Normal Daily Activities Research Articles

Characterizing the Impact of Physical Activity on Patients with Type 1 Diabetes Using Statistical and Machine Learning Models

Continuous glucose monitoring (CGM) represents a significant advancement in diabetes management, playing an important role in glycemic control for patients with type 1 diabetes (T1D). Despite their benefits, their performance is affected by numerous factors such as the carbohydrate intake, alcohol consumption, and physical activity (PA). Among these, PA could cause hypoglycemic episodes, which might happen after exercising. In this work, two main contributions are presented. First, we extend the performance evaluation of two glucose monitoring devices, Eversense and Free Style Libre (FSL), for measuring glucose concentrations during high-intensity PA and normal daily activity (NDA). The impact of PA is investigated considering (1) different glucose ranges (hypoglycemia, euglycemia, and hyperglycemia); and (2) four time periods throughout the day (morning, afternoon, evening, and night). Second, we evaluate the effectiveness of machine learning (ML) models, including logistic regression, K-nearest neighbors, and support vector machine, to automatically detect PA in T1D individuals using glucose measurements. The performance analysis showed significant differences between glucose levels obtained in the PA and NDA period for Eversense and FSL devices, specially in the hyperglycemic range and two time intervals (morning and afternoon). Both Eversense and FSL devices present measurements with large variability during strenuous PA, indicating that their users should be cautious. However, glucose recordings provided by monitoring devices are accurate for NDA, reaching similar values to capillary glucose device. Lastly, ML-based models yielded promising results to determine when an individual has performed PA, reaching an accuracy value of 0.93. The results can be used to develop an individualized data-driven classifier for each patient that categorizes glucose profiles based on the time interval during the day and according to if a patient performs PA. Our work contributes to the analysis of PA on the performance of CGM devices.

Women's expectations for system support for a healthy menopausal transition: A pilot study

BackgroundThis pilot study contributes to the knowledge on healthy menopause by adopting a person-centric, lifelong approach to support a healthy menopausal transition. It focuses on women's expectations of system support for this transition. MethodTwenty-two online in-depth interviews were conducted with women of various ages, experiences, and backgrounds in the United Kingdom, ensuring representation across the menopausal transition journey – before, during and after menopause. The interviews explored perceptions and expectations of healthy menopause and the required support. User journey and systems frameworks guided data collection and analysis. The pilot aimed to verify the feasibility of the developed study approach and protocol. ResultsA healthy menopausal transition is seen as preserving essential capacities to maintain normal daily activities despite bodily changes, a crucial aspect of ageing. Participants outlined a journey of awareness, contemplation of lifestyle adjustments, experimentation with new behaviours, and habit formation. These findings underscore the importance of fostering awareness and support for menopausal transition early in life. Participants also stressed the impact of the broader environment across the ageing journey, including education, research, health services, workplace dynamics, built environment, food industry, technology and innovation, media, advertising, and social networks. ConclusionsThis work highlights person-centric perceptions of healthy menopause, complementing existing biology-centred perspectives. By introducing a co-creation approach at the system level, it offers opportunities to define holistic support for the menopausal transition. The findings informed a knowledge exchange and ideation workshop with forty relevant system stakeholders to advance solution co-creation.

Exploring Perceived Limitations to Daily Activities Due to Chronic Conditions: A Person-Centered Approach to Measuring Multimorbidity Severity.

Person-centered approaches to measuring severity of multimorbidity (≥ 2 chronic conditions) can help clinicians assess the individual experience of multimorbidity and inform effective caregiving and intervention strategies. We examine how limitations in everyday activities attributable to specific chronic conditions act independently and in tandem to influence individual perceptions of multimorbidity severity. Data from the Panel Study of Income Dynamics (2005-2021) were used to investigate self-reported limitations in normal daily activities resulting from nine chronic conditions (hypertension, arthritis, diabetes, heart condition [heart disease/heart attack], cancer, lung disease, stroke, depression, and memory loss) in 4,318 adults aged 55-95 (18,878 person-wave observations). We used descriptive and inferential analyses to estimate limitations resulting from specific conditions, limitations attributable to condition combinations, and the contribution of comorbid conditions to condition-specific and overall severity. Follow-up analyses addressed mortality selection using inverse probability weighting (IPW) and examined cancer type and cancer status/treatment modality among respondents reporting cancer diagnosis. Of the more prevalent conditions, arthritis was associated with the most severe limitations to normal activities. Memory loss was the least frequent condition reported, but resulted in the most severe limitations, and as a comorbid condition, increased limitations reported for most conditions. IPW adjusted models revealed heterogeneity in estimates for some conditions including cancer and cancer survivors tended to report less lethal cancers that were cured or in remission. Our results suggest that efforts to prevent and treat arthritis and support cognitive function may reduce the severity of multimorbidity experienced by the individual.

Personalized sleep and nutritional strategies to combat adverse effects of night shift work: a controlled intervention protocol

Abstract Background Working during the night interferes with the timing of normal daily activities and is associated with an increased risk of chronic diseases. Under controlled experimental conditions, interventions focusing on sleep and nutrition can mitigate the short-term adverse effects of shift work. However, it is unclear how these results translate to real-life, how they can be targeted to individual conditions, and how they relate to long-term health. Therefore, the current study aims to implement a personalized sleep and nutritional intervention among night shift workers in the field. Methods A non-blinded controlled intervention study is used, consisting of a run-in period, an intervention of 3 months, post-intervention measurements, and a follow-up after 12 months. Three study arms are included: sleep intervention, nutritional intervention, and control group (n = 25 each). Participants are healthy 18–60-year male night shift workers, with at least one year of experience in night shift work. Information from the run-in period will be used to personalize the interventions. The main outcomes are sleep measurements and continuous interstitial glucose levels. Furthermore, general health biomarkers and parameters will be determined to further evaluate effects on long-term health. Discussion This study aims to mitigate negative health consequences associated with night shift work by introducing two personalized preventive interventions. If proven effective, the personalized interventions may serve as practical solutions that can have a meaningful impact on the sustainable health and employability of night shift workers. This study will thereby contribute to the current need for high–quality data on preventative strategies for night shift work in a real-life context. Trial registration This trial has been registered under ClinicalTrials.gov Identifier NCT06147089. Registered 27 November 2023.

Computational Shape Design Optimization of Femoral Implants: Towards Efficient Forging Manufacturing

Total hip replacement is one of the most successful orthopedic operations in modern times. Osteolysis of the femur bone results in implant loosening and failure due to improper loading. To reduce induced stress, enhance load transfer, and minimize stress, the use of Ti-6Al-4V alloy in bone implants was investigated. The objective of this study was to perform a three-dimensional finite element analysis (FEA) of the femoral stem to optimize its shape and analyze the developed deformations and stresses under operational loads. In addition, the challenges associated with the manufacturing optimization of the femoral stem using large strain-based finite element modeling were addressed. The numerical findings showed that the optimized femoral stem using Ti-6Al-4V alloy under the normal daily activities of a person presented a strains distribution that promote uniform load transfer from the proximal to the distal area, and provided a mass reduction of 26%. The stress distribution was found to range from 700 to 0.2 MPa in the critical neck area of the implant. The developed computational tool allows for improved customized designs that lower the risk of prosthesis loss due to stress shielding.

[Translated article] Anatomical and biomechanical factors of osteoporotic vertebral fracture and the occurrence of cascade fractures

Osteoporosis weakens the structural strength of bone to such an extent that normal daily activity may exceed the capacity of the vertebra to bear this load. Vertebral fracture and deformity is a hallmark of osteoporosis. The detriment of trabecular bone properties alone cannot explain the occurrence of osteoporotic vertebral fracture. The ability of the spine to bear and resist loads depends on the structural capacity of the vertebrae, but also on loading conditions arising from activities of daily living or low-energy trauma. This review describes the mechanical properties of the vertebral bone, the structural load-bearing capacity of the various elements forming the spine, the neuromuscular control of the trunk, as well as the biomechanics of the loads to which the spine is subjected in relation to the presence of osteoporosis and the risk of vertebral fracture. A better understanding of biomechanical factors may help to explain both the high incidence of osteoporotic vertebral fractures and their mechanism of production. Consideration of these issues may be important in the development of prevention and management strategies.

Intakes of Lean Proteins and Processed Meats and Differences in Mental Health between Rural and Metro Adults 50 Years and Older.

Mental health disparities exist between rural and metro areas of the United States. Differences in dietary intake may contribute to these disparities. We examined differences in dietary intake and mental health between those 50 years and older (n = 637) living in rural counties to those living in metro counties in North Dakota and the relationship between dietary intake to days with depression or anxiety. A survey was conducted throughout North Dakota. Items were modified from other surveys, such as the Behavioral Risk Factor Surveillance System questionnaires and the National Health Interview Survey Cancer Control Supplement Dietary Screener Questionnaire. Comparing medians, individuals more likely to be unable to perform normal daily activities due to mental health (p = 0.009) resided in rural areas instead of metro areas. Those living rurally also ate more processed meats (p = 0.005), while trending toward less lean protein intake (p = 0.056). Multinomial regression analyses controlling for covariates revealed that lean protein intake and fruit intake were inversely associated with days with depression and anxiety (all p < 0.05), whereas processed meat intake was positively associated with anxiety (p = 0.005). Clinicians working with older adults residing in rural areas should emphasize substituting lean proteins for processed meats.

Impact of Child Respiratory Syncytial Virus-Confirmed Infections on Caregivers in Japan: A Web-Based Survey.

Background/Objectives: Despite being the leading cause of acute lower respiratory tract infections in infants, the impact of respiratory syncytial virus (RSV) on the caregivers of infected children remains largely unexplored. This study is the first in Japan to examine the psychological, social, and economic burdens on caregivers of infants infected with RSV. Methods: An online questionnaire survey was used to understand the circumstances surrounding RSV infection and the psychological, social, and economic burdens on caregivers. Equal numbers of infants aged either <6 or ≥6 months were enrolled. Results: A total of 606 caregivers were included in the final analysis. Notably, 36.1% of the infants were hospitalized. Most caregivers (91.4%) felt anxious about their infants' RSV infection, and more than half (55.8%) answered that their anxiety interfered with their daily lives. Caregivers whose daily routines were disrupted due to concerns about RSV infection were more likely to hospitalize infants, particularly for extended stays. Infection significantly affected family dynamics, hindering normal daily activities and escalating stress, which in turn led to conflicts and arguments among family members (30.4%). Regarding the financial burden, most caregivers incurred medical expenses (34.2%). Additionally, 76.9% of caregivers expressed interest in the hypothetical RSV vaccination. Conclusions: In Japan, caregivers of infants with RSV experience had significant psychological burden regardless of whether the treatment is outpatient or inpatient. In addition, a non-negligible proportion of caregivers suffer from societal and economic burdens. This study lays the groundwork for all stakeholders to fully comprehend the comprehensive disease burden of child RSV infections.

ThP6.19 - Surgical Management in Sacrococcygeal Pilonidal Sinus Disease Depending on The Suggested Staging System

Abstract Background The ideal management of the PNS has not been established yet. However; The optimal method should cover rapid recovery and return to normal daily activities, low recurrence rate, be technically applicable with reasonable cost. Aim to evaluate outcomes with the use of a stage-based treatment approach. Method A cohort prospective analytical study was conducted at Basrah Teaching Hospital-Iraq, a total of 71 patients were operated based on the proposed staging system in the period between December 2018 to April 2022, the staging system (Stage I–IV) was defined by using the morphological extent. the collected data includes demographic, perioperative data, short and long-term outcomes. Results Stage IV had the highest abscess drainage, drain insertion, and hospital stay. Concerning the short and long-term complications, the following frequencies were observed: Collection (9.85%), Infection (8.45%), and Dehiscence (4.22%), the collection and dehiscence were highest among stage R while the lowest rate of collection and infection was among stage III cases (6.67%, 6.67%) accordingly. Primary healing was recorded (91.5%) among the overall included patients with the higher rates of stage II-a (100.0%) with the lowest being among stage R (71.4%). Stage IV patients experienced the longest time for functional recovery and wound healing (14.25± 7.13, 13.25± 7.27) accordingly. The Recurrence rate was (2.81%) commonly observed among stage II-a (16.67%). Conclusion PNS is a recognizable condition in our locality and presents in different stages, thus this proposed staging system categorizes its extent and is a valuable tool in tailoring surgical approaches to each stage, Furthermore, it provides a common language for the surgeon to communicate about the disease.

Long-term results and patient-reported outcomes after vascularized fibular graft use in the treatment of post-traumatic bone defects of femur shaft and tibia: A retrospective cohort and cross-sectional survey study

Post-traumatic critical-sized bone defects pose a reconstructive challenge for reconstructive surgeons. The vascularized fibula graft is a well-described treatment for osseous defects of the femur and tibia. This study aimed to assess long-term patient-reported quality of life, the success-, and complication rates in lower extremity reconstruction with vascularized fibula grafts. A retrospective cohort of 29 patients who underwent fibula graft reconstruction for critical-sized bone defects after post-traumatic tibial and femoral bone loss between 1990 and 2021 was included. To assess the health-related quality of life and return to work and satisfaction, a cross-sectional survey was performed using the short-form-36, lower extremity functional scale, and a self-made questionnaire including the DN4, satisfaction, and subjective ankle function. The median bone defect size was 8cm (IQR 9-7cm). The mental component scores were comparable to the Dutch population norm, whereas the impaired physical function scores were associated with pain (r 0.849, p<0.001). Neuropathic symptoms were reported in 7 out of 19 patients, and 11 out of 19 patients returned to normal daily activity. All respondents reported positive or neutral scores on overall satisfaction with the recovery. Bone healing was uneventful in 19 out of 29 patients. Union was achieved in 25 out of 29 patients. Persistent nonunion was observed in 4 patients, leading to amputation in 2 patients. Vascularized fibula graft use led to high union rates and limb salvage in patients with post-traumatic segmental bone loss of the tibia and femur. Patient satisfaction with the overall recovery was positive; however, functional outcomes remained impaired.

Ultrasound-Guided Percutaneous Fasciotomies for Patients With Chronic Exertional Compartment Syndrome

Chronic exertional compartment syndrome is a well-described potential cause of leg pain in high-level athletes and soldiers. Surgical treatment of chronic exertional compartment syndrome usually involves fasciotomy, with a reported rate of complications of up to 16%, including failure of complete compartmental release and delayed return to normal daily activity, which can take up to 6 to 12 weeks. The use of a minimally invasive approach under ultrasound guidance seems to improve clinical outcomes in young active patients. We recommend the following steps for effective execution of ultrasound-guided percutaneous fasciotomy: (1) location of the compartmental fascia and identification of the superficial peroneal nerve, (2) skin incision, (3) insertion of a hook under the compartmental fascia, and (4) sectioning of the fascia.

Effect of eight weeks of swimming on cardiovascular health: Reduction of risk factors in middle-aged men with hypertension

The aim of this study was to determine the effect of a swimming training course on cardiovascular risk factors in 50-60 year old men with high blood pressure. For this purpose, 20 hypertensive men aged 54.95±3.18 years, height 174.05±18.5 cm and weight 82.20±5.36 kg were selected in a targeted manner and they were randomly selected. They were placed in two groups of swimming training and control (10 people in each group). The swimming training group participated in an 8-week swimming training program. Aerobic swimming training with an intensity of 70% of the maximum heart rate, three sessions per week and 15 minutes in the first week, which gradually reached 45 minutes in the last week. During this period, the control group did not follow any regular physical activity program and only did their normal daily activities. Blood pressure, resting heart rate, body weight, cholesterol, triglyceride, LDL and HDL serum levels were evaluated before and after the intervention. Student's t statistical method for dependent and independent groups was also used for intra-group and inter-group comparison of variables, respectively. The results showed that a period of swimming training decreased weight, cholesterol, triglycerides, LDL, resting heart rate and blood pressure, as well as increased HDL in 50-60-year-old men with high blood pressure (P&lt;0.05). Therefore, based on these findings, it is concluded that a course of swimming training improves the profile of blood lipids and blood pressure in elderly men with high blood pressure, and since high blood pressure threatens health and heart attacks, swimming training can improve the health of old and elderly men is beneficial. The aim of this study was to determine the effect of a swimming training course on cardiovascular risk factors in 50-60 year old men with high blood pressure. For this purpose, 20 hypertensive men aged 54.95±3.18 years, height 174.05±18.5 cm and weight 82.20±5.36 kg were selected in a targeted manner and they were randomly selected. They were placed in two groups of swimming training and control (10 people in each group). The swimming training group participated in an 8-week swimming training program. Aerobic swimming training with an intensity of 70% of the maximum heart rate, three sessions per week and 15 minutes in the first week, which gradually reached 45 minutes in the last week. During this period, the control group did not follow any regular physical activity program and only did their normal daily activities. Blood pressure, resting heart rate, body weight, cholesterol, triglyceride, LDL and HDL serum levels were evaluated before and after the intervention. Student's t statistical method for dependent and independent groups was also used for intra-group and inter-group comparison of variables, respectively. The results showed that a period of swimming training decreased weight, cholesterol, triglycerides, LDL, resting heart rate and blood pressure, as well as increased HDL in 50-60-year-old men with high blood pressure (P&lt;0.05).

A Case Control Study of vNOTES versus Conventional Laparoscopic Salpingectomy for Ectopic Pregnancy

While the laparoscopic approach is the surgical treatment of choice for ectopic pregnancy, vNOTES is emerging as an alternative route with its good optical visibility and avoidance of abdominal incisions. The authors compare demographics and outcome data of vNOTES vs conventional laparoscopic salpingectomy for the surgical management of ectopic pregnancy. Case control study SETTING: A London University hospital PATIENTS: Women with ectopic pregnancy unsuitable for medical management who underwent surgical management INTERVENTION: 25 cases of vNOTES vs 25 conventional laparoscopic salpingectomy MEASUREMENTS AND MAIN RESULTS: The mean patient age (29.7±53 vs 31.4±6.7 days), parity (1.2±1.1 vs 1.6±2.1), BMI (26.7±5.3 vs 27.2±5.4 kg/m3), gestation age (8.44±2.1 vs 7.3±1.7 weeks) and βhCG levels (3725.4±3674.8 vs 4376.5±6493.4 IU/litre) were comparable (p>0.05, t test) between patients having vNOTES vs conventional laparoscopic salpingectomy. While estimated blood loss was similar (218.2±491.7 vs 173.5±138.7 mls)(p>0.001), vNOTES patients had statistically shorter duration of surgery (35.8±14.4 vs 75.8±19.7 mins)(p<0.001, t test) and length of stay (median: 11.5 vs 19.7 hours)(U=72, p<0.05, Mann-Whitney U test). Less patients in the vNOTES group required postoperative opioids (9% vs 25%) and median Visual Analogue Score (/10) for pain at 24 hours was significantly lower (2.0 vs 4.0)(U=75, p<0.05, Mann-Whitney U test). Patients from the vNOTES group were able to return to normal daily activity 11.3 days quicker (5.8±4.3 vs 17.1±8.2 days)(p<0.05, t test). vNOTES cases cost approximately USD150 more due to the price of the commercial kits but this is offset by reduced intraoperative time, length of stay and need for postprocedure analgesia. Patients undergoing vNOTES have shorter intraoperative times and length of stays, less postoperative pain and more rapid recovery, which help mitigate higher cost incurred by commercial kits. While the vNOTES approach for ectopic pregnancy appears safe and efficacious, more robust data from larger randomised studies are needed.

LEVELS OF PAIN AND INDEPENDENCE OF DAILY ACTIVITIES (ADL) ON OSTEOARTHRITIS PATIENTS

Patients with osteoarthritis will experience pain and limitation of motion which has an impact on difficulty in performing activities of daily living (ADL). Patients with these conditions also require recovery after total knee replacement surgery to restore normal physical, psychological, social, habitual and daily life activities. This study aims to determine the description of pain levels and independence of activity daily living (ADL). This study uses a descriptive design. The population of this study were all total knee replacement patients, 37 samples were selected using purposive sampling. The results showed that a total of 49.7% experienced severe pain and 84.6% of respondents had activity daily living (ADL) activities that were not independent. Nurses are needed to help improve the health status of ostheoarthritis patients so that the patient's quality of life can be maintained optimally. Avoid diseases that can aggravate and can fulfill daily needs independently. Health agencies need to further improve health promotion regarding the maintenance of independence and efforts to overcome pain levels in ostheoarthritis patients

Vaginal natural orifice transluminal endoscopic surgery (vNOTES) right hemicolectomy with intracorporeal anastomosis for cecal cancer.

Vaginal natural orifice transluminal endoscopic surgery (vNOTES) for colorectal cancer utilizes transvaginal access for bowel mobilization, vascular pedicle ligation, oncological resection, and bowel anastomosis, along with subsequent transvaginal natural orifice specimen extraction (NOSE), reducing or eliminating the need for transabdominal access. In this report, we describe the technique of vNOTES right hemicolectomy for cecal cancer, with intracorporeal anastomosis and transvaginal NOSE, including a step-by-step operative video. The patient was a 59-year-old Chinese female (body mass index 32.0kg/m2) with a cT3N0M0 3 cm cecal adenocarcinoma. Posterior colpotomy was created with insertion of a dual-ring wound protector. vNOTES D2 right hemicolectomy witha fully stapled intracorporeal anastomosis was performed via a homemade transvaginal glove port, using extra-long rigid instruments. A 10 mm, 30° rigid laparoscope was used for operative visualization through a transumbilical port, without additional percutaneous trocars. Operative difficulties pertained to suboptimal instrument reach, lack of triangulation, and frequent clashing within the restricted access space. Surgical duration was 300min, with 50ml of blood loss. There was minimal postoperative pain. Return of bowel function occurred on postoperative day 2, with discharge from hospital on postoperative day 3. The patient resumed normal daily activities and regular diet by 1-week post-surgery. Self-reported cosmetic satisfaction score was excellent. No operative complications were observed at 2 months' follow-up. vNOTES right hemicolectomy with intracorporeal anastomosis is safe and feasible in highly selected colon cancer patients. Operators should be proficient in conventional laparoscopic colectomy and transvaginal NOSE. More experience with the vNOTES technique is required to ascertain best practices.

The Proteomic Analysis of Chronic Migraine Exosomes Reveals Disease Patterns and Potential Biomarkers.

Exosomes have been identified as optimal biomarkers to screen for multiple diseases. However, few studies focus on the abundant exosome population isolated from plasma of migraine. This study investigated whether proteins in abundant exosomes can aid in the diagnosis of chronic migraine (CM). Plasma exosomes were collected by centrifugation, from which protein samples were extracted. A pilot study (CM, 18; episodic migraine (EM), 26) followed by a second dataset (CM, 26; EM, 16; tension-type headache (TTH), 20; control, 22) was applied to establish a diagnostic model of CM. We employed proteomics based on liquid chromatography-tandem mass spectrometry (LC-MS/MS) to search for potential candidate biomarkers in plasma exosomes from CM patients. In total, 530 proteins in plasma exosomes were co-detected. Among them, 13 proteins were found significantly dysregulated between the plasma exosomes of CM patients and other groups. The receiver operating characteristic curve analysis revealed a combination of six proteins (upregulated: RAP2B, AK1, BID, DAG1, PICALM, PSMB2) could distinguish CM patients with high accuracy. Linear correlation analysis showed that the combination was significantly correlated with Headache Impact Test (HIT-6) scores (assessing the negative impact of headaches on normal daily activity). The RT-qPCR results showed the same trends in CM models with nitroglycerin as the exosomal protein sequencing results. These data revealed dysregulated proteins in plasma exosomes of CM, and the combination of plasma exosomal proteins RAP2B, AK1, BID, DAG1, PICALM, and PSMB2 could serve as a novel candidate biomarker for CM diagnosis.

AYURVEDIC MANAGEMENT OF AVASCULAR NECROSIS WITH CHANDAN BALA LAKSHADI TAIL AND LAKSHADI GUGGUL

Avascular Necrosis (AVN) is a progressive degenerative condition of bone that mainly affects the bone of the lower region. It is more common in the hip joint. Avascular necrosis of the femoral head refers to the death of osteocytes with subsequent structural changes due to impaired blood supply. People between 30 and 50 years of age are usually affected. It is associated with excessive alcohol intake and long-term use of high-dose steroidal medications. On the contrary, Ayurvedic treatment provides long-term relief and prevents disease progression without drawbacks. it is Vata Pradhana Tridoshaja Vyadhi with Vikruti of Asthi-Majja Dhatu. In modern medicine, no specific treatment other than surgery is available. The present case study is upon a 45year male patient, diagnosed with avascular necrosis involving nearly 50 percent of the femoral head with moderate marrow oedema (stage 3rd) femoral head with complaints of pain in the bilateral hip region since one and half years, which was associated with difficulty in doing normal daily activities such as walking, sitting, squatting along with a change in the gate.

Totally Extra Peritoneal Management of Inguinal Hernia Repair: Our Experience in a Public Sector Hospital

Objective: The study objective is to analyze the clinical effectiveness and efficiency of laparoscopic TEP in our set up and to determine its surgical outcomes regarding incidence of early and late post-operative complications. Materials and Methods: A retrospective descriptive study was conducted at Surgical Unit II, Benazir Bhutto Hospital, Rawalpindi Medical University for 5 years and 6 months from January 2018 to June 2023. After approval from the ethical board, data was collected as a qualitative research study through focus group interviews. Adult patients aged between 20 to 70 years, selected by retrospective consecutive sampling who were presented in surgical OPD with unilateral, bilateral, or recurrent inguinal hernia, underwent laparoscopic TEP hernia repair. Patients were reviewed on 1st post-operative day, during 1st week, and at 6 months to 1 year post-surgery. Data was entered into a standard SPSS sheet version 26. Results: The primary outcomes were evaluated based on early postoperative complications including wound infection, seromas or hematoma, urinary retention and abscess formation or mesh infection, and late complications including recurrence and chronic pain. Clear advantages were observed for the laparoscopic TEP technique regarding early return to normal daily activities due to reduced postoperative complications. Conclusions: The newer advanced concepts in hernia surgeries have proven to have good control over early complications, and postoperative pain, with minimal recurrence. Surgeons should acquire adequate experience and anatomical knowledge before performing this advanced inguinal repair surgery.

Pituitary germinoma after resection of a mature third ventricular teratoma: illustrative case.

Metachronous intracranial germ cell tumors (iGCTs)-unrelated, histologically different iGCTs occurring at different time points-occurring within the same patient remain a rarity. Herein, the authors report such a case and discuss the literature and potential pathophysiological mechanisms leading to this phenomenon. A 9-year-old boy presented with new-onset impaired balance, headaches, nausea, visual disturbances, and left facial paresis. Magnetic resonance imaging (MRI) scans revealed a suspected pineal region teratoma originating from the pineal gland with consecutive obstructive hydrocephalus. A mature teratoma was diagnosed and resected. Postoperative recovery was good, and the patient could return to his normal daily activities. However, a new, slowly progressive lesion in the sellar region with an enlarged infundibular stalk was detected on follow-up MRI 3.5 years after initial pineal region teratoma resection. Biopsy revealed a newly developed pure germinoma. The patient was treated with radiotherapy plus chemotherapy and remained relapse free at the last follow-up. Sixteen other cases have reported a surgically resected primary mature teratoma, wherein patients developed metachronous germinomas during follow-up. Different theories try to elaborate this phenomenon, yet none can completely account for it. Although rare, metachronous iGCT is a phenomenon neurosurgeons should be aware of. In patients treated for iGCT, close long-term clinical, imaging, and laboratory follow-up is recommended. https://thejns.org/doi/10.3171/CASE2443.

Endoscopic Vein Harvesting - How Do We Do It?

The saphenous vein graft (SVG) remains the most used conduit as a second graft in Coronary Artery Bypass Grafting (CABG).1 Traditionally, surgeons harvest SVG with an open approach, making a long incision along the medial part of the leg or thigh. This procedure can potentially result in important complications, such as delayed wound healing, postoperative pain and infection.2 Thus, less invasive techniques for vessel harvesting have grown in popularity. Endoscopic vein harvesting (EVH) is a minimally invasive harvesting procedure, which only requires a short incision, leading to less wound complications and a faster return to normal daily activities. This article intends to describe how we do EVH technique in our centre, from the preparation of the patient to the postoperative period and share some tips and tricks from our experience.