Recent updates in laryngeal hemangioma management: a scoping review.

PURPOSE: To provide a comprehensive review of the current strategies in the management of laryngeal hemangiomas, with an aim to introduce a management algorithm that aligns with the variable clinical presentations and anatomical complexities of these lesions. METHODS: We conducted an extensive literature search across major databases using specific and general terms, combined with Boolean operators, to ensure comprehensiveness. Articles from January 2004 to August 2023 were included, with findings categorized by management approach. RESULTS: Laryngeal hemangiomas exhibit a spectrum of manifestations, ranging from asymptomatic lesions to those causing severe airway obstruction. Optimal management demands an individualized approach tailored to the patient's unique presentation and anatomical considerations. Diverse treatment modalities, each with distinct indications, advantages, and limitations, are explored. Notable highlights encompass the prominent role of Beta-blockers, notably Propranolol, in addressing problematic infantile hemangiomas, the nuanced efficacy of laser therapies contingent upon hemangioma type and depth, and the critical relevance of tracheotomy in emergencies. Novel approaches like transoral robotic surgery and transoral ultrasonic surgery, demonstrate promise in specific scenarios. We propose a management algorithm based on the complexity and presentation of laryngeal hemangiomas, emphasizing individualized treatment strategies, thereby addressing the unique challenges and nuances of each case. CONCLUSION: Laryngeal hemangioma management requires personalized approaches informed by diverse therapies, clinical expertise, and collaboration. The review introduces an algorithm spanning observation to advanced interventions, adapting to each case's complexity. Ongoing research promises innovative treatments.

Swedish consensus regarding difficult pre-hospital airway management: a Delphi study.

BACKGROUND: The aim of this study was to establish a consensus among experts in prehospital work regarding the management of difficult airways in prehospital care in Sweden. The results were subsequently used to develop an algorithm for handling difficult airway in prehospital care, as there was none available in Sweden prior to this study. METHODS: This two-round Delphi study was conducted by forming an expert panel comprising anesthesiologists and anesthesia nurses working in prehospital setting in Sweden. The expert panel responded digital forms with questions and statements related to airway management. The study continued until consensus was reached, defined as more than 70% agreement. The study took place from December 4, 2021, to May 15, 2022. RESULTS: In the first round, 74 participants took part, while the second round involved 37 participants. Consensus was reached in 16 out of 17 statements. 92% of the participants agreed that an airway algorithm adapted for prehospital use is necessary. CONCLUSIONS: The capacity to adapt the approach to airway management based on specific pre-hospital circumstances is crucial. It holds significance to establish a uniform framework that is applicable across various airway management scenarios. Consequently, the airway management algorithm that has been devised should be regarded as a recommendation, allowing for flexibility rather than being interpreted as a rigid course of action. This represents the inaugural nationwide algorithm for airway management designed exclusively for pre-hospital operations in Sweden. The algorithm is the result of a consensus reached by experts in pre-hospital care.

Multiple magnet ingestion in children: A problem on the rise.

AIM: Ingestion of multiple magnets is increasing these last 15 years in children. They have resulted in numerous reports of serious gastrointestinal complications such as bowel obstruction, ischaemia, necrosis, perforation and fistula formation and even led to death. The increasing number of world-wide reports of complications secondary to magnet ingestion and a frequently delayed diagnosis point to a lack of awareness about these risks among medical care-givers in our country and parents in general. METHODS: We reviewed retrospectively all cases of multiple magnet ingestion that required a gastro-intestinal or surgical procedure for removal from 2009 to 2020. RESULTS: Five children underwent gastroscopy removal and three colonoscopy removal of the magnets. Five patients required surgical (laparotomy or laparoscopy) removal of multiple magnets with intestinal perforations. CONCLUSIONS: We propose an updated management algorithm for multiple magnet ingestion to highlight awareness among primary physicians and parents of the presenting circumstances and symptoms as well as the potential complications associated with multiple magnet ingestion.

Impact of public health emergency response to COVID-19 on management and outcome for NSTEMI patients in Beijing: A single-center historic control.

BACKGROUND: During coronavirus disease 2019 (COVID-19) epidemic, reducing the number of invasive procedure and choosing conservative medication strategy for patients with non-ST-segment elevation myocardial infarction (NSTEMI) is unavoidable. Whether this relatively conservative strategy will impact in-hospital outcome for NSTEMI patients remains unclear. METHODS AND RESULTS: The current study included all consecutive NSTEMI patients who visited the emergency department in Fuwai Hospital from February 1 to March 31, 2020 and all the NSTEMI patients in the same period of 2019 as a historical control. Very-high-risk patients were defined as clinical presentation of heart failure, cardiac shock, cardiac arrest, recurrent chest pain, and life-threatening arrhythmias. The primary outcome was in-hospital major adverse cardiac events (MACE), defined as a composite of all-cause death, recurrent myocardial infarction, or heart failure. A total of 115 NSTEMI patients were enrolled since the outbreak of COVID-19, and a total of 145 patients were included in the control group. There was a tendency toward higher MACE risk in 2020 compared with 2019 (18.3% vs. 11.7%, p = .14). Among very-high-risk patients, early percutaneous coronary intervention (PCI) strategy in 2019 was associated with reduced MACE risk compared with delayed PCI in 2020 (60.6% [20/33] in 2020 vs. 27.9% [12/43] in 2019, p = .01). CONCLUSIONS: COVID-19 pandemic results in a significant reduction in immediate/early PCI and a trend toward higher adverse event rate during hospitalization, particular in very-high-risk patients.

Multidisciplinary Management of Complicated Pancreatitis: What Every Interventional Radiologist Should Know.

Management of acute pancreatitis is challenging in the presence of local complications that include pancreatic and peripancreatic collections and vascular complications. This review, targeted for interventional radiologists, describes minimally invasive endoscopic, image-guided percutaneous, and surgical procedures for management of complicated pancreatitis and provides insight into the procedures' algorithmic application. Local complications are optimally managed in a multidisciplinary team setting that includes advanced endoscopists; pancreatic surgeons; diagnostic and interventional radiologists; and specialists in infectious disease, nutrition, and critical care medicine. Large symptomatic or complicated sterile collections and secondary infected collections warrant drainage or débridement. The drainage is usually delayed for 4-6 weeks unless clinical deterioration warrants early intervention. If collections are accessible by endoscopy, endoscopic procedures are preferred to avoid pancreaticocutaneous fistulas. Image-guided percutaneous drainage is indicated for symptomatic collections that are not accessible for endoscopic drainage or that present in the acute setting before developing a mature wall. Peripancreatic arterial pseudoaneurysms should be embolized before necrosectomy procedures to prevent potentially life-threatening hemorrhage. Surgical procedures are reserved for symptomatic collections that persist despite endoscopic or interventional drainage attempts. Understanding these procedures facilitates their integration by interventional radiologists into the complex longitudinal care of patients with complicated pancreatitis.

Management of colorectal anastomotic leakage using endoscopic negative pressure therapy with or without protective ostomy: a retrospective study.

PURPOSE: Management of colorectal anastomotic leakage (AL) is patient-oriented and requires an interdisciplinary approach. We analyzed the management of AL according to its severity and presence of ostomy and proposed a therapy algorithm. METHODS: We identified all patients who underwent colorectal surgery and developed an AL in our clinic between 2012 and 2017. The management of AL was retrospectively analyzed according to the severity grade: asymptomatic (A), requesting interventional or antibiotic therapy (B), undergoing re-operation (C). The groups were compared according to the leakage characteristics, presence of ostomy, and patient clinical conditions. RESULTS: We identified 784 consecutive patients meeting the inclusion criteria. Of these, 10.8% experienced an AL (A = 18%, B = 48%, and C = 34%). The rate of successful ostomy closure was 100% (A), 68% (B), and 62% (C), respectively. Within group B, 91% of the patients were treated solely by endoscopic negative pressure therapy (ENPT), whereas 37% of the patients within group C required ENPT in addition to surgery. Seven cases within group B (17%) required no protective ostomy (nOB) during ENPT which was itself shorter and required less cycles in comparison to group B with ostomy (OB) (p = 0.017 and 0.111, respectively). Moreover, the leakage distance to anal verge was higher in the OB subgroup (p < 0.001). CONCLUSION: ENPT for the treatment of colorectal AL is efficient in combination with operative revision or protective ostomy. In selected patients, it is feasible also in the absence of a protective ostomy.

[Management algorithm for septic arthritis after anterior cruciate ligament reconstruction].

OBJECTIVE: To summarize the experience in the diagnosis and management of septic arthritis after anterior cruciate ligament reconstruction. METHODS: A retrospective review was conducted of all the arthroscopic anterior cruciate ligament reconstructions performed at Department of Sports Medicine, Peking University Third Hospital between January 2001 and December 2020. In the study, 65 of 27 867 patients experienced postoperative septic arthritis. The incidence, presentation, laboratory results, treatment, and outcome of all the infected patients were analyzed. The experiences of diagnosis and management of septic arthritis after anterior cruciate ligament reconstruction were summarized. RESULTS: A total of 27 867 anterior cruciate ligament reconstructions were performed at our department between January 2001 and December 2020. In the study, 65 (0.23%) patients were identified with postoperative septic arthritis. The most common symptoms of the infected patients were fever (38.7±0.5) ℃, knee swelling, pain, and restricted motion. The mean peripheral white blood cell count (WBC) was (9.2±2.6)×109/L (range 4.2×109/L-19.4×109/L), with (72.5±6.3) % (range 54.9%-85.1%) polymorphonuclear neutrophils (N). The mean erythrocyte sedimentation rate (ESR) was (59.9±24.1) mm/h (range 9-108 mm/h), C-reactive protein (CRP) was (10.9±5.7) mg/dL (range 1.2-30.8 mg/dL), and fibrinogen (FIB) level was (7.0±1.6) g/L (range 3.7-10.8 g/L). All of the laboratory results were statistically higher in the infection group compared with the normal postoperative group (P＜0.001). The synovial white blood cell count (SWBC) of aspirated knee joint fluid was (45.0±29.8)×109/L (range 7.1×109-76.5×109/L). Polymorphonuclear cell percentage (PMNC) was (90.27±7.86) % (range 60%-97%). In the study, 45 patients (69.2%) had positive aspirate cultures. Microbiology showed coagulase-negative Staphylococcus (CNS) and Staphylococcus aureus (SA) were the most common bacterium (34 cases and 7 cases, individually). There were 26 methicillin-resistant Staphylococcus. Both conservative (16 patients) and operative (49 patients) treatments were effective, but conservative group had a longer recovery time (5.6 d vs. 1.6 d, P=0.042). CONCLUSION: Septic arthritis after arthroscopic anterior cruciate ligament reconstruction is a rare but potentially devastating complication. The correct diagnosis relies on synovial fluid analysis and bacterial culture. Our proposed treatment protocol is arthroscopic debridement and antibiotic therapy as quickly as possible.

[The medical organization of primary care: competitiveness and reputation].

The article investigated the state of the competitive environment on the market of medical services of the Krasnodar territory, which included socio-economic indicators needed to understand current market conditions such as the number of medical organizations of primary care and health manpower; the volume of paid medical services, rendered to population of the region and individual costs for medical services; the investment performance of the industry, the possibility of participation of private medical organizations in the implementation of the Territorial program of obligatory medical insurance. The author's interpretation reveals the concept of «business reputation of a primary-level medical organization¼. It is proved that the «business reputation¼ on the Internet or online reputation has become a strategic tool for ensuring the competitive advantages of a primary - level medical organization. The content analysis of Internet resources conducted in the study showed that the online reputation of a primary care organization is primarily patient reviews (negative and positive), and online reputation management in the Internet is continuous work with patient reviews, the process of communicating with the audience, publishing information materials, etc. Monitoring popular sites on this topic prodoctorov.ru and Yandex. Search and analysis of patient reviews of medical organizations in Sochi allowed the authors to assess the online reputation of primary care organizations. In conclusion, the article presents an algorithm for managing online reputation on the Internet to ensure the competitiveness of primary care organizations.

Updates on Management of Adult Medulloblastoma.

OPINION STATEMENT: Medulloblastoma (MB) is a malignant embryonal tumor of the posterior fossa and is the most common type of brain cancer in pediatric patients. In contrast, adult MB is very rare with an incidence of 0.6 per million per year and mostly affects young adults below the age of 40. Recent molecular analyses of pediatric and adult MB have classified these tumors into at least four individual molecular subgroups (SHH, WNT, group 3, and group 4) with distinct demographics, histology, and prognosis. The discrete biological composition of these tumors likely explains the marked heterogeneity in responses seen to conventional therapies such as radiation and cytotoxic chemotherapies. Given the low incidence of adult MB, prospective studies are challenging and scarce, and management guidelines are largely derived from the pediatric MB patient population and retrospective data. However, adult MB is clinically and molecularly distinct from pediatric MB and a comprehensive review of published literature on adult MB highlighting their differences is warranted. Here, we review the management of adult MB focusing on recent studies exploring the effectiveness of upfront chemotherapy, clinical trials in the context of molecular subgroup-specific therapies, and the potential role of immunotherapy in treating this disease.

[Algorithm for the management of patients with stable coronary artery disease and high-grade ventricular arrhythmias]. / Algoritm vedeniia patsientov so stabil'noi ishemicheskoi bolezn'iu serdtsa i zheludochkovymi aritmiiami vysokikh gradatsii.

The paper gives an original algorithm for the management of patients with stable coronary artery disease, preserved/moderately reduced left ventricular systolic function, and high-grade ventricular arrhythmias from the first registration of the latter to the choice of treatment policy. Great attention is paid to the assessment of a private clinical case, by determining the nature of arrhythmias, and to the involvement of autonomic regulation in the genesis of ventricular arrhythmias. The importance of topical diagnosis of ventricular arrhythmias and identification of psychological disorders is emphasized. Diagnostic problems are solved in a step-by-step fashion using up-to-date techniques. The key point of the algorithm proposed is to prevent sudden cardiac death.

Classification, prevention and management of entero-atmospheric fistula: a state-of-the-art review.

BACKGROUND: Entero-atmospheric fistula (EAF) is an enteric fistula occurring in the setting of an open abdomen, thus creating a communication between the GI tract and the external atmosphere. Management and nursing of patients suffering EAF carries several challenges, and prevention of EAF should be the first and best treatment option. PURPOSE: Here, we present a novel modified classification of EAF and review the current state of the art in its prevention and management including nutritional issues and feeding strategies. We also provide an overview on surgical management principles, highlighting several surgical techniques for dealing with EAF that have been reported in the literature throughout the years. CONCLUSIONS: The treatment strategy for EAF should be multidisciplinary and multifaceted. Surgical treatment is most often multistep and should be tailored to the single patient, based on the type and characteristics of the EAF, following its correct identification and classification. The specific experience of surgeons and nursing staff in the management of EAF could be enhanced, applying distinct simulation-based ex vivo training models.

Advances in clinical management of eosinophilic esophagitis.

Eosinophilic esophagitis (EoE) is a chronic immune/antigen-mediated clinicopathologic condition that has become an increasingly important cause of upper gastrointestinal morbidity in adults and children over the past 2 decades. It is diagnosed based on symptoms of esophageal dysfunction, the presence of at least 15 eosinophils/high-power field in esophageal biopsy specimens, and exclusion of competing causes of esophageal eosinophilia, including proton pump inhibitor-responsive esophageal eosinophilia. We review what we have recently learned about the clinical aspects of EoE, discussing the clinical, endoscopic, and histological features of EoE in adults and children. We explain the current diagnostic criteria and challenges to diagnosis, including the role of gastroesophageal reflux disease and proton pump inhibitor-responsive esophageal eosinophilia. It is also important to consider the epidemiology of EoE (with a current incidence of 1 new case per 10,000 per year and prevalence of 0.5 to 1 case per 1000 per year) and disease progression. We review the main treatment approaches and new treatment options; EoE can be treated with topical corticosteroids, such as fluticasone and budesonide, or dietary strategies, such as amino acid-based formulas, allergy test-directed elimination diets, and nondirected empiric elimination diets. Endoscopic dilation has also become an important tool for treatment of fibrostenotic complications of EoE. There are a number of unresolved issues in EoE, including phenotypes, optimal treatment end points, the role of maintenance therapy, and treatment of refractory EoE. The care of patients with EoE and the study of the disease span many disciplines; EoE is ideally managed by a multidisciplinary team of gastroenterologists, allergists, pathologists, and dieticians.

An environment-adaptive management algorithm for hearing-support devices incorporating listening situation and noise type classifiers.

In order to provide more consistent sound intelligibility for the hearing-impaired person, regardless of environment, it is necessary to adjust the setting of the hearing-support (HS) device to accommodate various environmental circumstances. In this study, a fully automatic HS device management algorithm that can adapt to various environmental situations is proposed; it is composed of a listening-situation classifier, a noise-type classifier, an adaptive noise-reduction algorithm, and a management algorithm that can selectively turn on/off one or more of the three basic algorithms-beamforming, noise-reduction, and feedback cancellation-and can also adjust internal gains and parameters of the wide-dynamic-range compression (WDRC) and noise-reduction (NR) algorithms in accordance with variations in environmental situations. Experimental results demonstrated that the implemented algorithms can classify both listening situation and ambient noise type situations with high accuracies (92.8-96.4% and 90.9-99.4%, respectively), and the gains and parameters of the WDRC and NR algorithms were successfully adjusted according to variations in environmental situation. The average values of signal-to-noise ratio (SNR), frequency-weighted segmental SNR, Perceptual Evaluation of Speech Quality, and mean opinion test scores of 10 normal-hearing volunteers of the adaptive multiband spectral subtraction (MBSS) algorithm were improved by 1.74 dB, 2.11 dB, 0.49, and 0.68, respectively, compared to the conventional fixed-parameter MBSS algorithm. These results indicate that the proposed environment-adaptive management algorithm can be applied to HS devices to improve sound intelligibility for hearing-impaired individuals in various acoustic environments.

An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions.

OBJECT: Over the past decade, the incidence of bacterial spinal epidural abscess (SEA) has been increasing. In recent years, studies on this condition have been rampant in the literature. The authors present an 11-year institutional experience with SEA patients. Additionally, through an analysis of the contemporary literature, they provide an update on the challenging and controversial nature of this increasingly encountered condition. METHODS: An electronic medical record database was used to retrospectively analyze patients admitted with SEA from January 2001 through February 2012. Presenting symptoms, concurrent conditions, microorganisms, diagnostic modalities, treatments, and outcomes were examined. For the literature search, PubMed was used as the search engine. Studies published from January 1, 2000, through December 31, 2013, were critically reviewed. Data from articles on methodology, demographics, treatments, and outcomes were recorded. RESULTS: A total of 106 patients with bacterial SEA were identified. The mean ± SD age of patients was 63.3 ± 13.7 years, and 65.1% of patients were male. Common presenting signs and symptoms were back pain (47.1%) and focal neurological deficits (47.1%). Over 75% of SEAs were in the thoracolumbar spine, and over 50% were ventral. Approximately 34% had an infectious origin. Concurrent conditions included diabetes mellitus (35.8%), vascular conditions (31.3%), and renal insufficiency/dialysis (30.2%). The most commonly isolated organism was Staphylococcus aureus (70.7%), followed by Streptococcus spp. (6.6%). Surgery along with antibiotics was the treatment for 63 (59.4%) patients. Surgery involved spinal fusion for 19 (30.2%), discectomy for 14 (22.2%), and corpectomy for 9 (14.3%). Outcomes were reported objectively; at a mean ± SD follow-up time of 8.4 ± 26 weeks (range 0-192 weeks), outcome was good for 60.7% of patients and poor for 39.3%. The literature search yielded 40 articles, and the authors discuss the result of these studies. CONCLUSIONS: Bacterial SEA is an ominous condition that calls for early recognition. Neurological status at the time of presentation is a key factor in decision making and patient outcome. In recent years, surgical treatment has been advocated for patients with neurological deficits and failed response to medical therapy. Surgery should be performed immediately and before 36-72 hours from onset of neurological sequelae. However, the decision between medical or surgical intervention entails individual patient considerations including age, concurrent conditions, and objective findings. An evidence-based algorithm for diagnosis and treatment is suggested.

Occipital condyle fracture in the pediatric population: A management algorithm and systematic review.

Purpose: This study aims to develop an accessible stepwise management algorithm for pediatric presentations of occipital condyle fractures (OCFs) based on a systematic review of the published literature regarding diagnostic evaluation, treatment, and outcomes. Methods: A systematic review of the literature was conducted on PubMed to locate English language studies reporting on the management of pediatric OCFs. Data extraction of clinical presentation, management strategies, imaging, and treatment outcome was performed. Results: A total of 15 studies reporting on 38 patients aged 18 years and younger presenting with OCFs were identified. Loss of consciousness (LOC), depressed level of consciousness, neck pain, decreased neck range of motion (ROM), and cranial nerve injury were the most common presenting symptoms. Diagnostic imaging included radiographs, computed tomography (CT) scans, magnetic resonance imaging (MRI), and functional radiographs to assess cervical stability. Treatment options varied and included soft collar, hard collar, and halo vest. All studies resulted in a complete healing of the OCF, with resolution of associated pain. Conclusion: The proposed treatment algorithm suggests a framework for the management of pediatric OCFs based on the available evidence (levels of evidence: 3, 4). This review of the literature indicated that a stepwise approach should be utilized in the management of isolated pediatric OCFs.

Diagnostic and management strategies for pseudoaneurysm of the ulnar artery: A scoping review.

Introduction: Pseudoaneurysm of the ulnar artery (PUA) can arise secondary to several inciting etiologies and may lead to pain, arterial insufficiency, and ulnar nerve palsy. Given the relative infrequency of PUA diagnosis, there is no consensus regarding its proper diagnosis and management strategies. The purpose of this review is to summarize the existing data regarding PUA and develop an algorithm for management. Methods: A review was performed following PRISMA Extension for Scoping Reviews guidelines. Manuscripts were included if they 1) studied patients over the age of 18, 2) discussed specifics of the PUA and 3) detailed its management. Results: Thirty-one manuscripts were included, presenting data on 32 patients with a mean â€‹± â€‹standard deviation age of 46.9 â€‹± â€‹19.6 years. Ulnar artery injury mechanism included trauma (13/32, 40.6 â€‹%), iatrogenic (9/32, 28.1 â€‹%), and inherent connective tissue disease (4/32, 12.5 â€‹%), among others. Ultrasonography was the most common imaging modality (14/32, 43.7 â€‹%), and a majority (22/32, 68.8 â€‹%) of patients were managed surgically, typically via pseudoaneurysm resection â€‹± â€‹venous grafting for reconstruction. Non-operative interventions included ultrasound-guided compression therapy and thrombin injection. Conclusion: While PUA are infrequently diagnosed, inciting events such as accidental or iatrogenic trauma continue to be documented, and management guidelines are lacking. Duplex ultrasonography is recommended as the first line imaging study, with subsequent Allen Test to assess for ulnar artery vs. mixed dominance for hand perfusion. A pseudoaneurysm of 3 â€‹cm is proposed as a general threshold for considering intervention, with caveats for smaller lesions causing pain or neurologic symptoms. This review serves as a reference for physicians who encounter PUA.

Etiology and management of urethral calculi: A systematic review of contemporary series.

Objective: To conduct a systematic literature review on urethral calculi in a contemporary cohort describing etiology, investigation, and management patterns. Methods: A systematic search of MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL) databases was performed. Articles, including case reports and case series on urethral calculi published between January 2000 and December 2019, were included. Full-text manuscripts were reviewed for clinical parameters including symptomatology, etiology, medical history, investigations, treatment, and outcomes. Data were collated and analyzed with univariate methods. Results: Seventy-four publications met inclusion criteria, reporting on 95 cases. Voiding symptoms (41.1%), pain (40.0%), and acute urinary retention (32.6%) were common presenting features. Urethral calculi were most often initially investigated using plain X-ray (63.2%), with almost all radio-opaque (98.3%). Urethral calculi were frequently associated with coexistent bladder or upper urinary tract calculi (16.8%) and underlying urethral pathology (53.7%) including diverticulum (33.7%) or stricture (13.7%). Urethral calculi were most commonly managed with external urethrolithotomy (31.6%), retrograde manipulation (22.1%), and endoscopic in situ lithotripsy (17.9%). Conclusion: This unique systematic review of urethral calculi provided a summary of clinical features and treatment trends with a suggested treatment algorithm. Management in contemporary urological practice should be according to calculus size, shape, anatomical location, and presence of urethral pathology.

Charcot neuro-osteoarthropathy: a review of key concepts and an evidence-based surgical management algorithm.

Charcot neuro-osteoarthropathy (CNO), mainly as a result of diabetic neuropathy, is a complex problem which carries significant morbidity, and is an increasing burden on healthcare as demographics change globally. A multi-disciplinary team (MDT) is necessary to treat the multiple facets of this disease. The multifactorial and non-homogenous nature of this condition and its management, has prevented the development of comprehensive guidelines based on level 1 evidence. Although there is a trend to surgically treat these patients in tertiary centres, the increasing prevalence of CNO necessitates the capability of all units to manage this condition to an extent locally. This article conducted a thorough literature search of Pubmed and Embase from 2003 to 2023 including the following search terms; "Charcot" "neuroarthropathy" "diabetic foot" "management" "surgery" "treatment" "reconstruction". The results of this review have been summarised and synthesised into an evidence-based algorithm to aid in the surgical decision-making process, and improve the understanding of surgical management by the whole MDT.

Effect of a Management Algorithm for Wet Contamination of Peritoneal Dialysis System on the Prevention of Peritonitis: A Prospective Observational Study.

Introduction: Wet contamination was a common problem of peritoneal dialysis (PD) system. We developed a management algorithm for wet contamination of PD system (wet contamination) on the basis of the related research literature and clinical practice experience. The purpose of this study was to observe clinical effect of the management algorithm on the prevention of peritonitis. Methods: Patients treated wet contamination in a single PD center between October 2017 and September 2022 were included. A management algorithm was established to treat wet contamination. It comprised identification of the contamination type, addressing contaminated or aging catheters, prophylactic antibiotics, and retraining. Demographic data and clinical data about wet contamination were collected and compared. Results: One hundred and forty-one cases of wet contamination were included in this study. The mean age was 51.7 ± 14.1 years, and 49.6% were female. The proportion of diabetic nephropathy was 9.9%. The median PD duration was 27.0 (1.7-79.7) months. Eighteen episodes (12.8%) of wet contamination-associated peritonitis developed after wet contamination. The main pathogenic bacteria of peritonitis were Gram-positive bacteria (33.3%) and Gram-negative bacteria (27.8%). The incidence of wet contamination-associated peritonitis in the compliance with the management algorithm group was significantly lower than that in the non-compliance with the management algorithm group (0.9 vs. 48.6%; p < 0.001). Non-compliance with management algorithm (OR = 185.861, p < 0.001) together with advance age (OR = 1.116, p < 0.001) and longer distance from home to hospital (OR = 1.007, p < 0.001) were independent risk factors for wet contamination-associated peritonitis. Conclusion: The management algorithm for wet contamination of PD system could reduce the risk of peritonitis.