Efficacy of i-Port Advance system on patients satisfaction and glycemic control among patients with type 1 diabetes in Saudi Arabia

Background and aimsTo determine the efficacy of i-Port Advance system on patients satisfaction and glycemic control among patients with type 1 diabetes (T1D).MethodsThis prospective study was performed among 73 patients with T1D (13–29 years) at Prince Sultan Military Medical City, Riyadh, Saudi Arabia. Demographic data were collected at baseline and clinical characteristics were collected at baseline and 12 weeks. Patients’ responses to Morisky Medication Adherence Scale (MMAS-8) and Insulin Delivery Satisfaction Survey (IDSS) were recorded at baseline and 12 weeks after initiating the i-Port Advance system.ResultsAt 12 weeks, significant improvement was evident in the IDSS subscales, which comprises the IDSS effective (p = 0.048), burdensome (p = 0.032), and IDSS inconvenient (p = 0.001), with the total baseline IDSS score being 2.6 ± 0.42, and at 12 weeks being 3.7 ± 0.72 (p = 0.037). The MMAS total score at baseline was 4.6 ± 1.2, and at 12 weeks, it increased to 6.4 (p = 0.028). HbA1c level was 8.4% at baseline and decreased to 7.9% (p = 0.001) at 12 weeks. The total daily dose of insulin at baseline registered 0.9 ± 0.13, which declined to 0.8 ± 0.12 (p = 0.048) at 12 weeks. Fasting blood sugar value was 197 ± 23.4 at baseline, which dropped to 182 ± 24.5 at 12 weeks (p = 0.01); and the postprandial glucose at baseline was 195 ± 21.4 and declined to 177 ± 19.2 at 12 weeks (p = 0.01). The hypoglycemic episodes revealed a noteworthy reduction after the i-Port Advance system usage.ConclusionUse of i-Port Advance system was found to raise the patients’ satisfaction levels and lower both the hypoglycemic episodes as well as the HbA1c levels.     

Preoperative Prediction of Failure Following Two-Stage Revision for Knee Prosthetic Joint Infections

While two-stage revision is the gold standard for treatment of knee prosthetic joint infection (PJI), it is not without risk. The purpose of this study was to develop a tool to preoperatively predict the probability that a two-stage revision would fail to eradicate knee PJI. 3,809 surgical cases were retrospectively reviewed and data were collected from 314 charts. Overall, 105 (33.4%) cases failed to eradicate PJI using this procedure. Univariate analysis identified multiple variables independently associated with reinfection. Logistic regression was used to generate a model (bootstrap-corrected concordance index of 0.773) predicting failure of infection eradication. Preoperative knowledge of a high probability of failure may improve risk assessment, lead to more aggressive management, and allow for time to consider alternative therapies.     

Laparoscopic versus open surgical management of small bowel obstruction: an analysis of short-term outcomes

Background

Laparoscopy in acute care surgery continues to expand. While adhesive small bowel obstruction (SBO) has traditionally been managed via an open approach, appropriately selected patients may benefit from laparoscopy. The objective of our study was to compare short-term postoperative outcomes in patients with adhesive SBO treated with laparotomy versus laparoscopy.

Methods

Using the ACS NSQIP participant use files (2005–10), patients with a postoperative diagnosis of adhesive SBO were selected for inclusion in this study. Patients with bowel resections or concomitant procedures were excluded. Both univariate analyses and multivariate logistic regression were performed to compare 30-day outcomes in the open and laparoscopic groups.

Results

A total of 4,616 patients with adhesive SBO were identified: 3,697 (80.1 %) and 919 (19.3 %) in the open and laparoscopic groups, respectively. Mean operative time was similar in both groups. The mortality and overall complications were 84 (2.3 %) and 819 (22.2 %), respectively, in the open group compared to 7 (0.8 %) and 81 (8.8 %) in the laparoscopic group, with respective unadjusted odds ratios (ORs) of 0.33 (0.13–0.71, P < 0.01) and 0.39 (0.30–0.49, P < 0.01). The adjusted OR for overall complications was 0.46 (0.37–0.59, P < 0.01) favouring the laparoscopic group. The mean postoperative length of stay (LOS) was 8.4 days compared to 3.8 in the open and laparoscopic groups, respectively (P < 0.01).

Conclusion

The laparoscopic approach to treating adhesive SBO resulted in significantly fewer complications and shorter LOS.