6th Month Research Articles

Is The Dorsal Dartos Flap Rotation Technique Successful in Children with Isolated Penile Torsion?

Penile torsion is a counterclockwise rotational anomaly of the penile shaft or glans. We aimed to evaluate the results of dorsal dartos flap rotation technique in children with isolated penile torsion. 5470 boys who applied to our clinic between 2012 and 2022 for circumcision were evaluated for congenital isolated penile torsion. They were classified according to the degree and direction of torsion and clinical findings were analyzed. According to the degree of torsion, penile degloving or dorsal dartos flap rotation technique with circumcision was performed. Patients whose torsion corrected after penile degloving were excluded from the study. The results of dorsal dartos flap rotation technique were evaluated. Results: Congenital isolated penile torsion ≥60° was identified in 1.04 % (n=57) of the children. Eight patients whose torsion corrected after penile degloving were excluded from the study. 49 patients who underwent dorsal dartos flap rotation had a mean age of 4.94 years (1-9) and a mean operation time of 29.9 min (20-40). The mean degree of torsion was 77.6° (60-110). The mean operation times in the < 90° and ≥ 90° dorsal dartos flap groups were statistically significant (p<0.05). Residual torsion was statistically significant in the < 90° and ≥ 90° dorsal dartos flap groups (p<0.05). At the postoperative 1st and 6th month follow-ups, torsion less than 10 degrees was observed in 3 patients who underwent dorsal dartos flap rotation technique. No residual torsion was observed in other patients. Isolated penile torsion cases should not be overlooked during circumcision. It seems possible to obtain successful results with dorsal dartos flap rotation in moderate and severe torsions.

Assessing the efficacy and quality of Life improvements of botulinum toxin type a with topical minoxidil versus topical minoxidil in male androgenetic alopecia: a randomized controlled trial.

Androgenetic alopecia (AGA) is a common type of hair loss in men and efficacy and safety of current medical treatment remain limited. Therefore, the present study aimed to investigate the efficacy and safety of botulinum toxin type A (BTA) combined with Minoxidil in patients with AGA. 60 male patients were included in this study and control group received topical 5% Minoxidil and the treatment group received BTA combined with topical 5% Minoxidil. BTA injections (60-70 U) were administered at 30-35 scalp sites. Head photographs were taken at baseline, 2nd, 4th, and 6th months. Clinical descriptions recorded scalp conditions, and patient satisfaction along with Dermatology Life Quality Index scores were documented. The treatment group (TG) showed significant hair growth differences compared to the control group (CG) at the 4th month (P < 0.001) and 6th month (P = 0.0046) post-treatment. TG had improved Investigator Global Assessment (IGA) scores in the 4th month (P = 0.0001) and 6th month (P = 0.0259) compared to CG. Patient satisfaction in TG for hair growth and scalp improvement was higher than CG (all P < 0.05). TG exhibited substantial quality of life improvement at the 4-month (P = 0.0009) and 6-month (P = 0.0099). No adverse reactions were observed post-botulinum toxin injection. BTA combined with Minoxidil effectively promotes hair growth, enhances the quality of life, and alleviates scalp symptoms in male AGA patients at 4th and 6th months, with no adverse effects compared to Minoxidil alone.Trial registration number: Ethics Committee of Shanghai Tongji Hospital (ID: K-2018-026).

The association between preterm birth and the supplementation with vitamin D and calcium during pregnancy

Although vitamin D (VD) supplementation or calcium supplementation during pregnancy has become publicly accepted and part of health care behavior, the effect of co-supplementation on preterm birth remains unclear. To explore whether the supplementation with vitamin D and calcium during pregnancy is associated with preterm birth. The study was the baseline survey from the birth cohort in Jinan, which was built at one month after the baby birth. Preterm birth and monthly VD and calcium supplementation during pregnancy were obtained by the questionnaire. The logistic model was conducted to exam the association. The distributed lag nonlinear model was applied to explore the critical window for the supplements. Preterm birth occurred in 4.4 % (285/6501) of the study subjects with single live births and the rates were 39.7% and 82.6% for single VD supplementation or calcium supplementation in pregnancy. The adjusted OR (95% CI) for preterm birth was 1.428 (1.115-1.829) related to VD and 0.883 (0.652-1.216) related to calcium. It is interesting to note that the increased risk of preterm birth with VD supplementation during pregnancy was only seen in pregnant women who supplemented with calcium (OR was 1.600) and had a significant increase in preterm birth weight (P=0.040). Besides, supplementation VD with calcium during pregnancy from the 3rd to 6th month during pregnancy was associated with preterm birth (OR3rd=1.216, 95% CI: 1.119-1.320; OR4th=1.275, 95% CI: 1.152-1.411; OR5th=1.279, 95% CI: 1.130-1.446; OR6th=1.208, 95% CI: 1.076-1.356). Moreover, birth weight mediated 10.8% of the total effect of supplementation on preterm birth. Women who supplemented with VD among taking calcium during pregnancy were more likely to experience preterm birth, and birth weight partly mediates the effect. The critical window for association between supplements and preterm birth may be from the 3rd to 6th weeks of pregnancy.

The effect of an educational video about healthy diet on metabolic control of patients on hemodialysis: an interventional study with a one-year follow-up

BackgroundAdherence to diet is effective for metabolic control in patients on hemodialysis. There are educational pamphlets or booklets to improve patients’ knowledge about healthy diets. As video presentation is more desirable than the presentation of readable materials, we designed an educational video on healthy diets in renal failure patients who was played during several sessions of hemodialysis. We compared the effect of this modality on the knowledge, attitudes and metabolic control of the patients before and after the intervention.MethodsIn this interventional study, all the patients who were referred to the hemodialysis ward at Ashrafi-Esfahani Medical Center (Tehran, Iran) between May 2018 and March 2019 were enrolled (N = 190). Totally, 130 patients had inclusion criteria. An educational video about a healthy diet was shown seven times (once a week in the first month, once every two weeks in the second month, and once in the third month) during hemodialysis for the patients. The nephrologist prepared a video in the form of a lecture with graphic images for 20 min based on the healthy nutrition of the Kidney Federation of Iran’s Guide for hemodialysis patients. The questionnaire was completed in terms of awareness and attitudes, and blood and urine tests were performed at the 1st, 3rd, and 12th months. Serum parameters, including electrolytes, lipid profile, CBC-diff, dialysis efficacy (Kt/V), and the URR (urine filtration rate) were examined. Pre and post intervention values were compared via the statistical analysis performed using IBM SPSS. P-Value < 0.05 was significant.ResultsThe data of 128 people were analyzed at the end of the study. 55% of patients were 10–40 years old and 60% were male. 56% of patients were illiterate or had an elementary school education. The most common underlying diseases were hypertension and diabetes mellitus. Ten to 19% of participants had enough knowledge about the various components of a healthy diet for patients on hemodialysis. Approximately 25%, 14%, and 45% of the participants consumed a healthy diet for breakfast, lunch and dinner, respectively. A comparison of the mean values of the serum parameters before and after the intervention revealed significant changes in phosphorus, blood urea nitrogen, and hemoglobin with mean differences of -118.41 ± 22.84, 21.51 ± 10.38 (both P < 0.001), and 0.29 ± 1.18 (P = 0.044), respectively. The mean Kt/V was similar at all phases.ConclusionThe use of an educational video was effective for normalizing the metabolic parameters in patients under hemodialysis and can be an appropriate option, especially for illiterate patients.Trial registrationIRCT2016082229481N1.

Growth pattern, growth deceleration, and relevant predictors in girls treated with GnRHa: a retrospective longitudinal study.

This study aimed to analyze the height growth pattern and the incidence of significant growth deceleration in girls with CPP and EFP on GnRHa treatment, and thereby identify relevant predictors of growth deceleration. The data of 99 girls diagnosed with CPP and 47 girls with EFP were included in this retrospective analysis. The incidence of growth deceleration was calculated in both the first and second years. Multivariate logistic regression analysis was used to identify predictors indicative of growth deceleration. Growth velocity (GV) trajectories showed gradual decreases to the nadir at 18months of treatment, and then they recovered till the 24th month of treatment, especially in girls with CPP. Nevertheless, the recovery was significantly greater in the CPP group than EFP. In the first year, no significant difference in the incidence of growth deceleration was found between the CPP group and the EFP group [17.35 vs. 25.53 %, p=0.249]; in the second year, the CPP group had alower incidence than the EFP group [42.86 vs. 76.92 %, p=0.027]. The multivariate logistic regression analysis suggested that bone age (BA) was an independent predictor of growth deceleration (OR=2.264, 95 % CI: 1.268-4.042, p=0.006). The result of ROC curves showed the cut-off value of BA was 11.05 years. GV varies at different periods during GnRHa treatment. GnRHa should be used with more caution for EFPtreatment than for CPP. BA can be used to predict the occurrence of growth deceleration during GnRHa treatment.

A prospective randomized controlled study of multi-intravenous infusion of umbilical cord mesenchymal stem cells in patients with heart failure and reduced ejection fraction (PRIME-HFrEF) trial: Rationale and design

Background and objectiveThe use of mesenchymal stem cells for heart failure treatment has gained increasing interest. However, most studies have relied on a single injection approach, with no research yet confirming the effects of multiple administrations. The present trial aims to investigate the safety and efficacy of multi-intravenous infusion of umbilical cord-mesenchymal stem cells (UC-MSCs) in patients with heart failure and reduced ejection fraction (HFrEF). MethodsThe PRIME-HFrEF trial is a single-center, prospective, randomized, triple-blinded, placebo-controlled trial of multi-intravenous infusion of UC-MSCs in HFrEF patients. A total of 40 patients meeting the inclusion criteria for HFrEF were enrolled and randomized 1:1 to the MSC group or the placebo group. Patients enrolled will receive intravenous injections of either UC-MSCs or placebo every 6 weeks for three times. Both groups will be followed up for 12 months. The primary safety endpoint is the incidence of serious adverse events. The primary efficacy endpoint is a change in left ventricular ejection fraction (LVEF) measured by left ventricular opacification (LVO) with contrast echocardiography and magnetic resonance imaging (MRI) at 12 months. The secondary endpoints include a composite of the incidence of death and re-hospitalization caused by heart failure at the 12th month, serum NT-proBNP, growth stimulation expressed gene 2 (ST2), and a change of right ventricular structure and function. ConclusionsThe PRIME-HFrEF study is designed to shed new light on multiple UC-MSC administration regimens for heart failure treatment.

Microbiome of craft hard cheeses from raw goat milk during ripening

The production of craft cheeses from goat milk in small farms in Ukraine is becoming increasingly widespread. The uniqueness of goat cheeses made from raw milk is attributed to the significant diversity of microbiological processes that occur during their ripening, involving natural strains of bacteria, fungi, yeasts, and cheese mites. Therefore, this research aimed to determine the microbial composition of Caciotta and Canestrato goat cheeses during their ripening process. The number of mesophilic aerobic and facultative anaerobic microorganisms (MAFAM) in Caciotta cheese was stable on the 10th day, the 1st, and the 12th month, and decreased by 1.18–1.27 lg CFU/g by the 24th month of ripening. The number of mold fungi and yeasts in Caciotta cheese peaked in the 1st month but they were not detected in the 12th and 24th months of ripening. Lactic acid bacteria in Caciotta cheese formed the basis of MAFAM and were represented by Lactobacillus plantarum on the 10th day and the 1st month of ripening, Lactobacillus brevis and Leuconostoc pseudomesenteroides in the 12th month, and L. brevis and Leuconostoc mesenteroides in the 24th month. In 24-month-ripened Caciotta cheese, Escherichia coli, Enterobacter ludwigii, E. durans, E. faecalis, and E. hirae were detected. Lactic acid bacteria in Canestrato cheese formed the basis of MAFAM and were represented by L. mesenteroides from the 10th day to the 3rd month of age, L. pseudomesenteroides in the 6th month, and L. plantarum in the 12th month. Canestrato cheese was characterized by a significant presence of mold fungi and yeasts in all ripening periods except for the 6th month. In 12-month-ripened Canestrato cheese, Enterobacter cloacae, Bacillus cereus, Enterococcus durans, E. hirae, and E. faecalis were isolated. Cheese mites, Acarus siro, in various stages of development were found in the rind of both cheeses starting from the 6th month of ripening. The results of the researchers provide new data on the microbiome of craft hard cheeses made from raw goat milk and can be used to develop methods for controlling the population size of A. siro mites during their ripening.

The Efficacy of Triple Shoulder Injection with Steroids and Ozone in the Treatment of Chronic Shoulder Pain and Range of Motion Limitation

Objective: This study aimed to evaluate and compare the therapeutic effects of fluoroscopy-guided triple shoulder injections with steroids and, a combination of steroids and ozone. Methods: Data were retrospectively collected from the files of 70 patients diagnosed with non-specific chronic shoulder pain and received triple shoulder injections. The patients were divided into two groups. One group included triple shoulder injections with steroids under fluoroscopic guidance, while the other group included combination of steroids and ozone. Pain intensity was evaluated with the Visual Analog Scale (VAS), the patient's quality of life and functionality were assessed using the Shoulder Pain and Disability Index (SPADI), and the active range of motion (ROM) of shoulder abduction, external rotation, and flexion were measured by goniometry. Beck Depression Inventory (BDI) was used to measure the severity of depression before the procedure. All measurements were recorded at baseline and 1, 3, and 6 months after the procedure. Results: Baseline characteristics were similar in both groups. There was no statistical difference in VAS scores between the two groups at baseline, 1st, and 3rd months. However, in the 6th months, the VAS scores of patients treated with steroids plus ozone were significantly lower than those of patients treated with steroids (P&lt;0.001). Both groups showed significant improvements in SPADI pain, disability, and total subscores compared to pre-treatment values (P &lt; 0.001). There was a significant improvement in the ROM of the shoulder joint in both groups (p&lt;0.001). However, patients who received ozone and steroid treatments showed a significantly greater increase in SPADI and ROM of shoulder joints in the 6th months (p&lt;0.001). There was a positive correlation between BDI score and pain duration, and the severity of depression had no statistically significant effect on VAS scores. Conclusion: Results of this study revealed that triple shoulder injection with steroids or a combination of steroids and ozone proved to be an effective therapeutic approach for patients suffering from shoulder pain and limited mobility. The combination of ozone with steroids may lead to better results than using steroids alone. Furthermore, a long duration of pain increases the risk of chronic depression in patients.

Gingival Depigmentation by 810 nm Diode Laser and Cryosurgery Using 1,1,1,2-Tetrafluoroethane: A Clinical Study

Abstract Introduction: Pigmented gingival tissue is a common complaint of patients as unaesthetic. There is a dearth of literature comparing the efficacy of depigmentation by cryosurgery using a biocompatible material 1,1,1,2-tetrafluoroethylene gas and diode laser, which are relatively newer techniques. The study aims to evaluate and compare the efficacy of two different modalities of gingival depigmentation – 810 nm diode laser and cryosurgery using 1,1,1,2-tetrafluoroethane in managing gingival melanin pigmentation. Materials and Methods: A randomised controlled split-mouth trial was conducted on 15 participants. Depigmentation was done using an 810 nm diode laser and a cryosurgery technique using 1,1,1,2-tetrafluoroethane. Re-evaluation was performed at the 1st, 3rd and 6th months postoperatively. Dummett’s Oral Pigmentation Index (DOPI), Hedin’s Melanin Index (HMI), the Visual Analogue Scale for pain and Photometric analysis (RGB scale) were recorded and analysed. Results: DOPI and HMI in the subjects treated by laser and cryosurgery showed statistically significant differences (P &lt; 0.001) from baseline to 1 month, 3 months and 6 months. Intergroup comparison of RGB scores between the laser and cryosurgery depicted no significant difference at baseline (P = 0.06). Conclusions: Cryosurgery using 1,1,1,2-tetrafluoroethylene and laser ablation using an 810 nm diode laser technique was found to be equally effective for treating gingival pigmentation.

Optimizing HIV care: Insights from CD4 count, viral load, and demographic factors in a tertiary care centre of South Gujarat

PurposeDespite advancements in prevention, diagnosis, and treatment, HIV/AIDS remains a critical health concern, particularly in India. This study contributes valuable insights into HIV management strategies. This prospective and retrospective longitudinal observational study aimed to analyze the trends in CD4 cell count and viral load suppression among adult People Living with HIV (PLHIV) undergoing antiretroviral therapy (ART) and evaluate the influence of demographic factors and ART adherence on these parameters at the ART Centre of New Civil Hospital, Surat, India. Materials & methodsAdult PLHIV registered and initiated on ART between June 2017 and May 2018 at ART-NCH, Surat with Continuous follow-up until 2023 were included in the study. Data was collected and Statistical analysis was performed using Microsoft Excel and SPSS software. Other factors were evaluated for their influence on treatment outcomes. ResultsA longitudinally analyzed data from 365 adult PLHIV receiving ART with continuous follow-up until 2023 revealed significant trends, with CD4 counts increasing from 425 (1st month) to 612.67 (24th month), indicating improving immune function. Individuals on first-line ART regimens had significantly higher odds (OR: 3.5, 95 % CI: 1.1–11.3) of achieving CD4 counts ≥350 compared to those on second-line regimens. Adherence to treatment (OR: 1.98, 95 % CI: 1.1–3.4) also increased the odds of attaining CD4 counts ≥350. Viral load suppression was achieved in 353 out of 365 participants. ConclusionThis study highlights the need for tailored interventions to optimize immune recovery and viral load suppression among PLHIV. Recommendations include targeted intervention to improve long-term health outcomes.

Assessment of growth, and ion uptake of plant species, Conocarpus erectus and Dodonaea viscosa, on industrial solid waste

Present study assessed the growth of two plant species and ion uptake by them grown on different proportion of industrial solid waste and garden soil. The industrial waste having high concentration of chemicals were used with garden soil at different proportion i.e. 0% (T0), 5% (T1), 10% (T2), 15% (T3) and 20% (T4). Two species namely Conocarpus erectus (alien plant) and Dodonaea viscosa (indigenous) were used as test plants in pot study. Different parameters including growth, physiology, and anatomy of plants and concentration of cations (Na+, K+, Ca2+, and Mg2+) in the plant shoot and root were measured at different time duration (initial, 1st, 2nd, 3rd and 4th month). The key objective of the study was to use these plants to establish their plantations on the barren lands where industrial solid wastes were being disposed of. C. erectus showed better growth than D. viscosa, as well as more uptake of ions. A significant increase in plant growth was observed in fourth month in T1, where plant height reached 24.5% and 46% for C. erectus and D. viscosa, respectively. At harvest, in C. erectus, no significant difference in the fresh (65–78 g) and dry weight (24–30 g) of the shoot was observed across treatments compared to the control. In D. viscosa, at the time of harvest, the fresh and dry weights of the root and shoot showed a strong, significantly decreasing pattern across T1, T2, and T3, leading to the death of the plant at T3 and T4. Further, optimum ratio of waste soil to garden soil was found as 10:90 and 20:80 to establish the plantations of D. viscosa and C. erectus, respectively in areas where such solid waste from industries are disposed. Findings can be used for the restoration of such solid waste for the sustainable management of industrial areas and their associated ecosystems.

The Post-COVID-19 Functional Status Scale in moderate and severe COVID-19 infections in a tertiary referral hospital in Indonesia: a retrospective study

Background &amp; objective: Coronavirus disease 2019 (COVID-19) is known to have caused respiratory function derangement that can affect changes in the body's physiological conditions even after the active phase of infection is over. This study aimed to overview the Post-COVID-19 Functional Status (PCFS) scale at the 3rd and 6th months after treatment of moderate to severe COVID-19 infections in our tertiary referral hospital. Methodology: A descriptive observational study was conducted for confirmed COVID-19 patients with moderate to severe symptoms treated in Hasan Sadikin Hospital from June-August of 2021 by following them at third- and sixth-month post-infection and their PCFS was recorded. A total of 153 patients were enrolled in the study. Results: Eighty subjects (52.3%) were male, and 91 subjects (59.4%) had an average body mass index. Thirty-seven (24.2%) patients were diagnosed with severe symptoms, and 116 (75.8%) were diagnosed with moderate symptoms. In their third month post-infection, 30.7% of patients were on a scale of 0, 32.7% on a scale of 1, 20.9% on a scale of 2, 12.4% on a scale of 3, and 3.3% on a scale of 4. In their sixth month post-infection, 81.7% of patients were on a scale of 0, 15% on a scale of 1, and 3.3% on a scale of 3. Conclusion: The assessment of post-COVID-19 functional status has a significant role in understanding the pathophysiology and recovery process of the disease. The patients are recommended to have medical check-ups regarding organ function to determine the impact of COVID-19 and advised to undergo medical rehabilitation to return to their initial functional status. Keywords: COVID-19; Functional Status; PCFS; Post-Infection; Questionnaire Citation: Suwarman S, Rahman FA. The post-COVID-19 Functional Status Scale in moderate and severe COVID-19 infections in a tertiary referral hospital in Indonesia: a retrospective study. Anaesth. pain intensive care 2024;28(4):633−639; DOI: 10.35975/apic.v28i4.2505 Received: Mar 26, 2024; Reviewed: June 5, 2026; Accepted: June 6, 2026

Correlation of Urinary Soluble CD163 Levels With Disease Activity and Treatment Response in IgA Nephropathy

BackgroundThe TESTING trial demonstrated that corticosteroids reduce the risk of kidney failure in IgA nephropathy (IgAN) patients but increase the risk of serious adverse events. Reliable noninvasive biomarkers are needed to identify patients who would benefit most from corticosteroid therapy. Previous studies suggest glomerular macrophage infiltration is associated with the response to immunosuppressive therapy in IgAN and urinary soluble CD163(u-sCD163, a marker of M2c macrophage) is correlated with clinical remission in vasculitis. This study aims to investigate the association between u-sCD163 and response of steroids therapy in IgAN. MethodsWe measured u-sCD163 in patients from a large IgAN cohort including China participants of the TESTING trial. The correlation of baseline or serial u-sCD163 and their response of corticosteroids therapy or kidney outcomes were investigated. ResultsIn cross-sectional analysis, u-sCD163 levels correlated with kidney macrophage infiltration, especially in crescentic areas, and with active lesions. Subgroup analysis of the TESTING cohort showed higher levels u-sCD163 were associated with greater benefits from corticosteroids therapy in proteinuria remission [OR, 35.56 (95% CI, 7.62-292.34) vs 3.94 (95% CI, 1.39-12.93), p for interaction 0.036]. Corticosteroids therapy significantly reduced u-sCD163 levels at 6th month compared to placebo group [79% (IQR 58%,91%) vs 37% (-11%,58%), P<0.001]. There was no difference in the suppressive effects on u-sCD163 by either dosage of corticosteroids (full and reduced-dose). The suppression of u-sCD163 was significantly associated with a reduced risk of kidney progression events (adjusted HR 0.52,95% CI 0.30 to 0.93, P=0.027). ConclusionsU-sCD163 is a reliable noninvasive biomarker associated with active pathological lesions in IgAN and can guide glucocorticoid therapy.

Results of Stereotactic Body Radiotherapy With CyberKnife-M6 for Primary and Metastatic Lung Cancer.

The aim of the study was to evaluate the efficacy of stereotactic body radiotherapy (SBRT) using the CyberKnife-M6 (CK-M6) with lung optimized treatment (LOT) module in patients with primary lung cancer and lung metastases. Forty-two lesions from 35 patients were treated between 2019 and 2022. Four-dimensional computed tomography images were obtained when the patients were in a free breathing modality. Tracking modality was selected prospectively according to the visibility of the target. The median prescribed dose was 48 Gy in four fractions (fx) (28 - 55 Gy/1- 7 fx). The median age was 68 years (47 - 82 years), and 43% of cases were adenocarcinoma. The median lesion size was 15 mm (6 - 36 mm). Complete, partial and stable responses were obtained as 26%, 62%, and 9.5% at a median of 2 months (1 - 6 months), and 35.5%, 47.5% and 5% at the 12th month evaluation, respectively. Grade 3 and higher toxicity was not observed in any case. The mean and 2-year overall survival (OS) was 31.5 months and 54%, and the local recurrence-free survival (LRFS) was 29.6 months and 51%, respectively. In univariate analysis, target lesion type, complete response (CR), and higher esophagus maximum dose were favorable factors for OS and LRFS (P < 0.05). The CR at 12th month evaluation remained significant in multivariate analysis in terms of OS (hazard ratio = 8.602, 95% confidence interval: 1.05 - 70.01; P = 0.044). A mean LRFS of 29.6 months and OS of 31.5 months were obtained in patients with primary and metastatic lung cancer. With a median treatment time of 25 min, motion-managed strategy with CK-M6-LOT-based SBRT is an effective, safe, and comfortable treatment method for lung cancer.

Evaluation of the effect of atorvastatin on corneal endothelial cells during the initial 12-month period after acute coronary syndrome.

It was aimed to compare corneal endothelial changes during the initial 12-month period in which patients started using atorvastatin after a diagnosis of acute coronary syndrome (ACS). Forty-six participants (group 1) who underwent cardiac angioplasty and stenting for ACS and started using 80 mg atorvastatin in the early period were included in the study. In the study, a control group comprising 71 healthy adults (group 2) was included. These individuals did not use medication for any known systemic disease, had never taken statins, had no history of ocular surgery, and did not have any cornea-related eye diseases. Baseline and 12th month endothelial evaluations of group 1 and 2 participants were compared using specular microscopy. There were 28 female and 18 male participants in group 1 and 48 female and 23 male participants in group 2 (P = 0.455). The mean baseline corneal endothelial cell density (CECD) was not significantly higher in group 1 compared to group 2 (2471.4 ± 200 cells/mm2 vs 2428.2 ± 539.8 cells/mm2, P = 0.230). When the change between baseline and 12th month CECD was examined, the decrease in group 2 was significantly different from that in group 1 (-15,2 ± 31,9 and -44,8 ± 49,6, P = 0,002). Although the percentage of hexagonal cells decreased significantly in group 2 participants, no significant change was observed in group 1 (respectively; P < 0.001, P = 0.073). The endothelial cell coefficient of variation did not differ significantly in group 1 participants over a 1-year period (P = 0.192), and a significant increase was observed in group 2 (P < 0.001). This study revealed that atorvastatin may have a positive effect on corneal endothelium cell density and morphology.

Impact of socio-vocational rehabilitation on work productivity and social behavior of inpatients with chronic schizophrenia.

A large proportion of persons with schizophrenia are either abandoned by their family members in mental hospitals or do not have any family members to look after them. Therefore, almost 2/3rd of hospital beds are occupied by chronic schizophrenic patients. Very few beds are available for the treatment of acute mental patients who need urgent hospitalization. To assess the impact of a comprehensive socio-vocation rehabilitation package on the work productivity and social behavior of persons with chronic schizophrenia. Sixty chronic schizophrenic inpatients were included in the present study. Sociodemographic and clinical details were collected on a specially designed Performa for the study. Each patient was rated on a job-up-to-date form at baseline, 3 months, and 6 months after intervention. Data related to the vocational outcome were collected on the supervisor's evaluation form at the end of the first month and then after every month till the end of 6 months after intervention. The patient's social behavior was measured on the Social Behavior Schedule at baseline, 3 months, and 6 months after intervention. Significant improvement was found in the area of vocational outcomes when a comparison was made from the 1st month to the 6th month. Marked improvement was also noticed in their social behaviors after social and vocational rehabilitation. The overall results suggest that chronic schizophrenic inpatients can be properly rehabilitated if opportunity is provided to them.

Effects on calcium phosphate homeostasis after sodium-glucose cotransporter 2 inhibitor in patients with advanced chronic kidney disease and type 2 diabetes mellitus

BackgroundThe effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on calcium phosphate homeostasis in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) remain uncertain. MethodsA retrospective observational cohort study of patients with T2DM at CKD stage G3b-5ND who received SGLT2i as compared to control from 1 January 2015 through 31 December 2021 was recruited. Propensity score assignment at 1:3 ratio by logistic regression was done. All patients were followed for 12 months. Outcomes were changes in phosphate level. ResultsWe analyzed 1,450 SGLT2i users and 4,350 control subjects. At the 12th month, SGLT2i users had a slower increase in phosphate levels (absolute change: −0.01 ± 0.28 vs + 0.14 ± 0.34 mmol/L; percentage change: −0.74 % ± 25.56 vs + 10.88 ± 28.15 %, P for both < 0.001). The proportion of patients with high phosphate was lower with SGLT2i (8.2 % vs 24.6 % increase). In the generalized estimating equation, SGLT2i was linked to a longitudinal reduction in phosphate (B −0.039, P<0.001). ConclusionsSGLT2i can effectively slow down the progression of phosphate retention in advanced CKD with T2DM.

Increase in Breastfeeding Rates in Baby-Friendly Hospitals in Greece: Comparison with the National Study of 2017.

The primary purpose of this study was to correlate the factors influencing the onset and duration of exclusive breastfeeding (EBF) and breastfeeding (BF) rates at different time points in baby-friendly hospitals (BFHs) in Greece. This study was conducted from October 2020 to January 2022. The sample consisted of 1201 mothers with corresponding newborn births out of the total 7201 that took place during the same period. We used a questionnaire that the mothers answered during the first hour after birth, before being discharged from the maternity hospital, and at the 2nd, 4th, and 6th month of the infant's life. The results were compared with the data of the national study from 2017 (concerning births from general maternity hospitals and not only from BFHs). The EBF rate within 1 h after birth was 71.3%, which gradually declined to 21.2% in the 6th month. Between the two studies, differences were recorded in BF and EBF rates at the 6th and 4th month of the infants' life, respectively, especially in mothers who are less likely to breastfeed (e.g., those without breastfeeding experience, those over 40 years old, etc.). This study showed that EBF and BF rates are higher in infants born in BFHs compared to non-BFHs both during their hospitalization in the first days of life and during the first 6 months of life. BFHs also play a decisive role in mothers who, due to their socio-economic profile, have lower chances of starting to breastfeed.

Quantifying donor site morbidity in anterior cruciate ligament reconstruction using peroneus longus tendon autograft

Objectives: The objective of this study was to assess the donor site morbidity in patients having anterior cruciate ligament reconstruction (ACLR) using peroneus longus tendon (PLT) autograft. Methods: A prospective cohort study was conducted at the orthopedic department of Pakistan Atomic Energy Commission General Hospital, Islamabad, from July 2021 to July 2023. A total of 150 patients aged between 20 and 40 years with an anterior cruciate ligament injury requiring ligament reconstruction were included in the study. Exclusion criteria included previous ankle ligamentous injuries, fractures or surgeries around the ankle, and high-risk sports like football. After the ACLR surgery, the patients were assessed for pain, range of motion (ROM), and muscle power in the 6th week, 3rd month, and 6th month. Return to jogging without discomfort at the ankle during 1st min of jogging was assessed at six months. Results: Of the 150 patients, 142 (94.6%) were male and 8 (5.4%) were female. The mean age of participants was 32.53 ± 4.78 years. Pain and loss of ROM around the ankle were reduced after six months compared to three months and six weeks, that is, P &lt; 0.05. Muscle power was increased after six months (n = 152; 94.0%) (P &lt; 0.001). In the 6th month, 133 patients (88.7%) were able to jog without discomfort around the ankle joint during the 1st min of jogging, but 17 patients (11.3%) started jogging after six months without discomfort at the ankle joint during the 1st min of jogging (P &lt; 0.001). Conclusion: ACLR using the PLT autograft resulted in a good functional outcome, smooth rehabilitation with an early return to sports, and minimal complications at the donor site.

FAILURE OF THE FIRST BIOLOGIC TREATMENT IN PATIENTS WITH SPONDYLOARTHRITIS: DATA FROM THE MOROCCAN REGISTRY OF BIOLOGICAL THERAPIES IN RHEUMATIC DISEASES (RBSMR)

Introduction:Spondyloarthritis is a group of chronic inflammatory rheumatic diseases that commonly affect young adults. The advent of biological background treatments has revolutionized the management of these conditions, although some patients may not respond adequately to these interventions. Objectives: To assess the prevalence of first biological treatment failure in spondyloarthritis and identify the factors associated with this outcome. Methods: Our study included patients with spondyloarthritis retained according to the ASAS criteria, aged over 18 years, treated with biological treatment, and providing written informed consent. The participants were sourced from the ten rheumatology departments in Morocco, utilizing data from the RBSMR registry, a multicenter historical-prospective registry. Primary failure was characterized by treatment inefficacy within the initial six months, while secondary failure concerns cases of ineffectivenessbeyond six months of treatment. Patients were assessed every six months with a scheduled follow-up period of three years. Inclusion began in June 2017 and ended in January 2019, when the database was first frozen. Results: A total of 194 patients were included in the study. The mean age was 40.23 years with a standard deviation of 13.68. The gender ratio was 1.73 (M/F). The average disease duration was 615.9 weeks with a standard deviation of 349.12. HLA-B27 antigen was positive in 66% of patients. Peripheral involvement was observed in 70% of patients, axial involvement in 96.4%, and enthesic involvement in 61.5%. Radiographic sacroiliitis was identified in 87.6% of patients, radiographic coxitis in 40.7%, and sonographic coxitis in 19.8%. Regarding extra-articular manifestations, 14.5% of patients experienced anterior uveitis, 6.9% had cutaneous psoriasis, and 10.7% had concomitant chronic inflammatory bowel disease. The ASDAS CRP indicated high activity in 50.9% of patients, and the BASDAI (spondyloarthritis activity index) exceeded 4 in 79.2% of patients. During the initial visit, 22.5% of patients were undergoing corticosteroid therapy, and 53.8% were receiving csDMARDs. Etanercept was the most commonly prescribed biological, accounting for 33%. Over the three-year follow-up, five primary failures and 17 secondary failures to the first biological treatment were observed (eight failures at the 12th month, six at the 18th month, and three at the 24th month), resulting in a prevalence of 11,85% for the failure of the first biological. In bivariate analysis, no statistically significant factors were found to be associated with the failure of the first biological at the 6th, 12th, or 24th month visits. However, at the 18th-month visit, both the average BASDAI and C-reactive protein (CRP) levels were statistically higher in patients who experienced failure with the first biological. Conclusion: The failure of the first biologicaltreatment is a rather rare situation in our study. Specific factors were notably linked to this failure and should be considered in patient management, particularly elevated BASDAI and CRP values. These factors have also been reported in the literature to be associated with first biological treatment failure, along with additional factors.