Care Center Research Articles

Use of Ultra-Short Echo Time MRI to Improve Temporal Bone Imaging.

The short T2 nature of cortical bone causes it to appear similar to air on MR, forcing clinicians to rely on computed tomography imaging, with its attendant ionizing radiation exposure, to define temporal bone structures. Through the use of novel MR sequences with ultra-short echo times (UTE), short T2 structures are now able to be visualized, allowing for improved understanding of anatomical relationships. Eight patients (50% female) undergoing MR imaging of the skull base for diagnostic purposes (62.5% for vestibular schwannoma surveillance) at a tertiary care center were enrolled to evaluate the safety and efficacy of UTE imaging. CT scans were completed in 37.5% of the patients as part of their workup and used for comparison purposes. The repetition time, short echo time, and long echo time for the UTE sequence were 11, 0.032, and 2.2 msec, respectively. The protocol added 6 min to the total scanning time, and all patients tolerated the sequence without issue. The ossicles, mastoid air cells, antrum, and epitympanum were able to be seen and had a high Dice similarity coefficient when compared to CT (>0.5). UTE allowed for clear delineation of all segments of the facial nerve with a signal-to-noise ratio of 35 (although the BRAVO sequences had a superior ratio of 140). Vestibular schwannomas were able to be distinguished from normal brain parenchyma. UTE is safe and effective for visualizing anatomic structures not normally seen on traditional MRI, potentially allowing for improved surgical planning in patients. 3 Laryngoscope, 134:4691-4696, 2024.

Role of Azathioprine in the Management of ITP in the TPO-RA Era: A Single Centre Retrospective Study

Immune thrombocytopenia (ITP) is an autoimmune disease associated with low platelets and risk of bleeding. Standard-of-care treatment now includes the novel thrombopoietin-receptor agonists (TPO-RA). However, access to these modern therapeutics remains a challenge, limiting clinicians’ options. We investigated azathioprine in relapsed/refractory ITP to determine its efficacy and safety, focusing on evaluating its utility in post-TPO-RA patients.We retrospectively reviewed all adult patients, age 18 years and older, who were worked up for thrombocytopenia between 2009 and 2022 at a tertiary care centre in Ontario, Canada. Only ITP patients treated with azathioprine were included.We identified 92 ITP patients who received azathioprine, mean age 55.6 ± 22.3 years, 53 females and 39 males, with 64 having primary ITP. The overall response rate (ORR) was 47.8% (44/92), with a sustained response rate of 77.3% (34/44) at 6 months. Median time to response was 6 weeks. Fourteen patients (31.8%) relapsed with a median duration of response of 10 weeks. Most patients (73.9%) had documented side effects, with nausea/vomiting, infections and myelosuppression being the most common. The majority of patients received azathioprine as third-line; 6 patients were post-TPO-RA and 27 post-splenectomy. ORR was 50.0% (3/6) and 40.7% (11/27) in each group respectively.This is the largest retrospective study demonstrating benefit with azathioprine in relapsed/refractory ITP. Its efficacy remains consistent both post-TPO-RA (p=0.948) and post-splenectomy (p=0.259), offering clinicians a comparable drug response irrespective of prior TPO-RA exposure or splenectomy. We propose that azathioprine remains a viable option for relapsed/refractory ITP in the TPO-RA era.

Musculoskeletal melioidosis- a retrospective review of 22 cases from a tertiary care centre in South Tamilnadu

A retrospective review of culture confirmed musculoskeletal melioidosis reported between December 2014 and February 2024 was conducted. 22 of 100 patients with culture proven melioidosis infection had musculoskeletal involvement. Median age was 47 years with 95.4% being males. Osteomyelitis, septic arthritis and septic arthritis along with adjacent osteomyelitis were observed in 12, 9 and 4 cases respectively. All isolates were susceptible to meropenem and susceptible increased exposure to ceftazidime, doxycycline and cotrimoxazole. Twelve patients underwent surgical procedures. Four patients who died due to septicemia had multisystem involvement with positive blood cultures.

Endoluminal Approaches for Colorectal Neoplasia in Inflammatory Bowel Disease, A Viable Alternative for Colectomy?

IntroductionEndoscopic resection of visible dysplastic lesions in patients with inflammatory bowel disease (IBD) provides an alternative to colectomy for management. Endoscopic techniques that can be used include endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and a combined hybrid approach of ESD and EMR. These endoscopic treatments may allow organ preservation in patients with IBD. The aim of this study was to evaluate outcomes of endoscopic resection, including EMR, ESD and hybrid ESD/EMR, for the treatment of colorectal dysplasia in patients with IBD. MethodsWe performed a retrospective review of IBD patients who underwent endoscopic resection for colorectal dysplasia at our tertiary care center between 2014 to 2023. Patients were identified through a search of our endoscopy database. Medical records were reviewed to collect data on patient demographics, IBD history, details of endoscopic technique, procedural factors, final pathology results, and outcomes including recurrence of dysplasia. ResultsA total of 50 IBD patients underwent endoscopic resection, including 38 ESD, 11 hybrid ESD/EMR, and 1 EMR. Median age was 62 (IQR: 54-68) years and 34 (68%) were male. Median BMI was 27.6 (IQR: 24.8-31.7). Underlying diagnosis was ulcerative colitis in 33 (66%) and Crohn's disease in 17 (33%). Median disease duration was 27.5 years (IQR 8-30). Polyp locations were distributed as follows: right colon, rectum, left colon, transverse colon, and cecum, with 9 (18%) in each area. Median procedure time was 47.5minutes (IQR: 31.2-73.7). En bloc resection was achieved in 34 (68%) and piecemeal resection in 16 (32%). On pathology, median lesion size was 23.5 (IQR: 20.2-40) mm. High-grade dysplasia was found in 7 (14%) and low-grade dysplasia in 15 (30%). During a median follow-up period of 7.2 years, 18% of patients experienced recurrence. No significant difference in recurrence rates was observed between the ESD and ESD/EMR groups. ConclusionEndoscopic resection, including EMR, ESD and hybrid techniques, enables effective treatment of visible dysplastic lesions as an alternative to colectomy in patients with IBD. In this cohort, favorable short-term outcomes were demonstrated after endoscopic resection.

Analysis of clinical characteristics and factors affecting treatment responses in patients with pyoderma gangrenosum: a multicenter study of 239 patients☆

BackgroundPyoderma Gangrenosum (PG) is a chronic disease characterized by recalcitrant skin ulcers. ObjectiveWe aimed to evaluate the demographic, clinical characteristics, treatments and factors affecting the treatment responses of patients with PG. MethodsWe performed a multicenter study of 12 tertiary care centers. We analyzed the data of the patients who were followed up with a diagnosis of PG between the years 2012‒2022 retrospectively. ResultsWe included a total of 239 patients of whom 143 were female and 96 were male, with an average age of 54.2 ± 17.4 years. The most common treatment was systemic steroids (n = 181, 75.7%). Among these patients, 50.8% (n = 92) used systemic steroids as the sole systemic agent, while 49.2% (n = 89) used at least one adjuvant immunosuppressive agent. The independent factors determined in regression analysis to influence response to systemic steroids positively were disease onset age ≥ 30-years, negative pathergy, absence of leukocytosis, negative wound culture, presence of a single lesion, and absence of upper extremity involvement. Biological agents were used in 18.4% (n = 44) of the patients in the present study. We also analyzed pathergy positive PG and early onset (onset age < 30) PG separately due to their distinct clinical features which were revealed during statistical analysis. Study limitationsRetrospective nature of the present study. ConclusionsAnalyses of the factors influencing treatment responses are addressed in this study. Also, we concluded that investigation for accompanying autoinflammatory diseases of pathergy positive PG and early onset PG is necessary and the patients in these two groups are more resistant to treatment, necessitating more complicated treatments.

A Comparative Study of the Hand-held IC200 and Slit Lamp-mounted ST500 rebound tonometers with Goldmann Applanation Tonometry

To compare the agreement and repeatability of intraocular pressure (IOP) measured with the slit lamp-mounted ST500 rebound tonometer (iCare Finland Oy, Helsinki, Finland), the hand-held IC200 rebound tonometer (iCare Finland Oy) and Goldmann applanation tonometry (GAT). Cross-sectional study. Glaucoma patients and staff of the Eye Care Centre, Nova Scotia Health, Halifax, Canada. IOP was measured twice each with the IC200, ST500, and GAT. Bland-Altman analysis was used to compare each pair of tonometers and whether the difference between tonometers depended on mean IOP. Intra-class correlation coefficients were also computed. Repeatability of the measurements with each tonometer was assessed by calculating the mean and variance of the difference between the first and second measurement. The relationship between IOP and central corneal thickness was also evaluated. Agreement and repeatability of IOP measurements with the IC200, ST500 and GAT. One eye of 157 participants (64 men and 93 women) with a median (Interquartile range) age and CCT of 62 (45 - 72) years and 553 (533 - 572) μm, respectively, were enrolled. Median IOP with the IC500, ST500 and GAT was 17.1 (14.3 - 21.0), 16.5 (14.0 - 20.8) and 17.0 (14.0 - 20.5) mm Hg, respectively, while the range of IOP (measured with GAT) was 8.5 to 53.0 mm Hg. Measurements with the three tonometers were not statistically different from each other and in neither of the three paired comparisons was the difference in IOP between two tonometers dependent on mean IOP. The ICC values (0.97-0.98) showed excellent agreement between the tonometers. The variance of the difference between the first and second measurements of the ST500 was significantly lower than that of GAT (P = 0.04) and IC200 (P < 0.01). ICCs for intra-tonometer repeatability were also excellent (0.97-0.99). The ST500 shows good agreement with GAT over a large range of IOP, and significantly higher repeatability compared to the IC200 and GAT, suggesting it may be advantageous in clinical settings where topical anesthesia or skilled staff are unavailable.

Post-Cataract Surgery Fungal Endophthalmitis: 6-Year Experience in Management and Outcomes at a Tertiary Eye Care Center

Post-Cataract Surgery Fungal Endophthalmitis: 6-Year Experience in Management and Outcomes at a Tertiary Eye Care Center

Proactive total diet replacement referral for type 2 diabetes: A service evaluation

AimsType 2 Diabetes Mellitus morbidity disproportionally effects the most socioeconomically deprived 20 % of England. Total Diet Replacement (TDR) is a high impact intervention currently commissioned by Integrated Care Boards (ICB). Finding and referring eligible, motivated patients is a significant challenge. This study evaluates a 12-month population health management, proactive referral intervention commissioned by Nottingham and Nottinghamshire ICB during a 2-year TDR pilot designed to supplement referrals from primary care. MethodsA Diabetes specialist nurse clinically reviewed a list of potentially eligible patients found by searching routinely collected health care data from 16 primary care centres in 3 PCNs. Results19.7 % (50/254) of potential patients were referred during the intervention period. 19.3 % (49/254) were uncontactable. 39.8 % (101/254) declined referral. 17.7 % (45/254) were ineligible after clinical review. An interrupted time series analysis suggests monthly referrals increased during the study period due to the intervetion (F (1,22) = 5.19 p=0.0345). Searching for patients from more socioeconomically deprived areas (index of multiple deprivation deciles 1–3) did not meaningfully alter the referral yield (19.6 %, 19/97). ConclusionsProactive care interventions could be used to facilitate referrals to the TDR or other high impact interventions by healthcare commissioning bodies.

Transperineal Ultrasound In Clinically Diagnosed FistulaIn Ano Cases - A Cross-Sectional Study In A Tertiary Care Center

Fistula-in-ano (FIA) is a chronic and often recurrent anorectal condition characterized by an abnormal communication between the rectum or anal canal and the perianal skin. Accurate diagnosis and management of FIA remain challenging due to the complexity of fistula tracts and potential complications. Traditional diagnostic methods like clinical examination and fistulography are commonly employed, but these methods often lack detailed visualization of the fistulous tracts. In recent years, transperineal ultrasound (TPUS) has emerged as a non-invasive, radiation-free, and cost-effective tool in the assessment of FIA. This study aims to review the role of transperineal ultrasonography in the assessment of fistula-in-ano, with respect to its current techniques, advantages, clinical applications, and future directions.

Neuromelioidosis – A retrospective review of thirteen cases from a tertiary care centre from South India

Neurologic melioidosis warrants attention in view of its rarity and lethal consequences. We performed a retrospective review of culture confirmed neurologic melioidosis reported between 2017 and 2023. Thirteen patients were identified with median age 43 years and all but three were males. Brain parenchyma was involved in 57% cases (7/13) as cerebritis, encephalitis and macro abscess or micro abscess. Three patients had myelitis with spinal cord micro abscess and cerebral venous thrombosis in three other patients. Five patients died during hospitalization. Two were discharged against medical advice due to financial constraints. Six survivors were followed between one and eight months.

Prediction of perinatal mortality in early-onset fetal growth restriction: A post hoc analysis of the Dutch STRIDER trial to predict perinatal mortality in early-onset fetal growth restriction

ObjectiveEarly-onset fetal growth restriction affects about 0.3% of pregnancies, posing high perinatal risks due to placental insufficiency. Early-onset fetal growth restriction often coincides with early-onset pre-eclampsia, associated with significant mortality and morbidity. Clinical management varies among clinicians, with emphasis on intensive monitoring and timely delivery. Our objective was to improve clinical prediction of perinatal mortality in early-onset fetal growth restriction for parental counseling. Study designThis was a secondary analysis of prospective cohort data from the Dutch STRIDER trial. The study included 215 pregnant women diagnosed with severe early-onset fetal growth restriction between 20 + 0 and 29 + 6 weeks of gestation, from tertiary and secondary antenatal care centers in The Netherlands. Maternal and fetal characteristics were collected at inclusion, including sonographic and laboratory measurements. Analysis was performed using univariable and multivariable binary logistic regression to create a prediction model for perinatal mortality. The main outcome measures were fetal demise and neonatal mortality up to discharge. Results215 Participants were included for this analysis. Perinatal mortality occurred in 84 (39 %) cases; 51 (24 %) were fetal and 33 (15 %) neonatal. Fetal abdominal circumference, gestational age at diagnosis, estimated fetal weight Multiple of Median, absent or reversed end-diastolic flow of the umbilical artery, umbilical artery pulsatility index Multiple of Median, non-Caucasian ethnicity, male sex, placental growth factor level and uterine artery pulsatility index were independent predictors of perinatal mortality. Randomization allocation (sildenafil or placebo) had no predictive value for mortality. The prediction model including gestational age at diagnosis, estimated fetal weight Multiple of Median and umbilical artery pulsatility index Multiple of Median showed an area under the receiver operating characteristic curve of 0.840 (P < 0.01). Placental growth factor was measured in a subset of patients and was an independent prognostic factor and performed significantly better within the predictive model, however it did not improve the predictive value of the model. ConclusionsPrediction of perinatal mortality in early-onset fetal growth restriction is feasible with commonly available tests and measurements and could support decision making in management of pregnancy. However, implementation in practice requires further studies.

Differences in IgG afucosylation between groups with and without carotid atherosclerosis

BackgroundA previous study demonstrated that N-glycosylation profiles of IgG are associated with subclinical atherosclerosis in a British population. However, the generalisability of this finding to other ethnic groups remains to be investigated, and it has yet to account for additional traditional atherosclerotic risk factors. The present study, thus, aims to explore IgG N-glycosylation profiles in Han Chinese with atherosclerosis, and their potential role in atherosclerosis, while controlling for traditional atherosclerotic risk factors.MethodsData of this case-control study were obtained from an established umbrella Health Examination Cohort Study (registration number: ChiCTR2100048740). The investigation was conducted at the Health Care Centre of the First Affiliated Hospital of Shantou University Medical College in China, from August 1, 2021, to July 31, 2022. A sample of 69 carotid atherosclerosis (CAS) cases was recruited from the umbrella cohort, along with 69 controls without carotid atherosclerosis, matched by traditional atherosclerosis-related risk factors, including gender, age, smoking, alcohol consumption, hypertension, diabetes, dyslipidemia and obesity. Subsequently, serum IgG N-glycosylation was profiled using Ultra-Performance Liquid Chromatography.ResultsAfter propensity score matching, the relative abundance of IgG fucosylation in CAS cases was significantly lower than that in controls [95.32 (92.96, 95.99) vs. 95.96 (94.70, 96.58), P = 0.022]. The traditional atherosclerosis-related risk factors showed no statistically significant difference between CAS cases and controls (P > 0.05).ConclusionsThe reduced fucosylation of IgG in CAS cases underscores the pivotal role of afucosylation in CAS. Enhancing the inflammatory capability of IgG via initiating antibody-dependent cell-mediated cytotoxicity could be the potential mechanism behind this, which should be further verified by functional studies.

Unmet educational needs and expectations among tracheostomy recipients

ObjectiveThis study seeks to better understand unmet educational needs and treatment expectations in individuals with a tracheostomy. Study designRetrospective, cross-sectional survey. MethodsA survey was distributed to individuals who received a tracheostomy at a tertiary care center in the last five years as well as in Facebook support groups for tracheostomy and head and neck cancer patients. The survey focused on tracheostomy education, satisfaction with care, and gaps in treatment plan understanding. Primary outcome was rate of tracheostomy peri-operative experience being on-par with expectations. ResultsAmong 83 respondents, only report of pre-operative speech (p = 0.024) and swallow (p = 0.019) discussions were associated with peri-operative experience being on-par with expectations. Respondents were more likely to report importance of counseling regarding psychological well-being (p < 0.001) and post-operative social integration/interaction (p < 0.001) than they were to report receiving focused counseling about these topics. Qualitative analysis demonstrated the most frequently missing components of understanding of treatment plans included post-operative care and the post-operative experience (n = 19, 40.4 % each). Reasons for treatment not meeting expectations included lack of communication/education (n = 15, 39.5 %) and experience being worse than expected (n = 8, 21.1 %). Individuals frequently wanted more details of the experience of living with a tracheostomy (n = 25, 42.6 %) and details about tracheostomy care (n = 10, 16.4 %). ConclusionThis study demonstrates significant gaps in informational needs for individuals receiving a tracheostomy, emphasizing the importance of guideline-directed tracheostomy counseling. Specifically, more information is needed regarding expected post-surgical experience, tracheostomy care and maintenance, psychosocial wellbeing, and communication support.

Management considerations in grease versus non-grease scald burns in adults: A retrospective cohort study at a tertiary burn care facility

IntroductionScald burns are challenging to manage due to their evolutionary nature and nuanced injury pattern. Different mediums, such as hot water, steam, or grease, each have unique physical properties that may inflict more damage and incite a different inflammatory response. While pediatric patients are often the focus of scald burn research, a significant number of adults still suffer from scald burns, especially while cooking with hot grease. Our study aimed to analyze differences in injury pattern and management between grease versus non-grease scald burns. Materials and MethodsA retrospective chart review was done on all scald burn patients at a tertiary burn care center from January 2020 to December 2022. The primary outcomes were admission and length of stay with the primary exposure being grease versus non-grease scald burns. Secondary outcomes included rates of surgical excision and changes in surgical management plans. Multivariate regressions were employed to control for sex, age, total body surface area (TBSA), and burn thickness. ResultsOf 165 patients with scald burns, 41 out of 91 (45.1 %) with grease burns and 43 out of 74 (58.1 %) with non-grease burns were admitted. No statistically significant difference in length of hospital stay existed between admitted grease and non-grease burns (p = 0.45). Additionally, no differences were observed for surgical excision (p = 0.63) and changes in surgical management plans (p = 0.47) ConclusionThe mechanism of scald burn caused by either a grease or non-grease source is not associated with any differences in admission, length of hospital stay, or surgical management. Scald burn management should still focus on patient age, TBSA, and burn thickness regardless of the causative agent.

Coexistence of aerobic vaginitis caused by Enterococcus faecalis and human papilloma virus (HPV) infection as a risk factor for the development of cervical intraepithelial lesions

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim&amp;lt;/strong&amp;gt; To determine the prevalence of aerobic vaginitis (AV) caused by &amp;lt;em&amp;gt;Enterococcus faecalis (E. faecalis)&amp;lt;/em&amp;gt; in human papilloma virus (HPV)-positive women with pathological Pap test and to determine the most prevalent HPV type associated with &amp;lt;em&amp;gt;E. faecalis&amp;lt;/em&amp;gt; infection.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods&amp;lt;/strong&amp;gt; This prospective study was conducted at the Gynaecology Centre &amp;quot;Dr. Mahira Jahić&amp;quot; Tuzla and Primary Health Care Centre Te&amp;amp;scaron;anj (Bosnia and Herzegovina) in the period between February 2023 and March 2024. The research included 200 women aged 25 to 50 years. The examined group consisted of 100 women with a pathological (examined group) and 100 with a normal (control group) Pap test result.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results&amp;lt;/strong&amp;gt; Pathological Pap smears were found in 60 (out of 100; 60 %) women in the examined group: cervical intraepithelial neoplasia (CIN) 1 and CIN 2 &amp;amp;nbsp;in two women, respectively, CIN 3 in seven, atypical squamous cells of undetermined significance (ASCUS) in 29 and atypical squamous cells-high-grade cannot be excluded (ASC-H) in two women. Overall (both groups) prevalence of &amp;lt;em&amp;gt;E. faecalis&amp;lt;/em&amp;gt; was 25.5% (51women); in 45 (22.5%) women &amp;lt;em&amp;gt;E. faecalis&amp;lt;/em&amp;gt; was the only bacterial isolate, of which 42 (21%) in the examined group and three (1.5%) in the control group. High-risk HPV types were found in 62 (out of &amp;amp;nbsp;100; 62%) women with the pathological Pap smear test. The association of &amp;lt;em&amp;gt;E. faecalis&amp;lt;/em&amp;gt; and high-risk HPV positive women was found in 35 (35%) cases (moderately positive correlation; r=0.198).&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion&amp;lt;/strong&amp;gt; E. faecalis is very common in HPV 16 and 18 positive women and may represent a risk factor in the development of cervical intraepithelial lesions.&amp;lt;/p&amp;gt;

Frequency and impact of post-traumatic stress disorder and traumatic life events in patients with migraine

IntroductionPost-traumatic stress disorder (PTSD) has been proposed as a risk factor for chronification of migraine. The aim of this study was to investigate the frequency of PTSD and traumatic life events (TE) in patients with episodic (EM) and chronic migraine (CM) and their impact on clinical parameters, other comorbidities, and migraine biomarkers. Material and methodsPatients with EM and CM according to the International Classification of Headache Disorders (third edition; beta version) were recruited at a headache unit and a primary care centre. We used questionnaires validated for research on PTSD, TEs, cranial autonomic symptoms, comorbidities (depression, anxiety, and fatigue), disability, migraine impact, and quality of life. Baseline serum levels of CGRP, VIP, and PACAP were determined by ELISA. ResultsThe study included 116 patients: 35 with EM and 81 with CM. Nineteen presented refractory migraine. PTSD was detected in 23 patients (19.8%): 20 with CM and 3 with EM (chi-square: P = .046; Fisher T: P = .073). No significant differences were identified between the EM and CM groups for frequency of any TE nor the number of TEs per patient. A total of 5/19 patients with refractory migraine had experienced sexual violence (vs 2/97 with non-refractory migraine; P = .002). PTSD was associated with more autonomic symptoms; higher scores on anxiety, depression, and fatigue scales; and poorer quality of life; it did not change neuropeptide levels. ConclusionsOur results suggest that PTSD is frequent in patients with migraine, and especially CM, in our setting; history of sexual violence is particularly frequent in patients with refractory migraine. PTSD has a negative impact on migraine, with higher numbers of comorbidities and poorer quality of life; therefore, further research is needed in this patient group.

Ocular Surface Disease and Dry Eye Severity in Glaucoma Patients at Urban Private Eye Care Centres in Malaysia

Ocular Surface Disease and Dry Eye Severity in Glaucoma Patients at Urban Private Eye Care Centres in Malaysia

Unveiling Macrosomia Risks of Non-Diabetic Women: Insights from Second Trimester Maternal Lipid Profiles

Background: Macrosomia, characterized by excessive fetal growth, is common in infants born to women with pre-gestational diabetes and gestational diabetes mellitus (GDM). However, macrosomia, which leads to birth-related maternal and fetal complications and metabolic complications in the adolescence of the affected fetuses, also occurs in the pregnancies of non-diabetic women. This study aims to identify the association between second-trimester lipid profiles and macrosomia in non-diabetic pregnant women to aid in early diagnosis. Methods: This retrospective cohort study included 8,956 patients who delivered at a tertiary care center between 2017 and 2019. Exclusion criteria encompassed pre-existing diabetes, GDM, preeclampsia (PE), intrahepatic cholestasis of pregnancy, obesity, fetal chromosomal or genetic abnormalities, tobacco, alcohol, or drug use affecting lipid metabolism. Participants were divided into two groups: 621 with macrosomia and 873 controls. Second trimester maternal lipid profiles and demographic variables such as age, pregnancy week, and gender were assessed. Results: In the study cohort, maternal age (P=0.002), gestational week (P=0.003), and cesarean section rate (P&lt;0.001) were higher in the macrosomic group. High-density lipoprotein-cholesterol (HDL-C) was significantly lower, while total cholesterol (TC), triglycerides (TG), and low-density lipoprotein-cholesterol (LDL-C) were significantly higher in the macrosomic group (P&lt;0.001). Univariate analysis revealed positive associations between second-trimester TG (OR 1.023, 95% CI: 1.020‒1.033, P&lt;0.001), TC (OR 1.023, 95% CI: 1.016‒1.030, P&lt;0.001) and LDL-C (OR 1.036, 95% CI: 1.018-1.054, P&lt;0.001) with macrosomia and a negative association with HDL-C (OR 0.954, 95% CI: 0.923‒0.976, P&lt;0.001). However, after adjusted multivariable logistic analysis, only TG remained statistically significantly associated with macrosomia (OR 1.054, 95% CI: 1.033‒1.076, P&lt;0.001). Conclusion: Our study emphasizes the importance of early recognition and prevention of macrosomia. Structured prospective studies are needed to enhance macrosomia prediction and implement preventive measures, such as dietary modifications. These strategies will be crucial in preventing birth-related complications and long-term health risks, including diabetes, obesity, and cardiovascular diseases, associated with macrosomia.

Impact of Moderate or Severe Mitral and Tricuspid Valves Regurgitation after Transcatheter Aortic Valve Replacement

BackgroundTricuspid regurgitation (TR) and mitral regurgitation (MR) are common valvular conditions encountered in patients undergoing transcatheter aortic valve replacement (TAVR). This retrospective study investigates the impact of moderate or severe TR and MR on all-cause mortality in one-year post-TAVR patients. MethodsConsecutive patients who underwent TAVR at the 3 academic tertiary care centers in our health system between 2012 and 2018 were identified. Patients were stratified into 2 groups based on valvular regurgitation severity: moderate/severe MR vs. no/mild MR, and moderate/severe TR vs. no/mild TR. Primary outcome was all-cause mortality at 1-year and 5-year follow up, and secondary outcome was in-hospital death. Logistic regression analysis was conducted to assess the relationship between moderate/severe MR or TR and all-cause mortality at 1-year and 5-year follow-up. ResultsWe included a total of 1,071 patients who underwent TAVR with mean age 80.9 ± 8.6 years, 97% white, and 58.3% males. Moderate or severe MR group included 52 (4.88%) patients while mild or no MR group included 1,015 (95.12%) patients. There was no significant difference between both groups in TAVR procedure success rate (100% vs. 97.83%, p=0.283), in-hospital mortality (0 vs. 1.08%, p=0.450), or mortality at 1-year follow up (15.38% vs. 14.09%, p=0.794). At 5-year follow up, moderate/severe MR group had higher mortality (61.4% vs. 49.5%, p=0.046). In multivariable logistic regression analysis, moderate or severe MR did not show significant correlation with all-cause mortality at 1-year and 5-year follow up. Moderate or severe TR group included 86 (8.03%) patients while mild or no TR group included 985 (91.97%) patients. There was no difference between both groups in TAVR procedure success (98.8% vs. 97.9%, p=0.54) or in-hospital mortality (0% vs. 1.1%, p=0.33). At 1-year follow up, patients with moderate or severe TR had higher mortality (26.7% vs. 13.2%, p=0.001) compared to patients with mild or no TR. Same finding was noted with extended follow up at 5-years (68.3% vs. 48.7%, p<0.001). In multivariable cox regression analysis, moderate/severe TR was associated with higher all-cause mortality at 1-year (OR 1.94, 95% CI [01.09, 3.44], p=0.0.023) and at 5-year (OR 1.46, 95% CI [1.092, 1.952], p=0.0.011) follow up. Patients with combined moderate/severe MR and TR have even higher mortality compared to either moderate/severe valve regurgitation alone or mild/no valve regurgitation at 5-year follow up. ConclusionAt long term follow up, moderate/severe TR, but not MR, is associated with higher mortality in patients underwent TAVR. Combined moderate/severe TR and MR had even worse mortality. Careful assessment of multi-valvular heart disease prior to the procedure is warranted.

Lymphedema Awareness and Experience in the Turner Syndrome Community.

Lymphedema commonly affects females with Turner syndrome (TS), although it may be underrecognized and untreated. The objective of this study was to better understand self-reported lymphedema prevalence, knowledge, and experience in TS. A 24-question anonymous survey was distributed to females with TS or their caregivers at a TS community event, a TS adult comprehensive care center, and an associated pediatrics clinic. Survey questions assessed lymphedema awareness, diagnosis and history, treatments and compliance, and sequelae. Data were analyzed using descriptive statistics. Forty-one surveys were returned, with 51.2% (n = 21) completed by the patient (mean age 25.8 years), 26.8% by the caregiver (n = 11), 2.5% by both the patient and the caregiver (n = 1), and 19.5% (n = 8) with unmarked respondent type. Greater than 75% (n = 31) reported having heard of lymphedema, 26.8% (n = 11) reported discussing lymphedema with a healthcare provider, and 22% (n = 9) reported receiving a diagnosis of lymphedema. The median age at the time of lymphedema diagnosis was 2 years. The most commonly affected body sites were legs/feet, followed by arms/hands and neck/face; the majority of patients experienced lymphedema at multiple body sites. Lymphedema resolution was reported by half, with a median duration of 4.25 years. Only one-third of those with lymphedema reported receiving treatment for the condition, including use of specialized massage/manual lymphatic drainage and compression garments. Identification of knowledge gaps and experience with lymphedema in TS can help with the development of targeted educational interventions. Greater awareness and understanding of this treatable condition in TS may contribute to improved health outcomes.