University Hospital Center Research Articles

Evaluation of acute substance abuse patients admitted to the ICU by different scoring system.

Drug abuse poisoning is a significant public health problem in many countries all over the world. The recent study aimed to assess the applicability of NEWS II and APACHE II scores as predictors of the ICU admission of acute intoxication by substance abuse. The study enrolled 98 patients admitted to the Alexandria Poison Center of the Main University Hospital (APC-AMUH) with a history of acute intoxication with substance abuse. Collected data included socio-demographic data, circumstances of exposure, and clinical and laboratory data. These data were employed to calculate NEWS II and APACHE II scores. A total of 98 substance abuse patients were admitted. Morphine constituted the highest percentage of substance intoxication (33.7%), followed by methanol (23.5%) and tramadol (17.3%). About one-third of the patients needed the ICU admission (32.7%). The median of NEWS and APACHE II was 7. The mean values of NEWS II and APACHE II in patients who entered the ICU were significantly higher than in patients who did not enter the ICU. The cut-off value of the ROC curve of NEWS II and APACHE II scores for admission to the ICU was 8 for both. These findings suggest that NEWS II and APACHE II scores are good predictors for the evaluation of patients intoxicated by substance abuse who need ICU admission.

Retrospective analysis of 80 patients diagnosed with reversible cerebral vasoconstriction syndrome in the Helsinki Metropolitan Area.

Up to 80% of patients diagnosed with reversible cerebral vasoconstriction syndrome (RCVS) experience complications such as ischaemic stroke, intracerebral or subarachnoid haemorrhage or posterior reversible encephalopathy syndrome. The aim was to evaluate the incidence of complications in patients diagnosed with RCVS in our clinic. All adult patients (age >16 years) diagnosed with RCVS at the Helsinki University Central Hospital during the period between 1 January 2016 and 31 December 2022 were retrospectively identified. Medical and follow-up data were collected from medical records. Eighty patients diagnosed with RCVS were identified, of whom four patients had parenchymal lesions such as ischaemic stroke, intracerebral haemorrhage, posterior cerebral encephalopathy syndrome, subarachnoid haemorrhage or combinations thereof. The complication rate of RCVS is lower than in previously published cohorts. This may be related to better and earlier diagnostics and earlier withdrawal of possible triggers.

How effective is CBCT-guided endodontic access over 'brain-guided' accesses, and is this a likely addition to the general dental practitioner's armamentarium?

Non-randomised prospective single-arm controlled clinical trial. The main inclusion criteria for both guided and freehand access groups was pulp canal obliteration (PCO). All teeth underwent cone-beam CT (CBCT) scan prior to access. Null hypothesis was that there is no difference in technical failure between guided and unguided access. The primary outcome was canal location success as a discrete measure (found, not found, perforated). The secondary outcome was conservativeness of drill pathway using discrete measures (optimal precision, acceptable precision, technical failure (included canal not found and perforation)). Patients underwent one subsequent annual follow-up. Patients attended for consultation at one centre (University Hospital Leuven, Belgium). PCO extent was assigned using periapical radiograph followed by CBCT. Cases graded as 'high difficulty' (via qualitative assessment) by briefed endodontists within the centre were selected for the study. Control group was taken from historical records as assigning an active patient to the freehand over the guided group was considered unethical. Sample size calculation to achieve conventional 80% power and statistical significance of 0.05% was undertaken, mandating 60 teeth per group. An analysis including all data, without matching, was performed by a generalized linear model for binary data using a logit link function with the primary outcome (canal found or not found/perforation) as response variable and the technique (guided or freehanded) as explanatory variable. p ≤ 0.05 was considered statistically significant. Blinding of operators was not possible. Teeth were matched (paired) per group to achieve group homogeneity. Guided access yielded a 98.3% (n = 59/60) success rate with only one case unsuccessful (canal not found). In comparison, freehand access yielded 81% (n = 59/73) success rate, with 9.5% (n = 7/73) of teeth with canals unfound, and 9.5% (n = 7/73) of teeth perforated. Null hypothesis rejected given statistical significance of results (p = 0.011). Cases presenting with PCO that undergo guided access show optimal outcomes both from an endodontic and from a conservational perspective, with significant increased chances of canal location in a conservative manner. Freehand correction in guided access cases can be used to inform changes to initial guided access if the canal is not found.

Bridging the gap: attitudes and practices toward complementary and alternative medicine among oncology patients and healthcare professionals in Croatia

The prevalence of complementary and alternative medicine (CAM) use among oncology patients ranges from 30 to 80%, particularly higher in the United States compared to Europe. However, limited research exists on the attitudes of healthcare professionals and oncology patients toward CAM, especially within Western evidence-based medical settings. This study aims to address this gap by assessing CAM use prevalence among healthcare professionals and oncology patients and analyzing their cognitive, affective, and behavioral attitudes. Additionally, it explores the influence of sociodemographic factors and personal experiences on these attitudes. A cross-sectional survey was conducted between November 2022 and May 2023 at University Hospital Center Sisters of Mercy, Zagreb, Croatia. The study included 832 participants: 411 oncology patients and 421 healthcare professionals (100 physicians, 321 nurses/technicians). Data were collected using modified versions of the Health Belief Questionnaire (CHBQ) and Integrative Medicine Attitude Questionnaire (IMAQ). Statistical analysis included descriptive methods and tests such as Chi-square, Mann–Whitney U, Kruskal-Wallis, ANOVA, and post hoc Tukey tests. The results showed that 55.6% of oncology patients and 32.2% of healthcare workers had used CAM at least once. Oncology patients were more likely to use CAM than healthcare professionals, and among healthcare professionals, nurses/technicians used CAM more frequently than physicians. Significant differences in attitudes were observed based on sociodemographic factors. Positive attitudes were more common among women, older adults, individuals with lower education levels, nurses/technicians, those with longer work experience, non-oncology healthcare workers, believers, and those with lower incomes. Marital status and place of residence showed no significant effect. This study highlights a gap between cancer patients’ frequent, unsupervised CAM use and healthcare providers’ often skeptical attitudes, particularly among physicians. The findings underscore the need for targeted education for healthcare professionals, development of CAM management guidelines in oncology, and fostering open dialogue between patients and providers to optimize outcomes. Longitudinal research is recommended to explore CAM’s impact on clinical outcomes.

Job-exposure matrix (JEM) validity on crystalline silica among systemic sclerosis patients.

Systemic sclerosis (SSc) is the connective tissue disease with the highest individual mortality. Crystalline silica is known to be an occupational risk factor for SSc. To assess past crystalline silica exposure, we aimed to study the validity of a job exposure matrix (JEM) to assess occupational exposure to crystalline silica compared to specific occupational interviews in two populations of SSc patients. To demonstrate the reliability of JEM for the assessment of occupational exposure to hazards such as silica, in severe rare disorders like SSc. Patients from two university hospital centres underwent standardized assessment of occupational silica exposure and collected job histories through face-to-face interviews. A JEM from the French program Matgéné was used to assess silica exposure and compared to the standardized interview results. Standard metrics were computed for evaluate the accuracy of JEM. 67 participants from Rennes, and 119 from Tours were included, with respectively 10.5% and 18.0% of patients with silica exposure based on the results of the interview. The JEM with 50% probability cut-off had a good performance when compared with the classic assessment method. A cumulative exposure index from JEM over 250 had an area under the curve between 0.76 and 0.79 and also a very high positive likelihood ratio (17.14 and 10.29). Despite limitations inherent to JEMs and associated validation methods, the JEM used in this setting provided accurate results to assess occupational exposure to crystalline silica for clinical purposes such as in SSc patients, especially to detect positive cases.

Experience with the implementation of central venous catheters by medical oncologists in a non-surgical setting

Totally implantable central venous catheters (CVCs) are widely used in the management of patients with malignant diseases. Conventionally, port implantations were carried out by general surgeons and vascular radiologists. In recent years, the medical staff of the Medical Oncology department at the Central University Hospital of Asturias (HUCA) has developed a simplified methodology for the routine implantation of these devices. The aim of this study was to review our experience of CVCs and analyze the outcomes regarding catheter duration, complications, and cost comparison with respect to conventional port implantation by vascular radiologists. An observational epidemiological study was conducted, analyzing the methodology performed in a non-surgical, outpatient setting utilizing the Seldinger technique, without fluoroscopic control. A thorax X-ray was performed after each procedure and no prophylactic antibiotics were required. From January 2015 to March 2019, five hundred port systems were implanted, with a median age of 62 years (range 18–81), male 286/female 214. Most patients had a digestive tumor (79.4%). The right jugular vein was the most accessed in 345 patients (69%), followed by right subclavian in 144 (29%). Complications were observed in 49 patients (9.8%), immediate in 16 (3.2%), and late in 33 (6.6%). Thirty-nine devices were removed (7.8%). The cost incurred for port implantations by medical oncologists was lower (994.38 € cheaper for each device) compared to those implanted by vascular radiologists. Our experience suggests that implantation of port devices by medical oncologist in a non-surgical environment is safe and cost saving regarding conventional procedures.

Comparative efficacy analysis of laparoscopic-assisted transanal total mesorectal excision vs laparoscopic transanal mesorectal excision for low-lying rectal cancer.

With the continuous development of laparoscopic techniques in recent years, laparoscopic total mesorectal excision (LapTME) and laparoscopic-assisted transanal total mesorectal excision (TaTME) have gradually become important surgical techniques for treating low-lying rectal cancer (LRC). However, there is still controversy over the efficacy and safety of these two surgical modalities in LRC treatment. To compare the efficacy of LapTME vs TaTME in patients with LRC. Ninety-four patients with LRC who visited and were treated at the Affiliated Hengyang Hospital of Hunan Normal University & Hengyang Central Hospital between December 2022 and March 2024 were selected and divided into the LapTME (n = 44) and TaTME (n = 50) groups. Clinical operation indexes, postoperative recovery indicators, and postoperative complications were recorded. The anal resting pressure (ARP), anal maximum systolic pressure (MSP), and maximum tolerated volume (MTV) of the anal canal were also measured. The intestinal function of patients was evaluated by the Memorial Sloan Kettering Cancer Center (MSKCC) bowel function questionnaire. Serum norepinephrine (NE), adrenaline (AD), and cortisol (Cor) levels were measured. The Quality of Life Questionnaire Core 30 (QLQ-C30) was used for quality of life assessment. Compared with the LapTME group, the surgery time in the TaTME group was longer; intraoperative blood loss was low; time of anal exhaust, first postoperative ambulation, intestinal recovery, and hospital stay were shorter; and the distal incisal margin and specimen lengths were longer. The TaTME group also showed higher ARP, MSP, and MTV values and higher MSKCC and QLQ-C30 scores than the LapTME group 3 months postoperatively. Cor, AD, and NE levels were lower in the TaTME group than those in the LapTME group during recovery. We demonstrated that TaTME better improved anal function, reduced postoperative stress, and accelerated postoperative recovery and, hence, was safer for patients with LRC.

Primary adrenal insufficiency in children excluding congenital adrenal hyperplasia: insights from 33-year single-center experience in Tunisia.

Primary adrenal insufficiency (PAI) is a rare but potentially life-threatening condition. Congenital adrenal hyperplasia (CAH) is the most common cause of PAI in children. To date, numerous non-CAH causes have been identified through genetic analysis but they remain poorly characterized. We aimed to describe the clinical presentation, etiology, genetic analysis, and long-term outcome of non-CAH PAI in children. We retrospectively collected clinical and laboratory data from patients with non-CAH PAI who were followed up during a period of 33 years (1988-2020) at the pediatric department of a university hospital center in southern Tunisia. We identified 52 patients with non-CAH PAI (35 boys and 17 girls). The mean age at diagnosis was 4.8 years (0.05-18.7 years). Hyperpigmentation was the most frequent symptom at diagnosis (92.3%), followed by asthenia (84.6%), weight loss (57.7%), recurrent vomiting (53.8%), and dehydration (42.3%). The most prominent biochemical findings were hyponatremia (60.4%), hypoglycemia (35.4%), and hyperkalemia (16.6%). A total of 21patients (40.4%) presented with adrenal crisis at disease onset. The most common causes of non-CAH PAI were inherited genetic conditions and included Allgrove syndrome (n=15), X-linked adrenoleukodystrophy (n=10), autoimmune polyglandular syndrome (APS) type 2 (n=2), familial glucocorticoid deficiency type 1 (n=1), MCM4 mutation responsible for DNA repair defect (n=1), SF1 deficiency (n=1), APS type 1 (n=1), and autoimmune PAI (n=3). The cause of PAI remained unknown in 34.6% of cases. During follow-up, 24 patients (46.2%) presented with statural growth delay, and eight patients (15.4%) developed obesity. Allgrove syndrome was the most common etiology of non-CAH PAI in our study, followed by X-linked adrenoleukodystrophy. Today, advanced molecular analysis can be useful for diagnostic investigations, especially in patients with no specific diagnostic features.

P0500 Multi-Module Metaformer System for Distinguishing Crohn’s Disease from Intestinal Tuberculosis

Abstract Background Distinguishing Crohn’s Disease (CD) from Intestinal Tuberculosis (ITB) through endoscopy can be particularly challenging, especially for junior physicians or those in resource-limited settings. Accurate differentiation is essential for appropriate treatment and effective patient management. This study aims to develop a multimodal AI-assisted diagnostic model that integrates clinical data and colonoscopy images to reliably distinguish between CD and ITB. Methods Patients diagnosed with CD or ITB at Xiangya Third Hospital of Central South University and Hunan Chest Hospital between January 1, 2005, and August 1, 2023, were included in the study. An external validation set was obtained from Zhuzhou Central Hospital. Data collection involved clinical text information and colonoscopy images for each patient. A multimodal diagnostic model, based on the MetaFormer algorithm, was developed for differential diagnosis, which was evaluated using both internal and external validation sets. Model performance was assessed using accuracy, sensitivity, specificity, and F1 score, and compared to the performance of endoscopists. Results The analysis included 408 patients in the internal dataset (311 with CD and 97 with ITB) and 85 patients in the external validation set (62 with CD and 23 with ITB). The multimodal algorithm outperformed approaches that used a single data type. Compared to state-of-the-art CNN-based algorithms such as VILBERT, BLIP, and CLIP, the multimodal approach demonstrated significant superiority in performance metrics. In the internal dataset, the integrated model achieved 91.25% accuracy, 96.72% sensitivity, and 73.68% specificity, thereby effectively reducing misdiagnosis rates. The robustness of the model was confirmed through external validation, with results showing 91.76% accuracy, 95.16% sensitivity, and 82.61% specificity. The F1 score was calculated as 0.944. The model performance significantly outperforms different levels of endoscopist performance. Junior endoscopists had lower diagnostic accuracy compared to experts (76.24% vs. 85.15%), but using the model to assist junior endoscopists improved their diagnostic accuracy to levels comparable with expert endoscopists (83.17% vs. 85.15%). This indicates the model’s potential to enhance diagnostic accuracy and consistency in clinical practice. Conclusion The MetaFormer-based multimodal predictive model for differentiating CD and ITB demonstrates high discriminatory power, providing an accurate diagnostic tool to support clinical decision-making and improve patient outcomes.

Suspected Stonefish Envenomation in Reunion Island: 15 Years Later.

Although marine envenomations are a reason for consultation in tropical emergency departments, stonefish stings are particularly feared. Immediate management focuses on pain control, whereas late management addresses cutaneous complications. This study presents a new series and compares the management of these patients and their outcomes at our center over the past 20 years. This study presents a new series of 53 patients treated between 2016 and 2020 at the South Hospital of the University Hospital Center of Réunion following a sting attributed to the stonefish. We compared this new series with a previous series of patients treated at the same center for the same reason between 2001 and 2005. The series are comparable. Regarding early management, the use of regional anesthesia was more frequent (47 vs 3.5%). Half the patients received a strong opioid. Prescription of nonsteroidal anti-inflammatory drugs and corticosteroids persisted. Exposure to a heat source remained common. Prophylactic antibiotics were prescribed more frequently (64 vs 35%) and more uniformly with amoxicillin/clavulanate. Regarding late management, the average duration of hospitalization decreased (1.8 vs 2.6 d). Cutaneous complications were less frequent (9 vs 25%). No patient managed with regional anesthesia presented cutaneous complications. The management of patients in Réunion following Scorpaenidae stings has evolved over time. Regional anesthesia has become more widespread, and the prescription of probabilistic preventive antibiotic therapy is more homogeneous. These changes are associated with a shorter hospital stay and fewer cutaneous complications.

P0656 Adalimumab mono vs. combination therapy in Crohn’s Disease: Real world experience

Abstract Background The official ECCO guidelines/consensus paper strongly recommend adalimumab (ADA) monotherapy over combination therapy for both induction and maintaining remission in Crohn’s disease (CD). However, the supporting evidence is limited, ranging from low to moderate quality. Methods A retrospective, non-interventional, single-center chart review was conducted on bio-naïve and bio-experienced adult CD patients who were treated or had ongoing treatment with adalimumab from April 2012 to October 2024 at University Hospital Center Sestre milosrdnice, Zagreb, Croatia. Treatment persistence was evaluated as the primary outcome while therapeutic drug monitoring (TDM) and biochemical remission rates were analyzed for monotherapy (M) vs. combination therapy (C) groups. Biochemical remission was defined as Fcal<150 µg/g and CRP<5 mg/L. The minimum combination therapy duration was 6 months and secondary outcomes were measured at 6, 12 and 24 months after the introduction of therapy. Treatment persistence was assessed using Kaplan-Meier analysis. Repeated ANCOVA and Mann–Whitney tests were used for continuous variables and Chi-square test or Fisher exact test for categorical variables. Results Out of the 101 patients included in the study, 57.4% were male, with a median age of 36 (23-46) years. The median BMI was 23.1 (20.6–26.2) kg/m², and 31.7% of patients were smokers. Most patients were bio-naïve (81.2%) and anti-TNF-naïve (86.1%). Median disease duration was 65 (24–132.3) months. Combination therapy was used in 53.5% of patients, predominantly with azathioprine (81.1%), at a median dose of 1.6 (1.3-2) mg/kg for a median duration of 13 (7-23) months. No statistically significant difference in treatment persistence was observed between the C and M group (χ2(1, N = 101) =.296, P = .59). There was no significant difference found either in detection of ADA antibodies (p=.66 overall, p=.68 for TDM in the first 12 months) or in ADA serum levels (U=245, z=-0.258; p=.8) between the groups. Similarly, no statistically significant differences were observed in the rates of achieving biochemical remission at 12 months (χ2(1, N = 80) =1.014, P = .314). or in the dynamics of CRP (F(1,50)=.013, p=0.91) and FCal (F(1,38)=.001, p=0.97) values during the first year. In the subanalysis of anti-TNF-experienced patients, combination therapy was not associated with a higher rate of biochemical remission (p=0.57 for CRP and p=0.5 for Fcal), although the sample size within this group was limited. Conclusion In our cohort, adding an immunomodulator to adalimumab therapy did not improve treatment persistence, biochemical remission rates, serum drug levels, or prevent the development of anti-drug antibodies.

Bone marrow metastasis of ovarian cancer: A two‑center retrospective study and literature review.

Bone marrow metastasis (BMM) causes pancytopenia and disseminated intravascular coagulation (DIC), resulting in rapid mortality. The incidence of this disease is likely underestimated, with confirmed BMM occurring at approximately twice the rates expected clinically. The present study describes two detailed cases and includes a literature review of BMM caused by ovarian cancer. The existing medical records of patients admitted to Oita University Hospital (Yufu, Japan) and Saitama Medical University International Medical Center (Hidaka, Japan) were retrospectively analyzed and a literature review regarding BMM associated with ovarian cancer was conducted. The literature review of BMM of ovarian cancer, including the present cases, revealed that patient ages ranged between 37 and 71 years, with tumor histology described in 5 out of 8 cases. Notably, 3 previous cases involved rare histological types (small cell carcinoma, carcinosarcoma and mucinous carcinoid), whereas the present identified cases involved common types. The first case involved a patient who developed isolated BMM/carcinomatosis during maintenance therapy with olaparib for recurrent high-grade ovarian serous carcinoma. The patient initially presented with elevated cancer antigen 125 levels and decreased blood counts. Following the onset of BMM, the patient's lactate dehydrogenase level was elevated to 2,712 U/l. The second patient was diagnosed with BMM/carcinomatosis, concurrent with an initial diagnosis of ovarian clear cell carcinoma. Both patients subsequently developed pancytopenia and DIC, resulting in mortality. To the best of our knowledge, the present study is the first retrospective study of BMM of ovarian cancer. For early diagnosis, BMM should be considered in the differential diagnosis when a reduction in blood counts is accompanied by an elevation in serum tumor markers, regardless of histological type.

Aortic Valve Surgery in Patients Over 75 Years Old: Early Results and Predictors of Hospital Mortality

Background: Aortic valve surgery is the most essential part of worldwide heart valve surgery. In recent decades, the patient profile has changed even in our country, with the age of patients undergoing aortic valve surgery increasing significantly. The primary objectives of this study are the early results of aortic valve replacement surgery in patients over 75 years old and the negative predictors that affect hospital mortality. Materials and Methods: This is a retrospective study of 73 patients over 75 who underwent aortic valve surgery in 2014-2021 in our Cardiac Surgery Service, University Hospital Center “Mother Theresa” in Tirana. The patients' data regarding demographic, preoperative, operative, and postoperative variables were collected from the hospital's medical records. The data are presented in mean values and standard deviation. T-test and chi-squared test are also used. Results: This study involved 73 patients, 50 males and 23 females. The age range was 75-85, averaging 77.12±2.31 years. Hospital mortality was 4.1%. The incidence of major perioperative complications such as low cardiac output, stroke, respiratory problems, bleeding, atrial fibrillation, wound infection, and conduction disturbances was 6.8%, 2.7 %, 4.1%, 2.7 %, 21.9 %, 2.6%, and 4.2 %. Conclusions: Aortic valve surgery for elderly patients over 75 can be performed well. Concomitant procedures, prolonged extracorporeal circulation, and emergency intervention expose the patient to a high operative risk.

Selection of Prosthesis in Aortic Valve Surgery: Short Review and Trend in our Practice in 10 Years

Introduction: In our country, the predominant condition treated in aortic valve surgery in its early stages was aortic valve disease of rheumatic origin, primarily in patients under the age of 60. In recent decades, due to lifestyle changes, increased average lifespan, and a shift in surgical treatment concepts among the elderly, there has been a noticeable trend towards atherosclerotic aortic valve disease treated surgically. This condition poses challenges in selecting the type of prosthesis for surgical replacement—either bioprosthetic or mechanical. The replacement of the aortic valve, aside from its undeniable benefits for patients, also introduces various complications, such as bleeding related to anticoagulation, thromboembolism, prosthetic endocarditis, and structural degeneration of the prosthesis. These complications vary between the two main groups of prostheses: bioprosthetic and mechanical. In this context, we are confronted with the challenge of selecting the type of prosthesis suitable for each patient. This paper presents current issues regarding selecting aortic valve prostheses, considering factors related to the prosthesis and the patient. We will also discuss the trends in prosthesis usage in our country over the past decade. Materials and Methods: We reviewed the types of mechanical and bioprosthetic valves used over the past ten years at our clinic, the Cardiac Surgery Service of the University Hospital Center "Mother Teresa.” We consulted articles, studies, and guidelines for managing heart valve diseases from European and American cardiology associations. Conclusion: The choice of prosthesis for aortic valve replacement remains a current issue, involving considerations of patient-related and prosthesis-related factors. The decision is based on guidelines recommendations, surgical team judgment, and patient preference, following a detailed explanation of the benefits and risks associated with each type of prosthesis.

Challenges in Burns Management in a Tertiary Care Center in Albania

Introduction: Burn injuries represent a significant public health concern globally, with a substantial impact on morbidity and mortality rates, particularly in low- and middle-income countries. This study provides valuable insights into the epidemiology of burn injuries in Albania. It highlights the critical need for targeted interventions to reduce the incidence and severity of burns in the population. Materials and Methods: This retrospective cohort study examined burn patients at the Department of Burns and Plastic Surgery at Mother Teresa University Hospital Center in Tirana from January 2022 to January 2024. Data were collected from medical records in Tirana, Albania. Formal approval was obtained from the Ethics Committee of Mother Teresa Hospital. The data were recorded in Excel and analyzed using the SPSS statistics program. Results: This retrospective cohort study included 303 burn patients admitted between January 2022 and January 2024. Data on patient demographics, burn causes, total body surface area (TBSA), and burn severity were collected and analyzed using SPSS software. The mean patient age was 36.1 years, with children aged 0-10 most affected, especially 2-year-olds. The youngest patient was seven months old, and the oldest was 89. Male patients comprised 60.7% of the cohort. The leading cause of burns was scalding from hot liquids (39.9%), followed by flames (20.4%) and electrical burns (8.2%). The average TBSA affected was 23.06%. The mortality rate was 7.3%. Conclusion: Burn injuries present significant physical and psychological challenges. Despite advancements in burn care, the importance of preventive measures and public awareness campaigns must be addressed. These remain the most effective strategies to reduce burn incidence and severity. These findings underscore Albania's need for improved burn prevention and public safety initiatives.

Comprehensive Clinicopathological Analysis of Oral Reactive Hyperplastic Lesions Diagnosed in Libyan Population: Cross-Sectional Multicentric Study

Oral reactive hyperplastic lesions (ORHLs) are non-neoplastic tumor-like hyperplasia frequently developing in the oral mucosa due to chronic inflammation caused by many low-grade irritations. They are relatively common, and their clinical appearance resembles neoplastic proliferations. This study aims to determine the prevalence and distribution of ORHLs based on WHO's head and neck tumor classification (2022) in the Libyan population over the last 20 years and compare the results with previous literature. In this retrospective study, all the records of histologically diagnosed ORHLs between 2002 and 2023 collected from the Tripoli University Hospital and Saray Salam Center in Tripoli, Libya, were reviewed. Information regarding the age at diagnosis, gender, site affection, and histopathological diagnosis was extracted and analyzed using SPSS statistical software (V.26) using the Chi-square test. ORHLs constituted 14.5% of the total diagnosed cases (335/3210) in registered oral and maxillofacial biopsies. Pyogenic granuloma (PG) was the most common type of ORHL (48%) followed by irritational fibroma (IF) (30%), and peripheral giant cell granuloma (PGCG) (8%). The peak incidence of ORHLs was in the third and fourth decades (37.6% and 32.8% retrospectively), with an overall age at onset of diagnosis (Mean ± SD 36.4±7). The relationship between the age categories and ORHLs was statistically significant (P=0.03). Female predominance was found in all lesions with a ratio (2:1). Gingiva was the most prevalent anatomical location for ORHLs, accounting for 31% of cases. There have been some similarities and inconsistencies between our findings and previous studies involving various populations. We found a clear geographic difference in the relative incidence of oral reactive lesions in each Libyan governorate. The occurrence of ORHRLs in different nations can be retrospectively evaluated to improve knowledge of ORHLs, which is critical for pathologists and oral and maxillofacial surgeons.

Les enjeux des nouvelles technologies numériques sur le système de santé marocain : Cas du service de cardiologie -B- du Centre Hospitalier Universitaire Ibn Sina (CHUIS) Rabat

We live in the era of information technology (IT) innovations in the health sector, this has led to the appropriation of new organizational models which are profoundly changing the practice of medicine. Our study aims to determine the challenges of new digital technologies in the Moroccan health system, the case of the cardiology department - B - of the Ibn Sina University Hospital Center. This is a single-center observational descriptive-analytical study carried out at the level of the cardiology department - B- for 6 months, from September 1, 2022. Questionnaires were distributed in paper form to staff-affiliated medical doctor or carrying out their internships, using a digital device within the service. Thirty-one (31) responses were collected, with a participation rate of 78%; the age of the respondents varies between 21 to 55 years with an average of 30.3± 8.71 years with a female predominance of 67.7% and almost half of the health professionals in our sample 42% were residents. The most deployed digital device is the Hospital Information System (HIS) in 80.6%; 93.5% of respondents noted that saving of time is one of the advantages of telemedicine and 71% of respondents who affirmed that the better monitoring of patients located in isolated areas in order to avoid forgoing care. 74.2% of respondents considered that technical problems constituted an obstacle to the deployment of remote procedures; compared to 22.2% for a weak diagnosis; 64.5% of respondents noted that training would be a major lever for integrating more remote activities into their practices and 54.5% of respondents are in favor of adapted time slots. The benefits perceived by respondents of these digital tools are numerous, although there are obstacles preventing digital transformation from reaching its full potential. The use of new digital technologies in this health sector responds to positive challenges in terms of organizational and educational efficiency; this requires the coordination of all stakeholders. The cardiology department -B - is a space conducive to the implementation of new digital technologies.

Tracking clonal and plasmid transmission in colistin- and carbapenem-resistant Klebsiella pneumoniae.

The surveillance of mobile genetic elements facilitating the spread of antimicrobial resistance genes has been challenging. Here, we tracked both clonal and plasmid transmission in colistin- and carbapenem-resistant Klebsiella pneumoniae using short- and long-read sequencing technologies. We observed three clonal transmissions, all containing Incompatibility group (Inc) L plasmids and New Delhi metallo-beta-lactamase blaNDM-1, although not co-located on the same plasmid. One IncL-blaNDM-1 plasmid had been transferred between sequence type (ST) 392 and ST15, and the promiscuous IncL-blaOXA-48 plasmid was likely shared between a singleton and a clonal transmission of ST392. Plasmids within clonal outbreaks and between clusters and STs had 0-2 single nucleotide polymorphism (SNP) differences, showing high stability upon transfer to same or different STs. The simplest explanation, without a comprehensive analysis with long-read sequencing, would be the spread of a single common IncL-blaNDM-1 plasmid. However, here, we report blaNDM-1 in five different plasmids, emphasizing the need to investigate plasmid-mediated transmission for effective containment of outbreaks.IMPORTANCEAntimicrobial resistance occupies a central stage in global public health emergencies. Recently, efforts to track the genetic elements that facilitate the spread of resistance genes in plasmids outbreaks, utilizing short-read sequencing technologies, have been described. However, incomplete plasmid reconstruction from short-read sequencing data hinders full knowledge about plasmid structure, which makes the exploration very challenging. In this study, we used both short- and long-read sequencing in clinical Klebsiella pneumoniae from University Hospital Centre Zagreb, Croatia, which was resistant to both last-resort antibiotics colistin and carbapenem. Our results show complex transmission networks and sharing of plasmids, emphasizing multiple transmissions of plasmids harboring carbapenem and/or colistin resistance genes between and within K. pneumoniae clones. Only full-length sequencing plus a novel way of determining plasmid clusters resulted in the complete picture, showing how future active monitoring of plasmids as a vital tool for infection prevention and control could be implemented.

Noninvasive Oral Hyperspectral Imaging-Driven Digital Diagnosis of Heart Failure With Preserved Ejection Fraction: Model Development and Validation Study.

Oral microenvironmental disorders are associated with an increased risk of heart failure with preserved ejection fraction (HFpEF). Hyperspectral imaging (HSI) technology enables the detection of substances that are visually indistinguishable to the human eye, providing a noninvasive approach with extensive applications in medical diagnostics. The objective of this study is to develop and validate a digital, noninvasive oral diagnostic model for patients with HFpEF using HSI combined with various machine learning algorithms. Between April 2023 and August 2023, a total of 140 patients were recruited from Renmin Hospital of Wuhan University to serve as the training and internal testing groups for this study. Subsequently, from August 2024 to September 2024, an additional 35 patients were enrolled from Three Gorges University and Yichang Central People's Hospital to constitute the external testing group. After preprocessing to ensure image quality, spectral and textural features were extracted from the images. We extracted 25 spectral bands from each patient image and obtained 8 corresponding texture features to evaluate the performance of 28 machine learning algorithms for their ability to distinguish control participants from participants with HFpEF. The model demonstrating the optimal performance in both internal and external testing groups was selected to construct the HFpEF diagnostic model. Hyperspectral bands significant for identifying participants with HFpEF were identified for further interpretative analysis. The Shapley Additive Explanations (SHAP) model was used to provide analytical insights into feature importance. Participants were divided into a training group (n=105), internal testing group (n=35), and external testing group (n=35), with consistent baseline characteristics across groups. Among the 28 algorithms tested, the random forest algorithm demonstrated superior performance with an area under the receiver operating characteristic curve (AUC) of 0.884 and an accuracy of 82.9% in the internal testing group, as well as an AUC of 0.812 and an accuracy of 85.7% in the external testing group. For model interpretation, we used the top 25 features identified by the random forest algorithm. The SHAP analysis revealed discernible distinctions between control participants and participants with HFpEF, thereby validating the diagnostic model's capacity to accurately identify participants with HFpEF. This noninvasive and efficient model facilitates the identification of individuals with HFpEF, thereby promoting early detection, diagnosis, and treatment. Our research presents a clinically advanced diagnostic framework for HFpEF, validated using independent data sets and demonstrating significant potential to enhance patient care. China Clinical Trial Registry ChiCTR2300078855; https://www.chictr.org.cn/showproj.html?proj=207133.

Frequency of Uropathogenic Bacteria among Patients Visited to the National Reference University Hospital Center of N'Djamena (CHAD)

Frequency of Uropathogenic Bacteria among Patients Visited to the National Reference University Hospital Center of N'Djamena (CHAD)