Effectiveness of single versus double attachments in the correction of premolar rotation in adult patients: A retrospective study

Admission hyperglycemia has been reported as a mortality risk factor for septic nondiabetic patients; however, hyperglycemia's known association with hyperlactatemia was not addressed in these analyses. The objective was to determine whether the association of hyperglycemia with mortality remains significant when adjusted for concurrent hyperlactatemia. This was a post hoc, nested analysis of a retrospective cohort study performed at a single center. Providers had identified study subjects during their emergency department (ED) encounters; all data were collected from the electronic medical record (EMR). Nondiabetic adult ED patients hospitalized for suspected infection, two or more systemic inflammatory response syndrome (SIRS) criteria, and simultaneous lactate and glucose testing in the ED were enrolled. The setting was the ED of an urban teaching hospital from 2007 to 2009. To evaluate the association of hyperglycemia (glucose > 200 mg/dL) with hyperlactatemia (lactate ≥ 4.0 mmol/L), a logistic regression model was created. The outcome was a diagnosis of hyperlactatemia, and the primary variable of interest was hyperglycemia. A second model was created to determine if coexisting hyperlactatemia affects hyperglycemia's association with mortality; the main outcome was 28-day mortality, and the primary risk variable was hyperglycemia with an interaction term for simultaneous hyperlactatemia. Both models were adjusted for demographics; comorbidities; presenting infectious source; and objective evidence of renal, respiratory, hematologic, or cardiovascular dysfunction. A total of 1,236 ED patients were included, and the median age was 77 years (interquartile range [IQR] = 60 to 87 years). A total of 115 (9.3%) subjects were hyperglycemic, 162 (13%) were hyperlactatemic, and 214 (17%) died within 28 days of their initial ED visits. After adjustment, hyperglycemia was significantly associated with simultaneous hyperlactatemia (odds ratio [OR] = 4.14, 95% confidence interval [CI] = 2.65 to 6.45). Hyperglycemia and concurrent hyperlactatemia were associated with increased mortality risk (OR = 3.96, 95% CI = 2.01 to 7.79), but hyperglycemia in the absence of simultaneous hyperlactatemia was not (OR = 0.78, 95% CI = 0.39 to 1.57). In this cohort of septic adult nondiabetic patients, mortality risk did not increase with hyperglycemia unless associated with simultaneous hyperlactatemia. The previously reported association of hyperglycemia with mortality in nondiabetic sepsis may be due to the association of hyperglycemia with hyperlactatemia.

In the Philippines, patients on chronic hemodialysis with COVID-19 remain admitted in hospitals despite clinical recovery because most free-standing dialysis units require proof of negative conversion via Reverse Transcriptase - Polymerase Chain Reaction (RT-PCR). This study aims to determine the time to negative conversion of COVID-19 RT-PCR testing among adult patients on chronic hemodialysis with COVID-19 admitted at the Philippine General Hospital (PGH) and bring insight in using the symptom or time-based procedure as recommended by local guideline, and ultimately, to ensure delivery of adequate hemodialysis despite being infected with COVID-19, shorten isolation period, and conserve resources especially in resource-limited settings. This is a retrospective cohort study on all adult patients on chronic hemodialysis who were admitted in PGH after the diagnosis of COVID-19 by RT-PCR between March 2020 and February 2021. Descriptive statistics was used in summarizing the data. A total of 90 patients on chronic hemodialysis who tested positive for COVID-19 via RT-PCR admitted at PGH were included in the study. Most of these patients had moderate COVID-19 at 53.3%. The median number of days from onset of symptoms to clinical recovery was 14.5 days. The median time to first negative conversion was 18 days. Most of these patients had negative conversion at the second week. The correlation coefficient between time to clinical recovery and negative conversion was 0.214. Among adult patients on chronic hemodialysis who were admitted in PGH after the diagnosis of COVID-19, the time to negative conversion was longer compared to the time to clinical recovery with a very weak correlation between the two.

Changes occurred in the patterns of utilization of emergency medical services during the Middle East respiratory syndrome (MERS) outbreak. The purpose of this study was to analyze the patterns of adult and pediatric patients who visited the emergency department (ED) during the outbreak. This retrospective study was conducted by analyzing changes in the patterns of visits among adult and pediatric patients in the ED at one tertiary teaching hospital in Korea. The study was performed from June 1, 2013 to July 31, 2015. The MERS outbreak period was from June 1 to July 31, 2015, and we compared that period to the same periods in 2013 and 2014. We compared and analyzed the patients' characteristics, emergency severity index (ESI) level at the visit, cause of visit, diagnosis, final dispositions, injury/non-injury, length of stay at the ED (EDLOS), and hospitalization rate. A total of 9,107 patients visited the ED during this period. Of these patients, 2,572 (28.2%) were pediatric patients and 6,535 (71.8%) were adult patients. The most common cause of an ED visit was fever (adult patients: 21.6%, pediatric patients: 56.2%). The proportion of non-urgent visits involving an ESI level of 4 or 5 and the EDLOS decreased significantly in pediatric and adult patients in comparison to that during the past two years. This change was significant in pediatric patients. Among adult patients, the rate of injury decreased, whereas it increased among pediatric patients. During the MERS outbreak period, pediatric ED visits due to non-urgent cases decreased significantly and there were more pronounced differences in ED utilization patterns in pediatric patients than in adult patients.

Plasma leakage is one crucial point of dengue hemorrhagic fever (DHF) that differentiates it from dengue fever (DF). DHF has to meet 4 criteria which are 2 – 7 days of acute fever, hemorrhagic manifestation, thrombocytopenia (≤100.000 cells/mm3) and evidence of plasma leakage. Plasma leakage consists of increasing hematocrit ≥20%, hypoalbuminemia or evidence of pleural effusion or ascites. Often doctors only base their DHF diagnosis on the presence of thrombocytopenia. This study analyzed the presence of plasma leakage between adult and pediatric patients with a DHF diagnosis in RSUD Dr. Soetomo in order to make the diagnosis and healthcare services better in the future. This was a retrospective study which used medical records of DHF patients admitted from January to June 2014. 78 cases were included, 24 adult patients (31%) and 54 pediatric patients (69%). 29/78 (37%) patients had no evidence of plasma leakage. No adult patients had ascites whereas 11/54 (20%) pediatric patients presented with ascites. No adult patients had pleural effusion whereas 25/54 (53%) pediatric patients did. Most adult patients that had serum albumin checked had normal albumin levels (12/14 [86%]) while only 14/28 (52%) pediatric patients had normal albumin level. 5/22 (23%) adult patients versus 32/53 (60%) pediatric patients showed hematocrit increments ≥20%. Patients admitted with dengue virus infection may currently be often misclassified as DHF because there are no plasma leakage manifestation in some patients.. There are significant differences in plasma leakage manifestations between adult and pediatric patients which poses a theory that pediatric patients are more susceptible to have plasma leakage manifestations than adult patients.

Background and Objectives: Scientific literature about the effects of intraoperative use of dexmedetomidine on anesthetic requirements and time to tracheal extubation in elective adult heart surgery patients is limited. Methods: A retrospective cohort study in adult patients who underwent uncomplicated elective heart surgery was performed. 103 adult patients who received intraoperative dexmedetomidine (DEX cohort) were matched with 97 patients who did not receive intraoperative dexmedetomidine (control cohort). Matching by age, gender and type of heart surgery was done. Intraoperative requirements of anesthetics, tracheal extubation in the operating room and time to tracheal extubation in the ICU were extracted from their medical charts. Results: Both cohorts had similar demographic and preoperative characteristics. DEX cohort received smaller intraoperative anesthetic doses of fentanyl (3.2 mg/kg ± 1.3 vs control 12.5 mg/kg ± 5.9, p= 0.0001), thiopental (3.4 mg/kg ± 1.5 vs control 4.0 mg/kg ± 1.6, p= 0.018), and pancuronium (6.5 mg ± 2.3 vs control 8.0 mg ± 1.8, p= 0.0001). Frequency of intraoperative use of thiopental was low in DEX cohort patients compared with control group (81.6 % vs control 97.9%, p= 0.0001), as midazolam (22.3 % vs control 67%, p= 0.0001) and pancuronium (47.6 % vs control 98%, p= 0.0001). Time to tracheal extubation was shorter in DEX cohort (197 ± 118 min vs control 314 ± 265 min, p= 0.002). Tracheal extubation in the operating room was more frequent in the DEX cohort (46.6% vs control 9.3%, p= 0.0001). Postoperative hospital and UCI lengths of stay were similar in both cohorts.Conclusions: Intraoperative use of dexmedetomidine as coadjuvant of fentanylisoflurane based anesthesia for elective heart surgery in adult patients could reduce anesthetic requirements and facilitate early postoperative tracheal extubation.

Obinutuzumab is a novel glycoengineered type II anti-CD20 monoclonal antibody with more potent and sustained B-cell depletion than rituximab. This study aimed to evaluate the efficacy and safety of obinutuzumab monotherapy in adult patients with minimal change disease (MCD). We conducted a retrospective study including adult MCD patients treated with obinutuzumab or glucocorticoids (GC) between January 1, 2020 and June 30, 2025. The primary outcome was complete remission (CR) of nephrotic syndrome. Secondary outcomes included relapse and adverse events. 38 patients were enrolled (16 in the obinutuzumab group, 22 in the GC group). 9 patients in the obinutuzumab group had steroid-dependent or steroid-resistant MCD, and 7 were new-onset MCD treated with obinutuzumab due to GC intolerance, contraindications, or comorbidities. In new-onset MCD, patients receiving obinutuzumab were older with higher prevalence of hypertension, BMI, and HbA1c. The CR rate was 68.8% (11/16) in the obinutuzumab group, with no significant differences in CR rate or time to remission compared with GC. Multivariate Cox regression showed that obinutuzumab treatment was not independently associated with CR. No relapses were observed in the obinutuzumab group during follow-up, whereas 27.3% of GC-treated patients relapsed. This single-center retrospective study provides preliminary evidence that obinutuzumab monotherapy may induce and maintain remission in selected adult MCD patients (e.g., those with GC contraindications or intolerance). While its remission rate is comparable to conventional GC therapy in our cohort, further prospective validation is required before it can be recommended as a routine alternative to GC.

To assess results and morbidity of the periprostatic insertion of an artificial urinary sphincter (AUS) in adult male patients with a neurogenic bladder. A retrospective study was carried out on 51 adult male patients operated on in four urologic academic wards from April 1988 to January 2008. Among these patients, 31% (16/51) had spina bifida and 69% (35/51) had spinal cord injury. All patients suffered urinary incontinence secondary to sphincteric deficiency, and this was associated with detrusor overactivity in 39% of them (leading in these cases to an added bladder augmentation). Perfect continence was defined as a period of dryness of at least 4 h between two self-intermittent catheterizations (SIC) or spontaneous micturitions, moderate incontinence as nocturnal leakage or need to wear protection once during the day or for stress leakage, while severe incontinence was defined as uncontrollable leakage causing patient discomfort. Mean age at the procedure was 35 years (18-58). Mean follow-up was 83 months (CI 95%, 65-101). At the end of the study, 15 patients (29.4%) were lost to follow-up. One patient (2%) died shortly after the procedure from a pulmonary infection. Post-operative morbidity was observed in 19% (10/50) of the patients (8 urinary tract infection, 1 failure to perform SIC, 1intracranial hypertension). Of the patients in our study 74% had perfect or moderate continence with a working AUS after a 10-year follow-up We present a specific study on adult patients with a neurological lesion leading to bladder dysfunction treated by a periprostatic AUS. This procedure was effective in restoring urinary incontinence in the vast majority of our patients with an acceptable morbidity.

Sepsis-induced liver injury (SILI) is a fatal complication of organ failure that currently lacks reliable biomarkers for early diagnosis and risk prediction. This study aimed to explore the link between the systemic immune-inflammatory index (SII) and SILI in adult patients with sepsis in the intensive care unit (ICU) at Nanjing Drum Tower Hospital. This single-center retrospective study analyzed the baseline characteristics of patients with sepsis admitted to the ICU between 2020 and 2024. Multifactorial logistic regression was used to identify independent risk factors for SILI. Curve fitting and Subgroup analyzes were performed to provide evidence for the stratified management of patients with different clinical characteristics. Receiver operating characteristic (ROC) curve analysis was performed to determine the predictive capacity of the SII. A total of 231 patients were included, of whom 53 (22.9%) developed SILI during ICU hospitalization. Patients with SILI exhibited a significantly higher in-hospital mortality rate than non-SILI cases (52.8% vs. 25.3%, p < 0.001). Elevated SII at ICU admission was strongly associated with SILI development (p < 0.001). Multivariable logistic regression identified the SII as an independent risk factor for SILI. ROC curve analysis demonstrated that SII had superior predictive performance for SILI occurrence, with an area under the curve of 0.85 (95% CI: 0.784-0.907). This retrospective study revealed a substantial association between high SII and SILI in adult ICU patients with sepsis, suggesting that SII is a promising indicator for post-sepsis SILI risk prediction.

Review question/objective - In adult intensive care unit patients experiencing alcohol withdrawal, does the use of dexmedetomidine as an adjuvant to benzodiazepine-based therapy decrease delirium severity more effectively than benzodiazepine-based therapy alone? The objective of the systematic review is to examine the best available evidence of the clinical effectiveness of dexmedetomidine as an adjuvant to benzodiazepine-based therapy versus benzodiazepine-based therapy alone, in decreasing delirium severity associated with alcohol withdrawal in adult intensive care unit patients over the age of 18 years.

OBJECTIVES:To determine the frequency of unplanned ICU readmission (UIR) among adult (18–64) and elderly (65+) trauma patients and to compare the risk factors for UIR and its clinical impact between age groups.DESIGN:Retrospective cohort study using clinical data from a statewide trauma registry.SETTING:All accredited trauma centers in Pennsylvania.PATIENTS:Consecutive adult and elderly trauma patients requiring admission from the emergency department to the ICU between 2012 and 2017.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:Among the 48,340 included in the analysis, 49.5% were elderly and 3.8% experienced UIR. UIR was 1.7 times more likely among elderly patients and was associated with increased hospital length of stay in both age groups. UIR was associated with an absolute increased risk of hospital mortality of 6.1% among adult patients and 16.9% among elderly patients experiencing UIR. In addition to overall injury severity and burden of preexisting medical conditions, specific risk factors for UIR were identified in each age group. In adult but not elderly patients, UIR was significantly associated with history of stroke, peptic ulcer disease, cirrhosis, diabetes, and malignancy. In elderly but not adult patients, UIR was also significantly associated with chronic kidney disease.CONCLUSIONS:UIR is associated with worse clinical outcomes in both adult and elderly trauma patients, but risk factors and the magnitude of impact differ between age groups. Interventions to mitigate the risk of UIR that take into account patients’ age group and specific risk factors may improve outcomes.

This was a retrospective study. The aim of this study was to compare radiographic outcomes of Lenke 5C adolescent idiopathic scoliosis (AIS) patients treated by vertebral column manipulator (VCM) or simple rod derotation (SRD) maneuver. The direct vertebral rotation (DVR) technique has demonstrated better rotational and coronal correction than SRD, but clinical radiographic outcomes for Lenke 5C AIS following DVR using a VCM derotational device have not been described. A retrospective study was carried out in 39 Lenke 5C AIS patients treated by VCM (n=20) or SRD (n=19) techniques between April 2008 and June 2011. All patients had complete clinical record and radiographic data. Nine radiographic variables were collected and compared at 3 time points (preoperative, immediate postoperative, and minimum 2-year follow-up) between both groups. Scoliosis was successfully corrected in both groups. All patients obtained good coronal and sagittal balance, and no severe complications occurred. The postoperative apical rotation corrective rate of the VCM and SRD groups were 55.1% and 25.5%, respectively (P < 0.05). Lowest instrumented vertebra and stable vertebra (LIV-SV) was statistically significant between the VCM and SRD groups, the mean values were 1.2 ± 0.4 level and 0.7 ± 0.5 level (P < 0.05). The main curve corrective rates and LIV-tilt angle correction rates were not significantly different between groups, but it showed a spontaneous correction for the coronal LIV-tilt angle for both groups at the last follow-up. VCM improved postoperative apical axial rotational correction and lessened the lumbar fusion segment compared with the SRD technique, which might have a potential trend to reserve lumbar mobility.

Effect of lymphadenectomy on fertility and prognostic outcome in adult patients with clinically early-stage malignant ovarian germ cell tumors during fertility-sparing surgery: A retrospective multicenter study (178)

ObjectiveInfluenza virus infections cause a high disease and economic burden during seasonal epidemics. However, there is still a need for reliable disease burden estimates to provide a more detailed picture of the impact of influenza. Therefore, the objectives of this study is to estimate the incidence of hospitalisation for influenza virus infection and associated hospitalisation costs in adult patients in the Netherlands during two consecutive influenza seasons.MethodsWe conducted a retrospective study in adult patients with a laboratory confirmed influenza virus infection in three Dutch hospitals during respiratory seasons 2014–2015 and 2015–2016. Incidence was calculated as the weekly number of hospitalised influenza patients divided by the total population in the catchment populations of the three hospitals. Arithmetic mean hospitalisation costs per patient were estimated and included costs for emergency department consultation, diagnostics, general ward and/or intensive care unit admission, isolation, antibiotic and/or antiviral treatment. These hospitalisation costs were extrapolated to national level and expressed in 2017 euros.ResultsThe study population consisted of 380 hospitalised adult influenza patients. The seasonal cumulative incidence was 3.5 cases per 10,000 persons in respiratory season 2014–2015, compared to 1.8 cases per 10,000 persons in 2015–2016. The arithmetic mean hospitalisation cost per influenza patient was €6128 (95% CI €4934–€7737) per patient in 2014–2015 and €8280 (95% CI €6254–€10,665) in 2015–2016, potentially reaching total hospitalisation costs of €28 million in 2014–2015 and €20 million in 2015–2016.ConclusionsInfluenza virus infections lead to 1.8–3.5 hospitalised patients per 10,000 persons, with mean hospitalisation costs of €6100–€8300 per adult patient, resulting in 20–28 million euros annually in The Netherlands. The highest arithmetic mean hospitalisation costs per patient were found in the 45–64 year age group. These influenza burden estimates could be used for future influenza cost-effectiveness and impact studies.Electronic supplementary materialThe online version of this article (10.1007/s10198-020-01172-1) contains supplementary material, which is available to authorized users.

Single-dose rasburicase for the treatment and prevention of hyperuricaemia in adult and paediatric patients with cancer at high risk of tumour lysis syndrome (TLS) has been widely adopted in pharmacy practice as unlabelled use with limited clinical evidence. This meta-analysis study evaluated the efficacy and cost savings of a single-dose rasburicase (SDR) regimen compared with the Food and Drug Administration-approved daily dosing of rasburicase (DDR) for 5days or the traditional treatment with allopurinol in adult cancer patients with hyperuricaemia or at high risk for TLS. Prospective and retrospective studies were retrieved from a systemic search of major electronic data sources. Studies included in the meta-analysis were those with SDR for the prophylaxis of high-risk TLS or treatment of hyperuricaemia in adult patients with cancer. The results of response rate and controlling of time-dependent plasma uric acid (UA) reduction were pooled and compared with the results from patients treated with DDR for 5days or patients treated with allopurinol. A cost analysis was performed to analyse the treatment costs for adults with hyperuricaemia or at high risk for TLS. Ten studies (eight retrospective and two prospective) evaluated the SDR response rate and plasma UA level reduction over time. The pooled total number of patients treated with SDR (from 0·05mg/kg to 0·20mg/kg) was 269. The pooled response rate of the SDR arm was not significantly different than that of DDR (0·2mg/kg) arm (88·15% vs. 90·18%, P=0·542), but significantly stronger than that of allopurinol (300mg/day orally days 1 to 5) arm (response rate: 88·15% vs. 66%, P<0·0005). Pooled SDR group efficiently controlled the plasma uric acid (UA) level below 4·5mg/dL over 24h, 48h and 72h, whereas DDR reduced plasma UA levels to hypouricaemia level (<2mg/dl). In addition, cost analysis demonstrated that standard-dose SDR (≥6mg) has non-inferior clinical benefit and significant cost savings compared with the DDR regimen. Single-dose rasburicase (SDR) for adult cancer patients with hyperuricaemia or at high risk for TLS demonstrated better response rate and stronger control of uric acid level compared with allopurinol. SDR response rate was not inferior to that of DDR, and the standard-dose SDR generates more cost savings compared with the DDR. It suggests that the single-dose rasburicase is clinically effective and cost efficient for the prophylaxis of high-risk TLS and the treatment of hyperuricaemia in adult patients with cancer. Additional randomized control studies are needed to confirm the findings of this meta-analysis study.

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