The 30-day hospital readmission and mortality after surgery in colorectal cancer patients.

PURPOSE: Hospital readmissions in the first weeks following surgery are common, expensive, and associated with increased mortality among colorectal cancer patients. This study is designed to assess the 30-day hospital readmission after colorectal cancer surgery and evaluate the risk factors that affect hospital readmission. METHODS: The study uses data from the Ministry of National Guard-Health Affairs Cancer Registry. All colorectal cancer patients who underwent colorectal cancer surgery between January 1, 2016, and November 31, 2021, were investigated. Factors examined were age, gender, marital status, Body Mass Index, Charlson Comorbidity Index, chemotherapy, radiotherapy, tumor stage, grade, site, surgical approach, length of stay, and discharge location. Kaplan-Meier curves were constructed to assess survival rates between readmitted and non-readmitted patients, and logistic regressions were performed to assess predictors of readmission. RESULTS: A total of 356 patients underwent tumor resection and 49 patients were readmitted within 30-day of index discharge. The most common reasons for hospital readmissions were gastrointestinal (22.45%), urinary tract infection (16.33%), and surgical site infection (12.24%). In the multivariable analysis, females were 89% more likely to be readmitted compared to males (odds ratio 1.89, 95% confidence intervals 1.00-3.58). Patients with distant metastatic tumors have higher odds of readmission (odds ratio 4.52, 95% confidence intervals 1.39-14.71) compared to patients with localized disease. CONCLUSIONS: Colorectal cancer readmission is more common in patients with metastatic disease. Strategies to reduce readmission include planned transition to outpatient care, especially among patients with a high risk of readmission.

Evaluation of Antimicrobial Stewardship Programs (ASPs) and their perceived level of success at Makkah region hospitals, Kingdom of Saudi Arabia.

Antimicrobial stewardship programs (ASPs) are collaborative efforts to optimize antimicrobial use in healthcare institutions through evidence-based quality improvement strategies. The general administration of pharmaceutical care in the Saudi ministry of health (MOH) is putting outstanding efforts in implementing antimicrobial stewardship in Saudi health care settings. Several surveys have been conducted globally and reported many types of antimicrobial stewardship strategies in health institutions and their effectiveness. This study aims to identify ASPs in Makkah region hospitals and their perceived level of success. We administered a regional survey to explore current progress and issues related to the implementation of ASPs in Makkah region hospitals at the pharmacy level (n = 25). Among responding hospitals, 19 (76%) hospitals, the most commonly reported ASP were as following: formulary restrictions (90%) for broad-spectrum antimicrobials and use of prospective feedback on antimicrobial prescribing (68%), use of clinical guidelines and pathways (100%), and use of automatic stop orders (68%) to limit inappropriate antimicrobial therapy. The study outcomes will also be of pivotal importance to devise policies and strategies for antimicrobial stewardship implementation in other non-MOH settings in the Makkah region. Based on our results, all reported institutions have at least one antimicrobial stewardship program in a process with a high success rate. A multidisciplinary ASP approach, active involvement of drug & therapeutic committee, formulary restrictions, and availability of education & training of pharmacists and physicians on ASP are the primary elements for perceived successful antimicrobial stewardship programs in the Makkah region hospitals.

Risk indicators of depression among medical, dental, nursing, pharmacology, and other medical science students in Saudi Arabia.

The aim of the study was to investigate the prevalence and risk indicators of depression in undergraduate students of health-related specialties. A systematic random sample of 398 students from seven health colleges was included. The assessment tool was a self-reported questionnaire based on Becks Depression Inventory (BDI). Participant status was categorized into Absence (BDI = 0-13) or Presence (BDI = 14-60) of depression. Data analyses included descriptive statistics, bivariate analysis, and stepwise logistic regression. About 45% of students reported having mild-to-severe depression. The significant risk indicators for depression were: gender, recent loss of family members, type of study, year of study, presence of psychological illnesses, social life, satisfaction with each of the following: the specialty, teaching staff, college facilities. The regression model showed the following factors to remain significantly related to depression: presence of psychological illness, social life style, recent loss of family member, and satisfaction with teaching staff. In conclusion, a significant number of undergraduate students have depression. This study indicates the need to support this group of students by the community and the university administration. Students' academic and social advisers' roles are recommended to be more effective. Teaching staff are recommended to have their teaching and communication skills enhanced.

Association of benign paroxysmal positional vertigo with vitamin D deficiency: a systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE: Benign paroxysmal positional vertigo (BPPV) is an idiopathic recurrent inner ear illness that is caused most often by an imbalance in the metabolism of calcium carbonate crystals (otoconia) inside the semicircular canals, in which the otoconia begin to circulate freely after being dislodged from the basic structure. The underlying etiology of this imbalance has not yet been well established; however, a few recent articles have revealed that vitamin D level abnormality in these patients might play a role. Therefore, we conducted the current systematic review analysis to explore potential associations of vitamin D level with the occurrence as well as the recurrence of BPPV disease. METHODS: A comprehensive literature search was conducted using different databases to retrieve all of the articles that have evaluated possible associations, irrespective of the study design. Then, we reported different vitamin D3 levels from BPPV groups and control groups to estimate the standardized mean difference (SMD) between the BPPV and control groups. We also calculated the effect size of each study under the random effects statistical model. RESULTS: Of the 703 studies that we identified, only 37 studies were found to be potential for our analysis, and of these, only seven met our predetermined criteria. Two meta-analyses were conducted with respect to the occurrence and the recurrence of BPPV. When the BPPV cases were compared to the controls (free of BPPV disease), there was an insignificant reduction in vitamin D level among the diseased groups (SMD = - 2.20; 95% CI - 6.66 to 2.26). In contrast, when the recurrent BPPV groups were compared with the non-recurrent BPPV groups, the statistical analysis showed significantly lower level of vitamin D among the recurrence BPPV groups (SMD = - 4.47; 95% CI - 7.55 to - 1.29). CONCLUSION: Although a negative vitamin D imbalance has been reported among some BPPV patients, this review analysis failed to establish a relationship between the occurrence of BPPV and low vitamin D level. However, low vitamin D level was significantly evident among patients with recurrent episodes of BPPV.

Perceptions, Perceived Barriers, and Practices of Physicians' towards Evidence-Based Medicine.

OBJECTIVE: To investigate physicians' perceptions and practices towards Evidence-Based Medicine (EBM) and physicians perceived barriers in one institute of Saudi Arabia. METHODS: One hundred seventeen practicing physicians at King Abdulaziz University Hospital, Jeddah were included in the study. A validated questionnaire was used for collecting data. The questionnaire had four parts and included questions addressing perceptions and practices about EBM as well as associated variables and barriers to practicing it. RESULTS: The majority of the respondents had a positive attitude toward EBM. Only 23.9% of participants reported that they are incorporating EBM into their practice. Knowledge about EBM databases was not good. The most common "regularly" read journal was the New England Journal of Medicine (31.6%), followed by the British Medical Journal (12.0%). Some of the respondents had an understanding and were able to explain to others the technical terms use in EBM such as odds ratio (19.7%), relative risk (22.2%), absolute risk (23.9%) and others. The major perceived barriers to practicing EBM was the lack of free personal time (27.4%), availability and access to information (27.4%), difficulties in involving in whole practice (12.0%) and lack of investment by health authorities (12.8%). CONCLUSION: The attitude of the practicing doctors towards EBM was good, but knowledge and practice were not up to the mark.

Real-life experiences and barriers to adjuvant chemotherapy in Saudi patients with advanced stage II and stage III colon cancer.

BACKGROUND: Colorectal cancer is the most common malignancy in Saudi males and third most common in females. Patients with locally advanced colon cancer may eventually develop metastatic disease if not treated promptly and according to guidelines. The recent National Comprehensive Cancer Network guideline recommends tumor resection followed by adjuvant chemotherapy for stage III and high-risk stage II tumors. Therefore, the objective of this study was to characterize patients with locally advanced colon cancer and identify factors associated with the use of adjuvant chemotherapy and the addition of oxaliplatin in locally advanced colon cancer patients. METHODS: All patients diagnosed with locally advanced colon cancer at National Guard Health Affairs (NGHA) during 2016-2021 were investigated. Patients' characteristics were compared using Chi-square and Fisher exact test, whereas predictors of adjuvant chemotherapy/Oxaliplatin use were identified using univariate and multivariate logistic regression. RESULTS: Out of 222 patients diagnosed with locally advanced colon cancer, 133 received adjuvant chemotherapy. Factors associated with adjuvant chemotherapy administration were age and smoking status. In the multivariable analysis, older patients were less likely to receive oxaliplatin than younger patients. Stage III patients diagnosed during 2019-2021 had 5.61 times higher odds of receiving oxaliplatin. CONCLUSION: The findings of this study show that older patients and smokers are less likely to be treated with adjuvant chemotherapy. Moreover, age as well as diagnosis year were important determinants of oxaliplatin administration in stage III locally advanced colon cancer patients.

The Effects of Solvent on Superhydrophobic Polyurethane Coating Incorporated with Hydrophilic SiO2 Nanoparticles as Antifouling Paint.

Polyurethane (PU) paint with a hydrophobic surface can be easily fouled. In this study, hydrophilic silica nanoparticles and hydrophobic silane were used to modify the surface hydrophobicity that affects the fouling properties of PU paint. Blending silica nanoparticles followed by silane modification only resulted in a slight change in surface morphology and water contact angle. However, the fouling test using kaolinite slurry containing dye showed discouraging results when perfluorooctyltriethoxy silane was used to modify the PU coating blended with silica. The fouled area of this coating increased to 98.80%, compared to the unmodified PU coating, with a fouled area of 30.42%. Although the PU coating blended with silica nanoparticles did not show a significant change in surface morphology and water contact angle without silane modification, the fouled area was reduced to 3.37%. Surface chemistry could be the significant factor that affects the antifouling properties of PU coating. PU coatings were also coated with silica nanoparticles dispersed in different solvents using the dual-layer coating method. The surface roughness was significantly improved by spray-coated silica nanoparticles on PU coatings. The ethanol solvent increased the surface hydrophilicity significantly, and a water contact angle of 18.04° was attained. Both tetrahydrofuran (THF) and paint thinner allowed the adhesion of silica nanoparticles on PU coatings sufficiently, but the excellent solubility of PU in THF caused the embedment of silica nanoparticles. The surface roughness of the PU coating modified using silica nanoparticles in THF was lower than the PU coating modified using silica nanoparticles in paint thinner. The latter coating not only attained a superhydrophobic surface with a water contact angle of 152.71°, but also achieved an antifouling surface with a fouled area as low as 0.06%.

Prevalence, Microbiological Profile, and Risk Factors of Surgical Site Infections in Saudi Patients with Colorectal Cancer.

Background: Resection surgery in patients with colorectal cancer (CRC) patients is associated with potential complications, including surgical site infection (SSI). Objectives: To estimate the prevalence rate of SSI, identify the common pathogens responsible for SSI, and determine potential risk factors for SSI development in a cohort from Saudi Arabia. Materials and Methods: Patients with CRC who underwent bowel resection surgery at King Abdulaziz Medical City, Riyadh, between January 01, 2016, and December 31, 2019, were retrospectively included. Demographics, comorbidities, surgical procedure data, and the results of preoperative laboratory tests were retrospectively collected from medical records through the health information system. The study population was divided into two groups: those who developed SSI and those who did not. Results: A total of 92 patients with CRC who underwent resection surgery were included, of which 54 (58.7%) were males. The median age was 65 (IQR 55.5-75.0) years. SSI was observed in 25 (27.2%) patients. The most frequently isolated organisms were Escherichia coli and Pseudomonas aeruginosa, followed by Klebsiella pneumoniae, vancomycin-sensitive Enterococcus faecium, and methicillin-resistant Staphylococcus aureus. Three E. coli isolates were producers of extended-spectrum beta-lactamases, and two K. pneumoniae isolates exhibited a multidrug resistance profile. Low preoperative serum albumin level was identified as a significant independent risk factor for developing SSI (AOR = 0.853, 95% CI = 0.748-0.973, P = 0.0181). Conclusion: The study found a notable prevalence of SSI among the included patients. Gram-negative bacteria were more involved in SSI events and were also associated with drug-resistance patterns. Gut microbiota bacteria were most commonly involved in SSIs. Low preoperative serum albumin levels predicted the development of postoperative SSI, and thus its close monitoring and management before surgery could reduce the SSIs.

Treatment efficacy of repositioning maneuvers in multiple canal benign paroxysmal positional vertigo: a systematic review and meta-analysis.

Introduction: Benign paroxysmal positional vertigo (BPPV) involving the posterior canal is more common than other canals; however, simultaneous involvement of multiple canals can be seen up to 20% of all BPPV cases. The diagnosis and management of multiple canal BPPV can be quite challenging due to the complexity of findings. Therefore, this systematic review and meta-analysis aimed at unveiling the most effective repositioning strategy for the treatment of multiple canal BPPV. Methods: A literature search through PubMed, Scopus, and Web of Science databases was conducted using search terms such as BPPV, multiple canals, bilateral BPPV, repositioning maneuvers etc. After duplicate removal, the retained articles underwent various stages of elimination by two independent reviewers, and a third reviewer resolved the discrepancy between them. Results: A total of 22 articles were included in the systematic review. These publications documented 5,196 patients diagnosed with BPPV, of which 513 had multiple canal BPPV. Of 295 individuals with multiple canal BPPV, 58.9% were effectively treated in 1 session, whereas 18.3 and 4.4% achieved a symptom-free state after two and three sessions, respectively. Failure of treatment using repositioning maneuvers was found in 18.4%. Possible implications: This study offers insight into the real world of BPPV management in single and multiple canal BPPV. It is evident that repositioning maneuvers provide rapid and long-lasting relief of BPPV in most single canal BPPV patients; however, multiple canal BPPV often requires repeated treatment, and the risk of recurrence is higher in this variety than the single canal BPPV.

Complete Pathological Response to Platinum-Based Neoadjuvant Chemotherapy in BRCA2-Associated Locally Advanced Pancreatic Cancer: A Case Report and Literature Review.

Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignant disease and is considered the fourth leading cause of death among cancer patients in the United States. Mutations in the BRCA gene, which is a DNA repair gene, increase the risk of PDAC, and among all patients with PDAC, about 8%-10% have a BRCA2 mutation. The finding of gene mutations is associated with a better response to platinum-based chemotherapy. Here, we present a case of a 59-year-old male with a BRCA2 gene mutation who was diagnosed with locally advanced pancreatic cancer and had achieved a complete pathological response to the FOLFIRINOX (leucovorin calcium, fluorouracil, irinotecan hydrochloride, and oxaliplatin) regimen and Whipple procedure. We also present our literature findings on response types in BRCA2 PDAC patients, as well as consensus on the use of different therapies. The use of platinum-based chemotherapy with BRCA2 is highly recommended as the first-line treatment. Most PDAC patients remain untested for BRCA2 mutation even though their genetic status influences the selection of drug regimens. Thus, we recommend genetic testing for everyone with PDAC.

Antibiotic Exposure Concurrently with Anti-PD1 Blockade Therapy Reduces Overall Survival in Patients with Child-Pugh Class A Advanced Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is the third leading cause of cancer death worldwide with a poor prognosis. Treatment with immune checkpoint inhibitors (ICIs) has improved overall survival in patients with HCC. However, not all patients benefit from the treatment. In this study, 59 patients with HCC were enrolled from two medical centers in Saudi Arabia, with 34% using antibiotics concurrently with their Nivolumab (anti-PD1 blockade). The impact of antibiotic use on the clinical outcomes of patients with HCC undergoing treatment with anti-PD1 blockade was examined. The patients' overall survival (OS) was 5 months (95% CI: 3.2, 6.7) compared to 10 months (95% CI: 0, 22.2) (p = 0.08). Notably, patients with Child-Pugh A cirrhosis receiving anti-PD1 blockade treatment without concurrent antibiotic use showed a significantly longer median OS reaching 22 months (95% CI: 6.5, 37.4) compared to those who were given antibiotics with a median OS of 6 months (95% CI: 2.7, 9.2) (p = 0.02). This difference in overall survival was particularly found in Child-Pugh class A patients receiving anti-PD1 blockade. These findings suggest that antibiotic use may negatively affect survival outcomes in HCC patients undergoing anti-PD1 blockade, potentially due to antibiotic-induced alterations to the gut microbiome impacting the anti-PD1 blockade response. This study suggests the need for careful consideration when prescribing antibiotics to patients with HCC receiving anti-PD1 blockade.

Evaluation of Knowledge of Immunotherapy Toxicities Among Emergency Physicians in Riyadh, Saudi Arabia.

Introduction Immunotherapy is considered a new modality in the treatment of cancer with emerging different toxicity profiles. It is essential for healthcare practitioners to be aware of these side effects. Emergency medicine physicians are first-line health providers and should have the required knowledge and understanding of immunotherapy-related adverse effects to be able to identify and manage such patients. The study aimed to assess the level of knowledge of immunotherapy toxicity among emergency medicine physicians in Riyadh. Methods This cross-sectional study was conducted at the largest emergency medicine training centers in Riyadh. In total, 106 emergency medicine physicians participated. The questionnaire contained multiple-choice questions that assessed the knowledge and management of immunotherapy-related toxicities. Results The majority of the participants were male residents. The response rate varied for the selected training centers. Regarding the level of knowledge regarding the toxic side effects of cancer immunotherapy, the majority were likely to choose "I don't know." Conclusion This study, in support of the literature, revealed the gap in knowledge of the basic principles of cancer immunotherapy, despite increasing uses and indications of immunotherapy. The findings indicate the need for non-oncologist health practitioners, including emergency physicians, to enhance their knowledge of immunotherapy-related adverse events in order to improve their clinical decision-making skills.

Complete pathological response of post neoadjuvant chemotherapy in colorectal cancer with liver metastasis: a case report.

Treatment of metastatic colorectal cancer has evolved throughout the years and various methods have been proposed to reach a pathological complete response state. We report a case of a 73-year-old male presented with a sigmoid adenocarcinoma with two synchronous liver metastases. The patient received five cycles of FOLFOX neoadjuvant chemotherapy, 41% reduction of tumor size was noted upon reassessment. Therefore, a low anterior resection of the rectum and synchronous resection of segment 5 and 8 of the liver was done along with right-sided diaphragmatic stripping. A pathological complete response was achieved in both primary and secondary tumors that are considered rare and challenging in metastatic colorectal cancer. Neoadjuvant chemotherapy showed promising findings in advanced colorectal cancer.

VOR gain of lateral semicircular canal using video head impulse test in acute unilateral vestibular hypofunction: A systematic review.

Introduction: Acute unilateral vestibular hypofunction is characterized by sudden onset of vertigo or dizziness, vomiting/nausea, gait instability, and nystagmus. This is commonly described as an acute vestibular syndrome and usually attributed to vestibular neuritis; however, up to 25% of acute vestibular syndrome is caused by a stroke of posterior circulations. The video head impulse test is a recent tool in the vestibular test battery that assesses the vestibule-ocular reflex by measuring the VOR gain and recording overt and covert saccades, these findings have been found to be helpful in the diagnosis of various vestibular disorders. Method: A literature search was conducted in databases, including PubMed Central, PubMed, and Web of Science. All the articles that define video head impulse test (vHIT), acute vestibular hypofunction, and vestibular neuritis were considered for the preliminary search. No limits were placed on the date of publication. The searches were limited to studies with full-text availability, published in English, and including human subjects. Search words such as "head impulse test," "video head impulse test," "vestibular ocular reflex," "acute vestibular syndrome," "acute vestibular hypofunction," "vestibular neuritis," and "vHIT in central vestibular disorders" were entered into different databases in different combinations using boolean operators such as AND, OR, and NOT. Results: Searches across different databases, including Web of Science, PubMed Central, and PubMed, resulted in a total of 1,790 articles. Title screening was done for all the articles. Out of the 1,790 articles, we found that 245 articles were related to vestibular hypofunction i.e., 1,545 articles were removed at this stage. A further 56 duplicate articles were removed. This led to a final screening of 189 articles. The exclusion criteria included unavailability of full text, studies reported in languages other than English, case reports, reviews, and articles including participants having other comorbid conditions. This final screening led to 133 articles being excluded, which led to the full-text screening of 56 articles. After screening the full-text articles as per the eligibility criteria, 21 articles were found to be eligible for the systematic review. Among the remaining studies, six articles were excluded due to different specific reasons. A total of 15 articles were included in this systematic review. The mean VOR gain for the patients with vestibular neuritis was 0.48 ± 0.14 for the ipsilesional ear, whereas the mean VOR gain was > 0.80 in the contralesional ear for all the patients with acute vestibular neuritis. In patients with PICA lesions, the VOR gain for the ipsilesional ear was 0.90 (range 0.87-0.94) and for the contralesional ear was 0.88 (range 0.84-0.93). In patients with AICA lesions, the mean VOR gain was variable. Based on the above mean VOR gain findings, the authors propose the following adjective description scale of VOR of the lateral canal using vHIT: normal VOR gain above 0.80, mild VOR gain loss for 0.70-0.79, moderate loss for 0.69-0.4, severe loss for 0.39-0.2, and profound loss for < 0.2.

Neural-based modeling adsorption capacity of metal organic framework materials with application in wastewater treatment.

We developed a computational-based model for simulating adsorption capacity of a novel layered double hydroxide (LDH) and metal organic framework (MOF) nanocomposite in separation of ions including Pb(II) and Cd(II) from aqueous solutions. The simulated adsorbent was a composite of UiO-66-(Zr)-(COOH)2 MOF grown onto the surface of functionalized Ni50-Co50-LDH sheets. This novel adsorbent showed high surface area for adsorption capacity, and was chosen to develop the model for study of ions removal using this adsorbent. A number of measured data was collected and used in the simulations via the artificial intelligence technique. Artificial neural network (ANN) technique was used for simulation of the data in which ion type and initial concentration of the ions in the feed was selected as the input variables to the neural network. The neural network was trained using the input data for simulation of the adsorption capacity. Two hidden layers with activation functions in form of linear and non-linear were designed for the construction of artificial neural network. The model's training and validation revealed high accuracy with statistical parameters of R2 equal to 0.99 for the fitting data. The trained ANN modeling showed that increasing the initial content of Pb(II) and Cd(II) ions led to a significant increment in the adsorption capacity (Qe) and Cd(II) had higher adsorption due to its strong interaction with the adsorbent surface. The neural model indicated superior predictive capability in simulation of the obtained data for removal of Pb(II) and Cd(II) from an aqueous solution.

State-of-the-Art Review on the Application of Membrane Bioreactors for Molecular Micro-Contaminant Removal from Aquatic Environment.

In recent years, the emergence of disparate micro-contaminants in aquatic environments such as water/wastewater sources has eventuated in serious concerns about humans' health all over the world. Membrane bioreactor (MBR) is considered a noteworthy membrane-based technology, and has been recently of great interest for the removal micro-contaminants. The prominent objective of this review paper is to provide a state-of-the-art review on the potential utilization of MBRs in the field of wastewater treatment and micro-contaminant removal from aquatic/non-aquatic environments. Moreover, the operational advantages of MBRs compared to other traditional technologies in removing disparate sorts of micro-contaminants are discussed to study the ways to increase the sustainability of a clean water supplement. Additionally, common types of micro-contaminants in water/wastewater sources are introduced and their potential detriments on humans' well-being are presented to inform expert readers about the necessity of micro-contaminant removal. Eventually, operational challenges towards the industrial application of MBRs are presented and the authors discuss feasible future perspectives and suitable solutions to overcome these challenges.

An Interdisciplinary Approach to the Management of Individuals With Tracheostomy.

BACKGROUND: Study objectives were to identify the proportion of tracheostomy subjects with successful decannulation, time to decannulation after ICU discharge, and predictors of long-term tracheostomy based on an interdisciplinary team approach. METHODS: This retrospective cohort study recruited all adult tracheostomy patients admitted between January 2016 and December 2018. Long-term tracheostomy patients with recurrent admissions and compromised airway and patients with neck tumors obstructing the airway were excluded. Data regarding subjects' demographics, comorbidities, Glasgow coma score (GCS), feeding, ICU discharge date, decannulation date, and outcome were collected. The interdisciplinary team members included tracheostomy resource nurse; respiratory therapist; speech clinician; ear, nose, and throat specialist; and rehab medicine specialist. RESULTS: Of the 221 subjects followed during the study period, 16% (36/221) were excluded, and the remaining 84% (185/221) underwent the decannulation protocol. Subjects who failed capping multiple times 114/185 (62%) were labeled long term and did not progress to decannulation. We successfully decannulated 71/185 subjects (38%), and none developed decannulation failure. Forty deaths occurred during hospitalization, but none was due to tracheostomy complications. The median time to decannulation after ICU discharge was 47 d. Predictors of long-term tracheostomy were GCS < 11 (odds ratio [OR] 5.6 [95% CI 2.7-12.0]), age ≥ 65 y (OR 4.5 [95% CI (2.1-10.0]), comorbidities ≥ 2 (OR 4.0 [95% CI 1.5-11.2]), and female sex (OR 3.0 [95% CI 1.3-7.4]). The proportion of subjects with long-term tracheostomy significantly increased with the total number of predictors (Fisher exact test, P < .001). CONCLUSIONS: Long-term tracheostomy was a common outcome among subjects with a tracheostomy. Older age, low GCS, female gender, and the number of comorbidities were significant long-term tracheostomy predictors. Further studies to assess outcomes and predictors of tracheostomy are needed.

Elucidating the effect of process parameters on the production of hydrogen-rich syngas by biomass and coal Co-gasification techniques: A multi-criteria modeling approach.

The thermochemical processes such as gasification and co-gasification of biomass and coal are promising route for producing hydrogen-rich syngas. However, the process is characterized with complex reactions that pose a tremendous challenge in terms of controlling the process variables. This challenge can be overcome using appropriate machine learning algorithm to model the nonlinear complex relationship between the predictors and the targeted response. Hence, this study aimed to employ various machine learning algorithms such as regression models, support vector machine regression (SVM), gaussian processing regression (GPR), and artificial neural networks (ANN) for modeling hydrogen-rich syngas production by gasification and co-gasification of biomass and coal. A total of 12 machine learning algorithms which comprises the regression models, SVM, GPR, and ANN were configured, trained using 124 datasets. The performances of the algorithms were evaluated using the coefficient of determination (R2), root mean square error (RMSE), mean square error (MSE), and mean absolute error (MAE). In all cases, the ANN algorithms offer superior performances and displayed robust predictions of the hydrogen-rich syngas from the co-gasification processes. The R2 of both the Levenberg-Marquardt- and Bayesian Regularization-trained ANN obtained from the prediction of the hydrogen-rich syngas was found to be within 0.857-0.998 with low prediction errors. The sensitivity analysis to determine the effect of the process parameters on the model output revealed that all the parameters showed a varying level of influence. In most of the processes, the gasification temperature was found to have the most significant influence on the model output.

Patterns of self-reported recovery from chemosensory dysfunction following SARS-CoV-2 infection: insights after 1 year of the pandemic.

BACKGROUND: The coronavirus disease (COVID-19), due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), causes chemosensory dysfunction. AIMS/OBJECTIVES: To determine the characteristics of chemosensory dysfunction and to identify factors associated with chemosensory complete recovery and time to recovery. MATERIALS AND METHODS: This cross-sectional study included all patients presenting with chemosensory dysfunction and confirmed SARS-CoV-2 infection from May to August 2020 who underwent telemedicine follow-up after 1 year to assess their chemosensory recovery. RESULTS: A total of 372 patients were included, of which 53.8% were male. The mean age ± SD was 37.45 ± 13.44. The majority experienced combined (olfactory and gustatory) dysfunction (85.7%), and 315 patients (84.7%) had complete loss of chemosensory function. The independent predictors associated with a low likelihood of complete recovery were parosmia (aOR 0.16, p < .001), upper respiratory tract symptoms (aOR 0.28, p = .001), and dyspnoea (aOR 0.21, p < .001), whereas the factors associated with a long recovery period were parosmia (aOR 12.04, p = .002), headache (aOR 7.19, p = .007), and hypertension (aOR 7.76, p = .039). CONCLUSIONS: A full recovery outcome was predominant. The presence of parosmia was linked to both an incomplete recovery and a long time to recovery. SIGNIFICANCE: Parosmia and respiratory symptoms are implicated in the incomplete recuperation of chemosensory function.

Prophylactic Central Neck Dissection for Clinically Node-Negative Papillary Thyroid Carcinoma.

OBJECTIVE: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that scrutinized the oncological benefits and postsurgical complications of total thyroidectomy (TT) plus prophylactic central neck dissection (pCND) versus TT alone among clinically node-negative (cN0) papillary thyroid cancer (PTC) patients. METHODS: We screened five databases from inception to September 4, 2021 and evaluated the risk of bias of the eligible studies. We pooled dichotomous outcomes using the risk ratio (RR) with 95% confidence interval (CI). RESULTS: Overall, we included 5 RCTs with low risk of bias comprising 795 patients (TT plus pCND = 410 and TT alone = 385). With regard to efficacy endpoint, the rate of structural loco-regional recurrence did not significantly differ between both groups (n = 4 RCTs, RR = 0.49, 95% CI [0.19, 1.27], P = .14). With regard to safety endpoints, the rates of hypoparathyroidism (n = 5 RCTs, RR = 1.48, 95% CI [0.73, 2.97], P = .27), recurrent laryngeal nerve injury (n = 5 RCTs, RR = 1.34, 95% CI [0.59, 3.03], P = .48), and bleeding (n = 3 RCTs, RR = 1.75, 95% CI [0.42, 7.26], P = .44) did not significantly differ between both groups. CONCLUSION: For cN0 PTC patients, there was no significant difference between TT plus pCND and TT alone with regard to the rate of structural loco-regional recurrence or frequency of postsurgical complications. Adaptation of pCND in cN0 PTC patients should be contemplated by taking into consideration the clinical oncological benefits and rate of postsurgical adverse events. LEVEL OF EVIDENCE: 1 Laryngoscope, 132:1320-1328, 2022.