Treatment Centers Research Articles

The Role of Metabolic Therapy in the Treatment of Chronic Coronary Syndrome. Results of Own Research

Ischemic heart disease (IHD) and stroke are the main causes of mortality and disability worldwide. One of the most controversial issues in modern cardiology is the feasibility of using metabolic drugs for the treatment of patients with angina. The main directions in metabolic therapy are optimization of energy production and expenditure and normalization of the balance between the intensity of free radical oxidation and antioxidant processes. The objective: to determine the clinical effectiveness of combined metabolic therapy with domestic drugs meldonium, ethylmethylhydroxypyridine succinate and armadin in the complex treatment of military personnel with IHD. Materials and methods. The study included 36 military personnel with coronary artery disease with stable angina pectoris of functional class II–III. Patients were treated in the cardiology department of the Military Medical Clinical Treatment and Rehabilitation Center (Irpin). All examined patients were male, the average age was 43.7 ± 2.7 years, the duration of the disease was 4.2 ± 2.3 years, the onset of angina attacks was 39.6 ± 2.8 years. All patients received standard therapy in accordance with the ESC recommendation. Additionally intravenous drip infusions of meldonium (100 mg/ml, 5 ml per 100.0 saline), ethylmethylhydroxypyridine succinate (50 mg/ml, 2 ml intravenously in a 1:2 dilution in saline, slowly in a jet) and armadin (300 mg, 1 tablet in the evening for 2 weeks, then 1 tablet solution twice a day for 4 weeks) were prescribed. The effectiveness of the prescribed complex was monitored based on the dynamics of clinical status, bicycle ergometry indicators, and Holter ECG monitoring before the start of treatment and after 14–16 days. Results. The use of metabolic therapy significantly improved the general condition of patients, reduced the number of angina attacks, and reduced the need for nitroglycerin tablets. Analysis of the sample with dosed physical activity before the start of therapy revealed a significant percentage of patients with ST segment depression of 2 mm at the height of physical activity, and the total relative number of patients with ST segment depression of 1.5–2 mm was 72.2%. During the repeated examination ST segment depression was not determined in 94.4% of patients. Before treatment, rhythm disturbances in the form of supraventricular and ventricular extrasystoles were recorded on the background of maximum exercise, and after treatment, no rhythm disturbances were detected. In the dynamics of the therapy, it was possible to achieve a decrease in blood pressure (BP) indicators during exercise, the level of systolic BP decreased by 16.4%, and diastolic BP – by 9.4% (p < 0.05). Recovery time significantly decreased by 35.2%, but oxygen consumption and tolerance index significantly increased. Conclusions. The results of the study demonstrated that combination therapy with domestically produced metabolic drugs (meldonium, ethylmethylhydroxypyridine succinate and armadine) with a combination of injectable and tablet forms showed high effectiveness in the treatment of military personnel with coronary artery disease. The combination of drugs that patients received during the study demonstrated good tolerability and the absence of adverse reactions.

Patient experience of an abstinence-based Indigenous residential treatment program in Northern Ontario: a descriptive qualitative study.

Indigenous peoples with substance use disorders (SUD) and intergenerational trauma (IGT) face complex healthcare needs. Therefore understanding Indigenous patient experiences is crucial for enhancing care delivery, fostering engagement, and achieving optimal outcomes, yet few studies explore the motivations for seeking, staying in, and utilizing treatment from an Indigenous perspective. The goal of this study was to understand the patient experience with an abstinence-based treatment model in a residential treatment setting. A qualitative thematic study was conducted between April 2018 and February 2020 at Benbowpka treatment centre in Blind River, Ontario, Canada. We evaluated the results of the abstinence-based model intervention from the patient's perspective. The Client Quality Assurance Survey tool was employed to gather this data. The data underwent thematic analysis to derive meaningful insights. A total of 157 patients were interviewed. The results were categorized into three parts: (1) Critical events that encouraged participants to seeking treatment; (2) Benefits experienced by participants while they were in the program; (3) Participants take-aways and priorities after completing the program. Core themes emerged in each category and each theme is sub-categorized into quadrants of the Medicine Wheel. Firstly, there was a critical juncture that significantly impacted participants' lives that motivated them to seek treatment at the Benbowpka Treatment Centre. Second, during the study, participants admission to the Benbowopka Treatment Centre, the participants benefitted from a holistic program that addresses spiritual, physical, mental and emotional aspects of healing. Third, participants identified tangible ways in which they implement the skills they gained during the program in their daily lives. Overall, study demonstrates that clients benefitted from both the program activities and the traditional healing practices. This research identified that SUD Indigenous residential treatment programs need to include culture, healing practices, activities and relationships that are part of the treatment process. This study found that the cultural elements and healing practices of the program were highly valued by clients.

The Full Blood Count and D-Dimers of Patients Infected with COVID-19 at the Bamenda Treatment Center

Coronavirus disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus-2, is an ongoing global pandemic affecting multiple organ systems, including the hematopoietic system, particularly in severe cases, which has been sparingly reported. This study aimed to describe the hematological profile (WBC count, lymphocyte count, hemoglobin, platelet count, and D-dimers) of COVID-19 patients and assess the impact of these changes on outcomes at the Bamenda Treatment Center. A cross-sectional retrospective study was conducted on medical records of eligible COVID-19 patients from April 20, 2020, to May 31, 2021, including cases with Full Blood Count or D-dimers but excluding those with confirmed death on arrival. Socio-demographic, clinical, and para-clinical data were analyzed using SPSS version 23, with significance set at p<0.05 and a 95% confidence interval. Of the 497 cases included, the mean age was 43.45±22.2 years, with a female predominance (male- to-female ratio of 1:1.5). Key findings included lymphocytopenia in 35.9% of participants and elevated D-dimers in 58.5%, with higher median D-dimers observed among non-survivors (Median: 1470.69, IQR: 5020.2) and those requiring supplemental oxygen (Median: 1289.75; IQR: 321.42–5341.67). Additionally, hospitalized patients with low platelet counts (83.3%) had significantly lower mean platelet counts than those quarantined at home (16.7%) (p<0.001). These findings highlight the significance of hematological changes among COVID-19 patients, particularly elevated D-dimers and lymphocytopenia, and underscore the need to monitor full blood count and D-dimers during initial consultations to enhance patient management and risk stratification.

Plasma Interleukin-35 Levels Predict the Prognosis in Patients with HBV-Related Acute-on-Chronic Liver Failure.

This study aimed to investigate the impact of IL-35 on the prognosis of patients with HBV-ACLF. We recruited 69 patients with HBV-ACLF, 20 patients with chronic hepatitis B (CHB), 17 patients with liver cirrhosis (LC), and 20 healthy controls (HCs) from a regional infectious disease treatment center in China. Plasma levels of IL-35 at baseline were detected using ELISA. Plasma IL-35 levels in the HBV-ACLF group were the highest among all four groups. Furthermore, survivors exhibited significantly higher IL-35 levels than non-survivors (p < 0.001). IL-35 levels correlated with MELD (r = -0.678, p < 0.001), COSSH-ACLF IIs (r = -0.581, p < 0.001), alpha-fetoprotein (AFP) (r = 0.433, p < 0.001), creatinine (Cr) (r =-0.396, p = 0.001), and lactate (r =-0.38, p =0.001). The combination of plasma IL-35 and MELD score had the highest mortality prediction efficiency, with an area under the curve (AUC) of 0.895 (95% CI: 0.812-0.978, p < 0.001), a sensitivity of 80.6%, and a specificity of 93.9%. Additionally, the Kaplan-Meier analysis revealed that lower levels of IL-35 (≤191.5pg/mL) were associated with poorer survival rates in HBV-ACLF patients (p < 0.001). Our results demonstrated that IL-35 could be an effective predictive marker for the prognosis of HBV-ACLF and improve the predictive performance when combined with the MELD score.

Analysis of the current status of red blood cell transfusion in very preterm infants from Chinese Neonatal Network in 2022

Objective: To analyze the current status of red blood cell transfusion in very preterm infants (VPI) (gestational age at birth <32 weeks) from Chinese Neonatal Network (CHNN) in 2022. Methods: This cross-sectional study was based on the CHNN VPI cohort. It included 6 985 VPI admitted to CHNN 89 participating centers within 24 hours after birth in 2022. VPI with major congenital anomalies or those transferred to non-CHNN centers for treatment or discharged against medical advice were excluded. VPI were categorized based on whether they received red blood cell transfusions, their gestational age at birth, the type of respiratory support received during transfusion, and whether the pre-transfusion hemoglobin levels exceeded the thresholds. General characteristics, red blood cell transfusion rates, number of transfusions, timing of the first transfusion, and pre-transfusion hemoglobin levels were compared among different groups. The incidence of adverse outcomes between the group of VPI who received transfusions above the threshold and those who received transfusions below the threshold were compared. Comparison among different groups was conducted using χ2 tests, Kruskal-Wallis H tests, Mann-Whitney U test, and so on. Trends by gestational age at birth were evaluated by Cochran-Armitage tests and Jonckheere-Terpstra tests for trend. Results: Among the 6 985 VPI, 3 865 cases(55.3%) were male, with a gestational age at birth of 30.0 (28.6, 31.0) weeks and a birth weight of (1 302±321) g. Overall, 3 617 cases (51.8%) received red blood cell transfusion, while 3 368 cases (48.2%) did not. The red blood cell transfusion rate was 51.8% (3 617/6 985), with rates of 77.7% (893/1 150) for those born before 28 weeks gestational age and 46.7% (2 724/5 835) for those born between 28 and 31 weeks gestational age. A total of 9 616 times red blood cell transfusions were administered to 3 617 VPI, with 632 times missing pre-transfusion hemoglobin data, and 8 984 times included in the analysis. Of the red blood cell transfusions, 25.6% (2 459/9 616) were administered when invasive respiratory support was required, 51.3% (4 934/9 616) were receiving non-invasive respiratory support, while 23.1% (2 223/9, 616) were given when no respiratory support was needed. Compared to the non-transfusion group, the red blood cell transfusion group had a higher rate of pregnancy-induced hypertension in mothers, lower rates of born via cesarean section and mother's antenatal steroid administration, smaller gestational age, lower birth weight, a higher proportion of small-for-gestational-age, multiple births, and proportions of Apgar score at the 5th minute after birth ≤3 (all P<0.05). They were also less likely to be female, born in hospital or undergo delayed cord clamping (all P<0.01). Additionally, higher transport risk index of physiologic stability score at admission were observed in the red blood cell transfusion group (P<0.001). The number of red blood cell transfusion was 2 (1, 3) times, with the first transfusion occurring at an age of 18 (8, 29) days, and a pre-transfusion hemoglobin level of 97 (86, 109) g/L. For VPI ≤7 days of age, the pre-transfusion hemoglobin levels for invasive respiratory support, non-invasive respiratory support, or no respiratory support, respectively, with no statistically significant differences between groups (H=5.59, P=0.061). For VPI aged 8 to 21 days and≥22 days, the levels with statistically differences between groups (both P<0.01). Red blood cell transfusions above recommended thresholds were observed in all respiratory support categories at different stages of life, with the highest prevalence in infants aged 8 to 21 days and≥22 days who did not require respiratory support, at 90.1% (264/273) and 91.1%(1 578/1 732), respectively. The rate of necrotizing enterocolitis was higher in the above-threshold group (χ2=10.59,P=0.001), and the duration of hospital stay was longer in the above-threshold group (Z=4.67, P<0.001) compared to the below-threshold group. Conclusions: In 2022, the red blood cell transfusion rate was relatively high among VPI from CHNN. Pre-transfusion hemoglobin levels frequently exceeded recommended transfusion thresholds.

Application of a novel gastro-laryngeal mask in upper gastrointestinal endoscopy surgery: A pilot randomized clinical trial.

The Gastro-Laryngeal Mask (Jcerity EndoscoperTM Airway) is a new airway management technique utilized in patients undergoing upper gastrointestinal endoscopy surgery under general anesthesia, but evidence of its effectiveness and safety is scarce. To assess the success rate of insertion, cardiovascular response, airway pressure, time taken for placement, nausea or vomiting, pharyngodynia, and other complications of using the new type of back-open gastroscopy laryngeal mask. We screened 1401 patients; 105 were ineligible, and 40 declined to participate. Participants were randomly allocated into the Jcerity EndoscoperTM Airway (JEA) group and the endotracheal tube (ET) group. Among them, 1266 patients were randomly assigned to receive endotracheal intubation (n = 633) or JEA (n = 633). Compared with the ET group, the JEA group had a significantly shorter insertion time and less cardiovascular response during insertion. The time taken for extubation after anesthesia and residence time in PACU in the JEA group was shorter than in the ET group. Especially, the incidence of pharyngodynia in the JEA group was lower than that in the ET group. The satisfaction of endoscopists with the JEA reached 99.4%. This study showed that the back-open JEA can not only provide a safe and effective airway guarantee for patients but also provide convenience for gastroenterologists to carry out endoscopic operations. The trial was registered before patient enrollment at the Chinese Clinical Trial Registry Center (ChiCTR2100046864, principal investigator: Yunqi Lv, date of registration: 2021-05-29). The study was conducted in the painless diagnosis and treatment center of the First Affiliated Hospital of Zhengzhou University from June 2021 to October 2023(Date of enrolment of the first research participant:2021-06-01).

Would provision of Take Home Naloxone Kits by Emergency Medical Services be perceived as acceptable to people at risk of opioid overdose? A qualitative study

ABSTRACT OBJECTIVES Take home naloxone kits can reduce mortality, but we know little about how they are perceived by people with lived experience of opioid use. Provision of naloxone in the community has been shown to significantly reduce mortality from opioid overdose. Currently, this is predominantly through drug treatment support services but expanding provision through other services might be effective in increasing kit take-up and mortality reduction. This study aimed to examine participants' experiences of opiate overdose and acceptability of provision of naloxone kits through ambulance/paramedic emergency services (EMS) and hospital Emergency Departments (ED). METHODS Qualitative interviews were conducted with 26 people who had direct experience of opioid use. Participants were recruited at two substance-use treatment centres and a third sector support organisation in three large cities in the United Kingdom. Interviews examined respondents’ experiences of opioid use and opioid overdose, access and personal use of naloxone kits, and opinions about kit provision from EMS and hospital ED staff. Interview data were thematically analysed using a constant comparative method. RESULTS Four key themes were identified during analysis: 1) High levels of overdose experience and knowledge of naloxone and naloxone kits; 2) naloxone kits were perceived as effective and easy to use 3) There were some concerns around the risks of administering naloxone, such as peer aggression during withdrawal. 4) Participants supported much wider personal, family and peer provision of naloxone kits from community support organisations as well as from EMS. CONCLUSIONS Participants felt naloxone kits were an important resource and they wanted increased provision across a range of services including EMS and hospital ED staff as well as community pharmacies and needle exchange centres. Participants wanted naloxone kit provision to be extended to peers, family and friends.

Effect of COVID-19 restriction measures on multidrug resistant tuberculosis case notifications and treatment outcomes at treatment centres in Uganda

BackgroundMultidrug resistant tuberculosis (MDR-TB) is a global public health threat. In 2021, an incidence of 3.6% was reported among new TB patients, and 18% was reported among previously treated patients. The emergence of the COVID-19 pandemic impacted the health sector, although little is known about the effect of restrictive COVID-19 measures on MDR-TB case notifications and treatment outcomes in Uganda. This study aimed to assess the effect of COVID-19 restriction measures on MDR-TB case notifications and treatment outcomes at treatment centres in Uganda.MethodsThis was a retrospective cohort study in which a total of 483 participants were enrolled—238 before (March 2018-February 2020) and 245 during (March 2020-February 2022) COVID-19 restrictions. The data were extracted from the Drug-Resistant Tuberculosis (DR-TB) Health Management Information System (HMIS), and patient charts, and census sampling was employed. Interrupted time series (ITSA) was used to compare MDR-TB case notifications and treatment outcomes.ResultsBefore the COVID-19 restrictions, the majority 58.0% were aged less than or equal to 38 years whereas during the restrictions, the majority 51.8% were aged greater than 38 years. A total of 238 cases of MDRTB were reported before, and 245 cases were reported during the restrictions. There was no immediate (β2; 0.134) or sustained (β3; 0.494) impact of COVID-19 restriction measures on monthly MDR-TB case notifications. The mean number of monthly MDR-TB notifications was similar for the 3-month period before (11.0 cases per month) and during (10.0 cases per month) the COVID-19 restrictions (p-value 0.661). The proportions of patients who achieved successful MDR-TB treatment before (81.5%) and during (81.7%) COVID-19 restriction was not significantly different (p- value < 0.001). During the COVID-19 restrictions, not being married (aPR 0.85, 95% CI: 0.74—0.97) and treatment delay greater than 7 days (aPR 0.87, 95% CI 0.78—0.96) were negatively associated with successful treatment outcomes.ConclusionRestrictive COVID-19 measures did not affect MDR-TB case notifications or treatment outcomes. Not being married and having a treatment delay greater than 7 days reduced the chances of a successful treatment outcome during COVID-19. The WHO and MoH should continue strengthening active case finding, contact screening and community engagement to consolidate MDR-TB control and management in preparation for similar future pandemics.

Is there still a place for etomidate in the management of Cushing's syndrome? The experience of a single center of low-dose etomidate and combined etomidate-osilodrostat treatment in severe hypercortisolemia.

Severe Cushing's syndrome (SCS) is a life-threatening endocrine condition that requires prompt medical intervention. Intravenous etomidate infusion is considered to be the most effective in rapid cortisol overproduction inhibition. This single-center retrospective study aimed to present the safety and effectiveness of intravenous, low-dose, lipid-formulated etomidate infusion in patients with SCS. Seven patients with complicated SCS related to ectopic ACTH syndrome (n = 6) or Cushing's disease (n = 1) who received low-dose etomidate infusion as a part of their cortisol-lowering treatment between April 2019 and April 2024 in the Department of Internal Medicine, Endocrinology and Diabetes of Medical University of Warsaw were included in the study. A continuous etomidate infusion was initiated at 0.01-0.02 mg/kg/h. In all patients, rapid control of hypercortisolemia was achieved with a median time of 30 h (range: 12-48 h). Median serum cortisol concentration reduced from 101.9 μg/dL (range: 78.2-119.6 μg/dL) before etomidate to 19.5 μg/dL (range: 18.3-22.5) after 72 h of etomidate treatment. Etomidate infusion was followed by etomidate and osilodrostat combined treatment and then osilodrostat monotherapy in four patients; one patient underwent adrenalectomy, and two patients died during etomidate infusion due to complications of advanced malignancy. This study shows that low-dose and short-term lipid formulation etomidate therapy is highly effective in severe hypercortisolemia management. Combined therapy with etomidate and osilodrostat is well tolerated and could serve as a bridge in long-term SCS treatment.

Characteristics of Helicopter Emergency Medical Services (HEMS) Interventions for Burn Patients-A Four-Year Retrospective Analysis.

Background: The World Health Organization (WHO) estimates that 180,000 patients die from burns every year, which is considered a serious public health issue. Patients with burns require immediate pre-hospital care and transport to specialized treatment facilities. The aim of this study was to outline the profile of the burn patient from the perspective of the Polish Medical Air Rescue (PMAR), as well as to analyze the medical procedures being implemented. Methods: The study includes 2154 interventions by air emergency medical teams (AEMS) which provided aid for burn patients. The analysis covered the period from 2018 to 2022, including nationwide data made available from the IT systems of the PMAR. Statistical design was used, allowing for correlations of variables, at a significance level of p < 0.05. Results: Patients' ages ranged from 1 month to 96 years (mean 35.05; SD ± 26.88). Adult patients (n = 1409; 65.41%) constituted the vast majority. The number of interventions to children below 1-year-old was noticeable (n = 394; 18.29%). Men were the most likely to suffer burns, up to three times more often than women (n = 1574, 73.07% vs. n = 570, 26.46%. T29-burns to multiple body areas (n = 890)-and T21-burns to the trunk (n = 255)-were most frequently reported as diagnoses according to the ICD-10 classification. A statistically significant association was found between age group and ICD-10 diagnosis (p < 0.001). The vast majority of patients were transported from the scene directly to Burn Treatment Centers (n = 1373; 63.74%). Treatment of pain by helicopter emergency medical services (HEMS) crews appeared to be effective (p < 0.001), and other interventions consisted of administering medications-ketamine (23.72%), rocuronium bromide (15.78%), propofol (14.02%)-and procedures such as sedation (30.87%), as well as intubation (13.42%) and mechanical ventilation (13.23%). Conclusions: The burn patient profile indicates men with a mean age of 35 years. Nevertheless, HEMS crews often carry out missions to infants and newborns. The most common diagnosis was extensive body burns. In 63.74% of the missions, patients were transported to the Burn Treatment Center. The HEMS crews implement effective pharmacological analgesia, and handle rescue medications and procedures to stabilize the patient's condition.

The influential factors of depression among caregivers of children with Cleft Lip and/or Palate: a path analysis based on diathesis-stress theoretical model

BackgroundDepression is the most common psychological phenomenon among caregivers of children with Cleft Lip and/or Palate and affects the quality of life, treatment satisfaction, children’s self-esteem and parent–child relationship. However, Existing studies have limited explanations for the mechanisms that lead to depression in caregivers of children with Cleft Lip and/or Palate. The present study aimed to identify factors influencing depression among caregivers of children with Cleft Lip and/or Palate and to provide a reference point and new ideas for future research.MethodsThis cross-sectional study investigated 248 caregivers at two Cleft Lip and/or Palate treatment centers in China, spanning from April 2019 to July 2020. The diathesis-stress model was used to construct the model, and data analysis was conducted using SPSS 26.0 and AMOS 25.0. Path analysis was employed to test the hypothetical model, and the fit of the model was evaluated using Chi-Square/degree of freedom, Goodness-of-Fit Index, Normed Fit Index, Relative Fit Index, Incremental Fit Index, Tacker-Lewis Index, Comparative Fit Index and Root Mean Square Error of Approximation.ResultsThe study found that the average level of depression among caregivers of children with Cleft Lip and/or Palate was 4.83 (4.79). Additionally, 43.5% of caregivers exhibited depressive symptoms. The fit of the modified path model was found to be satisfactory, with the following indices: Chi-Square/degree of freedom = 1.881, Goodness-of-Fit Index = 0.986, Normed Fit Index = 0.973, Relative Fit Index = 0.919, Incremental Fit Index = 0.987, Tucker-Lewis Index = 0.960, Comparative Fit Index = 0.987, and Root Mean Square Error of Approximation (RMSEA) = 0.060. The results indicated that parenting stress had the greatest direct impact on depression, followed by hope. Indirect effects on depression were observed for optimism, resilience, and coping, which were mediated through perceived social support and parenting stress.ConclusionsThis study suggests that depression in caregivers of children with Cleft Lip and/or Palate was leadingly influenced by parenting stress and hope. Strategies aimed at the key factors are expected to decrease depression.

Optimizing delivery strategies for 3HP TB preventive treatment in Tanzania: A qualitative study on acceptability of family approach in HIV care and treatment centers

Tanzania rolled-out a 12-dose, weekly regimen of isoniazid plus rifapentine (3HP) TB preventive treatment in January 2024. The 3HP completion rate is generally ≥80%, varying by delivery strategy and programmatic setting. Before the roll-out, a mixed methods study was conducted to assess whether a family approach involving family member support, SMS reminders, and three health education sessions was acceptable and optimized 3HP uptake and completion. This paper describes acceptability of the family approach among people living with HIV (PLHIV), treatment supporters (TS), and community health workers (CHWs). This was a qualitative descriptive study in 12 HIV care and treatment centers across six administrative regions. We purposively sampled 20 PLHIV, 12 CHWs for in-depth interviews, and 23 TS for three focus group discussions held between September and December 2023. The theoretical framework of acceptability guided thematic-content analysis using a framework approach. Participants understood that PLHIV have an increased risk for active TB and that 3HP provides shortened treatment for TB disease prevention. They learned about TB and 3HP through health education sessions, but participation of TS was low due to expensive transportation costs to clinics. Receiving support from a trusted person and SMS were perceived as good adherence reminders. The majority reported mild self-limiting side effects but expressed positive attitudes because of the shortened treatment, TB counseling, satisfaction from helping others, lifestyle and work alignment, and reduced work burden. Some PLHIV had difficulties identifying supportive family members, so they chose close friends or CHWs. The family approach to supporting 3HP adherence is widely accepted by PLHIVs, TS, and CHWs in the context of person-centered care that respects their preferences. We recommend its adoption in programmatic settings as a combined approach, considering changes made during the study. However, further research is warranted to assess its acceptance among other populations eligible for 3HP.

Impact of endocrine disorders associated with cleft lip and palate.

Any impediment to the development of midline structures i.e. hypothalamus, pituitary and oral cavity may cause anatomical and functional issues. We aimed to determine the association of endocrine disorders with anatomic defects of midline structures i.e. cleft types and syndromes, as well as their impact on postoperative intensive care unit (ICU) admissions and complications. A total of 6000 patients from the Cleft Lip and/or Palate (CLP) Treatment Center between September 2014 - February 2022 were included. Patients with physical findings or biochemistry that may indicate endocrine disorders were examined by the Division of Pediatric Endocrinology. Data concerning sex, operation age, cleft types, coexisting endocrine disorders, syndromes, echocardiography, postoperative complications as well as postoperative intensive care unit (ICU) admissions were recorded. The study group consisted of 78 patients with endocrine disorders, with a mean follow-up time of 59±7 months. One hundred and nine CLP operations were performed. The most common endocrine disorders coexisting in CLP patients were hypothyroidism (44.8%) and growth hormone (GH) deficiency (14.1%). Of the patients, 29.4% had genetic syndromes. The median age of operation in patients with endocrine disorders was 5 months (Q1-Q3: 4-8 months) for cleft lip and 15 months (Q1-Q3: 12-20 months) for cleft palate repair. Of the patients with CLP and endocrine disorders, 24% required postoperative ICU admission. Age of operation and ICU admission rates were higher compared to the general population of patients with CLP in our center (p<0.01). Endocrine disorders, particularly hypothyroidism and GH deficiency, are frequent in CLP. Furthermore, our data suggest that endocrine disorders may complicate the postoperative course. Thus, investigation of these problems is crucial for appropriate treatment as well as adopting measures to successfully manage the postoperative course.

The pioneers Schwerin and Brandenburg-Görden in the development of alcohol use disorder therapy in the GDR

The aim of this study was to provide insights into the addiction therapy concepts applied at the clinics of Hugo von Keyserlingk in Schwerin and Hubertus Windischmann in Brandenburg and to enable an understanding of the specific problems in this subsector of psychiatric care in the GDR. Works published primarily in the GDR were identified, analyzed and contextualized, with expert interviews with von Keyserlingk and Windischmann complementing the findings. Initially limited approaches to alcoholism treatment after the Second World War gradually developed into more complex and diverse structures. Thus, from the 1960s on, von Keyserlingk established an addiction clinic, while Windischmann established an addiction treatment center in Brandenburg with various therapeutic options. Von Keyserlingk's and Windischmann's contributions play a significant role in the development of therapeutic concepts. The study shows that they played a pioneering role in alcohol patient care in the GDR.

Detailed Transfer Line Beam Characteristics at an Operational Proton Therapy Center

The McLaren Proton Therapy Center functions as a multi-room, clinically active cancer treatment center. Beam position, size, and current measurements along the transfer lines have been utilized together with simulations to validate computer models for the Center’s transfer lines and associated beam parameters. Beam profile monitor (BPM) data collected along the beamlines provided detailed beam measurements. A computer tool, utilizing nonlinear constrained optimization programs that are integrated with a beam envelope code, was used to find detailed beam phase space parameters (centroids, sigma matrices) that reproduced the measured data. Quadrupole scan and steerer scan experiments have been used to validate the calibration and alignment of these devices, as well as to independently confirm beam parameters at selected locations. Beam current measurements along the beamlines were used to infer transmission efficiencies and then compared to multi-particle simulations in order to identify beam loss locations. The work resulted in an improved understanding of the beams and beam transfer lines to support further beamline optimization and design activities. The experimental and simulation methodologies, tools, and results and their interpretations should be applicable to many types of operating accelerator facilities.

Relevance of reporting leprosy related disability at the completion of multi drug therapy: A 5-year retrospective analysis of disability in persons affected by leprosy at ALERT Hospital Ethiopia.

Leprosy is one of the neglected tropical diseases associated with significant morbidity in endemic regions. It causes disability affecting the daily activities and social participation of affected individuals. Understanding the prevalence and trend of leprosy-related disability throughout the world and the accuracy of disability data counted by WHO is crucial in guiding efforts to be made towards the targets set by WHO to be achieved by 2030. This study aims to show the significance of reporting leprosy-related disability at the end of MDT and critique how disability is counted in the context of WHO data. This is a mixed method study with a 5-year retrospective analysis of outcomes of newly diagnosed leprosy patients at ALERT Hospital in Ethiopia from 2016 to 2020. A comparative review and analysis of leprosy related G2D (Grade 2 Disability), globally, regionally, and in Ethiopia using WHO data was also done. In addition, semi-structured interview of health workers (HCWs) and professionals working in the field of leprosy at various organizations was conducted. The trend of G2D among newly diagnosed leprosy patients shows no decline globally for the past 20 years. It is increasing in Africa and stable in the Southeast Asian and American regions where majority of leprosy patients are found showing the gap in early case identification and prompt treatment of leprosy cases. The total number of newly diagnosed leprosy cases at ALERT hospital between January 2016 and December 2020 were 1032 and among those patients who had completed treatment the prevalence of G2D was 33% at diagnosis and 23% at completion. The interview has also shown gaps in the completeness and quality of disability data reported to WHO and how disability is counted. Leprosy related G2D among newly diagnosed patient is not declining worldwide and even increasing in endemic regions like Ethiopia. More training should be given to health professionals in assessing disability. WHO should make some changes in the way it counts disability as the current definitions are prone to interpretation bias and lacks uniformity among various programmes and health workers. Prospective studies are needed in assessing disability progression post MDT so as design interventions and strategies in preventing worsening of disability after patients are discharged from treatment centre.

Biochemical profiles of patients with COVID-19 during the first and second waves in Ethiopia.

Coronavirus disease 2019 (COVID-19) is a highly infectious disease caused by severe acute respiratory syndrome coronavirus 2. Nasopharyngeal swabs (NP swabs) were used for patients with COVID-19 who demonstrated serious clinical symptoms and disturbances in biochemical parameters. The biochemical profiles of these patients remain ambiguous and differ from wave to wave of COVID-19 infections. Herein, we conducted a multicenter retrospective cohort study with 538 patients with COVID-19 at six COVID-19 treatment centers in Ethiopia. Professional data collectors collected the data. Descriptive statistics were used to summarize the data, and independent t-tests and chi-square tests were used to assess the relationships between the continuous and categorical variables across waves, respectively. In total, 240 and 298 patients were included from the first and second waves, respectively. Men and individuals aged 53-69 years were more likely to be infected in each wave. The mean alkaline phosphatase (p < 0.001) and sodium levels (p = 0.035) significantly differed between patients across the two waves of COVID-19; the significant difference in the alkaline phosphatase levels of patients between the two waves was -45.425. All the symptoms of COVID-19 were significantly (p < 0.05) associated with the waves of the pandemic. Patients in both waves had no chronic disease comorbidities. This study showed that the mean alkaline phosphatase and sodium levels differed significantly across the first two waves of the pandemic at six COVID-19 treatment centers in Ethiopia while all clinical symptoms of COVID-19 were associated with the first two waves of the pandemic.

Alterations in surface-based brain morphometry in men with opioid use disorder

ABSTRACT Background: Cortical differences in thickness, folding, and complexity may reflect synaptic pruning and myelination alterations. Individuals with opioid use disorder (OUD) may demonstrate differences in these cortical metrics due to neurodevelopmental aberrations or early opioid exposure. Objectives: We compared the cortical metrics between individuals with OUD and controls. The influence of age and duration of opioid exposure were considered indirect evidence for preexisting or opioid-exposure-based structural aberrations. Methods: Sixty-nine treatment-naïve men with OUD (52 heroin, 17 non-heroin) and 25 age and education-matched non-drug-using male controls were recruited from a treatment center and community, respectively. 3-Tesla Siemens Magnetom Verio scanner and Computational Anatomy Toolbox 12 were used for image acquisition and processing. Cortical parcellation was performed using Destrieux atlas. Surface-based morphometry (SBM) metrics were cortical thickness, sulcal depth, fractal dimension, and gyrification index. Results: Only two cortical areas survived corrections for multiple comparisons: persons with OUD had greater sulcal depth in the right lateral orbital sulcus (p = .0003, Glass’s delta = 0.98) and lower gyrification index in the left frontal middle gyrus (p = .0005, Glass’s delta = 0.67) than controls. The group-by-age interaction effect on the cortical thickness was non-significant. Lower age of initiation of opioid use was associated with larger cortical thickness in the inferior frontal (r = -0.36, p = .002) and anterior cingulate (r = -0.35, p = .003) regions. Duration of OUD negatively correlated with cortical thickness in frontal and occipital areas (r > −.30, p = .004–.007). Conclusion: Cortical abnormalities may stem from altered synaptic pruning and myelination, possibly due to neurodevelopmental aberrations or early opioid exposure.

Contributions of neurologists to diagnostic timelines of ALS and thinkALS as an early referral instrument for clinicians

Objectives: To evaluate neurologists and other clinicians’ contributions to U.S. ALS diagnostic timelines. Background: Over the past two decades, the average time to ALS diagnosis in the U.S. has remained unchanged at 12 months. ALS patients see 3-4 clinicians prior to referral to an ALS specialist for diagnosis confirmation and/or treatment initiation. There is an urgent need to identify where delays occur, so that targeted clinician awareness may be raised about early suspicion and referrals. Methods: Review of Medicare claims database for health care utilization patterns by ALS beneficiaries during diagnostic journey. Survey of typical clinic wait times for new consultations reported by 75-78 ALS Certified Treatment Centers of Excellence (2019-2021). Results: During 2011-2021, 78,520 Medicare beneficiaries were diagnosed with ALS (T0). The mean (median) timelines between first neurologist ambulatory visit and T0, is 16.5 (11.0) months; mean ± SD for ALS/neuromuscular providers being 9.6 ± 12.6 months versus 16.7 ± 17.5 months for non-neuromuscular neurologists. During the 12-months preceding T0, an ALS patient undergoes median(max) 1.5(4.0) brain-MRIs, 1.6(6.0) spine-MRIs, and 1.3(4.0) electromyography studies. Greater than 75% of ALS centers consistently report ≤ 4 week wait times for new ALS consults. This study introduces “thinkALS,” an easy-to-use clinical diagnostic and referral guide for non-ALS neurologists to tackle this challenge. Conclusions: This study is the first to provide metrics on how non-neuromuscular/ALS specialists contribute to ALS diagnostic timelines in the U.S.

The Certification Ranking of Stroke Treatment Centers Is Unclear to the General Public.

BACKGROUND: Certified stroke treatment centers are classified based on their available resources to treat stroke including an Acute Stroke Ready Hospital (ASRH), a primary stroke center (PSC), a Thrombectomy-Capable Stroke Center (TCSC), and comprehensive stroke centers (CSCs). These hospitals all provide varying levels of care with CSCs being the most able to treat all types and complexities of stroke. This undergraduate nursing-led study explored the public's preference for treatment at different certified stroke treatment centers. METHODS: This study was a prospective nonrandomized observational survey of English-speaking adults at a plasma donation center in the Southwest United States. Subjects completed a 2-minute survey asking whether they would drive to the hospital or call 911 during a suspected stroke, and at which type of hospital they would prefer to be treated. RESULTS: Of 249 respondents, 204 (81.9%) indicated that they would call 911 for hospital transport, and 45 (18.1%) would drive their family member to a hospital. Most respondents (95/248, 38.3%) would prefer treatment at a PSC, 90 (36.3%) preferred an ASRH, 52 (21.0%) preferred a CSC, and 11 (4.4%) preferred a TCSC. There was no association between transportation preference and hospital preference dichotomized as CSC or PSC versus ASRH or TCSC (χ2 = 0.021, P = .885), nor CSC versus other (χ2 = 0.944, P = .331). CONCLUSION: Most respondents did not select CSC as the preferred treatment site, and 1 in 5 would drive rather than call 911. This indicates a knowledge gap regarding stroke center classification that warrants increased education.