Risk Of Complications Research Articles

Tubeless ureteroenteric anastomosis in robot-assisted radical cystectomy with intracorporeal urinary diversion does not increase the risk of anastomotic stenosis or postoperative complications.

The objective is to demonstrate that omitting ureteral stent placement in robotic intracorporeal urinary diversion does not lead to increased risk of perioperative complications, namely ureteral strictures or anastomotic leaks. We retrospectively reviewed the records of 68 consecutive patients who underwent robotic radical cystectomy with ileal conduit creation or orthotopic neobladder by a single surgeon between January 2020 and September 2023. Chronologically, the first cohort of patients had ureteral stents placed to bridge the ureteroenteric anastomosis, and in the second cohort, stenting was omitted. Cohort 1 consisted of 28 patients with surgeries performed between January 2020 and April 2021, while cohort 2 had 40 patients who underwent surgery from April 2021 to September 2023. The cohorts were well matched with regard to patient age, gender, ASA score and rate of neoadjuvant chemotherapy. The choice of urinary diversion was left to surgeon and patient preference, and there was no significant difference in the proportion of ileal conduits versus orthotopic neobladders within each cohort. Estimated blood loss, total operative time, inpatient length of stay and pathologic T and N staging did not statistically differ between the cohorts. Overall, there was no difference in the rates of postoperative ileus, ureteral stricture, anastomotic leak, infectious complications, and 30-day readmission rates between the groups. Tubeless ureteroenteric anastomosis in patients undergoing robotic radical cystectomy with intracorporeal diversion does not appear to increase the risk of anastomotic strictures or postoperative complications. Further prospective evaluation is warranted.

Biallelic and monoallelic variants in EFEMP1 can cause a severe and distinct subtype of heritable connective tissue disorder.

Variants in EFEMP1, encoding Fibulin-3, were previously reported as a rare cause of heritable connective tissue disorder (HCTD) with recurrent hernias and joint hypermobility. We report three new cases with biallelic or monoallelic EFEMP1 variants and severe hernia phenotypes. Two male siblings of 10 and 13 years old presented with marfanoid habitus, recurrent inguinal and umbilical hernias, generalized joint hypermobility, and scoliosis. Parents and halfsiblings reported joint hypermobility and umbilical hernias. The eldest boy died at age 16 from incarcerated gastrointestinal herniation complicated by gastric and bowel necrosis with perforation. Autopsy revealed widespread intestinal diverticula. Immunohistochemistry of skin and fascia tissue did not reveal any abnormalities, including normal staining of elastic fibers. Both siblings harbored compound heterozygous likely pathogenic EFEMP1 variants (c.1320 + 2T > A, p.? and c.698G > A, p.Gly233Asp). An unrelated 58-year-old male had marfanoid features, high myopia, recurrent diaphragmatic and inguinal hernias, and chronic gastrointestinal dilatation with severe malabsorption. Both his dizygotic twin-brother and mother had recurrent hernias and high myopia. This man died at 59 years of age, and autopsy showed extensive diaphragmatic herniation, bowel diverticula, and pulmonary emphysema. A heterozygous EFEMP1 splice-variant (c.81 + 1G > A, p.?) was identified, causing exon skipping leading to a start-loss. Targeted genome reanalysis nor RNA-sequencing revealed a second variant at the other allele. The reported individuals expand the clinical and pathological phenotypes of EFEMP1-related disease, a distinct entity within the spectrum of HCTD. The severe and recurrent hernias, gastrointestinal dilatation, and diverticulosis result in an increased risk for life-threatening complications, demanding early recognition and close monitoring.

Using heart rate variability to predict neurological outcomes in preterm infants: a scoping review.

Infants born preterm are at higher risk of neurological complications, including intraventricular haemorrhage and white matter injury. After discharge, these infants may experience adverse neurodevelopmental outcomes and exhibit lower educational attainment. Early detection of brain injury and accurate prediction of neurodevelopmental impairment would allow early intervention and support. Heart rate variability (HRV) describes the variation of time intervals between each subsequent heartbeat. HRV is controlled by the autonomic nervous system, which may be affected by hypoxia and compromised blood flow. While HRV has primarily been investigated in neonatal sepsis, the association between HRV, brain injury and neurodevelopmental outcomes in preterm infants is less established. The present scoping review examines the utility of HRV monitoring for predicting short-term and long-term neurological outcomes in preterm infants. Following systematic search of Medline, Embase, Web of Science and the Cochrane Library, 15 studies were included. Nine studies examined the relationship between HRV and brain injury, with all but two showed an association. Eight studies examined the relationship between HRV and long-term outcomes and all eight found an association. This scoping review suggests that decreased HRV in the neonatal period is associated with short- and long-term neurodevelopmental outcomes in preterm infants. IMPACT: Changes in heart rate variability correlate with the occurrence of intraventricular haemorrhage in preterm infants. A decrease in heart rate variability may precede the development of intraventricular haemorrhage. Alterations in heart rate variability correlate with long-term neurodevelopmental outcomes. Significant variability exists in metrics used in assessing heart rate variability.

Impact of operative position on rotational alignment after intramedullary nailing of trochanteric fractures: a comparative analysis of lateral decubitus versus supine position.

Fixation of trochanteric fractures with an intramedullary nail in a non-physiological position can cause poor functional outcomes. The aim of this study is to evaluate the effect of intraoperative patient position on rotational alignment in intramedullary nail fixation of trochanteric fractures. The femoral rotational alignment of 84 trochanteric fracture patients who underwent intramedullary nailing was measured by computed tomography (CT) images. Patients were divided into two groups: the supine position on the fracture table (FT) (Group 1, n = 42) and the lateral decubitus (LD) position (Group 2, n = 42). Femoral malrotation angles were measured and divided into three subgroups: insignificant, significant,andexcessive.The number of intraoperative fluoroscopy images, preparation time, surgery time, and anesthesia time in both groups were compared. The malrotation degrees of patients in Group 1 ranged from 17° external rotation (ER) to 57° internal rotation (IR), with a mean of 10° IR. Of the patients in Group 1, 27 were insignificant, 5 were significant, and 10 were in the excessive subgroup. The malrotation degrees of patients in Group 2 ranged from 33° ER to 47° IR, with a mean of 11° IR. Of the patients in Group 2, 21 were insignificant, 12were significant, and 9 were in the excessive subgroup. There was no statistically significant relationship between patient position and malrotation angle. The number of intraoperative fluoroscopy images, preparation time, and anesthesia time were statistically lower in Group 2. There was no statistically significant difference between Group 1 and Group 2 in terms of surgery time. Intramedullary nailing in the LD position is a reliable and practical surgical method in the treatment of femoral trochanteric fractures since there is no need for the use of a FT, the surgeon is exposed to less radiation, there is no risk of complications related to the traction of the FT, and there is a shorter operation time.

Considering User Experience and Behavioral Approaches in the Design of mHealth Interventions for Atrial Fibrillation: Systematic Review.

Atrial fibrillation (AF) is a leading chronic cardiac disease associated with an increased risk of stroke, cardiac complications, and general mortality. Mobile health (mHealth) interventions, including wearable devices and apps, can aid in the detection, screening, and management of AF to improve patient outcomes. The inclusion of approaches that consider user experiences and behavior in the design of health care interventions can increase the usability of mHealth interventions, and hence, hopefully, yield an increase in positive outcomes in the lives of users. This study aims to show how research has considered user experiences and behavioral approaches in designing mHealth interventions for AF detection, screening, and management; the phases of designing complex interventions from the UK Medical Research Council (MRC) were referenced: namely, identification, development, feasibility, evaluation, and implementation. Studies published until September 7, 2022, that examined user experiences and behavioral approaches associated with mHealth interventions in the context of AF were extracted from multiple databases. The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were used. A total of 2219 records were extracted, with only 55 records reporting on usability, user experiences, or behavioral approaches more widely for designing mHealth interventions in the context of AF. When mapping the studies onto the phases of the UK MRC's guidance for developing and evaluating complex interventions, the following was found: in the identification phase, there were significant differences between the needs of patients and health care workers. In the development phase, user perspectives guided the iterative development of apps, interfaces, and intervention protocols in 4 studies. Most studies (43/55, 78%) assessed the usability of interventions in the feasibility phase as an outcome, although the data collection tools were not designed together with users and stakeholders. Studies that examined the evaluation and implementation phase entailed reporting on challenges in user participation, acceptance, and workflows that could not be captured by studies in the previous phases. To realize the envisaged human behavior intended through treatment, review results highlight the scant inclusion of behavior change approaches for mHealth interventions across multiple levels of sociotechnical health care systems. While interventions at the level of the individual (micro) and the level of communities (meso) were found in the studies reviewed, no studies were found intervening at societal levels (macro). Studies also failed to consider the temporal variation of user goals and feedback in the design of long-term behavioral interventions. In this systematic review, we proposed 2 contributions: first, mapping studies to different phases of the MRC framework for developing and evaluating complex interventions, and second, mapping behavioral approaches to different levels of health care systems. Finally, we discuss the wider implications of our results in guiding future mHealth research.

Women and midwives’ experiences of an audio-visual enhanced hospital birth environment: An interview study

ProblemMost hospital birth environments remain clinical in appearance and are not attuned to the neurohormonal processes that orchestrate labour and birth. Hospital environments are therefore not aligned with the innate needs of a woman to feel safe and secure in the place where she gives birth. BackgroundResearch has suggested that audio-visual effects such as nature images and sounds may help promote physiological labour in women at low risk of complications. This study aimed to explore the experiences of women labouring in a hospital birth environment enhanced with audio-visual technology, regardless of pregnancy complexity and use of interventions. Experiences of midwives providing one-to-one midwifery care in this environment were also explored. MethodsTranscripts of semi-structured interviews conducted with thirty-two women and six midwives were analysed thematically. FindingsUniversally, women reported that access to audio-visual imagery and soundtracks in the birth environment positively influenced their experience of labour. Nature images and sounds during labour helped create serenity and calmness within the woman and her surroundings, allowing her to relax and focus inwards. Midwives used this technology to create a calm and psychologically safe environment for women giving birth in the hospital. Projecting nature images and sounds became a medium for midwives to create ambience and instil calmness in the clinical environment. Midwives also reported observing positive impacts on the behaviours of other clinicians entering the room. ConclusionAudio-visual enhancement of the hospital birth environment was found to enhance women’s birth experiences and support midwives providing woman-centred care.

Thermo-expandable intraprostatic nitinol stents in the treatment of bladder outlet obstruction: a consecutive case series.

In high-risk patients, prostatic stents may alleviate obstruction at the prostate level. Since 2020 we have used thermo-expandable intraprostatic nitinol stents. Here we document outcomes through the first years with the procedure. We reviewed patients who had undergone stent treatment between May 2020 and October 2023. Patient and procedural data, urinary symptoms, complications and side effects were recorded. Descriptive statistics were used to summarize outcomes and we evaluated predictors of success and complications using robust multiple regression analyses. We included 52 consecutive patients with a median age of 82 years (range 71-96) and a median Charlson Comorbidity Index of 6 (3-11). Forty-seven men used indwelling catheters, two used clean intermittent catheterization, and three had severe lower urinary tract symptoms. Stents were placed under general anesthesia, sedation, and local anesthesia in 39, 4, and 9 men, respectively. The median treatment time was 14 min (range 8-40). One complication, in the form of an infection requiring IV antibiotics, occurred. Subsequently, 45 men (87%) were able to void spontaneously without bothersome symptoms. After a median of 11 (2-44) months, 8 men had their stents removed due to recurring symptoms. This gives an overall success rate of 37/52 patients (71%). No predictors of success or complications were identified. Thermo-expandable intraprostatic nitinol stents demonstrate a high success rate with a low risk of complications and may serve as an alternative to permanent or intermittent catheterization for men who are unable or unwilling to undergo flow-improving surgery.

Intraoperative Complications as Predictors of Flap Failure in Autologous Breast Reconstruction.

Intraoperative microvascular complications in autologous breast reconstruction significantly increase the risk of post-operative complications. No study has identified which specific intraoperative complications contribute to partial or total flap loss. A retrospective chart review of microsurgical breast reconstructions by five surgeons between 2009-2020 analyzed operative variables and patient outcomes, with complications determined from the operative report. Flap loss rates were compared between cases with and without intraoperative complications. Statistical analysis was performed using Fischer exact and t-tests for discrete and continuous variables, respectively. Intraoperative complications were analyzed for 1465 autologous breast flaps performed in 916 patients. Early partial flap loss was predicted by arterial anastomosis revision (2.90% vs 0.44%, p=.03) and alternate venous outflow (14.29% vs 0.41%, p=.002), with no association with intraoperative thrombosis, venous revision, or difficult recipient or flap dissection. In comparison, early total flap loss was predicted by intraoperative arterial revision (5.80% vs 0.51%, p=.001), venous revision (5.45% vs 0.57%, p=.007), intraoperative thrombosis (12.12% vs 0.49%, p<.001), and difficult flap dissection (2.91% vs 0.59%, p=.04). Difficult flap dissection was the only intraoperative variable associated with late partial flap loss (6.80% vs 1.69%, p=.004). Late total flap loss only occurred in 6/1465 flaps, the sole association being difficult recipient vessel dissection (2.78% vs 0.29%, p=.03). Post-operative arterial and venous compromise occurred in 1.10% (13/1187) and 2.53% (30/1187) of cases with no intraoperative complications, respectively, compared to 3.2% (9/278, p=0.02) and 6.12% (17/278, p=0.002) in cases with an intraoperative complication. Alternate venous outflow predicts early partial flap loss, while intraoperative thrombosis, and arterial and venous revision predict early total loss. Difficult flap dissection was associated with early total and late partial flap loss, while difficult recipient vessel dissection was associated with late total flap loss.

Real-world effectiveness and safety of handheld ultrasound in pleural procedures.

The use of ultrasound for pleural procedures is associated with a decreased risk of complications. Handheld ultrasounds allow for easier evaluation of the pleural space. Limited data exists for the use of such devices for pleural procedures. The primary objective of our study was to assess the effectiveness and safety of handheld ultrasound for pleural procedures. We performed a prospective observational study, including all consecutive patients who underwent pleural procedures using the handheld ultrasound between September 2021 and November 2023. A total of 332 pleural procedures were attempted with handheld ultrasound, of which 329 pleural procedures (99.1%) were successfully performed. The median volume of fluid drained was 500 (interquartile range: 300-800). Thoracentesis was performed in 127 patients (38.5%), tube thoracostomy in 179 patients (54.4%), and medical thoracoscopy in 23 patients (7.0%). Exudative pleural effusions were found in 264 patients (80.0%), of which 152 (46.2%) were determined to be due to infectious etiologies. A total of 4 (1.2%) patients had a complication due to the procedure. 2 patients (0.6%) had a pneumothorax, while 2 patients (0.6%) developed a hemothorax. A total of 101 patients had either low platelets (<50×109/L) or use of anti-platelet or anti-coagulant drugs. 128 patients (38.8%) were on positive pressure support during the pleural procedure. Our study shows that handheld ultrasounds are effective and safe for pleural procedures, including cases with septated pleural effusions and patients on anti-platelet or anti-coagulant drugs.

Migraine in antiphospholipid syndrome and hereditary thrombophilia: pregnancy-related clinical and diagnostic features and therapeutic issues

Introduction. Migraine is one of the most common primary headaches and a risk factor for cardiovascular and cerebrovascular diseases. Antiphospholipid syndrome (APS) and hereditary thrombophilia (HT) causing pathological pregnancy are highly associated with migraine. Timely migraine recognition related to APS and HT facilitates earlier initiation of thrombophilia pathogenetic therapy and prevention of potential complications.Aim: to analyze the literature data on migraine clinical and diagnostic features in APS and HT as well as pregnancy-related therapeutic issues.Materials and Methods. A search for scientific literature was conducted in electronic databases including PubMed, Google Scholar, eLibrary from 2004 until May 2024. The search methodological basis included the presence of the following keywords and their combinations in Russian and English: "migraine", "antiphospholipid syndrome", "thrombophilia", "migraine and pregnancy", "migraine and thrombophilia", "migraine and cardiovascular diseases". As a result, a total of 184 publications were identified. Next, 62 articles were included in the review.Results. At the current stage, neurologists have no means to diagnose migraine in APS and HT based on headache-intrinsic characteristics. Pregnancy increases a risk of thrombotic complications. A migraine observed in patient's history should be crucial while assessing pregnancy-related obstetric risk. While diagnosing migraine, neurologists need to examine patient obstetric history. The data on most effective and safe therapy for pregnancy-related migraine attacks remain scarce.Conclusion. The frequent association between APS and HT with migraine, the lack of clear migraine clinical features in thrombophilia, patients’ reproductive age, and the high risk of thrombotic complications necessitate collaboration between neurologists and obstetricians-gynecologists for timely diagnostics and management of such patients. The impact of various types of antithrombotic therapy on migraine course requires further clarification. It is promising to conduct studies able to determine of whether migraine attack prevention can avoid adverse pregnancy outcomes in women with former migraine.

MNGA-08 SKULL BASE TUMOR RESECTION IN LOW-RESOURCE SETTINGS: A REVIEW OF THREE CASES AT THE KENYATTA NATIONAL HOSPITAL

Abstract Skull-based tumors are challenging to treat surgically due to their proximity to vital structures and the risk of complications. In low-resource settings, the availability of advanced neurosurgical equipment and expertise is limited, which may affect the outcomes of these patients. We report the outcomes of three patients with skull base tumors who underwent surgery at the Kenyatta National Hospital, Kenya. We retrospectively reviewed the medical records and followed up with three patients who underwent surgery for skull base tumors between October and November 2023. We collected data on their demographic characteristics, clinical presentation, imaging findings, surgical procedures, histopathological diagnosis, and postoperative course. The three patients were male, aged 42, 40, and 36 years. The common presentation was with headache, but dizziness and other cerebellar deficits were common. Imaging revealed defined lesions in the posterior fossa, involving the cerebellum and brainstem. The differential diagnosis included hemangioblastoma and meningioma. The surgical approach with anatomically-specified craniotomy with resection of the tumor and decompression. The postoperative course was uneventful for the first and third patients, who showed improvement in their neurological symptoms and signs. The second patient had repeat surgery. Skull base tumor surgery in a low-resource setting can achieve favorable outcomes with careful patient selection, meticulous surgical technique, and multidisciplinary care. However, the challenges of limited resources and high complication rates remain. Further studies are needed to evaluate the long-term outcomes and quality of life of these patients.

Disorder of Glucose Metabolism and Therapy: Implications on the Natural History of Advanced Chronic Liver Disease

Introduction: Hepatogenous diabetes (HD) is a disorder of glucose metabolism (DGM) that develops as a complication of advanced chronic liver disease (ACLD) with an estimated prevalence of 20–70%. It appears to be associated with a larger number of decompensations, but its impact on the natural history of the disease is unclear. The treatment of DGM is hampered by the fact that some therapeutic agents are associated with a risk of complications in ACLD. The aim of this work was to study DGM in a population of patients with ACLD: prevalence, liver disease decompensation episodes, mortality analysis and study of the impact of antidiabetic therapies in patients with ACLD who developed DGM. Materials and Methods: A cohort of consecutive patients with ACLD without previous DGM, who attended a Hepatology clinic in the period of January to June 2015 was selected. Follow-up was carried out for 5 years. Data on age, gender, date of diagnosis and etiology of ACLD, Child-Pugh and MELD-Na classifications at enrollment, development of DGM, and antidiabetic therapy were collected. Logistic regression models for hospitalizations due to decompensated ACLD, ascites, hepatic encephalopathy (HE), upper gastrointestinal bleeding (UGB), hepatocellular carcinoma (HCC), portal vein thrombosis (PVT), infectious complications, acute-on-chronic liver failure (ACLF), and death were built. A survival analysis for patients with and without DGM was also performed. Treatment effectiveness for patients with DGM was assessed. Results: Initially, 221 patients were included, 154 (69.7%) of whom developed DGM after the diagnosis of ACLD. DGM patients presented a significantly higher number of hospitalizations. Odds ratio (OR) for death was not significantly related with DGM. At 5 years of follow-up, 68.9% of patients with DGM were alive, against 81.8% without DGM (p = 0.087). From the 154 patients who were diagnosed with DGM, 42.9% were not receiving pharmacological treatment for DGM. Treated patients were prescribed with either biguanides (34.8%), a SGLT2 inhibitor (8.6%), or insulin (7.7%). Only 1 patient was treated with a GLP-1 analogue. A tendency of OR favoring treatment was observed for biguanides and SGLT2 inhibitors in all outcomes except ascites. In the univariable analysis, the use of biguanides was associated with lower risk of death (OR: 0.84 [95% CI: 0.73–0.96]) and HE (OR: 0.85 [95% CI: 0.73–0.98]). Conclusion: DGM occurs with high prevalence in patients with ACLD and it seems to be related to more hospitalizations, which highlights the importance of its early identification and appropriate therapeutic approach. In the absence of contraindications, biguanides should be considered for treatment of patients with ACLD and DGM as they appear to be associated with a tendency to better outcomes and may present some advantage in terms of survival.

The effect of Traumeel LT ad us. vet. on the perioperative inflammatory response after castration of stallions: a prospective, randomized, double-blinded study

IntroductionStallion castration is a standard procedure with a risk of post-surgical complications. Castration induces an acute phase response (APR). Serum Amyloid-A (SAA) is a well-studied major acute phase protein (APP), that has been shown to be a good marker for the development of post-surgical complications. The current gold standard for reducing the APR after castration is Flunixin-Meglumin, which is a non-steroidal anti-inflammatory drug (NSAID) inhibiting COX1/2. In contrast, Traumeel LT ad us. vet. can modulate the APR by induction of the inflammation resolution. The aim of this study was to compare the effect of Flunixin-Meglumin and Traumeel LT ad us. vet. on the acute phase response.Material and methodsA total of 60 stallions were recruited and 54 stallions entered the study with 27 stallions in each treatment group. The stallions were treated pre- and postoperatively with either Flunixin-Meglumin (FL) or with Traumeel LT ad us. vet. (TR). Blood was taken before and 24 h, 48 h and 72 h after castration. The following main parameters were assessed: SAA, fibrinogen, iron, white blood cells, neutrophils, Interleukin1ß, and cortisol. Wound healing and pain were assessed at 8 time points.ResultsThe main variable SAA was increased after surgery reaching a mean value of 122 µg/ml in the FL group and a mean SAA of 226 µg/ml in the TR group 48 h after surgery, reaching a significant difference only at the 24 h timepoint (p = 0.03). All stallions had the highest pain summary score 8 hours after surgery, with decreasing values thereafter. The pain scores were not statistically different at any time point. In the FL group five stallions developed a suture dehiscence compared to only one stallion in the TR group (p = 0.001).DiscussionWithin the limitations of this study, Traumeel LT ad us. vet. seems to have proresolving effects on the inflammation induced by surgery making it a valuable treatment to reduce the APR induced by castration. Due to its different mode of action, Traumeel LT ad us. vet. might be an alternative treatment option if gastrointestinal side effects or renal side effects of NSAIDs should be avoided. Further studies are needed combining Traumeel LT ad us. vet. and Flunixin.

Opioid-free General Anesthesia and Awake Fiberoptic Intubation with Dexmedetomidine in a Class IV Obese Patient with Cervical Spondylosis

Abstract Patients with Class IV obesity (C4O) (body mass index [BMI] &gt;50 kg/m2) are at a particularly high risk of anesthesia-related complications during the postoperative period, e.g., critical respiratory events (CREs) including respiratory arrest and oversedation, leading to problems with maintaining open airway, hypoxia, and hypercapnia. We present the case of a 67-year-old C4O (BMI 57.2 kg/m2) female patient with cervical spondylosis, scheduled for laparoscopic sleeve gastrectomy. Preanesthesia evaluation revealed hypertension, type 2 diabetes mellitus (DM), nonalcoholic steatohepatitis, and obstructive sleep apnea as comorbidities. Awake fiberoptic intubation was planned because of a high potential for difficult intubation (neck circumference of 45 cm, cervical spondylosis, reduced neck mobility, and type 2 DM), using topical anesthesia and dexmedetomidine (Dex) infusion. General anesthesia was given with desflurane and muscle relaxant. “Opioid-free anesthesia,” wherein use of systemic, neuraxial, or intracavitary opioids is completely eliminated, was maintained with Dex infusion for sedation and analgesia. Reversal of anesthesia was done in Fowler’s position (FP), and after extubation, nasopharyngeal airway connected to high-flow oxygen (10 L/min) via tubing was used, which facilitated spontaneous breathing, maintaining oxygen saturation and uneventful recovery. Postoperatively, intravenous paracetamol alone was adequate for effective pain relief. The patient remained hemodynamically stable throughout the perioperative period. This case underscores the benefits of “opioid-free anesthesia” using intraoperative Dex infusion and efficacious use of nasopharyngeal airway in FP postoperatively, avoiding requirement of ventilator, in supermorbidly obese patients, reducing CREs and optimizing postoperative outcomes.

Study of the use of La Roche-Posay Dermatological Laboratory skincare products for radiodermatitis prevention and treatment

Risks of adverse effects during therapy increase along with progress in oncology and development of new treatment methods. Thus, radiotherapy, one of the main methods of treatment of malignant tumors of various locations, can cause radiodermatitis: an adverse side effect manifesting on the skin in the irradiated area or near it. Clinical manifestations vary from stage to stage and negatively affect patients’ willingness to undergo or continue treatment due to fear of esthetic defects of the skin. Additionally, development of advanced stage radiodermatitis carries the risk of infectious complications in this area. One of the goals of radiation therapists is management of radiation-induced dermatitis and search for techniques aimed at its treatment and prevention.This study evaluates the effects of several products and their components on clinical manifestations of radiodermatitis caused by radiation therapy.

A-154 Non-standard body fluid validation of d-dimer analysis of organox liver perfusate to support clinical evaluations of donor livers prior to transplantation

Abstract Background Non-standard body fluid analysis is considered a challenge to laboratories since very few have been approved by the FDA for routine testing. As medical procedures evolve, the laboratory must balance the requirement to uphold regulatory standards while also supporting procedures that improve patient care. The LUMC Liver Transplant Team recently implemented the use of the FDA-approved OrganOx Metra normothermic machine perfusion instrument for maintaining donor livers under physiologic conditions prior to transplantation. The team mitigates risk for biliary complications associated with fibrin microthrombi by perfusing a combination of alteplase rTPA with fresh frozen plasma and monitoring the prevalence of fibrin through the release of D-dimers over the course of ex situ normothermic preservation. Liver perfusate is not an FDA-approved specimen type for the analysis of D-dimer and requires laboratory verification as a compatible specimen for analysis. Methods The D-dimer HS 500 assay was performed on an ACL TOP 750 analyzer. Carry-over studies evaluated activated partial thromboplastin time (aPTT) of a normal control (citrated plasma) specimen initially, and repeatedly in-between sets of D-dimer measurements of heparinized perfusate specimen. Recovery studies were performed by mixing liver perfusate with citrated plasma spiked with D-dimer in known ratios, allowing for the calculation of an expected value of D-dimer. Results Carry-over studies measuring aPTTs of normal plasma specimens provided %CVs of 1 and 3%. Recovery of D-dimer in seven sets of independent add-mixture series (three mixed specimen per set) was on average 105% with a range from 95 to 113% recovery. Conclusions Concern for cross-contamination of perfusate specimen containing heparin anticoagulant on analyzers used to evaluate routine coagulation testing was mitigated by the results of the carry-over study, which provided %CV within the manufacturer limit for intraday precision. Recovery studies evaluating matrix effect for the analysis of D-dimer on liver perfusate generated under the LUMC liver transplant protocol indicated that the matrix of the perfusate did not impact D-dimer analysis, as compared to the FDA-approved specimen type.

Dietary habits, nutritional knowledge, and nutritional status among cardiological patients, including those with obesity and diabetes

BackgroundCardiovascular disease is a leading cause of death worldwide. The increase in patients with obesity and diabetes raises the risk of cardiovascular diseases. Proper eating habits and adequate nutritional knowledge play a key role in preventing and treating these conditions. This study aimed to evaluate the dietary habits, nutritional knowledge, and nutritional status of patients hospitalized in a cardiology department in Poland, including those with obesity or diabetes.MethodsThe study was conducted at St. Barbara Regional Specialized Hospital No. 5 in Sosnowiec from January to June 2021, involving 301 patients, 154 women (51.2%) and 147 men (48.8%), aged 29 to 87. Participants were assessed for BMI, NRS 2002 scale, morphology, biochemistry results, blood pressure, and examined for nutritional knowledge and habits using proprietary questionnaires. A proprietary scale was used to assess eating habits.ResultsMost cardiology patients were overweight or obese, with 80% exceeding the normal weight range. No significant gender differences were noted in malnutrition risk on the NRS 2002 scale. The study found patients rarely consumed recommended amounts of vegetables, fruits, legumes, whole grains, fish, and dairy products. Only 26.2% regularly ate a second breakfast, and just 9.3% chose water with meals. However, consumption of salty snacks, energy drinks, and alcohol was low. Biochemical and blood test analysis did not show significant differences between patients with diabetes, obesity, and others.ConclusionMost cardiology patients were overweight or obese, which poses a significant risk for further health complications, including cardiovascular diseases. Although patients with diabetes and/or obesity had better nutritional knowledge in some areas, this did not lead to healthier eating habits. The absence of significant differences in biochemical tests suggests that overall lifestyle and diet are crucial to cardiovascular health.

Exploring the Intersection of Blood Transfusion and Same-Day Computed Tomography Imaging: An Overview of Clinical Risks and Practices

The use of transfusions, whether involving whole blood or specific blood components, is essential for managing various clinical conditions. Many cases are acute, often requiring post-transfusion imaging evaluation. While there is no absolute contraindication for chest imaging following blood transfusion, it should be approached cautiously. We conducted a comprehensive search across multiple databases and registries. Research studies were limited to full-text original articles, reviews, and case reports published in English, involved human subjects, and focused on the interplay between blood transfusions and contrast-enhanced imaging. Scientific analyses were excluded if they did not focus on transfusion practices in the context of imaging or failed to address issues such as hemoglobin thresholds, transfusion reactions, or the clinical implications of contrast agents. Our research fills this gap by emphasizing the need for a cautious, multidisciplinary approach to post-transfusion computed tomography (CT) scans, especially in the presence of contrast agents. This study calls for increased awareness of the heightened risk of complications, such as autoimmune hemolysis, when both procedures are performed together. New insights from our research recommend individualized assessments and close patient monitoring when combining these interventions. Nevertheless, patients need to be hemodynamically and clinically stable before undergoing CT. Discussions. Symptoms that develop within the first 24 h post-transfusion are classified as secondary post-transfusion reactions unless proven otherwise. The prevalence of side effects from same-day CT scans and blood transfusions is challenging to quantify, as few studies focus on this combination. Transfusions and contrast-enhanced CT scans share overlapping adverse reactions and carry significant risks. Acute hemolytic red blood cell transfusion reactions are among the most frequent side effects, with a prevalence of 1:12,000–38,000. Conclusion. Our study contributes new insights to the literature by filling the gap concerning the interplay between transfusions and contrast media, paving the way for more informed clinical protocols to enhance patient safety.

Surgical management of obstructing ureteral stones during pregnancy: A systematic review of different techniques.

Renal colic is the most common non-obstetric cause of abdominal pain during pregnancy and is associated with a higher risk of complications in these women. When invasive treatment is required, options are temporary drainage with ureteral stent (JJ) or percutaneous nephrostomy (PCN), or immediate definitive treatment with ureteroscopy (URS). Our goal was to review the safety and efficacy of these procedures in treating urolithiasis during pregnancy. Adhering to the PRISMA checklist guidelines, we searched PubMed, Embase, and Scopus databases for articles on the efficacy and complications of the three procedures in pregnant women. The quality of evidence and risk of bias were evaluated using the Critical Appraisal Skills Programme and the Institute of Health Economics tools. We included 45 articles, totaling 3424 interventions in pregnant women - 2188 URS, 719 JJ, and 517 PCN. URS was the most assessed procedure, with stone-free rates comparable to the non-pregnant patients. The most frequent complications were lower urinary symptoms and infections independently of the intervention. Obstetric complications for all interventions included 167 cases of preterm labor, resulting in 24 premature births. No statistically significant differences in post-operative complications were reported between the procedures in the few comparative studies. Despite the absence of high-quality studies, current evidence suggests that URS, JJ, and PCN are all safe and effective during pregnancy. As most patients submitted to temporary drainage require a second procedure post-delivery, primary URS appears more efficient. Therefore, it is the preferred option unless there are indications for temporary drainage.

Surgical treatment of chronic pancreatitis with an inflammatory pancreatic head mass: a retrospective study

BackgroundConservative treatment of chronic pancreatitis has only a limited effect in most patients. Surgery offers very good long-term results, even in the early stages of the disease. Unfortunately, only a minority of patients undergo surgical treatment. The aim of this work was to summarise the current treatment options for patients with an inflammatory mass of the pancreatic head. Data from patients in our study demonstrates that the surgery is a safe method, and here we compare the perioperative and early postoperative outcomes of patients who underwent a pancreatoduodenectomy and duodenum-preserving pancreatic head resection for chronic pancreatitis.MethodsAll patients who underwent a pancreaticoduodenectomy or a duodenum-preserving pancreatic head resection in our department between 2014 and 2022 were included in this study. Perioperative and early postoperative results were statistically analysed and compared.ResultsThirty-eight pancreaticoduodenectomies and 23 duodenum-preserving pancreatic head resections were performed. The overall mortality was 3%, whereas the in-hospital mortality after pancreaticoduodenectomy was 5%. The mortality after duodenum-preserving pancreatic head resection was 0%. No statistically significant differences in the hospital stay, blood loss, and serious morbidity were found in either surgery. Operative time was significantly shorter in the duodenum-preserving pancreatic head resection group.ConclusionsBoth pancreatoduodenectomy and duodenum-preserving pancreatic head resection are safe treatment options. Duodenum-preserving pancreatic head resection showed a statistically significant superiority in the operative time compared to pancreaticoduodenectomy. Although other monitored parameters did not show a statistically significant difference, the high risk of complications after pancreaticoduodenectomy with a mortality of 5%; maintenance of the duodenum and upper loop of jejunum, and lower risk of metabolic dysfunctions after duodenum-preserving pancreatic head resection may favour duodenum-preserving pancreatic head resection in recommended diagnoses. Attending physicians should be more encouraged to use a multidisciplinary approach to assess the suitability of surgical treatment in patients with chronic pancreatitis.