2-year Period Research Articles

Endoscopic push through tragal cartilage tympanoplasty: A 10-year retrospective review of our technique and outcomes

BACKGROUND Endoscopic ear surgery (EES) provides a magnified, high-definition view of the otological surgical field. EES allows otologists to avoid surgical incisions and associated postoperative complications. It is an ideal technique for the performance and teaching of tympanoplasty. AIM To examine the efficacy of total Endoscopic Push Through Tragal Cartilage Tympanoplasty (EPTTCT), at our institution over a 10-year period. METHODS A retrospective analysis of 168 cases of EPTTCT for closure of small to medium tympanic membrane perforations from 2013-2023 was conducted. Patient sex, age range (pediatric vs adult), etiology of injury, success rate, complications, and postoperative hearing status were collected. RESULTS Graft uptake results indicated success in 94% of patients, with less than a 2% complication rate. Postoperative pure tone audiometry demonstrated hearing status improvement in 69% of patients. CONCLUSION EPTTCT has been shown to be effective in tympanic membrane perforation closures with minimal complications. This study further demonstrates the efficacy and safety of these procedures in a single-center review.

Pediatric Toy-Related Ocular Injuries in the United States: A National Electronic Injury Surveillance System Study

ABSTRACT Purpose The purpose of this study is to evaluate the epidemiological trends, primary ocular diagnosis, and degree of injury severity in pediatric patients after a toy-related ocular trauma. Methods A cross-sectional analysis was conducted using data from the National Electronic Injury Surveillance System Study (NEISS), encompassing patients who visited emergency departments over a 5-year period from January 1, 2017, to December 31, 2021, with toy-related ocular injuries. Descriptive statistics were employed using Microsoft Excel. Results Among the 1439 toy-related ocular injuries identified, the mean age of injury was 6.67 ± 4.36 years. The highest proportion of injuries occurred in the 2–5 years age group (27.2%). The NEISS database classified the severity of injury – the majority of which were minor anterior segment injuries. Toy guns with projectiles were identified as the most common type of toy associated with ocular eye injury. While most injuries were minor, a small percentage was severe. Conclusion Age-appropriate toy selection and adult supervision during playtime are recommended preventive measures to mitigate the incidence and severity of traumatic eye injuries in children.

Oral Antibiotics and Risk of Serious Cutaneous Adverse Drug Reactions.

Serious cutaneous adverse drug reactions (cADRs) are potentially life-threatening drug hypersensitivity reactions involving the skin and internal organs. Antibiotics are a recognized cause of these reactions, but no studies have compared relative risks across antibiotic classes. To explore the risk of serious cADRs associated with commonly prescribed oral antibiotics, and to characterize outcomes of patients hospitalized for them. Nested case-control study using population-based linked administrative datasets among adults aged 66 years or older who received at least 1 oral antibiotic between 2002 and 2022 in Ontario, Canada. Cases were those who had an emergency department (ED) visit or hospitalization for serious cADRs within 60 days of the prescription, and each case was matched with up to 4 controls who did not. Various classes of oral antibiotics. Conditional logistic regression estimate of the association between different classes of oral antibiotics and serious cADRs, using macrolides as the reference group. During the 20-year study period, we identified 21 758 older adults (median age, 75 years; 64.1% female) who had an ED visit or hospitalization for serious cADRs following antibiotic therapy and 87 025 matched controls who did not. In the primary analysis, sulfonamide antibiotics (adjusted odds ratio [aOR], 2.9; 95% CI, 2.7-3.1) and cephalosporins (aOR, 2.6; 95% CI, 2.5-2.8) were most strongly associated with serious cADRs relative to macrolides. Additional associations were evident with nitrofurantoin (aOR, 2.2; 95% CI, 2.1-2.4), penicillins (aOR, 1.4; 95% CI, 1.3-1.5), and fluoroquinolones (aOR, 1.3; 95% CI, 1.2-1.4). The crude rate of ED visits or hospitalization for cADRs was highest for cephalosporins (4.92 per 1000 prescriptions; 95% CI, 4.86-4.99) and sulfonamide antibiotics (3.22 per 1000 prescriptions; 95% CI, 3.15-3.28). Among the 2852 case patients hospitalized for cADRs, the median length of stay was 6 days (IQR, 3-13 days), 9.6% required transfer to a critical care unit, and 5.3% died in the hospital. Commonly prescribed oral antibiotics are associated with an increased risk of serious cADRs compared with macrolides, with sulfonamides and cephalosporins carrying the highest risk. Prescribers should preferentially use lower-risk antibiotics when clinically appropriate.

Metabolic dysfunction-associated steatotic liver disease (SLD) and alcohol-associated liver disease, but not SLD without metabolic dysfunction, are independently associated with new onset of chronic kidney disease during a 10-year follow-up period.

The new nomenclature of steatotic liver disease (SLD) including metabolic dysfunction-associated SLD (MASLD), MASLD and increased alcohol intake (MetALD), and alcohol-associated liver disease (ALD) has recently been proposed. We aimed to elucidate the relationship between each category of SLD and chronic kidney disease (CKD). We investigated the effects of various SLDs on the development of CKD, defined as estimated glomerular filtration rate (eGFR)<60mL/min/1.73m2 or positive for urinary protein, during a 10-year period in 12138 Japanese subjects (men/women, 7984/4154; mean age, 48years) who received annual health examinations including abdominal ultrasonography. The prevalences of SLD without metabolic dysfunction (SLD-MD[-]), MASLD, MetALD, and ALD were 1.7%, 26.3%, 4.9%, and 1.9%, respectively. During the follow-up period, 1963 subjects (16.2%) (men/women, 1374 [17.2%]/589 [14.2%]) had new onset of CKD. Multivariable Cox proportional hazard model analyses after adjustment of age, sex, eGFR, current smoking habit, diabetes mellitus, hypertension, and dyslipidemia showed that the hazard ratios (HR [95% confidence interval]) for the development of CKD in subjects with MASLD (1.20 [1.08-1.33], p=0.001) and those with ALD (1.41 [1.05-1.88], p=0.022), but not those with MetALD (1.11 [0.90-1.36], p=0.332), were significantly higher than the HR in subjects with non-SLD. Interestingly, subjects with SLD-MD[-] had a significantly lower HR (0.61 [0.39-0.96], p=0.034) than that in subjects with non-SLD. The addition of the novel classification of SLDs into traditional risk factors for the development of CKD significantly improved the discriminatory capacity. MASLD and ALD, but not SLD-MD[-], are independently associated with the development of CKD.

National trends in patterns of under-vaccination in early childhood: national immunization survey-child, United States, 2011-2021.

The study objective was to examine national trends in patterns of under-vaccination in the United States. The National Immunization Survey-Child (NIS-Child) is an annual cross-sectional survey that collects provider-verified vaccination records from a large national probability sample of children. Records from the 2011-2021 NIS-Child were used to assess receipt of the combined 7-vaccine series by age 24 months. Based on prior work, patterns indicative of hesitancy included zero vaccines, not starting ≥ 1 series, and consistent vaccine-limiting. Patterns indicative of practical issues included starting all series but missing doses. Up-to-date (UTD) was defined as receiving all doses in the combined 7-vaccine series. The study population comprised 127,257 children. Over the observation period, patterns indicative of hesitancy significantly decreased (p-trend <0.0001), patterns indicative of practical issues significantly decreased (p-trend <0.0001), and UTD significantly increased (p-trend <0.0001). In 2021, the weighted percent in each category was: probable hesitancy 6.3% (95% confidence interval [CI] 5.4%, 7.2%), probable practical issues 26.0% (95% CI 24.4%, 27.6%), and UTD 67.7% (95% CI 66.0%, 69.4%). Over an 11-year period, vaccination coverage in the United States for the combined 7-vaccine series has improved, with patterns suggestive of practical issues or hesitancy declining.

Outcomes 10-years after traumatic spinal cord injury in Botswana - a long-term follow-up study

Study designProspective follow-up study.ObjectivesTo describe outcomes, survival, and attendance to routine follow-up visits 10 years post-SCI.SettingThe national SCI-rehabilitation center in Botswana.MethodsAll persons who were admitted with traumatic SCI during a 2-year period, 2011–2013, and survived up to 2 years post-injury were included. Data were collected from the medical records from the follow-up assessment closest to 10 years post-SCI and included demographic and clinical characteristics, functional outcomes, and secondary complications. Data regarding mortalities were received from relatives. Statistical comparisons were made, when possible, between those who attend follow-up assessment and those who did not, and between those who survived up to 10 years post-SCI and those who died.ResultsThe follow-up rate was 76% (19/25) of known survivors. No statistically significant factors were found to affect the follow-up rate. Secondary complications rates were for pressure ulcers and urinary tract infections 21%. Self-catheterisation and suprapubic catheter were the preferred methods to manage neurogenic bladder dysfunction. Ten persons (26%) had deceased since 2nd follow-up assessment. The causes of death were probably SCI-related in more than half of the cases.ConclusionsThis was a follow-up study at year 10 after acute TSCI in Botswana conducted at the national SCI-rehabilitation center. The study supports previous reports regarding the importance of that having specialized SCI units and the need of structured follow-ups, a responsible person in charge of scheduling, and updated patient registers. We found high follow-up rate, low rates of complications and of patients being lost to follow-up.

SGLT2 Inhibitors, Malnutrition, Cachexia, and Survival in Heart Failure Patients with a History of Anthracycline Treatment.

Patients undergoing anthracycline-based cancer treatments have an increased risk of heart failure (HF) and adverse metabolic outcomes such as malnutrition and cachexia. This retrospective study explored the impact of sodium-glucose co-transporter 2 inhibitors (SGLT2i) on these outcomes in HF patients previously treated with anthracyclines. Using the TriNetx research network, we identified 1,545 patients with a history of SGLT2i use and 17,681 without. We then performed 1:1 propensity score matching resulting in 1,323 patients within each cohort. Patients were analyzed over a 5-year period. SGLT2i use was associated with significantly reduced risks of cachexia (HR 0.453, 95% CI [0.286-0.718]), malnutrition (HR 0.702, 95% CI [0.547-0.900]), adult failure to thrive (HR 0.489, 95% CI [0.345-0.693]), and all-cause mortality (HR 0.490, 95% CI [0.423-0.568]). These findings call for additional research to determine whether SGLT2i may indeed improve nutritional status and survival in patients receiving anthracycline therapy.

Clinical features, surgical management and outcome of squamous and basal cell carcinoma in squamates and chelonians.

Squamous cell carcinoma (SCC) is one of the most commonly diagnosed neoplastic disorders in reptiles. Recently, however, it has been demonstrated that basal cell carcinomas (BCCs) are frequently misclassified as SCCs. Several histological SCC and BCC variants have been characterised and their classification may allow the establishment of appropriate prognosis estimation and treatment approaches. To describe the clinical features and surgical outcomes of SCCs and BCCs diagnosed between 2010 and 2022 in reptiles. Thirty-three captive reptiles (21 squamates and 12 chelonians). Detailed clinical history, including staging and surgical outcomes, were performed. Statistical analysis assessed significant factors using Prism (v8.2.1). While SCC was predominantly diagnosed in lizards, BCC was most commonly diagnosed in chelonians, and both neoplasms mainly occurred in adult to aged, male individuals. Although the gross pathological findings were highly comparable between SCC and BCC, considerable variation could be seen according to the primary location (oral, cutaneous or epidermis of the shell). Humane euthanasia or noncurative intent surgeries were performed in a minority of the cases. Curative intent surgeries were successful in 19 of 27 cases during a 1- to 7-year follow-up period, yet recurrence was seen in 8 cases. The results of this study allowed the identification of significant high-risk prognostic factors for SCC and BCC in reptiles. This study contributes to predicting the clinical behaviour and prognosis of distinct SCC and BCC histological variants, and selecting the most appropriate treatment protocol.

Longitudinal variation of correlations between different components of assessment within a medical school

BackgroundAn assessment program should be inclusive and ensure that the various components of medical knowledge, clinical skills, and professionalism are assessed. The level and the variation over time in the strength of the correlation between these components of assessment is still a matter of study. Based on the meaningful learning theory and the integrated learning theory, we hypothesize that these components increase their connections during the medical school course.MethodsThis is a retrospective cohort study that analyzed data collected for a 10-year period in one medical school. We included students from the 3rd to 6th year of medical school from 2011 to 2021. Three assessment components were addressed: Knowledge, Clinical Skills, and Professionalism. For data analysis, Pearson correlation coefficients (R) and R2 were calculated to study the correlation between variables and a z-test on Fisher's r-to-z was used to determine the differences between correlation coefficients.Results949 medical students were included in the study. The correlation between Clinical Skills and Professionalism showed a medium to strong association (Pearson's R ranging from 0.485 to 0.734), while the correlation between Knowledge and Professionalism was weaker but exhibited a steady evolution with Pearson's R fluctuating between 0.075 and 0.218. The Knowledge and Clinical Skills correlation became statistically significant from 2013 onwards and peaking at Pearson's R of 0.440 for the cohort spanning 2016–2019. We also revealed a strengthening of correlations between Professionalism and Clinical Skills from the beginning to the end of clinical training, but not with the knowledge component.ConclusionsThis analysis contributes to our understanding of the dynamics of correlations of different assessment components within an institution and provides a framework for how they interact and influence each other.Trial registrationThis study was not a clinical trial, but a retrospective observational study, without health care interventions. Nevertheless, we provide herein the number of the study as submitted to the Ethics committee – CEICVS 146/2021.

Epidemiology of ANCA vasculitis in Northern Spain.

The incidence of anti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis (AAV) shows disparate results due to variable classification criteria and heterogeneous-population series. We aimed to estimate the incidence of AAV in a well-defined population with standardized classification criteria. Population-based study of AAV patients diagnosed from January 2000 to December 2023 in Cantabria, Northern Spain. Patients were classified according to ACR/EULAR 2022 into granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), or unclassified vasculitis if the criteria were not met. Eosinophilic granulomatosis with polyangiitis (EGPA) patients were not included. The annual incidence rates were estimated by cases over 1,000 000 (106) (95% CI) including overall AVV, type of AAV, sex, and year of diagnosis. A literature review was also performed. We included 152 (80/72 men; mean age; 70.6 ± 13.18 years) patients. They were classified as MPA (67; 44%), GPA (64; 42.2%), and unclassified vasculitis (21; 13.8%). Annual incidence was 13.4 (10-16.8)/106 [male 14.5 (10.5-18.5); female 12.1 (8.7-15.6)]. The Annual incidence of MPA was 5.9 (4-7.8)/106 and GPA 5.6 (3.9-7.3)/106. The mean Annual incidence increased from 6.1 (4.5-7.7)/106-16.5 (5.6-27.4)/106 in the last three years, particularly, in GPA from 2.3 (0.3-4.9)/106-8.2 (2-14.5)/106. The prevalence of AAV was 184.7 (181-188)/106. During a 20-year period we found that the incidence of AAV (GPA and MPA) in Northern Spain is higher than Southern Spain, but lower than Northern European countries. An increase in the incidence was observed in the last years.

Changes in Need for Uniqueness From 2000 Until 2020

People have a need to express themselves and to be unique from others. However, this need might conflict with other goals, such as the need to belong and fit in with others. Recent research and polling suggest that people may be more reluctant to express themselves and stand out than in previous years, but few studies have examined such societal trends in a systematic way. We examined changes in need for uniqueness among 1,339,160 Internet respondents (Mage = 21.09, SD = 9.69; 65.8% women) from 2000 and 2020. Across the 20-year period, participants who completed the survey more recently reported a lower need for uniqueness, particularly in terms of not wanting to defend their beliefs in public forums and caring more about what others think about them. Results are discussed in the context of possible causes of changes in uniqueness desires and the possible societal implications.

Changes in ASCVD Risk Scores in a Predominantly Black Cohort with HIV and Associated Comorbidities: A Preliminary Study.

People with HIV (PWH) have increased risk of atherosclerotic cardiovascular disease (ASCVD) compared to non-PWH, but the reasons for this increased risk remain elusive. We investigated the change in ASCVD risk scores over 4-years to identify clinical factors associated with change in risk scores or high risk scores. We conducted a preliminary study using retrospective analysis of PWH, between 40-75 years old, seen at the Evelyn Jordan Center with at least two routine HIV visits. We collected clinical and demographic data and calculated the ASCVD risk scores using the Pooled Cohort Equation. Exploratory analyses examined change in risk score categories over time. Final adjusted analysis examined factors associated with change in continuous risk scores over time. Our sample included 187 PWH, 166 were Black/African American and 79 were female. We found no significant change in ASCVD risk score over time. The risk score was significantly higher in PWH with hepatitis C (7.34%; 95% CI 2.59, 12.09; p=0.003) and trended higher in those with dual hepatitis B/C and hepatitis B compared to those without hepatitis (p=0.07). We found that ASCVD risk did not change over a 4-year period among predominantly Black young PWH, but infection with hepatitis C and dual hepatitis B/C were associated with higher ASCVD risk scores. Our findings illustrate the need for further longitudinal studies evaluating change in CVD risk and investigating viral hepatitis as an added potential contributor to increased CVD risk in high-risk, vulnerable populations.

Profile of spontaneous bacterial peritonitis in non-alcoholic fatty liver disease cirrhosis

Background: Etiology of chronic liver disease (CLD) has an impact on the profile of spontaneous bacterial peritonitis (SBP) in terms of infection acquisition, resistance pattern, and treatment outcome. Aims and Objectives: This study aimed to study infection acquisition, antibiotic resistance pattern, and treatment outcome in patients with non-alcoholic fatty liver disease (NAFLD) cirrhosis with SBP. Materials and Methods: This observational prospective study was carried out in Government Medical College; Srinagar: over a period of 2 years from 2017 onward. We did analysis of patients with NAFLDs cirrhosis. We studied infection acquisition, antibiotic resistance pattern, and treatment outcome in this group of patients. Results: Over 2-year period, 246 patients were enrolled. The mean age of patients was 57.09±13.90 years. Hepatitis B virus and NAFLD were the major etiological contributors to the burden of CLD amounting to 51.20% in Kashmir. SBP was present in 33/57 (57.90%) of NAFLD cirrhosis patients. Child-Turcotte-Pugh Class C was 63.60%. Patients with culture-positive SBP (CP-SBP) were 45.45%. In patients of SBP with etiology other than NAFLD, CP-SBP was 61% whereas culture-negative SBP was 38.77%. Conclusion: In our region, NAFLD is one of the leading contributors to CLD. In this study, the trend toward worse treatment outcome and mortality in the patients with NAFLD SBP was observed.

Assessment of hepatitis c core antigen in epithelial salivary gland neoplasms (ex-vivo study)

BackgroundSalivary gland neoplasms (SGNs) pose a challenge to both pathologists and clinicians. Despite research, the etiology of these neoplasms remains unclear. This study aimed to identify any potential association between the presence of hepatitis C virus (HCV) at the protein or gene level and epithelial salivary gland neoplasms.MethodsFormalin-fixed paraffin-embedded (FFPE) blocks of epithelial salivary gland neoplasms were retrieved from the archives of the Oral and Maxillofacial Pathology Department, Faculty of Dentistry, Cairo University within the 5-year period from 2016 to 2020. Immunohistochemistry was used to assess HCV core antigen, while reverse transcription polymerase chain reaction was employed for the evaluation of HCV RNA.ResultsA total of 44 specimens were collected, 28 of which were benign neoplasms and 16 were malignant neoplasms. There was a statistically significant difference in HCV positivity between the two groups (P-value = 0.036). Benign tumors showed a statistically significant lower percentage of positive cases than malignant tumors. The localization of staining was also evaluated, revealing various patterns of HCV core antigen expression, including diffuse cytoplasmic, patchy cytoplasmic, nuclear, and a combination of nuclear and cytoplasmic expression. There was no statistically significant difference between the expression patterns in benign and malignant tumors (P-value = 0.616). Given that Pleomorphic Adenoma and Mucoepidermoid Carcinoma were the predominant tumor types in this study, four cases were selected for RNA detection. HCV RNA was detected in all cases using RT-PCR.ConclusionsHCV core antigen is frequently detected in SGNs and is suggested to be a potential risk factor for the development of these neoplasms. Further studies are required to discover other biomarkers, their roles, and the pathways associated with HCV in SGNs.

Serologically Confirmed Human Leptospirosis in Colombia, 2015-2020.

Leptospirosis, a bacterial infection transmitted through contact with infected animals or contaminated water sources, imposes a substantial health burden in Colombia. Since 2007, the National Institute of Health (INS) has mandated the notification and confirmation of all suspected leptospirosis cases. This passive surveillance program employs the microscopic agglutination test (MAT) on serum samples to ascertain confirmed cases of leptospirosis infection. However, the absence of a robust surveillance system has hindered our comprehensive understanding of the morbidity, mortality, geographical distribution, species/serovars, and strains responsible for severe disease. Our study aimed to provide an epidemiological overview of MAT-confirmed human leptospirosis cases reported over 6 years (2015-2020) in Colombia. In addition, we offer insights into the status of leptospirosis in the country, focusing on risk factors and proposing potential improvements for diagnosis and disease management. During the 6-year surveillance period, the laboratory at the INS received 3,535 serum samples from suspected human leptospirosis cases, with 880 (25%) confirmed through MAT. The incidence of leptospirosis was calculated at 1.9 cases per 100,000 people, with a higher prevalence among men (82.1%). Furthermore, 54 (6.1%) deaths were confirmed as leptospirosis, and cases were documented across nearly all regions of Colombia. Our findings emphasize the urgent need to strengthen leptospirosis laboratory surveillance, implement effective prevention measures, and enhance diagnostic capabilities in Colombia. The analysis conducted in this study provides the groundwork for estimating the impact of leptospirosis and raises awareness of its significance in public health.

Molecular epidemiology of string test-positive Klebsiella pneumoniae isolates in Huzhou, China, 2020-2023

ObjectiveThis study used whole-genome sequencing (WGS) to explore the genetic diversity, virulence factors, and antimicrobial resistance determinants of string test-positive Klebsiella pneumoniae (KP) over a 4-year surveillance period in Huzhou, China.MethodsIn total, 632 clinical isolates were collected via hospital surveillance from 2020 to 2023; 100 were positive in the string test and these 100 strains were subjected to antimicrobial susceptibility testing using an agar dilution method followed by WGS.ResultsThe resistance rates to cefotaxime (77.0%), trimethoprim-sulfamethoxazole (67.0%), and nalidixic acid (64.0%) were high. Multilocus sequence typing revealed high genetic diversity; there were 33 sequence types (STs) and 15 capsular serotypes. The most common ST was ST23 (16.0%) and the most common capsular serotype was K1 (22.5%). Virulome analysis revealed among-strain differences in virulence factors that affected bacterial adherence, efflux pump action, iron uptake, nutritional factors, metabolic regulation, the secretion system, and toxin production. The Kleborate strain-specific virulence scores of all 100 string test-positive KPs were derived: 28 strains scored 5, 28 scored 4, 21 scored 3, 12 scored 1, and 11 scored 0. All 77 strains with scores of 3 to 5 contained the iucA gene. The phylogeny based on whole-genome single nucleotide polymorphisms (wgSNPs) indicated high clonality; the string test-positive KP strains were grouped into six clades. Closely related isolates in each genetic cluster usually shared STs.ConclusionThe present study highlights the significance of the KP iucA gene in terms of hypervirulence and the diverse genotypes of string test-positive KP strains isolated in Huzhou hospitals.

Validating respiratory sarcopenia diagnostic criteria by mortality based on a position paper by four professional organizations: Insights from the Otassha study.

The Japanese Society for Respiratory Care and Rehabilitation, Japanese Association on Sarcopenia and Frailty, Japanese Society of Respiratory Physical Therapy, and Japanese Association of Rehabilitation Nutrition proposed the definition and diagnosis of respiratory sarcopenia using low respiratory muscle strength and appendicular skeletal muscle mass (ASM; ASM/height2) instead of respiratory muscle mass; however, these parameters have not been validated. This study aimed to confirm the validity of the respiratory sarcopenia definition proposed by these four professional organizations. Participants of our cohort study in 2015 of 468 community-dwelling older people who were evaluated for sarcopenia and underwent spirometry were included in this analysis. We determined two respiratory sarcopenia models based on low skeletal muscle mass and respiratory muscle strength. Low skeletal muscle mass was defined by low ASM/height2, and low respiratory muscle strength was defined by peak expiratory flow rate (PEFR) or percentage of predicted PEFR (%PEFR). Survival status was assessed 5 years after baseline assessment (in 2020). To evaluate the validity of the cut-off values for PEFR and %PEFR, we determined different respiratory sarcopenia models by sequentially varying the cut-off values for each parameter, including ASM/height2, from high to low. We subsequently calculated the hazard ratio (HR) for mortality for each respiratory sarcopenia model using the Cox proportional hazards model. Additionally, we plotted the HR for each combination of cut-off values for ASM/height2 and PEFR or %PEFR on a three-dimensional chart to observe the relationship between the different cut-off values and HR. A total of 31 people died during the 5-year observation period. With ASM/height2 cut-off values of approximately 7.0 kg/m2 for men and 5.7 kg/m2 for women and %PEFR cut-off values of 66-75%, respiratory sarcopenia was associated with mortality risk (HR, 2.36-3.27, point estimation range). The definition of respiratory sarcopenia by the four professional organizations is related to future health outcomes, and this definition is valid. Geriatr Gerontol Int 2024; ••: ••-••.

Urothelial cancer: State of art in ukraine and improvement pathways

Aim: This study aims to assess the effectiveness of urothelial cancer treatment in Ukraine, utilizing population-based data from the National Cancer Registry. The primary goal is to evaluate trends and approaches to therapy, with a focus on overall survival rates in patients with urothelial tumors. Materials and methods: A retrospective cross-sectional analysis was conducted based on the National Cancer Registry, involving 12,698 patients (2008-2020) with urothelial tumors of the upper urinary tract (UTUC) and bladder cancer (BC) who underwent surgical treatment. Demographic indicators, surgical interventions, complications, and survival rates were analyzed. Results: Average age for all patients was 70 years. The number of patients undergoing radical treatment was 1820 (15%) among BC and 573 (59%) among UTUC. The 30-day readmission rate was low for both, with a slightly higher preference for UTUC (2,3 vs. 4,6%). Whereas grade III or higher Cl-Dindo complications were seen in only 0,2% of cases. Notable findings include low frequency of neoadjuvant (7%) and adjuvant chemotherapy (28%) among patients with invasive urothelial carcinomas. Median eGFR for invasive UTUC before and after surgery was 63,2 and 51,4 mL/min respectively (P=0,00054). Directly opposite trend was seen in BC - 61,2 and 68,7 mL/min respectively (P=0,0026). For BC, the overall survival rates by stages were: I — 73%, II — 49%, III — 18%, and IV — 11% (chi-square=1807.207; P=0.000001). As for UTUC, the 5-year overall survival rates corresponded to the literature data, but there was a pronounced negative trend towards a decrease in this indicator after a 10-year period for all stages (chi-square=146.298; P=0.000003). Conclusion: The study emphasizes the importance of effective systemic treatments, adherence to treatment guidelines, and the need for multidisciplinary consultations among Ukrainian patients with urothelial cancer.

Addressing musculoskeletal curricular inadequacies within undergraduate medical education

BackgroundMusculoskeletal (MSK) injuries and diseases place a significant burden on the health care system. Despite this, research indicates that physician training in the area of MSK medicine has historically been inadequate, with a majority of medical students feeling that their training in MSK medicine is lacking. The goal of this investigation was to evaluate the efficacy of a new preclinical MSK curriculum that was implemented within a nationally accredited allopathic medical program.MethodsRetrospective analysis was completed on five consecutive years (2017–2021) of preclinical MSK curricular data for 549 medical students, including mid and end-of-course examinations and end-of-course student satisfaction surveys. Both parametric and non-parametric methods of analysis were used to examine within and between class differences (P < 0.05).ResultsThe new MSK curriculum covered 15 of 16 “core or must know” topics in MSK medicine, and academic performance was consistently high over the 5-year period of analysis (final course marks ranged from 76.6 ± 7.1 to 81.4 ± 8.1; failures/year: range from 0 to 4), being equal or above levels of student performance observed for other courses delivered during preclinical studies. Likert data from end-of-course surveys demonstrated that feedback was overwhelmingly positive (overall course satisfaction ranged from a low of 3.07/4.00 to a high of 3.56/4.00) and indicated that students felt that the new preclinical MSK curriculum did effectively support medical student learning and knowledge retention.ConclusionResults are expected to help advance the current body of knowledge that is dedicated to improving physician learning and knowledge retention in the area of MSK medicine and provides a curricular model that could be used by other nationally accredited medical programs to help enhance MSK learning at the preclinical levels of physician training.

Оценка приоритетов использования программных бюджетных расходов в регионах Российской Федерации

This article is devoted to the search for an answer to the question whether the promotion of socio-economic development is among the key priorities of using the budget potential of the subjects of the Russian Federation. To solve this problem, the study has developed methodological tools for assessing the use of the budget potential of the region. Mainly, it includes justification of priorities and directions of using the budget potential of the region, determination of the proportion of priorities and its dynamics, calculation of the importance of priorities based on a modified formula of their elasticity according to the maximum achieved budget potential of the region. In practice, the application of the developed methodological tools will make it possible to measure and adjust the ratio of directions and priorities for the use of the budget potential of the region, depending on the goals and conditions of the development of the social sphere and the economy. According to the developed tools, as well as on the basis of official reporting data from the Federal Treasury, the Federal State Statistics Service, and the Ministry of Finance of the Russian Federation, an approbation diagnosis of the use of budget potential was carried out on the example of 85 subjects of the Russian Federation over a 15-year period from 2006 to 2020. It was determined that 7/10 of the realized budget potential of the subjects of the Russian Federation was used for the current priority, 2/10 — for transfer, 1/10 — for investment. The empirical results obtained in the work confirmed the hypothesis that the use of budget resources of regions for short-term stabilization purposes is more important than financing longterm stimulation of socio-economic development of territories. According to the results of the approbation, ways to increase the efficiency of using the budget potential of the region to stimulate its socio-economic development are identified.