Single-center Investigation Research Articles

Exploring the Relationship Between Daratumumab Treatment and Stem Cell Collection in Newly Diagnosed Multiple Myeloma (NDMM) Patients Undergoing Transplantation: Insights From a Single-Center Investigation

Exploring the Relationship Between Daratumumab Treatment and Stem Cell Collection in Newly Diagnosed Multiple Myeloma (NDMM) Patients Undergoing Transplantation: Insights From a Single-Center Investigation

B-355 Assessment of Calcitonin Cutoff Values for Post-Thyroidectomy Surveillance in Patients with Medullary Thyroid Carcinoma: Findings from a Single-Center Investigation

Abstract Background Patients with sporadic or hereditary Medullary Thyroid Carcinoma (MTC) often undergo total thyroidectomy and lymph node dissection, with postoperative surveillance relying on serum calcitonin levels and ultrasound examinations. According to American Thyroid Association (ATA) guidelines, detectable levels of serum calcitonin and Carcinoembryonic Antigen (CEA) post-thyroidectomy suggest potential disease persistence or recurrence, necessitating frequent monitoring for early detection. This study sought to reassess the role of postoperative calcitonin levels in identifying possible tumor recurrence. Methods A retrospective analysis was conducted using Siemens Atellica to test calcitonin levels in 562 samples collected between 09/27/2022 and 08/11/2023, at least 3 months post-total thyroidectomy. Imaging studies performed within 6 months of the calcitonin assessment were also reviewed. Sample pools with calcitonin concentrations near 3.00 and 5.00 pg/mL were utilized to determine the limit of quantification (LoQ). CEA results were included for comparison. Additionally, 16 serum samples were analyzed using the Roche Cobas system at a reference laboratory. Results Precision analysis around 3.00 and 5.00 pg/mL revealed coefficients of variation (CVs) of 16.49% and 8.87%, respectively. Comparison of calcitonin levels between Siemens Atellica and Roche Cobas systems demonstrated consistent levels < 5.00 pg/mL in 15 out of 16 samples, indicating alignment and reliability between the platforms. A calcitonin cutoff of 1.89 pg/mL yielded 43% sensitivity and 67% specificity, while a cutoff of 5.00 pg/mL resulted in 0% sensitivity and 100% specificity. Conclusions Our findings suggest that a 5 pg/mL calcitonin cutoff on the Siemens Atellica platform may be suitable for identifying tumor persistence or recurrence in post-thyroidectomy patients within our institution. However, individual laboratories should establish their LoQ criteria when interpreting calcitonin levels for postoperative monitoring of tumor recurrence.

Survival Outcomes in Patients With Muscle-Invasive Bladder Cancer Receiving Neoadjuvant Chemotherapy Stratified by Number of Cycles

IntroductionThe ≥3 cycles of neoadjuvant cisplatin-based chemotherapy (NAC) are commonly administered to treat MIBC. However, some patients are unable to complete all planned cycles of NAC. Prognosis of patients receiving <3 cycles of NAC has yet to be elucidated. MethodsThis retrospective single-center study quantifies pathologic complete response (pT0N0), recurrence-free survival (RFS), and 5-year overall survival (OS) in patients treated with <3 cycles of NAC compared to ≥3 cycles. Patients with MIBC between 2004 and 2018 receiving at least 1 cycle of cisplatin-based NAC were included. Exclusion criteria were metastasis before initiation of NAC, progression/death during NAC. Patient characteristics were compared using chi-square tests, Fisher's exact tests, and Wilcoxon rank sum tests. Kaplan Meier curves, log-rank tests, and Cox proportional hazards models compared RFS adjusting for patient age, ECOG status, GFR, stage, node positivity, and NAC regimen. 5-year OS was analyzed via logistic regression with the aforementioned patient characteristics in the cohort of patients with 5 years of follow-up, unless deceased prior. ResultsIn a cohort of 256 patients, the median RFS was 11.6 months (95% CI 7.79, 28.5) versus 79.5 months (95% CI 62.13, NA) in those receiving ≥3 cycles of NAC. Of 228 patients with documented pathologic stage, complete pathologic response (pT0) was observed in 9.4% of patients receiving <3 cycles, and 27.0% of patients receiving ≥3 cycles of NAC (P = .008). In 195 patients with a minimum of 5 years of follow-up, patients with <3 cycles the 5-year OS was 13.3% with <3 cycles compared to 53.3% with ≥3 cycles of NAC. ConclusionsIn this retrospective, single-center investigation, early cessation of planned NAC was associated with worse pCR rate, RFS, and OS. While further prospective evaluation is required to confirm causality, clinicians should prioritize administering at least 3 cycles of NAC when feasible to optimize outcomes.

WP3.16 - Comparing Outcomes in Acute Upper Gastrointestinal Bleeding: Initial Presentation versus In-hospital Incidence - A Single-Centre Investigation

Abstract Aims Acute upper gastrointestinal bleeding (AUGIB) is a gastrointestinal emergency with varied patient outcomes. We aimed to compare the outcomes of patients whose primary admission presentation was AUGIB versus inpatients who subsequently developed AUGIB as a complication. Methods This was a retrospective study of all adult patients receiving endoscopy for AUGIB in a single surgical unit from September 2021 to September 2022. Patient demographics, laboratory results, medical history and clinical progress, 30 and 90-day mortality were compared. Results 145 patients were identified, 75 (51.7%) were male and median age was 65 years (IQR 53-75). 117 presented to hospital with AUGIB (group 1) and 28 developed AUGIB as an inpatient (group 2). Median length-of-stay was 3.3 vs 10 days, respectively (p=0.014). Group 2 were more likely to present with symptomatic anaemia (p=0.001), higher National Early Warning System scores (p&amp;lt;0.001), shock (p&amp;lt;0.001), higher Glasgow-Blatchford score (p&amp;lt;0.001) and require blood transfusions (p&amp;lt;0.001). Group 2 had higher ASA Scores (p&amp;lt;0.001) and higher 30-day and 90-day all-cause mortality. No statistical correlations were noted regarding the distribution of endoscopic diagnoses obtained between both groups.Group 1(n=117)Group 2(n=28)P-Value30-Day all-cause Mortality4 (3.4%)4 (14.3%)0.02490-Day all-cause Mortality9 (7.7%)8 (28.6)0.002 Conclusion Our results echo previous studies that patients who develop AUGIB whilst an inpatient have significantly poorer outcomes. Causation is likely multifactorial and warrants further study. It remains important to closely apply the AUGIB care bundle and early critical care input to optimize outcome.

Troponin-I as a Prognostic Marker in Patients with Coronavirus Disease 2019: Insights from a Single-center Investigation

Background: Troponin-I is conventionally correlated with myocardial injury, but its relevance in assessing the severity of coronavirus disease 2019 (COVID-19) and its implications for patient management remains an area of ongoing investigation. This study was designed to assess the correlation between troponin-I levels and the disease severity among patients with COVID-19. Materials and Methods: This retrospective study was conducted at a tertiary care center in India between April 2020 and November 2021. The patients with reverse transcription-polymerase chain reaction who tested positive for COVID-19 infection, and who underwent troponin-I examination at presentation were included in the study. A comparison of baseline clinical characteristics among patients who survived and who did not survive post-COVID-19 was done, and risk factors associated with mortality among hospitalized patients were analyzed. Results: A total of 1673 patients were enrolled in this study. Of these, 1431 patients survived, and 242 patients did not survive post-COVID-19. The mean age of the patients with troponin-I levels ≤0.06 ng/ml was 49.66 ± 17.88 years and that of patients with troponin-I levels &gt;0.06 ng/ml was 60.13 ± 20.04 years. The nonsurvival rate was high in patients aged &gt;50 years compared to the patients aged ≤50 years (81.4% vs. 18.6%; P &lt; 0.001). The mortality rate was high in patients with troponin-I levels &gt;0.06 ng/ml compared to the patients with troponin-I levels ≤0.06 ng/ml (51.7% vs. 48.3%; P &lt; 0.001). Breathlessness (odds ratio [OR]: 26.901; P &lt; 0.001), cut-off troponin-I levels (OR: 8.246; P &lt; 0.001), and other comorbidities (OR: 8.246; P &lt; 0.001) were independently correlated with mortality among hospitalized patients with COVID-19. Conclusion: This study demonstrated that elevated troponin-I level at presentation was associated with disease severity and increased mortality in patients with COVID-19.

#1803 Is class II lupus nephritis as benign as one thinks?

Abstract Background and Aims The classification of Lupus Nephritis (LN) plays a pivotal role in determining prognosis and guiding treatment, aligning with ISN/RPS recommendations. KDIGO and EULAR advocate for immunosuppression in cases of proliferative LN (Class III/IV) and Class V with nephrotic syndrome, while “non-proliferative” instances (Class I and II) are advised conservative care. In a contrasting approach, GLOSEN recommends immunosuppression for Class II if persistent proteinuria exceeds 1g. ISN/RPS suggests incorporating activity and chronicity indexes to further refine the classification of LN. Concerns surrounding immunosuppression in LN Class II arise from its favorable long-term kidney survival and potential drug toxicity. However, the need for caution is underscored by a 30–50% class transformation rate. Limited research comparing the long-term prognosis of treated and untreated patients exists due to the gradual progression of the disease. The use of Activity (NIH-A) and Chronicity (NIH-C) indexes, particularly in the context of protocol biopsies, offers an opportunity to reassess the perceived benign nature of LN Class II. Method In this single-center investigation, patients diagnosed with LN belonging to Class II or II+V from 1999 to 2021 were examined. Biopsies were classified according to ISN/RPS criteria and evaluated using the NIH-A and NIH-C Indexes. Patients previously diagnosed with Class III/IV LN and those experiencing class transformation to a proliferative class were excluded. We present the findings in a descriptive manner. Results Sixteen patients, with a median age of 38.5 (12 female), were included. Histological findings from the initial biopsies revealed a NIH-A of 0, with NIH-C exceeding 0 in 31% (5/16) cases. Six patients exhibited Class II plus V, with varying NIH-C scores. The primary contributors to NIH-C in the initial biopsies were tubular atrophy and interstitial fibrosis. Ten patients underwent a second biopsy after an average time lapse of 39 months (7-101). The decision for most second biopsies was based on clinical judgment rather than a standardized protocol. One patient initially diagnosed with Class II+V displayed Class II on the second biopsy, and vice versa. In 70% of patients the NIH-C increased, primarily driven by glomerulosclerosis. The rise in NIH-C scores was observed in 3/6 patients with Class II+V and in all 4 patients with isolated Class II. Most patients received mycophenolate, and 3 were treated with low-dose prednisolone. The clinical and histologic characteristics of the 10 patients who underwent a second biopsy are outlined in Tables 1 and 2. Conclusion Our limited, biased study raises questions rather than providing definitive evidence. The consistent NIH-C rise challenges Class II LN perceived benign nature. It is plausible that not all LN Class II cases are equivalent and histological variances, such as mesangial proliferation, or its focal or diffuse distribution impact outcomes. Histological variations and treatment impact on LN Class II warrant further investigation.

Retrospective analysis of the incidence of appendiceal neoplasm and malignancy in patients treated for suspected acute appendicitis

BackgroundNonoperative management of uncomplicated appendicitis is currently being promoted as treatment option, albeit 0.7–2.5% of appendectomies performed due to suspected acute appendicitis show histologically malignant findings. The purpose of this study was to investigate the incidence of neoplasm and malignancy of the appendix in patients presenting with suspected acute appendicitis in real world setting.MethodsThis is a retrospective single-centre investigation of 457 patients undergoing appendectomy between the years 2017–2020. The patients’ demographics, symptoms and diagnosis, intraoperative findings, and histopathological results were analysed.ResultsIn 3.7% (n = 17) histological analysis revealed neoplasms or malignancies. Median age was 48 years (20–90 years), without sex predominance. Leukocytes (11.3 ± 3.7 G/l) and C-reactive protein (54.2 ± 69.0 mg/l) were elevated. Histological analysis revealed low-grade mucinous appendiceal neoplasia (n = 3), sessile serrated adenoma of the appendix (n = 3), neuroendocrine tumours (n = 7), appendiceal adenocarcinoma of intestinal type (n = 3), and goblet cell carcinoma (n = 1). Additional treatment varied between no treatment or follow-up due to early tumour stage (n = 4), follow-up care (n = 3), additional surgical treatment (n = 8), or best supportive care (n = 2).ConclusionsPreoperative diagnosis of appendiceal tumours is difficult. Nonoperative management of patients with acute, uncomplicated appendicitis potentially prevents the correct diagnosis of malignant appendiceal pathologies. Therefore, close follow-up or surgical removal of the appendix is mandatory.

Use of paralytic agents during the operative treatment of type III supracondylar humerus fractures in children: A single-center investigation and survey of Pediatric Orthopaedic Society of North America members

BackgroundParalytic agents are occasionally used during the surgical treatment of type III (OTA 13A2) supracondylar humerus fractures (SCHFx) in children depending on surgeon preference. Paralytic agents create a neuromuscular blockade and therefore may potentially help with ease of fracture reduction. Controversy regarding the use of a paralytic agent as an adjunct to anesthesia exists due to potential associated adverse drug reactions, including prolonged paralysis, cardiovascular effects, or electrolyte abnormalities.The purpose of this study was to investigate intraoperative paralytic use in pediatric type III SCHFx and to report survey responses of members of the Pediatric Orthopaedic Society of North America (POSNA) on paralytic use in SCHFx management. MethodsA retrospective chart review identified 319 type III SCHFx treated at our institution (January 2016-May 2019). Patients were assigned to three groups: Group 1, surgical treatment without a paralytic agent (n=240); Group 2, treatment with rocuronium (n=43); Group 3, treatment with succinylcholine (n=36). POSNA members were surveyed regarding paralytic use intraoperatively for type III SCHFx (November–December 2021) on paralytic use frequency, request for paralytics, reversal agent use, average time to surgery after injury and/or presentation, effect of time to surgery after injury and/or presentation on when to use a paralytic, annual number of SCHFx surgeries performed, awareness of paralytic complications, and years of surgeon experience. Statistical analysis was performed. ResultsAverage patient age was 5.2±2.2 years. Group 2 had significant increases in anesthesia duration, surgical duration, fluoroscopic time, and radiation exposure compared to Group 1. Group 2 had a higher conversion rate to open reduction than other groups. No statistically significant difference was found among groups in terms of sex, body mass index (BMI), laterality, radiographic measurements, or rates of open procedures or complications. Survey results indicated 32% (24/76) routinely use paralytics during closed reduction maneuvers; 71% (17/24) request administering paralytics at the beginning/before the case; and 33% (8/24) use paralytics in all type III SCHFx. ConclusionsSurgeons at our center reported paralytic use for closed reduction in 25% of patients; similarly, one-third of POSNA survey respondents reported paralytic use during operative management. Although paralytic agents are used during the treatment of supracondylar humerus fractures in children this study was unable to demonstrate an association of advantageous outcomes, such as shorter surgical times. Routine paralytic use to facilitate closed reduction of supracondylar humerus fractures in children warrants further study. Level of EvidenceLevel III, Retrospective chart review; Therapeutic study

Significance of Cytomegalovirus gB Genotypes in Adult Patients Undergoing Hematopoietic Stem Cell Transplantation: Insights from a Single-Centre Investigation.

Cytomegalovirus (CMV) infection is a major clinical issue after allogeneic hematopoietic stem cell transplantation (HSCT). The CMV envelope glycoproteins are key in viral pathogenesis; the glycoprotein B (gB) encoded by the UL55 gene might be an important determinant of viral virulence and disease severity marker in patients treated with allogeneic HSCT. Our aim was to investigate the molecular diversity of CMV gB and inquire into the associations between UL55 gene variations and clinical manifestations in adult patients treated with allogeneic HSCT. The most prevalent genotypes were gB1 and gB4 (11/27, 40.7%). Patients with genotype gB1 infection had earlier platelet engraftment (p < 0.033) and less frequent minimal/measurable residual disease post HSCT than those without this genotype. Patients with gB4 glycoprotein infection had a significantly lower CD4+/CD8+ ratio at D90 (p < 0.026). Interestingly, patients with gB5 glycoprotein infection had shorter overall survival from base condition diagnosis (p < 0.042), as well as shorter overall survival after HSCT (p < 0.036). Acute GvHD was noted more frequently in those with mixed-genotype infection (p = 0.047). The study included fifty-nine adult patients treated with allogeneic HSCT. Peripheral venous blood was sampled typically per week, with detection of CMV performed by quantitative real-time PCR. Multiplex nested PCR was used to determine specific gB genotypes, which were then statistically compared vis-à-vis specific clinical variables. Our study points to variations in the viral UL55 locus imparting both beneficial (earlier platelet engraftment, less frequent MRD post HSCT) and adverse effects (shorter overall survival, more frequent acute GvHD, less frequent 100% chimerism at day 90) to the transplanted host. Comprehensive molecular investigations are necessary to validate this apparent duality, as the potential benefits of CMV could perhaps be utilized for the benefit of the patient in the future.

GDF-15: a novel biomarker of heart failure predicts short-term and long-term heart-failure rehospitalization and short-term mortality in patients with acute heart failure syndrome

BackgroundAcute heart failure (AHF) is a potentially life-threatening clinical syndrome, usually requiring hospital admission. Growth Differentiation Factor-15 (GDF-15) is a distant member of the transforming growth factor-β. The increased expression of GDF-15 has been observed during heart failure (HF) and is associated with worse outcomes. However, the relationship between GDF-15 and AHF is not well understood with limited evidence among Thai patients.PurposeInvestigate the correlation between biomarker levels (measured upon admission and discharge) and short- and long-term adverse outcomes, encompassing all-cause mortality and heart-failure (HF) rehospitalization (at 30, 90, and 180 days, as well as throughout the entire follow-up duration) in individuals experiencing acute HF.MethodsThis is a prospective single-center investigation involving patients admitted for AHF. Biomarkers, including GDF-15, high-sensitivity troponin T (hsTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP), were assessed upon admission and discharge. Outcomes, including all-cause mortality and HF rehospitalization, were examined. Logarithmic transformations were applied to the biomarker variables for subsequent analysis. Univariate and multivariate analyses of cause-specific hazards were conducted using the Cox proportional hazards regression model, while subdistribution hazards were assessed using the Fine-Gray regression model to evaluate outcomes.ResultsA total of 84 patients were enrolled (mean age of 69 years, 52% females). The GDF-15 level significantly decreased during admission (median at the time of admission 6,346 pg/mL, median at the time of discharge 5,711 pg/mL; p < 0.01). All-cause mortality at 30 days and 180 days were 6.0% and 16.7%, respectively. HF rehospitalization at 30 days and 180 days were 15.5% and 28.6%, respectively. Univariate analysis showed that total orthoedema congestion score (p = 0.02) and admission GDF-15 level (p = 0.01) were associated with 30-day all-cause mortality, whereas hsTnT or NT-proBNP levels did not show significant associations. However, higher levels of NT-proBNP upon admission were associated with all-cause mortality when considering the entire follow-up period (p < 0.01). Both univariate and multivariate analyses demonstrated that lower discharge GDF-15 levels and a greater reduction in GDF-15 levels from admission to discharge were associated with a lower risk of 30-day rehospitalization. Similarly, univariate analysis revealed that a greater reduction in NT-proBNP levels from admission to discharge was associated with lower 30-day rehospitalization rates. At 180 days, a greater reduction in GDF-15 levels remained associated with lower hazards and incidence of rehospitalization.ConclusionThe significant decrease in Growth Differentiation Factor-15 (GDF-15) levels during hospitalization suggests its potential as a dynamic marker reflecting the course of AHF. Importantly, higher GDF-15 levels at admission were associated with an increased risk of 30-day all-cause mortality, highlighting its prognostic value in this patient population. Moreover, lower discharge GDF-15 levels, reductions in GDF-15 from admission to discharge, and decreases in NT-proBNP from admission to discharge were associated with a reduced risk of 30-day rehospitalization.

Combined MRI-TRUS fusion targeted and systematic biopsy versus systematic biopsy alone for the detection of prostate cancer: protocol for a prospective single-centre trial

IntroductionThe classic way of diagnosing prostate cancer (PCa) is by conducting the 12-core systematic biopsy (SB). However, it has a low detection rate for clinically significant PCa (csPCa) and can...

Assessing Post-Transplant Outcomes in Hematopoietic Stem Cell Recipients from Rural, Appalachian, and Medically Underserved Regions: Insights from a Single-Center Investigation

Assessing Post-Transplant Outcomes in Hematopoietic Stem Cell Recipients from Rural, Appalachian, and Medically Underserved Regions: Insights from a Single-Center Investigation

Exploring the Role of Serum Cystatin C in Early Detection of Acute Kidney Injury among On-Pump Cardiac Surgery Patients: A Single-Center Investigation in Bangladesh

Exploring the Role of Serum Cystatin C in Early Detection of Acute Kidney Injury among On-Pump Cardiac Surgery Patients: A Single-Center Investigation in Bangladesh

Streptococcus pneumoniae associated hemolytic uremic syndrome in children.

Previous small-scale, single-center investigations of Streptococcus pneumoniae associated hemolytic uremic syndrome (SpHUS) have shown increased disease severity among SpHUS relative to non-SpHUS patients. Our study compares the impact of S. pneumoniae on patient outcomes between SpHUS cases and non-SpHUS controls using the national, multicenter retrospective Pediatric Health Information Systems (PHIS) Database. Children <18 years of age with a diagnosis of HUS were included. Univariate analyses and multivariable linear and logistic regressions were utilized to assess the impact of S. pneumoniae on mortality, length of stay (LOS), intensive care unit admission (ICU), and mechanical ventilation use. Models were adjusted for demographic and clinical characteristics, including cardiac, neurologic, pulmonary, gastrointestinal, immunologic and renal clinical complications. Of 3,952 index HUS hospitalizations, 231 (5.8%) were due to SpHUS. SpHUS patients had worse outcomes, including longer hospital stays, increased rate of ICU admission, and increased use of mechanical ventilation (p < 0.001 for all). There was a strong positive relationship between clinical complications and adverse outcomes. After adjusting for covariates, SpHUS was associated with an increase in hospital LOS by 3.47 days (p = 0.009) and overall ICU-LOS by 4.21 days (p < 0.001). SpHUS was also associated with increased likelihood of mechanical ventilation (OR: 3.08; p < 0.001), with no increase in ICU admission (p = 0.070) and in-hospital mortality (p = 0.3874). Our study highlights that SpHUS patients are at increased risk of multiple adverse outcomes likely due to the summative impact of pneumococcal infection and HUS as well as more frequent clinical complications.

Frequency of Diagnostic Variants of Kidney Disease in Diabetic Kidney Disease Patients: A Single-Center Investigation

Frequency of Diagnostic Variants of Kidney Disease in Diabetic Kidney Disease Patients: A Single-Center Investigation

Accurate and non-invasive localization of multi-focal ground-glass opacities via electromagnetic navigation bronchoscopy assisting video-assisted thoracoscopic surgery: a single-center study.

Accurate localization of multi-focal ground-glass opacities (GGOs) is crucial for successful video-assisted thoracoscopic surgery (VATS). Electromagnetic navigation bronchoscopy (ENB) provides a minimally invasive and dependable approach for precise localization. This study assessed the accuracy and safety of ENB-guided localization in cases involving multi-focal GGOs. This retrospective study presents a single-center investigation into ENB-guided localization, utilizing methylene blue, for multi-focal GGOs assisting VATS. Clinical, surgical, and pathological data were collected from patients who underwent ENB-guided localization between 23 December 2019 and 31 August 2022. The study examined 57 patients with multi-focal GGOs who underwent ENB-guided localization and VATS. A total of 150 GGOs were treated, with ENB-guided localization taking a median time of 65min. Following localization, all patients proceeded to VATS, with a median duration of 170min. The median lesion size measured 7.8mm, with a 5-mm distance between GGO and pleura or fissure. When the distance between GGO and pleura/fissure exceeded 1cm, an additional location point was introduced below the pleura or fissure based on GGO location. No complications related to localization were observed. The overall malignancy rate stood at 66%. Location precision was confirmed by measuring the marker-to-GGO lesion distance, resulting in a 94% (141/150) accuracy rate for GGO localization. ENB-guided methylene blue injection is a safe and precise method to treat multi-focal GGOs, potentially minimizing operation time and simplifying lesion detection.

Comparsion of Outcomes of Single Versus Multiple Mini-Tract Percutaneous Nephrolithotomy for Staghorn Renal Stone Clearance

Background: Staghorn calculi are branched stones that contain extra than Failure to cast off staghorn calculus might also additionally ruin the parenchyma and kidney feature and motive life-threatening sepsis. Therefore, whole elimination and clearance rates are more often than not taken into consideration while managing staghorn stones. The aim of this study was to investigate the efficacy and safety of multi-tract percutaneous nephrolithotomy (PNL) against the benchmark of the single tract approach. Material and Methods: A randomized clinical trial was conducted at institute of kidney disease Peshawar “between 1stMarch 2022 to 31st Oct 2022” after fulfilling the inclusion criteria. A total 100 patients were included in this study using consecutive non portability sampling technique. Patients who received single- or multiple-tract mPCNL depended on the stone complexity of their computed tomography (CT) images before the operation. In addition, 50 patients who underwent the single mini-tract (&lt;21-Fr sheath) percutaneous method (Group A) compared with 50 patients who required multiple (≥2) mini tracts (Group 2) Results: A total 100 patients with staghorn calculi (Male 33(57.8%) , Female 21(48.8%) and Male 23 (40.3%) , Female 22 (51.1% ) were treated with two types of tracts for mini PCNL, i.e single- and multiple-tract mini PCNL, respectively. The mean stone size was in single tract was 12.67±8.06 and multiple tracts was 17.23±10.49; a significant difference in stone size in Groups A and B, respectively; (P = 0.005). In addition, the Stone Hounsfield unit means score in single tract was 919.73 and multiple tracts were 1070.11. S. T. O. N. E. score in Group 2 was significantly higher (8.4±1.7 10.6±1.3 = 0.001). Practical Implication: In this study a multi-tract PCNL has been shown to be an effective and secure expansion of a single-tract PCNL for big stone burden and complex kidney stone disease. The benefit of this study was to investigate the efficacy and safety of multi-tract percutaneous nephrolithotomy (PNL) against the benchmark of the single tract approach. Conclusion: A multi-tract PCNL has been shown to be an effective and secure expansion of a single-tract PCNL for big stone burden and complex kidney stone disease in this randomised clinical trial single-center investigation. Future prospective studies should concentrate on how well the technique can help individuals with severe stone disease require fewer interventions before becoming stone-free. Keywords: Multiple-Tract, Percutaneous Nephrolithotomy, Staghorn Calculi, Kidney Stone Disease,

Prostatic artery embolization using reflux-control microcatheter: prospective experience addressing feasibility

PurposeTo evaluate the efficacy and safety of Prostatic Artery Embolization (PAE) using a reflux control microcatheter.Materials and methodsThis is a prospective, single-center investigation that included 10 patients undergoing PAE for treatment of lower urinary tract symptoms (LUTS) attributed to benign prostate hyperplasia (BPH). Baseline, 3-month, and 12-month efficacy endpoints were obtained for all patients and included prostate-specific antigen (PSA), uroflowmetry, pelvic magnetic resonance imaging (MRI), and clinical assessment using the International Prostate Symptom Score (IPSS) questionnaire and the IPSS-Quality of life (QoL) item. Complications were assessed using the Cirse classification system.ResultsTen patients entered statistical analysis and presented with significant LUTS improvement 12 months after PAE, as follows: mean IPSS reduction of 86.6% (2.8 vs. 20.7, − 17.9, P < 0.001), mean QoL reduction of 79.4% (1.1 vs. 5.4, − 4.3, P < 0.001), mean prostatic volume reduction of 38.4% (69.3 cm3 vs. 112.5 cm3, − 43.2 cm3, P < 0.001), mean peak urinary flow (Qmax) increase of 199.4% (19.9 mL/s vs. 6.6 mL/s, + 13.3 mL/s, P = 0.006) and mean PSA reduction of 50.1% (3.0 ng/mL vs. 6.1 ng/mL, − 3.0 ng/mL, P < 0.001). One patient (10%) needed transurethral resection of the prostate (TURP) after PAE due to a ball-valve effect. One microcatheter (10%) needed to be replaced during PAE due to occlusion. Non-target embolization was not observed in the cohort.ConclusionThis initial experience suggests that PAE using a reflux control microcatheter is effective and safe for the treatment of LUTS attributed to BPH.

Clinical results from spine operations and expert interviews a multi center study

Objective: This study aims to assess the short-term clinical results of spine procedures performed in a QHAMC, Nowshera, Pakistan. Methods: This study was conducted in orthopedic unit and neurosurgery unit of a QHAMC, Nowshera in Pakistan where this single-center investigation was carried out. The phrase "short-term clinical outcome" was used in this research to refer to the results of spine procedures within one week of the surgery. These results were broken down into three categories: Recovery, complications, and deaths. This particular research looked at a total of 208 different instances. In these patients, procedures such as Fenestration and discectomies, laminectomy, anterior cervical discectomies, and transpedicular fixations were performed. Results: Recovery was shown in terms of the muscle power restored in the limbs according to MRC scale criteria at the time of discharging each patient.

Single-center investigation on central-line-associated bloodstream infections and blood-culture contamination during the early months of the coronavirus disease 2019 (COVID-19) pandemic.

In this retrospective cohort study, we assessed central-line-associated bloodstream infections (CLABSIs) and blood-culture contamination frequency during the first pandemic wave. Coronavirus disease 2019 (COVID-19) was significantly associated with CLABSI and blood-culture contamination. In the COVID-19 cohort, malignancy was associated with CLABSI. Black race, end-stage renal disease, and obesity were associated with blood-culture contamination.