willpower, social influence, and time for maintaining a healthy diet. These barriers were significantly associated with demographic factors such as obesity grade, comorbidities, and educational level. Addressing these barriers is essential for developing effective interventions to support lifestyle changes in obese patients.

Analysis of ballistic trajectories and its association with clinical outcomes in civilian penetrating brain injury.

Civilian penetrating brain injuries (PBI) caused by firearms are a medical emergency with high rates of morbidity and mortality. The aim of this study was to evaluate the association between trajectory vectors in CT brain angiography and clinical outcomes in patients with civilian gunshots. This is a retrospective analytical cross-sectional study that includes patients over 15 years of age with PBI due to firearms, admitted from January 2019 to December 2021 at a University Hospital in Cali, Colombia. A brain CT with angio-CT was performed the first day of admission. An XYZ coordinate system centered on the Turk's saddle was developed. Trajectories of projectiles were plotted and compared to a patient 0 in a 3D-Slicer software. A bivariate analysis of the clinical and geometric characteristics of the trajectory was performed. Primary outcomes include mortality and disability at 6 months. Twenty-eight patients with a mean age of 27.39 ± 11.66 years were included. The vectors of non-survivors show a trend, crossing at a specific area. This area was designated as a "potential lethal zone" and inside this area, injuries around 25.3mm from the circle of Willis, were associated with greater mortality (p < 0.005). In our study PBI avoiding the ventricular system, brain stem, dorsum sellae and the circle of Willis were associated with more survivability. A "potential lethal zone" was detected and associated with poor outcome after civilian PBI due to firearms. A better evaluation of the performance of this "potential lethal zone" in larger studies will be required.

Association between late pregnancy prehypertension and adverse outcomes among newborns of women delivered at a tertiary hospital in Eastern Uganda: a prospective cohort study

BackgroundPrehypertension during pregnancy is currently not considered as a high-risk pregnancy state in existing guidelines despite recent research correlating it with higher rates of morbidity and mortality in both the mother and the fetus. Studies on prehypertension have not been conducted in Africa despite high rates of poor neonatal outcomes.AimsThe study aimed to determine the association between late pregnancy prehypertension and adverse outcomes in newborns of women with late pregnancy prehypertension at Jinja Regional Referral Hospital.Methods and materialsBetween September 2022 and January 2023, a hospital-based prospective cohort study including 300 pregnant women was conducted. Participants were divided according to third-trimester blood pressure, as determined by the JNC-8 criteria. Following hospital admission for labor and delivery, 150 normotensive women and 150 prehypertensive women were identified and followed until delivery, and their neonates were followed until death or hospital discharge. A p value of ≤ 0.05 was the threshold for statistical significance when comparing the groups using the relative risk, X2, and Mantel-Haenszel adjustment.ResultsComposite adverse neonatal outcomes were more common in prehypertensive women compared to normotensive women (48.67% versus 32.67%), particularly Small-for-Gestation Age (SGA), stillbirth, and composite adverse neonatal outcomes had significantly higher likelihood, with aRRs of 1.63 (95% CI 1.10–2.42, p = 0.037), 9.0 (95% CI 1.15–70.16, p = 0.010), and 1.55 (95% CI 1.16–2.08, p < 0.001), respectively. By a linear model, birthweight decreased by 45.1 g for every 10 mmHg rise in systolic blood pressure (p = 0.041, Pearson correlation of -0.118).Conclusion and recommendationsPrehypertension in late pregnancy increased risks for adverse neonatal outcomes, thus a need to potentially lower pregnancy hypertension cut-off levels possibly through adopting the ACC/AHA blood pressure definitions for pregnant women.

SP4.3 - Pancreatoduodenectomy for malignancy with concomitant arterial resection: results from the Recurrence After Whipple’s (RAW) study

Abstract Background Most centres are reluctant to perform pancreatoduodenectomy (PD) with concomitant arterial resection (AR) in patients with a cancer affecting the pancreatic head. This is because outcomes are poor and the potential benefits of an aggressive resection are unlikely to outweigh the potential risks, particularly in a patient with an aggressive tumour and limited life expectance. AR has been shown to correlate with higher rates of morbidity, reoperation and mortality, and reduced overall survival. However, AR may be justified in selected patients in specialist centres. This study aimed to compare the outcomes of PD patients who underwent AR to those who did not. Methods Data were extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes of PD performed for pancreatic head malignancy (29 centres from eight countries, n=1484). Patients who underwent AR were identified and compared to those who did not undergo AR using the chi-squared test. The following were compared: length of stay (LoS), incidence of postpancreatectomy haemorrhage (PPH), and rates of unplanned return to theatre, 30-day readmission, 90-day mortality, and five-year survival. Results Out of 1484 patients, 8.8% did not have data regarding their AR status recorded so they were excluded. Of the rest, 25 (1.8%) underwent AR. Despite the small sample size, these patients had significantly higher rates of PPH (20.0 vs 5.9%, p=0.0004) and reduced five-year survival (12.0% vs 33.1%, p=0.03). Conclusion AR should be reserved for selected PD patients in specialist units. Despite our small sample size, our multicentre study demonstrated that these patients have higher incidence of PPH and reduced long-term survival