Organ Offer Review Cards: Improving Transparency on the Kidney Transplant Waitlist.

INTRODUCTION: The 2022 National Academy of Sciences, Engineering, and Medicine report on equity in organ transplantation highlighted limited transparency and accountability for organ offer declines and recommended prioritizing patient engagement in decisions regarding organ offers. Yet, there is no guidance on how to incorporate patients in organ offers. We elected to study the experiences of patients on the waitlist and their perception of a novel Organ Offer Review Card (OORC). METHODS: A prototype OORC was created using Donornet refusal codes. Sixty randomly selected kidney waitlist patients at a single center were asked to participate in a web-based survey focusing on current medical decision-making preferences and perceptions of the prototype OORC. RESULTS: Among the 43 patients reached, 17 (39.5%) completed the survey. Most participants (88.2%) expressed it was important to be involved in the decision-making about organ offers, with 100.0% of respondents wanting to know why an organ was declined. Regarding the prototype OORC, 94.1% thought it helped them understand the factors and priorities considered when selecting an organ, and 88.2% said it increased their belief that their team was acting in their best interest. CONCLUSION: An OORC could increase transparency and communication during the waitlist process while enhancing trust in the transplant team.

Empagliflozin May be a Game Changer in Managing Pulmonary Embolism: A Case Report.

Pulmonary Embolism (PE) tolls heavy casualty on human lives because it is often misdiagnosed, and patients have limited access to quality care in resource constraint settings. It usually propagates from deep vein thrombosis of lower limbs. A Bangladeshi old lady suddenly developed symptoms on 19 March 2023. She had predisposing conditions like Type-2 Diabetes mellitus, hypertension and knee replacement surgery that made her bedridden for several years. Finding all the available parameters suggestive of PE, she received standard care but failed to have complete remission. When Empagliflozin was added to her treatment plan, she responded very well and got full recovery off her illness. This is the take away of the story.

Incidence, Clinical Characteristics, and Outcomes of Clostridium difficile Infection in a Tertiary Care Center in Bahrain.

Background Clostridioides difficile infection (CDI) represents a significant healthcare challenge associated with antibiotic use and healthcare settings. While healthcare facility-onset CDI (HO-CDI) rates have been extensively studied, the incidence and risk factors of CDI in various settings, including the community, require further investigation. Aim This study aims to examine the incidence rates of CDI in a major governmental hospital in Bahrain, identify risk factors for CDI, and assess the effectiveness of infection control measures. Method We conducted a retrospective study at the Salmaniya Medical Complex (SMC), analyzing all confirmed cases of CDI over a 30-month period from January 2021 to June 2023. CDI cases were screened using glutamine dehydrogenase antigen detection and confirmed using molecular assays like polymerase chain reaction and/or toxin assays for confirmation. The study categorized CDI cases based on their onset (hospital or community) and explored associated risk factors, including antibiotic use, proton pump inhibitor (PPI) therapy, and patient demographics. Infection control practices were also evaluated for their role in managing CDI. Results About 57 new CDI cases were identified during the study period, with a HO-CDI incidence rate of 0.5 per 10,000 patient days. While HO-CDI rates remained stable, community-onset (CO)-CDI cases increased. The median patient age was 61.8 years, without notable differences between genders. Key risk factors for CDI were antimicrobial therapy, use of acid-reducing agents, age, and underlying comorbidities. The mortality rate stood at 35.1%. The ATLAS score (i.e., age, treatment with antibiotics, leukocyte count, albumin level, and serum creatinine) was a reliable predictor of mortality. Critical care admission and low albumin levels emerged as significant independent risk factors for mortality. Conclusions The study demonstrates a low incidence rate of HO-CDI at SMC, attributed to effective infection control and antibiotic stewardship programs. The overall CDI rate increased during the study period, driven by a rise in CO cases; further investigating the risk factors among this category in our study revealed that most patients were exposed to antibiotic therapy within the past three months of their CDI diagnosis. The rise in CO-CDI cases underscores the need for broader community-based interventions and awareness regarding antibiotic and PPI use.

Modified sutureless and glue-free method versus conventional sutures for conjunctival autograft fixation in primary pterygium surgery: a systematic review and meta-analysis.

BACKGROUND: Pterygium is a common ocular surface disorder that requires surgical intervention for treatment. Conjunctival autografts are preferred over simple excision due to lower recurrence rates. This systematic review and meta-analysis compared the modified sutureless glue-free (MSGF) method with conventional sutures (CS) for conjunctival autograft fixation in primary pterygium surgery. METHODS: A comprehensive search was conducted in MEDLINE, Embase, CENTRAL, Google Scholar and ClinicalTrials.gov for randomised controlled trials (RCTs) comparing MSGF and CS conjunctival autografts. Outcome measures included operation time, recurrence and postoperative complications. Standardised mean difference (SMD) and risk ratio (RR) were used for continuous and dichotomous outcomes, respectively. RESULTS: 11 RCTs involving 833 participants were included. The analysis revealed that MSGF had a significantly shorter operation time compared with CS (SMD -3.704, 95% CI -5.122 to -2.287, p<0.001). CS was associated with a higher risk of foreign body sensation (RR 0.22, 95% CI 0.06 to 0.74, p=0.01). MSGF was associated with a higher risk of graft dehiscence (RR 9.01, 95% CI 2.74 to 29.68, p=0.000) and graft retraction (RR 2.37, 95% CI 1.17 to 4.77, p=0.02). No significant differences were found in recurrence, graft haemorrhage, granuloma, Dellen and conjunctival oedema. CONCLUSION: Using the MSGF technique in conjunctival autograft fixation for pterygium surgery reduces operation time by relying solely on the patient's blood for fixation. However, it increases the risk of graft dehiscence and retraction. However, CS is linked to a higher likelihood of experiencing foreign body sensations. Understanding the learning curve and surgeon familiarity with novel techniques is crucial for optimising patient care and surgical outcomes, while individualised decision-making is necessary considering the advantages and disadvantages of each approach. Further research is warranted to minimise complications and optimise surgical outcomes.

Impact of Helicobacter pylori Eradication on Surgical Treatment of Peptic Ulcer Disease: Systematic Review.

Peptic ulcer disease (PUD) poses a significant global healthcare challenge, with an intricate interplay between stomach acid-pepsin levels and mucosal protective mechanisms. The emergence of Helicobacter pylori (H. pylori) as a major etiological factor revolutionized the therapeutic landscape, highlighting the importance of bacterial eradication in PUD management. Surgical intervention remains vital, particularly in cases of perforated peptic ulcers, despite a shift towards conservative approaches. Understanding the impact of H. pylori eradication on surgical outcomes is crucial for optimizing PUD management. This systematic review was conducted to assess how H. pylori eradication treatment impacts surgical results in patients with PUD. The criteria for inclusion involved research studies on individuals aged 18 years and older with a diagnosis of PUD that necessitated surgical treatment. Important results comprised eradication rates, complications after surgery, recurrence rates, and overall outcomes for patients. Two researchers independently screened and extracted data from electronic databases using a thorough search strategy. The evaluation of quality employed standardized instruments for randomized controlled trials and cohort studies. Nine research projects met the requirements for inclusion, offering information on the effectiveness of H. pylori elimination treatment on surgical results. Different rates of eradication were noted, with a notable number of patients experiencing postoperative complications. Recurrence of ulcers was a concern, despite treatment, emphasizing the complexity of PUD management. Studies have shown that eradication therapy is effective in certain patient groups, like young men with perforated peptic ulcers. Still, there are obstacles, especially for patients who test negative for H. pylori and experience recurring ulcers. The integration of H. pylori eradication with surgical intervention represents a holistic approach to PUD management. Although eradication therapy has the potential to enhance surgical results, difficulties remain, requiring personalized treatment approaches that consider patients' unique characteristics and the cause of the disease. This research adds to the growing knowledge of PUD treatment, stressing the importance of proper management.