Complicated History Research Articles

P323 Defining Normal Bowel Wall Thickness on Intestinal Ultrasound in an International Multicenter Cohort of Children with Inflammatory Bowel Disease in Sustained Deep Remission

Abstract Background Intestinal ultrasound (IUS) is a non-invasive, patient-centric tool for detecting and monitoring activity in patients with inflammatory bowel disease (IBD). Bowel wall thickness (BWT) is the most important parameter for assessing IBD activity, however, normal values are extrapolated from adults. We aimed to define normal BWT in children with IBD who achieved sustained deep remission. Methods International, multicentre, retrospective, pediatric IUS database including IBD patients (< 18 years) without a prior history of surgery or complications who underwent IUS after achieving sustained deep remission: absence of ulcerations on ileocolonoscopy and/or transmural healing on magnetic resonance enterography or computed tomography enterography and steroid-free clinical remission from 2020-2023. Descriptive statistics summarized data as percentages for categorical variables and median [IQR] for continuous variables. Primary outcome was median BWT by segment: sigmoid colon (SC), descending colon (DC), transverse colon (TC), ascending colon (AC), and terminal ileum (TI), assessed using Kruskall Wallis. Secondary outcomes included univariate association of BWT and age, sex, disease duration, diagnosis (Crohn’s disease (CD) vs. ulcerative colitis (UC)/IBD-unspecified (IBD-U) and medication exposure. Results 80 patients (33 (41%) female; 51 (64%) CD:26 (33%)UC:3 (4%)IBD-U, median age 15.2 [14-16.6] years) with 400 bowel segments were included. Forty (50%) received anti-tumor necrosis factor therapy (anti-TNF), 18 (23%) ustekinumab (UST), 10 (12%) mesalamine(5-ASA), 6 (8%) vedolizumab (VDZ), 5 (6%) immunomodulator monotherapy (IM), and 1 (1%) upadacitinib (UPA) (Table 1). Median BWT was 1.3 [1.0-1.6]mm for SC, 1.3 [1.1-1.7]mm for DC, 1.3 [1.0-1.6] mm for TC, 1.3 [1.0-1.6]mm for AC, and 1.3 [1.1-1.5]mm for TI (Figure 1). There was no difference in BWT between segments (p=0.7952), age (p=0.1952) or sex (p=0.781). BWT was negatively associated with disease duration (p<0.05). UC patients had a 0.16 mm thinner BWT than CD (p<0.05). Mean BWT in patients on VDZ was thinner than those on anti-TNF monotherapy (-0.19mm, p<0.05). BWT in patients on anti-TNF combination therapy was thicker than patients on anti-TNF monotherapy (0.21mm, p<0.05). There was no BWT difference between patients on IM, 5-ASA and UST compared to anti-TNF (p>0.05). Conclusion Normal BWT for children with IBD in deep remission is less than adults, and unaffected by age, sex and bowel segment. BWT may be affected by disease duration, phenotype and medication exposure. These findings are crucial to the standardized assessment of transmural healing in children with IBD.

Predictive Value of Blood Glucose Coefficient of Variation for Prognoses in Patients with Diabetes Mellitus-Associated Herpes Zoster

BACKGROUND: Herpes zoster (HZ) and diabetes mellitus (DM) are common diseases in middle-aged and older adults aged 50 years or more, and the prevalence of DM-associated HZ is gradually increasing. Several studies have confirmed that DM is a significant risk factor for postherpetic neuralgia (PHN). However, few studies have investigated the correlation between blood glucose-related indices and prognoses in patients with DM-associated HZ. The purpose of this study was to investigate the effect of blood glucose-related indices on the prognoses of these patients. OBJECTIVES: The purpose of this study was to observe the potential value of blood glucose-related indices in predicting prognoses in patients with DM-associated HZ. STUDY DESIGN: A retrospective, observational study. SETTING: The study was carried out in the Pain Department of the First Hospital Affiliated to Jiaxing College in Jiaxing, China. METHODS: Patients with DM-associated HZ admitted to the First Hospital of Jiaxing between October 2019 and February 2022 were enrolled. The patients were divided into PHN and non-PHN groups. Demographic data, including gender, age, period of first clinical visit, site of involvement, history of DM, DM-related complications, comorbidities, and treatment were collected. Simultaneously, blood glucose-related data, including blood glucose level at admission (GLUadm), blood glucose level difference (GLUdif), and blood glucose coefficient of variation (GLUcv) were collected. Univariate and multivariate logistic regression analyses were performed to analyze factors affecting prognosis. A receiver operating characteristic (ROC) curve was constructed to assess the value of GLUcv in predicting prognosis. RESULTS: Overall, 136 patients were included. Among them, 65 and 71 were in the PHN and non-PHN groups, respectively. Univariate analysis showed that gender (x^2 = 2.023, P = 0.044), history of DM (x^2 = 3.850, P < 0.001), DM-related complications (x^2 = 3.238, P = 0.016), comorbidities (x^2 = 2.439, P = 0.019), and GLUcv (x^2 = 3.576, P < 0.001) were associated with PHN. Multivariate logistic regression analysis showed that a history of DM >= 10 years (OR = 4.096, 95% CI: 1.759–10.082, P = 0.001), comorbidities (OR = 2.680, 95% CI: 1.143–6.567, P = 0.026), and GLUcv >= 30.56 (OR = 5.234, 95% CI: 2.325–12.603, P = 0.001) were independent factors. The ROC curve revealed that GLUcv had a high predictive value for PHN (AUC = 0.714, P < 0.001). LIMITATIONS: The nonrandomized, single-center, retrospective design and small sample size are major limitations of this study. CONCLUSIONS: GLUcv has a high predictive value for the prognoses of patients with DM-associated HZ. The higher the GLUcv value, the likelier the patient is to have a poor prognosis. KEY WORDS: Blood glucose, coefficient of variation, herpes zoster, diabetes mellitus

The Protection of Privacy Rights and Professional Secrecy in the First Czechoslovak Republic (1918–1938)

The protection of personality and the legal aspects of maintaining professional secrecy have a complicated history of development in many countries of the world. The evolvement of privacy rights and the protection of professional secrecy remain fairly known in the period of the First Czechoslovak Republic (1918–1938) in both contemporary and historical legal scholarship, despite a substantial number of cases were heard before the courts of the First Czechoslovak Republic upon the said subject. The research shows, that the protection of various privacy-related rights was anchored by different norms of the Civil Code, the Penal Code and other legislative acts; several outstanding court cases heard before the Supreme Court of the First Czechoslovak Republic displayed that the most frequent violations of this type were defamations, privacy violations and insults to the honor of the deceased. In some other cases, the Supreme Court discussed the issues of inviolability of letter correspondence and the admissibility of evidence containing a professional secret.

Health-related quality of life in children after surgical repair of esophageal atresia: a cross-sectional study in China.

To investigate health-related quality of life (HRQOL) in patients after surgical repair for esophageal atresia (EA) and identify its potential influencing factors. A total of 102 EA children who had previously visited our hospital participated in this cross-sectional study. Basic data and disease data of the patients were collected. The HRQOL was measured with the Pediatric Quality of Life Inventory™4.0 (PedsQL™4.0) and EA-QOL questionnaire and ranked on a reverse 0-100 scale, with a higher number indicative of a better HRQOL perception. The scores of PedsQL™4.0 in children with EA were collected and compared with that of the demographically matched healthy control group. Meanwhile, the condition-specific HRQOL of EA was analyzed by the EA-QOL questionnaire, and the potential clinical factors that influenced the HRQOL were determined by the generalized linear model. The group of EA and control reached a similar score in the generic PedsQL™4.0 (EA group: 86.55 ± 9.69; control group: 89.41 ± 6.54; p = 0.670). There was no significant difference between the EA group and the control group in other domains except the school functioning. Condition-specific HRQOL in the 2-7-year-old group had the highest score in social isolation and stress domain and the lowest score in the physical health and treatment domain, with an overall quality of life score of 83.48 ± 10.22. The scores of the 8-17-year-old group were relatively high in social relationships and health and well-being and lowest in the eating domain, with an overall quality of life score of 89.43 ± 8.57. Heart malformation, complicated esophageal surgery history, respiratory symptoms,and digestive symptoms in the past 1 month were the main factors affecting the HRQOL of children aged 2-7 years. Complicated esophageal surgery history, respiratory symptoms, and digestive symptoms in the past 1 month were the main factors affecting the HRQOL of children aged 8-17 years. The findings suggest that patients with EA generally had a good HRQOL. However, EA children with postoperative complications and associated symptoms have lower scores in the EA-QOL questionnaire.

Cardiovascular and renal diseases in type 2 diabetes patients: 5-year cumulative incidence of the first occurred manifestation and hospitalization cost: a cohort within the French SNDS nationwide claims database

BackgroundMyocardial infarction (MI), stroke, peripheral arterial disease (PAD), heart failure (HF) and chronic kidney disease (CKD) are common cardiovascular renal diseases (CVRD) manifestations for type 2 diabetes. The objective was to estimate the incidence of the first occurring CVRD manifestation and cumulative hospitalization costs of each CVRD manifestation for type 2 diabetes without CVRD history.MethodsA cohort study of all type 2 diabetes free of CVRD as of January 1st 2014, was identified and followed-up for 5 years within the French SNDS nationwide claims database. The cumulative incidence of the first occurring CVRD manifestation was estimated using the cumulative incidence function, with death as a competing risk. Cumulative hospitalization costs of each CVRD manifestations were estimated from the perspective of all payers.ResultsFrom 2,079,089 type 2 diabetes without cancer or transplantation, 76.5% were free of CVRD at baseline with a mean age of 65 years, 52% of women and 7% with microvascular complications history. The cumulative incidence of a first CVRD manifestation was 15.3% after 5 years of follow-up with a constant linear increase over time for all CVRD manifestations: The most frequent was CKD representing 40.6% of first occurred CVRD manifestation, followed by HF (23.0%), then PAD (13.5%), stroke (13.2%) and MI (9.7%). HF and CKD together reached about one patient out of ten after 5 years and represented 63.6% of first CVRD manifestations. The 5-year global cost of all CVRD hospitalizations was 3.9 billion euros (B€), i.e. 2,450€ per patient of the whole cohort, with an exponential increase over time for each specific CVRD manifestation. The costliest was CKD (2.0 B€), followed by HF (1.2 B€), then PAD (0.7 B€), stroke (0.6 B€) and MI (0.3 B€).Conclusions/interpretationWhile MI, stroke and PAD remain classic major risks of complications for CVRD-free type 2 diabetes, HF and CKD nowadays represent individually a higher risk and cost than each of these classic manifestations, and jointly represents a risk and a cost twice as high as these three classic manifestations all together. This should encourage the development of specific HF and CKD preventive strategies.

Continent-island boundary and environment-shaped evolution in the marine amphipod Ampithoe marcuzzii complex (Crustacea: Eumalacostraca: Ampithoidae)

Marine amphipods are crustaceans that lack a larval phase and consequently have low dispersion rates. Despite that, these crustaceans present a remarkable ability to be transported by rafting on natural floating substrata, especially macroalgae, where they find shelter, food and a mating ground. The species Ampithoe marcuzzii is widely distributed throughout the western Atlantic Ocean. Here, it was used as a model to study seascape genomics and phylogeography in invertebrates with low dispersion capacities. We anticipated that the lineages would present isolation-by-distance patterns. However, surface currents and other abiotic variables could facilitate connectivity among distant sites. Based on mitochondrial and nuclear genes, SNPs, and environmental associations, we observed the presence of a species complex within A. marcuzzii, separating mainland and insular populations. Each species showed an independent evolutionary history, with a strong latitudinal population structure and evidence of isolation-by-distance and isolation-by-environment, characterizing the 'continent' species. Historical expansion and environmental variables were observed associated with the southeastern population, and ecological niche modeling corroborated the region as a paleorefuge. Conversely, populations from 'islands' presented complicated evolutionary histories, with closer localities genetically isolated and distant localities connected. These findings indicate that insular populations with low dispersion capacity might be more susceptible to spatial connectivity by floating substrata and to changes in surface currents. In contrast, mainland populations might be more vulnerable to local climate changes due to lack of gene flow.

Are Gender-Affirming Plastic Surgeons Adequately Compensated? An Analysis of Relative Value Units.

Gender-affirming surgery (GAS) has a complicated history within US health care. As GAS procedures and reimbursement availability continue to uptrend, the present study aims to investigate whether compensation is equitable between GAS procedures and general plastic surgery procedures. The National Surgical Quality Improvement Program database was queried for all surgeries performed by plastic surgeons from 2016 to 2020. Cases were assigned to the GAS or non-GAS cohort using ICD-10 codes. Duplicate Current Procedural Terminology (CPT) codes were removed for analysis. Operative time, total wRVUs, wRVUs per hour (wRVU/h), reoperation/readmission rate, and number of concurrent procedures were compared between the cohorts. A total of 132,319 non-GAS and 3,583 GAS were identified. After duplicate CPT removal, 299 cases (21 unique CPTs) remained in the GAS cohort and 20,022 (37 unique CPTs) in the non-GAS cohort. Operative time was higher in the GAS cohort (262.9 vs 120.7 min, P < 0.001), as were total wRVUs (59.4 vs 21.6, P < 0.001). Reoperation/readmission rate (7.0% vs 6.0%) and wRVU/h (15.8 vs 15.1) were not significantly different (all P > 0.05). There was a positive correlation between total operative time and total wRVUs (P < 0.001) and a negative correlation between total operative time and wRVU/h (P < 0.001). Proportional wRVUs are allocated to gender affirming plastic procedures. However, the RVU scale does not allocate proportional wRVUs to longer operative times for both GAS and general plastic surgeries. Compensation for gender affirming plastic surgeries is higher than that of general plastic surgeries; however, there is no difference in wRVUs per hour on comparison.

Taxonomies of exclusion: Storytelling, naming and classification in an age of extinction

Abstract Among the stories on individual examples of charismatic fauna, there are also extinction stories that evoke databases and their aesthetics in how they list endangered species. At the same time, these different stories grapple with a legacy of taxonomy that, while necessary in conservation, also carries a history of exclusion. This paper turns to the poetry of Claire Wahmanholm and Juliana Spahr to consider some of the ways extinction stories can be told outside of the relatively narrow scope of charismatic species. To begin, I reflect on extinction storytelling and the classificatory impulse in some of these stories, including poetry. Then, I consider scientific practices of naming before I turn back to Wahmanholm and Spahr and explore practices of naming and classification in their poetry. Following that, I dwell on the influence of scientific classification on the ways people including poets can engage with extinction. The poems in this paper are not merely an object for analysis; they should be considered an invitation to come to terms with and move beyond complicated histories and practices of naming and classification in storytelling.

Investigating the depression, anxiety, and stress-related factors in near-miss mothers.

Life-threatening complications during pregnancy and childbirth could have an impact on the physical and mental health of mothers. The present research aimed to investigate the factors related to depression, anxiety, and stress among mothers who have survived maternal near-miss situations. This is a descriptive-analytical study, and the data have been collected cross-sectionally. Near-miss mothers who had given birth within the past year were selected through the census method (having at least one criterion of the clinical, laboratory, and management standard of the World Health Organization). The Depression, Anxiety, and Stress Scale (DASS-21) and a demographic questionnaire on personal, family, fertility, and care information were filled out by these mothers. One hundred fifty-four near-miss mothers were investigated. The findings indicated that lack of social support, domestic violence, and marital dissatisfaction leads to a significant increase in the mean score of depression among near-miss mothers. In addition, according to the findings, an unemployed spouse, low level of education, lack of social support, recent unintended pregnancy, high blood pressure, and bleeding during pregnancy result in a significant increase in the mean score of stress among near-miss mothers. The findings also showed that domestic violence, a history of infertility, heart disease, and bleeding complications significantly increase anxiety in near-miss mothers. Considering the high levels of depression, anxiety, and stress in near-miss mothers, it is of utmost importance to pursue and check up on their mental health, as they are one of the most vulnerable groups in society. It is crucial to provide them support long after discharge to reintegrate these mothers into normal living as per the present study's findings.

The Efficiency of Antiosteoporosis Medicine after Intertrochanteric Fracture Surgery: A Retrospective Study of Refracture Rate, Function Recovery, Complications, and Mortality in the Chinese Elderly Population

Abstract Objective This research aimed to discern the effects of antiosteoporosis medication on postoperative functional recovery, refracture incidence, complications, and mortality in geriatric patients with intertrochanteric fractures. Methods A retrospective study was conducted on 250 patients aged 65 years and above who underwent surgery for intertrochanteric fractures between January 2013 and December 2014. Intertrochanteric fracture is diagnosed with International Classification of Diseases 10th Revision code (S72.101) and classified by the Evans–Jensen system. Collected data encompassed demographic details, pre- and postoperative histories of antiosteoporotic medication, functional outcomes (measured using Harris hip score, Parker Mobility Score, and EuroQol-5 Dimension [EQ-5D] scores), refracture incidences, complications, and survival rates. The antiosteoporotic regimen was categorized into essential (calcium, vitamin D) and advanced medications (bisphosphonate, calcitonin, etc.). Outcomes between patients on antiosteoporosis treatment (AO group) and those without (control group) were compared. Results The cohort comprised 250 patients, with a gender distribution of 85 males (34%) and 165 females (66%), and a mean age of 79.8 ± 7.0 years. The median follow-up period was 15.82 months (maximum 31.13 months). Postoperatively, 126 (50.4%) patients were administered antiosteoporotic treatment. The refracture incidence in the AO group (2.4%, n = 3) was notably lower than the control group (8.9%, n = 11), manifesting a substantial risk reduction (odds ratio 0.251, 95% confidence interval 0.068–0.920, p = 0.024). While no marked differences in functional outcomes between the AO and control groups were observed (Harris score [96.17 ± 7.77 vs. 97.29 ± 6.74, p = 0.074), Parker score [8.54 ± 1.26 vs. 8.62 ± 1.18, p = 0.411], EQ-5D [0.83 ± 0.05 vs. 0.82 ± 0.06, p = 0.186]), patients administered a combination of essential and advanced drugs showcased significantly improved Harris and EQ-5D scores compared to those on essential drugs alone (Harris score [77.93 ± 2.04 vs. 84.94 ± 2.73, p = 0.015], EQ-5D [0.65 ± 0.03 vs. 0.75 ± 0.04, p = 0.015]). Conclusion Postoperative antiosteoporosis treatment acts as a deterrent against refracture following intertrochanteric fracture surgeries, evidenced by a decline in refracture rates. However, the treatment's impact on functional recovery, quality of life, complications, and mortality remains indistinct. Interestingly, the combined administration of essential and advanced antiosteoporotic drugs seems to foster enhanced functional outcomes, warranting further exploration in future studies.

Spontaneous pneumothorax as an early manifestation of pulmonary sarcoidosis: a case-based review

Background: Sarcoidosis is a multisystem inflammatory disorder characterized by non-caseating granulomas with predominantly lung manifestations that can cause restrictive or, less commonly, obstructive lung disease. Rarely is pneumothorax a manifestation of sarcoidosis; it has been reported as an early finding in sarcoidosis, but it is typically attributed to ruptured bullae, cysts, or pleural granulomas. Case Presentation: We present a unique case of spontaneous pneumothorax attributed to biopsy-proven sarcoid disease in a patient with no prior history of pulmonary complications. The patient’s rapid development of novel pulmonary sequelae necessitates treatment of sarcoidosis early in the disease course. Conclusion: We recommend a treatment plan of appropriate chest tube placement in the affected lung(s) and prompt steroid therapy for patients with sarcoidosis presenting with a pneumothorax. We also review the literature for the etiology, pathophysiology, and presentation of pneumothorax in sarcoidosis, treatment of this sequela, and pulmonary function test findings in these patients.

Risk factors for incisional hernia after liver transplantation in the era of mammalian target of rapamycin inhibitors use: a retrospective study of living donor liver transplantation dominant center in Korea.

Incisional hernia (IH) is a common complication after liver transplantation (LT) with an incidence rate of 5% to 46%. This retrospective study aimed to evaluate the risk factors for IH development after LT in the era of mammalian target of rapamycin (mTOR) inhibitors use. Data on patients who underwent LT between 2015 and 2021 were retrospectively reviewed. The patients were divided into 2 groups (IH group and non-IH group) according to the postoperative occurrence of IH. We analyzed data from 878 patients during the study period, with 28 patients (3.2%) developing IH. According to multivariate analysis, body mass index exceeding 25 kg/m2 and the use of mTOR inhibitors within the first month after LT were the sole significant factors for both IH occurrence and the subsequent need for repair operations. Notably, a history of wound complications, a Model for End-stage Liver Disease score, and the timing of LT-whether conducted during regular hours or at night-did not emerge as significant risk factors for IH after LT. Our study reveals a higher incidence of IH among obese patients following LT, often requiring surgical repair, particularly in cases involving mTOR inhibitor usage within the initial month after LT. Consequently, it is crucial to exercise increased vigilance, especially in obese patients, and exercise caution when considering early mTOR inhibitor administration after LT.

Surgical complications of bariatric surgery among patients with rheumatic diseases.

Obesity is one the most prevalent diseases all around the world. Some studies have shown a relationship between obesity and the worsening of rheumatic disorders. Higher rates of surgical complications might also be seen among these patients. This retrospective-descriptive study was performed on 25 patients with rheumatic disease referred to Loghman Hakim Hospital (Tehran- Iran) and candidates for bariatric surgery (laparoscopic Roux-en-Y gastric and laparoscopic sleeve gastrectomy) from 2018 to 2020. Duration of hospitalization after surgery and history of post-operation surgical and rheumatic complications were assessed. Patients were followed through 6 months after surgery. The age (Mean±SD) of recruited patients was (38.4 ±10.0) years. The mean body mass index was 45.54 kg/m2 with the minimum and maximum values of 37.5 kg/m2 and 56.5 kg/m2. Among them, the prevalence of rheumatic disorders was rheumatoid arthritis 32%, psoriasis 28%, gout 16%, lupus erythematosus 8%, and other rheumatologic disorders 16%, respectively. One patient had a surgical complication that was a port site infection. One patient had a relapse of gout and other patients had remission and also, their therapeutic drugs were discontinued or reduced. Patients with rheumatic disorders revealed no higher surgical complication rate after bariatric surgery, and bariatric surgery helped disease remission among these patients.

Physiotherapeutic management of Hydrocephalus-Ex vacuo: A Case Report

Hydrocephalus Ex-vacuo refers to an elevated volume with no increasing Cerebrospinal Fluid (CSF) pressure, particularly in instances of diminished brain tissue. Since there is no increased intracranial pressure in Hydrocephalus Ex-vacuo, few general symptoms such as irritability, drowsiness, and even larger head presentation can be absent compared to congenital hydrocephalus. The current case study presents a one-year-old male child exhibiting delays in developmental milestones, including poor head and trunk control, associated with a history of prenatal bleeding and subsequent birth complications. Despite a seemingly normal birth, the child experienced postnatal complications such as vomiting, seizures, and abdominal distension, leading to a 15-day Neonatal Intensive Care Unit (NICU) stay. Persistent delays prompted medical consultations, culminating in a referral for physiotherapy following Magnetic Resonance Imaging (MRI) findings indicative of hydrocephalus ex-vacuo. Clinical assessments revealed a restricted range of motion, muscle tightness in the lower extremities, and poor muscle control and reflex persistence. Imaging confirmed ventricular enlargement consistent with Hydrocephalus Ex-vacuo, necessitating targeted physiotherapy interventions. Therapeutic strategies focused on promoting head and trunk control through prone positioning, bolster support, and dynamic exercises utilising physio balls. Progressive interventions facilitated significant improvements within six months, highlighting the efficacy of early rehabilitation and parental involvement in achieving motor milestones. The present case underscores the importance of timely diagnosis, multidisciplinary collaboration, and rehabilitative interventions in optimising outcomes for children with hydrocephalus ex-vacuo. Further research is warranted to explore additional therapeutic modalities and long-term prognostic indicators for this patient population.

Spontaneous pneumothorax as an early manifestation of pulmonary sarcoidosis: a case-based review

Background: Sarcoidosis is a multisystem inflammatory disorder characterized by non-caseating granulomas with predominantly lung manifestations that can cause restrictive or, less commonly, obstructive lung disease. Rarely is pneumothorax a manifestation of sarcoidosis; it has been reported as an early finding in sarcoidosis, but it is typically attributed to ruptured bullae, cysts, or pleural granulomas. Case Presentation: We present a unique case of spontaneous pneumothorax attributed to biopsy-proven sarcoid disease in a patient with no prior history of pulmonary complications. The patient’s rapid development of novel pulmonary sequelae necessitates treatment of sarcoidosis early in the disease course. Conclusion: We recommend a treatment plan of appropriate chest tube placement in the affected lung(s) and prompt steroid therapy for patients with sarcoidosis presenting with a pneumothorax. We also review the literature for the etiology, pathophysiology, and presentation of pneumothorax in sarcoidosis, treatment of this sequela, and pulmonary function test findings in these patients.

740 Maternal history of recurrent pregnancy loss and placental related complications

740 Maternal history of recurrent pregnancy loss and placental related complications

Amyand&amp;apos;s hernia unveiled: a case report on perforated appendix within the inguinal hernia sac

Background: Acute appendicitis (AA) is still a common cause of lower abdominal pain, which frequently leads to emergency room (ER) visits. A case of perforated appendix within the inguinal hernia sac was presented. Case presentation: The clinical journey of a 30-year-old male patient with acute right iliac fossa pain suggestive of recurrent appendicitis was detailed in this case report. The patient\&amp;apos;s complicated medical history, which included dostinex-treated hyperprolactinemia and a previous episode of conservatively managed appendicitis in 2017, sets the stage for complex diagnostic challenges. The patient complained of acute localized tenderness and pain in the right iliac fossa, but no gastrointestinal symptoms, fever, or diarrhea were present. The admission laboratory results showed elevated white blood cells (WBC) (15.2), hemoglobin (Hb) (15.8), and platelet (PLT) (191) levels. Computed tomography scans exposed a perforated appendix within the right inguinal hernial sac surrounded by inflammatory changes. Laparoscopic appendectomy revealed a perforated appendix within the inguinal hernial sac, necessitating omental dissection and drainage. The postoperative course was uneventful, with a 7-day hospital stay and subsequent OPD follow-up. Microscopic examination confirmed acute suppurative appendicitis with periappendicitis aligning with clinical and radiological assessments. Conclusions: Amyand\&amp;apos;s hernia is a rare type of hernia that involves the appendix. A perforated appendix within a groin hernia is unusual and necessitates immediate source control to manage infection and prevent sepsis.

The Tarnished Legacy of a Wonder Drug: Revisiting the Complicated History of Clozapine.

Anecdotal evidence of superior efficacy and lack of extrapyramidal symptoms in treating schizophrenia made clozapine a promising therapy in the United States during the early 1970s. In 1975, however, numerous fatal cases of clozapine-related agranulocytosis in Finland nearly ended the drug's development. Convinced of the significant benefits to patients, some clinicians in the United States advocated having clozapine available on a case-by-case humanitarian basis, which eventually helped resurrect the drug for Food and Drug Administration approval in 1989. This article builds on previous literature by utilizing oral histories from clinicians, researchers, and a patient's family member to understand how clozapine was saved. Exploring these stakeholders' perspectives has value to modern clinicians, who underprescribe the drug despite demonstrable benefits for treatment-resistant schizophrenia and suicide prevention.

Frequency of thrombophilia-associated mutations and polymorphisms in pregnant women with a history of thrombosis or pregnancy complications

Abstract Objectives To assess the frequency of multiple thrombophilia-associated mutations and polymorphisms in a selected population of high-risk pregnancies. Methods Thrombophilia screening was performed for 1,500 pregnant women with prior pregnancy complications or thrombotic events. Nine thrombophilia-associated mutations or polymorphisms were screened: factor V Leiden, factor V H1299R, prothrombin G20210A, MTHFR C677T, MTHFR A1298C, factor XIII V34L, PAI-1 4G/5G polymorphisms, EPCR G4600A, EPCR C4678G. Results Out of the 1,500 patients, 1,291 fulfilled the criteria for data interpretation. All patients had low-risk thrombophilia-associated genetic variants. Only 1.24 % of cases presented high-risk abnormalities (homozygous factor V Leiden/prothrombin G20210A, or both mutations in heterozygous form). Heterozygous factor V Leiden occurred in 10.38 % of cases, while only 5.81 % carried heterozygous prothrombin G20210A mutation. The frequency of prothrombin G20210A mutation was higher (10.37 %) in the subgroup associating factor V Leiden, than in the subgroup lacking it (5.36 %). Low-risk genetic variants occurred with a higher frequency: 23.78 % factor V H1299R, 57.32 % MTHFR C677T, 55.54 % MTHFR A1298C, 44.07 % factor XIII V34L, 73.20 % PAI-1 4G/5G polymorphisms, 69.64 % EPCR G4600A, and 69.63 % EPCR C4678G. Conclusions All patients had at least one prothrombotic genetic mutation or variant. Our data highlight the need for thrombophilia screening, including low-risk genetic variants, in a high-risk population of pregnant women with a history of pregnancy complications or thrombotic events.

Planned Parenthood Before and AfterRoe: Historical Lessons for the Current Fight

During the 1970s, Planned Parenthood (PP) went from an established, well-funded birth control provider in the political mainstream to a controversial organization associated with abortion. As abortion rights mobilized both feminists and a conservative opposition, the agenda and rhetoric of PP had to expand and adjust accordingly. This project explores the ways PP’s mission and the political terrain in which it operated became more complicated in this decade, focusing on the strategies it adopted to survive. There is much to be learned from how the organization sought to weather the unique tensions experienced by the legalization of abortion, the energy of the women’s movement, and the emerging backlash against perceived liberal excesses as it navigated the often oppositional demands of being both a service provider and advocate. As abortion access enters a new era of vulnerability and contestation, the role of PP remains uncertain. In exploring a key moment in the organization’s past, we also ponder the role of PP in the Dobbs era and whether it has either the capacity or political will to serve its constituents given its complicated history and still complicated present.