30-day Follow-up Period Research Articles

Efficacy of autologous micrografts technology: a promising approach for chronic wound healing and tissue regeneration-a pilot study.

This study explores the efficacy of Autologous Micrografts Technology (AMG) in treating chronic wounds refractory to traditional therapies. AMGs, derived from adipose tissue or dermis using a mechanical fragmentation process, were applied to patients with post-surgical dehiscence. A comprehensive evaluation of wound healing outcomes, including surface area reduction and complete healing, was conducted over a 90-day follow-up period. Additionally, the study investigated the cellular antioxidant activity of AMG solutions and characterized the exosomes obtained through mechanical disaggregation. Results indicate significant improvements (p < 0.05) in wound healing, with 91.66% of patients showing at least a 50% reduction in lesion size and 75% achieving complete healing by day 90. Notably, AMG technology demonstrated immediate efficacy with fat-only application, while combined dermis and fat micrografts showed longer-term benefits, particularly in chronic wounds. The study also elucidated the mechanism of action of AMGs, highlighting their role in enhancing cellular antioxidant activity and exosome-mediated tissue regeneration. Overall, these findings underscore the promising potential of AMG technology as a versatile and effective treatment option for chronic wounds, warranting further investigation into its mechanisms and clinical applications.

Enhancing ventricular remodeling and cardiac function in post-acute myocardial infarction with sacubitril/valsartan.

To evaluate the therapeutic effect of sacubitril/valsartan compared to enalapril in managing heart failure (HF) after percutaneous coronary intervention (PCI). From January 2018 to December 2021, 63 hospitalized patients diagnosed with HF following acute myocardial infarction (AMI) were enrolled in this prospective clinical trial. The observation group was comprised of 31 patients treated with sacubitril/valsartan (LCZ696) sodium tablets, while the control group, including 32 patients, received enalapril maleate tablets. All patients received standard HF therapy, including water-soluble aspirin, hydroclopidogrel sulfate, once-daily bivalirudin calcium, twice-daily metoprolol tartrate (dose titrated based on heart rate), once-daily spironolactone (dose adjusted for electrolytes), and once-daily dehydroimidazole (dose adjusted for electrolytes). HF symptom control, N-terminal B-type natriuretic peptide precursor (NT-proBNP) levels, cardiac anatomical parameters, heart rate, blood pressure, and 6-minute walking distance over a 90-day follow-up were assessed. The study is registered under ClinicalTrials.gov [ChiCTR2100042944]. On the 30th day post-discharge, the observation group exhibited a marked decrease in NT-proBNP levels and an improvement in left ventricular end-diastolic diameter, in contrast to the control group (both P<0.05). By the 90th day, the observation group showed significant improvements in left ventricular ejection fraction and left ventricular end-systolic diameter index, along with reduced blood pressure and serum creatinine levels (all P<0.05). Furthermore, the observation group displayed a more favorable New York Heart Association class distribution and enhanced performance in the 6-minute walk test (both P<0.05). No significant difference in the incidence of major adverse cardiovascular events was observed between the two groups during the 90-day follow-up period (P>0.05). Our findings indicate that sacubitril/valsartan (LCZ696) Sodium Tablets effectively enhance ventricular remodeling and cardiac function in patients with HF post-AMI, following a short-term treatment regimen. This therapeutic approach holds promise for improving clinical outcomes in this patient population.

Discharge Opioid Prescription and Consumption Following Surgery: The POPCORN Observational Study.

Few studies have evaluated opioid consumption after various inpatient surgical procedures. To describe opioid prescription patterns and to characterize patient-reported use of opioids after surgery. This single-centre prospective observational study was conducted between February and October 2021 at the Jewish General Hospital in Montréal, Quebec. Patients 18 years of age or older who underwent a surgical procedure, were hospitalized for 24 hours or longer after the procedure, and had an opioid prescription at the time of discharge were included. Data were collected for the quantity of opioids prescribed, as documented in hospital records, and the quantity consumed, as reported by participants. Various potential predictors of opioid consumption were explored, and data were also collected on patients' use of non-opioid coanalgesia, scores on the Numeric Rating Scale for pain, opioid renewal requests, and proper opioid disposal during the 30-day follow-up period. A total of 150 participants completed the study. The median dose prescribed was 10 opioid pills (75.0 morphine milligram equivalents). By the end of the follow-up period, a median of 1 pill (7.5 morphine milligram equivalents) had been consumed from the total amount in the discharge prescription. Overall, 66 participants (44.0%) did not consume any of the opioids prescribed at discharge. Of the total number of pills prescribed, 58.2% (1193/2050) were unused, and 7.0% (5/71) of participants with unused pills disposed of them properly. Following discharge from hospital, postoperative patients consumed a median proportion of only 10% of prescribed opioid pills. More than half of all prescribed pills were unused. Protocols implementing specific prescribing strategies warrant further investigation to evaluate their potential impact on opioid prescription and consumption.

IMPAHCT: A randomized phase 2b/3 study of inhaled imatinib for pulmonary arterial hypertension.

AV-101 (imatinib) powder for inhalation, an investigational dry powder inhaled formulation of imatinib designed to target the underlying pathobiology of pulmonary arterial hypertension, was generally well tolerated in healthy adults in a phase 1 single and multiple ascending dose study. Inhaled Imatinib Pulmonary Arterial Hypertension Clinical Trial (IMPAHCT; NCT05036135) is a phase 2b/3, randomized, double-blind, placebo-controlled, dose-ranging, and confirmatory study. IMPAHCT is designed to identify an optimal AV-101 dose (phase 2b primary endpoint: pulmonary vascular resistance) and assess the efficacy (phase 3 primary endpoint: 6-min walk distance), safety, and tolerability of AV-101 dose levels in subjects with pulmonary arterial hypertension using background therapies. The study has an operationally seamless, adaptive design allowing for continuous recruitment. It includes three parts; subjects enrolled in Part 1 (phase 2b dose-response portion) or Part 2 (phase 3 intermediate portion) will be randomized 1:1:1:1 to 10, 35, 70 mg AV-101, or placebo (twice daily), respectively. Subjects enrolled in Part 3 (phase 3 optimal dose portion) will be randomized 1:1 to the optimal dose of AV-101 and placebo (twice daily), respectively. All study parts include a screening period, a 24-week treatment period, and a 30-day safety follow-up period; the total duration is ∼32 weeks. Participation is possible in only one study part. IMPAHCT has the potential to advance therapies for patients with pulmonary arterial hypertension by assessing the efficacy and safety of a novel investigational drug-device combination (AV-101) using an improved study design that has the potential to save 6-12 months of development time. ClinicalTrials.gov Identifier: NCT05036135.

Preoperatively administered single dose of dexketoprofen decreases pain intensity on the first 5 days after craniotomy: A single-centre placebo-controlled, randomized trial.

Headache attributed to craniotomy is an underestimated and under-treated condition. Previous studies confirmed the efficacy of preemptive analgesia with non-steroidal anti-inflammatory agents. The aim of the present work was to test the hypothesis of whether a single preoperatively administered dose of dexketoprofen (DEX) has the potency to decrease postcraniotomy headache (PCH) as compared to placebo (PL). This is a single-centre, randomized, PL-controlled trial comparing the effect of a single oral dose of 25 mg DEX to PL on the intensity of PCH. Patients undergoing craniotomy were randomly allocated to DEX and PL groups. Patients rated their actual and worst daily pain using visual analogue scale (VAS) scores during intrahospital treatment (0-5 days) and 30 and 90 days postoperatively. Two hundred patients were included. DEX decreased the worst daily pain intensity in the first 24 h only; the 5-days cumulative score of actual pain was 9.7 ± 7.9 cm for the DEX group and 12.6 ± 10.5 cm for the PL group, respectively (p = 0.03). This difference disappeared in the late, 30-, and 90-day follow-up period. No differences in VAS scores could be detected in supra- and infratentorial cases among the DEX and PL groups. A single preoperative dose of 25 mg of DEX slightly decreases the intensity of PCH in the first 5 days after craniotomy but it does not have an effect on chronic headaches and postoperative analgesic requirements.

Disease Flares Following COVID-19 Vaccination in Patients with Inflammatory Bowel Disease.

Objective Flares of inflammatory bowel disease (IBD) can occur infrequently after vaccination for coronavirus disease 2019 (COVID-19), although the details of this phenomenon are poorly understood. To clarify the possibility of an unfavorable response in patients with IBD, we investigated IBD-related symptoms during the COVID-19 vaccination. Methods Between October 2021 and February 2022, we obtained the COVID-19 vaccination status of 411 IBD patients who were being treated at our institution. The disease course of IBD after vaccination was investigated in 188 patients with ulcerative colitis (UC) and 119 patients with Crohn's disease (CD) who had received at least one dose of the vaccine during the clinical remission phase. The baseline characteristics before vaccination were compared between the patients with UC with or without disease flares. Results During the 30-day follow-up period, eight patients with UC (4.3%) and one patient with CD (0.8%) experienced disease flares following vaccination. Disease flares occurred after the first vaccination in six patients and after the second vaccination in three patients. As for the timing of onset of disease flares, eight events (88.9%) occurred within one week of vaccination. Two patients required hospitalization, and one patient with CD required surgery for an intra-abdominal abscess. The baseline characteristics did not significantly differ between patients with UC who experienced flares and those who did not. Conclusion IBD flares following COVID-19 vaccination are rare and vaccination should therefore be recommended for patients with IBD. However, the possibility of disease flares should be considered for approximately one week after each vaccination, especially in patients with UC.

A Phase 2, Open-Label Study to Assess the Pharmacokinetics, Pharmacodynamics and Safety of Orally Administered Epeleuton in Patients with Sickle Cell Disease

Background. Sickle cell disease (SCD) is a rare hereditary multi-system disorder that is caused by a single mutation in the beta allele of the hemoglobin gene, leading to the production of sickle hemoglobin (HbS). HbS polymerizes when deoxygenated, resulting in red blood cell (RBC) sickling and membrane damage, ultimately leading to a cascade of events which include hemolysis, chronic anemia, inflammation, and vaso-occlusion. Despite recent progress, there is a need for additional disease-modifying therapeutic options. Epeleuton is 15-hydroxy eicosapentaenoic acid (15(S)-HEPE) ethyl ester, a novel synthetic second generation w-3 fatty acid which targets key drivers of hemolysis and multicellular adhesion. In preclinical studies in Townes humanized SCD mice and SCD patient RBCs, epeleuton acts as a disease-modifying agent by simultaneously decreasing (a) systemic and local inflammatory activation, (b) endothelial adhesion, (c) organ damage and (d) intravascular hemolysis and sickling. Epeleuton has been administered to 343 subjects in clinical trials, with a favorable safety and tolerability profile. Objective To evaluate the pharmacokinetics, pharmacodynamics and safety of orally administered epeleuton in patients with SCD. Study Design and Methods. This open-label, phase 2, multicenter study (NCT05861453) will enroll approximately 30 adult patients with a confirmed diagnosis of SCD (HbSS and HbSß0-thalassemia). Participants must have hemoglobin levels of 5.0-9.5g/dL at screening, 2-10 vaso-occlusive crises (VOCs) in the past 12 months, and a high adhesion index at screening defined as RBC laminin adhesion &amp;gt; 400 cells. Concomitant treatment with a stable dose of hydroxyurea is permitted during the study. Key exclusion criteria include receiving an RBC transfusion within three months of enrolment, receiving voxelotor, crizanlizumab or l-glutamine within six weeks of enrolment and, prior hematopoietic stem cell transplant. The trial has a 28-day screening period, followed by a 16-week treatment phase and a 30-day post-treatment follow-up period. Study participants will attend the clinic on 6 occasions at screening, baseline, weeks 4, 8 and 16 (end-of-treatment) and the week 20 post-treatment follow-up visit. Enrolled patients will receive epeleuton 2g BID (4g daily) for 16 weeks. Study endpoints include change from baseline in hemoglobin levels, hemolytic markers, assessments of RBC health, soluble adhesion molecules, RBC adhesion, whole blood adhesion and rates of VOC. Conclusion: Treatments that can simultaneously target hemolysis and cellular adhesion may have an important disease-modifying utility for patients with SCD. The results of this study are anticipated to confirm the potential of epeleuton to address multiple aspects of SCD and to guide the design and conduct of future studies in patients with SCD.

Association of a calcium channel blocker and diuretic prescribing cascade with adverse events: A population-based cohort study.

Prescribing cascades occur when a drug adverse event is misinterpreted as a new medical condition and a second, potentially unnecessary drug, is prescribed to treat the adverse event. The population-level consequences of prescribing cascades remain unknown. This population-based cohort study used linked health administrative databases in Ontario, Canada. The study included community-dwelling adults, 66 years of age or older with hypertension and no history of heart failure (HF) or diuretic use in the prior year, newly dispensed a calcium channel blocker (CCB). Individuals subsequently dispensed a diuretic within 90 days of incident CCB dispensing were classified as the prescribing cascade group, and compared to those not dispensed a diuretic, classified as the non-prescribing cascade group. Those with and without a prescribing cascade were matched one-to-one on the propensity score and sex. The primary outcome was a serious adverse event (SAE), which was the composite of emergency room visits and hospitalizations in the 90-day follow-up period. We estimated hazard ratios (HRs) with 95% confidence intervals (CI) for SAE using an Andersen-Gill recurrent events regression model. Among 39,347 older adults with hypertension and no history of HF who were newly dispensed a CCB, 1881 (4.8%) had a new diuretic dispensed within 90 days after CCB initiation. Compared to the non-prescribing cascade group, those in the prescribing cascade group had higher rates of SAEs (HR: 1.21, 95% CI: 1.02-1.43). The CCB-diuretic prescribing cascade was associated with an increased rate of SAEs, suggesting harm beyond prescribing a second drug therapy. Our study raises awareness of the downstream impact of the CCB-diuretic prescribing cascade at a population level and provides an opportunity for clinicians who identify this prescribing cascade to review their patients' medications to determine if they can be optimized.

Shock score for prediction of clinical outcomes among stable patients with acute symptomatic pulmonary embolism

BackgroundThe Composite Pulmonary Embolism Shock (CPES) score has been developed to identify normotensive patients with acute pulmonary embolism (PE) and a low cardiac index (referred to as normotensive shock). We aimed to externally assess the validity of this model for predicting a complicated course among hemodynamically stable patients with acute PE. MethodsUsing prospectively collected data from the PROgnosTic valuE of Computed Tomography scan (PROTECT) study, we calculated the CPES score for each patient and the proportion of patients with a score > 3. We calculated the test performance characteristics to predict a complicated course (i.e., death from any cause, hemodynamic collapse, or recurrent PE) and the discriminatory power using the area under the receiver operating characteristic curve. ResultsSixty-three of the 848 (7.4 %) patients had a complicated course during the 30-day follow-up period. Of the 848 enrolled patients, the CPES score was positive (i.e., score > 3) in 78 (9.2 %). The specificity was 92.1 % (723/785), the positive predictive value was 20.5 % (16/78), and the positive likelihood ratio was 3.22 for a complicated course. The areas under the receiver operating characteristic curve for a complicated course were 0.71 (95 % confidence interval [CI], 0.65–0.78). With the higher score risk classification threshold (cutoff score > 4), the proportion of patients designated as positive was 2.1 %, and the specificity was 98.1 %. When echocardiographic right ventricle (RV) dysfunction was replaced by computed tomographic RV enlargement, the specificity was 85.4 %, the positive predictive value was 14.2 %, and the positive likelihood ratio was 2.06 for a complicated course. When analyses were restricted to the subgroup of patients with intermediate-risk PE, the specificity and the positive predictive value for a complicated course were identical to the overall cohort. ConclusionsThe CPES score has acceptable C-statistic, excellent specificity, and low positive predictive value for identification of hemodynamic deterioration in normotensive patients with PE.ClinicalTrials.gov number: NCT02238639.

Association of antecedent statin use on 30-day, 60-day and 90-day mortality among Mississippi Medicaid beneficiaries diagnosed with COVID-19

ObjectiveTo assess if the antecedent statin use was associated with all-cause death among COVID-19 patients enrolled in Medicaid.DesignCohort study.SettingMississippi Medicaid population.ParticipantsThis study included 10 792 Mississippi Medicaid-enrolled patients between 18...

A novel imaging index for predicting adverse progression in acute-on-chronic liver failure related to hepatitis B virus: the low erector spine index

BackgroundIt is widely known that muscle mass influences the outcomes of many chronic diseases. Erector spine mass is a convenient parameter obtained from routine abdominal computed tomography (CT). The clinical application value of erector spine mass, and whether erector spine mass could predict the outcome of disease has not been studied.AimTo evaluate the role of the erector spine index (ESI) calculated based on abdominal CT imaging in the progression of acute-on-chronic liver failure related to the hepatitis B virus (HBV-ACLF).MethodsWe performed a retrospective study of 118 HBV-ACLF patients and calculated the ESI (the total erector spine area normalized for height2 in meters) for each patient through abdominal CT. The findings were analyzed regarding the progression of HBV-ACLF and the ESI at baseline, including mortality and the development of complications.ResultsThe ESI level was associated with mortality and the development of complications. During the 90-day follow-up period, patients with a low ESI (<12.05 cm2/m2) had higher mortality than those with a high ESI (≥ 12.05 cm2/m2) (51.7% vs. 26.7%), and the cumulative survival rates were 71.0%±4.6 and 85.8%±3.9, respectively (log-rank P = 0.003). The hazard ratios (HRs) calculated using univariable and multivariable analyses were 2.23(95% confidence interval (CI): 1.25–4.21, P = 0.005) and 2.52 (95% CI: 1.34–9.24, P = 0.011), respectively. Patients with a low ESI (<12.05 cm2/m2) had higher incidences of kidney dysfunction (43.5% vs. 23.2%, P = 0.029; log-rank P = 0.017) and hepatic encephalopathy (39.6% vs. 14.0%, P = 0.003; log-rank P = 0.010) than those with a high ESI. A low ESI was an independent risk factor for kidney dysfunction (adjusted HR = 1.36, 95% CI: 1.05–2.93, P = 0.043) and the development of hepatic encephalopathy (adjusted HR = 2.26; 95% CI: 2.05–3.13, P = 0.036). In addition, the presence of hepatic encephalopathy (the odds ratio (OR) = 2.26, 95% CI: 2.05–3.18, P = 0.006), spontaneous bacterial peritonitis (OR = 3.95, 95% CI: 1.01–5.46, P = 0.037), and kidney dysfunction (OR = 4.47, 95% CI: 1.02–9.64, P = 0.032) was independently associated with a low ESI in patients.ConclusionA low ESI is an independent risk factor for mortality in patients with HBV-ACLF, as well as the development of kidney dysfunction and hepatic encephalopathy.

Repeated electroporation enhances the responsiveness to cisplatin-based intra-tumoral chemotherapy in murine breast cancer: revival of the electro-chemotherapy concept

Background and aims: Electroporation demonstrated certain modulable actions on tumoral cell membrane permeability to increase the intracellular bioavailability of chemotherapeutic drugs. The current in vivo study aimed to investigate the synergic effect of concomitant electroporation application to the intratumoral administration of cisplatin on murine invasive ductal adenocarcinoma breast cancer. Methods: The fragments of the extracted tumor were implanted subcutaneously in healthy female Balb/C mice. Having reached the determined tumoral volume, the mice were randomly divided into five groups, including control, intratumoral cisplatin injection, tumoral electroporation application, electrochemotherapy (ECT), and double course ECT. The normalized tumoral volume and the inhibition ratios were calculated during a 30-day follow-up period. The data were tested by ANONA, and a statistically significant level was set at P&lt;0.05. Results: The inhibition ratio was significantly different between the intra-tumoral cisplatin administration and tumoral electroporation application groups compared to the control group (P&lt;0.05). ECT displayed superior results in comparison to the two later groups (P&lt;0.05). The double-course ECT group even represented a significant difference compared to the ECT group (P&lt;0.05). Conclusion: Concomitant ECT to the cisplatin intratumoral administration indicated contributive anti-tumoral impacts in an in vivo murine model of invasive ductal adenocarcinoma breast cancer. ECT promises further applications to overcome the occurrence of therapeutic resistance to chemotherapeutic drugs.

Telemedicine Buprenorphine Initiation and Retention in Opioid Use Disorder Treatment for Medicaid Enrollees

Early COVID-19 mitigation strategies placed an additional burden on individuals seeking care for opioid use disorder (OUD). Telemedicine provided a way to initiate and maintain transmucosal buprenorphine treatment of OUD. To examine associations between transmucosal buprenorphine OUD treatment modality (telemedicine vs traditional) during the COVID-19 public health emergency and the health outcomes of treatment retention and opioid-related nonfatal overdose. This retrospective cohort study was conducted using Medicaid claims and enrollment data from November 1, 2019, to December 31, 2020, for individuals aged 18 to 64 years from Kentucky and Ohio. Data were collected and analyzed in June 2022, with data updated during revision in August 2023. The primary exposure of interest was the modality of the transmucosal buprenorphine OUD treatment initiation. Relevant patient demographic and comorbidity characteristics were included in regression models. There were 2 main outcomes of interest: retention in treatment after initiation and opioid-related nonfatal overdose after initiation. For outcomes measured after initiation, a 90-day follow-up period was used. The main analysis used a new-user study design; transmucosal buprenorphine OUD treatment initiation was defined as initiation after more than a 60-day gap in buprenorphine treatment. In addition, uptake of telemedicine for buprenorphine was examined, overall and within patients initiating treatment, across quarters in 2020. This study included 41 266 individuals in Kentucky (21 269 women [51.5%]; mean [SD] age, 37.9 [9.0] years) and 50 648 individuals in Ohio (26 425 women [52.2%]; mean [SD] age, 37.1 [9.3] years) who received buprenorphine in 2020, with 18 250 and 24 741 people initiating buprenorphine in Kentucky and Ohio, respectively. Telemedicine buprenorphine initiations increased sharply at the beginning of 2020. Compared with nontelemedicine initiation, telemedicine initiation was associated with better odds of 90-day retention with buprenorphine in both states (Kentucky: adjusted odds ratio, 1.13 [95% CI, 1.01-1.27]; Ohio: adjusted odds ratio, 1.19 [95% CI, 1.06-1.32]) in a regression analysis adjusting for patient demographic and comorbidity characteristics. Telemedicine initiation was not associated with opioid-related nonfatal overdose (Kentucky: adjusted odds ratio, 0.89 [95% CI, 0.56-1.40]; Ohio: adjusted odds ratio, 1.08 [95% CI, 0.83-1.41]). In this cohort study of Medicaid enrollees receiving buprenorphine for OUD, telemedicine buprenorphine initiation was associated with retention in treatment early during the COVID-19 pandemic. These findings add to the literature demonstrating positive outcomes associated with the use of telemedicine for treatment of OUD.

Performance of BeBack Crossing Catheter in Chronic Total Occlusion in Patients With Chronic Limb-Threatening Ischemia: A Single-Center Experience.

To describe a single-center experience in the treatment of chronic limb-threatening ischemia (CLTI) with the application of BeBack catheter (Bentley InnoMed, Germany) in patients with arterial chronic total occlusion (CTO). A retrospective review of patients who underwent limb revascularizations using the BeBack catheter between 2015 and 2022. All patients had an initial failed attempt using a traditional guidewire and catheter technique. Technical success was considered whenever a successful re-entry or lesion crossing using the study device was achieved. Procedural success was defined as recanalization of the occluded artery with residual stenosis of less than 30%, and improvement in ankle-brachial index (ABI) after 24 hours. A Rutherford score was assigned to each limb and affected anatomical segments and lesion length were documented. Procedural access sites and complications were noted. The study included 72 patients who underwent 78 procedures using the BeBack crossing catheter. Procedural success was achieved in 91% of cases, with a technical success rate of 92.3%. The most frequently involved occluded segments were the femoral and popliteal arteries. The average ABI improved from 0.59 to 0.95 after the procedure. The most used access site was the contralateral femoral, and the BeBack catheter was employed on 85 occasions. Only 1 patient suffered a severe immediate adverse effect, and during the 30-day follow-up period, 2 patients needed reintervention. Unfortunately, 3 patients died during the follow-up period. The BeBack catheter offers a viable option for the treatment of patients with chronic total occlusion, with high procedural success and a low complication rate. The BeBack catheter presents a notable advancement for clinicians managing chronic limb-threatening ischemia (CLTI) and arterial chronic total occlusion (CTO), showcasing over 90% procedural and technical success rates in this study. Its adept ability to navigate and recanalize occluded segments provides a robust alternative, especially when traditional techniques falter. This innovation may chane clinical strategies in vascular interventions, offering an efficient and reliable option, thereby potentially enhancing patient outcomes in limb revascularizations.

Interscalene block for elective musculoskeletal shoulder surgery in patients with obstructive sleep apnea – Is it safe?

Objectives: Obstructive sleep apnea (OSA) patients increasingly require shoulder surgery. Their management can be complex for anesthetists and surgeons. Interscalene nerve blocks are used routinely in shoulder surgery, providing adequate analgesia. This study aimed to investigate whether using an interscalene block in patients with OSA is associated with increased postoperative complications and morbidity when undergoing elective musculoskeletal shoulder surgery. Methods: Patients undergoing elective musculoskeletal shoulder operations with OSA were recruited for the study. They received an interscalene brachial plexus nerve block, with or without general anesthesia. Continuous positive airway pressure (CPAP) was used routinely in the perioperative period. Patients were followed up at 24 h and 30 days postoperatively. Patients were reviewed for complications, recovery time, and length of hospital stay. Results: Thirty-one patients were included in the study: 20 arthroscopic and 11 open shoulder procedures. No patients suffered any perioperative morbidity or mortality in the first 24 h or 30-day follow-up periods. There were no complications nor high dependency unit admissions. Conclusion: This study indicates that OSA patients may safely undergo musculoskeletal shoulder surgery with an interscalene nerve block without an increase in perioperative morbidity and mortality. The use of an interscalene nerve block is important as it reduces or eliminates the use of opioids. Furthermore, CPAP use assists in preventing common complications related to the OSA cohort, facilitating day-case surgery.

Clinical effectiveness of nirmatrelvir plus ritonavir in the treatment of COVID-19 in patients with cirrhosis

ABSTRACT Objectives This retrospective cohort study assessed the clinical effectiveness of nirmatrelvirplus ritonavir (NMV-r) in treating COVID-19 in patients with liver cirrhosis(LC). Methods The data of non-hospitalized adult patients with LC who had COVID-19 were selected from the TriNetX platform for the period between 1 March 20201 March 2020, and 31 December 202231 December 2022. Propensity score matching was used to match patients receiving NMV-r (theNMV-r group) with those not receiving NMV-r (the control group). Hazard ratios(HRs) along with 95% confidence intervals (CIs) for the primary outcome – a composite of all-cause hospitalization or mortality during the 30-day follow-up period – were calculated and compared. Results Two cohorts of 2,369 patients each with balanced baseline characteristics were identified.During the follow-up period, the NMV-r group had a lower risk of all-cause hospitalization or mortality (HR, 0.642;95% CI, 0.503–0.819) than did the control group.NMV-r was also associated with a reduced risk of individual all-cause hospitalization (HR 0.681, 95% CI 0.530–0.876])and all-cause mortality (HR, 0.270; 95% CI,0.129–0.562). This association was consistently observed in the subgroups of age, sex, vaccination status, and LC severity. Conclusions NMV-r can reduce all-cause hospitalization and mortality among patients with LC who have COVID-19.

Association between nirmatrelvir plus ritonavir and the outcomes of non-hospitalized obese patients with COVID-19

To investigate the association between nirmatrelvir plus ritonavir (NMV-r) and the outcomes of non-hospitalized obese patients with coronavirus disease 2019 (COVID-19). This retrospective cohort study used the TriNetX research network to identify non-hospitalized obese adult patients with COVID-19 between 1 January 2022 and 30 June 2023. Propensity score matching was used to match patients receiving NMV-r (NMV-r group) with those not receiving NMV-r (control group). The primary outcome was the compositive outcome of all-cause emergency department (ED) visits, hospitalization or death during the 30-day follow-up period. Using propensity score matching methods, two cohorts of 30,969 patients each with balanced baseline characteristics were identified. During the follow-up period, the NMV-r group had a lower risk of all-cause ED visits, hospitalization or death [4.80% (n=1489) vs 5.50% (n=1705); hazard ratio (HR) 0.900, 95% confidence interval (CI) 0.839-0.965]. Compared with the control group, the NMV-r group had a lower risk of all-cause ED visits (HR 0.812, 95% CI 0.740-0.891) and all-cause mortality (HR 0.089, 95% CI 0.027-0.288). The lower risk in the NMV-r group compared with the control group was observed consistently in most subgroup analyses according to body mass index (30.0-34.9 kg/m2: HR 0.68, 95% CI 0.55-0.82; 35.0-39.9 kg/m2: HR 0.67, 95% CI 0.52-0.87), age (4-64 years: HR 0.83, 95% CI 0.75-0.92; ≥65 years: HR 0.88, 95% CI 0.79-0.98), sex (men: HR 0.69, 95% CI 0.60-0.79; women: HR 0.69, 95% CI 0.63-0.76) and vaccination status (unvaccinated: HR 0.75, 95% CI 0.70-0.81). NMV-r is associated with reduced risk of all-cause ED visits, hospitalization and death for non-hospitalized obese patients with COVID-19. Accordingly, these findings support the use of NMV-r in obese patients.

Excluding pregnancy-associated deep vein thrombosis with whole-leg ultrasound

BackgroundDeep vein thrombosis (DVT) is common in pregnancy, yet data are limited on the best diagnostic strategies in pregnant patients suspected of DVT. ObjectivesWe conducted a prospective cohort study to evaluate the rate of symptomatic DVT in the 90 days after a negative whole-leg compression ultrasound (CUS) in pregnant women presenting with DVT symptoms. MethodsIn this prospective cohort study, we enrolled pregnant patients suspected of DVT between 2011 and 2019 who were referred to the vascular imaging laboratory at a tertiary care center and had anticoagulation held after a negative whole-leg CUS. Primary outcome was objectively confirmed DVT or pulmonary embolism or death due to venous thromboembolism (VTE). ResultsWhole-leg CUS yielded normal results in 186 patients (97.9%) and identified DVT in 4 (2.1%). The mean age was 30 and 164 were White. Among the 186 patients with a negative, initial whole-leg CUS who did not receive anticoagulation, there were 2 DVT events identified over the 90-day follow-up period, for an overall rate of 1.1% (95% CI: 0.2-3.4%). The study was terminated before full planned accrual for administrative reasons. ConclusionThe rate of symptomatic DVT is low in pregnant patients who have a single, negative whole-leg CUS and did not receive anticoagulation. Adequately powered studies should prospectively assess whole-leg CUS in a larger population alone and in combination with pre-test probability scores and/or D-dimer to determine its role in the evaluation of suspected DVT in pregnancy.

Predictive Factors of Mortality in Patients with Nonvariceal Upper Gastrointestinal Bleeding

Background: Nonvariceal upper gastrointestinal bleeding (NVUGIB) is one of the most common medical emergencies and often represents a life-threatening event. The aim of this study is to find potential predictive factors associated with 30-day mortality in patients with NVUGIB. Methods and Results: Our prospective study was conducted in Mother Teresa Hospital between May 2022 and December 2022. A total of 224 patients (aged &gt;18 years) with NVUGIB were included in the study. Demographical and clinical characteristics, endoscopic findings, and laboratory tests were reviewed during a 30-day follow-up period. Logistic regression was employed to identify the independent predictors of mortality. The mean age of the 224 patients enrolled in the study was 63.21±16.3 years and most patients (72.8%) were male. One hundred fifty (66.9%) patients had comorbidities. The most common endoscopic diagnoses underlying NVUGIB episodes were duodenal ulcers (53.1%). Recurrent bleeding was recorded in 50(22.3%) patients. Out of 224 patients included in the study, 24(10.7%) died within 30 days of admission, 20(8.9%) died during hospitalization, and 4(1.8%) died after discharge. The mean age of death was 76.42±12.59 years; 95.8% of deaths were associated with one or more major comorbidities. In the multivariate logistic regression, after the exclusion of confounding factors, low red blood cell (RBC) (P=0.043, OR=0.413, CI 95%: 0.176-0.974), warfarin (P=0.036, OR=10.547, CI 95%: 1.165-95.462), and Rockall score (RS) &gt;5 (P=0.034, OR=4.107, CI 95%: 1.114-15.139) were found to be independent predictive factors for mortality. Conclusion: The 30-day mortality rate remained high after NVUGIB, especially during hospitalization. Low RBC, warfarin, and RS&gt;5 were independent factors of mortality in patients with NVUGIB.

Risk of cytomegalovirus diseases among coronavirus disease survivors: A retrospective cohort study.

This study was aimed at investigating the risk of cytomegalovirus (CMV) disease among coronavirus disease 2019 (COVID-19) survivors. In this retrospective cohort study, we used the TriNetX research network to identify adults with and without COVID-19 between January 1, 2022 and December 31, 2022. Propensity score matching was used to match the patients with and without COVID-19. The primary outcome was the risk of CMV disease during the 90-day follow-up period. Two matched cohorts comprising 2 501 634 patients with balanced baseline characteristics were created using propensity score matching. During the follow-up period, patients with COVID-19 had a higher risk of CMV disease than those without COVID-19 (hazard ratio [HR], 2.55; 95% confidence interval: 2.01-3.23). The higher risk of CMV disease in the COVID-19 cohort compared with that of the non-COVID-19 cohort remained unchanged in the subgroup analyses by sex (men: HR, 1.85 [1.38-2.47]; women: HR, 2.31 [1.63-3.27]), age (18-64 years: HR, 2.21 [1.71-2.85]; ≥65 years: HR, 1.97 [1.20-3.25]), obesity (HR, 1.54 [1.04-2.30]), diabetes mellitus (HR, 1.50 [1.08-2.08]), cancer (HR, 3.10 [1.95-4.92]), glucocorticoid use (HR, 3.14 [2.45-4.02]), transplantation (HR, 1.38 [1.08-1.77]), and unvaccinated status (HR, 2.37 [1.82-3.08]). In conclusion, COVID-19 can increase the risk of CMV disease. Clinicians should be aware of the risk of CMV disease in patients with COVID-19.