Clinic Of University Hospital Research Articles

Sympatholytic Effect of the High Thoracic Erector Spinae Plane Block

BACKGROUND: The erector spinae plane block (ESPB), which was introduced for the management of thoracic pain, is a technically easy and relatively noninvasive ultrasound (ULSD)-guided technique. Although the ESPB is used widely in variable clinical situations, its sympatholytic effect has never been studied. OBJECTIVES: The purpose of this study is to demonstrate the sympatholytic effect of the high thoracic ESPB by comparing the blocked and unblocked sides of patients’ upper extremities, using the changes in the perfusion index (PI). STUDY DESIGN: Prospective, single-group, and open-label study. SETTING: The study was carried out in the pain clinic of a tertiary university hospital. METHODS: This study included 47 patients with upper extremity pain and various diseases who received T2 or T3 ESPBs using 20 mL of 0.2% ropivacaine. For the evaluation of the sympatholytic effect, measurements were taken on the numeric rating scale (NRS), the neck disability index (NDI), and the PI. RESULTS: The PIs of the blocked sides demonstrated significant increases at 10, 20, and 30 minutes compared to the PIs of the baseline and unblocked sides (P < 0.001). The PI ratio at 10 minutes was 2.74 ± 1.65, which was the highest value during the measurement period. Until 30 minutes after the ESPB, the PI ratio was significantly higher in the blocked side than in the unblocked side. During the study period, significant reductions in NRS and NDI scores were found irrespective of disease entity. Limitation: The period of PI measurement was only 30 minutes, so we could not determine the time point when the PI returned to the baseline value. CONCLUSION: The high thoracic ESPB was effective in relieving upper extremity pain in diverse disease entities, and the PIs of patients’ blocked sides demonstrated significant increases over the baseline value and contralateral unblocked sides. KEY WORDS: Erector spinae plane block, perfusion index, numerical rating scale, upper extremity pain

Predictors of a Favorable Response to Erector Spinae Plane Block for Lumbosacral Radiculopathy

BACKGROUND: The erector spinae plane block (ESPB), which was introduced to manage the thoracic pain, is a technical easy and less invasive ultrasound-guided technique. Although the ESPB is used widely in various clinical situations, no studies have evaluated the association between the clinical outcomes of the ESPB and the numerical changes of the perfusion index (PI). OBJECTIVES: The purpose of this study is to investigate the association between the clinical response following ESPB and other possible factors including the changes of PI. STUDY DESIGN: Prospective, nonrandomized, and an open-label study. SETTING: The pain clinic of a tertiary university hospital. METHODS: This study included 91 patients of low back pain with degenerative spinal disease who received L4 ESPB using 20 mL of 0.2% ropivacaine. For the predication of clinical outcome, the PI was measured for 30 min at the blocked side subsequent to the ESPB. Various demographic data were also analyzed to predict the clinical outcomes. RESULTS: The PI of the responder group was higher value than that of the nonresponder group until 30 min but did not show any statistically significant differences. Multivariate logistic regression analysis revealed that the duration of pain (odds ratio [OR], 0.95; 95% CI, 0.90-1.00; P = 0.043), the right side injection (OR, 3.87; 95% CI, 1.42-10.55; P = 0.008), and the PI ratio of 1.5–3 at 10 min (OR, 3.79; 95% CI, 1.36-10.57; P = 0.011), were independent factors associated with successful outcomes. Limitation: The responder and the nonresponders were categorized using only changes of the numeric rating scale. The categorization based on the changes of functional disability or quality of life was not used. CONCLUSION: The right side injection, duration of pain less than 3 months, PI ratio of 1.5–3 at 10 min following the ESPB were associated with successful clinical outcomes. KEY WORDS: Erector spinae plane block, perfusion index, numeric rating scale, low back pain

Exploring the Impact of COVID-19 on Ulcerative Colitis Patients: A Lifestyle Perspective.

Background and Objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 is the new coronavirus that caused the coronavirus disease 2019 (COVID-19) outbreak. Studies have increasingly reported the involvement of organs outside the respiratory system, including the gastrointestinal tract. Data on the association between COVID-19 and ulcerative colitis (UC) are lacking. Materials and Methods: In this one-centre cross-sectional study, 49 patients with UC from the Riga East Clinical University Hospital outpatient clinic were included from June 2021 to December 2021. The patients were divided into two groups according to their history of a confirmed positive or negative COVID-19 status. Data on their lifestyle, diet, and medications and the food supplements used by the patients were collected during interviews and analysed using the R 4.2.1 software. Results: Out of 49 patients, 33 (63.3%) were male and 13 (36.7%) were female, with a mean age of 32.33 ± 8.6 years. Fourteen patients (28.6%) had a confirmed COVID-19 infection in the last year. The most common COVID-19-related symptoms were a fever and rhinorrhoea. A third of patients followed the inflammatory bowel disease diet (16; 32.7%); out of these patients, 12 (34.3%) did not contract COVID-19 (OR: 0.78 (0.18; 2.98), p > 0.05). In the COVID-19-positive group, the majority of patients did not use vitamin D (11; 79% vs. 3; 21%, (OR: 0.38 (0.07; 1.51), p = 0.28) or probiotics (11; 78.6% vs. 3; 21.4%, OR: 1.33 (0.23; 6.28), p = 0.7). In the COVID-19-positive group, most patients did not smoke (12; 85.7% vs. 2; 14.3%, p = 0.475) and did not use alcohol (9; 64.3% vs. 5; 35.7%, OR: 0.63 (0.16; 2.57), p = 0.5). Most of the patients who participated in sports activities were COVID-negative (18; 51.4% vs. 6; 42.9%, p = 0.82). Conclusions: There were no statistically significant differences in the use of food supplements, probiotics, or vitamins; the lifestyle habits; or the COVID-19 status in patients with UC.

Automatization of CT Annotation: Combining AI Efficiency with Expert Precision.

The integration of artificial intelligence (AI), particularly through machine learning (ML) and deep learning (DL) algorithms, marks a transformative progression in medical imaging diagnostics. This technical note elucidates a novel methodology for semantic segmentation of the vertebral column in CT scans, exemplified by a dataset of 250 patients from Riga East Clinical University Hospital. Our approach centers on the accurate identification and labeling of individual vertebrae, ranging from C1 to the sacrum-coccyx complex. Patient selection was meticulously conducted, ensuring demographic balance in age and sex, and excluding scans with significant vertebral abnormalities to reduce confounding variables. This strategic selection bolstered the representativeness of our sample, thereby enhancing the external validity of our findings. Our workflow streamlined the segmentation process by eliminating the need for volume stitching, aligning seamlessly with the methodology we present. By leveraging AI, we have introduced a semi-automated annotation system that enables initial data labeling even by individuals without medical expertise. This phase is complemented by thorough manual validation against established anatomical standards, significantly reducing the time traditionally required for segmentation. This dual approach not only conserves resources but also expedites project timelines. While this method significantly advances radiological data annotation, it is not devoid of challenges, such as the necessity for manual validation by anatomically skilled personnel and reliance on specialized GPU hardware. Nonetheless, our methodology represents a substantial leap forward in medical data semantic segmentation, highlighting the potential of AI-driven approaches to revolutionize clinical and research practices in radiology.

The use of the SIMONA 111 integrated monitoring system in assessing the dynamics of rehabilitation treatment of patients with past coronavirus pneumonia. Clinical observations

The new coronovirus infection affects not only physical health, but also causes significant damage to the mental state of the population. Therefore, the stage of rehabilitation treatment makes it necessary to combine various treatment methods for the most effective restoration of the quality of life and psychological comfort of patients.
 This article presents clinical observations as part of a study of rehabilitation methods after a new coronavirus infection brought on the basis of Sechenov University and Medsi Clinical Hospital No. 1. A distinctive feature of rehabilitation was the use of hypoxic/hyperoxy therapy in combination with the main course of rehabilitation treatment and the SIMONA 111 integrated monitoring system as a method of control, treatment analysis and a way of visual interaction with patients. This approach allowed not only to obtain objective data on the dynamics of treatment, but also to establish better contact with the patient.

Characterisation of frequency of norovirus infection among hospitalised patients of Children’s clinical university hospital in 2021

Objective. To characterize the frequency of norovirus infection depending on where infection was acquired, age, sex, department profile, presence of other pathogens and socio-demographic factors among hospitalized patients of “Children’s Clinical University Hospital” in 2021. Materials and Methods. Data was taken from the Children’s Clinical University Hospital internal information system Andromeda and the laboratory information system DIALAB about hospitalized patients in 2021 with a diagnosis of acute gastroenteropathy caused by norovirus (A08.1). A total number of included cases in the data analysis were 266 children aged 17 years and younger. For statistical data analysis descriptive statistical methods and single-factor, multi-factor binary logistic regression was used. Results. The incidence of healthcare-associated norovirus infection (NoV-HAI) was 4.14 cases per 1000 hospitalized children per year. There were no statistically significant differences between socio-demographic factors, the presence of other pathogens and place where infection was acquired. The chances of becoming infected with NoV in the hospital’s therapeutic profile departments were 3.99 (CI 2.07-7.69) times higher than in the departments of infectious diseases. Children with chronic illnesses and norovirus (NoV) infection were only in the NoV-HAI group (n = 10). In the NoV group acquired in the society, children were 5.24 times more likely (CI 2.71-10.13) to suffer from dehydration than in the NoV-HAI group. Conclusions. The chances of hospitalized children to obtain NoV-HAI are related to compliance with infection control measures in departments of different profiles, not to the child’s socio-demographic factors.

Prevalence and anti-microbial resistance of Staphylococcus spp. isolated from the environment and veterinary personnel in a Spanish veterinary teaching hospital.

Methicillin-resistant Staphylococcus (MRS) bacteria, including methicillin-resistant S. aureus and methicillin-resistant S. pseudintermedius (MRSP), pose a significant threat in veterinary medicine, given their potential for zoonotic transmission and their implications for companion animals and humans' health. This study aimed to assess the prevalence of MRS and anti-microbial resistance patterns at a university clinical hospital in Madrid, Spain. Samples were collected from both the environment and hospital staff at Veterinary Clinical Hospital of Alfonso X el Sabio University. Anti-microbial susceptibility assays, molecular detection of mecA gene and genetic relationships among the identified bacterial strains were performed. The study revealed an MRS prevalence of 1.50% in environmental samples, with MRSP accounting for 0.75% of the cases. Genetically related MRSP strains were found in different hospital areas. Among hospital staff, there was a MRS prevalence of 14.03%, including S. pseudintermedius and S. epidermidis strains. Antibiogram tests revealed multi-drug resistance among MRSP strains. Additionally, methicillin-resistant coagulase-negative staphylococci were isolated, suggesting potential cross-species transmission. This study underscores the presence of MRS in a veterinary clinical hospital, highlighting the significance of infection control through the implementation of protective measures, stringent hygiene practices among personnel and in the environment and responsible use of antibiotics. Further research is necessary to assess MRS incidence in animal patients and explore geographical variations, enhancing our understanding of MRS in veterinary medicine and addressing its challenges.

Microbiological Findings, Infection Risk Factors and Complications Among Children after Tracheostomy

Introduction. Bacterial infection of the respiratory tract is highly common among pediatric patients with tracheostomy, yet there is no wide knowledge about the prevalence of different airway microbes, the incidence of bacterial infection, infection risk factors, and complications. The aim of the study was to analyze the prevalence of airway microbes, the incidence of bacterial infection, infection risk factors, and complications. Methods. Retrospective data of officially reported cases were collected from 2018 to 2022 at Riga Children's Clinical University Hospital (RCCUH). Demographic factors, airway microbiological findings, tracheostomy-related complications, underlying conditions, and outcomes for 37 patients were gathered from the hospital's database Andromeda. The data were analyzed using MS Excel. This study received ethical approval from RSU Ethics Committee. Results. Microbiological analyses were done in 78.3% (n=29) of the cases. Most cultures were obtained from airway aspirate. Altogether 46 different species of microbes were identified. The most frequently identified bacteria were Pseudomonas aeruginosa (in 72.4% of the cases; n=21) and Staphylococcus aureus (65.5%; n=19). Forty-eight percent (n=18) of the patients had respiratory tract infections that required hospitalization. Overall, there were 60 hospitalization episodes of which 51.6% (n=31) were caused by pulmonary bacterial infection, 25.0% (n=15) by non-bacterial infection, and 0.05% (n=3) because of local wound infection. The rest 18.3% (n=11) of hospitalization episodes were due to granulation tissue. The risk factor that showed the greatest significance in the development of bacterial infection was ventilator dependency. Formation of granulation tissue in the airways was found to be the most common complication among pediatric patients with tracheostomy. Conclusion. This study summarizes the most common pathogens, risk factors, and complications, which should be considered while treating pediatric patients after tracheostomy. The results of this study demonstrate that P. aeruginosa and S. aureus have the highest prevalence among these patients. This research is currently used to develop guidelines for pediatric patients with tracheostomy care in RCCUH. Keywords: pediatric tracheostomy; respiratory infections; tracheostomy complications.

Rates of additional vaccinations to national calendar for children visiting the child health surveillance and immunization clinic of a tertiary university hospital

Rates of additional vaccinations to national calendar for children visiting the child health surveillance and immunization clinic of a tertiary university hospital

Effects of internal limiting membrane peeling versus non-internal limiting membrane peeling during vitrectomy for diabetic tractional retinal detachment on postoperative macular thickness, foveal contour, and formation of epiretinal membranes

Aim To investigate the impact of internal limiting membrane (ILM) peeling during vitrectomy for diabetic tractional retinal detachment (TRD) on postoperative central macular thickness, foveal contour, and creation or reformation of epiretinal membranes. Methods In a randomized trial, patients aged 40–65 years old with TRD were recruited from the outpatient clinic in Suez Canal University Hospital from August 2020 to February 2022. Patients were randomized into two groups: group 1 did vitrectomy with ILM peeling, while group 2 did vitrectomy without ILM peeling. At 1, 3, and 6 months after surgery, optical coherence tomography (OCT) was carried out to investigate the central macular thickness (CMT), foveal contour, and epiretinal membrane’s presence. For categorical variables, the Chi-squared test or Fisher’s exact test was performed, while the Student’s t-test was used to assess differences in continuous data. Results Thirty-two patients (16 in each group) completed the required follow-up. There was no significant difference between both groups concerning the affected eye (P=1.00). There was no statistically significant difference regarding the CMT recorded via optical coherence tomography at any point of follow-up in the two groups (P=0.289). Also, there was no statistically significant difference regarding the presence of foveal depression at any point of follow-up in the two groups (P=0.680). On the other hand, the percentage of patients who showed no presence of epiretinal membranes in the ILM peeling group was statistically significant when compared with the non-ILM peeling group (P<0.001). Conclusions ILM peeling decreases the incidence of epiretinal membrane proliferation following diabetic vitrectomy.

Recurrent reproductive failure and celiac genetic susceptibility, a leading role of gluten.

The prevalence of gluten-related disorders, mainly celiac disease (CD) and non-celiac gluten sensitivity (NCGS), varies between 0.6% and 13% in the general population. There is controversial evidence regarding the association of both CD and NCGS with extra-digestive manifestations, including recurrent reproductive failure (RRF), which may have clinical implications. To study the prevalence of HLA susceptibility alleles for CD/NCGS in a cohort of female patients with RRF from a single reference center and to evaluate the effect of a gluten-free diet on reproductive success. A retrospective study was conducted on 173 patients with RRF, consecutively attended at the Reproductive Immunology Unit of San Carlos University Clinical Hospital in Madrid. We collected and analyzed the clinical, analytical, and immunological profiles of RRF patients who presented HLA alleles associated with CD and NCGS (HLA DQ2.2, DQ2.5, DQ8, and DQ7.5). We observed a significantly higher prevalence of HLA alleles associated with CD and NCGS in our RRF cohort compared to the prevalence in the general population (69% vs. 35%-40%, p<0.0001). Only 2.3% of patients met the criteria for a CD diagnosis. In our RRF cohort, HLA-genetic susceptibility for CD/NCGS (HLA-risk group) was associated with a significantly higher rate of hypothyroidism compared to patients without these alleles (HLA-negative group) (48.7% vs. 26.92%, p=0.03). Patients with HLA-genetic susceptibility for CD/NCGS and thyroid disease had a significantly higher success rate in the subsequent pregnancy after management (55% vs. 30%, p=0.002). Two factors were found to be significant in this group: a gluten-free diet (p=0.019) and the use of levothyroxine (p=0.042). In our cohort of RRF patients, we observed a significantly higher prevalence of HLA susceptibility genes for CD/NCGS compared to the general population, also associated with a higher incidence of thyroid alterations. A gluten-free diet and the use of levothyroxine in cases of thyroid pathology had significant beneficial effects on pregnancy outcomes. We suggest that HLA typing for CD/NCGS and a gluten-free diet, in the presence of risk alleles, can improve pregnancy outcomes in RRF patients.

Violence against infertile women: comparative study in Upper verses Lower Egypt

Background: Infertility is a common gynecological problem that is associated with social stigma, social neglect, economic deprivation, emotional stress, unhappiness and marital instability. Violence against women is a global major health and human right concerns as this affects millions of women all over the world across ethnicity, culture, socioeconomic and educational classes. Infertile women have been deemed particularly vulnerable to domestic abuse in several studies. Aim: highlight and compare the prevalence and trends of domestic violence among infertile women receiving treatment for infertility in Upper verses Lower Egypt. Methods: A cross-sectional comparative study on 200 infertile women. The study was carried out at Beni-Suef University's Center for Diagnosis and Treatment of Delayed Reproduction and Gynecological Outpatient Clinic Beni-Suef University Hospital and gynecological outpatient clinic, Port Said University Hospital. Results: Women either upper Egyptian or lower Egyptian infertile women experienced and exposed all forms of domestic violence. The Upper &amp; Lower studied Egyptian women experienced physical violence in about 70.0% &amp; 68.0% and verbal violence in about 69.0% &amp; 62.0% and financial violence in about 48.0% &amp;46.0% and violence in about sexual violence in about 45.0% &amp; 28.0%, since not been able to have a baby successfully and in the past years. Relationships between physical and verbal aggression that are statistically significant include age, different types of infertility, the gender of children (p&lt;0.05). Conclusion: However, is no statistically significant deference between geographical area (upper or lower) and types of violence experienced by infertile women, all form of violence were more prevalent among upper Egyptian infertile women. Recommendations: (1) It is recommended that additional research be done with a larger sample from other provinces of Upper Egypt with regard to infertility and its psychological effects. (2) The relationship between violence and reproductive results requires more study, as do effective psychosocial interventions. Research on emotions and coping mechanisms within the context of treatment is particularly important.

Multiple Pregnancies Over a Five-Year Period; Complications in Pregnancy, Mode of Delivery and Perinatal Outcome

Background: The aim of this study was to determine type and frequency of complications during multiple pregnancies, mode of delivery and perinatal outcome in three groups of pregnant women, categorized by gestational age of pregnancy.Methods: In cross-sectional epidemiological study data were collected and processed from the medical database of University Clinical Hospital in Mostar in the period between 2015. and 2019. A total of 149 pregnant women and their neonates were included and divided into three groups according to gestational age: moderately preterm birth (from 22 to 33 + 6 weeks - MPTB), late preterm birth (from 34 to 36 + 6 weeks - LPTB ), term birth (from 37 weeks). SPSS for Windows software (version 23.0, SPSS Inc, Chicago, Illinois, USA) was used for statistical analysis.Main findings: Of the total 149 pregnancies, 64.86% were completed by C-section and it was the dominant mode of delivery in all gestational groups. Hypertension, PPROM and gestational diabetes pregnancy were the most common complications in the group of term birth, PPROM and preeclampsia in the LPTB group, multiple maternal complications in the group MPTB (p &lt;0.001). In both twins, respiratory distress syndrome (RDS) was the most common complication in MPTB group, and neonatal jaundice and perinatal infection and sepsis in the LPTB and term birth group.Principal conclusions: Caesarian section was dominant mode of delivery in all groups. RDS and multiple complications were significantly more common in MPTP group, and neonatal jaundice, perinatal infections and sepsis in LPTP and term birth group.Key words: multiple pregnancy, PPROM, preeclampsia, hypertension, perinatal complications, caesarian section.

Enhancing the Adult and Paediatric Palliative Care System: Spanish Professionals' and Family Caregivers' Suggestions for Comprehensive Improvement.

This research critically explores deficiencies in the palliative care system, focusing on evaluation and treatment aspects for both adult and paediatric patients. Using a qualitative methodology, the study engages healthcare professionals and family caregivers to uncover perspectives on the existing state of palliative care. Conducted through three focus groups and a semi-structured in-depth interview with participants recruited from Virgen de la Arrixaca University Clinical Hospital, this research illustrates critical issues, highlighting the insufficient healthcare workforce and resources to meet the comprehensive needs of patients and their families. Recommendations include holistic care addressing social, emotional, psychological, socio-familiar, and economic dimensions, supported by embedded support groups and the enforcement of relationships with palliative associations. This study also advocates for improved health institutional coordination, social worker support, and ongoing health professional satisfaction monitoring. In paediatric care, specific demands involve specialised units, medical team continuity, 24 h paediatrician care, and a more professional paediatric approach. Beyond problem identification, this study offers valuable insights for shaping health policies and tools, incorporating new indicators and introducing grief bereavement support in clinical reports, contributing to the advancement of patient evaluation in palliative care.

Clinical characteristics of psychotic disorders in patients with childhood trauma.

Childhood trauma is an important predictor of psychotic disorders, with special emphasis on physical and sexual abuse. It influences the clinical picture and course of psychotic disorders. This study was conducted in the Department of Psychiatry of the University Clinical Hospital Mostar. The sample consisted of 135 participants, aged 18 to 65 years. The screening instrument to examine cognitive status was the short version of MMSE-2. Patients' background information was collected using a sociodemographic questionnaire constructed for this study. To determine childhood trauma, the Child Abuse Experience Inventory was used to examine physical, sexual, and emotional abuse, neglect and domestic violence. The positive and negative syndrome scale scale was used to evaluate the clinical profile of psychoticism, the SSI questionnaire was used to evaluate the severity of suicidality, and the functionality of the participants was evaluated using the WHODAS 2.0. Results indicate that a significant number of participants with psychotic disorders experienced childhood trauma, an important determinant of their illness. Participants who had witnessed abuse had more severe clinical presentations (earlier onset and longer duration of illness) and more pronounced psychotic symptomatology and a lower degree of functionality. Decreased functionality is associated with witnessing abuse and physical abuse. During the civil war, a significant percentage of the participants were in childhood and adolescent development (26.7%) and exposed to frequent emotional abuse and domestic violence. As 1 traumatic event in childhood makes a person more susceptible to more traumatic experiences during life. Childhood trauma is a serious and pervasive problem that has a significant impact on the development, course, and severity of the clinical presentation of psychotic disorders. Accordingly, it is necessary to provide continuous education to mental health workers, primarily psychiatrists, regarding childhood trauma so that treatment may be approached more systematically and a plan of therapeutic interventions may be more adequately designed, which would necessarily include psychosocial support in addition to pharmacotherapy.

Debate on the oncologic potential of sex steroid preparations

Background. Thanks to numerous worldwide studies, the significant contribution of the hormonal component to the oncological risks of the organs of the female reproductive system is beyond doubt. Of great interest is the analysis of world research on the oncological potential of hormonal drugs, namely COCs and MGT, since this issue continues to be one of the most complex and controversial.&#x0D; Aim. This study aimed to contribution of hormonal factors to the development of cancer of the female reproductive system, namely breast, cervical, endometrial and ovarian cancers.&#x0D; Materials and Methods. The study was conducted on the basis of the Center of Gynecology and Reproductive Technologies of the FSAU “National Medical Research Center “Treatment and Rehabilitation Center” of the Ministry of Health of the Russian Federation, the Department of Oncogynecology of the University Clinical Hospital No. 4 of the I.M. Sechenov First Moscow State Medical University. The analysis of medical documentation for the period from January 2015 to December 2021 was carried out. The study included 1842 patients with verified oncological disease of the female reproductive system, who had a history of taking hormonal drugs of the following pharmacological groups: hormonal contraceptives, menopausal hormone therapy drugs. The age of all patients ranged from 26 to 83 years (mean age 51.98±10.3 years). The control group consisted of 611 patients without oncological diseases, who have a history of indications for taking hormonal drugs of these pharmacological groups.&#x0D; Results. When assessing the effect of the duration of MGT intake on the risk of developing breast cancer, it was found that MGT intake for a total of more than 6 years was associated with a higher risk of developing breast cancer (HR 1.18; CI 1.02–1.36; p 0.001). Using the Wald method, we found that the probability of developing breast cancer is associated with a BMI of more than 25 kg/m2 and long-term intake of combined MGT for a total of more than 6 years. When assessing the effect of the duration of MGT intake on the risk of developing RTM, it was found that MGT intake for a total of more than 6 years was associated with a higher risk of developing RTM (HR 1,432; CI 1,172–1,750; p 0.001). Using the Wald method, we found that the probability of developing RTM is associated with the presence of a BMI of more than 25 kg/m2, prolonged MGT intake for a total of more than 6 years and the presence of endometrial hyperplastic processes, adenomyosis, hypertension in the anamnesis. When assessing the effect of the duration of COC intake on the risk of developing breast cancer, it was found that taking COC for a total of more than 7 years was associated with a higher risk of developing breast cancer (HR 1.68; CI 1.1–2.5; p=0.010). According to the Wald method, it was revealed that the probability of developing breast cancer is associated with the presence of HPV type 16, a BMI of more than 25 kg/m2 and prolonged intake of COCs for a total of more than 7 years. When assessing the effect of the duration of MGT intake on the risk of developing PC, it was found that MGT intake for a total of more than 9 years was associated with a higher risk of developing PC (HR 1.65; CI 1.2–2.3; p=0.010). Using the Wald method, we found that the probability of developing RYA is associated with the presence of a BMI of more than 25 kg/m2, MGT intake and the presence of endometrial hyperplastic processes in the anamnesis.&#x0D; Conclusions. With prolonged use of sex steroids, there is a tendency to increase the risk of developing cancer of the female reproductive system. Careful follow-up and limitation of the duration of taking sex steroids in risk groups will reduce carcinogenic risks.

A Sociological Approach to Vasectomized Patient’s Trajectories at the Buenos Aires University Clinical Hospital “José de San Martín”

According to Argentinian Ministry of Health records the number of patients requesting vasectomy increased twelve times in public hospitals, between 2015 and 2019. Physicians and specialists account for this change in recent years, arguing, among other reasons, a cultural change where the male assumes an active position in contraceptive methods. This research addresses vasectomized patient´s trajectory at the Buenos Aires University Clinical Hospital “José de San Martín”. Our aim was to define from a sociological point of view if we are actually witnessing a cultural change. While considering the last ten years (2012-2022), through a diachronic study analyzing patient´s demand at the Male Fertility Laboratory (n: 1136) we found out that although the main motivation is fertility a minority (6%) consulting to confirm the absence of sperm in the ejaculate following vasectomy increased significantly in 2022 (Pearson’s Chi-square p&lt;0.0001). After qualitative/quantitative interviews to the former patient´s group (n:36) two subpopulations were distinguished the childless (42%; Median age: 30 years old; range: 24-35) and those having a family (58%; Median age: 39 years old; range: 35-54). Most of them had a university degree (67%) and learned about this anticontraceptive method by the internet. It is remarkable that 94% of them were not aware of the Argentinan Law 236139 sanctioned in 2006 that grants their right to vasectomy. Among all the patients randomly interviewed in 2022 (n:200) condom anticontraceptive method was the best known (67%). Finally we conclude that in the meantime we are facing a New Trend that comprises a high educational level segment of our people that can become the seed of a Cultural Change in the future encompassing the whole society.

Comparison of Salivary Secretion, pH, and Buffer Capacity Between COVID-19 Vaccinated and Unvaccinated Child Patients Visiting Dental Clinics of University Hospitals in Riyadh City, Saudi Arabia.

This study aimed to assess and compare the salivary secretion, pH, and buffer capacity between COVID-19 vaccinated and unvaccinated child patients visiting the clinics of private university dental hospitals in Riyadh, Saudi Arabia. This is the first comparative assessment of salivary parameters between unvaccinated and COVID-19-vaccinated child patients. The study sample comprised COVID-19 unvaccinated (n = 66) and vaccinated (n = 66) pediatric dental patients aged 4-12 years seeking dental care in clinics of private university hospitals. Paraffin-stimulated saliva was collected from unvaccinated and vaccinated study participants, and the amount of saliva secreted per minute was noted. Salivary pH and buffering capacity (by 5 mmol Hydrochloric acid titration) were measured using a benchtop digital pH meter. The data obtained were compared between unvaccinated and vaccinated participants using an independent t-test. The results showed a significantly higher salivary secretion rate in unvaccinated than vaccinated study participants (0.83 ± 0.24 mL/min vs 0.67 ± 0.24 mL/min, p = 0.001). Similarly, unvaccinated subjects compared to vaccinated subjects exhibited a significantly higher pH (7.33 ± 0.39 vs 7.04 ± 0.46, p < 0.001) and buffering capacity (6.31 ± 1.55 vs 5.40 ± 1.22, p < 0.001). Moreover, unvaccinated females demonstrated a significantly higher salivary secretion (0.87 ± 0.23 vs 0.71 ± 0.25, t = 2.627, p = 0.011) and buffering capacity 6.19 ± 1.52 vs 5.34 ± 1.25, t = 2.404, p = 0.019) than vaccinated females. Similarly, unvaccinated male exhibited significantly higher salivary secretion (0.80 ± 0.25 vs 0.64 ± 0.23, t = 2.670, p = 0.009), salivary pH (7.39 ± 0.45 vs 6.94 ± 0.41, t=4.309, p<0.001) and buffering capacity (6.42 ± 1.60 vs 5.45 ± 1.21, t = 2.875, p = 0.005) than the vaccinated male subjects. The vaccinated subjects showed a significantly lower mean salivary secretion, pH, and buffering capacity than unvaccinated participants. Hence, COVID-19 vaccination is likely to affect salivary parameters among pediatric patients.

Investigation of the risk factors associated with osteoporosis in postmenopausal women

Osteoporosis is a substantial global public health issue. The objective of this study was to evaluate the risk variables associated with osteoporosis among patients seeking care at an outpatient menopausal clinic in a tertiary university hospital. In this retrospective, cross-sectional study postmenopausal women who attended the outpatient menopause clinic of Başkent University Hospital between June 01, 2014, and August 31, 2015, were enrolled. Patients’ datasheets were reviewed and data including age, body mass index, parity, duration and age of menopause, history of smoking and oral contraceptive pills (OCPs) use, natural or surgical menopause, and calcium-containing food consumption were collected through a standardized questionnaire. Bone mineral density (BMD) was measured at the femur neck and lumbar spine by dual energy X-ray absorptiometry. A total of 1,148 women with a mean age of 53.5±6.7 years, mean duration of menopause 7.1±6.2 years and mean age of menopause 46.3±5.1 years were identified. Of these, 235 (20.5%) were diagnosed as having osteoporosis. The average femur and lumbar T-values showed a decrease in normal weight patients compared to overweight, obese, and morbidly obese patients (F=22,337, p<0.001 and F=50,195, p<0.001, respectively). The mean femur T-values were higher in participants who used OCPs, regularly consumed a calcium-rich diet, and performed regular physical activity (p<0.05, p<0.01 and p<0.05). Positive correlations were noted between giving birth and femur T-values (r=0.065, p=0.027), between natural menopause and lumbar T-values (r=0.060, p=0.043), and between consuming a calcium-rich diet and femur T-values (r=0.087, p=0.003 and r=0.064, p=0.031, respectively). Using OCPs, lifelong physical activity, and a healthy diet rich in calcium are important factors for the prevention of low lumbar spine and femoral BMD and by implication, osteoporosis.

Retrospective and Observational Study on CAR-T 19 Bridge Therapies in Pediatric, Adolescents and Young Adults

INTRODUCTION CAR-T therapy has revolutionized the treatment of B-ALL. The development of CAR-T therapy is a long and delicate process where once apheresis is done, a bridge period that least until CAR-T cells are infused starts. Meanwhile, the objective will be to maintain disease control, decrease tumor burden (TB) and prevent disease progression with no severe comorbidities by the administration of a bridge chemotherapy. That will decrease the risk of severe (grade 3-4 ASTCT) Cytokine Release Syndrome (CRS) and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) with an improvement of event free survival. Nevertheless, there is no consensus nor standard guidelines about bridge chemotherapy type, especially in pediatric patients. In this way, the main objective of this study is to identify CAR-T outcomes in pediatric, adolescents and young adults (AYA) diagnosed of BCP-ALL based on bridge chemotherapy. MATHERIAL AND METHODS An observational, retrospective and non-interventional study of Spanish pediatric and AYA under 24 years old diagnosed with BCP-ALL treated with tisagenlecleucel that have been registered by the Spanish Hematopoietic Stem Cell Transplantation and Cellular Therapy (GETH-TC) CAR-T clinical database from years 2017 to 2022. Data have been collected from nine centers members of GETH-TC CAR-T workgroup: La Paz University Hospital, Sant Joan de Déu University Hospital, Virgen del Rocío University Hospital, Niño Jesús Pediatric University Hospital, Gregorio Marañón General University Hospital, Vall d'Hebron University Hospital, Salamanca Clinic University Hospital, Germans Trials i Pujol University Hospital and Valencia Clinic Hospital. General, pre-CAR-T, CAR-T-related and post-CAR-T variables have been analysed from GET-TC CAR-T database, highlighting those related to bridge therapy and related outcomes. Bridging chemotherapy was analyzed considering whether the patients had received high (myelosuppression ≥7 days) or low (myelosuppression ≤7 days) intensity schemes, or in contrast, immunotherapy. Fisher's Exact Test for count data and Log Rank test for Overall Survival (OS), Relapse Free Survival (RFS) and Duration of Response (DOR). Variables with p&amp;lt;0.05 value have been considered of statistical significance. RESULTS Baseline characteristics of the 103 patients are summarized in Table 1. CRS after infusion was presented in 86 (83.5%) patients. Grade 3-4 was developed in 4/29 (13.8%) with low pre infusion TB in contrast to 18/55 (32.7%) with high TB (p=0.001). Complete remission (CR) was achieved 87 (85.3%) patients. All patients (100%) with a low TB were in CR VS 78.2% in the high TB arm (p=0.015). Otherwise, 91.9% of those patients that received low intensity bridge chemotherapy or immunotherapy were in CR VS 71% of those where high intensity bridge was administered (p=0.027). With a median of 23.75 months, OS at 12 months was 62.23% (CI95% 51.71-74.89). No statistical significance was found between bridge chemotherapy groups, although it was higher in low intensity and immunotherapy group (68.33% CI95% 55.41-84.27) VS (57.89% CI95% 40.43-82.89) (p=0.11). With a median of 9.26 months, RFS at 12 months was 41.7% (CI95% 31.71-54.85). No statistical significance was found between bridge chemotherapy groups, but was higher in low intensity group and immunotherapy (51.8% CI95% 39.45-68.01) VS (34.69% CI95% 18.59-64.74) (p=0.089). With a median of 8.28 months, DOR at 12 months was 41.7% (CI95% 31.71-54.85). No statistical significance was found between bridge chemotherapy groups, with an increasing tendency in low intensity group and immunotherapy (51.8% CI95% 39.45-68.01) VS (34.69% CI95% 18.59-64.74) (p=0.089). In the multivariate analysis, grade 3-4 CRS HR 8.7 (CI95% 0.82-92) (p = 0.072) and high TB HR 4.7 (CI95% 1.1-20) (p = 0.038) were related with a decreased OS. CONCLUSIONS Receiving low intensity bridge or immunotherapy is related with high rates of CR. In the same way, in this group of patients there is tendency to achieve higher OS, RFS and DOR. This is the reason because its use should be prioritized avoiding those of high intensity bridge chemotherapy. High TB is an important risk factor related with a poor response and high grade CRS development, so it is essential to reduce TB previous CAR-T infusion in order to improve outcomes and reduce toxicities.