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The health care system for the elderly is fragmented, that is worsened when readmission occurs to different hospitals. There is limited investigation into the impact of fragmentation on geriatric trauma patient outcomes. The aim of this study was to compare the outcomes following readmissions after geriatric trauma. The Nationwide Readmissions Database (2016-2017) was queried for elderly trauma patients (aged ≥65 years) readmitted due to any cause. Patients were divided into 2 groups according to readmission: index vs non-index hospital. Outcomes were 30 and 180-day complications, mortality, and the number of subsequent readmissions. Multivariable logistic regression was performed to analyze the independent predictors of fragmentation of care. A total of 36,176 trauma patients were readmitted, of which 3856 elderly patients (aged ≥65 years) were readmitted: index hospital (3420; 89%) vs non-index hospital (436; 11%). Following 1:2 propensity matching, elderly with non-index hospital readmission had higher rates of death and MI within 180 days (P =.01 and.02, respectively). They had statistically higher 30 and 180-day pneumonia (P <.01), CHF (P <.01), arrhythmias (P <.01), MI (P <.01), sepsis (P <.01), and UTI (P <.01). On multivariable binary logistic regression analysis, pneumonia (OR 1.70, P =.03), congestive heart failure (CHF) (OR 1.80, P =.03), female gender (OR.72, P =.04), and severe Head and Neck trauma (AIS≥3) (OR 1.50, P <.01) on index admission were independent predictors of fragmentation of care. While the increase in time to readmission (OR 1.01, P <.01) was also associated independently with non-index hospital admission. Fragmented care after geriatric trauma could be associated with higher mortality and complications. [ABSTRACT FROM AUTHOR]

Background: About 50% of the elderly undergoing emergency abdominal surgery are malnourished. The role of timely surgical nutritional access in this group of patients is unknown.Methods: We analyzed the National Inpatient Sample database from 2009 through the first three-quarters of 2015 of patients aged ≥65 years who were malnourished and underwent major abdominal surgery for the acute abdomen within the first 2 days of hospital admission.Results: Of 3 246 721 patients analyzed, 4311 patients met inclusion criteria. Of these, only 507 (11.8%) patients had surgical nutritional access (gastrostomy or jejunostomy) (group I), while 3804 patients (88.2%) did not (group II). In the propensity score-matched population, there were 482 patients in each group. The patients in group I had lower odds of mortality and postoperative gastrointestinal complications (paralytic ileus, anastomotic dehiscence, and intestinal fistulae) (P-value <.01, respectively).Discussion: Elderly who receive surgical nutritional access have lower rates of gastrointestinal complications and mortality. [ABSTRACT FROM AUTHOR]

Background. Anal canal adenocarcinoma (AA) is an uncommon tumor of the gastrointestinal tract. We seek to provide a detailed description of the incidence, demographics, and outcome of this rare tumor in the United States. Methods. The data on anal canal adenocarcinoma from SEER Program, between 1973–2015, were extracted. We analyzed the incidence rates by demographics and tumor characteristics, followed by analysis of its impact on survival. Results. The incidence of AA increased initially by 4.03% yearly from 1973 to 1985 but had a modest decline of 0.32% annually thereafter. The mean age for diagnosis of AA was 68.12 ± 14.02 years. Males outnumbered females by 54.8 to 45.2%. Tumors were mostly localized on presentation (44.4%) and moderately differentiated (41.1%). Age generally correlated with poor overall cancer survival. However, young patients (age <40 years) also showed poor long-term survival. Patients with localized disease and well-differentiated tumors showed better survival outcomes. Surgical intervention improved survival significantly as compared to patients who did not (116.7 months vs 42.7 months, p < 0.01). Conclusions. Anal canal adenocarcinoma demonstrated a poor bimodal cancer-free survival in both younger and older patient groups. Surgery significantly improves odds of survival and should be offered to patients amenable to intervention. [ABSTRACT FROM AUTHOR]

Although surgical volunteer missions (SVMs) have become a popular approach for reducing the burden of surgical disease worldwide, the outcomes of specific procedures in the context of a mission are underreported. The aim of this study was to evaluate outcomes and efficiency of thyroid surgery within a surgical mission. This was a retrospective analysis of medical records of all patients who underwent thyroid surgery within a SVM from 2006 to 2019. Postoperative complication rate was the safety endpoint, whereas length of hospital stay (LOS) was the efficiency endpoint. Serious complications were defined as Clavien–Dindo class 3–5 complications. Expected safety and efficiency outcomes were calculated using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) surgical risk calculator and compared to their observed counterparts. A total of 464 thyroidectomies were performed during the study period. Mean age of the patients was 40.3 ± 10.8 years, and male-to-female ratio was 72 : 392. Expected overall (p=0.127) and serious complication rates (p=0.738) were not significantly different from their observed counterparts. Expected LOS was found to be significantly shorter as compared to its observed counterpart (0.6 ± 0.2 vs. 2.5 ± 1.0 days; p<0.001). This study found thyroid surgery performed within a surgical mission to be safe. NSQIP surgical risk calculator underestimates the LOS following thyroidectomy in surgical missions. [ABSTRACT FROM AUTHOR]

The article presents a case study of 14 years old male who diagnosed with Traumatic Subclavian Arterial Compression Injury. Topics discussed patient underwent with sonography for trauma, which showed no sign of abnormal bleeding; and includes information on subclavian artery and vein were exposed by left infraclavicular incision.

Context: Oral squamous cell carcinoma (OSCC) is the most common malignancy in India and tobacco and betel nut chewing are well established risk factors. Despite successful campaigns to help people shun this habit in developing countries the incidence has rather gone up and HPV and sexual practices are now definitely implicated for this. Aim: An attempt was made to generate Indian data on role of HPV and sexual practices in relation to OSCC. Settings and Design: A prospective observational study was conducted on 50 patients with oral squamous cell carcinoma. Materials and Methods: Tissue biopsies from fifty patients of oral squamous cell carcinoma (OSCC) were subjected to PCR analysis to look for presence of HPV 16 and 18. Fifty patients with benign lesions were taken as control. Statistical Methods Used: The data was statistically analysed using SPSS version 22 and chi square test. Results: 42% of OSCC patients were found to harbour HPV 16 and 18 whereas only 8% of patients with benign lesions had HPV 16 and 18. A significant number of HPV positive patients i.e. 9 out of 21 gave history of multiple sexual partners and oral sex. Conclusions: This high percentage of HPV in OSCC in an Indian population from a tertiary care centre in north India and its association with prevailing sexual practices is quite significant. [ABSTRACT FROM AUTHOR]

The article present a case study of a 78-year-old farmer with a past medical history of stage IV metastatic melanoma on second-line chemotherapy. It mentions a computed tomography scan revealed massive splenomegaly, which on physical examination was palpable and visible on the left abdomen; and also mentions the e patient's postoperative course was complicated by accumulations of hemorrhagic ascites requiring percutaneous drainage.

The article presents a case study of a 38-year-old man presented with acute abdomen and peritonitis after accidently sustaining kick to the abdomen while playing soccer and results of his Computed tomography scan of the abdomen showed a large soft tissue mass with complex density Hounsfield units. It mentions GI stromal tumors (GISTs) consider as a rare malignant tumors originating from the intestinal cells of Cajal.

Simple Summary: Sporadic medullary thyroid cancer can occur anytime in life although they tend to present at a later age (≥45 years old) when the tumors are more easily discernible or become symptomatic. We present, in this study, a group of patients diagnosed with medullary thyroid cancer at or after 45 years of age when they are more likely to develop sporadic forms of medullary thyroid cancer with regard to their natural history and prognosis. In this study, we evaluated factors affecting survival in such patients. We found that the incidence of medullary thyroid cancer in patients ≥45 years of age is increasing. Our findings suggest that patients should be offered surgical resection at an early stage to improve their outcomes. Sporadic medullary thyroid cancer (MTC) can occur anytime in life although they tend to present at a later age (≥45 years old) when the tumors are more easily discernible or become symptomatic. We aimed to identify the factors affecting the survival in patients ≥45 years of age diagnosed with MTC. We analyzed the Surveillance, Epidemiology, and End Results (SEER) registry from 1973–2016 focusing on patients ≥45 years of age with MTC as an isolated primary. A total of 2533 patients aged ≥45 years with MTC were identified. There has been a statistically significant increase of 1.19% per year in the incidence of MTC for this group of patients. The disease was more common in females and the Caucasian population. Most patients had localized disease on presentation (47.6%). Increasing age and advanced stage of presentation were associated with worse survival with HR 1.05 (p < 0.001) and HR 3.68 (p < 0.001), respectively. Female sex and surgical resection were associated with improved survival with HR 0.74 (p < 0.001) and 0.36 (p < 0.001), respectively. In conclusion, the incidence of MTC in patients ≥45 years of age is increasing. Patients should be offered surgical resection at an early stage to improve their outcomes. [ABSTRACT FROM AUTHOR]