Clinical Outcomes of Splenic Artery Embolization Versus Splenectomy in the Management of Hemodynamically Stable High-Grade Blunt Splenic Injuries: A National Analysis.

INTRODUCTION: This study aims to compare the outcomes of splenic artery embolization (SAE) versus splenectomy in adult trauma patients with high-grade blunt splenic injuries. METHODS: This retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database (2017-2021) compared SAE versus splenectomy in adults with blunt high-grade splenic injuries (grade ≥ IV). Patients were stratified first by hemodynamic status then splenic injury grade. Outcomes included in-hospital mortality, intensive care unit length of stay (ICU-LOS), and transfusion requirements at four and 24 h from arrival. RESULTS: Three thousand one hundred nine hemodynamically stable patients were analyzed, with 2975 (95.7%) undergoing splenectomy and 134 (4.3%) with SAE. One thousand eight hundred sixty five patients had grade IV splenic injuries, and 1244 had grade V. Patients managed with SAE had 72% lower odds of in-hospital mortality (odds ratio [OR] 0.28; P = 0.002), significantly shorter ICU-LOS (7 versus 9 d, 95%, P = 0.028), and received a mean of 1606 mL less packed red blood cells at four h compared to those undergoing splenectomy. Patients with grade IV or V injuries both had significantly lower odds of mortality (IV: OR 0.153, P < 0.001; V: OR 0.365, P = 0.041) and were given less packed red blood cells within four h when treated with SAE (2056 mL versus 405 mL, P < 0.001). CONCLUSIONS: SAE may be a safer and more effective management approach for hemodynamically stable adult trauma patients with high-grade blunt splenic injuries, as demonstrated by its association with significantly lower rates of in-hospital mortality, shorter ICU-LOS, and lower transfusion requirements compared to splenectomy.

National Analysis of Outcomes for Adult Trauma Patients With Isolated Severe Blunt Traumatic Brain Injury Following Venous Thromboembolism Prophylaxis.

INTRODUCTION: We aim to evaluate the association of early versus late venous thromboembolism (VTE) prophylaxis on in-hospital mortality among patients with severe blunt isolated traumatic brain injuries. METHODS: Data from the American College of Surgeons Trauma Quality Program Participant Use File for 2017-2021 were analyzed. The target population included adult trauma patients with severe isolated traumatic brain injury (TBI). VTE prophylaxis types (low molecular weight heparin and unfractionated heparin) and their administration timing were analyzed in relation to in-hospital complications and mortality. RESULTS: The study comprised 3609 patients, predominantly Caucasian males, with an average age of 48.5 y. Early VTE prophylaxis recipients were younger (P < 0.01) and more likely to receive unfractionated heparin (P < 0.01). VTE prophylaxis later than 24 h was associated with a higher average injury severity score and longer intensive care unit stays (P < 0.01). Logistic regression revealed that VTE prophylaxis later than 24 h was associated with significant reduction of in-hospital mortality by 38% (odds ratio 0.62, 95% confidence interval 0.40-0.94, P = 0.02). Additionally, low molecular weight heparin use was associated with decreased mortality odds by 30% (odds ratio 0.70, 95% confidence interval 0.55-0.89, P < 0.01). CONCLUSIONS: VTE prophylaxis later than 24 h is associated with a reduced risk of in-hospital mortality in patients with severe isolated blunt TBI, as opposed to VTE prophylaxis within 24 h. These findings suggest the need for timely and appropriate VTE prophylaxis in TBI care, highlighting the critical need for a comprehensive assessment and further research concerning the safety and effectiveness of VTE prophylaxis in these patient populations.

An examination of antibiotic administration in septorhinoplasty: A systematic review and meta-analysis.

PURPOSE: Septoplasty and rhinoplasty are common otolaryngological procedures, often combined as septorhinoplasty (SRP), offering aesthetic and functional benefits. These surgeries are believed to potentially risk postoperative infections due to natural bacterial flora in the nares. This study evaluates the effectiveness of prophylactic antibiotics in reducing post-surgical infection complications. MATERIALS AND METHODS: A systematic review was conducted using PubMed, Cochrane, and Web of Science, adhering to PRISMA guidelines, focusing on antibiotic use in septoplasty, rhinoplasty, and SRP. The study included randomized control trials, single/double-blind studies, retrospective chart reviews, and prospective cohort studies, excluding pediatric, non-human research, or studies with inaccessible data. Postoperative infection rates were analyzed utilizing R software as a form of Statistic. RESULTS: From 697 articles, 15 studies were chosen for meta-analysis, involving 2225 patients, with 1274 receiving prophylactic antibiotics and 951 as controls. The meta-analysis indicated an odds ratio of 0.65 (95 % CI: [0.23, 1.89]), showing no significant protective effect of prophylactic antibiotics. DISCUSSION: The study found no significant infection rate reduction with prophylactic antibiotic use. Notable were inconsistencies in study designs, antibiotic administration timing, and varied surgical practices. Antibiotic use risks were considered. Study limitations include potential biases and the retrospective nature of many studies. CONCLUSIONS: This review and meta-analysis found no substantial evidence supporting prophylactic antibiotics' effectiveness in reducing postoperative infection rates in septoplasty, rhinoplasty, and SRP, indicating a need to reevaluate practices and develop evidence-based guidelines. Future research should focus on comprehensive, randomized control studies, covering both preoperative and postoperative stages.

Overview of Dermatological Manifestations Associated with the COVID-19 Infection.

COVID-19 is an infectious disease caused by SARS-CoV-2 that is characterized by respiratory symptoms, fever, and chills.[1] While these systemic symptoms are widely known and well understood, there have also been reports of dermatological manifestations in patients with COVID-19. These manifestations include chilblain-like lesions, maculopapular lesions, urticarial lesions, necrosis, and other varicella-like exanthems.[2] The pathogenesis of these lesions are not well understood, but the procoagulant and pro-inflammatory state induced by COVID-19 infections may be contributing to varied cutaneous manifestations.[3] Drug interactions and concurrent hypersensitivity reactions have also been postulated.[4] This review aims to compile and analyze various retrospective studies and case reports to summarize the clinical presentation of dermatological lesions associated with COVID-19 infections and suggest further areas of research.

The Role of Compassionate Care in Medicine: Toward Improving Patients' Quality of Care and Satisfaction.

INTRODUCTION: Despite its description as a cornerstone of a healthcare provider's professional identity, the impact of compassionate care on various aspects of medicine has been poorly defined. In this review, we aimed to elucidate the role of compassionate care in various aspects of medicine and healthcare delivery. METHODS: Four databases were searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol for a literature review regarding compassionate care and its intersection with medical education, patient-provider communication, patient care, and clinical outcomes, patient and provider characteristics, telemedicine and artificial intelligence, caregiver compassion fatigue, and cost of care. RESULTS: Twenty-two articles met the inclusion criteria. Analysis revealed that clinical outcomes are correlated with the degree of patients' perception of empathy and compassion from their providers. Along with enhanced patient outcomes, compassionate care was shown to reduce the costs of care, compassion fatigue and burnout, and the number of malpractice claims. However, compassion can be perceived differently among patients of various cultural and ethnic backgrounds. Compassion training sessions can be implemented among residents in surgical and nonsurgical medical specialties to improve perceived compassion. Furthermore, the use of telehealth modalities may positively or negatively impact compassionate care, requiring further exploration. CONCLUSIONS: Compassionate care plays a crucial role in improving patient care and clinical outcomes while reducing caregiver burnout and the risk of malpractice litigation. However, a lack of compassion training and caregiver compassion fatigue may detract from the delivery of effective compassionate care.

Increased rhinovirus/enterovirus infections including Ev-D68 in the United States, a challenge for healthcare providers amidst influenza virus infection and the COVID-19 pandemic.

In March 2020, WHO declared SARS-CoV-2 a global pandemic and lockdowns were enforced in most of the United States. Self-protective measures and travel restrictions were implemented, and schools/universities initiated online learning. Consequently, the global incidence and hospitalization rates of seasonal respiratory infections decreased significantly up to early 2021. Despite the decrease in hospitalization rates due to respiratory illnesses other than Covid-19, hospitals and healthcare providers faced huge stressors regarding workload dueto the pandemic. Furthermore, higher vaccination rates across the United States decreased non pharmaceutical interventions (NPI) implementation increasing the risk of major seasonal viral outbreaks. This editorial discusses the increased Rhinovirus/Enterovirus infections in the United States, challenges faced by healthcare providers and provides recommendations to address the issue.

Analyzing the Visibility of Gender-Affirming Surgery Education on US Plastic Surgery Residency Program Web Sites.

BACKGROUND: As the demand for gender affirmation grows, teaching gender-affirming surgery (GAS) in plastic and reconstructive surgery (PRS) programs has become increasingly important. Residency applicants interested in GAS often use program web sites to explore potential training opportunities. Our study aimed to quantify the GAS training opportunities promoted on residency program web sites and determine the characteristics of programs likely to promote GAS training. METHODS: An assessment of 88 integrated PRS residency programs' web sites was conducted between 2021 and 2022. Plastic and reconstructive surgery residency and institutional webpages were queried for geographical location, training opportunities in GAS through residency or fellowship, and the number of faculty performing GAS. Descriptive statistics and multivariable regressions were used to describe and identify factors associated with increased GAS residency training opportunities. RESULTS: Twenty-six percent of PRS residencies mentioned training opportunities for GAS on their web sites. Gender-affirming surgery fellowships were offered at 7% of institutions, and an additional 7% were available via adjunct academic programs. Programs with faculty practicing GAS were 54% more likely to mention GAS on their residency page (odds ratio, 1.54; 95% confidence interval, 1.14-2.21; P = 0.009). CONCLUSIONS: Few PRS residency programs mention GAS on their web sites. As GAS becomes a more robust component of plastic surgery, appropriate information about the extent of GAS training should be available for applicants. Determining how local, state, and federal policies impact programs' abilities to highlight GAS should be investigated in future studies.

The Genetic Susceptibility to Psoriasis and the Relationship of Linked Genes to Our Treatment Options.

Understanding the factors creating genetic susceptibility in psoriasis may provide a basis for improving targeted treatment strategies. In this review, we discuss the genes linked to the pathogenesis of psoriasis and their relationship to the available treatment options. To identify the relevant genetic markers and treatments, we searched PubMed, Google Scholar, MEDLINE, and Web of Science with keywords, including genetic susceptibility to psoriasis, genetics and psoriasis, psoriasis treatments, and biologics treatments in psoriasis. The articles in English from database inception to 1/1/23 were included. Case reports and series were excluded. Gene variant forms commonly implicated in the pathogenesis of psoriasis include those encoding for interleukins, interferons, and other mediators involved in inflammatory pathways, such as JAK/STAT, and NF-κB. Several of the treatments for psoriasis (for example IL23 and TYK2 inhibitors) target the products of genes linked to psoriasis. Multiple genes are linked to the pathogenesis of psoriasis. This understanding may provide an avenue for the development of new psoriasis treatment strategies and for more effective, safer treatment outcomes.

The impact of current investigational drugs for acne on future treatment strategies.

INTRODUCTION: Acne vulgaris is one of the most prevalent diseases worldwide with a considerably high cost and a burden on quality of life. There are currently many topical and systemic therapies for acne; however, many are limited by their local adverse event profile. This review provides an update on current, novel Phase I and II trials for acne vulgaris. AREAS COVERED: This review searched the National Institutes of Health US National Library of Medicine online database of clinical trials (ClinicalTrials.gov) for ongoing Phase I and II trials. Only papers discussing novel therapies were discussed, and combinations of previously FDA-approved drugs were excluded. EXPERT OPINION: The current investigational approaches to acne treatment reflect an attempt to mitigate the underlying cause of acne pathogenesis. By targeting key mechanisms involved, studies aim to show long-term improvement with less frequent treatment use. This provides potential for more tolerable treatments with better patient adherence, in turn leading to increased efficacy.

The Utilization of ChatGPT in Reshaping Future Medical Education and Learning Perspectives: A Curse or a Blessing?

BACKGROUND: ChatGPT has substantial potential to revolutionize medical education. We aim to assess how medical students and laypeople evaluate information produced by ChatGPT compared to an evidence-based resource on the diagnosis and management of 5 common surgical conditions. METHODS: A 60-question anonymous online survey was distributed to third- and fourth-year U.S. medical students and laypeople to evaluate articles produced by ChatGPT and an evidence-based source on clarity, relevance, reliability, validity, organization, and comprehensiveness. Participants received 2 blinded articles, 1 from each source, for each surgical condition. Paired-sample t-tests were used to compare ratings between the 2 sources. RESULTS: Of 56 survey participants, 50.9% (n = 28) were U.S. medical students and 49.1% (n = 27) were from the general population. Medical students reported that ChatGPT articles displayed significantly more clarity (appendicitis: 4.39 vs 3.89, P = .020; diverticulitis: 4.54 vs 3.68, P < .001; SBO 4.43 vs 3.79, P = .003; GI bleed: 4.36 vs 3.93, P = .020) and better organization (diverticulitis: 4.36 vs 3.68, P = .021; SBO: 4.39 vs 3.82, P = .033) than the evidence-based source. However, for all 5 conditions, medical students found evidence-based passages to be more comprehensive than ChatGPT articles (cholecystitis: 4.04 vs 3.36, P = .009; appendicitis: 4.07 vs 3.36, P = .015; diverticulitis: 4.07 vs 3.36, P = .015; small bowel obstruction: 4.11 vs 3.54, P = .030; upper GI bleed: 4.11 vs 3.29, P = .003). CONCLUSION: Medical students perceived ChatGPT articles to be clearer and better organized than evidence-based sources on the pathogenesis, diagnosis, and management of 5 common surgical pathologies. However, evidence-based articles were rated as significantly more comprehensive.

Outcomes of Preperitoneal Packing and Angioembolization for Hemorrhage Control in Hemodynamically Unstable Pelvic Fractures: A Systematic Review and Meta-Analysis.

BACKGROUND: Hemodynamically unstable pelvic fractures are often life-threatening injuries; however, the optimal management remains uncertain. This systematic review and meta-analysis aim to evaluate the most appropriate primary management of hemorrhage in adult patients with hemodynamically unstable pelvic fractures by comparing outcomes following the initial use of preperitoneal packing (PPP) vs angioembolization (AE). METHODS: A systematic search of PubMed, Embase, Google Scholar, and ProQuest databases was conducted following PRISMA guidelines. Studies assessing hemorrhage management in trauma patients with hemodynamically unstable pelvic fractures were included. The data extracted from selected articles included patient demographics, study design, and outcomes such as 24-hour PRBC transfusions, in-hospital mortality, and DVT rate. RESULTS: Eight articles were included in the systematic review. Among the included studies, 2040 patients with hemodynamically unstable pelvic fractures were analyzed. Meta-analyses revealed that treatment with PPP was associated with fewer 24-hour PRBC transfusions (mean difference = -1.0, 95% CI: -1.8 to -.2) than AE. However, no significant differences were noted in in-hospital mortality (RR: .91, 95% CI: .80-1.05) and the rate of deep vein thrombosis (RR: .89, 95% CI: .62-1.28) between groups. CONCLUSION: The findings of this study suggest that primary management with PPP was associated with fewer 24-hour PRBC transfusions compared to AE. The choice of primary management with PPP or AE did not significantly impact in-hospital mortality. Future studies should address clinical outcomes and the factors that affect them to better understand the impact of different management strategies and direct the creation of practice management guidelines.

Evaluating the Factors Influencing Residency Match for Surgical Specialty Applicants and Programs: Challenges and Future Directions.

INTRODUCTION: We aim to evaluate the impact of recent changes in the residency matching process on surgical specialties' applicants and programs to offer recommendations on residency selection and matching processes. METHODS: We utilized five databases while employing a Boolean query to search for studies from 2015 to March 2024. The search selection focused on factors and recent changes influencing residency match results across surgical specialties, including USMLE Step 1 pass/fail, research productivity, interview structure, and preference and geographic signaling. RESULTS: The shift of the USMLE Step 1 to a pass/fail scoring system revealed a consensus among surgical program directors (PDs) and applicants not in favor of the change due to the emphasis on additional application elements. Research productivity was identified as a significant factor, especially in neurosurgery (with an average of 18.3 publications per applicant) and vascular surgery (8.3 publications), indicating a positive correlation between the number of publications and match outcomes. The adoption of virtual interviews has been well-received by both applicants and PDs, leading to an increase in the number of interviews offered and applicants. The implementation of preference and geographic signaling mechanisms has improved interview rates for applicants who utilize them. CONCLUSION: The transition to a pass/fail USMLE Step 1 has raised concerns among surgical specialties, necessitating a greater focus on Step 2 scores and research productivity. Virtual interviews and signaling have improved the accessibility and reach of the residency application process, however, the full impact of these changes on the perception of applicant-program fit remains unclear.

Enhancing safety & reducing fatalities in U.S. national parks: An evaluation of injury trends and policy implications in the ten most visited parks.

INTRODUCTION: National parks in the United States experience a significant number of annual visits, and with increasing popularity, injuries are expected to rise. This study aims to assess fatal injuries in the top ten most visited U.S. national parks from 2013 to 2022 to improve current policies and develop effective prevention strategies. METHODS: A cross-sectional study was conducted using public National Park Service data. Data including visitor demographics, injury cause, and location, were collected. Fatal injuries were categorized by season, age group, and gender. RESULTS: Summer had the highest total number of fatal injuries. The winter season had the highest rate of fatal injuries per 10 million visitors. The number of fatal injuries per 10 million visitors decreased from 2013 to 2022 for most parks. The South Region reported the highest total number of fatalities. The West Region demonstrated higher rates when adjusted for visitor volume. Fatal injuries were most prevalent in the 35-44 age group, followed by the 15-24 and 25-34 age groups, with the least incidents in the 0-14 age group, and were more common among males (71.5 % of total injuries). CONCLUSION: This study found the highest number of total injuries occurring in summer; however, winter presented a higher risk per visitor. Slips and falls were the most common cause of injuries, requiring targeted safety measures. Males in the 35-44 age group reported the highest fatality rates. These findings highlight the necessity for improved monitoring and reporting to better understand injury causes and formulate specific, evidence-based policies for prevention.

Racial Distribution and Associated Outcomes for Patients With and Without Severe-Isolated Traumatic Brain Injuries Following Venous Thromboembolism Prophylaxis.

INTRODUCTION: Disparities in venous thromboembolism (VTE) incidence and prophylaxis have been observed across racial groups. This study investigates the relationship between race, injury type, and the timing of VTE prophylaxis in severe trauma patients, both with and without isolated traumatic brain injuries. The primary goal is to analyze how these factors interact and their potential impact on clinical outcomes. METHODS: A retrospective cohort study of the American College of Surgeons Trauma Quality Program Participant Use File (ACS-TQIP-PUF) from 2018 to 2021. Patient demographics, injury categories, VTE prophylaxis timing, injury severity, and in-hospital complications were collected. Multivariable regression models explored associations between race, injury type, VTE prophylaxis, and in-hospital mortality. Groups were analyzed by injury profile (isolated TBI vs non-TBI) and then by VTE prophylaxis timing (early ≤24 hours, late >24 hours). RESULTS: Of 68,504 trauma patients analyzed, the majority were non-Hispanic or Latino (83.3%), White (71.2%), and male (69.6%). Patients receiving late VTE prophylaxis had higher rates of DVT and PE across race groups than patients with early prophylaxis. Logistic regression showed Asian patients with TBI receiving early prophylaxis were significantly more likely to have in-hospital mortality (OR 16.27, CI = 1.11-237.43, P = .04) than other races. CONCLUSION: Patients who received late prophylaxis had higher VTE rates than early prophylaxis, independent of injury pattern or race. Additionally, assessing the implications of race in early VTE prophylaxis for isolated TBI showed that adult Asian patients had 16 times higher odds of in-hospital mortality compared to other races.

Evaluating the Long-Term Outcomes of Periodontal Surgery vs. Non-Surgical Treatment in Aggressive Periodontitis.

Background: Aggressive periodontitis is a severe form of periodontal disease characterized by rapid tissue destruction and tooth loss. The optimal treatment approach for managing this condition remains a topic of debate. Materials and Methods: A retrospective cohort study was conducted, involving patients diagnosed with aggressive periodontitis who received either surgical or non-surgical treatment between 2010 and 2020. Clinical and radiographic data were collected at baseline and regular intervals over a 5-year follow-up period. Surgical interventions included flap surgery, guided tissue regeneration, and bone grafting, while non-surgical treatments comprised scaling and root planning with or without adjunctive antibiotics. The primary outcomes assessed included changes in probing depth, clinical attachment level, tooth loss, and patient-reported quality of life measures. Results: A total of 120 patients were included in the study, with 60 patients in each treatment group. The surgical group demonstrated significantly greater reductions in probing depth and gains in clinical attachment level compared to the non-surgical group (P < 0.05). Tooth loss was significantly lower in the surgical group over the 5 years (P < 0.01). Patient-reported outcomes also favored the surgical group, with improved oral health-related quality of life. However, the surgical group had a higher incidence of postoperative complications. Conclusion: This study suggests that periodontal surgery yields superior long-term outcomes in the management of aggressive periodontitis compared to non-surgical treatment.

Evaluating the Accuracy, Comprehensiveness, and Validity of ChatGPT Compared to Evidence-Based Sources Regarding Common Surgical Conditions: Surgeons' Perspectives.

BACKGROUND: This study aims to assess the accuracy, comprehensiveness, and validity of ChatGPT compared to evidence-based sources regarding the diagnosis and management of common surgical conditions by surveying the perceptions of U.S. board-certified practicing surgeons. METHODS: An anonymous cross-sectional survey was distributed to U.S. practicing surgeons from June 2023 to March 2024. The survey comprised 94 multiple-choice questions evaluating diagnostic and management information for five common surgical conditions from evidence-based sources or generated by ChatGPT. Statistical analysis included descriptive statistics and paired-sample t-tests. RESULTS: Participating surgeons were primarily aged 40-50 years (43%), male (86%), White (57%), and had 5-10 years or >15 years of experience (86%). The majority of surgeons had no prior experience with ChatGPT in surgical practice (86%). For material discussing both acute cholecystitis and upper gastrointestinal hemorrhage, evidence-based sources were rated as significantly more comprehensive (3.57 (±.535) vs 2.00 (±1.16), P = .025) (4.14 (±.69) vs 2.43 (±.98), P < .001) and valid (3.71 (±.488) vs 2.86 (±1.07), P = .045) (3.71 (±.76) vs 2.71 (±.95) P = .038) than ChatGPT. However, there was no significant difference in accuracy between the two sources (3.71 vs 3.29, P = .289) (3.57 vs 2.71, P = .111). CONCLUSION: Surveyed U.S. board-certified practicing surgeons rated evidence-based sources as significantly more comprehensive and valid compared to ChatGPT across the majority of surveyed surgical conditions. However, there was no significant difference in accuracy between the sources across the majority of surveyed conditions. While ChatGPT may offer potential benefits in surgical practice, further refinement and validation are necessary to enhance its utility and acceptance among surgeons.