Surgery Clinic Research Articles

Effect of the COVID-19 Pandemic on the Management of Breast Cancer Patients

Background: The COVID-19 pandemic has significantly affected breast cancer patients by causing delays in diagnosis and treatment processes. This study aims to investigate the effects of the pandemic on the treatment process and short-term outcomes of breast cancer patients. Methods: This retrospective, cross-sectional, single-center study included 414 patients who underwent surgery for breast cancer at the Inonu University General Surgery Clinic between March 2018 and June 2021. The patients were divided into two groups: pre-pandemic (Pre-COVID-19; n = 240) and pandemic (COVID-19 Era; n = 174) periods. The groups were compared in terms of demographic, clinical, and histopathological variables. Results: During the pandemic period, the use of neoadjuvant therapy (from 21.3% to 34.5%) and preoperative PET-CT imaging (from 80.4% to 90.8%) rates increased, while breast-conserving surgery (from 27.9% to 19.0%) and the presence of comorbid diseases (from 45.0% to 29.9%) decreased significantly. While there was no significant difference between the groups in terms of the time from diagnosis to surgery (25 vs. 28.5 days, p = 0.121), the time to report the pathology result after surgery decreased during the pandemic period (28 vs. 23 days, p < 0.001). There was no significant difference between the groups in terms of immunohistochemical (ER, PR, Ki-67, E-cadherin, and c-erbB2), histopathological (lymphovascular invasion, perineural invasion, comedo necrosis, modified Bloom–Richardson grade, and TNM classification), and clinical (recurrence, metastasis, and axillary lymph node metastasis) features of the tumor. The mortality rate in the Pre-COVID-19 group (7.1%) was significantly higher than in the COVID-19 Era group (2.3%) (p = 0.049). Finally, in terms of the survival analysis, a statistically significant difference was found between the Pre-COVID-19 and COVID-19 Era groups in terms of the mean follow-up duration of the patients (p = 0.044). Conclusions: The study results show that the use of neoadjuvant therapy and radical surgery preference increased in breast cancer treatment during the pandemic period, but there was no significant change in tumor biology and histopathological features. Breast-conserving surgery rates, comorbidity rates, and pathology reporting times were significantly shortened. Long-term follow-up periods of 3 and 5 years are needed to see the impact of the pandemic on breast cancer patients.

A Cetylpyridinium Chloride Oral Rinse Reduces Salivary Viral Load in Randomized Controlled Trials.

Evaluating the antiviral potential of commercially available mouthrinses on SARS-CoV-2 holds potential for reducing transmission, particularly as novel variants emerge. Because SARS-CoV-2 is transmitted primarily through salivary and respiratory secretions and aerosols, strategies to reduce salivary viral burden in an antigen-agnostic manner are attractive for mitigating spread in dental, otolaryngology, and orofacial surgery clinics where patients may need to unmask. Patients (n = 128) with confirmed COVID-19-positive status within 10 days of symptom onset or positive test result were enrolled in a double-blind randomized controlled trial of Food and Drug Administration-approved mouthrinses containing active ingredients ethanol, hydrogen peroxide, povidone iodine, chlorhexidine gluconate, cetylpyridinium chloride (CPC), or saline. The CPC, ethanol, and sterile water rinses were followed in a second double-blind randomized controlled trial (n = 230). Participants provided a saliva sample before rinsing (baseline) and again at 30 and 60 min after rinse. Quantitative polymerase chain reaction was used to determine salivary SARS-CoV-2 viral load at all time points. An adjusted linear mixed-effect model was employed to compare viral load after rinsing relative to baseline. The rinse containing CPC significantly reduced salivary SARS-CoV-2 viral load 30 min postrinse relative to baseline (P = .015), whereas no other rinse significantly affected viral load at 30 min after rinsing. At 60 min postrinsing, no group had a significant reduction in SARS-CoV-2 copy number relative to baseline, indicating a rebound in salivary viral load over a 1-hour window. Participants indicated a fair to good rinsing experience with the CPC product and high willingness to use oral rinses before and during dental and medical health care visits. Our findings suggest that preprocedural oral rinsing could be implemented as a feasible, inexpensive approach to mitigate spread of SARS-CoV-2 and potentially other enveloped viruses for short periods, which is relevant to clinical procedures involving the nasal and oropharyngeal region. Rinsing with a cetylpyridinium chloride-containing mouthrinse can significantly reduce salivary SARS-CoV-2 viral load for up to 30 min; patients are willing to use mouthrinses in medical and dental settings to limit transmission risk in clinics.

Standardized List Evaluating Apnea (SLEAP): A Comprehensive Survey to Define the Quality of Life in OSA.

To develop and validate a patient-reported outcome measure (PROM) to evaluate the quality of life (QoL) among patients with obstructive sleep apnea (OSA). A prospective cohort study. Tertiary referral center. We developed a 15-item English questionnaire that was administered to 176 adults with OSA and 22 adult controls without symptoms of OSA in a tertiary sleep surgery clinic between June 2021 and December 2021. The internal consistency and test-retest reliability were measured using the Cronbach's α and the intraclass correlation coefficient, respectively. The 2-sample Wilcoxon rank-sum (Mann-Whitney) test was applied to compare the 2 groups. Convergent validity of the test scores of the questionnaire was compared to previously validated outcome measures and objective sleep study outcomes using the Spearman correlation coefficient. Of the 198 respondents (176 cases and 22 controls); 71% were men and 29% were women. The internal consistency was excellent with the α of .92 (lower 95% confidence limit of 0.90). All the test-retest correlations were positive, significant, and strong ranging from 0.50 to 0.90. The differences between cases and controls were statistically significant for all the items and for the total score. The total score of the questionnaire with the Epworth Sleepiness Scale and objective OSA measures was moderate to strong. The new tool provides a validated PROM to evaluate the QoL among OSA patients specifically, with excellent internal consistency, reasonable test-retest reliability, discriminant validity, and construct validity. Level 4.

Reliability of a portable toe pressure photoplethysmography device compared to a stationary laser doppler flowmeter.

The study aimed to investigate the reliability of a portable toe pressure (TP) photoplethysmography device (PPG) by comparing it to a stationary laser Doppler flowmeter (LD) used in the Helsinki University Hospital. The study evaluated if lower limb arterial circulation could be reliably evaluated with the portable PPG which is more affordable and mobile than the stationary LD. TPs were measured from 102 toes of 54 patients in the vascular surgery outpatient clinic, vascular surgery ward and interventional radiology recovery ward of Helsinki University Hospital. According to the study protocol TPs were measured twice with the PPG device. If the difference between the values was over 10 mmHg, a third measurement was done and two of the closest values were selected for the final analysis. The lowest value displayed by the PPG device was 30 mmHg. Lower than 30 mmHg values were reported as 25 mmHg in the analysis. The repeatability and reliability of the PPG measurements were compared to the LD with Bland Altman plots. Most patients had rest pain (n = 29) or claudication (n = 9). Prior to TP measurement, 24 patients had undergone lower limb revascularization through either a hybrid (n = 3), open (n = 10) or endovascular (n = 11) procedure. The mean absolute difference between PPG and LD measurement values was 15 mmHg (95% confidence interval 12-18 mmHg). 87.5% of lower limbs with significant arterial insufficiency (TP <60 mmHg with LD, n = 49) had a PPG measurement value of <60 mmHg. Conversely, 84.8% of lower limbs that did not exceed the ischemia criterion of TP ≥60 mmHg with LD had a PPG measurement value of ≥60 mmHg. Mean absolute difference of two consecutive PPG measurement values was 4 mmHg (95% CI 3-5 mmHg). The PPG device is a light and affordable option for the assessment of lower limb arterial circulation in primary health care. It is moderately reliable to exclude significant lower limb arterial insufficiency and may reduce unnecessary referrals to the vascular surgery clinic. The repeatability of the PPG device is satisfactory. However, it requires training to use, and the results must always be interpreted with consideration for the patient's clinical status.

Quality of Life, Perceived Stigma, and Challenges Faced by the Parents of Girls with Congenital Adrenal Hyperplasia.

To assess the quality of life (QoL), perceived stigma, and extent of anxiety and/or depression among parents of female children with congenital adrenal hyperplasia (CAH). Observational cross-sectional study. Place and Duration of the Study: Department of Paediatric Surgery and Endocrinology Clinics of National Institute of Child Health (NICH), Karachi, Pakistan, from June to December 2022. Parents of the female children diagnosed with CAH were enrolled. A validated parent self-report questionnaire, parent- focused items of the experiences and reactions questionnaire used for assessing disorders of sex development (DSD)-related experienced or anticipated stigma and the patient health questionnaire-4 (PHQ-4) were used to gather the information. The scores were calculated for each item and compared among mothers and fathers. Independent samples student t-test was used to find any significant differences between the mean scores. A value of p <0.05 was considered statistically significant. Out of the 98 parents, there were 74 (75.5%) mothers and 24 (24.5%) fathers. The score recorded in all three tools showed multiple challenges that had a negative impact on parents. In QoL assessment for experiences and reactions, scores between mothers and fathers were similar. In the PHQ-4 tool, the scores were significantly related to the female gender of the parents as anxiety and depression were more reported in mothers (p = 0.046). In parents of children >7 years of age, the differences in scores were statistically significant for the domains such as talking to others, and stigma. The parental QoL was affected resulting in limited social interactions with the feeling of being stigmatised. Many reported significant anxiety and/or depression. Parental anxiety, Congenital adrenal hyperplasia, Disorders of sex development, Gender assignment, Gender.

Comparison of early and late term results of onlay and sublay mesh approaches in open incisional hernia surgery

Aims: Despite the increase in minimally invasive techniques, open techniques continue to be frequently used in incisional hernia repairs. In open incisional hernia surgeries, onlay and sublay techniques are the most frequently preferred depending on the area where the mesh is placed. In this study, we aimed to compare these two techniques by analyzing perioperative findings. Methods: Data from elective open incisional hernia surgeries (onlay and sublay) performed by the same surgical team in the general surgery clinic between 01.01.2023 and 31.12.2023 were retrospectively reviewed. Emergency surgeries, laparoscopic or combined surgeries, patients who did not undergo mesh repair, patients who received preoperative botulinum toxin due to “loss of domain”, patients with missing data, and patients who did not continue their follow-up were excluded from the study. Results: The data of a total of 74 patients who met the inclusion criteria were analyzed in the study. Onlay procedure was performed in 53 (71%) patients and sublay procedure was performed in 21 (19%) patients with a retromuscular approach. No intraoperative complications were detected in any of the patients. There were statistically significant differences between the groups in terms of female gender (p: 0.007), duration of surgery (p&lt;0.001) and duration of hospital stay (p&lt;0.001). There were no statistically significant differences between the groups in terms of complications (p:0.42), unexpected re-admission (p:0.779) and six-month recurrence (p: 0.779). Conclusion: Onlay or sublay techniques can be safely applied in open incisional hernia surgery because they have acceptable complication and recurrence rates. Surgical experience and patient factors are the main determinants of which technique to apply.

Immediate Reconstruction With Autologous Temporoparietal Fascia After Enucleation of Infected or Extruded Alloplastic Nasal Implants.

Simultaneous reconstruction after removal of nasal silicone implants was published as diced, autologous rib and ear auricular cartilages, and each had their shortcomings. Temporoparietal fascial grafts were used for facial and nasal contouring, vascularized tissue coverage, and augmentation the nose, lip. The temporoparietal fascia graft may be considered for in-time replacement of allografts and remaining bulkiness. From 2006 until 2008, the temporoparietal fascial graft was used in 20 referred patients with nasal allografts in a medical center. The female-to-male ratio is 17:3. The mean age is around 32.6 years old. All the patients refused disfigurement after the removal of the implants for at least 3 months. All the patients were followed up for 5 years. All patients recovered within 1 to 2 weeks. The nasal skin envelop was preserved or healed. There was neither graft exposure, nor recurred infection. The procedure is a useful method of eliminating inflammatory squeals. The temporoparietal fascial graft used, was able to bridge the 3-month gap without the implant. The smooth nasal dorsum skin was regained with adequate nasal projection. All patients were followed up in plastic surgery clinics without recurrence. There are no reports in the English literature of the use of temporoparietal fascial grafts to treat nasal implant infection. The temporoparietal fascial graft is a simple and reliable method to provide thin, broad, pliable, easy neovascularized, adequate coverage, contour, and bulk on the cartilage dorsum of the nose, an inconspicuous donor site, consistency, and minimal resorption.

Acceptance of Cosmetic Surgery: Client Perspectives

Background: In the past decade, there has been an increase in the number of cosmetic procedures performed globally. About one-third of individuals who undergo cosmetic procedures are under the age of 35 years. Several factors can influence acceptance of cosmetic surgery including media, religion, and individual factors among others. Objective: The objective of this current study is to investigate the motivations behind individuals choosing to undergo cosmetic surgery. Material and methods: This study was a cross-sectional single-center, conducted to assess the attitudes and acceptance of cosmetic surgery among attendees at Cosmetic and beauty centres in the city of Mosul, Iraq between September -November of 2022. All patients at the plastic surgery clinics were given a questionnaire that they were instructed to fill out in their own time. The likelihood of having cosmetic surgery scale, the Rosenberg self-esteem scale, the life happiness scale, and the physical attractiveness scale were used to measure the correlation between these variables and other factors. With a p-value of less than 0.05, the results might be considered reliable. Pearson's correlation coefficient was used for the investigation of correlations (r). Results: The mean age was 31.47 years, the standard deviation was 2.8, the range of ages was 15-52 years, and the median age was 29.89 years. There was an insignificant weak positive connection between participants' self-esteem and their acceptance of cosmetic surgery (r=0.052) Conclusion: Lower levels of self-esteem and life satisfaction, greater exposure to cosmetic surgery in the media (especially television), increased time spent in front of the TV, and religious affiliation were all found to be significant predictors of future use of cosmetic surgery in the current study.

Serum Levels of Semaphorin 4C in Breast Cancer – Assessment of Prognostic Value and Potential for Monitoring Surgical Treatment Response

Abstract Introduction. The global burden of breast cancer (BC) has encouraged ceaseless research in exploring novel biomarkers, aiming to optimize BC management and prognosis. Objective. To explore the prognostic value of serum SEMA4C and investigate its potential for monitoring the response to surgical treatment in patients with BC. Materials and methods. Seventy-five (75) pre-treatment patients from the Clinic of Surgery with invasive BC without any initial treatment prior to blood sample collection were included in the study. The enzyme-linked immunosorbent assay (ELISA) method was used to measure serum levels of SEMA4C in human serum. Participants were divided based on pathological stage, nodal involvement and histological grade. Follow-up blood samples of 35 patients who underwent surgery were collected to investigate if SEMA4C could measure the response to surgical treatment. Results. Postoperative serum levels of SEMA4C were significantly lower than preoperative levels (p p &lt; 0.001). Regarding prognostic value, no statistically significant difference was observed in terms of the pathological stage (p = 0.181), lymph node (LN) status (p = 0.752), and histological grade (p = 0.412). Conclusion. According to our study, serum SEMA4C levels did not differ significantly in terms of pathological stage, LN status and histological grade. Notably, postoperative serum levels of SEMA4C were significantly decreased after surgical treatment compared to preoperative values, which underscores the potential of SEMA4C as a putative candidate biomarker for monitoring response to therapy in patients with BC. However, additional research is mandatory to validate the role of SEMA4C in BC.

Factors that impact the implementation of patient reported outcomes in routine clinical care for peripheral artery disease from the patient perspective.

Patient reported outcome measures (PROMs) are well-suited for the longitudinal assessment of quality of life, including depression and physical limitations associated with peripheral artery disease (PAD) that are not routinely assessed in clinical care. This study was designed to gain the patient perspective to facilitate implementation of PROMs into clinical practice for PAD management. Twenty-three patients with PAD at a single vascular surgery clinic were enrolled for a qualitative interview, July-December 2022. Patients completed PROMIS Physical Function and Depression assessments before undergoing semi-structured interviews. Two researchers used an inductive thematic analysis to analyze emergent themes from transcribed interviews. The average age of participants was 69.5 ± 8.2years; 91% were Caucasian, and 39% were female. Qualitative interviews revealed three implementation-related themes: (1) patient preferences on the timing and type of PROMs collected, (2) PROMs applications in outpatient PAD care, including discussions with their physician, and (3) the clinical value of PROMs. Overall, patients with PAD prefer PROMs related to quality of life and physical function over other domains. Patients appreciate the convenience to complete PROMs before their appointment. Patients would like to verbally discuss meaningful score changes with their providers without the use of graphical aids. Most patients believe PROMs are valuable in their clinical care if their physician reviews the results and the PROM questions apply to their disease symptoms. Patient preferences inform future successful implementations and will improve patient completion rates for the collection and clinical use of PROMs in PAD clinical care.

Does Discussing Patient-reported Outcome Measures Increase Pain Self-efficacy at an Orthopaedic Visit? A Prospective, Sequential, Comparative Series.

Pain self-efficacy, or the ability to carry out desired activities in the presence of pain, can affect a patient's ability to function before and after orthopaedic surgery. Previous studies suggest that shared decision-making practices such as discussing patient-reported outcome measures (PROMs) can activate patients and improve their pain self-efficacy. However, the ability of PROMs to influence pain self-efficacy in patients who have undergone orthopaedic surgery has yet to be investigated. (1) Is immediately discussing the results of a PROM associated with an increase pain self-efficacy in new patients presenting to the orthopaedic surgery clinic? (2) Is there a correlation between patient resilience or patient involvement in decision-making in changes in pain self-efficacy? This was a prospective, sequential, comparative series completed between February to October 2023 at a single large tertiary referral center at a multispecialty orthopaedic clinic. Orthopaedic subspecialties included total joint arthroplasty, spine, hand, sports, and trauma. The first 64 patients underwent standard care, and the following 64 had a conversation with their orthopaedic surgeon about their PROMs during the initial intake visit. We collected scores from the Pain Self-Efficacy Questionnaire (PSEQ), Brief Resilience Scale (BRS), and Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function form (PF-SF10a) and data on demographic characteristics before the visit. The PSEQ is a validated PROM used to measure pain self-efficacy, while the BRS measures the ability of patients to recover from stress, and the PROMIS PF-SF10a is used to assess overall physical function. PROMs have been utilized frequently for their ability to report the real-time physical and psychological well-being of patients. In the standard care group, the PROMIS PF-SF10a score was not discussed with the patient. In the PROMs group, the physician discussed the PROMIS PF-SF10a score using a script that gave context to the patient's score. Additional conversation about the patient's score was permitted but not required for all patients. Scores from the Observing Patient Involvement in Decision Making (OPTION-5) instrument were recorded during the visit as a measure of patient involvement in clinical decision-making. After the visit, both groups completed the PSEQ. The primary outcome was change in the PSEQ. Change in pain self-efficacy was recorded as greater or less than the minimum clinically important difference, previously defined at 8.5 points for the PSEQ [10]. The secondary outcomes were correlation between PSEQ change and the BRS or OPTION-5. Between the PROMs and standard care groups, there was no difference in the change in PSEQ scores from before the visit to after (mean ± SD change in control 4 ± 10 versus change in PROMs group 3 ± 7, mean difference 1 [95% confidence interval (CI) -2.0 to 4.0]; p = 0.29). Fifty-six percent (36 of 64) of patients in the standard care group demonstrated an increase in pain self-efficacy (of whom 22% [14 of 64] had clinically important improvements), and 59% (38 of 64) of patients in the PROMs group demonstrated an increase in pain self-efficacy (of whom 19% [12 of 64] had clinically important improvements). In the control group, there was no correlation between the change in PSEQ score and resiliency (BRS score r = -0.13 [95% CI -0.36 to 0.12]; p = 0.30) or patient involvement in decision-making (OPTION-5 r = 0.003 [95% CI -0.24 to 0.25]; p = 0.98). Similarly, in the PROMs group, there was no correlation between the change in PSEQ score and resiliency (BRS score r = -0.10 [95% CI -0.33 to 0.16]; p = 0.45) or patient involvement in decision-making (OPTION-5 r = -0.02 [95% CI -0.26 to 0.23]; p = 0.88). Discussing PROMs results (PROMIS PF-SF10a) at the point of care did not increase pain self-efficacy during one visit. Therefore, surgeons do not need to discuss pain self-efficacy PROM scores in order to influence patient pain self-efficacy. While PROMs remain valuable tools for assessing patient outcomes, further work may assess whether the collection of PROMs itself may increase pain self-efficacy or whether longitudinal discussion of PROMs with patients changes pain self-efficacy. Level II, therapeutic study.

Cognitive Impairment is common and unrecognized in vascular surgery patients

ObjectivesPatients’ capacities to understand and act upon healthcare information is crucial to decision-making and high-quality care. Cognitive impairment (CI) has been associated with adverse outcomes across a range of diseases and surgeries. Despite the importance of CI, there is little to no information on its prevalence and severity in vascular surgery patients in the United States. We therefore conducted a prospective observational study to better characterize the prevalence and severity of CI in a contemporary vascular surgery practice. MethodsWe enrolled 111 outpatients attending a vascular surgery clinic using pragmatic consecutive sampling. Patients were excluded if they had a previous diagnosis of blindness, deafness, or dementia. Subjects completed a demographic survey and the Montreal Cognitive Assessment (MoCA), which was administered by a trained proctor. Chart review was used to assess comorbidities. The MoCA is a validated tool consisting of tasks such as clock drawing for assessing CI. It has a lower educational bias and higher sensitivity for detecting mild impairment compared to other exams. The MoCA is scored from 0-30 based on an objective grading system. Scores between 0-9, 10-17, 18-25, and 26-30 indicate severe, moderate, mild, and no CI respectively. Statistical analysis, including multivariable modeling was performed using SAS. ResultsOf 163 patients, our analysis included 111 consecutive vascular patients who completed the MoCA. The average age of the entire cohort was 64.1 years, and 58.6% were male. The majority of the patients in the study were white (80.1%). The mean MoCA score of the entire cohort was 22.6 (mild CI). Of all subjects, 77% had CI: 68% with mild and 9% with moderate CI. Hypertension (p=.024), congestive heart failure (CHF) (p=.028), fewer years of education (p=.032), and Medicaid enrollment (p=.046) all had significant univariate associations with CI. There was no statistically significant difference between age (p=.11) or the primary vascular diagnosis disease for which the patient sought treatment and CI (p=.49). Multivariable models demonstrated that only CHF (OR 3.8, p=.046) was statistically significantly associated with risk of CI. ConclusionIn this first-time prospective study of the entire spectrum of vascular patients in the U.S., we found that nearly 4 out of every 5 vascular surgery patients have undiagnosed cognitive impairment. Furthermore, we found that having CHF was associated with a higher likelihood of CI. Given the implications on consent, decision-making, and postoperative care, future work should focus on enrollment of a larger cohort along with an examination of the impact of CI on mortality, length of stay, and other outcomes.

Laryngopharyngeal Reflux in Otolaryngology-Head and Neck Surgery Clinic: An Epidemiological Survey.

Background and Objectives: Laryngopharyngeal reflux disease (LPRD) has been implicated in the etiology of many laryngeal disorders and is also closely related to the occurrence and progression of a variety of throat diseases, including chronic cough, leukoplakia of the larynx, dysphonia, and even laryngeal tumors. LPRD can significantly reduce the quality of life of patients and cause substantial medical and economic burdens to the society. Reflux Symptom Index (RSI), a self-administered 9-item outcomes instrument for laryngopharyngeal reflux (LPR), has been widely used to screen for LPRD, but there is a lack of feasibility studies on the use of RSI for LPRD screening and alternative diagnostic tools in otolaryngology-head and neck surgery (OHNS) clinics. To study the incidence, clinical characteristics, diagnostic status, and influencing factors of LPRD at OHNS clinics, RSI as an alternative diagnostic tool has also been studied. LPRD was defined as RSI > 13. Methods: Systematic collection of data by the RSI questionnaire was used to identify patients in the outpatient clinic suffering from LPRD; in addition, the personal history of participants was collected. Follow-up observation was carried out for 6 months for patients with suspected LPRD (RSI > 13), including whether they were treated with standardized anti-reflux therapy, and the questionnaire based on RSI was completed again after treatment. Results: The LPRD rate was 7.92% (94/1187) in this survey. The proportions of LPRD patients with smoking history (vs no smoking) and alcohol consumption history (vs. no alcohol consumption) were significantly higher (χ2 values: 7.025 and 4.562, and P values: .008 and .033; respectively). Smoking significantly increased the risk of LPRD (OR: 2.140, 95% CI: 1.058-4.331, P = .034). Among patients with LPRD positive, the incidence of "foreign body sensation in the throat" (symptom 8) score equal to 5 was the highest (19.15%). The severity of "excess mucus in the throat or postnasal drip" (symptom 3) contributed mostly to the total RSI score in patients with LPRD (r = .409, P < .001). ROC curve analysis showed that RSI ≥ 14 had a sensitivity of 72.9% and a specificity of 71.4% for the diagnosis of LPRD, with AUC = 0.797 (95% CI: 0.577-0.884, P < .001). Conclusions: The incidence of LPRD was high in patients we examined in OHNS clinics. We recommend that RSI can be used by otolaryngologists as a reliable tool for screening and diagnosing LPRD in OHNS clinics, which is beneficial for clinical practice.

Management of COVID-19 Infection Associated Lung Abscess with Secondary Pleural Empyema Using Percutaneous Intracavitary Drainage: Case Series and Review of the Literature.

Background/Objectives: COVID-19-related pulmonary complications, such as lung abscesses and pleural empyema, are rare but serious. This study presents a case series of three patients with COVID-19-associated lung abscesses complicated by pleural empyema, managed conservatively with percutaneous intracavitary drainage (ICD) and lavage. We assess the efficacy and safety of this treatment and compare our findings with the current literature. Methods: A retrospective analysis of three cases treated at the Clinic of Thoracic Surgery and Intensive Care Unit in Cluj-Napoca, Romania, was conducted. All patients developed severe lung involvement post-COVID-19, with abscesses rupturing into the pleural cavity. Conservative management included percutaneous ICD and daily lavage with isotonic saline, avoiding extensive surgery due to the patients' critical condition. Clinical, radiological, and functional outcomes were followed, and results were compared to similar cases in the literature. Results: Among 496 critically ill patients with COVID-19 infection, three patients (age 42-60) developed lung abscesses and bacterial superinfection. In all patients, the germs involved were identified (monomicrobial infection in 1, polymicrobial in 2 patients). The abscesses were treated with percutaneous ICD and lavage, leading to clinical improvement in all cases. Long-term drainage (94-290 days) was necessary to obtain healing, and none of the patients required lung resection or decortication. Serial CT scans showed resolution of the abscesses and empyema. All were successfully discharged, and long-term follow-up (30-32 months) revealed minor radiological sequelae and mild respiratory impairment. The literature review found three studies summarizing 45 patients with lung abscesses complicating COVID-19 infections, but only one study addressed the use of percutaneous ICD. The mortality reported in this group was high (50-65%). Conclusions: Conservative treatment with percutaneous ICD and lavage is effective in managing lung abscesses and pleural empyema in critically ill COVID-19 patients, offering a viable alternative to surgery in high-risk cases. This method may be beneficial in multidisciplinary care for non-surgical candidates.

Corneal Curvature of the Saudi Population in Relation to Age, Gender, Refractive Errors, and Central Corneal Thickness.

Corneal curvature (CC) is a crucial ocular optical system parameter, indicating the shape of the cornea expressed in radii. This study aims to investigate the relationship between CC, age, gender, refractive errors, and central corneal thickness (CCT) in Saudi Arabia, a field lacking in research. Data were gathered from Imam Medical Center in Riyadh and Dr. Sulaiman Al Habib Hospital in this randomized, hospital-based, retrospective analysis. Patients sent to the refractive surgery clinic for a laser-assisted in situ keratomileusis (LASIK) evaluation provided a total of 1,005 eyes for the study. Patients with stable refractions in all groups and those between the ages of 17 and 57 with no history of systemic illness, eye operations, or ocular pathology were included in the research, as were all groups with stable refractions. An ultrasound pachymeter was used to assess the CC and CCT. This study showed a mean CC of 42.93+/-1.4 at a mean age of 28.93+/-7.09. We found a significant negative, weak correlation between mean CC and CCT. Gender was not significantly associated with CC in myopic and hyperopic patients, while in patients with astigmatism, females were observed to have a significantly higher mean CC compared to males. A significant difference in the mean CC was observed across different refractive errors, and patients with astigmatism had the highest CC, followed by myopic and hyperopic patients.

Chatbot Demonstrates Moderate Interrater Reliability in Billing for Hand Surgery Clinic Encounters.

Artificial intelligence offers opportunities to improve the burden of health care administrative tasks. Application of machine learning to coding and billing for clinic encounters may represent time- and cost-saving benefits with low risk to patient outcomes. Gemini, a publicly available large language model chatbot, was queried with 139 de-identified patient encounters from a single surgeon and asked to provide the Current Procedural Terminology code based on the criteria for different encounter types. Percent agreement and Cohen's kappa coefficient were calculated. Gemini demonstrated 68% agreement for all encounter types, with a kappa coefficient of 0.586 corresponding to moderate interrater reliability. Agreement was highest for postoperative encounters (n = 43) with 98% agreement and lowest for new encounters (n = 27) with 48% agreement. Gemini recommended billing levels greater than the surgeon's billing level 31 times and lower billing levels 10 times, with 4 wrong encounter type codes. A publicly available chatbot without specific programming for health care billing demonstrated moderate interrater reliability with a hand surgeon in billing clinic encounters. Future integration of artificial intelligence tools in physician workflow may improve the accuracy and speed of billing encounters and lower administrative costs.

Early outcomes of treatment selections for infrarenal abdominal aortic aneurysms: The first five year experience of a single center

Aim: We examined the criteria governing patient selection in contemporary practice in cases of infrarenal abdominal aortic aneurysm (AAA) treated electively or urgently in our Cardiovascular Surgery Clinic (CVSC). Material and Methods: From January 2019 to January 2024, we retrospectively evaluated infrarenal AAA patients treated either electively or urgently with Open Surgical Repair (OSR) or standard Endovascular Aortic Repair (EVAR) at our CVSC. The primary endpoints are distribution of AAA patients by treatment modality, early morbidity and mortality. The secondary endpoints were intensive care unit (ICU) duration and length of hospital stay (LOS). Results: A total of 332 patients received EVAR (Group 1), including 296 elective cases, while 90 patients underwent OSR (Group 2), with 66 being elective. Early mortality rates were significantly lower in the EVAR group (1.3% for elective and 27.8% for emergent) compared to the OSR group (6.1% for elective and 54.2% for ruptured cases, p=0.001). Major postoperative complications occurred in 12.5% of elective EVAR patients and 39.4% of elective OSR patients (p=0.001), while in ruptured cases, the rates were 11.1% and 58.3%, respectively (p=0.001). Comparisons of ICU duration and LOS also favored EVAR (p=0.001). Conclusion: EVAR offers a survival benefit in the early period compared to OSR. The choice of treatment should be tailored to the patient's comorbidities, preferences, and the vascular surgeon's expertise. Advanced aortic centers with hybrid operating rooms (HOR) and specialized CVSCs should aim for optimized patient outcomes and cost-effectiveness in our country.

HPB SO15 - Developing protocol for managing diabetes after Distal pancreatectomy

Abstract Background The incidence of new-onset diabetes mellitus (NODM) has been reported to be 18% to 39% after pancreaticoduodenectomy and 5% to 42% after distal pancreatectomy. Postoperative NODM is historically referred to as type 3c diabetes mellitus (DM). Postoperative HbA1c levels over 7% or 52 mmol have been identified as one of the independent risk factors for tumor recurrence and overall poor survival after cancer-related resections. This study aimed to evaluate the current practice in glycemic monitoring of patients who had distal pancreatectomy and to develop a departmental protocol for Glycemic monitoring in the perioperative period. Method Electronic medical records of 74 patients were reviewed, of these, 61 patients who underwent distal pancreatectomy from Jan 2019 to Dec 2023 was included in the study. All patients with distal pancreatectomy were included irrespective of their pathological diagnosis. age or gender. Patients who died in the perioperative period or the ones who did not have distal pancreatectomy were excluded. (necrosectomy, drainage procedures, GIST, central pancreatectomy. Data analysis performed using Microsoft Excel Results The Age ranged from 24-86. 61 patients were included in the study where whereas male-to-female ratio is shown in the Pie Chart. 80% of the patients had investigations for glycemic status, Only 59% (36/61) had HBA1C done, additional 21% others had only glucose levels measured. 19.7% had no investigations to date. This graph shows the current diabetic status of patient The graph shows the variability in practice with no consistency. Overall 36% of our patients have become diabetic or Pre-diabetic post distal pancreatectomy. Conclusion There is a lack of consistency in the follow-up of our patients regarding glycemic control. This calls for the development of a defined departmental protocol for the follow-up of our patients. Every patient with pancreatectomy should have a glucose tolerance test/HBA1C pre-op in close liaison with the diabetic team. We made the following suggestions. HBA1C at 1 month post surgery in 1st clinic follow up. HBA1C every 6 months thereafter or advice GP if they were to be discharged after benign disease surgery. Information charts are to be made available to the ward base and added to the induction pack.

Measuring Outcomes Relevant to the Decolletage from the Patient Perspective: Development and Validation of the BODY-Q Decolletage Scale.

A range of cosmetic treatments to improve skin quality of the decolletage are available. To measure outcomes from the patient perspective, a rigorously developed patient-reported outcome measure is needed. To develop and validate the BODY-Q Decolletage scale. Appearance-related codes from BODY-Q concept elicitation interviews were reexamined and 13 items drafted and refined through patients and clinician debriefing interviews. The scale was tested in an online international sample of women >25 years who had previously received a treatment for the decolletage, or in the past 12 months had received a cosmetic treatment at a plastic surgery or dermatology clinic. Data were analysed with both Rasch measurement theory and classical test theory. Interviews conducted with 15 patients and 5 clinicians led to a 16-item scale with items that covered scenarios (mirror, photos, low neckline, lay on side, breasts together, arms crossed, get up, up close), compared (other people), age (youthful, age), qualitative (attractive, healthy), color (even-colored) and texture (smooth, texture). The field-test included 334 participants. An item with poor fit to the Rasch model was dropped. Data for the remaining 15 items fit the Rasch model (Chi-square=76.72, df=60, p=0.07). All items had ordered thresholds and good item fit. All reliability statistics were >0.93. A total of 19 of 20 pre-defined hypotheses (95%) were met providing evidence of construct validity. The Decolletage scale is available to incorporate the perspective of patients into clinical care and clinical trials of minimally invasive treatments to improve skin quality.

Enhancing Outcomes and Efficiency in Large Epidermal Cyst Management: Quality Improvement Approach in Primary Care.

Epidermal cysts are common benign lesions encountered in primary care, especially in minor surgery clinics. The management of large epidermal cysts (>5 cm in diameter) poses significant challenges, including surgical intervention requirements, potential for complications, and impacts on patient care and clinic workflow. The prevalence of these cysts underlines the need for optimised management strategies that are essential for enhancing patient outcomes and clinic efficiency. This quality improvement initiative sought to better manage large epidermal cysts in primary care settings. The initiative utilised the Plan-Do-Study-Act (PDSA) cycle over three distinct phases, with an emphasis on improving surgical techniques and postoperative care, optimising clinic workflow, and enhancing patient education and involvement. Over the course of this eighteen-month study, 100 patients who required surgical excision of large epidermal cysts were included. The interventions focused on standardising surgical protocols, implementing a new scheduling system, and developing comprehensive educational materials for patients. The programme contributed to major efficiency gains for surgeries: the average operative time was reduced from 45 min to 30. The postoperative complication rate decreased dramatically while patient and clinician satisfaction went up, as did clinic throughput. With patient education enhancements, follow-up adherence rose to 92% while the postoperative complication rate declined from 18% to 9% with the overall approach to patient engagement. The successful application of the PDSA cycles in this work demonstrates that quality improvement methodologies have a potential role in optimising management for large epidermal cysts in primary care settings. Developed interventions can therefore be put into routine care that will indeed improve patient outcome, clinician experience, and operational efficiency in minor surgery clinics.