Proportion Of Cases In Group Research Articles

Safety of performing multiple free flap surgeries by a single surgeon in a single day

With the growing popularity of the use of free flaps, surgeons may frequently encounter situations necessitating the performance of multiple free flap surgeries in a single day. Given its prolonged duration and technical complexity, concerns remain regarding their safety. This study investigated whether a single surgeon conducting multiple free flap surgeries in a day heightens the risk of complications. Patients who underwent free flap-based reconstruction from March 2002 to May 2023 were reviewed and categorized into 3 groups: one flap per day (Group 1), multiple flaps per day on the same patient (Group 2), and multiple flaps per day on different patients (Group 3). Outcomes, particularly perfusion-related complications (PRCs), were compared. In total, 1910 cases were analyzed: 1570 in Group 1, 126 in Group 2, and 214 in Group 3. Over time, the proportion of cases in Group 3 increased. Group 3 had fewer breast reconstruction cases but more lower extremity reconstructions, with a higher prevalence of chronic wounds. Although the rates of PRCs varied among groups, multivariable analysis exhibited no association of performing multiple flaps in a day with their occurrence, regardless of breast or nonbreast reconstruction. The rate of arterial insufficiency was significantly higher in group 3 compared with group 1 after adjusting for other variables. Performing multiple free flaps in a single day may not significantly increase the risks of overall PRCs. However, there appears to be a higher incidence of arterial insufficiency, emphasizing the need for careful planning and precise execution of procedures.

Shifting toward total drainless approach in DIEP flap-based breast reconstruction: Evaluation of safety

With increasing interest in swift postoperative recovery, there has been a trend toward omitting drains in deep inferior epigastric perforator (DIEP) flap-based breast reconstruction, ideally aiming to avoid drains in the breasts and abdomen. This study evaluated our transition toward total drainless reconstruction, focusing specifically on the safety of omitting drains in the breasts. Patients who underwent breast reconstruction with DIEP flap from 2018 to 2023 were reviewed. They were divided into 3 groups: group A (with drains in the abdomen and breast), group B (drains only in the breast), and group C (total drainless). For group C, routine ultrasound examinations were performed to check for fluid accumulation. Complication profiles were compared among the groups. In total, 294 cases were included, comprising 77 in group A, 112 in group B, and 105 in group C. Chronologically, a gradual increase in the proportion of cases in group C was observed, with the complication rates remaining stable. On comparing the complication profiles of the recipient and donor sites among the 3 groups, no significant differences were found. Breast seroma, persisting 1 month postoperatively, was exclusively detected in 6 (5.7%) cases within group C, all of whom were treated with outpatient clinic-based aspiration. When restricting the analysis to group C, a greater weight of mastectomy specimen and axillary lymph node dissections exhibited an independent association with breast seroma development. Smooth transition to total drainless DIEP breast reconstruction appears safe, without significantly increasing the risks of complication.

Efficacy of Topical Oxygen Therapy as an Adjuvant to Conventional Dressing in Wound Healing – A Randomised Controlled Study

Background: The prevalence of lower limb ulcers is common in India and there is a dearth of research work regarding the use of topical oxygen therapy (TOT) in wound healing. The present research aimed to compare the efficacy of wound healing in lower limb ulcers with and without TOT as an adjuvant to conventional dressing. Materials and Methods: This randomised controlled study was conducted in patients aged between 18 and 65 years with diabetic foot ulcers, ulcers secondary to peripheral arterial disease, ulcers due to chronic venous insufficiency, pressure sores and traumatic ulcers. Post-debridement patients were randomised into two groups of 35 patients each. Group A and Group B patients received TOT along with normal saline dressing and only normal saline dressings, respectively. Results: The median surface area of the wound on post-debridement day, day 3, day 7, 1 week after discharge and 1-month post-operatively was significantly lower in Group A as compared to Group B. The percentage reduction in surface area of the wound at 1-month post-operative follow-up was significantly higher in Group A as compared to Group B. Significantly higher proportion of cases in Group A had relatively better ulcer bed score (scores 0 or 1) at day 7 and 1-month post-operative follow-up as compared to Group B. The median amount of exudate on post-debridement day, day 3, day 7 and 1 week after discharge was significantly lower in Group A as compared to Group B. Conclusions: TOT can be used to improve wound healing in lower limb ulcers.

Colombian ocular infectious epidemiology study (COIES): presumed ocular tuberculosis incidence and sociodemographic characterization, 2015–2020

ABSTRACT Purpose This study aims to describe the incidence and geographical distribution of presumed ocular tuberculosis (POTB) in Colombia between 2015 and 2020 based on the Colombian Ministry of Health and Social Protection data. Methods We conducted a claims-based study using the Integrated Social Protection Information System database from the Colombian Ministry of Health. We used the specific code of the International Classification of Diseases for Ocular Tuberculosis (A18.5) and tuberculosis from 2015 to 2020 to estimate the incidence and the demographic status of the disease in Colombia. We used STROBE guidelines. Results During the 6 years of study, the crude unadjusted incidence was 0.2 new cases of POTB in one million consulting patients and 55 new cases of POTB in 100,000 patients with TB showing a decreasing pattern of the disease. From the 28 new cases, the mean age of presentation was 41.4 years (SD ± 25.3) with a female predominance (60.7% of the cases). Distribution by age shows a higher proportion of cases in groups 15–19 (14%), 20–24 (11%), 55–59 (11%), and 60–64 (11%) years of age. The geographic analysis showed a higher number of cases in Andean region, followed by the Caribbean and Pacific regions. Conclusions This is the first study that determines the incidence of POTB in a developing country from Latin America. POTB incidence in Colombia is lower than the reported worldwide. It could be attributed to a low burden of Tuberculosis in Colombia, underdiagnosis, and a low rate of immigration from countries with a high burden of TB.

Correlation of Corneal and Scleral Topography in Cases with Ectasias and Normal Corneas

Background and Objective
 To determine the relationships between corneal and scleral elevation topography in subjects with corneal ectasias and normal corneas.
 
 Material and Methods
 This is a multi-site retrospective study. Ocular surface topography (sMap3D, Precision Ocular Metrology, US) was collected on 115 eyes with prolate cornea profile (Group A) and 227 eyes showing corneal ectasia (Group B). Sagittal height (SAG 1) was measured in the axis of the highest elevated point of the cornea (apex), defined by the meridian joining this apex to the geometrical center of the cornea at an 16 mm chord diameter (8-mm radius). Another sag value was evaluated 180° away (SAG 2) at the same diameter/radius. The difference in height between SAG 1 and SAG 2 represents a quadrant specific effect (QSE). Conjunctival toricity is estimated by comparing the best fit of the conjunctival/scleral shape data to a toric (Sin2) curve; the root- mean-squared error (RMSE) of this curve, a measure of irregularity, was also calculated.
 
 Results
 The ectasia subjects demonstrated greater QSE, (p<0.001), standard toricity (p<0.001) and RMSE (p<0.001) on the sclera compared to normal cornea cases. If the apex of the ectasia was ≥1.25mm from the corneal center, the asymmetry was greater. Within the Group A, standard toricity was significantly higher than QSE (p<0.001) suggesting a more regular conjunctival pattern. As a proof, a significantly greater proportion of cases in Group B vs. Group A (57% vs. 26%, p<0.001) were found with conjunctival irregular shape, as previously defined. In both groups, subjects graded as having spherical/toric scleral shape had significantly lower RMSE values than those graded as having irregular shapes (p<0.001).
 
 Conclusion
 Subjects with corneal ectasia have a different scleral shape compared to those with normal corneal profiles, largely presenting as a quadrant specific effect along the same axis. This difference is higher if the apex of the ectasia is ≥1.25 mm from the corneal center. RMSE seems to correlate with scleral shape classification in both groups.

Utilization of echocardiography by internists and cardiologists: A comparative study

To compare the utilization of echocardiography as a diagnostic tool by internists and cardiologists. Retrospective study. Tertiary care university hospital. Indications and clinical utility of echocardiographic studies ordered by cardiologists (group A, n = 301) and internists (group B, n = 297) were compared by chart review. The two groups of patients were analyzed to determine if the studies detected new cardiac pathology and/or altered patient management. The proportion of studies with abnormal results were similar in both groups (19% versus 14%, P > 0.05). The results of echocardiography, however, led to a change in management more often when the study was ordered by cardiologists (16% versus 10%, P < 0.05). A significantly greater proportion of studies were ordered for evaluation of valvular function by internists (44% versus 33%, P < 0.05). Echocardiography detected valvular abnormalities in a similar proportion of cases in groups A and B (14% versus 10%, P > 0.05). However, diagnostic yield was very poor when the study was performed in patients with suspected mitral valve prolapse in both groups. Cardiologists utilized echocardiography more often for evaluation of left ventricular function (35% versus 18%, P < 0.01) and in the setting of atherosclerotic heart disease for detecting wall motion abnormalities (14% versus 5%, P < 0.01). Diagnostic yield of echocardiography is similar when ordered by internists and cardiologists. With the information obtained, management is altered in a slightly greater proportion of cases involving a cardiologist. This may be due to utilization of echocardiography more often for estimating left ventricular function and for detecting wall motion abnormalities by cardiologists.