Recent Surgery Research Articles

Prospective evaluation of the diagnostic accuracy of FDG-PET/CT for the detection of sternal wound infection post-sternotomy

PurposeSternal wound infections (SWI) are complications of sternotomy and can be divided into deep SWI (DSWI) and superficial SWI (SSWI). In recent years, the use of 18F-Fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in diagnosing infections and inflammation has expanded significantly, with a growing number of clinical indications. This study assesses FDG-PET/CT diagnostic role in DSWI detection, the evolution of FDG uptake intensity in patients without DSWI and the potential biomarkers for DSWIs prediction.MethodsWe conducted a single center prospective study of consecutive patients referred for suspected SWI post-median sternotomy. Gold standard diagnosis was established by chart review of clinical follow-up, surgical findings, and cultures. To characterize the time between sternotomy and imaging, participants were subsequently subdivided into recent (< 3 months) or remote surgery (≥ 3 months) groups.Results44 FDG-PET/CT scans, 12 (27%) of which had DSWI according to the gold standard, were collected and analyzed. 20 studies were assigned to the recent group, and 24 studies to the remote surgery group. Sensitivity and specificity of FDG-PET/CT for detection of DSWI were 67% and 66%, respectively and an accuracy of 66% was obtained. Positive and negative predictive values were 42% and 84%, respectively. The NPV was higher in the remote surgery group (100%) compared to the recent surgery group (73%). SUVmax of the median sternal wound was significantly higher in the DSWI (9.3 ± 2.3) than the non-DSWI group (7.1 ± 3.0) (p = 0.025). There was however significant overlap of SUVmax between the two groups. CRP, WBC counts, and PCT levels were not significantly different between the DSWI and non-DSWI groups (p ≥ 0.34).ConclusionFDG-PET/CT has modest sensitivity and specificity for the detection of DSWI post-sternotomy. FDG-PET/CT results must take into account time since surgery; when PET/CT is performed more than 3 months following surgery, a negative scan can exclude DSWI with a high level of certainty.

P-1030. Mortality attributable to candidemia: Results from the European Confederation of Medical Mycology Multinational Observational Cohort Study Candida III

Abstract Background Despite advances in antifungals, Candida infections still have a high mortality rate of up to 40%. The ECMM Candida III study in Europe investigated the changing epidemiology and outcomes, highlighting the need to understand and manage these infections. Methods In this observational cohort study, participating hospitals enrolled the first ten consecutive adults with confirmed candidemia. Data collected included patient demographics, risk factors, hospital stay length (with a 90-day follow-up), diagnostic procedures, Candida species, treatment details, and outcome. Controls were matched in a 1:1 ratio from the same hospitals, ensuring similarity in age, underlying illness, ICU versus normal ward stay, and recent major surgery. The study described overall and attributable mortality and assessed survival probability for both cases and controls. Results The study included 171 pairs consisting of patients with candidemia and matched controls from 28 institutions. In those with candidemia, overall mortality was 40.4%. The attributable mortality was 18.1% overall but differed among the causative Candida species (7.7% for Candida albicans, 23.7% for Candida glabrata, 7.7% for Candida parapsilosis, and 63.6% for Candida tropicalis). Regarding risk factors, the presence of central venous catheter, total parenteral nutrition, and acute or chronic kidney disease were significantly more common in cases versus controls. Length of hospitalization and ICU stay were significantly longer in candidemia cases (20 days (IQR 10-33) vs. 15 days (IQR 7-28); p=0.004). Conclusion Although overall mortality remains high in this matched case/control analysis, attributable mortality has decreased compared to historical cohorts. This may be due to a better prognosis for candidemia caused by Candida albicans, which has an attributable mortality of 7.7%, while candidemia cases caused by non-albicans Candida exhibit higher attributable mortality. Disclosures Oliver A. Cornely, Prof. Dr., Abbott: Honoraria|Abbvie: Advisor/Consultant|Abbvie: Honoraria|AiCuris: Advisor/Consultant|Akademie fur Infektionmedizin: Honoraria|Al-Jazeera Pharmaceuticals/Hikma: Honoraria|amedes: Honoraria|AstraZeneca: Honoraria|Basilea: Advisor/Consultant|Biocon: Advisor/Consultant|BMBF: Grant/Research Support|Boston Strategic Partners: Advisor/Consultant|CIdara: Advisor/Consultant|CIdara: Expert Testimony|CIdara: Grant/Research Support|CIdara: Participation on a DRC or DSMB|CoRe Consulting: Stocks/Bonds (Private Company)|Deutscher Arzteverlag: Honoraria|DZIF: Grant/Research Support|EasyRadiology: Stocks/Bonds (Private Company)|EU-DG RTD: Grant/Research Support|F2G: Grant/Research Support|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Grupo Biotoscana/United Medical/Knight: Honoraria|GSK: Advisor/Consultant|GSK: Honoraria|IQVIA: Advisor/Consultant|IQVIA: Participation on a DRC or DSMB|Janssen: Advisor/Consultant|Janssen: Participation on a DRC or DSMB|Matinas: Advisor/Consultant|MedPace: Advisor/Consultant|MedPace: Grant/Research Support|MedPace: Participation on a DRC or DSMB|Medscape/WebMD: Honoraria|MedUpdate: Honoraria|Menarini: Advisor/Consultant|Moderna: Honoraria|Molecular Partners: Advisor/Consultant|MSD: Grant/Research Support|MSD: Honoraria|MSG-ERC: Advisor/Consultant|Mundipharma: Advisor/Consultant|Mundipharma: Grant/Research Support|Mundipharma: Honoraria|Noscendo: Honoraria|Noxxon: Advisor/Consultant|Octapharma: Advisor/Consultant|Octapharma: Grant/Research Support|Pardes: Advisor/Consultant|Partner Therapeutics: Advisor/Consultant|Patent: US18/562644|Paul-Martini-Stiftung: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|PSI: Advisor/Consultant|PSI: Participation on a DRC or DSMB|Pulmocide: Participation on a DRC or DSMB|Sandoz: Honoraria|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support|Seqirus: Advisor/Consultant|Seqirus: Honoraria|Seres: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Honoraria|streamedup!: Honoraria|The Prime Meridian Group: Advisor/Consultant|Touch Independent: Honoraria|Vitis: Honoraria Jean-Pierre Gangneux, Prof., Gilead: Honoraria|MundiPharma: Advisor/Consultant|MundiPharma: Honoraria|Pfizer: Honoraria|Shionogi: Honoraria Matteo Bassetti, PhD, Angelini: Advisor/Consultant|Angelini: Honoraria|Astellas: Advisor/Consultant|Astellas: Honoraria|bioMerieux: Advisor/Consultant|bioMerieux: Honoraria|Cidara: Advisor/Consultant|Cidara: Honoraria|Gilead: Advisor/Consultant|Gilead: Honoraria|Menarini: Advisor/Consultant|Menarini: Honoraria|MSD: Advisor/Consultant|MSD: Honoraria|Nabriva: Advisor/Consultant|Nabriva: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Tetraphase: Advisor/Consultant|Tetraphase: Honoraria

P-372. Candida auris Outbreak in a Cardiothoracic Transplant Intensive Care Unit: Implications for Infection Prevention

Abstract Background Candida auris is a yeast that causes invasive infections such as bloodstream infections (BSIs); mortality rates for C. auris BSIs may be as high as 80%. Rates have been climbing in the U.S. Exposure to skilled nursing facilities (SNFs), long-term acute care hospitals (LTACHs), or inpatient rehabilitation facilities (IRFs) represents a known risk factor for C. auris. Our institution experienced a C. auris outbreak from September 2023 - January 2024. Figure 1: C. auris Outbreak Epidemic Curve Methods C. auris cases in the outbreak were identified from clinical specimens and admission and weekly surveillance via polymerase chain reaction (PCR). Clinical characteristics were determined through chart review. A multidisciplinary team implemented infection prevention (IP) interventions to curb nosocomial spread. Infection Prevention Interventions Results There were 20 cases of C. auris identified in our CTICU between July 2023 and January 2024 (Figure 1). Whole-genome sequencing and phylogenetic analysis based on pairwise single nucleotide polymorphism (WG-SNP) distance revealed two outbreak clusters. Of the 20 patients, 13 (65%) were solid organ transplant/acute mechanical circulatory support patients and three (15%) had prior SNF, LTACH, or IRF exposure. Four (20%) patients had C. auris BSIs and seven (35%) patients died, including all patients with BSIs. The mean duration of antibiotic use in the four patients was 67 days. IP interventions addressed potential vehicles of transmission including healthcare personnel hands, shared patient equipment, and the environment (Table 1). Conclusion Only 15% of patients had prior SNF/LTACH/IRF exposure; many were admitted from home and/or outside hospitals with risk factors including recent surgery and antimicrobial use. This suggests the epidemiology of C. auris may be changing, and it may be prudent to consider routine admission and weekly surveillance on inpatient units deemed high risk for C. auris. Effective IP interventions included interventional hand hygiene auditing, increased accountability and oversight for shared patient equipment, limiting the number of rounding providers in rooms, and auditing environmental cleaning. Sustaining these efforts is crucial to keep pace with an evolving C. auris landscape. Disclosures All Authors: No reported disclosures

Reported Postoperative Surgical Site Infections in Tertiary Care Hospitals, Systematic Review of Recent Literature.

The objective of this systematic review is to evaluate the patterns of postsurgical site infections, pre-surgical antibiotics prophylaxis, and related clinical outcomes in the recently published literature. This systematic review is registered with PROSPERO registration number CRD42023398963. Several databases and individual journal websites were used to collect data from PubMed/Medline, TRIP, SCOPUS, Elsevier, Springer, ProQuest, and EMBASE. The established criteria of inclusion were RCTs, retrospective, prospective, and cross-sectional studies with patients who had a recent surgical procedure. Excluded from the study designs were systematic reviews, prospective studies, data on pediatrics, and data on disabilities. Quality assessment analysis of the results for randomized controlled trials (RCT) used CONSORT guidelines and STROBE guidelines for cross-sectional and cohort studies. A total of 328 articles were identified from different databases. Among them, 15 studies were included for data extraction and qualitative analysis. A total of 33,193 patients with an average rate of 11.5% (surgical site infections- SSIs) were identified in these studies during 2008-2022. The mean rate of SSIs among the total number of immunocompromised patients/procedures was 10.2%. The SSI on patients undergoing major surgical procedures with visible incisions was 26.0%. The majority of the studies reported the use of pre-surgical antibiotic prophylaxis. Cefazolin was mostly prescribed antibiotics and administered in 90% of patients. Other antibiotics included ceftriaxone (4%), cloxacillin (3%), and vancomycin (4%). The mean reported rate of SSIs with combination antibiotic prophylaxis therapy was 22.8%. This systematic review concluded the limited reported data on surgical site infections (SSIs). The overuse of pre-surgical antibiotic prophylaxis has been reported in several studies. This study recommended developing standardized guidelines on the use of antibiotics related to surgical cases rather than co-morbidities.

Incidence of Venous Thromboembolism and Its Associated Risk Factors in Newly Diagnosed Multiple Myeloma Patients in the Klang Valley, Malaysia

Background: Venous thromboembolism (VTE) is a potentially severe medical problem among multiple myeloma (MM) patients, with evolving treatment regimens potentially increasing the thrombotic risk. Data on VTE incidence and risk factors in multiethnic Malaysian MM patients are limited. This study aimed to assess VTE incidence and risk factors in newly diagnosed MM (NDMM) patients at two tertiary centres in Klang Valley, Malaysia. Methods: This retrospective cohort study included NDMM patients, aged ≥18, diagnosed between January 2015 and December 2022 at Hospital Canselor Tuanku Muhriz and Hospital Ampang. Patient demographics, clinical characteristics, MM therapies, and thromboprophylaxis data were analysed. VTE is defined as deep vein thrombosis (DVT) or pulmonary embolism (PE), confirmed by imaging. Results: Among the 216 NDMM patients (mean age: 62.4 ± 10.6 years), 22 (10.2%) developed VTE (15 DVT, five PE, and two both). The median time from MM diagnosis to VTE was 3.5 months (IQR 5.3). A univariate analysis identified the female sex, an ECOG performance status ≥ 2, diabetes mellitus, a recent orthopaedic surgery (&lt;6 months), a SAVED score ≥ 2, and an IMPEDE-VTE score &gt; 3 as significant risk factors. In the multivariable logistic regression, the female sex (aOR 8.56, 95% CI: 1.95–37.48), an ECOG status ≥ 2 (aOR 12.74, 95% CI: 3.37–48.17), and a recent orthopaedic surgery (aOR 21.79, 95% CI: 3.10–153.38) were the independent risk factors of VTE among NDMM patients. Conclusions: VTE incidence in our NDMM cohort was 10.2%. Independent risk factors included the female sex, a poor performance status, and a recent orthopaedic surgery. Individualised thromboprophylaxis strategies are crucial, warranting further real-world studies to optimise anticoagulation regimens.

Assessment of upper extremity functional capacity in following osteosynthesis for upper limb fractures using a novel method for determining total reachable workspace.

This study aimed to assess reachable workspace (RWS) in patients post-osteosynthesis of shoulder, elbow, or wrist fractures and explore correlations with self-reported function and kinesiophobia. An observational case-control study compared patients with fractures to a control group, utilizing questionnaires and 3D kinematic data. The sample included 66 individuals who had undergone osteosynthesis: 21 with shoulder fractures, 10 with elbow fractures, and 22 with wrist fractures. A control group of 23 participants without upper limb pathologies was also established. Inclusion criteria were ages 18-80 and recent surgery; exclusions were previous upper limb surgeries, cervical pathologies, systemic diseases or nerve injuries. RWS, the three-dimensional volume the hand can reach, was measured with participants standing. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia (TKS), and physical disability and pain were measured using the DASH questionnaire and the Numeric Pain Rating Scale (NPRS). Fracture groups exhibited significant RWS reductions (62-85%) compared to the control group, with no significant differences among the fracture types. RWS showed a high correlation with TKS (R = 0.77) and a moderate correlation with DASH (R = 0.52). RWS is a promising biomechanical parameter for assessing upper limb function post-fracture, aiding in refining rehabilitation protocols.

Preoperative Templating Prior to Total Hip Arthroplasty: A Closed-Loop Audit.

Preoperative templating is an essential process in total hip arthroplasty (THA), aiding surgical planning and implant selection to optimize patient outcomes. Despite its significance, templating is inconsistently practiced, influenced by factors such as surgeon experience and institutional protocols. In light of increasing THA rates, this study aimed to assess adherence to templating guidelines within our institution and evaluate the impact of a new protocol on compliance. We conducted a closed-loop audit with an initial review of 50 THA cases, assessing the frequency and timing of preoperative templating. Following the first audit cycle, a departmental protocol was introduced, mandating templating radiographs 7-180 days before surgery, supported by a departmental rota. In the subsequent audit cycle, another 50 patients were reviewed. Templating was performed using TraumaCad software(Orthocrat Ltd, Petach Tikva, Israel) on anteroposterior pelvic radiographs with a calibration sphere. Statistical analysis was conducted using Welch's unpaired t-test. Leg length changes were evaluated in all patients based on their two most recent radiographs during the second audit cycle to determine if leg lengths had changed over time. In the pre-intervention cycle, only 20% of patients had templating radiographs within the recommended timeframe, with an average of 140 days between the most recent radiograph and surgery. Post-intervention, compliance improved significantly, with 70% of patients receiving templating radiographs within the specified period (p < 0.0001), and the average time between the most recent radiograph and surgery reduced to 33 days. A mean leg length change of 2.26 mm was observed, with changes ranging from 0 to 17 mm between radiographs. The mean interval between radiographs was 386 days. This closed-loop audit found that implementing booking preoperative templating radiographs prior to THA and integrating them as part of the preoperative assessment process had a significant impact on the number of patients having appropriate imaging performed preoperatively. Simple interventions, such as the introduction of a roster, helped ensure compliance in the booking of departmental radiographs. This study has shown how patient parameters can change over time and emphasizes the importance of ensuring up-to-date imaging to allow accurate surgical planning.

Drug‐induced choroidal effusion: Cases review

Purpose: Choroidal effusion is a well‐known complication of intraocular surgery, but it can happen as a drug adverse effect.Methods: We present three clinical cases of choroidal effusion as a result of systemic treatments.Results: 82‐years‐old woman presents with pain and loss of vision in left eye. She was treated with acenocumarol. She had bilateral phacoemulsification two months ago with normal development. Visual acuity (VA) was 0.8 right eye and 0.3 left eye, intraocular pressure (IOP) was 16/18 mmHg and anterior segment exploration was normal. She had a complete choroidal effusion and a temporal serous retinal detachment in her left eye. After one week of topical steroids and atropine, fundus alterations had disappeared.65‐years‐old male presents with blurred vision and photopsias in right eye since one week. The patient has a history of type II diabetes and benign prostatic hyperplasia, treated with tamsulosine. First day exploration was: AV 0.3 right eye and 0.5 left eye, he was phakic and IOP was 16 mmHg both eyes. On right eye fundus, there where severe choroidal effusion. Topical and oral steroid treatment was started and cycloplegia. After one month, choroidal effusion had disappeared and VA improved.86‐years‐old male had bilateral painless loss of VA. He was diagnosed of Parkinson's disease and treated with rotigotine. First day exploration was: VA 0.5 right eye and 0.3 left eye, no alterations in anterior segment and IOP was 12 mmHg both eyes. On fundus examination, bilateral nasal choroidal effusion were found. Topical steroid and cycloplegia were the treatment and rotigotine was suspended. Seven days after rotigotine's interruption, both eyes choroidal effusion had disappeared.Conclusions: Drug‐induced choroidal effusion must be on the differential diagnosis if there are no antecedents of IOP alterations or recent surgeries. Ophthalmology patients are increasingly older and pluripathologic so drug adverse effects will be more common.

A preliminary experience on the efficacy, safety and short-term results in the treatment of acute bilateral iliofemoral deep vein thrombosis with the Angiojet rheolytic thrombectomy.

This study aimed to examine the early clinical outcomes of AngioJet rheolytic thrombectomy (RT) in patients with acute bilateral iliofemoral deep vein thrombosis (IFDVT), with a specific focus on the incidence of post-thrombotic syndrome (PTS). From March 2021 to August 2023, sixteen consecutive patients with acute bilateral IFDVT treated with AngioJet RT at our center were evaluated. Primary outcomes include patency of the target veins, development of PTS, recurrent DVT, and procedure related death. Secondary outcomes included minor or major bleeding, acute kidney injury (AKI), documented haemoglobinuria, cardiac event, pulmonary embolism, limb loss, and death. The mean age of the patients was 69 ± 12 years (range, 53-87 years). Malignancy and recent major surgery were the most prevalent risk factors, each observed in 25% of patients (n=4). Technical success, complete clot removal, and alleviation of symptoms were achieved in all patients (n=16; 100%). In a quarter of the patients (n=4), transient hemoglobinuria was observed following the procedure. This complication resolved spontaneously after adequate fluid replenishment. Minor bleeding occurred in three patients (19%), while no patients had major bleeding complication. There was one postoperative AKI and transient bradycardia (6%). Three patients died after the procedures (19%). One patient (6%) developed postoperative massive PE. The mean follow-up was 11±6 months (range, 5-19 months). The primary patency rate was 92% and 91%, respectively, six and twelve months after procedures. One patient had reocclusion during the follow-up. AngioJet RT applied to patients with bilateral IFDVT provides a promising picture, providing a patent vein lumen with high procedural success and achieving convincing early symptomatic improvement in severely symptomatic patients with impaired quality of life. In this early case series, the feasibility of the AngioJet device in elderly cases appears to be a significant problem. Therefore, patient selection is essential.

Impact of diagnostic stewardship on catheter-associated urinary tract infections and patient outcomes.

Diagnostic stewardship of urine cultures from patients with indwelling urinary catheters may improve diagnostic specificity and clinical relevance of the test, but risk of patient harm is uncertain. We retrospectively evaluated the impact of a computerized clinical decision support tool to promote institutional appropriateness criteria (neutropenia, kidney transplant, recent urologic surgery, or radiologic evidence of urinary tract obstruction) for urine cultures from patients with an indwelling urinary catheter. The primary outcome was a change in catheter-associated urinary tract infection (CAUTI) rate from baseline (34 mo) to intervention period (30 mo, including a 2-mo wash-in period). We analyzed patient-level outcomes and adverse events. Adjusted CAUTI rate decreased from 1.203 to 0.75 per 1,000 catheter-days (P = 0.52). Of 598 patients triggering decision support, 284 (47.5%) urine cultures were collected in agreement with institutional criteria and 314 (52.5%) were averted. Of 314 patients whose urine cultures were averted, 2 had a subsequent urine culture within 7 days that resulted in a change in antimicrobial therapy and 2 had diagnosis of bacteremia with suspected urinary source, but there were no delays in effective treatment. A diagnostic stewardship intervention was associated with an approximately 50% decrease in urine culture testing for inpatients with a urinary catheter. However, the overall CAUTI rate did not decrease significantly. Adverse outcomes were rare and minor among patients who had a urine culture averted. Diagnostic stewardship may be safe and effective as part of a multimodal program to reduce unnecessary urine cultures among patients with indwelling urinary catheters.

Immune-related adverse events with renal colic as the main manifestation: a case report of sintilimab-induced ureteritis/cystitis treated by ureteral stent and review of the literature

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of systemic cancer therapy. During disinhibiting the antitumor responses of immune system, ICIs may also cause unique immune-related adverse events (irAEs) which could affect any organ. Here, we report a rare case of sintilimab-induced ureteritis/cystitis in a 55-year-old male undergoing neoadjuvant chemo-immunotherapy for gastric cancer. The patient presented with severe renal colic, hematuria, and hydronephrosis. Antibiotic antispasmodic and nonsteroidal anti-inflammatory drug treatment failed to alleviate symptoms. The application of corticosteroid was negated for recent extirpative surgery under plan. Bilateral ureteral stenting effectively resolved the pain and improved renal function. The patient later successfully underwent laparoscopic radical gastrectomy with significant tumor regression in postoperative pathology. This case highlights ureteral stenting as a potential corticosteroid-free treatment option for ICI-induced ureteritis/cystitis.

Does Prior Lower Abdominal Surgery Prevent Laparoscopic Hernia Repair (Totally Extraperitoneal or Transabdominal Preperitoneal)? A Prospective Observational Study.

Objective: Totally extraperitoneal (TEP) surgeries were considered contraindicated in patients who underwent lower abdominal surgery until recently. However, in recent surgeries, it has been reported that they can be performed safely in those cases. Our aim in this study is to investigate the effectiveness of laparoscopic hernia repair methods in patients who have and have not had lower abdominal surgery before. Patients and Method: This study was a prospective observational study between May 2018 and May 2023. Two hundred eighty-eight patients were included in the study. The operation was started with the TEP technique in all patients. Patients, classified in two groups who had not previously undergone abdominal surgery (n = 216) (Group I) and who had surgery (n = 72) (Group II). Demographic characteristics of patients, intraoperative and postoperative complications were determined. In addition to descriptive statistical methods (mean, standard deviation), Shapiro-Wilk normality test, independent t test, and chi-square test were used to evaluate the data. Logistic regression analysis was performed to determine the factors affecting the presence of Previous Surgery and Peritoneal Tear. Results were evaluated at the significance level of P < .05. Results: Two hundred fifty-nine patients were operated with TEP method. TEP method was converted to transabdominal preperitoneal (TAPP) in 9 patients from Group I and 20 patients from Group II. Intraoperative and postoperative complications were recorded. Conclusion: With increasing experience in laparoscopic hernia surgery, it is now possible to perform hernia surgeries with preperitoneal (TEP) and abdominal approaches (TAPP) in patients who have previously undergone lower abdominal surgery.

Pulmonary Embolism as a Cause of Death in Medico-legal Death in North of Jordan in the Period of 2017-2021

Background: Pulmonary embolism (PE) is a potentially fatal illness where blood clots block the arteries in the lungs. These clots typically come from the deep veins in the lower limbs. It is a significant contributor to illness and death on a global scale. Objective: This study aims to analyze the forensic deaths resulting from PE in the northern region of Jordan, namely those received at the Forensic Medicine Teaching Centre in Irbid, Jordan, between the years 2017 and 2021. Methods: A retrospective study was conducted to collect data from files of cases diagnosed with PE as a prime cause of death. The study sample included 80 cases of PE. A working Excel spreadsheet was created to collect data for all cases. Data analysis was made using the SPSS software version 21. Descriptive statistics were used to describe and represent data in tables. Result: During a span of 5 years, a total of 80 instances of death caused by PE were examined. Our study revealed that 55% of the cases were females, and the bulk of fatalities (67.6%) took place during the cold months of winter and fall. Regarding the age group, it was discovered that 46.3% of individuals fell within the age range of 25 to 45 years. 45% of the cases were not obese, and 81.3% of the cases had no history of prior surgery. Out of the total number of cases, 66.3% had not been immobilized. Additionally, 88.6% of the female cases were not pregnant, and 82.5% of cases did not have any prior trauma. Most individuals had large thromboembolism 56.3% and 70% of patients exhibited emboli in both pulmonary arteries. Out of all the patients, 76.3% exhibited lung congestion, whereas only 15% reported discharge. Conclusion: Multiple reasons cause PE deaths in northern Jordan. Female death rates rise somewhat, mostly among 25-45-year-olds. Recent surgery, trauma, and immobility dramatically affect PE death rates. Obese people had a lower PE mortality rate than non-obese people. Winter and fall have a somewhat greater PE rate than summer and spring.

IMPACT OF BLOOD FLOW RESTRICTION TRAINING (BFRT) VERSUS TRADITIONAL STRENGTH TRAINING IN KNEE OSTEOARTHRITIS ON PAIN AND QOL

Background: Osteoarthritis (OA) is the third leading cause of disability worldwide, significantly impacting pain, physical function, and quality of life (QoL). Among its types, knee osteoarthritis (KOA) is the most prevalent, affecting over 80% of individuals with OA. Effective conservative management is crucial for mitigating its physical and social burden. Exercise therapy, including strength training, has been widely utilized; however, the comparative efficacy of blood flow restriction training (BFRT) and traditional strength training remains underexplored. Objective: This study aimed to compare the impact of BFRT and traditional strength training on pain and QoL in patients with KOA. Methods: This randomized controlled trial was conducted between March 2024 and August 2024, enrolling 38 patients with KOA using a purposive sampling technique. Participants aged 40–70 years with clinically and radiologically confirmed KOA experiencing moderate-to-severe symptoms were included. Patients with contraindications to BFRT, such as vascular disorders or recent surgeries, were excluded. The interventions included BFRT with low-load resistance and traditional high-load strength training. Pain and QoL were assessed using the Visual Analogue Scale (VAS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS), respectively. Ethical considerations were followed throughout the study, and SPSS version 24 was used for statistical analysis. Results: Baseline VAS scores were 7.4 ± 1.1 for the BFRT group and 7.3 ± 1.2 for the traditional group (p = 0.87). Post-intervention, VAS improved significantly in both groups, with BFRT showing a greater reduction (3.2 ± 1.0) compared to the traditional group (4.5 ± 1.1, p = 0.01). KOOS scores improved from 48.6 ± 6.9 to 72.3 ± 7.5 in the BFRT group and from 47.9 ± 7.2 to 64.7 ± 8.1 in the traditional group (p = 0.03). Both groups demonstrated significant improvements, with BFRT showing superior results. Conclusion: Both BFRT and traditional strength training significantly improved pain and QoL in KOA patients, with BFRT yielding more pronounced benefits. BFRT offers a promising low-load alternative for managing pain and enhancing QoL in individuals with KOA.

The age, sex, and provoked factors of acute symptomatic deep vein thrombosis on the left and right lower extremities.

Deep vein thrombosis (DVT) of the left and right lower extremities was treated in the same way, but the left and right extremities received different levels of attention. This study aimed to investigate the differences between the right and left lower extremity deep vein thrombosis (LEDVT). Clinical characteristics of LEDVT patients from July 2020 to June 2022 were retrospectively analyzed to compare the incidence of LEDVT on different limbs, demographics, predisposing factors, and anatomical characteristics. The exclusion criteria were bilateral LEDVT and recurrent thrombosis. Measured data was analyzed using independent samples t-test or Mann-Whitney test. Count data were analyzed by Chi-square test. A p<0.05 was considered a statistically significant difference. There were 478 patients included in this study and the ratio of patients with LEDVT on the left and right limbs was 3.16:1 (363:115). LEDVT of the left limb was predominantly female, and the age was usually > 50 years (50 - 60 years: 16.80%; > 60 years: 57.30%). The primary predisposing factor was iliac vein compression syndrome, with iliofemoral thrombosis being the main type. Male patients with LEDVT on the right limb were predominant and the age of onset was usually ≤ 60 years (52.17%). The main predisposing factor was recent surgery or trauma (< 30 days) and femoropopliteal thrombosis was the main type. In more detail, the left iliac vein was compressed mainly in the proximal segment, and the right iliac vein was compressed mainly in the intermediate and distal segments. Recent surgery or trauma to the locomotor system and genitourinary system often induced LEDVT. The incidence of LEDVT on the left is significantly higher than that on the right. LEDVT on different sides has different characteristics, which is crucial for prevention and diagnosis in the relevant population so there are also differences in treatment of the affected limbs.

Diagnosing and treating cellulitis in horses

Background: Cellulitis is a commonly observed condition in horses, which often requires an urgent or emergency veterinary visit. The condition often presents with acute‐onset diffuse limb swelling, heat, pitting oedema and pain on palpation of the affected limb. Lameness is variable but can be severe and the horse may display signs of extreme discomfort, alongside tachycardia, tachypnoea and pyrexia. Risk factors such as blunt trauma, recent wounds, recent surgery or recent injections have been identified, and studies suggest that cellulitis is more common in the hindlimbs than forelimbs.Aim of the article: This article provides an overview of the physiology of oedema formation and discusses the diagnosis and treatment options available for cases of cellulitis in horses.

BS O02 - Impact of Bariatric surgery on Obesity Indices and Reproductive Hormones: A Prospective Study in Morbidly Obese Women

Abstract Background Obesity, defined by a BMI of 30 kg/m² or higher, is influenced by genetics, socio-economic, and cultural factors. Genetic predispositions affect metabolism and energy regulation, while environmental factors like sedentary lifestyles and poor food environments worsen obesity. Obesity disrupts hormonal balances, impacting sex hormone levels and menstrual cycles, leading to infertility in women. This hormonal imbalance affects oocyte quality and ovulation. Bariatric surgery offers significant weight loss and metabolic improvements, enhancing reproductive hormone profiles and insulin sensitivity. Our study explores how sleeve gastrectomy affects BMI and hormone levels, aiming to understand its impact on obesity management and reproductive health. Method This prospective observational study examines the effects of laparoscopic sleeve gastrectomy on reproductive hormones and ovarian function in 32 morbidly obese women, adhering to Helsinki Declaration ethics. Participants, aged 18-50 with no menopause or chronic illness, consented to the study. Exclusions included those with polycystic ovary syndrome, recent reproductive organ surgery, or recent infertility medications. The study assessed changes in BMI, antral follicles, anti-Müllerian hormone, and reproductive hormones before surgery and at 6 and 12 months post-surgery. Blood samples and transvaginal ultrasounds were conducted preoperatively and at 6 and 12 months postoperatively to monitor outcomes. Results The study involved participants with an average age of 33 and a mean BMI of 42.12. Significant changes were observed post-sleeve gastrectomy at 6 and 12 months (p &amp;lt; 0.001). At 6 months, BMI decreased by 9.24 units, AMH levels dropped from 3 to 2.5 ng/mL, and antral follicle counts in both ovaries declined. By 12 months, BMI decreased by 16.47 units, AMH levels fell to 2 ng/mL, and antral follicle counts further reduced. Hormonal changes included increases in FSH, LH, and estradiol, while SHBG levels rose, and free testosterone levels decreased significantly. Conclusion Individual hormone responses to weight loss and surgery necessitate personalized obesity treatments. Tailoring surgical approaches and care to hormonal profiles can optimize outcomes and reduce complications. Monitoring AMH levels post-surgery can offer insights into reproductive effects, aiding clinical management and counseling for women with obesity-related infertility. We highlight the significant impact of sleeve gastrectomy on physiological parameters in obese individuals, especially regarding reproductive health and metabolic regulation. The findings enhance understanding of the changes associated with bariatric surgery and its potential benefits for metabolic and reproductive health.

Risk Factors and Outcomes of Acute Pulmonary Embolism in African Patients: A Systematic Review.

Pulmonary embolism is a common cause of morbidity and mortality. Numerous risk factors have been identified that predispose patients to this disease. This study aims to identify these risk factors and the possible outcomes (recovery or mortality) after receiving treatment from any hospital. Healthcare is expensive in Africa, hence hindering its easy accessibility. PubMed, Scopus, and African Journals Online were searched from the database inception to October 2024 to identify relevant studies. A total of 719 articles were identified, for which 172 duplicate articles were removed. After screening 592 articles by title and abstract, 508 were excluded. Eighty-four articles were screened by full text to determine their eligibility. Finally, 13 articles were used in the final qualitative analysis. We included original research published in English in peer-reviewed journals from January 2000 to September 2024 that reported the risk factors and outcomes of pulmonary embolism, and studies that used computed tomography pulmonary angiography as a diagnosis of acute pulmonary embolism in patients more than 18 years old, irrespective of gender and medical or surgical condition, managed in any African hospital, were included. In total, 7650 patients were included in 13 articles, from 10 countries (Nigeria, Togo, Angola, Kenya, Cameroon, South Africa, Sierra Leone, Egypt, DR Congo, and Ethiopia), and 861 patients had pulmonary embolism. The mean age of the reported patients ranged from 40.8 to 64.4 years across the studies. There were 309 male and 552 female patients diagnosed with pulmonary embolism. The study types included in this review are retrospective studies,cross-sectional studies, and case-control studies. Deep vein thrombosis (DVT), heart disease, immobilization, obesity, smoking, recent surgery, and malignancy were the most commonly identified risk factors across the included articles. Pulmonary embolism contributes significantly to morbidity and mortality among African patients, with key risk factors including DVT, immobilization, heart disease, obesity, smoking, recent surgery, malignancy, pregnancy, and contraceptive use. Limited diagnostic resources in low-resource settings pose a major challenge, but adopting affordable diagnostic alternatives and clinical algorithms could improve outcomes by enabling earlier diagnosis and timely treatment. The availability and implementation of a standardized PE treatment protocol will ensure quality care, decrease mortality, and increase recovery rates.

Correlation of Diabetic Symptoms with Severity of Diabetes Mellitus in Middle-Aged Population

Purpose: To investigate the correlation of symptoms of Diabetes with the severity of Diabetes Mellitus (DM) in Middle-aged subjects with diabetes. Participants: 68 subjects with diagnosed diabetes mellitus between the ages of 40 and 60 with/without symptoms of neuropathy were included. Participants with neurological disease, recent surgical procedures or injuries to feet, vascular disease, and cognitive impairment were excluded. Method: In a cross-sectional observational study, a total of 68 middle-aged diabetic subjects were interviewed in terms of demographic data, Fasting Blood Sugar (FBS), Post-Prandial Blood Sugar (PPBS), HBA1c, duration of diabetes, and associated medical conditions. All participants were examined by the Michigan Neuropathy Screening Instrument (MNSI). MNSI consists of 2 parts. 1) questionnaire 2) clinical examination. Analysis: Statistical analysis was done by SPSS 20 &amp; Spearman correlation test was applied. Results: In mild diabetes, hba1c has a weak positive correlation (r=0.232) with MNSI-1 and a very weak positive (0.016) correlation with MNSI-2. In moderate diabetes, hba1c has significant(p=0.003) strong positive correlation (r=0.703) with MNSI-1 and significant (p=0.019) moderate positive correlation (r=0.0596) with MNSI-2. In severe diabetes, hba1c has significant (p=0.028) moderate positive correlation (r=0.532) with MNSI-1 and significant (p=0.034) moderate positive (0.515) correlation with MNSI-2 Conclusion: Diabetic symptoms are moderately correlated with moderate &amp; severe levels of Diabetes based on hba1c in the middle-aged population. Keywords: Diabetes Mellitus, Middle age, Diabetic symptoms, Michigan Neuropathy Screening Instrument.

Clinical Features and Risk Factors of 134 HA-PTE Patients

&amp;lt;i&amp;gt;Objective&amp;lt;/i&amp;gt;: The objective of this study was to determine the clinical features and risk factors for hospital-associated pulmonary thromboembolism (HA-PTE) in Taizhou Hospital of Zhejiang Province. &amp;lt;i&amp;gt;Methods&amp;lt;/i&amp;gt;: The clinical data of 513 pulmonary thromboembolism (PTE) patients who were admitted to Taizhou Hospital of Zhejiang Province in from January 1st, 2020, to December 31st, 2022, were retrospectively analyzed. The HA-PTE group and the community-associated PTE (CA-PTE) group were classified according to whether these disorders occurred during hospitalization or within a 90-day period of admission to the hospital (including inpatients with at least two days of hospitalization stay or a surgical procedure under or regional anesthesia). Differences in clinical features, risk factors and other indicators were also analyzed between the two groups. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: A total of 513 patients with acute PTE were analyzed in the present study. Among them, 134 patients had HA-PTE, and 379 patients had CA-PTE. Patients in the HA-PTE group had less dyspnea or hemoptysis and more fever and chest pain. The all-cause mortality rate in the HA-PTE group was greater than that in the CA-PTE group, but it was not statistically significant. In comparison to community-acquired pulmonary thromboembolism (CA-PTE), long-term bed rest, active malignancy, lung infection, acute cerebral infarction, and fracture were observed as more prevalent risk factors in the hospital-acquired pulmonary thromboembolism (HA-PTE) group. Additionally, recent surgery (within one month post-operation) and central venous catheterization were identified as independent risk factors in the HA-PTE group. According to the subgroup analysis of the HA-PTE group, the all-cause mortality rate of patients who experienced HA-PTE in the hospital was lower than that of patients who experienced HA-PTE which in 90 days after admission (1.56% versus 2.85%, respectively); however, the difference was not statistically significant. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: More than half of the HA-PTE events were associated with recent hospitalization. HA-PTE and CA-PTE have different risk factors; when combined with different clinical symptoms, they have a higher incidence of HA-PTE occurring in the hospital. More attention should be given to inpatients to reduce the incidence of HA-PTE.