Patient Demographics Research Articles

Assessing the effectiveness of measurement scales in evaluating the health-related quality of life in rare disease patients after treatment: a systematic review

BackgroundRare diseases often entail significant challenges in clinical management and health-related quality of life (HRQoL) assessment. HRQoL assessment tools for rare diseases show substantial variability in outcomes, influenced by disease heterogeneity, intervention types, and scale characteristics. The variability in reported quality of life (QoL) improvements following interventions reflects a need to evaluate the effectiveness of HRQoL assessment tools and understand their suitability across diverse contexts.ObjectiveThis systematic review aims to analyse the effectiveness of various assessment scales in evaluating QoL and explores the general trends observed in the studies using the same and different assessment scales on rare diseases.MethodsA comprehensive literature search was conducted across various databases to identify studies that reported QoL outcomes related to interventions for rare diseases. Search terms included various synonyms, and both the generic and specific terms related to rare diseases and QoL. Key variables, including intervention types, patient demographics, study design, and geographical factors, were analysed to determine their role in influencing the reported HRQoL outcomes. The findings were then compared with existing literature to identify consistent patterns and discrepancies.ResultsA total of 39 studies were included, comprising randomised controlled trials, observational studies, and cohort studies, with 4737 participants. Significant variations were observed in QoL improvements across studies, even when using the same assessment scales. These differences were primarily attributed to the heterogeneity in disease severity, intervention types, and patient characteristics. Studies employing disease-specific scales reported more nuanced outcomes than generic ones. Additionally, methodological differences, including study design and intervention type, contributed to variations in results and geographical factors influencing patients’ perceptions of health and well-being.ConclusionThe reported differences in QoL outcomes across studies can be explained by a combination of factors, including disease heterogeneity, treatment modalities, patient demographics, and assessment scale characteristics. These findings underscore the importance of selecting appropriate HRQoL assessment tools based on the research context and patient population. For more accurate comparisons across studies, it is crucial to consider these factors alongside consistent methodology and cultural adaptability of scales. Future research should focus on developing standardised guidelines for QoL assessments that accommodate the diverse needs of patients with rare diseases.

Sinus laser therapy versus Karydakis flap procedure in the management of pilonidal sinus disease: a comparative analysis of intraoperative parameters and postoperative outcome.

This study aimed to investigate the utility of minimally invasive sinus laser therapy (SiLaT) versus flap surgery (Karydakis flap procedure) in terms of intraoperative parameters and postoperative outcome in patients with pilonidal sinus disease (PSD). A total of 106 patients with PSD (mean ± SD age: 26.4 ± 7.0years, 86.8% male) treated with Karydakis flap procedure (KF group; n = 63) or sinus laser therapy (SiLaT group; n = 43) were included in this retrospective study. Data on patient demographics, operative characteristics (number of openings, length of sinus tract, and operative time), and postoperative outcome including postoperative (day 1) pain intensity-visual analog scale (VAS) scores, time to return to work after surgery (days), complication rate, and recurrence rate were recorded in each patient and compared between KF and SiLaT groups. The SiLaT versus KF procedure was associated with significantly shorter operative time [median (min-max) 17 (12-28) versus 27 (20-44) min, p = 0.001], lower pain scores [3 (1-4) versus 5 (3-7), p = 0.001], and earlier return to work [1 (1-3) versus 10 (5-20) days, p = 0.001]. Although no significant difference was noted in complication and recurrence rates between the KF and SiLaT groups, 6.3% (wound infection only) and 3.2% of patients in the KF group but none of the patients in the SiLaT group developed complication and recurrence, respectively. SiLaT seems to be a promising minimally invasive technique for the management of PSD, being comparable to the KF procedure in terms of complications and recurrence, along with added advantages of shorter operative time, reduced postoperative pain, and earlier return to work.

Isolated Sagittal Craniosynostosis and Open or Endoscopic Cranial Vault Remodeling: An Evaluation of Developmental Outcomes.

Craniosynostosis, a condition involving the premature fusion of cranial sutures, can impair brain development and potentially lead to developmental delays. This study compares open cranial vault remodeling versus endoscopic strip craniectomy treatment for isolated sagittal craniosynostosis, primarily focusing on development outcomes. A retrospective cohort study was conducted at a tertiary pediatric surgery center, involving all 45 patients treated surgically for isolated sagittal craniosynostosis from 2013 to 2024. Patients were categorized into 2 groups based on surgical intervention: open cranial vault remodeling (n=17) and endoscopic strip craniectomy (n=28). Data collected included patient demographics, intraoperative specifics, and postoperative outcomes. Developmental outcomes were assessed using postoperative progress notes. Of the 45 patients, those undergoing open surgery were older (10.7mo and 9.4kg versus 3.3mo and 6.4kg, P<0.001) and experienced higher use of intraoperative drains (65% versus 0%, P<0.001), more prolonged procedures (189 versus 58min, P<0.001), more significant blood loss (102 versus 62mL, P=0.009), longer stays (3.3 versus 2.6d, P=0.011), and higher opioid prescription rates (82% versus 43%, P=0.013) compared to the endoscopic group. Within 12 months postoperatively, social delays were more common in the open group (19 versus 0%, P=0.049), and, postoperatively in general, cognitive delays were more common in the open group (31% versus 4%, P=0.023) when compared to the endoscopic group. Endoscopic cranial vault remodeling produces preferentially better hemodynamic, postoperative, and hospital stay outcomes. Although inferences into long-term developmental delay outcomes were limited due to sample size, a preferential benefit toward endoscopic intervention may exist.

Radiofrequency Ablation for Solitary Autonomously Functioning Thyroid Nodules: Multicenter Study from Latin America.

Background: Autonomously functioning thyroid nodules (AFTNs) represent ∼5% of all thyroid nodules and often necessitate definitive treatments such as surgery or radioiodine (131I), both of which have inherent risks. Radiofrequency ablation (RFA) has emerged as an effective and safe therapeutic option for managing AFTNs. This study aims to assess the effectiveness and safety of RFA for solitary AFTNs in various countries across Latin America. Methods: This retrospective, observational, multicenter cohort study included patients with a solitary AFTN that was histologically confirmed as benign and treated with a single session of RFA. The study included an analysis of patient demographics, sonographic characteristics of the nodules, thyroid profile assessment at each follow-up visit, evaluation of clinical symptoms to determine the achievement of a euthyroid state, and the measurement of nodule volume reduction. In addition, a bivariate analysis was conducted to identify associations between these variables and the resolution of hyperthyroidism. Results: Our study enrolled 81 patients with a solitary, benign AFTN. The volume reduction ratio (VRR) consistently increased over the follow-up period, with medians of -50%, -74.9%, -78.4%, and -90.2% at 1, 3, 6, and 12 months, respectively. The rate of resolution of hyperthyroidism was 93.8% (76/81). Following the RFA procedure, 58.02% of patients (47/81) normalized their thyrotropin levels within 1 month of follow-up, and by 3 months, an additional 33.3% had achieved normalization (27/81). Notably, a baseline volume ≥10, 20, or 30 mL did not affect the achievement of clinical success. In bivariate analyses, a VRR ≥50% at the 6-month follow-up was associated with the resolution of hyperthyroidism. Overall complications occurred in 6.2% of patients (5/81), including 1.2% (1/81) of a major complication (transient Horner syndrome), 3.7% cases of transient dysphonia (3/81), and 1.2% (1/81) of hypothyroidism requiring low-dose levothyroxine replacement. Conclusions: The results of this multicenter study suggest that RFA is a promising treatment option for patients with solitary AFTN, regardless of their baseline characteristics, including volume, age, or composition. The clinical success of the intervention may be related to the VRR at 6 months.

CLINICAL PROFILE AND OUTCOME AMONG ADULT COVID-19 PATIENTS ADMITTED IN SELECTED LEVEL 1 HOSPITAL IN QUIRINO PROVINCE: A RETROSPECTIVE STUDY

The COVID-19 pandemic has posed unprecedented challenges to healthcare systems worldwide, necessitating a thorough understanding of its impact on patient demographics, clinical presentations, and outcomes. Thus, this study was conducted to investigate the demographic and clinical profiles, as well as outcomes, of COVID-19 patients admitted to Quirino Province Medical Hospital from 2021 to 2022. The patient population exhibited a diverse age distribution, with a concentration in the 58-67 age group, indicating potential higher risks for severe illness among older adults. Respiratory issues were predominant. Also, there were patients experiencing moderate disease severity and facing severe disease. Despite most patients having no comorbidities, cardiovascular conditions led among those with comorbidities, emphasizing the need for cardiac health monitoring. As to clinical outcomes large number of patients were discharged alive, Significant differences in clinical status and outcomes were observed when grouped by age, sex, civil status, and occupation. Age and civil status demonstrated notable associations with disease severity, while sex and occupation had less influence. These findings underscore the importance of tailored healthcare strategies, proactive planning, and early detection to effectively manage COVID-19 patients and promote health equity. Further research is essential to adapt and improve healthcare approaches in this dynamic landscape. KEYWORDS: Clinical Profile, Clinical Outcome, Comorbidity, COVID-19, Severity

Elective outpatient middle meningeal artery embolization for chronic subdural hematoma is safe

BackgroundMiddle meningeal artery embolization (MMAE) is a safe and effective treatment for chronic subdural hematoma (cSDH); however, the appropriate level of postoperative care is unknown.ObjectiveTo evaluate whether elective MMAE for...

Factors associated with gender specific adolescent presentations to the emergency department for suicide risk behaviors during the COVID-19 pandemic.

Adolescent presentations to the emergency department (ED) for suicide-related thoughts and behaviors (SRTBs) increased during the COVID-19 pandemic. Gender expansive youth were particularly impacted by the loss of gender-specific services, however, data examining ED pandemic presentations of gender expansive youth for SRTBs are scarce. Data were collected at a tertiary care center in Canada. Adolescents aged 12 to 17 presenting with SRTBs were recruited during two periods: March 2018 - March 2020 (pre-pandemic) and March 2021 - May 2023 (during pandemic). Patient demographics, mental health symptoms, and pre-ED visit healthcare utilization were examined. We identified 202 adolescents (70 pre-pandemic; 132 during pandemic), with a mean age of 14.3 years. Compared with pre-pandemic, during pandemic adolescents were more likely to identify as gender expansive [pre: 5.7% versus during: 24.2%; p = .01] and were of European descent [pre: 28.6% versus during: 59.1%; p < .01]. During the pandemic, gender expansive adolescents, on average, exhibited higher suicidal ideation, measured by Suicide Ideation Questionnaire Junior scores, compared with cisgender adolescents [gender expansive: mean = 64.3 (standard deviation = 12.1) versus cisgender participants: mean = 58.0 (standard deviation = 14.5); p = .03]. There were no differences in demographics, healthcare utilization, depression or anxiety symptom severity between gender expansive and cisgender adolescents. Adolescents presenting to the ED with SRTBs during the pandemic were more likely to identify as gender expansive than those presenting pre-pandemic. Gender expansive adolescents exhibited increased suicidal ideation compared to cisgender adolescents during the pandemic.

Racial and Ethnic Disparities in Child Abuse Identification and Inpatient Treatment.

Child abuse is a leading cause of morbidity in early childhood. Accurate detection remains challenging. To describe racial and ethnic disproportionalities in suspicion for child abuse (SCA) in pediatric patients admitted after traumatic injury. This retrospective, multicenter cross-sectional study performed between 2022 and 2024 examined a representative national sample of children and adolescents (aged <18 years) admitted for pediatric trauma indications from 2006 to 2019. Data were from the Kids' Inpatient Database (KID), the largest publicly available all-payer pediatric inpatient care database. Patient demographics, injury severity, and hospitalization characteristics were classified by race and ethnicity and compared using univariate and multivariate regression. Statistical analysis was performed between March 2022 and October 2024. The SCA subgroup was identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes corresponding to child and adolescent maltreatment. The primary outcome was the racial and ethnic composition of pediatric patients admitted after traumatic injury with SCA vs those without SCA. Among the weighted total of 634 309 pediatric patients with complete data included in the study, 13 579 patients had injuries attributable to SCA (SCA subgroup; mean [SD] age, 1.70 [0.04] years; 7650 male [56.3%]; 2868 Black [21.1%], 2293, Hispanic [16.9%], and 5675 White [41.8%]) and 620 730 patients did not (non-SCA subgroup; mean [SD] age, 9.70 [0.01] years; 395 158 male [63.7%]; 86 376 Black [13.9%], 108 406 Hispanic [17.5%], and 298 748 White [48.1%]). The racial and ethnic distribution of the non-SCA subgroup was similar to that of the 2010 US Census. In the SCA subgroup, Black patients (odds ratio [OR], 1.75; 95% CI, 1.65-1.85; P < .001) and Hispanic patients were overrepresented (OR, 1.11; 95% CI, 1.05-1.18; P < .001) and White patients were underrepresented compared with the Census. After controlling for socioeconomic factors and hospital characteristics among 504 365 (weighted) observations in White, Black, and Hispanic patients (493 530 patients without and 10 835 patients with SCA), Black race remained an independent risk factor associated with SCA (OR, 1.10; 95% CI, 1.03-1.17; P = .004), whereas Hispanic race was found to be a protective factor associated with decreased odds of SCA (OR, 0.71; 95% CI, 0.67-0.76; P < .001). Compared with White patients in the SCA subgroup, Black patients had a 26.5% (95% CI, 11.0%-44.3%) longer length of stay (P < .001) for mild to moderate injuries and a 40.1% (95% CI, 16.4%-68.5%) longer length of stay (P < .001) for serious injury. In this study, Black children and adolescents were suspected to have experienced child abuse at higher rates than children and adolescents of other racial and ethnic backgrounds. More research is necessary to understand the origins of these disparities to reduce them in child abuse identification.

Change in Emergency Department Length of Stay Following Routine Adoption of Dual-Energy Computed Tomography to Differentiate Intracranial Hemorrhage from Calcification.

Dual energy computed tomography (DECT) is an advanced CT technique which has been shown to improve accuracy in distinguishing between intracranial hemorrhage and calcification, which is often challenging on conventional CT and therefore may warrant repeat imaging in the emergency department (ED) to document stability and exclude enlarging intracranial hemorrhage. We hypothesized that implementation of a DECT head protocol with fully automated post processing in the ED would decrease the need for repeat imaging and therefore reduce overall ED length of stay (LOS). This is a retrospective study comparing ED length of stay over a one-year period before (7/1/2016-6/30/2017) and after (7/1/2018-6/30/2019) implementing a DECT head protocol, for patients scanned for headache, trauma or fall, who were found to have indeterminate intracranial hyperdensities on conventional images, and were subsequently discharged home from the ER (excluding patients who were admitted, taken to the OR, or left against medical advice). Additional clinical information regarding ED time course and management were also reviewed, including data on time to CT scan, CT report, and if applicable, time to repeat CT head and neurosurgical consultation. There was no significant difference in patient demographics and CT indications between the pre-DECT and post-DECT cohorts. There was a small but statistically significant difference in mean baseline ED LOS in the initial cohorts of 20 minutes (p=0.002). After the inclusion of only intracranial indeterminate hyperdensities, there was a larger statistically significant difference in ED LOS, with mean pre-DECT LOS of 421 minutes and mean post-DECT LOS of 272 mins, resulting in mean LOS reduction of 149 mins (p=0.003). The increased ED LOS correlated with increased frequency of neurosurgical consultation and repeat CT head for the findings of indeterminate intracranial hyperdensities. ED LOS was significantly longer in the pre-DECT cohort, which was partly attributable to neurosurgical consultation and repeat CT head performed for indeterminate intracranial hyperdensities. DECT＝ Dual Energy CT; ED LOS＝ Emergency department length of stay; NECT = Noncontrast enhanced CT; VNCa= Virtual non-calcium.

Significant association of miRNA 34a with BRCA1 expression in pancreatic ductal adenocarcinoma: an insight on miRNA regulatory pathways in the Pakistani population

BackgroundPancreatic Ductal Adenocarcinoma (PDAC) is among the most aggressive cancers, characterized by high mortality rates. Studies on various cancers across the globe indicate that regulatory miRNAs play a vital role in cellular signaling. However, the expression and interactions of these miRNAs in the Pakistani patients with PDAC is yet to be explored. Here, we aim to investigate a panel of four regulatory miRNAs (miRNA 34a, 30b, 142 and 137) in PDAC and their interaction with selected target proteins in the signaling pathway (KRAS, p53, BRCA1, APC).MethodsWe conducted a study on 109 PDAC patients to analyze the selected miRNAs and protein targets. Formalin Fixed Paraffin Embedded (FFPE) tumor samples were obtained from the hospital’s department of histopathology. After confirmation of diagnosis and appropriate tumor content, tissues were processed for RNA extraction. Based on the acceptable quality and quantity of RNA, 43 samples were proceeded for qRT-PCR. Relative expression of the miRNAs was determined through 2−[ΔΔCt] method. Further, FFPE tumor blocks were used to perform tissue sectioning followed by immunohistochemistry experiments. Stained slides were scored independently by two pathologists according to set criteria.ResultsExpression profiles revealed that miRNA 34a, 30b, and 142 showed high expression in approximately 69–70% of cases, while miRNA 137 had a lower high expression frequency (53.4%). Among protein biomarkers, KRAS, BRCA1, and APC were predominantly expressed, with high expression levels observed in 79.1%, 69.8%, and 51.2% of cases, respectively, whereas p53 showed positive expression in only 34.9% of cases. Statistical analysis showed that expression of miRNA 34a was significantly associated with the expression of BRCA1 (p = 0.034). No significant associations were observed for KRAS, p53, or APC with the selected miRNAs. Moreover, the expression of miRNA 34a independently showed significant association with miRNA 30b (p = 0.000) and miRNA 137 (p = 0.001). None of the miRNA showed an association with the overall survival, patient demographics or the clinicopathological characteristics.ConclusionOur study highlights a potential bi-directional regulatory relationship between BRCA1 and miRNA 34a, suggesting that miRNA 34a may both respond to and influence BRCA1 activity within cellular signaling pathways. This complex interaction points to a layered regulatory network that could play a crucial role in tumor suppression in PDAC, underscoring the therapeutic potential of targeting this miRNA-protein crosstalk.

Assessing institutional responsibility in scientific misconduct: A case study of enoximone research by Joachim Boldt.

Enoximone, a phosphodiesterase III inhibitor, was approved in Germany in 1989 and initially proposed for heart failure and perioperative cardiac conditions. The research of Joachim Boldt and his supervisor Gunter Hempelmann came under scrutiny after investigations revealed systematic scientific misconduct leading to numerous retractions. Therefore, early enoximone studies by Boldt and Hempelmann from 1988 to 1991 were reviewed. PubMed-listed publications and dissertations on enoximone from the Justus-Liebig-University of Giessen were analyzed for study design, participant demographics, methods, and outcomes. The data were screened for duplications and inconsistencies. Of seven randomized controlled trial articles identified, two were retracted. Five of the non-retracted articles reported similarly designed studies and included similar patient cohorts. The analysis revealed overlap in patient demographics and reported outcomes and inconsistencies in cardiac index values between trials, suggesting data duplication and manipulation. Several other articles have been retracted. The analysis results of misconduct and co-authorship of retracted studies during Boldt's late formative years indicate inadequate mentorship. The university's slow response in supporting the retraction of publications involving scientific misconduct indicates systemic oversight problems. All five publications analyzed remained active and warrant retraction to maintain the integrity of the scientific record. This analysis highlights the need for improved institutional supervision. The current guidelines of the Committee on Publication Ethics for retraction are inadequate for large-scale scientific misconduct. Comprehensive ethics training, regular audits, and transparent reporting are essential to ensure the credibility of published research.

Frequency of Bacterial Etiological Factors and Antibiotic Resistance of Infections Caused by Urinary Catheters in Patients in Khorramabad City: A Retrospective Study

Background: The use of urinary catheters is considered one of the most significant factors contributing to urinary tract infections (UTIs), particularly when catheters are used for prolonged periods. Understanding the patterns of catheter-related UTIs and the associated antibiotic resistance is crucial for effective prevention and treatment. Objectives: This study aimed to investigate the prevalence of bacterial causes and antibiotic resistance in catheter-associated UTIs among patients hospitalized in Khorramabad teaching hospitals during 2022 - 2023. Methods: This retrospective study analyzed patient records of individuals with urinary catheters in Khorramabad teaching hospitals. A researcher-designed checklist collected data on patient demographics (age and sex), medical history, length of hospital stay, hospital department, bacterial pathogens identified from cultures, and antibiotic resistance profiles. Data analysis was performed using Stata version 16. Results: The most frequently isolated pathogens in catheter-associated UTIs were Escherichia coli (41.20%), Staphylococcus saprophyticus (20.80%), and Klebsiella pneumoniae (18.40%). Among antibiotics, amoxicillin (59.2%) and ampicillin (53.6%) showed the highest rates of resistance, while imipenem (11.6%) and amikacin (17.6%) exhibited the lowest resistance rates. A statistically significant correlation (P &lt; 0.05) was observed between antibiotic resistance to amoxicillin, ampicillin, and imipenem and a history of prior antibiotic use. Conclusions: The findings suggest that amikacin and imipenem are effective options for initiating empirical therapy for catheter-associated UTIs until antibiogram results become available. Given the importance of emerging antibiotic resistance and the evolving susceptibility patterns of bacterial pathogens, performing antibiogram testing is essential for optimizing treatment outcomes in these infections.

Declining Blowout Fracture Cases and Rising Costs in South Korea (2010-2023).

Blowout fractures are a significant component of maxillofacial trauma care, but their incidence appears to be declining in South Korea. This study aims to investigate the trends in blowout fracture cases from 2010 to 2023 and assess the implications for plastic and reconstructive surgery, as well as the financial burden on patients. A retrospective observational study was conducted using data from the Health Insurance Review and Assessment Service in South Korea. Patients diagnosed with orbital fractures (International Classification of Diseases, 10th Revision code S02.3) between 2010 and 2023 were included. Variables such as patient demographics, National Health Insurance (NHI) payments, and patient out-of-pocket expenses in United States dollars were analyzed. Time-series forecasting was performed using the Auto-Regressive Integrated Moving Average (1,1,1) model to predict future trends. A total of 163,146 patients were diagnosed with blowout fractures from 2010 to 2023. The number of cases decreased by 48.0%, from 18,340 in 2010 to 9534 in 2023 (P < 0.001). Despite the decline in cases, the average NHI payment per patient increased by 135.5%, and patient out-of-pocket expenses rose by 127.5% (P < 0.01). Strong negative correlations were found between patient numbers and per-patient costs for both NHI payments (r = -0.933) and patient expenses (r = -0.929). The Auto-Regressive Integrated Moving Average model forecasts suggest that case numbers may stabilize, but health care costs will continue to rise through 2028. The declining trend in blowout fracture cases poses challenges to the sustainability of this subspecialty in plastic and reconstructive surgery. Concurrently, the increasing financial burden on patients highlights limitations in the current health care coverage. Plastic and reconstructive surgeons must adapt by diversifying skills and fostering interdisciplinary collaboration. Policy reforms are necessary to reduce the financial burden on patients and ensure equitable access to care.

Early Continuous Electroencephalography, Clinical Parameters, and Short-Term Functional Outcomes in Pediatric Traumatic Brain Injury: Single-Center, Retrospective Cohort, 2010-2020.

Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality. This study first investigates clinical characteristics and continuous electroencephalography (cEEG) parameters associated with short-term functional outcomes in pediatric patients following TBI. Second, we use these data for a hypothesis-generating model about outcomes. Retrospective cohort study. PICU within a quaternary care hospital. Pediatric patients (< 18 yr) admitted from January 2010 to December 2020 with TBI who underwent cEEG within 72 hours of admission. None. Patient demographics, clinical parameters, hospital course, and cEEG features were reviewed for associations with mortality and new disability (as defined by change in Functional Status Score between admission and discharge of ≥ 3 points). A statistical prediction model for patient outcome was created combining cEEG parameters with admission Glasgow Coma Scale (GCS) score and radiographic findings. We included 142 patients: 100 (70%) of whom had no new disability at hospital discharge; 42 (30%) had a new disability, including eight deaths. Univariate analysis showed favorable outcomes were associated with normal electroencephalogram background, reactivity, and sleep features (p < 0.001 for each). A model inclusive of these electroencephalogram parameters and GCS had high predictive ability for outcome with 0.94 with 95% CI (0.90-0.98). Specific cEEG findings observed acutely after injury, in combination with other clinical characteristics, may serve as biomarkers for short-term functional outcomes after pediatric TBI. Further validation of the model in another population is now required.

Transophthalmic Artery Embolization of Anterior Skull Base Meningiomas: Technical Case Series.

Preoperative embolization of anterior skull base meningiomas can facilitate surgical resection by reducing tumor vascularity. However, transophthalmic artery embolization carries risks of visual complications. This study aimed to evaluate the safety and efficacy of this technique using modern endovascular tools. This retrospective study included patients with anterior skull base meningiomas who underwent preoperative transophthalmic artery embolization followed by surgical resection between January 2022 and April 2024. Patient demographics, tumor characteristics, embolization details, surgical outcomes, and complications were analyzed. Seven patients (median age 57 years; 6 male) underwent embolization for tumors located primarily at the planum sphenoidale (58%). Unilateral embolization was performed in most cases, with one bilateral transophthalmic approach. Commonly embolized branches included the anterior and posterior ethmoidal arteries. Polyvinyl alcohol particles were the primary embolic agent (71%). Angiographic devascularization was achieved in all cases without complications. Gross total resection was achieved in 71%, with a median blood loss of 427 cc. At a 9-month follow-up, the median modified Rankin Scale score was 1. With careful patient selection, advanced microcatheter technology, and meticulous technique, preoperative transophthalmic artery embolization can be safely performed to facilitate resection of anterior skull base meningiomas. These results suggest it is a viable option for well-selected patients at experienced centers, though larger prospective studies are needed. Fr = French (unit of measurement for catheter diameter); IQR = Interquartile range; IRB = Institutional Review Board; PVA = Polyvinyl alcohol; TOAE = Transophthalmic artery embolization; WHO = World Health Organization.

Lumen-Apposing Metal Stents in the Management of Complex Pelvic Abscesses

Background: Lumen-apposing metal stents (LAMS) are utilized in a wide range of therapeutic gastrointestinal applications. We present our experience with LAMS-assisted drainage of complex pelvic abscesses at a large safety-net hospital. Methods: EUS-guided LAMS placements for pelvic abscesses from July 2020 to June 2024 were analyzed. Data were collected on patient demographics, procedure indications, fluid collection size, stent characteristics, stent dwell time, and complications. All cases underwent multidisciplinary review with Surgery and Interventional Radiology (IR) prior to LAMS-assisted drainage; all were deemed not amenable to drainage by IR. Results: Eleven patients underwent EUS-guided drainage of complex pelvic abscesses with cautery-enhanced LAMS. Diverticulitis was the most common cause of abscesses (n = 6; 55%). The average time from presentation to drainage was 7 days (1–18). The average abscess size was 7.2 cm (3.9–12.0 cm). The most common LAMS size was 15 mm × 10 mm; each was placed through the left colon and rectum with both technical and clinical success. All abscesses completely resolved with a mean stent dwell time of 28 days (17–42 days). After stent removal, the fistula was not routinely closed. No complications such as stent migration, bleeding, or perforation occurred. There were no recurrences and no patients required additional surgical or IR procedures with a mean follow-up of 25 weeks (SD 35.6). Conclusions: Adequate drainage is the cornerstone of pelvic abscess management, but IR or surgical access can be challenging, with inadequate drainage and prolonged hospitalization leading to significant morbidity. In our experience, EUS-guided, LAMS-assisted drainage provides a safe and effective alternative for managing pelvic abscesses.

Enhancing Aesthetics in Bilateral DIEP Flap Breast Reconstruction: the Role of Tissue Pre-Expansion.

Achieving symmetrical outcomes in bilateral autologous breast reconstruction is challenging, particularly in cases of asymmetrical recipient sites. Tissue pre-expansion is proposed to improve aesthetics by enlarging the skin envelope for refined breast shaping. This study examines its efficacy in bilateral DIEP flap reconstructions. This study systematically evaluated 43 patients that underwent bilateral DIEP flap breast reconstruction between 2004 and 2021. The efficacy of tissue pre-expansion in enhancing aesthetic outcomes, patient demographics, and complications were analysed. Aesthetic outcomes were measured using the aesthetic item score (AIS). Patients had an average age of 48.67 years (range: 29-79) and BMI of 27.08 (range: 23-36). Of these, 65.12% had undergone radiotherapy and 83.72% chemotherapy before reconstruction. Patients predominantly received secondary breast reconstruction (72.02%). Pre-expansion significantly improved breast symmetry and the overall aesthetic result (OAR) in cases of asymmetrical recipient-site conditions (3.76 vs. 3.16, p = 0.006 and 7.08 vs. 6.27, p = 0.03, respectively). There was a non-significant trend towards better breast form and volume, with no effect on scarring. For patients with symmetrical recipient-site conditions, pre-expansion did not significantly impact the aesthetic outcome. No significant differences in complication rates were observed. Tissue pre-expansion significantly enhances aesthetic outcomes of bilateral autologous breast reconstruction, notably breast symmetry and OAR, in patients with asymmetrical recipient-site conditions. However, careful patient selection and preoperative planning are essential for leveraging pre-expansion's benefits, emphasizing the importance of informed decision-making and expectation management.This publication/studyinvestigates the efficacy of tissue pre-expansion in enhancing aesthetic outcomes for bilateral DIEP flap breast reconstructions. Detailed analysis of 43 patients that received bilateral DIEP reconstruction with and without pre-expansion. Finds significant improvements in breast symmetry and overall aesthetic rating (OAR) for patients with asymmetrical recipient-site conditions. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Radical prostatectomy outcomes of prostate cancer cases: Insights from a leading surgeon's experience in Azerbaijan.

Prostate cancer is a significant health concern worldwide and ranks as the 4th most frequent cancer among men in Azerbaijan. While robot-assisted laparoscopic radical prostatectomy is the preferred surgical technique in many countries, open retropubic radical prostatectomy (ORP) remains the primary treatment option in Azerbaijan due to limited access to robotic surgical systems. This study aims to analyze the outcomes of ORP in patients with local and locally advanced prostate cancer. We retrospectively evaluated 95 men who underwent extraperitoneal retropubic ORP for prostate cancer at our center between May 2020 and December 2023. Comprehensive data on patient demographics, preoperative parameters, surgical details, and postoperative outcomes were collected. Statistical analyses were conducted using IBM SPSS 27.0 software. The mean age of the patients was 65.9 years. The median preoperative PSA level was 14.8 ng/mL, and lymph node enlargement was identified in 29.5% of patients. A rectal injury occurred in one patient (1.1%) as the only intraoperative complication. The mean intraoperative blood loss was 330 mL, and the median hospital stay was 6 days. A positive surgical margin was observed in 38.9% of cases. Diabetes mellitus and higher intraoperative blood loss were associated with prolonged hospital stays (≥ 7 days). Erectile dysfunction was reported in 52.6% of patients 6 months postoperatively, while urinary incontinence was observed in 2.2%. ORP outcomes in Azerbaijan are comparable to those reported for laparoscopic and robot-assisted techniques in terms of perioperative and oncological results. Despite the absence of advanced surgical technology, ORP remains an effective treatment option for prostate cancer when performed by experienced surgeons.

Adherence to national trauma triage criteria in Norway: a cross-sectional study

BackgroundNorwegian hospitals employed individual trauma triage criteria until 2015 when nationwide criteria were implemented. There is a lack of empirical evidence regarding adherence to Norwegian national criteria for activation of the trauma team (NTrC) and the decision-making processes regarding trauma team activation (TTA) within Norwegian trauma hospitals. The objectives of this study were to investigate institutional adherence to the NTrC and to investigate similarities and differences in the decision-making process leading to TTA in Norwegian trauma hospitals.MethodsA digital semi-structured questionnaire regarding adherence to criteria, TTA decision-making and criteria documentation was distributed to all Norwegian trauma hospitals (n = 38) in the spring of 2022. Contact details of trauma coordinators and registrars were provided by the Norwegian Trauma Registry secretariat. Follow-up telephone interviews were conducted at the investigator’s discretion in cases of non-respondents or need to clarify answers.ResultsThirty-eight trauma hospitals were invited to answer the survey, where 35 hospitals responded (92%), making 35 the denominator of the results. Thirty-four (97.1%) hospitals stated that they followed NTrC. Thirty-three (94.3%) of the responding hospitals provided documentation of their criteria in use, of which twenty-eight (80%) of responding hospitals adhered to the NTrC. Three (8.6%) hospitals employed a tiered TTA approach with different sized teams. In addition four hospitals (11.4%) used specialized teams to meet the needs of defined patient groups (e.g. geriatric patients, traumatic brain injury). Twenty-one (60%) of the responding hospitals had written guidelines on who could perform TTA and in 18 hospitals (51.4%) TTA could be performed by pre-hospital personnel. Twenty-three (65.7%) of the hospitals documented which criteria that were used for TTA.ConclusionThere is good adherence to the national criteria for activation of the trauma team among Norwegian trauma hospitals after implementation of national guidelines. Individual hospitals argue the use of certain local criteria and trauma team activation decision-making processes to increase their precision in specific patient populations and demographics. Further steps should be done to reduce the variation in TTA decision-making processes among hospitals and improve documentation quality.

Development and internal validation of El-Shazly-Buchholz's nomogram to predict postoperative complications after PCNL: A multicenter study.

A model to predict the risk of surgical complications following percutaneous nephrolithotomy (PCNL) could be a useful tool to guide clinical decision-making. The aim of this study was to develop a simple and widely applicable stratification tool to be used for patient counseling, surgical planning, evaluation of outcomes, and academic reporting. Data of patients who underwent PCNL were retrieved from the database of the collaborating centers including demographics of patients, characteristics of their stones and urinary tracts, and perioperative data. The primary outcome was the development of postoperative complications. Data were randomly split into a training dataset (85%) and a validation dataset (15%). A univariate and multivariate logistic regression analysis of the training dataset was performed to identify independent predictors of postoperative complications. Model variables were used to construct a nomogram that was internally validated on the testing dataset by measuring calibration, discrimination, and plotting the decision curve. Six hundred thirty one patients (245 Males) with a median (IQR) age of 49 (37-56) years were included. Post-operative complications occurred in 147 (23.3%) patients. Significant predictors of complications included preoperative urine culture (p < 0.001), largest stone diameter (p = 0.02), and intraoperative blood loss (p = 0.002). A nomogram was developed from the predictors and applied to the validation dataset showing an area under the curve (95%CI) of 66.4% (52.2;80.6). This new scoring system emphasized patient characteristics and operative details rather than stone characters to predict the morbidity of PCNL. Furthermore, it should facilitate risk adjustment, enabling physicians to better define the nephrolithiasis disease continuum and identify patients who should be referred to tertiary care centers.