Single Tertiary Care Center Research Articles

The optimal cutoff for intertwin delivery interval: A retrospective cohort study.

To determine the cutoff of intertwin delivery intervals (IDIs) as a predictor for neonatal acidemia. This retrospective cohort study was conducted at a single tertiary care center. Women attempting vaginal delivery of twins between 2010 and 2019 and who reached the second stage of labor were included. The cutoff point for prolonged IDI was established using a receiver operating characteristic (ROC) curve and Youden's J statistic. Maternal and neonatal outcomes were compared between short and prolonged IDI cohorts. A total of 461 women were included in the study. A cutoff time of 10 min was found to be the best predictor for neonatal acidemia (arterial cord pH ≤ 7.1), with a sensitivity of 90% and a specificity of 59%. Second twins delivered more than 10 min after the first twin were more likely to be acidemic and to have a 5-min Apgar score of 7 or less (13.5% vs 3.3%, P = 0.01, and 8.4% vs 3.2%, P = 0.02, respectively). An IDI of more than 10 min was also associated with increased rate of cesarean delivery and placental abruption (13.5% vs 0.8%, P < 0.001, and 3.4% vs 0.8%, P = 0.047, respectively). No other adverse maternal or neonatal outcomes were statistically significant between cohorts. An IDI of more than 10 min is associated with a higher risk for neonatal academia, with a low 5-min Apgar score, and higher cesarean delivery and placental abruption rates. These findings provide insights that are valuable when counseling and managing twin pregnancies attempting vaginal delivery. Interventions aimed at shortening the IDI should be considered to prevent adverse neonatal outcomes.

Clinical Outcomes Following Transcatheter Mitral Valve-in-Valve Replacement Using a Meril Myval Transcatheter Heart Valve

Transcatheter mitral valve-in-valve (TMViV) replacement for degenerated surgically implanted bioprosthetic valves has been described by both transseptal and transapical approaches. The balloon-expandable Myval transcatheter valve (Meril Life Science, Vapi, India) is commonly used for transcatheter valve-in-valve procedures in India. This study aimed to report in-hospital, 30-day, and 1-year outcomes of Myval patients who underwent TMViV in a single tertiary care centre in India. Symptomatic patients with surgical bioprosthetic mitral valve failure with New York Heart Association (NYHA) class III-IV symptoms, despite optimal medical therapy and high or very high risk for redo surgery, were assigned to TMViV following heart team discussions. Data were retrospectively collected and outcomes assessed. Twenty patients were treated, with mean age 64.4 years, 60% were female, and mean Society of Thoracic Surgeons (STS) predicted risk of operative mortality score was 8.1. The failure mechanism was combined stenosis and regurgitation in 60% of patients. Technical success was achieved in 100% of patients. The mean postprocedure and 30-day gradients were 4.6±2.7 and 6.3±2.1, respectively. None of them had significant valvular or paravalvular leaks or left ventricular outflow tract obstruction. All-cause mortality at 1 year was 10%, and all survivors were in New York Heart Association (NYHA) class I or II. TMViV replacement with a Meril Myval can be safely performed with high technical success, and low 30-day and 1-year mortality.

Detection of Scedosporium spp.: Colonizer or pathogen? A retrospective analysis of clinical significance and management in a large tertiary center.

Infections with Scedosporium spp. are emerging in the past two decades and are associated with a high mortality rate. Microbiological detection can be associated with either colonization or infection. Evolution from colonization into infection is difficult to predict and clinical management upon microbiological detection is complex. Microbiological samples from 2015 to 2021 were retrospectively analyzed in a single tertiary care center. Classification into colonization or infection was performed upon first microbiological detection. Clinical evolution was observed until July 2023. Further diagnostic procedures after initial detection were analyzed. Among 38 patients with microbiological detection of Scedosporium spp., 10 were diagnosed with an infection at the initial detection and two progressed from colonization to infection during the observation time. The main sites of infection were lung (5/12; 41.6%) followed by ocular sites (4/12; 33.3%). Imaging, bronchoscopy or biopsies upon detection were performed in a minority of patients. Overall mortality rate was similar in both groups initially classified as colonization or infection [30.7% and 33.3%, respectively (P=1.0)]. In all patients where surgical debridement of site of infection was performed (5/12; 42%); no death was observed. Although death occurred more often in the group without eradication (3/4; 75%) compared with the group with successful eradication (1/8; 12.5%), statistical significance could not be reached (P=0.053). As therapeutic management directly impacts patients' outcome, a multidisciplinary approach upon microbiological detection of Scedosporium spp. should be encouraged. Data from larger cohorts are warranted in order to analyze contributing factors favoring the evolution from colonization into infection.

Socioeconomic Disadvantage Predicts Decreased Likelihood of Maintaining a Functional Knee Arthroplasty Following Treatment for Prosthetic Joint Infection

BackgroundProsthetic joint infection (PJI) carries major morbidity and mortality as well as a complicated and lengthy treatment course. In patients who have high degrees of socioeconomic disadvantage, this may be a particularly devastating complication. Our study sought to evaluate the impact of socioeconomic deprivation on outcomes following treatment for PJI of the knee. MethodsWe conducted a retrospective review of revision total knee arthroplasty (TKA) procedures performed for the treatment of initial PJI between 2008 and 2020 at a single tertiary care center in the United States. The Area Deprivation Index (ADI) was used to quantify socioeconomic deprivation. The primary outcome measure was presence of a functional knee joint at the time of most recent follow-up defined as TKA components or an articulating spacer. A total of 96 patients were included for analysis. The median follow-up duration was 26.5 months. ResultsThere was no significant difference in the rate of treatment failure (P = .63). However, the proportion of patients who had a functional knee arthroplasty (in contrast to having undergone arthrodesis, amputation, or retention of a static spacer) declined significantly with increasing ADI index (81.8% for the least disadvantaged group, 58.7% for the middle group, 42.9% for the most disadvantaged group, P = .021). ConclusionsPatients who have a higher socioeconomic disadvantage as measured by ADI are less likely to maintain a functional knee arthroplasty following treatment for TKA PJI. These findings support continued efforts to improve access to care and optimize treatment plans for patients who have socioeconomic disadvantage.

Characterization and Outcomes of Iatrogenic Urethral Catheterization Injuries.

Iatrogenic injury during urethral catheterization is a common reason for inpatient urologic consultation and is associated with increased morbidity and resource utilization. Literature defining the patient population, interventions, or outcomes associated with traumatic catheterization is scarce. We performed a retrospective review of consults for adult urethral catheterization at a single tertiary care center (July 2017-December 2019), with focus on patient characteristics and complications. Traumatic urethral catheterization was defined as catheterization by the primary team with at least 1 of these conditions: gross hematuria, meatal blood, or cystoscopic evidence of urethral trauma. Characteristics collected included urologic history, catheterization circumstances, procedural intervention, and subsequent visits. Three hundred urology consults for urethral catheterization were identified, including 98 (33%) traumatic events (5.3 incidents/1000 catheters placed). All traumatic catheterization consults were in men (median age 69 years). Most (71%) patients sustaining injury had significant urologic history (eg, benign prostatic hyperplasia, urethral stricture). Sixty-three (64%) consults were determined to be uncomplicated (not requiring any procedural intervention for catheter placement). Gross hematuria was the most common sequela (50% of patients). The 30-day catheter-associated urinary tract infection rate was 13%, and 2 patients developed sepsis. Complications required a total of 52 additional hospital admission days, 19 of which were intensive-care level, as well 113 outpatient urology visits. Traumatic urethral catheterization is associated with increased need for procedural intervention, risk of catheter-associated urinary tract infection, and additional resource utilization. Further studies on traumatic catheterization are needed to guide systemic efforts for minimizing injury and cost.

Impact of timing of delivery for type 2 diabetes on perinatal outcomes

AimsTo compare obstetric and neonatal outcomes in patients with type 2 diabetes mellitus (T2DM) who had scheduled delivery at full term (≥ 39 0/7 weeks) compared to early term (37 0/7 – 38 6/7 weeks) for T2DM indications. MethodsThis was a retrospective cohort study that included all singletons with T2DM with a scheduled delivery at a single tertiary care center between January 2008 and March 2022. Outcomes were compared using Fisher's exact test. Results107 singleton pregnancies were included. There was no significant difference in primary cesarean delivery between the two groups. The early term group had significantly higher rates of NICU admission compared to the term group (52% vs 32%, p = 0.05, OR 2.3, 95% CI 1.0–5.0), a finding that remained statistically significant on adjusted analysis (adjusted OR 2.81, 95% CI 1.04–7.58). ConclusionsIn singleton pregnancies undergoing scheduled delivery for T2DM-specific indications, early term deliveries were associated with significantly increased odds of NICU admission when compared to term deliveries, even after adjusting for surrogate markers of glycemic control. These findings suggest that early term delivery contributes to risk of NICU admission, rather than the indication for delivery itself. These findings should be replicated in a larger cohort.

Non-cirrhotic portal hypertension (NCPH): demographic, clinicopathological, short and long term outcome of shunt surgery – PSRS- a single center tertiary care hospital experience in Eastern India (Odisha)

Non-cirrhotic portal hypertension (NCPH): demographic, clinicopathological, short and long term outcome of shunt surgery – PSRS- a single center tertiary care hospital experience in Eastern India (Odisha)

An Approach to the Investigation of Thrombocytosis: Differentiating between Essential Thrombocythemia and Secondary Thrombocytosis.

Thrombocytosis is a common reason for referral to Hematology. Differentiating between secondary causes of thrombocytosis and essential thrombocythemia (ET) is often clinically challenging. A practical diagnostic approach to identify secondary thrombocytosis could reduce overinvestigation such as next generation sequencing (NGS) panel. All adult patients with thrombocytosis (≥450 × 109/L) who underwent molecular testing at a single tertiary care centre between January 1, 2018 and May 31, 2021 were evaluated. Clinical and laboratory variables were compared between patients with secondary thrombocytosis vs. ET. Clinical variables included smoking, thrombosis, splenectomy, active malignancy, chronic inflammatory disease, and iron deficiency anemia. Laboratory variables included complete blood count (CBC), ferritin, and myeloid mutations detected by NGS. The overall yield of molecular testing was 52.4%; 92.1% of which were mutations in JAK2, CALR, and/or MPL. Clinical factors predictive of ET included history of arterial thrombosis (p < 0.05); active malignancy, chronic inflammatory disease, splenectomy, and iron deficiency were associated with secondary thrombocytosis (p < 0.05). A diagnosis of ET was associated with higher hemoglobin, mean corpuscular volume (MCV), red cell distribution width (RDW), and mean platelet volume (MPV), while secondary thrombocytosis was associated with higher body mass index, white blood cells, and neutrophils (p < 0.01). A practical approach to investigating patients with persistent thrombocytosis based on clinical characteristics such as active malignancy, chronic inflammatory disease, splenectomy, and iron deficiency may assist in accurately identifying patients more likely to have secondary causes of thrombocytosis and reduce overinvestigation, particularly costly molecular testing.

Insight into the management of patients with melanoma in times of the COVID-19 pandemic: A single-center experience

Background/Aim. Despite all innovations in medicine, melanoma still has a rising incidence and high mortality and thus represents a significant challenge for the healthcare system. The pandemic of the coronavirus disease 2019 (COVID-19), spanning three years, redirected healthcare resources, suspended preventive programs, and strained the healthcare system, significantly impacting melanoma management. The aim of this study was to assess the influence of the COVID-19 pandemic on the treatment of melanoma patients. Methods. This retrospective study analyzed melanoma patients treated at a single tertiary care center over two distinct three-year periods: pre-COVID period (2017-2020) and the COVID-19 pandemic period (2020-2022). The following data were collected and compared: patient demographics, melanoma characteristics, time intervals from biopsy to surgery, and the share of thin and thick melanoma. Results. During the COVID-19 pandemic period, there was a 30% reduction in melanoma patients compared to the pre-COVID- 19 period. The decline was most pronounced in 2020 when the state of emergency was introduced in the country. Thin melanoma percentage as a measurement of successful screening programs decreased significantly during the COVID-19 pandemic (11.57% vs. 24.01%), while median Breslow thickness remained stable. The distribution of different histological types was consistent across both periods. The average time from biopsy to surgery remained similar between the two periods, around 40 days. Conclusion. Despite challenges posed by the COVID-19 pandemic, melanoma remains a critical healthcare issue. This study emphasized the significance of prioritizing melanoma care in emergencies, ensuring patient identification and timely treatment in order to optimize survival and minimize treatment costs.

A prospective study to assess the feasibility of single port laparoscopic needle assisted repair of pediatric inguinal hernias

Background: Congenital inguinal hernias are very common paediatric surgical conditions with incidence of 0.8 – 4.4% in children and up to 30% in preterm babies, which occur due to the failure of closure of the processus vaginalis. While the gold standard treatment remains to be open herniotomy, in the last two decades minimally invasive surgeries have revolutionized the hernia surgery and have evolved from 3 port to single port, intracorporeal knotting to extracorporeal knotting and 5 mm camera port to 3 mm camera port with multiple benefits. Methodology: This is a prospective study conducted at a single tertiary care centre over 1 year. All the patients admitted under the Department of Paediatric Surgery, with a clinical and/or radiological diagnosis of inguinal hernia and planned for single port laparoscopic needle assisted repair were included in the study. Data was collected in terms of intra operative finding, duration of procedure, complications, pain and post operative hospital stay. Results: A total of 40 patients were included in the study with a male predominance. Clinically majority were right inguinal hernia which was reducible. Intraoperatively, 7 cases of bilateral hernia were identified which were not detected pre operatively. 2 patients who underwent this procedure had complications and majority of the patients had mild pain. Conclusion: Single port laparoscopic herniotomy is at par with gold standard open herniotomy in the paediatric population. This procedure has better cosmesis, lesser post operative pain, hospital stay and most importantly it could identify occult hernias.

Hepatobiliary complications in children with sickle cell disease; retrospective single-center study

Objective: This study aimed to determine how common hepatobiliary complications were in children with sickle cell disease (SCD). Methods: This was a retrospective descriptive study conducted at a single tertiary health care center, King Saud Medical City (KSMC), Pediatric Hospital, Riyadh from April 2023 to April 2024. Patient recruitment was done by reviewing the medical records. All pediatric patient cases under 14 years, with SCD in both genders were included without specifying any race or ethnic characteristic. Results: A total of 143 patient cases with SCD were included from the hospital database. More than half of them were males. Hepatobiliary complications were observed in 19.5% of patients with SCD, cholelithiasis occurred in 26 (18.2%), cholangiopathy (bile duct stenosis) occurred in 3 (2.1%) and only one patient had acute hepatic sequestration (AHS). Biliary complication (cholelithiasis) was significantly associated with age and raised alanine aminotransferase (ALT) (p-value 0.042). Raised ALT was associated significantly with age, hemoglobin (Hb) level, and AHS. Total bilirubin &amp;gt; 2 mg/dl (&amp;gt; 34 micro mol/L) and direct bilirubin &amp;gt; 1 mg/dl (&amp;gt; 17 micro mol/L) were observed in 26.9% and 61.5% of patients who had cholelithiasis respectively, low Hb in 46.2% and low platelet in 30.8%. Conclusion: Hepatobiliary complications were observed in less than one-fifth of patients with SCD. The most common complication observed was cholelithiasis, rare complications were cholangiopathy and AHS.

Survival Rate and Short-term Outcomes of Extremely Preterm Infants: A Tertiary Care Center Experience from the Private Sector

Background: Premature birth is one of the leading causes of death in the world. The global incidence of prematurity ranges from 5% to 11% of all births. The aim of this study was to assess the outcome of extremely preterm infants born below 29 weeks in our institution, with regard to survival and major short-term outcomes, and compare our results with national and international centers. This study is the first to be conducted in a private tertiary care hospital in Saudi Arabia. Materials and Methods: This was a retrospective descriptive cohort study that reviewed the medical records of preterm infants admitted to the neonatal intensive care unit at the International Medical Center, Jeddah, Kingdom of Saudi Arabia, between January 2014 and January 2020. We compared our results to the national data from King Faisal Specialist Hospital and Research Center-Riyadh, King Abdulaziz Medical City (KAMC)-Jeddah and KAMC Riyadh, King Abdulaziz Medical City-Alhasa, the National Institute of Child Health and Human Development Neonatal Research Network, and the Canadian Neonatal Network. Results: A total of 92 preterm infants were included: 3, 8, 17, 17, 29, and 18 infants with a gestational age of 23 weeks, 24 weeks, 25 weeks, 26 weeks, 27 weeks, and 28 weeks, respectively. The mean gestational age was 25 weeks and 5 days. Fifty-four infants (58.7%) survived to hospital discharge. In terms of short-term outcomes, 13% had bronchopulmonary dysplasia, hemodynamically significant ductus arteriosus was present in 27%, and retinopathy of prematurity was found in 13%, necrotizing enterocolitis was diagnosed in 5.4%, while late-onset sepsis was reported in 23.9% of infants. Conclusion: Our study represents outcomes of Extremely Preterm Infants in a single Private tertiary Care Center from Saudi Arabia with a comparison to national and international data. Though it cannot be generalized our data can be used as an add-value cohort toward establishing countrywide neonatal network to better plan regional resource allocation and utilization and facilitate ongoing audit, benchmarking, and overall quality improvement initiatives.

Human Leukocyte Antigen-B51 Association and Behcet’s Disease in Saudi Arabia

Introduction: Behcet’s disease (BD) is a chronic systemic inflammatory vasculitis of unknown etiology, characterized by recurrent oral ulcers, genital ulcers, skin lesions, ocular lesions, and other systemic manifestations. The pathogenesis of BD is unclear. Multiple studies have suggested close correlation between BD and human leukocyte antigen-B51 (HLA-B51) as a genetic factor. In our study, we aim to identify the association of HLA-B51 as a risk factor and its association with the multiple clinical signs and symptoms of Saudi BD patients in the kingdom of Saudi Arabia. Materials and Methods: A retrospective study was conducted at a tertiary treatment center in the rheumatology subspecialty clinics, Riyadh, Saudi Arabia, from 2013 to 2018. The study was conducted by searching the hospital database for BD and HLA-B51. Results: HLA-B51 positivity was observed in 20 of the 38 patients in our sample, accounting for about a quarter of the total (52.6%). Conclusion: Our retrospective study found that HLA-B51 was positive in 52.6% of Saudi patients attending a single tertiary care center. However, a larger multicenter study is required to validate these observational data.

Activated Partial Thromboplastin Time (aPTT) as a Screening Test for Predicting Bleeding Manifestations in Adult Patients with Dengue Infection – A Diagnostic Accuracy Study

Abstract Background: Thrombocytopenia has been well established in dengue infections; however, coagulopathy is yet to be explored. Objective: The primary outcome was to assess derangement of activated partial thromboplastin time (aPTT) as a predictor of bleeding manifestations and severity of disease in dengue. Methods: This prospective cohort study included adults with dengue fever confirmed by serology, presenting to a single tertiary care center in South India. A structured questionnaire was used to extract clinical features and laboratory parameters at presentation, including aPTT. The patients were clinically observed during their course of illness for the outcomes of major and minor bleeding manifestations along with features of severe dengue. Results: Between May 2020 and September 2021, 140 patients were screened and 122 were recruited. Among these, 72 patients had normal aPTT and 50 had deranged aPTT. There were 41 bleeding events noted and 35 patients had severe dengue. There was a statistically significant correlation for aPTT derangement with major bleeding events (relative risk [RR] =4.03 [95% confidence interval (CI): 1.6–10.5]; P = 0.002), with minor bleeding events (RR = 2.52 [95% CI: 1.1–5.6]; P = 0.017) and with severity of dengue (RR = 3.14 [95% CI: 1.7–5.8); P &lt; 0.001]. aPTT had a good negative predictive value of 93.1% (95% CI: 84.5–97.7) for major bleeding. There was no statistically significant correlation between thrombocytopenia and bleeding manifestations. Conclusion: aPTT can be used as an indicator for predicting bleeding events and severity in dengue fever, with a good negative predictive value.

Clinical and histological characteristics of breast lumps: A 20-year single private sector tertiary care center experience

Background and objective: The presence of a breast lump is an alarming experience. This is because of the growing awareness of breast cancer among the public. Therefore, a comprehensive diagnosis of breast lumps is vital. This study aims to identify the clinical and histological characteristics of breast lumps of patients presenting to a tertiary care center in Colombo, Sri Lanka. Methods: This 20 year, retrospective study analyzed the clinical and histological characteristics of all patients with breast lumps who were admitted only to Nawaloka Hospital, Colombo from 2003 to 2023. Data were retrieved through past medical records and a computer-based health information system from Nawaloka Hospital. A general surgeon analyzed all the records. The records were analyzed with relation to demographics, presenting symptoms, presence of a lump or mass, and histological diagnosis. This study was aimed to determine the characteristics of breast lumps in a selected sample of patients who were admitted with breast lumps to a single private sector tertiary care hospital. Ethical clearance was granted. No conflict of interest. Results: Total of 352 patients had breast lumps [female-342 (97.1%): male-10(2.9%)]. Data from 342 female and 10 male patients who were admitted with breast lumps or masses were analyzed. There were 252 /352 self-referrals, 60 / 352 referrals were from general practitioners and 40 / 352 were referred following screening. Most females were 21 to 50 years (n=219, 64%). Ninety-seven per cent of the female patients had palpable breast lumps. Most males with breast lumps were in the age group of 51-60 years. Males had relatively larger lumps (&gt; 2cm, 80%) at the time of their presentation. In both genders, the most common quadrant for occurrence of breast lumps was the upper outer quadrant (F: 55% &amp; M: 60%). Fibroadenoma was the commonest variety of lump in both sexes (F: 49% &amp; M: 60%). However, most males who presented with breast lumps were found to have breast cancer (M: 40% vs. F: 10%). Histologically, invasive carcinoma of no specific type (NST) was the most common type (M: 75% &amp; F: 63%). Thirty-five female patients had carcinoma, ten were below the age of 50 years, and two were in their early 30s. Conclusion: Our study sample showed that most of the patients were females. The most common benign breast lump was fibroadenoma and the malignant variant was invasive carcinoma of no specific type (NST). Furthermore, it showed that at the time of presentations males had larger breast lumps with and raised percentage of malignant breast lumps.

PLERIXAFOR FOR HEALTHY PERIPHERAL BLOOD HEMATOPOIETIC STEM CELL DONORS IN PEDIATRIC ALLOGENEIC HSCT.

Data on use of plerixafor for peripheral blood stem cell(PBSC) mobilization in children with cancer undergoing autologous hematopoietic stem cell transplantation(HSCT) is there in literature. The use of plerixafor for normal healthy allogeneic donors is not reported much, especially in the pediatric setting. In this retrospective analysis from a single tertiary care centre in India, we report the efficacy and safety of the use of plerixafor in five healthy allogeneic PB-HSC donors and compare the outcomes with five others allogeneic HSCT’s in which plerixafor was not used. Ten allogeneic HSCT were included in the analysis, 5 in which the donor received plerixafor and in the other five the donor did not get it. In all the HSCT, PB HSC were the product.&#x0D; No significant difference in terms of recipients age and weight; donors age and weight and the CD- 34 count in PB before plerixafor were there between the two groups. However, the CD-34 HSC count in the harvested product was significantly higher in the group that received plerixafor (p=0.032). The stem cell dose transfused to the patient was also higher when the donor got plerixafor, although the difference was not significant. None of the donors suffered any side effects and underwent the subsequent apheresis uneventfully.&#x0D; The use of plerixafor in healthy stem cell donors (both pediatric and adult) for allogeneic stem cell transplant allowed a better yield of stem cells. In our experience the use of plerixafor was safe for the donors.

Multiple sclerosis-associated uveitis - A series from South India.

To report clinical profiles of multiple sclerosis (MS)-associated uveitis in seven cases from a single tertiary eye care center in South India. Retrospective case series 2013-2023. Seven cases of MS-associated uveitis were retrieved from our databases. There were five females and two males. The diagnosis of MS was made by the neurologist in all cases. Bilaterality was seen in all cases. Intermediate uveitis was the most common presentation (five cases). It was associated with peripheral retinal vasculitis (two cases) and disc pallor (two cases). Fuchs heterochromic iridocyclitis (one case) and incomplete Vogt-Koyanagi-Harada (VKH)-like presentation with a peripapillary choroidal neovascular membrane (one case) were the other presentations. In the case with incomplete VKH-like presentation, whole genome sequencing revealed a heterozygous non-synonymous variation (c.1228C>T) in exon 10 of TNFRSF1A, suggestive of susceptibility to multiple sclerosis 5 due to mutation in the TNFRS1A gene on chromosome 12p13.31. All cases received systemic steroids. Azathioprine (three cases) and rituximab (three cases) were the commonly used immunomodulatory drugs. The visual outcome was good in all cases at the last follow-up. MS-associated uveitis is underreported in India. This series highlights the clinical profile of MS-associated uveitis in India.

Exploring the Role of Artificial Intelligence Chatbots in Preoperative Counseling for Head and Neck Cancer Surgery.

To evaluate the potential use of artificial intelligence (AI) chatbots, such as ChatGPT, in preoperative counseling for patients undergoing head and neck cancer surgery. Cross-Sectional Survey Study. Single institution tertiary care center. ChatGPT was used to generate presurgical educational information including indications, risks, and recovery time for five common head and neck surgeries. Chatbot-generated information was compared with information gathered from a simple browser search (first publicly available website excluding scholarly articles). The accuracy of the information, readability, thoroughness, and number of errors were compared by five experienced head and neck surgeons in a blinded fashion. Each surgeon then chose a preference between the two information sources for each surgery. With the exception of total word count, ChatGPT-generated pre-surgical information has similar readability, content of knowledge, accuracy, thoroughness, and numbers of medical errors when compared to publicly available websites. Additionally, ChatGPT was preferred 48% of the time by experienced head and neck surgeons. Head and neck surgeons rated ChatGPT-generated and readily available online educational materials similarly. Further refinement in AI technology may soon open more avenues for patient counseling. Future investigations into the medical safety of AI counseling and exploring patients' perspectives would be of strong interest. N/A. Laryngoscope, 134:2757-2761, 2024.

Total laryngectomy and readmission: causes, rates and predictors

BackgroundTotal laryngectomy (TL) is a complex procedure, and patients undergoing TL are at high risk for readmission, which exposes them to hospital-acquired complications. Readmission rate is a metric for quality of care. We aimed to identify the rate, causes, and predictors of hospital readmission within 60 days after discharge following TL.MethodsThis is a 12-year retrospective study where we included all patients undergoing TL in a single tertiary care center between 2008 and 2022. Patient charts were reviewed for demographics, comorbidities, and causes for readmission.ResultsOf 83 patients who underwent TL, 12 (14.50%) were readmitted within 60 days. Common causes were surgical site infection (33.33%) and mucocutaneous fistula (25%). Significant predictors for readmission were tobacco use (P = 0.003), African ethnicity (P = 0.004), being unmarried (P < 0.001), lower preoperative serum albumin (P < 0.001), higher preoperative TSH (P = 0.03), higher preoperative neutrophil count (P = 0.035), higher American Society of Anesthesiology (ASA) score (P = 0.028), and higher Cumulative Illness Rating Scale (CIRS) score (P = 0.029).ConclusionOne in every seven patients were readmitted following TL. Frequent causes include wound infection and fistulas. Predictors include preoperative hypoalbuminemia, hypothyroidism, African ethnicity, being unmarried, tobacco use, and a higher baseline burden of comorbidities. Such factors can be targeted to reduce hospital readmission rates.

Case series of branch retinal vein occlusion secondary to rhegmatogenous retinal detachment and its surgical management

BackgroundTo review cases of branch retinal vein occlusion (BRVO) secondary to rhegmatogenous retinal detachment (RRD) and its surgical management and presume their mechanism.MethodsMedical records of patients who underwent surgery for RRD between 2015 and 2019 at a single tertiary care center were retrospectively reviewed. New BRVO secondary to RRD or its surgical procedure was diagnosed based on the fundus examination and its clinical course.ResultsA total of 734 RRD surgeries were performed for five years, and six cases of new BRVOs were noticed in the first year after surgery (incidence was 0.68%: six cases of BRVO / 734 cases of surgical RRD); five cases occurred after vitrectomy, and one occurred after scleral buckling. In three cases, retinal veins were presumed to already be partially occluded related due to a kink of the retinal vein seen before surgery. In the other three cases, the retinal veins were presumed to have incurred damage during vitrectomy.ConclusionIn the present cohort, RRD or its related procedures caused BRVO within a year of surgery at an incidence of 0.68%. The proposed mechanisms are kinks of the retinal vein on the detached retina and damage to the retinal vein during vitrectomy.