Search Results (1,226)

Background/Objectives: Postoperative complications such as wound infections and sepsis are common in diabetic patients, often resulting in longer hospital stays and higher morbidity. This study hypothesizes that a Random Forest Classifier can accurately predict these complications, enabling early clinical interventions. The model utilizes ensemble learning to integrate diverse patient data and improve predictive accuracy beyond traditional risk assessments. Methods: A comprehensive retrospective analysis was performed using data extracted from the National Surgical Quality Improvement Program (NSQIP) database. The dataset encompassed a wide array of variables, including demographic factors, clinical markers, and detailed surgical data (specialty, type of anesthesia, duration of surgery). Each variable was meticulously encoded into numerical formats, with categorical variables transformed through one-hot encoding, and continuous variables were normalized. The dataset was partitioned into training (80%) and testing (20%) subsets, ensuring a balanced representation of the target outcomes. The Random Forest Classifier was selected due to its robustness in handling high-dimensional data and its ability to model complex interactions between variables. Results: The Random Forest model showed accuracy rates of 94.38% for wound infection and 94.94% for sepsis. Precision and recall metrics also exceeded 94%, highlighting the model’s accuracy in identifying true positives and reducing false positives. ROC curve analysis yielded AUC values of 0.92 for wound infection and 0.95 for sepsis, indicating strong discriminative capability. Feature importance analysis further identified key predictors, including surgical duration, specific laboratory markers, and patient comorbidities. Conclusions: This study demonstrates the Random Forest Classifier’s strong predictive ability for postoperative wound infections and sepsis in diabetic patients. The model’s high-performance metrics indicate its potential for real-time risk stratification in clinical workflows. Future research should validate these findings in diverse populations and surgical settings. Incorporating this predictive model into clinical practice has the potential to significantly improve patient outcomes and reduce healthcare costs. Full article

As life expectancy continues to increase, age-related disorders are becoming more prevalent. Among these, vascular complications resulting from chronic inflammation are particularly concerning, as they impair angiogenesis and hinder tissue repair, both processes that heavily rely on a well-structured extracellular matrix (ECM). In this context, MicroMatrix^® UBM Particulate, a skin substitute composed of collagen, laminin, and proteoglycans, appears to offer properties conducive to tissue regeneration. The aim of this study was to evaluate the regenerative potential of MicroMatrix^® combined with the Secretome of human Dental Pulp Stem Cells (hDPSC-S), using the medicinal leech Hirudo verbana, a well-established model for studying wound healing, angiogenesis, and tissue regeneration. Adult leeches were injected with MicroMatrix^® either suspended in FBS-free medium (CTRL) or supplemented with hDPSC-S. 1-week post-treatment, the animals were sacrificed and subjected to morphological and immunohistochemical analyses. Our findings revealed that MicroMatrix^® successfully integrated into the leech body wall. Notably, when supplemented with hDPSC-S, there was a marked increase in cell infiltration, including telocytes and Hematopoietic Precursor Stem Cells, along with a significantly higher vessel density compared to CTRL. These results support the effectiveness of the cell-free device composed of MicroMatrix^® and hDPSC-S, highlighting its potential as a promising strategy for regenerative therapies aimed at treating complex wounds with poor vascularization. Full article

Background and Objectives: This study aimed to investigate the effect of intraoperative hyaluronic acid (HA) application on short-term functional outcomes after open surgical repair of Achilles tendon rupture. Materials and Methods: This retrospective cohort study included 102 patients screened at three tertiary centers (January 2023–October 2024). After applying the exclusion criteria, 64 patients were analyzed (32 HA, 32 control), with group allocation based on the intraoperative use of HA. The primary outcomes were the American Orthopaedic Foot and Ankle Society (AOFAS) Score and the Achilles Tendon Total Rupture Score (ATRS), evaluated at 3, 6, and 12 months; the Short Form 36 (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, assessed at 6 and 12 months; and physical-performance tests (heel-rise endurance, single-leg hop distance, and calf muscle strength), performed at 6 and 12 months. Complications, including re-rupture, wound infection, and delayed wound healing, were also recorded. Results: At 6 months, the HA group had higher AOFAS scores (mean difference: 9.0, 95% CI: 6.3–11.7, p = 0.008) and ATRSs (mean difference: 7.0, 95% CI: 3.8–10.2, p = 0.008) than the controls. The differences were smaller but remained significant at 12 months (AOFAS mean difference: 5.0, 95% CI: 2.5–7.5, p = 0.034; ATRS mean difference: 4.0, 95% CI: 1.1–6.9, p = 0.034). The SF-36 PCS and MCS scores were also superior in the HA group at 6 and 12 months (all p < 0.05). The physical-performance tests (heel-rise endurance, single-leg hop, calf strength) showed significant mean differences, with the HA group scoring higher at both timepoints (all p < 0.05). Complication rates were low and not significantly different between groups (all p > 0.05). Conclusions: Intraoperative HA application during open Achilles tendon repair was associated with improvements in short-term functional recovery, general health status, and physical performance without increasing complication rates. These findings support the use of HA as a safe adjunct to optimize tendon gliding; however, prospective randomized controlled trials are needed to confirm these results. Full article

Background/Objectives: Surgical site infections (SSIs) following pancreaticoduodenectomy contribute to significant morbidity and healthcare costs. Negative pressure wound therapy (NPWT) has emerged as a potential preventive intervention; however, evidence regarding its efficacy in pancreatic surgery remains limited. This systematic review and meta-analysis aimed to evaluate the efficacy of NPWT compared to conventional dressings in preventing SSI following pancreaticoduodenectomy. Methods: PubMed, Scopus, BASE, Cochrane CENTRAL, and ClinicalTrials.gov were systematically searched from their inception to 2 April 2025. Randomized clinical trials and observational studies comparing NPWT with conventional dressings in patients undergoing pancreaticoduodenectomy were included. Two independent reviewers extracted the data and assessed the methodological quality. Random-effects meta-analysis was performed to calculate the pooled relative risks (RRs) with 95% CIs. The primary outcome was the incidence of SSI. The secondary outcomes included pancreatic fistula, seroma formation, incisional hernia, and readmission rates. Results: Nine studies (three randomized clinical trials and six observational studies) comprising 1247 patients were included. NPWT was associated with a significant reduction in SSI compared with conventional dressings (RR, 0.61; 95% CI, 0.41–0.90). Subgroup analysis revealed varying effects by study design: retrospective cohort studies showed a nonsignificant trend toward SSI reduction (RR, 0.53; 95% CI, 0.19–1.48), randomized clinical trials demonstrated a nonsignificant trend favoring NPWT (RR, 0.67; 95% CI, 0.37–1.23), and the single prospective cohort study showed significant SSI reduction (RR, 0.48; 95% CI, 0.28–0.84). No significant differences were observed in pancreatic fistula rates between the NPWT and conventional dressing groups. Prophylactic NPWT application, longer duration (≥5 days), and higher negative pressure settings (−125 mmHg) appeared more effective than therapeutic application, shorter duration, and lower-pressure settings, respectively. Conclusions: This systematic review and meta-analysis suggests that NPWT is associated with a reduced SSI risk following pancreaticoduodenectomy. The greatest benefit may be achieved with prophylactic application in high-risk patients, longer therapy duration, and higher negative pressure settings. These findings support the consideration of NPWT as part of SSI prevention strategies in pancreatic surgery, particularly for patients with identified risk factors. Full article

Background: The treatment of wounds remains a significant clinical challenge, particularly in chronic and infected wounds, where delayed healing often results in complications. Recent advances in biomaterials have highlighted the potential of polymer-based scaffolds as promising platforms for wound management due to their ability to mimic the extracellular matrix, support tissue regeneration, and provide a moist environment conducive to healing. Objectives: This review aims to provide a comprehensive overview of the recent progress in the design and application of polymer-based scaffolds loaded with essential oil (EO) components, emphasizing their role in promoting effective wound healing. Methods: Relevant literature on polymeric scaffolds and EO-based bioactive agents was systematically reviewed, focusing on studies that investigated the biological activities, fabrication techniques, and therapeutic performance of EO-loaded scaffolds in wound management. Results: Findings from recent studies indicate that EO components, particularly monoterpenoids such as thymol, carvacrol, and eugenol, exhibit remarkable antimicrobial, anti-inflammatory, antioxidant, and analgesic properties that accelerate wound healing. When incorporated into polymer matrices, these components enhance scaffold biocompatibility, antimicrobial efficacy, and tissue regeneration capacity through synergistic interactions. Conclusions: The integration of essential oil components into polymeric scaffolds represents a promising strategy for developing multifunctional wound dressings. Such systems combine the structural advantages of polymers with the therapeutic benefits of EOs, offering an effective platform for accelerating healing and preventing wound infections. Full article

In Africa, the folkloric practices involving plant-based remedies play a crucial role in livestock farming, often attributed to the limited access to modern veterinary services. The use of Acacia species (including those reclassified as Vachellia species) in ethnoveterinary medicine has garnered increasing interest due to their high protein content and medicinal (including anti-parasitic) properties, offering a sustainable source of fodder particularly in arid and semi-arid regions. However, scientific assessment of their efficacy and safety remains limited. This systematic review examines the ethnoveterinary uses, biological efficacy and safety of Acacia species across Africa. A literature search was conducted using PubMed, Google Scholar and Scopus, yielding 519 relevant studies published between 2001 and 2024. After applying the inclusion and exclusion criteria, 43 eligible studies were analyzed based on their relevance, geographical location and livestock disease applications. Plants of the World online database was used to validate the names of the species and authority. Ethiopia had the highest usage of Acacia species (25%), then Nigeria (20%) followed by both South Africa (15%) and Namibia (15%). Vachellia nilotica (Acacia nilotica) was the most frequently cited species (26.3%), followed by Vachellia karroo (Acacia karroo) (15.8%). Ethnobotanical records indicate that the different Acacia species have been traditionally used to treat conditions such as diarrhea, wound infections and complications such as retained placenta. Pharmacological studies corroborate the therapeutic benefits of Acacia species with evidence of their antimicrobial, anti-inflammatory, antioxidant and anthelmintic effects, though some toxicity concerns exist at high dosages. The systematic review revealed the efficacy and safety (to some extent) of Acacia species in livestock disease management, emphasizing their potential integration into veterinary medicine. However, the dearth of in vivo studies underscores the need for pre-clinical and clinical trials to establish safe and effective dosages for use in livestock. Full article

Background: Pancreatic and hepatobiliary tumors continue to rank among the deadliest cancers worldwide. Due to a low response rate to treatment, these tumors continue to have a high death rate, a poor prognosis and survival rate, and an overall poor patient outcome. The multimodal strategy used in current treatment includes systemic therapy, radiation therapy, and surgery. However, surgery remains the only treatment with curative intent. Preoperative biliary drainage has a direct impact on the perioperative prognosis of patients with obstructive jaundice and significantly compromised liver function due to hepato-bilio-pancreatic malignancies. Our study’s goal was to determine the safest and most efficient preoperative biliary drainage technique by conducting a systematic review and meta-analysis of resectable periampullary cancers. Methods: Our approach consisted of searching PubMed, BMC Medicine, and Scopus databases using keywords with a result of 1104 articles from 2010 to 2023. The remaining 24 articles that met our inclusion criteria were subjected to meta-analysis using R Commander 4.3.2. Results: Endoscopic retrograde biliary drainage (ERBD) demonstrated a higher rate of postprocedural pancreatitis (RR = 2.22, p < 0.01), intra-abdominal abscess (RR = 1.64, p < 0.01), and delayed gastric emptying (DGE) (RR = 2.07, p < 0.01) than percutaneous transhepatic biliary drainage (PTBD) or endoscopic nasobiliary drainage (ENBD). Plastic stent (PS) had higher rates of catheter occlusion (RR = 2.20, p < 0.01) and POPF (RR = 1.66, p < 0.01) compared to self-expandable metallic stent (SEMS), which could explain a longer hospital stay (MD = 2.41 days, p < 0.01). However, PS had lower rates of grade 1–2 complications (RR = 0.79, p = 0.017) and wound infection rates (RR = 0.66, p = 0.017) than self-expandable metallic stent (SEMS). Conclusions: The choice of a preoperative drainage method can influence postprocedural and postoperative complications rates. ERBD appears to be associated with higher procedure-related and postoperative complication rates and may be linked to a prolonged hospital stay compared to ENBD or PTBD. Moreover, the type of stent placed through ERBD procedure had an important impact on prognosis, as PS had a higher rate of catheter occlusion and POPF, with a prolonged hospital stay compared to SEMS, while mild complications and wound infections were less common in PS group. Full article

Diabetic foot infections (DFIs) are a significant complication in patients with diabetes, often leading to severe clinical complications including amputation and increased mortality rates. The effective management of these infections is complicated by the rise in antibiotic resistance among the microbial populations involved. In this paper, we undertake a systematic review and meta-analysis to explore the bacterial profiles, as well as their antibiotic resistance patterns in DFIs, encompassing studies published between 2014 and 2024. A total of 28 studies were selected from several databases, including PubMed, Google Scholar, EBSCOhost, and ScienceDirect, published from 2014 to 2024, specifically focusing on diabetic foot infections and antibiotic resistance. Diabetic foot infections arise from a combination of factors, including peripheral neuropathy, poor circulation, and immune system impairment, making diabetic patients prone to unnoticed injuries, impaired wound healing, and a higher risk of infections. The severity of DFIs often depends on the size and depth of the ulcers, with larger, deeper ulcers posing additional risks of infection and complications, such as osteomyelitis and sepsis. Our study synthesizes information on the total isolates of microbes, their resistance to one or more groups of antibiotics, and resistance panel results across multiple antibiotics, including amoxicillin/clavulanate, trimethoprim/sulfamethoxazole, ciprofloxacin, and others. We meticulously catalog the resistance of key bacterial strains—Escherichia coli, Enterobacter spp., Proteus spp., Pseudomonas spp., Staphylococcus aureus, and others—highlighting patterns of resistance to single and multiple antibiotic groups. This systematic review also analyzes the correlations of various comorbidities reported by the diabetic foot infection patient populations in the included studies with multiple antibiotic resistance patterns. Subsequently, this analytical review study addresses the rising prevalence of antibiotic-resistant pathogens and underscores the need for antibiotic stewardship programs to promote judicious use of antibiotics, reduce the spread of resistant strains, and enhance therapeutic outcomes. In addition, the review discusses the implications of resistance to empirical antibiotic treatments, underscoring the necessity for tailored antibiotic therapy based on culture and sensitivity results to optimize treatment outcomes. Full article

Background and Clinical Significance: The objective of this case study is to report on the clinical outcomes of a hard-to-heal posterior upper-thigh pressure ulcer when managed with a sterile human amniotic membrane tissue allograft. Case Presentation: Retrospective case data of a patient who received five applications of barrera^TM between February 2024 and April 2024 as part of their care regimen for a chronic pressure ulcer was obtained from a single wound care group. Data evaluated consisted of past patient medical history, concomitant medications, previous wound care treatments, wound type, wound size, adjunctive wound therapies and wound outcomes post allograft. The chronic pressure ulcer, measuring at 10.5 cm² prior to allograft application, achieved complete closure at the last observation post the final, fifth application. Wound size attenuation was seen as early as 1 week post initial allograft application. No adverse events or complications related to barrera^TM were observed. Conclusions: Results suggest that the application of dual-layer allografts in the context of chronic ulcers may represent a safe and effective wound management utility. Full article

Background/Objectives: Negative-Pressure Wound Therapy (NPWT) is increasingly used to promote wound healing in chronic and complicated wounds, but its use in surgical oncology is still debated due to theoretical concerns about promoting local tumor recurrence. The aim of this study is to review the available evidence on the oncologic safety of NPWT, specifically regarding the risk of local recurrence in patients undergoing surgery for cutaneous melanoma (CM) or soft tissue sarcoma (STS). Methods: A systematic review of the literature was conducted using the MEDLINE/PubMed, EMBASE, and Scopus databases through December 2024 (PROSPERO: CRD42024623405). Case series, retrospective cohort studies, and randomized clinical trials reporting survival data in melanoma and sarcoma patients treated with NPWT were eligible for inclusion. PRISMA guidelines were followed and quality assessment checked. Results: Seventeen studies were eligible for the analysis with a total of 285 patients, 197 affected by soft tissue sarcoma and 88 by cutaneous melanoma. The pooled proportion of local recurrence was 5% in patients treated with NPWT, regardless of the histology considered (STS and CM). When comparing NPWT to conventional wound therapy, both the pooled risk ratio (0.87; 95% CI: 0.24–3.11; Tau² = 0.14; I² = 8%) and odds ratio (0.83; 95% CI: 0.20–3.39; Tau² = 0.18) indicated no statistically significant difference in the recurrence rate. Conclusions: Current evidence does not suggest an increased risk of local recurrence associated with NPWT in melanoma or sarcoma patients, and mostly, NPWT may have important advantages over standard surgical dressings. More high-power randomized controlled trials with wider follow-up periods are needed to make it possible for practitioners to use this technique without being afraid of higher risk local recurrences. Full article

Cataracts cause vision loss in rabbits, often either spontaneously or as secondary to uveitis. This study considers the ophthalmic presentation, treatment, and outcome of phacoemulsification in seven pet rabbits: six presenting with lens cloudiness and one presenting with a white mass in the iris. Ophthalmic examinations revealed cataracts. The treatment plan was phacoemulsification. Encephalitozoon cuniculi was identified via an enzyme-linked immunosorbent assay technique performed on all rabbits. Ocular ultrasonography was performed to rule out retinal detachment. Phacoemulsification using the one-handed technique without intraocular lens implantation was performed in 8 of the eyes of the 7 rabbits. After surgery, the corneal wounds healed within 2 weeks. All rabbits were comfortable with opening their eyes and had a positive dazzle reflex and a clear visual axis, with no other severe complications (such as retinal detachment, intraocular hemorrhaging, or uncontrolled glaucoma) throughout the post-operative period. Postoperative complications consisted of corneal edema around the surgical wound (2 eyes; 25%); partial anterior synechiae (1 eye; 12.5%); partial posterior synechiae (5 eyes; 3 eyes before surgery and 2 eyes after surgery; 25%); posterior capsular opacities (3 eyes; 37.5%); and lens fiber overgrowths (2 eyes; 25%). In conclusion, successful phacoemulsification was achieved in the seven pet rabbits. Full article

Wound healing is impaired under diabetic conditions due to reduced angiogenesis, thereby increasing the risk of wound-healing complications. Studies have shown that inhibition of α- and β-adrenoceptors delays wound healing. This study investigates the effects of topical salbutamol (TS) on STZ-induced diabetic wound healing in rats. The rats were divided into two initial groups: non-diabetic and diabetic. Diabetes mellitus was induced in the second group with STZ (65 mg/kg). Excision wounds were inflicted on the dorsal thoracic region, 1–1.5 cm away from the vertebral column on either side, following anesthesia on all groups. Group 2 was subdivided into untreated diabetic wounds, low-dose-TS-treated diabetic wounds (6.25 mg/mL), medium-dose-TS-treated diabetic wounds (12.5 mg/mL), and high-dose-TS-treated diabetic wounds (25 mg/mL), and were monitored for 14 days. Percentage wound contraction and the time required for complete wound closure were observed and recorded. In addition, oxidative stress and inflammatory markers such as NO, CRP, MPO, TGF-β1, TNF-α, IL-6, IL-1β, NO, and hexosamine were estimated in wound exudates and tissue over 14 days. TS treatment resulted in 100% wound contraction in all treated wounds within 14 days compared to untreated non-diabetic and diabetic wounds. Increased NO, TGF-β1, and hexosamine activity was observed in TS-treated wounds when compared to untreated diabetic wounds. In addition, TS treatment decreased the activity of IL-1β, TNF-α, IL-6, CRP, and MPO, all of which were elevated in the untreated diabetic wounds. The current study shows that the application of TS significantly improved diabetic wound contraction and aided the healing process. Angiogenic markers, such as TGF-β1 and NO, were prominently increased, supporting the role of sympathetic nerve stimulation in angiogenesis. Full article

Background: Excessive scarring remains a frequent complication in plastic surgery, yet standardized preventive strategies are lacking. Type I collagen-based biomaterials may support regenerative processes and improve scar outcomes. Methods: This case series includes six female patients (ages 24–52) undergoing wound management after trauma and procedures including blepharoplasty, abdominoplasty, and revision mammaplasty. Native collagen type I (7% or 15%) was injected along wound margins or into hypertrophic scars at 3–4 week intervals. Outcomes were assessed through patient-reported symptoms and Antera 3D imaging (vascularity, pigmentation, surface topography). Results: Patients reported reduced tightness, pruritus, and scar stiffness after initial sessions. Antera 3D imaging showed decreased vascular and pigment indices, and a reduction in surface elevation over follow-up (up to 14 months). No adverse effects such as atrophy or infection were observed. Conclusions: Native type I collagen was well tolerated and may be a useful adjunct for wound healing and scar modulation following plastic surgery. Full article

Background: Despite advances in surgical techniques and perioperative care, pancreatic resections such as pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) remain high-risk procedures. Postoperative complications significantly impact morbidity, mortality, and patient quality of life. Methods: This narrative review summarizes recent literature on major complications following pancreatic surgery, including postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), and post-pancreatectomy hemorrhage (PPH), with an emphasis on incidence, risk factors, outcomes, and current preventive strategies. Results: POPF is a leading complication, occurring in 5–22% of cases and often linked with sepsis and hemorrhage. Key risk factors include high BMI, soft pancreatic texture, and small duct size. Preventive measures like Pasireotide, modified anastomosis techniques, and neoadjuvant therapy show variable success. DGE affects up to 57% of PD patients and is associated with prolonged recovery; antecolic reconstruction and erythromycin may reduce incidence. PPH, though less frequent (3–13%), can be life-threatening, particularly when secondary to POPF. Endovascular approaches are now favored for late arterial bleeding. Other complications include wound infections, abscesses, bile leaks, and pulmonary issues, all contributing to extended hospital stays and diminished quality of life. Conclusions: Pancreatic surgery continues to carry significant risks, with POPF, DGE, and PPH being the most impactful complications. While multiple interventions have shown promise, standardized protocols and predictive tools are still needed. Surgery should be performed in high-volume centers with experienced multidisciplinary teams to optimize outcomes. Full article

Background: Antimicrobial resistance (AMR) is a major global health threat, particularly in surgical site infections (SSIs), where multidrug-resistant (MDR) pathogens complicate treatment. Objective: This study aimed to identify antimicrobial resistance genes and assess their prevalence in bacterial species causing SSIs in Lebanon. Materials and Methods: The present research is a multicenter and prospective study that included patients who developed SSIs after surgery in seven hospitals, within the period of January 2024–September 2024. Bacterial isolates from wound swabs or tissue samples were identified using standard microbiological methods. Antimicrobial susceptibility was tested by disk diffusion, and resistance genes were detected by PCR. Data were analyzed using Statistical Package for the Social Sciences (SPSS). Results: Among 6933 surgical patients, 63 developed SSIs (0.91%; 95% CI [0.70–1.15]). Gram-negative bacteria predominated (73%), mainly Escherichia coli and Pseudomonas aeruginosa, while Gram-positive isolates accounted for 27%, mostly Staphylococcus aureus. MDR was observed in 71% of Gram-positive and 61% of Gram-negative isolates. The most frequent genes were mecA in S. aureus (100%) and coagulase-negative staphylococci (83.3%); bla_CTX-M in E. coli, Klebsiella pneumoniae, and Enterobacter cloacae (100%); and bla_NDM in E. cloacae (100%) and Acinetobacter baumannii (60%). bla_KPC was less common, and no isolates carried Imipenemase (IMP), Verona integron-encoded metallo-β-lactamase (VIM), and Oxacillinase-48-like β-lactamase (OXA-48). Conclusions: This study highlights the high prevalence of antibiotic resistance in agents causing SSIs in Lebanese hospitals. Resistance genes, particularly mecA, bla_CTX-M, and blaNDM, were highly prevalent in SSI pathogens, underscoring the urgent need for surveillance and judicious antibiotic use in Lebanese hospitals. Full article