Patient Recovery Time Research Articles

Retrospective analysis of prognostic factors in HICH patients after neuroendoscopic hematoma evacuation

The objective of this study is to investigate key prognostic factors of clinical data and prognostic factors in patients with hypertensive intracerebral hemorrhage (HICH) who have undergone neuroendoscopic hematoma evacuation, specifically focusing on those with a hemorrhage volume of 20-40 mL, to identify the determinants influencing their prognosis. In this study, a total of 113 patients were ultimately included in the analysis. Variables such as age, preoperative Glasgow Coma Scale (GCS) scores, and hemorrhage locations were assessed. LASSO logistic regression was employed to select pertinent variables, which were then incorporated into a multivariate logistic regression model. The model’s performance was evaluated using ROC and calibration curves, along with clinical utility curves, and the recovery times of patients were analyzed using Kaplan–Meier curves, complemented by COX regression analysis. These three variables—Age (OR: 0.811; 95% CI 0.711–0.925), GCS score (OR: 25.923; 95% CI 4.108–163.598), and ICH location (OR: 7.345; 95% CI 1.811–29.783)—are strong predictors of intracerebral hemorrhage prognosis. Among the patients analyzed, 85.84% experienced a favorable prognosis. Younger age, higher preoperative GCS scores, and hemorrhages located in the basal ganglia and cerebral lobes were associated with better outcomes (mRS score of 0–3) . The nomogram, validated by an ROC curve analysis yielding an AUC of 0.9417 and the Hosmer–Lemeshow test, demonstrated accurate predictive and calibration capabilities for postoperative prognosis in patients with hypertensive intracerebral hemorrhage. Kaplan–Meier intervals and COX regression analysis indicated that age is a significant factor affecting the recovery time of these patients. Age, GCS score, and ICH location are significant prognostic factors for patients undergoing neuroendoscopic hematoma evacuation following hypertensive intracerebral hemorrhage, with age being a particularly important determinant of recovery time. Younger age, higher GCS scores, and lobar hemorrhage are associated with better prognosis.

Early results of female patients who underwent mitral valve surgery through periareolar incision approach.

Approaches that require less invasive procedures, offer heal in a shorter time and provide better cosmetic results have gained importance with the technological and modern developments in cardiac surgery. Esthetically preferred results can be achieved after heart valve surgery using a periareolar incision, especially in female patients. In the present study, we aimed to present our results after surgery using periareolar incision in female patients. We retrospectively evaluated the 1-year follow-up results in the postoperative period of isolated mitral valve replacement and tricuspid valve repair with mitral valve replacement using a periareolar incision with direct observation in 32 patients between 2020 and 2023. At the end of 1-year follow-up, we evaluated the patients' visual satisfaction with the incision site using a visual analog scale. According to the postoperative follow-up results, no prosthetic mitral valve dysfunction was detected in any of the patients at the 1st year echocardiography controls. Mild tricuspid valve insufficiency was detected in 3 patients who underwent tricuspid valve repair. Besides, a high level of satisfaction was observed in the patients' incision site evaluations with a visual analog scale at the end of the first year, and no numbness was reported in the periareolar region in any of the patients. Our study shows that surgical results similar to conventional methods can be achieved with the periareolar approach, and patient satisfaction and recovery times are shorter and more satisfying. We also think that the periareolar incision can be made without videoassisted equipment and this may reduce the surgical cost.

Combining azole antifungals with venetoclax plus azacitidine in patients with newly diagnosed acute myeloid leukemia

ABSTRACT The combination of venetoclax (VEN) with hypomethylating agents (HMAs) improves survival in patients with acute myeloid leukemia (AML) and may cause neutropenia requiring combined antifungal therapy or prophylaxis. The inhibition of cytochrome P450 activity by azole antifungal agents leads to elevated blood concentrations of VEN. This study aimed to evaluate the efficacy and safety of venetoclax plus azacitidine (AZA) with azoles in newly diagnosed AML patients. The primary endpoints included complete remission (CR), complete remission with incomplete blood cell recovery (CRi), composite CR (CRc, CR + CRi), blood cell recovery time and incidence of infections. The CRc was 50.0% in the azole group and 56% in the nonazole group (p > 0.05). In the azole group, the median recovery times for patients with ANC >500 cells/mm3 and ANC >1,000 cells/mm3 were 19 and 25 days, respectively. For the nonazole group, the corresponding times were 16 and 19 days (p < 0.05). In the azole group, the median durations for patients with a PLT >50,000/mm3 and >100,000/mm3 were 18 and 20 days, respectively. For the nonazole group, the corresponding times were 16 and 19 days (p > 0.05). The incidences of fungal and bacterial infections were not significantly different (30.8% vs 26.1% and 50.0% vs 56.0%) (p > 0.05). The cost-effectiveness ratio of the azole group is lower. There was no significant difference between VEN + AZA with or without azole in terms of efficacy, infection, or partial hematological toxicity. However, the combination of azoles may prolong the neutrophil recovery time. Azole combination could reduce the amount of venetoclax and improve health economics.

Клінічна характеристика та особливості хірургічного лікування пацієнтів із простими кістами нирок

Simple renal cysts are quite common in adults with an incidence that increases with age. Renal cysts are composed of enclosed liquid or semisolid fluid and are commonly identified through abdominal imaging. The purpose of this study was to compare the clinical and laboratory characteristics of patients with simple renal cysts who underwent aspiration sclerotherapy or laparoscopic resection and establish the association between these parameters. The research was conduc­ted on the basis of the urology department of the St. Panteleimon Hospital between 2021 and 2023, 46 patients who underwent surgical removal of a renal cysts were analyzed. The main methods of treating kidney cysts were aspiration sclerotherapy and laparoscopic unroofing. Patients were divided into groups depending on the treatment method (aspiration sclerothe­rapy or laparoscopic unroofing). In order to establish the differences, a comparative analysis was carried out by age, sex, results of clinical parameters, cyst localization and recurren­ces. The association between clinical parameters and treatment methods was assessed using Pearson’s χ2 test. Statistical analysis of the obtained data was carried out with the help of software packages SPSS v. 25.0 and EXCEL. There were 13 men (62 %) and 8 women (38 %) among patients who underwent lapa­roscopic unroofing. Right renal cysts were found in 8 patients (38 %), and left renal cysts were found in 13 patients (62 %). The mean age of the patients was 56±2.6 years. Among the patients undergoing aspiration sclerotherapy, there were 11 men (44 %) and 14 women (56 %). The right kidney cyst was found in 14 patients (56 %), and the left kidney cyst was found in 11 patients (44 %). The mean age of the patients was 63±2.2 years. The mean size of kidney cysts in patients who underwent laparoscopic unroofing was 70±3.6 mm. In patients undergoing aspiration sclerotherapy, the size of kidney cysts was 72±5.4 mm. There was no statistically significant difference in age, sex, and size of kidney cysts in patients who underwent aspiration sclerotherapy and laparoscopic unroofing. It was established that there was no statistically significant difference in age, sex, or size of renal cysts in patients undergoing surgical treatment. In patients after laparoscopic unroofing, relapses have not been established in the clinic. However, the frequency of recurrence in patients after aspiration sclerotherapy is 74±9 % of the total number of patients, which is a fairly high rate of recurrence of renal cysts. We found that laparoscopic unroofing was associated with a lower recurrence rate compared with aspiration sclerotherapy. It should be noted that laparoscopic unroofing is a more effective method of treatment compared to aspiration sclerotherapy. We emphasize that laparoscopy is a modern approach to renal cyst surgery, which not only reduces trauma, shortens the recovery time of patients, but also ensures high accuracy and efficiency of treatment.

Time to recovery following cataract surgery and its predictors among patients undergoing surgery at two selected Public Hospitals in Hawassa, Sidama, Ethiopia.

Cataract surgery is a commonly performed procedure aimed at restoring vision in individuals affected by cataracts. The duration of recovery following cataract surgery can vary among patients and is influenced by a multitude of factors. Therefore, the purpose of this study was to determine the time to recovery from cataracts and its predictors among patients treated with cataract surgery at two selected Public Hospitals in Hawassa, Sidama regional state, Ethiopia. Institution-based retrospective cohort study was conducted among 444 cataract patients treated with surgery from January 01, 2019, to December 30, 2021. A simple random sampling method was used to select two public hospitals. The data was collected using Kobo toolbox Version 4 and trained data collectors. STATA Version 16 was used for analysis. To estimate the recovery time and compare survival probability among variables Kaplan-Meir curve and Log-rank test were used. The cox-Proportional hazards model was used to identify significant predictors of time to recovery. The association was reported using the adjusted hazards ratio (AHR) with a 95% confidence interval (95%CI), and the significance level was set at a p-value of 0.05. This study showed that 76.14% of cataract patients recovered from cataracts. The average time taken to recover from a cataract was 30 weeks (IQR = 15 to 48) 95%, CI, (26-33). Age 40-60 years (AHR = 2.04 CI; 1.12-3.82), urban dwellers (AHR = 1.48; 95% CI, 1.13-1.93), medium/high level of visual acuity (AHR = 1.49 CI; 1.14-1.94), secondary cataract (AHR = 1.56 CI; 1.11-2.18) and traumatic cataract (AHR = 1.82 CI; 1.32-2.52) were associated with time to recovery of cataract patients. According to this study, the time to recovery of cataract patients was slightly high. Cataract patients' time to recovery was affected by age, residence, pre-operative visual acuity, presence of diabetes mellitus, and post-operative complications. To improve recovery time of cataract patients, treatment strategies must be prioritized.

Early vestibular rehabilitation initiation is associated with faster recovery after sport related concussion

ObjectivesVestibular rehabilitation is a recommended treatment after sport related concussion (SRC), but the optimal timing is not fully understood. This research examined the association between the timing of vestibular rehabilitation initiation and recovery time in adolescent patients with SRC. DesignRetrospective cross-sectional. Methods112 patients with SRC were referred to vestibular rehabilitation at a specialty concussion clinic. Vestibular rehabilitation initiation was defined as days from date of injury to date of first vestibular rehabilitation assessment. Patients were dichotomized by vestibular rehabilitation initiation: EARLY (8–10 days) and LATE (>10 days). Recovery time was defined as days between injury and medical clearance from the clinic. Results60 (average age 15.22 ± 1.61 years; 51.7 % male) patients were in the EARLY group and 52 (average age 15.37 ± 1.31 years, 28.9 % male) patients were in the LATE group. There were more female patients in the LATE group (p = 0.01) and the LATE group had their first clinic visit later than the EARLY group (p < 0.02). The EARLY group had shorter recovery time (median 26, IQR [21, 32.5] days) compared to the LATE group (median 31, IQR [23.5, 52.5] days; p = 0.02). After controlling for confounding variables, the LATE group had recovery times that were 1.39 times as long as the EARLY group (p < 0.01). ConclusionsFor patients with vestibular issues after SRC, early vestibular rehabilitation initiation is associated with faster recovery time after SRC. The current study provides clarity on the optimal timing of vestibular rehabilitation after SRC.

Meta-analysis study on anesthetic sedation recovery and onset times in pediatric and elderly patients undergoing CT and MRI.

Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are crucial diagnostic modalities that require patients to remain immobile for extended periods, with anesthesia sometimes used for comfort and image quality enhancement. The study compares dexmedetomidine and propofol in reducing recovery time and sedation onset in pediatric and elderly patients undergoing CT and MRI procedures. A meta-analysis of fifteen studies assessing recovery time, sedation onset, and failed sedation between dexmedetomidine and propofol in pediatric and elderly patients during CT and MRI was conducted. The study indicated that the administration of anaesthesia markedly improved patient compliance and reduced motion artefacts in both CT and MRI (P<0.00001, I2=94%). The meta-analysis indicated that the mean difference (MD) in the onset of sedation was significantly faster in the control group (P<0.00001, I2=96%). The study reveals that dexmedetomidine and propofol anesthesia can improve patient image quality during CT and MRI procedures by reducing motion artefacts. Dexmedetomidine sedated people more quickly than propofol, but no significant differences in sedation duration were observed.

Is the transection of the hernia sac during laparoscopic inguinal hernioplasty safe and feasible? An updated systematic review and meta-analysis.

There is a debate over whether to transect or completely reduce the hernia sac during laparoscopic tension-free repair of inguinal hernia. This study endeavors to systematically assess the efficacy and safety of two approaches, namely transected sac (TS) and completely reduced sac (RS), in laparoscopic tension-free repair of inguinal hernia. Utilizing a meta-analysis methodology, we aim to provide a comprehensive analysis of these techniques. A comprehensive search was conducted across PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov databases to identify comparative studies focusing on laparoscopic tension-free repair of inguinal hernia, specifically comparing TS and RS techniques. The selected studies were subjected to meta-analysis using RevMan 5.3 software. A total of 8 studies, involving 2995 patients with inguinal hernia, were included in the analysis. The meta-analysis results revealed that the TS group had a higher incidence of seroma compared to the RS group [OR = 1.74, 95% CI (1.35, 2.25), P < 0.0001], and a prolonged time to return to normal activity postoperatively [MD = 0.99, 95% CI (0.85, 1.14), P < 0.00001]. However, no statistically significant differences were observed between the two groups in terms of operation time [MD = -1.75, 95% CI (- 8.72, 5.22), P = 0.62], incidence of postoperative pain [OR = 1.00, 95% CI (0.41, 2.44), P = 1.00], overall postoperative complication rate [OR = 0.98, 95% CI (0.43, 2.20), P = 0.95], and recurrence rate fOR = 2.53, 95% CI (0.61, 10.39), P = 0.20]. Transected sac in laparoscopic inguinal hernia repair is associated with an increased incidence of seroma and a longer recovery time for patients to return to normal activity. Clinical trial registration Registration number is INPLASY20223110070.

Unleashing the potential of AI in modern healthcare: Machine learning algorithms and intelligent medical robots

Artificial intelligence (AI) is playing an increasingly vital role in transforming the medical field, particularly in areas like medical imaging, clinical decision-making, pathology, and minimally invasive surgery. The rapid growth of medical data and the continuous refinement of machine learning algorithms have propelled AI's integration into healthcare. This study explores the advancements and applications of AI, specifically machine learning algorithms and intelligent medical robots, in enhancing diagnostics, treatment, and healthcare delivery. A comprehensive review of current AI applications in healthcare, including its use in medical imaging, pathology, clinical decision-making, and robotic-assisted surgery, was conducted. AI technologies such as the Da Vinci Surgical Robot and machine learning-based diagnostic tools have significantly improved diagnostic accuracy and the precision of minimally invasive surgeries. AI-driven systems also contributed to better clinical decision support, faster recovery times for patients, and more accurate treatment plans. Overall, AI, through machine learning algorithms and intelligent medical robots, is revolutionizing healthcare by offering promising improvements in diagnostics, surgical precision, and patient care.

Rapid recovery after total hip arthroplasty: direct anterior approach combined with PENG block and lateral cutaneous femoral nerve block

Introduction The "gold" standard for the treatment of late stages of coxarthrosis is total hip arthroplasty. Direct anterior approach (DAA) refers to minimally invasive surgical interventions in orthopaedics. Extended anesthetic measures in combination with low-traumatic surgical techniques may reduce postoperative pain and accelerate patient's recovery.The purpose of the study was to compare the recovery times of patients after hip arthroplasty using DAA in combination with PENG block, lateral cutaneous femoral nerve (LCFN) block and without extended anesthetic measures.Materials and methods A prospective randomized comparative clinical study was performed, which involved 62 patients divided into two groups: the study one (n = 29) and the control one (n = 33). In both groups, arthroplasty was performed using DAA. Patients of the study group underwent PENG block and LCFN block. The patients in the control group did not receive extended anesthesia. The evaluation criteria were pain assessment using the visual analogue scale (VAS), administration of painkillers, patient’s mobility and the length of hospital stay.Results The VAS score for pain in the study group were lower than in the control group after 6 hours — 3.7 (3.4; 4.1) and 4.3 (4.2; 4.8); 24 hours after surgery — 3.5 (3.3; 3.6) and 4.1 (3.9; 4.5) (p &lt; 0.001). After 48 hours, the indices were comparable: 3.5 (3.1; 4.1) and 3.7 (3.6; 3.9) (p = 0.19). The rate of requests for pain relief in the first 24 hours was lower in the study group than in the control group: 2 (1; 2) and 3 (2; 3) cases (p = 0.003). The results of the manual muscle test after 6 hours and 24 hours were comparable (p &gt; 0.05). The time interval between the end of the operation and the first walking on crutches was shorter in the study group — 3.1 hours (2.9; 3.4) and 3.98 hours (3.8; 4.2) (p &lt; 0.001). The length of hospital stay was shorter in the study group: 1.5 (1.2; 2) and 2.5 (2; 3) days (p &lt; 0.001).Discussion Lower postoperative pain allows faster activation of patients, thus improving the results of the early rehabilitation period.Conclusion The use of PENG block and LCFN block in arthroplasty with the use of DAA has clinical effectiveness in the first 24 hours, and helps to accelerate the postoperative recovery of patients.

Predictors of Post-COVID-19 Recovery: A Single-Center Study

Background: The average duration of recovery time in COVID-19 patients after contracting can be affected by various factors. Understanding the average duration of recovery time is important in formulating preventive measures/interventions. This study aims to assess predictors of post-COVID-19 recovery. Methods: This observational longitudinal study was conducted among COVID-19 patients admitted to Vasei Hospital in Sabzevar, Iran in 2021. Data were extracted from the Hospital Information System. COVID-19 Experiences (COVEX) questionnaire was used to assess the type and severity of symptoms. Patients who were admitted to the hospital were assessed at baseline and were followed up one month and two months after discharge through telephone calls. Chi-square test was used to examine the association between demographic variables, clinical variables, disease symptoms, and time to recovery. Results: A total of 250 COVID-19 cases were followed up for 30 and 60 days after discharge. The mean duration of recovery from COVID-19 was significantly higher in women, old patients, those with higher BMI, cases without physical activity, those with severe chest CT scan results, patients with severe diseases, and those who were discharged after 30 days (P-Value&lt; 0.05). Patients with dry cough and chest pain were less likely to make a full recovery after 30 days. The cases with dry cough, headache, dyspnea, and chest pain were less likely to make a full recovery after 60 days than those without (P-Value&lt; 0.05). Conclusion: Health providers in healthcare centers should give priority to high-risk groups (e.g. those with severe chest radiography results, and those with severe disease severity). The presence of dry cough and chest pain was found to be a risk factor for delayed recovery. Initial assessment of COVID-19 patients, such as chest CT scans, can predict the severity of the disease and unfavorable outcomes. Moreover, it seems the management of comorbidities can play a vital role in recovery from COVID-19.

Effect of Nutritional Status and Haemodialysis Parameters on Health Related Quality of Life and Post Dialysis Recovery Time in Prevalent Haemodialysis Patients

Abstract Background The majority of patients with an impaired renal function may be classified as to a certain stage of chronic kidney disease (CKD) progressing to end-stage renal disease (ESRD) and requiring renal replacement therapy (RRT). Aim of the Work To study the effect of current nutritional status of haemodialysis patients and other variables (socio-demographic, physical, biochemical and dialysis treatment parameters) on health related quality of life and post dialysis recovery time among haemodialysis patients in haemodialysis units in Desouq general hospital, Kafr-Elshiekh Governorate. Patients and Methods Type of Study: We conducted an observational cross-sectional study. Study Setting: The study was conducted in haemodialysis units in Desouq general hospital, Kafr-Elshiekh governorate. Study Period: from July to September in 2021. Study Population: 100 prevalent End Stage Renal Disease (ESRD) patients on regular haemodialysis 3 times per week in Desouq general hospital. Results The result of this study concluded that the factors affecting nutritional status for those patients were age &amp; dialysis wintage, serum HB, serum calcium, both serum albumin &amp; serum pre-albumin, intake of: (carbohydrate, potassium, calcium, phosphorous &amp; magnesium) &amp; anthropometric measurement of; (Weight, BMI, calf circumference, BSF, TSF, MAMC &amp; MAC). Also, our study concluded that the factors affecting QOL for our patients were; SGA score (as a surrogate for nutritional status), duration of session, serum albumin &amp; prealbumin, height, MAC, MAMC &amp;calf circumference. Patients with poor nutrition have a poor physical and mental quality of life. Hence, it becomes important (not only for us but also for them) to identify such patients and intervene earlier, in order to improve their quality of life and also reduce morbidity which in turn helps in reducing mortality. Conclusion Malnutrition is one of the most commonly encountered (&amp;treatable) problems in haemodialysis population in Egypt as it increases the morbidity and mortality. SGA (M- SGAS) and HRQOL SF 36 (Kidney Disease and Quality of Life--Short Form (KDQOL- SF™) version 1.3) are simple to use, bedside and readily available tools for nutritional &amp; QOL assessment of MHD patients, respectively.

Comparison between Low Flux and High Flux Hemodialysis in Rebound of the Metabolic Profile and in Post-Dialysis Recovery Time in Prevalent Hemodialysis Patients

Abstract Background It is known that the high flux membranes now are widely used all over the world due to the higher permeability of the high flux membranes compared to low flux ones to middle molecules, remove more serum endotoxins and improve the patient general condition and quality of life. This study aims at exploring the effect of using High flux membrane in rebound metabolic profile in the prevalent hemodialysis patients and also its effect on post dialysis recovery time Methods This descriptive analytic study included the available data in hemodialysis patients in Port- Said Al Eman Hemodialysis Unit. Data was collected between March and September 2022. This clinical trial, 100 patients who met the inclusion criteria were randomly assigned to have their regular hemodialysis sessions with low flux dialysis membranes and examined for rebound metabolic laboratory investigations (4 hours post dialysis) and post dialysis recovery time questionnaire DRT, then compare the same previois parameters while using high flux dialysis membranes and consider which of both dialysers is better to use for the hemodialysis patients Results Of the 100 patients in the sample the Mean 4 hours post dialysis urea in low flux was 106.65 ± 3.1 and in high flux was 76.67 ± 3.1. Mean 4 hours post dialysis phosphorus in low flux was 6.17 ± 0.14 and in high flux was 4.45 ± 0.14. Mean 4 hours post dialysis CRP in low flux was 7.88 ± 0.72 and in high flux which was 3.84 ± 0.72. Mean 4 hours post dialysis Calcium in low flux was 9.17 ± 0.09 and in high flux which was 9.77 ± 0.09. Mean 4 hours post dialysis Potassium in low flux was 5.3 ± 0.08 and in high flux which was 4.7 ± 0.08. Mean 4 hours post dialysis Magnesium in low flux was 2.24 ± 0.03 and in high flux which was 2.33 ± 0.03. Mean 4 hours post dialysis Bicarbonate in low flux was 21.96 ± 0.27 and in high flux which was 24.23 ± 0.27. Significant strong correlation between The fewer CRP Rebound 4 hours post and the shorter the post dialysis recovery time in high flux membrane p = 0.003. Significant strong correlation between The fewer Ultrafiltration volume removal and the shorter the post dialysis recovery time in both dialysers p &amp;lt; 0.001. Significant strong correlation between The lower decrease in serum Bicarbonate level and post dialysis 4 hours and post dialysis recovery time in high flux membranes p &amp;lt; 0.001. Conclusion The fewer CRP rebound and higher Bicarbonate serum concentration 4 hours post dialysis and the shorter the post dialysis recovery time.

Exosomes and microRNAs: insights into their roles in thermal-induced skin injury, wound healing and scarring.

A burn is a type of injury to the skin or other tissues caused by heat, chemicals, electricity, sunlight, or radiation. Burn injuries have been proven to have the potential for long-term detrimental effects on the human body. The conventional therapeutic approaches are not able to effectively and easily heal these burn wounds completely. The main potential drawbacks of these treatments include hypertrophic scarring, contracture, infection, necrosis, allergic reactions, prolonged healing times, and unsatisfactory cosmetic results. The existence of these drawbacks and limitations in current treatment approaches necessitates the need to search for and develop better, more efficient therapies. The regenerative potential of microRNAs (miRNAs) and the exosomal miRNAs derived from various cell types, especially stem cells, offer advantages that outweigh traditional burn wound healing treatment procedures. The use of multiple types of stem cells is gaining interest due to their improved healing efficiency for various applications. Stem cells have several key distinguishing characteristics, including the ability to promote more effective and rapid healing of burn wounds, reduced inflammation levels at the wound site, and less scar tissue formation and fibrosis. In this review, we have discussed the stages of wound healing, the role of exosomes and miRNAs in improving thermal-induced wounds, and the impact of miRNAs in preventing the formation of hypertrophic scars. Research studies, pre-clinical and clinical, on the use of different cell-derived exosomal miRNAs and miRNAs for the treatment of thermal burns have been documented from the year 2000 up to the current time. Studies show that the use of different cell-derived exosomal miRNAs and miRNAs can improve the healing of burn wounds. The migration of exosomal miRNAs to the site of a wound leads to inhibition of apoptosis, induction of autophagy, re-epithelialization, granulation, regeneration of skin appendages, and angiogenesis. In conclusion, this study underscores the importance of integrating miRNA and exosome research into treatment strategies for burn injuries, paving the way for novel therapeutic approaches that could significantly improve patient outcomes and recovery times.

Continuous Catheter Techniques Versus Single-Injection Nerve Blocks: A Comprehensive Review of Postoperative Pain Management Strategies.

Effective postoperative pain management is crucial for optimizing patient recovery and enhancing surgical outcomes. This review compares two prominent regional anesthesia techniques, continuous catheter techniques and single-injection nerve blocks, focusing on their efficacy, safety, and impact on patient outcomes. Single-injection nerve blocks involve administering a one-time anesthetic dose to a specific nerve or plexus, offering immediate but transient pain relief. In contrast, continuous catheter techniques utilize a catheter to deliver a continuous infusion of anesthetic, providing extended analgesia. The review synthesizes current evidence on the effectiveness of each method, highlighting that single-injection blocks are advantageous for their simplicity and rapid onset but may require supplementary pain management for longer procedures. Continuous catheter techniques, while offering prolonged pain relief, carry risks such as infection and catheter displacement. The comparative analysis of these techniques reveals that both have distinct roles in postoperative care, with choice depending on the surgical procedure and patient needs. Patient satisfaction, recovery times, and overall outcomes are critical factors in determining the optimal pain management strategy. Future research should focus on refining these techniques and exploring innovations to improve patient care and pain management outcomes. This review provides insights for clinicians to make informed decisions about postoperative pain management to enhance patient comfort and recovery.

Comparison of dexmedetomidine versus nalbuphine in ketamine based procedural sedation for pediatric cathlab procedures: A prospective double blinded randomized trial

: The aim of the current study was to compare the effects of nalbuphine and dexmedetomidine as premedication sedative agent for ketamine based deep sedation on hemodynamics, sedation level and need for additional boluses of ketamine, and recovery time in pediatric patients undergoing various cardiac catheterization procedure.: Sixty pediatric patients undergoing cardiac catheterization were enrolled in the current study. Patients were randomly distributed to two equal groups of 30 patients each: Group D and Group N. Patients randomized to Group D received a bolus of dexmedetomidine at 1 μg/kg over 10 min and Group N received a bolus of nalbuphine 0.1 mg/kg over 10min. In both the groups patients were induced with Inj ketamine 2mg/kg. After induction dose inj ketamine 0.5mg/kg boluses were given to achieve and maintain the target Ramsay Sedation Score (RSS)≥ 4. Mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (SPO2), and sedation scores were recorded. Recovery time, perioperative adverse events, and total ketamine consumption required for anesthesia maintenance were also recorded.: There was significant decreased in HR from baseline in group D at 10, 20, and 30min of the procedure with no significant difference as regards the MAP between the two study groups. Ketamine consumption in group N was significantly lower than in group D to maintain RSS in desired range. The recovery time was significantly shorter in group N when compared with group D. Respiratory variables were maintained in both the groups with two patients reported airway obstruction which was partial. No significant difference was found in intra and postoperative adverse effect between the groups. : The nalbuphine was found to be superior to dexmedetomidine as a premedication sedation for pediatric cathlab procedure in terms of reduced consumption of ketamine for adequate intraoperative sedation to conduct the procedure with better hemodynamic control and the shorter recovery time.

Predictors of Delayed Recovery in Japanese Patients With Whiplash-Associated Disorders: The Role of Initial Catastrophizing and Disability Levels.

Background Whiplash-associated disorders are sequelae of traffic accidents that frequently result in sustained pain and disability due to a broader spectrum of symptoms than typical neck pain. Several studies have used the length of time from injury to the completion of insurance claims as a measure of recovery time for patients with whiplash-associated disorders. However, studies on the initial factors in patients whose treatment exceeds 90 days are lacking. Therefore, this study aimed to identify key factors predicting prolonged treatment duration in Japanese patients with whiplash-associated disorders. Methodology We included 103 outpatients who presented with neck pain after a motor vehicle accident. During their initial visits, various factors were comprehensively assessed, including pain intensity, Neck Disability Index (NDI), six items of the Pain Catastrophizing Scale (PCS-6), a short version of the Tampa Scale of Kinesiophobia, the Injustice Experience Questionnaire, cervical range of motion, and radiographic findings. Patients were categorized into "early recovery" or "delayed recovery" groups based on the time elapsed between the first assessment and the end of the treatment period. Logistic regression analysis identified cut-off values from receiver operating characteristic curves to help identify factors contributing to delays in the recovery process. Results Analysis showed that initial NDI and PCS-6 scores of ≥35% and ≥12, respectively, were significant predictors of delayed recovery, increasing the odds of delay by factors of 3.19 and 4.46, respectively. Conclusions Our findings may aid in appropriate clinical decision-making and lead to interventions to minimize the negative impact of prolonged treatment duration on patient recovery.

Production of platelet-rich plasma (PRP)-enriched scaffolds for bone tissue regeneration with 3D printing technology

Bone disorders signify diverse abnormalities in the structure, development, and functions of bone tissue in the human body, with a significant correlation to ageing, insufficient physical activity, and escalating obesity. Recent advancements in bone tissue engineering aim to enhance bone tissue formation through the use of biomaterials, growth factors, and cells. The present study focuses on the fabrication and characterisation of scaffolds with a composition of gelatin (GEL) / sodium alginate (SA) / hydroxyapatite (HA) / platelet-rich plasma (PRP) using the 3D printing process. The inclusion of PRP, derived from blood, is of particular interest due to its potential to enhance bone regeneration through various growth factors. Scanning electron microscope (SEM) analysis revealed average pore sizes ranging from 481.50 ± 7.65 to 623.96 ± 11.54 µm. SEM images also showed that scaffold surfaces became smooth as the concentration of PRP increased. The mechanical test results demonstrated that as the PRP increased, the compressive strength decreased. When the swelling and degradation behaviours of scaffolds were examined, it was observed that GEL/SA/HA/3PRP scaffolds exhibited approximately 200 % swelling capability until the 4th day. GEL/SA/HA scaffolds showed a degradation behaviour about 70 % higher compared to other groups. A controlled release profile of PRP was maintained up to the 144th, 216th, and 240th hours from the scaffolds. According to the highest correlation coefficients (R2) in the release kinetics of scaffolds, GEL/SA/HA/0.5PRP and GEL/SA/HA/1PRP scaffolds were explained by the first-order model. In contrast, the GEL/SA/HA/3PRP scaffold was described using the Korsmeyer–Peppas model. The MTT analysis conducted with osteoblast cells showed that scaffolds did not demonstrate any toxic effects and facilitated cell adhesion by inducing the formation of extensions. These findings underscore the potential of PRP-incorporated GEL/SA/HA composites as a promising approach for bone tissue engineering, offering significant advancements in the treatment of bone disorders. This could lead to more effective treatments for bone disorders and injuries, reducing the need for more invasive procedures and improving patient recovery times.

Is there a relationship between hyperchloremia status and the risk of developing acute kidney injury in pediatric patients with diabetic ketoacidosis?

Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM). Prerenal acute kidney injury (AKI) is associated with profound hypovolemia and reduced renal perfusion. Results regarding hyperchloremia-associated AKI in patients with DKA are conflicting; we therefore investigated the potential relationship between hyperchloremia status and the risk of developing AKI. This single-center cohort study included 113 newly diagnosed T1DM patients with DKA admitted to the pediatric intensive care unit. Laboratory parameters, including Na, K, urea, creatinine, and chloride levels, were retrospectively reviewed at the time of presentation and at 12, 24 and 36h. AKI was defined using the eGFR according to the pediatric RIFLE classification criteria. Twenty-two (19.5%) of the 113 patients were in the AKI group. Two-way repeated-measures ANOVA showed significant (P values ≤ 0.01) time interaction effects within the groups based on the eGFR and the serum chloride, hyperchloremia, and phosphate levels. Serum chloride levels did not differ between the groups during the first 12h (p > 0.05) but were significantly greater in the AKI group than in the non-AKI group at 24h and 36h (p < 0.01). The final DKA resolution time was significantly greater in the AKI group than in the non-AKI group [22.2 (9.5) vs. 17.0 (12.0) h, respectively; p = 0.03]. However, the groups had similar lengths of hospital stay [13.0 (8.0) days vs. 12.0 (4.0) days, respectively; p = 0.17].Conclusions: Hyperchloremia may be iatrogenic rather than causative during treatment. This may worsen renal failure and prolong the recovery and treatment time for DKA patients. What is Known? • Acute kidney injury resulting from severe volume depletion is a common occurrence in diabetic ketoacidosis and typically requires significant volume replacement therapy. • In recent years, hyperchloremia has been associated with increased risks of AKI, morbidity, and mortality in some conditions, such as diabetic ketoacidosis. What is New? • The incidence of hyperchloremia increases over time during the treatment of diabetic ketoacidosis. • Hyperchloremia may be an iatrogenic element rather than a cause of acute kidney injury during the treatment of diabetic ketoacidosis.

Analysis of the Effect of Endarterectomy and Carotid Stenting Applied to Patients with Carotid Artery Stenosis

Objective: To explore the effect of endothelial stripping and carotid stenting applied to patients with carotid artery stenosis. Methods: 90 patients with carotid artery stenosis were selected and divided into 2 groups by equal randomization method, with 45 cases in each group. One group was subjected to endothelial debridement and the other group was subjected to carotid artery stenting. The evaluation scales corresponding to the perioperative indexes of the two groups were compared and evaluated. Results: The operative time, intraoperative bleeding, and postoperative pain scores of CEA patients were significantly better than those of CAS, with statistically significant differences (P &lt; 0.05). The incidence rate of vascular events in CAS patients (4.44%) was lower than that of CEA (20.00%), with statistically significant differences (P &lt; 0.05), and the postoperative blood pressure recovery time of CAS patients was significantly better than that of CEA, with statistically significant differences (P &lt; 0.05). Conclusion: CEA and CAS are both effective methods for treating carotid artery stenosis, and it is necessary to choose the most suitable method in the process of treatment in combination with the actual situation of the patient, to obtain the best therapeutic effect. For patients with more severe carotid artery stenosis or unstable plaques confined to the opening of the internal carotid artery, it is more suitable to choose the CAS method.