Frequent Follow-up Research Articles

P0943 Estimated benefits and willingness of remote monitoring in IBD patients under maintenance therapy – ATTENDANT study

Abstract Background Following STRIDE II guidelines, patients with inflammatory bowel diseases (IBD) are tightly monitored evaluating effectiveness of IBD-therapies and predicting flares. In many centres, patients on stable conventional therapy typically have annual outpatient visits with their IBD physician, while patients on advanced therapies are seen every six months. However, the growing number of IBD patients in active follow-up is straining outpatient clinic capacity and increasing time pressures on healthcare professionals. Furthermore, many patients do not require specialised interventions during these visits, and those in long-term remission often prefer less frequent follow-up to reduce absenteeism from work or school. We aimed to evaluate the potential optimization of resources of remote monitoring for IBD patients in a large-volume referral centre. Methods An anonymous survey was conducted in 300 adult IBD patients, either untreated or on stable subcutaneous or oral maintenance therapy for at least two years, to assess their interest in a remote monitoring program and gather insights into their preferences for its implementation. Results Of the 300 patients, 48% were male, 68% had Crohn’s disease, 31% ulcerative colitis and 1% IBD type unclassified. Forty-one percent had a disease duration of more than 20 years. Additionally, 17% were without any IBD-related therapy, 9% were on conventional therapy only, and 74% were receiving subcutaneous or oral advanced therapy. Most patients (68%) were actively employed, 70% of whom worked full-time. Notably, 77% (n=230) expressed interest in significantly reducing their outpatient visits in favour of remote monitoring. The study also identified cost and time savings for patients, as an outpatient visit takes approximately 3 hours (range 2-4 hours). Also, 24% incur public transport cost of 25 to 56 euros to attend the clinic (N = 41). Among the patients interested in remote monitoring, 94% were willing to complete three-monthly questionnaires taking about 10 minutes, and 94% agreed to annual blood analyses. Regarding faecal calprotectin, 66% were open to conducting home-based stool analyses every three months, while 72% would agree to bring a stool sample to their general practitioner or local hospital. Also, 79% were willing to attend biennial outpatient visits (Fig1). Patients also emphasized the importance of personal contact in establishing a trustworthy and safe remote monitoring system. Conclusion Remote monitoring is a promising program for IBD patients in stable remission, offering potential financial and time savings for employers, patients, and society. However, further research is required to evaluate the safety and feasibility of this approach.

Presentation and surgical management approaches of giant presacral and sacral schwannomas: a case report and systematic review and meta-analysis.

Giant sacral and presacral schwannomas are very rare conditions and their prevalence is estimated to account for only 0.3 to 3.3% of overall schwannomas. Current published literature about these tumors is limited to case reports and small case series. In this paper we systematically reviewed and analyzed the available literature on giant sacral schwannomas focusing on identifying the presenting symptoms, Klimo type, surgical approach, recurrence rate and postoperative complications. Following the PRISMA guidelines, we conducted a literature search on electronic databases to obtain the relevant studies until March 2024. We included reports of surgically managed giant sacral schwannomas; either involving tumor of at least 2 adjacent vertebra or had a maximum diameter of 5cm or more. Presenting symptoms, tumor size, morphology, surgical approach and postoperative complications were reported. A total of 102 studies with 201 unique patients were included in our analysis (mean age 45.4 ± 9.8, 49.7% females). The most common presenting symptoms were lower extremity radicular pain (19.5%), lower back pain (14.1%), lower extremity numbness or paresthesia (9%), and constipation (7.6%). Most surgeries used an open posterior approach (40.1%) or open anterior approach (33.5%). Postoperative complications occurred in (29.3%) of patients and 10% had local recurrence or progression of their tumor. On linear regression the volume of the tumor could significantly predict the estimated amount of blood loss (P = 0.03). We found that an anterior approach was far more likely to be used in patients with Klimo type III, (P < 0.001). Similarly, posterior approach was mostly used for Klimo type I and type II (P < 0.001). The management approach of giant sacral and presacral schwannomas are mainly tailored according to the tumor size and location. Due to the benign nature and the overall recurrence rate of the tumor, frequent imaging follow-up is required after safe resection with adequate clean margins.

Tricuspid Regurgitation after Orthotopic Heart Transplantation: Trajectories and Association With Mortality.

Tricuspid regurgitation (TR) is common immediately after orthotopic heart transplantation (OHT), though the expected outcomes of TR over time remain undefined. In this study, we examined the natural trajectory of TR in the first 120 days post-transplantation. We observed the clinical phenotypes of trajectories of TR after OHT, and assessed trajectory correlation with 1-year mortality and degree of right ventricular (RV) dysfunction. All patients who underwent OHT at a single institution from January 2009 to July 2019 were included, unless death occurred during the index hospitalization. TR and RV dysfunction on follow-up transthoracic echocardiograms were tracked on 4-point scales and latent-class mixed modeling (LCMM) identified classes of TR trajectories. Fisher's exact test was used to compare 1-year mortalities between classes. Based on LCMM, four distinct classes of TR trajectories emerged, characterized as sustained (n = 40), variable (n = 172), stable (n = 175), and recovered (n = 189) TR. Significant differences in mortality rates were found amongst classes at 10.0%, 8.1%, 4.0%, and 2.6%, respectively (p = 0.025). The degree of RV dysfunction mirrored TR severity in all subsets except the sustained TR group. The trajectory of TR in the first 120 days post-OHT is associated with 1-year mortality. In many subsets, there is a close association with TR grade and RV function improvement. However, in the sustained TR group, RV function improved without subsequent improvement in TR severity. These findings could identify patients with higher mortality risk for whom more frequent follow-up or intervention is warranted.

Are current follow-up intervals justified in patients with non-emergent aortic surgeries?

Evidence for different surveillance protocols following aortic treatment is still lacking. Aim of this study was to analyze the clinical relevance of a first follow-up visit after 6 months. Between 01/2018 and 12/2019, 464 patients treated for non-emergent aortic pathologies were retrospectively analysed. Incidence of aortic events during follow-up (ie death, reintervention, endoleaks, anastomotic/new aneurysms, and diameter progression over time) was investigated. A discrete-time non-homogeneous Markov-chain model was used to analyse the data and to arrive at the number of skipped 6-month follow-up visits needed to harm a patient. After 6 months 2 (1.77%) patients had died, 15 (15.31%) patients suffered from aortic events, and a total of 4 (3.67%) patients had undergone reintervention after endovascular surgery, compared to 0 deaths, 2 (0.59%) patients with aortic events and 5 (1.48%) reinterventions after open-surgery. In our Markov Chain Model, after 6 months, 4.75% of patients showed aortic events, received a reintervention, or died. Sixty patients would need to skip their 6-month follow-up visit for one indication for reintervention to go unnoticed. Only 24 would need to skip it for one complication to go by unnoticed. This number is 55 after open surgery and 9 after endovascular. After elective endovascular or open aortic surgery without immediate in-hospital postoperative aortic events, the first follow-up visit after 6 months is important. Extending the first interval to longer time periods might lead to a considerable increase in missed aortic events. The cost and radiation exposure of frequent follow-ups must be balanced against the benefits of early preventative aortic interventions, warranting further research.

Drug-induced liver injury related to avacopan therapy.

The efficacy of avacopan as remission induction therapy for Anti-Neutrophil Cytoplasmic Autoantibody (ANCA)-associated vasculitis (AAV) is well-established. However, concerns regarding liver injury post-avacopan treatment remain, especially in Japan. Therefore, this study aimed to investigate drug-induced liver injury (DILI) associated with avacopan treatment. This study included 22 patients with AAV who were treated with avacopan at multiple centers in Japan between September 2021 and March 2024. DILI was assessed by the Japanese version of a revised electronic causality assessment method (RECAM-J 2023). Among the 22 patients treated with avacopan, DILI was observed in nine cases (40.9%): six with microscopic polyangiitis and three with granulomatosis with polyangiitis. Severe DILI with elevated total bilirubin (T-Bil) was observed in four of the nine patients (44.4%), a few weeks after the initiation of avacopan therapy. Eight of the nine patients (88.9%) with DILI improved after discontinuation of avacopan and other medications, and one patient developed vanishing bile duct syndrome (VBDS) leading to death. Avacopan-induced DILI was classified into three patterns: 1, short-term injury without T-Bil elevation; 2, transient cholestatic liver injury with T-Bil elevation; 3, decompensated liver injury with marked T-Bil elevation (VBDS). The risk factors for severe DILI with T-Bil elevation in Japanese patients included older age, lower body mass index, and early onset DILI following the initiation of avacopan treatment. Avacopan-induced DILI is relatively common in Japan and could be lethal. Frequent laboratory follow-ups should be considered, especially for elderly and low-body-weight patients.

Associations of Cumulative Adulthood, Childhood and Life-long Insulin with Adulthood Retinal Microvasculature.

Exogenous insulin is reported to have both vasodilatory and vasoconstrictive effects on the microvasculature. Little is known about the associations of long-term endogenous insulin exposure with microvasculature. To test the hypothesis that long-term exposure to high insulin levels in childhood and adulthood is associated with adverse changes in retinal microvasculature in adulthood in a population without diabetes. We analyzed data derived from the longitudinal Cardiovascular Risk in Young Finns Study (YFS). The first cross-sectional study was conducted in 1980, and participants were followed for 31 years from childhood to adulthood with frequent follow-up visits. Fundus photos were taken in 2011, and microvascular outcome measures were derived in participants at the age of 34-49 years (n=1684). After exclusion of individuals with diabetes or missing insulin measures, 1166 participants formed the population of the present study. Cumulative exposure as the area under the curve (AUC) for adulthood (10-year exposure between 2001 and 2011), and childhood (exposure between ages 6-18 years) insulin and other cardiovascular risk factors were determined. Additionally, adulthood and childhood cumulative AUCs were summarized to construct life-long AUCs. Higher adulthood, childhood and life-long exposure for cumulative insulin was associated with decreased retinal arteriolar diameter when adjusted for age and sex, and further for cumulative conventional cardiovascular risk factors. Cumulative childhood, adulthood and life-long insulin are associated with decreased retinal arteriolar diameter in adulthood in a population of participants without diabetes, independently of conventional cardiovascular risk factors.

Calcifediol and paricalcitol as adjunctive therapies for HSV-1 keratitis and corneal perforation: A case report.

Herpes simplex virus 1 establishes a latent infection in trigeminal ganglia. Reactivation causes cold sores, as well as viral keratitis. The purpose of this study was to report potential benefits of using active vitamin D receptor ligands (VDR-agonists) as adjunctive therapies for the treatment of infectious corneal perforations, and prevention of HSV recurrence. A 57-year-old female with a past history of episodic, poorly-healing, corneal erosions, recurring orolabial herpetic lesions, as well as PCR-confirmed recurrences of herpes simplex keratitis presented with a burning sensation and slight pain in the right eye. Examination indicated HSV keratitis. Topical antibiotic and oral antiviral treatments were prescribed. Despite these standard-of-care treatments, a perforated corneal ulcer ensued. Corneal perforation associated with HSV-1 keratitis recurrence, later confirmed by PCR analysis of corneal scrapings. Corneal perforation was treated with a human fibrin glue, fortified with multilayered amniotic membrane transplant, as well as a therapeutical contact lens. Following surgery, calcifediol and paricalcitol were started as oral adjunctive therapies in an attempt to boost tissue regeneration and innate-immunity within the slow-healing cornea. Anterior segment optical-coherence tomography was used to measure corneal thickness. Frequent follow-ups with various specialists allowed for comprehensive patient evaluation, and meticulous screening for any signs indicating potential HSV-1 recurrence. Following calcifediol-paricalcitol therapy corneal thickening, and re-epithelization ensued. During combined calcifediol-paricalcitol therapy, the patient has had no recurrence of herpes simplex keratitis, or orolabial herpes lesions. Corneal stabilization avoided a high-risk, full-thickness corneal transplantation, facilitating future cataract surgery, and allowing for some degree of visual recovery in this eye.

Women Autonomy in Health Care Decision Making and Associated Factors Among Postpartum Women in Southern Ethiopia: A Cross-Sectional Study.

Women's autonomy in healthcare decision-making is crucial for improving maternal and child health. Despite its importance, there is limited evidence on autonomous healthcare decision making particularly in postpartum women. Thus, this study aimed to assess the prevalence of postpartum women's autonomy in healthcare decision making and its associated factors in Chencha town, Gamo zone, southern Ethiopia. A community based cross-sectional study was conducted among 617 postpartum women in southern Ethiopia from October 1 to November 30, 2023. A study participants were selected by a simple random sampling technique. The data were collected through pretested and interviewer administered questionnaire. Following coding and entry into Epi-data version 3.1, the data were exported into statistical package for social science software (SPSS version 26) for analysis. A logistic regression model was fitted and, variables with p < 0.05 were declared to be significantly associated with women autonomy in healthcare decision-making. In this study, 61.6% of postpartum women have autonomous in their health care decision making with 95% confidence interval (CI): 57.4, 65.3. Women age over 35 years (AOR = 3.2, 95% CI: 1.7, 6.0), enrollment in community-based health insurance (AOR = 1.5 95% CI: 1.0, 2.3), having four and above antenatal care visits (AOR = 2.5, 95% CI: 1.6, 3.8), using skilled delivery service (AOR = 4.3, 95% CI: 2.9, 6.6), having primary educational level (AOR = 4.9, 95% CI: 3.0, 8.0), and secondary and above educational level (AOR = 5, 95% CI: 3.1, 8.0) were positively associated with women autonomy in health care decision making. This study revealed that majority of postpartum women were autonomous in their healthcare decision making. Maternal age, educational status, enrollment in community-based health insurance, having frequent ANC follow-up and using skilled delivery service were factors significantly associated with women's autonomy. Focus should be given to improve women antenatal care follow-up and the enrollment of community-based health insurance.

Impact of Health Education Programme on Adherence to Treatment in Knee Osteoarthritis: An Interventional Study on Egyptian Patients.

To measure the level of adherence of patients with primary knee osteoarthritis (KOA) to an interventional therapeutic and rehabilitation programme and investigate factors that hinder patients' adherence. A total of 154 participants with primary knee osteoarthritis (KOA) were divided into intervention and control groups. The intervention protocol included patient education on the nature and treatment of KOA, therapeutic exercise, a weight loss programme for overweight patients, and a physical therapy programme. Participants were followed for 3months. The Visual Analog Scale for Pain (VAS-p), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and knee Kellgren-Lawrence OA grading were measured before and after the intervention. Additionally, the Morisky adherence questionnaire and the WHO Multidimensional Framework for factors affecting adherence were assessed. One fifty four participants with KOA were randomly allocated into intervention and control groups. A low level of adherence was detected in both groups (68.8% in the intervention group vs. 84.4% in the control group). Patients who followed the interventional programme were more adherent. Adherence to therapy was associated with a reduction in the Visual Analog Scale for Pain (VAS-p) (p=0.016) and improved function as measured by WOMAC (p=0.018). Factors primarily associated with patient non-adherence included unemployment (67.8%), low income (59.3%), no previous response to therapy (58.5%), less frequent follow-up visits (55.1%), lack of insurance (66.9%), difficult access to services (59.3%), and high cost of services (55.1%). Adherence to treatment in OA patients is a significant concern and a common problem, appearing to be associated more with socioeconomic factors than with pain and function.

Local Endoscopic Treatment of Low-Grade Urothelial Tumors in the Upper Urinary Tract-Oncological Outcome of a Consecutive Single-Center Series of 118 Patients.

Upper urinary tract urothelial tumors are mostly treated with the use of endoscopic laser ablation. The treatment is recommended when the tumor is low grade and non-invasive. The aim of the present study was to investigate the oncological outcome of patients treated endoscopically for low-grade (LG) upper tract urothelial carcinoma (UTUC). One hundred and eighteen consecutive patients with pTa LG UTUC initially treated with laser ablation from 2012-2022 at a single university hospital were included. Patient and tumor characteristics, treatment, and oncological outcomes were retrospectively registered from electronic medical journals. Survival analysis was performed using Kaplan-Meier and Nelson-Aalen plots. The median number of local recurrences was 2 with a median time to first recurrence of 5 months (IQR: 2-46). The 2-year share of patients having no recurrence was 28.8%. The risk of recurrence was highest within the first 3 years following initial treatment. Two-year survival function with no progression and preserved renal unit was 67.9%. The two-year overall survival (OS) and disease-specific survival (DSS) were 84.2% and 97.1%. The 5-year OS and DSS were 59.1% and 94.1%. The median follow-up time for OS was 36 months (IQR: 20.3-58.8). In the patient series, we found that the risk of recurrence following laser ablation of LG UTUC was high; however, it was associated with a low risk of progression and high OS and DSS. Therefore, we conclude that treatment with laser ablation in patients with LG UTUC is safe, although frequent follow-up is needed to detect recurrence.

Prevalence of and factors associated with overweight and obesity in patients with severe mental disorders in Shenzhen: results from the urban Chinese population.

To determine the prevalence of overweight and obesity in patients with severe mental disorders (SMD) and the factors associated with their socio-demographic and disease characteristics in a cross-sectional population-based study. This analysis examined the prevalence of overweight and obesity in 14 868 managed SMD patients in an urban area of Shenzhen city based on data from the health information monitoring system in 2021. Multivariate logistic regression were used to identify the factors associated with the prevalence of overweight and obesity in patients with SMD. China. 14 868 patients with SMD. The prevalence of overweight and obesity in patients with SMD in this study was 32·6 % and 16·1 %, respectively. In multivariate analysis, married status, Shenzhen household registration, management durations of 5-10 years and >10 years, participation in family physician services, taking clozapine or aripiprazole, FPG > 6·1 mmol/l, hypertension, TC ≥ 5·2 mmol/l, TG ≥ 1·7 mmol/l, and more frequent follow-ups in the past year were associated with higher odds of overweight and obesity. Compared to their respective reference categories, living with parents, spouse and children, taking risperidone, aripiprazole, amisulpride and perphenazine, FPG > 6·1 mmol/l, hypertension, TC ≥ 5·2 mmol/l, TG ≥ 1·7 mmol/l, and more frequent follow-ups in the past year were associated with higher odds of obesity. We observed a high prevalence of overweight and obesity in patients with SMD in this study. The findings highlight the need for integrated management of overweight and obesity risk factors among patients with SMD.

More vs Less Frequent Follow-Up Testing and 10-Year Mortality in Patients With Stage II or III Colorectal Cancer

Although intensive follow-up of patients after curative surgery for colorectal cancer is common in clinical practice, evidence for a long-term survival benefit of more frequent testing is limited. To examine overall and colorectal cancer-specific mortality rates in patients with stage II or III colorectal cancer who underwent curative surgery and underwent high-frequency or low-frequency follow-up testing. This randomized clinical trial with posttrial prespecified follow-up was performed in 23 centers in Sweden and Denmark. The original study enrolled 2509 patients with stage II or III colorectal cancer from Sweden, Denmark, and Uruguay (1 center) who received treatment from January 1, 2006, through December 31, 2010, and were followed up for up to 5 years. The participants from Sweden and Denmark were then followed up for 10 years through population-based health registries. The 53 patients from Uruguay were not included in the posttrial follow-up. Statistical analysis was performed from March to June 2024. Patients were randomly allocated to follow-up testing with computed tomography (CT) scans and serum carcinoembryonic antigen (CEA) screening at 6, 12, 18, 24, and 36 months after surgery (high-frequency group; 1227 patients), or at 12 and 36 months after surgery (low-frequency group, 1229 patients). The outcomes were 10-year overall mortality and colorectal cancer-specific mortality rates. Both intention-to-treat and per-protocol analyses were performed. Of the 2555 patients who were randomly allocated, 2509 were included in the intention-to-treat analysis, of whom 2456 (97.9%) were included in this posttrial analysis (median age, 65 years [IQR, 59-70 years]; 1355 male patients [55.2%]). The 10-year overall mortality rate for the high-frequency group was 27.1% (333 of 1227; 95% CI, 24.7%-29.7%) compared with 28.4% (349 of 1229; 95% CI, 26.0%-31.0%) in the low-frequency group (risk difference, 1.3% [95% CI, -2.3% to 4.8%]). The 10-year colorectal cancer-specific mortality rate in the high-frequency group was 15.6% (191 of 1227; 95% CI, 13.6%-17.7%) compared with 16.0% (196 of 1229; 95% CI, 14.0%-18.1%) in the low-frequency group (risk difference, 0.4% [95% CI, -2.5% to 3.3%]). The same pattern resulted from the per-protocol analysis. Among patients with stage II or III colorectal cancer, more frequent follow-up testing with CT scans and CEA testing did not result in a significant reduction in 10-year overall mortality or colorectal cancer-specific mortality. The results of this trial should be considered as the evidence base for updating clinical guidelines. ClinicalTrials.gov Identifier: NCT00225641.

GLP-1 Receptor Agonists: A Promising Therapy for Modern Lifestyle Diseases with Unforeseen Challenges.

Modern lifestyle diseases remain a persistent challenge in healthcare. Currently, about 422 million people worldwide are affected by diabetes, while 1 in 8 people are living with obesity. The development of glucagon-like peptide 1 receptor agonists (GLP-1RAs) has marked a significant milestone in treating these conditions. Interest in GLP-1RAs has grown due to evidence that, beyond their established role in diabetes management, these drugs influence other metabolic disorders. This is attributed to the fact that GLP-1 receptors are found in various healthy human tissues. However, a potential cause for concern is the expression of GLP-1 receptors in certain cancers. This review focuses on the most recent findings concerning the actions of GLP-1RAs, detailing their documented impact on the thyroid gland and pancreas. It addresses concerns about the long-term use of GLP-1RAs in relation to the development of pancreatitis, pancreatic cancer, and thyroid neoplasms by exploring the mechanisms and long-term effects in different patient subgroups and including data not discussed previously. This review was conducted through an examination of the literature available in the MedLine (PubMed) database, covering publications from 1978 to 10 May 2024. The collected articles were selected based on their relevance to studies of GLP-1 agonists and their effects on the pancreas and thyroid and assessed to meet the established inclusion criteria. The revised papers suggest that prolonged use of GLP-1RA could contribute to the formation of thyroid tumors and may increase the risk of acute inflammatory conditions such as pancreatitis, particularly in high-risk patients. Therefore, physicians should advise patients on the need for more frequent and detailed follow-ups.

Weight Recurrence Trends Among Participants Post Laparoscopic Sleeve Gastrectomy: A 13-Year Single-Centre Retrospective Study in Kuwait

Weight recurrence (WR) is a frequent complication in patients post metabolic and bariatric surgery (MBS)(1). However, there is no consensus on WR definitions(2). Patients’ preoperative characteristics are believed to have an association with WR(1). This study aimed to evaluate WR 3 to 13 years after laparoscopic sleeve gastrectomy (LSG) using three commonly used definitions and investigate potential risk factors.A retrospective analysis examined data from patients’ medical records who underwent primary LSG between 2008 and 2019. Inclusion criteria were patients aged 18 years or older, eligible for MBS, and with at least three years of follow-up. Those with previous MBS, revised surgical procedures post-LSG, or who had the surgery in 2019 were excluded. Dividing the analysis into three post-LSG periods (1st year, 2nd year and &gt;2nd year). The primary outcome was WR over time utilizing three definitions: &gt;10% increase in nadir weight, &gt;10% increase in nadir weight (nadir 1 to 2 years), and percentage of excess weight loss (EWL) &lt;50% with a body mass index (BMI) &gt;35 kg/m2. Survival analysis techniques were used to assess the occurrence and timing of WR. Potential risk factors of WR including age, gender, BMI, obesity-related comorbidities, duration post-LSG, and attendance to follow-up visits were assessed using binary logistic regression.Only 219 out of 2982 patients met the inclusion criteria and were included in the analysis. Patients’ mean age and BMI were 37.21 ± 10.44 years and 45.92 ± 6.99 kg/m2, respectively, with females constituting the majority (64%). Weight recurrence varied between different definitions, ranging from 31% to 61%. The estimated median time for WR was significant starting from 9 years when applying the nadir weight definitions while from 6 years when EWL&lt;50% &amp; BMI&gt;35 kg/m2 definition was used. Binary logistic regression analysis identified several risk factors for WR considering the definition of EWL &lt;50% with BMI &gt;35 kg/m2: older age [OR 1.104, 95% CI (1.0591.151), p-value &lt;0.001] and higher preoperative BMI [OR 1.352, 95% CI (1.242-1.473), p-value &lt;0.001]; while male gender [OR 0.314, 95% CI (0.137−0.720), p-value 0.006] and frequent follow-up visits [OR 0.528, 95% CI (0.382−0.730), p-value &lt;0.001] were protective factors against WR. Other definitions did not demonstrate significant associations except for a longer duration post-LSG as a risk factor for WR when applying the definition of &gt;10% increase from nadir weight (nadir weight 1 to 2 years) [OR 1.153, 95% CI (1.050-1.267), p-value 0.003].This study explored factors that influenced WR post-LSG. Potential risk factors including age, gender, BMI, and time varied according to the WR definition applied. More research is necessary to establish a consensus on a suggested definition that aligns with the clinical parameters and comorbidity status of patients for application in upcoming research and clinical settings.

Treatment of gingival enlargement caused by orthodontic treatment

The aim of this study was to assess the healing process of gingival enlargement in adolescents with and without fixed orthodontic appliances using conventional scalpel treatments over a 3-month follow-up period. 20 patients with gingival enlargement were divided into two groups. The control group, without fixed orthodontic appliances, received mechanical treatment through conventional scalpel. Test group, comprising patients with fixed orthodontic appliances, was treated using conventional scalpel. Follow-up visits were conducted on days 1 and 90. Clinical periodontal parameters, including plaque index, gingival index, bleeding on probing, probing pocket depth, and gingival overgrowth index, were compared across groups at different time intervals from baseline. All groups exhibited statistically significant reductions in clinical periodontal parameters during the study period (P &lt; 0.05). Test group, treated with conventional scalpel, showed the fastest and most consistent improvements in the healing process compared to baseline. Conventional scalpel therapy proved to be an effective method for treating gingival enlargement, with no reported discomfort or pain during or after the procedure. Given the challenges patients with fixed orthodontic appliances face in maintaining oral hygiene, they should be scheduled for more frequent follow-ups and given thorough home-care instructions.

Predictive Value of Cord Blood Bilirubin for Hyperbilirubinemia in Term Neonates with ABO Incompatibility

Introduction: Jaundice affects 60% of full-term and 80% of preterm neonates. Feto-maternal ABO incompatibilities occur in 20-25% of pregnancies, but severe haemolytic disease develops in only 10%. ABO-incompatible babies have doubled the risk of jaundice requiring treatment and a 5-10 times increased risk of exchange transfusions. Objective: Aim of this study was to determine if cord blood bilirubin (CBB) can predict hyperbilirubinemia in term babies with ABO setup prior to discharge that would help to decrease readmission and subsequently complications due to jaundice. Methods: A hospital-based prospective observational study was conducted at Patan Hospital. Cord blood group and bilirubin levels were collected from newborns of O positive mothers. Babies with A positive and B positive blood groups had their CBB levels measured and were followed daily for 72 hours. Serum bilirubin was tested based on clinical judgment to detect hyperbilirubinemia and treated per NICE guidelines. Data were analysed using SPSS v21.0, Mann-Whitney test, ANOVA, and ROC analysis. Results: Among 66 cases, significant hyperbilirubinemia was seen in 7 neonates (10.6%). It was more common in B positive babies (12.2%) compared to A positive (8%). Mean CBB was 3.45 ± 0.57 in those developing significant hyperbilirubinemia. A CBB of 2.95 mg/dL had the highest sensitivity (86%), specificity (94%), and negative predictive value (98%) for predicting hyperbilirubinemia in ABO setup babies. Conclusion: Term babies with ABO incompatibility and CBB&lt;2.95 mg /dL are unlikely to need further evaluation, while those with cord bilirubin level ≥2.95 mg/dL should have frequent early follow-ups.

Analysis of 179 posterior communicating artery infundibular dilations demonstrating low risk for transformation to aneurysm or rupture and the usefulness of the “round defect”

ObjectiveOutpouchings, particularly those originating from the posterior communicating artery off the internal carotid artery (Pcom-Ops), are often unable to be categorized definitively as aneurysms or infundibula resulting in frequent clinical imaging and follow-up. We aimed to investigate potential correlations between growth and rupture rates and easily definable imaging characteristics in Pcom-Ops. MethodsWe analyzed CT and MR imaging of Pcom-Ops identified in a case series of patients seen between 2007 and 2022. For each outpouching, the length of the base, hypotenuse, and round defect, defined as the deviation from triangular shape, were calculated. These measurements were used to estimate the conical volume and eccentricity of the Pcom-Op. Results179 Pcom-Ops were identified from 152 patients who were followed for an average of for 3.2 ± 3.2 years. Bilateral Pcom-Ops were present in 17.8 % patients and 7.2 % had an underlying connective tissue disease. Only one Pcom-Op in a patient with polycystic kidney disease subsequently became a clear aneurysm after 6.3 years. The average approximated volume and round defect at presentation were 2.3 ± 2.2 mm3 and 0.29 ± 0.16 mm, respectively. Volume and round defect changed minimally over time followed. Outlier analysis of round defect, determined by Z-score more than 3 standard deviations above the mean, was not associated with evolution into clear aneurysms. ConclusionPcom-Ops rarely enlarge or rupture. Pcom-Op eccentricity does not predict high risk Pcom-Ops. Thus Pcom-Ops in general may not require close follow-up over time. However, Pcom-Ops in patients with connective tissue diseases should be monitored more closely.

Management of low-level HIV viremia during antiretroviral therapy: Delphi consensus statement and appraisal of the evidence

ObjectiveWhile antiretroviral therapy (ART) is highly effective, detection of low levels of HIV-1 RNA in plasma is common in treated individuals. Given the uncertainties on the topic, we convened a...

A Study of Clinico-Microbiological Profile and Treatment Outcomes of Infectious Keratitis.

Background Infectious keratitis (IK) is one of the major causes of corneal blindness in developing and developed nations.Numerous infections, including bacterial, fungal, viral, and protozoa, have been linked to IK. Corneal perforations can happen as one of the complications of IK. In this study, we aim to determine the clinical and microbiological profile and to studythe treatment outcomes of IK. Material and methods It is a prospective, observational, and experimental study conducted in a tertiary care hospital and research centerin Western Maharashtra, India, from September 2022 to June 2024. The sample size was 107 patients with IK. All patients were above 15 years of age, and all cases of microbial keratitis were within the inclusion criteria. Patients less than 15 years of age, patients with any other associated corneal pathology, healed cases of infectious keratitis, peripheral ulcerative keratitis, patients not willing to participate in the study, or not giving consent were excluded. Patients were examined thoroughly, and corneal scraping samples were collected and sent for microbiological examination. Appropriate treatment was provided through medical or surgical management, and treatment outcomes were evaluated during frequent follow-up visits. Results In our study, the majority of patients originated from rural areas, with most being over 60 years of age. Diabetes mellitus was seen in 24.3%, and a history of ocular trauma was present in 48.5% of patients. Staphylococcus epidermidis (3.74%) was the most common organism seen on gram staining, followed by Staphylococcus aureus (2.8%). Pseudomonas aeruginosa was the only gram-negative organism seen. The number of patients who had fungal isolates positive on culture was 57%, 12.1% had bacterial, and 30% had no growth of microorganisms. Fusarium species were seen in 39.2% of culture isolates, followed by Aspergillus flavus and Niger in 7.47% each. In 96% of medically managed patients, ulcers healed within two months. All ulcers with severe and moderate depth required therapeutic penetrating keratoplasty. A graft was in place in 95.2% after therapeutic penetrating keratoplasty, while one patient had graft rejection, and in one patient, endophthalmitis was seen. Conclusion Staphylococcus epidermidiswas the most common bacterial agent isolated on gram staining, and Pseudomonas aeruginosa was the only gram-negative bacillus isolated on gram staining. Fungal isolates were the most common isolates observed on culture, seen in more than half of the IK patients in our study. The majority of patientswho underwent medical management had ulcers healed in two months. The majority of the patients who underwent surgical management had fungal isolates positive.We recommend further research to be conducted in a generalized population, including urban settings, to understand the risk factors, microbiological profile, and treatment outcomes for IK.

Evaluation of the Effect of Diet Adherence on Nutritional Status and Metabolic Control in Children with Phenylketonuria Consuming a Phenylalanine-Restricted Diet: A Single-Center Study

Objective: The aim of this study was to determine the dietary habits of patients with phenylketonuria (PKU) in different age groups, to assess energy, protein and phenylalanine intakes, and to evaluate dietary compliance and its effect on metabolic control. Material and Methods: The study, conducted between 1 March 2022 and 30 September 2022, the study involved 20 children aged 2-18 diagnosed with PKU at the Department of Pediatric Metabolism Outpatient Clinic of Ankara Bilkent City Hospital. Participants were evaluated for diet compliance and had their blood phenylalanine and tyrosine levels were measured. Results: Among the 20 patients, 42.9% (n=9) were female and 57.1% (n=11) were male, with a mean age of 4.7±3.22 years. Age distribution was 70% (n=14) aged 2-6, 20% (n=4) aged 6-10, and 10% (n=2) aged 10-13. Patients attended four follow-ups over six months. A moderate negative correlation was found between daily dietary phenylalanine and blood phenylalanine levels in the first and last controls, and a high negative correlation in the 2nd and 3rd controls (p=0.006, p&amp;lt;0.001, p&amp;lt;0.001, p=0.013). A positive moderate correlation was found between the frequency of daily amino acid mixture consumption and diet compliance (p=0.025). Increased meal frequency improved diet compliance. No significant relationship was found between blood phenylalanine levels and amino acid mixture consumption, diet compliance, or daily amino acid mixture consumption frequency. Conclusion: In PKU, nutritional habits, daily phenylalanine intake and amino acid mixture consumption frequency impact dietary compliance and metabolic control. Lifelong medical nutrition therapy requires multidisciplinary team support, frequent follow-ups and adherence to the recommended diet.