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Cureus May 2024Background After anterior resection (AR), one of the most debilitating complications is low anterior resection syndrome (LARS) seen in about 64% of patients. The...
Background After anterior resection (AR), one of the most debilitating complications is low anterior resection syndrome (LARS) seen in about 64% of patients. The severity of the LARS score was significantly correlated with neoadjuvant treatment, the extent of rectal surgery, complication by the anastomotic leak, female gender, and age < 64 years. In this study, we analyzed the impact of various clinical factors on LARS and also the various domains of quality of life (QoL). Purpose To assess the incidence of LARS in patients undergoing sphincter-sparing surgery for rectal cancer after the patient starts long-term defecating per anus, change in the QoL, and relation to LARS and factors affecting it. Methods One year before, 72 patients who had undergone AR in the Regional Cancer Centre were interviewed by a trained interviewer and data was collected from the file. The questionnaires used were the Wexner Incontinence score, LARS Malayalam Questionnaire, and European Organisation For Research and Treatment of Cancer (EORTC) QLQ C30 Malayalam translations. Statistical measures The LARS score was used to categorize patients into three grades. The scores were compared with clinical and social factors using the χ2 test for association. Continuous variables were compared by the Spearman Rho test. Results Details of patients were studied (male: 55.6% (40) and female: 44.4% (32)). Fifty patients underwent low anterior resection (LAR). The mean LARS score was 25.61, with 47.2% of patients having severe LARS score. The mean Wexner score was 6.84. The relation with type of surgery, approach (laparoscopic vs open), or type of neoadjuvant therapy was not found to be significant. A higher LARS score did not impact overall QoL as assessed by FACT-C. Insomnia and diarrhea symptoms scores were significantly worsened. The pain score was worse for those undergoing stapler anastomosis. Wexner's score was worse for those who had received adjuvant chemotherapy. Role functioning score was better for AR compared to low anterior resection (LAR). Only distance from the anal verge was found to be a significant cause of LARS and was negatively correlated. Discussion LARS of severe degrees were seen in most patients. No modifiable risk factors were significantly found to affect the chance of LARS. However, LARS did not have a significant impact on QoL, neither did the type of surgery. So sphincter preservation can be offered to the patients, but all patients undergoing LAR should be counseled well about the risk of LARS before surgery.
PubMed: 38860066
DOI: 10.7759/cureus.60059 -
Gastroenterologia Y Hepatologia Jun 2024Defecation disorders can occur as a consequence of functional or structural anorectal dysfunctions during voiding. The aims of this study is to assess the prevalence of...
BACKGROUND/AIMS
Defecation disorders can occur as a consequence of functional or structural anorectal dysfunctions during voiding. The aims of this study is to assess the prevalence of structural (SDD) vs functional (FDD) defecation disorders among patients with clinical complaints of obstructive defecation (OD) and their relationship with patients' expulsive capacity.
PATIENTS AND METHODS
Retrospective study of 588 patients with OD studied between 2012-2020 with evacuation defecography (ED), and anorectal manometry (ARM) in a subgroup of 294.
RESULTS
90.3% patients were women, age was 58.5±12.4 years. Most (83.7%) had SDD (43.7% rectocele, 45.3% prolapse, 19.3% enterocele, and 8.5% megarectum), all SDD being more prevalent in women except for megarectum. Functional assessments showed: a) absence of rectification of anorectal angle in 51% of patients and poor pelvic descent in 31.6% at ED; and b) dyssynergic defecation in 89.9%, hypertonic IAS in 44%, and 33.3% rectal hyposensitivity, at ARM. Overall, 46.4% of patients were categorised as pure SDD, 37.3% a combination of SDD+FDD, and 16.3% as having pure FDD. Rectal emptying was impaired in 66.2% of SDD, 71.3% of FDD and in 78% of patients with both (p=0.017).
CONCLUSIONS
There was a high prevalence of SDD in middle-aged women with complaints of OD. Incomplete rectal emptying was more prevalent in FDD than in SDD although FDD and SDD frequently coexist. We recommend a stepwise therapeutic approach always starting with therapy directed to improve FDD and relaxation of striated pelvic floor muscles.
PubMed: 38857752
DOI: 10.1016/j.gastrohep.2024.502219 -
Mathematical Biosciences Jun 2024In addition to the traditional transmission route via the biting-and-defecating process, non-human host predation of triatomines is recognized as another significant...
In addition to the traditional transmission route via the biting-and-defecating process, non-human host predation of triatomines is recognized as another significant avenue for Chagas disease transmission. In this paper, we develop an eco-epidemiological model to investigate the impact of predation on the disease's spread. Two critical thresholds, R (the basic reproduction number of triatomines) and R (the basic reproduction number of the Chagas parasite), are derived to delineate the model's dynamics. Through the construction of appropriate Lyapunov functions and the application of the Bendixson-Dulac theorem, the global asymptotic stabilities of the equilibria are fully established. The vector-free equilibrium E is globally stable when R<1. E, the disease-free equilibrium, is globally stable when R>1 and R<1, while the endemic equilibrium E is globally stable when both R>1 and R>1. Numerical simulations highlight that the degree of host predation on triatomines, influenced by non-human hosts activities, can variably increase or decrease the Chagas disease transmission risk. Specifically, low or high levels of host predation can reduce R to below unity, while intermediate levels may increase the infected host populations, albeit with a reduction in R. These findings highlight the role played by non-human hosts and offer crucial insights for the prevention and control of Chagas disease.
PubMed: 38851529
DOI: 10.1016/j.mbs.2024.109230 -
International Urogynecology Journal Jun 2024Pelvic floor damage can contribute to pelvic floor dysfunction, including constipation. Most studies focus on constipation during pregnancy, whereas information...
INTRODUCTION AND HYPOTHESIS
Pelvic floor damage can contribute to pelvic floor dysfunction, including constipation. Most studies focus on constipation during pregnancy, whereas information regarding the mode of delivery in relation to constipation is limited. We hypothesise that women with a history of vaginal delivery report constipation more often than women with a history of caesarean section.
METHODS
This was a retrospective cross-sectional multicentre study conducted in the Netherlands. All included patients (n = 2,643) completed the Groningen Defecation and Fecal Continence questionnaire to assess bowel problems of the last 6 months. Parametric tests, Chi-squared, univariable and multivariable regression analyses were performed.
RESULTS
Among 2,643 parous women, 2,248 delivered vaginally (85.1%) and 395 (14.9%) by caesarean section. Altogether, 649 women (24.6%) suffered from constipation. Women in the vaginal delivery group were constipated more often than women in the caesarean section group (25.5% versus 19.0%, p = 0.005). For women who had delivered vaginally, multivariable regression analysis showed an odds ratio for constipation of 1.47 (95% confidence interval, 1.109-1.938, p = 0.007). The odds ratio for constipation in women with a spontaneous perineal tear was 1.4 times higher than in women with an intact perineum (p = 0.030). Furthermore, the vaginal delivery group reported difficulties regarding bowel emptying (p = 0.048), straining (p = 0.027), incomplete defecation (p = 0.043), not able to defecate daily (p = 0.018), manually assisted defecation (p = 0.015) and had higher Renzi scores (p = 0.043) more often.
CONCLUSIONS
Women in the vaginal delivery group have higher prevalences and odds ratios for constipation. Furthermore, a perineal tear during vaginal delivery increases the odds ratio for constipation.
PubMed: 38847821
DOI: 10.1007/s00192-024-05824-1 -
Microbes and Infection Jun 2024Pathogen avoidance is a crucial and evolutionarily conserved behavior that enhances survival by preventing infection in diverse species, including Caenorhabditis elegans...
Pathogen avoidance is a crucial and evolutionarily conserved behavior that enhances survival by preventing infection in diverse species, including Caenorhabditis elegans (C. elegans). This behavior relies on multiple chemosensory neurons equipped with cilia that are exposed to the external environment. However, the specific role of neuronal cilia in pathogen avoidance has not been completely elucidated. Herein, we discovered that osm-3(p802) mutants, which lack chemosensory neuronal cilia, exhibit slower avoidance of the pathogen Pseudomonas aeruginosa PA14, but not Escherichia coli OP50. This observation was consistent when osm-3(p802) mutants were exposed to P. aeruginosa PAO1. Following an encounter with PA14, the pumping, thrashing, and defecation behaviors of osm-3 mutants were comparable to those of the wild-type. However, the osm-3 mutants demonstrated reduced intestinal colonization of PA14, suggesting that they have stronger intestinal clearance ability. We conducted RNA-seq to identify genes responding to external stimuli that were differentially expressed owing to the loss of osm-3 and PA14 infection. Using RNAi, we demonstrated that three of these genes were essential for normal pathogen avoidance. In conclusion, our findings demonstrate that the loss of chemosensory neuronal cilia reduces pathogen avoidance in C. elegans while delaying intestinal colonization.
PubMed: 38843949
DOI: 10.1016/j.micinf.2024.105370 -
Alternative Therapies in Health and... Jun 2024Accelerated recovery programs have gained recognition for their potential to enhance postoperative outcomes. However, their effectiveness in gynecological oncology...
BACKGROUND
Accelerated recovery programs have gained recognition for their potential to enhance postoperative outcomes. However, their effectiveness in gynecological oncology remains understudied.
OBJECTIVE
This study aims to assess the efficacy of accelerated recovery care in enhancing postoperative outcomes and patient satisfaction following surgery.
METHODS
A quasi-experimental design was employed, and we included 72 patients undergoing cytoreductive surgery for ovarian tumors at The First Affiliated Hospital of Nanjing Medical University between October 1st, 2019, and May 31st, 2020. The patients were divided into two groups: an observation group receiving accelerated recovery care and a control group receiving standard care. Nursing staff administered comprehensive pre-and postoperative care, utilizing Mindray iPM10 monitors to monitor vital signs. Additionally, postoperative rehabilitation training and dietary guidance were provided. Complication rates, recovery indicators, and patient satisfaction were compared between the two groups.
RESULTS
The complication rate in the observation group was significantly lower at 2.78% compared to 11.11% in the control group (P < .05). Patients in the observation group exhibited significantly faster recovery indicators, including time to first flatulence, first defecation, and time to ambulation (P < .05). Moreover, patients in the observation group reported lower abdominal distension and pain scores, with 100% satisfaction rates.
CONCLUSION
Implementing accelerated recovery nursing demonstrates a notable reduction in postoperative complication rates among surgical patients, concurrently fostering an expedited recovery process and heightened patient satisfaction. The provision of comprehensive nursing attention and guidance throughout the perioperative continuum emerges as indispensable for optimizing patient recovery outcomes.
PubMed: 38843426
DOI: No ID Found -
Alternative Therapies in Health and... Jun 2024Cytoreductive surgery for gynecological ovarian cancer involves the removal of tumor masses and affected tissue, aiming to achieve optimal debulking. Accelerated...
BACKGROUND
Cytoreductive surgery for gynecological ovarian cancer involves the removal of tumor masses and affected tissue, aiming to achieve optimal debulking. Accelerated recovery nursing, a comprehensive care model, focuses on expediting post-surgical recovery and enhancing patient satisfaction. It has emerged as a vital approach to optimize post-surgical outcomes and patient satisfaction.
OBJECTIVE
This study evaluates the impact of accelerated recovery care on surgical patients to enhance recovery outcomes and patient satisfaction post-surgery.
METHODS
The study utilized an observational and control group design and selected 72 patients undergoing ovarian tumor cytoreductive surgery at The First Affiliated Hospital of Nanjing Medical University between October 1st, 2019, and May 31st, 2020. These patients were divided into two groups: an observation group and a control group, each comprising 36 patients, with one group receiving standard care and the other accelerated recovery care. Nursing staff provided comprehensive pre-and post-operative care, monitoring patients' vital signs using Mindray iPM10 monitors. Postoperative rehabilitation training and dietary guidance were administered. Complication rates, recovery indicators, and patient satisfaction were compared between the groups.
RESULTS
The observation group exhibited a significantly lower complication rate (2.78%) compared to the control group (11.11%) (P < .05). Patients in the observation group demonstrated faster recovery indicators, including time to first flatulence, first defecation, and first mobilization from bed (P < .05). Additionally, abdominal distension and pain scores were lower in the observation group, with 100% patient satisfaction.
CONCLUSIONS
Implementation of accelerated recovery nursing significantly reduces surgical patient complication rates, facilitates recovery, and enhances patient satisfaction. Nursing attention and guidance throughout the surgical process are crucial for optimal patient outcomes. This study emphasizes the importance of thorough care protocols in improving surgical recovery.
PubMed: 38843421
DOI: No ID Found -
Archivos Espanoles de Urologia May 2024Predictive care in patients undergoing ureteroscopic stone surgery has emerged as a promising approach. Thus, this study aims to enhance personalised nursing plans and...
OBJECTIVE
Predictive care in patients undergoing ureteroscopic stone surgery has emerged as a promising approach. Thus, this study aims to enhance personalised nursing plans and reduce the risk of complications by conducting predictive analysis of possible risks early in the treatment and nursing process.
METHODS
Clinical data were collected from 108 patients who underwent ureteroscopic stone surgery and were admitted to our hospital between January 2020 and January 2023. Patients were divided into a control group (conventional nursing, n = 53) and an observation group (predictive care, n = 55) based on the nursing method, and various clinical indicators were compared between the two groups of surgical patients.
RESULTS
No significant difference in general data was found between the two groups ( > 0.05). Compared with the control group, the first time to exhaust gas ( < 0.05), the first time to get out of bed ( < 0.05), the time to exhaust stone ( < 0.05), the first time to defecate ( < 0.05) and the length of hospital stay ( < 0.05) in the observation group were shorter; 1 day after surgery, no significant differences in all dimensions of the general comfort questionnaire (GCQ) score were found; 2 days after surgery, the GCQ score in all dimensions of the observation group was significantly higher than that of the control group ( < 0.05). The incidence of postoperative complications in the observation group was significantly lower than that in the control group ( < 0.05).
CONCLUSIONS
Predictive nursing can effectively improve the patients with ureteral calculi, accelerate the process of postoperative recovery and reduce the occurrence of complications; Thus, this process is worthy of widespread clinical promotion.
Topics: Humans; Retrospective Studies; Male; Ureteral Calculi; Female; Middle Aged; Postoperative Complications; Adult; Ureteroscopy; Recovery of Function; Aged
PubMed: 38840288
DOI: 10.56434/j.arch.esp.urol.20247704.59 -
Scientific Reports Jun 2024Free Fecal Liquid (FFL), also termed Fecal Water Syndrome (FWS), is an ailment in horses characterized by variable solid and liquid (water) phases at defecation. The...
Free Fecal Liquid (FFL), also termed Fecal Water Syndrome (FWS), is an ailment in horses characterized by variable solid and liquid (water) phases at defecation. The liquid phase can be excreted before, during, or after the solid defecation phase. While the underlying causes of FFL are unknown, hindgut dysbiosis is suggested to be associated with FFL. Three European studies investigated dysbiosis in horses with FFL using 16S rRNA sequencing and reported results that conflicted between each other. In the present study, we also used 16S rRNA sequencing to study the fecal microbial composition in 14 Canadian horses with FFL, and 11 healthy stable mate controls. We found no significant difference in fecal microbial composition between FFL and healthy horses, which further supports that dysbiosis is not associated with FFL.
Topics: Horses; Animals; Feces; RNA, Ribosomal, 16S; Dysbiosis; Horse Diseases; Male; Canada; Female; Gastrointestinal Microbiome
PubMed: 38839848
DOI: 10.1038/s41598-024-63868-1 -
Surgery Jun 2024Rectal cancer surgery risks causing bowel dysfunction, which has an important impact on health-related quality of life. The validity of generic tools used to measure...
BACKGROUND
Rectal cancer surgery risks causing bowel dysfunction, which has an important impact on health-related quality of life. The validity of generic tools used to measure health-related quality of life after bowel dysfunction is unclear. This study aims to determine the content validity of health-related quality-of-life measurement tools in rectal cancer.
METHODS
This was a qualitative single-center study in which adult patients who underwent rectal cancer surgery with sphincter preservation from July 2017 to October 2020 were recruited. Patients were excluded if they developed local metastasis, required a permanent stoma, or had surgery <1 year since recruitment. Telephone-based semi-structured interviews were conducted. Bowel dysfunction was measured using the Low Anterior Resection Syndrome score. Content analysis was achieved using the International Classification of Functioning framework.
RESULTS
Recurrent bowel dysfunction-related concepts included "Mental functions," "Defecation functions," "Emotional functions," "Recreation and leisure," "Intimate relationships," and "Remunerative employment." A mean of 7.5 recurrent bowel dysfunction-related concepts were identified within the health-related quality of life instruments analyzed. The European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire-C30 (n = 11) and the 36-Item Short Form Health Survey (n = 9) covered the greatest number of recurrent bowel dysfunction-related concepts. Concepts such as "Mental functions," "Urination functions," "Sexual functions," "Driving," and "Mobility" were not covered by any instrument.
CONCLUSION
The content of traditional health-related quality-of-life instruments is missing important areas that represent the impact of bowel dysfunction after rectal cancer surgery on health-related quality of life. These findings could help improve patient-centered care in rectal cancer surgery.
PubMed: 38839434
DOI: 10.1016/j.surg.2024.04.038