Sanamed

RISK FACTOR STRATIFICATION AND EARLY DETECTION OF INCISIONAL HERNIAS AFTER CESAREAN AND OPEN GYNECOLOGIC PROCEDURES: A PROSPECTIVE OBSERVATIONAL STUDY

Muhammad M Memon, Sajad Ahmad Salati , Zaheera Saadia — Fri, 31 Oct 2025 11:46:25 +0100

Background: Incisional hernia is a major complication of abdominal surgery, leading to pain, functional impairment, and increased healthcare costs. This study aimed to identify and rank risk factors for incisional hernia in patients undergoing Cesarean section or open gynecologic surgery, and to evaluate strategies for early detection.

Methods: From January 2023 to June 2025, a prospective observational study enrolled 200 women, each followed for 12 months. Half of the women underwent Cesarean section (n=100) and the other half underwent open gynecologic surgery (n=100). Data were collected on patient demographics, body mass index, comorbidities, surgical details, and complications. The primary outcome was the incidence of incisional hernia within one year, assessed by clinical examinations at 6 weeks, 6 months, and 12 months.

Results: The overall incidence of incisional hernia was 8.0% (16/200), with 6.0% (6/100) after Cesarean section and 10.0% (10/100) after open gynecologic procedures. Multivariable analysis identified independent risk factors: higher body mass index (adjusted odds ratio 1.12 per unit, 95% confidence interval 1.05–1.19, p<0.001), vertical incision (odds ratio 4.10, 95% CI 1.75–9.60, p=0.001), postoperative wound infection (odds ratio 5.22, 95% CI 2.15–12.67, p<0.001), and history of two or more prior Cesarean sections (odds ratio 3.85, 95% CI 1.42–10.45, p=0.008). Continuous fascial closure was protective (odds ratio 0.42, 95% CI 0.20–0.88, p=0.022). Early patient-reported symptoms preceding diagnosis included a palpable bulge (75%), persistent pain (62.5%), and discomfort during activity (50%).

Conclusion: Higher body mass index, vertical incisions, wound infection, and multiple prior Cesarean sections are significant risk factors for incisional hernia. Using transverse incisions and continuous fascial closure, when possible, together with vigilant wound care and patient education on self-examination for early symptoms, can help reduce risk and enable early detection in high-risk patients.

AVULSION FRACTURES OF THE ANTERIOR ILIAC SPINE IN CHILDREN AND ADOLESCENTS: CLINICAL OUTCOMES OF NON-OPERATIVE TREATMENT

Mon, 24 Nov 2025 11:23:16 +0100

Objective: Avulsion fractures of the anterior iliac spine are injuries typically seen in physically active children and adolescents. There is no clear consensus regarding the optimal treatment, particularly concerning the degree of fragment displacement that warrants surgical intervention.

Aim: The aim of this study was to analyze the clinical outcomes of non-operative treatment of pelvic avulsion fractures in adolescents and to examine the relationship between patient age and rehabilitation duration.

Patients and Methods: A retrospective study was conducted on 12 adolescent patients with radiographically confirmed pelvic avulsion fractures. Data on age, fracture location, injury mechanism, treatment, and rehabilitation duration were collected and analyzed. All patients underwent non-operative management consisting of rest, analgesics, and crutch-assisted ambulation, followed by physical therapy.

Results: All patients were male, with a mean age of 12 years. The most common fracture site was the anterior inferior iliac spine (66.6%). All fractures healed without complications. Rehabilitation duration tended to be shorter in younger patients. Functional outcomes were excellent, with all patients returning to their pre-injury activity levels.

Conclusion: Non-operative treatment is an effective and safe approach for managing pelvic avulsion fractures in adolescents, even in cases with fragment displacement up to 15 mm. It provides excellent functional recovery without complications, supporting its use as the first-line treatment in this population.

EVALUATION OF HEMODYNAMIC AND BIOMARKER CHANGES IN PATIENTS UNDERGOING SURGICAL AORTIC VALVE REPLACEMENT

Mon, 24 Nov 2025 11:24:34 +0100

Background: Aortic stenosis (AS) is a systemic disease characterized by valvular obstruction, ventricular remodeling, and perioperative vulnerability to oxygen supply–demand imbalance. This study evaluated perioperative metabolic and biomarker dynamics and early postoperative outcomes in patients undergoing surgical aortic valve replacement (AVR).

Patients and Methods: A prospective observational study was conducted on 60 consecutive adults with severe AS who underwent surgical AVR at a single center. Demographics, anthropometric data, intraoperative variables, complications, and pre- and postoperative hemodynamic and laboratory parameters were evaluated. Postoperatively, the following were assessed at 6 and 24 hours: mean arterial pressure (MAP), arterial oxygen saturation (SaO₂), partial pressure of oxygen (PaO₂), pH, partial pressure of carbon dioxide (PaCO₂), hemoglobin (Hb), lactate, and creatine kinase–MB isoenzyme (CK-MB). Continuous data are presented as mean ± standard deviation (SD) or median (interquartile range, IQR). Paired t-tests were used to compare values between 6 and 24 hours.

Results: The mean age was 69.9 ± 7.3 years; 58.3% were male. Mean anesthesia and operation times were 151.5 ± 21.8 and 126.8 ± 20.6 minutes, respectively; mean cardiopulmonary bypass (CPB) and cross-clamp times were 78.3 ± 17.6 and 58.5 ± 16.7 minutes. Nearly half of the patients (46.7%) had no postoperative complications; others experienced bleeding (16.7%), arrhythmias requiring therapy (6.7%), permanent pacemaker implantation (8.3%), re-exploration (6.7%), infection (8.3%), respiratory failure (3.3%), or renal failure (3.3%). From 6 to 24 hours postoperatively, lactate decreased (2.34 ± 0.96 →1.87 ± 0.98 mmol/L; p = 0.006) and CK-MB declined (52.5 ± 34.2 →39.0 ± 30.8 U/L; p = 0.001), while Hb increased (103.5 ± 10.1 →120.1 ± 22.9 g/L; p < 0.001). pH decreased modestly (7.396 ± 0.057 →7.365 ± 0.065; p = 0.015). MAP, SaO₂, PaO₂, and PaCO₂ showed no significant changes. The median hospital stay was 7 days (IQR 6–8).

Conclusions: In patients undergoing surgical AVR for AS, early postoperative trends demonstrated an improving metabolic profile (lower lactate) and biomarker normalization (CK-MB) with stable oxygenation, alongside low-to-moderate complication rates and a consistent 7-day median stay. Integrating perioperative oxygen-balance markers and cardiac biomarkers with imaging and left ventricular hypertrophy (LVH) assessment may refine timing and risk stratification for intervention. Prospective studies with standardized imaging and longer follow-up are warranted to link early metabolic recovery with ventricular remodeling and clinical outcomes.

AORTIC AND SUPERIOR MESENTERIC ARTERY THROMBOSIS IN ANTITHROMBIN III DEFICIENCY-DIAGNOSTIC AND THERAPEUTIC CHALLENGES IN CONSERVATIVE MANAGEMENT

Surla Dimitrije, Marija Nikolić, Nemanja Trifunović, Milica Stojadinović — Fri, 28 Nov 2025 00:00:00 +0100

Introduction: Thrombosis of large arterial vessels, such as the abdominal aorta and superior mesenteric artery, is a rare but serious condition that requires timely diagnosis and appropriate management. One of the risk factors is antithrombin III (AT III) deficiency, a rare coagulation disorder that increases the likelihood of thrombosis. While arterial thromboses are less common than venous ones, they can have significant clinical consequences.

Case report: We present the case of a 39-year-old woman hospitalized due to sudden abdominal pain. Diagnostic imaging, including a contrast-enhanced CT scan of the abdomen and pelvis and CT angiography, revealed thrombosis of the distal abdominal aorta and superior mesenteric artery. Laboratory testing confirmed low AT III levels, while tests for hereditary thrombophilias were negative, suggesting a likely acquired deficiency.

The patient was treated conservatively with AT III concentrate, low-molecular-weight heparin, and oral anticoagulation, alongside regular INR monitoring. Therapy was complemented with cardioprotective and gastroprotective medications, as well as physical rehabilitation. During hospitalization, the patient remained hemodynamically stable, and symptoms gradually resolved. Follow-up imaging after several months demonstrated complete recanalization of the affected vessels. Long-term monitoring over two years confirmed stable clinical status and absence of recurrent thrombosis.

Conclusion: This case highlights the importance of early diagnosis, identification of the underlying cause, and carefully implemented conservative management in patients with AT III deficiency. It demonstrates that even in extensive arterial thrombosis, conservative management can preserve organ function and achieve a favorable outcome without the need for surgical intervention.

ANTIMICROBIAL STEWARDSHIP ACROSS THE SURGICAL PATHWAY

Massimo Sartelli, Dzemail Detanac — Fri, 31 Oct 2025 11:47:22 +0100

Antimicrobial stewardship programs (ASPs) help ensure antibiotics are used effectively to treat infections, reduce side effects, and slow the spread of antibiotic resistance. Improving collaboration among healthcare professionals is the most important way to strengthen ASPs in hospitals.

So far, most ASPs have focused on medical specialities and applied the same approach to all hospital settings. In surgery, it is essential to understand the local cultural and contextual factors that shape prescribing habits so targeted strategies can be developed. Antibiotic stewardship in surgery must be integrated with strict infection prevention and source control, as all three work together to improve patient care.

Effective ASPs usually combine persuasive strategies, which educate and influence prescribers, with restrictive ones, which limit certain practices. While clinical guidelines turn evidence into practice and improve the quality of care, they do not always fit local realities. Adapting them into locally relevant tools, such as protocols, bundles, checklists, and posters, can boost acceptance and adherence. Actively involving prescribers in developing these tools increases the likelihood of meaningful change. Clearly defining responsibilities for specific actions within these protocols helps ensure they are followed.

THE LIFE AND LEGACY OF ERNEST AMORY CODMAN: A PIONEER OF OUTCOMES AND A FORERUNNER OF MODERN QUALITY MEASUREMENT SYSTEMS IN HEALTHCARE

Aleksandar Medarević — Tue, 25 Nov 2025 13:58:55 +0100

Ernest Amory Codman (1869–1940) was an American surgeon, reformer, and visionary whose work marked the beginnings of systematic quality measurement in medicine. The first part of this paper traces his life and career: his education at Harvard Medical School, his work at Massachusetts General Hospital, his conflicts with colleagues over his insistence on public reporting of outcomes, his founding of a private hospital, and the establishment of the Bone Sarcoma Registry—one of the first disease-specific registries in history.

The second part of the paper analyzes his philosophy of the “End Result System” through a comparative table in which its core principles—patient monitoring, complication tracking, transparency, continuous improvement, and accountability—are compared with their modern equivalents, such as outcome indicators, national registries, public reporting systems, quality improvement (QI) methodologies, and health information systems.

The paper concludes that Codman’s work represents both the biographical story of a persistent reformer and a conceptual foundation for modern quality measurement systems in healthcare.

REASSESING RIBONUCLEIC ACID ISOLATION FROM HUMAN MONONUCLEAR CELL CULTURE WITH MAGNETIC BEADS PRE-ENRICHMENT FOR MOLECULAR ANALYSIS

Ilker Sengul, Demet Sengul — Tue, 23 Dec 2025 00:00:00 +0100

Dear Editor,

It is with considerable interest that I have perused the recently published contribution by Bhatia, entitled “Ribonucleic Acid Isolation from Human Mononuclear Cell Culture with Magnetic Beads Pre-enrichment for Molecular Analysis,” set forth within Sanamed, volume 19(1). The author addresses a conundrum of pronounced import for those engaged in molecular analyses and the development of immunotherapies. As such, the established difficulty of extracting ribonucleic acid (RNA), particularly from mononuclear cell (MNC) cultures exceeding a few months in age, is well documented within the author’s own laboratory experience, having persisted, as stated, for over two years of consistent failure.

The developed methodology, centered upon the pre-enrichment of the cultured MNCs utilizing Cluster of Differentiation 45 (CD45)-specific magnetic beads antecedent to the customary mini column isolation, proves efficacious where previous attempts faltered. The successful isolation of RNA from cultures exceeding six months in duration—confirmed through spectrophotometric yield measurements and subsequent conventional and real-time Polymerase Chain Reaction (PCR) assays for the beta-actin housekeeping gene—is indeed a notable technical advancement. The assertion that this study constitutes the inaugural demonstration of isolating RNA from aged human MNC cultures via specific magnetic beads is, moreover, a claim that warrants careful consideration.

Notwithstanding the demonstrated success of this technique, one might cast an inquiring gaze upon certain aspects of the execution and presentation. Firstly, the affiliation of the esteemed author with Genekam Biotechnology AG, which entity serves as the sole source for the crucial magnetic beads, the mini column isolation kit, the PCR kits, and the specialized magnetic rack, invites circumspection. Whilst proprietary methods often feature in novel protocols, the near-total reliance upon reagents and apparatus supplied by the author’s own commercial interest renders the protocol less immediately accessible or generalizable for laboratories not possessed of the aforementioned instruments and supplies. The efficacy of the method, therefore, appears for the present to be closely associated with this particular commercial supply chain.

Secondly, whilst the author reports that the initial method failed consistently over two years, and that isolation without magnetic beads was not achieved, the results presented lack detailed quantitative metrics comparing the failed isolations to the successes. The presentation of “failure” in Table 1 illustrates the necessity of the pre-enrichment step, yet does not afford the readership an optimal means to gauge the precise extent of nucleic acid degradation or inhibition encountered previously—data which would further illuminate the magnitude of the technical challenge overcome.

Finally, the discussion alludes to further consequential applications of the isolated RNA—namely, its conversion to complementary DNA (cDNA) and subsequent use for other purposes—yet these vital data are deferred for “future publications.” Herewith, a more comprehensive elucidation of the robustness of the isolated material might have been advantageously reserved for this singular publication, ensuring that the full scope of the methodology’s utility is presented forthwith (1).

In essence, whilst the developed magnetic bead pre-enrichment methodology provides a much-needed solution for obtaining RNA from refractory MNC cultures, it is sincerely hoped that future work will include more extensive comparative data and endeavor to ascertain the protocol's viability utilizing reagents sourced from diverse suppliers, thereby further affirming its widespread applicability in molecular diagnostics and therapeutic development. This issue merits further investigation. We thank Bhatia et al. (1) for their valuable study on RNA isolation from human MNC culture with molecular analysis.