Desfechos obstétricos adversos durante a COVID-19: uma série de casos retrospectiva / Adverse obstetric outcomes during COVID-19: a retrospective case series / Resultados obstétricos adversos durante el COVID-19: serie de casos retrospectiva

Objetivo: analisar as características e os desfechos obstétricos adversos em gestantes/puérperas infectadas pelo SARS-CoV-2 em serviço de referência. Método: série de casos retrospectiva entre gestantes com Covid-19 em um hospital universitário em Minas Gerais, Brasil, atendidas no serviço de 2020 a 2021, coletados em abril de 2022, empregando-se estatística descritiva para análise dos dados através do Statistical Package for the Social Science. Resultados: incluídas 26 gestantes, em sua maioria brancas, que tiveram como principais desfechos obstétricos adversos a internação em UTI (43,5%), parto prematuro (34,6%), dado reestratificado de semanas para dias para investigar o encurtamento da gestação, onde constatou-se média de 38,6 dias potenciais de gravidez perdidos dos 280 dias ideais, e ainda 15,4% evoluíram para óbito materno. Conclusão: o estudo proporcionou evidenciar a necessidade de vigilância e atenção às gestantes com foco nos principais desfechos adversos, podendo-se intervir em tempo oportuno para diminuir adversidades.

Objective: to analyze the characteristics and adverse obstetric outcomes in pregnant/puerperal women infected by SARS-CoV-2 at a reference service. Method: a retrospective case series conducted among pregnant women with Covid-19 in a university hospital from Minas Gerais, Brazil, treated at the service from 2020 to 2021. The cases were collected in April 2022 employing descriptive statistics for data analysis in the Statistical Package for the Social Science. Results: a total of 26 pregnant women were included, mostly white-skinned, whose main adverse obstetric outcomes were admission to the ICU (43.5%), premature birth (34.6%) and data restratified from weeks to days to investigate shortening of pregnancy, where a mean of 38.6 potential days of pregnancy were lost out of the ideal 280 days, and 15.4% resulted in maternal death. Conclusion: the study provided evidence of the need for surveillance and care for pregnant women with a focus on the main adverse outcomes, enabling timely intervention to reduce adversities.

Objetivo: analizar las características y resultados obstétricos adversos en gestantes/puérperas infectadas por SARS-CoV-2 en un servicio de referencia. Método: serie de casos retrospectiva entre gestantes con Covid-19 en un hospital universitario de Minas Gerais, Brasil, atendidas en el servicio de 2020 a 2021. Los datos se recolectaron en abril de 2022, se utilizó estadística descriptiva para analizar los datos mediante el Statistical Package for the Social Science. Resultados: se incluyeron 26 gestantes, la mayoría de raza blanca, cuyos principales resultados obstétricos adversos fueron ingreso a UCI (43,5%), parto prematuro (34,6%), dato reestratificado de semanas a días para investigar el acortamiento de la gestación, que arrojó como resultado un promedio de 38,6. Se comprobó que se perdieron en promedio 38,6 días potenciales de embarazo de los 280 días ideales, y muerte materna (15,4%). Conclusión: la evidencia que proporcionó el estudio indica que es necesario vigilar y atender a las gestantes enfocándose en los principales resultados adversos, lo que permite intervenir de forma oportuna para reducir adversidades.

Uso y complicaciones del cateterismo urinario en salas de cuidados moderados de un hospital universitario

Introducción: El cateterismo urinario es un procedimiento frecuente y en ocasiones es utilizado por fuera de las indicaciones aceptadas para el mismo. Esto aumenta el riesgo de complicaciones vinculadas a su uso, por lo que pueden ser prevenibles. El objetivo del estudio es conocer las características del uso de cateterismo urinario en pacientes ingresados en salas de cuidados moderados de un hospital universitario del tercer nivel de atención, determinar la frecuencia, duración e indicaciones más frecuentes, así como evaluar la presencia de complicaciones asociadas al mismo Metodología: Estudio de corte transversal, realizado en salas de cuidados moderados de un hospital terciario y universitario de Montevideo, Uruguay, el 21 de diciembre de 2022. Se incluyeron pacientes hospitalizados que presentaban o presentaron catéter vesical en la presente internación y se completó la recolección de variables mediante la revisión de la historia clínica. Resultados: De 155 pacientes ingresados en salas de cuidados moderados, a 26 (16,7%) les fue colocado un catéter urinario. La mediana de edad fue 61 años, 80% eran de sexo masculino. La mediana de internación fue de 22 días. En todos los pacientes se utilizó sonda vesical y el 54% fue colocado en el Departamento de Emergencia. En el 46% de los pacientes no se encontró indicación escrita de colocación en la historia clínica. En 50% de los casos no está especificado el motivo de indicación de sonda vesical, mientras que las indicaciones identificadas más frecuentes fueron el control de diuresis (27%) y la desobstrucción de vía urinaria baja (23%). La duración de cateterismo fue de una mediana de 13,5 días, mientras que el 27% de los pacientes la usaron más de 30 días. 35% de los pacientes presentaron complicaciones vinculadas a la sonda vesical, en su mayoría no infecciosas (27%) y 15% presentaron infección urinaria. Estos pacientes tuvieron una duración de cateterismo mayor a los que no presentaron complicaciones (23 vs 10 días, p=0,411). Conclusiones: El catéter vesical fue utilizado en un porcentaje no despreciable de pacientes ingresados en salas de cuidados moderados, de forma prolongada y frecuentemente sin indicación precisa, lo cual expone a un riesgo aumentado de complicaciones vinculadas.

Introduction: Urinary catheterization is a frequent procedure and is sometimes used outside of its accepted indications. This increases the risk of complications related to its use, so they may be preventable. The objective of this study is to know the characteristics of the use of urinary catheterization in patients admitted to moderate care wards of a tertiary care university hospital, to determine the frequency, duration and most frequent indications, as well as to evaluate the presence of associated complications. Methodology: Cross-sectional study, carried out in moderate care wards of a tertiary care and university hospital in Montevideo, Uruguay, on December 21, 2022. Hospitalized patients who present or presented a bladder catheter during the present hospitalization were included, and the collection of variables was completed by reviewing the medical history. Results: Of 155 patients admitted to moderate care wards, 26 (16.7%) had a urinary catheter placed. The median age was 61 years, 80% were male. The median hospitalization was 22 days. In all patients a bladder catheter was used and 54% were placed in the Emergency Department. In 46% of the patients, no written indication for placement was found in the clinical history. In 50% of cases, the reason for indicating the bladder catheter is not specified, while the most frequent indications identified were diuresis control (27%) and lower urinary tract obstruction (23%). The duration of catheterization was a median of 13.5 days, while 27% of the patients used it for more than 30 days. 35% of the patients presented complications related to the bladder catheter, mostly non-infectious (27%) and 15% presented urinary tract infection. These patients had a longer duration of catheterization than those without complications (23 vs 10 days, p=0,411). Conclusions: The bladder catheter was used in a non-negligible percentage of patients admitted to moderate care wards, for a long time and often without a precise indication, which exposes them to an increased risk of related complications.

Introdução: O cateterismo urinário é um procedimento frequente e às vezes é usado fora de suas indicações aceitas. Isso aumenta o risco de complicações relacionadas ao seu uso, portanto, podem ser evitáveis. O objetivo deste estudo é conhecer as características do uso do cateterismo urinário em pacientes internados em enfermarias de cuidados moderados de um hospital universitário terciário, determinar a frequência, duração e indicações mais frequentes, bem como avaliar a presença de complicações associadas ao mesmo. Metodologia: Estudo transversal, realizado em quartos de cuidados moderados de um hospital terciário e universitário em Montevidéu, Uruguai, em 21 de dezembro de 2022. Foram incluídos pacientes que apresentaram ou apresentaram sonda vesical durante a internação atual e a coleta de variáveis ​​foi concluída .revisando o histórico médico. Resultados: Dos 155 pacientes admitidos em enfermarias de cuidados moderados, 26 (16,7%) tiveram um cateter urinário colocado. A idade média foi de 61 anos, 80% eram do sexo masculino. A mediana de internação foi de 22 dias. Em todos os doentes foi utilizada sonda vesical e 54% foram internados no Serviço de Urgência. Em 46% dos pacientes, nenhuma indicação escrita para colocação foi encontrada na história clínica. Em 50% dos casos não é especificado o motivo da indicação da sonda vesical, enquanto as indicações mais frequentes identificadas foram controle da diurese (27%) e desobstrução do trato urinário inferior (23%). A duração do cateterismo foi em média de 13,5 dias, enquanto 27% dos pacientes o utilizaram por mais de 30 dias. 35% dos pacientes apresentaram complicações relacionadas ao cateter vesical, em sua maioria não infecciosas (27%) e 15% apresentaram infecção urinária. Esses pacientes tiveram uma duração mais longa de cateterismo do que aqueles sem complicações (23 vs 10 dias, p=0,411). Conclusões: A sonda vesical foi utilizada em percentual não desprezível de pacientes internados em quartos de cuidados moderados, por tempo prolongado e muitas vezes sem indicação precisa, o que os expõe a um risco aumentado de complicações associadas.

Challenges in Implementing a Total Hip Arthroplasty Program in a Developing Country: Our Experience at Monkole Hospital in the Democratic Republic of Congo. / Desafíos al implementar un programa de Artroplastia Total de Cadera en un país en vías de desarrollo: Nuestra Experiencia en el Hospital Monkole de la República Democrática del Congo.

BACKGROUND AND OBJECTIVES: Total hip arthroplasty (THA) is an effective surgery for treating hip osteoarthritis, but access is limited in Sub-Saharan Africa due to multiple challenges. This article describes the implementation of a THA program at Monkole Hospital in the Democratic Republic of Congo, focusing on the technical challenges and surgical complications. The objective is to share our experience to assist other professionals and organizations in similar settings. MATERIALS AND METHODS: Eight THA surgery campaigns were conducted between July 2019 and February 2023. Most patients presented with femoral head necrosis secondary to sickle cell anemia. Demographic and surgical data, technical difficulties, and complications were prospectively collected, and follow-up was conducted by a local orthopedic surgeon. RESULTS: Seventy-three surgeries were performed on 63 patients with a mean age of 34 years and an average follow-up of 24 months. Seventeen intraoperative technical incidents (23.2%) were observed. The postoperative complication rate was 9.5%, and three patients required revision surgery due to complications. CONCLUSIONS: The THA program at Monkole Hospital demonstrates that it is feasible to perform complex surgeries in developing countries and that it is a cost-effective procedure that improves patients' quality of life, provided there are adequate hospital infrastructures, team training, availability of implants, and ensured proper care and follow-up. Training local surgeons and investing in resources are key to the sustainability of the program and the improvement of surgical care.

Extracranial Complications in Monitored and Non-Monitored Patients with Traumatic Brain Injury in the BEST TRIP Trial and a Companion Observational Cohort.

INTRODUCTION: Extracranial complications occur commonly in patients with traumatic brain injury (TBI) and can have implications for patient outcome. Patient-specific risk factors for developing these complications are not well studied, particularly in low and middle-income countries (LMIC). The study objective was to determine patient-specific risk factors for development of extracranial complications in TBI. METHODS: We assessed the relationship between patient demographic and injury factors and incidence of extracranial complications using data collected September 2008-October 2011 from the BEST TRIP trial, a randomized controlled trial assessing TBI management protocolized on intracranial pressure (ICP) monitoring versus imaging and clinical exam, and a companion observational patient cohort. RESULTS: Extracranial infections (55%), respiratory complications (19%), hyponatremia (27%), hypernatremia (27%), hospital acquired pressure ulcers (6%), coagulopathy (9%), cardiac arrest (10%), and shock (5%) occurred at a rate of ≥5% in our study population; overall combined rate of these complications was 82.3%. Tracheostomy in the intensive care unit (p<0.001), tracheostomy timing (p=0.025), mannitol and hypertonic saline doses (p<0.001), brain-specific therapy days and brain-specific therapy intensity (p<0.001), extracranial surgery (p<0.001), and neuroworsening with pupil asymmetry (p=0.038) were all significantly related to the development of one of these complications by univariable analysis. Multivariable analysis revealed ICP monitor use and brain-specific therapy intensity to be the most common factors associated with individual complications. CONCLUSIONS: Extracranial complications are common following TBI. ICP monitoring and treatment are related to extra-cranial complications. This supports the need for reassessing the risk-benefit balance of our current management approaches in the interest of improving outcome.

Respiratory Aspects of Primary Ciliary Dyskinesia.

This review article explores the respiratory aspects of primary ciliary dyskinesia (PCD), a rare, heterogenous, genetic disorder characterized by impaired motile ciliary function. It discusses the clinical diagnosis and management strategies for PCD-related respiratory disease, including chronic sinusitis, otitis media with effusion, recurrent pneumonia, and bronchiectasis. The review emphasizes the need for a multidisciplinary approach to optimize care and clinical trials to improve outcomes in individuals with PCD, highlighting the importance of accurate diagnosis.

Full weight bearing after internal fixation of isolated distal fibular fractures with anatomically contoured locking plates: Our institutional experience.

Isolated fractures of the distal fibula mainly affect young, active people. In most cases, fixation is by open reduction with or without casting for six weeks without weight bearing. The current trend is to reduce this period of non-weight-bearing in order to promote earlier functional rehabilitation. The improved mechanical stability resulting from the use of plates with locking screws has changed the postoperative management of many fractures, but there is little evidence for the ankle. Between October 2013 and August 2015, 36 patients were enrolled in a prospective study to evaluate the performance of internal fixation of isolated distal fibular fractures using a lateral anatomically contoured titanium locking plate (InitialA® plate from Newclip Technics, Haute Goulaine, France) with immediate mobilisation and full weight bearing. No patient required further surgery due to mechanical failure or non-union. The bone healing rate was 100 % at 3 months. Two patients had septic complications requiring plate removal and antibiotic treatment and were eventually cured. The use of anatomically contoured locking plates provides strong and stable fixation, allowing immediate full weight-bearing. Such a technique has the advantage of a short recovery time and an early return to work without additional complications.

Inflammatory Bowel Disease as a Risk Factor for Complications and Revisions Following Lumbar Discectomy.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Patients with IBD are at an increased risk for postoperative complications following surgery. The goal of this study is to investigate if inflammatory bowel disease (IBD) is a risk factor for complications following lumbar discectomy. METHODS: We identified IBD patients who underwent lumbar discectomy for lumbar disc herniation (LDH) and matched to them with controls without IBD in a1:5 ratio. We excluded patients with a history of spinal injury, cancer, infection, trauma, or surgery to remove the digestive tract. We used multivariate logistic regression analyses to compare postoperative outcomes, including 90-day complications, 90-day emergency department visits, and 90-day readmissions. In addition, 2-year re-discectomy rates and a 3-year lumbar fusion rate were compared between the cohorts. RESULTS: After applying the study criteria, we identified 6134 IBD patients with LDH for further analysis. With the exception of dura tears, patients with IBD had significantly higher rates of medical complications, incision-related complications, ED visits, and readmission rates compared to patients without IBD, especially for the 2-year and 3-year rates of disc recurrence and revision surgery. CONCLUSIONS: Patients with IBD who underwent lumbar discectomy are at a significantly higher rate of complications. Therefore, spine surgeons and other health care providers should be aware of this higher risk associated with IBD patients and properly treat the patients' IBD before surgery to lower these risks.

The potential of glucose management indicator for the estimation of glucose disposal rate in people with type 1 diabetes.

BACKGROUND AND AIMS: Insulin resistance is a growing feature in type 1 diabetes (T1D). It can be quantified by calculating the estimated glucose disposal rate (eGDR) with the Epstein's formula, which includes laboratory-measured glycated hemoglobin (HbA1c). We aimed the current research to assess the agreement between the conventional eGDR formula and an alternative one (eGDR-GMI) incorporating the glucose management indicator (GMI) derived from continuous glucose monitoring (CGM). We also explored the relationship between eGDR-GMI, cardiovascular risk factors, and the prevalence of diabetes-related complications. METHODS AND RESULTS: We designed a cross-sectional study that included adults with T1D. eGDR-GMI and eGDR (mg/kg/min) were calculated using GMI or HbA1c, waist circumference, and hypertensive state. Clinical data were collected from electronic medical records. The analyses encompassed 158 participants with a mean age of 39 ± 13 years. The Bland-Altman analysis showed a good agreement between eGDR-GMI and eGDR. When we divided participants in eGDR-GMI tertiles we found a higher prevalence of diabetes-related complications and a less favorable metabolic profile in the lowest eGDR-GMI tertile. The relative risk of retinopathy, nephropathy, and neuropathy significantly increased by approximately 1 unit with each decrease in eGDR-GMI, regardless of age, sex, disease duration, lipids, and smoking habit. CONCLUSIONS: eGDR-GMI represents a valid and robust alternative to the eGDR to assess insulin resistance in T1D. Low eGDR-GMI is associated with diabetes complications and a less favorable metabolic profile. Incorporating the eGDR-GMI into clinical practice can enhance the characterization of T1D people and allow for a more personalized treatment approach.

Resective surgery for mesial temporal lobe epilepsy associated with hippocampal sclerosis in patients over 50 years: a case-control study.

BACKGROUND: Mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE/HS) is the most common cause of drug-resistant focal seizures and surgical resection is the primary treatment option, with seizure-free rates ranging from 60 to 80%. However, data on postsurgical seizure outcomes in patients ≥ 50 years of age are limited. This study aimed to assess the efficacy and safety of surgery in this age group compared to younger patients. METHODS: We performed a retrospective analysis of data from resective surgeries conducted in patients with MTLE/HS between 1990 and 2022. We focused on patients aged ≥ 50 years and compared the surgical safety and efficacy variables between this group and a control group of patients aged < 50 years through a case-control study. RESULTS: Among the 450 MTLE/HS patients who underwent surgery during the inclusion period, 61 (13.6%) were aged ≥ 50 years and matched with 183 younger patients, totaling 244 study participants. The two groups had similar characteristics. At the last follow-up (median 5.7 years), Engel I outcomes were achieved in 80.3% of the older patients and 81.4% of the younger patients, with no significant difference (p = 0.85). Postoperative cognitive and psychiatric outcomes did not differ between the groups. Major complication rates were also comparable, at 3.3% in the older group and 2.7% in the younger group (p = 0.83). The extratemporal ictal abnormalities observed on video-EEG were the only variable that demonstrated a significant association with an unfavorable seizure outcome in the older group (OR 9.3, 95% CI [1.8-47.6], p = 0.005). CONCLUSIONS: This study provides grade 3 evidence that resective surgery for MTLE/HS patients aged ≥ 50 years is as effective and safe as it is for younger patients, and thus should be considered as the primary treatment option for drug-resistant cases.

Surgical intervention for lung cancer in patients aged 75 and above: potential associations with increased mortality rates-a single-center observational study.

BACKGROUND: Lung cancer, which is diagnosed two to three times more frequently in patients over the age of 70, is a leading cause of cancer-specific mortality. Given the elevated risk of morbidity and mortality, surgical intervention may not always be the most appropriate primary treatment option. This study aims to evaluate specific risk factors associated with postoperative morbidity and mortality in elderly patients and to optimize patient selection therefore improving surgical outcomes. PATIENTS AND METHODS: The study encompassed a cohort of 73 patients aged 75 and above who underwent surgical treatment for non-small cell lung cancer (NSCLC) at the Department of Thoracic Surgery of the P. Hertsen Moscow Oncological Research Institute between 2015 and 2021. All patients underwent preoperative evaluation, including PET/CT staging and functional assessment, carried out by a multidisciplinary team comprising thoracic surgeons, anesthesiologists, and other medical specialists. RESULTS: The investigation revealed a postoperative mortality rate of 5.5% and a postoperative morbidity incidence of 16.4%, with occurrences of atrial fibrillation in 41.6%, persistent air leak in 33.3%, and pneumonia in 25% of complicated cases. At the one-year follow-up, 88% of patients remained free from relapse, whereas at three years, this rate stood at 66%. During the follow-up period, 16 patients (22%) passed away, with a median survival duration of 44 months. Survival rates at one year, three years, and five years were 71%, 66%, and 35%, respectively. Multivariate analysis disclosed several significant factors predicting a complex postoperative period, including stage IIIb (p = 0.023), pN1 (p = 0.049), pN2 (p = 0.030), and central location (p = 0.007). Additionally, overall survival was primarily influenced by a Charlson comorbidity index of 6 (p = 0.044), stage Ia2 (p = 0.033), and the necessity for thoracotomy (p = 0.045). CONCLUSION: Each case of lung cancer in patients aged 75 and older necessitates an individualized approach. Given the higher mortality rate relative to younger patients, comprehensive risk assessment and preoperative management of underlying comorbidities are imperative, with the involvement of anesthesiologists, intensive care physicians, cardiologists, and other relevant specialists as needed.

Effective and safe pediatric sedation.

Pediatric sedation is a crucial tool for minimizing pain and anxiety during procedures and examinations in children. However, it is not without risks. This review provides a comprehensive review of pediatric sedation, including both established practices and recent advancements. A thorough pre-procedural evaluation is crucial to mitigate these risks. Skilled healthcare professionals trained in pediatric sedation are paramount to ensure a safe and effective procedure. The choice of sedative medication depends on various factors, such as the type of procedure and the patient's medical condition. Medications, used alone or in combination, offer sedation with varying onset times and durations. Non-pharmacological approaches can complement pharmacological sedation and further reduce potential complications. Preventing sedation-related complications requires a multidisciplinary approach. This includes collaborative decision-making, vigilant monitoring throughout the procedure, and a focus on patient safety. Recovery involves ensuring the child returns to their baseline status before discharge, following established criteria. In conclusion, successful pediatric sedation hinges on a comprehensive strategy. This strategy encompasses a thorough evaluation, skilled personnel, appropriate medication selection, vigilant monitoring, and a focus on patient safety throughout the process. By following these steps, we can minimize risks and achieve successful outcomes.

High comorbidity burden and low incidence of adverse events in primary shoulder arthroplasty in tertiary care at a university hospital.

Background: Reducing perioperative risk is in the focus of primary arthroplasty caregivers. Primary shoulder arthroplasty patients are considered among those with the lowest perioperative risk. Nonetheless, in tertiary care centres and university settings patients with significant comorbidities are being treated. It remains unclear whether the overall comorbidity burden is truly higher and if this results in an increased frequency of adverse events (AE). As a result, we conducted a study to assess the comorbidity burden and the frequency of major perioperative adverse events and predictive factors following primary shoulder arthroplasty in the university setting. Methods: A retrospective cohort analysis was conducted on patients undergoing primary shoulder arthroplasty for a non-trauma, non-tumour indication from January 1st, 2014 through December 31st, 2018. Administrative data were recorded to assess comorbidity burden and revision surgery within the first postoperative year. Major adverse events were routinely recorded on a weekly basis by the treating physicians. Descriptive and comparative statistical analyses were performed. The cohort was compared against a large North American sample. Results: Of 386 patients who underwent 400 primary shoulder arthroplasties 14 (3.5 %) experienced adverse events. While AE were distributed equally among anatomical and reverse shoulder arthroplasties, no adverse event was recorded in the 34 hemiarthroplasty patients. The cohort showed an increased comorbidity burden in international comparison. Peptic ulcer disease was significantly associated with AE, while mild liver disease experienced a trend towards AE. Conclusion: We found an increased comorbidity burden and a low rate of AE for primary shoulder arthroplasty in a tertiary care and university setting. The distinct role of peptic ulcer disease in this cohort and the trend in mild liver disease merit further investigation in larger samples. The findings underscore the importance of perioperative risk assessment and management. Level of evidence: III, retrospective cohort study.

Multi-organ Thromboembolic Crisis: A Case Report of Concomitant Stroke, Myocardial Infarction, and Pulmonary Embolism.

Management of acute coronary syndrome (ACS), cerebrovascular accident (CVA), and pulmonary embolism (PE) necessitates prompt intervention, as delayed treatment may lead to severe consequences. Each of these conditions presents significant challenges and carries a high risk of morbidity and mortality. We present the case of an 86-year-old female with a history of stage 4 urothelial carcinoma metastasized to the lungs, who presented to the emergency department (ED) with acute ischemic stroke (AIS), ST-segment elevation myocardial infarction (STEMI), and bilateral PE. We propose the term "multi-organ thromboembolic crisis" (MOTEC) to streamline the communication and management approach for patients experiencing critical thromboembolic events affecting multiple organ systems.

Scrotal Migration of the Ventriculoperitoneal Shunt: A Case Report and Review of the Literature.

Ventriculoperitoneal (VP) shunt placement is the most frequently used treatment for hydrocephalus. This procedure is not always free of complications, and patients may need additional surgeries to overcome these complications. We are presenting the case of a seven-month-old baby who underwent myelomeningocele repair and VP shunt placement 13 days ago and now presents with inguinal swelling extending into the scrotum. The radiological workup revealed that the peritoneal end of the VP shunt had migrated to the scrotum, causing hydrocele. The shunt was relocated to the abdomen after a right herniotomy and sac reduction. He was discharged on the second postoperative day without any complications, and the further recovery was good at three months. Scrotal migration of a VP shunt is a rare complication and can be avoided by careful early assessment of inguinal hernia or patent processus vaginalis and its surgical repair.

Patent Ductus Arteriosus in Association With Agenesis of Corpus Callosum: Syndromic Links, Difficult Airway Challenges, and Pediatric Anesthesia Management.

Agenesis of corpus callosum (ACC) is a congenital absence of corpus callosum either completely or partially; without deficits in behavior or function during the first two years of life. Patent ductus arteriosus (PDA) is a congenital cardiac defect in which there is persistent contact between the pulmonary artery and the descending thoracic aorta due to failure of the normal physiologic closure of the fetal ductus. This article details a unique case of a three-month-old male infant who was initially diagnosed with PDA and later discovered to have corpus callosum agenesis. The child was posted on a PDA device for closure. Here, we will be discussing syndromic association, difficult airway, procedure-related factors, and pediatric anesthesia management of this rare case.

Assessment of Functional Outcome and Postoperative Complications in Proximal Humerus Fracture Patients Managed With Proximal Humerus Internal Locking System (PHILOS) Plating.

BACKGROUND: Proximal humerus fractures are primarily common in the old age group. The appropriate approach to managing such displaced and comminuted fracture patterns is often questionable. Hence, this study was conducted to assess the functional outcome of proximal humerus fractures following treatment with a proximal humerus locking plate and to assess the frequency of complications in such patients. METHODOLOGY: In this robust study, 33 cases of proximal humerus fractures underwent surgical management at a prestigious teaching hospital from February 2021 to August 2022 utilizing a proximal humerus internal locking system (PHILOS) plate. The NEER classification was employed to categorize the fractures, and the NEER score was used for functional assessment. It's crucial to note that individuals with pathological fractures, associated injuries in the ipsilateral limb, nerve injuries, and cases of open fracture were rigorously excluded from the study. RESULTS: The mean age was 47 ± 5.2 years. Based on NEER's classification, the distribution of fractures was as follows: two-part fractures accounted for 18.18% (n = 6) of cases, three-part fractures for 54.54% (n = 18) of cases, and four-part fractures for 27.27% (n = 9) of cases. A history of road traffic accidents and falls was reported in 54.54% (n = 18) and 45.45% (n = 15) of cases, respectively. Functional outcome assessment utilizing NEER's score revealed a minimum score of 48 and a maximum of 96, with an average score of 82.96 ± 12.73. Notably, 39% of patients demonstrated excellent results, 27% exhibited satisfactorily, 21% manifested unsatisfactorily, and 12.12% presented failure outcomes. Of the 33 operated cases, 81.8% (n = 27) exhibited no complications during follow-up. The predominant complication observed was shoulder stiffness (9.09%, n = 3), followed by Varus mal-union (6.06%, n = 2), and superficial surgical site infection (3.03%, n = 1), managed with debridement and antibiotics leading to subsequent resolution. CONCLUSIONS: Managing proximal humerus fractures has consistently posed a formidable challenge. Our study indicates that using the PHILOS plate represents a reliable option for addressing such fractures. This plate provides sturdy fixation, facilitates early mobilization, and culminates in exceptional functional outcomes. The insights gained from this study can inform clinical decision-making and guide orthopedic surgeons in selecting the appropriate treatment strategy for proximal humerus fracture patients.

Complications and Mortality After Surgery in Patients with Chronic Kidney Disease: A Retrospective Cohort Study Based on a Multicenter Clinical Database.

Objective: To evaluate the postoperative complications and mortality among patients with chronic kidney disease. Methods: Biochemical measurements, diagnosis codes for CKD and comorbid conditions for surgical patients aged ≥20 years were obtained from electronic medical records of three large hospitals in Taiwan in 2009-2017. We conducted this retrospective cohort study by using propensity score-matching methods to balance the baseline characteristics between CKD and non-CKD groups. The multiple logistic regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of risks of primary outcome (included postoperative mortality) and secondary outcome (included postoperative infectious complications and non-infectious complications) associated with CKD. Results: Among 31950 eligible surgical patients, the adjusted OR of in-hospital mortality in patients with CKD was 5.49 (95% CI 3.42-8.81) compared with that in non-CKD controls. The adjusted ORs of postoperative septicemia, pneumonia and cellulitis in patients with CKD were 5.90 (95% CI 2.12-16.5), 5.39 (95% CI 1.37-21.16), and 4.42 (95% CI 1.57-12.4), respectively, when compared with the non-CKD patients. CKD was also associated with postoperative stroke (OR 2.21, 95% CI 1.47-3.31). Conclusion: Patients with CKD are at increased risk of postoperative stroke, infectious complications, and mortality. Our study implicated that it is crucial to improve the levels of hemoglobin and K+ in patients with CKD before surgery. Preventive strategies should be developed to improve clinical outcomes in these populations.

Effects of vitrectomy combined with internal limiting membrane peeling in patients with diabetic macular edema.

BACKGROUND: Diabetic macular edema (DME), a chronic microvascular complication of diabetes, is a leading cause of visual impairment and blindness. Pars plana vitrectomy (PPV) can restore the normal macular structure and reduce macular edema, whereas internal limiting membrane (ILM) peeling is used to treat tractional macular diseases. Despite the advantages, there is limited research on the combined effects of PPV with ILM peeling. AIM: To observe the effects of PPV combined with ILM peeling on postoperative central macular thickness (CMT), best-corrected visual acuity (BCVA), cystoid macular edema (CME) volume, and complications in patients with DME. METHODS: Eighty-one patients (92 eyes) diagnosed with DME at the Beijing Shanqu Liangxiang Hospital between January and December 2022 were randomly divided to undergo PPV alone (control group: 41 patients, 47 eyes) or PPV + ILM peeling (stripping group: 40 patients, 45 eyes); a single surgeon performed all surgeries. The two groups were compared preoperatively and 1 and 3 months postoperatively. RESULTS: Preoperatively, both groups had comparable values of CMT, BCVA, and CME volume (P > 0.05). After surgery (both 1 and 3 months), both groups showed significant reductions in CMT, BCVA, and CME volume compared to preoperative levels, with the stripping group showing more significant reductions compared to the control group (P < 0.05). Further repeated-measures ANOVA analysis for within-group differences revealed significant effects of group and time, and interaction effects for CMT, BCVA, and CME volume (P < 0.05). There were no significant differences in the incidence of complications between the groups (retinal detachment: control = 2, stripping = 1; endophthalmitis: Control = 4, stripping = 1; no cases of secondary glaucoma or macular holes; χ 2 = 0.296, P = 0.587). CONCLUSION: PPV with ILM peeling can significantly improve the visual acuity of patients with DME, reduce CMT, and improve CME with fewer complications.

Predictors of Higher Costs Following Reverse Total Shoulder Arthroplasty.

Objectives: The rising popularity of reverse total shoulder arthroplasties (RTSA) demands attention to its growing costs on the healthcare system, especially with the implementation of bundled payments. Charges associated with patients' inpatient stays can be mitigated with a better understanding of the drivers of cost following RTSA. In this study, we evaluate potential pre-operative and post-operative factors associated with higher inpatient costs following RTSA. Methods: We identified 59,925 patients who underwent RTSA using the National Inpatient Sample between 2016 and 2019. Total inpatient hospital charges were collected, and patients were divided into "normal cost" or "high cost" groups. The high cost group was defined as patients with total costs greater than the 75th percentile. Univariate and multivariate analyses were performed on pre-operative demographic and comorbidity variables as well as post-operative surgical and medical complications to predict factors associated with higher costs. T-tests and Chi-squared tests were performed, and odds ratios were calculated. Results: The mean total charges were $141.213.93 in the high cost group and $59,181.94 in the normal cost group. Following multivariate analysis, non-white patients were associated with higher costs by 1.31-fold (P<0.001), but sex and age were not. Cirrhosis and non-elective admission had higher odds of higher costs by 1.56-fold (P<0.001) and 3.13-fold (P<0.001), respectively. Among surgical complications, there were higher odds of high costs for periprosthetic infection by 2.43-fold (P<0.001), periprosthetic mechanical complication by 1.28-fold (P<0.001), and periprosthetic fracture by 1.56-fold (P<0.001). Medical complications generally had higher odds of high costs than surgical complications, with deep vein thrombosis having nearly five times (P<0.001) and myocardial infarction almost four times (P<0.001) higher odds of high inpatient costs. Conclusion: Post-operative medical complications were the most predictive factors of higher cost following RTSA. Pre-operative optimization to prevent infection and medical complications is imperative to mitigate the economic burden of RTSA's.

No Decrease in Early Survivorship of Dual Mobility Implants in Primary Total Hip Arthroplasty.

Background: Dual mobility (DM) implants in primary total hip arthroplasty (THA) have gained recent popularity; however, safety concerns persist. The purpose of this study was twofold: 1) assess trends in DM implant adoption; and 2) evaluate the impact of modular DM implants on dislocation and all-cause revision rates at short-term follow-up. Methods: This retrospective study identified patients in our institutional arthroplasty database who underwent primary posterior approach THA for degenerative conditions from November 2013 to December 2020. Patients undergoing primary THA for fracture were excluded. Patients were divided into two cohorts: modular DM and non-DM implants. Annual DM utilization and dislocation rates were recorded. Patient records were reviewed to determine implant selection and identify indications for dislocations and reoperations. Results: Institutional adoption was rapid, increasing from 3.4% in 2013 to 47.1% in 2020. Of the 4548 primary THA cases from 2013 to 2020, 2859 (62.9%) had minimum one-year follow-up data for inclusion. There were 724 (25.3%) with DM implants and 2135 (74.7%) with non-DM implants. The DM group had a significantly lower dislocation rate (0.14% vs 0.84%, P = .04), with similar all-cause revision rates (2.49% vs 2.72%, P = .74) at one-year follow-up. No cases of DM-specific complications (metallosis or intraprosthetic dislocations) were noted. Conclusions: From 2013 to 2020, DM implant utilization in primary THA steadily increased. Use of modular DM implants is associated with a decreased dislocation rate without compromised survivorship at one-year follow-up when compared to non-DM implants. No instances of modular DM-specific complications were identified; however, longer-term surveillance is necessary to verify these findings. Level of Evidence: Prognostic Level III.