King Hussein Cancer Center

Anterior cervical procedures in octogenarians carry substantial perioperative risks, underscoring the need for accurate preoperative assessment. Frailty, defined as diminished physiological reserve, is a recognized predictor of adverse surgical outcomes. Two validated measures—the modified 5-Factor Frailty Index (mFI-5) and the Risk Analysis Index (RAI)—are widely used, but their comparative predictive performance in this population is not well established. We aim to compare the predictive performance of mFI-5 versus RAI for 30-day postoperative outcomes following elective anterior cervical procedures in octogenarians. We conducted a retrospective cohort study using ACS-NSQIP data (2015–2021) of patients aged 80–89 years undergoing elective anterior cervical procedures. The primary outcome was 30-day mortality, with secondary outcomes of major complications, readmission, reoperation, and non-home discharge. Frailty was measured by mFI-5 and RAI, univariate AUROC comparisons were performed for each frailty index separately, followed by multivariable adjustment. Internal validation was performed using bootstrap resampling, with enhanced sensitivity analyses for mortality. Among 870 patients, RAI classified 19.5

BACKGROUND:The rise in antimicrobial resistance has necessitated the exploration of novel antimicrobial agents. Zinc oxide nanoparticles (ZnO-NPs) have gained prominence due to their biocompatibility, minimal toxicity, and potent antimicrobial properties. This study evaluates the antimicrobial activity of ZnO-NPs synthesized from Phoenix dactylifera root extract and their potential applications in disinfection. METHODOLOGY:ZnO-NPs were synthesized using an eco-friendly method involving Phoenix dactylifera root extract and zinc acetate at varied concentrations and ratios, followed by annealing. The nanoparticles were characterized and assessed for antimicrobial activity against a spectrum of bacterial and fungal isolates using microtiter broth dilution, disc diffusion, and pour plate assays. Disinfection efficacy was evaluated on water samples and surfaces. Additionally, the impact of ZnO-NPs on acid-fast bacilli (AFB) isolates was examined using VersaTrek Mycobottles. RESULTS:ZnO-NPs exhibited potent antimicrobial activity against Gram-positive and Gram-negative bacteria, with minimum inhibitory concentrations (MICs) ranging from 9.7 to 310 µg/mL. Disc diffusion assays revealed larger inhibition zones in Gram-positive bacteria compared to Gram-negative strains, with MRSA showing the widest zone (24 mm). ZnO-NPs significantly reduced colony-forming units (CFU) on water and surfaces, achieving complete bacterial inhibition on laboratory benches within 20 minutes. The nanoparticles demonstrated bactericidal effects against AFB isolates, highlighting their broad-spectrum efficacy. CONCLUSION:The study underscores the potential of ZnO-NPs as a versatile antimicrobial agent effective against MDR (multidrug-resistant) pathogens and environmental contaminants. Their rapid action and broad-spectrum activity make them suitable for disinfection in clinical and environmental settings. Future research could explore synergistic combinations with traditional antimicrobials to enhance efficacy against infections that are resistant to treatment.

OBJECTIVE:A definition of refractory septic shock is necessary to guide diagnosis, management, prognostication, research, and future guidelines for this most severe form of the disease. We sought to achieve consensus on clinical criteria that would be used to define refractory septic shock. DESIGN:Review of literature, expert panel position statements, and Delphi rounds with an international expert group. SETTING:Consensus was defined as having at least 75% of panellists in agreement or disagreement on the three highest or lowest levels of a 7-point Likert scale or based on responses to single- or multiple-choice questions, respectively. SUBJECTS:A panel of multinational, multiprofessional and multidisciplinary critical care experts assembled by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine (57 invitations and 56 participants). MEASUREMENTS AND MAIN RESULTS:A five-round Delphi process was conducted for consensus and stability. The steering committee proposed 34 statements, and five of them were rejected by panel experts after round 2. Among 29 statements selected from eight domains, consensus was reached for 13. The panel agreed on the need for a comprehensive consensus set of clinical criteria for refractory septic shock. Markers of organ dysfunction (75%, 2 rounds), tissue perfusion (91.1%, 2 rounds) including lactate (94.6%, 2 rounds) and capillary refill time (76.8%, 2 rounds), assessment of fluid-responsiveness after initial resuscitation (92.9%, 5 rounds), and use of vasoactive drugs at norepinephrine equivalents greater than 0.5 µg/kg/min (75.0%, 3 rounds), were selected as clinical criteria of refractory septic shock. The use of critical care ultrasound (CCUS) (92.9%, 3 rounds) was the single diagnostic modality that reached a consensus-based agreement. CONCLUSIONS:A consensus for 13 criteria to frame the definition of refractory septic shock was reached. Refractory septic shock is characterised by persistently elevated lactate concentrations and or prolonged capillary refill time in patients with septic shock who are fluid unresponsive, require a norepinephrine base equivalent dose greater than 0.5 micrograms per kilogram per minute, and undergo CCUS assessment when mixed shock is suspected.

Accurate staging of unfavorable intermediate- or high-risk prostate cancer (PCa) is essential for treatment decisions. Conventional imaging often fails to detect lymph node, bone, and visceral metastases, and for this purpose 68Ga-prostate-specific membrane antigen (PSMA)-11 PET/CT is clinically used. This prospective, multicenter, International Atomic Energy Agency-supported trial evaluated the accuracy of 68Ga-PSMA-11 PET/CT for initial staging compared with MRI and histopathology and the impact of 68Ga-PSMA-11 PET/CT on determining surgical eligibility. Methods: In a prospective, international study supported by the International Atomic Energy Agency, 775 patients with high-risk or unfavorable intermediate-risk PCa from 12 centers across 11 countries-including low-, middle-, and high-income settings, scheduled for radical prostatectomy based on conventional imaging (including bone scanning and pelvic MRI) underwent 68Ga-PSMA-11 PET/CT before treatment. PET and MRI findings were compared with radical prostatectomy histopathology, and the impact of PET on radical prostatectomy was assessed. Results: 68Ga-PSMA-11 PET/CT detected metastatic disease (M1) in 20.4% of cases, altering management and preventing prostatectomy in 24.0%. The accuracy for seminal vesicle invasion was 90.1% for 68Ga-PSMA-11 PET/CT versus 57.3% for MRI, and for lymph node metastases it was 91.1% for 68Ga-PSMA-11 PET/CT versus 69.7% for MRI. In 13.1% of patients (78/593), there were discordant results between 68Ga-PSMA-11 PET/CT and histopathology. 68Ga-PSMA-11 PET/CT had false-negative lymph node findings in 8.6% of cases, with the most clinically significant being 4.5% of patients incorrectly staged as N0. False-positive lymph node findings at 68Ga-PSMA-11 PET/CT occurred in 4.5% of patients. Conclusion: 68Ga-PSMA-11 PET/CT significantly improves staging accuracy, reducing the indication for prostatectomy and impacting treatment decisions. These findings, from a broad international cohort including low-, middle-, and high-income countries, support the global adoption of 68Ga-PSMA-11 PET/CT into standard staging protocols for high-risk PCa.

BACKGROUND:The Common Terminology Criteria for Adverse Events (CTCAE) is the standard for provider-based rating of adverse events in oncology, but its reliability for symptomatic adverse events is low. Patient-reported outcome (PRO) data might improve the inter-rater reliability of CTCAE assessments. We investigated whether providers' access to PRO data enhances the inter-rater reliability of CTCAE ratings and the detection of symptomatic adverse events. METHODS:This multinational, open-label, randomised controlled trial was done in 11 hospitals in ten countries. Adults (aged ≥18 years) with any cancer diagnosis receiving chemotherapy, immunotherapy, or radiotherapy of curative or palliative intent were eligible. Patients were randomly assigned (1:1) to the intervention group (in which providers saw patients' PRO data as they were doing CTCAE assessments) or the control group (in which providers did not have access to PRO data) within each centre through a minimisation algorithm and a weighted cutoff; no additional stratification factors were applied. Patients completed the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and 16 additional items from the EORTC Item Library, covering 17 symptomatic adverse events. Two independent providers (oncologists or trained nurses) did CTCAE ratings. The primary endpoint was the inter-rater reliability of CTCAE ratings, expressed as intraclass correlation coefficients (ICCs), for all patients with complete assessments. The trial was registered at ClinicalTrials.gov (NCT04066868) and is now closed. FINDINGS:Between Feb 10, 2020, and Dec 6, 2024, a total of 1067 patients were enrolled (538 in the control group and 529 in the intervention group), with full data from 512 patients in the control group and 501 in the intervention group included in the analysis. Median age was 59 years (IQR 46-68); 558 (55·1%) of 1013 were female and 455 (44·9%) were male. Most had good functional status (403 [79%] of 512 had ECOG 0-1 in the control group and 371 [74%] of 501 in the intervention group). The most common cancer types were haematological (control group: 137 [27%] of 512; intervention group: 131 [26%] of 501), breast (control group: 118 [23%]; intervention group: 107 [21%]), and gastrointestinal (control group: 98 [19%]; intervention group: 89 [18%]). Inter-rater reliability was significantly higher in the intervention group for 13 of 17 symptomatic adverse events, with the largest differences for memory impairment (ICC 0·176; p<0·0001), irritability (0·161; p<0·0001), concentration impairment (0·157; p<0·0001), depression (0·126; p=0·0012), and anxiety (0·109; p=0·0018). There was no significant difference for pain, rash, and peripheral sensory neuropathy and the reliability was significantly higher in the control group than the intervention group for diarrhoea (ICC -0·066; p=0·013). INTERPRETATION:Availability of PRO data to providers for CTCAE rating improves the consistency of provider-based symptomatic adverse event detection in patients with cancer. PRO data supports reliable assessment of treatment-related toxicity, highlighting the value of integrating PRO data into clinical evaluations within cancer trials. FUNDING:EORTC Quality of Life Group.