Shorter Hospital Research Articles

Clinical comprehensive treatment protocol for managing diabetic foot ulcers: A retrospective cohort study.

Diabetic foot ulcers (DFUs) are a common complication of diabetes, often leading to severe infections, amputations, and reduced quality of life. The current standard treatment protocols for DFUs have limitations in promoting efficient wound healing and preventing complications. A comprehensive treatment approach targeting multiple aspects of wound care may offer improved outcomes for patients with DFUs. The hypothesis of this study is that a comprehensive treatment protocol for DFUs will result in faster wound healing, reduced amputation rates, and improved overall patient outcomes compared to standard treatment protocols. To compare the efficacy and safety of a comprehensive treatment protocol for DFUs with those of the standard treatment protocol. This retrospective study included 62 patients with DFUs, enrolled between January 2022 and January 2024, randomly assigned to the experimental (n = 32) or control (n = 30) group. The experimental group received a comprehensive treatment comprising blood circulation improvement, debridement, vacuum sealing drainage, recombinant human epidermal growth factor and anti-inflammatory dressing, and skin grafting. The control group received standard treatment, which included wound cleaning and dressing, antibiotics administration, and surgical debridement or amputation, if necessary. Time taken to reduce the white blood cell count, number of dressing changes, wound healing rate and time, and amputation rate were assessed. The experimental group exhibited significantly better outcomes than those of the control group in terms of the wound healing rate, wound healing time, and amputation rate. Additionally, the comprehensive treatment protocol was safe and well tolerated by the patients. Comprehensive treatment for DFUs is more effective than standard treatment, promoting granulation tissue growth, shortening hospitalization time, reducing pain and amputation rate, improving wound healing, and enhancing quality of life.

Initial Experience With Robotic Liver Resection in the United States.

This study's aim was to show the feasibility and safety of robotic liver resection (RLR) even without extensive experience in major laparoscopic liver resection (LLR). A single center, retrospective analysis was performed for consecutive liver resections for solid liver tumors from 2014 to 2022. The analysis included 226 liver resections, comprising 127 (56.2%) open surgeries, 28 (12.4%) LLR, and 71 (31.4%) RLR. The rate of RLR increased and that of LLR decreased over time. In a comparison between propensity score matching-selected open liver resection and RLR (41:41), RLR had significantly less blood loss (384 ± 413 vs 649 ± 646mL, P = .030) and shorter hospital stay (4.4 ± 3.0 vs 6.4 ± 3.7 days, P = .010), as well as comparable operative time (289 ± 123 vs 290 ± 132 mins, P = .954). A comparison between LLR and RLR showed comparable perioperative outcomes, even with more surgeries with higher difficulty score included in RLR (5.2 ± 2.7 vs 4.3 ± 2.5, P = .147). The analysis of the learning curve in RLR demonstrated that blood loss, conversion rate, and complication rate consistently improved over time, with the case number required to achieve the learning curve appearing to be 60 cases. The findings suggest that RLR is a feasible, safe, and acceptable platform for liver resection, and that the safe implementation and dissemination of RLR can be achieved without solid experience of LLR.

Minimally invasive approaches versus conventional sternotomy for aortic valve replacement in patients with aortic valve disease: a systematic review and meta-analysis of 17,269 patients

Background: Aortic valve replacement (AVR) is a common procedure for aortic valve pathologies, particularly in the elderly. While traditional open AVR is established, minimally invasive techniques aim to reduce morbidity and enhance treatment outcomes. Our meta-analysis compares these approaches with conventional sternotomy, offering insights into short and long-term mortality and postoperative results. This study provides valuable evidence for informed decision-making between conventional and minimally invasive approaches for AVR. Materials and Methods: Till august 2023, PubMed, Embase, and MEDLINE databases were searched for Randomized controlled trials (RCT) and propensity score matched (PSM) studies comparing minimally invasive approaches [mini-sternotomy (MS) and right mini thoracotomy (RMT)] with full sternotomy (FS) for AVR. Various outcomes were analyzed, including mortality rates, bypass and clamp times, length of hospital stay, and complications. Risk ratios (RR) and the weighted mean differences (WMD) with corresponding 95% confidence intervals were calculated using Review Manager. Results: Forty-eight studies were included having 17,269 patients in total. When compared to FS, there was no statistically significant difference in in-hospital mortality in MS (RR:0.80; 95%CI:0.50 to 1.27; I2=1%; P=0.42) and RMT (RR:0.70; 95%CI:0.36 to 1.35; I2=0%; P=0.29). FS was also linked with considerably longer cardiopulmonary bypass duration than MS (MD:8.68; 95%CI:5.81 to 11.56; I2=92%; P=0.00001). The hospital length of stay was determined to be shorter in MS (MD:−0.58; 95%CI:−1.08 to −0.09; I2=89%; P=0.02) with no statistically significant difference in RMT (MD:−0.67; 95%CI:−1.42 to 0.08; I2=84%; P=0.08) when compared to FS. Conclusions: While mortality rates were comparable in minimally invasive approaches and FS, analysis shows that MS, due to fewer respiratory and renal insufficiencies, as well as shorter hospital and ICU stay, may be a safer approach than both RMT and FS.

Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) in the Treatment of Gastric Cancer: Feasibility, Efficacy and Safety-A Systematic Review and Meta-Analysis.

Background: Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is an emerging technique for delivering chemotherapy directly to the peritoneum via a pressurized aerosol. Its growing attention stems from its effectiveness in treating peritoneal carcinomatosis (PC) originating from various primary tumors, with gastric cancer (GC) being among the most prevalent. This study aimed to systematically investigate PIPAC's therapeutic role in gastric cancer peritoneal metastasis (GCPM). Methods: The systematic review and meta-analysis followed the PRISMA 2020 guidelines, searching Pubmed, Web of Science, and SCOPUS databases. The meta-analysis of relative risks and mean differences compared patients undergoing one or two PIPAC sessions with those completing three or more, assessing various outcomes. Results: Eighteen studies underwent qualitative analysis, and four underwent quantitative analysis. Patients with three or more PIPAC procedures had shorter hospital stays (MD = -1.2; 95%CI (-1.9; -0.5); p < 0.001), higher rates of histopathological response (RR = 1.77, 95%CI 1.08; 2.90; p = 0.023), and significantly improved overall survival (MD = 6.0; 95%CI 4.2; 7.8; p < 0.001). Other outcomes showed no significant differences. Conclusions: PIPAC demonstrated efficacy in carefully selected patients, enhancing histopathologic response rates and overall survival without prolonging hospital stays. This study underscores the necessity for randomized controlled trials and precise selection criteria to refine PIPAC's implementation in clinical practice.

Implementation of the 300-mL Rule for the Management of Traumatic Hemothorax.

Traumatic hemothorax (HTX) is often managed with tube thoracostomy (TT); however, TT carries a high complication rate. In 2017, a guideline was implemented at our Level I trauma center to observe traumatic HTX ≤300mL in hemodynamically stable patients. We hypothesized that this guideline would decrease TT placement without increasing observation failure rates. This was a single-center retrospective review of all adult patients admitted with a HTX on computed tomography (CT) before (2015-2016) and after (2018-2019) the guideline implementation. Exclusion criteria were TT placement prior to CT scan, absence of CT scan, death within 5 days of admission, and a concurrent pneumothorax (PTX) >20mm. HTX volume was calculated using CT scan images and Mergo's formula: V=d 2xL (V: volume; d: depth; L: length). The primary outcome was observation failure, defined as the need for TT, video-assisted thoracoscopic surgery, thoracotomy after repeat imaging or worsening of symptoms and pulmonary morbidity. A total of 357 patients met inclusion criteria, of whom 210 were admitted after guideline implementation. There were no significant differences in baseline demographics, comorbidities, or injury characteristics across both cohorts. The post-implementation cohort had a significant increase in observation rate (75% vs 59%) and a decrease in TT placement (42% vs 57%). Moreover, the post-implementation group had a statistically significant shorter hospital (6 vs 8 days) and ICU (2 vs 3 days) LOS. No significant differences in observation failure, pulmonary complications, 30-day readmission, or 30-day mortality were observed across both cohorts. The implementation of the 300mL guideline led to a decrease in TT placement without increasing observation failure or complication rates. Level III, Therapeutic/Care Management.

Impact of Time from Injury to Surgery on Postoperative Functional Recovery in Large Volume Traumatic Extradural Hematomas

Abstract Background In traumatic brain injury (TBI) patients, the time from trauma to cranial surgery is always of great concern to patients and neurosurgeons. Patients and Methods A retrospective study conducted on 93 TBI patients presented with Glasgow Coma Scale from 4 to 13 and were operated for large volume (≥ 40 cm3) extradural hematoma (EDH) from July 2020 to December 2022. Surgery was done either within 6 hours following trauma (group A) or later than 6 hours (group B). We evaluated the impact of time from injury to surgery on postoperative clinical recovery, survival, and hospital stay. Results Fifty patients (53.8%) were operated upon within 6 hours after trauma and 43 patients (46.2%) had operations later than 6 hours. No significant difference was found between the two study groups regarding any of the preoperative clinical or radiological factors except for the mean time from injury to surgery (p &lt; 0.001). Delayed surgery &gt; 6 hours was significantly associated with higher postoperative mortality (p = 0.014). Hospital stay was significantly shorter in patients operated ≤ 6 hours (p = 0.006). Patients operated ≤ 6 hours showed significantly favorable functional recovery both at discharge (p = 0.010) and after 1 month of follow-up (p = 0.023). Conclusion Timely surgical intervention for large volume traumatic EDH is the gold standard. Early surgery “within 6 hours from trauma” not only can save patients' life but also is significantly associated with postoperative favorable clinical recovery, low morbidity, and short hospital stay.

Outcomes after laparoscopic or open liver resection for nonalcoholic fatty liver disease-associated hepatocellular carcinoma: a propensity score-matching study.

Laparoscopic liver resection (LLR) is rapidly gaining popularity; however, its efficacy for nonalcoholic fatty liver disease (NAFLD)-associated hepatocellular carcinoma (HCC) (NAFLD-HCC) has been not evaluated. The purpose of this study was to compare short- and long-term outcomes between LLR and open liver resection (OLR) among patients with NAFLD-HCC. We used a single-institution database to analyze data for patients who underwent LLR or OLR for NAFLD-HCC from January 2007 to December 2022. We performed propensity score-matching analyses to compare overall postoperative complications, major morbidities, duration of surgery, blood loss, transfusion, length of stay, recurrence, and survival between the two groups. Among 210 eligible patients, 46 pairs were created by propensity score matching. Complication rates were 28% for OLR and 11% for LLR (p = 0.036). There were no significant differences in major morbidities (15% vs. 8.7%, p = 0.522) or duration of surgery (199 min vs. 189 min, p = 0.785). LLR was associated with a lower incidence of blood transfusion (22% vs. 4.4%, p = 0.013), less blood loss (415 vs. 54 mL, p < 0.001), and shorter postoperative hospital stay (9 vs. 6 days, p < 0.001). Differences in recurrence-free survival and overall survival between the two groups were not statistically significant (p = 0.222 and 0.301, respectively). LLR was superior to OLR for NAFLD-HCC in terms of overall postoperative complications, blood loss, blood transfusion, and postoperative length of stay. Moreover, recurrence-free survival and overall survival were comparable between LLR and OLR. Although there is a need for careful LLR candidate selection according to tumor size and location, LLR can be regarded as a preferred treatment for NAFLD-HCC over OLR.

A Propensity Score-Matched Analysis of Single-Port vs. Multi-Port Laparoscopic Total Abdominal Colectomy with End Ileostomy for Medically Refractory Ulcerative Colitis.

Medically refractory ulcerative colitis (UC) necessitates surgical intervention, with total abdominal colectomy with end ileostomy being a definitive treatment. The comparison between single-port and multi-port laparoscopic surgery outcomes remains underexplored. To compare the surgical outcomes of single-port versus multi-port laparoscopic surgery in patients undergoing total abdominal colectomy with end ileostomy for medically refractory UC. A retrospective analysis comparing single-port to multi-port surgery in UC patients from 2010 to 2020. Patients were propensity score-matched 3:1 (multi-port to single-port) on baseline characteristics. Single center academic hospital. Binary outcomes were compared using a multivariable logistic regression model, and a subset analysis was conducted for postoperative stump leak based on stump implantation during surgery. These metrics were compared between the single-port and multi-port groups to assess the differences in surgical outcomes. The multi-port and single-port groups included 642 and 114 patients, respectively. Matched cohort included 342 multi-ports and 114 single-ports. We observed a statistically significant difference in mean operation time, with the single-port procedure taking 43 minutes less than the multi-port laparoscopy. There were no significant differences between the two groups in postoperative stump leaks, postoperative ileus, stoma site complications, postoperative readmission within 30 days, postoperative reoperation within 30 days, and subsequent IPAA surgery. In the subset analysis, stump implantation was associated with a higher risk of stump leak in the multiport group. The single-port group had a shorter hospital stay. Retrospective nature, being conducted at a single center. Single-incision laparoscopic total abdominal colectomy in the treatment of mucosal ulcerative colitis is a safe, effective, and efficient approach. In our cohort, as compared to multi-port approach, single incision laparoscopy has shown shorter operation times and better overall length of stay. Taking into account less invasive approach, decreased abdominal trauma, and faster recovery, single-port surgery is a viable alternative to multi-port surgery. See Video Abstract.

β-lactamase and macrolide resistance gene carriage in E. coli isolates among children discharged from inpatient care in western Kenya: a cross-sectional study

Abstract Background Antimicrobial resistance (AMR) is a global threat to infectious disease control, particularly among recently hospitalized children. We sought to determine the prevalence and mitigating factors of resistance in enteric Escherichia coli among children discharged from health facilities in western Kenya. Methods Between June 2016 and November 2019, children aged 1-59 months were enrolled at the point of discharge from hospital. E. coli was isolated by microbiological culture from rectal swabs at baseline. β-lactamases and macrolide resistance-conferring genes were detected by PCR. The modified Poisson regression model was used to assess the predictors mph(A) and CTX-M-type ESBL. Results Of the 238 children whose E. coli isolates were tested, 91 (38.2%) and 109 (45.8%) had detectable CTX-M-type ESBL and mph(A) genes, respectively. Antibiotic treatment during hospitalization (adjusted prevalence ratio [aPR]=2.47; 95%CI:1.12-5.43, p=0.025), length of hospitalization (aPR=1.42; 95%CI:1.00-2.01, p=0.052), and the practice of open defecation (aPR=2.47; 95%CI:1.40-4.36, p=0.002) were independent predictors for CTX-M-type ESBL and for mph(A) genes. Pneumococcal vaccination was associated with a 43% lower likelihood of CTX-M-type ESBL (aPR=0.57; 95%CI:0.38-0.85, p=0.005), whilst measles vaccination was associated with a 32% lower likelihood of mph(A) gene (aPR=0.68; 95%CI:0.49-0.93, p=0.017) in E. coli isolates. Conclusions Among children discharged from hospital, history of vaccination, shorter hospital stay, lack of in-hospital antibiotic exposure and improved sanitation were associated with lower likelihood of AMR genes. AMR control programs should consider strategies beyond antimicrobial stewardship, including improvements in sanitation, increased vaccine coverage and the development of novel vaccines, to mitigate the continued spread of AMR.

Clinical Outcomes of Slow versus Rapid Enteral Feeding Advancement in Very Low Birth Weight Neonates at a Tertiary Care Center

In India, every year around 3.5 million babies are born premature, accounting for almost 13% of total livebirths in the country as compared to 5% to 7% incidence in the West. Preterm is defined as babies born before 37 weeks ofpregnancy. The rapidity of feed volume increments involves controversies like faster weight gain, shorter hospital stays, therisk of necrotizing enterocolitis and vice versa. Methods: The present study was a randomized controlled trial conducted fromJune 1, 2018 to October 31, 2019. All infants in the study were randomized to slow and rapid feeding protocols by a stratifiedblock randomization sequence of 2, 4, 6 blocks. Group 1 or the slow advancement group included 64 newborns babies andGroup 2 or the rapid advancement group included 69 newborns babies. Results: The average weight gain in Group 1 was4.41 ± 0.9 g and in Group 2 it was 6.33 ± 1.3 g, the difference was statistically significant (p &lt; 0.02). Sixty out of 64 newbornsregained birth weight within 16.87 ± 0.9 days in Group 1, while 64 out of 69 newborns regained birth weight within 13.63 ±0.9 days in Group 2. The difference was statistically significant. Increment in the mean occipitofrontal circumference perweek was 0.29 ± 0.27 cm Group 1, while in Group 2 it was 0.42 ± 0.05 cm; the difference was statistically significant. Meanaverage length increment per week was found to be 0.55 ± 0.04 cm and 0.69 ± 0.05 cm in Group 1 and Group 2, respectively,the difference was statistically significant (p &lt; 0.005). The mean duration of hospital stay was 27.47 ± 3.33 days in Group 1while in Group 2, the duration of stay was 23.15 ± 2.22 days, the difference was statistically significant. Conclusion: Ourstudy supports enteral nutrition by rapid enteral feeding regimen in stable preterm neonates with very low birth weight

Paravertebral vs. Epidural Analgesia for Liver Surgery (PEALS): Protocol for a randomized controlled pilot study

Background Perioperative thoracic epidural analgesia (TEA) is commonly used in hepatectomy patients since it is opioid-sparing and reduces cardiorespiratory complications. However, TEA has a high failure rate and is associated with potentially devastating complications (particularly spinal haematoma) and the risk is increased with hepatectomy. Thus, some centres favour systemic opioid-based modalities which, in turn, are associated with inferior analgesia and well-known risks/side-effects. Hence, alternative analgesic methods are desirable. Paravertebral block (PVB) has been used in liver resection with advantages including haemodynamic stability, low failure rates, and low risk of spinal haematoma. Our purpose is to conduct a blinded, pilot RCT with hepatectomy patients randomised to receive TEA or PVB for perioperative analgesia. We hypothesise that opioid consumption, time to first analgesic request, and pain scores will be comparable between groups, but PVB patients will require fewer perioperative vasopressors/blood products, and have fewer adverse events and a shorter hospital stay. Methods With ethics approval, this non-inferiority, pilot RCT with a convenience sample of 50 hepatectomy patients will examine whether PVB imparts analgesia comparable to TEA but with fewer adverse effects. Primary outcomes are surrogates of analgesia for 72 h postoperatively (i.e., opioid consumption, time to first analgesic request and pain scores at rest and with coughing); Secondary outcomes are blood products/fluids administered; side effects/complications until 72 h postoperatively; length of hospital stay. The results will be used to plan a large multicentre trial comparing TEA vs. PVB in hepatectomy patients. This study has a high potential to positively impact the quality/safety of patient care. ClinicalTrials.gov registration NCT02909322 (09-21-2016); Available at URL: https://clinicaltrials.gov/ct2/show/NCT0290932

Safety and efficacy of enhanced recovery after surgery among patients undergoing percutaneous nephrolithotomy: a systematic review and meta-analysis.

The enhanced recovery after surgery (ERAS) method has been widely used in surgery and anesthesia worldwide and has been applied to a wide range of surgical specialties, including colorectal surgery, gynecology, liver surgery, breast surgery, urology, and spinal surgery. An increasing number of studies have demonstrated its safety and efficacy in various fields. The safety and effectiveness of ERAS for percutaneous nephrolithotomy (PCNL) remain controversial. This study aimed to review the safety and effectiveness of ERAS for PCNL. The Chinese National Knowledge Infrastructure (CNKI), Wan Fang, Chinese Biomedical Literature Service System (SinoMed), Chinese Science and Technology Journal Full Text Database (VIP), Cochrane Library, PubMed, Web of Science, and Embase databases were searched for eligible studies published until September 19, 2022. Outcome measures included postoperative hospital stay, total hospital stay, incidence of postoperative complications, stone-free rate (SFR), operative time, postoperative indwelling nephrostomy tube time, catheter encumbrance time, and nursing satisfaction. All analyses were performed using random effects or fixed effects models. Clinical heterogeneity was treated with subgroup, sensitivity, or descriptive analyses only when clinical heterogeneity was not excluded. Publication bias was assessed using funnel plots. Twenty-five studies (1,545 observational patients and 1,562 controls) were included. The ERAS group had a shorter postoperative hospital stay [WMD=-2.59, 95% CI=(-3.04, -2.14), P<0.001], total hospital stay [WMD=-2.59, 95% CI=(-3.04, -2.14), P<0.001], and lower complication rate [RR=0.36, 95% CI=(0.29, 0.43), P<0.001] than the control group. The ERAS group had a shorter surgery time [WMD=-3.57, 95% CI=(-5.88, -1.26), P=0.003], postoperative indwelling nephrostomy tube time [WMD=-1.94, 95% CI=(-2.69, -1.19), P<0.001], catheter encumbrance time [WMD=-2.65, 95% CI=(-4.83, -0.46), P=0.02], and higher satisfaction [RR=1.15, 95% CI=(1.05, 1.25), P=0.001] than the control group. The difference in the stone-free rate between the two groups was not statistically significant [RR=1.03, 95% CI=(0.97, 1.09), P=0.38], but the stone-free rate of the observation group (ERAS group) in each study was higher than that of the control group. ERAS not only ensures the safety of PCNL but also promotes postoperative rehabilitation of patients (shorter surgery time, postoperative indwelling nephrostomy tube time, postoperative hospital time, and lower complication rate). At the same time, differences in the stone-free rate were not statistically significant, but the stone-free rate of ERAS in each study was higher than that of the usual care for PCNL patients.

NSQIP audit of enhanced recovery after surgery protocols for radical cystectomy.

11009 Background: Utilization of enhanced recovery after surgery (ERAS) protocols for radical cystectomy (RC) has been associated with improved postoperative recovery and shorter hospital stays. The multiple components within ERAS leads itself to heterogenous implementation across different institutions. We aimed to assess the impact of increasing compliance to ERAS components on postoperative outcomes in patients who underwent RC. Methods: The National Surgical Quality Improvement Program database included 3,708 patients who underwent RC from 2019 to 2021. ERAS components of interest included regional anesthesia block, no bowel prep, no prolonged NGT or NPO status, VTE prophylaxis with mechanical and pharmacologic means, and antibiotic duration &lt; 24 hours. Baseline characteristics and complications were stratified by number of ERAS components utilized (≤ 3, 4, or 5). Statistical endpoints included thirty-day complications, length of stay (LOS), and readmissions. Optimal RC outcome was defined as absence of any postoperative complication, reoperation, prolonged LOS (75th percentile, 8 days) with no readmission. Multivariable analyses with Bonferroni correction were performed to assess the association between ERAS compliance and outcomes. Results: Of the 3,708 patients who underwent RC with ERAS components utilized, 1,506 (41%) received ≤ 3 interventions, 1454 (39%) received 4, and 748 (20%) received 5. Baseline characteristics were relatively similar across the three groups. On multivariable analysis adjusted for multiple hypothesis testing, when compared to patients who received ≤ 3 interventions, patients who received 4 and 5 interventions had lower rates of any complication (OR 0.71; 99% CI [0.58 - 0.88], OR 0.74 [0.57 - 0.95], respectively), and shorter LOS (β -1.32 [-1.69, -0.95], β -1.74 [-2.19, -1.28], respectively). Moreover, patients with increased ERAS compliance experienced increased odds of an optimal outcome (OR 1.68 [1.38 – 2.05], OR 1.97 [1.55 – 2.51], respectively). Conclusions: Greater adherence to ERAS protocol interventions yielded superior post-operative outcomes for patients who underwent RC. This large-scale analysis supports that ERAS protocols are beneficial in a dose-dependent fashion and should be utilized. [Table: see text]

Endemic Bladder Stone Disease in Children, Pattern And Current Management: Experience From A Centre In Peri-Urban Setting In Pakistan.

To share our recent experience of the pattern and demography of endemic bladder calculi in children and the outcomes of current management strategies for the removal of bladder calculi in a peri-urban setting. This retrospective longitudinal study was carried out at a dedicated urology centre. All patients with endemic bladder stones from January 2020 to December 2021 managed at our centre were included in this study. After discharge, each patient was followed up for 1 year. Data analysis was carried out with IBM SPSS v23. Mean and standard deviation were calculated for normally distributed continuous variables; for non-normally distributed continuous variables, median and IQR were calculated; frequency and percentage were calculated for categorical variables. This study included 254 patients, with a male-to-female ratio of 10.5:1. The mean age of the patients was 4.80 ± 2.86 years. Ninety-one percent of the patients belonged to rural areas. Open cystolithotomy (OC) was performed in 11 (4.3%) patients, transurethral cystolithotripsy (TUCL) in 165 (65.0%), and percutaneous cystolithotomy (PCCL) in 78 (30.7%). The mean operative time was 48.8±4.34 minutes for TUCL, 36.18±7.4 minutes for open cystolithotomy, and 38.6±5.2 minutes for PCCL. The most common stone composition was ammonium urate + calcium phosphate (33.1%). The complication rate was 4.8% in TUCL, 12.8% in PCCL, and 27.3% in open cystolithotomy. Stone clearance was 98.1% for TUCL and 100% for both PCCL and OC. Pediatric bladder calculus is still endemic in rural areas of Sindh with poor socioeconomic backgrounds. Timely diagnosis and early intervention with preventive measures can lead to better outcomes and fewer complications. Minimally invasive methods of cystolithotomy have a shorter hospital stay, are more cost-effective, and have fewer complications as compared to open cystolithotomy.

Association of Serum Bicarbonate Level with Mortality in Patients with Acute Kidney Injury: A Retrospective Cohort Study

ABSTRACT Background: Metabolic acidosis due to a decreased level of serum bicarbonate in patients with chronic kidney disease is associated with increased mortality, but the association of serum bicarbonate with outcomes in patients with acute kidney injury (AKI) is uncertain. We investigated the association of serum bicarbonate level with mortality in patients with AKI. Methods: The study cohort consisted of 4800 patients diagnosed with AKI at multiple hospitals between September 17, 2013, and April 14, 2014. Smooth curve fitting, threshold effect analysis, and multiple regression analysis were used to assess the relationship between serum bicarbonate and 14-day mortality (primary outcome) and with intensive care unit (ICU) admission, length of hospitalization, and total hospital costs (secondary outcomes). Results: Multiple regression analysis, adjusting for confounding factors, demonstrated a U-shaped association between serum bicarbonate levels and AKI mortality. The lowest mortality rate was observed in patients with a bicarbonate level of 26.9 mmol/L, while greater rates were observed in those with lower and higher levels. Additionally, patients with AKI exhibiting high serum bicarbonate levels (&gt; 26.9 mmol/L) had a significantly lower rate of ICU admission and a shorter hospital stay compared to those with low serum bicarbonate levels (&lt; 26.9 mmol/L). Conclusion: A serum bicarbonate level of 26–29 mmol/L in patients with AKI is associated with a lower 14-day mortality rate, with the lowest rate observed at a serum bicarbonate level of 26.9 mmol/L. Prospective clinical studies are needed to determine whether optimizing the serum bicarbonate level can decrease mortality in this population.

Whole blood transcriptome in long-COVID patients reveals association with lung function and immune response

BackgroundMonths after infection with SARS-CoV-2, at least 10% of patients still experience complaints. Long-COVID is a heterogeneous disease and clustering efforts revealed multiple phenotypes on a clinical level. However, the molecular pathways underlying long-COVID phenotypes are still poorly understood. ObjectivesThis study aims to cluster patients according to their blood transcriptomes and uncover the pathways underlying their disease. MethodsBlood was collected from 77 patients with long-COVID from the P4O2 COVID-19 study. Unsupervised hierarchical clustering was performed on the whole blood transcriptome. These clusters were analysed for differences in clinical features, pulmonary function tests and gene ontology (GO) term enrichment. ResultsClustering revealed two distinct clusters on a transcriptome level. Compared to cluster 2 (n=65), patients in cluster 1 (n=12) showed a higher rate of pre-existing cardiovascular disease (58% vs 22%), higher prevalence of gastrointestinal symptoms (58% vs 29%), shorter hospital duration during SARS-CoV-2 infection (median: 3 vs 8 days), lower Tiffeneau index (72% vs 81%) and lower diffusion capacity of the lung for carbon monoxide (DLCO) (68% vs 85% predicted). GO-term enrichment analysis revealed upregulation of genes involved in the antiviral innate immune response in cluster 1, while genes involved with the adaptive immune response were upregulated in cluster 2. ConclusionThis study provides a start in uncovering the pathophysiological mechanisms underlying long-COVID. Further research is required to unravel why the immune response is different in these clusters, and to identify potential therapeutic targets to create an optimized treatment or monitoring strategy for the individual long-COVID patient.

Patient Preferences for Operative Versus Nonoperative Treatment of LC1 Pelvis Fracture: A Discrete Choice Experiment.

To quantify how patients with lateral compression type 1 (LC1) pelvis fracture value attributes of operative versus nonoperative treatment. Discrete choice experiment. Three US Level 1 trauma centers. Adult survivors of an LC1 pelvis treated between June 2016 and March 2023 were identified from institutional registries. The choice experiment was administered as a survey from March through August 2023. Participants chose between 12 hypothetical comparisons of treatment attributes including operative or nonoperative care, risk of death, severity of pain, risk of secondary surgery, shorter hospital stay, discharge destination, and independence in ambulation within 1 month of injury. The marginal utility of each treatment attribute, for example, the strength of participants' aggregate preference for an attribute as indicated by their survey choices, was estimated by multinomial logit modeling with and without stratification by treatment received. Four hundred forty-nine eligible patients were identified. The survey was distributed to 182 patients and collected from 72 patients (39%) at a median 2.3 years after injury. Respondents were 66% female with a median age of 59 years (IQR, 34-69 years). Before injury, 94% ambulated independently and 75% were working; 41% received operative treatment. Independence with ambulation provided the highest relative marginal utility (21%, P < 0.001), followed by discharge to home versus skilled nursing (20%, P < 0.001), moderate versus severe postdischarge pain (17%, P < 0.001), shorter hospital stay (16%, P < 0.001), secondary surgery (15%, P < 0.001), and mortality (10%, P = 0.02). Overall, no relative utility for operative versus nonoperative treatment was observed (2%, P = 0.54). However, respondents strongly preferred the treatment they received: operative patients valued operative treatment (utility, 0.37 vs. -0.37, P < 0.001); nonoperative patients valued nonoperative treatment (utility, 0.19 vs. -0.19, P < 0.001). LC1 pelvis fracture patients valued independence with ambulation, shorter hospital stay, and avoiding secondary surgery and mortality in the month after their injury. Patients preferred the treatment they received rather than operative versus nonoperative care.

Application of Human Acellular Dermal Matrix with Skin Graft for Lacunar Soft-Tissue Defect of Lateral Heel after Calcaneal Fracture.

To investigate the clinical effect of human acellular dermal matrix (HADM) combined with split-thickness skin graft in repairing lacunar soft tissue defects of the lateral heel after calcaneal fracture. From June 2018 to October 2020, providers repaired 11 cases of lacunar soft tissue defects at the lateral part of the heel using HADM combined with split-thickness skin graft. After thorough debridement, the HADM was trimmed and filled into the lacunar defect area. Once the wound was covered, a split-thickness skin graft and negative-pressure wound therapy were applied. Providers evaluated the appearance, scar, ductility of the skin graft site, appearance of the donor site, healing time, and any reoperation at follow-up. Of the 11 cases, 8 patients achieved successful wound healing by primary intention. Three patients showed partial necrosis in the edge of the skin graft, but the wound healed after standard wound care. Evaluation at 6 and 12 months after surgery showed that all patients had wound healing and mild local scarring; there was no obvious pigmentation or scar formation in the donor skin area. The average healing time was 37.5 days (range, 24-43 days). The HADM combined with split-thickness skin graft is a simple and effective reconstruction method for lacunar soft tissue defect of the lateral heel after calcaneal fracture. In this small sample, the combination demonstrated few infections, minor scar formation, few donor site complications, and relatively short hospital stays.

Right-sided acute diverticulitis in a North African country: Presentation and management in one surgical center.

Right-sided diverticulitis is a rare entity in North Africa. Therefore, it is usually misdiagnosed, and the management of cecal diverticulitis is aggressive in most cases, whereas nowadays, most studies recommend a conservative approach with promising results. This study aims to describe the presentation, management, and outcomes of right-sided diverticulitis (RSD) and to present the experience of one surgical center in Tunisia. This is a retrospective study including all patients presented with RSD, in the Department of Surgery "A" of the Charles Nicolle Hospital between 2007 and 2021. Forty patients were included in our study. The mean age was 42years with a standard deviation of 14. The sex ratio was 1.1. Only 2 patients had chronic constipation. All patients presented right-sided abdominal pain, and only 3 patients had diarrhea. Twenty one patients were diagnosed during surgery. Fourteen patients were treated successfully by conservative management. An operative procedure was performed in 26 cases: 21 had a diverticulectomy (80%), two had an ileal resection (8%), and three had a right colectomy (11.5%). No postoperative events occurred with a short hospital stay (5±3days). Follow-up showed no recurrences. Right-sided diverticulitis has a lower incidence and complication rate compared to left-sided diverticulitis. Conservative treatment has demonstrated favorable outcomes in managing RSD, although the available evidence remains limited.

Short-term Outcomes of Laparoscopic Versus Open Liver Resection in the Elderly: A Propensity Score-matched Analysis.

With the aging of the population, there is a rising proportion of elderly patients undergoing liver resection. However, the safety and efficacy of laparoscopic liver resection (LLR) in the elderly have not yet been established. In this study, we compared the short-term results of LLR and open liver resection (OLR) in elderly patients using propensity score matched (PSM) analysis. The study comprised 237 elderly patients aged 65 years and older who had undergone liver resection between 2015 to 2021, excluding biliary and vascular reconstruction and simultaneous surgeries other than liver resection. We conducted PSM analysis for baseline characteristics (age, sex, BMI, ASA-PS, disease, procedure, tumor size, and number of tumors) to eliminate potential selection bias. We then compared short-term postoperative outcomes between LLR and OLR groups in patients selected by PSM analysis. Applying PSM analysis, 90 cases each were selected for the LLR and OLR groups. The LLR group had a significantly lower complication rate (Clavien-Dindo: CD ≥II) (19% vs. 33%, p=0.03), especially bile leakage (CD ≥II) (0% vs. 6.7%, p=0.03) compared with those in the OLR group. In addition, a shorter operation time (244 min vs. 351 min, p<0.01), less blood loss (150 ml vs. 335 ml, p<0.01), and shorter hospital stay (8 days vs. 12 days, p<0.01) were observed in the LLR group. No operative or in-hospital deaths were observed in both groups. LLR can be safely performed in elderly patients and offers better short-term outcomes.