scholarly journals Surgical Outcome of Exvivo Preserved Autologous Cranioplasty - A Novel Approach

2019 ◽  
Vol 16 (3) ◽  
pp. 43-49
Author(s):  
Bikram Shakya ◽  
Bidur KC ◽  
Amit Thapa
Keyword(s):  
Ex Vivo ◽  
Financial Burden ◽  
Length Of Hospital Stay ◽  
College Teaching ◽  
Bone Flap ◽  
Common Procedure ◽  
Exact Test ◽  
Primary Surgery ◽  
Institutional Review ◽  
Novel Approach

Autologous cranioplasty is an increasingly common procedure performed in neurosurgical centers following a decompressive craniectomy. Available evidence on the safety of autologous bone flap preservation and cranioplasty is limited due to a large diversity in study conducted, nature of pathology and reported outcomes. In this Institutional Review Board-approved retrospective observational study, patients who underwent neurosurgical intervention as“craniectomy followed by cranioplasty” at the Department of Neurological Surgery, Kathmandu Medical College Teaching Hospital were enrolled retrospectively from 1st May 2012 to 30th April2019. The craniectomy bone flap was preserved exvivo, dipped in spirit solution in deep freeze, then autoclaved prior to cranioplasty. Data were collected from the hospital’s electronic database. Information analyzed included patient age, sex, indication forcraniectomy, interval between craniectomy and cranioplasty, length of hospital stay, peri-operativecomplications and mean time of follow-up. Patients who underwent a cranioplasty following removal of an infected bone flap after a craniotomy were excluded from the study. Associated complications were assessed and statistical analysis was performed using a Fisher’s exact test. There were a total of 210 patients with 92vascular, 58 post traumatic. With all these surgeries undergone we had 9% complication rate, all of whom underwent cranioplasty later than four weeks of primary surgery (p = <0.0001).Ex-vivo preservation and autoclaving of bone flap is a simple technique with significant benefits in our hospital and national scenario with significantly less financial burden to patients

scholarly journals The Incidence and Causes of Unplanned Reoperations as a Quality Indicator in Pediatric Surgery

Children ◽  
2022 ◽  
Vol 9 (1) ◽  
pp. 106
Author(s):  
Miro Jukić ◽  
Ivona Biuk ◽  
Zenon Pogorelić
Keyword(s):  
Postoperative Period ◽  
Quality Indicator ◽  
Pediatric Surgery ◽  
Pediatric Patients ◽  
Length Of Hospital Stay ◽  
Common Procedure ◽  
Asa Score ◽  
Primary Surgery ◽  
Management Of Complications ◽  
Duration Of Surgery

Background: Unplanned return to the operating room (uROR) within the 30-day postoperative period can be used as a quality indicator in pediatric surgery. The aim of this study was to investigate and evaluate uROR as a quality indicator. Methods: The case records of pediatric patients who underwent reoperation within the 30-day period after primary surgery, from 1 January 2018 to 31 December 2020 were retrospectively reviewed. The primary outcome of the study was the rate of uROR as a quality indicator in pediatric surgery. Secondary outcomes were indications for primary and secondary surgery, types and management of complications, factors that led to uROR, length of hospital stay, duration of surgery and anesthesia, and starting time of surgery. Results: A total of 3982 surgical procedures, under general anesthesia, were performed during the three-year study period (2018, n = 1432; 2019, n = 1435; 2020, n = 1115). Elective and emergency surgeries were performed in 3032 (76.1%) and 950 (23.9%) patients, respectively. During the study period 19 (0.5%) pediatric patients, with the median age of 11 years (IQR 3, 16), underwent uROR within the 30-day postoperative period. The uROR incidence was 6 (0.4%), 6 (0.4%), and 7 (0.6%) for years 2018, 2019, and 2020, respectively (p = 0.697). The incidence of uROR was significantly higher in males (n = 14; 73.7%) than in females (n = 5; 26.3%) (p = 0.002). The share of unplanned reoperations in studied period was 4.5 times higher in primarily emergency surgeries compared to primarily elective surgeries (p < 0.001). The difference in incidence was 0.9% (95% CI, 0.4–1.4). Out of children that underwent uROR within the 30-day period after elective procedures, 50% had American Society of Anesthesiologists (ASA) score three or higher (p = 0.016). The most common procedure which led to uROR was appendectomy (n = 5, 26.3%) while the errors in surgical technique were the most common cause for uROR (n = 11, 57.9%). Conclusion: Unplanned reoperations within the 30-day period after the initial surgical procedure can be a good quality indicator in pediatric surgery. Risk factors associated with uROR are emergency surgery, male gender, and ASA score ≥3 in elective pediatric surgery.

scholarly journals Marker for the pre-clinical development of bone substitute materials

2017 ◽  
Vol 3 (2) ◽  
pp. 711-715
Author(s):  
Michael de Wild ◽  
Simon Zimmermann ◽  
Marcel Obrecht ◽  
Michel Dard
Keyword(s):  
Bone Graft ◽  
Mechanical Stability ◽  
Clinical Performance ◽  
Ex Vivo ◽  
Region Of Interest ◽  
Defect Site ◽  
Novel Approach ◽  
Bone Substitute Materials ◽  
Clinical Experiments

AbstractThin mechanically stable Ti-cages have been developed for the in-vivo application as X-ray and histology markers for the optimized evaluation of pre-clinical performance of bone graft materials. A metallic frame defines the region of interest during histological investigations and supports the identification of the defect site. This standardization of the procedure enhances the quality of pre-clinical experiments. Different models of thin metallic frameworks were designed and produced out of titanium by additive manufacturing (Selective Laser Melting). The productibility, the mechanical stability, the handling and suitability of several frame geometries were tested during surgery in artificial and in ex-vivo bone before a series of cages was preclinically investigated in the female Göttingen minipigs model. With our novel approach, a flexible process was established that can be adapted to the requirements of any specific animal model and bone graft testing.

scholarly journals A Novel Approach to Pharmacy Practice Law Instruction

Pharmacy ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 75
Author(s):  
Matthew Deneff ◽  
Lisa M. Holle ◽  
Jill M. Fitzgerald ◽  
Kathryn Wheeler
Keyword(s):  
Student Perceptions ◽  
Pharmacy Practice ◽  
Pharmacy Education ◽  
Survey Study ◽  
State Laws ◽  
Institutional Review ◽  
Novel Approach ◽  
Study Results ◽  
Course Changes ◽  
Main Component

Pharmacy law instruction is often taught as a didactic course; however practical application of pharmacy law is a main component of pharmacy practice. Technology-based simulations are becoming more frequently used to enhance didactic pharmacy education. The goal of this study was to evaluate the utility of and student perceptions on the usefulness of MyDispense community pharmacy simulation for additional law instruction that if successful might prompt curricular revamping. This Institutional Review Board–approved, two-year, qualitative, prospective, survey study was conducted in a case study class where students completed MyDispense exercises focused on common legal issues that arise in practice, both individually before and within groups during class. Participating students completed a qualitative survey directed at use of MyDispense for pharmacy law review, which included a series of close-ended questions graded on a Likert scale and open-ended questions thematically grouped. Thirty-eight (41%) and twenty-eight (31%) students completed surveys in 2017 and 2018, respectively. The majority of respondents felt exercises improved their understanding of pharmacy laws, focused on challenging areas, and were more interesting than additional lectures. However, certain topics were reported as irrelevant based on practice experiences or not ideal for simulation, and students desired exercises on state laws versus pharmacy policies. Students reported the MyDispense simulation exercises helped them to recall pharmacy laws and focus on topics that were challenging. These study results prompted curricular revamping to incorporate MyDispense throughout the curriculum for practice in recognizing and solving legal scenarios, along with didactic course changes.

Comparison of Clinical Outcomes With Drug Coated Balloons Versus Plain Balloon Angioplasty In Chronic Limb-Threatening Ischemia

2021 ◽  
pp. 153857442110225
Author(s):  
Joel Mathew John ◽  
Vimalin Samuel ◽  
Dheepak Selvaraj ◽  
Prabhu Premkumar ◽  
Albert A Kota ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Interventional Procedure ◽  
Tertiary Care ◽  
Arterial Disease ◽  
Multivariable Logistic Regression Analysis ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
Exact Test ◽  
Institutional Review ◽  
Chi Square Test

Objective: The use of drug coated balloon (DCB) for angioplasty has shown superior efficacy against plain balloons for treating complex infrainguinal arterial disease. We report and compare the clinical outcomes following application of DCB(Paclitaxel) and plain angioplasty (POBA) in our tertiary care centre. Methods: A retrospective, single centre analysis of 301 patients with chronic limb-threatening ischemia involving the infrainguinal segment was conducted between September 2014 and September 2018, after approval from the Institutional review board. We analyzed clinical outcomes by measuring postoperative ABI improvement, restenosis requiring reintervention procedure, minor and major amputations at the end of 18 months. . To find the association between the group variables (POBA and DCB) and other risk variables, Chi-square test/Fisher’s exact test was used. Multivariable logistic regression analysis was used. Results: Patients who underwent treatment with plain balloon (POBA) and DCB(Paclitaxel) angioplasty were 246(81.7%) and 55(18.3%) respectively. Our study group was predominantly male (Male: Female = 6.7:1), most patients were more than 50 years of age (n = 251, 83.4%). Smoking (n = 199, 66.1%) and diabetes (n = 210, 69.8%) were the most common atherosclerotic risk factors. Postoperative Ankle Brachial Pressure Index (ABI) improvement were similar in both groups (POBA = 57.7%; DCB = 69.8%; p = 0.103). Minor and major amputations following POBA were 26% and 22%; and DCB were 12.7% and 16.4% respectively. Re-stenosis requiring a re-interventional procedure within 18 months was 15%, (n = 37) following POBA; and 12.7% (n = 7) following DCB (p = 0.661). Conclusions: This retrospective study shows similar clinical limb related outcomes following POBA and DCB at 18 months. However, our comparative analysis between the POBA and DCB groups was totally unadjusted and not adjusted for common confounders such as age and sex. Hence, for one to draw definitive conclusions leading to changes in clinical practice; a randomized, prospective study with a larger patient cohort is needed.

scholarly journals Prevention of Post-Operative Adhesions: A Comprehensive Review of Present and Emerging Strategies

Biomolecules ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1027
Author(s):  
Ali Fatehi Hassanabad ◽  
Anna N. Zarzycki ◽  
Kristina Jeon ◽  
Jameson A. Dundas ◽  
Vishnu Vasanthan ◽  
...  
Keyword(s):  
Tissue Engineering ◽  
Financial Burden ◽  
Adhesion Formation ◽  
Length Of Hospital Stay ◽  
Engineering Research ◽  
Surgical Adhesions ◽  
Preventative Strategy ◽  
Underlying Mechanisms ◽  
And Personalized Medicine ◽  
Tissue Engineering Research

Post-operative adhesions affect patients undergoing all types of surgeries. They are associated with serious complications, including higher risk of morbidity and mortality. Given increased hospitalization, longer operative times, and longer length of hospital stay, post-surgical adhesions also pose a great financial burden. Although our knowledge of some of the underlying mechanisms driving adhesion formation has significantly improved over the past two decades, literature has yet to fully explain the pathogenesis and etiology of post-surgical adhesions. As a result, finding an ideal preventative strategy and leveraging appropriate tissue engineering strategies has proven to be difficult. Different products have been developed and enjoyed various levels of success along the translational tissue engineering research spectrum, but their clinical translation has been limited. Herein, we comprehensively review the agents and products that have been developed to mitigate post-operative adhesion formation. We also assess emerging strategies that aid in facilitating precision and personalized medicine to improve outcomes for patients and our healthcare system.

P–530 The use of wide thresholds for detecting intermediate chromosomal CNV up to 80% doesn’t improve PGT-A ability to discriminate true mosaic from uniformly aneuploid embryos

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
L Girardi ◽  
M Serdaroğulları ◽  
C Patassini ◽  
S Caroselli ◽  
M Costa ◽  
...  
Keyword(s):  
Inner Cell Mass ◽  
False Negative ◽  
Cell Mass ◽  
Categorical Variables ◽  
P Value ◽  
Sequencing Data ◽  
Preimplantation Genetic Testing ◽  
Exact Test ◽  
Institutional Review ◽  
Wide Range

Abstract Study question What is the effect of varying diagnostic thresholds on the accuracy of Next Generation Sequencing (NGS)-based preimplantation genetic testing for aneuploidies (PGT-A)? Summary answer When single trophectoderm biopsies are tested, the employment of 80% upper threshold increases mosaic calls and false negative aneuploidy results compared to more stringent thresholds. What is known already Trophectoderm (TE) biopsy coupled with NGS-based PGT-A technologies are able to accurately predict Inner Cell Mass’ (ICM) constitution when uniform whole chromosome aneuploidies are considered. However, minor technical and biological inconsistencies in NGS procedures and biopsy specimens can result in subtle variability in analytical results. In this context, the stringency of thresholds employed for diagnostic calls can lead to incorrect classification of uniformly aneuploid embryos into the mosaic category, ultimately affecting PGT-A accuracy. In this study, we evaluated the diagnostic predictivity of different aneuploidy classification criteria by employing blinded analysis of chromosome copy number values (CNV) in multifocal blastocyst biopsies. Study design, size, duration The accuracy of different aneuploidy diagnostic cut-offs was assessed comparing chromosomal CNV in intra-blastocysts multifocal biopsies. Enrolled embryos were donated for research between June and September 2020. The Institutional Review Board at the Near East University approved the study (project: YDU/20l9/70–849). Embryos diagnosed with uniform chromosomal alterations (single or multiple) in their clinical TE biopsy (n = 27) were disaggregated into 5 portions: the ICM and 4 TE biopsies. Overall, 135 specimens were collected and analysed. Participants/materials, setting, methods Twenty-seven donated blastocysts were warmed and disaggregated in TE biopsies and ICM (n = 135 biopsies). PGT-A analysis was performed using Ion ReproSeq PGS kit and Ion S5 sequencer (ThermoFisher). Sequencing data were blindly analysed with Ion-Reporter software. Intra-blastocyst comparison of raw NGS data was performed employing different thresholds commonly used for aneuploidy classification. CNV for each chromosome were reported as aneuploid according to 70% or 80% thresholds. Categorical variables were compared using Fisher’s exact test. Main results and the role of chance In this study, a total of 50 aneuploid patterns in 27 disaggregated embryos were explored. Single TE biopsy results were considered as true positive when they displayed the same alteration detected in the ICM at levels above the 70% or 80% thresholds. Alternatively, alterations detected in the euploid or mosaic range were considered as false negative aneuploidy results. When the 70% threshold was applied, aneuploidy findings were confirmed in 94.5% of TE biopsies analyzed (n = 189/200; 95%CI=90.37–37.22), while 5.5% showed a mosaic profile (50–70%) but uniformly abnormal ICM. Positive (PPV) and negative predictive value (NPV) per chromosome were 100.0% (n = 189/189; 95%CI=98.07–100.00) and 99.5% (n = 2192/2203; 95%CI=99.11–99.75) respectively. When the upper cut-off was experimentally placed at 80% of abnormal cells, a significant decrease (p-value=0.0097) in the percentage of confirmed aneuploid calls was observed (86.5%; n = 173/200; 95%CI=80.97–90.91), resulting in mosaicism overcalling, especially in the high range (50–80%). Less stringent thresholds led to extremely high PPV (100.0%; n = 173/173; 95%CI=97.89–100.00), while NPV decreased to 98.8% (n = 2192/2219; 95%CI=98.30–99.23). Furthermore, no additional true mosaic patterns were identified with the use of wide range thresholds for aneuploidy classification. Limitations, reasons for caution This approach involved the analysis of aneuploidy CNV thresholds at the embryo level and lacked from genotyping-based confirmation analysis. Moreover, aneuploid embryos with known meiotic partial deletion/duplication were not included. Wider implications of the findings: The use of wide thresholds for detecting intermediate chromosomal CNV up to 80% doesn’t improve PGT-A ability to discriminate true mosaic from uniformly aneuploid embryos, lowering overall diagnostic accuracy. Hence, a proportion of the embryos diagnosed as mosaic using wide calling thresholds may actually be uniformly aneuploid and inadvertently transferred. Trial registration number N/A

scholarly journals A novel approach: combining dental enamel hypoplasia and paleoparasitological analysis in medieval Islamic individuals buried in Santarém (Portugal)

2017 ◽  
pp. 111-133 ◽  
Author(s):  
Daniela Cunha ◽  
Ana Luísa Santos ◽  
António Matias ◽  
Luciana Sianto
Keyword(s):  
Physiological Stress ◽  
Intestinal Parasites ◽  
Dental Enamel ◽  
Optical Microscope ◽  
Enamel Hypoplasia ◽  
Exact Test ◽  
Helminth Infections ◽  
Novel Approach ◽  
Linear Enamel Hypoplasia ◽  
Long Term Impact

Paleopathological and paleoparasitological studies seek evidences to understand health and disease in past populations. These two approaches are often used independently despite the obvious importance of its complementary. This paper aims to explore the possible relation between a common indicator of childhood stress and infection by intestinal parasites. Thirty adult individuals from the Islamic necropolis of Santarém (9th-12th cent. AD) were macroscopically examined for linear enamel hypoplasia. Sediment from the pelvis and skull of each skeleton were observed under the optical microscope in search of helminth eggs. Hypoplasic defects were identified in 46.67% of the individuals, mostly on canines and incisors. Eggs from Ascaris lumbricoides and Trichuris trichiura were identified respectively in 4 and 2 individuals. The Fisher’s exact test was performed to analyze whether the individuals with evidences of stress in early childhood were more prone to helminth infections or death at younger ages. Although these variables were shown to be independent, this exploratory study highlights the contribution of combining paleopathological and paleoparasitological methods to address the long-term impact of the physiological stress exposure in early life on the immune system. Furthermore, variety of factors that could have influenced these results are discussed and interpreted in a biocultural perspective.

New Doppler imaging technique for assessing angiogenesis in breast tumors: correlation with immunohistochemically analyzed microvessels density

2018 ◽  
Vol 59 (12) ◽  
pp. 1414-1421 ◽  
Author(s):  
Sewha Kim ◽  
Hye Jin Lee ◽  
Kyung Hee Ko ◽  
Ah Young Park ◽  
Jieun Koh ◽  
...  
Keyword(s):  
Imaging Technique ◽  
Color Doppler ◽  
Flow Distribution ◽  
Immunohistochemical Analysis ◽  
Breast Tumors ◽  
Doppler Imaging ◽  
Exact Test ◽  
Vascular Flow ◽  
Institutional Review ◽  
Student’S T

Background Microvessel density (MVD) is associated with grade and prognosis in breast tumors. However, conventional color Doppler flow (CDF) imaging has been limited to represent MVD of breast tumors. Purpose To evaluate whether a new Doppler imaging technique (AngioPLUS) can represent MVD of breast tumors. Material and Methods The institutional review board approved this retrospective study, and patients’ informed consent was waived. CDF and AngioPLUS were available in pathologically confirmed 55 breast tumors of 53 women. For each lesion, vascular flow patterns (distribution and amount) of both Doppler images were retrospectively reviewed, and MVD was measured using immunohistochemical analysis of the biopsied tissue sections. MVD was subcategorized as low or high group with reference to the median. The associations between the Doppler features and MVD were evaluated using Fisher’s exact test and Student’s t test. Results Of the 55 masses, 28 (50.9%) were benign and 27 (49.1%) were malignant. Vascular flow distribution and amount of both Doppler imaging were different between the benign and malignant lesions (CDF, P = 0.020 and P = 0.010; AngioPLUS, P = 0.002 and P = 0.005). MVD had no significant relationships with CDF features, but vascular flow distribution on AngioPLUS showed significant differences between the lesions with low and high MVD ( P = 0.020); Combined distribution was more frequent in the high MVD lesions than in the low MVD lesions (17/28, 60.7% vs. 6/27, 22.2%). Conclusion Our data confirmed the correlation between a new Doppler imaging technique, AngioPLUS, and MVD. We suggest that AngioPLUS can be used for assessing MVD in breast tumors.

scholarly journals Adverse Drug Reaction (ADR) as a Cause of Hospitalization at a Government Hospital in Saudi Arabia: A Prospective Observational Study

2019 ◽  
Vol 14 (3) ◽  
pp. 192-198 ◽  
Author(s):  
Nouf Alayed ◽  
Bushra Alkhalifah ◽  
Munirah Alharbi ◽  
Naief Alwohaibi ◽  
Maryam Farooqui
Keyword(s):  
Saudi Arabia ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Hospital Admissions ◽  
Financial Burden ◽  
Length Of Hospital Stay ◽  
Morbidity And Mortality ◽  
Severity Assessment ◽  
Hospitalization Rates ◽  
Naranjo Algorithm

Background: ADRs represent a substantial burden on health care resources worldwide and are considered as one of the leading causes of morbidity and mortality which significantly affects hospitalization rates. However, ADR related hospital admissions are not well explored in Saudi Arabia. Objectives: The current study aims to evaluate ADR-related admissions at King Saud Hospital, Unaizah, Qassim, Saudi Arabia. Method: A prospective, observational study was conducted at King Saud Hospital Unaizah. Over a period of 6 months, patients above 12 years of age who visited the Emergency Department (ED) with an ADR were included in this study. The investigators collected patient data by reviewing the patient's medical records and the ED records for admission. The Naranjo algorithm was used to assess the causality of the suspected ADR, and Hartwig’s Severity Assessment Scale was used to assess the severity of the ADR. Results: Out of 4739 admissions to the wards, 38 (0.801%) were related to an ADR. The majority of patients were male (52.6%), with a mean age of ± 49.08 years. The total length of hospital stay was 565 days with a mean of ± 14.87 days. The causality assessment shows that 35 (92.1%) cases were probable ADRs, whereas 3 (7.9%) cases were possible ADRs. Moreover, the severity assessment showed that 6 (15.1%) cases were mild, and 27 (71.1%) and 5 (13.2%) cases were moderate and severe, respectively. In regard to the outcome of patients, most patients recovered after the ADR, and 2 ADRs resulted in the death of the patient. Conclusion: Our study shows that ADRs as a cause of hospitalization in Qassim population is considerably low. However, ADRs may contribute to morbidity and mortality and result in a considerable financial burden.

An Evaluation of Snake Bites and Antivenin Use at a Regional Medical Center

2010 ◽  
Vol 76 (7) ◽  
pp. 755-758
Author(s):  
Larry I. Watson ◽  
Christy Spivey ◽  
Cen Rema Menon ◽  
Cyrus A. Kotwall ◽  
Thomas V. Clancy ◽  
...  
Keyword(s):  
Medical Center ◽  
Length Of Hospital Stay ◽  
Clinical Information ◽  
P Value ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Snake Bites ◽  
Regional Medical ◽  
Regional Medical Center ◽  
Physical Findings

Snake bites are a rare but challenging problem for surgeons. The purpose of our study was to evaluate our experience with snake bites at a regional medical center. We reviewed patients treated for snake bites from 2004 to July 2008. Demographics, clinical information, and outcomes were documented. Descriptive statistics were used, and χ2, t test, and Fisher exact test were used to compare patients based on antivenin use. A P value < 0.05 was considered significant. Over the study period, 126 patients presented to the emergency department with 44 (35%) requiring hospital admission. The average age was 38 years (range, 2 to 76 years); 66 per cent were male and 95 per cent white. Bites most commonly occurred in the summer and fall months with none from December through March. Copperhead bites accounted for 50 per cent of bites. An average of 4.8 vials of antivenin was given to 61 per cent of admitted patients with 93 per cent receiving the drug within 6 hours. Minor reactions to antivenin occurred in three patients (11%). Two patients required surgery (5%), and the readmission rate was 7 per cent. There was no known morbidity or mortality. When comparing patients who received antivenin with patients who did not, the only significant clinical variables were an increased prothrombin time (12.1 vs 11.7, respectively; P = 0.048) and a longer length of hospital stay (3 vs 1.8 days, P = 0.0006) in patients receiving antivenin. The majority of patients with snake bites can be treated with supportive care and antivenin when indicated. Antivenin use at our institution is largely based on physical findings and not related to laboratory values.

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