OMEN with breast cancer particularly individuals diagnosed at ……..a relatively early age have an increased occurrence of osteoporosis.Aim of present work is to apply Dual Energy X-ray Absorptiometry (DEXA) technique on breast cancer patients who undergoing chemotherapy treatment for monitoring bone health and occurrence of osteoporosis.DEXA is considered as the most common and accurate way, to perform the Bone Mineral Area Density (BMAD) scanning.DEXA scan for Lumbar Spine (LS) and Total Hip (TH) have been done in the present study for two age groups of women.First group ranged from 25 to 36 years old and second one ranged from 41 to 47 years old.All diagnosed women by any disease affects bone metabolism or classified as a osteoporosis patient have been excluded, in the beginning, of this study and the DEXA scan was completed for each participant at 0-month (baseline; controlled patients), 6-months and 12-months in order to record the effect of chemotherapy treatment.For both groups, after 6-months a reduction of LS-BMAD and TH-BMAD baselines values have been detected; LS-BMAD reduced significantly from 1.186 g/cm 2 ± 0.083 to 1.143 g/cm 2 ± 0.083, and TH-BMAD reduced significantly from 1.003 g/cm 2 ± 0.028 to 0.975 g/cm 2 ± 0.028.After twelve months, BMAD values of LS and TH were 1.125 g/cm 2 ± 0.018, 0.969 g/cm 2 ± 0.006, respectively.The present study took place over twelve months and demonstrates that adjuvant systemic chemotherapy has deleterious effect on BMAD in pre-menopausal women with early breast cancer; also a great effect of age on BMAD has been revealed.
Background: Patients who need emergency general surgery (EGS) face an increase in 30-day mortality and complicationrates that can be anticipated by emergency surgery score (ESS).Aim: The study aimed to measure the validity and efficacy of ESS application on EGS patients admitted at Beni-SuefUniversity Hospital to calculate the rates of postoperative mortality, complications, reoperation, and ICU admission.Patients and Methods: This was a retrospective validation study. The study included 200 patients (older adults andelderly) who were admitted to the general surgery ward for EGS from September 1, 2023 to March 1 2024. The primaryoutcome was measuring the 30-day mortality rate. However, the secondary outcomes were measuring the occurrence of at least one complication, reoperation, and ICU admission rates. Admitted comorbidities, as well as preoperative laboratory tests, were collected. Surgical outcomes were predicted for patients using ESS calculation. Postoperative outcomes were tracked from the day of surgery to 30 days.Results: Among patients admitted, total prevalence of 30-day mortality was nine (4.5%), while 30-day complications ratewas 27%. There was a significant increase (P<0.001) in mortality due to the increase of ESS with an area under the curve(AUC) NELA score (0.846) and confidence interval (CI) (95% CI: 0.717–0.976), and AUC P-POSSUM score of 0.811and CI (95% CI: 0.734–0.972) with no significant difference between the two scores (P=0.369), and AUC P-POSSUMscore of 0.811 and CI (95% CI: 0.734–0.972) with no significant difference between the two scores (P=0.369). There wasa significant increase (P<0.001) in the prediction of at least one complication due to the increase of ESS with an AUCNELA score (0.919) and CI (95% CI: 0.88–0.957) and AUC P-POSSUM score (0.927) and CI (95% CI: 0.82–0.945), withno significant difference between the two scores (P=0.269). There was a significant increase in ICU readmission due tothe increase of ESS (P<0.001) with an AUC (0.785) and CI (95% CI: 0.678–0.892).Conclusion: ESS is a golden key in predicting mortality, complications, and ICU admission among elderly patients whounderwent EGS and can be used for frontline decision-making, family and patient guidance, resource allocation, andquality monitoring of elderly surgical care.
Percutaneous endoscopic gastrostomy (PEG) tube placement remains a core competency of gastroenterology fellowship, although this procedure is performed infrequently. Some training programs lack sufficient procedural volume for trainees to develop confidence and competence in this procedure. We aimed to determine the impact of a simulation-based educational intervention on trainee technical skill and procedural attitudes in simulated PEG tube placement.Gastroenterology fellows were invited to participate in the study. Baseline procedural attitudes toward PEG tube placement (self-confidence, perceived skill level, perceived level of required supervision) were assessed before simulation training using a Likert scale. Baseline technical skills were assessed by video recording-simulated PEG tube placement on a PEG tube simulator with scoring using a procedural checklist. Fellows next underwent individualized simulation training and repeated simulated PEG tube placement until greater than 90% of checklist items were achieved. Procedural attitudes were reassessed directly after the simulation. Technical skill and procedural attitudes were then reassessed 6 to 12 weeks later (delayed posttraining).Twelve fellows completed the study. Simulation training led to significant improvement in technical skill at delayed reassessment (52.9 ± 14.3% vs. 78.0 ± 8.9% correct, P = 0.0002). Simulation training also led to significant immediate improvements in self-confidence (2.1 ± 0.7 vs. 3.1 ± 0.3, P = 0.001), perceived skill level (2.2 ± 1.0 vs. 4 ± 1.1, P < 0.001), and perceived level of required supervision (2.2 ± 0.9 vs. 3.2 ± 0.6, P = 0.003).Simulation training led to sustained improvements in gastroenterology fellows' technical skill and procedural attitudes in PEG tube placement. Incorporation of simulation curricula in gastroenterology fellowships for this infrequently performed procedure should be considered.
