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Teiji Yagasaki,1,2 Yoshimi Yokoyama,2 Ayaka Yagasaki,1,2 Kenta Hozumi,2 Sho Ichikawa2,3 1Yagasaki Eye Clinic, Ichinomiya, Aichi, Japan; 2Department of Ophthalmology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Aichi, Japan; 3Chukyo Eye Clinic, Nagoya, Aichi, JapanCorrespondence: Teiji Yagasaki, Email y-teiji@jb3.so-net.ne.jpPurpose: Favorable stereoacuity does not develop in all patients with partially refractive accommodative esotropia (PRAET) successfully aligned, and there have been few previous reports on the factors influencing stereoacuity outcomes in patients with PRAET treated with prismatic correction (PPC) and/or surgery. This study aimed to analyze factors affecting stereoacuity outcomes in patients of PRAET treated with PPC and surgery.Study Design: Retrospective study.Methods: Sixty-six patients with alignment within 10 prism diopters at final visit with PPC and surgery were included. According to the final stereoacuity, patients were grouped into the fine group (≤ 60 arcsec (“)), the coarse group (60 “ 6 months, ≤ 2 years; late: > 2 years) was carried out with the Kruskal–Wallis test.Results: There were no differences in ages at initial PPC, at surgery, at final visit, durations of misalignment, of PPC, or after surgery; however, significant differences in ages at onset and initial visit were found. Age at onset in the absent group was significantly earlier than those of the fine and the coarse groups (p < 0.001 and p < 0.001, respectively). Moreover, of the 25 patients with age at onset > 2 years, 18 patients (72%) showed fine or coarse stereoacuity (p < 0.001).Conclusion: Although stereoacuity outcomes in patients with early onset were poor despite of the finally successful alignments obtained with PPC and surgery, fine stereoacuity and coarse stereoacuity were obtained in 24% and 44% of patients with age at onset > 2 years.Keywords: partially refractive accommodative esotropia, prism correction, stereoacuity, critical period, surgery

Introduction Actinomycosis is an uncommon inflammatory bacterial disease caused by Actinomyces species, especially Actinomyces Israeli. Abdominopelvic forms are relatively rare and may involve the colon as a solid mass, mimicking a malignant tumor. Case presentation A 68-year-old Tunisian man, with a history of diabetes, hypertension, penicillin allergy, and renal failure, presented to the emergency department with abdominal pain, vomiting, and bowel obstruction. CT scan showed an acute intestinal obstruction upstream with obstructive tissular mass at the sigmoid colon. Emergency surgery revealed a sigmoid mass and a pre-perforative cecum. Subtotal colectomy was performed, with ileostomy and distal end closure. Histological examination confirmed Actinomyces infection. The patient was then placed on long-term doxycycline and Bactrim, with no recurrence over a 9-month follow-up period. Conclusion Abdominal actinomycosis, though rare, presents diagnostic challenges. It can be mistaken for malignancy, leading to unnecessary surgery in non-complicated cases, since it is effectively treated by antibiotics. In complicated cases, a combined approach involving both surgery and antibiotic therapy is necessary until the infection is completely eradicated.

Introduction Actinomycosis is an uncommon inflammatory bacterial disease caused by Actinomyces species, especially Actinomyces Israeli. Abdominopelvic forms are relatively rare and may involve the colon as a solid mass, mimicking a malignant tumor. Case presentation A 68-year-old Tunisian man, with a history of diabetes, hypertension, penicillin allergy, and renal failure, presented to the emergency department with abdominal pain, vomiting, and bowel obstruction. CT scan showed an acute intestinal obstruction upstream with obstructive tissular mass at the sigmoid colon. Emergency surgery revealed a sigmoid mass and a pre-perforative cecum. Total colectomy was performed, with ileostomy and distal end closure. Histological examination confirmed Actinomyces infection. The patient was then placed on long-term doxycycline and Bactrim, with no recurrence over a 9-month follow-up period. Conclusion Abdominal actinomycosis, though rare, presents diagnostic challenges. It can be mistaken for malignancy, leading to unnecessary surgery in non-complicated cases, since it is effectively treated by antibiotics. In complicated cases, a combined approach involving both surgery and antibiotic therapy is necessary until the infection is completely eradicated.

Bianca Poletti,1 Georgia Stringer,2 Kate Furness3,4 1Faculty of Health Science (Biomedical Science), Swinburne University of Technology, Hawthorn, Victoria, 3122, Australia; 2Department of Nutrition and Dietetics, Eastern Health, Melbourne, Australia; 3Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorn, Victoria, 3122, Australia; 4Department Sport, Exercise and Nutrition Sciences, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, 3086, AustraliaCorrespondence: Kate Furness, La Trobe University, Department of Sport, Exercise and Nutrition Sciences, School of Allied Health, Human Services and Sport, Bundoora, Victoria, 3086, Australia, Email kate.furness@latrobe.edu.auObjective: This study explores the experience of adults undergoing major abdominal surgery pre-implementation of an Enhanced Recovery after Surgery program at a tertiary hospital in Melbourne, Australia, to enhance health promotion in Australian hospitals.Methodology: Patients who were undergoing major abdominal surgery and who consented to participate were recruited in this study. Patients were chosen based on an inclusion-exclusion criterion. In-depth, semi-structured qualitative interviews were conducted by telephone and transcribed verbatim by the primary researcher. Thematic analysis was used and synthesised into five inductive themes. Eighteen participants aged between 51 and 82 years were interviewed. Codes were categorised into inductive themes: 1) preparedness for surgery; 2) communication; 3) aftercare; 4) expectations of surgery; and 5) overall experience utilising an iterative process. The following themes and subthemes emerged from the qualitative synthesis.Results: Patients undergo a variety of experiences throughout the perioperative care period. Patient care and experience may be improved through increased access to patient engagement, information and communication, use of multimedia and teach-back method, optimization of the hospital environment and through providing adequate planning and support on discharge.Conclusion: Evidence of barriers to enhancing patient surgical experience can be used to guide the implementation of Enhanced Recovery after Surgery protocols in Australian hospitals and therefore may limit its generalizability. This will improve health promotion as these findings provide valuable insights into integrative methods that can be considered to be important for achieving person-centred care. This knowledge can be useful in clinical practice, implementation and education programs for ERAS.Keywords: patient care, perioperative care, patient engagement, communication, surgery

Introduction Actinomycosis is an uncommon inflammatory bacterial disease caused by Actinomyces species, especially Actinomyces Israeli. Abdominopelvic forms are relatively rare and may involve the colon as a solid mass, mimicking a malignant tumor. Case presentation A 68-year-old Tunisian man, with a history of diabetes, hypertension, penicillin allergy, and renal failure, presented to the emergency department with abdominal pain, vomiting, and bowel obstruction. CT scan showed an acute intestinal obstruction upstream with obstructive tissular mass at the sigmoid colon. Emergency surgery revealed a sigmoid mass and a pre-perforative cecum. Subtotal colectomy was performed, with ileostomy and distal end closure. Histological examination confirmed Actinomyces infection. The patient was then placed on long-term doxycycline and Bactrim, with no recurrence over a 9-month follow-up period. Conclusion Abdominal actinomycosis, though rare, presents diagnostic challenges. It can be mistaken for malignancy, leading to unnecessary surgery in non-complicated cases, since it is effectively treated by antibiotics. In complicated cases, a combined approach involving both surgery and antibiotic therapy is necessary until the infection is completely eradicated.

The aim of this study was to evaluate two liver biopsy techniques by transrectal Natural Orifice Transluminal Endoscopic Surgery (NOTES) and compare tensiometric parameters of rectal sealing using 2-octyl cyanoacrylate glue or conventional rectal sutures in a dog cadaver model. In sixteen dog cadavers two liver biopsy techniques were performed via transrectal NOTES using either polypectomy diathermy forceps or endoscopic oval biopsy forceps. The cadavers were divided into two groups: Glue Group (GG) where rectal sealing was performed with 2-octyl cyanoacrylate glue and Suture Group (SG) with the rectal defect sealed with simple continuous extracorporeal 3-0 polydioxanone sutures. The rupture pressure of the seals was measured on a rectal burst test. The diathermy polypectomy endoscopic forceps biopsy technique was significantly faster (p

Filip Tichanek,1,2 Asta Försti,3,4 Otto Hemminki,5,6 Akseli Hemminki,5,7 Kari Hemminki1,8 1Biomedical Center, Faculty of Medicine, Charles University Pilsen, Pilsen, 30605, Czech Republic; 2Institute of Pathological Physiology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic; 3Hopp Children’s Cancer Center (KiTZ), Heidelberg, Germany; 4Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany; 5Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland; 6Department of Urology, Helsinki University Hospital, Helsinki, Finland; 7Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland; 8Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, GermanyCorrespondence: Kari Hemminki, Email k.hemminki@dkfz.deObjective: Lung cancer is often diagnosed at an advanced stage and survival has been poor, although long-term studies have been rare. We analyzed data on survival in lung cancer from Denmark, Finland, Norway, and Sweden over a 50-year period (1971– 2020).Methods: Relative 1- and 5-year survival data were obtained from the NORDCAN database for 1971– 2020. We used generalized additive models to estimate survival trends over time and uncertainty of these estimates. We additionally calculated conditional survival from the 1st to 5th year (5/1-year), estimated annual changes in survival rates, and determined significant breaking points.Results: In 2016– 2020, 5-year survival rate for lung cancer was best for Norwegian men (26.6%) and women (33.2%). The sex difference was significant and it was found for each country. Survival improved modestly until the year 2000, after which time survival curves increased steeply and kept the linear shape to the end of follow-up, indicating consistent improvement in survival. Survival curves for 1- and 5/1-year survival were almost superimposable, indicating that deaths in the first year were approximately as many as in the subsequent 4 years, thus marking sustained long-term survival.Conclusion: We could document a positive development in lung cancer survival with steep upward trends after the year 2000. Intensions for curative treatment have been increasing and the outcomes have been improving with the help of novel imaging methods. Pathways for facile patient access to treatment have been instituted. Close to 90% of the patients are ever smokers. National anti-smoking acts and alerting people who smoke about early symptoms may be beneficial, as metastatic lung cancer remains difficult to cure.Keywords: smoking, lung cancer, relative survival, conditional survival, treatment, surgery

Introduction Orbital lipoma is an extremely rare tumor, representing less than 1% of all orbital tumors. We review the literature and describe the presentation, the differential diagnosis and the management of this tumor. Case report We report the case of a 63-year-old patient who was referred for a diplopia with recent hemi-cranial headache. Physical examination showed no exophthalmos nor decrease in visual acuity. The patient complained of diplopia on elevation and oculomotricity examination showed limited elevation of the right eye. The Hess Lancaster test was in favor of a limited course of the right inferior rectus muscle. Magnetic resonance imaging revealed a fusiform tissue process in the right inferior rectus muscle with a fatty signal. A complete excision of the tumor was performed by a trasncunjonctival approach. Cytopathological examination was consistent with a pleomorphic lipoma. The postoperative period was uneventful. The definitive histopathologic diagnosis was a lipoma. The postoperative Magnetic resonance imaging showed the complete disappearance of the lesion. With 3 years of follow up, there is no sign of recurrence or ocular motility trouble. Conclusion: Lipomas are rare tumors in the orbit. The clinic is variable depending on the size and the site. The clinical diagnosis is difficult to make. Only histology allows the final diagnosis.

Sloths are wild animals with arboreal habits, with slow metabolism, found in tropical forests from South America to Central America. However, the lack of knowledge of their anatomy does not favor the conservation of the species in veterinary care centers, due to its peculiar anatomy. Therefore, the objective of this study was to describe the topography and morphology of the spleen of the species Bradypusvariegatus, in order to collect more information to support and assist in the clinical-surgical processes of the species. Eight corpses of B. variegatus, previously fixed with 20% formaldehyde and preserved in 30% saline solution, were dissected for the macroscopic study of the spleen. A healthy animal, living in semi-captivity, was assigned to perform a tomography of the abdominal region, for observation of the spleen, while two specimens were destined for the microscopic study of the organ immediately after death. Based on the data obtained, the spleen presented a topography and tissue composition similar to other mammals, but its morphology, absence of visceral lienal hilum and anatomical arrangement in the abdominal cavity differed from most domestic and wild animals.

Introduction Orbital lipoma is an extremely rare tumor, representing less than 1% of all orbital tumors. We review the literature and describe the presentation, the differential diagnosis and the management of this tumor. Case report We report the case of a 63-year-old patient who was referred for a diplopia with recent hemi-cranial headache. Physical examination showed no exophthalmos nor decrease in visual acuity. The patient complained of diplopia on elevation and oculomotricity examination showed limited elevation of the right eye. The Hess Lancaster test was in favor of a limited course of the right inferior rectus muscle. Magnetic resonance imaging revealed a fusiform tissue process in the right inferior rectus muscle with a fatty signal. A complete excision of the tumor was performed by a trasncunjonctival approach. Cytopathological examination was consistent with a pleomorphic lipoma. The postoperative period was uneventful. The definitive histopathologic diagnosis was a lipoma. The postoperative Magnetic resonance imaging showed the complete disappearance of the lesion. With 3 years of follow up, there is no sign of recurrence or ocular motility trouble. Conclusion: Lipomas are rare tumors in the orbit. The clinic is variable depending on the size and the site. The clinical diagnosis is difficult to make. Only histology allows the final diagnosis.

Amaç: Bu çalışmada, ameliyat öncesi hastaların oral sıvı/besin alımının kısıtlanması konusunda hemşirelerin bilgi, tutum ve uygulamalarının güncel rehberlere uygunluğu araştırıldı. Yöntem: Tanımlayıcı tipteki araştırma, Ağustos-Eylül 2019 tarihleri arasında Bitlis Devlet Hastanesi ve Bitlis/Tatvan Devlet Hastanesi’nde yapıldı. Araştırmanın evrenini cerrahi kliniklerde çalışan tüm hemşireler (N:55), örneklemini ise araştırmaya katılmayı kabul eden 51 hemşire oluşturdu. Verilerin toplanmasında anket formu kullanıldı ve SPSS 20.0 paket programında tanımlayıcı istatistiksel yöntemler kullanılarak analiz edildi. Bulgular: Hemşirelerin %66,7’si kadın, yaş ortalaması 27,39±4.5, %80,4’ü lisans mezunudur. Meslekte çalışma süresi ortalama 4,21±3,61, çalıştıkları serviste ise ortalama 1,82±1,5 yıldır. Hemşirelerin tamamı hastalara aç kalma gerekçesini açıkladıklarını, %96,1’i kliniklerde gece 12’den sonra oral alımın kesildiğini belirtmiştir. %96,1’i hastaların 8 saatten fazla aç kaldığını düşünmesine rağmen %49’u gece 12’den sonra aç bırakma prosedürünü doğru bulduğunu belirtmiştir. ‘Ameliyat öncesi hastaların aç bırakılma sebebi nedir?’, ‘Hastalar ameliyattan önce hafif yemekleri ne zamana kadar yiyebilirler?’, ‘Hastalar ameliyattan önce berrak sıvıları (su, meyve suyu, çay ve kahve) ne zamana kadar alabilirler?’, ‘Hastalar ameliyattan önce süt, süt ürünleri, sütlü kahve, bebek maması gibi besinleri ne zamana kadar alabilirler?’ ve ‘Bebek hastalar ameliyattan önce anne sütünü ne zamana kadar alabilirler?’ sorularına doğru cevap verenlerin oranı sırasıyla; %76,5, %13,7, %3,9, %13,7 ve %25,5 şeklindeydi. Sonuç: Hemşirelerin, oral alımın kesilmesi konusunda çoğunlukla geleneksel yaklaşımı uyguladığı görüldü. Ameliyat öncesi açlık konusunda bilgi düzeylerinin ve uygulamalarının güncel rehberlere uygunluğunun düşük olduğu saptandı. Konuyla ilgili daha geniş çaplı çalışmaların yapılması faydalı olacaktır. Ayrıca multidisipliner bir anlayışla rehberlerin gözden geçirilmesi ve uygulamaya yönelik kanıta dayalı protokollerin geliştirilmesi gerekmektedir.

INTRODUCTION: Lumbar spinal stenosis (LSS) is 'a clinical syndrome of the buttock or lower extremity pain, which may occur with or without back pain, associated with diminished space available for the neural and vascular elements in the lumbar spine.' This study aims to analyze the clinical and radiological outcomes of lumbar decompression in patients with degenerative LSS. METHODS: The patients with degenerative LSS in the Department of Neurosurgery of Haydarpasa Numune Training and Research Hospital were included retrospectively. The radiological evaluations were measured with the extreme PACS system (2010) by magnetic resonance imaging. The clinical outcomes were evaluated with visual analog score (VAS) and Japanese orthopedic association (JOA) scores. Odom's criteria were used for outcomes. RESULTS: Thirty-five patients over 65 years old with degenerative LSS were underwent posterior decompression surgery. Of the participants, 40% (n=14) were male and 60% (n=21) were female. The mean age is 63.34+-8.08. The area measurements, modified area measurements, AP diameter measurements of the right and left lateral recess, right and left lateral transverse AP diameter measurements, and AP diameter measurements of the right and left neural foramen were improved after surgery. VAS and JOA scores were good after surgery. Fourteen patients had an excellent result, 12 patients had a good result, and nine patients had a fair result according to Odom's criteria. DISCUSSION AND CONCLUSION: Improvements in the VAS and JOA scores are prominent after surgery. Foraminotomy and expansion of the lateral recess during surgery increased the quality of life and improved post-operative radiologic parameters in over 65 years of age with degenerative LSS.

Immature teratoma is one of the rare malignant germ cell tumours presented in pregnancy. Here, we present 26-year-old pregnant women who had an incidental finding of left adnexal mass in an anomaly scan at 19 weeks of pregnancy. Laparotomy with peritoneal fluid cytology, left salpingo-oophorectomy and omental biopsy at 20 weeks of pregnancy revealed immature teratoma stage 1A, grade 2 in the histopathology report. However, she followed up with the metastatic mass in the pouch of Douglas at 30 weeks of pregnancy in magnetic resonance imaging despite being counselled for possible chemotherapy and surveillance. A baby with a good Apgar score and grade 3 immature teratoma in the metastatic mass was revealed following the exploratory laparotomy and cesarean section at 36 weeks of pregnancy. Fertility-sparing surgery with chemotherapy during pregnancy for high-grade tumours may result in a good prognosis.

Introduction Orbital lipoma is an extremely rare tumor, representing less than 1% of all orbital tumors. We review the literature and describe the presentation, the differential diagnosis and the management of this tumor. Case report We report the case of a 63-year-old patient who was referred for a diplopia with recent hemi-cranial headache. Physical examination showed no exophthalmos nor decrease in visual acuity. The patient complained of diplopia on elevation and oculomotricity examination showed limited elevation of the right eye. The Hess Lancaster test was in favor of a limited course of the right inferior rectus muscle. Magnetic resonance imaging revealed a fusiform tissue process in the right inferior rectus muscle with a fatty signal. A complete excision of the tumor was performed by a trasncunjonctival approach. Cytopathological examination was consistent with a pleomorphic lipoma. The postoperative period was uneventful. The definitive histopathologic diagnosis was a lipoma. The postoperative Magnetic resonance imaging showed the complete disappearance of the lesion. With 3 years of follow up, there is no sign of recurrence or ocular motility trouble. Conclusion: Lipomas are rare tumors in the orbit. The clinic is variable depending on the size and the site. The clinical diagnosis is difficult to make. Only histology allows the final diagnosis.

Congenital malformations are structural and functional abnormalities that present at birth. Congenital head malformations were present in 231 (22 bovine and 209 buffalo) calves referred to Mansoura veterinary teaching hospital, beside private farm stations at Dakahleya Province, and during field training trips between October 2015 and December 2021. This survey was carried on for the awareness of scientists, veterinarians and animals' owners. Diagnosis of those abnormalities was based on history and clinical examinations that were dependent upon visual inspection and surgical exploration. Those head malformations include: anophthalmia (0.43%), enophthalmos (0.43%), unilateral and bilateral strabismus (squint) (1.72%), heterochromia iridis (86.58%), conjunctival dermoid cyst (0.86%), cheiloschisis (harelip) (0.43%), campylognathia (curved jaw) (3%), absence of external ear (anotia) (0.43%), nasal dermoid (0.43%), double tongue (0.86%), hydrocephalus (0.86%), diprosopus (double face) (0.86%), cranioschisis (0.86%), cyclopia (0.43%). Buffalo calves were found with more congenital head malformations than bovine calves. In bovine, mixed breed calves have higher incidence of head malformations compared to native. Surgical treatment was carried out for cases affected with conjunctival dermoid cyst, nasal dermoid, double tongue, cranioschisis. Congenital anomalies which cannot be corrected surgically but the animal will survive in a normal condition were: campylognathia (curved jaw), strabismus, heterochromis iridis and anotia.

Introduction: The SARS-CoV-2 (COVID-19) pandemic has brought about instability in healthcare providers worldwide; this includes rural settings that had fewer cases of COVID-19 in the first year of the pandemic. This article examines the impact of COVID-19 on the surgical services offered at the Balfour Hospital, Orkney Islands, Scotland in the UK and the impact the pandemic had indirectly on the service in 2020. Methods: The authors conducted a retrospective study concentrating on surgical services including emergency hospital presentations and the number of cancer diagnoses, specifically colorectal. Colorectal malignancies were specifically investigated as in the Balfour Hospital they are primarily diagnosed by surgeons. Focus was on diagnosis and outcomes between June 2020 and October 2020, in comparison with the previous year. This time period was chosen because surgical services reconvened after a period of inactivity due to the COVID-19 pandemic. The types of emergency admission into the Balfour Hospital during this time were examined, as well as delayed surgeries and the impact of delaying surgery. Results: The data show that, although the prevalence of cancers diagnosed was static, patients presented at a much later stage, with significant impact on prognosis and quality of life. Aside from cancer diagnosis, non-urgent work was significantly disrupted due to the pandemic in 2020. The average waiting time for non-urgent clinic consultation increased from 6 weeks to 18 weeks during this period. The number of patients awaiting endoscopic investigations increased threefold. There was also an increase in the number of emergency admissions due to complications of disease. Conclusion: Although the effects of COVID-19 have been felt nationwide, the impact is more exaggerated in rural communities such as Orkney due to the small population. It is likely the indirect impact on surgical morbidity and mortality in Orkney in 2020 was disproportionately higher than the impact of COVID-19 in the local community. Furthermore, due to limited island resources, a significant number of patients required transfer to tertiary centres for management of complications. This is a unique issue affecting rural communities.

Adhesion is a leading cause of small bowel obstruction. Adhesive small bowel obstruction has significant challenges in diagnosis, treatment and prevention with considerable impact on morbidity and socioeconomic burden. Small bowel obstruction caused by adhesion or any other aetiology is clinically indistinguishable due to similar clinical presentation. Computed Tomography scans and water-soluble contrast studies are more specific in diagnosis and possess value in predicting the need for surgery. Surgical management is indicated only in complicated cases or failed conservative treatments with the majority resolving with non-operative management. However, there is no clear-cut consensus about the timing of operative intervention. Meticulous surgical practice is the keystone in preventing adhesion formation despite the availability of numerous pharmacological and surgical strategies. This review aims to update the current knowledge of the pathophysiology of adhesion formation, treatment options and various prevention modalities of adhesive small bowel obstruction.

Nowadays robotic technology provides massive advantages over traditional procedures, including shorter hospitalization and rehabilitation time, and less pain and discomfort. This paper presents the fundamental requirements of a surgical robot, its applications, advantages and disadvantages of different topologies and concludes with a comparison between surgical robots and surgeons.

Introduction: surgical site infection is one of the most important causes of mortality and morbidity: use of the prophylactic antibiotic is one of the effective methods for its prevention, the present study aimed to investigate the status of prophylactic administration of antibiotics in Surgery Department of Shahid Sadoughi Hospital of Yazd City in 2018. Methods: this descriptive cross-sectional study was performed on 600 patients from General Surgery Department of Shahid Sadoughi Hospital of Yazd City in 2018. Data were collected by questionnaire. Selection of the prophylactic antibiotic (pa), the dosage, time, type and the route of antibiotic administration were compared with ASHP ( American Society of Health System Pharmacistis) and -Clinical Medicine Strategy of Using Preventive Antibiotics in Surgeries (Iranian guideline). Data were analyzed by SPSS version 16 software. Results: Mean age of the patients was 35.02 ±19.12 years. Regarding the use or non-use of antibiotics 85.2%, the route of administration 85.2%, the dose of the drug 64.7% were in accordance with the instructions. The time of drug prescription was in accordance with the national instructions in 72.3% of cases and in accordance with ASHP in 72.8% of cases. The most inconsistency with ASHP and Iranian guideline was seen in the type of the antibiotic that was in accordance with ASHP and Iranian guideline in 50.7% and 48.8%, respectively. The overall appropriateness of PA was found in 50.7% and 48.8% cases according to ASHP and Iranian guideline, respectively. Conclusion: In the recent study, the most inconsistency with ASHP and Iranian guideline was seen in the type of prescription antibiotic.

Introduction: The prevalence of appendicitis is widespread among both adult and pediatric populations. Despite being so common, its diagnosis remains difficult. Initially, acute appendicitis is managed conservatively. To reduce morbidity and mortality, surgery must be performed promptly. The main objective of the study is to find out the prevalence of appendicitis among patients admitted to the department of surgery of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients admitted to the Department of Surgery of a tertiary care centre from 1 July 2021 to 1 July 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: 202/2079/80). Convenience sampling was done. The patient admitted to the Department of Surgery during the study period was included. Point estimate and 95% Confidence Interval were calculated. Results: Out of 2452 patients, the prevalence of appendicitis was 321 (13.09%) (11.75-14.43, 95% Confidence Interval). The mean age of the patients with appendicitis was 31.57±14.14 years and among them, males were 176 (54.83%). Conclusions: The prevalence of appendicitis among patients admitted to the department of surgery of a tertiary care centre was lower compared to other studies conducted in similar settings.

An 80 year-old woman was referred for a one-eyed palpebral edema. She had ptosis and oblique diplopia resistant to corticotherapy. An orbit magnetic resonance imaging showed a mass infiltrating the optic nerve, with an enhancement of the whole orbital musculature. Biopsies of the lacrimal gland were positive for immunoglobulin light chain amyloidosis. Debulking surgery is the main treatment modality for symptomatic patients with localized orbital amyloidosis. Diffuse orbital involvement may make excision difficult. We managed to treat her through radiation therapy to allow a surgical procedure, delivering 20 Gy in 10 fractions. The main aim of radiation therapy was to eradicate the B cells that produced the amyloid light chain deposition. After radiation therapy, the orbital inflammatory caused by the lymphoid infiltration diminished and corticotherapy could be stopped. The surgery could be performed with excellent clinical results. At 2-year follow-up, neither tumor regrowth nor late complications were detected. [ABSTRACT FROM AUTHOR]

Background: Enhanced recovery after surgery (ERAS) is now firmly established as a global surgical quality improvement initiative that results in both clinical improvements and cost benefits to the healthcare system. ERAS guidelines are based on the highest quality evidence available and as such require updating on a regular basis. The ERAS Gynecologic/Oncology guidelines were first published in February 2016. This is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery.1,2 Methods: Starting from the original ERAS Gynecologic/Oncology guidelines, the first author and senior authors identified topics for inclusion. International authors known for their expertise in gynecologic/oncology perioperative care were invited to participate in the guideline update. A database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with an emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system,3 whereby recommendations are given as follows: Strong recommendations: The panel is confident that the desirable effects of adherence to a recommendation outweigh the undesirable effects, weak recommendations: The desirable effects of adherence to a recommendation probably outweigh the undesirable effects, but the panel is less confident. Results: The evidence base, recommendations, evidence level, and recommendation grade are provided for each individual ERAS item below. The table 1 shows all the ERAS items with emphasis on changes for the 2019 guideline update. The (Table 2) shows items: (pre-operative optimization, pre-anesthetic medication, nausea and vomiting prophylaxis, urinary drainage, and early mobilization). These items not updated in 2019 guideline (no change in recommendation/evidence. All recommendations on ERAS protocol items are based on the best available evidence. The level of evidence for each item is presented accordingly. Conclusion: The updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.

Angiomyxoma is a soft-tissue lesion found particularly in women who are of childbearing age. It is mostly encountered in perineal, pelvic, and gluteal area. Due to its recurring nature, surgical intervention is necessary. In our case, a 39-year-old female patient who was operated with the perianal hemangioma pre-diagnosis and whose patholog-ic evaluation was reported as angiomyxoma was presented.

Abstract Background Surgery is a potential trigger of Guillain-Barré syndrome (GBS), a disorder which leads to an autoimmune-mediated attack of peripheral nerves. The present study was designed to explore clinical features of post-surgical GBS compared with those of general GBS in order to provide better clinical advice to patients undergoing surgery. Methods The medical records of GBS patients who were seen at 31 tertiary hospitals in southern China between January 1, 2013 and September 30, 2016 were retrospectively analyzed. Post-surgical GBS was defined as symptoms of GBS within 6 weeks after surgery. Clinical features of post-surgical GBS are described and are compared with general GBS. Results Among the 1001 GBS patient cases examined in this study, 45 (4.5%) patient cases exhibited symptoms of GBS within 6 weeks of undergoing surgery. Within this group, 36 (80.0%) patients developed initial symptoms of limb weakness. The average interval between surgery and symptom onset was 13.31 days. The most common type of surgery which triggered GBS was orthopedic surgery, followed by neurological surgery. Compared to general GBS, post-surgical GBS was characterized by a higher proportion of severe patients (Hughes functional grading scale (HFGS) score ≥ 3) upon admission and at nadir, higher HFGS scores at discharge, and longer hospital stays. Post-surgical GBS patients also had a significantly higher frequency of the acute motor axonal neuropathy subtype (37.9 vs. 14.2, respectively; P = 0.001). Conclusion Surgery is probably a potential trigger factor for GBS, especially orthopedic surgery. Infections secondary to surgery may play a role. The possibility of preceding (post-operative) infections was not excluded in this study. Clinical presentation of post-surgical GBS is characterized by a more severe course and poorer prognosis, and should be closely monitored. Trial registration chicTR-RRc-17,014,152 .

Introduction: Although intestinal obstruction is a very common surgical emergency, there is a dearth of evidence regarding its prevalence at our institute. The objective of this study is to find out the prevalence of intestinal obstruction among patients admitted to the Department of Surgery of a tertiary care centre. Methods: A descriptive cross-sectional study on a total of 6735 admitted patients' in Department of Surgery a tertiary care centre was conducted from 1st January, 2014 to 31st March, 2015. Data were collected retrospectively with ethical approval from Institutional Review Committee (Reference number: 106/071/072). All patients admitted to the surgery ward of the hospital with an age of 18 and above were included in the study. Convenience sampling was used. The data were recorded and analyzed using Microsoft Excel and Statistical Package for Social Sciences version 16.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of the 6735 admitted cases, the prevalence of intestinal obstruction among the admitted patients in the surgery department of the tertiary care centre was found to be 100 (1.48%) (1.19-1.77 at 95% Confidence Interval). The most common presentations were pain in the abdomen 93 (93%), vomiting 74 (74%), and abdominal distension 55 (55%). Conclusions: The prevalence of intestinal obstruction in our study was lower than the similar studies done in similar settings.

Acute abdominal pain is a frequent event in the paediatric population and appendicitis is the most common cause. Abdominal lymphangiomas occur most frequently in the mesenterium and are usually asymptomatic. Nevertheless, they can manifest as acute abdomen, needing surgical treatment. We report the case of a 5-year-old female operated on due to suspicion of acute abdomen. The pathological lesion was surgically removed during the second operation. The differential diagnosis of acute abdomen should be initially focused on the most common abdominal diseases. However, rare cases, like the presented one, must also be taken into consideration. Ultrasound examination plays important role in the initial differentiation of the causes of abdominal pain.

Background & objectives: Cataract is the most common cause of blindness in the world and it is estimated that about 100,000 cataract surgeries are performed annually in Iran. The aim of the present study was to determine the prevalence of different morphological types of cataract and some related causes in patients undergoing surgery at Noor Surgery Center in Ardabil. Methods: This descriptive cross-sectional study was performed on 780 patients referred to the Noor ophthalmology clinic in Ardabil with cataract diagnosis. The data were collected using a checklist by the researcher. Data analysis was performed using SPSS 25 software and descriptive statistical methods. Results: Of the 1,018 eyes (780 patients), 590 eyes (58%) were related to women and 428 eyes (42%) were related to men and the mean age of all patients was 65.88±11.43. the mean grade of posterior subcapsular cataract (PSC), nuclear and cortical cataracts were 4.56±0.62, 4.79±0.89 and 4.21±0.48 respectively. There was a significant difference between normal retina diabetics (p=0.034), pseudo exfoliation syndrome (PEX) (p=0.001), hyperopic (p=0.008), corneal opacity (p=0.036) and patients with nasolacrimal duct obstruction (NLDO) (p=0.032) and other patients in terms of cataract type (p=0.034). There was no significant relationship between other comorbidities and cataract type. Conclusion:According to the results of the present study based on the significant relationship of some diseases with different morphological types of cataracts, accurate preoperative evaluation and planning for associated comorbidities is recommended.

OBJECTIVE: Patients in surgical intensive care units are thought to be at the highest risk for developing candidemia, especially patients undergoing abdominal surgery. The present study aims to investigate risk factors for candidemia in patients with abdominal surgery. METHODS: A retrospective study was undertaken that involved patients admitted to the surgical ICU between January 2016 and January 2017. All postoperative adult patients (>18 years old) who underwent abdominal surgery were included in this study. RESULTS: During the one-year study period, 49 patients developed candidemia. Thirty-five of candida isolates were non-albicans strains. Of them, 25 (51%) isolates were Candida parapsilosis, eight (16.3%) isolates were C. glabrata, one (2%) isolate was C. tropicalis and one (2%) isolate was C. kefyr. The median age of all patients enrolled in this study was 60.5+-15.6 years. In univariate analysis, the duration of the hospital stays, intensive care unit stay, type of surgery, respiratory failure, total parenteral nutrition, transfusion and use of central venous catheter were significantly higher in patients with candidemia. In multivariate analysis, duration of hospital and intensive care unit stay and use of central venous catheter was associated with an increased risk of candidemia. The mortality rate of case patients was 36.7%. CONCLUSION: Patients undergoing abdominal surgery are at increased risk of candidemia, especially the patients with prolonged intensive care unit/hospital stay and the patients with a central venous catheters. Antifungal prophylaxis may be considered for patients with increased risk.

Background and Objectives: Sodium bicarbonate may be effective in reducing the pain since it creates an alkaloid environment and prevents acidosis. Therefore, this study aimed to investigate the effect of intraperitoneal irrigation using sodium bicarbonate on postoperative pain severity. Methods: This non-randomized, double-blind clinical trial was performed on 50 candidates for elective surgery with midline laparotomy at Besat Hospital in Hamadan, Iran, during 2017-18. The patients were assigned into an intervention (underwent intraperitoneal irrigation using sodium bicarbonate solution) and a control group (underwent intraperitoneal irrigation using the normal saline solution). The severity of the pain 12 and 24 h after the surgery in patients was measured using a Visual Analog Scale (VAS). Results: The mean ages of the patients were 48.87±11.68 and 49.56±15.44 years in the intervention and control groups, respectively. Regarding gender distribution, 52% of the participants were male. Moreover, the mean pain scores 12 h after the surgery were 6±1.71 and 7.56±1.47 in the intervention and control groups, respectively. Additionally, the mean pain scores obtained from VAS 24h after the surgery were 20.20±1.15 and 3.68±1.62 in the intervention and control groups, respectively. According to the results, the mean score of pain was significantly lower in the intervention group, compared to the control group (P

Surgery is a treatment choice in the presence of a giant emphysematous bulla (GBE) that covers at least one third of a hemithorax. In this article, a 53-year-old male patient who presented with complaints of progressive shortness of breath, sputum, and inability to perform his daily activities, diagnosed as bilateral GBE after radiological examinations, and post-operative problems were discussed. The right side GBE was operated on. In the postoperative period, there was an air leakage (AL), and the expansion of the lung was insufficient. As soon as respiratory distress and purulent secretion occurred, this important problem was resolved with autologous blood administration. In the presence of GBE, it is difficult to predict the surgical outcome about the lung tissue in the preoperative period. Very serious problems can be encountered in the postoperative period. In the postoperative period, the prolongation of HK and the inability of the lung to expand are very serious problems. Autologous blood application is safe, easy and effective in solving these problems.

Introduction: Pyoderma gangrenosum (PG) of the breast is a rare that present as a painful ulcer on the skin. It usually affects people in their 20s to 50s and occurs in both men and women. Typically, PG affects the legs in adults. In children, it may affect the legs, buttocks, head, and neck. Pyoderma gangrenosum is characterized by a papule, nodule, or pustule that progresses to an injured lesion with unknown boundaries. In this study, a case of Pyoderma gangrenosum is introduced after breast surgery. A 38-year-old woman with a 3 cm wound in the right breast area that has gradually grown has been examined for exudative bloody discharge for the past 2 weeks. Two weeks after breast surgery, a three-centimeter progressive wound has formed on the surface of the breast, which gradually grew larger. During treatment, several oral and injectable antibiotics were prescribed that have not been effective in healing the wound. A biopsy lesion was reported in which a non-specific skin lesion with hyperplasia and vesicle formation without malignancy was reported. The patient had no gastrointestinal symptoms. Infliximab was started and continued for the patient. Conclusion: In the differential diagnosis of resistant skin wounds, especially in the leg area, and in this case in the breast the diagnosis of pyoderma gangrenosome should always be considered. Even if the patient has no history of inflammatory bowel disease, pyoderma gangrenosum may occur before intestinal manifestations.

Introduction: Actinomycosis is an uncommon inflammatory bacterial disease caused by Actinomyces species, especially Actinomyces Israeli. Abdominopelvic forms are relatively rare and may involve the colon as a solid mass, mimicking a malignant tumor., Case Presentation: A 68-year-old Tunisian man, with a history of diabetes, hypertension, penicillin allergy, and renal failure, presented to the emergency department with abdominal pain, vomiting, and bowel obstruction. CT scan showed an acute intestinal obstruction upstream with obstructive tissular mass at the sigmoid colon. Emergency surgery revealed a sigmoid mass and a pre-perforative cecum. Total colectomy was performed, with ileostomy and distal end closure. Histological examination confirmed Actinomyces infection. The patient was then placed on long-term doxycycline and Bactrim, with no recurrence over a 9-month follow-up period., Conclusion: Abdominal actinomycosis, though rare, presents diagnostic challenges. It can be mistaken for malignancy, leading to unnecessary surgery in non-complicated cases, since it is effectively treated by antibiotics. In complicated cases, a combined approach involving both surgery and antibiotic therapy is necessary until the infection is completely eradicated., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Hajri M et al.)

Large cell neuroendocrine carcinoma (LCNEC) is one of the rarest types of bladder cancer, with an aggressive course and a poor prognosis. We report a case of LCNEC of the bladder associated with a prostatic adenocarcinoma. A very rare association, to our knowledge, is described for the first time in the literature. The patient was a 76-year-old non-smoker male, who presented with intermittent hematuria and dysuria. Cystoscopy revealed a lesion on the right lateral bladder wall. Biopsy was in favor of a LCNEC with muscle invasion. The CT scan showed the presence of a second lesion in the prostate, confirmed by histological examination. The patient was treated by neoadjuvant chemotherapy of the cisplatin-etoposide type for large-cell bladder neuroendocrine carcinoma, and hormone therapy with luteinizing hormone-releasing hormone (LH-RH) analogs for prostatic adenocarcinoma, followed by radical surgery. Given the rarity of this tumor, LCNEC treatment lacks precision. Many cases are published with different therapeutic strategies. A literature review would be interesting to codify the therapeutic strategy for this rare tumor., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Nassira et al.)

Objective: To compare primary failure rates for radiocephalic, brachiocephalic and brachiobasilic fistulas between patients with and without diabetes mellitus. Study Design: Cross-sectional study. Place and Duration of Study: Department of Vascular Surgery, Combined Military Hospital, Peshawar Pakistan Aug 2020 to Mar 2022. Methodology: Patients with chronic kidney disease referred for arteriovenous fistula surgery were included. Groups of patients with and without diabetes were age and gender-matched. Pre-operative ultrasound mapping was used for sitting, with a 3 mm diameter outflow vein set as the minimum criterion. End-to-side anastomosis using a parachute technique was performed. Patients were followed up at two, four and six weeks after surgery to assess the functional status of fistulas clinically. Results: There were 172 patients, including 71 with diabetes mellitus. The mean age was 54.67±20.56 years. Overall, there was no difference between the two groups in rates of primary fistula failure at six weeks 9(12.67%) vs 8(7.92%), p=0.304). Brachiocephalic fistulas were made in a greater proportion of patients with diabetes as compared to those without diabetes. At six weeks, 5(10.64%) of these amongst the former were non-functional, as compared to none in the letter group (p=0.024). There was no difference in radiocephalic and brachiobasilic fistula maturity rates between the two groups at the end of the sixth postoperative week. Conclusion: Diabetes mellitus is associated with higher primary failure rates in brachiocephalic fistulas, but the outcomes are the same for radiocephalic and brachiobasilic fistulas as compared to patients without diabetes. [ABSTRACT FROM AUTHOR]

Objective: Retrosternal thyroid is the presence of thyroid tissue in the mediastinum either by enlarging of the cervical or by an ectopic mediastinal thyroid. Surgery for a retrosternal thyroid has technical differences than conventional cervical thyroid surgery and has a higher risk of complications. This paper aims to analyze the cases with retrosternal thyroid and to evaluate the outcomes of the surgery. Materials and Methods: Retrospective analysis in terms of age, sex, clinical course, thyroid hormone levels, parathormone (PTH) levels, diagnostic methods, and fine needle aspiration cytology (FNAC) results and complications of 36 cases that underwent surgery was performed. Results: In addition to routine evaluation for thyroid pathology, computerized tomography was used for each patient. Thirty-four surgeries were completed with a cervical incision, one with a sternotomy and one with a thoracotomy. Four patients (11.1%) experienced temporary postoperative hypocalcemia, and one patient had a transient vocal cord immobility. Neither permanent hypocalcemia nor vocal cord paralysis was present in any of the patients postoperatively. Conclusion: Planning surgery as early as possible is suggested to avoid compression symptoms and possible malignancy. Cervical approach is mostly enough for the majority of patients; however, in case of a need of an additional (transthoracic) approach, multidisciplinary planning with thoracic surgeons is proposed. The risk of complications in experienced centers is parallel to cervical thyroidectomy.

Tina Gambling,1 Andrew F Long21School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK; 2School of Healthcare, University of Leeds, Leeds, UKPurpose: To develop and validate a patient-centered, evaluative outcome measure to assess patient-significant and identified impacts of the three pediatric hip conditions (the “Quality of Life, Concerns and Impact Measure” (QoLC&I)), for use by patients and clinicians in discussions over treatment options and the evaluation of treatment and post-operative rehabilitation.Patients and methods: The measure was developed through a qualitative study, via two web-based forums (patient narratives, n=84) and one specialist orthopedic adult hip clinic (conducting interviews, n=38). The draft (1) measure was piloted in an asynchronous web-based discussion group forum; following revision, it was piloted with a group of clinicians and patients to assess its patient and clinical utility, face and content validity. The final, refined prototype measure (QoLC&I, draft 3) was subjected to psychometric evaluation.Results: A total of 230 patients provided useable data for the psychometric analysis: 70% (160) had a confirmed diagnosis of Developmental Dysplasia of the Hip, 15% (35) Perthes, 11% (26) Slipped Upper Femoral Epiphyses; 4% (9) PHC not stated. The scale showed good acceptability (few missing items, good spread, low floor/ceiling effects), relevance (76% stating they would find the measure useful in their discussions with clinicians), and good internal consistency (Cronbach’s α=0.98; average ICC=0.98). Hypotheses on convergent validity (with the General Health Questionnaire, to measure depression, and the International Hip Outcome Tool Short Form, to measure quality of life) and divergent validity (with the General Self-Efficacy Scale, to measure coping) were confirmed.Conclusion: The 64-item QoL&CI measure is a practical and valid measure addressing areas of clinical and patient significance and has potential value to assist patients and clinicians in discussions about treatment choices and treatment progress. Future research will address further psychometric testing (test–retest validity and responsiveness to change), in additional sites, and embedding the measure into clinical practice.Keywords: Developmental Dysplasia of the Hip, Perthes disease, Slipped Upper Femoral Epiphyses, psychology, osteoarthritis

INTRODUCTION: In this study we aimed to evaluate the efficacy of artificial urinary sphincter (AUS) surgery in the treatment of incontinence especially due to sphincter incompetence after prostate surgery,retrospectively according to surgical outcomes and patient satisfaction. METHODS: In our clinic the data of patients who underwent AUS surgery between 2009 and 2018 were evaluated retrospectively. In order to evaluate the incontinence status of the patients before and after the operation, the success rate of AUS surgery and patients satisfaction after AUS surgery, the ICIQ-SF (International Consultation on Incontinence Questionnaire Short Form), which is a questionnaire for urinary incontinence evaluation before and after the operation, was filled. RESULTS: The mean age of the patients was 67.92 +- 24.08 years and the mean follow-up period was 66.38 +- 11.17 months. Daily amount of pad usage and ICIQ-SF score were 4.23 +- 1.49 and 16.84 +- 4.64 in the preoperative period and 1.33 +- 1.01 and 2.91 +- 0.64 in the postoperative period respectively. When these results were compared, there was a statistically significant difference in terms of both the consumption of pads and the ICIQ-SF score (p

Gait impairments in people with Charcot Marie Tooths disease are the combined result of ankle-foot deformities, muscle weakness, and somatosensory impairments. People with Charcot-Marie-Tooth disease often experience pain and difficulties when walking, especially barefoot. They also trip and fall frequently and have a lower than normal gait speed and distance. Because these gait impairments and related complaints are disabling, clinical management aimed at improving gait is important. Management involves both conservative and surgical treatment options, each with limited scientific evidence. However, a treatment algorithm that describes both conservative and surgical treatment options is currently lacking. This study sets out a step-wise treatment algorithm, based on evidence, if available, and otherwise reflecting practice-based experience. The treatment algorithm will be of value in daily clinical practice, and will serve as a template for future research.

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Left paraduodenal hernia (PDH), may present as a surgical emergency with an increased risk of strangulation and incarceration. The diagnosis is challenging because of the non-specific presentation. In the absence of common epigastric or upper abdominal pathology and non-resolving symptoms, a high index of suspicion is required to diagnose left PDH. This report describes a case of radiologically diagnosed left paraduodenal hernia and subsequent successful surgery. It also includes a review of midgut embryology, and the anatomy and radiology of left PDH.

Background: Surgery is a potential trigger of Guillain-Barré syndrome (GBS), a disorder which leads to an autoimmune-mediated attack of peripheral nerves. The present study was designed to explore clinical features of post-surgical GBS compared with those of general GBS in order to provide better clinical advice to patients undergoing surgery.Methods: The medical records of GBS patients who were seen at 31 tertiary hospitals in southern China between January 1, 2013 and September 30, 2016 were retrospectively analyzed. Post-surgical GBS was defined as symptoms of GBS within 6 weeks after surgery. Clinical features of post-surgical GBS are described and are compared with general GBS.Results: Among the 1001 GBS patient cases examined in this study, 45 (4.5%) patient cases exhibited symptoms of GBS within 6 weeks of undergoing surgery. Within this group, 36 (80.0%) patients developed initial symptoms of limb weakness. The average interval between surgery and symptom onset was 13.31 days. The most common type of surgery which triggered GBS was orthopedic surgery, followed by neurological surgery. Compared to general GBS, post-surgical GBS was characterized by a higher proportion of severe patients (Hughes functional grading scale (HFGS) score ≥ 3) upon admission and at nadir, higher HFGS scores at discharge, and longer hospital stays. Post-surgical GBS patients also had a significantly higher frequency of the acute motor axonal neuropathy subtype (37.9 vs. 14.2, respectively; P = 0.001).Conclusion: Surgery is probably a potential trigger factor for GBS, especially orthopedic surgery. Infections secondary to surgery may play a role. The possibility of preceding (post-operative) infections was not excluded in this study. Clinical presentation of post-surgical GBS is characterized by a more severe course and poorer prognosis, and should be closely monitored.Trial Registration: chicTR-RRc-17,014,152 . [ABSTRACT FROM AUTHOR]

Hip fractures are a serious global health concern with a substantial impact on senior patients' mobility, quality of life, and morbidity. Patients with psychiatric pathology may experience heightened levels of distress, making pain management more challenging. The presence of multiple comorbidities may complicate the therapeutic management of hip fractures. Treatment plans must be carefully tailored to accommodate each individual's unique medical history and current health status. We looked for improving pain evaluation and management in patients with dementia and choosing the best treatment according to age and comorbidities. This study highlights the mortality rate in surgically and non-surgically treated patients and possible correlations with other factors. We conducted a prospective study on 184 patients over 60 years old, with dementia and hip fractures, between 2018 and 2020 in Romania, within the Galati County Clinical Hospital. We applied the Charlson Comorbidity Index, ACE III test, EQ5D5L, and Harris test scores to assess the comorbidities, respectively, pain levels, mobilization in daily life activities, self-care and severity of dementia to exert the optimal treatment for patients with dementia and hip fracture. Our study pointed out that pain was frequently excruciating in non-operated patients compared to those who were operated. Most non-operated patients were immobilized in bed, they required careful and permanent care, while most of the operated patients experienced lower pain levels. While some risk factors of morbidity and mortality, such as comorbidities, severity of dementia, high age, and previous living situations are not preventable, delayed surgery, and general anesthesia risks may be prevented. Despite the treatment, mortality was high both at 6 months and 2 years, with increased survival rate in surgical treated patients. Our study addresses issues such as the importance of mental state evaluation in elderly patients in therapeutic decisions, the surgical intervention and the particularities in pre- and postoperative pain control in patients with dementia, topics that are insufficiently established in the current practical guidelines., Competing Interests: Conflict of interests: The authors declare that they have no competing interests., (Copyright © 2024, Applied Systems.)