Patient Recovery Time Research Articles

General anesthesia techniques reducing the time to satisfy phase I post-anesthesia care unit discharge criteria: Narrative review of randomized clinical trials and cohort studies studying unit bypass, supplemented with computer simulation

We performed a narrative review of bypass of the phase I post-anesthesia care unit (PACU) following general anesthesia to gain insight into ways to reduce the time until patients are ready for PACU discharge following general anesthesia. Web of Science and PubMed literature searches were performed. Publications’ references and citations were examined. The Scale for the Assessment of Narrative Review Articles’ six components were satisfied. The 14 articles included 17 studies, with nearly all patients being adults. Most studies’ patients underwent outpatient surgery with an average surgical duration of less than 100 min . The studies applied several different, but similar, criteria to choose if patients bypass the PACU. Notably, 13 of 17 studies and all five with the largest observed bypass rates used some version of the White-Song fast-track bypass criteria. Propofol was used uniformly for induction of general anesthesia. Most studies included at least one antiemetic prophylactically, a local anesthetic administered by the surgeon, and a non-opioid analgesic. The six studies with the largest observed bypass rates used remifentanil or restricted use of intraoperative opioids. We then considered economics. While achievable PACU bypass rates are insufficient to reduce healthcare costs, reducing mean PACU time markedly can lower the nursing labor costs, the total time until the last patient exits the PACU, and the incidence of patients recovering in operating rooms because of unavailable PACU nurses or beds. We examined probability distributions of brief patient recovery times by using Gas Man, an uptake and distribution software program, simulating times until reaching constant incremental reductions (0.1 %) in vessel-rich concentrations of desflurane and sevoflurane once the vaporizer was set to zero. Results showed that simulated recovery from volatile anesthetics can have recovery times appearing log-normal, as seen empirically. Thus, patients already meeting discharge criteria upon PACU arrival can be the far-left fraction of one population of patients. The implication is that the narrative review results for PACU bypass provide insight into how to have more patients with very brief times to recovery. Therefore, future studies should quantify the effectiveness and economic benefits of anesthesia practitioners aiming not for PACU bypass, per se, but rather that the patients meet PACU discharge criteria by the 5–10 min after unit arrival when the practitioner has completed PACU handoff and finished documentation in the anesthesia record.

Estimation of non-monotonic transition rates inasemi-Markov process with covariates adjustments andapplication to caregivers' stress data.

With the large ongoing number of aged people and Alzheimer's disease (AD) patients worldwide, unpaid caregivers have become the primary sources of their daily caregiving. Alzheimer's family caregivers often suffer from physical and mental morbidities owing to various reasons. The aims of this paper were to develop alternate methods to understand the transition properties, the dynamic change, and the long-run behavior of AD caregivers' stress levels, by assuming their transition to the next level only depends on the duration of the current stress level. In this paper, we modeled the transition rates in the semi-Markov Process with log-logistic hazard functions. We assumed the transition rates were non-monotonic over time and the scale of transition rates depended on covariates. We also extended the uniform accelerated expansion to calculate the long-run probability distribution of stress levels while adjusting for multiple covariates. The proposed methods were evaluated through an empirical study. The application results showed that all the transition rates of caregivers' stress levels were right skewed. Care recipients' baseline age was significantly associated with the transitions. The long-run probability of severe state was slightly higher, implying a prolonged recovery time for severe stress patients.

Laparoscopic exploration versus conservative treatment in stable blunt abdominal trauma patients

Background: Laparoscopy is now a standard procedure in general surgery, and as technique and equipment advance, more complicated procedures are being carried out using this minimally invasive approach. With less patient morbidity, postoperative complications, and recovery time than open procedures, laparoscopic surgery aims to offer equal or better visualisation. Numerous laparoscopic procedures, such as cholecystectomy, gastroesophageal reflux procedures, and diagnostic laparoscopy, have demonstrably achieved this goal. Despite the advantages of laparoscopy in the trauma population, its complexity and potential hemodynamic instability due to intra-abdominal injury typically prevent its use. This cutting-edge technology may help carefully chosen trauma patients. According to estimates, 10% of all deaths worldwide were due to trauma. Methods: This prospective study included 29 patients with history of blunt abdominal trauma and vitally stable following initial resuscitation admitted to Casualty and Emergency Unit, ainshams university hospitals and Elzhor Hospital port said, during the period from June 2022 to December 2022. Results: The patients in study were 21 males (82 % of total) 10 males in (LE) representing approximately 77 % and 11 males in conservative group representing approximately (87 %), and 8 females (18 % of total) 2 females in (LE) and 6 in conservative group. As Regarding the hospital stay, in this study, the patients managed by (LE) had shorter hospital stay in relation to those managed conservatively, as the patients results revealed that the overall hospital stay for (LE) was significantly shorter, with an average of 5.69 ± 1.887 days. In this study, the group that benefit the most from shortening the hospital stay was the patients with haemoperitonium with no definite injuries, followed by patients with splenic injuries, while differences in hospital stay in patients with hepatic injuries were not significant. All patients had access to follow-up information for three months after discharge. There were no infective or late hemorrhagic complications observed. Conclusion: Laparoscopic exploration was found to be most beneficial in patients with blunt abdominal trauma who had a CT scan that revealed haemoperitonium but no organ injuries., and to less extent in cases with splenic injuries, while there was no significant data favoring (LE) on conservative treatment in patients with hepatic injuries.

The Relationship Between Natural Medicine Use and Recovery Time in Early Adult COVID-19 Patients

COVID-19 is a single-stranded RNA virus that infects through droplets. Drug consumption is one of the factors that affect the recovery of COVID-19 patients. The drug that has become a trend in the world is the use of natural ingredients, but people do not know whether it is effective in shortening the recovery time. Therefore, it is necessary to conduct research related to the relationship between the use of natural ingredients with the length of recovery of COVID-19 patients in early adulthood. This study used an analytical observational design with a cross-sectional method on 94 respondents in the Grogol Village area. Respondents fill out questionnaires via Google form and fill out questionnaires directly. Bivariate analysis of data using SPSS version 29. A total of 50 subjects consumed natural medicines (53.2%), namely jamu (58%), and 34 of them consumed almost every day (68%). There was no significant relationship between the use of natural medicine with the length of recovery of COVID-19 patients in early adulthood

Time to Recovery from COVID-19 and Its Predictors in Patients Hospitalized at Tibebe Ghion Specialized Hospital Care and Treatment Center, A Retrospective Follow-Up Study, North West Ethiopia.

Since the end of 2019, the world has been facing a new coronavirus disease 19 (COVID-19), which is considered a global pandemic. COVID-19 is considered a major public health burden due to the uncontrolled morbidity and mortality of the global community. The World Health Organization estimates the recovery time as 2 weeks for patients with mild infection and 3 to 6 weeks for those with serious illnesses. The recovery time and its predictors are not well studied in Ethiopia yet. Therefore, the aim of this study was to estimate time to recovery from COVID-19 and its predictors among COVID-19 patients admitted to Tibebe Ghion Specialized Hospital care and treatment center, North West Ethiopia. An institution-based retrospective follow-up study was conducted among 452 COVID-19 patients admitted to Tibebe Ghion Specialized Hospital from March 2020 to September 2021. Simple random sampling using a table of random number generators was used to select study units. Data entry and analysis were performed using EpiData 3.1 and Stata version 14, respectively. Bivariable and multivariable Cox proportional hazard analyses were used to identify predictors of recovery time. An AHR at a 5% level of significance was used to identify significant predictors. : Among 452 COVID-19 patients, 437 (88%) were recovered, with a median recovery time of 9 days. Recovery time was significantly related to age (AHR = 0.98; 95% CI = 0.97, 0.99), oxygen saturation (AHR = 0.42; 95% CI = 0.31, 0.56), shortness of breath (AHR = 0.65; 95% CI = 0.47, 0.85), disease severity (moderate (AHR = 0.63; 95% CI = 0.47, 0.85) and severe (AHR = 0.32; 95% CI = 0.22, 0.47)), and comorbidities (AHR = 0.67; 95% CI = 0.53, 0.84). Conclusions and recommendations: The overall median recovery time was 9 days. Older age, low oxygen saturation, shortness of breath, disease severity (moderate and severe), history of comorbidities, and high-level of WBC were predictors of delayed recovery time. On the other hand, corticosteroid use significantly shortens the median recovery time of COVID-19 patients. Thus, patients presented with older age, low oxygen saturation, shortness of breath, moderate and severe COVID-19 disease, comorbidities, and increased WBC need to be closely monitoring and followed up by healthcare providers. In addition, there should be special attention during the administration of corticosteroid.

ANALYSIS OF THE NASAL MICROBIOME IN PATIENTS PRE AND POST RHINOPLASTY: EXPLORING THE POSSIBLE CLINICAL IMPLICATIONS IN A PRIVATE HOSPITAL AND OTORHINOLARYNGOLOGY

Rhinoplasty is a common and effective plastic surgery to improve the aesthetics of the nose and, in some cases, respiratory function. This surgery remodels nasal structures, not only visibly, but also affecting the nasal microbiota, a community of microorganisms. The objective of this study was to understand how rhinoplasty influences the nasal microbiota, focusing on the prevalence of pathogenic bacteria, as well as the clinical implications of these changes. To investigate these changes, the research was conducted in a private otorhinolaryngology hospital environment. Bilateral nasal swabs were collected and bacterial culture was performed. Statistical analysis was used to explore possible associations between altered nasal microbiota and postoperative complications, as well as the quality of healing and recovery time of patients undergoing rhinoplasty. In 8 patients, rhinoplasty showed an initial prevalence of Staphylococcus aureus (62.5%) and Klebsiella aerogenes (25%). After surgery, 66.7% presented undetected results, suggesting a potential improvement in the nasal microbiota. Individual variability highlights the need for personalized approaches in preventing post-surgical infections. No statistically significant correlation was observed between nasal microbiota and surgical complications. Other characteristics were not significant on the effect of surgery and culture results. This research deepened the understanding of the nasal microbiome in patients undergoing rhinoplasty. In total, data from 8 patients were analyzed, revealing intriguing microbiological patterns. The decrease in post-surgery bacterial detection suggests potential benefits in reducing infectious risks, pointing to practical implications in clinical practice. Although valuable, we recognize the limitations of the study, encouraging future expansive research to consolidate and expand this knowledge.v

Impact of an enhanced recovery after surgery program with a multimodal analgesia care pathway on opioid prescribing and clinical outcomes for patients undergoing colorectal surgery

Background Opioids are a mainstay for acute pain management, but their side effects can adversely impact patient recovery. Multimodal analgesia (MMA) is recommended for treatment of postoperative pain and has been incorporated in enhanced recovery after surgery (ERAS) protocols. The objective of this quality improvement study was to implement an MMA care pathway as part of an ERAS program for colorectal surgery and to measure the effect of this intervention on patient outcomes and costs. Methods This pre-post study included 856 adult inpatients who underwent an elective colorectal surgery at three hospitals within an integrated healthcare system. The impact of ERAS program implementation on opioid prescribing practices, outcomes, and costs was examined after adjusting for clinical and demographic confounders. Results Improvements were seen in MMA compliance (34.0% vs 65.5%, P < 0.0001) and ERAS compliance (50.4% vs 57.6%, P < 0.0001). Reductions in mean days on opioids (4.2 vs 3.2), daily (51.6 vs 33.4 mg) and total (228.8 vs 112.7 mg) morphine milligram equivalents given during hospitalization, and risk-adjusted length of stay (4.3 vs 3.6 days, P < 0.05) were also observed. Conclusions Implementing ERAS programs that include MMA care pathways as standard of care may result in more judicious use of opioids and reduce patient recovery time.

Efficacy of Kan Jang® in Patients with Mild COVID-19: A Randomized, Quadruple-Blind, Placebo-Controlled Trial.

Background and aim. This study aimed to assess the efficacy of the treatment of Kan Jang®, a fixed combination of Andrographis paniculata (Burm. F.) Wall. ex. Nees and Eleutherococcus senticosus (Rupr. & Maxim.) Maxim extracts in patients with mild symptoms of COVID-19. Methods. One hundred and forty patients received six capsules of Kan Jang® (n = 68, daily dose of andrographolides-90 mg) or placebo (n = 72) and supportive treatment (paracetamol) for 14 consecutive days in a randomized, quadruple-blinded, placebo-controlled, two-parallel-group design. The efficacy outcomes were the rate of cases turning to severe, the detection rate of coronavirus SARS-CoV-2 over the time of treatment, the duration, and the severity of symptoms (sore throat, runny nose, cough, headache, fatigue, loss of smell, taste, pain in muscles) in the acute phase of the disease. Other efficacy measures included improving cognitive and physical performance, quality of life, and the levels of inflammatory blood markers-interleukin 6 (IL-6), C-reactive protein, and D-dimer. Results. Kan Jang® significantly (p < 0.05) reduced the rate of cases turning to severe (5.36%) compared to the placebo (17.86%) and decreased the detection rate of SARS-CoV-2 virus over the time of the treatment. The statistical difference in the rates of patients with clinical deterioration in the Kan Jang treatment and placebo control groups was significant (p = 0.0176) both in the 112 patients in the included-per-protocol (IPP) analysis and in the 140 patients in the intended-to-treat (ITT) analysis (p = 0.0236); the absolute risk reduction in cases thanks to the Kan Jang treatment was 12.5%, and the number we needed to treat with Kan Jang was 8. The patient's recovery time (number of sick days at the home/clinic) was shorter in the Kan Jang group compared with the placebo group. The rate of attenuation of inflammatory symptoms in the Kan Jang® group was significantly higher, decreasing the severity of cough, sore throat/pain, runny nose, and muscle soreness compared with the placebo group. Kan Jang® significantly decreased the Wisconsin Upper Respiratory Symptoms scores compared to the placebo in the sample size of 140 patients. However, the relief of fatigue and headache and the decrease in IL-6 in the blood were observed only in a subset of 86 patients infected during the second three waves of the pandemic. Kan Jang® significantly increased physical activity and workout; however, it did not affect cognitive functions (attention and memory), quality of life score, inflammatory marker D-dimer, and C-reactive protein compared with the placebo group. Conclusions. Overall, the results of this study suggest that Kan Jang® is effective in treating mild and moderate COVID-19 irrespective of the SARS-CoV-2 variant of infection.

The Effect of Passive Rom on Recovery Time Post Operative Patient in Recovery Room Brawijaya University Hospital Malang

Recovering from general anesthesia is a risk factor for morbidity and mortality in any operation. One of the main complications after anesthesia is delayed recovery. This study aims to determine the effect of passive ROM mobilization on the recovery time of postoperative patients with general. This type of research is quantitative with a research designquasy experienceusePosttest Only non equivalent Control Group Design. The population is patients who underwent surgery with general anesthesia, amounting to 40 people. Sampling using the methodconsecutive sampling with a total sample of 40 people divided into 2 groups, namely the control group 20 people and the experimental group 20 people. Measuring tool using observationscore aldreteand patient recovery time. The data analyze using Paired T-test. The results of the study showed that most of the control group respondents experienced recovery time of &gt;15 minutes (65%) and most of the experimental group respondents experienced &lt;15 minutes of recovery time (70%). The nurse immediately didRange Of Motion Passive after the patient finished surgery with general anesthesiain order to help expel secretions in the respiratory tract and accelerate peripheral circulation to support optimal respiratory function, as well as improve the body's metabolism and physiology of vital organs that affect recovery.

Higher Efficacy of Shufeng Tongqiao Decoction in Treating Acute Suppurative Otitis Media with Tobramycin Compared to Levofloxacinor Drops

We have evaluated the effects of Shufeng Tongqiao decoction on the efficacy of tobramycin drops and levofloxacin drops in treating acute suppurative otitis media. To this end, 200 patients with acute suppurative otitis media were divided into 4 treatment groups (A, B, C, and D) of 50 patients per group. Patients in groups A and B received a combination of Shufeng Tongqiao decoction plus levofloxacinor and tobramycin drops, respectively. Patients in groups C and D received only levofloxacinor and tobramycin drops, respectively. Among these four groups, group B (Shufeng Tongqiao decoction + tobramycin) was the most effective in decreasing the time of tinnitus and ear pain, discharge of pus and hearing loss (P &lt; 0.05), and serum levels of proinflammatory cytokines. Also, this group promoted the quality of life as well as the clearance rate of pathogenic bacteria much faster relative to other groups. In conclusion, Shufeng Tongqiao decoction in combination with tobramycin drops has a significant curative effect in treating acute suppurative otitis media, which can improve the clearance rate of pathogenic bacteria, shorten the recovery time of patients, and promote the quality of life of patients.

Factors Influencing Postoperative Recovery Time of Patients With Gastric Cancer.

To explore the factors associated with prolonged enhanced recovery after surgery (ERAS) time in gastric cancer patients who underwent gastrectomy. This was a retrospective of patients with gastric cancer who received ERAS at our hospital between 01/2014 and 01/2022. The outcome was prolonged ERAS time. Factors associated with prolonged ERAS time of patients undergoing gastric cancer surgery were analyzed by logistic regression. Among 663 patients, 182 (27.6%) patients had a prolonged ERAS time. The postoperative time to the first flatus time was 2.8 ± 1.2 days. There were 41 (6.2%) patients with intestinal obstruction, 25 (3.8%) with abdominal infection, and four (0.5%) with anastomotic leakage. The multivariable analysis showed that age >80 years (OR = 1.57, 95% CI: 1.31-4.40, P = 0.048), laparoscopic surgery (OR = 0.45, 95% CI: 0.21-0.95, P = 0.035), intraoperative jejunostomy (OR = 334.60, 95% CI: 2.81-39,831.90, P = 0.017), postoperative time to the first flatus time (OR = 3.79, 95% CI: 1.23-11.68, P = 0.021), total gastrectomy (OR = 0.08, 95% CI: 0.01-0.94, P = 0.044), and patient compliance with ERAS (OR = 0.01, 95% CI: 0-0.09, P < 0.001) were independently associated with prolonged ERAS time. Age >80 years, laparoscopic surgery, intraoperative jejunostomy, postoperative time to the first flatus time, total gastrectomy, and patient compliance with ERAS might be factors associated with prolonged ERAS time in gastric cancer patients.

Clinical recovery time for Sars-Cov-2 Infection in healthcare workers with full and booster vaccination

The increase of infections at the end of 2021 and January 2022 due to the Omicron variant in Ecuador, raises doubts regarding the effectiveness of booster vaccination, which questions the protection provided by booster vaccination and how often to apply it. A sample of 419 cases is taken and compared with the personnel that have complete (58% with third dose) and incomplete (42%) immunization schedules as of December 2021 and January 2022, and the time of symptomatic recovery after SARS infection is determined afterwards. The results show no difference in the recovery time in patients within the two groups and similar symptoms were observed. It is concluded that, given the results, there is no evidence of the need for a third dose in general, but rather, it would be reasonable to focus the efforts of a second booster only in specific vulnerable populations, thus avoiding unnecessary adverse effects that are becoming more frequent, and even allowing the existing vaccines available in countries where they are really needed.

Study on Prevention and Treatment Strategies for Pressure Injury in Operating Room

Objective: To study the prevention and treatment strategies for pressure injury in the operating room. Methods: 116 patients who underwent surgery in our hospital from January 2016 to May 2023 were selected as research subjects by random number method, and were randomly divided into the research group (n=58) and the control group (n=58). The control group was treated with conventional interventions, and the research group was treated with interventions in the operating room. The incidence of pressure injuries, pressure injury recovery scoring, SAS, and SDS scores were compared between the two groups. Results: After the intervention, the incidence of pressure injuries in the research group was lower than that in the control group, and the postoperative mobility and perception were better than those in the control group. In addition, the negative emotions such as anxiety and depression produced during the treatment of the patients in the research group were more effectively alleviated under intervention. The results of this study are statistically significant, with P &lt; 0.05. Conclusion: Intervention measures can effectively alleviate the negative emotions produced during the treatment of patients, reduce the incidence of postoperative pressure injuries, alleviate the patient's pain and financial pressure, shorten the recovery time of patients, and improve the mobility and perception ability of patients after the occurrence of compression injuries.

The prognostic effect of concomitant COVID-19 with spontaneous pneumothorax.

The aim of this study was to investigate the prevalence of novel coronavirus disease 2019 (COVID-19) in patients hospitalized with primary spontaneous pneumothorax and to evaluate its possible effects on the clinical course, treatment, and the prognosis. Between April 2020 and January 2021, a total of 86 patients (78 males, 8 females; mean age: 27±5 years; range, 16 to 40 years) who had no underlying lung disease and were diagnosed with the first episode of spontaneous pneumothorax were retrospectively analyzed. At the same time of diagnosis, all patients were screened for COVID-19 via polymerase chain reaction test of nasopharyngeal swabs. According to the test results, the patients were divided into two groups as COVID-19(+) and COVID-19(-). The duration of air leak, hospital stay, recurrence rates and treatment modalities, and mortality rates of the two groups were compared. Following a pneumothorax diagnosis, 18 (21%) patients were diagnosed with COVID-19. In COVID-19(+) patients, the mean air leak and lung expansion duration were significantly longer (p<0.0001 for both). In these patients, the mean length of hospital stay was also significantly longer (p<0.0001). During the median follow-up of six months, no mortality was observed and the recurrence rate was similar between the two groups (p=0.998). Our study results suggest that COVID-19 negatively affects the recovery time in patients with spontaneous pneumothorax.

Smart Smile: Revolutionizing Dentistry With Artificial Intelligence.

Artificial intelligence (AI) has emerged as a transformative technology in various industries, and its potential in dentistry is gaining significant attention. This abstract explores the future prospects of AI in dentistry, highlighting its potential to revolutionize clinical practice, improve patient outcomes, and enhance the overall efficiency of dental care. The application of AI in dentistry encompasses several key areas, including diagnosis, treatment planning, image analysis, patient management, and personalized care. AI algorithms have shown promising results in the automated detection and diagnosis of dental conditions, such as caries, periodontal diseases, and oral cancers, aiding clinicians in early intervention and improving treatment outcomes. Furthermore, AI-powered treatment planning systems leverage machine learning techniques to analyze vast amounts of patient data, considering factors like medical history, anatomical variations, and treatment success rates. These systems provide dentists with valuable insights and support in making evidence-based treatment decisions, ultimately leading to more predictable and tailored treatment approaches. While the potential of AI in dentistry is immense, it is essential to address certain challenges, including data privacy, algorithm bias, and regulatory considerations. Collaborative efforts between dental professionals, AI experts, and policymakers are crucial to developing robust frameworks that ensure the responsible and ethical implementation of AI in dentistry. Moreover, AI-driven robotics has introduced innovative approaches to dental surgery, enabling precise and minimally invasive procedures, and ultimately reducing patient discomfort and recovery time. Virtual reality (VR) and augmented reality (AR) applications further enhance dental education and training, allowing dental professionals to refine their skills in a realistic and immersive environment. AI holds tremendous promise in shaping the future of dentistry. Through its ability to analyze vast amounts of data, provide accurate diagnoses, facilitate treatment planning, improve image analysis, streamline patient management, and enable personalized care, AI has the potential to enhance dental practice and significantly improve patient outcomes. Embracing this technology and its future development will undoubtedly revolutionize the field of dentistry, fostering a more efficient, precise, and patient-centric approach to oral healthcare. Overall, AI represents a powerful tool that has the potential to revolutionize various aspects of society, from improving healthcare outcomes to optimizing business operations. Continued research, development, and responsible implementation of AI technologies will shape our future, unlocking new possibilities and transforming the way we live and work.

Retracted: Effects of Dexmedetomidine on Postoperative Pain and Recovery Time in Obese Patients.

[This retracts the article DOI: 10.1155/2022/9715704.].

Requirement for Discharge in the Care of a Responsible Adult in Procedural Sedation in the Emergency Department: Necessity or Potential Barrier to Health Equity?

BackgroundProcedural sedation is commonly practiced by emergency physicians to facilitate patient care in the emergency department (ED). Although various guidelines have modernized our approach to procedural sedation, many procedural sedation guidelines and practices still often require that patients be discharged into the care of a responsible adult. DiscussionSuch requirement for discharge often cannot be met by underserved and undomiciled patients. Benzodiazepines, opioids, propofol, ketamine, “ketofol,” etomidate, and methohexital have all been utilized for procedural sedation in the ED. For patients who may require discharge without the presence of an accompanying responsible adult, ketamine, propofol, methohexital, “ketofol,” and etomidate are ideal agents for procedural sedation given rapid onsets, short durations of action, and rapid recovery times in patients without renal or hepatic impairment. Proper pre- and postprocedure protocols should be utilized when performing procedural sedation to ensure patient safety. Through the use of appropriate medications and observation protocols, patients can safely be discharged 2 to 4 h postprocedure. ConclusionThere is no pharmacodynamic or pharmacokinetic basis to require discharge in the care of a responsible adult after procedural sedation. Thoughtful medication selection and the use of evidence-based pre- and postprocedure protocols in the ED can help circumvent this requirement, which likely disproportionally impacts patients who are of low socioeconomic status or undomiciled.

Role of spinal anesthesia in robot-assisted radical prostatectomy: Gamble or opportunity?

To the Editor, Although postoperative pain associated with robot-assisted radical prostatectomy (RARP) is less than pain following the open technique, it remains a fundamental issue as it can be a significant source of discomfort for the patient and lengthen recovery times after surgery. The optimal management of pain after RARP is far from being fully elucidated and many factors have to be evaluated to choose the best analgesic approach. [...].

Using of herbal mucolytics in the complex therapy of acute and chronic rhinosinusitis

Chronic rhinosinusitis is a polyetiological heterogeneous disease that is characterized by inflammation of the nasal mucosa and paranasal sinuses. The clinical picture of this pathology may include nasal congestion and rhinorrhea. Studies on the pathogenesis of chronic rhinosinusitis have yielded insufficient results, however, a number of factors that predispose to the development of this disease are currently identified according to clinical guidelines. Among these are both anatomical anomalies and some chronic diseases (rhinitis, atopy), immune system disorders (immunodeficiencies), etc. Mucoactive drugs are used in the treatment of acute and chronic rhinosinusitis to restore the transport function of the upper respiratory tract epithelium. Their mechanism of action is aimed at restoring mucociliary clearance. This therapy also affects the viscous discharge, which is produced during rhinosinusitis and accumulates in the paranasal sinuses and nasal cavity, worsening the course of the inflammatory process. Specialists distinguish the following forms of mucoactive drugs: mucolytics, mucokinetics and mucoregulators. The article considers the aspects of the clinical use of herbal mucolytics for the treatment of acute and chronic rhinosinusitis, in the pathogenesis of which the nasal mucosa edema plays a key role. The authors summarise the most conclusive evidence to date on the need to use herbal mucolytics in the complex therapy of acute and chronic rhinosinusitis. The modern topical therapy of acute and chronic rhinosinusitis in the otorhinolaryngology practice is presented. Herbal medicinal products have a proven secretolytic and anti-inflammatory effect, accelerate the relief of symptoms and reduce the recovery time of patients. The clinical guidelines recommend to prescribe these drugs in addition to the complex therapy of rhinosinusitis to patients suffering from ARS and CRS, who has no contraindications.

Protective effect of ursodeoxycholic acid on COVID-19 in patients with chronic liver disease.

Ursodeoxycholic acid (UDCA) may reduce susceptibility to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection by downregulating angiotensin-converting enzyme 2 (ACE2), based on recent experimental investigation. This study aimed to determine the potential protective effect of UDCA against SARS-CoV-2 infection in patients with chronic liver disease. Patients with chronic liver disease receiving UDCA (taking UDCA ≥1 month) at Beijing Ditan Hospital between January 2022 and December 2022 were consecutively enrolled. These patients were matched in a 1:1 ratio to those with liver disease not receiving UDCA during the same period by using a propensity score matching analysis with nearest neighbor matching algorithm. We conducted a phone survey of coronavirus disease 2019 (COVID-19) infection during the early phase of the pandemic liberation (from 15 December 2022 to 15 January 2023). The risk of COVID-19 was compared in two matched cohorts of 225 UDCA users and 225 non-UDCA users based on patient self-report. In the adjusted analysis, the control group was superior to the UDCA group in COVID-19 vaccination rates and liver function indicators, including γ-glutamyl transpeptidase and alkaline phosphatase (p < 0.05). UDCA was associated with a lower incidence of SARS-CoV-2 infection (UDCA 85.3% vs. control 94.2%, p = 0.002), more mild cases (80.0% vs. 72.0%, p = 0.047), and shorter median time from infection to recovery (5 vs. 7 days, p < 0.001). Logistic regression analysis showed that UDCA was a significant protective factor against COVID-19 infection (OR: 0.32, 95%CI: 0.16-0.64, p = 0.001). Furthermore, diabetes mellitus (OR: 2.48, 95%CI: 1.11-5.54, p = 0.027) and moderate/severe infection (OR: 8.94, 95%CI: 1.07-74.61, p = 0.043) were more likely to prolong the time from infection to recovery. UDCA therapy may be beneficial in reducing COVID-19 infection risk, alleviating symptoms, and shortening the recovery time in patients with chronic liver disease. However, it should be emphasized that the conclusions were based on patient self-report rather than classical COVID-19 detection by experimental investigations. Further large clinical and experimental studies are needed to validate these findings.