Declaration Of Helsinki Research Articles

The Heidelberg registry of atrial fibrillation. a summary in the era of transition of oral anticoagulation regimes over an 11-year period

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): The study was supported by a research grant from Daiichi Sankyo and Bayer diagnostics. The sponsor had no influence on the study concept, data collection, or interpretation. Background Management of patients with atrial fibrillation (AF) has improved in recent years. Particularly, the shift from vitamin-k containing (VKA) oral anticoagulation (OAC) regimes to factor Xa or thrombin inhibitor containing non-vitamin K regimes (NOAC) regimes has revolutionized stroke prevention in AF patients. Purpose This study aimed to illustrate the shift from VKA to NOAC regimes over an 11-year period in an emergency department (ED) setting. Methods The Heidelberg Registry of Atrial Fibrillation (HERA-FIB) is a retrospective, observational single-center study and collected data from patients with AF presenting to the ED of our hospital between 2009 and 2020. Inclusion criteria were (a) diagnosis of AF and (b) age >18 years. Exclusion criteria were (a) non-availability of at least one high sensitive troponin T value and (b) lost to follow-up for all-cause mortality. Repeated visits to the ED were also excluded. Clinical data was accessed retrospectively from available medical records. A sequential follow-up was performed for all-cause mortality, stroke, major bleeding and myocardial infarction. This study was conducted according to ethical principles stated in the Declaration of Helsinki (2008). Results Within the inclusion period of HERA-FIB a total of 76,528 visits to CPU were screened over an 11-year time period. 24.4% were excluded for other diagnosis than AF, resulting in a total of 12,279 visits to ED within the inclusion period. Here, a total of 5.4% of the patients were excluded after re-adjustment of AF diagnosis, 1,5% for non-sufficient laboratory values and 10% for lost-to follow-up. The total study population of HERA-FIB included 10,222 patients with the diagnosis of AF. Within the inclusion period of HERA-FIB, a significant change form VKA containing to NOAC containing anticoagulation regimes could be detected among patients presenting to the ED. Additionally, the number of patients on OAC compared to the number of patients without any OAC regime increased over time. Within the inclusion period, a total of 69.7% received an OAC regime. Here 59.5% of the AF patients received a NOAC and 40.5% VKA at discharge. Hazard ratio for patients on VKA for all-cause mortality was 1.25 (95%CI: 1.11-1.41), p=0.0003. Conclusions HERA-FIB is one of the largest real-world retrospective single-center databases for patients with AF, reflecting the shift from NOAC to VKA containing anticoagulation regimes in AF patients presenting to an ED over an 11-year period.

The role of rhythm control in patients with first diagnosed atrial fibrillation in a real world collective

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Bayer. Background There has been conflicting evidence regarding the importance of rhythm control as opposed to rate control in patients with atrial fibrillation (AF). Thus, no clear recommendation on early rhythm control for risk reduction is given in the current guidelines. However, some evidence suggests that rhythm control is superior to rate control in patients with a recent diagnosis of AF. Purpose We aim to characterize patients with first diagnosed AF and evaluate the effect of a rhythm control strategy at the time of diagnosis on long term cardiovascular outcomes. Methods This is a single center, retrospective observational sub study based as a part of the HERA-FIB project. HERA-FIB included 10.222 patients presenting to the emergency department (ED) of the department of cardiology of a university hospital from June 2009 to March 2020. We consecutively included all patients with a history AF or current AF upon presentation, regardless of the reason for presentation. A structured follow-up regarding survival and major cardiovascular events was performed. Mean follow up was 23 months (IQR 12-35). Patient care was not influenced. The project was performed according to the declaration of Helsinki and was approved by the local ethics committee and registered at ClinicalTrials.gov (Identifier: NCT05995561). Results. After adjudication we included 10.222 patients in this study. Of those 2758 (27%) had no previous history of AF and were first diagnosed with AF upon presentation. There were major differences in baseline characteristics as patients with first diagnosed AF were younger (73 years vs 76 years, p<0.0001), showed a normal left ventricular function more often (47.9% vs 40.2%, p<0.0001) and had fewer histories of coronary artery disease (CAD) (30.2% vs 48.0%, p<0.0001) and fewer histories of stroke or transient ischemic attack (TIA) (9.0% vs 14.0%, p<0.0001). In contrast they had higher heart rates (113 bpm vs 84 bpm, p<0.0001) on admission. Among the patients with first diagnosed AF 24.6% received a cardioversion (either pharmacological of electrical). Patients with first diagnosed AF undergoing rhythm control treatment showed lower rates for all-cause mortality (10.4% vs 18.2%, p<0.0001) and myocardial infarction (2.4% vs. 5.2%, p=0.0045) as compared to patients first diagnosed with AF not recieving a cardioversion. However, no differences for strokes (2.7% vs 3.3%, p=0.6158) or severe bleeding according to ISTH major bleeding criteria (4.0% vs. 5.3%, p=0.2252) could be detected. Conclusions Patients presenting to an ED with first diagnosed AF are younger and show fewer comorbidities compared to patients with pre-existing AF. Patients with first diagnosed AF seem to profit from early rhythm control strategies showing a reduction for the rates of all-cause mortality and myocardial infarction. However, no difference for stroke or major bleeding events could be detected. Additional, prospective studies are required to verify this hypothesis.

Workplace Bullying and Depression, Mediating Role of Insomnia Among Employees

Background: Workplace bullying is characterized by unpleasant and unethical behavior, which can manifest directly or indirectly, affecting individuals' mental health. Insomnia is also a known consequence of workplace bullying, which can lead to depression. Objective: To explore the association between workplace bullying, insomnia, and depression among employees in Lahore, and to determine the mediating role of insomnia in the relationship between workplace bullying and depression. Methods: This study employed a correlational research design with a purposive sample of 200 employees, both male and female, from Lahore, Pakistan. Data were collected using a demographic form, a 21-item Workplace Bullying Scale, the Insomnia Severity Index (ISI), and the Depression, Anxiety, and Stress Scale-21 (DASS-21). The study followed the principles outlined in the Declaration of Helsinki, and statistical analysis was conducted using SPSS version 25, including descriptive statistics, correlation analysis, and regression analysis. Results: The mean score for workplace bullying was 42.54 (SD = 15.8), for insomnia was 9.88 (SD = 6.26), and for depression was 18.97 (SD = 13.69). There were significant positive correlations between workplace bullying, insomnia, and depression, with correlation coefficients of 0.53, 0.62, and 0.61, respectively (all p < 0.01). Both workplace bullying (B = 0.36, p < 0.001) and insomnia (B = 0.84, p < 0.001) were significant predictors of depression. Insomnia also mediated the relationship between workplace bullying and depression, with an indirect effect of 0.1714 (95% CI: 0.1105, 0.2393). Conclusion: Workplace bullying contributes to higher levels of depression among employees, with insomnia serving as a mediator. Both workplace bullying and insomnia are significant predictors of depression. These findings highlight the importance of addressing workplace bullying to improve employee mental health.

Abstract PO2-17-09: Overall survival differences between HER2 Low and other breast cancer subtypes in a reference center in Brazil

Abstract Background: Breast cancer (BC) is a heterogeneous disease, and its subtypes have different prognosis and diverse responses to endocrine therapy and chemotherapy. In clinical practice, immunohistochemical markers are often used to classify BC into subtypes according to the presence of hormone receptors, human epidermal growth factor receptor 2 (HER2) and evaluation of proliferation measured by Ki67. Recently, there has been a suggestion for a possible alternative terminology for situations involving IHC 1+ or 2+ with negative ISH, this proposed term is referred to as HER2-low and represents about 50 to 55% of all primary BC. There are relevant gaps regarding the outcomes of HER2-low BC. Considering the new emerging therapies for HER2-low, a better description of the epidemiology, response to treatment and results of this population is extremely relevant. Objective: The purpose of this study was to use real-world data in order to investigate the Brazilian patients with BC treated in a Reference Center and evaluate the survival outcomes in different subtypes identified by molecular immunohistochemistry including HER2-Low and evaluate the survival in subtypes by stage. Methods: This retrospective cohort study included women, age > 18 years with breast cancer treated between 2010 and 2019 at Perola Byington Hospital in the city of São Paulo, Brazil. After the diagnose, the included patients were submitted to an immunohistochemical analysis to identify the subtype of the BC. Institutional Review Board of Pérola Byington Hospital approved the use of patients' data before the beginning of the study, under the reference number CAAE 7238317.6.0000.0069). An informed consent was dismissed, and this study was carried out according to the Declaration of Helsinki, including protection of patients' confidentiality. The primary outcome measure was overall survival (OS), which was defined as the length of time (in months) from the date of diagnosis to the date of death (from any cause). The secondary outcome measure was disease-free survival (DFS), which was defined as the length of time after the end of the primary cancer treatment in which the patient survives without any signs or symptoms of cancer. Continuous variables were summarized using their mean. Qualitative variables were summarized for the general population and by HCI subgroups using counts, percentages, and absolute numbers. The Kaplan-Meier method was used to estimate survival rates and mean survival times in the general population and by groups. All statistical tests were bilateral and p< 0.05 was considered significant. Statistical analyses were performed using the Python programming language version 3.8. Results: Between January 2010 and December 2019, 1,826 women were diagnosed with breast cancer and classified as a HER2-low subtype, among the 9,278 participants included in the study (19,68%). Regarding the OS analysis, patients with the "Luminal A" subtype had better survival (106 months) results when compared with the other subtypes and women with triple negative disease had the worse prognosis with OS of 96 months. The median survival in HER2-low with hormonal receptor positive was 101 months and statistically significant when compared with 90 months in HER2-low hormonal receptor negative (p < 0,01). When looking for stage IV HER2-low and HER2+ have better overall survival rates compared to other subtypes. Conclusion: This real-world data study shows difference in the prevalence of the HER2-low subtype. In addition, there is a difference in OS between tumor subtypes and when evaluating the HER2-low subtype with or without the presence of receptors, this difference is marked. Citation Format: Andre Mattar, Andressa Amorim, Marina Diogenes, Marcelo Antonini, Francisco Pimentel Cavalcante, Luiz Henrique Gebrim. Overall survival differences between HER2 Low and other breast cancer subtypes in a reference center in Brazil [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-17-09.

Prevalence and Comparison of Dental Caries of 6 to 12 Years Age in Government and Private School Children of Peshawar City, Pakistan

Background: Dental caries remains a significant public health issue globally, affecting both developed and developing nations. Studies have shown varying prevalence rates based on geographic, socioeconomic, and cultural factors, particularly among school-aged children. The city of Peshawar, with its diverse population, provides a unique setting to study these variables in relation to oral health outcomes among children. Objective: This study aimed to determine the prevalence of dental caries among school children aged 6 to 12 years in Peshawar, Pakistan, and to compare the rates between students from government and private schools. Additionally, the study sought to explore the association of dental caries with dietary habits, particularly the consumption of sweets, chocolates, and candies. Methods: A cross-sectional study was conducted involving 376 school children from both government and private schools in Peshawar. Participants underwent detailed oral examinations to assess for dental caries, and data on their dietary habits were collected through questionnaires. Informed consent was obtained from parents or guardians according to the Declaration of Helsinki. The Statistical Package for the Social Sciences (SPSS) Version 22 was used for data analysis, employing descriptive statistics to calculate frequencies, percentages, and mean values. Results: The overall prevalence of dental caries among the participants was 55.05%. Boys exhibited a slightly higher prevalence (53.2% in males compared to 62.7% in females). The consumption of sugary snacks was significantly associated with the presence of caries; 95.6% of carious children regularly consumed sweets, chocolates, or candies. There was no significant difference in caries prevalence between children from government (53.2%) and private schools (57.5%). Conclusion: The study highlights a high prevalence of dental caries among school-aged children in Peshawar, which correlates strongly with sugar consumption but not with the type of school attended. These findings underscore the need for targeted public health interventions to reduce sugar intake and improve oral hygiene among children.

Female RNA concussion (FeRNAC) study: assessing hormone profiles and salivary RNA in females with concussion by emergency departments in New Zealand: a study protocol

BackgroundFemales of reproductive age with concussion report a greater number of symptoms that can be more severe and continue for longer than age matched males. Underlying mechanisms for sex differences are not well understood. Short non-coding Ribonucleic Acids (sncRNAs) are candidate salivary biomarkers for concussion and have been studied primarily in male athletes. Female sex hormones influence expression of these biomarkers, and it remains unclear whether a similar pattern of sncRNA expression would be observed in females following concussion. This study aims to evaluate recovery time, the ratio of salivary sncRNAs and symptom severity across different hormone profiles in females presenting to emergency departments (ED) with concussion and, to investigate the presence of low energy availability (LEA) as a potential modifier of concussion symptoms.MethodsThis prospective cohort study recruits participants from New Zealand EDs who are biologically female, of reproductive age (16–50 years) and with a confirmed diagnosis of concussion from an ED healthcare professional. Participants are excluded by ED healthcare professionals from study recruitment as part of initial routine assessment if they have a pre-diagnosed psychiatric condition, neurological condition (i.e., epilepsy, cerebral palsy) or more than three previously diagnosed concussions. Participants provide a saliva sample for measurement of sncRNA’s, and online survey responses relating to hormone profile and symptom recovery at 7-day intervals after injury until they report a full return to work/study. The study is being performed in accordance with ethical standards of the Declaration of Helsinki with ethics approval obtained from the Health and Disability Ethics Committee (HDEC #2021 EXP 11655), Auckland University of Technology Ethics Committee (AUTEC #22/110) and locality consent through Wellington hospital research office.DiscussionIf saliva samples confirm presence of sncRNAs in females with concussion, it will provide evidence of the potential of saliva sampling as an objective tool to aid in diagnosis of, and confirmation of recovery from, concussion. Findings will determine whether expression of sncRNAs is influenced by steroid hormones in females and may outline the need for sex specific application and interpretation of sncRNAs as a clinical and/or research tool.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) registration number ACTRN12623001129673.

Порівняльний аналіз субклінічного тривожно-депресивного синдрому в пацієнтів із гострим інфарктом міокарда з елевацією сегмента ST до та під час активних бойових дій у Харківській області

The aim – to assess subclinical emotional distress in patients with ST-Elevation Myocardial Infarction (STEMI) before and during the ongoing conflict in the Kharkiv Region. Materials and methods. The study encompassed 242 patients exhibiting subclinical emotional distress and hospitalized with STEMI at «L.T. Malaya TNI of NAMSU» before active conflict, compared with 65 patients during the conflict. Adherence to ethical standards was ensured, in line with the 1964 Helsinki Declaration, and the protocol received approval from the local ethics committee (Protocol № 8, dated 29.08.2016, and Protocol № 4, dated 12.05.2022). Participants completed the DASS-21 questionnaire, reflecting their emotional state 10–14 days prior, and received STEMI treatment as per current guidelines.Results. We showed that anxiety more frequent appeared during the active hostilities (p=0.0218). Depression had the influence on excessive smoking (p=0.0199), LV EF decrease (p=0.0057), LDL-C increase (p=0.0393). Anxiety and stress intrude into hypertension frequency (p=0.0171, p=0.0489) consequently as well as anxiety – on LDL-C increase (p=0.0068). All data of subclinical emotional distress during active hostilities associate with the frequency of smoking increase: p=0.0422 for depression, p=0.0275 for anxiety and p=0.0199 for stress. Depression associates with LVEF decrease (p=0.0267), the leucocytes count increase (p=0.0467), high frequency of hypertension (p=0.0410). Anxiety associates with higher heart rate (p=0.0277), depression and stress – with younger age (p=0.0369).Conclusions. Our research demonstrates close associations between the data of subclinical emotional distress both in patients with STEMI before and during the active hostilities in Kharkiv Region. Data were assessed with DASS-21 questionnaire on 10 –14 day prior the event. These results should be undertaken during general practitioner’s appointment to prevent further cardiovascular event.

Impact of Levels of Perceived Stress Among Senior Nursing Undergraduates in Clinical Practice on Mobile Addiction: A Cross-Sectional Study

This cross-sectional study aimed to explore the relationship between levels of perceived stress by senior nursing undergraduates during clinical training and the extent of mobile addiction. The study was carried out at the nursing faculty, aligning with the tenets of the Helsinki Declaration and STROBE writing standards. Ninety-eight senior nursing undergraduate students participated in the research. Data collection involved the use of a "Descriptive Characteristics Information Form," the "Perceived Stress Scale for Nursing Students," and the "Mobile Addiction Scale." SPSS 24.0 was used to analyse the data. Among the participants, 62.9% (n=61) were female, with a mean age of 22.41±2.58 years. While 83% (n=83) expressed satisfaction with their department, 52.6% (n=51) reported frequent mobile device use, primarily for social media. On average, students spent 4.56±2.12 hours daily on mobile devices. The mean score for perceived stress was 66.51±22.32, and for mobile addiction, it was 67.72±20.34. The perceived stress level accounted for 12% of the variance in mobile addiction. The study revealed a significant impact of stress experienced during clinical practice on mobile addiction among senior nursing undergraduates. It reveals the significance of providing stress management training to improve students' coping mechanisms and increase their awareness of mobile addiction.

Changes in blood metabolomes as potential markers for severity and prognosis in doxorubicin-induced cardiotoxicity: a study in HER2-positive and HER2-negative breast cancer patients.

We aimed to compare the changes in blood metabolomes and cardiac parameters following doxorubicin treatment in HER2-positive and HER2-negative breast cancer patients. Additionally, the potential roles of changes in blood metabolomes as severity and prognostic markers of doxorubicin-induced cardiotoxicity were determined. HER2-positive (n = 37) and HER2-negative (n = 37) breast cancer patients were enrolled. Cardiac function assessment and blood collection were performed at baseline and 2weeks after completion of doxorubicin treatment in all patients, as well as at three months after completion of doxorubicin treatment in HER2-negative breast cancer patients. Blood obtained at all three-time points was processed for measuring cardiac injury biomarkers. Blood obtained at baseline and 2weeks after completion of doxorubicin treatment were also processed for measuring systemic oxidative stress and 85 metabolome levels. Cardiac injury and systolic dysfunction 2weeks after completion of doxorubicin treatment were comparable between these two groups of patients. However, only HER2-negative breast cancer patients exhibited increased systemic oxidative stress and cardiac autonomic dysfunction at this time point. Moreover, 33 and 29 blood metabolomes were altered at 2weeks after completion of doxorubicin treatment in HER2-positive and HER2-negative breast cancer patients, respectively. The changes in most of these metabolomes were correlated with the changes in cardiac parameters, both at 2weeks and 3months after completion of doxorubicin treatment. The changes in blood metabolomes following doxorubicin treatment were dependent on HER2 status, and these changes might serve as severity and prognostic markers of doxorubicin-induced cardiotoxicity. The study was conducted under ethical approval from the Institutional Review Board of the Faculty of Medicine, Chiang Mai University (Registration number: MED-2563-07001; Date: April 28, 2020). The study also complied with the Declaration of Helsinki.

Morphofunctional changes in ventral and dorsal hippocampus in adult rats after chronic mild stress: a preclinical experimental study

Background. Stressful influences, depending on their severity and duration, can cause the development of pathological conditions. Repeated episodes of stress cause functional and structural changes in the central nervous system and can cause the development of depressive conditions. Depression is one of the leading mental illnesses. One of the most stress-sensitive brain structures is the hippocampus. Objective. To study is to evaluate structural changes in the hippocampus, which is considered as a heterogeneous structure with separate dorsal and ventral regions, to evaluate the expression of inducible nitric oxide synthase, endothelial nitric oxide synthase, serine racemase, synaptophysin in a mild stress model.Methods. A study of the effects of mild stress was carried out on 16 adult male Wistar rats (age 12 months, body weight 350–400 g). After acclimatization, the rats were divided into two equal groups (n = 8): intact (control) and stressed. When keeping animals, modeling and removing them from the experiment, we were guided by the Regulations for Carrying Out Work Using Laboratory Animals and the Declaration of Helsinki. Experimental modeling of depression in animals was induced by mild stress exposure for 7 days (30 minutes daily). Euthanasia was performed in a CO2 incubator. The brain was fixed in neutral buffered 10% formalin. Paraffin sections were made in the frontal plane, stained with hematoxylin and eosin, thionin using the Nissl method and examined at a level from –2.40 to –3.96 mm relative to bregma using an Axio Lab A1 microscope (Carl Zeiss Microscopy GmbH, Germany). Photo documentation was carried out with an AxioCam 105 color camera (Carl Zeiss Microscopy GmbH, Germany). Using the Image Analysis module of the ZEN 1.1.2.0 program (Carl Zeiss Microscopy GmbH, Germany) in the pyramidal layer of the hippocampus. Statistical analysis was performed with Microsoft Office Excel 2016 (Microsoft, USA) and Prism 6 (GraphPad Software Inc., USA). Comparisons of two conditions were made by nonparametric Mann-Whitney-U test to avoid a statistical bias of unequal data distribution. The level of significance was set at p < 0.05. The summarized data were presented as a as mean ± standard error of mean.Results. Functional research methods and assessment of pathological changes in hippocampal neurons are presented. An increase in the relative number of wrinkled hyperchromatic pyramidal neurons in the dorsal cornu ammonis field 3 in stressed rats was noted by 23.6% (p < 0.05) compared to the control. There was an increase in the relative number of inducible nitric oxide synthase-immunopositive neurons in the dorsal cornu ammonis field 3 by 40% ( p < 0.05) and the relative area of inducible nitric oxide synthase-immunoreactive material by 35% (p < 0.05) in the pyramidal layer of cornu ammonis field 3 in stressed rats. A decrease in the relative area of synaptophysin-immunopositive material in stressed rats was found in the ventral cornu ammonis field 3 compared to the control group by 16.8% (p < 0.05); decrease in the relative area of serine racemase-immunopositive material in dorsal cornu ammonis field 3 by 4.3% (p < 0.05) and ventral cornu ammonis field 3 by 7.8% (p < 0.05).Conclusion. The results of the study demonstrate that mild stress is an adequate model of depression in rats. In animals exposed to mild stress, pronounced morphological signs of damage to hippocampal neurons were revealed; motor and indicative exploratory activity decreases. Differences were found in morphofunctional changes in the dorsal and ventral parts of the hippocampus under the influence of mild stress. In cornu ammonis field 3 of the dorsal hippocampus, in contrast to the ventral section, more pronounced signs of damage to pyramidal layer neurons were observed. The increase in the relative number of inducible nitric oxide synthase-immunopositive neurons and the relative area of inducible nitric oxide synthase-immunoreactive material in the cornu ammonis field 3 pyramidal layer in stressed rats indicates an increase in nitric oxide production and the participation of nitrooxide-dependent free radical mechanisms of damage to hippocampal neurons. The decrease in the relative area of synaptophysin-immunoreactive material in stressed rats may contribute to changes in synaptic plasticity. A decrease in the relative area of serine racemase-immunoreactive material in the dorsal and ventral parts of cornu ammonis field 3 is considered to be a sign of a possible decrease in N-methyl-D-aspartate-dependent neurotransmission in the hippocampus under stress.

Mid- and long-term clinical results of the Elektra and Moovis prosthesis for trapeziometacarpal joint replacement

BackgroundTotal joint arthroplasty as a surgical treatment option for trapeziometacarpal joint arthritis is recently revived. The aim of this study is to report on mid- and long-term results of the Elektra (single-mobility) and Moovis (dual-mobility) prosthesis for treatment of primary thumb carpometacarpal joint arthritis.MethodsIn this retrospective, monocentric, descriptive cohort study, 31 prostheses were evaluated that were implanted by a single surgeon in 26 patients between 2009 and 2019. Indication for surgery was trapeziometacarpal joint osteoarthritis (Eaton/Littler Stage II and III). Clinical and radiological follow-up was performed at a minimum of 24 months. The postoperative assessment included range of motion, pain, strength as well as functional scores (DASH, MHQ). Implant survival and complications were the primary endpoints.Results10 Elektra and 21 Moovis prostheses were implanted between 2009 and 2019 with a mean follow-up of 74.2 months in the Elektra and 41.4 months in the Moovis group. The average patients’ age at surgery was 64 years. Postoperative pain levels (VAS 0–10) were below 2 at rest and under stress in both groups. Grip/pinch strength and range of motion showed results comparable to the contralateral hand. Opposition was excellent with an average Kapandji index of 9.6 in both groups. Elektra achieved slightly better functional scores in the DASH and MHQ score. Satisfaction was high in both groups, and 96% of the patients would recommend the procedure. Metacarpophalangeal hyperextension > 15° was seen in 3 patients per group preoperatively and was corrected to < 5° post-surgery. 3 Elektra prostheses were revised due to cup loosening and dislocation for cup and/or neck replacement or secondary trapeziectomy. 1 Moovis prosthesis was revised with an exchange of the neck to a larger size due to restricted movement. After the mean follow-up of 7.9 years in Elektra and 3.5 years in MOOVIS, cumulative survival was 68.6% vs. 95.2%, respectively.ConclusionsIn this mid- to long-term retrospective analysis, total joint arthroplasty in primary trapeziometacarpal joint arthritis results in low pain levels, excellent mobility and clinical function. Patient satisfaction is overall high. While revision due to cup loosening occurred more often in patients with single-mobility implants, no cases of dislocation or loosening of components were observed in the dual-mobility group.Trial registrationThe study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of the Medical Faculty of Heidelberg University, reference number S-150/2020.

Prevalence of Low Back Pain in Pregnant Females

Background: Low back pain (LBP) during pregnancy is a common condition that affects a significant number of women, impacting their daily activities and overall quality of life. Various studies have documented the prevalence and severity of LBP among pregnant women, highlighting the need for more focused healthcare strategies. Objective: The aim of this study was to assess the prevalence, onset, and severity of LBP in pregnant women, and to evaluate the impact of LBP on their daily activities, with a view to enhancing prenatal care and management approaches. Methods: A cross-sectional study was conducted over six months at two hospitals in Lahore, involving 181 pregnant women selected through non-probability convenience sampling. Data were collected using the Oswestry Low Back Pain Disability Questionnaire and the Numeric Pain Index Scale. Statistical analysis was performed using SPSS version 25, focusing on descriptive statistics to calculate means, standard deviations, and prevalence percentages. Ethical considerations followed the Helsinki Declaration guidelines, with informed consent obtained from all participants. Results: The prevalence of LBP among the participants was 76.8%. The pain onset was most frequently reported in the second trimester (38.1% of cases). Severity assessments revealed 36.5% of participants experienced moderate pain and 40.3% severe pain. LBP significantly impaired daily functions, with many women reporting difficulties in walking, sitting, and engaging in other routine activities. Conclusion: LBP is highly prevalent among pregnant women and begins primarily in the second trimester, with a considerable impact on daily activities. This study emphasizes the necessity for routine prenatal assessment and targeted interventions to manage LBP, which could improve pregnancy outcomes and maternal health.

Association Between Knee Pain and Patellofemoral Syndrome (PFS) In Football Players

Background: Knee pain and patellofemoral syndrome (PFS) are common among athletes, particularly in sports requiring extensive lower limb use such as football. These conditions can significantly impair performance and quality of life. Objective: This study aimed to investigate the prevalence and severity of knee pain and patellofemoral syndrome among football players, and to explore the association between these conditions. Methods: The study was conducted with 145 football players who provided informed consent, in alignment with the Declaration of Helsinki. Data were collected using structured surveys that included the Numeric Pain Rating Scale and the Kujala Scoring questionnaire. The analysis utilized SPSS software (version 25) to conduct descriptive and inferential statistics. Qualitative data were assessed by frequencies and percentages, while quantitative data analysis involved computing means and standard deviations. The association between knee pain and PFS was examined using a Pearson Chi-Square test. Results: The average age of participants was 22.95 years (SD = 2.83), ranging from 19 to 28 years. Regarding knee pain, 8.3% reported no pain, 26.2% mild pain, 32.4% moderate pain, and 33.1% severe pain. For PFS symptoms, 10.3% of players had no symptoms, 27.6% mild, 31.7% moderate, and 30.3% severe symptoms. The Pearson Chi-Square test yielded a p-value of less than 0.05, indicating a significant association between knee pain and the presence of PFS. Conclusion: The study confirmed a significant correlation between knee pain and PFS among football players, highlighting the need for targeted preventive and therapeutic strategies in sports settings to enhance player health and performance.

Frequency and Patterns of Traumatic Dental Injuries Reported at Islamabad Dental Hospital: A Retrospective Study.

Background: Traumatic dental injuries (TDIs) are increasingly becoming a public health concern, with a significant number of cases presenting to emergency departments worldwide. They affect a diverse age range, particularly children and adolescents, and are influenced by various etiological factors such as falls, sports injuries, and road traffic accidents. Previous studies have indicated a gender predisposition, with males more frequently affected, and a pattern of injury that varies by region. Objective: This study aimed to investigate the frequency and patterns of TDIs treated at the Department of Operative Dentistry, Islamabad Dental Hospital, and to analyze the management strategies employed. Methods: A retrospective cross-sectional analysis was conducted, examining patient records from 2015 to 2022. Approval was obtained from the institutional review board, aligning with the Declaration of Helsinki. Data from complete TDIs forms were extracted, detailing the type of injury, timing, and treatment administered. Statistical analysis was performed using SPSS v.23, with chi-square tests applied to examine the association between the type of trauma and demographic variables. Results: A total of 88 teeth with TDIs were recorded. The most common injuries were complicated crown fractures (28.4%) and root fractures (17.0%), with splinting (31.8%) and root canal treatments (29.5%) being the most frequent management procedures. Male patients were predominantly affected. Notably, adult cases surpassed those of children and adolescents, contrary to global trends. Conclusion: TDIs constitute a significant portion of dental emergency cases, with specific patterns and treatments that vary by demographics. Immediate and appropriate management, guided by current guidelines, is essential. Efforts should focus on increasing awareness and providing adequate training to healthcare providers for timely and effective treatment of TDIs.

Evaluation of Epidemiological Risk Features and Hematological Parameters in the Lymphoma Patients in the Larkana Region

Background: Hodgkin lymphoma (HL) is a type of lymphatic cancer that is distinctly characterized and classified into various subtypes, with varying prognoses based on the stage at diagnosis and treatment modalities. Despite advances in treatment, the specific demographic and clinical factors influencing treatment outcomes and the incidence of side effects, such as chemotherapy-induced anemia and neutropenia, remain under-explored, particularly in diverse regional settings. Objective: This study aims to evaluate the epidemiological risk features and hematological parameters of lymphoma patients in the Larkana region, with a focus on the impact of chemotherapy on these parameters. Methods: A case-control study was conducted over twelve months at Linar Hospital in Larkana, involving 40 participants aged between 10 and 70 years. Informed consent was obtained, aligning with ethical standards akin to the Declaration of Helsinki. Two types of blood samples were collected pre- and post-chemotherapy for hematological analysis including total leukocyte count, hemoglobin, and platelet levels, which were assessed using Complete Blood Count (CBC) containers with EDTA. Statistical analysis was performed using Microsoft Excel 2010 and SPSS Version 23, utilizing descriptive statistics and the Student's t-test. Results: The study documented a decrease in mean hemoglobin levels from 11.42 ± 1.74 g/dL before chemotherapy to 10.65 ± 1.55 g/dL after (p = 0.001), mean white blood cell count from 7.30 ± 2.6 × 10^3/uL to 5.71 ± 2.1 × 10^3/uL (p = 0.003), and platelet count from 297.52 ± 116.2 × 10^3/uL to 230.2 ± 72.6 × 10^3/uL (p = 0.001). These findings indicate a significant hematological impact associated with chemotherapy. Conclusion: The significant reduction in critical hematological parameters among lymphoma patients’ post-chemotherapy highlights the need for rigorous monitoring and tailored management strategies to mitigate treatment side effects. The findings emphasize the importance of comprehensive patient care and support in improving treatment outcomes in lymphoma.

Peripheral Arterial Disease in Diabetes and its Relation to Cardiovascular Risk Factors in Women

Objectives: Peripheral arterial disease (PAD) is characterized by occlusive disease in the abdominal aorta, iliac, and femoral arteries, leading to reduced blood flow and complications. Diabetes mellitus (DM) is known to contribute to the development and progression of PAD due to factors such as hyperglycemia, dyslipidemia, endothelial dysfunction, and inflammation. However, PAD may be underdiagnosed in women with DM, leading to adverse cardiovascular outcomes. The present study aimed to investigate the prevalence of PAD in women with type 2 DM (T2DM) and its relationship with cardiovascular risk factors. Materials and Methods: This hospital-based, cross-sectional, and observational study was conducted for a period of 3 months from June 10, 2023, to September 10, 2023, in the outpatient department of general medicine. After obtaining the approval from the Institutional Ethical Committee, the study was performed according to the Declarations of Helsinki and Good Clinical Practice requirements for human subject protection. Non-probability purposive sampling technique was used to enroll participants. Participants underwent face-to-face interviews and clinical examinations. Sociodemographic data, medical history, and pharmacotherapy details were collected. Laboratory investigations were conducted, including blood glucose, lipid profile, and glycosylated hemoglobin (HbA1C) tests. The ankle-brachial index (ABI) was measured. Results: The results showed that the majority of the participants were between 50 and 70 years of age, married, and had a high school education. Participants had an average body mass index (BMI) indicating overweight, and the average duration of diabetes was 6.571 years. Hypertension was the most prevalent comorbidity. Overweight, obesity I, and obesity II were present in 15.25% (n = 19), 33.6% (n = 42), and 8.8% (n = 11), respectively. Average values for HbA1C, fasting blood glucose (FBG), and postprandial blood glucose (PPBG) were within the diabetic range. ABI was normal in the right side, left side, and bilateral in 43.2%, 56%, and 14.4% of participants, respectively. ABI was borderline on the right side, left side, and bilateral in 40.8%, 36.8%, and 22.4% of participants, respectively. PAD was observed on the right side, left side, and bilateral in 16%, 7.2%, and 4% of participants, respectively. BMI, duration of DM, glycosylated hemoglobin, FBG, and PPBG showed significant negative correlations with ABI. Age, triglycerides, high-density lipoprotein, and low-density lipoprotein did not show any statistically significant correlation with ABI. Conclusion: The study highlighted the importance of screening for PAD in women with T2DM to improve cardiovascular outcomes. The findings shed light on the prevalence of risk factors for PAD and their association with the disease. These insights can contribute to the development of targeted interventions to reduce adverse clinical outcomes in this population.

Computed Tomography Findings in the Evaluation of Urolithiasis

Background: Urolithiasis, or the formation of urinary tract stones, is a prevalent condition that affects individuals worldwide, predominantly impacting middle-aged and elderly demographics. Computed tomography (CT) has emerged as a superior diagnostic tool for urolithiasis due to its high sensitivity and specificity, offering detailed insights into the size, location, density, and composition of stones. Objective: The objective of this study was to evaluate the efficacy of unenhanced computed tomography in the diagnosis and characterization of urinary tract stones, focusing on their size, location, and associated clinical symptoms. Methods: A cross-sectional study was conducted at the Diagnostic Center of CMH Hospital Lahore over four months, involving 70 patients with suspected or confirmed urolithiasis. Participants were selected using non-probability convenient sampling and underwent 128-slice MDCT imaging without contrast. Data collection included demographic information, clinical symptoms, and CT findings regarding stone characteristics. The ethical standards adhered to the Declaration of Helsinki, with all participants providing informed consent. Results: The study comprised 74.3% male and 25.7% female participants, with the highest prevalence of urolithiasis observed in the 30-40 year age group (32.9%). CT imaging detected stones in 95.7% of the participants, with a significant incidence of smaller stones (1-5 mm) at 31.4%. Hydronephrosis was noted in 85.7% of cases, and hydroureter in 54.3%. The most common stone density ranged from 500-1000 HU (41.4%), and stones were more frequently located on the right side (32.9%). Conclusion: Unenhanced CT proved to be a highly effective diagnostic tool for assessing urinary tract stones, providing essential data on stone size, density, and location, as well as associated clinical symptoms. This modality enhances the ability to tailor treatment strategies effectively, thereby improving patient outcomes.

Characteristic Features of Dietary Patterns and Physical Activity among Medical Students

Introduction This paper deals with the investigation of controlled risk factors associated with body weight disorders of young people with overweight and obesity. Authors are convinced that the formation of a conscious attitude to health in youth and early diagnosis of any abnormalities through the dynamic monitoring of adolescents and young people with excess body weight could help in the solution to this problem. Methods Statistical and sociological methods were used during the investigation. 80 students from a medical university participated in this research. In the survey, Google Forms online application were used. The authors followed all the principles of bioethics and medical deontology in conformity with the requirements of the Helsinki Declaration. The questionnaire contained points about the diet, food habits and preferences, socio-economic status of the respondent’s family, the level of their physical activity, knowledge about a healthy lifestyle, and relationships in the group. Results The primary processing of the obtained data was carried out using the methods of descriptive and analytical statistics with the provision of results in the form of relative indicators (Р, %) with an error (m, p). The specificity of the eating behavior of youth was connected with the absence of a food regime, the multiplicity of meals, and the low level of eating culture (lack of a permanent place to eat or eating in front of a computer or TV). Moreover, such habits, like eating before going to bed, eating under stress, or frequently visiting fast food restaurants, were typical for this group of population. A large number of young people were found to be prone to use advertised products. Conclusion Young people’s awareness of healthy nutrition has been found to be insufficient, and the level of physical activity in the studied group as unsatisfactory. Significant features of physical activity associated with maladaptive eating behavior have been observed to be a lack of physical activity on weekdays, absence of morning gymnastics, failure to comply with the norms of rational nutrition in the family, or low level of information about healthy nutrition.

Corrigendum to: An 88-year-old Man with Rare Giant Liposarcoma of the Scrotum.

A typographical error has appeared in the ethical acceptance number in the manuscript titled "An 88-year-old Man with Rare Giant Liposarcoma of the Scrotum", 2024; 20: e310823220564 [1]. Original: This study was approved by the ethics committees of Beijing Friendship Hospital, Capital Medical University (2023- P2-110-02) and conducted by the Declaration of Helsinki. Corrected: This study was approved by the ethics committees of Beijing Friendship Hospital, Capital Medical University (2024- P2-073) and conducted by the Declaration of Helsinki. The original article can be found online at https://www.eurekaselect.com/article/134182.

Skin closUre in carPal tunnEl Release (SUPER): protocol for a blinded randomised controlled trial comparing absorbable and non-absorbable sutures in carpal tunnel release

IntroductionCarpal tunnel syndrome is a common disorder affecting a substantial portion of the general population. Surgical intervention is often deemed necessary, with the median nerve release being one of the...