Bowel preparation for elective colorectal resection: multi-treatment machine learning analysis on 6241 cases from a prospective Italian cohort

background current evidence concerning bowel preparation before elective colorectal surgery is still controversial. this study aimed to compare the incidence of anastomotic leakage (AL), surgical site infections (SSIs), and overall morbidity (any adverse event, OM) after elective colorectal surgery using four different types of bowel preparation. methods a prospective database gathered among 78 Italian surgical centers in two prospective studies, including 6241 patients who underwent elective colorectal resection with anastomosis for malignant or benign disease, was re-analyzed through a multi-treatment machine-learning model considering no bowel preparation (NBP; No. = 3742; 60.0%) as the reference treatment arm, compared to oral antibiotics alone (oA; No. = 406; 6.5%), mechanical bowel preparation alone (MBP; No. = 1486; 23.8%), or in combination with oAB (MoABP; No. = 607; 9.7%). twenty covariates related to biometric data, surgical procedures, perioperative management, and hospital/center data potentially affecting outcomes were included and balanced into the model. the primary endpoints were AL, SSIs, and OM. all the results were reported as odds ratio (OR) with 95% confidence intervals (95% CI). results compared to NBP, MBP showed significantly higher AL risk (OR 1.82; 95% CI 1.23-2.71; p = .003) and OM risk (OR 1.38; 95% CI 1.10-1.72; p = .005), no significant differences for all the endpoints were recorded in the oA group, whereas MoABP showed a significantly reduced SSI risk (OR 0.45; 95% CI 0.25-0.79; p = .008). conclusions MoABP significantly reduced the SSI risk after elective colorectal surgery, therefore representing a valid alternative to NBP

Abdominal drainage after elective colorectal surgery: propensity score-matched retrospective analysis of an Italian cohort

background: In italy, surgeons continue to drain the abdominal cavity in more than 50 per cent of patients after colorectal resection. the aim of this study was to evaluate the impact of abdominal drain placement on early adverse events in patients undergoing elective colorectal surgery. methods: a database was retrospectively analysed through a 1:1 propensity score-matching model including 21 covariates. the primary endpoint was the postoperative duration of stay, and the secondary endpoints were surgical site infections, infectious morbidity rate defined as surgical site infections plus pulmonary infections plus urinary infections, anastomotic leakage, overall morbidity rate, major morbidity rate, reoperation and mortality rates. the results of multiple logistic regression analyses were presented as odds ratios (OR) and 95 per cent c.i. results: a total of 6157 patients were analysed to produce two well-balanced groups of 1802 patients: group (A), no abdominal drain(s) and group (B), abdominal drain(s). group a versus group B showed a significantly lower risk of postoperative duration of stay >6 days (OR 0.60; 95 per cent c.i. 0.51-0.70; P < 0.001). a mean postoperative duration of stay difference of 0.86 days was detected between groups. no difference was recorded between the two groups for all the other endpoints. conclusion: this study confirms that placement of abdominal drain(s) after elective colorectal surgery is associated with a non-clinically significant longer (0.86 days) postoperative duration of stay but has no impact on any other secondary outcomes, confirming that abdominal drains should not be used routinely in colorectal surgery

Mild Hypoxic–Ischemic Encephalopathy: Can Neurophysiological Monitoring Predict Unfavorable Neurological Outcome? A Systematic Review and Meta-analysis

Objective Hypoxic–ischemic encephalopathy (HIE) is the second cause of neonatal deaths and one of the main conditions responsible for long-term neurological disability. Contrary to past belief, children with mild HIE can also experience long-term neurological sequelae. The aim of this systematic review is to determine the predictive value of long-term neurological outcome of (electroencephalogram) EEG/amplitude-integrated electroencephalogram (aEEG) in children who complained mild HIE. Study Design From a first search on PubMed, Google Scholar, and clinicalTrials.gov databases, only five articles were considered suitable for this study review. A statistical meta-analysis with the evaluation of odds ratio was performed on three of these studies. Results No correlation was found between the characteristics of the electrical activity of the brain obtained through EEG/aEEG in infants with mild HIE and subsequent neurological involvement. Conclusion EEG/aEEG monitoring in infants with mild HIE cannot be considered a useful tool in predicting their neurodevelopmental outcome, and its use for this purpose is reported as barely reliable

PANS/PANDAS: Clinical Experience in IVIG Treatment and State of the Art in Rehabilitation Approaches

Pediatricacute-onsetneuropsychiatricsyndrome(PANS) isaconditioncharacterized by theabrupt, dramaticonset of obsessive–compulsivedisorder (OCD) or eating restriction accompaniedbyequallyabruptandseverecomorbidneuropsychiatricsymptoms.PANDAS(pediatric autoimmuneneuropsychiatricdisorderassociatedwithstreptococcalinfection)isaheterogeneous syndromeidentifiedaspost-Streptococcuspyogenesinfection(β-hemolyticStreptococcusgroupA) complicationsregardingthecentralnervoussystemwithspecificinvolvementofneuropsychiatric andbehavioral skills. Inthefirstpartofourstudy,weshareourexperience inthetreatment ofagroupofextreme-grade(accordingtoCY-BOCSseverityscale)symptomaticpatientswith intravenousimmunoglobulin(IVIG),followingthemostrecentstudiesregardingthedosageofthe drug.Ourcontributionistoshareourexperiencemadeonasampleof55patientsallinthehighestlevel ofaseveritygrade. Inthesecondpartofourstudy,wealsoanalyzetheliteratureonPANS/PANDAS rehabilitationtherapy,sinceintheliteraturethereisnodiscussionofunionandcomparisononthis method.Objective:Thisstudyaimstoevaluatetheclinicalfeaturesofthepatientsobservedfrom differentItaliancohorts,withtheattemptatevaluatingclinicalresponsetoIVIGtreatmentinchildren withanextremeseveritygradeofPANS/PANDASdisease.Furthermore,afterhavinganalyzedthe literature,weproposerehabilitationtherapyasanaddedvaluetothepharmacologicaltreatment. MaterialsandMethods:Atotalof55patientswithadiagnosisofPANS/PANDAS,whobelongedtoan extremegradeofdisease,wereenrolled.AllpatientswereadministeredwithIVIGtreatmentat2g/kg perdayfortwoconsecutivedays.Results:Fromourstudy,anoticeableimprovement(untilcomplete remission)ofsymptomswasevidentforatleastoneyearin47outof55(85%)observedchildren, while11outofthese43(25%)showedanevidentsymptomsremissioninasingleattemptandthe remaining32(75%)requiredasecondadministrationtonoticealastingsymptomaticimprovement