Initial Evaluation Research Articles

Retrospective Case Series in Patients With Suspected Pelvic Venous Disorder: The Use of Ultrasound in Diagnosis and Treatment of Complex Pelvic Venous Disease

Pelvic venous disorders encompass a broad range of conditions associated with pelvic venous insufficiency, often presenting in multiparous women as chronic pelvic pain and heaviness, vulvar and lower extremity varicosities, and other symptoms of venous congestion. Differential diagnoses of chronic pelvic pain include dysmenorrhea, pelvic venous disorders, endometriosis, and irritable bowel syndrome. Pathophysiology and treatment can vary significantly in pelvic venous disorder. Duplex imaging is an essential first-line tool in diagnosing and treating pelvic venous disorder. We performed a retrospective review of 3 multiparous female patients with suspected pelvic venous disorder, with an emphasis on the usage of duplex imaging for diagnosis and treatment. The first case involved a 32-year-old female gravida 3 with pelvic pain and varicosities postpartum. Transabdominal ultrasound revealed left ovarian vein reflux with retrograde flow and left renal vein compression. She underwent left ovarian vein embolization with significant improvement in symptoms. The second case involved a 42-year-old female gravida 2 with deep pelvic pressure and pelvic varicosities, symptoms worsening at night. Venography and intravascular ultrasound revealed left common iliac vein compression, left ovarian vein dilation, and left renal vein compression. She underwent left ovarian vein coil embolization, vein stenting, and sclerotherapy, which improved pelvic pain, but left flank pain persisted. She was referred out for surgical intervention. The third case involved a 29-year-old female gravida 4 with severe left pelvic pain around ovulation. Transabdominal ultrasound revealed left ovarian vein reflux with spontaneous retrograde flow, left renal vein compression, and left common iliac vein compression. After further diagnostic imaging, the patient underwent bilateral ovarian vein embolization with some improvement. These 3 cases demonstrate the complexity of pelvic venous disorder and the important role that duplex imaging plays in initial evaluation of patients with suspected pelvic venous disorder.

Construction of Internet Plus Wound Care Service Quality Evaluation System Based on Donabedian and SERVQUAL Models-A Delphi-Analytic Hierarchy Process Study.

The objective of this study was to develop an Internet Plus wound care service quality evaluation system within the context of digital and intelligent medical care services. We utilized the Donabedian and SERVQUAL models as the theoretical framework, establishing an initial evaluation system through a literature review and semi-structured interviews. This evaluation system was refined through two rounds of Delphi expert consultations, and the weights of each level of indicators were determined using the Analytic Hierarchy Process (AHP). The statistical results indicated a return rate of 100%, with authority coefficients of the experts at 0.898 and 0.906, respectively. The experts' opinions were relatively concentrated and consistent. After two rounds of consultations, the importance values of indicators exceeded 4.5 points, the variation coefficient was below 0.25, and the Kendall coordination coefficients for secondary and tertiary indicators were 0.163 and 0.131, respectively, all with p < 0.001. The final indicator system comprised 3 primary indicators, 10 secondary indicators, and 59 tertiary indicators, demonstrating strong scientific validity and reliability.

Endocrinologic Findings That Necessitate Referral.

This paper aims to support primary care providers to recognize pediatric endocrine conditions, assisting with initial evaluation and timely identification of children and adolescents who may need endocrinology referral.

Scale to predict risk for refractory septic shock based on a hybrid approach using machine learning and regression modeling.

To develop a scale to predict refractory septic shock (SS) based on clinical variables recorded during initial evaluations of patients. Multicenter retrospective study of data for patients with suspected infection registered in the Marketplace for Medical Information in Intensive Care (MIMIC-IV). These data were used for the development and internal validation of the refractory SS scale (RSSS). For external validation, we used retrospective data for 2 cohorts: 1) patients diagnosed with SS in an emergency department (ED cohort) whose data were registered in a Korean SS registry, and 2) patients diagnosed with SS in 6 hospital intensive care units (ICU cohort). A machine-learning automatic clinical scoring system (AutoScore) was used in the development phase. The performance of the RSSS in the validation cohorts was assessed with the area under the receiver operating characteristic curve (AUROC) for each. The primary outcome was the development of refractory SS within 24 hours of ICU admission. Refractory SS was defined by the need for a norepinephrine-equivalent dose greater than 0.5 µg/kg/min. We collected data for 29 618 patients from the MIMIC-IV registry, 3113 patients for the ED cohort, and 1015 for the ICU cohort. The RSSS had 6 predictors: serum lactate level, systolic blood pressure, heart rate, temperature, arterial pH, and leukocyte count. The scale's AUROCs were as follows: 0.873 (95% CI, 0.846-0.900) in the internal validation, 0.705 (95% CI, 0.678-0.733) in the ED cohort on arrival, 0.781 (95% CI, 0.757-0.805) in the ED cohort at the moment of diagnosing hypoperfusion or hypotension, and 0.822 (95% CI, 0.787-0.857) in the ICU cohort. Calibration was acceptable in all the cohorts. The RSSS had adequate diagnostic accuracy in multiple cohorts of patients diagnosed in the ED and ICU.

First true blood pressure measurement with micropulse detection of arterial opening achieved

There is a well-accepted need for a new more accurate solution to automatic blood pressure measurement, in spite of clinical convenience continuing to encourage the adoption of oscillometric devices with their known poor accuracy throughout healthcare. Our solution avoids estimates, mathematical modelling, oscillometric algorithms, and inadequate calibration against numerous private clinical data sets. Here we show that our new technique detects, from an arm cuff, micropulses associated with arterial opening between systolic and diastolic pressures; hence detecting systole at the first micropulse and diastole at the last, during cuff deflation. Our technique has equivalent accuracy to the gold standard auscultatory method, and is significantly better than the requirements of the current international standard for blood pressure devices. Our results provide scientific evidence for the effectiveness of our technique, and demonstrate significant clinically important improvements. We anticipate that our technique can be automated easily and economically. We acknowledge that this early study is an initial manual evaluation, but expect this new technique to be an automated universal solution for true blood pressure measurement, and a vital step change in an important clinical measurement in healthcare of the worldwide population.

Progressive ataxia, cognitive decline, urinary incontinence, and unexplained hydrocephalus: a rare case of idiopathic normal pressure hydrocephalus in epileptic patient

Introduction: Idiopathic normal pressure hydrocephalus (iNPH) poses diagnostic challenges due to its overlapping symptoms with other neurodegenerative disorders. The clinical trial of gait disturbance, cognitive impairment, and urinary incontinence often mimics other conditions, making accurate diagnosis crucial. Case presentation: A 67-year-old male with a 40-year history of epilepsy presented with progressive gait abnormalities, cognitive decline, and bladder incontinence over 5 years. Initial evaluation revealed a magnetic gait, impaired short-term memory, and a Mini-Mental State Examination score of 17/30. MRI and CT scans showed ventriculomegaly without elevated cerebrospinal fluid (CSF) pressure. A lumbar puncture with a positive CSF tap test confirmed iNPH, and ventriculoperitoneal shunt surgery was performed, resulting in significant improvement in symptoms. Discussion: iNPH is characterized by the triad of gait disturbance, cognitive impairment, and urinary incontinence. Its diagnosis is primarily based on clinical presentation and neuroimaging. The CSF tap test is a crucial diagnostic tool, and shunt surgery remains the standard treatment. This case underscores the need for a high index of suspicion for iNPH in patients with atypical presentations and emphasizes the importance of long-term follow-up to monitor treatment efficacy. Conclusion: This case highlights the complexity of diagnosing iNPH, particularly in patients with comorbid conditions such as epilepsy. Thorough diagnostic evaluations and timely intervention are critical for improving patient outcomes. Long-term monitoring is essential to assess the effectiveness of treatment and manage potential complications.

Challenges Surrounding Hemodialysis Initiation Faced by Undocumented Immigrants.

Hemodialysis care in the United States for undocumented immigrants remains a challenging issue. The objective of this study is to evaluate the timeliness of nephrology and vascular surgery care provided to undocumented immigrants with end-stage renal disease (ESRD) compared to their documented counterparts. Additionally, we evaluate catheter-related complications in undocumented patients on hemodialysis (HD). A retrospective chart analysis was performed of patients undergoing first-time arteriovenous access (AVA) creation at a single center from 2012-2018 to compare outcomes between documented and undocumented patients. Additionally, within the undocumented group, we compared outcomes between patients dependent on a central venous catheter (CVC group) to patients with a CVC and transition to an AVA (CAV group). The primary outcomes were time to initial evaluation by nephrology, vascular surgery, and AVA creation, as well as complications associated with long-term CVC use within the undocumented patients. 290 patients underwent first-time AVA creation (62 undocumented, 228 documented). Undocumented patients were younger at the time of surgery and, more commonly, Hispanic. Undocumented patients were more likely to receive their first nephrology evaluation upon HD initiation (59.7% vs 25.4%, p<0.001). Regarding vascular access surgery initial evaluation for AVA creation, undocumented patients were more likely to be evaluated after initiating HD (74.2% vs. 38.6%, p<0.001). After being evaluated for AVA creation, there was no difference in time from vascular surgery evaluation to surgery (25 days vs. 20 days, p=0.95) or from surgery to AVA maturation (77 days vs. 57 days, p=0.31). As a result, undocumented patients were more likely to start dialysis with a CVC (90.3% vs 66.7%, p=0.0004). Undocumented in the CVC group were more likely to experience catheter-related complications compared to their undocumented counterparts in the CAV group (CVC 72.5% vs CAV 45.9%, p=0.032). The CAV patients were found to have an earlier occurrence of their first catheter-related complications, driving an earlier evaluation for AVA creation and subsequent CVC removal. Due to limited access to healthcare, undocumented immigrants with ESRD had a significant delay in evaluation by nephrologists and vascular access surgeons for AVA creation with a higher use of CVC for dialysis initiation. CVC-related complications are highly frequent and avoidable in undocumented patients with an earlier referral for creation of appropriate AVA.

The role of cardiac magnetic resonance in cardiac arrest without initial underlying cause

Abstract Introduction The primary cause of sudden cardiac death is ischemic heart disease, but often we evaluate patients where this is excluded. Initial evaluation with echocardiogram may overlook certain morphological or functional alterations. Cardiac magnetic resonance (CMR) is recommended for survivors of cardiac arrest (CA) without a clear underlying cause (class I, level B). There is a lack of data from multicenter studies. Our aim is to assess whether CMR helps to clarify the aetiology of CA in our setting. Methods Retrospective observational study of survivors of CA with good neurological outcome with suspected cardiac cause admitted to Cardiology from October 2016 to April 2024. The patients did not show significant coronary lesions or those considered to be responsible for the arrest. CMR was performed for aetiological study and, on an individual basis, electrophysiology study, provocation test and/or genetics. Baseline characteristics and results of complementary tests were recorded. Results Thirty-two patients were included (figure 1). The average age was 50±9 years, over half were men (62,5%), and the majority had a shockable rhythm (87.5%). Genetic testing revealed a variant of uncertain significance or pathogenic in 40.6%. CMR found left ventricular (LV) systolic dysfunction in 31.3%, dilation in 18.8%, hypertrophy in 9.4%, and nonspecific morphological alterations in 9.4%. Similarly, right ventricular (RV) systolic dysfunction was observed in 9.4%, dilation in 6.3%, and morphological alterations in 6.3%. Diffuse fibrosis or interstitial disease was noted in 21.9%, edema in 18.8%, and late gadolinium enhancement in LV and/or RV in 40.6%. Figure 2 shows CMR diagnosis and final diagnosis based on initial suspicion. CMR reclassified 37.5% of patients and provided the diagnosis in 62.5% of patients. Conclusions CMR is a non-invasive test that constitutes a valuable tool in the context of initially non-ischemic CA, providing a comprehensive evaluation of cardiac structure, function, and tissue characterization. Routine use of CMR after CA decreases the percentage of patients classified as idiopathic ventricular fibrillation and reclassifies the diagnosis in more than a third, with consequences for the management and prognosis of the patient and their families. Demographic data and complementary tests Initial, CMR and final diagnosis

P-1766. Evaluation of a Comprehensive Antimicrobial Stewardship Initiative for Gram-Negative Bacteremia in 21 Acute Care Hospitals

Abstract Background Shorter antibiotic courses are non-inferior to longer for treatment of uncomplicated gram-negative bacteremia (GNB). This study evaluated the impact of a pharmacist-driven stewardship effort to use clinical decision support software (CDSS; ILÚM Insight, Infectious Diseases Connect, Inc.) plus an evidence-based treatment algorithm on antibiotic duration of therapy (DOT) for GNB in the UPMC health system, USA. Methods This retrospective cohort study utilized CDSS alerts for Enterobacterales GNB in adults from March to August 2022 (pre-intervention) and March to August 2023 (post-intervention). We excluded patients with complicated or polymicrobial GNB, admission ≤ 24 hours or death ≤ 72 hours after blood culture result, index culture outside of a UPMC facility, or severe immunocompromising condition. We matched patients using a propensity score incorporating age, sex, and comorbidities. We compared total antibiotic DOT using a Wilcoxon rank-sum test, and compared key secondary outcomes, including infection-related readmission, C. difficile infection (CDI), development of multi-drug resistant organisms (MDRO), and all-cause death using Cochran-Mantel-Haenszel statistics. Results After initial screening, 1586 patients met inclusion criteria; of these, 411 and 426 patients were included in final pre- and post-intervention analyses, respectively (Table 1). Primary reasons for exclusion were complicated (35.8%) or polymicrobial (7.3%) infection. Median DOT was shorter post-intervention (10.5 days) versus pre-intervention (12.5 days; p &amp;lt; 0.0001), and patients receiving ≤ 7 days of therapy increased from 14.8% to 19.6% post-intervention. Pharmacist engagement with CDSS alerts increased from 29% to 41% (p &amp;lt; 0.005). Rate of IV to oral de-escalation, percent discharge on antibiotics, length of stay, and rate of treatment-emergent adverse effects did not differ significantly pre- and post-intervention (Table 2). Conclusion Preliminary findings suggest that pharmacist engagement with CDSS alerts in combination with an evidence-based treatment algorithm is associated with shorter antibiotic therapy duration. Ongoing subgroup analyses will help target future stewardship efforts to certain patient populations or facilities for continued improvement. Disclosures Ryan K. Shields, PharmD, MS, Allergan: Advisor/Consultant|Cidara: Advisor/Consultant|Entasis: Advisor/Consultant|GSK: Advisor/Consultant|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Menarini: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Roche: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Utility: Advisor/Consultant|Venatorx: Advisor/Consultant|Venatorx: Grant/Research Support Erin K. McCreary, PharmD, Abbvie: Advisor/Consultant|Basilea: Advisor/Consultant|Ciadara: Advisor/Consultant|Entasis: Advisor/Consultant|Ferring: Advisor/Consultant|GSK: Advisor/Consultant|GSK: Honoraria|Melinta: Advisor/Consultant|Merck: Advisor/Consultant|Pfizer: Honoraria|Shionogi: Advisor/Consultant|Shionogi: Honoraria

Enhancing professionalism in post-graduate medical education: the initial implementation and evaluation of a longitudinal curriculum for geriatrics residents in Toronto, Canada

Background: Professionalism is vital in medicine, yet gaps exist in its teaching within post-graduate medical education (PGME). Methods: We developed an eight-session curriculum on professionalism for geriatrics residents at the University of Toronto. Topics included personal-professional identity, physician well-being, communication, and leadership, incorporating a focus on self-reflection throughout. We evaluated the curriculum in two ways: (1) we captured immediate reactions using standard evaluations with Likert-scale questions on teaching effectiveness. (2) Graduated residents participated in semi-structured interviews to assess deeper reactions and longer-term impacts on professional identity and practice. Interview transcripts were rigorously analyzed using thematic. Results: The teaching effectiveness scores averaged from 80 written evaluations were excellent: 4.45/5 (89%). We interviewed 12 of 22 eligible graduates (55%). Thematic analysis demonstrated that the curriculum impacted residents in three key thematic areas: (1) it led participants to understand their role as physicians in a more comprehensive way, while staying consistent with their personal values and strengths. (2) Communication skills training in particular equipped learners with important skills needed to enact their professional standards. (3) Through developing a supportive community and practicing mindful self-reflection, participants reported improvements in their well-being. Conclusions: This paper demonstrates that professionalism can and should be integrated into the formal curriculum of post-graduate medical education. Key success factors in our study included a focus on fostering peer support and training in communication skills as a concrete method to actualize personal professional standards.

An Initial Evaluation of the Effects of an Exchange Task with Varying Amounts of Exchange Points in Triadic Interactions

An Initial Evaluation of the Effects of an Exchange Task with Varying Amounts of Exchange Points in Triadic Interactions

Utility of Computed Tomography Angiography of the Head in the Management of the Blunt Trauma Patient with Intracranial Hemorrhage.

Computed tomography angiography of the head (CTAH) is not routinely obtained during the initial evaluation of patients with traumatic intracranial hemorrhage (ICH); however, it is useful for diagnosing vascular pathologies that may have led to the bleed. The aims of this study were to identify traumatic ICH patient characteristics on presentation that are associated with positive CTAH findings to elucidate which ones should prompt a CTAH and compare outcomes of patients with positive and negative CTAH findings. This is a retrospective cohort study of 522 patients who had blunt traumatic ICH and subsequently received CTAH between January 1, 2017, and January 1, 2022. Patients were then sorted into two cohorts: positive and negative CTAH findings. The CTAH findings were our primary outcomes and included a spectrum of traumatic vascular injuries as well as nontraumatic vascular pathologies. Secondary outcomes included mortality, intensive care unit admission, intensive care unit length of stay, and neurological intervention rates. A total of 108 patients (20.7%) had positive CTAH findings. Patients with positive CTAH findings were more likely to be older, have lower heart rate, have more neurological deficits at admission, have fewer signs of external injury, and have increased need for cerebral angiogram and neuro-embolization. Patients with no pathologic CTAH findings were 3.9 times more likely to be alive at discharge. Initial heart rate and presence of neurological deficits on arrival were found to be independent predictors of positive CTAH findings. Empiric CTAH is not necessary in all traumatic ICH patients. However, given the increased rates of neurologic procedures and mortality in patients with positive findings on CTAH, we recommend obtaining CTAH in blunt traumatic ICH patients who present with neurological deficits. The presence of external injuries alone should not influence the clinician's decision to obtain a CTAH. Prognostic and Epidemiological; Level III.

Short on time—big on impact: MeetingHacks as a digital intervention to enhance virtual meeting collaboration

Abstract This contribution to the journal ‘Gruppe. Interaktion. Organisation. (GIO)’ presents a novel video learning format for optimizing virtual meetings as well as initial evaluation data on its usefulness and application in an organizational context: the MeetingHacks. Effective collaboration in virtual meetings requires a novel approach to fusing communication and technology. To enhance virtual meetings through accessible digital interventions, we developed MeetingHacks, a series of short videos based on findings of contemporary meeting science. These MeetingHacks address general aspects as well as professional, methodological, social, and proactive aspects of meeting behavior, aligning with the four facets of team skills of the Kassler competence grid. The introductory video, Meetings General, triggers reflective processes to enhance the impact of the subsequent MeetingHacks. Meetings Professional focuses on professional skills, particularly the interplay of problems and solutions and knowledge transfer, drawing on results from interaction analysis and shared mental models. Meetings Structured addresses methodological behavior, emphasizing structured meeting designs. Meetings Social covers prosocial behavior, focusing on making social and informal interaction in virtual meetings more tangible. Meetings Proactive highlights responsibility and proactivity in meetings, informed by interaction analysis and reflection research. The MeetingHacks were implemented over five weeks in a corporate setting and evaluated for their usefulness, applicability, and fit within daily routines. The results demonstrated the benefits and limits of MeetingHacks in an organizational context. Based on this evaluation, this article critically discusses the merits and further development of the MeetingHacks and their effectiveness as a digital intervention.

P-12 ACTH-INDEPENDENT CUSHING SYNDROME WITH INCONCLUSIVE ADRENAL CT SCAN RESULTS

Abstract Clinical Case We present the case of a 21-year-old lady who visited the Faiha Specialized Diabetes, Endocrine, and Metabolism Center (FDEMC) in Basrah, south of Iraq in 2022. She presented for evaluation of gradually increased hirsutism and secondary amenorrhea. Menarche started at the age of 11 years old; it was regular then, at the age of 13, the patient began to have menstrual irregularities with cycles every 2-3 months and in the same time she noticed gradually increased hair growth in her upper chin, abdomen, and back until the age of 19 years when she visited our center for medical advice. By this time, the patient had secondary amenorrhea; the last cycle was more than 6 months ago. Clinical examination revealed moon face, facial plethora, acanthosis nigricans, buffalo hump, lemon-on-stick appearance, and central obesity with wide purple striae more than 1 cm in diameter. The Ferriman-Gallwey score (FG score) was 30/36, with no frontal baldness, BP 130/90, her height was 148 cm and her BMI was 28.7 kg/m². When Carney's complex features were inspected, she had no skin lesions and her Echocardiogram was normal. Drug history was negative. Family history revealed and older sister diagnosed with ACTH-independent Cushing syndrome, who died 10 years ago, on day 4 post-bilateral adrenalectomy, due to complications. Laboratory results revealed cortisol: 23 µg/dL, ACTH &amp;lt;1 pg/mL, DHEAS: 400 µg/dL, total testosterone: 163ng/dL, estradiol: 39.7 pg/mL, and 1-mg overnight dexamethasone suppression test: 21.8 µg/dL. TSH, FSH, LH were normal. Pelvic ultrasonography was normal, apart from mild PCOS changes. The Initial CT-scan of the adrenal gland was normal and pituitary MRI was also normal. ACTH-independent Cushing syndrome was diagnosed, and due to the unfortunate death of her sister, the patient pursued medical treatment for now, ketoconazole tab 200 mg TID was started with interval CT of the adrenals to assess any future changes. A DEXA scan was done with a total Z-score of -1.5. Serum cortisol basal and 2-hours postprandial was done twice on two different occasions and didn’t show any significant difference. After 2 months of ketoconazole treatment, the menstrual cycle resumed but was irregular, being every 14 days (polymenorrhea) and she developed hypertension. Her serum potassium levels did not change from the baseline and stayed around 4.5 mmol/L, and her HbA1c was 5.7. Conclusion The patient is now on ketoconazole tab 200 mg four times a day; her FG score is 26/36; regular cycle and the BP is controlled with spironolactone tab 50mg OD. We don’t have genetic studies, and the only available drug that is suitable for her condition is ketoconazole, which is being up-titrated until the maximum dose is reached. The patient is open to the surgical option if offered any in the future.Figure 1:CT scan of adrenal glandsThis is the second CT scan of adrenal showing thickening of the adrenals, this was taken in November 2023 after 6 months from the initial CT scan. Table 1:Biochemical evaluation after starting ketoconazole tab 200mgBiochemical evaluation after starting ketoconazole tab 200mg three times daily Table 2:Initial biochemical evaluation done to the patient at the FDEMCThis table shows the initial visits results of the patient done at FDEMC, which supports the diagnosis of Cushing syndrome. ONDST: 1 mg overnight dexamethasone suppression test

Hormones, Age, and Erectile Dysfunction: Should Routine Testing Be Part of the Initial Evaluation?

Background/Objectives: The aim of this study was to investigate the relationship between age, the severity of erectile dysfunction (ED), and the various hormones that may influence erectile function. Methods: A multicenter cross-sectional study was conducted between January 2015 and December 2023. The study assessed age, sexual function using the IIEF-15 questionnaire, and the levels of total testosterone (TT), free testosterone (FT), FSH, LH, estradiol, prolactin (PRL), and SHBG. Results: A total of 411 patients were included in the study. The mean age of the patients was 63.19 years. The vast majority (91.73%) exhibited some degree of ED. The severity of ED increases with age, ranging from 56.26 years for patients without ED to 73.12 years for those with severe ED. A statistically significant negative correlation was observed between IIEF and age, while a positive correlation was observed between IIEF and serum levels of TT and FT (p &lt; 0.05). Age was significantly correlated with all evaluated hormones (p &lt; 0.01), except estradiol and prolactin. Total testosterone levels progressively decreased with the increase in the severity of erectile dysfunction, from a median of 7.05 ng/mL in patients with normal erectile function to 3.56 ng/mL in those with severe symptoms, remaining above the normal minimum threshold across all groups, whereas free testosterone (FT) levels also declined progressively. All erectile dysfunction groups had median FT levels below the normal minimum threshold. FSH, LH, and SHBG showed an increase with each progressive severity of erectile dysfunction. The multivariate linear regression revealed that IIEF scores are significantly associated with age, TT, and FT levels, while FSH did not present a statistically significant association in this model. Conclusions: Age shows a significant statistical correlation with both the severity of erectile dysfunction and the levels of total testosterone, free testosterone, LH, FSH, and SHBG. Total and free testosterone levels are significantly associated with the severity of erectile dysfunction, with free testosterone median values remaining above the normal minimum threshold in all patients with erectile dysfunction. Therefore, free testosterone should be considered a routine test, alongside total testosterone. In contrast, LH, estradiol, SHBG, and prolactin do not demonstrate any statistical correlation with erectile dysfunction and should not be recommended as routine investigations.

Ancient Schwannoma of the Left Pleura: A Rare Case Report

Ancient schwannoma, a rare subtype of schwannomas, is a benign tumour typically diagnosed through imaging and histopathological examination. This case reports describes a 36 year old female who presented with cough. Initial evaluation revealed a mass lesion on left side of thorax via Chest X ray

Evaluation of keratinized tissue augmentation using amnion/chorion allograft vs. autogenous connective tissue in implant therapy: a retrospective study

ObjectivesSuccessful implant therapy must also ensure the integration of the soft tissues around the crown/abutment emergence profile. The existing literature does not consistently agree on the necessity of a minimal amount of keratinized tissue (KT), though it appears advantageous for the long-term stability and aesthetics of implants. The purpose of this clinical retrospective study is to compare the effectiveness of amnion/chorion membrane and autogenous subepithelial connective tissue in increasing the keratinized mucosa and maintaining it over a 5-year follow-up.Methods Twenty patients who had previously undergone implant surgery were included in the study. Ten patients had received the allograft (Group 1) and ten had received autogenous connective tissue (Group 2).An independent examiner retrospectively analyzed the patient records at 7, 15, and 60 days, and five years post-procedure. Data from these observations were collected and analyzed using SPSS Statistics, version 25. Descriptive statistical analysis was conducted.Results All patients exhibited an increase in KT. For Group 1, the mean KT width measurements were 1.27 ± 0.46 mm at the initial evaluation, increasing to 2.00 ± 0.38 mm, 2.80 ± 0.78 mm, 3.27 ± 0.80 mm, and 3.01 ± 0.68 mm at 7, 15, and 60 days post-surgery (with prosthesis delivery on day 60), and five years after prosthetic rehabilitation, respectively.ConclusionsWithin the limitations of this retrospective clinical study, both amnion/chorion and connective tissue show significant potential for KT expansion when used in conjunction with implant surgery.Clinical relevanceThe use of allografts, due their low morbidity, and acceptable results should be considered as a viable option for soft tissues augmentations.

Developmental Patterns in Autism and Other Neurodevelopmental Disorders in Preschool Children

Background: Neurodevelopmental disorders (NDDs) encompass an inclusive group of conditions that appear during the developmental period but continue to persist in adulthood, ranging from particular difficulties to a global impairment of social, cognitive, and emotional functioning. The developmental trajectories associated with these conditions are highly heterogeneous. This study aimed to analyze and compare developmental and adaptive profiles of preschool-aged children with different NDDs to better characterize their developmental trajectories. Methods: We analyzed data from the initial global evaluation of 196 children with NDDs (aged 20 to 71 months), enrolled in three subgroups: 108 with autism spectrum disorder (ASD), 52 with language disorder (LD), and 36 with mixed specific developmental disorder (MSDD). A comprehensive neuropsychiatric evaluation was performed using standardized tools (Griffiths-III, ADOS-2, VABS-II, and ADI-R), and the parents completed the DP-3 and the CBCL 1½-5. Results: Our results showed that all NDDs exhibited poor psychomotor skills, with children with ASD being the most impaired, although their profiles were comparable to those of MSDD in communication and motor areas. CBCL’s pervasive developmental problem scale has been shown to provide relevant information for distinguishing children with ASD. Furthermore, DP-3 and VABS-II measure highly differentiated developmental profiles of each diagnostic group. Conclusions: Our results highlighted the importance of including parents’/caregivers’ perspectives in defining children’s functioning and the possibility of using DP-3 as a screening tool for different neurodevelopmental disorders.

Content evaluation of pruritus, skin pain and sleep disturbance patient-reported outcome measures for adolescents and adults with moderate-to-severe atopic dermatitis: qualitative interviews.

Pruritus, skin pain and sleep disturbance place a significant burden on individuals with moderate-to-severe atopic dermatitis (AD) and negatively affect their quality of life. Fit-for-purpose patient-reported outcome measures (PROMs) that assess AD-related pruritus, skin pain and sleep disturbance are important for evaluating the effectiveness of new AD treatments. To evaluate the content validity of five AD-related PROMs in adolescents and adults with moderate-to-severe AD [the Worst Pruritus Numeric Rating Scale (NRS), the AD Skin Pain NRS, the Sleep Disturbance NRS, the skin pain-specific Patient Global Impression of Change (PGIC) and the skin pain-specific Patient Global Impression of Severity (PGIS)], and to assess patient-reported experience with pruritus, skin pain and sleep disturbance. A qualitative study in adolescents (aged 12-17 years) and adults (aged ≥ 18 years) with moderate-to-severe AD was conducted in two consecutive stages. In each stage, two iterative rounds of individual interviews were conducted by experienced interviewers. All interviews included concept elicitation and cognitive debriefing components. Data were analysed using thematic analysis. Twenty-seven adults and 20 adolescents with moderate-to-severe AD took part in the initial content evaluation (stage 1) of the Worst Pruritus NRS (1.0) and AD Skin Pain NRS (1.0) (n = 26; 16 adults, 10 adolescents) and in the subsequent content evaluation (stage 2) of the revised Worst Pruritus NRS (1.1), revised AD Skin Pain NRS (1.1), Sleep Disturbance NRS, skin pain-specific PGIC and skin pain-specific PGIS (n = 21; 11 adults, 10 adolescents). The results were generally aligned and consistent for adult and adolescent participants. Additionally, we found that sleep disturbance is relevant and important for evaluation in adults and adolescents with moderate-to-severe AD (stage 2), while also providing further confirmation of this for pruritus and skin pain (stages 1 and 2). Our findings support the content validity of the revised Worst Pruritus NRS (1.1), revised AD Skin Pain NRS (1.1), Sleep Disturbance NRS, skin pain-specific PGIC and skin pain-specific PGIS in individuals aged ≥ 12 years with moderate-to-severe AD. Furthermore, the findings support sleep disturbance, skin pain and pruritus as being relevant and important for adolescents and adults with moderate-to-severe AD.

Systematic review of the needs and health-related quality of life domains relevant to people surviving cancer in Europe.

To systematically review qualitative studies on outcomes, needs, experiences, preferences, concerns and health-related quality of life (HRQoL) of people surviving cancer in Europe in the last decade. Protocol registered ( https://www.crd.york.ac.uk/PROSPERO , ID575065). studies with qualitative methods, constructs related to HRQoL, andadults surviving cancer in Europe. The search was conducted in PubMed and Scopus since 2013. Abstracts and full text were revised, data extracted and study risk of bias assessed independently by two researchers. The primary outcomes were the themes arising from each study. A thematic analysis stratified according to the study objective was undertaken by grouping themes into categories. Of 18,256 articles identified, 43 fulfilled the inclusion criteria: 16 studies with a generic objective and 27 with specific objectives. Seven categories (57 themes) emerged from the studies with a generic focus: Clinical Management (n = 16), Symptoms and Physical Function (n = 5), Psychological Function (n = 21), Social Function (n = 18), HRQoL (n = 3), Life Disruption (n = 6), and Individual Factors (n = 1). The 12 studies focused on treatment and care experiences stand out among those with specific objectives, with most themes fitting into the same seven categories. Results clearly showed the predominance of the social and psychological function domains over physical domains among people surviving cancer, additionally identifying specific needs in clinical management, such as information and communication, and relationship with and support from professionals. Therefore, these aspects should be incorporated into the evaluation of patient-centred initiatives for people surviving cancer. only two databases were searched, and most European countries were not represented.