Doctors Hospital at Renaissance

Patients with a BMI (Body Mass Index) ≥ 60kg/m2 are at high risk for bariatric surgery. They have higher complication rates, longer length of stay and greater technical difficulties with surgery. Surgical robots offer better ergonomics and precision, which facilitate surgery. The role of the robot in patients with obesity class V (BMI ≥ 60kg/m2) surgery has not been adequately evaluated. This study reports data of over 230,000 patients regarding bariatric surgery. We aim to compare the results of laparoscopic and robotic RYGB in patients with BMI ≥ 60kg/m2. MBSAQIP database. Patients aged 18-80 years who underwent Roux-en-Y gastric bypass (RYGB) were included using the 2020-2023 MBSAQIP database. We compared the 30-day outcomes of laparoscopic versus robotic RYGB in patients with BMI < 60kg/m2 versus BMI ≥ 60kg/m2. There are 233,828 patients in this study. Patients with BMI ≥ 60kg/m2, as compared to BMI < 60kg/m2, were more likely to have postoperative complications (5,23% vs. 4,44%, p = 0,039), acute renal failure (0,23% vs. 0,07%, p = 0,007), unplanned admission to ICU (1,08% vs. 0,73%, p = 0,029) and Emergency Department visits after discharge (12,38% vs. 11,02%, p = 0,019). There is no difference in 30-day complication rate between laparoscopic and robotic RYGB in patients with BMI ≥ 60kg/m2. Patients with BMI ≥ 60kg/m2 have higher rates of complications compared to patients with BMI < 60kg/m2. RRYGB seems to be a safe to perform in patients with BMI ≥ 60kg/m2 with no difference in 30-day complication rate, longer average operating time but shorter length of stay. There is still a need for good quality multi-centre prospective research study to define the best approach for patients with obesity class V.

The standard treatment for Hormone Receptor-Positive breast cancer (BC) is Oral Endocrine Therapy (OET). OET reduces BC recurrence rates by ~ 50%, and non-adherence to OET leads to worse outcomes. However, OET adherence remains suboptimal, particularly among low socioeconomic status populations. This study assessed 12-month OET adherence and identified factors associated with non-adherence among BC patients at a multispecialty hospital in Edinburg, Texas in the Rio Grande Valley region. A 12-month single-center retrospective study of BC patients taking OET was conducted. Information on patient demographics, tumor characteristics, and prescription details was gathered from electronic medical records. Inclusion criteria included patients 18years or older who filled at least one OET prescription. OET adherence was assessed using the proportion of Days Covered. Differences between the adherent and non-adherent groups were analyzed using chi-square and Student's t-tests, while multivariable logistic regression was employed to identify factors associated with non-adherence. Of the total 346 adult female patients, 322 (93%) were Hispanic/Latino. The mean age was 60.8years, and the mean body mass index was 30.7. Only 122 (35.3%) patients were adherent at 12months. Patients with diabetes were less likely to be adherent (odds ratio, 0.44; 95% confidence interval: 0.25-0.80). Longer duration of therapy was associated with higher OET adherence, which was estimated to increase 1.84-fold with each additional year of therapy. Approximately two-thirds of BC patients were non-adherent to OET. Diabetes and shorter time on therapy predicted poorer adherence. These results present the urgent need to address barriers to OET adherence among BC patients in the underserved area of South Texas.

Background: Atrial fibrillation (AF) is a common comorbidity in the U.S. and significantly contributes to the incidence of acute ischemic strokes. This study examines the impact of household income on management and outcomes of Acute ischemic stroke in patients with AF. Research: Question: How does socioeconomic status impact the management and outcomes of Acute ischemic stroke in patients with AF? Methods: We used data from the National Inpatient Sample database (2018-2020), analyzing adult hospitalizations with primary diagnosis of acute ischemic stroke and secondary diagnosis of AF. Patients were grouped into four income quartiles: Q1 ($1 - $51,999), Q2 ($52,000 - $65,999), Q3 ($66,000 - $87,999), and Q4 ($88,000+). Outcomes included in-hospital mortality, utilization of endovascular thrombectomy (EVT), length of stay (LOS), inflation-adjusted total charge (IATC), intracranial hemorrhage (ICH) and sepsis. Multivariable logistic and linear regression analyses were performed, for demographic, clinical, and hospital factors. Results: A total of 340,835 hospitalizations with Acute ischemic stroke and AF were identified. Mean age was 77 years (11), and 52% were female. When comparing highest income quartile to lowest, admissions in the highest income quartile had significantly lower in-hospital mortality rates (6.5% vs. 7.0%; p &lt; 0.001), lower sepsis rates (2.7% vs. 3.3%; p = 0.032), shorter mean LOS (6.2 vs. 7.7 days; p &lt; 0.001), and higher mean IATC ($116,076 vs. $107,568; p = 0.06). Hospitalizations in highest income quartile had higher rates of ICH (9.4% vs. 9.1%; p = 0.11) and EVT (6.8% vs. 6.1%; p = 0.7), but these differences were not statistically significant. After adjusting for confounders, higher income stayed markedly associated with lower in-hospital mortality (adjusted odds ratio [aOR]: 0.78, 95% CI: 0.70–0.86; p &lt; 0.001), lower sepsis rates (aOR: 0.85, 95% CI: 0.74–0.99; p = 0.032), shorter LOS (aOR: -0.28, 95% CI: -0.43 to -0.14; p &lt; 0.001), and higher IATC (aOR: 2,403, 95% CI: -4,911 to 105; p = 0.06). There were no significant differences observed in ICH (aOR: 0.95, 95% CI: 0.87–1.03; p = 0.02) and EVT (aOR: 1.06, 95% CI: 0.95–1.19; p = 0.3) between highest and lowest income quartiles. Conclusion: Higher socioeconomic status is associated with lower in-hospital mortality and sepsis rates, shorter LOS, and higher IATC. These disparities suggest the need for targeted interventions to address socioeconomic inequalities and improve stroke care.

BackgroundDepression significantly impacts health systems worldwide, particularly in Latin America, where cultural stigmatization and misconceptions about mental health deter individuals from seeking help. Healthcare professionals’ attitudes toward depression may affect its prevention, diagnosis and treatment.ObjectiveTo categorize Latin American healthcare professionals’ attitudes towards diagnosis and management of depression in subgroups using the Spanish-validated Revised Depression Attitude Questionnaire (SR-DAQ).MethodsA cross-sectional study surveyed 2,409 professionals using SR-DAQ from 2019 to 2022. Latent class analysis and multinomial logistic regression were used to identify attitude classes and explore demographic influences.ResultsAmong our sample, four attitude classes were identified: Depression Skeptics (21%), Depression Cautious (33%), Depression Neutrals (18%), and Depression Advocates (28%). Gender and medical subspecialty significantly influenced class membership, with females and mental health specialists more likely to be part of the Advocates.ConclusionThe study reveals varied attitudes towards depression among Latin American healthcare professionals, suggesting the need for tailored public health strategies to enhance effective depression care and management.

Mastectomies have long been used as a surgical treatment for malignant and benign disorders of the breast, both as a therapy and prophylaxis in high-risk patients. A nipple-sparing mastectomy (NSM) allows for the removal of most of the glandular and ductal tissues while preserving the surface architecture of the nipple-areola complex (NAC). This report summarizes the current mastectomy practices and suggests an expansion of the established surgical selection criteria for NSM in the context of immediate implant-based breast reconstruction. We present two cases in which a novel hybrid oncoplastic approach was used and discuss its safety and efficacy when performing primary breast reconstruction in female patients considered non-ideal candidates for NSM.

Identify the types of pain experienced by individuals with PD and beneficial treatment options.

Glucocorticoid therapy is a well-established iatrogenic cause of secondary osteoporosis. This form of osteoporosis is known as glucocorticoid-induced osteoporosis (GIOP). We present the case of a 78-year-old woman who developed avascular necrosis and complete collapse of the femoral head after a high-dose steroid taper for asthma. Imaging showed subsequent femoral head collapse with the presence of protrusio acetabuli. The patient underwent a posterior total hip arthroplasty. This case is unique because of the extremely high dose of steroids and the timing of her fracture. The case reveals the adverse effects of prolonged glucocorticoid use on bone health, showing the need for proper preventive measures such as bone density scans and proper supplementation if needed. Using anti-osteoporotic medications such as bisphosphonates or denosumab can mitigate the occurrence of GIOP. Early recognition and proper management are critical in decreasing the incidence of GIOP-related fractures.

This case report highlights a rare occurrence of an isolated manubrium fracture in a 17-year-old high school football quarterback. Such fracturesare uncommon in athletes despite the high-impact nature of contact sports. The injury was sustained during a tackle and confirmed via imaging as an oblique fracture to the right lateral manubrium with minimal posterior displacement. No reduction or surgical intervention was required, and the patient was managed conservatively with rest, analgesia, and physical therapy, including eccentric training to aid recovery and strength rebuilding. The report discusses mechanisms and the risk of manubrium fractures in contact sports, emphasizing the role of direct trauma and repetitive stresses as etiologies. Imaging modalities such as X-ray and CT scans are essential for accurate diagnosis and ruling out associated injuries to vital thoracic structures. Management ranges from non-operative approaches for non-displaced fractures to surgical interventions for severe cases with rehabilitation focusing on pain management, functional recovery, and return-to-play readiness. Recognizing and managing rare sternal injuries in athletes is important, with an emphasis on a multidisciplinary approach to ensure optimal recovery and safe reintegration into sports. Tailored rehabilitation with incorporation of eccentric training is effective in enhancing recovery while mitigating the risk of re-injury.

Abdominoplasty represents one of the most recognized operations performed by plastic surgeons. Despite its long history and ubiquity, the procedure retains a largely individualistic component, affected by a surgeon's artistry as much as by known clinical approaches. Consequently, complication incidence reporting has been variable, particularly that of umbilical dehiscence. This study aims to demonstrate the incorporation of periumbilical fascioplasty to reliably limit umbilical necrosis, particularly in cases where maximal rectus plication is desired. We present a series of 30 patients who underwent abdominoplasty at a single center under 1 surgeon between 2021 and 2024. Abdominoplasties were performed in standard fashion. Following extensive midline abdominal wall plication, the umbilicus is identified deep within the plication. Periumbilical fascioplasty is then performed by incising the anterior rectus fascia circumferential to the position of the umbilicus, releasing any adherences to the underlying rectus muscle, and suturing the imbricated anterior rectus fascial segment onto the anteriorly exposed fascia, thereby anteriorly transposing the base of the umbilicus. This further eliminates the compression caused by the vertical vector of traditional midline plication while simultaneously displacing the umbilical base anteriorly. Abdominal skin is then transposed, and the umbilicus is externalized in the desired fashion. This approach resulted in 0 cases of umbilical skin necrosis and dehiscence. Although approximately 15 additional minutes are required in this process, the reduced need for follow-up corrective surgery should be considered. In applying this protocol, a surgeon may be more confident that they may achieve maximum midline plication while improving umbilical survivability metrics.