Total Cases Research Articles

Management of renal artery aneurysms: A retrospective study.

Although renal artery aneurysms (RAAs) are rare and often asymptomatic with slow growth, their natural progression and optimal management are not well understood. Treatment recommendations for RAAs do exist; however, they are supported by limited data. A retrospective cohort study was conducted to explore the management of patients diagnosed with an RAA at our institution from January 1st, 2013, to December 31st, 2020. Patients were identified through a search of our radiological database, followed by a comprehensive chart review for further assessment. Data collection encompassed patient and aneurysm characteristics, the rationale for initial imaging, treatment, surveillance, and all-cause mortality. One hundred eighty-five patients were diagnosed with or treated for RAAs at our center during this timeframe, with most aneurysms having been discovered incidentally. Average aneurysm size was 1.40cm (±0.05). Of those treated, the mean size was 2.38cm (±0.24). Among aneurysms larger than 3cm in size, comprising 3.24% of the total cases, 83.3% underwent treatment procedures. Only 20% of women of childbearing age received treatment for their aneurysms. There was one instance of aneurysm rupture, with no associated mortality or significant morbidity. Our institution's management of RAAs over the period of the study generally aligned with guidelines. One potential area of improvement is more proactive intervention for women of childbearing age.

A replication study using the World Health Organization pharmacovigilance database (VigiBase®) to evaluate whether an association between ketamine and esketamine and alcohol and substance misuse exists

Background and objectivesKetamine and esketamine are increasingly prescribed in the treatment of resistant mood disorders and persons at risk of suicide. Ketamine is a drug of misuse with increasing non-therapeutic use in the general population. Herein, our aim was to determine whether ketamine and/or esketamine are disproportionately associated with reports of substance and/or alcohol misuse. MethodsReplicating a similar analysis recently conducted using the Food and Drug Administration Adverse Event Reporting System (FAERS) database, we identified cases of “alcohol problem, alcoholism, alcohol abuse, substance dependence, substance use disorder (SUD), substance abuse, drug dependence, drug use disorder and drug abuse” in association with ketamine and esketamine reported to the World Health Organization Pharmacovigilance Database (WHO VigiBase). We searched the database from inception to January 2024. The reporting odds ratio (ROR) of each of the aforementioned parameters was calculated; acetaminophen was used as the control. The numerator of the equation represents the number of cases (n) and the denominator represents the total cases of psychiatric disorders (N). Significance was obtained when the lower limit of the 95 % confidence (CI) > 1.0. ResultsThe RORs for ketamine was increased for most parameters (i.e., alcohol abuse (3.24), substance dependence (12.48), substance use disorder (170.44), substance abuse (2.94), drug dependence (2.88), drug use disorder (11.54) and drug abuse (2.85), respectively). With respect to esketamine, the RORs were observed to be different from ketamine insofar as we observed a reduction in the RORs for three parameters (i.e., substance abuse (0.41), drug dependence (0.083) and drug abuse (0.052), respectively). The IC025 values were significant for ketamine in cases of alcohol abuse (0.35), substance dependence (0.50), substance use disorder (2.77), substance abuse (0.83), drug dependence (0.97), drug use disorder (1.95) and drug abuse (0.94). Additionally, oxycontin showed significant IC025 values for substance use disorder (0.0014), substance abuse (0.042), and drug dependence (0.17). ConclusionEsketamine was not associated with an increased ROR for any parameter of alcohol and/or substance use disorder. Mixed results were observed with ketamine with some RORs increased and others decreased. Estimating RORs using a pharmacovigilance database does not establish causation in the case of elevated RORs and cannot be assumed to be a therapeutic effect when lower RORs were observed.

Overview of Granular Cell Tumor General Hospitals in Iraq over 11-years

Granular cell tumor is rare tumors from Schwann cells with clinicopathological feature results, which may be showed in both benign and malignant tumor. Several tumors commonly appear in the oral cavity, gastrointestinal tract and skin. This must be appropriately treated to avoid repetition or metastatic cancer lesions. The aim study is to search clinicopathological aspects of granular cell tumor diagnosed at different general hospitals in Iraq and to compare these findings with epidemiological findings from different governorates positions. The data was collected from different Iraq governorates in mouth and tongue area from 2010 to 2020 years. Different parameters were displayed like age group, gender, topography, morphology and distribution of annual patients of the tumor. According to the available of the all information about these characteristics was revealed the inclusion criteria. The factors frequencies were calculated from descriptive analysis of the data. The total (101) cases of granular cell tumor in mouth and tongue location were found. (17) cases was the maximum value in 2015 year and it followed by (15) cases in 2019 year as compared to other years. Baghdad governorate (95) cases has a greatly patients than other governorates. (59) Cases with (58.40 %) of female gender and (42) cases with (41.60) of male and the female to male ratio was (1.38:1).

Evaluation of Cervix by Colposcopic Directed Histopathology: A Single Center Study

Background: The most common malignancy among women worldwide is cervical cancer. With the right screening, it is a disease that can be prevented and cured. Colposcopy is a useful method for identifying and treating precancerous cervical lesions after primary screening. The most reliable method for identifying precancerous lesions is histopathology. Objectives: Purpose of This study aims to evaluate the cervix by colposcopic directed histopathology in a tertiary care hospital. Methods: This Cross-sectional study was conducted among 67 patients from North east medical college and Hospital, Sylhet. The study was done for the period of “January 2022 to June 2023 “. Patients having the following complaints: positive visual inspection of the cervix (VIA + ve) with 3-5% acetic acid, post-coital bleeding, postmenopausal bleeding, and intermenstrual bleeding were recruited for the study. Written informed consent was obtained from the participants. Results: Out of the total cases, 23 (34.33%) had squamous cell carcinoma, 14 (20.89%) had LSIL, 11 (16.42%) had adenocarcinoma, 9 (13.43%) had HSIL, and 7 (10.45%) had cervical intraepithelial neoplasia. Adenosquamous was 4.48% in 3 instances. Conclusion: The colposcopic guided histological investigation found squamous cell carcinoma to be the most common cervical neoplasia in this study. Afterwards, a large proportion of cases are attributed to LSIL, adenocarcinoma, HSIL, CIN, and adenosquamous carcinoma.

Human Orthohantavirus disease prevalence and genotype distribution in the U.S., 2008–2020: a retrospective observational study

In the United States (U.S.), hantavirus pulmonary syndrome (HPS) and non-HPS hantavirus infection are nationally notifiable diseases. Criteria for identifying human cases are based on clinical symptoms (HPS or non-HPS) and acute diagnostic results (IgM+, rising IgG+ titers, RT-PCR+, or immunohistochemistry (IHC)+). Here we provide an overview of diagnostic testing and summarize human Hantavirus disease occurrence and genotype distribution in the U.S. from 2008 to2020. Epidemiological data from the national hantavirus registry was merged with laboratory diagnostic testing results performed at the CDC. Residual hantavirus-positive specimens were sequenced, and the available epidemiological and genetic data sets were linked to conduct a genomic epidemiological study of hantavirus disease in the U.S. From 1993 to 2020, 833 human hantavirus cases have been identified, and from 2008 to 2020, 335 human cases have occurred. Among New World (NW) hantavirus cases detected at the CDC diagnostic laboratory (representing 29.2% of total cases), most (85.0%) were detected during acute disease, however, some convalescent cases were detected in states not traditionally associated with hantavirus infections (Connecticut, Missouri, New Jersey, Pennsylvania, Tennessee, and Vermont). From 1993 to 2020, 94.9% (745/785) of U.S. hantaviruses cases were detected west of the Mississippi with 45.7% (359/785) in the Four Corners region of the U.S. From 2008 to 2020, 67.7% of NW hantavirus cases were detected between the months of March and August. Sequencing of RT-PCR-positive cases demonstrates a geographic separation of Orthohantavirus sinnombreense species [Sin Nombre virus (SNV), New York virus, and Monongahela virus]; however, there is a large gap in viral sequence data from the Northwestern and Central U.S. Finally, these data indicate that commercial IgM assays are not concordant with CDC-developed assays, and that "concordant positive" (i.e., commercial IgM+ and CDC IgM+ results) specimens exhibit clinical characteristics of hantavirus disease. Hantaviral disease is broadly distributed in the contiguous U.S, viral variants are localised to specific geographic regions, and hantaviral disease infrequently detected in most Southeastern states. Discordant results between two diagnostic detection methods highlight the need for an improved standardised testing plan in the U.S. Hantavirus surveillance and detection will continue to improve with clearly defined, systematic reporting methods, as well as explicit guidelines for clinical characterization and diagnostic criteria. This work was funded by core funds provided to the Viral Special Pathogens Branch at CDC.

Improvement of medication adherence for desmopressin by adjusting the prescription dosage in male patients with overactive bladder: A claims database analysis.

Desmopressin is widely used for nocturia in patients with nocturnal polyuria. We investigated the continuation rate and adherence for desmopressin in patients with overactive bladder and nocturia using a claims database and evaluated factors that improved adherence. Patients with nocturia in a Japanese claims database who started desmopressin between September 2019 and July 2021 were evaluated. Drug persistence was assessed using the Kaplan-Meier method for initial prescription of desmopressin. The proportion of days covered (PDC) was also evaluated among patients with prescription persistence. Multivariate analysis was performed using logistic regression analysis to identify factors predicting adherence to desmopressin. The study included 72,888 patients entered into Japan Medical Data Center (JMDC) database between September 2019 and July 2021. For the 236 patients prescribed desmopressin formulations, mean prescription duration was 114 days. Among the total cases, 90 (38.1%) cases were prescribed only once, mean PDC was 0.60, and the number of high-adherence patients (PDC ≥ 0.80) was 108 (45.8%). Desmopressin prescription doses were fixed in 216 patients and adjusted in 20 patients. Multivariate analysis identified prescription dose adjustment for desmopressin as significantly associated with high PDC. Desmopressin showed a 38% dropout rate after the first dose. However, high medication continuation and high medication adherence rates (PDC) could be maintained with prescription adjustments. Careful patient monitoring and appropriate adjustment of the desmopressin dosage appear to be important factors in improving nocturia.

Cytomorphological patterns and clinical features of presumptive tubercular lymphadenitis patients and their comparison with bacteriological detection methods: a cross-sectional study

IntroductionTuberculous lymphadenitis (TBLN) is an infection of the lymph node caused by Mycobacterium tuberculosis. Histological diagnoses of presumptive patients are often accompanied by cytomorphological features. However, the sensitivities of these features are often precluded by the variable degrees of narrative similarities compared to other diagnostic modalities.ObjectiveThe aim of this study was to investigate and compare the cytomorphological and clinical features of presumptive TBLN patients with bacteriological detection methods.MethodsA similar cohort of TBLN patients from our previous study who were enrolled prospectively from the ALERT Specialized Hospital, Addis Ababa, Ethiopia, was considered for this analysis. SPSS version 26 was used for data analysis. Descriptive analysis was conducted to characterize the study population using the independent variable and presented with frequency tables. The chi-square test was used to measure the association. A P-value of < 0.05 was considered statistically significant.ResultsUsing FNAC, 60/126 (47.6%) of the participants were reported to have features consistent with TB. Of the total FNAC-positive cases, many (30/60 and 27/60) showed pattern B (caseous necrosis only) and pattern C (epithelioid granuloma with caseous necrosis), respectively. Strong concordance was observed in Pattern A (abundant caseous necrosis with few epithelioid macrophages) followed by patterns B and C with GeneXpert and MGIT culture (P value < 0.001). Night sweats and alcohol intake were shown to correlate with positive cases as reported by FNAC (P value = 0.008 respectively), GeneXpert (P value = 0.02 & 0.001), and culture methods (P-value = < 0.001 & 0.002).ConclusionCytomorphological features, particularly patterns A, B, and C, could be considered in the diagnosis of TBLN given their comparable outcomes with bacteriological detection methods. On another note, we recommend that due care and attention be given when treating TBLN patients based solely on clinical presentation, as these diagnostics may be prone to false results, leading to inappropriate administration of anti-TB drugs and other consequences.

Evaluation of the Role of Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio and Mean Platelet Volume as Predictors of the Outcome in Patients with Hemotoxic Snake Bite: A Prospective Study on Patients in Poison Control Centers Ain Shams University Hospitals and Assiut University Hospitals

Abstract Background Snakebite envenomation is considered a major health problem especially in developing centuries. Snakebite envenomation cause major morbidities, disabilities and mortalities. Novel biomarkers as; neutrophils to lymphocytes Ratio (NLR) and plateletto lymphocytes Ratio (PLR)are hematological inflammatory indices that can be a guide for diagnosis, prognosis of the snakebite envenomation. Methodology This was a prospective case control study, which was carried out on 60 hemotoxic snake bite envenomed patients that admitted at Poisoning Control Center AinShams University Hospitals (PCCAUH) and Assiut University Hospitals (AUH) in the period from 1st of July 2019 to 31st of October 2021. In addition, 60 healthy volunteers were used as control subjects. The study aimed to evaluate the role of NLR, PLR and Mean Platelet Volume (MPV) at admission as predictors of the outcome in patients with hemotoxic snakebite envenomation. The patients were divided into mild, moderate and severe groups according to severity of snake envenomation. Result Sixty hemotoxic snake bite envenomed patients (28 patients admitted at PCC-ASUH and 32 admitted at AUH), were divided into (38.4%) mild, (31.6%) moderate and (30%) severe groups according to the severity of snake envenomation. Maximum incidence was found in male (95%) from rural areas (80%) and were farmers (43.3%) from total cases. It was observed that bite was more frequent at lower limbs (70%), outdoors (81.6%), at night (51%) and during autumn season (43.3%). It was found that there was significant positive correlation between NLR at admission and duration of hospitalization, PLR, creatine phosphokinase (CPK) level and whitebloodcells (WBCs) count. While, significant negative correlation was found between NLR and prothrombin concentration (PC), red blood cells(RBCs) and plateletcounts. Also, significant positive correlation was found between PLR at admission and duration of hospitalization, NLR, CPK level and platelets count. Inaddition, significant positive correlation was found between MPV and PT. About 47 (78.33%) patients had complete recovery and about 13 (21.67%) patients recovered with complications including; local complications in (21.67%), systemic complications in (13.33%) and chronic complications In (5%). There were no recorded deaths in the study. It was found that hemotoxic snake bit eenvenomed patients Admitted at PCC-ASUH were significantly more severe,required more antivenom vials and more intensive care unit(ICU) admission than those admitted at AUH. Conclusion NLR and PLR values at admission were significantly high in hemotoxic snake bite envenomed patients and can be used as predictors for diagnosis and prognosis of hemotoxic snake envenomation.In addition, NLR and PLR had significant association with severity of envenomation, duration of hospitalization.

I Pack Block versus Adductor Canal Block for Post-Operative Pain Management in Total Knee Arthroplasty

Abstract Background Total knee arthroplasty (TKA) is a highly distressful major surgery, with a significant potential for complications, not only because of the surgical and anesthetic impact of the procedure, but also because of the demographic and clinical characteristics of the target population. Careful pain management is necessary post-operative to achieve early post-operative mobilization while ensuring patient comfort throughout and preventing post-operative complications. Objective we aim to compare postoperative pain management and post- operative analgesic consumption between IPACK block and Adductor canal block in total knee arthroplasty cases. Methods After obtaining approval from the medical ethical committee in Ain Shams University, this Prospective randomized controlled double-blind clinical trial study was conducted in the operating theatres of Ain shams University Hospitals. Study period March 2022 to August 2022. Physical status: ASA 1 or 2 and candidates for spinal anaesthesia undergoing total knee arthroplasty. Age group: 40-65 years. Sample sizes of 30 patients in total; 15 in group I (group I) and 15 in group II (group A). Results As for the comparison between effect of IPACK block and Adductor canal block as regard post-operative pain in total knee arthroplasty, it showed that there is significance regarding the numeric version of the visual analogue scale (VAS) that was used to assess postoperative pain and its intensity with range 1-3 for Adductor canal block and 2-4 for IPACK block. Conclusion The comparison between effect of IPACK block and Adductor canal block as regard post-operative pain in total knee arthroplasty showed significant difference regarding the numeric version of the visual analogue scale (VAS) that was used to assess postoperative pain and its intensity with range 1-3 for Adductor canal block and 2-4 for IPACK block. These findings with our study primary and secondary outcomes showed that Adductor canal block has more analgesic effect with respect to IPACK block regarding pain assessment but with no significant difference regarding the by the time till first analgesia postoperative and Total analgesics consumption (in mg.) over 24-hour period post-operative.

Study of the Efficacy and Safety of Darbepoetin Alfa versus Epoetin Alfa in the Treatment of Anemia in Pediatric Patients on Regular Hemodialysis

Abstract Background Anemia is a common comorbidity in patients with chronic kidney disease (CKD). That affects the vast majority and can have a significant impact on patient morbidity and mortality. Erythropoiesis-stimulating agents (ESAs) are the main lines in management of anemia in hemodialysis patients. Replacement therapy with recombinant human erythropoietin (r- HuEPO) has provided an effective treatment for patients with renal “Epoetin alfa” is a recombinant erythropoietin with the same amino acid sequence as human erythropoietin (EPO). In comparison to epoetin alfa, darbepoetin alfa (DPO) contains an increased amount of sialic acid-containing carbohydrate chains. It shows a much longer elimination half-life than epoetin alfa, with prolonged erythropoietic effect. Aim of the Work to evaluate whether darbpoetin and epopoetin alpha can be used interchangeably on the same patient, achieving the same desired effect and to detect any difference in the occurrence of side effects between both ESAs. Patient and Methods This was a crossover study that took place in the Pediatrics Dialysis unit, Children’s Hospital, Ain Shams University. The study was conducted on 40 children with end stage renal disease on regular hemodialysis over a period of 6 months. The patients were randomly put into two groups A and B, each group contained 20 patients. Each group received one type of ESA either ( darbpoetin alpha or epopoetin alpha )for 3 months and then shifted to the other type of ESA for another 3 months. The dosage of epoetin alfa used was (200 IU/kg/week) and a conversion rate of EPO: DPO, 300:1. A period of 6 weeks was agreed as a washout period after the first drug given in both groups in which no results were recorded but ESA was not stopped due to its essentiality. Blood tests (hemoglobin (Hb), serum urea, serum creatinine and iron profile; (S. iron, S. ferritin, TIBC, and transferrin saturation)) were withdrawn at the start and the end of the 3 months’ period of each drug. Results We found no difference on the Hb level with both drugs. The interchange between them did not yield any significant drop in the Hb levels. Hb target in both EPO and DPO was reached in 22.5% of total cases, and was not reached in 62.5%. This proved that both drugs give the same effect with nearly negligible difference. No serious Sside effect as convulsions, hypertension, and thrombosis were noticed in both groups. Conclusion The target Hb was not reached in most patients of both groups of ESRD on regular hemodialysis at the unit and none of both drugs showed superior results or less side effects than the other.

Trends in Operative Case Logs of Chief Residents in Surgery by Sex and Race: A 5-year National Study.

To examine case logs reported by general surgery residents and identify potential disparities in operative experience. A recent study of 21 institutions noted significant differences between the number of cases reported during general surgery residency by trainees who are underrepresented in medicine (URiM) versus trainees who are not URiM (non-URiM). This study also identified differences between female residents and male residents. We partnered with the Accreditation Council for Graduate Medical Education to examine case logs reported from all accredited general surgery programs in the United States. This is the first time these data have been examined nationally. We examined total case logs submitted by graduating residents between 2017 and 2022. Group differences in mean reported case logs were examined using paired t tests for female versus male and URiM versus non-URiM overall case numbers. A total of 6458 residents submitted case logs from 319 accredited programs. Eight-hundred fifty-four (13%) were URiM and 5604 (87%) were non-URiM. Over the 5-year study period, URM residents submitted 1096.95 (SD ± 160.57) major cases versus 1115.96 (±160.53) for non-URiM residents (difference = 19 cases, P = 0.001). Case logs were submitted by 3833 (60.1%) male residents and 2625 (39.9%) female residents over the 5-year study period. Male residents reported 1128.56 (SD ± 168.32) cases versus 1091.38 (±145.98) cases reported by females (difference = 37.18, P < 0.001). When looking at surgeon chief and teaching assistant cases, there was no significant difference noted between cases submitted by URiM versus non- URiM residents. However, male residents reported significantly more in both categories than their female peers ( P < 0.001). Overall, URiM residents submitted fewer cases in the 5-year study period than their non-URiM peers. The gap in submitted cases between male and female residents was more pronounced, with male residents submitting significantly more cases than their female counterparts. This finding was consistent and statistically significant throughout the entire study period, in most case categories, and without narrowing of difference over time. A difference of 30 to 40 cases can amount to 1 to 3 months of surgical training and is a concerning national trend deserving the attention of every training program and our governing institutions.

The cost-effectiveness of reusable flexible ureteroscopes: An institutional audit.

A flexible ureteroscope (FU) is an important tool in the urologist's armamentarium. This study aims to check the durability and cost-effectiveness of conventional FU. The institution registry of damaged FU over the last 7 years was reviewed. A total of 17 flexible scopes were used. The data of 13 scopes (11 Storz fiberoptic and 2 Seesheen digital) are included in this study. A total of 1905 cases were performed. The cost of scope, duration of use, number of cases done by each scope, and nature of damage were evaluated. We compared the cost-effectiveness of conventional scopes with published costs on disposable scopes. The mean number of cases done by fiberoptic scope was 159 (range 25-334). The total cases done by 2 digital scopes were 135 and 25. The mean life of fiberoptic and digital scopes was 17 (range 4-31) and 8 months, respectively. The mean cost of fiberoptic scope was Indian Rupee (INR) 338,951 ($4082.7221) and INR 525,000 ($6323.7138) for digital scope. The cost per case for reusable scope is calculated by dividing the mean cost of FU by the mean number of cases done. The reprocessing cost of INR 527 was then added. Thus, the average cost per procedure for fiberoptic and digital FU was INR 2658.76 and INR 7089.50, respectively. We compared this cost with a projected cost of disposable FUbased on today's market data, which ranged from INR 60,000 to 107,427. The reusable scopes are durable, cost-effective, and an excellent option for high case-load institutions.

Goos–Hänchen shifts on spin representation

We analyze the Goos–Hänchen (GH) shift and longitudinal spin splitting (LSS) at a planar interface between two optical media in the spin representation. While these optical effects have been studied previously, we examine the direct and cross-reflected light fields, and their interference from the spin representation to reveal the physical mechanism of the GH shift and establish a quantitative relationship between it and LSS. Furthermore, we show that angular asymmetric spin splitting occurs under the spin representation when linearly polarized light with a phase difference of 180° and an amplitude ratio angle deviating from 45° impinges on the air–glass interface at Brewster’s angle. Finally, we reveal that the spin component field of the reflected light field for the total reflection case is different from that of the Brewster angle reflection, the most typical manifestation is that the intensity of the two spin component fields is not equal.

Surgical Management of Achilles Tendon Ruptures in the United States 2006-2020, an ABOS Part II Oral Examination Case List Database Study.

In correlation with a growing body of evidence regarding nonoperative management for Achilles tendon rupture (ATR), studies from Europe and Canada have displayed a decreasing incidence in surgical management, which has not been noted in the United States. The primary objective of this study is to evaluate the US trend in ATR repair volume. The American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination Case List Database was used. All cases using Current Procedural Terminology codes for primary ATR repair were requested from the years 2006-2020. Total submitted Achilles repair volume, the number of candidates submitting an Achilles repair case, and the overall submitted case volume per examination year was analyzed. Poisson and linear regressions were used to determine statistically significant trends. The total number of Achilles repair cases submitted for the ABOS Part II Oral Examination significantly increased from 2006 to 2011 and then decreased until 2020. Taking Achilles repair cases as a proportion of total orthopaedic cases submitted, the same trend was seen. The number of candidates submitting an Achilles repair case increased from 2006 to 2009 and then decreased until 2020. Foot and Ankle fellowship-trained candidates submitted an increasing number of ATR repair cases per candidate during the time period studied. This is the first study to demonstrate a decline in the volume of ATR repair in the United States. The decline in ATR repair volume seen in the ABOS Part II Case Lists does not match previously published US surgeon practice patterns but is not necessarily generalizable to beyond this period. Although the overall ATR repair volume in the ABOS Part II Case Lists is decreasing, we found Foot and Ankle fellowship-trained surgeons are operating on an increasing number of ATRs during their board collection period. Level III, retrospective cohort study.

Intramyometrial and intravenous oxytocin compared to intravenous carbetocin for prevention of postpartum hemorrhage in elective cesarean section-A quasi-randomized controlled phase IV non-inferiority interventional trial.

Our objective was to assess non-inferiority of the unique approach used in our institution of combined 10 IU IM (intramyometrial) and 10 IU IV (intravenous) oxytocin to carbetocin IV in preventing severe postpartum blood loss in elective cesarean sections. The design was a prospective controlled phase IV non-inferiority interventional trial. The setting was a tertiary center at University Hospital, Zurich, Switzerland. The population consisted of 550 women undergoing elective cesarean section after 36 completed weeks of gestation at low risk for postpartum hemorrhage (PPH). Participants were assigned to either combined oxytocin regimen (10 IU IM and 10 IU IV) or carbetocin (100 μg IV). Non-inferiority for oxytocin for severe PPH was assessed with a 0.05 margin using the Newcombe-Wilson score method. The main outcome measures were severe postpartum blood loss defined as delta hemoglobin (∆Hb, Hb prepartum-Hb postpartum) ≥30 g/L. Non-inferiority of combined oxytocin (IM/IV) in preventing severe postpartum blood loss was not shown (17 women in the oxytocin group vs. 7 in the carbetocin group). The number needed to treat when using carbetocin was 28. The risk difference for ∆Hb ≥30 g/L was 0.04 (oxytocin 0.06 vs. 0.03), 95% confidence interval (CI) (0.00-0.08). No significant difference was observed for ∆Hb (median 12 [IQR 7.0-19.0] vs. 11 [5.0-17.0], p = 0.07), estimated blood loss (median 500 [IQR 400-600] vs. 500 [400-575], p = 0.38), or the PPH rate defined as estimated blood loss ≥1000 mL (12[4.5] vs. 5 [2.0], risk difference 0.03, 95% CI (-0.01 to 0.06), p = 0.16). More additional uterotonics were administered in the oxytocin group compared to the carbetocin group (15.2% vs. 5.9%, p = 0.001). Total case costs were non-significantly different in the oxytocin group (US $ 10 146 vs. 9621, mean difference 471.4, CI (-476.5 to 1419.3), p = 0.33). Combined (IM/IV) oxytocin is not non-inferior to carbetocin regarding severe postpartum blood loss defined as postpartum Hb decrease ≥30 g/L in elective cesarean sections. We recommend carbetocin for use in clinical practice for elective cesarean sections.

Impact of Updating Surgical Instrumentation Preference Cards on Operating Room Operations

Hospital systems across the United States have implemented quality improvement initiatives designed to mitigate unnecessary waste and decrease healthcare costs that are frequently passed on to patients. One key source of waste is excess sterile instrumentation in surgical operating rooms. This quality improvement project identified waste by auditing and updating surgical instrumentation preference cards (SIPCs) for the three most common procedures at a multi-center academic health system. Unnecessary items were recorded and savings calculated using 2022 supplier price data. Forty-nine procedures were audited, resulting in changes to 111 unique SIPCs. Although this process produced significant savings for the health system, it was limited to fewer than 10% of the total cases performed. Total savings were observed at $337,007 with savings of $56,254 for open instrumentation. A manual audit of all SIPCs across the institution and regular updates has the potential to decrease instrumentation waste and annual expenditures by approximately $4 million.

Poster 397: Orthopaedic Injury Analysis Among Male and Female High School and Collegiate Aged Soccer Players Presenting to United States Emergency Departments

Objectives: Soccer is the second most played sport in America by participation, with upwards of 12 million players nationally in 2018. A majority of those athletes are adolescents and young adults, with 71% of players falling between the ages of 6 and 24. This study aimed to determine if any injury profile differences exist in the intra- and post-COVID eras between male and female soccer players in both high school and college. Methods: Deidentified Emergency Department data for the years 2020-2022 were queried using the Consumer Product Safety Commission's National Electronic Injury Surveillance System (CPSC NEISS). The raw data was further stratified for a high school age range of 13-17 and a college age range of 18-24. Each of these age ranges were filtered for diagnosis codes 52, 55, 57, and 64 correlating with concussions, dislocations, fractures, and sprains/strains, respectively. The location filter was set to code 9 for a location of sports and recreation. Using the narrative filter, the resultant cases were limited to those that mentioned “soccer”. The identified patient data for each year was collated for total case counts. A Test of Equal Proportions with a Yates Continuity Correction was performed to compare the rate of individual and categorized injuries by sex within each age range and within the same sex between age groups. Results: There were 693, 1371, and 1524 injuries in 2020, 2021, and 2022 respectively, for a total of 3588 injuries. Using statistical weights, this translated to a national estimate of 88,576 soccer-related injuries over that timeframe. Categorically, in each of the three years, males had a higher proportion of fractures when compared to females in the 13-17 age range (p&lt;0.001), while the high school aged females sustained a significantly higher proportion of concussions and sprains/strains (p&lt;0.001). Per specific injury, males experienced a greater rate of clavicular, isolated radial, wrist, nonspecific forearm, finger, and nonspecific lower leg fractures than females aged 13-17 (p&lt;0.001, p&lt;0.027, p&lt;0.001, p&lt;0.001, p&lt;0.025, p&lt;0.029). Conversely, high school aged females were diagnosed with knee and ankle sprains/strains at a higher rate than their male counterparts (p&lt;0.012, p&lt;0.001). There were no significant injury profile differences between college aged male and female soccer athletes. When comparing high school versus college aged males, those in the 13-17 group experienced a larger rate of fractures and concussions, while those in the 18-24 group experienced a greater proportion of dislocations and sprains/strains (p&lt;0.001, p&lt;0.037, p&lt;0.004, p&lt;0.001). College aged males were diagnosed with higher rates of shoulder dislocations, skull fractures, finger fractures, knee sprains/strains, and ankle sprains/strains when compared to their younger counterparts (p&lt;0.001, p&lt;0.007, p&lt;0.001, p&lt;0.001, p&lt;0.05). On the other hand, high school aged male soccer players proportionally sustained more isolated radial, nonspecific forearm, wrist, and pelvic fractures (p&lt;0.001, p&lt;0.001, p&lt;0.002, p&lt;0.002). The only significant difference between high school and college aged females were higher rates of concussions in the 13-17 age group, whereas 18-24 year olds experienced a larger proportion of skull fractures (p&lt;0.01, p&lt;0.01). Conclusions: Since 2020, high school aged males experienced a significantly higher rate of fractures, whereas their female counterparts sustained a larger proportion of concussions and sprains/strains. Within males across all age ranges, higher rates of concussions and fractures were found in adolescents, whereas college males were more often diagnosed with dislocations and sprains/strains. Within females across all ages, high school soccer players experienced a larger proportion of concussions, while college players were diagnosed with a higher rate of skull fractures. Injury profiles between males and females soccer players in college showed no significant differences. Current literature surrounding age and skill-level based soccer injury profiling is limited, with most data reflective of the previous two decades. Our findings allow for insight on the intra- and post-COVID athlete, highlighting potential areas for injury prevention based on sex and age, while underscoring injuries of high clinical suspicion commonly seen in soccer players presenting to US emergency departments.

Evaluation of Sphenoid Sinus Pneumatization Subtypes in Posteroanterior and Lateral Directions on CT Imaging

Background: Sphenoid sinus (SS) variations are diverse, and identifying them before transsphenoidal interventions is essential. The gold standard imaging method for assessing the morphological characteristics of the SS is computed tomography (CT), which yields valuable information. Objectives: This study used CT imaging to evaluate SS pneumatization in the Turkish population's posteroanterior (PA) and lateral directions. Methods: Head CT images of 509 cases in total were evaluated retrospectively. Initially, SS types were determined based on PA pneumatization. Afterward, the new classification was used, and SS pneumatizations were defined in the lateral direction accordingly. Results: According to PA pneumatization, conchal (0.6%), presellar (16.7%), sellar (66.4%), and post-sellar pneumatization (16.3%) were detected. Accordingly, the relationship between SS type and gender was insignificant (P = 0.354). When the lateral type pneumatization classification was used, the right lateral body (39.9%) and left lateral body (32.2%) were found to be the most common types. The relationship between SS lateral-type pneumatization and gender was insignificant (P = 0.388). Conclusions: Sphenoid sinus pneumatization shows significant individual variability, which is beneficial to evaluate before surgery. In addition, more information was obtained about pneumatization using lateral direction typing as a new classification.

Mechanisms of resistance to trastuzumab in HER2-positive gastric cancer.

Gastric cancer is one of the most prevalent cancers worldwide, and human epidermal growth factor receptor 2 (HER2)-positive cases account for approximately 20% of the total cases. Currently, trastuzumab + chemotherapy is the recommended first-line treatment for patients with HER2-positive advanced gastric cancer, and the combination has exhibited definite efficacy in HER2-targeted therapy. However, the emergence of drug resistance during treatment considerably reduces its effectiveness; thus, it is imperative to investigate the potential mechanisms underlying resistance. In the present review article, we comprehensively introduce multiple mechanisms underlying resistance to trastuzumab in HER2-positive gastric cancer cases, aiming to provide insights for rectifying issues associated with resistance to trastuzumab and devising subsequent treatment strategies.

Therapeutic Options in Hydatid Hepatic Cyst Surgery: A Retrospective Analysis of Three Surgical Approaches.

Hydatid disease is endemic in certain geographical areas where animal breeding is common, frequently challenging the medical services in these regions. Hydatid cysts most often affect the liver, with damage to other organs accounting for around one-third of the total cases. The alternative to interventional or pharmacological approaches is surgical treatment, available in variants such as laparoscopy, laparoscopy with special instruments for hydatid disease, or open surgery. This article aims to analyze the outcomes of these three types of surgical approaches, considering preoperative indications, operative techniques and efficiency, and immediate and long-term postoperative results. A total of 149 patients from two different surgical units were analyzed over a period of seven years. It was observed that males were more affected by this pathology (53.02%), with the majority of patients coming from rural areas (62.42%). The distribution by surgical procedure type showed that 50.34% were operated on using open surgery, 33.56% by means of a laparoscopic approach with the usual instruments, and 16.11% by means of a laparoscopic approach with special instruments. The laparoscopic procedure with special instruments presented a lower rate of conversion to open surgery compared to the usual laparoscopic approach (p = 0.014). The analysis of the average operative duration revealed statistically significant differences between the three types of surgical techniques (p < 0.05), noting that interventions with specialized instruments had the shortest duration, while open surgery had the longest operative time (72.5 ± 27.23 min vs. 154 ± 52.04 min). In terms of intraoperative complications, they were documented in 8.34% of cases for the group operated on with special instruments, in 12.24% of cases for the standard laparoscopy group, and in 16% of cases for the open surgery group. Maximal cystectomy was the preferred method for resolving these cysts using minimally invasive surgery (p < 0.001), while Lagrot pericystectomy was preferred in the open approach (p < 0.001). The most frequent postoperative complication was biliary fistula (24.16%), encountered in varying percentages across each technique but without significant statistical difference (p > 0.05). Open surgery was associated with a longer length of hospitalization compared to minimally invasive procedures (p < 0.05), a higher number of late postoperative complications (p = 0.002), and a significantly higher number of recurrences (p < 0.001) compared to the other two techniques. The present study highlights the effectiveness of minimally invasive surgery for hydatid cysts as a safe alternative with fewer complications and superior results compared to open surgery. Additionally, it provides a comparative analysis of these surgical approaches (special instruments, standard laparoscopy, and open surgery) to hydatid disease for the first time. Under the circumstances where pharmacological treatment is recommended as a supportive measure before and after procedures, and using medication alone as the primary treatment option shows only modest efficacy, there is a necessity to consider invasive treatment methods. Percutaneous procedures represent the least invasive form of treatment, yielding results comparable to surgery in terms of efficacy. However, their effectiveness is influenced by factors such as the cyst's stage of development, its location, and the challenges in achieving complete intra-procedural isolation. Laparoscopy, particularly when using specialized instruments tailored to the tactical and technical demands of managing hydatid disease, serves to address the limitations of percutaneous methods. Open surgery's role is increasingly restricted, primarily serving as a fallback option in laparoscopic procedures or in cases complicated by hydatid disease. In conclusion, despite the rising popularity of percutaneous methods, surgery remains a viable therapeutic option for treating hydatid disease. Minimally invasive surgical interventions are increasingly versatile and yield comparable outcomes, further solidifying the role of surgery in its management.