Patients In Study Group Research Articles

Effect of Designed Bundle Protocol about Ventilator Associated Pneumonia on Nurses' Performance, Compliance, and Patient Outcomes

Context: Ventilator-associated pneumonia (VAP) is considered one of the leading causes of morbidity and mortality due to nosocomial infections among ventilated patients.
 Aim: To evaluate the effect of a designed bundle protocol about ventilator-associated pneumonia on nurses' performance, compliance, and patient outcomes.
 Methods: The study employed the quasi-experimental research (pre/post-test) (study/control) design. This study was conducted at the intensive care unit of Benha University Hospital. A convenience sample of 50 critical care nurses and a purposive sample of 66 patients were enrolled in the current study. Three tools were used to collect data. Nurses' knowledge assessment questionnaire; nurses' practice assessment checklist; The VAP bundle compliance checklist; and patient outcomes assessment record.
 Results: Statistically significant improvement in total knowledge and practice mean scores post implementing a designed bundle protocol compared to pre-implementing a designed bundle protocol at p <0.001. Also, there was a statistically significant improvement in nurses’ compliance with a highly statistically significant difference between nurses’ compliance with practices of VAP bundle pre-and post designed bundle protocol implementation. Immediately after a designed bundle protocol implementation, the study group patients exhibited a statistically significant difference between all clinical pulmonary infection score items except for oxygenation status and radiographic findings.
 Conclusion: The study group nurses who received designed bundle protocol training would get improved knowledge, practices, and compliance scores than pre-designed bundle protocol training. Also, the study group of patients who were cared for by trained nurses on the designed bundle protocol would get better outcomes such as a better score of CPIS, shorter length of stay in the intensive care unit, less duration on mechanical ventilation compared to the control group who received routine hospital nursing care. The study recommended replication of the study using a large probability sample from a different geographical area to allow for greater generalization of the results.

Our experience in cell therapy in surgical problems

Aim: To study the effect and efficacy of autologous bone marrow cell therapy in various surgical pathologies of varied etiology which were refractory to conventional methods of management. Material and method: Ethical committee clearance and informed consent of patients were taken. Two groups of each surgical pathologies were selected randomly. The patients in study group were treated by conventional methods followed by autologous bone marrow cell application locally, whereas patients in control group were treated by conventional methods only. The patients were then followed post-operatively and analyzed by statistical methods. Result: Post-operatively the patients in study group experienced faster recovery by appearing good quality granulation tissue and rapid epithelisation and there was also significant reduction in local pain. Biopsy showed improved fibroblast, macrophages, neovascularisation and less necrosis per HPF in study group as comparison to control group. Conclusion: Autologous bone marrow cell therapy is a novel method in the management of various surgical pathologies.

The influence of prior dental pathology on medical complications and peri-prosthetic joint infections following primary shoulder arthroplasty.

Antibiotic prophylaxis before invasive dental procedures is a common practice in the USA. Consensus regarding the influence of prior dental pathology (DP) on postoperative complications is lacking. The objectives are to determine the association of DP prior to shoulder arthroplasty (SA) on: (1) lengths of stay (LOS), (2) medical complications, (3) readmissions, (4) implant-related complications including peri-prosthetic joint infections (PJIs) and (5) healthcare expenditures. The PearlDiver database was queried for primary shoulder arthroplasty from 2010 to 2020. Patients with history of dental caries or dental implant placement before SA represented the study group (n = 1419). Patients without prior DP represented controls (n = 7062). Study group patients were 1:5 ratio matched to controls by age, sex, and comorbidities. Outcomes included LOS, 90-day complications, readmissions, 2-year implant-related complications, and healthcare reimbursements. Logistic regression was used to calculate odds ratios (OR) of complications and readmissions. T tests compared LOS and costs. P values < 0.003 were significant. LOS (2.17 vs. 2.07days; p = 0.071) were similar between groups. Patients with DP had higher 90-day medical complications compared to controls (OR: 1.74, p < 0.0001), including myocardial infarctions (2.2% vs. 0.8%; OR: 2.79, p < 0.0001), acute kidney injuries (8.3% vs. 4.6%; OR: 1.92, p < 0.0001), and pneumonias (8.7% vs. 5.3%; OR: 1.72, p < 0.0001). Readmission rates (1.97% vs. 1.54%; p = 0.248) were similar. Two-year implant complications were higher in patients with DP compared to controls (16.1% vs. 11.5%; OR: 1.38, p = 0.0003), including dislocations (6.4% vs. 4.5%; OR: 1.45, p = 0.002) and mechanical loosenings (4.0% vs. 2.4%; OR: 1.67, p = 0.001); however, PJIs were similar (2.2% vs. 1.9%; OR: 1.12, p = 0.583). Healthcare expenditures between groups were similar ($12,611 vs. $12,059; p = 0.075). Patients with prior DP have higher 90-day medical complications and 2-year implant-related complications. Two-year incidence of PJIs were similar between groups. These findings can help shoulder surgeons counsel patients with a pertinent dental history. Retrospective comparative study.

Computer-aided clinical image analysis as a predictor of sentinel lymph node positivity in cutaneous melanoma.

BACKGROUNDDelays in sentinel lymph node (SLN) biopsy may affect the positivity of non-SLNs. For these reasons, effort is being directed at obtaining reliable information regarding SLN positivity prior to surgical excision. However, the existing tools, e.g., dermoscopy, do not recognize statistically significant predictive criteria for SLN positivity in melanomas.AIMTo investigate the possible association of computer-assisted objectively obtained color, color texture, sharpness and geometry variables with SLN positivity.METHODSWe retrospectively reviewed and analyzed the computerized medical records of all patients diagnosed with cutaneous melanoma in a tertiary hospital in Germany during a 3-year period. The study included patients with histologically confirmed melanomas with Breslow > 0.75 mm who underwent lesion excision and SLN biopsy during the study period and who had clinical images shot with a digital camera and a handheld ruler aligned beside the lesion.RESULTSNinety-nine patients with an equal number of lesions met the inclusion criteria and were included in the analysis. Overall mean (± standard deviation) age was 66 (15) years. The study group consisted of 20 patients with tumor-positive SLN (SLN+) biopsy, who were compared to 79 patients with tumor-negative SLN biopsy specimen (control group). The two groups differed significantly in terms of age (61 years vs 68 years) and histological subtype, with the SLN+ patients being younger and presenting more often with nodular or secondary nodular tumors (P < 0.05). The study group patients showed significantly higher eccentricity (i.e. distance between color and geometrical midpoint) as well as higher sharpness (i.e. these lesions were more discrete from the surrounding normal skin, P < 0.05). Regarding color variables, SLN+ patients demonstrated higher range in all four color intensities (gray, red, green, blue) and significantly higher skewness in three color intensities (gray, red, blue), P < 0.05. Color texture variables, i.e. lacunarity, were comparable in both groups.CONCLUSIONSLN+ patients demonstrated significantly higher eccentricity, higher sharpness, higher range in all four color intensities (gray, red, green, blue) and significantly higher skewness in three color intensities (gray, red, blue). Further prospective studies are needed to better understand the effectiveness of clinical image processing in SLN+ melanoma patients.

Effectiveness of Injected Platelet-Rich Plasma in the Treatment of Diabetic Foot Ulcer Disease.

ObjectivesPlatelet-rich plasma (PRP) has become quite a popular course of treatment and has tremendous healing properties. Our research question inquired about the effectiveness of injected formula of PRP as the cure for diabetic foot ulcer in comparison to the conventional dressing.Methodology A prospective observational study was conducted at the Department of Diabetes and Endocrinology, Lady Reading Hospital, Peshawar, Pakistan, between July 2020 to January 2021. Patients' data were collected from the department's database after taking approval from the department. In our study, the selected patients were categorized into two equal groups - i.e. 80 cases in each group and were randomized by using randomization allocation software. In group I (study group) patients received PRP (1 ml /1 cm2) around the wound edges and in the base of the ulcer, while group II (control group) patients were treated with conventional dressing. Each patient was inspected for wounds on days 0, 14, 28, 90, and 180 on the basis of Wagner's classification of wounds to assess efficacy. A proforma was used to collect the required data and then utilized electronically for research analysis.ResultsThe mean ± SD of age was 54.4±8.56 and 57.7±10.1 years in the injected PRP (study) and conventional dressing (control) groups, respectively. Of the 30 patients, 13 (43.3%) males and 17 (56.7%) females were enrolled in the study group, while 14 (46.7%) males and 16 (53.3%) females were included in the control group. The PRP was found effective in reducing the wound in about 64 (80%) patients, while wound dressing was effective in 37 (46.25%) patients (p<0.0001). In female patients, the wound healing was significantly better in the study group as compared to the control group (p<0.0001). Moreover, in patients aged above 55 years, frequently higher rates of wound reduction were observed in the study group as compared to the control group (p<0.0001). ConclusionThe study concluded that injected PRP was significantly better than conventional dressing in the management of diabetic foot ulcer. More clinical trials are necessary to evaluate the effectiveness of injected PRP to validate the current findings.

P82. The association of cannabis use disorder in patients undergoing primary 1- to 2- level lumbar fusion: an analysis of a nationwide claims database

<h3>BACKGROUND CONTEXT</h3> As the legalization of cannabis continues to increase nationwide, studies evaluating the association of cannabis use disorder (CUD) on outcomes following primary 1- to 2- level lumbar fusion (1-2LF) for lumbar degenerative disc disease (DDD) is of critical importance. <h3>PURPOSE</h3> Therefore, the aims of this study were to utilize a large nationwide administrative claims database to determine whether CUD patients undergoing 1-2LF for lumbar is associated with: 1) longer in-hospital lengths of stay (LOS); 2) medical complications; and 3) costs of care. <h3>STUDY DESIGN/SETTING</h3> Using a nationwide United States private payor database, a retrospective query from January 1, 2010 to December 31, 2018 was performed. Patients and complications were identified using International Classification of Disease, Ninth Revision (ICD-9), ICD-10, and Current Procedural Terminology (CPT) codes. <h3>PATIENT SAMPLE</h3> The inclusion criteria for the study group consisted of those patients undergoing primary 1-2LF for lumbar DDD who have CUD, while those patients without CUD served as the comparison cohort. Exclusions from the study were those patients undergoing spine surgery for traumatic causes, malignancy, infections, or more than 1- to 2- levels. To minimize any potential confounding bias, study group patients were 1:5 ratio matched to a comparison cohort by age, sex, and the following comorbid conditions - alcohol abuse, chronic obstructive pulmonary disease (COPD), diabetes mellitus, hyperlipidemia, hypertension, and obesity - defined as a body mass index greater than 30 kilograms per meter squared (kg/m2). Ratio matching was used to increase the overall sample size of the study. The aforementioned comorbid conditions were used as they have been associated with CUD. Following the random matching sequence, the query yielded 22,815 patients within the study (n = 3,805) and comparison (n = 19,010) cohort. <h3>OUTCOME MEASURES</h3> Primary endpoints of the study were to compare in-hospital LOS, 90-day medical complications, in addition to day of surgery and total global 90-day episode of care costs. <h3>METHODS</h3> Welch's t-tests were used to compare in-hospital LOS and costs of care, whereas a multivariate logistic regression model was used to calculate the odds-ratios (OR) and 95% confidence intervals (95%CI) on CUD on 90-day medical complications. Due to the ease of finding statistical significance with large database studies, a Bonferroni correction was performed to reduce the probability of a type I error. Thus, a p-value less than 0.001 was considered to be statistically significant. <h3>RESULTS</h3> CUD patients were found to have significantly longer in-hospital LOS compared to their counterparts (5- vs. 3- days, p < 0.0001). Additionally, CUD patients incurred significantly higher rates and odds of developing medical complications (31.88 vs. 18.01%; OR: 1.41, 95%CI: 1.29 to 1.54, p < 0.0001) such as deep vein thromboses (0.63 vs. 0.14%; OR: 3.07, 95%CI: 1.73 to 5.41, p < 0.0001), respiratory failures (0.81 vs. 0.22%: OR: 2.57, 95%CI: 1.58 to 4.13, p < 0.0001), myocardial infarctions (0.87 vs. 0.29%; OR: 2.08, 95%CI: 1.32 to 3.23, p < 0.0001), acute kidney injuries (4.05 vs. 1.62%; OR: 1.74, 95%CI: 1.41 to 2.14, p < 0.0001), pneumoniae (4.73 vs. 2.35%; OR: 1.51, 95%CI: 1.26 to 1.82, p < 0.0001), in addition to other complications (Table 2). CUD patients were also found to have significantly higher day of surgery ($54,196.00 vs. $52,717.26, p < 0.0001) and total global 90-day episode of care costs ($58,252.53 vs. $57,041.93, p < 0.0001). <h3>CONCLUSIONS</h3> As the number of states continue to decriminalize and legalize cannabis use, understanding the impact of CUD following surgical procedures is of critical importance. This study aimed to analyze the association of CUD on outcomes following 1-2LF for lumbar DDD. After adjusting for baseline covariates, this study of over 22,000 patients demonstrated CUD to be associated with longer in-hospital LOS, and higher rates of 90-day complications and healthcare expenditures. The study is vital as it can allow orthopedic surgeons and health care professionals to adequately educate patients on the outcomes of their procedure. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

The association of iron deficiency anemia and perioperative complications following revision total knee arthroplasty

BackgroundRecent studies show an increase in the prevalence of iron deficiency anemia (IDA) worldwide and a concomitant rise in the number of revision total knee arthroplasty (RTKA). The literature evaluating the association between IDA and perioperative outcomes following RTKA are limited. Therefore, the purpose of this study was to determine whether IDA patients undergoing RTKA have higher rates of (1) in-hospital lengths of stay (LOS), (2) complications; and (3) costs.MethodsUsing International Classification of Disease, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT), a retrospective query was performed from January 1st, 2005 to March 31st, 2014. The inclusion criteria consisted of those patients who have IDA undergoing RTKA. Study group patients were 1:5 ratio matched to a comparison cohort by age, sex, and various comorbidities: coronary artery disease, chronic obstructive pulmonary disease, diabetes mellitus, hyperlipidemia, hypertension, obesity, and tobacco use, yielding a total of 106,534 patients within the study (n = 17,784) and control (n = 88,750) cohorts. Outcomes assessed included: in-hospital LOS, costs of care, and medical complications. Multivariate Logistic regression analyses were used to calculate the odds-ratios (OR) and respective 95% confidence intervals (95%CI). Welch’s t-tests were used to compare in-hospital LOS and costs of care. Following Bonferroni-correction, a P-value less than 0.001 was considered statistically significant.ResultsIDA patients undergoing RTKA were found to have significantly higher in-hospital LOS (4-days vs. 3-days, P < 0.0001). Additionally, IDA patients were found to have significantly higher odds (OR) of medical complications (OR: 5.29, P < 0.0001) such as: pneumonia (OR: 6.86, P < 0.0001), respiratory failures (OR: 5.95, P < 0.0001), myocardial infarctions (OR: 4.31, P < 0.0001) and other complications. Furthermore, IDA patients incurred significantly higher day of surgery ($16,976.01 vs. $14,515.81, P < 0.0001) and 90-day costs ($22,548.71 vs. $16,819.15, P < 0.0001).ConclusionThe study demonstrated IDA patients undergoing RTKA have higher rates of in-hospital LOS, costs of care, and medical complications. Orthopedic surgeons and other healthcare professionals can use this information to adequately educate these patients of the potential complications following their procedure.

Characteristics and prevalence of orofacial pain as an initial symptom of oral and oropharyngeal cancer and its impact on the patient's functionality and quality of life

To evaluate the prevalence and characteristics of orofacial pain in oral and oropharyngeal cancer (OOC), at diagnosis. a) Study group (SG; n = 74) patients with cancer were divided into 2 subgroups: oral cancer (OC) and oropharyngeal cancer (OPC); b) control group (CG; n = 74) patients within dental care. An Orofacial Pain Assessment, verbal descriptive scale, Helkimo dysfunction index, Quality of Life questionnaire, and Karnofsky performance status (KPS) was used for evaluation. The mean age was 58.46 years (79.7% male) in SG, 58.61 years (20.3% male) in CG. The pain within the SG was indicated by the following: prevalence = 91.9% (21.6% in stages 0, I, or II; 70.3% in III or IV); reason for seeking care = 50.1%; main complaint = 55.4%; most important issue in the past 7 days = 74.3%; breakthrough-like pain = 64.9%; main features: chewing or swallowing as triggering factors, wake up patient, variable duration, independent of daytime, multiple descriptors, and earache. The following indexes were worse within the SG: clinical dysfunction, quality of life, and KPS. In addition, the OC subgroup reported toothache-like pain and burning; whereas the OPC subgroup reported heavy swallowing as triggering factor, throat as location, and a bilateral earache. At diagnosis, orofacial pain, including breakthrough-like pain, was prevalent in patients with OOC, and the pattern was heterogeneous. Predominantly, the pain was moderate to severe, related to stage of cancer, and already compromising the patients' quality of life and functionality.

Trends in use of prostacyclin analogs for management of CDH-associated pulmonary hypertension.

Off-label use of prostacyclins to manage congenital diaphragmatic hernia-associated pulmonary hypertension (CDH-PHTN) has been described over recent years, but use is not standardized across institutions. This study aims to describe trends in use of these medications in the CDH Study Group (CDHSG) patients. The CDHSG was queried for all patients born from 2007 to 2019. Records were reviewed to describe the number of patients receiving prostacyclins, the day of life on which the agent was started, start time relative to ECLS, the duration of medication use, and continuation of the medication at the time of discharge. Finally, trends in use by year of birth were evaluated to assess for changes in use over time. There were 6439 patients identified from the registry who were born during the study period. 4372 (68%) patients received medications to treat pulmonary hypertension. Of these, 604 (14%) received a prostacyclin at some point during their care. The median start time for prostacyclins was 7.5days of life (mean 16.9days, SD 32.5days), and the median duration was 12.5days (mean 25.1days, SD 49.1days). Among patients who received prostacyclins, 340 patients required ECLS during care, 53 (15.5%) of whom started the prostacyclin prior to ECLS, and 159 (46.8%) of whom started prostacyclin therapy during their ECLS run. Only a small cohort (26/604, 4.3%) required continuation of the prostacyclin at the time of discharge. The proportion of patients receiving a prostacyclin remained relatively stable over the study period. While the proportion of patients receiving a prostacyclin for management of CDH-PHTN has remained relatively stable over the last 13years, there is significant variation in timing of initiation and duration of use especially in the pre-ECLS period that warrants further investigation to describe optimal use in these patients.

Effective Analysis of Multichannel Functional Electrical Stimulation plus Early Rehabilitation Training for Hemiplegic Patients after Stroke.

Purpose The research paper aims to investigate the value of multichannel functional electrical stimulation (FES) plus early rehabilitation training for hemiplegic patients after stroke attacks and assesses the impact of the combined therapy on walking capacity and daily life activities of patients. Methods Totally, 100 hemiplegic patients after stroke treated in No. 215 Hospital of Shaanxi Nuclear Industry from March 2019 to July 2020 were recruited and randomized into the control group and study group, with 50 cases in each group. The control group received early rehabilitation training, and the study group received multiple channel FES plus early rehabilitation. The rehabilitation effective rate, the Fugl–Meyer Assessment (FMA), the Berg Balance Scale (BBS), National Institutes of Health Stroke Scale (NIHSS), Barthel index (BI), the Quality of Life index (QLI), Mental Status Scale in Nonpsychiatric Settings (MSSNS), Self-rating Anxiety Scale (SAS), Self-rating depression scale (SDS), and the incidence of adverse response were evaluated. Results The study group patients had higher scores in FMA, BBS, BI, and QLI than the control group. Multiple channel FES plus early rehabilitation adopted in the study group resulted in a higher rehabilitation efficacy and a longer walking duration at 1, 2, and 4 weeks after the treatment. NIHSS score, MSSNS score, SAS score, SDS score, and incidence rate of adverse response in the study group were significantly lower compared to those of the control group. Conclusions Multichannel FES plus early rehabilitation training effectively enhances the rehabilitation of patients after stroke attacks.

Leptin and Epicardial Fat: New Markers of Psoriasis in Children? Prospective Cross-Sectional Study

Background. Psoriasis is a polygenic multifactorial immune-mediated disease. Its course can be aggravated by associated obesity. Recently, there is negative trend that is characterized by the increase in the number of moderate to severe psoriasis cases among children, and majority of them have obesity. Identification of factors that that are relevant in these two conditions will allow us to improve and optimize the genetically engineered biological therapy for this category of patients.Objective. The aim of the study is to evaluate epicardial adipose tissue thickness, serum leptin levels, eating behavior via the data from Children’s Eating Behaviour Questionnaire (CEBQ) for patients with psoriasis and obesity, and compare the results with control group – patients with psoriasis and no associated obesity.Results. We have studied 12 patients with established diagnosis of psoriasis, 5 of them had diagnosis of obesity. Epicardial fat thickening was revealed in 20% of cases in the study group (patients with psoriasis and obesity), and no epicardial fat thickening was revealed in the control group. The increase in serum leptin was revealed in 100% of cases in obese patients with psoriasis, and only in 14% of cases in the control group. The mean leptin level in obese patients was 16.65 ng/ml, in the group with normal body weight – 7.08 ng/ml. Obese patients have shown higher values in “food approach” scales group in comparison to normal weight patients.Conclusion. Patients with obesity and psoriasis has shown elevated leptin levels, higher incidence of epicardial fat thickening, and tendency to develop abnormal eating behavior.

Right and left coronary artery angiography with single Judkins left catheter via right radial artery

Objectives: The aim of this study was to assess the safety and efficacy of single Judkins left (JL) catheter to view right and left coronary artery in right transradial coronary angiography. Methods: A total of 266 patients underwent coronary angiography from the right radial artery were studied prospectively. Patients with ad-hoc percutaneous coronary intervention (PCI), peripheral angiography, ventriculography or aortography procedures (67 patients) were excluded from the study. Coronary angiography was performed with the JL catheter as single catheter group in 171 of the remaining 199 patients, and with the Judkins right and left catheters as the control group in the other 28 patients. Complications, procedure success, procedure time and fluoroscopy time were evaluated between the two groups. Results: Procedure success were 93% (159/171) in patients with a single catheter group and 96.4% (27/28) in patients with two catheter (Judkins right and left) group (control group) (p = 0.49). Complications (spasm) are the same between the two groups (8 of 171 [4.7%] patients in study group and 1 of 28 [3.6%] patients in control group, p = 0.79). Fluroscopy time in single JL catheter group was significantly higher (6.20 ± 4.97 min vs 3.76 ± 2.78 min, p = 0.01). Conclusions: Single JL catheter using to view right and left coronary artery in right transradial coronary angiography was safe and effective. In our study, the success rate of getting left and right coronary artery images with a single JL catheter as high as 93%. However, insisting on imaging with a single catheter extends the duration of fluoroscopy time.

MEASUREMENT OF THE ATD ANGLE IN THE PATIENT OF DIABETICS MELLITUS: A RELIABLE MARKER.

Background: DM has been shown to be associated with certain dermatoglyphic traits and Indians in particular have been shown to be predisposed to DM. It can be used for early and inexpensive screening of individuals at risk for DM. Aim of present study was to measure the atdangle in the patient of Diabetics Mellitus and compare it with control. The present comparative case control study was conducted in theMaterial &amp; Methods: Department of Medicine, Saraswati Medical College&amp;Hospital, Unnao.100clinically diagnosed diabetic patients in study group werecompared with same age group of 100 non- diabetic patients. Patients with deformity of hand, Chromosomal abnormalities like Klinefelter's syndrome, Turner's syndrome etc. and diseases like congenital anomalies, neurological disorders, carcinomas and psychiatric diseases were excluded from the study. The mean atd angles were signicantly lower in DM group and mean dat angles were signicantly higher in DM groupObservation: than controls whereas adt angles were signicantly higher in left and signicantly lower in right of the DM group (p&lt;0.05). It was noted thatmean atd angles in both male and femaleparticipant was signicantly lower in DM group in both hand and mean dat angles were signicantly higher in DM than controls group; whereas adt angles in both male and female participants were higher signicantly in left and insignicantly lower in right of the DM group (p&lt;0.05). The mean Atd angles were signicantly decreased in DM group, angle 'Adt' showed signicant increase inConclusion: left hand and mean dat angles were signicantly increased in both hands of the cases as compared to controls.

P-43978269-291 - Intraoperative navigation and surgical margins in locally advanced malignant midface tumors.

<h3>Introduction</h3> The surgical treatment of midface tumors is often highly complex. The three-dimensional anatomy of the midface and advanced maxillary tumors make anatomical orientation difficult, which increases the risk of affected surgical margins. The main objective is to answer the question: Does intraoperative navigation improve oncological results in complex midface resections? <h3>Material and Methods</h3> Thirty-two patients with malignant midface advanced tumors were included.16 patients were prospectively selected and surgery was performed with intraoperative navigation (ION). A control group of 16 patients was retrospectively selected and surgery was performed without ION. A systematic margin analysis was performed selecting 6 surgical margins for each surgical piece and 192 surgical margins in total were analyzed. <h3>Results</h3> Squamous carcinoma was the most frequent histological type (56.25% in study group and 68.75% in control group). Complex maxillectomies (types IV-V-VI Brown and Shaw) were performed in 9 of 16 patients in study group (56.25%) and in 2 of 16 (12.5%) in control group. There were 11 of 96 margins affected in study group (11.5%) and 16 of 96 affected margins in control group (16.7%). Chi square test was not statistically significative (p 0.299). The most affected surgical margin was the deep margin in both groups, 9 of 16 (56.25%) in control group and 6 of 11 (54.5%) in the study group. <h3>Conclusion</h3> The use of intraoperative navigation facilitates the resection of advanced midface malignancies and it seems to improve tumor-free margin status with less intraoperative complications. However, further prospective trials with a larger cohort are required to confirm these preliminary results.

Serum protein and electrolyte imbalances are associated with chemotherapy induced neutropenia

IntroductionCancer and its treatment using various chemotherapeutic agents can have many adverse side effects. These side effects often result in significant changes in haematological and biochemical composition of blood. As a result, the regular monitoring of serum biochemical and haematological changes plays an important role in management of disease. The present study aimed to determine the relationship between haematological and biochemical changes in neutropenic cancer patients following chemotherapy. Specifically we evaluated the association between neutrophil count and serum proteins and electrolytes. MethodsFor this purpose we analysed retrospectively collected laboratory results from two independent patient cohorts. Each cohort was divided into a control group consisting of patients with normal haematological parameters and a study group which included patients with reduced neutrophil counts. Neutropenic patients (study group) were cancer patients on chemotherapy. Results and conclusionBlood samples of cancer patients in study group showed reduction in haemoglobin, neutrophils and platelets. Neutropenic group showed a significant reduction in serum albumin, total protein, calcium, and potassium. Our results show that patients with severe neutropenia had pronounced changes in serum protein and electrolytes and increased incidence of abnormal serum protein and electrolyte level. The changes in the neutrophil counts showed a positive correlation with the changes in serum protein and electrolyte levels. A similar trend was seen in both the patient cohorts: the discovery set (176 patients) and the validation set (200 patients). Taken together our results suggest that chemotherapy-induced neutropenia is associated with dysregulation in haemoglobin, platelets, serum proteins and electrolytes.

Effect of nursing interventions protocol on patients' clinical outcomes undergoing peri cerebral aneurysm coiling

Introduction: Cerebral aneurysm coiling considers ideal treatment for intracranial aneurysms. Objective: to evaluate the effect of nursing interventions protocol on patients' clinical outcomes undergoing peri cerebral aneurysm coiling. Materials and methods: Quasi-experimental study conducted at the Neuro-psychiatry Center affiliated to Tanta University. A Convenience sample of 60 adult patients undergoing peri cerebral aneurysm coiling for the first time. Four tools used Tool I Patients Structured interview schedule. Tool II Glasgow Coma Scale. Tool III Numerical rating scale. Tool IV: Post aneurysmal patient assessment tools. Results: The present study shows that less than half of both study and control group age ranged from 41-60 years, also it shows that more than half of study group and approximately two third of control group were female. In addition, it reveals that there was improvement of post aneurysmal coiling nursing interventions protocol mean results which include that majority of study group post nursing interventions protocol and minority of control group post routine hospital care haven’t localized pain and neck stiffness, furthermore all patients of study group and less than two third of control group haven’t localized hematoma, Moreover majority of study group and less than one quarter of control group haven’t aneurysmal nausea.

Personalized Embryo Transfer Outcomes in Recurrent Implantation Failure Patients Following Endometrial Receptivity Array With Pre-Implantation Genetic Testing.

IntroductionImplantation failure is a trending problem for pregnancy outcomes. Women's reproduction rates can increase by in-vitro fertilization, which comes with frequent implantation failures. These failures can be mitigated by the personalization of embryo transfer depending on the patient's implantation window. The study aimed to assess the importance of using an endometrial receptivity array (ERA) combined with pre-implantation genetic testing in patients with recurrent implantation failure (RIF) and the significant role of personalized embryo transfer (PET) after ERA in patients with a displaced window of implantation. The study also determined the efficacy of this approach in improving clinical outcomes.MethodsWe conducted this observational retrospective study following approval by the Ethics Committee of Wings In-Vitro Fertilization (IVF) Women's Hospital, a unit of Reveba Infertility Clinics Pvt. Ltd., Ahmadabad (Approval No. 2019/002/31B). Two hundred ninety-one RIF patients were recruited and categorized into Group I (patients without ERA group) and Group II (ERA study group). Patients in the ERA study group were screened for ERA and subclassified into receptive and nonreceptive ERA groups. PET was performed for all subjects in the ERA study group according to their receptivity as assessed by ERA. We also screened some of the patients for ploidy (genetic) status of embryos by pre-implantation genetic testing for aneuploidy (PGT-A) before embryo transfer. The study had a power of 95% and an alpha of 0.05; therefore, 80 ± 2 subjects were required to conduct the study. ResultsThe primary outcome was the clinical pregnancy rate followed by the implantation rate. We found an improved clinical pregnancy rate and implantation rate (73.5% and 78.6%) in the nonreceptive endometrial group after adjusting their embryo transfer schedule to their endometrial receptivity. The clinical pregnancy rate (64% and 65%) and implantation rate (65% and 74%) in receptive and nonreceptive ERA (respectively) were high in subjects with donor oocytes for IVF/intracytoplasmic sperm injection. In addition, patients who opted for PGT-A to eliminate the risk of transferring aneuploidy embryos had significantly better implantation (88% and 95% receptive and nonreceptive, respectively) and clinical pregnancy rates (100% in both groups) compared to non-PGT-A screened patients (p<0.05; 34% and 37% clinical pregnancy rate, 96% and 57% implantation rate in receptive and nonreceptive groups, respectively).ConclusionEndometrial receptivity assessment is a highly beneficial method to assess the genetic expression of the endometrium and embryo transfer timing. In our study, in patients with recurrent implantation failure, this technology found receptivity issues and provided a chance to plan embryo transfer according to the window of implantation. The combination of PGT-A with ERA rules out the genetic issues related to embryos. In RIF patients, ERA results-guided PET improved the implantation rate and reproductive outcomes.

FADS Polymorphisms Affect the Clinical and Biochemical Phenotypes of Metabolic Syndrome.

Long-chain polyunsaturated fatty acids (LC-PUFAs) play important roles in human health, from controlling inflammation to lipid and glucose homeostasis. In our previous study, which employed a cluster analysis of a plasma fatty acid (FA) pattern, we identified two clusters of metabolic syndrome (MetS) independent of clinical and biochemical parameters within the whole study group (controls together with metabolic syndrome (MetS) patients). FA desaturase (FADS) genes are the key regulators of LC-PUFA metabolism. The aim of this study was to analyze associations between FADS polymorphisms and clusters of MetS. The study group consisted of 188 controls and 166 patients with MetS. The first cluster contained 71 controls (CON1) and 109 MetS patients (MetS1). The second cluster consisted of 117 controls (CON2) and 57 MetS patients (MetS2). In comparison with MetS2, cluster MetS1 displayed a more adverse risk profile. Cluster CON1 had, in comparison with CON2, higher body weight and increased triacylglycerol levels (p < 0.05). We found that the FADS rs174537 (p < 0.001), rs174570 (p < 0.01), and rs174602 (p < 0.05) polymorphisms along with two inferred haplotypes had statistically significant genotype associations with the splitting of MetS into MetS1 and MetS2. Conversely, we observed no significant differences in the distribution of FADS polymorphisms between MetS and CON subjects, or between CON1 and CON2. These associations between FADS polymorphisms and two clusters of MetS (differing in waist circumference, HOMA-IR, lipolysis, and oxidative stress) implicate the important influence of genetic factors on the phenotypic manifestation of MetS.

Antegrade endobiliary forceps biopsy under the optical coherence tomography control in the diagnosis of Klatskin tumor: preliminary results

Background: Transcutaneous transhepatic endobiliary forceps biopsy is an accepted method for verification of extrahepatic cholangiocarcinoma, but its sensitivity ranges from zero to 94%. In the recent years, optical coherence tomography (OCT) has been actively used to diagnose malignancies.&#x0D; Aim: To assess diagnostic accuracy of the OCT-assisted intraductal forceps biopsy in patients with Klatskin tumor.&#x0D; Materials and methods: From 2013 to 2021, 161 patients with preliminary diagnosis of Klatskin tumor were seen in Russian Scientific Center of Radiology and Surgical Technologies named after Academician A.M. Granov. The retrospective study included 48 patients and 51 procedures of the forceps biopsy. In 14 (29%) patients of the main study group, the biopsy procedure was performed with OCT assistance, whereas the control group (34 patients, 71%) had their biopsies without the OCT.&#x0D; Results: All procedures were technically successful. In the main and in the control study groups, sensitivity was 92.3% versus 73.3% (p = 0.32) and specificity 100% versus 85.7% (p = 0.88), respectively. Malignant neoplasm of the biliary tract was found in 13 cases versus 23 in the control group, with the degree of the tumor differentiation being determined in 64.3% (n = 9), versus 48.7% (n = 18) (p = 0.89), respectively. There were no adverse events associated with OCT and biopsy sampling in the main study group. In the control group, 4/37 procedures (10.8%) were associated with hemobilia, which was successfully treated conservatively within 24 hours without any prolongation of the hospital stay.&#x0D; Conclusion: Our preliminary results indicate that antegrade endobiliary forceps biopsy is a safe and informative technique. The OCT navigation increases the sensitivity and specificity of the diagnosis. This allows for a personalized choice of chemotherapy. OCT is a promising technique for differential diagnosis of Klatskin tumor from benign biliary strictures. Further large-scale studies are required to introduce it into everyday practice.

Effectiveness of Cognitive Restructuring on Intensity of Pain in Cancer Patients: A Pilot Study in Oncology Department of Tertiary Care Hospital.

Background:Pain is a most feared symptom among cancer patients. It not only affects physical health but it is a psychological burden and affects overall quality of life in cancer patients. it interferes the activity of daily living and treatment outcome. cognitive restructuring is very useful psychological treatment to reduce pain. Objectives:The purpose of the study was to assess level of pain, evaluate effectiveness of cognitive restructuring on intensity of pain and to find association of pain with demographic variables. Methods:Quasi experimental study was conducted in oncology department of SKIMS tertiary care hospital. Purposive sampling technique was used to select 22 patients for study group and 22 patients for control group. CBPS and Numerical rating pain scale was used to measure intensity of pain. Data collected by interview method. Results:The results showed significant difference p<0.05 at only in anxiety,face and activity on CBPS scores. Mean score of NPRS was 27.27% of moderate pain and severe pain reduced from 63.64 to to 0.% in study group after CR. Results revealed Significant association of pain with age, gender and period of illness. Conclusion:Based on findings of the study it is concluded that CR has significant impact in cancer patients on reducing pain and can ease problems related to pain. CR is an appropriate intervention to reduce the symptoms of cancer patients which has indirect impact on cancer treatment.