Type Of Surgery Research Articles

Anesthesia for the Patient Undergoing Knee Procedures.

Anesthesia for patients undergoing knee procedures encompasses a large patient population with significant variation in patient age, comorbidities, and type of surgery. In addition, these procedures are performed in vastly different surgical environments, including large academic hospitals, private hospitals, and out-patient surgical centers. These variabilities require a thoughtful and individualized anesthetic approach tailored toward the medical and surgical needs of each patient. This article discusses anesthetic approaches to patients with acute, subacute, and chronic knee-related pathology requiring surgery. We will also review pertinent knee anatomy and innervation and discuss regional nerve blocks and their applications to knee-related surgical procedures.

CHRONIC PYOGENIC SPONDYLITIS IN PATIENTS WITH SPINAL GOUT: CLINICAL SERIES AND LITERATURE REVIEW

The aim of the study. To analyze of the follow-up results of surgical treatment of chronic pyogenic spondylitis in patients with spinal gout and systematize the literature data on the issue. Methods. Design – case series and literature review. The clinical part of the study included 6 consecutively operated patients from 2018 to 2021. The diagnosis of spinal gout and chronic pyogenic spondylitis was verified according to the results of histologic and bacteriologic studies of surgical material. Follow-up results evaluated at least 24 months. The peculiarities of clinical and laboratory, radiological and histologic manifestations of the disease were studied. Literature data systematization was carried out using the medical databases PubMed, Google Scholar, eLIBRARY. The depth of the search was from 2013 to 2023. Results. The average age of the patients was 55 ± 9 years. The duration of the diagnostic pause was 8 ± 5 years. Multisegmented lesions of the lumbar (n1 = 4) and thoracic (n2 = 2) spine prevailed. According to the classification of Pola E. et al. (2017) the following types of spondylitis were identified: B3 (n3 = 1), C1 (n4 = 1), C3 (n5 = 2) and C4 (n6 = 2). The clinical presentation was dominated by chronic back pain, with an intensity of 6.1 ± 1.4 VAS scores. Neurologic disorders of the lower extremities and pelvic (ASIA scale) corresponded to types B (n7 = 1) and C (n8 = 4). The type of surgery: three-column reconstruction from combined approach in 2 cases and anterior column reconstruction in 2 cases, three-column reconstruction from posterior approach in 1 case, and debridement of the epidural space and anterior column from posterior approach in 1 case. The literature review is based on 17 publications, analyzed at the final stage.

Accuracy of Intraocular lens power calculation in pediatric traumatic cataract.

To evaluate the prediction error (PE) in pediatric traumatic cataract surgery involving primary or secondary intraocular lens implantation (IOL) and the factors affecting it. Retrospective data of unilateral traumatic cataract eyes of children aged ≤16 years were collected between February 2019 and March 2022 at a tertiary eye care hospital. Absolute PE was calculated by deducting the target refraction from the observed refraction at 6 weeks postsurgery following suture removal. Simulated PE was calculated in eyes with corneal scar replacing the affected eye keratometry (K) with the K of the fellow eye and standard K (44D) and was then compared with absolute PE. Fifty children with a mean age of 9.5 years (2-16 years) were included. Mean absolute PE was 1.63 ± 1.8D (0 to 9D). Absolute PE was not affected by the age at surgery, method of biometry, duration of injury, type of cataract surgery, position of IOL, and preoperative keratometry. The absolute PE was affected by axial length (AXL) being <1.5D in AXL of 22.73 ± 0.84 mm, <1.5-2D in AXL of 22.07 ± 0.61 mm, and >2D in AXL of 22.01 ± 0.74 mm (P = 0.039) in univariate analysis. In multivariate analysis, none of the factors affected the absolute PE. In 34 eyes with corneal scar, higher variability in PE was observed. The standard K resulted in greater simulated PE as compared to the affected eye average K in eyes with scar involving the visual axis. Absolute PE following pediatric traumatic cataract was studied. It was higher in shorter AXLs. In corneal scar involving the visual axis, using the fellow eye K yielded lesser simulated PE as compared to standard K.

Clinical Course and Outcomes of Autoimmune Versus Non-Autoimmune Surgically Induced Scleral Necrosis: A Multicentric Comparative Study

ABSTRACT Background To analyze the clinical course and outcomes of autoimmune vs. non-autoimmune surgically induced scleral necrosis (SISN). Methods Multicentric, retrospective, comparative cohort study. Eighty-two eyes of 70 patients with SISN were classified according to pathogenic mechanism into autoimmune vs. non-autoimmune. Main outcome measures included necrosis onset, type of surgery, associated systemic disease, visual acuity, and treatment were analysed in patients followed for ≥ 6 months. Results Forty-six (65.7%) patients were women, and the median age was 66 (range: 24–90) years. Most patients (82.9%) had unilateral disease. The median time between surgery and SISN onset was 58 (1–480) months. Thirty-one (37.8%) eyes were classified as autoimmune, and 51 (62.2%) as non-autoimmune SISN. Autoimmune SISN was associated with a shorter time between the surgical procedure and SISN onset than non-autoimmune cases (median of 26 vs. 60 months, p = 0.024). Also, autoimmune SISN was associated with cataract extraction (93.5% vs. 25.5%, p < 0.001), severe scleral inflammation (58.1% vs. 17.6%, p < 0.001), and higher incidence of ocular complications (67.7% vs. 33.3%, p = 0.002) than non-autoimmune cases. Remission was achieved with medical management alone in 44 (86.3%) eyes from the non-autoimmune and in 27 (87.1%) from the autoimmune group (p = 0.916). Surgical management was required in 11 (13.4%) eyes, including two requiring enucleations due to scleral perforation and phthisis bulbi. Conclusions Eyes with autoimmune SISN had a higher rate of cataract surgery, severe scleral inflammation, and ocular complications. Early SISN diagnosis and appropriate management, based on clinical features and pathogenic mechanisms, are critical to avoid sight-threatening complications.

Assessment of Safe Early Fixation Strategies in a Cohort Polytraumatized Patients – How is the Surgical Treatment Influenced by the Injury Pattern?

Abstract Background While the inital assessment and the intial treatment of potentially life-threatening injuries is well-described, the surgical treatment strategy following initial resuscitation remains controversial. Timepoint of surgery and type of surgery still reamin topic of discussions. Various, different strategies for optimal timing of fracture fixation in polytrauma patients exist. Aims This study tests the hypothesis that a concept of clearing patients for early definitive surgery that relies on anatomical and physiologic parameters is influenced by the injury distribution. Methods Polytrauma patients treated at a Level 1 trauma center (01.01.2016 - 31.12.2018). Inclusion: primary admission, injury severity score (ISS) ≥16points, requirement of surgical fixation of major extremity or a truncal injury. Exclusion: death &amp;lt;72h after admission, severe traumatic brain injury (TBI). Stratification according to surgical fixation concept: Early total care (ETC, all surgeries &amp;lt;24 h), safe definitive surgery (SDS, staged surgeries &amp;lt;72h), and damage control orthopaedics (DCO, definitive care after stabilization). Endpoints: mortality, complication rates. Parameters of interest: Injury severity and distribution (ISS/AIS), pathophysiologic parameters of hemorrhagic shock, coagulopathy, hypothermia, soft tissue trauma. Results 527 patients, mean age 54.8 SD19.9 years, mean ISS 26.9 SD9.0 points, mortality 20.5%. Group ETC (n=21, 3.9%), Group SDS (n = 284, 53.9%), Group DCO (n = 222, 42.1%). Abdominal and spinal injuries associated with ETC (AIS Abdomen; OR 2.1, 95%CI 1.1 to 4.0, p = 0.026: AIS Spine OR 2.0, 95%CI 1.2 to 3.4, p = 0.007). Extremity and pelvic injuries associated with SDS (OR 1.8, 95%CI 1.1 to 2.8, p = 0.012 and OR 1.3, 95%CI 1.0 to 1.7, p = 0.036), head injuries associated with DCO (OR1.5, 95%CI 1.3 to 1.8, p &amp;lt;0.001). Head injuries were most relevant for mortality and were associated with patients undergoing DCO (29.7%) (ETC; 23.8%, SDS; 13.0%). Conclusion The concept of staged early fixation for major extremity and axial injuries (SDS) was successfully applied in the majority of patients. Predominant head and abdominal injuries were associated with ETC or DCO. The injury distribution influences decision making towards surgical management that is associated with a low complication rate.

The feasibility, acceptability, safety, and effects of early weight bearing in humeral fractures – a scoping review

Purpose Non-weight bearing is often recommended after humeral fractures. This review aims to summarise the extent and nature of the evidence for the feasibility, acceptability, safety, and effects of early weight bearing (EWB) in people with humeral fractures, treated operatively or non-operatively. Methods Data sources identified published (PUBMED, EMBASE, CINAHL) and unpublished (ClinicalTrials.gov, CENTRAL, NIHR Open Research, OpenGrey) literature. Independent data extraction was conducted by two reviewers. Results 13 901 records were retrieved. Ten studies, involving 515 post-operative patients and 351 healthcare professionals, were included. EWB was found to be feasible in nine studies. There was limited evidence regarding adherence to EWB. Trauma and orthopaedic surgeons reported that EWB was acceptable. This depended on surgery type and whether it was a post-operative polytrauma case. No acceptability data was reported from patients’ perspectives. Only one study reported two patients who developed unsatisfactory outcomes from excessive post-operative EWB. Positive effects of EWB were reported on disability level, pain, shoulder and elbow motion, and union. Conclusion There is some evidence for the feasibility, safety, and effectiveness of post-operative EWB after humeral fractures. There was limited data on the acceptability of EWB. Heterogeneous study designs, and variations in EWB protocols limit conclusions.

Prevalence of cosmetic surgery and its relationship with psychosocial status: a population based study in Sulaymaniyah, Iraq

Purpose This study aims to investigate the prevalence of cosmetic surgery and its relationship with the level of mental health and socioeconomic variables in Sulaymaniyah city in Iraq. Design/methodology/approach This descriptive-analytical and cross-sectional study was conducted on 941 subjects who were selected using multistage sampling method. Data were collected using a checklist as well as a questionnaire. Data analysis was done using chi-square test and multiple logistic regression model using Stata software version 20. Findings The prevalence of cosmetic surgery was 13.4% (female: 17.5%; male: 8.2%). The most common types of cosmetic surgery were rhinoplasty (7.6%) in women and hair transplant (5.5%) in men. Overall, rhinoplasty (7.6%) was the most common type of cosmetic surgery among both groups. In total, the prevalence of having symptoms of mental disorders was 34.5% and it was significantly higher among people with a history of cosmetic surgery (65.1%) than those without any experience of having cosmetic surgery (29.8%) (p &lt; 0.001). Being female (odds ratio [OR] = 2.07; 95% confidence interval [CI]: 1.33–3.22), having mild symptoms of mental disorders (OR = 2.76; 95% CI: 1.71–4.47) and having moderate or severe symptoms of mental disorders (OR = 7.48; 95% CI: 4.60–12.29) were among the important variables that could affect performing cosmetic surgery. Originality/value The prevalence of cosmetic surgery in Sulaymaniyah is high, and based on the findings of this study, gender and mental health status are effective factors in this regard. Designing targeted interventions is suggested with an emphasis on the findings of this study to reduce the rate of cosmetic surgeries.

The Impact of Metabolic and Bariatric Surgery on Apo B100 Levels in Individuals with high BMI: A Multi-Centric Prospective Cohort Study.

Metabolic and Bariatric surgery (MBS) leads to significant weight loss and improvements in obesity-related comorbidities. However, the impact of MBS on Apolipoprotein B100 (Apo-B100) regulation is unclear. Apo-B100 is essential for the assembly and secretion of serum lipoprotein particles. Elevated levels of these factors can accelerate the development of atherosclerotic plaques in blood vessels. This study aimed to evaluate changes in Apo-B100 levels following MBS. 121 participants from the Iranian National Obesity and Metabolic Surgery Database (INOSD) underwent Laparoscopic Sleeve Gastrectomy (LSG) (n = 43), One-Anastomosis Gastric Bypass (OAGB) (n = 70) or Roux-en-Y Gastric Bypass (RYGB) (n = 8). Serum Apo-B100, lipid profiles, liver enzymes, and fasting glucose were measured preoperatively and six months postoperatively. Apo-B100 levels significantly decreased from 94.63 ± 14.35 mg/dL preoperatively to 62.97 ± 19.97 mg/dL after six months (p < 0.01), alongside reductions in total cholesterol, triglycerides, LDL, VLDL, AST, and ALT (p < 0.05). Greater Apo-B100 reductions occurred in non-diabetics versus people with diabetes (p = 0.012) and strongly correlated with baseline Apo-B100 (r = 0.455, p < 0.01) and LDL levels (r = 0.413, p < 0.01). However, surgery type did not impact Apo-B100 changes in multivariate analysis (p > 0.05). Bariatric surgery leads to a significant reduction in Apo-B100 levels and improvements in lipid profiles and liver enzymes, indicating a positive impact on dyslipidemia and cardiovascular risk in individuals with high BMI.

Wait times and breast cancer survival: a population-based retrospective cohort study using CanIMPACT data.

The time from breast cancer surgery to chemotherapy has been shown to affect survival outcomes; however, the effect of time from first breast cancer-related healthcare contact to first cancer specialist consultation, or the time from first breast cancer-related healthcare contact to adjuvant chemotherapy on survival has not been well explored. We aimed to determine whether various wait times along the breast cancer treatment pathway (contact-to-consultation, contact-to-chemotherapy, surgery-to-chemotherapy) were associated with overall survival in women within the Canadian province of Ontario. We performed a population-based retrospective cohort study of women diagnosed with stage I-III breast cancer in Ontario between 2007 and 2011 who received surgery and adjuvant chemotherapy. This was the Ontario cohort of a larger, nationwide study (the Canadian Team to improve Community-Based Cancer Care along the Continuum - CanIMPACT). We used Cox-proportional hazards regression to determine the association between the contact-to-consultation, contact-to-chemotherapy, and surgery-to-chemotherapy intervals and overall survival while adjusting for cancer stage, age, comorbidity, neighborhood income, immigration status, surgery type, and method of cancer detection. Among 12,782 breast cancer patients, longer surgery-to-chemotherapy intervals (HR 1.13, 95% CI 1.03-1.18 per 30-day increase), but not the contact-to-consultation (HR 0.979, 95% CI 0.95-1.01 per 30-day increase), nor the more comprehensive contact-to-chemotherapy intervals (HR 1.00, 95% CI 0.98-1.02 per 30-day increase) were associated with decreased survival in our adjusted analyses. Our findings emphasize the prognostic importance of a shorter surgery-to-chemotherapy interval, whereas the contact-to-consultation and contact-to-chemotherapy intervals have less impact on survival outcomes.

Impact of bariatric surgery on circulating irisin levels: a systematic review and meta‑analysis.

This systematic review and meta-analysis evaluated changes in circulating irisin levels after bariatric surgery. A systematic search was performed across Embase, Scopus, PubMed, and Web of Science for this study. The meta-analysis was conducted using Comprehensive Meta-Analysis (CMA) V4 software. The overall effect size was depicted through a random-effects meta-analysis and the leave-one-out method. The meta-analysis, which included 13 studies with a total of 407 participants, showed a statistically non-significant reduction in circulating irisin levels following bariatric surgery (SMD: - 0.089, 95% CI - 0.281, 0.102, 95% PI: - 0.790, 0.611, p = 0.360; I2:70.56). Our research found no significant change in irisin levels after bariatric surgery. Moreover, these findings were not associated with the type of surgery or the duration of follow-up.

The left atrial appendage closure by surgery 2 trial: statistical analysis plan for a randomized multicenter trial exploring if the closure of the left atrial appendage during open-heart surgery reduces stroke irrespective of patients’ stroke risk and preoperative atrial fibrillation status

BackgroundSurgical left atrial appendage (LAA) closure concomitant to open-heart surgery prevents thromboembolism in high-risk patients. Nevertheless, high-level evidence does not exist for LAA closure performed in patients with any CHA2DS2-VASc score and preoperative atrial fibrillation or flutter (AF) status—the current trial attempts to provide such evidence.MethodsThe study is designed as a randomized, open-label, blinded outcome assessor, multicenter trial of adult patients undergoing first-time elective open-heart surgery. Patients with and without AF and any CHA2DS2-VASc score will be enrolled. The primary exclusion criteria are planned LAA closure, planned AF ablation, or ongoing endocarditis. Before randomization, a three-step stratification process will sort patients by site, surgery type, and preoperative or expected oral anticoagulation treatment. Patients will undergo balanced randomization (1:1) to LAA closure on top of the planned cardiac surgery or standard care. Block sizes vary from 8 to 16. Neurologists blinded to randomization will adjudicate the primary outcome of stroke, including transient ischemic attack (TIA). The secondary outcomes include a composite outcome of stroke, including TIA, and silent cerebral infarcts, an outcome of ischemic stroke, including TIA, and a composite outcome of stroke and all-cause mortality. LAA closure is expected to provide a 60% relative risk reduction. In total, 1500 patients will be randomized and followed for 2 years.DiscussionThe trial is expected to help form future guidelines within surgical LAA closure. This statistical analysis plan ensures transparency of analyses and limits potential reporting biases.Trial registrationClinicaltrials.gov, NCT03724318. Registered 26 October 2018, https://clinicaltrials.gov/study/NCT03724318.Protocol versionhttps://doi.org/10.1016/j.ahj.2023.06.003.

Severe cholecystitis during the COVID-19 pandemic : Influence of the COVID-19 pandemic on the frequency of surgery and outcome for elective and emergency cholecystectomy: a monocentric retrospective cohort analysis

With the outbreak of the COVID-19 pandemic medical care focused on management of the infectious event. Elective interventions were cancelled and the general advice was to stay at home. How this impacted urgent and elective cholecystectomies is the subject of this work. Urgent and elective cholecystectomy patients during the first year of the pandemic were compared with those of the previous year. The primary endpoint was the frequency of surgery. Furthermore, the American Society of Anesthesiologists (ASA) score, symptom duration until presentation as well as until surgery, preoperative inflammatory parameters, imaging, positive Murphy's sign, type and duration of surgery, intraoperative drain placement, intraoperative and histological severity, need for and duration of postoperative antibiotic therapy, intensive care stay, length of stay and occurrence of postoperative complications were recorded. During the pandemic patients were sicker (ASA2.13 vs. 2.31; p = 0.039), the operating time was prolonged (64.4 min vs. 74.9 min; p = 0.001) and patients were more likely to have concomitant peritonitis (15.4% vs. 29.1%: p = 0.007). Furthermore, there was atrend in the presence of leukocytosis, apositive Murphy's sign, intraoperative drain placement, intraoperative severity of inflammation, duration of postoperative antibiotic therapy and complication rate. During the COVID-19 pandemic cholecystitis presented with more pronounced inflammation, the surgical conditions were more difficult and postoperative recovery was prolonged.

Visual Outcome following Blunt Ocular Trauma among Patients attended Tobruk Medical Center

Visual Outcome following Blunt Ocular Trauma among Patients attended Tobruk Medical Center

Clinical outcomes of the light adjustable lens in eyes with a history of prior corneal refractive surgery.

This study aimed to evaluate the visual and refractive outcomes in eyes with a history of laser corneal refractive surgery implanted with the second-generation light-adjustable lens (LAL). Private Practice, Sioux Falls, South Dakota, US. Retrospective, consecutive case series. Eyes with a history of prior corneal refractive surgery that underwent cataract surgery with implantation of the LAL and were targeted for plano were included. Data on the type and number of prior refractive surgeries were collected, in addition to the timing and number of postoperative adjustments. The primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and the percentage (%) of eyes within ±0.25 diopter (D), ±0.50D, and ±1.00 D of their refractive target. 76 eyes from 70 patients were included. A total of 45 eyes with a history of one prior refractive surgery and 31 eyes with a history of ≥2 refractive surgeries were included. 74% (n=56) of all eyes achieved UDVA of 20/20 or better, 88% (n=67) achieved 20/25 UDVA or better and 93% (n=71) were correctable to 20/20 or better postoperatively. For refractive outcomes, 66% of eyes (n=50) were within ±0.25 D and 86% (n=65) were within ±0.50 D of refractive target. Patients with a history of laser corneal refractive surgery achieved favorable visual and refractive outcomes with the LAL. This intraocular lens (IOL), which affords postoperative adjustability, is a promising option for patients with a history of corneal refractive surgery who maintain high expectations for functional uncorrected acuity following cataract surgery.

Profile and Prevalence of Oral and Maxillofacial Diseases Among Armed Forces Personnel and Their Families in Military Dental Centre, Cumilla

Background: Oral and maxillofacial diseases encompass a wide range of conditions in and around oral cavity and in maxillofacial region. It includes maxillofacial trauma, cyst and tumour of jaw bones, conditions involving impacted wisdom teeth, oral premalignant and malignant lesions, fascial space infection around maxillofacial region, temporomandibular joint disorder, dental implantology, salivary gland disorder and congenital defects of jaw bones. Maxillofacial region is more vulnerable to sustain injuries in the battlefield. In peace time, various maxillofacial diseases reduce the overall performances of the troops. The aim of this study is to delineate rank wise distribution of armed forces personnel reported with maxillofacial diseases, gender distribution, types of maxillofacial diseases, different types of surgical procedures performed and types of anesthesia used. Methods: A descriptive cross-sectional study was conducted to assess the prevalence of maxillofacial diseases among the armed forces personnel and their entitled family members during the period of 1st January 2019 to 31st December 2019 in Military Dental Centre, Cumilla. Purposive sampling technique and semi structured questionnaire was used to include the patients in this study.Data were analyzed by using Statistical Packages for Social Sciences (SPSS) version 25. Results: A total of 170 cases were evaluated and treated. Male patients were 110(65%) and female were 60(35%). Among the military personnel numbers of sainik (privates) were highest 32(35%). Impacted wisdom teeth cases were mostly found 80(47%). In case of impacted teeth mesio angular impactions were most 35(35%). In case of maxillofacial pathological conditions cystic lesions were most in number 22(39%) (n=56). Maxillofacial soft tissue laceration cases were highest 05(29%) (n=17) among all trauma patients. Surgical extraction of wisdom teeth were mostly performed surgery 80(59%) (n=138). In regards to administration of anesthesia, 128(93%) cases were performed under local anesthesia and 10(7%) were under general anesthesia. Conclusion: The present study imparts valuable perception about the types and prevalence of maxillofacial diseases and the treatment modalities among the armed forces personnel and their families in Cumilla area. Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 24-30

C5 nerve root palsy (without prior cervical decompression) case series: 9 patients with critical delay to presentation.

Distinguishing between cervical nerve root and intrinsic shoulder pathology can be a difficult task given the overlapping and often coexisting symptoms. The objective of this study was to highlight the often-complicated presentation of these symptoms and the subsequent potential for delay in care regarding this subset of patients. A total of 9patients, managed by one of two different surgeons, were identified with a history of C5 nerve root palsy. A chart review was conducted, and the following information was recorded: presenting complaint, time from symptom onset to diagnosis, time from symptom onset to presentation to a spine surgeon, first specialist seen for symptoms, non-spinal advanced imaging and treatment conducted before diagnosis, preoperative and postoperative exam, time to recovery, and type of surgery. We observed an average time from onset of symptoms to presentation to a spine surgeon to be 31.6weeks. These patients' time to full recovery after cervical decompression was 15weeks. : We observed a critical delay to presentation in this series of patients with C5 nerve palsy. C5 nerve palsy should remain an elemental part of the differential diagnosis in the setting of any shoulder or neck pain presenting with weakness.

The Role of Tranexamic Acid (TXA) In Spine Surgery for Patients with Comorbidities in Basra/Iraq

Background: Blood loss occurs frequently and remains a challenge in spinal surgery. As significant intra and postoperative hemorrhage negatively affects patient outcomes by increasing coagulopathy, postoperative hematoma, and anemia. The need for allogenic blood transfusions can lead to potential transfusion reactions and infections, in addition to increasing long-term mortality rates. Although there are many randomized control trials and meta-analysis investigating the role of tranexamic acid (TXA), we could not find any study that investigated the role of TXA in patients with medical comorbidities. Therefore, tackling the role of TXA in patients with single or multiple comorbidities is of valuable outcome to our locality as most of the patients have indeed associated comorbidities. Objectives: to investigate the role of tranexamic acid in decreasing perioperative blood loss in patients with multiple comorbidities as compared to otherwise healthy individuals. Patients and methods: A single center randomized control trial. We included patients that were about to undergo simple decompressive surgeries for lumbar canal stenosis and fixation with decompression for spondylolisthesis. Patients were randomly categorized into cases (who received TXA) and controls who received NS. Patients then were subcategorized according to comorbidities and types of surgeries. Intraoperative blood loss was calculated using the suction drain and the gauze while the post operative bleeding was calculated using the drain output. Results: There was 441.84 ml (49.6 %) decrease in intraoperative bleeding for patients who received TXA as compared to controls regardless the type of surgery and regardless the presence or absence of comorbidities. Hypertensive patients had 52.7 % reduction in intraoperative bleeding when received TXA, Diabetic patients showed 44.4 % reduction in bleeding, Obese patients showed 51.1% reduction and patients with multiple comorbidities showed 51% reduction in intraoperative bleeding while healthy individuals showed 38.9% reduction in intraoperative bleeding. Conclusion: TXA was even more effective in decreasing intraoperative bleeding in patients with multiple comorbidities as compared to healthy individuals.

Factors contributing to weight loss success after bariatric procedures in patient over 65 years old - a multicenter retrospective cohort study.

Although bariatric surgery in patients over 65 years of age gives comparable results to treatment in the younger population, there are still controversies regarding the indications for surgery, risk assessment and choice between different types of surgery. The study aimed to identify the factors contributing to weight loss success after bariatric surgery in patients over 65 years of age. This is a retrospective, multicenter cohort study of patients with obesity aged over 65 years undergoing primary laparoscopic bariatric surgery in the years 2008-2022. Data came from 11 bariatric centers. Patients were divided into two groups: responders (R) who achieved more than 50% EWL and non-responders (NR) who achieved less than 50% EWL. Both groups were compared. Uni- and multivariate logistic regression was used to identify predictors of weight loss success. Out of 274 analyzed patients, the average BMI before surgery was 42.9kg/m2. The most common obesity-related diseases were hypertension (85.1%) and type 2 diabetes (53.3%). Sleeve gastrectomy was the most frequently performed procedure (85.4%). Uni- and multivariate logistic regression analysis confirmed preoperative BMI (OR=0.9, 95%CI:0.82-0.98, P=0.02), duration of diabetes >10 years (OR=0.3, 95%CI:0.09-0.82, P=0.02), balloon placement (OR=10.6, 95%CI: 1.33-84.83, P=0.03), time since first visit (OR=0.9, 95%CI:0.84-0.99, P=0.04), preoperative weight loss (OR=0.9, 95%CI:0.86-0.98, P=0.01) and OAGB (OR=15.7, 95%CI:1.71-143.99, P=0.02) to have a significant impact on weight loss success 1 year after bariatric surgery. Patients with higher preoperative weight loss may have a poorer response to surgery. OAGB emerged as the most beneficial type of surgery in terms of weight loss. Intragastric balloon placement before surgery may be effective in patients above 65 years of age and may be considered as a two-stage approach.

Factors Associated With Postoperative Complications in Patients Who Underwent Parotidectomy: A Retrospective Study

Objectives: This study aimed to determine the prevalence of complications after parotidectomy and identify factors associated with these complications. Methods: Data from patients who underwent parotidectomy for neoplasms in 2 tertiary centers were analyzed. Patient characteristics and postoperative complications were collected. Demographics, diabetes, and smoking status were evaluated using descriptive statistics. The prevalence of complications was determined and associations with smoking, surgical type, preoperative facial nerve involvement, final pathology, and Milan category were examined using chi-squared and correlation analyses. Results: Majority of patients were male (59.5%), falling within the age range of 31 to 50 years (42.7%). The most common complication was facial nerve weakness (23.6%), followed by seroma (19.1%), ear numbness (17.3%), and tumor recurrence (8.7%). Xerostomia demonstrated a correlation with smoking, while more invasive types of surgery showed associations with surgical site infection and tumor recurrence. Malignant disease on the final pathology and higher Milan category exhibited links with salivary fistula. No clear associations were found between preoperative facial nerve involvement and any of the complications. Age and body mass index (BMI) did not demonstrate significant correlations with complications. Conclusions: This study highlights the prevalence and associations of postparotidectomy complication. Facial nerve weakness was the most common followed by seroma and ear numbness. Smoking was correlated with xerostomia, while more invasive type of surgery was correlated with infection and recurrence. Age and BMI did not have associations. Personalized approaches and understanding factors for effective management are important. Further research is recommended to validate the outcome and understand the recovery from parotidectomy.

Evaluation of musculoskeletal system injuries after the 2023 Kahramanmaraş Turkey earthquakes: Our single-center experience.

This study aimed to retrospectively analyze patients who presented to the orthopedic and traumatology clinic following the 2023 Kahramanmaraş earthquakes. Over a week after the earthquakes, two hundred and sixty patients were consulted at our clinic. Demographic data of the patients, duration of being under the rubble, fracture locations, types of surgeries performed, number of surgical sessions attended by individuals, and early mortality rate within one month were determined. The mean age of the patients was 40.2 ± 22.4 years. One hundred thirty-eight (53.1%) were female, and 122 (46.9%) were male. The average duration of being under the rubble was determined as 27.1 ± 28.0 hours. Sixteen patients died within one month after the earthquake. The one-month mortality rate among patients with orthopedic injuries was 6.15%. Forty-seven fasciotomies were performed in 35 patients, and 22 amputations were performed in 19 patients. The most injured region was the lower extremity (78 cases, 40%). The ratio of external and internal fixation in extremity fractures was 22%. The management of musculoskeletal injuries can be successful with proper triage and treatment plans. Decisions regarding fasciotomy and amputation in patients with crush syndrome following an earthquake should be individualized. Implant sets should be planned accordingly, especially considering the higher occurrence of lower extremity injuries.