Compromised Patients Research Articles

ENHANCING FUNCTIONAL CAPACITY AND QUALITY OF LIFE WITH ECCENTRIC CYCLING TRAINING IN HEART FAILURE PATIENTS: A RANDOMIZED CONTROLLED TRIAL

INTRODUCTION Exercise training is recommended for comprehensive management of patients with heart failure and reduced ejection fraction (HFrEF). However, limited exercise capacity prevents many patients from gaining optimal training benefit. Given eccentric cycling is well tolerated in HFrEF, and enables greater power output, we hypothesized that eccentric cycling training would result in superior functional outcomes than concentric cycling training when the interventions were matched for heart rate (HR). METHODS Forty-five participants (9♀, 57±13 y; BMI 27±5 kg/m2) with HFrEF (ejection fraction 33±10%, New York Heart Association class II) were randomized in a 1:1 superiority clinical trial to either eccentric cycling training (ET, n = 25) or concentric cycling training (CT, n = 20). Each intervention involved 2-weeks of familiarization and 12-weeks of training at matched relative intensity (40-80% of HR reserve), twice weekly. Primary outcome was peak oxygen consumption (V̇O2peak), secondary outcomes included 6-minute walk, functional lower extremity strength and health-related quality of life (Minnesota Living with Heart Failure, MLHF). RESULTS Repeated measures ANOVA revealed significant interaction effects for 6-min walk (ET 476±77 to 547±80 m vs CT 485±106 to 516±113 m, P=0.015), 30s sit-to-stand (ET 12±3 to 16±3 repetitions vs CT 13±4 to 14±3 repetitions, P=0.002), and timed up-and-go (ET 7.2±1.2 to 6.2±1.1 s vs CT 7.6±1.5 to 7.3±1.9 s, P=0.019). There were significant time effects for V̇O2peak (ET: 17.7±4.8 to 19.1±5.2 ml/kg/min and CT 17.4±6.0 to 19.8±6.0 ml/kg/min, P<0.001), and MLWHF (ET 31±24 to 23±16 and CT 32±19 to 27±16, P=0.003). CONCLUSION When matched for heart rate to control cardiovascular burden, ET demonstrated superior effect in functional capacity, and similar benefits in aerobic capacity (V̇O2peak) and health-related quality of life, when compared to CT. ET is a novel and efficacious approach for clinical benefit in highly compromised HFrEF patients, who represent a challenge in terms of exercise prescription.

Early and late implant loss in a university-based periodontal setting: A retrospective analysis on 1821 patients and 2639 implants over a period of 18 years.

The aim of this study was to retrospectively analyze the implant failure rate, not due to peri-implantitis, in periodontally compromised patients rehabilitated with at least one dental implant placed in a specialist university setting over the last 18 years. Records of patients receiving dental implants at the Department of Periodontology, University of Bern, Switzerland, between 2005 and 2022 were analyzed. Data on 1821 patients with 2639 implants were retrieved. Fifty-nine patients experienced implant loss (rate at patient level: 3.2%) out of which 2.1% were early and 1.1% late implant losses, respectively. The majority of the 59 patients were males (68%) and 27.1% were smokers. Eight mm implants were lost with the highest rate (42.4%) followed by 10 mm implants (31.8%). The rate of lost maxillary implants was more than twice as high compared with that of mandibular implants (69.7 vs. 30.3%). Within the study limitations, the implant failure rate in this cohort of patients enrolled in regular supportive periodontal and peri-implant care, was low.

Titanium Surface Modification Techniques to Enhance Osteoblasts and Bone Formation for Dental Implants: A Narrative Review on Current Advances

Surface modifications for titanium, a material of choice for dental implants, can greatly alter the surface micro/nanotopography and composition of implants, leading to notable enhancements in their hydrophilicity, mechanical properties, osseointegration performance, and antibacterial performance, as well as their impacts on osteoblast activity and bone formation processes. This article aims to update titanium surface modification techniques for dental implants from the past to the present, along with their effects on osteoblasts and bone formation, by thoroughly summarizing findings from published studies. Peer-reviewed articles published in English consisting of in vitro, in vivo, and clinical studies on titanium dental implant surface treatments were searched in Google Scholar, PubMed/MEDLINE, ScienceDirect, and the Scopus databases from January 1983 to December 2023 and included in this review. The previous studies show that implant surface roughness, condition, and hydrophilicity are crucial for osteoblast adhesion and growth. While various techniques enhance osseointegration comparably, one of the most common approaches to accomplishing these properties is sandblasting large-grit acid etching surface treatment and coating with hydroxyapatite or chitosan. In conclusion, this review points out the efficacy of different subtraction and addition techniques in enhancing the surface properties of titanium dental implants, promoting favorable outcomes in terms of osteoblast activity and bone formation in various degrees. However, most existing studies predominantly compare treated and non-treated titanium, revealing a need for more comprehensive studies comparing the effects of various modification techniques. Moreover, further investigation of factors playing a role in the dynamic osseointegration process in addition to osteoblasts and their functions, as well as improved surface modification techniques for the treatment of compromised patients, is greatly required.

Supportive periodontal care in dental practice: Part 1 - the importance and implications for general dental practitioners.

Supportive periodontal care is an essential component of maintaining the outcome of periodontal treatment. It is essential to ensure cost benefit to both patients and the health services where millions are spent on treating patients with periodontal disease. The dentist must be able to recognise the crucial and important role they play in providing supportive care and therapy to periodontally compromised patients, either independently or as part of a wider dental team, over and above the various challenges they may experience in the provision of such care in general dental practice. The timely intervention with treatment or referral during this phase will help reduce the risk of tooth loss and adverse consequences to the dentist and their team by way of litigation. The aim of this paper is to provide an update on the delivery of supportive periodontal care in general dental practice with a particular reference to the role of the dentist.

Defunctioning ileostomy for typhoid ileal perforations: Out of the frying pan into the fire?

Typhoid ileal perforation (TIP) is a common surgical emergency in low-middle income countries (LMICs). Its high surgical morbidity and mortality is due to its often late presentation or diagnosis, the patient's malnutrition, severe peritoneal contamination and unavailability of intensive care in most peripheral hospitals. This prompted the philosophy of minimizing the crisis by avoiding any repair or anastomosis, limiting the surgery in these physiologically compromised patients and performing only a temporary defunctioning ileostomy (DI) which could then be closed 10-12 weeks later.

Complications of oropharyngeal dysphagia in older individuals and patients with neurological disorders: insights from Mataró hospital, Catalonia, Spain.

Oropharyngeal dysphagia (OD) significantly impacts older individuals and neurologically compromised patients, hindering safe ingestion of food and liquids. Despite its prevalence, OD remains underdiagnosed and undertreated, leading to severe complications such as malnutrition, dehydration, respiratory infections, and aspiration pneumonia (AP), and increases hospital readmissions. This study analyzes the intricate relationship between OD and various clinical complications in older individuals and patients with neurological disorders. Utilizing retrospective analysis and narrative review, our work consolidates findings from prior studies on Hospital de Mataro's dysphagia patient cohort. Revisiting OD's intricate association with clinical complications, it presents data via odds ratios (OR), incidence ratios (IR), and hazard ratios (HR) from univariate and multivariate analyses. Five studies (2001-2014) involving 3,328 patients were scrutinized. OD exhibited independent and significant associations with various complications among older patients. Older individuals with OD faced heightened 1-month (ODDS 3.28) and 1-year (OR 3.42) mortality risks post-pneumonia diagnosis. OD correlated with a 2.72-fold risk of malnutrition, 2.39-fold risk of lower respiratory tract infections, 1.82-fold pneumonia readmissions (IR), and 5.07-fold AP readmissions (IR). Post-stroke OD is linked to neurological impairment (OR 3.38) and respiratory (OR 9.54) and urinary infections (OR 7.77), alongside extended hospital stays (beta coefficient 2.11). Oropharyngeal dysphagia causes and significantly exacerbates diverse clinical complications in older and post-stroke patients, emphasizing the urgent need for proactive identification, comprehensive assessment, and tailored management. Acknowledging OD's broader implications in general medical practice is pivotal to improving patient outcomes and healthcare quality.

Closed sinus lift and fixed prostheses versus implant-assisted overdentures in management of atrophied distal extension maxillary ridges: A one-year randomized clinical trial

Rehabilitation of elderly or medically compromised patients with an atrophied unilateral posterior maxillary ridge by an implant-supported prosthesis may be complicated by maxillary sinus pneumatization with insufficient bone for implant placement. This short-term clinical trial assessed clinical results of closed sinus lift and fixed prosthesis versus implant-assisted overdentures in the management of participants with atrophied distal extension maxillary ridges. Forty participants with unilateral atrophying distal extension maxillary ridges were randomly assigned into 2 groups. The CSL group (n=20) participants received fixed prostheses supported by 3 implants following a closed sinus lift. The IOD group (n=20) participants received removable partial overdentures assisted by a single implant that was positioned mesially to the maxillary sinus. The modified plaque index (MPI), modified gingival index (MGI), pocket depth (PD), implant stability (IS), and vertical bone loss (VBL) were measured at prosthesis delivery (T0), and 6 (T6) and 12 months (T12) after delivery. The oral health impact profile (OHIP-14) questionnaire was used to assess oral health-related quality of life (OHRQoL) at T12. Significant differences between observation times were performed using Friedman and Wilcoxon signed-rank tests for MPI and MGI and using repeated measures ANOVA with Bonferroni correction of P values for PD, IS, VBL, and OHIP. Between-group comparison of MPI and MGI the Mann-Whitney test was used, while for PD, IS, VBL, and OHIP comparison was made using independent samples t test (α=.05 for all tests). The implant survival rates were 100% for both groups. MPI and PD significantly increased with time for both groups. MGI significantly increased with time for the CSL group only (P=.049). The IS significantly decreased with time for the IOD group. VBL increased significantly from T6 to T12 for the CSL (P=.042) and the IOD (P=.002) groups. The CSL group recorded higher MPI, MGI, PD, and IS values than the IOD group (P<.05). The IOD group recorded higher VBL than the CSL group (P<.001). The CSL group scored significantly lower OHIP-14 values (better OHRQoL) than the IOD group for all values (P<.05). In comparison with implant-assisted partial overdentures, closed sinus lift with fixed prostheses had higher implant stability, reduced bone loss, and higher participant OHRQoL. However, peri-implant soft tissue health was found to be better with implant overdentures.

Prognostic impact of limited resection vs. inadequate adjuvant therapy in patients with pathologic stage II or III non-small cell lung cancer: results from the Korean Association of Lung Cancer Registry.

For patients with stage II and III non-small cell lung cancer (NSCLC), various multi-modality treatments are required. However, depending on the individual conditions of patients, there will be a significant difference in prognosis. Therefore, this study investigated the clinical impact of inadequate treatment (limited surgery and inadequate adjuvant therapy) in patients with NSCLC stage II or III using data from the Korean Association of Lung Cancer Registry (KALC-R) between 2014 and 2016. Of the 8,110 new lung cancer cases registered at the Korea Central Cancer Registry in 2014-2016, 721 patients with stage II or III NSCLC were selected and divided into three groups according to differences in cancer treatment methods. In group A, patients underwent standard surgery and completed adjuvant therapy. In group B, patients underwent standard surgery without completing adjuvant therapy. In group C, patients received adjuvant therapy after limited surgery. After performing propensity score matching (PSM) for selected patients, overall survival (OS) and disease-free survival (DFS) rates of the three groups of patients with stage II and III NSCLC patients were then compared. Of the 721 patients with NSCLC, 239, 437, and 45 belonged to groups A, B, and C, respectively. After 1:3 PS matching for groups B and C, the 5-year survival rate of patients with stage II or III NSCLC were 68.0% and 26.7% for groups B and C, respectively and the DFS rate was 59.1% and 16.2% for groups B and C, respectively. The therapeutic effect of the standard surgery was the best. Although patients received adjuvant therapy, limited resection resulted in a poorer prognosis in compromised patients compared with omitting adjuvant therapy followed by standard surgery. Thus, surgical treatment should be considered in patients who are unable to complete surgical and adjuvant therapy.

Prevalence of unnecessary antibiotic prescriptions among dental visits, 2019.

The US National Action Plan for Combating Antibiotic-Resistant Bacteria established a goal to decrease unnecessary outpatient antibiotic use by 50%. However, data to inform this goal have been limited to medical settings and have not included dental prescribing. Thus, we sought to identify the proportion of antibiotics prescribed inappropriately by dentists to inform outpatient stewardship efforts. Cross-sectional analysis of 2019 Veterans' Affairs (VA) national electronic health record data. Antibiotics prescribed by dentists were evaluated for appropriateness based on 2 definitions: one derived from current guidelines (consensus-based recommendations) and the other based on relevant clinical literature (nonconsensus). A clustered binomial logistic regression model determined factors associated with discordant prescribing. In total, 92,224 antibiotic prescriptions (63% amoxicillin; mean supply, 8.0 days) were associated with 88,539 dental visits. Prophylaxis for complications in medically compromised patients was associated with the most (30.9%) antibiotic prescriptions, followed by prevention of postsurgical complications (20.1%) and infective endocarditis (18.0%). At the visit level, 15,476 (17.5%) met the consensus-based definition for appropriate antibiotic usage and 56,946 (64.3%) met the nonconsensus definition. More than half of antibiotics prescribed by dentists do not have guidelines supporting their use. Regardless of definition applied, antibiotics prescribed by dentists were commonly unnecessary. Improving prescribing by dentists is critical to reach the national goal to decrease unnecessary antibiotic use.

EFFECTIVENESS OF PHOTODYNAMIC THERAPY IN THE TREATMENT OF ORAL CANDIDIASIS IN DENTAL PROSTHESIS USERS: A LITERATURE REVIEW

Oral Candidosis is a disease caused by fungi of the genus Candida, which is opportunistic and associated with immunologically compromised patients and/or those with reduced oral hygiene. The present study seeks to evaluate the use of Photodynamic Therapy to combat Oral Candidosis in denture users. A search was carried out in the databases: Pubmed, Scielo and VHL, selecting publications from the last ten years available in the literature. In this way, 106 studies were found, however, only 15 studies met the inclusion criteria. After analyzing the articles, it can be concluded that photodynamic therapy proved to be efficient in combating Oral Candidosis in patients using dental prostheses.

Latest Concepts in the Endodontic Management of Kidney Patients.

Doubtlessly, kidney patients present acommon challenge in endodontic practice, so specialists in this field should know and follow several key points regarding this group of medically compromised patients. This reviewpaper aims to explain kidney disease and its complications, as well asnotify and discuss the latest concepts on anesthesia, pain management, antibiotic prophylaxis/stewardship, and the risk of viral diseases for these patients, and also the oral manifestations of kidney diseases that may guideendodontists to diagnose kidney intervention and prevent hazardous consequences that may happen during or following endodontic practice on these patients. For this purpose,relevant keywords were searched on Scopus, PubMed, Medline, and Web of Science to find published papers from 1980 to July 2023. Based on the quality, validity, and novelty 57 published articles were selected to provide this review to notify the most important concepts and considerations regarding endodontic management of kidney patients. Overall, it is concluded that training and education of general dentists, as well as endodontic specialistswith strong technical, scientific, human, and moral knowledge about kidney patients, with emphasis on the philosophy of prevention of common dangerous systemic consequences originating from endodontic treatments, is the responsibility of dental schools in undergraduate as well as post-graduate programs.

Antifungal Activity of Selected Indigenous Medicinal Plants in Sri Lanka Against Candida Infections

Candida infections have been recorded as an emerging health concern among immune- compromised patients, infants and pregnant women in Asia, Africa and Europe. Skin diseases, genital infections, candidiasis and candidemia caused by overgrowth of symbiotic Candida species in the human body are treated by antifungal drugs. The common drugs viz., fluconazole, flucytosine, amphotericin B, nystatin, etc. are responsible for more side effects in the human body while Candida species are indicating a resistance towards them. Therefore, the continuous discovery of antifungal compounds against Candida infections is an essential process. Thus, the current study focused on the determination of the antifungal activity of water extracts of selected indigenous medicinal plants in Sri Lanka towards Candida infections. Three common indigenous medicinal plants; Cyperus rotundus (roots, tubers, leaves and flowers), Acalipha indica (roots, stem, leaves and flowers) and Aloe barbadensis Miller (gel and leaves) were collected and their water extracts (10 g/25 mL) were screened for the antifungal activity against two common Candida species; Candida glabrata and Candida parapsilosis using disk diffusion method. Briefly, the pathogenic bacterial lawns were prepared by spreading equalized solutions of C. glabrata and C. parapsilosis on Muller Hinton Agar supplemented with 2% glucose. Sterile paper disks soaked with 30 µL of water extracts of each plant part were placed on pathogen lawns. Sterile distilled water was used as the negative control. The plates were incubated at 37° C overnight and observed for clear zone formation. According to the results, the water extract of C. rotundus tubers indicated an inhibitory action by giving clear inhibition zones against both tested Candida species. All other water extracts of medicinal plants indicated negative inhibitory actions against tested Candida species. The results revealed that C. rotundus tubers consist of antifungal activity against C. glabrata and C. parapsilosis. Hence, C. rotundus tubers can be used as an effective treatment for infections caused by the tested Candida species.&#x0D; &#x0D; Keywords: Antifungal activity, Candida infections, Indigenous medicinal plants, Cyperusrotundus, Water extracts&#x0D;

COVID-19 vaccine response in Neuromyelitis Optica Spectrum Disorder

Objectives and aimsNeuromyelitis Optica Spectrum Disorder (NMOSD) is a disabling autoimmune disease of the central nervous system that requires immunosuppressants to control the relapses. The latter puts them at risk for more severe COVID-19 infection. Vaccines are an effective way to control the pandemic. However, we do not know how effective they are in immunologically compromised patients. We aimed to evaluate and compare antibody levels in NMOSD patients treated with disease-modifying therapies after two doses of inactivated and mRNA COVID-19 vaccines. MethodsPatients with NMOSD diagnosis and age-sex matched healthy controls who received two doses of either inactivated and mRNA COVID-19 vaccine were recruited in the study. Serum samples were collected at least two weeks after the second dose. ResultsSerum samples from 24 NMOSD patients (Mean age-36.58, Female-70.83%) and 24 healthy controls (Mean age-36.71, Female-70.83%) were evaluated. Mean antibody titer was lower in the NMOSD group (Mean; SD (2.43 ± 1.51) than in healthy controls (Mean; SD 3.23 ± 0.80). Seronegativity was only seen in the rituximab group, there were no such cases in the azathioprine group. (9 vs 0). ConclusionsThe study shows that NMOSD patients treated with rituximab may still be susceptible to severe COVID-19 infection even after both inactivated and mRNA vaccines.

Transforaminal endoscopic lumbar foraminotomy for octogenarian patients.

Radiculopathy caused by lumbar foraminal stenosis in older people has become more common in the aging general population. However, patients aged ≥80 years rarely undergo conventional open surgery under general anesthesia because of the high risk of peri-operative morbidity and adverse events. Therefore, less invasive surgical alternatives are needed for older or medically handicapped patients. Transforaminal endoscopic lumbar foraminotomy (TELF) under local anesthesia may be helpful in at-risk patients, although only limited information is available regarding the clinical outcomes of this procedure in octogenarians. Therefore, this study aimed to investigate the safety and efficacy of TELF for treating radiculopathy induced by foraminal stenosis in octogenarian patients. Overall, 32 consecutive octogenarian patients with lumbar foraminal stenosis underwent TELF between January 2019 and January 2021. The inclusion criterion was unilateral radiculopathy secondary to lumbar foraminal stenosis. The pain focus was confirmed using imaging studies and selective nerve blocks. Full-scale foraminal decompression was performed using a percutaneous transforaminal endoscopic approach under local anesthesia. Surgical outcomes were assessed using the visual analog pain score, Oswestry Disability Index, and modified MacNab criteria. The pain scores and functional outcomes improved significantly during the 24-month follow-up period, and the rate of clinical improvement was 93.75% in 30 of the 32 patients. None of the patients experienced systemic complications. TELF under local anesthesia is an effective and safe treatment for foraminal stenosis in octogenarian or medically compromised patients. The mid-term follow-up did not reveal any significant progression in spinal stability. Therefore, this endoscopic procedure can be an effective alternative to aggressive surgery for managing lumbar foraminal stenosis in octogenarian patients with intractable radiculopathy.

Assessing the prognostic utility of clinical and radiomic features for COVID-19 patients admitted to ICU: challenges and lessons learned.

Severe cases of COVID-19 often necessitate escalation to the Intensive Care Unit (ICU), where patients may face grave outcomes, including mortality. Chest X-rays play a crucial role in the diagnostic process for evaluating COVID-19 patients. Our collaborative efforts with Michigan Medicine in monitoring patient outcomes within the ICU have motivated us to investigate the potential advantages of incorporating clinical information and chest X-ray images for predicting patient outcomes. We propose an analytical workflow to address challenges such as the absence of standardized approaches for image pre-processing and data utilization. We then propose an ensemble learning approach designed to maximize the information derived from multiple prediction algorithms. This entails optimizing the weights within the ensemble and considering the common variability present in individual risk scores. Our simulations demonstrate the superior performance of this weighted ensemble averaging approach across various scenarios. We apply this refined ensemble methodology to analyze post-ICU COVID-19 mortality, an occurrence observed in 21% of COVID-19 patients admitted to the ICU at Michigan Medicine. Our findings reveal substantial performance improvement when incorporating imaging data compared to models trained solely on clinical risk factors. Furthermore, the addition of radiomic features yields even larger enhancements, particularly among older and more medically compromised patients. These results may carry implications for enhancing patient outcomes in similar clinical contexts.

Facts and trends in dental antibiotic and analgesic prescriptions in Germany, 2012–2021

ObjectivesThe study aims to overview German dentists’ development of antibiotic and analgesic prescriptions from 2012 to 2021.Materials and methodsA longitudinal database analysis was performed based on the annual reports of the “Research Institute for Local Health Care Systems” (WIdO, Berlin).ResultsFrom 2012 until 2021, dental antibiotic prescriptions fell by 17.9%. In contrast, the dental proportion of antibiotic prescriptions compared to all antibiotic prescriptions in Germany increased from 9.1 to 13.6%. Aminopenicillins enhanced their share from 35.6 to 49.4%, while clindamycin prescriptions declined from 37.8 to 23.4%. The proportion of ibuprofen prescriptions significantly increased from 60.4% in 2012 to 79.0% in 2021.ConclusionsSince 2013, the most frequently prescribed antibiotic by German dentists has been amoxicillin reaching nearly half of all dental antibiotic prescriptions in 2021. Simultaneously, the proportion of clindamycin has steadily decreased, but the level is still high compared to international data. During the past decade, ibuprofen as a first-line analgesic in German dentistry was continuously gaining in importance.Clinical relevanceAminopenicillins have the best risk–benefit balance in dentistry, but the use of antibiotics generally must be limited only to cases of severe infections or compromised patients. Pre-existing diseases or permanent medications should always be considered when choosing an analgesic.

Assessment of oral health awareness and hygiene practice in hemophilic patients in Indore: A cross-sectional study

: Haemophilia is a genetic X linked recessive bleeding disorder characterized by a deficiency or absence of certain clotting factors in the blood, primarily factors VIII (haemophilia A) or factor IX (haemophilia B). Dental caries and periodontal diseases are two main oral diseases affecting majority of population, but their effects are enhanced in hemophiliacs and medically compromised patients. There is a lack of epidemiological studies regarding oral health and oral hygiene of hemophilic patient especially in central India. This study therefore, aimed to evaluate the oral hygiene awareness and hygiene practices of patients with hemophilia in Indore district. This cross-sectional study was conducted on 30 hemophilic patients who were selected via snow ball sampling technique. The patients who were ready to participate voluntarily in the study were included. A study questionnaire in Hindi and English was given to the patients to obtain their knowledge about oral hygiene and dental health awareness.: Thirty hemophilic patients participated in the study with a mean age of 20 ±15 years. All the participants were male. Although hemophilic patients were conscious of oral hygiene, the study found most of them had poor dental practices. The majority of participants (56.67%) reported of using soft-bristled brushes. Only 56.67% of the participants reported cleaning their mouths after meals and having seen gum bleeding. The majority of hemophilia patients (46.15%) reported using Factor VIII, while some also used Tranexamic acid (15.39%).: Oral hygiene is crucial for everyone, but it holds particular importance for individuals with hemophilia. Good oral hygiene reduces the need for invasive dental treatments, minimizing potential complications.

Complex Sleeve Lobectomy Has Lower Postoperative Major Complications Than Pneumonectomy in Patients with Centrally Located Non-Small-Cell Lung Cancer.

Standard sleeve lobectomies are recommended over pneumonectomy (PN), but the efficacy and oncological proficiency of complex sleeve lobectomies (CSLs) have not been completely investigated. The aim of this study was to report our experience in CSL in patients affected by a centrally located non-small-cell lung cancer (NSCLC), comparing all the variables and outcomes with PN. From 2014 to 2022, we collected the data of patients who underwent PN and CSL for NSCLC, excluding neuroendocrine tumors, salvage surgery or carinal resection. Regression analysis was used to assess the association between procedures and complications; the Kaplan-Meier method and Cox regression analysis were used to evaluate survival and risk factors of reduced survival. We analyzed n = 38 extended sleeve lobectomies and n= 6 double-sleeve lobectomies (CSL group) and n= 60 PNs. We had a trend toward higher postoperative mortality in the PN group (5% vs. 0%, p = 0.13). Major complications and bronchial fistula developed in 21.7% and 6.8% (p = 0.038) and in 6.7% and 4.5% (p = 0.64), respectively. The right side was identified as risk factor for major complications, whereas age > 70 and PN had a trend of association in multivariable analysis. The median OS was similar between the two groups (p = 0.76) and cancer recurrence was the only significant risk factors of reduced OS. Excluding functionally compromised patients, the OS of CSL was better than that of PN (67% vs. 42%, p = 0.25). Considering that major complications are often associated with mortality after surgery for centrally located NSCLC, CSLs could be considered an alternative to PN while also ensuring comparable survival.

Using Inhalation Sedation for Oral Surgery

With increasing waiting lists across the UK for oral surgery under general anaesthesia (GA), inhalation sedation (IS) may provide the answer for patients to be treated more quickly. The authors believe it is an underused technique for the management of anxious and medically compromised patients requiring oral surgery. This article demonstrates, with patient examples, how IS can be used effectively. CPD/Clinical Relevance: This article is relevant to general dental practitioners, oral surgeons and those working in sedation services.

Open Season: The Targets of Dobbs

ABSTRACT Dobbs v. Jackson Women’s Health Organization took the unprecedented step of revoking a constitutional right that citizens had relied upon for half a century. The opinion created a legal chaos with no clear answers to medical crises. It also targets victims who are particularly vulnerable due to financial, medical, or legal constraints. This article examines what groups have become legal targets in the wake of Dobbs, including medically compromised patients, the intellectually disabled, immigrants, and doctors. Also discussed are those who cause abortion but have not been targeted by Dobbs (such as biological fathers and criminals who commit acts of rape or incest). A discussion of who is doing the targeting examines officials acting in a law enforcement capacity and “civilians” who have financial incentives to target vulnerable victims. Recommendations are made for effective abortion policy.