Low Threshold for Laparoscopic Exploration in Dementia Patients With Unexplained Abdominal Pain and Risk Factors for Acute Mesenteric Ischemia.

Acute mesenteric ischemia (AMI) is associated with a high mortality and morbidity. There are limited studies on the presentation and management of elderly dementia patients with AMI. The following case of an 88-year-old female with dementia presenting with AMI highlights the challenges in the care of elderly dementia patients with AMI, the importance of identifying risk factors and hallmarks of acute mesenteric ischemia early in the clinical course, and suggests that aggressive workup with diagnostic laparoscopy is crucial to timely diagnosis and effective care.

Impact of Time to Treatment on Endovascular Thrombectomy Outcomes in the Early Versus Late Treatment Time Windows.

Background: The impact of time to treatment on outcomes of endovascular thrombectomy (EVT) especially in patients presenting after 6 hours from symptom onset is not well characterized. We studied the differences in characteristics and treatment timelines of EVT-treated patients participating in the Florida Stroke Registry and aimed to characterize the extent to which time impacts EVT outcomes in the early and late time windows.

Methods: Prospectively collected data from Get With the Guidelines-Stroke hospitals participating in the Florida Stroke Registry from January 2010 to April 2020 were reviewed.

Effects of Dienogest Therapy on Endometriosis-Related Dysmenorrhea, Dyspareunia, and Endometrioma Size.

Introduction: Endometriosis is an estrogen-dependent chronic inflammatory disease that is defined by the presence of endometrial-like tissue outside of the uterus. The most common localization is the ovaries, and endometriosis in this location is then called an endometrioma. According to the European Society of Human Reproduction and Embryology (ESHRE) (2022) guidelines, the most commonly prescribed treatments for endometriosis include drugs that alter the hormonal milieu.

INTERFASCIAL PLANE BLOCKS IN OBSTETRIC AND GYNECOLOGIC SURGERY.

Introduction: Interfascial plane blocks (IPB) are truncal blocks with local anesthetic injected into space between two muscle layers. IPBs are easy to learn, simple to perform, provide satisfactory analgesia up to 24 hours, having a minimal risk of complications.

Methods: We present a retrospective analysis of the patients who had IPB as a part of postoperative pain management plan following either CD or hysterectomy in Leskovac General Hospital, Serbia during the period April 2017 - February 2022.

Financial Toxicity in Emergency General Surgery: Novel Propensity-Matched Outcome Comparison.

Background: Financial toxicity describes the harmful effect of individual treatment costs and fiscal burdens that have a compounding negative impact on outcomes in surgery. While this phenomenon has been widely studied in surgical oncology, the purpose of this study was to perform a novel exploration of the impact of financial toxicity in emergency general surgery (EGS) patients throughout the US.

Study Design: The Nationwide Readmissions Database for January and February 2018 was queried for all EGS patients aged 18 to 65 years.

An Ultrasound Survey of the Radial and Ulnar Arteries in an American Population: Implications for Transradial Access.

Background: Palpation-guided access of the radial artery (RA) has transradial access (TRA) failure rates averaging 6%-7%. This study aimed to measure RA and ulnar artery (UA) diameters by ultrasound in a typical American population, in hopes of elucidating data that may improve TRA success rates.

Methods: Intraprocedural ultrasound measurements of the RA and UA in 565 consecutive patients undergoing TRA were retrospectively analyzed.

Outcomes of laparoscopic versus open resection of pediatric choledochal cyst.

Background: Untreated pediatric choledochal cyst (CC) is associated with complications including cholangitis, pancreatitis, and risk of malignancy. Therefore, CC is typically treated by surgical excision with biliary reconstruction. Both open and laparoscopic (lap) surgical approaches are regularly used, but outcomes have not been compared on a national level.

Newborn Screening Long-Term Follow-Up Clinics (Continuity Clinics) in the Philippines during the COVID-19 Pandemic: Continuing Quality Patient Care.

The COVID-19 pandemic has challenged healthcare systems worldwide. In the Philippines, long-term care for patients with conditions identified through newborn screening (NBS) is coordinated through Newborn Screening Continuity Clinics (NBSCCs). These clinics are integral to achieving optimal outcomes by providing follow-up oversight and assistance for individuals identified through screening.

Effects of the Sodium-Glucose Cotransporter Inhibitors on Cardiovascular Death and All-Cause Mortality: A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Clinical Trials.

Background: Patients with diabetes mellitus are at an increased risk of cardiovascular morbidity and all-cause mortality. Heart failure and type 2 diabetes often occur concomitantly, and each disease independently increases the risk for the other.

Objective: Emerging data have revealed that some sodium-glucose cotransporter inhibitors (SGLTi) improve cardiovascular and renal outcomes, particularly in patients with type 2 diabetes.

Using Right-Sided Roll to Improve Reliability of Focused Assessment with Sonography in Trauma: An Eastern Association for the Surgery of Trauma Multicenter Prospective Study.

Background: The Focused Assessment Sonography in Trauma (FAST) examination is the standard of care for detecting hemoperitoneum in hypotensive blunt trauma patients. A pilot study demonstrated earlier identification of intra-abdominal fluid via FAST after right-sided roll (FASTeR) when compared with the standard FAST. The purpose of this study was to evaluate this phenomenon prospectively in hypotensive blunt trauma patients.

Income Disparities in Nationwide Outcomes of Malrotation with Midgut Volvulus.

Background: Malrotation with midgut volvulus is a surgical emergency commonly encountered in pediatric surgical practice. Outcomes are excellent with timely diagnosis and treatment, but the development of bowel ischemia is associated with many negative consequences.

Methods: The Nationwide Readmissions Database was used to identify patients 0-18 years (excluding newborns) with malrotation and midgut volvulus from 2010 to 2014.

Geographic Distribution of Cancer Care Providers in the Philippines.

Purpose: In the Philippines, a lower middle-income country in Southeast Asia, 6 of 10 Filipinos die without seeing a doctor. To ensure universal access to cancer care, providers must be equitably distributed. Therefore, we evaluated the distribution of oncologists across all 17 regions in the Philippines.

Estimating economic and disease burden of snakebite in ASEAN countries using a decision analytic model.

Background: Understanding the burden of snakebite is crucial for developing evidence-informed strategies to pursue the goal set by the World Health Organization to halve morbidity and mortality of snakebite by 2030. However, there was no such information in the Association of Southeast Asian Nations (ASEAN) countries.

Methodology: A decision analytic model was developed to estimate annual burden of snakebite in seven countries, including Malaysia, Thailand, Indonesia, Philippines, Vietnam, Lao PDR, and Myanmar.

Clinical Reasoning: A 51-Year-Old Woman With Diplopia and Headache.

A 51-year-old woman presented with a pressure-like headache behind her right eye and horizontal diplopia. On examination, she was unable to abduct or adduct the right eye but had intact vertical eye movements. Her deficits could not be overcome using the oculocephalic reflex.

Pneumothorax in the Setting of Spinal Surgery: A Case Report and Review of the Literature.

The purpose of this paper is to review the occurrence and management of a tension pneumothorax, which was exacerbated status post posterior spinal surgery. A retrospective review of intraoperative reports, imaging, and pertinent medical records was conducted for a patient who underwent posterior spinal surgery with a tiny apical pneumothorax, which subsequently developed into a major pneumothorax. The clinical signs imperative to recognition and prompt treatment are discussed.

Cultivating a Resiliency Model for Emergency Department and Intensive Care Unit Staff Through Peer Support: A Program Description.

Emergency department (ED) and intensive care unit (ICU) staff experience significant and ongoing exposure to mental health trauma due to the extremely high number of tragic cases consistently seen. Despite awareness of the magnitude of this problem, there is a scarcity of clinical efforts directed toward reducing and managing secondary traumatic stress and vicarious trauma. In an effort to promote resiliency in these frontline workers, we describe development and implementation of the Adapted Peer Support Resiliency Program (APSRP), a psychoeducational and cognitive reframing behavioral-based program equipped with peer support professionals who are trained in cognitive-behavioral strategies specifically tailored toward the needs of this population.

Variants of may be Linked to Poor Response to Metformin.

Purpose: A study among Filipinos revealed that only 15% of patients with diabetes achieved glycemic control, and poor response to metformin could be one of the possible reasons. Recent studies demonstrate how genetic variations influence response to metformin. Hence, the present study aimed to determine genetic variants associated with poor response to metformin.

Are phenome-wide association studies feasible in a developing country?

Phenome-wide association studies (PheWASs), a powerful approach that examines phenotypes associated with a genetic marker, have been used extensively in highly developed countries. Although there may be a clear need for PheWAS in a developing country such as the Philippines, limitations related to resources and practicality would make conducting them a challenge.

Glomerular Disease in Temporal Association with SARS-CoV-2 Vaccination: A Series of 29 Cases.

Background: Immune responses to vaccination are a known trigger for a new onset of glomerular disease or disease flare in susceptible individuals. Mass immunization against SARS-CoV-2 in the COVID-19 pandemic provides a unique opportunity to study vaccination-associated autoimmune kidney diseases. In the recent literature, there are several patient reports demonstrating a temporal association of SARS-CoV-2 immunization and kidney diseases.