Treatment Follow-up Research Articles

Coeliac disease: complications and comorbidities.

Coeliac disease is an autoimmune disease characterized by small intestinal villus atrophy and inflammation upon exposure to gluten. It has a global prevalence of approximately 1%. Although the gluten-free diet can be an effective treatment, this diet is burdensome with practical difficulties and frequent inadvertent gluten exposure. Moreover, there are a variety of potential complications and comorbidities of coeliac disease that might be related to malabsorption and/or chronic immune activation. Overall, individuals with coeliac disease have increased mortality compared with the general population, underscoring the severity of this common disease. Comorbidities and complications that have been associated with coeliac disease include poor growth, reproductive complications, kidney and liver diseases, respiratory disease (such as pneumonia) and infections (including sepsis). Furthermore, coeliac disease has been linked to other autoimmune disease and psychiatric disease, as well as certain cancers. Data suggest that mucosal healing on a gluten-free diet might protect against some, but not all, of these complications. In this Review, we present absolute and relative risks of coeliac-associated disorders. We discuss underlying mechanisms, the role of the gluten-free diet and mucosal healing, as well as implications for follow-up and non-dietary treatment of coeliac disease.

Effectiveness of a multicentre randomized controlled trial with three different nurse-led intervention management programmes for patients with heart failure: the main results of the MEETinCY study.

A single-blinded, multicentred randomized controlled trial (RCT) was employed to examine the effectiveness of a 3-month telephone follow-up, a telephone follow-up with education before discharge, or education only before discharge on the heart failure (HF) knowledge, HF self-care management, and health-related quality of life (HR-QoL) in patients with HF by a nurse specialist. This is a multicentre RCT with three different intervention groups (IGs) and one control group. Participants in the first IG received education on HF self-management principles before discharge. The second IGs were enrolled to a 3-month telephone follow-up educational programme in addition to the pre-discharge educational session. The third IG received the telephone follow-up intervention only for 3 months. A total of 357 patients with HF were enrolled to the study of whom 262 participants completed the intervention. Outcome measures included HF-related QoL, HF self-care, and HF-related knowledge. Intervention effects were analysed using the Cohen d (rm) coefficient for repeated measurements and ANCOVA. There was a significant improvement in the physical dimension of the HR-QoL (F = 2.7, df = 3, P = 0.046) between the control group and in-person education group. In HF-related self-care, the telephone component alone or in combination with in-person education led to greater improvement than the control group (F = 3, df = 3, P = 0.034). Self-care practices were improved in the education and telephone arms as compared to the control group (P = 0.002). Education and telephone support on self-care management may improve the physical dimension of HR-QoL. ClinicalTrials.gov: NCT01905176.

Diagnosis of rare signet-ring cell carcinoma of bile duct by endoscopic ultrasonography combined with a peroral direct cholangioscopy biopsy.

Biliary signet-ring cell carcinoma is a rare malignant tumor of the biliary tract. signet-ring cell carcinoma often occurs in the gastrointestinal tract. In this case, we can intuitively see the location, shape and scope of the tumor through endoscopic ultrasonography (EUS) combined with a peroral direct choledochoscope. Through the direct view biopsy technology, the tumor tissue in the biliary tract can be accurately sampled, providing a precise plan for the follow-up treatment of patients.

Prevalence of cardiometabolic co-morbidities in patients with vs persons without chronic hepatitis B: The FitLiver cohort study.

Chronic hepatitis B (CHB) affects > 300 million people worldwide. The combination of CHB and cardiometabolic co-morbidities increases the risk of liver-related morbidity and mortality. However, international guidelines for CHB treatment do not provide recommendations for follow-up examinations or treatment of patients with CHB and cardiometabolic comorbidities. In studies investigating cardiometabolic co-morbidity in patients with CHB, inconsistent findings have been observed, and both lower and higher prevalence of cardiometabolic co-morbidities compared to the general population have been reported. It is unclear whether patients with CHB living in Denmark have an increased prevalence of cardiometabolic co-morbidities. To investigate the prevalence of cardiometabolic comorbidities in patients with CHB and matched non-CHB comparison group. We examined patients with CHB and age-, sex-, body mass index (BMI)-, and country-of-birth matched comparison group. Defining cardiometabolic co-morbidity: Obesity (BMI > 25 kg/m2/abnormal waist-to-hip ratio), metabolic dysfunction-associated steatotic liver disease (MASLD), hypercholesterolemia (total-cholesterol > 5 mmol/L/statin use), hypertension (systolic ≥ 135 mmHg/ diastolic ≥ 85 mmHg/antihypertensive medication) and type 2 diabetes (T2D) (2-hour oral glucose tolerance test glucose > 11.1 mmol/L/HbA1c > 48 mmol/mol/ antidiabetic medication). Physical activity was evaluated using maximal oxygen consumption (VO2max), activity monitors, and a questionnaire. We included 98 patients with CHB and 49 persons in the comparison group. The two groups were well-matched, showing no significant differences in age, sex, BMI, country-of-birth, education, or employment. Among patients with CHB, the following prevalence of cardiometabolic co-morbidity was found: 77% were obese, 45% had MASLD, 38% had hypercholesterolemia, 26% had hypertension, and 7% had T2D, which did not differ significantly from the comparison group, apart from lower prevalence of hemoglobin A1c (HbA1c) ≥ 48 mmol/L or known T2D. Both groups had low VO2max of 27 mL/kg/minute in the patients with CHB and 30 mL/kg/minute in the comparison group, and the patients with CHB had a shorter self-assessed sitting time. The patients with CHB and the comparison group were well-matched and had a similar prevalence of cardiometabolic comorbidities. Furthermore, both groups had low levels of physical fitness.

Risk factors and preventive measures for severe orofacial and neck infections: a three-year observational study

BackgroundThe purpose of this study was to identify the risk factors of severe orofacial and neck infections and the factors that could prevent them and reduce their severity.MethodsA three-year prospective observational study was conducted from 8.15.2016 to 8.31.2019 at a tertiary care hospital. 94 patients participated the study. The criteria for inclusion in the study were that the patients were adults with neck and severe orofacial infections that required treatment in hospital. Patients under the age of 18 and patients who did not consent to participate in the study were excluded. The responses to the questionnaire designed for this study were collected, as was supplemental data from medical records. The patient data were analyzed. Length of stay (LOS), intensive care unit (ICU) stay, complications and mortality were used as the main outcome variables, and various pre-admission factors and clinical and laboratory parameters were used as the predictor variables. The method used was univariate analysis.ResultsIn 79 (84.0%) cases, surgery confirmed an abscess and pus. Age (p = 0.001) and underlying diseases (p = 0.024) contributed to complications. Bulging of the lateral pharyngeal wall or laryngeal swelling on admission was significantly related to the need for intensive care treatment (p < 0.001). The spaces most often involved were the submandibular (n = 15; 16.0%), sublingual (n = 15; 16.0%) and parapharyngeal (n = 14; 14.9%) spaces. Sixty-three cases (67.0%) were of odontogenic origin, and 58.5% of the patients reported having attended previous health care appointments due to an acute dental problem. The patients with odontogenic infections had poor oral hygiene and most likely did not brush their teeth daily (p = 0.029). “Dishwater” pus was associated with longer hospitalization (p < 0.001), intensive care treatment (p < 0.001), and surgical revisions (p < 0.001). One lethal outcome (1.1%) was reported.ConclusionAge and underlying illnesses should be considered complicating factors, and lateral pharyngeal or laryngeal edema should be considered risk factors for ICU treatment. This study also emphasized the preventive role of good dental hygiene and the importance of patients’ follow-up treatment after acute dental interventions.

Prevalence and Risk Factors of Developmental Delay among High-risk Preterm NICU Graduates – A Cross-Sectional Study

Objectives: Preterm and low birth weight neonates are vulnerable to developing neurodevelopmental handicaps more frequently compared to their term counterparts. Neurodevelopmental delay is multifactorial and is likely a consequence of an immature brain, perinatal risk factors, and environmental exposures. The study objective was to determine the prevalence of developmental delay in high-risk preterm infants and also to determine the risk factors for delay in development. Material and Methods: The study was an analytical cross-sectional study conducted in the Department of Pediatrics of a tertiary care medical college hospital from October 2021 to October 2022. Infants born as high-risk preterm neonates who required neonatal intensive care unit (NICU) stay in the early neonatal period were included in the study at the corrected age of 1 year after informed parental consent. Infants whose parents did not consent to the study were excluded from the study. Details of maternal, neonatal, and perinatal risk factors were noted in a pro forma. All infants included in the study were part of the follow-up program in the high risk newborn follow-up clinic and were assessed for growth and development periodically. A detailed neurological examination was done. During the follow-up of high-risk neonates, clinical assessment tools like Amiel-Tison angles were used. Details regarding the passive tone and active tone were documented in the follow-up card and reviewed. Early intervention was planned if tone abnormalities were identified. Developmental screening was done using the Trivandrum developmental screening test. Only trivandrum developmental screening test (TDSC) was used in screening, and confirmatory tests such as Bayley and developmental assessment scale for Indian infants (DASII) were not used in the study center. Although TDSC is not a confirmatory test, in a resource-limited setting, it may help to identify infants with delays in development early and refer them to a higher center. The prevalence of developmental delay was expressed in proportion with a 95% confidence interval (CI). Risk factors were determined by bivariate, followed by multivariate logistic regression analysis. P &lt; 0.05 was considered significant. Results: The present study included infants who were high-risk preterm NICU graduates, of whom 57.2% were male. 22.7% of neonates had birth weight &lt;1750 g. The prevalence (95% CI) of developmental delay was 18 % (12.2–27.6%). There were 18% neonates with gross motor delay, 13% with delay in fine motor development, 18% with delayed language development, and 14% with delay in social and adaptive milestones. By multivariate analysis, it was found that among the neonatal risk factors, apnea and birth weight &lt;1.75 kg were independent risk factors for developmental delay. Conclusion: High-risk preterm NICU graduates are at risk of neurodevelopmental delay, and we observed an 18% prevalence of delay. Periodic follow-up and early intervention of babies with risk factors such as apnea and birth weight &lt;1.75 kg is necessary.

Skin cancer risk in over 200.000 patients with haematologic malignancies in 30 years; a nationwide population-based study in the Netherlands.

Patients with haematologic malignancies are at increased risk of developing skin cancer and often experience worse skin cancer-related outcomes. However, there is a lack of nationwide, population-based data with long-term follow-up on the incidence and risks of different skin cancer types across all haematologic malignancies. To assess population-based risk estimates for cutaneous squamous cell carcinoma (CSCC), malignant melanoma (MM), Merkel cell carcinoma (MCC), and basal cell carcinoma (BCC) among patients with haematologic malignancies, stratified by skin cancer type and haematologic malignancy subgroup. These estimates can serve as a base for surveillance guidelines and patient education. This nationwide population-based epidemiologic cohort study used data on 210,794 patients diagnosed with a haematologic malignancy between 1989 and 2020 from the Netherlands Cancer Registry (NCR). In addition, data on each type of histopathologically confirmed skin cancer per patient after haematologic malignancy diagnosis was retrieved from the NCR. Patients with a history of skin cancer prior to their haematologic malignancy were excluded. Cumulative incidences, standardized incidence ratio's (SIRs), and absolute excess risks for each of the four skin cancers were calculated and stratified by haematologic malignancy subgroup, age, sex, follow-up, and primary treatment. The overall 10-year cumulative incidence of developing a first skin cancer was 2.6% for CSCC, 0.5% for MM, 0.05% for MCC, and 4.8% for BCC. Compared to the general population, nearly all haematologic malignancy subgroups showed more than a twofold increased risk of CSCC, MM, MCC and BCC. Patients with chronic lymphocytic leukemia (CLL) showed the highest risks for each of the four skin cancers, with SIRs of 4.4 for CSCC, 2.7 for MM, 9.3 for MCC, and 2.6 for BCC. These elevated risks persisted for more than 30 years after haematologic malignancy diagnosis. Patients with all types of haematologic malignancies, and especially those with CLL, have a lifetime increased risk of developing different types of skin cancer. These findings highlight the importance of creating awareness among patients and care providers about this increased risk and promoting sun-protective measures and regular skin self-examinations in this high-risk population.

Factors Related to Adherence to Therapy in Patients Using Oral Anticoagulants in Outpatient Follow-Up

Introduction: Factors related to therapy adherence can influence the complexity of care for patients using anticoagulants. Objective: To identify the factors related to patient adherence to oral anticoagulant treatment in outpatient follow-up. Materials and Methods: This is a descriptive, cross-sectional study with a quantitative approach, conducted at the oral anticoagulation outpatient clinic of a cardiology reference hospital in northern and northeastern Brazil. A questionnaire with sociodemographic and clinical variables and an instrument measuring treatment adherence were employed. The data was analyzed using the Statistical Package for the Social Sciences and the Chi-squared and Fisher’s exact statistical tests. All the statistical tests applied a significance level of 5 %. Results: 202 patients were screened, 66.3 % of whom were classified as adherent. Patients with a clinical referral for valve replacement, a treatment time longer than five years, and an international normalized ratio (INR) value outside the therapeutic target showed greater adherence to treatment. In addition, having a sedentary lifestyle and the use of antiarrhythmic medication were significantly associated with adherence. Variables such as sex, income, occupation, level of education, and the presence of complications were not significantly associated with treatment adherence. Conclusion: This study’s findings highlight that adherence to treatment with anticoagulants hinges more on clinical factors and health behavior than on sociodemographic characteristics. Although traditionally studied, these are not necessarily reliable predictors of adherence. The essential factor seems to be more closely related to health education and medical and family support, which emphasizes the need for individualized support for these patients, with a focus on awareness and regular clinical follow-up.

N33 Construction and Application of a Digital Management Platform for the Whole Course of Inflammatory Bowel Disease Patients Based on Action Research

Abstract Background Utilize digital technology to construct a digital platform-based comprehensive management model for Inflammatory Bowel Disease (IBD) patients, and design and develop a digital management platform for IBD patients to achieve efficient, convenient, and intelligent IBD management. Methods From October 2021 to December 2022, under the guidance of action research methodology and based on the chronic disease care model, a digital platform-based management model for the entire course of Inflammatory Bowel Disease (IBD) patients was constructed through a spiral cycle process of "diagnosis, planning, implementation, evaluation, and reflection." Leveraging digital technology and using the online hospital as a vehicle, a comprehensive management platform for IBD patients throughout the entire course of their disease was designed and developed. A total of 83 IBD patients were selected and divided into a control group of 42 cases and an intervention group of 41 cases. The control group received outpatient follow-up plus standard treatment, while the intervention group received outpatient follow-up, standard treatment, and a digital comprehensive course management model. Each group was followed up for 3 and 6 months to observe the patients' fecal calprotectin levels, Inflammatory Bowel Disease Short Health Status (IBDSHS), and patient satisfaction. Results After two rounds of action research, a comprehensive management model for IBD patients throughout the entire course of their disease has been established, comprising three major elements: a digital platform, patients, and a healthcare management team. This platform offers services such as doctor-patient interaction, health consultation, self-management support, health data upload, access to laboratory test reports, and informational support. The intervention group showed lower fecal calprotectin levels at both 3 and 6 months compared to the control group; improvements in all dimensions of the brief health status were significantly greater in the intervention group, and satisfaction was higher in the intervention group than in the control group. Conclusion This study employs action research methods, integrating the practical aspects of IBD clinical diagnosis and care in China, the characteristics of IBD, patient needs, and medical staff requirements, to construct a digital platform-based management model for the entire course of IBD patients. This model not only aligns with the trend of innovative development in China's medical services but also establishes a closed-loop management model centered on IBD patients throughout the entire course of the disease, serving as a tool for the comprehensive management of IBD patients.

P0445 High risk of colorectal cancer after high-grade dysplasia in Inflammatory Bowel Disease patients

Abstract Background Colonic high-grade dysplasia (HGD) is the highest-risk precursor of colorectal cancer (CRC) in inflammatory bowel disease (IBD) patients with reported incidence rates of 1.0-3.5%.1-4 Data on metachronous CRC risk after HGD in IBD are limited and outdated. The aim of this study was to determine the long-term risk of CRC and colorectal neoplasia (including indefinite for dysplasia, low-grade dysplasia, HGD and CRC) after a first diagnosis of HGD in IBD, and to assess HGD treatment strategies. Methods In this nationwide retrospective cohort study, patients with both a colonic IBD and HGD diagnosis between 1991 and 2021 were extracted from the Dutch nationwide pathology databank (PALGA). The primary outcome was the cumulative incidence of metachronous CRC and colorectal neoplasia. Cox proportional hazard models were used to assess associations with metachronous CRC. Kaplan Meier curves were used to show proctocolectomy free survival per decade. Results CRC was diagnosed in 358 of 1,223 patients with HGD (29.3%) after a median 0.3 years (IQR 0.1-2.7, figure 1). Of these, 203 patients (16.6%) were diagnosed with CRC within 6 months after the first HGD diagnosis and were considered synchronous CRC patients. Metachronous CRC was diagnosed in 155 of 1,020 patients (15.2%) after a median 4.1 years (IQR 1.3-11.0). The 1-, 5-, and 10-year cumulative incidences of metachronous CRC after HGD were 2.9%, 10.4%, and 17.2%, respectively. After a median of 2.2 years (IQR 1.0-5.7), 642 patients (62.9%) developed metachronous colorectal neoplasia (indefinite for dysplasia as highest grade: n=12 [1.9%]; low-grade dysplasia: n=243 [37.9%]; HGD: n=220 [34.3%]; CRC: n=155 [24.1%], figure 1). The 1-, 5- and 10-year cumulative incidences of metachronous colorectal neoplasia were 18.0%, 53.9% and 75.0%, respectively. Post-inflammatory polyps (aHR 1.88, 95% CI 1.33-2.65, p&amp;lt;0.01), strictures (aHR 1.62, 95% CI 1.02-2.58, p=0.04), invisible index HGD (aHR 2.04, 95% CI 1.24-3.35, p&amp;lt;0.01), academic follow-up (aHR 1.54, 95% CI 1.10-2.17, p=0.01), and endoscopic vs. surgical treatment (aHR 2.31, 95% CI 1.17-4.57, p=0.02) were associated with metachronous CRC. Proctocolectomy was performed in 209 (17.1%) patients after a median 4.7 years (IQR 1.5-9.7) after index HGD diagnosis. Proctocolectomy free survival did not differ between decades of HGD diagnosis after 8 years of follow-up (p=0.58). Conclusion The high cumulative incidence of synchronous and metachronous CRC after a diagnosis of HGD underlines the high-risk profile for this subgroup of IBD patients. The possible advantages of colon sparing treatment for HGD should be balanced with the subsequent higher risk of metachronous CRC and colorectal neoplasia and resulting need for stringent endoscopic surveillance.

P0920 Long term follow-up of patients with ulcerative colitis after suspension of infliximab for stable deep remission

Abstract Background Infliximab (IFX) is the first anti-TNF biologic drug approved for treating moderate to severe ulcerative colitis (UC). While IFX is effective in inducing mucosal healing and enhancing quality of life, concerns persist about the long-term safety and cost-effectiveness of extended immunosuppression. Current guidelines lack clarity on when to discontinue treatment after achieving stable deep remission. Moreover, existing literature is limited to studies characterised by small sample sizes and heterogenous criteria for defining remission. We aimed to evaluate the outcomes in UC patients who discontinued IFX after achieving stable deep remission, to identify predictors of relapse post-discontinuation, and to examine the clinical course in those who experienced a relapse. Methods In this single-center, retrospective, observational study, we analyzed UC patients at our tertiary IBD Referral Center who discontinued IFX due to sustained deep remission, defined as the combination of partial Mayo subscore ≤ 1 and endoscopic Mayo score = 0, and who had at least 1 year of follow-up post treatment withdrawal. We assessed the relapse rates at intervals of 6 months, 1 year, 2 years, and beyond 2 years post-IFX discontinuation. For patients who relapsed, we recorded the therapeutic strategy and its effectiveness, including the necessity for colectomy. We performed univariate and multivariate analyses to identify relapse predictors post-treatment suspension. Results From 2006 to 2022, 790 UC patients received IFX treatment at our center; 113 patients suspended IFX due to stable deep remission with at least 1 year of follow-up and were included in this study. Of these, 41.6% maintained remission over a median of 5.17 years. Flare rates were 14.2%, 23.9%, and 35.5% within 6, 12, and 24 months, respectively, with 58.4% experiencing a flare overall. Multivariate analysis showed that longer treatment duration reduced relapse risk (p=0.001), while steroid use during IFX treatment and early IFX initiation post-diagnosis increased relapse risk (p=0.004 and p=0.043, respectively). Most patients who relapsed were successfully managed medically either with a course of steroids, restarting IFX, or initiating a different type of biologic/small molecule, whereas the rate of colectomy was 7.1%. Conclusion This study is one of the largest to date with the longest follow-up that evaluates outcomes post-IFX discontinuation in UC patients in deep remission. Our findings suggest that withdrawal of IFX treatment can be considered in carefully selected cases. In patients who relapse after IFX suspension, medical treatment is often effective, and the rate of colectomy is low. Further studies are warranted to better identify ideal candidates for treatment withdrawal.

Medial Patellofemoral Ligament Repair with Suture Tape Augmentation Can Yield Good Midterm Clinical Outcomes Regardless of Skeletal Maturity and Joint Laxity.

While several studies have reported short-term clinical outcomes after medial patellofemoral ligament (MPFL) repair with suture tape augmentation, there is still a dearth of knowledge regarding midterm clinical outcomes. This study aimed to evaluate the midterm clinical outcomes of MPFL repair with suture tape augmentation in patients with patellar dislocation. We retrospectively reviewed the clinical records of patients who underwent MPFL repair with suture tape augmentation for at least one episode of patellar dislocation between 2015 and 2020. Patient-reported clinical outcomes (PROs) were evaluated via the International Knee Documentation Committee (IKDC) score and the knee injury osteoarthritis outcome score (KOOS). In total, 17 knees (4 males and 13 females) who underwent MPFL repair with suture tape augmentation with a mean follow-up of 54.6 ± 19.5 months were included in this study. PROs significantly improved from preoperatively to the final follow-up (IKDC score: 50.7 ± 26.6 vs. 88.8 ± 13.0, p < 0.001; KOOS: 68.8 ± 23.3 vs. 91.2 ± 8.4, p = 0.011) without reducing the patient's activity level at the final follow-up (UCLA AS score: 7.9 ± 2.4 at preinjury vs. 7.9 ± 2.2 at the final follow-up, p = 0.655). Subgroup analysis revealed good postoperative outcomes, regardless of the patient's skeletal maturity or the presence or absence of generalized laxity. In conclusion, MPFL repair with suture tape augmentation is a safe and effective treatment for midterm follow-up.

Patient perspectives on stress after ICU and a short primary care based psychological intervention – results from a qualitative sub‑study of the PICTURE trial

BackgroundApproximately 20–25% of patients who survive medical treatment at an intensive care unit (ICU) develop post-traumatic stress symptoms. There is currently a gap in follow-up care for them. As part of the PICTURE study, general practitioners (GPs) carried out a brief interview-based intervention. The aim of this sub-study is to record the most distressing memories of ICU treatment from the patient’s perspective and their evaluation of a GP-based brief psychological intervention.MethodsParticipants were recruited from the intervention group of the main PICTURE study using selective sampling. All of them had experienced an ICU stay with mechanical ventilation and severe organ failure in the previous two years. They were interviewed about their experience of psychological stress during their ICU stay and their retrospective evaluation of the intervention. Semi-structured, guideline-based telephone interviews were conducted for this purpose, processed, and analyzed using the structuring qualitative content analysis based on Mayring.FindingsWhen asked N = 8 patients about the most stressful memory of their stay at ICU, the main themes were helplessness, pain, fixation, inability to communicate and sleep disturbances. The question of amnesia regarding the stay in the ICU was answered affirmatively by half of the interviewees but was not experienced as stressful. The brief trauma-focused intervention carried out by their GPs was well received by all respondents.ConclusionsThe interviewees confirm that aversive traumatizing experiences are often associated with intensive care treatment and reinforce each other. These are due to the treatment setting but should be reduced wherever possible. In view of chronification and the lack of specific follow-up treatment options for these patients and the long waiting times for psychotherapy, the implementation of low-threshold treatment options by GPs appears to be ideally suited to closing this gap in care, particularly for patients with mild to moderate symptoms of a post-traumatic stress disorder.Trial registrationThe main trial was registered at ClinTrials gov (NCT03315390) and at the German Register of Clinical Trials (DRKS, DRKS00012589) on 17/10/2017.

Factors Associated with Clinically Significant Extrinsic Compression on Gastroduodenal Endoscopy.

Although clinicians frequently encounter incidentally detected gastroduodenal extrinsic compressive lesions (GDECLs) on upper gastrointestinal endoscopy (UGE), theoptimal management approach for GDECLs has not been fully established. This study aimed to stratify and identify important factors associated with clinically significant GDECLs that require regular follow-up or further treatment. Between June 2007 and December 2015, a total of 73 patients with suspected GDECLs on UGE at Kyung Hee University Hospital at Gangdong were identified and studied retrospectively. After the final diagnosis, patients were divided into the following two groups: clinically significant GDECLs, which requires regular follow-up or further treatment, and clinically non-significant GDECLs. Among 73 GDECLs, 23 (31.5%) lesions were classified as clinically significant GDECLs and 50 (68.5%) as clinically non-significant GDECLs. In multivariate analysis, clinical and endoscopic parameters that were independently associated with clinically significant GDECLs included older age (≥ 60years), large size (≥ 4cm) of extrinsic compression, previous history of intra-abdominal malignancy, and symptoms of abdominal distension (all p < 0.05). Several clinical and endoscopic parameters showed significant association with the identification of clinically significant GDECLs on endoscopy. These predictive factors might be useful in determining whether to perform further diagnostic work-up in patients with GDECLs.

Cost Analysis of Epilepsy Healthcare in Adults: A Direct Cost Estimate From a Colombian Perspective.

To estimate the direct healthcare costs related to outpatient care and hospital stays for adults with epilepsy in the context of the Colombian healthcare system. A cost analysis was conducted from a base case, which included direct medical costs related to diagnosis, follow-up, pharmacological and surgical treatment, and in-hospital care for status epilepticus. A Delphi panel was carried out to identify and quantify cost-generating events. The monetary valuation was estimated using official databases and tariff manuals available in Colombia. The cost distribution was obtained using the bootstrapping method. Two one-way deterministic sensitivity analyses were performed. The total annual cost of an adult patient with epilepsy without including hospital stays is US dollars $2416.31. If at least 1 intensive care unit stay (8-day average) is included to treat a patient with status epilepticus, the total annual cost increases to $61 567.72. The total cost of resective surgery is $14 894.44, and the vagus nerve stimulation implant costs $26 565.86. Epilepsy in adults represents a significant economic burden for the Colombian healthcare system, comparable to that of other upper-middle-income countries. The majority of expenditure is attributed to intensive care unit stays, less financial resources would be required if patients achieve better control of the disease.

Understanding the Impact of YouTube Videos on Parents of Children with Developmental Delay and Disabilities

Children go through several developmental milestones at an early age. When a child becomes slow or cannot even reach one or more of these milestones compared to other typically developing children, that condition is called Developmental Delays and Disabilities (DDDs). Children's DDDs create much parental stress, resulting in social isolation and loneliness. YouTubers make videos on DDDs to assist parents and other caregivers. We need to gain more knowledge of how these videos are created and how much they impact the parents of children with DDDs. We followed a mixed-method approach to annotate and analyze 1,532 YouTube videos on children's DDDs. Our analysis found that YouTube videos on DDDs support the community with critical informational content and provide mental and emotional strength through content related to personal experiences. Our analysis of the comments in these videos explored how YouTubers and viewers created a strong community connection through these video content. Most importantly, the interviews with the parents of children with DDDs revealed how parents find these videos relatable and critical for taking necessary actions for their children's DDDs diagnosis and follow-up treatments. We concluded by discussing platform-centric design implications for supporting parents and other caregivers of children with DDDs.

Characteristics and Dosing Patterns of Tirzepatide Users with Type2 Diabetes in the United States.

The study objective was to describe characteristics and utilization patterns of tirzepatide users with type2 diabetes (T2D) using the Healthcare Integrated Research Database in the USA. Adults (≥18years) included had T2D diagnosis; ≥1 tirzepatide claim (May2022-January 2023; first claim date = index date); and continuous medical and pharmacy enrollment during the 6-month baseline and follow-up periods from the index date. Baseline demographics, clinical characteristics, and 6-month follow-up dosing and treatment patterns were summarized descriptively. The study included 15,665 patients with T2D initiating tirzepatide (mean age: 53.2years; 58.5% women; 76.7% non-Hispanic white). During the 6-month baseline period, hypertension (69.2%), dyslipidemia (69.2%), overweight/obesity (58.4%), and obstructive sleep apnea (22.8%) were commonly reported comorbidities. Over half of the patients (51.2%) had used glucagon-like peptide-1 (GLP-1) receptor agonist (RA) before initiating tirzepatide. The mean glycated hemoglobin (HbA1c) was 7.6% (n = 5175), and 58.4% of these patients had HbA1c ≥7%. The mean body mass index (BMI) was 38.7kg/m2 (n = 3459), and 87.8% of these patients either had Class1, 2, or 3 obesity. Among patients with a single prescription on each fill date (N = 14,986), 84.1% initiated tirzepatide at ≤5mg dose. During sixth prescription refill (n = 7304), 56.5% were receiving tirzepatide doses of <10mg. During the 6-month follow-up period, 69.6% of patients had ≥1 dose escalation and 17.2% had ≥1 dose de-escalation. The mean time to first dose escalation was 59.1days and first dose de-escalation was 104.8days. Tirzepatide adherence (proportion of days covered [PDC] ≥80%) was 57.5% and persistence (45-day gap) was 73.3% at 6months. Of patients who discontinued tirzepatide (n = 4177; 26.7%), 29.1% re-initiated tirzepatide (45-day gap). Patients with T2D initiating tirzepatide had multimorbidity; uncontrolled diabetes; and mean BMI was consistent with Class2 obesity. Patients showed favorable tirzepatide adherence and persistence profiles, and the majority remained at <10mg doses during the 6-month follow-up period.

Long-term outcome and rehabilitation needs after acquired brain injury in children and adolescents – an evaluation in a Swedish cohort

Children with acquired brain injury (ABI) are at risk of developing cognitive, physical, or emotional impairments that affect their daily lives at home, school, and in society. Purpose: To explore this, we used the Swedish version of the Child and Family Follow-up Survey (CFFS-SWE) to describe the participation of 39 children (aged 5–17 years) who had sustained ABIs. Materials and Methods: We assessed their participation using the CFFS-SWE at three points: upon discharge from the acute hospital, six months post-discharge, and between one and four years after discharge. Results: Findings revealed that 69% of the children had rehabilitation needs at discharge, with physical symptoms, pain, mobility, and visual difficulties being the most common. Environmental barriers to participation included family stress, inadequate information about diagnosis and/or treatment, lack of assistance in school, and lack of family finances. Additionally, 31% of the sample had unmet support needs in everyday life. Conclusion: The study underscores the necessity of implementing structured follow-up and early rehabilitation interventions for children with ABI to improve their long-term outcomes.

Anal Cancer Screening: 10-Year Experience of a Specialized Outpatient Clinic.

In 2012, the Department of Visceral Surgery of the Lausanne University Hospital CHUV implemented a dedicated high-resolution anoscopy (HRA) outpatient clinic for surveillance and follow-up purposes. This 10-year longitudinal study analyzed 537 patients (2214 visits) using a structured screening protocol. Dysplastic lesions were detected in 49% of patients, predominantly low-grade squamous intraepithelial lesions (LSILs, 74%). Among LSIL cases, 6% progressed to high-grade squamous intraepithelial lesions (HSILs) within 24 months, reaching 25% cumulative progression at 36 months. Of HSIL patients, 3% developed carcinoma in situ after 48 months. Notably, no invasive carcinoma was observed during the follow-up. Four patients diagnosed with squamous cell carcinoma at initial screening were treated with chemoradiotherapy, and one required salvage surgery. Independent risk factors for the presence of higher-stage precancerous lesions (≥HSILs) were the presence of high-risk HPV genotypes (OR 14.5, 95% CI 5-42.2, p < 0.001), detectable HIV viral load (OR 5.4, 95% CI 1.8-16.7, p = 0.003), and symptoms at the first screening visit (OR 3.2, 95% CI 1.1-9.9, p = 0.04). HIV-positive status was associated with a trend towards an increased risk of progression (OR 2.79, p = 0.073). These findings highlight the importance of systematic follow-up and early intervention in high-risk populations to prevent anal cancer progression.

Use of Antibiotics in Companion Animals from 133 German Practices from 2018 to 2023.

Background/Objectives: While antibiotic usage in farm animals has been systematically monitored and reduced in many countries, including Germany, data on companion animals such as dogs and cats remain scarce. To address this gap, a study was conducted in Germany to analyze patterns of antibiotic use in dogs and cats. Methods: Antibiotic usage data were obtained from debevet, a cloud-based veterinary practice management software based in Berlin, Germany. Practices with fewer than 100 patients were excluded, and data from 2018 to 2022 were analyzed. Results: The analysis included 477,310 consultations of 78,381 dogs and 241,532 consultations of 55,729 cats across 133 veterinary practices. Antibiotics were used in 12.9% of dog consultations and 22.5% of cat consultations, with substantial variation across practices. Aminopenicillins, particularly amoxicillin, were the most commonly used antibiotics, while the highest-priority critically important antibiotics (HPCIAs) accounted for 12.4% of treatments. Follow-up treatments led to changes in antibiotic substances in 9.3% of cases, often within the first two days. Indications varied by species, with respiratory issues more frequent in cats and orthopedic problems in dogs. Body weight and breed characteristics influenced the likelihood of antibiotic treatment, with short-nosed breeds showing higher odds. Conclusions: The routine data analysis provided valuable insights into antibiotic use in dogs and cats, enabling tracking trends across species and indications over time. While some specific information was missing, the invoicing data's completeness, the cost-effectiveness of their use, and their unbiased nature make them a robust tool for monitoring and informing legislative changes.