Charts Of Patients Research Articles

Tocilizumab – a disease-modulating treatment for thyroid associated ophthalmopathy?

ABSTRACT Purpose To analyze Tocilizumab (TCZ, an interleukin 6 inhibitor) as a second-line treatment for thyroid-associated ophthalmopathy (TAO). Methods In this retrospective observational study, the charts of patients with moderately severe to severe TAO who received intravenous Tocilizumab as a second-line treatment 2020-2023 were reviewed. Results Twenty-three patients were enrolled in the study. At the follow-up visit 24 weeks after the initiation of treatment, 14 out of 22 patients (63.6%, one missing data) had a reduction of proptosis of 2 mm or more. The mean proptosis decreased from 21.07 (±3.23) to 19.18 (±2.52) mm in the right eye (RE) and from 20.61 (±3.12) to 19.95 (±2.81) mm in the left eye (LE). Twenty patients (87%) also showed a reduction of the clinical activity score (CAS) of at least two points with a mean decrease from 5.22 (±1.53) pre-treatment to 2.09 (±1.38) post-treatment points. The median patient total follow-up time after treatment was ten (range 6–26) months. The comparisons reached strong significance between pre-treatment and 24 weeks, as well as pre-treatment and final visit assessments for both proptosis and clinical activity scores. Serum TRAb levels also dropped significantly, and only two patients needed re-treatment with TCZ. Improvement of diplopia did not reach statistical significance. Conclusions Intravenous Tocilizumab as a second-line treatment for TAO led to a significant improvement of proptosis and CAS at 24 weeks follow-up, with a sustained effect over time.

How Often Is Rifampin Therapy Initiated and Completed in Patients With Periprosthetic Joint Infections?

Rifampin therapy is indicated for the treatment of staphylococcal periprosthetic joint infection (PJI) in patients who have undergone debridement, antibiotics, and implant retention (DAIR) or one-stage revision as per the Infectious Diseases Society of America (IDSA) guideline. Given the well-established effectiveness of rifampin as adjunctive therapy in staphylococcal PJI, it is crucial to evaluate its utilization in practice and identify factors that contribute to its underuse or incomplete administration, as these deviations may undermine treatment efficacy and patient outcomes. Among patients who met clear indications for rifampin use having undergone DAIR or one-stage revision for staphylococcal PJI, (1) what proportion of patients did not receive it? (2) What proportion of patients started it but did not complete the planned course? (3) Where documented in the medical record, what were the common reasons for not using it or prematurely discontinuing it, and in what percentage of the patients' charts was no reason given? (4) What proportion of patients were taking a medication that put them at risk for a drug-drug interaction (DDI)? Using an institutional database, patients who underwent DAIR or revision arthroplasty for PJI from January 2013 to April 2023 were identified (n = 935). We defined clear indications for rifampin use as a patient diagnosed with staphylococcal PJI treated via DAIR or one-stage revision, as set forth by the clinical practice guidelines of the IDSA. Based on those indications, we surveyed patients' electronic medical records (EMRs) and calculated the proportion of patients who did not receive the drug in situations where it would have seemed appropriate that they receive it. We then determined the planned length of antibiotic management and calculated the proportion of patients whose planned courses of rifampin were not completed based on what was documented in each patient's chart. Next, we performed a review of the EMR and recorded qualitatively the reasons why patients either did not receive rifampin or why the planned course was not completed, as well as the percentage of patients whose medical records did not indicate why the drug was not used or was discontinued before the planned course had been administered. Last, we retrospectively reviewed the medications that the patients were taking at the time of indicated adjunctive rifampin initiation and evaluated whether there were DDIs and the potential severity of those interactions. A total of 9% (87 of 935) of patients who underwent DAIR or revision arthroplasty for PJI met IDSA criteria, suggesting that rifampin use would have been appropriate. Of those meeting IDSA criteria, 49% (43 of 87) started rifampin. Of those who started on rifampin for staphylococcal PJI, 19% (8 of 43) discontinued it before the planned 6-week course was complete as documented in the EMR. Among the patients who did not receive rifampin when it appeared that they ought to have based on IDSA criteria, no reason for this decision was documented in 70% (31 of 44); among those for whom a reason was documented, it was DDI in 8 of 13, concern for hepatotoxicity in 1 of 13, history of a side effect in 1 of 13, and other reasons in 3 of 13. Among the patients whose courses were terminated before the planned course was completed, it was a gastrointestinal issue in 5 of 8, acute kidney injury in 1 of 8, or other reasons in 2 of 8. Only about one-half of patients who met IDSA criteria for adjunctive rifampin therapy for staphylococcal PJI after DAIR or one-stage revision at a large tertiary referral academic center were started on treatment. For most patients who did not receive rifampin, there is no documentation for why not. Given the evidence of superior outcomes for patients treated with adjunctive rifampin, it is imperative that all patients meeting criteria be started on the medication unless there is a clear contraindication, which should be documented. Future studies should further evaluate the clinical benefit of rifampin when treating staphylococcal PJI and which DDIs would be considered true contraindications of treatment. This could be achieved with a prospective study that evaluates successful long-term infection-free survival after treatment with adjunctive rifampin while accounting for and stratifying the potential clinical risk of these DDIs. Level IV, therapeutic study.

Frequency of remission achievement in the pre-treat-to-target decade in juvenile idiopathic arthritis

BackgroundOver the past two decades there has been a remarkable advance in the management of juvenile idiopathic arthritis (JIA), which has led to considerable improvement in prognosis. In 2018, the introduction of the treat-to-target (T2T) strategy in JIA has been advocated to further ameliorate disease outcome. To provide a benchmark for comparing future outcomes in the “T2T era”, this study investigates the percentage of JIA patients who achieved clinical inactive disease (CID) in the decade that preceded the publication of the T2T recommendations in JIA.MethodsThe clinical charts of all JIA patients followed at the study center between 2007 and 2017 who were first seen within 6 months after disease onset and had a minimum of 6-month follow-up information available were reviewed retrospectively. The attainment of CID, defined by 2004 Wallace criteria, was assessed cross-sectionally at 6, 12, 24, and 60 months after first observation.ResultsA total of 394 patients were included. Patients were classified into four “functional phenotypes”: systemic arthritis (7.1%), oligoarthritis (48.2%), polyarthritis (40.4%), and other arthritis (4.3%). The overall frequency of CID was 25.1% at 6 months, 34.5% at 12 months, 44.6% at 24 months, and 49.1% at 60 months. The systemic and oligoarticular subgroups had the highest rates of CID at 6 months (32.1% and 29.5%, respectively) and at 12 months (40% and 41.1%, respectively). At the 60-month evaluation, which was available for 226 out of 394 patients (57.4%), the frequency of CID among patients still followed at study center was 42.9%, 51.7%, 46.7%, and 45.5% for the systemic, oligoarticular, polyarticular, and other arthritis phenotypes, respectively.ConclusionA sizeable proportion of patients treated in the decade preceding the beginning of the “T2T era” and on continued follow-up did not achieve or maintain the state of CID over the long term. Future studies will determine whether the application of the T2T strategy increases the ability to achieve sustained disease quiescence in patients who respond suboptimally to the conventional therapeutic regimens.

P0974 Risk factors for anti-TNFα induced paradoxical psoriasis in Inflammatory Bowel Disease and association with an IL-23 receptor polymorphism: A retrospective study

Abstract Background Anti-tumor necrosis factor (TNF)-α therapy is frequently used to treat inflammatory bowel disease (IBD). Paradoxical psoriasis (PP) is a known adverse effect of this drug class resulting in disfiguring skin lesions that may impact quality of life and lead to treatment cessation. To date, there are no tools to identify individuals who are susceptible to developing PP. Variations in the IL-23 receptor (IL23R) gene have been linked to psoriasis onset and may be implicated in PP. The aims of this study are 1. to study the incidence and outcomes of PP in anti-TNFα treated IBD patients at an academic centre in London, Ontario, Canada and 2. to examine risk factors associated with PP including the IL23R variant (IL23R1142G>A). Methods We performed a retrospective study of adult IBD patients treated with anti-TNFα therapies at London Health Sciences Centre between 2012 and 2024. Patient charts were reviewed for clinical variables and disease outcomes from the time of anti-TNFα exposure until treatment discontinuation or last follow-up. Patients’ serum was retrospectively genotyped for the IL23R1142G>A variant. Results We identified 496 IBD patients with 570 unique anti-TNFα exposures between 2012 and 2024. 26 patients developed 29 cases of PP while the remaining 473 patients did not develop PP after exposure to 542 anti-TNFα therapies, corresponding to a PP incidence rate of 5.1% in the study population. There was an increased proportion of patients with PP who had a positive family and personal history of psoriasis, though the latter was not significant (Table 1). The IL23R variant was more common in patients who developed PP compared to those who did not (46.2% vs. 5.1%, OR 16.04, 95% CI 6.69-38.41, Figure 1). The average time to develop PP was 9.5 months, with 55% of patients on high-dose anti-TNFα maintenance regimens. Majority of patients had moderate-to-severe disease (72.4%) based on body surface area (BSA) involvement and required treatment cessation (69.0%). All participants had complete resolution of PP following discontinuation of anti-TNFα therapy. Conclusion We identified an increased frequency of the IL23R1142G>A variant in patients who developed PP following anti-TNFα exposure compared to those who did not. Personal and family history of psoriasis were also more common in those who developed PP. Future studies should investigate other drug and disease characteristics that may predict those at highest risk for this anti-TNFα drug effect.

Povidone-Iodine Versus Saline Irrigation on Reduction of Surgical Site Infections in Total Hip and Knee Arthroplasty: A Retrospective, Propensity-Matched Cohort.

Introduction: Surgical site infection (SSI) after total hip and knee arthroplasty (THA/TKA) is a major complication leading to morbidity and mortality. Perioperative irrigation, frequently with antiseptic compounds including povidone-iodine (PI), is the standard of care in reducing SSI. Evidence supporting the value of PI versus nonantiseptic substances varies. This study aims to identify whether PI irrigation in THA/TKA reduces the rate of SSI versus normal saline irrigation. Patients and Methods: A retrospective, propensity-matched cohort study of patients who underwent TKA or THA was conducted using data from patient charts, hospital infection control surveillance software, and operative reports. SSI rates of patients who had received PI versus saline irrigation were compared. Patient medical status, demographics, and procedure details were considered for propensity score determination and matching. Results: The study encompassed 21,482 patients. The unadjusted univariate analysis demonstrated no statistically significant difference in SSI rate between PI and saline (p = 0.759). Multivariate analysis showed that men, patients with diabetes, and those with a 2-3 h procedure time had increased risk of SSI, but differences were not observed between irrigation groups. Propensity score matching yielded 21 (0.25%) SSI in the matched PI group and 19 (0.23%) in the saline group (odds ratio: 1.10; confidence interval: 0.59-2.06). Conclusions: This investigation proposes that PI irrigation is not significantly different to saline in reducing SSI in this population. When cost is of concern, saline irrigation is equally effective and therefore a sensible option.

P0248 Insomnia as a determinant of poor IBD disease course

Abstract Background Insomnia is one of the most common sleep disorders, affecting up to 30% of the adult population worldwide. Sleep disorders can have a marked impact on immune functions and inflammation, including in patients with inflammatory bowel diseases (IBD) in both active and inactive disease states. Whether insomnia preceding IBD flares affects clinical outcomes is unknown. We examined the association between insomnia and IBD-related outcomes in adults diagnosed with of Crohn’s disease (CD) or ulcerative colitis (UC). Methods A retrospective, real-world, cohort study utilizing the Lynx MD’s electronic medical record dataset, provided by a US-based community gastroenterology practice. Deidentified patient charts were analyzed to identify patients with a confirmed diagnosis of IBD (either CD or UC). Eligibility criteria included: ≥3 diagnoses of IBD, ≥1 diagnoses of IBD and: histopathologic diagnosis of IBD; or IBD related surgery; or ≥ 3 months of treatment with standard accepted therapies for IBD; and ≥3 years of follow-up. IBD-related events of hospitalization and/or surgery were recorded. The cohort was classified into two groups based on insomnia diagnosis, prior to IBD related hospitalizations or surgeries. We implemented Cox Proportional Regression models to estimate Hazard Ratios for the IBD-related outcomes. Results Among 20,011 patients with IBD, 10,775 (54%) were women, at a mean age of 48.2 ± 18.2 years old, 11,842 (59%) were diagnosed with UC and 8,169 (41%) with CD. Over 3,100 patients (16%) were diagnosed with insomnia prior to the first IBD related hospitalization or surgery. In an unadjusted model, insomnia was significantly associated with IBD-related hospitalizations - hazard ratio (HR) of 1.43 (95% CI 1.28, 1.59) and IBD related surgeries - HR of 1.42 (95% CI 1.12, 1.81). After adjustment for age, sex, race, body mass index, anxiety and type of IBD (CD vs. UC), IBD-affected patients with insomnia had a higher HR of hospitalization and surgery: HR of 1.35 (95% CI 1.2,1.51) and 1.29 (95% CI 1.01,1.66), respectively, compared to those without insomnia. Conclusion In a large real-life dataset of patients with IBD, we found higher rates of IBD-related hospitalizations and surgeries among patients with comorbid insomnia, suggesting that insomnia may be associated with a more severe course of IBD.

Clinical presentation of hemifacial microsomia in a South African population.

Hemifacial microsomia (HFM) presentation includes gross distorted ramus, malposition temporomandibular joint, small glenoid fossa, distorted condyle and notch, malformed orbit, cupping ear or absent external ear, and facial nerve palsy. HFM is the second most prevalent congenital deformity of the face, with little literature from the South African population. This retrospective study elucidated the demographic characteristics and clinical presentations of HFM patients in a select South African population and compared it to the literature. Methods: A retrospective study of HFM patients diagnosed through clinical presentation and confirmed by plain radiograph or computed tomography was conducted. The patient's charts were reviewed for age, sex, laterality, side, the severity of the deformity, and associated craniofacial and extra-craniofacial anomalies. The clinical presentation of malformations was categorised according to the OMENS classification, using five major craniofacial manifestations of HFM. Twenty-five patients were included, with a male-to-female ratio of 1:1.78. The population distribution is 60% Black, 32% Indian, 4% White and 4% Coloured. A right-to-left laterality ratio of 1.4:1 and 4% bilateral affectation. This study showed 100% mandibular hypoplasia, 84% ear deformity, 40% orbital deformity, 60% facial nerve defect and 100% soft tissue defect affectation with noticeable facial asymmetry. Other craniofacial anomalies were recorded in 84%, while extracraniofacial anomalies were recorded in 40% of this HFM population. There is a high degree of variability in the deformities in HFM in the South African population, distinguishing it from the international population. A multidisciplinary approach is required for its treatment and management.

Performance on the Concussion Balance Test Is Indicative of Time to Recovery in Athletes Following Sports-Related Concussion: An Exploratory Analysis.

Sports-related concussions (SRCs) are commonly occurring injuries among athletic and recreationally active populations. SRCs can result in vestibular dysfunction that should resolve before returning to activity. It has been suggested that vestibular impairment is a factor that may influence recovery time. The objective of this study was to evaluate the effect of vestibular function on recovery following SRC. Retrospective chart review. Multidisciplinary Concussion Clinic. A total of 32 patient charts (21 males, 15.34 [1.47]y, 171.29 [8.44]cm, 68.37 [15.47]kg) from patients diagnosed with SRC presenting to a concussion clinic between August of 2016 and July 2017 with clinician-identified vestibular involvement were included. Scores on the Post-Concussion Symptom Scale, Dynamic Visual Acuity Test, Gaze Stabilization Test, Concussion Balance Test (COBALT), and other clinical data were used for analysis. Descriptive statistics were calculated for all variables. Pearson correlations were used to identify variables related to time to recovery. Variables were entered into a forward linear regression model. Moderate to good relationships were identified between days to recovery and Dynamic Visual Acuity Test lines lost in the leftward direction (1.17 [0.52]; r = .39, P = .04), COBALT-condition 8 sway velocity (1.20 [0.18]; r = .44, P = .01), and days to successful completion of the COBALT (14.72 [8.35]; r = .63, P < .001). Patients' predicted time to recover was equal to 14.61 (0.86) (days to successful COBALT). The model was significant (P < .001, R2 = .30). The single predictor of time to recover was the number of days to successful completion of the COBALT. Thus, the ability to complete the task may be more informative than the performance on the task in predicting recovery time.

Admission outcomes and their associated factors among children admitted to the paediatric emergency unit within 24 hours of Dilla University Referral Hospital, Ethiopia, 2023: a cross-sectional study

BackgroundChildren in paediatric emergency units are those who need special attention, and unless treated early, they are a vulnerable population to unwanted outcomes like death, discharge against medical advice or...

Management of nutritional deficiencies following one anastomosis gastric bypass (OAGB): a single-center experience.

Metabolic/bariatric surgery (MBS) remains the most effective and long-lasting treatment for obesity and its complications. Apart from any surgical complications, the often less obvious but possibly severe side-effects of nutritional deficiencies have become of interest in recent years. OAGB is known to come with the need for thorough supplementation. Retrospective study; university-hospital based. Assessing nutritional issues and their management in a real-life cohort of patients undergoing OAGB. Patients that underwent OABG between 01/2018 and 08/2019 were retrospectively assessed. Laboratory values (gained from electronic patients charts) were analyzed for nutritional issues (parathyroid hormone, vitamin A, E, D, B12, folic acid, albumin, ferritin, iron, and transferrin saturation) as well as postoperative complications and reoperations. Furthermore, weight development, improvement/remission of obesity-related complications, and regular intake of multivitamin supplementation (MVS) were assessed. 120 patients underwent OAGB; 89 were female. A follow-up was available for 101 patients. Mean length of follow-up was 27.8 ± 20.9months. OAGB led to a %TWL of 36.7 ± 9.5% and %EWL of 86.8 ± 25.5%. Preoperative deficiencies were vitamin D (53.3%), followed by folic acid (16.7%) and vitamin A (6.7%). During follow-up, every patient developed at least one deficiency, hypovitaminosis D and A were predominant (74.3% and 41.0%), and 31 suffered from folic acid deficiency (30.7%). Hypovitaminosis B12 and calcium deficiency was observed in three patients (2.9%). Although advised to, only 45.5% opted for the intake of specialized MVS, whereas 10% did not take any MVS at all. More than half of all patients (53.5%) took additional supplements. Nineteen patients underwent reoperations associated with the initial OAGB. Two conclusions can be drawn: First, there is a general need for bypass patients to get assessed for a broad array of deficiencies over time. Second, MVS is essential for patients that had bypass surgery. Additionally, compliance needs to be promoted by educating patients as well as other treating physicians.

Increasing Serious Illness Conversations in Patients at High Risk of One-Year Mortality Using Improvement Science: A Quality Improvement Study.

Background: Serious illness conversation (SIC) in an important skillset for clinicians. A review of mortality meetings from an urban academic hospital highlighted the need for early engagement in SICs and advance care planning (ACP) to align medical treatments with patient-centered outcomes. The aim of this study was to increase SICs and their documentation in patients with low one-year survival probability identified by updated Charlson Comorbidity Index (CCI) scores. Methods: This was a quality improvement study with data collected pre- and post-intervention at a large urban level one trauma center in Virginia, which also serves as a primary teaching hospital to about 400 residents and fellows. Patient chart reviews were completed to assess medical records and hospitalization data. Chi square tests were used to identify statistical significance with the alpha level set at <0.05. Integrated care managers were trained to identify and discuss high CCI scores during interdisciplinary rounds. Providers were encouraged to document SICs with identified patients in extent of care (EOC) notes within the hospital's cloud-based electronic health record known as EPIC. Results: Sixty-two patients with high CCI scores were documented, with 16 (25.81%, p = 0.0001) having EOC notes. Patients with documented EOC notes were significantly more likely to change their focus of care, prompting palliative care (63.04% vs. 50%, p = 0.007) and hospice consults (93.48% vs. 68.75%, p = 0.01), compared to those without. Post-intervention surveys revealed that although 50% of providers conducted SICs, fewer used EOC notes for documentation. Conclusion: This initial intervention suggests that the documentation of SICs increases engagement in ACP, palliative care, hospice consultations, and do not resuscitate decisions.

Epidemiology and outcomes of patients with cardiac arrest in the emergency department of a lower middle-income country

BackgroundAdvanced cardiovascular life support (ACLS) for cardiac arrest is a cornerstone of emergency care and yet remains poorly studied in low- and middle-income countries. We characterised the clinical epidemiology and...

Effect of Intrathecal Baclofen on Bladder Function in Patients With Severe Supraspinal Spasticity.

Neurogenic bladder dysfunction is a prevalent condition characterized by impaired bladder control resulting from neurological conditions, for example, spinal cord injury or traumatic brain injury (TBI). Detrusor overactivity is a typical symptom of central nervous system damage. A lesion affecting the pontine neural network typically results in loss of tonic inhibition exerted by the pontine micturition center and causes involuntary detrusor contractions. Intrathecal baclofen (ITB), primarily indicated for spasticity management, holds potential in addressing the underlying mechanisms of neurogenic bladder dysfunction. Urodynamic data were extracted from clinical charts of patients with severe supraspinal spasticity who received ITB treatment. Urodynamic studies were performed before pump implantation (PRE), after surgery (POST), and when achieving an effective steady state ITB dosage (ss-ITB), as reflected by a reduction in Modified Ashworth Scale (MAS) score. To determine potential risk factors for a poor response to ITB with respect to bladder function, patients were post hoc categorized into good and poor responders based on post void residual volume at ss-ITB. Apart from significantly reducing MAS scores, ITB caused significant increases in reflex volume, bladder capacity, and residual volume, and significant decreases in maximal detrusor and vesical pressures. Significant differences between good and poor responders (with respect to bladder function) were noted for reflex volume, bladder capacity, and residual volume at ss-ITB, whereas no urodynamic parameter served to differentiate the two groups at PRE. This study confirms a beneficial effect of ITB on bladder function in patients with severe supraspinal spasticity. However, concurring with the literature, a small subgroup of patients experienced serious deterioration in terms of increased reflex volume and residual volume, posing the risk of subsequent renal damage. Unfortunately, no urodynamic parameter predicted such a poor response to ITB before treatment initiation.

Safety of hyperbaric oxygen therapy in non-emergent patients with a history of seizures: A retrospective cohort study.

Hyperbaric oxygen therapy (HBOT) is well established as a treatment for various medical conditions. However, it poses a risk of oxygen toxicity, which can cause seizures particularly in individuals with pre-existing seizure disorders. Consequently, seizure disorders are considered a relative contraindication to HBOT. Despite this, the relative risk of HBOT-induced seizures in this patient population remains unclear. This retrospective cohort study aims to evaluate the safety of HBOT among patients with pre-existing seizure disorders. After obtaining approval from the Research Ethics Board, we retrospectively reviewed the patient charts of individuals with a history of seizures who were referred to the Rouge Valley Hyperbaric Medical Center and Toronto General Hyperbaric Medicine Unit for HBOT between January 2020 and December 2023. Relevant demographic information, past medical history, and HBOT session treatment protocols, such as the treatment pressure set in absolute atmospheric pressure (ATA) and number of air breaks, were recorded. The collected data was analyzed using descriptive statistics. A total of 43 patients were referred to HBOT during the study period, and 21 patients did not proceed with the treatments. In total, 634 HBOT sessions were administered to 22 patients in monoplace chambers with five-minute air breaks, and one patient experienced a seizure event. Each patient completed an average of 29 (range 3-60) sessions lasting 90-120 minutes at 1.8 ATA (n = 3), 2.0 ATA (n = 18), or 2.4 ATA (n = 1). Fifteen patients were on oral antiseizure medications during the HBOT course. The overall incidence of seizures was one in 634 treatments. While patients with a history of seizures may develop seizure activity during HBOT, the majority can safely undergo treatment when predetermined protocols are followed. With careful management and adherence to established protocols, HBOT can be a viable treatment option for those with seizure histories.

Diabetic ketoacidosis treatment outcomes and its associated factors among adult patients with diabetes mellitus admitted to public hospitals in Nekemte Town, Ethiopia: a cross-sectional study.

Diabetic ketoacidosis (DKA) is a serious and acute complication of diabetes mellitus. In Ethiopia, the mortality associated with acute diabetes complications ranges from 9.8% to 12%. Despite this, there is limited information on the clinical outcomes of DKA in our study location. Therefore, this study aimed to assess the magnitude and associated factors of DKA treatment outcomes among adult patients with diabetes admitted to public hospitals in Nekemte Town, Ethiopia. To assess the DKA treatment outcomes and their associated factors among adult patients with diabetes admitted to public hospitals in Nekemte Town. A 5-year cross-sectional study was conducted using a systematic random sampling technique among 201 patients from 1 July to 31 August 2023. DKA treatment outcomes were assessed at discharge. Pharmacists collected data by reviewing patient charts using Kobo Toolbox software. The data were then exported to SPSS Version 27 for analysis. Both bivariable and multivariable logistic regression analyses were performed. Variables with a P-value < 0.25 in the bivariable logistic regression were entered into the multivariable regression analysis to control for potential confounders. An adjusted odds ratio with a 95% confidence interval was used to identify predictors of treatment outcomes. A P-value < 0.05 was considered significant in the multivariable analysis. Complete data was available for 201 patients admitted with DKA. The majority, 178 (88.6%), improved and were discharged. Independent predictors of DKA recovery were comorbidities [AOR: 3.45, 95% CI: 1.33, 9.72], admission Glasgow Coma Scale (GCS) score (<8) [AOR: 2.74, 95% CI: 1.02, 7.34], random blood glucose (RBS) (≥ 500) [AOR: 3.07 (95% CI: 1.12, 8.39)], and urine ketones (≥+3) [AOR: 3.24, 95% CI: 1.18, 8.88]. Most of the treated patients with DKA were discharged with improvement. Comorbidity, admission GCS, RBS, and urine ketones were independently associated with DKA recovery. In general, significant consideration should be given to DKA prevention, early detection, and appropriate hospital management.

Incidence of Attention‐Deficit/Hyperactivity Disorder Between 2016 and 2023: A Retrospective Cohort

ObjectiveThe present retrospective cohort study sought to advance our understanding of the incidence and recent trends in new ADHD diagnoses among adolescents and adults between 2016 and 2023 in a clinical setting.MethodParticipants (N = 144,103) included adolescents and adult patients who actively utilized Sisters of Saint Mary (SSM) healthcare services. ICD‐10 codes were used to identify new ADHD diagnoses in patient charts. Joinpoint regression analysis determined incidence rates and trends of ADHD diagnoses, stratified by age group.ResultsIn adults, a significant (−10.6%; 95% CI −25.0%, −2.8%) downward trend in ADHD incidence was observed from 2016 to 2020, whereas a significant (+15.2%; 95% CI: 2.0%, 40.3%) upward trend was indicated from 2020 to 2023. Among adolescents, a significant (−26.1%; 95% CI: −33.4%, −14.4%) downward trend was observed between 2016 and 2018, while the incidence rate remained stable during 2018–2023.ConclusionsThis study is one of the largest retrospective cohort studies to investigate the incidence of new ADHD diagnoses among adolescents and adults in clinical practice, including before, during, and after the height of the COVID‐19 pandemic. Results indicate fluctuations in the incidence rates of new ADHD diagnoses in recent years, with well‐defined trends observed for adolescents and adults. Future directions should include the investigation of the underlying factors contributing to these diagnostic trends.Relevance to clinical practiceAdvancing our understanding of diagnostic trends in clinical practice promotes accurate diagnosis and improved management of ADHD. Study findings support future investigation in identifying potential modifiable risk factors, ensuring sufficient treatment resources, developing targeted interventions, and addressing diagnostic disparities.

Velopharyngeal Insufficiency and Impaired Tongue Movement Indicate Neuromuscular Disorders: A 10-Year Statistical Study in a Single Tertiary Institution.

Objectives: This study aimed to determine the positive predictive value of our NMD Suspicion Criteria in the diagnosis of NMDs. Other clinical factors routinely examined in our voice and swallowing examinations were also investigated to see if they had a significant association with the diagnosis of NMDs. Methods: This study retrospectively investigated the medical charts of patients who visited our Voice and Swallowing outpatient clinic between 2013 and 2022. Patients with previously diagnosed NMDs were excluded from the analysis. Among the remaining patients, we included those that were referred to neurologists for further evaluation due to suspicion of having an NMD based on the NMD Suspicion Criteria. The patients were then divided into groups according to the status of their diagnosis within 2 years of referral as "diagnosed", "denied", or "observed". These three groups of patients were then compared according to the following clinical findings; velopharyngeal insufficiency (VPI), tongue atrophy, impaired tongue movement, dysarthria, vocal fold mobility impairment, dysphagia, involuntary movement, gait disturbances, weight loss, and a sense of fatigue in order to see if they were significantly associated with the diagnosis of NMDs. Results: Of 3769 outpatients without a confirmed diagnosis of NMDs, 37 were referred to neurologists for suspected NMDs, and 19 (51%) were diagnosed with NMDs. VPI and impaired tongue movement were significant diagnostic factors for NMDs (p = 0.014, 0.033). VPI during speech (p = 0.045) was more strongly associated with the diagnosis of NMDs than VPI during swallowing (p = 0.076). Fatigue was a significant related factor for other diseases (non-NMDs) causing Voice and Swallowing problems (p = 0.049). Conclusions: In the outpatient clinic setting, suspicion of NMD should be raised, particularly when VPI and impaired tongue movement are observed, prompting a thorough assessment of velopharyngeal closure during both speech and swallowing.

Incidence of adult tonsillectomy for hypertrophic indications in Southwest Finland

Background Large palatine tonsils cause a variety of symptoms including obstructive sleep apnea and snoring. In adults, the prevalence of tonsillar hypertrophy remains uncertain. Aims We estimated the incidence of tonsillectomy for adult palatine tonsillar hypertrophy using population data and retrospective patient charts. Material and Methods Patient data were retrospectively collected between 2004 and 2018 in the Hospital District of Southwest Finland. Adult patients with tonsil hypertrophy, obstructive sleep apnea or mouth breathing/snoring as an indication for surgery were included. Data were verified from patient charts. To determine in adults the incidence of tonsillectomy for tonsillar hypertrophy, the number of surgeries was compared to population data. Results The incidence of tonsillectomy for adult tonsillar hypertrophy was 8.49 per 100000 person-years. In our hospital district, 9.5% of adults who underwent tonsil surgery had tonsillar hypertrophy. The incidence rate reduced with age. The most common indication for surgery of hypertrophic tonsils was snoring (30.8%). In this study, 12.7% of patients with asymmetric tonsils had malignancy with the most common being lymphoma. Conclusions and Significance Symptomatic adult tonsil hypertrophy remains rare. In adults, tonsil asymmetry should invoke a suspicion of lymphoma. Even during adulthood, as age increases, tonsillar hypertrophy becomes less common.

Use of a trigger tool to describe and screen drug-related hospital admissions in older adults: the TRIGGAge retrospective cohort study.

Drug-related hospital admissions (DRAs) can account for 5%-40% of total hospital admissions in older adults, with a significant proportion deemed preventable. To increase the detection of DRAs, in 2021, a revised trigger tool listing 21 frequent causes of admissions and medications at risk was proposed. This study aimed to describe DRAs using this trigger tool in a French acute geriatric ward and to assess the performance of the tool. This was a retrospective cohort study in a 20-bed geriatric unit including all patients hospitalised in 2023. During the first quarter of 2024, each patient's chart was adjudicated by using a two-step standardised review procedure to assess whether the admission was a DRA. The potentially at cause medications and reasons for admission were also assessed. During the study period, 483 patients were hospitalised in the acute-care geriatric ward (mean age 86.7 ± 6.15years). After adjudication, 207 admissions (43%) were identified as DRAs; 70% were considered preventable. The main causes of DRAs were falls/fractures (33%), bleeding (23%) and delirium (14%). The drugs most frequently responsible were diuretics (21%), renin-angiotensin system inhibitors (20%) and direct oral anticoagulants (15%). The overall sensitivity and specificity of the tool for detecting DRAs was 90% (95% CI 88-93) and 72% (68-76), respectively. After adjudication, the trigger tool helped detect 83% more DRAs as compared with the attending geriatrician. DRAs are frequent in a geriatric population and often preventable. Their detection may be improved by the use of a trigger tool.

Functional Outcomes of Patients with Ankylosed Elbow Managed with Fascia Lata Interposition Arthroplasty and Early Post-operative Active Motion Protocol

Background: Interposition arthroplasty is a non-prosthetic-requiring surgery that restores motion in young patients with ankylosed elbows who are not amenable to total elbow arthroplasty, elbow arthrodesis, or resection arthroplasty. This procedure usually requires extensive soft tissue stripping to free the elbow joint, an interposition graft, and post-operative immobilization. Objective: This study determined the functional outcomes of patients who underwent interposition arthroplasty of the elbow with early post-operative active motion exercise protocol, foregoing external fixation. Methodology: The study retrospectively reviewed charts of patients treated by a single surgeon for ankylosed elbows from 2017 to 2023 in a tertiary institution. All patients initiated early overhead active motion exercises as early as 24–48 hours post-surgery without any external fixation. Pre-operative and last follow-up functional outcomes were determined using the Mayo Elbow Performance and Fil-DASH scores. Result: The study included six patients with a mean age of 44 (24–61). Mayo Elbow Performance improved by a mean of 23% and Fil-DASH scores improved by a mean of 92%. Patients’ average arc of motion was 65˚ at a mean follow-up of 20 months. All elbows were stable and painless throughout the arc of motion. Conclusion: Interposition arthroplasty using tensor fascia lata graft combined with early overhead active motion is a viable surgical option for pain relief and improvement of motion in patients with elbow ankylosis who are candidates for either total elbow arthroplasty or arthrodesis.