Objective:Surgical site infections (SSIs) are among the most common postoperative complications, contributing to morbidity, prolonged hospital stays, and healthcare costs. Prophylactic antibiotics are widely used, but the optimal regimen for clean elective surgeries remains debated. Material and Methods:A hospital-based analytical cross-sectional study was conducted over a six-month period (March-August 2025) in the department of general surgery of a tertiary-care teaching hospital. Ninety-four consecutive patients undergoing clean elective surgeries were enrolled and allocated to two groups: Group A (n=52) received a single intravenous (IV) dose of cefotaxime 30 minutes prior to incision, and Group B (n=42) received postoperative multidose oral antibiotics according to institutional protocol. Baseline demographic and clinical data were recorded, and patients were monitored for signs of SSI, including fever, tachycardia, redness, and wound discharge. Results:The mean age of Group A participants was 28.3±5.9 years compared to 36.4±7.3 years in Group B (p=0.042), though other socio-demographic variables were comparable. The overall incidence of SSI signs was low in both groups. Fever occurred in 13.4% of Group A and 14.2% of Group B; tachycardia occurred in 9.6% and 7.1%; redness in 1.9% and 7.1%; and wound discharge in 3.8% and 2.3% in Groups A and B, respectively; none of these differences were statistically significant (p>0.05 for all). Conclusion:Single-dose IV prophylaxis was as effective as postoperative multi-dose oral antibiotics in preventing SSIs in clean elective surgeries. Short-course prophylaxis is sufficient in this setting and supports rational antibiotic stewardship.
Objective:Acute mesenteric ischemia (AMI) is a life-threatening condition characterized by rapid deterioration, yet it is often identified late owing to vague and non-specific clinical findings. Identifying laboratory markers that can assist in early mortality prediction remains essential for improving outcomes. This study aimed to determine whether the bicarbonate-to-lactate ratio (HCO₃/lactate) and the albumin-to-creatinine ratio could serve as reliable predictors of early mortality in patients with AMI. Material and Methods:This retrospective case-control study included 87 patients who underwent surgical treatment for acute arterial mesenteric ischemia caused by superior mesenteric artery embolism between 2015 and 2025. Demographic characteristics, comorbidities, laboratory findings, and mortality outcomes were evaluated. The predictive performance of the bicarbonate-to-lactate and albumin-to-creatinine ratios was assessed using receiver operating characteristic (ROC) analysis; independent predictors of mortality were identified through multivariate logistic regression. Results:The 28-day mortality rate was 62.1%. In univariate analysis, lower bicarbonate and albumin levels, reduced HCO₃/lactate and albumin/creatinine ratios, and higher lactate, creatinine, and C-reactive protein values were significantly associated with mortality (p<0.05). ROC analysis identified values of <6 for the HCO₃/lactate ratio and <2.6 for the albumin/creatinine ratio as the best cut-off values. In the multivariate model, a HCO₃/lactate ratio <6 increased the risk of death by more than 13-fold, while an albumin/creatinine ratio <2.6 increased mortality risk by approximately 4.5-fold. Conclusion:Both the HCO₃/lactate and albumin/creatinine ratios are simple, inexpensive, and easily obtainable biochemical markers that may assist clinicians in predicting early mortality in AMI. Their incorporation into early evaluation algorithms could enhance risk stratification, although validation through prospective studies is warranted.
Objective:Acute abdominal pain (AAP) is a leading cause of visits to the emergency department (ED) and is often a condition requiring immediate attention and timely management to prevent potentially serious complications like sepsis. Despite the importance of this topic, public knowledge about AAP and when to seek care remains underexplored, particularly among non-medical populations. This study aimed to assess public knowledge, attitudes, and practices regarding AAP, identify their sources of health information about the condition, and pinpoint barriers to seeking medical care in Jordan. Material and Methods:A cross-sectional survey was conducted among Jordanian adults using a self-administered questionnaire that was developed after a thorough literature review, tested and validated in a pilot study. Convenience and snowball sampling methods were used to collect data, which were analyzed using descriptive and inferential statistics, including linear regression analysis to identify predictors of knowledge and attitudes. Results:A total of 1.566 Jordanians participated in the study, with a median age of 26 years (interquartile range: 23-41). The most commonly perceived cause of AAP was the digestive system (86%), with changes in bowel habits (57%) and bloating (51%) being the most recognized associated symptoms. The mean knowledge score was 6.9±3.0, with most participants having fair (53.8%) or good (35.3%) knowledge scores. The vast majority (91.8%) had a positive attitude regarding the importance of raising and awarding about AAP, with a mean score of 7.89±1.66 out of 10. Age, female gender, marital status, parenthood, and prior abdominal surgery were positively associated with both better knowledge and attitude scores (p-values <0.05). However, when experiencing AAP, 35.5% reported that they would take painkillers and wait, and 30% would rest at home, while only 19.7% would seek medical help. Moreover, 4% stated that they would not seek care even in the presence of red flag symptoms. The main barriers to seeking care included long waiting times (47%) and lack of confidence in healthcare providers (31%). Regarding the sources of information about AAP, doctors and health professionals were the primary source of AAP knowledge (61%), followed by personal experiences and advice from friends and family (41%). Conclusion:Most participants had fair to good knowledge and a positive attitude toward AAP, yet a significant proportion opted for self-management over seeking medical help. The main barriers to seeking care included long waiting times, and distrust in healthcare providers. Well-coordinated education campaigns and system-level interventions are advocated to overcome the existing barriers and improve outcome for AAP in Jordan.
Objective: Distinguishing preoperative criteria and postoperative histological features of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) from those of other thyroid tumors with follicular architecture and papillary nuclear features (non-NIFTP) is crucial to prevent overtreatment. In this study, we aim to identify the predictive factors of NIFTP. Material and Methods: We conducted a retrospective study in which we collected cases of thyroid tumors with follicular architecture and papillary nuclear features diagnosed between 2012 and 2022. Clinicopathological characteristics, therapeutic modalities, and follow-up were compared between NIFTP and non-NIFTP tumors. Results: Forty cases of NIFTP and 44 cases of non-NIFTP were identified. NIFTP accounted for 8.83% of all PTCs and 33.6% of all thyroid tumors with follicular architecture and papillary nuclear features. NIFTP was associated with younger age (p=0.005), isoechoic nodules on ultrasound (US) (p=0.004), regular contours (p=0.028), absence of microcalcifications (p=0.005), and predominance in European Thyroid Imaging Reporting and Data System 2 and 3 scores (p<0.001).They predominantly exhibited a nuclear score of 2 (p<0.001), focal nuclear abnormalities (p=0.015), and a thin capsule (p=0.004). No case of NIFTP showed distant or lymph node metastases. Multivariate analysis identified a nuclear score of 2, focal nuclear abnormalities, and a thin tumor capsule as independently associated with NIFTP. Conclusion: Our findings demonstrated the indolent nature of NIFTP and the utility of cervical US in raising preoperative suspicion for this entity. Because findings regarding the Bethesda classification were not available in our study, a prospective multicenter study with a larger sample size and a longer follow-up period is warranted to address this limitation.
Objective:This study aimed to evaluate contemporary surgical approaches and decision-making patterns of general surgeons in the management of recurrent inguinal hernia following laparoscopic inguinal hernia repair (LIHR), with particular emphasis on recurrence timing, surgeon experience, and annual laparoscopic case volume. Material and Methods:The questionnaire consisted of 26 items, including both multiple-choice and short-answer questions, and was designed to assess demographic characteristics, surgical experience, preferred surgical techniques, preoperative evaluation strategies, and management approaches for recurrent inguinal hernia following LIHR. Recurrences were classified as early (≤2 years) or late (>2 years) based on the postoperative time interval. Results:A total of 179 surgeons participated in the survey. Most respondents were male and had ≤10 years of surgical experience. Surgeons with higher annual laparoscopic hernia repair volumes were significantly more likely to prefer re-laparoscopic posterior approaches for both early and late recurrences, whereas surgeons with lower case volumes predominantly favored open anterior repair techniques (p<0.05). Surgical preferences also varied in female patients and according to the initial repair technique (transabdominal preperitoneal or total extraperitoneal). Nearly two-thirds of participants reported insufficient or only partially sufficient training in recurrent hernia repair, while the majority strongly agreed on the need for national or international clinical guidelines. Conclusion:Surgeon experience and annual laparoscopic case volume significantly influence the management of recurrent inguinal hernia following LIHR. As laparoscopic expertise increases, re-laparoscopic approaches are more frequently adopted. These findings highlight the need for standardized training programs and evidence-based guidelines to optimize the management of recurrent inguinal hernia after laparoscopic repair.
