Improving patient safety during position changes under general anaesthesia: "CHOPP check"- a new patient safety and educational tool.

The requirement to change position whilst under general anaesthesia may expose patients to significant risks. We devised and implemented a concise and comprehensive patient positioning safety tool with the aim of reducing risks and improving patient safety during position changes under anaesthesia.

Incidence of radiographic pulmonary abnormalities after posterior spinal fusion surgery for pediatric scoliosis.

Background and Aims: Pulmonary complications are the most common non-neurologic complications following surgical correction of scoliosis. These can affect postoperative recovery by increasing the length of stay and/or the need for ventilatory support. The aim of this retrospective study is to determine the incidence of radiographic abnormalities reported in chest radiography after posterior spinal fusion surgery for the treatment of scoliosis in children. Material and Methods: A retrospective chart review of all patients who underwent posterior spinal fusion surgery in our center between January 2016 and December 2019 was attempted. Radiographic data including chest and spine radiographs were reviewed on the national integrated medical imaging system using medical record numbers for all patients in the 7 postoperative days. Results: Seventy-six (45.5%) of the 167 patients developed radiographic abnormalities in the postoperative period. There was evidence of atelectasis in 50 (29.9%) patients, pleural effusion in 50 (29.9%) patients, pulmonary consolidation in 8 (4.8%) patients, pneumothorax in 6 (3.6%) patients, subcutaneous emphysema in 5 (3%) patients, and rib fracture in 1 (0.6%) patient. Four (2.4%) patients were noted to have an intercostal tube inserted postoperatively, three for treating pneumothorax, and one for pleural effusion. Conclusion: A large number of radiographic pulmonary abnormalities were encountered in children following surgical treatment of pediatric scoliosis. Although not all radiographic findings may be clinically significant, early recognition may guide clinical management. The incidence of air leak (pneumothorax, subcutaneous emphysema) was significant and could influence local protocol formulation with regards to obtaining immediate postoperative chest radiograph and intervention if clinically necessary.

Variable versus fixed-rate infusion of phenylephrine during cesarean delivery: a randomized controlled trial.

BACKGROUND: Phenylephrine is the most commonly used vasopressor for prophylaxis against maternal hypotension during cesarean delivery; however, the best regimen for its administration is not well established. Although variable infusion protocols had been suggested for phenylephrine infusion, evidence-based evaluation of variable infusion regimens are lacking. The aim of this work is to compare variable infusion, fixed on-and-off infusion, and intermittent boluses of phenylephrine for prophylaxis against maternal hypotension during cesarean delivery. METHODS: A randomized controlled study was conducted, including full-term pregnant women scheduled for elective cesarean delivery. Participants were divided into three groups which received phenylephrine by either intermittent boluses (1.5 mcg/Kg phenylephrine), fixed on-and-off infusion (with a dose of 0.75 mcg/Kg/min), or variable infusion (with a starting dose of 0.75 mcg/Kg/min). The three groups were compared with regard to frequency of: maternal hypotension (primary outcome), second episode hypotension, reactive hypertension, and bradycardia. Other outcomes included heart rate, systolic blood pressure, physician interventions, and neonatal outcomes. RESULTS: Two-hundred and seventeen mothers were available for final analysis. The 2 infusion groups showed less incidence of maternal hypotension {26/70 (37%), 22/71 (31%), and (51/76 (67%)} and higher incidence of reactive hypertension compared to the intermittent boluses group without significant differences between the two former groups. The number of physician interventions was highest in the variable infusion group compared to the other two groups. The intermittent boluses group showed lower systolic blood pressure and higher heart rate compared to the two infusion groups; whilst the two later groups were comparable. CONCLUSION: Both phenylephrine infusion regimens equally prevented maternal hypotension during cesarean delivery compared to intermittent boluses regimen. Due to higher number of physician interventions in the variable infusion regimen, the current recommendations which favor this regimen over fixed infusion regimen might need re-evaluation.

Association between lncRNAs with stem cells in cancer; a particular focus on lncRNA-CSCs axis in cancer immunopathogenesis.

A unique population of cells known as cancer stem cells (CSCs) is essential to developing and spreading cancer. Cancer initiation, maintenance, and progression are all believed to be significantly impacted by the distinct characteristics these cells exhibit regarding self-renewal, proliferation, and differentiation. Transcriptional, post-transcriptional, and translational processes are the only steps of gene expression that lncRNAs can affect. As a result, these proteins participate in numerous biological processes, including the repair of DNA damage, inflammatory reactions, metabolic control, the survival of cells, intercellular communication, and the development and specialization of cells. Studies have indicated that lncRNAs are important for controlling the increase in the subset of CSCs contributing to cancer development. The knowledge that is currently available about lncRNAs and their critical role in maintaining the biological properties of CSCs is highlighted in this study.

The impact of COVID-19 on neurosurgical theatre activity in the National Neurosurgical Centre of Ireland.

BACKGROUND: The global healthcare activity including neurosurgical services has been significantly impacted by the COVID-19 pandemic. AIM: Compare neurosurgical theatre activity from 2019 (pre-pandemic) to that of the subsequent pandemic years (2020-2021) and explore how each wave of COVID-19 infection impacted activity levels. METHODS: A retrospective analysis of neurosurgical theatre activity at the National Neurosurgical Centre of Ireland was performed from 1 January 2019 till 31 December 2021. The extracted data included date, surgical procedure, demographics of the patient and case scheduling (elective or emergency). RESULTS: In total, 6139 neurosurgical procedures were recorded throughout the study period. Two thousand one hundred forty-four neurosurgical procedures were recorded in 2019, 2052 in 2020 and 1943 in 2021 corresponding to a reduction in theatre activity by 4.3% and 9.4% in 2020 and 2021 respectively. The lowest number of monthly caseloads was recorded in April 2020 during the first wave of the pandemic. The first quarter of 2021 recorded the lowest number of quarterly surgical procedures over the entire 3-year period contributing to just 19.4% of 2021 caseload. Subgroup analysis showed a significant reduction in trans-sphenoidal pituitary surgeries post-pandemic by 36% and 44% in 2020 and 2021 respectively. CONCLUSIONS: Despite the exceptional stress imposed on our institution by COVID-19, the neurosurgical service managed to maintain comparable activity levels to 2019. The 2021 activity levels were more significantly impacted with 9.4% reduction when compared with pre-pandemic figures in 2019. Institutions need to develop a robust emergency plan to reduce the impact of any subsequent pandemics on healthcare delivery.

Comparative study between the excision-ligation and autoligation of vas deferens technique for teaser rams preparation.

AIM: The present study was designed to demonstrate the autoligation (AL) of vas deferens and the excision-ligation (EL) technique to generate vasectomized rams to reduce the complications, operative time, and price of the vasectomy techniques. MATERIALS AND METHODS: A total of 12 healthy and mature Iraqi Awassi rams were used, which divided into two groups, six rams for each one. The former group was performed the EL technique while the latter group, the AL of vas deferens technique was used. RESULTS: The results of the present study found that both techniques were same with the reproductive efficient examinations that mean the two techniques had same ability to close the male genital passage for teaser rams preparation. However, the methods were different with the histopathological changes, operation time, prices, and complications, which were minor in the AL of vas deferens compared with the EL technique. CONCLUSION: The AL technique of vas deferens to prepare teaser animal is recommended over the EL technique due to different aspects such as cost, fewer complications, and active teaser for a long period are the main aspects of AL technique.