Surgical Apgar score in prediction of post-operative complications in gynecological surgery

Background: This study was aimed at estimating the ability of 10-point “Surgical Apgar Score” (SAS) to predict postoperative complications in gynecological surgery.Methods: All women undergoing laparotomy (elective and emergency) in the Department of Obstetrics and Gynecology at Kasturba Hospital, Manipal, between November 2014 and June 2015, were included. Age, BMI, comorbidities and postoperative complications were analyzed. The SAS was calculated from the estimated blood loss, lowest heart rate, and lowest mean arterial pressure. Descriptive statistics and univariate statistics were used. Occurrence of major postoperative complications represented the primary outcome.Results: A total of 146 cases meeting the inclusion criteria were analyzed. The patients belonged to the age group of 20-60 years. One or more comorbidities were seen to be present in 50 (34.2%) of the patients. With regard to BMI, 62 (42.5%) of the patients were in the normal category. Major post-operative complications were identified in 11 cases (7.5%). On univariate analyses, occurrence of postoperative complications were associated with presence of comorbidities (p=0.047) and SAS belonging to the high-risk category (p=0.001).Conclusions: The SAS is a significant predictor of postoperative complications following gynecological surgery. This metric, along with a consideration of comorbidities, can be helpful in determining prognosis, directing decision making in the operation theatre, and in postoperative care.

ASSESSMENT OF THE EXTENT OF MYOPIA AND ITS ASSOCIATED FACTORS IN CHILDREN OF AGE BETWEEN 6 TO 12 YEARS

Background: The main reason of visual disability is myopia that can be avoided. Objective: The goal of this research study was to assess the extent of myopia and its associated factors in children of age between 6 to 12 years. These children were presented to ophthalmology outpatient of Sir Ganga Ram Hospital, Lahore. Patients and methods: From 1st July, 2017 to 30th June 2018, this research study was organized. The children selected for this study were between 6 to 12 years. The study was carried out in ophthalmology outpatient department of Sir Ganga Ram Hospital, Lahore. Written agreement was sign by the parents of children visiting Ophthalmology outpatient department. Ethical committee of the Hospital accepted the consent. By means of questionnaire, factors that were associated with the disease were noted. Personal information f every child selected for study, was assembled. In this way by using Snellen’s chart, sensitivity of each child wa] noticed. 1% cyclopentolate eye drops were used for these children who were observed sensitivity less than 6/6. Then these children experience refraction. Refraction was carried out by means of retinoscopy. If any dissimilarity was presented, it was examined through chi square test. SPSS-21 was employed for data entry and assessment. The value of P was <_0.05 which was considered valuable. Results: Total children selected for study were 2936. The percentage of female was 67.37%.The percentage of children between 6 -8 years, 9-11 years and 12 years of age was 32.86% , 54.67% and 12.47 respectively. The percentage of myopic children was 57.93%. The time duration of TV watching was ≤1 hour per day, 2-4 hours and >4 hours in 62.39% ,35.62% and 2.02% children respectively. The percentage of the children were playing games or using computer for 1 hour was 60.72% ,35.66% for 2-4 hours and 3.62% for >4 hours. 17.3% children were reading for ≤1 hours, 76.22% fir 2-8 hours and 6.48% for>8 hours. The family background of 65.8% children was positive for myopia. Conclusion: Work and myopia had strong association. Parental myopia was also linked to myopia. Keywords: Myopia, Risk factors, Reading hours

Reducing the donor site morbidity in radial forearm free flaps by utilizing a narrow radial forearm free flap

Background: The radial forearm free flap (RFFF) has remained a leading choice of many plastic surgeons as a fasciocutaneous flap due to its versatility, pedicle length, and simple elevation technique. However, donor site morbidity has led many reconstructive surgeons to limit their use of the RFFF and to use other flaps instead. We propose that using a narrow RFFF (nRFFF) decreases the aesthetic and functional morbidity of the donor site.Methods: We report our experiences with the nRFFF from April 2012 through May 2015 at the Department of Plastic, Reconstructive, and Hand Surgery at Liaquat National Hospital, Karachi. The donor defects were closed primarily. The Stony Brook Scar Evaluation Scale and comparison with the contralateral hand were used to assess aesthetic and functional outcomes, respectively.Results: A total of 24 patients underwent nRFFF procedures during the study period. The donor arm showed excellent motor function in 22 cases (91.7%), and very good function in the remaining two cases (8.3%). The aesthetic outcomes were excellent in four patients (16.6%), very good in eight patients (33.3%), good in 10 patients (41.6%), and fair in two patients (8.3%) who developed a hypertrophic scar. All flaps were successful and there were no cases of partial or complete loss.Conclusions: For small to medium-sized soft tissue defects, the nRFFF had acceptable outcomes due to its thinness, pliability, and major reduction in donor site aesthetic and functional morbidity

Histopathological Assessment of Microvascular Invasion in Hepatocellular Carcinoma Resection Specimens and its Correlation with Tumor Size and Grade

OBJECTIVES To determine the histopathological assessment of microvascular invasion in Hepatocellular Carcinoma Resection Specimens and its correlation with tumour size and grade. METHODOLOGY This retrospective cross-sectional study included the biopsy-proven Hepatocellular (HCC) case with microvascular invasion (MVI) noted in the resected specimens evaluated by two independent consultants Histopathologists. The exclusion criteria were; all patients below 18 years, unfixed autolyzed samples, and incomplete requisition-filled forms. Numerical data, i.e., patient age and tumour size, are presented as mean with standard deviation. Categorical variables, i.e., tumour size, grade, and presence or absence of MVI, were submitted as numbers with percentages. Continuous variables, i.e., tumour size and differentiation grade, were assessed using the Chi-square test. A p-value of ≤ 0.05 was considered significant. RESULTSMost patients, 34.4%, fall into the age group of 47-70. Most patients were males, 63.6%, and microvascular invasion was noted in 49.09% of cases. Most cases were of moderate to poorly differentiated tumours, 80.0%. MVI was statistically significant with the grade of the tumour. CONCLUSION Microvascular invasion is an important prognostic marker noted in a surgical resection specimen. Although the exact definition and risk stratification is unclear, survival studies have proven that MVI is associated with poor outcomes

From information seeking to information avoidance: Understanding the health information behavior during a global health crisis

Individuals seek information for informed decision-making, and they consult a variety of information sources nowadays. However, studies show that information from multiple sources can lead to information overload, which then creates negative psychological and behavioral responses. Drawing on the Stimulus-Organism-Response (S-O-R) framework, we propose a model to understand the effect of information seeking, information sources, and information overload (Stimuli) on information anxiety (psychological organism), and consequent behavioral response, information avoidance during the global health crisis (COVID-19). The proposed model was tested using partial least square structural equation modeling (PLS-SEM) for which data were collected from 321 Finnish adults using an online survey. People found to seek information from traditional sources such as mass media, print media, and online sources such as official websites and websites of newspapers and forums. Social media and personal networks were not the preferred sources. On the other hand, among different information sources, social media exposure has a significant relationship with information overload as well as information anxiety. Besides, information overload also predicted information anxiety, which further resulted in information avoidance.</p

Racial Disparities in Emergency General Surgery: Do Differences in Outcomes Persist Among Universally Insured Military Patients?

Research Objective: Described as one of the most serious health problems affecting the nation, racial disparities are estimated to account for \u3e83,000 deaths, \u3e$57 billion per year. They have been identified in multiple surgical settings, including differences in outcomes by race among emergency general surgery(EGS) patients. As many minority patients are uninsured, increasing access to care is thought to be a viable solution to mitigate inequities. The objectives of this study were to determine whether racial disparities in 30/90/180day outcomes exist within a universally-insured population of military/civilian-dependent EGS patients and whether differences in outcomes differentially persist in care received at military-vs-civilian hospitals and among sponsors who are enlisted-service members-vs-officers. It also considered longer-term outcomes of care. Study Design: Risk-adjusted survival analyses using Cox proportional-hazards models assessed race-based differences in mortality, major morbidity, and readmission from index-hospital admission (discharge for readmission) through 30/90/180days. Models accounted for hospital clustering and possible biases associated with missing race (reweighted-estimating equations). Sub-analyses considered effects restricted to operative interventions, stratified by 24 EGS-diagnostic categories defined by the American Association for the Surgery of Trauma(AAST), and effect modification related to rank (SES-proxy: officers-vs-enlisted-sponsors) and military-vs-civilian-hospital care. Population Studied: Five years of national TRICARE Prime/Prime-plus data, which provides insurance to active/reserve/retired members of the US Armed Services and dependents, were queried for adults (≥18y) with primary EGS conditions, defined by the AAST. Patients who did not have an index admission between 01/01/2006-01/07/2010 (minimum 180days follow-up) or who were not continuously enrolled in TRICARE for 180days were excluded. Non-surviving patients were retained while they survived. Principal Findings: A total of 101,011 patients were included: 73.5% White, 14.5% Black, 4.4% Asian, 7.7% other. Risk-adjusted analyses reported equivalent-or-better mortality and readmission outcomes among minority patients at 30/90/180days—even when restricted to civilian hospitals where studies suggest that EGS disparities are found. Readmissions within military hospitals were lower among minority patients. Major morbidity was higher among Black versus White patients (HR[95%CI]): 30day-1.23[1.13-1.35], 90day-1.18[1.09-1.28], 180day-1.15[1.07-1.24]—a finding driven by appendiceal disorders (HR:1.69-1.70). No other diagnostic category-based HR was significant. When considered by rank, significant effects were isolated to enlisted-service members. However, given the relatively small number of patients who were (dependents of) officers, it is difficult to determine whether rank-based findings are a result of social determinants or influenced by the limited number of minority patients. Conclusions: The first of its kind to examine racial disparities in longer-term outcomes of EGS care, this longitudinal analysis of military patients demonstrated apparent mitigation of racial disparities within a universally-insured health system when compared to the overall US health system. Efforts to explain findings based on consideration of care provided in military-vs-civilian hospitals, among specific EGS-diagnostic categories, and based on sponsor rank revealed modification of the association between race and outcomes to some extent for all three. Implications for Policy or Practice: The contrast between results for universally-insured military/civilian-dependent patients and reported disparities among all US civilian patients merits consideration. The data speak to the importance of insurance-coverage in the development of disparities interventions nationwide and will help to inform policy within the DoD

Phylogeny, sequence-typing and virulence profile of uropathogenic Escherichia coli (UPEC) strains from Pakistan

Abstract Background Escherichia coli lineage ST131 predominates across various spectra of extra-intestinal infections, including urinary tract infection (UTI). The distinctive resistance profile, diverse armamentarium of virulence factors and rapid global dissemination of ST131 E. coli makes it an intriguing pathogen. However, not much is known about the prevalence and genetic attributes of ST131 lineage in Pakistan. Methods We estimated prevalence and genetic attributes of E. coli ST131 isolates causing UTI among 155 randomly selected samples. Samples were analyzed for phylogenetic grouping, O-typing and fumC/fimH typing. Isolates were further tested for the ESBL and virulence factors using PCR. Results Overall, 59% of the UPEC isolates belonged to the phylogenetic group B2, followed by D = 28%, B1 = 8% and A = 5%. Among 18 different Sequence-types, ST131 was the dominant lineage (n = 71; 46%) out of which 72% of the isolates were assigned to the phylogenetic group B2, while 61% adhered to the serogroup O25b. FumC/fimH typing confirmed 49% of the ST131 as H30 sub-types. In this study, significant numbers of the identified ST131 isolates were MDR and 42% showed ESBL phenotypes, out of which 37% carried bla-CTX-M-15. Moreover, different virulence factors were detected in following percentages: fimH,155(100%), iutA 86 (55%), feoB 76 (49%), papC 75 (48%), papGII 70 (45%), kpsMTII 40 (26%), papEF 37 (24%), fyuA 37 (24%), usp 22 (14%), papA 20 (13%), sfa/foc20 (13%), hlyA 18 (12%), afa 15 (10%), cdtB 11 (7%), papGI 6 (4%), papGIII 6 (4%), kpsMTIII 4 (3%) and bmaE2 (1%). Conclusion Conclusively, this study provides important insight into the genetic and virulence attributes of pandemic MDR ST131 strains involved in UTIs. It also highlights higher prevalence of ST131-O25b-H30 UPEC isolates in patients, which was previously unreported from this part of globe.https://deepblue.lib.umich.edu/bitstream/2027.42/152123/1/12879_2019_Article_4258.pd

Corrigendum: Reprogramming the immunosuppressive tumor microenvironment: exploiting angiogenesis and thrombosis to enhance immunotherapy

This review focuses on the immunosuppressive effects of tumor angiogenesis and coagulation on the tumor microenvironment (TME). We summarize previous research efforts leveraging these observations and targeting these processes to enhance immunotherapy outcomes. Clinical trials have documented improved outcomes when combining anti-angiogenic agents and immunotherapy. However, their overall survival benefit over conventional therapy remains limited and certain tumors exhibit poor response to anti-angiogenic therapy. Additionally, whilst preclinical studies have shown several components of the tumor coagulome to curb effective anti-tumor immune responses, the clinical studies reporting combinations of anticoagulants with immunotherapies have demonstrated variable treatment outcomes. By reviewing the current state of the literature on this topic, we address the key questions and future directions in the field, the answers of which are crucial for developing effective strategies to reprogram the TME in order to further the field of cancer immunotherapy

Reprogramming the immunosuppressive tumor microenvironment: exploiting angiogenesis and thrombosis to enhance immunotherapy

This review focuses on the immunosuppressive effects of tumor angiogenesis and coagulation on the tumor microenvironment (TME). We summarize previous research efforts leveraging these observations and targeting these processes to enhance immunotherapy outcomes. Clinical trials have documented improved outcomes when combining anti-angiogenic agents and immunotherapy. However, their overall survival benefit over conventional therapy remains limited and certain tumors exhibit poor response to anti-angiogenic therapy. Additionally, whilst preclinical studies have shown several components of the tumor coagulome to curb effective anti-tumor immune responses, the clinical studies reporting combinations of anticoagulants with immunotherapies have demonstrated variable treatment outcomes. By reviewing the current state of the literature on this topic, we address the key questions and future directions in the field, the answers of which are crucial for developing effective strategies to reprogram the TME in order to further the field of cancer immunotherapy

Protocol for the stimulating β3-Adrenergic receptors for peripheral artery disease (STAR-PAD) trial: a double-blinded, randomised, placebo-controlled study evaluating the effects of mirabegron on functional performance in patients with peripheral arterial disease

Introduction: There is currently only one approved medication effective at improving walking distance in people with intermittent claudication. Preclinical data suggest that the β3-adrenergic receptor agonist (mirabegron) could be repurposed to treat intermittent claudication associated with peripheral artery disease. The aim of the Stimulating β3-Adrenergic Receptors for Peripheral Artery Disease (STAR-PAD) trial is to test whether mirabegron improves walking distance in people with intermittent claudication. Methods and analysis: The STAR-PAD trial is a Phase II, multicentre, double-blind, randomised, placebo-controlled trial of mirabegron versus placebo on walking distance in patients with PAD. A total of 120 patients aged ≥40 years with stable PAD and intermittent claudication will be randomly assigned (1:1 ratio) to receive either mirabegron (50 mg orally once a day) or matched placebo, for 12 weeks. The primary endpoint is change in peak walking distance as assessed by a graded treadmill test. Secondary endpoints will include: (i) initial claudication distance; (ii) average daily step count and total step count and (iii) functional status and quality of life assessment. Mechanistic substudies will examine potential effects of mirabegron on vascular function, including brachial artery flow-mediate dilatation; MRI assessment of lower limb blood flow, tissue perfusion and arterial stiffness and numbers and angiogenesis potential of endothelial progenitor cells. Given that mirabegron is safe and clinically available for alternative purposes, a positive study is positioned to immediately impact patient care. Ethics and dissemination: The STAR-PAD trial is approved by the Northern Sydney Local Health District Human Research Ethics Committee (HREC/18/HAWKE/50). The study results will be published in peer-reviewed medical or scientific journals and presented at scientific meetings, regardless of the study outcomes