Prolonged Hospital Research Articles

Early discharge with elevated C-reactive protein levels is safe after endoscopic-assisted coronary bypass grafting: Optimisation of postoperative care.

This study describes the perioperative kinetics of C-reactive protein in patients undergoing endoscopic coronary artery bypass grafting for single target vessel left anterior descending disease, with early postoperative discharge. From July 2021 to April 2024, patients were included in this single-centre retrospective study (N = 208), excluding C-reactive protein-modulating complications. Perioperative and 14-day follow-up C-reactive protein levels and clinical signs of infections were analysed. After endoscopic coronary artery bypass grafting, the C-reactive protein values on the first postoperative day were 44 [24-65] and 140 [88-200] mg/L at Day 3. Most patients were discharged after 3 days (64.4%), regardless of the level of C-reactive protein, and the majority experienced a return of C-reactive protein levels to baseline during follow-up, 6 [6-15] mg/L. Two patients had an infection requiring intervention and readmission (1.0%). The return of C-reactive protein to baseline levels at follow-up and the low incidence of clinical infections suggest that patients can be discharged safely, and prolonged hospitalisation is unnecessary. For perioperative care practitioners, these findings underscore the value of shorter hospital admissions in optimising resource use and improving patient flow, enhancing both patient outcomes and operational efficiency.

Hyperkalaemia among hospital admissions: prevalence, risk factors, treatment and impact on length of stay

BackgroundHyperkalaemia is one of the common electrolyte disorders among hospital patients, affected by many risk factors including medications and medical conditions. Prompt treatment is important given its impact on patient mortality and morbidity, which can lead to negative patient outcomes and healthcare resource utilisation. This study aims to describe the prevalence, characteristics, and treatment of patients admitted to hospitals with hyperkalaemia and compare findings between patients with kidney failure on maintenance haemodialysis therapy and patients without kidney failure. It also aims to identify associations between hyperkalaemia and hospital length of stay.MethodsWe undertook a retrospective cohort study on adult patients admitted to Townsville University Hospital between 1st January 2018 and 31st December 2022 (n = 99,047). Patients were included if they had a serum potassium result of 5.1 mmol/L and above during their admission/s. Statistical analysis was conducted using several methods. A Welch’s t test and Chi-square test were employed to assess differences between groups of patients with kidney failure on maintenance haemodialysis therapy and those without kidney failure. For comparison among multiple groups with varying severities of hyperkalaemia, the Kruskal-Wallis test with Mann-Whitney U test and logistic regression were used.Results8,775 hyperkalaemic patients were included in the study, with a mean age of 64.7 years. The prevalence of hyperkalaemia was 8.9% of patients. Risk factors for hyperkalaemia were highly prevalent among those who had the condition during their admissions. Patients with kidney failure on haemodialysis who had hyperkalaemia were, on average, 6 years younger, more often Indigenous, and experienced more severe hyperkalaemia compared to other patients without kidney failure. There was a notable difference in hyperkalaemia treatment between groups with varying degrees of hyperkalaemia severity. Hyperkalaemia was not found to be associated with prolonged hospital stay.ConclusionHyperkalaemia is common among hospital admissions. Patients with kidney failure on haemodialysis are at higher risk of developing severe hyperkalaemia. Treatment for hyperkalaemia was variable and likely insufficient. Timely detection and treatment of hyperkalaemia is recommended.

Barriers and Facilitators to Age-Friendly Health Care: A Scoping Review.

As the global population ages, older adults are increasingly experiencing more complex health problems, resulting in an increase in the prevalence of prolonged hospitalisation. This study aimed to explore the barriers and facilitators to age-friendly health care. Scoping review. A systematic search was performed from 2004 to 2024 in the following eight electronic databases: PubMed, Cochrane Library, Web of Science, EBSCOhost, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, China Science and Technology Journal Database and WanFang. A manual search was conducted through the references of the included papers and related publications. This review utilised the scoping review methodology framework proposed by Arksey and O'Malley. Studies were screened and extracted independently by two reviewers using a standardised form. Thematic synthesis was used to summarise data. The PRISMA-ScR Checklist was also used. Thirty-seven studies were included. The following six themes were identified: (1) communication and services; (2) facilities and environment; (3) leadership and policy; (4) information management and investment; (5) education and training and (6) multidisciplinary resources. Several barriers and facilitators to age-friendly health care have been reported. Communication and service issues are critical to age-friendly care both in developed and developing countries. Understanding modifiable barriers and facilitators is essential to addressing these factors and promoting evidence-based care for older individuals. With the rapid growth of ageing populations worldwide, hospitals need to adapt to ensure age-friendly health care for older patients, and this review provides insights on barriers and facilitators to age-friendly health care. To this end, the review is designed to stimulate global discussions among hospital leaders, clinicians and staff; policymakers and researchers to improve care for patients as they age. No patient or public contribution.

Beta-Lactam Resistance

Objective: Investigate beta-lactam resistance in order to identify the associated factors, the main beta-lactam resistant microorganisms and their complications. Theoretical Framework: Beta-lactam resistance is a worldwide health problem, consisting of the inability to respond to the action of antibiotics. Method: retrospective qualitative cross-sectional study with a descriptive analysis, the data collection technique was a review of scientific articles published from 2018, in Spanish and English, in databases such as Scielo, PubMed, Cochrane, Scopus, Organizations such as the World Health and Pan American Health. The information was organized in tables. Results and Discussion: The results obtained revealed that resistance to this group of drugs is as common as their free prescription, being gram-negative the most common germs to present resistance; prolonged hospital stay is an aggravating factor in the casuistry. Research Implications: These implications could span medicine, pharmacêutics, epidemiology, public health and environmental management Originality/Value: The relevance and value of this research are evidenced in magnifying this public health problem and taking action on the matter.

Increased risk of adverse events following the treatment of associated versus elementary acetabular fractures: a matched analysis of short-term complications

PurposeThis retrospective cohort study aims to compare short-term complication rates between patients receiving open reduction and internal fixation (ORIF) for associated versus elementary acetabular fractures, with a secondary objective of identifying independent risk factors for adverse outcomes.MethodsThe American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried using current procedural terminology (CPT) codes to identify patients that underwent ORIF for associated acetabular (CPT 27228) or elementary acetabular fractures (CPT 27226, 27227) from 2010 to 2021. Propensity score matching was employed to account for baseline differences and the short-term complication rates were compared between the cohorts.ResultsWe identified 1,330 patients who underwent ORIF for an acetabular fracture between 2010 and 2021, including 868 patients with elementary fractures and 462 with associated fractures. After matching, there were 462 patients in each cohort. The matched associated acetabular fracture group experienced higher rates of any adverse event (AAE, p = 0.029), transfusion (p = 0.010), and reoperation (p = 0.049). Increased age, increased operative time, higher body mass index (BMI), and prolonged hospital length of stay (LOS) augmented the risk of any complication.ConclusionThe findings of this study identify areas of greater risk of postoperative complications after ORIF in individuals with associated versus elementary acetabular fractures. Discussion of these heightened risks is critical to appropriate patient care. Understanding these risks plays an important role in the clinical decision-making process and may identify areas to monitor patients postoperatively.

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.

Excess hospital length of stay and extra cost attributable to primary prolonged postoperative ileus in open alimentary tract surgery: a multicenter cohort analysis in China

BackgroundProlonged postoperative ileus (PPOI) reportedly leads to compromised postoperative recovery and increased healthcare costs. However, the evidence for this claim was obtained from studies that included patients with both primary and secondary PPOI. How primary PPOI affects the hospital length of stay (LOS) and healthcare costs is not well documented. A multicenter cohort analysis was performed to investigate the potentially detrimental effect of primary PPOI on hospital LOS and healthcare costs.MethodsIn total, 2083 patients who underwent open abdominal surgery from 22 tertiary hospitals in China were prospectively registered in a PPOI cohort. Of these, 1863 patients without secondary PPOI were analyzed. Poisson regression for hospital LOS and log-transformed linear regression for healthcare costs were performed to identify whether primary PPOI was an independent risk factor.ResultsThe incidence of primary PPOI was 13.2% (246/1863). The median LOS was significantly longer in the PPOI than non-PPOI group (12 vs. 11 days, p < 0.001). The median healthcare cost was significantly higher in the PPOI than non-PPOI group (70,672 vs. 67,597 CNY, p = 0.016). Multivariate Poisson regression and log-transformed linear regression showed that 12% of prolonged LOS and 4.6% of healthcare costs were due to primary PPOI.ConclusionsPrimary PPOI is a potential source of prolonged hospital LOS and extra healthcare costs for patients undergoing open abdominal surgery. Cost-effective approaches are needed to manage and prevent primary PPOI.

Developing a theory of change to guide the design and implementation of a caregiver-centric support service

BackgroundSet against the backdrop of a rapidly ageing population and growing emphasis on the importance of ageing-in-place, family members often assume the role of a caregiver. Navigating through a complex healthcare system while simultaneously juggling the daily care needs of their care-recipients, caregivers often become worn out by the intense caregiver stress and burden, neglecting their own well-being. This translates to adverse health and economic outcomes such as prolonged hospital stays and increased nursing home placement of care-recipients. Seeking to better support caregivers, we developed a theory of change to guide the design and implementation of a caregiver support programme – Project Carer Matters.MethodsWe applied theory of change methodology to explain how the Project’s interventions were hypothesised to lead to their identified short-to-long term goals, drawing on a causal analysis based on available evidence. The theory of change was developed with insights garnered from previous research studies conducted on caregiver stress, stakeholder engagement sessions and multiple dialogues with clinical experts and hospital leaders.ResultsOur final theory of change is the result of the evaluation of the Project in its pilot phase. It is populated with the resources, activities and short-to-long term outcomes that can be attributed or linked to the Project. Multiple meetings and discussion with stakeholders over the pilot prompted frequent practice of the Plan, Do, Study, Act model to refine the ongoing implementation process and the theory of change itself.ConclusionsA theory of change is essential in guiding the design, implementation and evaluation of a complex health care intervention such as Project Carer Matters. The development of the theory of change is a journey and not a resultant product. This journey has also led us to learn that 1) a theory of change needs to be dynamic and ever evolving with time and context, 2) the perspectives of relevant stakeholders need to be included in this process to ensure the feasibility and sustainability of the project in the long run and 3) frequent stakeholder engagements are essential in enabling the implementation team to fine-tune the Project in an effective manner.Trial registrationClinicalTrials.gov, NCT05205135, registered on 24/01/2022.

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.

Recommendations on Rapid Diagnostic Point-of-care Molecular Tests for Respiratory Infections in the United Arab Emirates

Traditional testing methods in the Middle East Region, including the United Arab Emirates (UAE), particularly the testing of Respiratory Syncytial Virus (RSV), influenza, group A streptococcus (GAS), and COVID-19 have the potential to be upgraded to new and advanced diagnostics methods that improve lead time to diagnosis, consumption of healthcare resources and patient experience. In addition, based on the research, it was reported that there is an underreporting of respiratory cases, overuse of antibiotics, and prolonged hospitalizations which is posing pressure on UAE healthcare stakeholders. A literature review was done exploring UAE's current diagnostic practices, recommended guidelines, diagnostic gaps, and challenges in RSV, GAS, Influenza, and COVID-19. This was followed by stakeholder discussions focusing on assessing current diagnostic practices, usage of rapid molecular point-of-care (POC) diagnostic tests, current gaps in diagnosis, targeted profiles for POC testing, and potential impact on patient management for targeted respiratory infections. A round table discussion with healthcare experts, insurance experts, key opinion leaders, and pulmonologists discussed challenges and opportunities in treating respiratory diseases. UAE healthcare stakeholders suggest that introducing alternative and up-to-date diagnostic methods such as POC molecular testing is expected to improve healthcare outcomes, optimize resources, and develop a robust case management of respiratory tract infections. It is essential to emphasize that by introducing POC testing, precision medicine is reinforced, efficiency is achieved, and the overall management of population health is enhanced.

Emergence of Candida famata Fungemia in an Immunocompromised Patient: A Case Report Highlighting Clinical Presentation, Diagnosis, and Therapeutic Strategy

Candida famata, once regarded as benign, is now being recognized as an opportunistic pathogen. This case presents an 88-year-old male with multiple comorbidities who developed C. famata bloodstream infection during treatment for healthcare-associated pneumonia complicated by prolonged catheter use and hospital stay. Antifungal therapy with voriconazole led to clinical improvement and eventual discharge of the patient in stable condition. The rarity of C. famata infection presents diagnostic and therapeutic challenges. This case highlights the importance of timely antifungal therapy and a multidisciplinary approach in managing invasive candidiasis, particularly in immunocompromised patients. Further research is needed to optimize treatment.

Infection in nicu setting pose serious health risks to neonates - A meta-analysis

Infections in Neonatal Intensive Care Units (NICUs) pose significant health risks to neonates, particularly due to their underdeveloped immune systems and the invasive procedures often necessary for treatment. These infections can lead to severe complications, prolonged hospital stays, and increased mortality rates. This meta-analysis aims to assess the prevalence, risk factors, outcomes, and preventive strategies associated with infections in NICU settings to better understand the scope of the problem and provide insights for improved healthcare practices. A systematic search was conducted across multiple databases, including PubMed, CINAHL, and Medline, for peer-reviewed studies published in the last two decades. Studies were selected based on criteria that included focus on NICU-acquired infections, study design, and outcomes reported on neonatal health. Data on infection prevalence, types, risk factors, treatment efficacy, and preventive interventions were extracted and analyzed using meta-analytic techniques to calculate pooled estimates and examine statistical associations. Findings indicate a high prevalence of infections in NICUs, with bloodstream infections, pneumonia, and urinary tract infections as the most common types. Risk factors such as prematurity, low birth weight, invasive procedures, and prolonged NICU stay significantly increase infection rates. Neonates with infections demonstrated higher morbidity, longer hospital stays, and a higher risk of long-term health complications. Preventive measures, particularly hand hygiene protocols, sterilization practices, and early identification strategies, were associated with reduced infection rates. Infections in NICUs remain a critical issue, impacting neonatal outcomes and healthcare costs. Strengthening preventive measures and developing standardized protocols for infection control are essential to reduce infection rates and improve neonatal health outcomes. Further research is needed to identify the most effective interventions and foster a culture of infection prevention within NICU settings.

The Predictive Role of Preoperative Malnutrition Assessment in Postoperative Outcomes of Patients Undergoing Surgery Due to Gastrointestinal Cancer: A Cross-Sectional Observational Study.

Background: Malnutrition affects patients undergoing surgery for gastrointestinal cancers and contributes to poor postoperative outcomes, including increased complication rates, longer hospital stays, and higher mortality. Despite the availability of several malnutrition screening tools and prognostic scores, their effectiveness in predicting postoperative outcomes remains unclear. This study aimed to compare the predictive accuracy of Patient-Generated Subjective Global Assessment (PG-SGA), Global Leadership Initiative on Malnutrition (GLIM), Geriatric Nutritional Risk Index (GNRI), and Controlling Nutritional Status (CONUT) score for postoperative outcomes in patients undergoing surgery for colorectal, hepato-pancreato-biliary and upper gastrointestinal cancers. Methods: A cross-sectional observational study from March 2022 to October 2023 was conducted in two university surgical departments, after registration on ClinicalTrials database (NCT05795374). Patient characteristics, preoperative nutritional status and postoperative outcomes were analyzed. Results: In total, 480 patients were enrolled. CONUT and GNRI demonstrated high specificity (over 90% and 80%, respectively) for predicting overall complications, major complications, prolonged hospital stay, mortality, and advanced disease stage across all cancer types. Notably, CONUT showed a specificity over 97% and GNRI over 89.7% for colorectal and upper gastrointestinal cancer patients, respectively, despite their lower sensitivity. On the contrary, PG-SGA and GLIM presented better sensitivity (up to 50%), but slightly lower specificity (up to 86.4%). Conclusions: CONUT and GNRI are valuable for ruling out non-at-risk patients for adverse postoperative outcomes, while PG-SGA and GLIM provide better sensitivity. A step-up approach-initial screening with PG-SGA and GLIM, followed by detailed evaluation with CONUT or GNRI- should be validated in future studies across diverse clinical settings.

Protocol for an embedded randomised controlled trial of Early versus Late Stopping of Antibiotics in children with Febrile Neutropenia (ELSA-FN).

In children with cancer, febrile neutropenia (FN) is one of the most common complications of treatment, a leading cause of unplanned and prolonged hospital admission and is the key driver of antibiotic exposure. Co-designed with key stakeholders, 'Early versus Late Stopping of Antibiotics in high-risk FN' (ELSA-FN) is a randomised controlled, non-inferiority trial that compares stopping antibiotics in clinically stable patients after 48 hours with the current standard of care, continuing antibiotics until absolute neutrophil recovery. As an Australian first, we will exploit the potential of electronic medical record (EMR) systems, embedding all key aspects of the trial including screening, consent, randomisation and data collection into standard clinical and EMR workflows. We aim to randomise 320 children with high-risk FN and prospectively collect data on safety, acceptability to clinicians and families, as well as several secondary outcomes related to antibiotic exposure. The findings will contribute to optimal antibiotic use in children with FN internationally and inform design and implementation of future EMR-embedded trials.

Short-medium term complications of bariatric surgery: a pilot study.

Bariatric surgery (BS) stands as a highly effective intervention for severe obesity; however, limited understanding exists regarding its short to medium-term complications. This study aimed to analyze short-medium term complications in patients undergoing BS in an Ecuadorian hospital. A retrospective cohort study included 1132 patients who underwent BS between October 2021 and April 2022, specifically evaluating those with complications needing hospital readmission. Demographic, clinical, surgical, and therapeutic data were collected. The degree of complications was evaluated using the Clavien-Dindo classification. Out of the 1132 patients, 1.6% experienced early complications requiring hospital readmission within the first six months post-BS. Complications occurred in 7% of patients with revisional surgery, 2% with gastric bypass, and 1.2% with gastric sleeve. The most common complications were stenosis (28%), leaks/fistulas (17%), gallbladder and/or bile duct pathologies (17%), and fever (17%). Management strategies involved conservative treatment (28%), combined endoscopic and surgical approaches (28%), and surgical reintervention alone (33%). According to the Clavien-Dindo classification, 28% presented mild-moderate and 72% serious complications. BS showed a low incidence of early complications that required readmission. However, a substantial proportion (almost 70%) of patients with early complications experienced severe ones, resulting in prolonged hospital stays. These findings emphasize the need for ongoing monitoring and specialized care in the postoperative period, contributing valuable insights to the safety profile of BS in an Ecuadorian context.

Usefulness of simplified comprehensive geriatric assessment as a pre-ERCP screening for the elderly.

Endoscopic retrograde cholangiopancreatography (ERCP) is often performed in elderly patients for stone removal and biliary drainage following common bile duct stones or malignant biliary obstruction. Safety in ERCP should be considered in elderly patients due to complications and decreased activities of daily living (ADL), but there are no adequate pretest evaluation criteria. In recent years, the usefulness of the comprehensive geriatric assessment (CGA) for planning treatment and predicting prognosis has been reported. We retrospectively analyzed consecutive patients who underwent ERCP at our institution between October 2021 and June 2023. The relationship between CGA and ERCP outcomes was examined by dividing CGA scores into three groups (Group A; score 0, Group B; score 1-4, Group C; score 5-7) among patients 65 years of age and older. Risk factors for prolonged hospitalization were identified using univariate and multivariate analysis. Of the 388 patients, 290 were 65 or older with a CGA score. The median length of hospital stay was significantly longer in the higher CGA7 scores group (5 vs. 8 vs. 15 days, p < .01). There was no significant difference in the rate of adverse events (p = .54) and median total procedure time (p = .35). In univariate and multivariate analysis, higher CGA score groups were significant risk factors for a prolonged hospital stay. CGA appears to be a valuable tool for preadmission screening in elderly patients undergoing ERCP.

Acute Kidney Injury in Children Admitted with Diabetic Ketoacidosis

Background and Aims: Diabetic ketoacidosis (DKA) poses a risk for acute kidney injury (AKI) in children, with incidence varying across different regions and populations. The aim of the study is to assess the proportion and predictors of AKI in children with DKA and to assess the impact of AKI on the duration of hospital stay and recovery from metabolic acidosis. Methods: Medical records of children under 14 years admitted with DKA between 2021 and 2023 were analysed retrospectively. Data on clinical characteristics and outcomes were collected and analysed using descriptive and inferential statistics. Results: Out of 31 patients, 7 (22.6%) developed AKI. Statistically significant differences were found between the AKI and non-AKI groups in terms of age, body mass index, corrected sodium and blood urea levels. Children with AKI had a longer median duration of hospital stay (10 vs. 6 days, P = .002) and a longer time to recover from metabolic acidosis (96 vs. 39 hours, P = .001) compared with those without AKI. Conclusion: A significant proportion of children with DKA are affected with AKI, leading to prolonged hospitalisation and delayed recovery from metabolic acidosis. Identifying predictors of AKI can help in the early recognition and management of this complication, improving patient outcomes.

Platinum nanozyme embedded in hyaluronate with multifunctional attributes synergistically promoting tracheal fistula healing.

Respiratory tract fistulas, including tracheal and bronchial fistulas, usually cause prolonged hospitalization with developed complications and even death, while respiratory tract fistula healing remains challenging. Exploring effectiveness and mechanism in animal systems using well-designed bio-nanomaterials will improve our understanding of fistula management. Hyaluronate (hyaluronan or hyaluronic acid) has been widely studied as a promising coating material for bio-nanomaterials in treatment applications. Herein, by combining the intrinsic bioactivities of sodium hyaluronate (SHA) and the enzyme-like activities of platinum (Pt) nanoparticles (NPs), obtained SHA-PtNPs defined as nanozymes (Enzyme-like nanomaterials) have been proposed to treat tracheal fistulas. Results reveal that introducing SHA endows the fabrication of PtNPs with dispersibility, small particle size (3.7 nm), stability, etc. On the other hand, SHA-PtNPs present high catalase-like (3320 U/g), superoxide dismutase-like activities (129,000 U/g), and hydroxyl radicals elimination capacity, thereby exerting excellent reactive oxide species scavenging ability. We have systematically verified the above properties of SHA-PtNPs in vitro. SHA-PtNPs show outstanding biocompatibility, promote cell proliferation and migration, and have considerable hemocompatibility and hemostasis. Afterward, rabbit tracheal fistula models that were treated with SHA-PtNPs in vivo showed a significant improvement in the closure of the fistulas and an increase in quality. This was evident through a substantial decrease in inflammation, increased angiogenesis, stimulation of re-epithelialization, and highly ordered alignment of collagen fibers. No significant side effects were observed. In summary, this work initiates an in vivo treatment for tracheal fistula models by taking advantage of both naturally sourced polysaccharides and nanozymes.

Factors associated with severity and length of hospital stay in patients with acute upper gastrointestinal bleeding: insights from two Ethiopian hospitals

BackgroundUpper gastrointestinal bleeding (UGIB) is a critical emergency with substantial morbidity and mortality. Outcomes depend on bleeding severity, patient risk factors, and comorbidities. This study evaluated clinical patterns and factors influencing disease severity and hospital stay among patients present with UGIB symptoms at two major Ethiopian hospitals.MethodsA retrospective, cross-sectional review was conducted on 199 UGIB patients admitted to Yekatit 12 Hospital Medical College (Y12HMC) and Tikur Anbesa Specialized Hospital (TASH) from September 2022 to September 2023. Data on demographics, clinical presentations, endoscopic findings, and outcomes were analyzed using SPSS version 26. Binary logistic regression assessed associations, with statistical significance set at P < 0.05.ResultsOf 199 patients, 70.9% were male, predominantly aged 18–40. Hematemesis (63.8%) and hematemesis with melena (27.6%) were common presentations. Endoscopy was not performed on more than half of the participants, with 116 patients (58.3%) not undergoing this procedure. Among the 83 cases who did have endoscopy, esophageal varices emerged as the most common condition, observed in 43.3% (36 cases. Smoking (AOR = 1.77), alcohol intake (AOR = 1.89), and drug use (AOR = 1.34) were linked to higher severity scores. Alcohol use, comorbidities, liver disease, and previous drug use correlated with prolonged hospital stays.ConclusionUGIB predominantly affects younger males, with hematemesis as the primary presentation. Key factors like smoking, alcohol intake, and drug use were associated with greater disease severity and longer hospital stays. These findings suggest the importance of lifestyle interventions, particularly in resource-limited settings.

Bipolar radiofrequency track cautery during abdominal biopsies: teaching points and lessons learned.

Abdominal percutaneous needle biopsies are commonly performed minimally invasive procedures to obtain tissue samples for histopathological diagnosis. Severe post-biopsy bleeding is uncommon but can be associated with prolonged hospitalization, additional interventions, morbidity, and death. Many factors may increase bleeding risk and various peri-procedural and intra-procedural strategies may minimize bleeding risk. Bipolar radiofrequency track cautery is one method that may reduce the risk of post-biopsy bleeding or tumor seeding. This paper offers an illustrative case-based review of teaching points and lessons learned in our experience using a commercially available bipolar radiofrequency track cautery device during percutaneous image-guided abdominal biopsies.