{Background: COVID-19 caused restrictions and re-allocation of medical resources among all healthcare services. During the peak of the pandemic, several unrelated–yet critical–conditions had silently taken their toll. Infective endocarditis (IE), owing to its non-specific clinical presentation, may have been largely mislabeled as COVID-19 in a number of cases. Results: This retrospective observational study reviewed all IE presentations at an IE unit in a university hospital during the peak of COVID-19. Patient characteristics, courses, and outcomes were compared with historical controls from our IE database published before the COVID era. We identified 30 IE cases [Group A] during the COVID-19 peak in our region (June 2021 to June 2022), with a 25% decrease compared to the usual annual rate. This is in contrast to the expected surge during the pandemic. Compared with group B (398 published IE cases from our database), group A had significantly longer symptoms-to-presentation intervals (60 [31–92] vs. 28 [14–72] days

BACKGROUND AND OBJECTIVE:With lumbar spine fusion being one of the most commonly performed spinal surgeries, investigating common complications such as adjacent segment disease (ASD) is a high priority. To the authors' knowledge, there are no previous studies investigating the utility of the preoperative magnetic resonance imaging–based vertebral bone quality (VBQ) score in predicting radiographic and surgical ASD after lumbar spine fusion. We aimed to investigate the predictive factors for radiographic and surgical ASD, focusing on the predictive potential of the VBQ score.

METHODS:

A single-center retrospective analysis was conducted of all patients who underwent 1–3 level lumbar or lumbosacral interbody fusion for lumbar spine degenerative disease between 2014 and 2021 with a minimum 12 months of clinical and radiographic follow-up. Demographic data were collected, along with patient medical, and surgical data. Preoperative MRI was assessed in the included patients using the VBQ scoring system to identify whether radiographic ASD or surgical ASD could be predicted.

RESULTS:

A total of 417 patients were identified (mean age, 59.8 ± 12.4 years; women, 54.0%). Eighty-two (19.7%) patients developed radiographic ASD, and 58 (13.9%) developed surgical ASD. A higher VBQ score was a significant predictor of radiographic ASD in univariate analysis (2.4 ± 0.5 vs 3.3 ± 0.4; P < .001) and multivariate analysis (odds ratio, 1.601; 95% CI, 1.453-1.763; P < .001). For surgical ASD, a significantly higher VBQ score was seen in univariate analysis (2.3 ± 0.5 vs 3.3 ± 0.4; P < .001) and served as an independent risk factor in multivariate analysis (odds ratio, 1.509; 95% CI, 1.324-1.720; P < .001). We also identified preoperative disk bulge and preoperative existence of adjacent segment disk degeneration to be significant predictors of both radiographic and surgical ASD. Furthermore, 3-level fusion was also a significant predictor for surgical ASD.

CONCLUSION:

The VBQ scoring system might be a useful adjunct for predicting radiographic and surgical ASD.

SummaryBackground
Timely and safe elective health care facilitates return to normal activities for patients and prevents emergency admissions. Surgery is a cornerstone of elective care and relies on complex pathways. This study aimed to take a whole-system approach to evaluating access to and quality of elective health care globally, using inguinal hernia as a tracer condition.
Methods
This was a prospective, international, cohort study conducted between Jan 30 and May 21, 2023, in which any hospital performing inguinal hernia repairs was eligible to take part. Consecutive patients of any age undergoing primary inguinal hernia repair were included. A measurement set mapped to the attributes of WHO's Health System Building Blocks was defined to evaluate access (emergency surgery rates, bowel resection rates, and waiting times) and quality (mesh use, day-case rates, and postoperative complications). These were compared across World Bank income groups (high-income, upper-middle-income, lower-middle-income, and low-income countries), adjusted for hospital and country. Factors associated with postoperative complications were explored with a three-level multilevel logistic regression model.
Findings
18 058 patients from 640 hospitals in 83 countries were included, of whom 1287 (7·1%) underwent emergency surgery. Emergency surgery rates increased from high-income to low-income countries (6·8%, 9·7%, 11·4%, 14·2%), accompanied by an increase in bowel resection rates (1·2%, 1·4%, 2·3%, 4·2%). Overall waiting times for elective surgery were similar around the world (median 8·0 months from symptoms to surgery), largely because of delays between symptom onset and diagnosis rather than waiting for treatment. In 14 768 elective operations in adults, mesh use decreased from high-income to low-income countries (97·6%, 94·3%, 80·6%, 61·0%). In patients eligible for day-case surgery (n=12 658), day-case rates were low and variable (50·0%, 38·0%, 42·1%, 44·5%). Complications occurred in 2415 (13·4%) of 18 018 patients and were more common after emergency surgery (adjusted odds ratio 2·06, 95% CI 1·72–2·46) and bowel resection (1·85, 1·31–2·63), and less common after day-case surgery (0·39, 0·34–0·44).
Interpretation
This study demonstrates that elective health care is essential to preventing over-reliance on emergency systems. We identified actionable targets for system strengthening: clear referral pathways and increasing mesh repair in lower-income settings, and boosting day-case surgery in all income settings. These measures might strengthen non-surgical pathways too, reducing the burden on society and health services.
Funding
NIHR Global Health Research Unit on Global Surgery and Portuguese Hernia and Abdominal Wall Society (Sociedade Portuguesa de Hernia e Parede Abdominal).

Various production procedures, for carbon quantum dots (CQDs), are still being extensively researched to understand the nature of CQD luminescence. This study compares and examines the impact of chemical as well as green methods on the structural and optical properties of CQDs. We present a straightforward, cost-effective bottom-up method for producing fluorescent CQDs from lemon peels (L-CQDs), orange juice (O-CQDs), and citric acid (C-CQDs) without having to deal with time-consuming or ineffective post-processing processes. The proposed green synthesis has no toxic by-products, and the residual resources utilized promote the large-scale production of CQDs. X-ray diffraction, high-resolution transmission electron microscopy, FTIR, Raman, DLS, and UV–Vis spectroscopy are utilized to investigate the structure and optical characteristics of the prepared CQDs. The as-prepared CQDS possess small particle sizes of 5.6 nm, 6.2 nm, and 1.1 nm for L-CQDs, O-CQDs, and C-CQDs samples, respectively. FTIR results reveal the coexistence of carboxylic and hydroxyl groups on the surface of the CQDs, as also supported by zeta-potential values. Maximal fluorescence intensity was reached at excitation wavelengths of 365, 250, and 280 nm with an emission color of blue, indigo, and light blue for L-CQDs, O-CQDs, and C-CQDs, respectively. The presented approaches show a high quantum yield of 88% for O-CQDs, 49% for L-CQDs, and 37% for C-CQDs. Due to their minuscule particle size, perfect water solubility, high stability, and tunable luminescence properties, the prepared CQDs are preferred for potential applications in multicolor imaging, metal ion sensing, and wastewater technologies.

In this study, we propose a new design based on photonic crystal fibers (PCFs) for broadband dispersion compensation in telecommunication networks. The proposed design has a hexagonal structure arrangement of air-holes rings of different diameters between the silica core and the cladding. The PCF properties like effective area, nonlinearity, dispersion slope, confinement loss, and birefringence are reported and discussed. For the best performance we present three designs A, B and C. Simulation results show that the three designs cover the six-telecommunication optical bands O-, E-, S-, C-, L- and U- bands (wavelengths ranging from 1260 to 1675 nm). Design A achieves a large negative dispersion value of about − 1716 ps/(nm.km) with relative dispersion slope equals to that of conventional single-mode optical fibers (SMFs) of about 0.0036 nm−1, which makes it very suitable for long-haul DWDM transmission systems. With a little modification in the core, designs B and C achieve much higher confinement ability and achieve a very large birefringence value for polarization mode dispersion and sensing applications. Design C is engineered to have exact opposite dispersion of SMF with zero dispersion at the wavelength 1310 nm, which makes it a promising design in CWDM transmission system. The numerical values have been investigated using the full vector finite element method.