Weeks Research Articles

Narrative Review of Lifestyle Interventions in Breast Cancer Survivors: Current Evidence and Future Directions.

One in eight females will be diagnosed with breast cancer in their lifetime. While medical advances have increased the likelihood of survival, up to 90% of females will gain weight during and after treatment increasing the risk of breast cancer recurrence and obesity related co-morbidities in survivorship. Behavioral lifestyle interventions focused on diet with or without physical activity can provide breast cancer survivors non-pharmacological options to decrease weight gain and cardiometabolic risk. A PubMed search was conducted to identify all behavioral lifestyle interventions focused on diet or diet combined with physical activity longer than 4 weeks of duration in breast cancer survivors that included body weight as an outcome. This review aims to summarize the effects on body weight, body composition and cardiometabolic risk markers are summarized. Based on the review, there is high heterogeneity in type and duration of the intervention to affect weight and cardiometabolic risk in survivorship. Calorie restriction with and without physical activity appears to promote weight loss among breast cancer survivors. However, the effects on cardiometabolic factors are less clear. Future studies should be powered for both body weight and cardiometabolic effects. Researchers should also consider interventions that are: 1) less complex, 2) recruit a more racially and ethnically diverse sample, 3) integrate resistance training, 4) implement the intervention in closer proximity to diagnosis, 5) target weight management in this population before it occurs and 6) analyze body composition in addition to body weight measurements.

Mammary Carcinoma Metastasizing to Renal Cell Carcinoma: A Case Report

Abstract Introduction/Objective The simultaneous occurrence of multiple primary cancers is rare, and even rarer is the phenomenon of one cancer metastasizing to another. Here, we present a case of mammary carcinoma and renal cell carcinoma diagnosed concurrently yet presenting as a cancer-to-cancer metastasis. Methods/Case Report A 79-year-old woman, with a 2-week duration of apnea and cough, was found to have right pleural effusion and underwent thoracocentesis. Cytological examination of the fluid revealed malignant cells suggestive of adenocarcinoma. CT abdomen and chest revealed a 1.6 cm right breast nodule, 4.4 cm right axillary mass and right renal lesions measuring 3.0 and 1.6 cm. Core biopsy of the renal lesion showed two populations of cells. One population exhibited moderate cytoplasm and enlarged nuclei displaying anisonucleosis and hyperchromasia arranged singly as well as in sheets and clusters. These cells stained positive for GATA 3, ER, mammaglobin and CK7. Intermixed, were the second population of cells with clear cytoplasm and low nuclear grade forming sheets and replacing renal tissue. These cells were positive for CA9, CD10 and PAX 8 but negative for P40. Based on these findings a diagnosis of low-grade renal carcinoma of clear cell type with a metastatic carcinoma of mammary origin was established. Results (if a Case Study enter NA) NA Conclusion Renal cell carcinoma and breast carcinoma are known to increase the occurrence of each other. When breast and renal lesions are identified concurrently, the possibility of breast metastasis should be strongly considered. However, the concurrent appearance of renal cell carcinoma harboring metastatic breast cancer is extremely rare.This contributes valuable insights into the complex interplay between different cancer types. Understanding these rare phenomena can aid in refining diagnostic approaches and treatment strategies.

Risk of Anterior Cruciate Ligament Tears in National Football League Players by Short, Normal, or Long Rest Weeks.

Introduction Anterior cruciate ligament (ACL) tears in National Football League (NFL) players are devastating injuries that take nearly a year to recover. Players that do return to sport have worse overall performance compared to pre-ACL tear. NFL players typically play regular season games on Sunday with the next game played on the following Sunday, allowing for 7 days between games. Deviation from the usual 7-day rest week has been proposed as a potential risk for ACL tear. The main objective of this study is to evaluate the risk of decreased rest or increased rest on ACL tear rates in NFL players. Methods ACL injury data of NFL players from the 2012-2013 season and 2022-2023 season were gathered from publicly available sources. Player demographic data, position, age at time of injury, seasons played, injury mechanism, and playing surface type were recorded. Injuries were characterized as short, normal, or long week injuries. ACL tears that occurred during the preseason, postseason, or during week 1 were excluded. Descriptive statistics were calculated to report means, ranges, and percentages. Data were analyzed to determine statistically significant differences using Fisher's exact, chi-square, or one-way ANOVA tests. Results A total of 524 ACL tears were recorded in NFL players during the study window. 304 ACL tears were excluded and 220 fit inclusion criteria. 24 ACL tears occurred during short weeks, 68 during long weeks, and 128 during normal weeks. Players were 1.8 times more likely to tear their ACL during a long week compared to a normal week (p<.001), and 1.5 times more likely to tear their ACL during a short week compared to a normal week (p=.02). Conclusion The findings from this study suggest that deviation from the normal 7-day NFL week increases the risk of an ACL tear in NFL players when increasing or decreasing rest time. Further research exploring the impact short and long rest times on player injury risk should be conducted to prevent season ending injuries.

Clinical course and radiographic resolution of pneumonia in dogs treated with a shorter versus longer course of antimicrobials: a randomized, double-masked, placebo-controlled study.

To describe clinical and radiographic outcomes in dogs with uncomplicated pneumonia receiving a shorter (2-week) versus longer (4-week) duration of antimicrobial therapy. 30 client-owned dogs with radiographic evidence of pneumonia. Dogs were randomly assigned to either a 2-week course of antimicrobials followed by a 2-week course of placebo medication (2-week group) or a 4-week course of antimicrobials (4-week group). All study investigators and owners were masked to the treatment group. Dogs were reevaluated at 12 ± 2 days and again at 28 ± 2 days for a physical examination and thoracic radiography. Standard documentation at visits included owner-reported clinical signs, nurse-acquired history, the clinician's physical examination, the number of affected lung lobe segments, and the global radiographic severity scores assigned. Outcomes investigated included the persistence of clinical and radiographic signs of pneumonia. 28 dogs (93.3%) experienced complete resolution of clinical signs by the first visit, and no dogs in either group experienced relapse of clinical signs during the study period. Eighteen of 30 dogs (60%) and 25 of 30 dogs (83%) experienced complete resolution of radiographic lesions at the first and second study visits, respectively. The remaining 5 dogs (17%) had either stable (4 dogs) or continued (1 dog) improvement in radiographic lesions. Resolution of clinical and radiographic signs followed similar courses in dogs with uncomplicated pneumonia receiving a 2-week course of antimicrobials compared to a 4-week course. Clinical signs may be more useful for guiding discontinuation of antimicrobial therapy for pneumonia than radiographic signs.

275 Frequency of chronic passive congestive livers at harvest in the Texas Panhandle and the association with carcass outcomes

Abstract Chronic passive congestive (CPC) livers are reported as one of the most common clinical signs of right-sided Bovine Congestive Heart Failure (BCHF). Frequency of CPC livers at harvest and the associated loss of offal and carcass value does not appear in the literature. Our objectives were to 1) quantify the frequency of CPC livers at harvest within the Texas Panhandle, and 2) evaluate the association with offal and carcass outcomes. Audits were performed over the duration of a production week (both harvest shifts) per each large commercial beef processing facility (4 total) in the Texas Panhandle. West Texas A&amp;M University trained personnel identified CPC (large blue) livers at evisceration and documented heart score (HS; scale 1 = normal to 5 = extreme structural changes), liver weight, USDA-FSIS inspection fate (U.S. Inspected &amp; Passed; U.S. Condemned) of the liver, remaining viscera, and carcass. Other visual observations (sex, predominant black hair coat color, carcass/visceral edema, liver abscesses) were noted. 1) Frequency data were documented among cattle-type populations: sex (steers, heifers, cows, bulls), and phenotype [native, dairy-cross, dairy, category-B (Mexico-origin)]. 2) Carcass and lot identification were collected for the purpose of tracking and obtaining carcass grading data. Of carcasses deemed wholesome-U.S. Inspected &amp; Passed, USDA yield and quality metrics [hot carcass weight (HCW), 12th-rib fat thickness (FT), ribeye area (REA), marbling score (MS)] of those identified with CPC, as well as data for the balance of respective lots were collected. Carcass outcomes of those exhibiting a CPC liver were compared with the outcomes of remaining lot. Frequency data were analyzed via chi-square. Carcass data were analyzed using mixed models, where occurrence of CPC liver was the fixed effect; facility, cattle type, and sex were random effects. A total of 83,527 animals were audited, with a CPC liver frequency of 0.17% (n = 144). Frequencies among sex (steer = 0.16%; heifer = 0.17%; cow = 0.33%; P &amp;lt; 0.01) and phenotypes (native = 0.15%; category-B = 0.04%; dairy cross = 0.14%; P = 0.01) were documented. Heart scores ranged from 1 to 4, with HS 3 occurring most frequently [HS 1 (n = 2); HS 2 (n = 39); HS 3 (n = 62); HS 4 (n = 17)]. Weights of CPC livers ranged from 7.3 kg to 34.4 kg; the heaviest CPC livers were recorded in cows (mean = 17.2 kg; P &amp;lt; 0.01). Despite USDA-FSIS guidelines, 2.08% of CPC livers were U.S. Inspected &amp; Passed, along with 16.90% of viscera and 84.03% of carcasses. Cow carcasses encountered the greatest U.S. Condemn-rates (38.24%) among the sex categories. Within the fed-beef population, natives were the only category resulting in U.S. Condemned carcasses (10.64%). All carcass outcomes were decreased (P ≤ 0.01) by CPC livers.

Risk of SARS-CoV-2 infection in professional settings, shops, shared transport, and leisure activities in France, 2020–2022

PurposeThe aim of the study was to identify settings associated with SARS-CoV-2 transmission throughout the COVID-19 pandemic in France.MethodsCases with recent SARS-CoV-2 infection were matched with controls (4:1 ratio) on age, sex, region, population size, and calendar week. Odds ratios for SARS-CoV-2 infection were estimated for nine periods in models adjusting for socio-demographic characteristics, health status, COVID-19 vaccine, and past infection.ResultsBetween October 27, 2020 and October 2, 2022, 175,688 cases were matched with 43,922 controls. An increased risk of infection was documented throughout the study for open-space offices compared to offices without open space (OR range across the nine periods: 1.12 to 1.57) and long-distance trains (1.25 to 1.88), and during most of the study for convenience stores (OR range in the periods with increased risk: 1.15 to 1.44), take-away delivery (1.07 to 1.28), car-pooling with relatives (1.09 to 1.68), taxis (1.08 to 1.89), airplanes (1.20 to 1.78), concerts (1.31 to 2.09) and night-clubs (1.45 to 2.95). No increase in transmission was associated with short-distance shared transport, car-pooling booked over platforms, markets, supermarkets and malls, hairdressers, museums, movie theatres, outdoor sports, and swimming pools. The increased risk of infection in bars and restaurants was no longer present in restaurants after reopening in June 2021. It persisted in bars only among those aged under 40 years.ConclusionClosed settings in which people are less likely to wear masks were most affected by SARS-CoV-2 transmission and should be the focus of air quality improvement.ClinicalTrials.gov (03/09/2022)NCT04607941.

Abstract P301: A Meta-Analysis of Randomized Controlled Trials: Aldosterone Synthase Inhibitors as a Therapeutic Strategy for Hypertension

Introduction: Hypertension is a widespread health concern globally, often associated with excessive aldosterone production. Aldosterone synthase inhibitors (ASIs) have been proposed as potential therapeutic agents. Yet, their effectiveness and safety in managing blood pressure in hypertensive adults are not definitively established. This study aims to elucidate this matter through a comprehensive systematic review and meta-analysis of Randomized Controlled Trials (RCTs). Hypothesis: We hypothesize that ASIs could be a safe and effective strategy for managing blood pressure in adults diagnosed with hypertension. Methods: A systematic review and meta-analysis of seven RCTs were conducted to assess the impact of ASIs versus placebo in hypertensive patients. The studies were systematically sourced from MEDLINE and EMBASE until March 30 th , 2024. Continuous outcomes were pooled using the mean difference (MD), and dichotomous outcomes were pooled using the risk ratio (RR), both with their respective confidence intervals (CI). Results: Our meta-analysis incorporated data from seven randomized studies, averaging 7.7 ± 2.4 weeks in duration, and involving a total of 1440 patients. Compared to placebo, ASIs showed effectiveness in controlling systolic blood pressure (MD: -6.12 mm Hg; 95% CI [−4.32, −7.92]; p &lt; 0.0001; I 2 = 0%) and diastolic blood pressure (MD: −2.71; 95% CI [−1.07, −4.36]; p = 0.001; I 2 = 0%). Notably, the incidence of adverse events did not significantly differ from that observed with placebo (RR: 1.11; 95% CI 0.95 to 1.29; p = 0.18; I 2 = 0%). Conclusions: Our findings suggest that ASIs could be a safe and effective approach for managing blood pressure in hypertensive adults, with no significant difference in the incidence of adverse events compared to placebo. These results advocate for further investigation of ASIs in larger, long-term trials to confirm their safety and efficacy, and to explore any additional therapeutic benefits over mineralocorticoid receptor antagonists. Future research should also thoroughly examine the potential benefits of these inhibitors in diverse patient populations, including those with obesity-associated hypertension and suppressed plasma renin activity.

Electronic Prescribing by Medical Students: Descriptive Data and Inferred Clinical Impact.

We analysed data from the electronic medication chart at tertiary healthcare facilities during Nov 2020-Nov 2023 following a reconfiguration of prescribing permissions allowing medical student inpatient prescribing. A total of 262 students prescribed for 2205 patients. The 17,769 prescriptions were spread throughout the 7-day week and were mainly created in the evening (1600-2100) and within 4 hours of patient entry into hospital. The supervising doctors approved 11,434 (64%) prescriptions, which are inferred to have saved 203 hours of doctor time. Allowing medical students to prescribe facilitates clinical workflow. The impact on student education and prescribing errors requires further work.

Baduanjin exercise for negative emotion of patients undergoing chemotherapy: a systematic review and meta-analysis.

Baduanjin was also called Eight Brocades (EB), a branch of Qigong exercise, is classified as a mild-to-moderate intensity aerobic exercise. It has been theorized that regular practice of EB can alleviate anxiety and depression in patients undergoing chemotherapy; however, there are currently no comprehensive quantitative reviews on the efficacy of EB for this population. Therefore, this meta-analysis aims to investigate the effects of EB on chemotherapy-treated patients. Eight electronic databases were searched from their inception until February 15, 2024, to identify relevant studies. The inclusion and exclusion criteria were applied to filter the retrieved studies. Outcomes were various quantitative assessments. This systematic review was registered in the PROSPERO Registry (registration number CRD42023466630). Nine randomized controlled trials (RCTs) met eligibility criteria (n = 704). The meta-analysis results demonstrated that EB significantly reduced levels of anxiety and depression. Subgroup analysis revealed that the intervention frequency of 1 time/day had a greater effect on the improvement of negative emotions, compared with 2 times/day and 5 times/week. The intervention duration of 4weeks showed more efficacy in reducing depression scores than 12weeks or 16weeks; however, no statistical difference was observed for anxiety scores. EB exercise can reduce depression and anxiety symptoms in chemotherapy-treated patients. However, the results should be interpreted with caution as existing methodological limitations. The findings provided insights into the development of public health initiatives to improve the negative emotion among chemotherapy-treated patients by EB exercise.

Daidzein ameliorates peripheral neuropathy in Sprague Dawley rats.

Neuropathy is the most common disorder comprising peripheral nerve damage in diabetic patients. Prolonged hyperglycaemia and oxidative stress cause metabolic imbalance and are the key reasons for the development of diabetic neuropathy. Daidzein, a soy isoflavone possesses potent anti-hyperglycaemic and antioxidant activity. The present study aims to check the protective effect of Daidzein in diabetic neuropathy in rats. The experimental animal model involved induction of diabetes in rats by intraperitoneal injection of streptozotocin (55mg/kg). Following confirmation of diabetes, the diabetic rats were subjected to oral treatment with varying doses of Daidzein (25, 50, and 100mg/kg) and pregabalin (30mg/kg) for a duration of 4weeks, initiated 6weeks after diabetes induction. Results indicated that Daidzein treatment led to a significant reduction in plasma glucose levels and an improvement in body weight among diabetic animals. Moreover, Daidzein demonstrated a positive impact on sensory functions, as evidenced by the effect on tail withdrawal and response latency. Mechanical hyperalgesia and allodynia, common symptoms of diabetic neuropathy, were also significantly reduced with both Daidzein and pregabalin treatment. Notably, nerve conduction velocities exhibited improvement following the administration of Daidzein and pregabalin. Further investigation into the molecular mechanisms revealed that Daidzein treatment resulted in a notable enhancement of antioxidant enzyme levels and a reduction in the overexpression of NOX-4 in the sciatic nerve. This suggests that Daidzein's therapeutic effect is associated with the inhibition of oxidative stress via NOX-4. In summary, the findings of study suggests that, Daidzein treatment significantly attenuated diabetic neuropathy by inhibiting oxidative stress via NOX-4 inhibition.

The etiological profile of chronic organic non-bloody diarrhea in India: Emergence of inflammatory bowel disease as a dominant cause.

Chronic non-bloody diarrhea may be attributed either to functional or organic diseases. The latter category may present with malabsorption syndrome if there is extensive involvement of the small bowel, whereas diseases of the large bowel may only present with diarrhea sans malabsorption. Indian data has predominantly focussed on the etiological spectrum of malabsorption syndrome in adults. The primary aim of the current study was to evaluate etiological spectrum of chronic organic non-bloody diarrhea in India. This prospective observational study was done at a tertiary care hospital in North India. Patients ≥ 18years presenting with chronic non-bloody diarrhea of > 4weeks duration were enrolled in the study after exclusion of patients with IBS and anal incontinence. During the study period of 12months, 100 patients with chronic organic non-bloody diarrhea were evaluated. A definite etiological diagnosis was made in 97 patients (97%). The mean age of the patients was 48 ± 16.7years (58% males). The median duration of diarrhea was 5.5months (interquartile range [IQR] 3.5, 11). Inflammatory bowel disease (IBD) accounted for 45% of the cases making it the predominant cause for organic diarrhea. GI infections and adult-onset celiac disease accounted for 18% and 9% of the cases, respectively. Pancreatic disease, benign or neoplastic, accounted for 6% of the total cases. Notably, gastrointestinal (GI) malignancies manifesting as chronic non-bloody diarrhea were diagnosed in 5% of the patients. Our data suggests a paradigm shift in the etiological spectrum of chronic organic non-bloody diarrhea in India with the emergence of IBD as the predominant cause displacing GI infections.

Care in the Community: A COVID-19 initiative to reduce hospital re-presentations among community-dwelling people.

The COVID-19 pandemic has had a substantial impact on the utilisation of hospital and emergency department (ED) services. We examined the effect of a rapid response service on hospital re-presentations among people discharged from the ED and short-stay wards at a tertiary referral hospital. This retrospective cohort study compared 112 patients who completed the Care in the Community program with 112 randomly selected controls. Both cases and controls were discharged from hospital between September 2020 and June 2021. Intervention patients were evaluated by a multidisciplinary team, who implemented a goal-directed program of up to 4-weeks duration. Logistic regression, negative binomial regression and Cox proportional hazards regression were used to evaluate outcomes at 28 days and at 6 months. The median time between referral and the first home visit was 3.9 days. In adjusted analyses, the intervention reduced hospital re-presentations at 28 days (odds ratio: .40, 95% confidence interval (CI): .17-.94) and lengthened the time to the first hospital re-presentation (hazard ratio: .59, 95% CI: .38-.92). Although the intervention did not reduce the total number of hospital re-presentations at 6 months (adjusted incidence rate ratio: .73, 95% CI: .49-1.08), it reduced total time spent in hospital by 303 days (582 vs. 885). This study is among the first to investigate the effect of a community-based intervention on hospital re-presentations during the COVID-19 pandemic. It provides evidence that a sustainable 4-week intervention is associated with reduced hospital re-presentations and time spent in hospital.

Post-gastric sleeve gastrectomy mixed Wernicke's and Hashimoto's encephalopathies with brain atrophy: A case-report from Qatar

We present a case of a 21-year-old male patient who presented with progressive dizziness, gait instability, and ataxia of 1-week duration. Three months prior to presentation, the patient underwent Laparoscopic Sleeve Gastrectomy (LSG). His workup showed a very low level of thiamine, high thyroid-stimulating hormone (TSH) level, and very low free thyroxine (T4). The patient was diagnosed with Wernicke Encephalopathy (WE) post LSG, exacerbated by Hashimoto Encephalopathy (HE), given the history of an underlying uncontrolled Hashimoto's thyroiditis (HT).

Reliability of a Modified Watson-Jones Classification for Tibial Tubercle Fractures in Children.

The first case report describing a pediatric fracture of the tibial tubercle was published in 1852 in the Medical Times and Gazette, a Journal of Medical Science, literature, criticism, and news. A century later, in 1955, Sir Watson-Jones introduced the first classification system for this fracture. Despite the existence of several classification systems for pediatric tibial tubercle fractures in the medical literature, a crucial aspect of their validation-reliability and reproducibility-has not yet been systematically evaluated. In this study, a modified Watson-Jones (mWJ) classification system of tibial tubercle fractures in children was assessed for intraobserver and interobserver variability. Using the mWJ classification, 3 board-certified pediatric orthopaedic surgeons and 3 orthopaedic surgery residents, classified thirty tibial tubercle fractures based on anteroposterior and lateral radiographs on 2 separate occasions in a 2-week duration. Further comparison was made to evaluate the impact of advanced imaging, specifically computed tomography or magnetic resonance imaging, on diagnostic reliability and reproducibility. The study found substantial intraobserver reliability of the mWJ classification based on radiographs alone, with a Cohen weighted kappa (κ w ) coefficient of 0.733. When advanced imaging was utilized, the reliability of the classification improved to κ w = 0.783. Similarly, interobserver reliability demonstrated substantial consistency among observers when using radiographs alone (κ w = 0.69) and improved agreement with advanced imaging (κ w = 0.75). Notably, there was no significant difference in reliability scores between senior-level attendings and residents when analyzed as separate groups. Fracture classification systems are clinically relevant tools that help organize and transfer knowledge efficiently, provide treatment guidance, propose prognostic expectations, and improve communication in academic literature. The present study demonstrated substantial reproducibility of an mWJ fracture classification system both between and within individual surgeon raters. Level III-diagnostic.

Exploring protective potential of Vitamin E in mitigating liver steatosis in alcoholic liver injury.

Objective: To investigate and assess the efficacy of Vitamin E in preventing or reducing fatty liver changes associated with alcoholic liver injury. Study Design: Experimental study. Setting: Department of Anatomy and Animal Facility of Peshawar Medical College, Peshawar. Period: February 2018 to April 2020. Methods: The study involved eighteen male domestic rabbits (Oryctolagus cuniculus), organizing them into categories based on the time frames specified for the research. Animals in "Category E8" were subjected to an 8-week time period, while those in "Category E4" underwent a 4-week experimental duration. Each category was further divided into three groups: "Control Group A" received standard laboratory food and daily access to normal saline as drinking water, "Experimental Group B" received standard nutrition, a 30% ethanol solution in distal water (30ml per kg/day) and normal saline for drinking, and "Experimental Group C" was treated with the necessary standard diet, a 30% ethanol solution in distal water (30ml per kg/day), and "Vitamin E" (50mg dissolved in 2ml distal water per kg/day) via nasogastric tube. Liver tissue specimens from all animals were stained with H&amp;E and Masson’s trichrome stain for quantification of fatty change. Results: A significant difference in steatosis development was observed among the E4 groups and among the E8 groups having a respective p-values of 0.001 and 0.003. This underscored the impact of alcohol within the context of alcohol-induced liver injury. However, no appreciable differences were noted between BI &amp; CI and BII &amp; CII (p-values &gt; 0.05) indicating no significant distinction in liver steatosis between subjects treated with vitamin E and those not receiving vitamin E. Conclusion: In the context of alcohol-induced liver injury, the study failed to deliver anticipated protective benefits of vitamin E. There is a possibility of adverse effects, potentially rendering its use counterproductive.

Mini-invasive video thoracoscopic interventions in patients with acute pleural empyema

The use of video thoracoscopic interventions in patients with acute pleural empyema is gaining momentum in modern thoracic surgery. The need of determining the optimal timing of their implementation depending on the duration of the disease and the nature of changes in the parietal and visceral pleura remains open. The nature of changes in the parietal and visceral pleura of 249 patients with acute pleural empyema treated with video thoracoscopic interventions was evaluated. Patients were divided into 5 groups depending on the duration of the disease. It was determined that fibrinous accumulations in acute pleural empyema are replaced by cavity fragmenting formations after 6 weeks from the onset of the disease. The cessation of purulent exudate accumulation and the duration of pleural drainage after thoracoscopy depends on the duration of the disease at the time of thoracoscopy, as evidenced by the duration of pleural drainage in the period up to one month – 8 days from the onset of the disease, up to two months – 15 days, and after 8 weeks of duration – reached 20 days. The main indications for open surgical intervention in this group of patients were the failure of fractional lavage of the empyema cavity due to drainage or the impossibility of adequate rehabilitation according to the presence of a bronchopleural fistula with a duration of its existence of no more than 1 month and no tendency to closure. Inflammatory changes in the pleura in the form of fibrin deposits and cavity fragmentation in pleural empyema increase rapidly enough, the possibility of its effective rehabilitation during thoracoscopy without open surgical interventions is limited to 6 weeks from the onset of the disease. Keywords: acute purulent diseases of the pleura, minimally invasive surgical treatment, sanitation of the pleural cavity, duration of the disease.

Respiratory Syncytial Virus in Adult Patients at a Tertiary Care Hospital in Germany: Clinical Features and Molecular Epidemiology of the Fusion Protein in the Severe Respiratory Season of 2022/2023.

Following an interseasonal rise in mainly pediatric respiratory syncytial virus (RSV) cases in Germany in 2021, an exceptionally high number of adult cases was observed in the subsequent respiratory season of 2022/2023. The aim of this study was to compare the clinical presentation of RSV infections in the pre- and post-SARS-CoV-2 pandemic periods. Additionally, the local epidemiology of the RSV fusion protein was analyzed at a molecular genetic and amino acid level. RSV detections in adults peaked in calendar week 1 of 2023, 8 weeks earlier than the earliest peak observed in the three pre-pandemic seasons. Although the median age of the adult patients was not different (66.5 vs. 65 years), subtle differences between both periods regarding comorbidities and the clinical presentation of RSV cases were noted. High rates of comorbidities prevailed; however, significantly lower numbers of patients with a history of lung transplantation (p = 0.009), chronic kidney disease (p = 0.013), and immunosuppression (p = 0.038) were observed in the 2022/2023 season. In contrast, significantly more lower respiratory tract infections (p < 0.001), in particular in the form of pneumonia (p = 0.015) and exacerbations of obstructive lung diseases (p = 0.008), were detected. An ICU admission was noted for 23.7% of all patients throughout the study period. Sequence analysis of the fusion protein gene revealed a close phylogenetic relatedness, regardless of the season of origin. However, especially for RSV-B, an accumulation of amino acid point substitutions was noted, including in antigenic site Ø. The SARS-CoV-2 pandemic had a tremendous impact on the seasonality of RSV, and the introduction of new vaccination and immunization strategies against RSV warrants further epidemiologic studies of this important pathogen.

Efficacy and Safety Evaluation of Tacrolimus-Eluting Stent in a Porcine Coronary Artery Model.

A drug-eluting stent (DES) is a highly beneficial medical device used to widen or unblock narrowed blood vessels. However, the drugs released by the implantation of DES may hinder the re-endothelialization process, increasing the risk of late thrombosis. We have developed a tacrolimus-eluting stent (TES) that as acts as a potent antiproliferative and immunosuppressive agent, enhancing endothelial regeneration. In addition, we assessed the safety and efficacy of TES through both in vitro and in vivo tests. Tacrolimus and Poly(lactic-co-glycolic acid) (PLGA) were applied to the metal stent using electrospinning equipment. The surface morphology of the stent was examined before and after coating using a scanning electron microscope (SEM) and energy dispersive X-rays (EDX). The drug release test was conducted through high-performance liquid chromatography (HPLC). Cell proliferation and migration assays were performed using smooth muscle cells (SMC). The stent was then inserted into the porcine coronary artery and monitored for a duration of 4weeks. SEM analysis confirmed that the coating surface was uniform. Furthermore, EDX analysis showed that the surface was coated with both polymer and drug components. The HPCL analysis of TCL at a wavelength of 215nm revealed that the drug was continuously released over a period of 4weeks. Smooth muscle cell migration was significantly decreased in the tacrolimus group (54.1% ± 11.90%) compared to the non-treated group (90.1% ± 4.86%). In animal experiments, the stenosis rate was significantly reduced in the TES group (29.6% ± 7.93%) compared to the bare metal stent group (41.3% ± 10.18%). Additionally, the fibrin score was found to be lower in the TES group compared to the group treated with a sirolimus-eluting stent (SES). Similar to SES, TES reduces neointimal proliferation in a porcine coronary artery model, specifically decreasing the fibrins score. Therefore, tacrolimus could be considered a promising drug for reducing restenosis and thrombosis.

The impact of SARS-CoV-2 on emergency health care demand: inverse relationship between COVID-like illnesses and ED accesses in Genoa, Italy.

SARS-CoV-2 has changed the demand for in-person health care. The aim of this study was to retrospectively analyzed data on access to San Martino Hospital Emergency Department (ED), Genoa, Italy, during the COVID-19 pandemic. Descriptive statistics for 180,117 records of patients accessing the ED between 2019 and 2021 were reported. A linear regression model was built to evaluate the relationship between the weekly number of COVID-like illness cases and ED attendances. In comparison to pre-pandemic levels, the median number of ED visits declined by 41.6% in 2020 and by 27.4% in 2021. The period of maximum drop in access (-61.9%) was the 2020 12-16th calendar weeks and coincided with the highest rates of COVID-like illness cases (+360%; 22.8% of total ED attendances). About 20% of the variation of the weekly number of ED attendances was explained by the number of COVID-like illness cases. In 2020 and 2021 non-urgent ED codes decreased (-6.7%; -7.3%) and both urgent and emergency ED codes increased (+4.8% and +3.9% the first; +1.9% and +3.5% the second). However, the absolute number of ED access fell drastically for all codes. In particular, the highest increase was registered in 2020 for acute respiratory infections (ARI), including COVID-19 (+3.28%), while traumas and eye diseases saw the highest decrease (-1.02%; -3.80%). While the reduction in non-urgent visits suggests avoidable pre-pandemic access levels, the decline in non-COVID-19 urgent accesses potentially points to an increase in delayed and missed care.

#1273 Rapidly progressive glomerulonephritis with anti-neutrophil cytoplasmic antibodies, in a patient on golimumab

Abstract Background 73-year-old Chinese lady presented with fever, gross hematuria, and dysuria of 1-week duration. She has seronegative arthritis and was treated with human anti-tumor necrosis factor alpha monoclonal antibody (TNF-alpha inhibitor), golimumab injection 50 mg monthly, as she had previous adverse reaction with sulfasalazine and methotrexate. She suffered from severe osteoporosis and was treated with oral alendronic acid. At presentation, her blood pressure was 172/76 mmHg and pulse rate 100 beats per minute. The highest recorded temperature was 38.1 degrees Celsius. Clinical examination was unremarkable. She was diagnosed with rapidly progressive glomerulonephritis (RPGN). Creatinine at presentation was 252 µmol/L, estimated glomerular filtration rate (eGFR) 16 mL/min/1.73 m2. Two months ago, her creatinine was 68 µmol/L, eGFR 66 mL/min/1.73 m2. Urinalysis showed dysmorphic red blood cells of more than 2250 per high power field, few white blood cells, and no epithelial cells. Urine protein/creatine ratio (UPCR) was 2.3 g/g and serum albumin level was 30 g/L. ANA was borderline raised at 1:160 titer with homogeneous pattern. Anti-double stranded DNA (anti-dsDNA) was indeterminate at 29.34 IU. Anti-myeloperoxidase (MPO) antibody was positive at 162 RU/mL (Normal &amp;lt; 20 RU/mL). Anti-proteinase-3 (PR3) antibody was negative. Serum complement levels (C3 and C4) were normal. Screening for hepatitis B, hepatitis C, and HIV was negative. Ultrasound imaging of the kidneys showed raised renal echoes and resistive index. Percutaneous kidney biopsy was performed. On light microscopy, 19 glomeruli were seen. Some displayed segmental increase in mesangial cells and expansion of mesangial matrix. 4 glomeruli showed cellular crescents (Fig. 1). Immunofluorescence showed dominant 2+ staining for Immunoglobulin A (IgA) in the mesangium and electron microscopy revealed electron dense deposits in the mesangial and para-mesangial region. An occasional tubuloreticular structure was found. Diagnosis of IgA nephropathy was made and Oxford classification was M0 E1 S0 T0 C1. Results Our patient presented with rapidly progressive glomerulonephritis (RPGN) with positive MPO antibody, as well as ANA and anti-dsDNA at indeterminate levels. TNF-alpha inhibitors may lead to autoantibody formation and kidney biopsy was the key in clinching the diagnosis for our patient. Diagnosis of IgA nephropathy was made on the basis of dominant mesangial IgA on immunofluorescence and ultrastructural electron dense deposits within the mesangial and para-mesangial area. To our best knowledge, there has been only one case of IgA nephropathy reported with golimumab that occurred after 3 years and with mild albuminuria and no decline in renal function. Golimumab was promptly discontinued for our patient and she was inducted with pulsed methylprednisolone and high dose oral prednisolone 1 mg/kg/day. As she had history of severe osteoporosis, oral mycophenolate mofetil at 750 mg twice a day was commenced as steroid sparing agent. Prednisolone dose was then tapered to 0.5 mg/kg/day. She achieved full clinical remission after 3 months of immunosuppressive therapy. MPO antibody level decreased to normal after 5 months. Arthritis activity remained quiescent and she was maintained on low dose prednisolone. Conclusion We report a case of IgA nephropathy with crescents associated with golimumab. Treatment was successful with withdrawal of drug, oral prednisolone and mycophenolate mofetil.