Frequent Cause Research Articles

Mechanisms of Injury for Traumatic Brain Injury Among U.S. Military Service Members Before and During the COVID-19 Pandemic.

To understand the mechanisms of injury and demographic risk factors associated with traumatic brain injury (TBI) patients among active and reserve service members in the U.S. Military before and during the COVID-10 pandemic. Active and reserve service members diagnosed with an incident TBI from January 2019 through September 2021 were selected. Traumatic brain injury patients diagnosed before March 1, 2020 were categorized as pre-COVID (PC), and patients diagnosed on or after March 1, 2020 were categorized as the intra-COVID (IC) group, aligning closely with the date when the World Health Organization officially proclaimed the pandemic. We determined the frequency of causes of injuries associated with TBI separate by sex, age, occupation, and TBI severity. In addition, we conducted multivariate logistic regression analyses to assess the demographic risk factors associated with TBI severity during the PC and IC eras. Our cohort included 48,562 TBI patients: 22,819 (47.0%) diagnosed during the PC era and 25,743 (53.0%) diagnosed during the IC era. The major mechanisms of injury within our TBI cohort were being struck by/against objects, falls/slips/trips, and motor vehicle traffic accidents before and during the pandemic. The most common causes of TBI were not impacted by COVID, but motor vehicle accidents did increase during the IC era. The mechanisms of injury associated with TBI differed by TBI severity: being struck by or against an object caused more mild and moderate TBI; motor vehicle accidents caused more severe TBI; and firearms was a major cause of penetrating TBI. In addition, the percentage of severe TBI because of firearms rose sharply during the IC era. Further, women were more likely to be diagnosed with mild TBI compared to men. Military leaders should consider how different causes of injury are associated with differing TBI severities and how certain demographic groups were vulnerable to specific TBI severities when developing injury prevention programs.

Probable Causative Agents and Demographic Patterns of Encephalitis, Meningitis, and Meningoencephalitis in a Single Tertiary Care Center.

Introduction Encephalitis, meningitis, and meningoencephalitis present significant challenges in clinical management owing to their diverse etiologies and potential complications. A high suspicion index is critical for guiding treatment strategies and improving patient outcomes. Understanding the demographic characteristics and frequency of causes of these conditions is essential to deliver optimized care. Objective This study aimed to investigate epidemiological causes and relative outcomes, including mortality, based on cultures, laboratory investigations, and demographic factors among patients with encephalitis, meningitis, and meningoencephalitis in a Saudi Arabian tertiary care center. Methods A retrospective cross-sectional study was conducted at King Abdulaziz Medical City (KAMC) in Jeddah, Saudi Arabia. Data were collected from patients admitted between April 2016 and December 2022 who met the specified inclusion criteria. Results Among 233 patients, meningitis was the most prevalent diagnosis (65.77%), with bacterial agents being the predominant causative agents (79.74%). Higher mortality was significant with pediatrics <5 years and adults >60 years. Conclusion This study provides valuable insights into the epidemiology and clinical outcomes of central neurological infections based on a Saudi Arabian cohort. These findings underscore the importance of an accurate diagnosis and tailored management strategies. Further studies are warranted to enhance our understanding and to inform more predictable characteristics targeted in optimizing healthcare delivery for patients with such conditions.

Impact of Radiation Therapy on Serum Humanin and MOTS-c Levels in Patients with Lung or Breast Cancer.

Lung and breast cancer are the most frequent causes of death from cancer globally. The objectives of this research were to evaluate the serum mitochondrial open reading frame of the 12S rRNA-c (MOTS-c) and humanin levels in lung or breast cancer patients, and investigate the impacts of radiation therapy on the circulating levels of these peptides. 35 lung cancer patients, 34 breast cancer patients, and healthy volunteers as a control group were recruited in this prospective observatory research. Lung cancer patients with stage IIIA/IIIB were treated with paclitaxel-based chemotherapy plus radiotherapy (2 Gy per day, 30 times, 60 Gy total dose). Breast cancer stage IIA/IIB patients were treated with postoperative locoregional radiation therapy (2 Gy per day, 25 times, 50 Gy total dose). The ELISA method was used to detect serum humanin and MOTS-c levels during, before, and after radiotherapy. We observed marked elevations in circulating MOTS-c, but not humanin levels in patients with lung cancer (P < 0.001). Radiation therapy led to a marked augmentation in MOTS-c levels in these patients (P < 0.001). On the other hand, there was a marked decline in humanin, but not MOTS-c, levels in breast cancer patients (P < 0.001). Our research has shown, for the first time, that increased MOTS-c and decreased humanin levels play a role in lung cancer and breast cancer, respectively. Additionally, radiotherapy modifies MOTS-c levels in patients with lung, but not breast cancer.

Metabolic Associated Fatty Liver Disease in Children and Adolescents: Mechanisms of a Silent Epidemic and Therapeutic Options.

Non-alcoholic fatty liver disease (NAFLD) is now identified as a hepatic sign of metabolic syndrome and is the most frequent cause of chronic liver disease in all ages. It is assumed that a genetic predisposition associated with epigenetic factors participates in the evolution of this condition. Visceral obesity and insulin resistance (IR) have always been considered the most important causative factors of Metabolic Syndrome (MetS) and NAFLD, but currently, the interaction between genetic heritage and environmental factors is increasingly considered fundamental in the genesis of metabolic disorders associated with NAFLD. In fact, in patients with NAFLD, insulin resistance, arterial hypertension, abdominal obesity, dyslipidemia and reduced intestinal permeability have often been found, as well as a higher prevalence of coronary artery disease, obstructive sleep apnea, polycystic ovary syndrome and osteopenia, which define a MetS framework. Early diagnosis is needed to prevent disease progression through primarily lifestyle interventions. Unfortunately, at present, there are no molecules recommended for pediatric patients. However, several new drugs are in clinical trials. For this reason, targeted studies on the interaction between genetics and environmental factors involved in the development of NAFLD and MetS and on the pathogenetic mechanisms that determine the evolution in non-alcoholic steatohepatitis (NASH), should be implemented. Therefore, it is desirable that future studies may be useful in identifying patients at risk of developing NAFLD and MetS early.

Therapeutic effect of honey on acute respiratory infections in adults

Context: In Morocco, acute respiratory infections (ARI) are a frequent cause of consultations in the first level health facilities. Scientific reports indicate that honey has an important biochemical therapeutic activity. Aims: To explore the therapeutic effect of honey on ARI in the Guelmim region of southern Morocco. Methods: This was a prospective clinical study aiming to compare the therapeutic effect of honey in the population that consumes it versus a control population, at the level of the regional hospital and health centers, the period of the study was between September 2022 and March 2023, All the participants were questioned through a questionnaire and the study of their files and monitoring forms. Results: The study population was divided into two equal groups of 417 people each. Honey significantly reduced the overall symptom score at Day 5 (p&lt;0.001) in the honey group compared with the reference group, according to the ANOVA test, the significant variables are age, presence of associated diseases, duration of illness, number of consultations for respiratory episodes and current smoking status, the present study also shows that non consumption of honey OR = 15.09 [10.26-22.17], high symptom score at D1 OR = 3.85 [2.37-5.39], frequency of nocturnal cough OR = 4.26 [1.65-10.9], frequency of diurnal cough OR = 3.34 [1.5-7.4], duration of illness OR = 7.12 [3.4-14.6] and type of cough OR = 1.5 [1.04-2.2] were the determinants of high symptom score at Day 5. Conclusions: Honey was effective in relieving symptoms associated with ARI and may be suggested as an adjuvant treatment in adults.

Learning from Mistakes—Dental Students’ Learning Experiences from Adverse Clinical Events

Clinical training in the teaching practice is essential for developing patient-specific skills, yet the transition from preclinical to clinical training presents significant challenges for students. This study aimed to comprehend the challenges and issues faced by students at the onset of clinical training. It retrospectively investigated adverse events presented at the advanced dentistry course by third-year pre-doctoral students from classes 202A, 202B, and 202C during their initial ten months of clinical practice at the teaching institution. In this study, adverse events were defined as any undesirable experiences or incidents associated with a clinical treatment and administrative procedures. A total of 279 adverse events presented were categorized into eight disciplines: Treatment planning (TP), Operative (OP), Periodontics (PER), Endodontics (EN), Oral Surgery (OS), Fixed Prosthodontics (FP), Removable Prosthodontics (RP), and Patient Management (PM). The distribution of events was as follows: TP (11.5%), OP (17.7%), PER (13.1%), EN (6.9%), OS (6.2%), FP (24.2%), RP (5.0%), and PM (15.4%), with FP, OP and PM experiencing the highest rates of adverse events. The distribution pattern within the disciplines was consistent, and no statistical difference was observed. Across these disciplines, a lack of clinical skill competency was identified as a primary cause of adverse events. Other contributing issues included miscommunication, insufficient explanations to patients, a lack of administrative support, case complexity, and a deficit in diagnostic examinations and skills. The frequency of causes varied across the three classes, but no significant differences was noted in OP, FP and OS, in which over 80% of causes were related to clinical skill competency. Adverse events in clinical settings are frequent. Knowing these beforehand can aid students’ performance. Students should prepare thoroughly before clinical practice and understand common causes of errors. Educators should recognize the challenges inexperienced students encounter. Awareness of typical mistakes can enhance success in demanding clinical scenarios.

Fréquence relative des causes de polyuro-polydipsie chez le chien et le chat : étude rétrospective de 205 cas (2015–2020)

Polyuro-polydipsia syndrome is common in veterinary medicine. The conditions causing polyuro-polydipsia are well documented, and the diagnostic approach is consensual. Nevertheless, the veterinary literature is deficient on the relative frequency of its causes. To the best of our knowledge, no case series or cohort studies have been carried out on this topic.The aim of this retrospective study of 122 polyuro-polydipsic dogs and 83 polyuro-polydipsic cats was to describe the epidemiological characteristics of these populations and to assess the relative frequency of causes in the two species. The median age of onset of polyuro-polydipsia was eight years (0,2-16) for dogs and 11 years (0,5-23) for cats. In the canine population, 16 groups of conditions were identified, the most frequent being kidney disease (32.8 %), diabetes mellitus (12,3 %) and hypercorticism (11.5 %). In the feline population, seven types of conditions were found, including 59 % kidney disease and 30 % diabetes mellitus.This clinical study is the first to highlight the relative frequency of the causes of polyuro-polydipsia in dogs and cats helping clinicians to prioritize their hypotheses and the investigations to be carried out in the face of polyuro-polydipsia.

Etiology of Acute Febrile Illnesses in Adults in the Defense Community in French Guiana.

In tropical countries, acute febrile illnesses represent a complex clinical problem for general practitioners. We describe the prevalence of different etiologies of acute febrile illnesses occurring among French service members and their families, excluding children, in general practice in French Guiana. From June 2017 to March 2020, patients with a fever ≥ 37.8°C with a duration of less than 15 days who sought medical care at the army medical centers in Cayenne and Kourou were prospectively enrolled. Based on clinical presentation, blood, urine, nasopharyngeal, and stool samples were collected for diagnostic testing for viruses, bacteria, and parasites (by direct examination, microscopic examination of blood smears, culture, serology, or polymerase chain reaction), and standardized biological tests were systematically performed. Among 175 patients retained for analysis, fever with nonspecific symptoms was predominant (46.9%), with 10 Plasmodium vivax malaria cases, 8 dengue infections, and 6 cases of Q fever. The second most frequent cause of acute febrile illness was upper respiratory tract infections (32.0%) due to influenza virus (n = 18) or human rhinovirus (n = 10). Among the causes of acute febrile illness in French Guiana, clinicians should first consider arboviruses and malaria, as well as Q fever in cases of elevated C-reactive protein with nonspecific symptoms and influenza in cases of signs and symptoms associated with upper respiratory tract infections. Despite an expanded microbiological search, the etiology of 51.4% of acute febrile illnesses remain unknown. Further investigations will be necessary to identify the etiology of acute febrile illnesses, including new pathogens, in French Guiana.

Frequency of different causes of thrombocytosis among patients presenting to tertiary care hospital.

Objective: To assess the prevalence and underlying causes of thrombocytosis among patients seeking medical attention at a prominent tertiary care facility located in Lahore. Thrombocytosis, characterized by an elevated platelet count, can signify an array of underlying health conditions, and this research seeks to unravel the frequency of these causes within the study population. Study Design: Cross-sectional. Setting: Department of Pathology, Allama Iqbal Medical College and Jinnah Hospital. Period: November 2019 to May 2020. Methods: A total of 150 patients were carefully selected from diverse medical specialties, including but not limited to medical, surgical, gynecological, obstetric, gastroenterological, nephrological, and intensive care units. The diagnostic criteria for thrombocytosis were aligned with the operational definition provided by the World Health Organization (platelet count exceeding &gt;450 x 10^9/L) during the stipulated study period. Statistical analysis of gathered data was performed using SPSS version 17.0. Results: The findings of the study showcased that infections and iron deficiency emerged as the predominant contributors to thrombocytosis among the adult patient cohort. These factors were trailed by conditions like chronic infections, trauma accompanied by blood loss, and instances of splenectomy. Interestingly, instances of primary thrombocytosis, notably essential thrombocythemia, constituted a mere 2% of the overall sample size, signifying its rarity within this adult population. Conclusion: In the realm of thrombocytosis, the research highlights a notable prevalence of secondary thrombocytosis, while primary thrombocytosis remains a considerably infrequent occurrence among adults. The study emphasizes the significance of infections and iron deficiency anemia as the leading triggers for secondary thrombocytosis. Such insights contribute to an improved understanding of the spectrum of conditions associated with elevated platelet counts and may aid clinicians in effectively diagnosing and managing these underlying causes.

A New Step-Up Dual Endoscopic Approach for Large-Size Infected Pancreatic Necrosis: Percutaneous Endoscopic Necrosectomy Followed by Transluminal Endoscopic Drainage/Necrosectomy.

Acute pancreatitis in 10% to 20% of cases can be associated with necrosis of the pancreatic gland, peripancreatic tissue, or both. We report a case series of a new endoscopic approach to treat infected pancreatic necrosis (IPN). Consecutive patients with IPN, extending from the perigastric area up to the paracolic gutters or into the pelvis, were prospectively studied from January 2017 to June 2022. The treatment protocol was radiologic percutaneous drainage as the first step, followed by fully covered metal stent placement (FC-SEMS) in the track of the catheter. Percutaneous endoscopic necrosectomy (PEN) was performed 2 to 4 days later using a flexible endoscope through the percutaneous tract. About 2 to 4 weeks later, when a matured sac was visible, EUS-guided endoscopic transluminal drainage (ETD) with lumen-apposing metal stents (LAMS) was performed. Control of sepsis with resolution of collection(s) was the primary outcome measure. We included 18 patients, males in 50% of cases with age 60±12 years old. Most frequent cause of pancreatitis was biliary (7 cases) followed by alcoholic in 6 cases; in 3 cases pancreatitis was caused by hyperlipemia and in 2 cases was idiopathic. Mean size of WON was 18±2cm. For PEN, SEMSs used were esophageal FC-SEMS. LAMS used for ETD were Hot Axios, Hot Spaxus and Nagistent. Mean time of endoscopic intervention for PEN and ETD was 18±3 and 37±4 days, respectively. In 5 cases adverse events occurred: 3 cases of overinflations resolved with introduction of Verres needles in abdomen. In 2 cases postprocedural GI bleeding required endoscopic intervention. In all cases control of sepsis was reached together with resolution of collections. No cases of deaths were observed. Step-up percutaneous and transluminal endoscopic necrosectomy therapy is an effective strategy for large-size IPN with combined central and peripheral necrosis.

Clinical characteristics of acute non-varicose upper gastrointestinal bleeding and the effect of endoscopic hemostasis.

Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) constitutes a prevalent emergency within Gastroenterology, encompassing 80%-90% of all gastrointestinal hemorrhage incidents. This condition is distinguished by its abrupt onset, swift progression, and notably elevated mortality rate. To gather clinical data from patients with ANVUGIB at our hospital in order to elucidate the clinical characteristics specific to our institution and analyze the therapeutic effectiveness of endoscopic hemostasis. We retrospectively retrieved the records of 532 patients diagnosed with ANVUGIB by endoscopy at our hospital between March 2021 and March 2023, utilizing our medical record system. Data pertaining to general patient information, etiological factors, disease outcomes, and other relevant variables were meticulously collected and analyzed. Among the 532 patients diagnosed with ANVUGIB, the male-to-female ratio was 2.91:1, with a higher prevalence among males. Notably, 43.6% of patients presented with black stool as their primary complaint, while 27.4% had hematemesis as their initial symptom. Upon admission, 17% of patients exhibited both hematemesis and black stool, while most ANVUGIB patients primarily complained of overt gastrointestinal bleeding. Urgent routine blood examinations at admission revealed that 75.8% of patients had anemia, with 63.4% experiencing moderate to severe anemia, and 1.5% having extremely severe anemia (hemoglobin < 30 g/L). With regard to etiology, 53.2% of patients experienced bleeding without a definitive trigger, 24.2% had a history of using gastric mucosa-irritating medications, 24.2% developed bleeding after alcohol consumption, 2.8% attributed it to improper diet, 1.7% to emotional excitement, and 2.3% to fatigue preceding the bleeding episode. Drug-induced ANVUGIB was more prevalent in the elderly than middle-aged and young individuals, while bleeding due to alcohol consumption showed the opposite trend. Additionally, diet-related bleeding was more common among the young age group compared to the middle-aged group. Gastrointestinal endoscopy identified peptic ulcers as the most frequent cause of ANVUGIB (73.3%), followed by gastrointestinal malignancies (10.9%), acute gastric mucous lesions (9.8%), and androgenic upper gastrointestinal bleeding (1.5%) among inpatients with ANVUGIB. Of the 532 patients with gastrointestinal bleeding, 68 underwent endoscopic hemostasis, resulting in an endoscopic treatment rate of 12.8%, with a high immediate hemostasis success rate of 94.1%. ANVUGIB patients exhibit diverse characteristics across different age groups, and endoscopic hemostatic treatments have demonstrated remarkable efficacy.

The role of immune checkpoint inhibitors in the development and treatment of infectious processes

The incidence and prevalence of oncological diseases, which are in second place in terms of the frequency of causes of death, is steadily increasing among the population of the Russian Federation. Advances in translational medicine, including immunotherapy, have revolutionized cancer treatment strategies. A special breakthrough has been achieved in two areas of immunotherapy that have modernized cancer treatment: chimeric T-cell receptors and antibodies known as immune checkpoint inhibitors (ICTs) blocking cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), programmed cell death protein-1 (PD-1) and ligand programmed cell death receptor (PD-L1). ICTs enhance the adaptive immune response of the tumor and can cause adverse effects as a result of hyperactivation of T cells, which often leads to the emergence of an opportunistic infection. In addition, immunosuppressive drugs, which are often prescribed to mitigate the side effects associated with ICT, are also a risk factor for infection. The purpose of the review is to analyze the literature on possible relationships between ICT inhibitors and the risk of infection, as well as to consider the possible benefits of ICT inhibitors as a treatment for various types of infections, including viral, parasitic and fungal, as well as sepsis. Although ICT inhibitors have demonstrated the ability to significantly prolong the life expectancy of patients with advanced cancer, they often lead to adverse events, which often requires treatment with immunosuppressive drugs, including corticosteroids, anti-TNF and other biological agents. The overall effect of ICT inhibitors on human infections remains poorly understood. Further research is needed to understand the basic mechanisms of the immunological effects of ICT inhibitors on various types of infections, which in some cases may be beneficial.

Evolution of European prostate cancer screening protocols and summary of ongoing trials.

Population-based organised repeated screening for prostate cancer has been found to reduce disease-specific mortality, but with substantial overdiagnosis leading to overtreatment. Although only very few countries have implemented a screening programme on a national level, individual prostate-specific antigen (PSA) testing is common. This opportunistic testing may have little favourable impact, while stressing the side-effects. The classic early detection protocols as were state-of-the-art in the 1990s applied a PSA and digital rectal examination threshold for sextant systematic prostate biopsy, with a fixed interval for re-testing, and limited indication for expectant management. In the three decades since these trials were started, different important improvements have become available in the cascade of screening, indication for biopsy, and treatment. The main developed aspects include: better identification of individuals at risk (using early/baseline PSA, family history, and/or genetic profile), individualised re-testing interval, optimised and individualised starting and stopping age, with gradual invitation at a fixed age rather than invitation of a wider range of age groups, risk stratification for biopsy (using PSA density, risk calculator, magnetic resonance imaging, serum and urine biomarkers, or combinations/sequences), targeted biopsy, transperineal biopsy approach, active surveillance for low-risk prostate cancer, and improved staging of disease. All these developments are suggested to decrease the side-effects of screening, while at least maintaining the advantages, but Level 1 evidence is lacking. The knowledge gained and new developments on early detection are being tested in different prospective screening trials throughout Europe. In addition, the European Union-funded PRostate cancer Awareness and Initiative for Screening in the European Union (PRAISE-U) project will compare and evaluate different screening pilots throughout Europe. Implementation and sustainability will also be addressed. Modern screening approaches may reduce the burden of the second most frequent cause of cancer-related death in European males, while minimising side-effects. Also, less efficacious opportunistic early detection may be indirectly reduced.

Human Campylobacter spp. infections in Italy.

Campylobacter is a frequent cause of enteric infections with common antimicrobial resistance issues. The most recent reports of campylobacteriosis in Italy include data from 2013 to 2016. We aimed to provide national epidemiological and microbiological data on human Campylobacter infections in Italy during the period 2017-2021. Data was collected from 19 Hospitals in 13 Italian Regions. Bacterial identification was performed by mass spectrometry. Antibiograms were determined with Etest or Kirby-Bauer (EUCAST criteria). In total, 5419 isolations of Campylobacter spp. were performed. The most common species were C. jejuni (n = 4535, 83.7%), followed by C. coli (n = 732, 13.5%) and C. fetus (n = 34, 0.6%). The mean age of patients was 34.61years and 57.1% were males. Outpatients accounted for 54% of the cases detected. Campylobacter were isolated from faeces in 97.3% of cases and in 2.7% from blood. C. fetus was mostly isolated from blood (88.2% of cases). We tested for antimicrobial susceptibility 4627 isolates (85.4%). Resistance to ciprofloxacin and tetracyclines was 75.5% and 54.8%, respectively; resistance to erythromycin was 4.8%; clarithromycin 2% and azithromycin 2%. 50% of C. jejuni and C. coli were resistant to ≥ 2 antibiotics. Over the study period, resistance to ciprofloxacin and tetracyclines significantly decreased (p < 0.005), while resistance to macrolides remained stable. Campylobacter resistance to fluoroquinolones and tetracyclines in Italy is decreasing but is still high, while macrolides retain good activity.

Effect of institutional antimicrobial stewardship guidelines on prescription of critically important antimicrobials for dogs and cats.

Veterinary hospital antimicrobial stewardship (AMS) guidelines might help combat antimicrobial resistance (AMR). Determine the conditions and types of infection for which antimicrobial drugs (AMDs) deemed critically important (CIA) by the World Health Organization (WHO) were prescribed and assess the effect of hospital AMS guidelines on adherence to International Society for Companion Animal Infectious Diseases published guidelines for the treatment of superficial bacterial folliculitis, respiratory tract disease and urinary tract infection in these cases. Dogs and cats managed at an academic veterinary hospital from 1/21 to 6/21 and 9/21 to 6/22. Prescriptions of cephalosporins (third or fourth generation), glycopeptides, macrolides/ketolides, polymyxins, and quinolones were identified. Data on culture and susceptibility (C/S) testing and previous AMD exposure were collected. Frequencies were compared between time periods using Fisher's exact test with Bonferroni corrections. In animals prescribed ≥1 WHO-CIA AMD, fluoroquinolones were the most frequently prescribed WHO-CIA class in dogs (567/1724, 32.9%) and cats (192/450, 42.7%). No animals were prescribed carbapenems, dihydrofolate reductase inhibitors/sulfonamides, or polymyxins. No cats were prescribed aminoglycosides or amphenicols. Institutional guidelines were followed in 57.8% (324/561) cases. The most frequent causes of nonadherence were failure to perform C/S testing 46.0% (109/237) and unnecessary use of a higher-tier AMD 43.0% (102/237). Bacterial C/S testing was more frequently performed after AMS guideline institution (59.7% vs. 46.8%, P = 0.0006). Adherence to published guidelines remained poor despite an increase in C/S testing. There were no changes in the frequencies of confirmed infections, positive cultures or AMD resistance between time periods.

Article Review: The Hepatic Physiology and Pathophysiology of Different Types of Hepatitis

Globally, viral hepatitis is a frequent cause of liver disease with high morbidity and fatality rates. Since the liver produces a large number of hematopoietic factors and carries out numerous essential tasks that influence metabolism throughout the body. The purpose of this study is to identify hematological complications in patients with acute viral hepatitis. This information will be useful for treating and monitoring these patients. Also, everyone should be aware of the symptoms of hepatitis. Due of this, this article.

Screening and diagnosis of primary aldosteronism. Consensus document of all the Spanish Societies involved in the management of primary aldosteronism.

Primary aldosteronism (PA) is the most frequent cause of secondary hypertension (HT), and is associated with a higher cardiometabolic risk than essential HT. However, PA remains underdiagnosed, probably due to several difficulties clinicians usually find in performing its diagnosis and subtype classification. The aim of this consensus is to provide practical recommendations focused on the prevalence and the diagnosis of PA and the clinical implications of aldosterone excess, from a multidisciplinary perspective, in a nominal group consensus approach by experts from the Spanish Society of Endocrinology and Nutrition (SEEN), Spanish Society of Cardiology (SEC), Spanish Society of Nephrology (SEN), Spanish Society of Internal Medicine (SEMI), Spanish Radiology Society (SERAM), Spanish Society of Vascular and Interventional Radiology (SERVEI), Spanish Society of Laboratory Medicine (SEQC(ML)), Spanish Society of Anatomic-Pathology, Spanish Association of Surgeons (AEC).

Ulcer Bleeding in the United States: Epidemiology, Treatment Success, and Resource Utilization.

Peptic ulcer disease is the most frequent cause of upper gastrointestinal bleeding. We sought to establish the epidemiology and hemostasis success rate of the different treatment modalities in this setting. Retrospective cohort study using the National Inpatient Sample. Non-elective adult admissions with a principal diagnosis of ulcer bleeding were included. The primary outcome was endoscopic, radiologic and surgical hemostasis success rate. Secondary outcomes were patients' demographics, in-hospital mortality and resource utilization. On subgroup analysis, gastric and duodenal ulcers were studied separately. Confounders were adjusted for using multivariate regression analysis. A total of 136,425 admissions (55% gastric and 45% duodenal ulcers) were included. The mean patient age was 67years. The majority of patients were males, Caucasians, of lower income and high comorbidity burden. The endoscopic, radiological and surgical therapy and hemostasis success rates were 33.6, 1.4, 0.1, and 95.1%, 89.1 and 66.7%, respectively. The in-hospital mortality rate was 1.9% overall, but 2.4% after successful and 11.1% after failed endoscopic hemostasis, respectively. Duodenal ulcers were associated with lower adjusted odds of successful endoscopic hemostasis, but higher odds of early and multiple endoscopies, endoscopic therapy, overall and successful radiological therapy, in-hospital mortality, longer length of stay and higher total hospitalization charges and costs. The ulcer bleeding endoscopic hemostasis success rate is 95.1%. Rescue therapy is associated with lower hemostasis success and more than a ten-fold increase in mortality rate. Duodenal ulcers are associated with worse treatment outcomes and higher resource utilization compared with gastric ulcers.

(100) Cavernovenous Leakage: A New Surgical Treatment in 171 Consecutive Patients with Severe, Drug-Resistant Erectile Dysfunction

Abstract Introduction Cavernovenous leakage (CVL) is a frequent cause of erectile dysfunction (ED) in which blood entering corpora cavernosa escapes too early due to abnormal venous network, for erections to develop or maintain. When PDE5Is are ineffective to compensate for leakage, CVL is a devastating condition, affecting millions worldwide for whom no specific treatment is currently proposed. Objective Evaluate results of a new method of treatment combining open surgery and embolization simultaneously during the same procedure, in patients with CVL resistant to PDE5Is. Methods 171 consecutive patients with severe ED for more than six months, with CVL diagnosed by pharmacologically-challenge penile duplex sonography (PC-PDS) using intracavernous injection of Prostaglandin E1 and Papaverine, were operated-on. Leaks were imaged by caverno-computed tomography. Patient with other cause of ED were excluded, all had refused a penile implant, signed an informed consent, had a control PC-PDS three months after surgery, and were clinically evaluated during follow-up. A retrospective analysis was performed on prospectively collected data. Comparisons of variables before and after surgery used a paired t-test. Results Mean age was 43.8±13.6 years, range 18–76. ED had started at the beginning of sexual life (30) in 47.4%. Mean ED duration before surgery was 11.1±9.1 years (range 0.5–30). All patients had two clinical signs of organic ED: 1. no phase of erection improvement in the past six months, 2. erection alterations during masturbation (Erection Hardness Score (EHS)&amp;lt;3 and/or erection instability). Signs suggesting CVL were 1. variation of erection hardness according to position during masturbations or intercourses in 59.1%, 2. erections instability during masturbation or intercourse in all patients. At three-month evaluation, mean pharmacologic EHS had increased from 2.56±.66 before surgery, to 3.40±.56 (p&amp;lt;.0001). All CVL hemodynamic parameters at PC-PDS had decreased compared to pre-surgery: mean End Diastolic Velocity (from 16.6±9.5 to 9.3±7.7 cm/s, p&amp;lt;.0001), mean leakage speed on Deep Dorsal Vein (from 12.8±13.4 to .8±3.2 cm/s, p&amp;lt;.0001), mean speed on any superficial vein (from 11.2±10.1 to 3.9±6.3 cm/s, p&amp;lt;.0001). Patients unable to perform penetrations despite ICC injection of Prostaglandin E1 20 micg plus Papaverine 40 mg (EHS&amp;lt;3) decreased from 66.9 to 11.6% (p&amp;lt;.001). At the end of the 29.8±20.4-month follow-up, IIEF-5 score had increased from 9.7±5.1 to 15.5±6.0 (p&amp;lt;.0001), clinical EHS during sexual intercourse from 2.0±.7 to 3.3±.7 (p&amp;lt;.0001), penetration success rate from 22.3±31,7 to 70.1±37.2% (p&amp;lt;.0001), mean EHS during masturbation from 2.11±.67 to 3.04±.75 (p&amp;lt;.0001), EHS at morning erection from .95±1.24 to 2.1±1.37 (p&amp;lt;.0001), before and after surgery, respectively. 30.4% did not take any medication for erection. Success rate defined by post-operative EHS&amp;gt;3 and/or EHS increase &amp;gt;0.5 and erection stability was 80.7%. 78.9% recognized sexual support by a sexual medicine specialist is necessary for sexual recovery after surgery. Conclusions Simultaneous open surgery and embolization is a new procedure that offers unprecedented documented results in CVL resistant to PDE5Is. Clinical screening of CVL in ED patients is simple and should be evaluated in sexual medicine practice. Disclosure No.

Difficult defecation in constipated patients: Diagnosis by minimally invasive diagnostic tests.

Defecation Disorders (DD) are a frequent cause of refractory chronic constipation. DD diagnosis requires anorectal physiology testing. Our aim was to evaluate the accuracy and Odds Ratio (OR) of a straining question (SQ) and a digital rectal examination (DRE) augmented by abdomen palpation on predicting a DD diagnosis in refractory CC patients. Two hundred and thirty-eight constipated patients were enrolled. Patients underwent SQ, augmented DRE and balloon evacuation test before entering the study and after a 30-day fiber/laxative trial. All patients underwent anorectal manometry. OR and accuracy were calculated for SQ and augmented DRE for both dyssynergic defecation and inadequate propulsion. "Anal Muscles" response was associated to both dyssynergic defecation and inadequate propulsion, with an OR of 13.6 and 5.85 and an accuracy of 78.5% and 66.4%, respectively. "Failed anal relaxation" on augmented DRE was associated with dyssynergic defecation, with an OR of 21.4 and an accuracy of 73.1%. "Failed abdominal contraction" on augmented DRE was associated with inadequate propulsion with an OR >100 and an accuracy of 97.1%. Our data support screening constipated patients for DD by SQ and augmented DRE to improve management and appropriateness of referral to biofeedback.