Nutritional screening is gaining recognition in perioperative medicine, as anesthesiologists need to assess patients’ nutritional status to identify malnutrition risks. Poor nutritional status is associated with increased perioperative complications, including postoperative pain. Effective pain management is crucial to prevent acute pain from developing into chronic pain. However, the link between malnutrition and pain is not well established, prompting interest in whether nutritional assessment tools correlate with pain severity. The Mini Nutritional Assessment Short‐Form (MNA‐SF) is a validated screening tool for geriatric patients, recommended by European Society for Clinical Nutrition and Metabolism (ESPEN) for routine use. The modified Nutrition Risk in Critically Ill (mNUTRIC) score evaluates critically ill patients’ nutritional risk, guiding interventions to improve outcomes. This study aimed to explore the relationship between nutritional status, inflammatory markers, and postoperative pain in elderly surgical patients to optimize care. A prospective study involving 108 elderly patients (≥ 70 years) assessed the preoperative nutritional status using MNA‐SF, mNUTRIC, Acute Physiology and Chronic Health Evaluation (APACHE), Sequential Organ Failure Assessment (SOFA), and inflammatory biomarkers (C‐reactive protein (CRP) and albumin (Alb)). Postoperative pain was measured at surgery, 30 days, and 6 months. Statistical analysis found significant links between the nutritional status and pain outcomes. Higher mNUTRIC and APACHE scores correlated with increased pain, while higher Alb and MNA‐SF scores were associated with lower pain levels. Chronic pain at 6 months was strongly linked to poor preoperative nutritional and inflammatory status. Findings suggest that nutritional deficiencies and inflammation are associated with postoperative pain and recovery. Integrating nutritional screening into preoperative assessments could improve outcomes by guiding interventions. Future research should refine predictive models to better understand the complex interplay between nutrition, inflammation, and pain in perioperative care. Trial Registration: ClinicalTrials.gov identifier: NCT06802575

Background: Hip joint fractures are the most common fractures in elderly patients and a major cause of neurological disorders. Objective: The purpose of this non-interventional, observational, prospective study is to evaluate the effects of physiotherapeutic interventions on the neuropsychophysiological profile of patients during the rehabilitation period after hip fracture surgery, starting from discharge from the hospital. Methods: This study involved 64 mainly elderly patients who underwent surgery for various hip fractures and followed a standardized physical therapy protocol in the rehabilitation center . The Mini-Mental State Examination (MMSE) and Confusion Assessment Method (CAM) scores which are part of the neurological assessment in the rehabilitation center, were recorded on the 1st, 5th, 15th, and 30th days of hospitalization. Statistical analysis followed and the results aimed to evaluate the role of physical therapy in enhancing recovery and preventing cognitive complications in the postoperative period. Results: The first 64 patients with hip fractures admitted in the rehabilitation center after the initiation of the study protocol were enrolled in the study. Always the same two observers recorded MMSE and CAM scores for each patient during the four aforementioned time points. A statistical analysis included descriptive statistics for each of the four studied time points proved that both MMSE and CAM scores showed statistically significant positive outcomes in the neuropsychophysiological profile of patients following the same physical therapy protocol. Conclusion: Suggesting and supporting physical therapy through well standardized protocols after hip fracture surgery is crucial for improving and maintaining neurological status, particularly for patients at high risk of neurological disorders and delirium during the immediate postoperative period.

Spinal anesthesia is widely used in total knee arthroplasty (TKA) because it provides reliable block characteristics and favorable perioperative outcomes. However, a key limitation is the relatively short duration of local anesthetics, which may require additional analgesia or a switch to general anesthesia. To address this, intrathecal adjuvants are used to extend the duration of the block and enhance postoperative pain management. Dexmedetomidine, a highly selective α₂-adrenergic agonist, has demonstrated sedative and analgesic properties without respiratory depression, making it an attractive alternative to opioids such as fentanyl. In this case series, 10 µg of intrathecal dexmedetomidine was combined with ropivacaine in 20 patients undergoing TKA. Outcomes assessed included onset and regression of sensory and motor block, postoperative pain scores, and hemodynamic stability. Dexmedetomidine produced a rapid block onset, extended sensory block lasting up to 12 hours in some patients, and a predictable pattern of motor regression. Postoperative analgesia was favorable, with most patients remaining pain-free for the first six hours and reporting only mild discomfort at 12 hours. Hemodynamic changes observed included reductions in heart rate (HR) and mean arterial pressure (MAP), with some patients requiring vasopressor support, though no serious adverse events occurred. Our findings align with randomized controlled trials (RCTs) and meta-analyses indicating that intrathecal dexmedetomidine extends block duration, reduces the need for postoperative analgesics, and offers a favorable efficacy and side-effect profile compared to fentanyl. This case series adds to the existing body of evidence by presenting real-world clinical data on the use of intrathecal dexmedetomidine as an adjuvant to ropivacaine in elderly patients undergoing TKA. It demonstrates the adjuvant’s safety, hemodynamic stability, and analgesic effectiveness in a routine hospital setting, supporting the applicability of findings from controlled trials to everyday anesthetic practice. Further large-scale studies are needed to refine dosing strategies and evaluate long-term outcomes in orthopedic populations.

Nutritional status is increasingly recognized as a critical factor influencing perioperative outcomes. In elderly surgical patients, undernutrition and inflammation may play a key role in the development of both acute and chronic postoperative pain. Despite this, few studies have explored their predictive value using machine learning approaches. This prospective, non-interventional study aimed to assess whether nutritional screening tools and biochemical biomarkers could predict postoperative pain trajectories, both acute and chronic, in elderly surgical patients, using interpretable machine learning methods. A total of 108 patients aged ≥70 undergoing elective surgery under spinal or general anesthesia were enrolled. Preoperative assessments included the Mini Nutritional Assessment-Short Form (MNA-SF), the modified Nutritional Risk in the Critically Ill score (mNUTRIC), the Acute Physiology and Chronic Health Evaluation (APACHE), the Sequential Organ Failure Assessment (SOFA), red cell distribution width (RDW), C-reactive protein (CRP), serum bilirubin, serum albumin, serum calcium, and serum ferritin. Pain was recorded at four time points: pre-surgery, immediately post-surgery, 30 days, and six months. XGBoost classifiers were trained to predict pain at each time point, using a custom ordinal-aware loss function and evaluated via accuracy, F1-scores, and confusion matrices. Feature importance was analyzed with SHAP values for model interpretability. The results were the following: Predictive accuracy varied across timepoints: 36% (pre-surgery), 52% (acute post-surgery), 42% (30 days), and 55% (six months). Misclassifications were predominantly within one ordinal level of the true pain score. SHapley Additive exPlanations (SHAP) analysis revealed APACHE, CRP, albumin, ferritin, and MNA-SF as key predictors across models. Chronic pain predictions at six months showed the highest accuracy and stability, highlighting the relevance of preoperative nutritional and inflammatory markers in long-term pain outcomes. In conclusion, this study uses interpretable machine learning in an innovative way to link nutritional screening and inflammation markers to postoperative pain in elderly patients. The findings emphasize the predictive role of nutritional and inflammatory status in pain trajectories and suggest that integrating such assessments into perioperative care may improve personalized pain management and recovery outcomes in the elderly.

Aortic root replacement for infected endocarditis is associated with excessive bleeding and very high mortality. Bleeding management is mostly achieved with allogenic blood product administration, concomitant pharmacologic agents, and application of hemostatic factors. An immunosuppressed male patient with large B-cell Lymphoma and thrombocytopenia with aortic root abscess underwent root replacement surgery with a homograft. After an allergic reaction to platelet transfusion, a hematologic consult was requested, and guided transfusion was performed perioperatively. In total, six pools of washed platelets and cryoprecipitate were administered. Fresh frozen plasma (FFP) was also used after a test dose. Patients with large B-cell lymphoma typically suffer from bone marrow suppression. An individualized approach is necessary to guide transfusion in this special population. The administration of FFP as a test dose before entering the cardiopulmonary bypass may be useful in managing hemodynamic compromise in case of a reaction. Multidisciplinary management led to a successful outcome.

Background and Clinical Significance: Intranasal foreign bodies are common pediatric otolaryngologic emergencies and are usually diagnosed and removed without difficulty. However, delayed or occult retention may mimic chronic unilateral sinonasal disease and occasionally result in severe inflammatory or infectious complications. This study presents three illustrative pediatric cases of delayed intranasal foreign bodies supported by a seven-year institutional experience. Case Presentation: A retrospective review was conducted of all pediatric patients (≤16 years) presenting with intranasal foreign bodies at a secondary referral hospital between January 2019 and May 2026. Demographic characteristics, clinical presentation, management, and outcomes were reviewed to provide institutional context. Among 82 identified patients, three children with delayed diagnosis and severe complications were selected for detailed presentation because they represented distinct clinical manifestations of prolonged foreign body retention. These included chronic unilateral rhinosinusitis caused by a retained peanut fragment, a medial orbital subperiosteal abscess secondary to a retained plastic nasal piercing component, and a foreign-body granuloma associated with retained nasal packing material. The remaining patients underwent uncomplicated removal, predominantly in the emergency department. Conclusions: The presented cases illustrate the diverse spectrum of complications that may occur following delayed intranasal foreign body retention in children. Persistent unilateral foul-smelling rhinorrhea, nasal obstruction, recurrent unilateral epistaxis, or refractory unilateral sinonasal symptoms should prompt careful evaluation for a retained foreign body. By combining detailed case descriptions with institutional experience, this report highlights the importance of maintaining a high index of suspicion and timely endoscopic management in children with persistent unilateral sinonasal symptoms.