Advanced Age Group Research Articles

Weekly touch calls with high-risk cohort of patients with commercial Medicare Advantage to reduce avoidable hospital admissions.

282 Background: Patients who have been diagnosed with cancer have an increased risk of complications and potential hospitalization instances. Those in more advanced age groups have an additional risk, especially those of the age group of 65 and higher. Avoidable hospitalizations increase the total cost of care and decrease patient quality of life during treatment. Methods: To reduce potentially avoidable hospital admissions, patients enrolled in a commercial insurance contract were reviewed weekly for a high-risk potential. Criteria for high-risk inclusion included: Any patient >75 years of age receiving treatment; Any patient receiving chemotherapy/radiation combination therapy; Any patient with the following diagnosis: Metastatic lung cancer, Metastatic pancreatic cancer, Multiple myeloma, Breast cancer, Prostate cancer with multiple HCC; Any patient receiving: Cisplatin, Adriamycin, Taxanes, Ifosfimide, Doxorubicin, or Carbo with AUC 4 or greater; Any patient that has had one visit to ER/hospital during the program During the recording period, the high-risk list of patients was reviewed weekly. Before the weekend, each patient identified was contacted by phone by a registered nurse for a weekly “touch call” to address side effects, treatment questions, complications, or concerns. Patients were reminded to contact the practice first when a non-life-threatening concern occurs. Results: The program began on April 1, 2020, with a baseline admission rate of 1.8%. At the conclusion of the program on March 31st, 2023, this cohort of patients had a 53.1% reduction in admission rates from their baseline. Additionally, the reimbursement PPPM was under target yearly, concluding at $65.64, $14.46 below the target amount of $80. The cohort consisted of a range of 36-75 patients per quarter, program total of 185 enrolled patients. Conclusions: Identifying potentially high-risk patients and conducting weekly, personalized calls before the weekend reduced the overall avoidable admission rate. Timely identification and support for high-risk patients reduces the total cost of care and potentially increases patient care quality during treatment. Period Practice Inpatient Admits per 1000 Benchmark Target Target Difference Targeted Reimbursement PPPM Actual Reimbursement PPPM Reimbursement Difference 2020 Q1 1.8% 754 378 $80 2020 Q4 -17.9% 680 233 $80 $75.56 -$4.44 2021 Q4 -31.5% 622 3 $80 $66.66 -$13.34 2022 Q4 -51.3% 602 -235 $80 $65.64 -$14.46

Comparative evaluation of surgical procedures for trigeminal neuralgia: a literature review

Trigeminal Neuralgia (TN) has been described in the literature as one of the commonest types of craniofacial pain disorders. TN refers to recurrent lancinating pain that occurs in the distribution of one or more branches of the fifth cranial nerve. The pain perception is typically unilateral, abrupt in onset, brief in duration, and usually starts after trivial stimuli. The overall prevalence of TN was reported around 0.7/1000 persons, but it tends to be higher in more advanced age groups since the initial onset of the symptoms most frequently starts at the age of 50–60 years. Although TN is more commonly seen in adults, pediatric TN represents <1.5% of all cases. Pediatric TN differs from adult TN primarily being bilateral in nature (42%) and associated with compression of multiple cranial nerves (46%). This review will evaluate the current surgical procedures used for the treatment of TN. Operative interventions for TN include microvascular decompression (MVD), balloon compression (BC), radiofrequency thermocoagulation (RF TC), glycerol rhizotomy (GR), and stereotactic radiosurgery (SRS). We review the historical development, advantages, and limitations of these operations. Additionally, we compare specific parameters for all current surgical procedures. We evaluated the short- and long-term outcomes, risk factors, complications and side effects in patients with TN who underwent operations. Arguments for and against the use of surgery for TN are presented. Next, surgical decision-making algorithm for refractory classical or idiopathic TN is proposed for patients who require surgery. This algorithm may be used by neurosurgeons in selecting the best surgical treatment. Lastly, we show the data on current clinical trials, the role of genetics to search for genes predisposing to TN. This project begins with the presumption that the risk for developing classical TN is in large part determined genetically. If so, given the power of modern genetic analysis, it should be possible to identify the underlying gene(s). At present, there is no ideal surgical procedure for trigeminal neuralgia—one that is minimally invasive, uniformly effective, lacking complications, and without failures or recurrences. MVD still remains the standard by which all other contemporary procedures are measured. MVD provides the longest pain-free interval, yet it is not free of morbidity and mortality. Stereotactic radiosurgery provides a reasonable noninvasive option, but it has delayed onset and a recurrence interval (a few years).

Survival of hospitalised COVID-19 patients in Hawassa, Ethiopia: a cohort study

The COVID-19 pandemic, caused by SARS-CoV-2, led to 622,119,701 reported cases and 6,546,118 deaths. Most studies on COVID-19 patients in hospitals are from high-income countries, lacking data for developing countries such as Ethiopia.This study assesses clinical features, demographics, and risk factors for in-hospital mortality in Hawassa, Ethiopia. The research cohort comprises 804 cases exhibiting clinical diagnoses and/or radiological findings and indicative of symptoms consistent with COVID-19 at Hawassa University Comprehensive Specialized Hospital from September 24, 2020, to November 26, 2021. In-hospital mortality rate was predicted using Cox regression. The median age was 45 years, with males making up 64.1% of the population. 173 (21.5%) fatalities occurred, with 125 (72.3%) among males. Male patients had higher mortality rates than females. Severe and critical cases were 24% and 21%. 49.1% had at least one comorbidity, with 12.6% having multiple. Common comorbidities were diabetes (15.9%) and hypertension (15.2%). The Cox regression in Ethiopian COVID-19 patients found that factors like gender, advanced age group, disease severity, symptoms upon admission, shortness of breath, sore throat, body weakness, hypertension, diabetes, multiple comorbidities, and prior health facility visits increased the risk of COVID-19 death, similar to high-income nations. However, in Ethiopia, COVID-19 patients were young and economically active. Patients with at least one symptom had reduced death risk. As a conclusion, COVID-19 in Ethiopia mainly affected the younger demographic, particularly economically active individuals. Early detection can reduce the risk of mortality. Prompt medical attention is essential, especially for individuals with comorbidities. Further research needed on diabetes and hypertension management to reduce mortality risk. Risk factors identified at admission play a crucial role in guiding clinical decisions for intensive monitoring and treatment. Broader risk indicators help prioritize patients for allocation of hospital resources, especially in regions with limited medical facilities. Government’s focus on timely testing and strict adherence to regulations crucial for reducing economic impact.

Utility of the morphological scoring of costal cartilage ossification in age estimation of adult Egyptians using multidetector computed tomography

Abstract Age estimation of adults is a challenging procedure in forensic practice. Inspired by the previous work by Chinese scholars, we established population specific age estimation models from the osseous and calcified projections (OCP) of costal cartilages, using three-dimensional volume-rendering technique. A total of 168 clinical CT scans (2 mm slice thickness) were used to develop the sex-specific age prediction models from a sample of Egyptians, comprising 70 females and 98 males, with documented ages between 12 and 85 years. The sample was also used for validating the Chinese model. We reported the differences between the predictive accuracy of the Egyptian (population specific) and Chinese (non population specific) models. The most accurate age estimation model was stepwise linear regression with standard error of estimates (SEE) of 10.9 and 11.8 years in males and females, respectively. For the simple linear regression models, the most accurate formula included OCP of the right second costal cartilage in males and OCP of the left third costal cartilage in females with SEE of 11.2 and 12.2 years, respectively and mean absolute error (MAE) of 8.8 and 9.6 years, respectively. By comparison, the best accuracy rates produced by the Chinese vs. the Egyptian models in males and females within 5 years were 30.61% and 32.86% vs. 35.71% and 32.86%, respectively, whereas within 10 years, the accuracy rates increased up to 57.14% and 58.57% vs. 72.45% and 64.29%, respectively. Although the accuracy rates from the Chinese models were lower than those obtained from the Egyptian models, the MAE and least error values were comparable in both sexes. Notable accurate age estimation rates in the advanced age group ≥40 years were reached being 81.25% to 97.92% in males and 69.77% to 93.02% in females. OCP of the right first costal cartilage was the most accurate in cross-population application for males and females with MAE values of 10.7 and 11.03 years, respectively with balanced accuracy rates of age estimation using the 10-year interval and 40-year cutoff.

Evaluation of Knowledge about Epilepsy among Undergraduate Health Students: A Cross-Sectional Study

Abstract Background Greater knowledge of undergraduate health students will provide quality care to patients with epilepsy. Most previous studies have targeted teachers, health care providers, and the general public. The purpose of this study was to assess the knowledge gaps of undergraduate health students on basic subjects of epilepsy, such as etiologies, symptoms, and treatment options. Methods Our study conducted a cross-sectional survey among undergraduate health students. We collected data using a descriptive information form. The chi-square test was employed to compare knowledge of seizure between demographic and academic variables. Results Of the total, 84.4% of students had read or heard about epilepsy. However, only 2.8% of students displayed good knowledge scores toward epilepsy. About 18.2 and 32% of students incorrectly identified that epilepsy could be due to possession by evil spirits and blood disorder, respectively. More than half of the students considered epilepsy to be nontreatable (52.1%) and a contagious disease (55.4%). Moreover, students in the advanced age group, medicine, and clinical years displayed significantly better knowledge scores than their peers (p < 0.05). All dental college students revealed poor scores in terms of knowledge about epilepsy's causes, symptoms, and treatment. Conclusion Our findings concluded that most undergraduate health students demonstrated poor knowledge scores regarding epilepsy. Notably, students studying in dental college and preclinical years had a lower understanding of epilepsy than their peers. This finding suggests that introducing comprehensive epilepsy education in all health-related courses could improve patient care.

The effectiveness of pulsed magnetic therapy, high-intensity magnetic stimulation of the pelvic floor muscles and intrauterine plasma therapy to restore endometrial receptivity after intrauterine interventions in patients of different age

Abstract. Objectives. Advanced age is the cause of female infertility. Restoring endometrial receptivity, especially after intrauterine interventions in women of different reproductive ages, is an unsolved problem of modern rehabilitation. The aim of the study was to evaluate the effectiveness of non-drug methods for restoring endometrial receptivity after intrauterine interventions in women of different reproductive ages. Material and methods. A prospective study was conducted with the participation of 120 women planning pregnancy and undergoing various surgical interventions for endometrial diseases. All patients were randomly divided into three equal groups according to the method of exposure: group 1 — patients received combined pulsed magnetic therapy and intrauterine plasma therapy of the endometrium; group 2 — patients underwent high-intensity magnetic stimulation of the pelvic floor muscles andintrauterine plasma therapy of the endometrium; group 3 — patients underwent pulsed magnetic therapy. Subsequently, in eachgroup, the patients were divided by age into two subgroups: up to 34 years and over 35 years. Results. According to the medical history, patients in the advanced age group were characterized by a significantly greater amount of pathology and a less active lifestyle. The pregnancy rate is twice higher in patients under 34 years of age. Normalization of the menstrual cycle and the rate of increase in blood flow through the uterine arteries occurred twice as fast in younger patients than in older ones. Endometrial thickness and normalization of pipell biopsy data after a course of treatment with high-intensity magnetic stimulation of the pelvic floor muscles and intrauterine plasma therapy were statistically significantly higher in the group of patients under 34 years of age. An increase in the speed of blood flow through the uterine arteries in patients over 35 years of age occurs more effectively with the help of pulsed magnetic therapy and intrauterine plasma therapy of the endometrium. Conclusion. Endometrial receptivity restoration in patients underwent intrauterine interventions using combined non-pharmacological methods is safe and effective. In patients under 34 years of age, the technique of choice may be high-intensity magnetic stimulation of the pelvic floor muscles with intrauterine plasma therapy. In patients over 35 years of age, the method of pulsed magnetic therapy with intrauterine plasma therapy of the endometrium is more effective.

National Estimates for the Percentage of All Readmissions With Demographic Features, Morbidity, Overall and Gender-Specific Mortality of Transcutaneous Versus Open Surgical Tricuspid Valve Replacement/Repair.

The aim of the study was to determine national estimates for the percentage of all readmissions with demographic features, length of stay (LOS), cost analysis, comorbidities, complications, overall and gender-specific mortality and complications of transcutaneous tricuspid valve replacement/repair (TTVR) vs. open surgical tricuspid valve replacement/repair (open TVR). Data were extrapolated from the Nationwide Readmissions Database (NRD) 2015-19. Of the 75,266,750 (unweighted) cases recorded in the 2015 - 2019 dataset, 429 had one or more of the percutaneous approach codes as per the ICD-10 dataset, and 10,077 had one or more of the open approach codes. Overall, the number of cases performed each year through open TVR was higher than TTVR, but there was an increased trend towards the TTVR every passing year. TTVR was performed more in females and advanced age groups than open TVR. The LOS and cost were lower in the TTVR group than in open TVR. Patients undergoing TTVR had more underlying comorbidities like congestive heart failure, hypertension, and uncomplicated diabetes mellitus. Overall mortality was 3.49% in TTVR vs. 6.09% in open TVR. The gender-specific analysis demonstrated higher female mortality in the open TVR compared to TTVR (5.45% vs. 3.03%). Male mortality was statistically insignificant between the two groups (6.8% vs. 4.3%, P-value = 0.15). Patients with TTVR had lower rates of complications than open TVR, except for arrhythmias, which were higher in TTVR. Patients undergoing open TVR required more intracardiac support, such as intra-aortic balloon pump (IABP) and Impella, than TTVR. TTVR is an emerging alternative to open TVR in patients with tricuspid valve diseases, especially tricuspid regurgitation. Despite having more underlying comorbidities, the TTVR group had lower in-hospital mortality, hospital cost, LOS, and fewer complications than open TVR.

Causes of acquired isolated neutropenia in adulthood: a single center study

Aims: Neutropenia, associated with several hereditary and acquired causes, is detected in a significant portion of patients presenting to the hematology outpatient clinic today. We conducted this study since we failed to find any Turkish publication on acquired isolated neutropenia in adults. Methods: This retrospective study examined data belonging to patients aged 18 years and older who applied to the adult hematology outpatient clinic whose absolute neutrophil count (ANC) was below the normal reference values (? 1.5 x 109/L). Results: 103 adult patients, 93 women and 10 men, were included in the study. Our study detected the cause of acquired isolated neutropenia as chronic idiopathic neutropenia (CINA) in 39.8% (n=41) of patients, autoimmune diseases in 18.4% (n=19), drugs in 14.6% (n=15), folate deficiency in 13.6% (n=14), infection in 9.7% (n=10), and hematological malignancy in 2.9% (n=3) and cyclic neutropenia in 1% (n=1). 92 patients (89.3%) were found to display mild neutropenia while 9 (8.7%) displayed moderate neutropenia and 2 (2%) displayed severe neutropenia. Interestingly, folate deficiency was detected in 6 of 9 (66.7%) moderately neutropenic patients. Conclusion: In our study, CINA was determined as the most common cause of acquired isolated neutropenia in adults, while autoimmune neutropenia was the second most common. In addition, the detection of folate deficiency in 6 of 9 patients (66.7%) with moderate neutropenia and the fact that these patients were in the advanced age group [mean 68 (range 62-81)] was a major finding of the study.

To appreciate the influence of contributed determinants on dental care utilization in the context of socio-economic inequalities

BackgroundTo appreciate dental care utilization in ‌the context of socio-economic inequalities, it is imperative to identify sources of inequalities and evaluate the extent to which dental care utilization is still related to socio-economic status. This study aimed to quantify the influence of contributed determinants on dental care utilization in the context of socio-economic inequalities amongst adults residing in Tehran metropolis.MethodsIn this cross-sectional community-based study, a stratified random sample of 1,510 subjects aged over 18 years was investigated by the zero-inflated Poisson analysis to measure the effect of determinants on utilization of dental care, and concentration index as well as the decomposition approach to identify the contributions of deterministic variables to the socio-economic inequality. Data was obtained by employing a phone interview survey. Individuals who were not willing or able to answer the questions in the telephone interview due to hearing or neurological problems did not participate in the interview. Dental care utilization was measured using the number of dental appointments.ResultsGender (male), oral health-related behaviors (such as brushing and dental flossing), experience of toothache, and concern about dental appearance were associated with an increased likelihood of utilizing dental care. Individuals who belonged to advanced age groups and lived alone significantly underutilized dental care. The concentration index equaling 0.05 (SE = 0.05) corroborates a pro-rich inequality. Decomposition analysis demonstrated the impact of oral health-related behaviors (i.e. dental brushing and use of dental flossing), concern about dental appearance, toothache, gender (male), insurance coverage of dental care, and smoking habit on the poor-rich gap in the dental care utilization.ConclusionsThe influence of socio-economic inequalities on dental care utilization is discernable along the entire spectrum of socio-economic status. Individuals with lower socio-economic status experience more underutilization of dental care. Community subgroups, particularly the more deprived bracket, require consideration from key stakeholders, including policymakers and health professionals for the enhancement of dental care utilization as revealed by underlying determinants.

Perception of the Family Caregiver in Care for Chronic Older Adults after Discharge

Introduction:The global trend of population longevity has highlighted the need for studies with advanced age groups. With the significant increase in the number of older adults, it is logical to reason that there will be an increase in demand for health care. Objective:The study aims to describe, through Bardin's phenomenological analysis, the family's perception of the continuity of care for chronic older adults after discharge. Method: This study is a descriptive and exploratory field study with a cross-sectional character and a qualitative approach. The study was conducted in a West Zone of São Paulo -Brazil hospital. The study subjects were family members of elderly clients expected to be discharged from the hospital. The data was collected through interviews and analyzed using Bardin's phenomenological analysis, which involves a systematic and rigorous process of categorizing and interpreting the data.

P-535 Effect of advanced female age (AFA) on the ratio of patients receiving mosaic embryo transfers

Abstract Study question How does female age affect ratio of patients with at least one euploid embryo (≥1EE) and at least one mosaic embryo without any euploid ones(≥1ME)? Summary answer Percentage of patients receiving mosaic embryo transfers increases with female age. What is known already Introduction of Next Generation Sequencing (NGS) to the area of Preimplantation Genetic Testing for Aneuploidy (PGT-A) has enabled detection of mosaicism in human embryos. Studies reporting the birth of healthy babies after the transfer of embryos with a chromosomal mosaic result on PGT-A have been published (Greco et al., 2015; Kahraman et al., 2020; Viotti et al., 2021 and 2023). Data suggested lower implantation rates and higher miscarriage rates when mosaics were compared with euploid embryo transfers. The percentage of mosaic embryos in overall tested embryos decreases with increased maternal age, similar to euploid embryos’ decline (Sanders et al., 2023). Study design, size, duration This retrospective study includes 7287 cycles with PGT-A performed between January 2017 and December 2023. Number of biopsied blastocysts was 21,277 and all were tested with NGS. All PGT-A testing was conducted on Ion Torrent S5 (Thermo Fisher Scientific) according to the manufacturer guidelines. The mosaic embryo reporting thresholds were determined as 20 to 80%. Participants/materials, setting, methods Euploidy ratio (ER) was defined as (euploid embryos (n)/ all tested embryos(n)). Mosaicism ratio (MR) was defined as (mosaic embryos (n)/all tested embryos(n)). Alternative mosaicism ratio (AMR) was defined as the number of mosaic embryos divided by the sum of euploid embryos and mosaic embryos. In other words, AMR can be defined as the number of mosaic embryos divided by non-aneuploid embryos. Female ages were divided into five categories: FAG1:<35, FAG2:35-37, FAG3:38-40, FAG4:41-42, FAG5:>42. Main results and the role of chance The number of cycles, total number and average biopsied embryos with standard deviations were highest in FA1 and declined with AFA: FAG1:2537, 9298, 3.7±2.2; FAG2:1348, 4140, 3.1±1.7; FAG3:1701, 4298, 2.5±1.6; FAG4: 958,2116, 2.2±1.5; FAG5:738, 2407, 1.9±1.2. ER and MR were observed to decrease with AFA: FAG1:%48.4, %15.2; FAG2:%39.0, %12.7; FAG3:%26.5, %10.5; FAG4:%14.9, %6.0; FAG5:%5.0, %2.6. This decrease was statistically significant (p < 0.0001, Chi-Square Test). However, when AMR was calculated among age groups, AMR was increasing with AFA: FAG1:%23.9; FAG2:%24.6; FAG3:%28.5;FAG4:%28.7; FAG5:%34.5 and this was also statistically significant (p = 0.0002, Chi-Square Test). Correlation of MR and AMR with female age groups were tested with Pearson correlation coefficient and MR was found to be negatively correlated with AFA whereas AMR was positively correlated (r=-0.19, p < 0.0001; r = 0.07, p < 0.0001, respectively). The ratio of patients with ≥1EE and ≥1ME was found to be decreasing with AFA when compared to overall tested cycles: FAG1: %83%, %7; FAG2: %69, %9; FAG3: %47, %11; FAG4: %28, %9; FAG5: %9, %4. However, the ratio of ≥ 1ME in cycles with transferrable embryos significantly increased with AFA consisting of more than one fourth of embryo transfer cycles above 38 years of age: FAG1: %7; FAG2: %12; FAG3: %19; FAG4: %24; FAG5: 31%. Limitations, reasons for caution These are the results of a single ART and Reproductive Genetics Center with its strictly defined standard operating procedures for PGT-A testing and ovarian stimulation protocols. Although not expected, different PGT-A testing methodologies or stimulation protocols may influence the above-mentioned outcomes. Wider implications of the findings The alternative mosaicism ratio defined here is generally overlooked but impacts the treatment strategies of ART patients, specifically for the advanced maternal age groups. Trial registration number not applicable

Narcotic Consumption Analysis among Severely Injured and Advanced Aged Trauma Patients.

Multimodal pain management has been shown to be effective in treating pain in acutely injured trauma patients. Our community-based, level 1 trauma center previously published in 2022 the efficacy of implementing multimodal pain control (MMPC) protocol in our inpatient trauma population which decreased the use of opioids while maintaining similar pain control. The MMPC group had a trend toward higher age and was significantly less injured. We hypothesize MMPC will reduce opioid consumption in both the advanced aged and more severely injured trauma populations while still providing adequate pain control. Defined by the year of admission, MMPC and physician managed pain control (PMPC) were compared in both advanced age groups and between the severely injured groups. The advanced age group included patients ≥55 years old. The severely injured group included ≥18 years old with ≥15 ISS. Primary outcomes were total opioid utilization per day, calculated in morphine milliequivalents (MME), and median daily pain scores. For the severely injured population, the MMPC group showed a 3-fold decrease in opioid use (30MME/d vs 90.3MME/d, P < .001) and lower pain scores (5/10 vs 6/10, P < .001) than the PMPC group. In the advance age group, there was no significant difference between MMPC and PMPC groups in opioid use (P = .974) or pain scores (P = .553). MMPC effectively reduces opioid consumption in a severely injured patient population while simultaneously improving pain control. Advanced age trauma patients can require complex pain management solutions and future research to determine their needs is recommended.

The relationship between patient characteristics, laboratory findings and outcomes of the patients presenting with seizures to the emergency department

Aims: Most patients with epilepsy have recurrent admissions to the emergency department (ED) during the disease. Insufficient information about this patient population causes a mismatch between patients' needs and health care delivery. For this reason, there is a need for objective methods that can be used to monitor seizure patients in EDs and to determine the need for hospitalization. This study aimed to develop management recommendations for patients with active seizures or a history of seizures prior to admission and contribute to the determination of the criteria for the ED follow-up period. Methods: This study was designed as a single-center, prospective, and observational study and included patients over 18 who presented to the ED for seizures. After the patients were included in the study, demographic and laboratory findings were recorded, and patients were followed up for 30 days for mortality and recurrent seizures. Results: Seventy-one patients were included in the study. The most known seizure causes were drug incompatibility (15.49%) and infection (9.86%). The most common comorbidities were Hypertension (16.90%), Diabetes Mellitus (12.68%), and cerebrovascular diseases (9.86%). The mortality rate was higher in patients who were hospitalized, had an active infection, and had a high CRP value. Conclusion: The 30-day mortality is higher in patients presenting to the ED with epileptic seizures; in the advanced age group, patients with active infection have an elevated C-reactive protein in laboratory parameters.

Promoter methylation status of RASSF1A and RASSF2A tumor suppressor genes in endometrial endometrioid carcinomas

We aimed to investigate the promoter methylation status of RASSF1A and RASSF2A tumor suppressor genes in endometrial endometrioid carcinomas with p53 wild type and mismatch repair proficient. Genomic DNAs were isolated from 50 specimens (15 formalin-fixed paraffin embedded tumor tissues, 15 paired blood samples and 20 normal endometrial tissues). Bisulfide modification and methylation-specific polymerase chain reaction were performed. As a result of the study, while no significance was found for RASSF1A gene (p = 0.08), a statistically significance was found for RASSF2A gene (p < 0.001), RASSF2A gene methylation status was also found higher in high grade tumors, advanced age (≥50) and nonsmokers groups. Our results indicate that RASSF2A gene may play a role in the carcinogenesis of endometrioid and it could be potential biomarker for early detection for endometrioid carcinoma. Further and larger investigations are needed to confirm our results.

MULTIPLE RESIDUAL ROOTS EXTRACTIONS AND ETIOPATHOGENESIS OF ASSOCIATED PERIAPICAL LESION: A SURGICAL CASE REPORT

Before any surgical intervention in dentistry, it is necessary to plan each case correctly, to induce a positive prognosis for patients, always enabling the functionality of the stomatognathic system. Men tend to have more teeth extracted than women, with more posterior teeth extracted in patients in more advanced age groups due to periodontal disease. The case presented leads to a discussion of the periapical lesions removed surgically. The etiology and study of the evolutionary process of pulp pathology and the supporting tissues of the dental element are substantial. The endo-periodontal interrelationship is unique and can be considered a single continuous system or biological unit with multiple forms of communication. In summary, this article seeks to highlight and report a surgical case of a patient diagnosed with periapical lesions associated with residual tooth roots, which were removed during the common exodontia protocol with the aim of total rehabilitation of the patient. The patient authorized all the images and information used in this study.

Age-Related Increase in Live-Birth Rates of First Frozen Thaw Embryo Compared With First Fresh Transfer in Initial Assisted Reproductive Technology Cycles Without Preimplantation Genetic Testing [ID 2683417

INTRODUCTION: Compare live-birth outcomes stratified by age between primary frozen (FET) and fresh transfers in initial autologous assisted reproductive technology (ART) cycles without preimplantation genetic testing (PGT). METHODS: This was a retrospective cohort study of autologous first ART cycles without PGT comparing success rates of primary embryo transfer (frozen thaw versus fresh) from the 2014–2020 SARTCORS database. We compared live-birth rate (LBR) stratified by age and cumulative live-birth rate (CLBR) for first FET versus first fresh cycles in first ART cycle. Primary transfer (FET or fresh) was the first transfer for an index retrieval. LBR was number of live births from first embryo transfer associated with first retrieval. CLBR was defined as at least one live birth from all linked embryo transfers within 1 year from initial retrieval. Multivariate logistic regression (MLR) determined association between live-birth outcomes and method of transfer. RESULTS: 228,171 first ART cycles resulted in primary embryo transfer. 62,100 initial FETs and 166,071 fresh transfers were compared. LBR was 48.3% for initial FETs versus 39.8% for initial fresh transfers (P&lt;.001). CLBR was 71.8% for initial FETs versus 59.2% for initial fresh transfers (P&lt;.001). MLR demonstrated that initial FETs had a greater chance of live birth across all age groups, with adjusted odds ratio of live birth incrementally increasing with advancing age groups. CONCLUSION: Overall, LBR and CLBR were greater for first FET than fresh transfers with incremental increases in odds of live birth with advancing age, suggesting the presence of a more favorable age-related change in endometrial receptivity present in frozen–thawed cycles.

Long-term follow-up results of multiparametric prostate MRI and the prognostic value of PI-RADS: a single-center retrospective cohort study

We aim to examine the long-term outcomes of patients who underwent multiparametric prostate magnetic resonance imaging (mp-MRI) for suspected prostate cancer (PCa), specifically based on their initial Prostate Imaging Reporting and Data System (PI-RADS) categories and various clinical factors. Our secondary aim is to evaluate the prognostic value of the PI-RADS through the National Comprehensive Cancer Network (NCCN) risk group distribution. This research was conducted as a single-center retrospective cohort study in a tertiary care hospital. A total of 1,359 cases having at least one histopathological examination after the initial mp-MRI and/or adequate clinical/radiological follow-up data were included in the clinically significant PCa (cs-PCa) diagnosis-free survival analysis. Initial mp-MRI dates were accepted as the start of follow-up for the time-to-event analysis. The event was defined as cs-PCa diagnosis (International Society of Urological Pathology ≥2). Patients who were not diagnosed with cs-PCa during follow-up were censored according to predefined literature-based criteria at the end of the maximum follow-up duration with no reasonable suspicion of PCa and no biopsy indication. The impact of various factors on survival was assessed using a log-rank test and multivariable Cox regression. Subsequently, 394 cases diagnosed with PCa during follow-up were evaluated, based on initial PI-RADS categories and NCCN risk groups. Three main risk factors for cs-PCa diagnosis during follow-up were an initial PI-RADS 5 category, initial PI-RADS 4 category, and high MRI-defined PSA density (mPSAD), with average hazard ratios of 29.52, 14.46, and 3.12, respectively. The PI-RADS 3 category, advanced age group, and biopsy-naïve status were identified as additional risk factors (hazard ratios: 2.03, 1.54-1.98, and 1.79, respectively). In the PI-RADS 1-2 cohort, 1, 3, and 5-year cs-PCa diagnosis-free survival rates were 99.1%, 96.5%, and 93.8%, respectively. For the PI-RADS 3 cohort, 1, 3, and 5-year cs-PCa diagnosis-free survival rates were 94.9%, 90.9%, and 89.1%, respectively. For the PI-RADS 4 cohort, 1, 3, and 5-year cs-PCa diagnosis-free survival rates were 56.6%, 55.1%, and 55.1%, respectively. These rates were found to all be 24.2% in the PI-RADS 5 cohort. Considering the 394 cases diagnosed with PCa during follow-up, PI-RADS ≥4 cases were more likely to harbor unfavorable PCa compared to PI-RADS ≤3 cases (P < 0.001). In the PI-RADS 3 subgroup analysis, a low mPSAD (<0.15 ng/mL2) was found to be a protective prognostic factor against unfavorable PCa (P = 0.005). The PI-RADS category has a significant impact on patient management and provides important diagnostic and prognostic information. Higher initial PI-RADS categories are associated with decreased follow-up losses, a shorter time to PCa diagnosis, increased biopsy rates, a higher likelihood of developing cs-PCa during follow-up, and a worse PCa prognosis. Combining mPSAD with PI-RADS categories could enhance diagnostic stratification in the identification of cs-PCa.

Assessment of knowledge towards first aid skills of epilepsy among undergraduate health students in Riyadh province of Saudi Arabia: A cross-sectional study

BackgroundApplying proper first-aid measures to patients with seizure episodes plays a vital role in preventing the adverse consequences of seizures. Most previous data focused on teachers, healthcare providers and the general public. This study aimed to assess the knowledge of seizure first-aid measures among undergraduate health students. MethodsThis descriptive, cross-sectional study was conducted between May 16 and 31, 2023, with 493 undergraduate health students of Riyadh Province who answered online surveys. The data were collected using the descriptive information form. The chi-square (χ2) test was employed to compare knowledge of seizure first aid between demographic variables. The relationship between knowledge score and independent variables was evaluated using multiple linear regression technique. ResultsOnly 1.6 % of participants demonstrated good knowledge scores toward seizure first-aid measures. The skill most frequently reported was to remove all harmful objects from their vicinity and loosen the tight clothes around the neck during a seizure; 68.7 % of the participants correctly answered with agreed. Conversely, the skill that received the lowest knowledge score among participants was putting a piece object such as a cloth, wallet, or spoon between the teeth to prevent tongue biting during a seizure; only 37.3 % of the participants correctly answered with disagree. Moreover, participants in the advanced age group, medicine and fifth-year, were found to be significant predictors of knowledge and exhibited better knowledge scores toward seizure first aid measures than their peers (p < 0.001). Furthermore, lectures and books were identified (69.6 %) as the most common source of information about seizure first aid. ConclusionThe study concluded that most undergraduate health students demonstrated poor knowledge scores in delivering seizure first aid. This finding suggests that introducing epilepsy education from the first year in all health-related courses is crucial to improving overall awareness and skills in providing seizure first aid.

Age-related increase in live-birth rates of first frozen thaw embryo versus first fresh transfer in initial assisted reproductive technology cycles without PGT

BackgroundThe landscape of assisted reproductive technology (ART) has seen a significant shift towards frozen-thawed embryo transfers (FET) over fresh transfers, driven by technological advancements and clinical considerations. This study aimed to compare live birth outcomes between primary FET and fresh transfers, focusing on cycles without preimplantation genetic testing (PGT), using United States national data from the SART CORS database spanning from 2014 to 2020.MethodsWe performed a retrospective cohort study of autologous first ART cycles without PGT comparing primary embryo transfer (frozen thaw vs. fresh) success rates from the 2014–2020 SARTCORS database. Live-birth rates (LBR) and cumulative live-birth rates (CLBR) were compared between first FET versus first fresh embryo transfer from an index retrieval. Multivariate logistic regression (MLR) determined association between live birth outcomes and method of transfer. In a subsequent sub-analysis, we compared these two embryo transfer methods among patients with either diminished ovarian reserve (DOR) or male factor infertility.Results228,171 first ART cycles resulted in primary embryo transfer. 62,100 initial FETs and 166,071 fresh transfers were compared. Initial FETs demonstrated higher LBR and CLBR compared to fresh transfers (LBR 48.3% vs. 39.8%, p < 0.001; CLBR 74.0% vs. 60.0%, p < 0.0001). MLR indicated greater chances of live birth with FET across all age groups, with adjusted odds ratio (aOR) of live-birth incrementally increasing with advancing age groups. For DOR cycles, LBR and CLBR were significantly higher for FET compared to fresh (33.9% vs. 26.0%, p < 0.001, 44.5% vs. 37.6%, p < 0.0001), respectively. MF cycles also demonstrated higher LBR and CLBR with FET (52.3% vs. 44.2%, p < 0.001, 81.2% vs. 68.9%, p < 0.0001), respectively. MLR demonstrated that in DOR cycles, initial FET was associated with greater chance of live birth in age groups ≥ 35yo (p < 0.01), with aOR of live birth increasingly considerably for those > 42yo (aOR 2.63, p < 0.0001).ConclusionsOverall LBR and CLBR were greater for first FET than fresh transfers with incremental increases in odds of live birth with advancing age, suggesting the presence of a more favorable age-related change in endometrial receptivity present in frozen-thawed cycles. For both DOR and MF cycles, LBR and CLBR after primary transfer were greater for first FET than fresh. However, this was particularly evident in older ages for DOR cycles. This suggests that supraphysiologic stimulation in older DOR cycles may be detrimental to endometrial receptivity, which is in part corrected for in FET cycles.

Optimal timing of starting growing rod treatment for early-onset scoliosis

BACKGROUND CONTEXTGrowing rod (GR) systems require periodical surgical intervention and may cause associated complications, as well as worsened sagittal plane deformity. Generally, the risk of complications decreases with an increment in age at the time of the index surgery with GR construct placement. However, the optimal timing to begin GR treatment has not reached a consensus yet. PURPOSEThis study was performed to investigate the effect of age at the index GR surgery on the complication rates and formulate clinical guidelines for the optimal timing to begin GR treatment for EOS patients. STUDY DESIGNKaplan-Meier analysis was used to determine complication occurrence as a function of the age at the index surgery and to determine the survival rates for the procedures. The receiver operator characteristic (ROC) curve was used to determine optimal cut-off values for the optimal timing of index surgery based on whether complications occurred or not. PATIENT SAMPLE54 patients who met the criteria were enrolled in this study. OUTCOME MEASURESThe following spinal parameters were measured: major coronal Cobb angle, global kyphosis (GK), and coronal balance (CB). CB was defined as the horizontal distance from the C7 plumb line to the center sacral vertical line. METHODSAll patients had completed GR treatment and had a minimum 1-year follow-up duration after the final surgical intervention. Patient data were collected as follows: age at the index surgery, gender, diagnosis, type of GR construct, and the number of lengthening procedures. The standing full-spine radiographs were obtained before and after the index surgery, before and after each lengthening procedure, before and after the final surgical intervention, and at the latest follow-up. Complications were categorized as implant, alignment, and general. RESULTSKaplan-Meier analysis of complications demonstrated a declining trend in complication rates with increasing age at the index surgery. The absence of perioperative complications was targeted, we constructed the ROC curve and the cut-off value was 71.0 months. Age at the index surgery was therefore categorized into two groups: younger-age group (≤ 71.0 months) and advanced-age group (> 71.0 months). There was a higher complication rate for the younger-age group than versus the advanced-age group (61.5% vs 22.0%, p=.011). PJK as a major alignment-related complication, was more frequent in the younger-age group than in the advanced-age group (30.8% vs 4.9%, p=.025). But the advanced-age group exhibited significantly more severe deformities before GR surgery compared to the younger-age group. CONCLUSIONSThis study shows that the elevated risk of complications observed in the younger-age group, which can be attributed to the younger age at the index surgery and the increased number of lengthening procedures during treatment. We suggest deferring the initiation of GR treatment until after the age of six years for EOS patients. We hope it will serve as a basis for GR technique in the treatment of EOS, with the ultimate goal of enhancing treatment outcomes for this challenging disorder.