Scheduled Follow-up Research Articles

Liquid Nitrogen Cryoballoon Ablation System for Paroxysmal Atrial Fibrillation: A Multicenter, Prospective, Single-Arm Clinical Trial

BackgroundCryoballoon ablation (CBA) has emerged as an effective treatment for atrial fibrillation (AF). ObjectivesThis study sought to assess the performance of a novel liquid nitrogen–driven CBA system and evaluate its safety and efficacy in the treatment of drug-resistant paroxysmal atrial fibrillation (PAF). MethodsThis was a prospective multicenter single-arm clinical trial with 10 participating tertiary hospitals enrolling 176 patients with PAF. All participants received liquid nitrogen–driven CBA developed by the Cryofocus Medtech Company. Scheduled follow-up was performed before discharge and 3 months, 6 months, and 12 months after CBA. The primary endpoints were defined as 1) treatment success (freedom from antiarrhythmic drugs and atrial tachycardia at 12 months after CBA); and 2) immediate success rate of pulmonary vein isolation. The safety endpoint was the incidence of device- and procedure-related adverse events (AEs) and all-cause mortality. ResultsA total of 172 participants were included, with an average age of 59.22 ± 9.25 years and 99 (57.56%) of them men. Immediate success rate was 97.67% (95% CI: 94.15%-99.36%) and 12-month treatment success rate was 82.56% (95% CI: 76.89%-88.23%), including a late recurrence rate of 13.61%. Incidences of device- and procedure-related AEs were 2.27% and 25.00%, respectively. Phrenic nerve palsy (PNP) occurred in 6 patients, of which 5 recovered during follow-up. Although the incidence of total severe AEs was 17.05%, including an all-cause mortality of 0.57%, only 1 case of permanent PNP was related to the CBA procedure. ConclusionsThis premarketing prospective multicenter single-arm clinical trial demonstrated that the liquid nitrogen cryoablation system is safe and effective in the treatment of PAF.

The Prognostic Significance of Selected HLA Alleles on Prostate Cancer Outcome.

Recently, we have shown that HLA-A*02:01 and HLA-A*24:02 in de novo metastatic prostate cancer (MPCa) have an important role in disease progression. Since de novo MPCa represents a small group among patients diagnosed with prostate cancer (PCa), it was obvious to try to extend the validity of our results to larger cohorts of PCa patients. Herein, we analyzed patients irrespective of their disease status at diagnosis to include, besides patients with MPCa, those with localized PCa (LPCa). Our goal was to specify the prognostic value of HLA-A*02:01 and HLA-A*24:02 for overall survival (OS) prospectively and for early biochemical recurrence (BCR) and castrate resistance (CR) as additional clinical endpoints in a prospective/retrospective manner, to improve clinical decisions for patients covering all stages of PCa. On univariate analysis, HLA-A alleles were significantly associated as prognostic biomarkers with early BCR (p = 0.028; HR = 1.822), OS (p = 0.013; HR = 1.547) and showed a trend for CR (p = 0.150; HR = 1.239). On multivariate analysis, HLA-A alleles proved to be independent prognosticators for early BCR (p = 0.017; HR = 2.008), CR (p = 0.005; HR = 1.615), and OS (p = 0.002; HR = 2.063). Kaplan-Meier analyses revealed that patients belonging to the HLA-A*02:01+HLA-A*24:02- group progressed much faster to BCR and CR and had also shorter OS compared to HLA-A*24:02+ patients. Patients being HLA-A*02:01-HLA-A*24:02- exhibited varying clinical outcomes, pointing to the presence of additional HLA-A alleles with potential prognostic value. Our data underline the HLA-A alleles as valuable prognostic biomarkers for PCa that may assist with the appropriate treatment and follow-up schedule based on the risk for disease progression to avoid over-diagnosis and over-treatment.

Neovascular Glaucoma as the Initial Presentation of Ocular Tuberculosis

Purpose: To report a case of ocular tuberculosis that first manifested as neovascular glaucoma.Case summary: A 76-year-old male visited our hospital complaining of decreased visual acuity in the left eye. He had undergone tuberculosis treatment 1 year prior, and had been cured. At the time of his visit, decreased visual acuity, increased intraocular pressure, and iris neovascularization were observed in the left eye. He was diagnosed with neovascular glaucoma and was started on treatment to lower the intraocular pressure. At the time of the visit, we also noticed vitreous opacity in both eyes. The patient did not attend his scheduled follow-up visit, but returned 2 months later complaining of decreased visual acuity in both eyes. The vitreous opacity in the retinae of both eyes had become aggravated. Diagnostic vitrectomy was performed on both eyes, and multiple yellowish-white circular lesions were observed throughout the retinae. Systemic abnormalities were suspected, and thus additional tests were performed. Bronchoalveolar lavage fluid analysis revealed recurrence of pulmonary tuberculosis, and tuberculosis treatment was recommenced. Temporary increases in ocular inflammation and deterioration were observed but improved after the addition of systemic steroids. The patient has been under observation without recurrence for about 1 year.Conclusions: Ocular tuberculosis can be expressed in the form of neovascular glaucoma, so ocular tuberculosis should be suspected if there is a history of tuberculosis and abnormal retinal findings.

Predictors of response to a lapse in anti-VEGF treatment in patients with macular edema secondary to retinal vein occlusion

ContexteL’œdème maculaire (OM) secondaire à une occlusion veineuse rétinienne (OVR) est une cause fréquente de perte de vision à l’échelle de la planète. Les injections d'anti-VEGF (facteur de croissance endothélial vasculaire) représentent le traitement de prédilection de l'OM secondaire à une OVR. Or, malgré leur efficacité, elles constituent un fardeau important pour les patients, d'où des taux élevés d'interruption du traitement et de perte de vue des patients pendant le suivi. MéthodesUne sous-analyse des effets de l'interruption du traitement chez des sujets présentant une OVR a réuni 60 patients, qui ont été séparés en 2 groupes : perte de vision et vision stable, selon l’évolution de la vision après une interruption du traitement. On a eu recours à une analyse de régression logistique qui utilisait l’âge, l'indice de masse corporelle (IMC), les antécédents de dyslipidémie et le temps écoulé depuis le diagnostic d'OVR à titre de facteurs de prédiction d'une perte de vision après une interruption du traitement. RésultatsLa durée moyenne de l'interruption du traitement, qui était de 5,6 mois, était similaire dans les 2 groupes (perte de vision et vision stable). Au départ, les patients du groupe perte de vision étaient plus âgés et avaient un IMC plus faible (p < 0,05). L’âge et les antécédents de dyslipidémie étaient associés à une augmentation de la probabilité de perte de vision par des facteurs de 1,23 (fourchette : 1,10–1,45) et de 8,40 (fourchette : 1,62–66,2), respectivement. L'IMC et le temps écoulé depuis le diagnostic d'OVR étaient associés à une diminution de la probabilité de perte de vision par des facteurs de 0,83 (fourchette : 0,69–0,95) et de 0,95 (fourchette : 0,90–0,99), respectivement. Le modèle final avait une spécificité de 87,5 % et une sensibilité de 70,0 %. ConclusionsIl est possible de prédire de manière raisonnablement précise les effets d'une interruption du traitement de l'OM secondaire à une OVR grâce à des données cliniques facilement accessibles, notamment l’âge, l'IMC, le temps écoulé depuis le diagnostic et les antécédents de dyslipidémie. Les professionnels de la santé doivent tenir compte de ces facteurs lorsqu'ils prodiguent des conseils à leurs patients et établissent un calendrier de suivi.

Rural patient and provider perceptions of telehealth implemented during the COVID-19 pandemic

BackgroundUnderstanding perceptions of telehealth implementation from patients and providers can improve the utility and sustainability of these programs, particularly in under-resourced rural settings. The purpose of this study was to evaluate both patient and provider perceptions of telehealth visits in a large rural healthcare system during the COVID-19 pandemic. To promote sustainability of telehealth approaches, we also assessed whether the percentage of missed appointments differed between in-person and telehealth visits.MethodsUsing anonymous surveys, we evaluated patient preferences and satisfaction with telehealth visits from November 2020 -March 2021 and assessed perceptions of telehealth efficiency and value among rural providers from September–October 2020. We examined whether telehealth perceptions differed according to patients’ age, educational attainment, insurance status, and distance to clinical site and providers’ age and length of time practicing medicine using ANOVA test. We also examined whether the percentage of missed appointments differed between in-person and telehealth visits at a family practice clinic within the rural healthcare system from April to September 2020 using a Chi-square test.ResultsOver 73% of rural patients had favorable perceptions of telehealth visits, and satisfaction was generally higher among younger patients. Patients reported difficulty with scheduling follow-up appointments, lack of personal contact and technology challenges as common barriers. Over 80% of the 219 providers responding to the survey reported that telehealth added value to their practice, while 36.6% agreed that telehealth visits are more efficient than in-person visits. Perception of telehealth value and efficiency did not differ by provider age (p = 0.67 and p = 0.67, respectively) or time in practice (p = 0.53 and p = 0.44, respectively). Technology challenges for the patient (91.3%) and provider (45.1%) were commonly reported. The percentage of missed appointments was slightly higher for telehealth visits compared to in-person visits, but the difference was not statistically significant (8.7% vs. 8.0%; p = 0.39).ConclusionsTelehealth perceptions were generally favorable among rural patients and providers, although satisfaction was lower among older patients and providers. Our findings suggest that telehealth approaches may add value and efficiency to rural clinical practice. However, technology issues for both patients and providers and gaps in care coordination need to be addressed to promote sustainability of telehealth approaches in rural practice.

P11.03.A DOES REGULAR SURVEILLANCE IMAGING IMPROVE SURVIVAL IN GLIOBLASTOMA? RESULTS FROM A NATIONAL, MULTI-CENTRE COHORT STUDY (INTERVAL-GB)

Abstract BACKGROUND Glioblastoma is the most common malignant primary brain tumour in adults and is usually incurable. Post-operative magnetic resonance imaging (MRI) is used to assess extent of resection, and subsequent follow-up MRI is used to monitor response to treatment and to detect progression. The benefit of regular, scheduled follow-up MRI on patient management and outcomes is unclear. MATERIAL AND METHODS In this multi-centre, retrospective observational cohort study we included patients with a histopathologically confirmed glioblastoma, operated between August 31, 2018 and February 1, 2019 who received any adjuvant oncological treatment. Follow-up MRI schedules, indications, and clinical outcomes were collected. The primary objective was to investigate the follow-up MRI surveillance practice after surgery for glioblastoma and assess compliance with recommendations from the National Institute for Health and Care Excellence (NICE) (Post-operative scan &amp;lt;72 hrs, MRI every 3-6 months). The secondary objectives were to determine indications for MRI scans and the association on overall survival (OS) and progression-free survival (PFS). RESULTS 754 patients, with a median age of 63 years (range: 21-84) from 26 neuro-oncology centres were included. Most patients had post-operative MRI within 72 hours of surgery (88.1%, N=407/462). The median number of subsequent follow-up MRI was 1 (Interquartile range 0-4). 28.1% of patients had follow-up MRI in accordance with NICE recommendations (N=212/754). Patients in this group were more likely to receive second-line chemotherapy (28.6% vs 19.5%, P=0.009). The median follow-up period was 10.5 months (IQR 5.3-19.4 months). Median overall survival was 15.1 months (95% CI 12.9-17.3) in the scheduled MRI group and 9.1 months (95% CI 7.8-10.4) in the non-compliant group. On multivariable cox regression analysis, regular, scheduled MRI was independently associated with longer overall survival (HR 1.67, 95% CI 1.33-2.10, P&amp;lt;0.001), but not PFS (HR 1.20, 95% CI 0.98-1.47, P=0.074). Patients with progression first detected on scheduled imaging had a significantly longer OS (18.4 vs 15.6 months, P=0.013) and PFS (9.9 months vs 7.9 months, P=0.041). CONCLUSION Following regular scheduled surveillance follow-up MRI for glioblastoma is associated with longer overall survival. Prospective trials are needed to determine whether regular or symptom-directed MRI influences survival outcomes and quality of life.

Towards patient-led follow-up after curative surgical resection of stage I, II and III colorectal cancer (DISTANCE-trial): a study protocol for a stepped-wedge cluster-randomised trial

BackgroundColorectal cancer (CRC) is among the most frequently diagnosed cancers. Approximately 20–30% of stage I-III CRC patients develop a recurrent tumour or metastases after curative surgical resection. Post-operative follow-up is indicated for the first five years after curative surgical resection. As intensified follow-up after curative surgical resection has shown no effect on survival, patient organisations and policy makers have advocated for a more patient-centred approach to follow-up. The objective of this study is to successfully implement patient-led, home-based follow-up (PHFU) in six hospitals in The Netherlands, with as ultimate aim to come to a recommendation for a patient-centred follow-up schedule for stage I-III CRC patients treated with surgical resection with curative intent.MethodsThis study is designed as a stepped-wedge cluster-randomised trial (SW-CRT) in six participating centres. During the trial, three centres will implement PHFU after six months; the other three centres will implement PHFU after 12 months of inclusion in the control group. Eligible patients are those with pT2-4N0M0 or pT1-4N1-2M0 CRC, who are 18 years or older and have been free of disease for 12 months after curative surgical resection. The studied intervention is PHFU, starting 12 months after curative resection. The in-hospital, standard-of-care follow-up currently implemented in the participating centres functions as the comparator. The proportion of patients who had contact with the hospital regarding CRC follow-up between 12–24 months after curative surgical resection is the primary endpoint of this study. Quality of life, fear of cancer recurrence, patient satisfaction, cost-effectiveness and survival are the secondary endpoints.DiscussionThe results of this study will provide evidence on whether nationwide implementation of PHFU for CRC in The Netherlands will be successful in reducing contact between patient and health care provider. Comparison of PROMs between in-hospital follow-up and PHFU will be provided. Moreover, the cost-effectiveness of PHFU will be assessed.Trial registrationDutch Trail Register (NTR): NL9266 (Registered on January 1st, 2021).

Adherence to Follow-Up and the Related Factors of Paediatric Glaucoma at a Tertiary Care Centre in Western Saudi Arabia.

Glaucoma is a main cause of blindness globally. In Saudi Arabia, congenital glaucoma is believed to affect 1 in every 2500 live births. In this study, we identified the adherence and evaluated the factors associated with non-compliance (non-adherence) to recommended follow-up appointments at King Abdulaziz University Hospital, a tertiary centre in Jeddah, Saudi Arabia. The medical records of paediatric patients diagnosed with glaucoma between 2009 and April 2022 were reviewed retrospectively. Demographic information, visit dates, scheduled follow-ups, and specific patients' glaucoma histories were all extracted from the records. Patients were categorized as adherent, non-adherent, or lost to tertiary follow-up (LTTF). Of 91 patients, 52 (57.1%) were adherent, 20 (22%) were non-adherent, and 19 (20.9%) were LTTF. Most adherent patients were Saudi (59.3% adherent, 26.5% non-adherent, 14.2% LTTF) (P = 0.02). Adherent patients were far likelier to live further away from the ophthalmology clinic (P = 0.03). The frequency of clinical encounters was statistically significantly different between adherence statuses. The non-adherent group had a higher average number of prescribed ocular medications (P = 0.03). The adherent patients had more frequent visits with elevated intraocular pressure (P = 0.02). A significantly high percentage of paediatric glaucoma patients were non-adherent to follow-up visits. When determining the non-compliance risk among paediatric glaucoma patients, physicians must consider the factors contributing to adherence status, which include nationality, distance to the ophthalmology clinic, and number of prescribed ocular medications.

Preoperative Neutrophils to Lymphocytes Ratio in Predicting the Response to BCG in High Grade Non-Muscle Invasive Bladder Cancer

Background Urinary bladder cancer (BC) is a highly prevalent disease affecting more than 400, 000 new cases and 165, 000 deaths yearly, it is the ninth most common cancer in the world, the 13th cause of cancer deaths and the seventh most common cancer worldwide in men with marked male predominance. Aim of the Work To assess the role of preoperative Neutrophils to Lymphocytes Ratio as a predictor for the response to BCG in patients with Non-Muscle invasive Bladder Cancer in patients who underwent Trans-Uretheral Resection of Bladder Tumour (TURBT). Patients and Methods This retrospective cohort study was conducted at tertiary care hospital at Urology department, Ain Shams University hospitals from January 2020 to January 2022 and performed on a total of 46 patients with high grade non-Muscle invasive Bladder Cancer who underwent Trans-Urethral Resection of Bladder Tumor and took BCG course. Results Study results revealed that there was a highly statistically significant relation between preoperative NLR and pathological improvement during Follow up (p-value=0.00) in addition to Tstage and histological grade during Follow up, also there is a statistically significant relation between NLR and tumor size as well as the age of the patient. Conclusion Pre-TURBT NLR when it is high (above 3) is associated with an increased risk of disease recurrence and progression in patients with high grade NMIBC. Moreover, it is an independent predictor of disease recurrence and progression in patients treated with BCG for high grade NMIBC. Pre-TURBT NLR could be a useful blood-based biomarker to improve patients’ risk-stratification facilitating clinical decision-making regarding therapy and follow-up scheduling.

Mental health and use of Medicare Benefits Schedule follow-up mental health services by Indigenous people in Australia during the COVID-19 pandemic.

Mental health care has declined during the COVID-19 pandemic as has attendance for preventive mental health health services. This study aimed to investigate trends in all types of mental health service claims identified in an Indigenous-specific health assessment for Indigenous people before and during COVID-19. We conducted an analysis of Medicare Benefits Scheme (MBS) mental health service items (Items 81,325 and 81,355), to investigate the trends in all types of mental health service claims specifically intended for Indigenous people of Australia. Data were analysed using descriptive statistics, including the total annual numbers of Indigenous peoples' mental health service claims cross-tabulated by age groups and gender, between the calendar years 2017-2021. Multivariable Poisson regression modelling was used to determine associations that were statistically significant. Our results indicate an overall rise in MBS claims for mental health follow-up services during 2019-2020 followed by a decline in 2020-2021. In addition, there was an overall decline in claims for follow-up psychology services across the time period 2019-2021. We found a significant decline in MBS items specific to follow-up mental health services (MBS Items 81,325 and 81,355) for Indigenous people in Australia suggesting a decline in attendance for mental health service follow-up which in turn may indicate a deficit in mental health care during the COVID-19 pandemic, an issue that may lead to poorer mental health outcomes in the future. Further research is needed to understand whether these changes were due to the impact of the COVID-19 pandemic or other factors.

Perspectives on the side effects of hormonal contraceptives among women of reproductive age in Kitwe district of Zambia: a qualitative explorative study

BackgroundGlobally, hormonal contraceptives have proved to be effective in the prevention of unwanted pregnancies. However, despite evidence of the many benefits associated with the use of hormonal contraceptives, concerns related to their safety and side effects have been reported. We conducted a study to explore the perspectives on the side effects of hormonal contraceptives among women of reproductive age in Kitwe district of Zambia.MethodsAn explorative qualitative study was done among 32 women of reproductive age (18–45 years). Participants were selected conveniently as they accessed family planning services at a designated reproductive, maternal, and child health facility. Data collection was done through in-depth interviews (IDIs). Recruitment of participants and data collection continued until the saturation point was reached. The interviews were recorded, translated, and transcribed verbatim. Data were imported into NVivo.x64 for coding and node generation after which categories and themes were developed manually.ResultsOverall, participants demonstrated a considerable amount of knowledge of family planning, recounting the economic and health benefits as well as demerits of family planning use. The main reasons for discontinuing and switching hormonal contraceptive methods were the desire to get pregnant and the fear of unpleasant side effects, including excessive bleeding or prolonged menstruation, headache, dizziness, lower abdominal/back pain, and weight gain. Most importantly, participants cited concerns about the delay in the resumption of fertility after the termination of contraception and how the side effects disrupted their daily activities at home.ConclusionThere is a need for family planning providers to offer family planning services that address the side effects of hormonal contraceptives during counselling and how women can manage them. Family planning services should adopt a patient-centred approach that takes into consideration the concerns regarding side effects and how this affects the quality of life among women. Also, there is a need to extend family planning services to include scheduled follow-ups and clinical management of contraceptive side effects among women.

Shear wave elastography and shear wave dispersion correlated to biopsy at the scheduled follow-up of pediatric liver grafts.

It is unknown how shear wave dispersion (SWD) is displayed in pediatric liver transplant recipients and not fully elucidated how ultrasound shear wave elastography (2D-SWE) display within this cohort, which is important to determine to improve noninvasive surveillance of these patients. The study aimed to compare SWE and SWD values with histopathology in pediatric liver recipients. Forty-eight pediatric liver recipients were examined with SWE in conjunction with an elective liver biopsy (clinically without complication). Additionally, SWD values were measured in 21 children. SWE and SWD values were compared to histologically determined fibrosis graded as none-to-mild (F0-1) and moderate-to-severe (F2-4), and inflammation graded as low (grade 0-1) and high (grade 2-4). Two children were excluded due to SWE IQR/median > 30% kPa. The mean age across 46 included patients was 10.9 years (range 1.4-18). The number of patients and median (range) SWE value (kPa) for each stage of fibrosis were: F0-1 [n = 23; 5.8 (3.2-16.1)], F2 [n = 22; 6.0 (4.5-25.9)], F3 [n = 1; 33.3], and F4 [n = 0]. Significantly higher SWE values and greater variability were registered in F2-4 vs. F0-1 (p = .05). Grade of fibrosis correlated weakly to SWE values (r = .3; p = .05), but not to SWD values (r = .2; p = .27). In patients with low-grade inflammation, median SWD was 13.7 m/s KHz (10.7-17.6). Only one patient had high-grade inflammation. Uncomplicated transplanted liver grafts in a small pediatric cohort revealed slightly increased SWE and SWD values compared to previously reported values in healthy children. This likely reflect both the fibrotic and inflammatory elements in the grafts; however, other confounders impacting the liver's viscoelastic properties are also probable factors.

COVID-19 pandemisinin ulusal göz hastalıkları toplantılarındaki bildiri katılımı üzerine etkileri

Purpose: The aim of the current study is to evaluate the effect of COVID-19 pandemic on paper participation in national ophthalmology meetings held by the Turkish Ophthalmology Association (TOA).&#x0D; Materials and methods: The data for the previous national ophthalmology meetings held by the TOA were gathered retrospectively from the TOA website. The COVID-19 pandemic-related online sessions and meetings with a scheduled in-person follow-up were taken into consideration. The number of poster and oral presentations and subject areas of the papers were recorded. &#x0D; Results: The total number of poster and oral presentations in online meetings was 1505, while it was 1294 in face-to-face meetings (a 14.0% difference). Regarding poster presentations, a total of 1001 posters were presented in online meetings, whereas number of poster presentations was 865 in face-to-face meetings. Similarly, in online meetings, the number of oral presentations was 504, while it was 429 in face-to-face meetings. This finding demonstrated both poster and oral presentation participation was higher by 13.5% and 14.8% (respectively) in online meetings than in the face-to-face meetings.&#x0D; Conclusion: It appears that national ophthalmology meetings held online during the COVID-19 pandemic had a favorable impact on the paper submission rate, and online meetings made sure that scientific sharing and collaboration continued and made it accessible to wider populations.

Development of an Optimized Protocol for Cochlear Implant Care to Increase Cochlear Implant Access.

To develop an evidence-based protocol for audiology-based, cochlear implant (CI) programming in the first year after activation. Retrospective case review. CI program at a tertiary medical center. One-hundred seventy-one patients (178 ears; mean age at implantation, 62.3 yr; 44.4% female) implanted between 2016 and 2021 with postlingual onset of deafness and no history of CI revision surgery. Patients included here had confirmed CI programming optimization based on CI-aided thresholds in the 20- to 30-dB-HL range as well as upper stimulation levels guided by electrically evoked stapedial reflex thresholds. Consonant-nucleus-consonant monosyllabic word recognition scores in the CI-alone and bilateral best-aided conditions at five time points: preoperative evaluation, and 1, 3, 6, and 12 months after activation. For both the CI-alone and bilateral best-aided conditions, consonant-nucleus-consonant word recognition significantly improved from preoperative evaluation to all postactivation time points. For the CI-alone condition, no significant differences were observed between 3 and 6 months, or from 6 to 12 months after activation. In contrast, for the bilateral best-aided condition, significant differences were observed between 1 and 3 months, and 3 and 6 months, but no difference in scores between 6 and 12 months. Based on the current data set and associated analyses, CI centers programming adult patients could eliminate either the 3- or 6-month visit from their clinical follow-up schedule if patient mapping of lower and upper stimulation levels is validated via CI-aided audiometric thresholds and electrically evoked stapedial reflex thresholds, respectively.

Small Testicular Masses: Contemporary Diagnostic and Treatment Strategies, Future Directions, and Knowledge Gaps

The incidental discovery of small masses in the testicles of young men is becoming an increasing clinical dilemma. We are learning that the malignancy rate in masses ≤ 2 cm is much lower than traditionally thought and could be as low as 13% to 21%. The challenge remains in identifying which of these patients harbor malignant tumors that need to be treated, and benign lesions that could be safely surveilled. The aim of this narrative review is to discuss the current scientific evidence, diagnostic work-up, and treatment strategies for small testicular masses. We also discuss selection criteria, follow-up schedules and triggers for intervention for the surveillance of these small testis masses. Furthermore, we give a set of recommendations for assessing and treating these patients, based on the available literature and our experience at a dedicated testicular cancer clinic.

Proportion of Attrition and Associated Factors Among Children Receiving Antiretroviral Therapy in Public Health Facilities, Southern Ethiopia.

Acquired immunodeficiency syndrome (AIDS) is a major global public health concern. Despite the improved access and utilization of antiretroviral therapy (ART), attrition from care among children continues to be a major obstacle to the effectiveness of ART programs. Hence, this study aimed to assess the proportion of attrition and associated factors among children receiving ART in public health facilities of Gamo and South Omo Zones, Southern Ethiopia. A retrospective follow-up study was conducted in public health facilities of Gamo and South Omo Zones in Southern Ethiopia from April 12, 2022, to May 10, 2022. The proportion of attrition was determined by dividing the number of attrition by the total number of participants. Descriptive statistics were calculated. A binary logistic regression model was used to identify factors associated with attrition. Statistical significance was set at p-value <0.05. The median age of the participants was 5.5 (IQR: 2-9) years. The proportion of attrition from ART care was 32.4% (95% confidence interval (CI): 27.57% to 37.69%). Death of either of the parents (adjusted odds ratio (AOR) = 2.19; 95% CI:1.14, 4.18), or both parents (AOR = 3.19; 95% CI: 1.20, 8.52), hemoglobin level <10mg/dL (AOR = 2.39, 95% CI: 1.21, 4.70), a cluster of differentiation (CD)4 count ≤200 cells/mm3 (AOR = 6.78, 95% CI: 3.16, 14.53), CD4 count 200-350 cells/mm3 (AOR = 2.65, 95% CI: 1.16, 6.03), suboptimal adherence (AOR = 6.38; 95% CI: 3.36, 12.19), and unchanged initial regimen (AOR = 6.88; 95% CI: 3.58, 13.19) were factors associated with attrition. Attrition from care is identified to be a substantial public health problem. Therefore, designing interventions to improve the timely tracing of missed follow-up schedules and adherence support is needed, especially for children with either/both parents died, unchanged initial regimen, low CD4, and/or low hemoglobin level.

"Natural" History of Operated Type A Aortic Dissection.

We describe the case of a 66-year-old gentleman with a previous replacement of the ascending aorta for an acute Type A aortic dissection who did not attend any scheduled follow-up visit. Seventeen years later, he presented to our institution with severe aortic regurgitation and with a giant aneurysmal dilation of the abdominal aorta.

Assessment of a close respiratory follow-up schedule at 3 and 6 months after acute COVID-19 and its related investigations

BackgroundRespiratory sequela after acute COVID-19 is common and requires medical follow-up. Considering its vast economic impact, there is still no consensus regarding the mid-term follow-up plan after recovery. ObjectiveTo evaluate the necessity of a close pulmonary follow-up schedule after acute COVID-19 and its related investigations. MethodsA prospective cohort study including adult patients after acute COVID-19 pneumonia. Patients were invited or referred to a 3- and 6-month follow-up visits at a large pulmonary institute in a tertiary center. Before each visit, patients completed demographic and clinical questionnaires, pulmonary function tests (PFTs), and chest CT scans. Results168 patients were included after completing both visits (medians of 80 and 177 days). Their mean age was 58 ± 15 and 52% recovered from severe or critical COVID-19. Between the two visits, there was no change in DLCOc (mean 73 ± 18 %predicted in both visits) and FVC (mean 90 ± 16 vs. 89 ± 16 %predicted). The COPD assessment tool and modified Medical Research Council scale had inverse correlations with the DLCOc, and similarly did not change between the visits. Occupational exposures were the only factor associated with a change in DLCOc during follow-up (3% decrease, p = 0.04). An improvement in chest CT findings at the second visit was not associated with a change in PFTs. ConclusionsMost clinical variables did not change during a close follow-up schedule in the first six months after acute COVID-19. Such a follow-up plan does not appear necessary and should be personalized to limit excessive costs and resources.

Time to reconsider skin cancer-related follow-up visits.

BCC, cSCC and melanoma have very intense follow-up schedules, which are mostly based on expert opinion and on recurrence rates. We found that as the incidence of skin cancer rises it is followed by a three-to-eightfold larger number of follow-up consultations, depending on the type of skin cancer, which will seriously impact dermatological care capacity. A reconsideration and further evaluation of the follow-up schedules will be necessary to keep dermatological care accessible to all patients.

Experiences and Perceptions of Telehealth Visits in Diabetes Care During and After the COVID-19 Pandemic Among Adults With Type 2 Diabetes and Their Providers: Qualitative Study.

Since the COVID-19 pandemic, telehealth has been widely adopted in outpatient settings in the United States. Although telehealth visits are publicly accepted in different settings, little is known about the situation after the wide adoption of telehealth from the perspectives of adults with type 2 diabetes mellitus (T2D) and their providers. This study aims to identify barriers and facilitators of maintaining continuity of care using telehealth for patients with T2D in a diabetes specialty clinic. As the second phase of a multimethod study to understand missed appointments among adults with T2D, we conducted semistructured, individual, in-depth phone or Zoom interviews with 23 adults with T2D (14/23, 61% women; mean age 55.1, SD 14.4, range 35-77 years) and 10 providers from diabetes clinics in a tertiary academic medical center in Maryland. Interviews were audio-recorded, transcribed, and analyzed using thematic content analysis by the research team. Adults with T2D and their providers generally reported positive experiences with telehealth visits for diabetes care with some technical challenges resulting in the need for in-person visits. We identified the following 3 themes: (1) "perceived benefits of telehealth visits," such as convenience, time and financial efficiencies, and independence from caregivers, benefits shared by both patients and providers; (2) "perceived technological challenges of telehealth visits," such as disparities in digital health literacy, frustration caused by unstable internet connection, and difficulty sharing glucose data, challenges shared by both patients and providers; and (3) "impact of telehealth visits on the quality of diabetes care," including lack of diabetes quality measures and needs and preferences for in-person visits, shared mainly from providers' perspectives with some patient input. Telehealth is generally received positively in diabetes care with some persistent challenges that might compromise the quality of diabetes care. Telehealth technology and glucose data platforms must incorporate user experience and user-centered design to optimize telehealth use in diabetes care. Clinical practices need to consider new workflows for telehealth visits to facilitate easier follow-up scheduling and lab completion. Future research to investigate the ideal balance between in-person and telehealth visits in diabetes care is warranted to enhance the quality of diabetes care and to optimize diabetes outcomes. Policy flexibilities should also be considered to broaden access to diabetes care for all patients with T2D.