Good Treatment Outcomes Research Articles

Case report: Metagenomic next-generation sequencing for the diagnosis of rare Nocardia aobensis infection in a patient with immune thrombocytopenia

BackgroundNocardiosis poses a diagnostic challenge due to its rarity in clinical practice, non-specific clinical symptoms and imaging features, and the limitations of traditional detection methods. Nocardia aobensis (N. aobensis) is rarely detected in clinical samples. Metagenomic next-generation sequencing (mNGS) offers significant advantages over traditional methods for rapid and accurate diagnosis of infectious diseases, especially for rare pathogens.Case presentationA 52-year-old woman with a history of immune thrombocytopenia for over 2 years was hospitalized for recurrent fever and cough lasting for 10 days. Her initial diagnosis on admission was community-acquired pneumonia, based on chest computed tomography findings of lung inflammation lesion. Empirical treatment with moxifloxacin and trimethoprim-sulfamethoxazole (TMP-SMZ) was initiated. However, her condition failed to improve significantly even after 1 week of treatment. Bronchoalveolar lavage fluid (BALF) subjected to mNGS revealed the presence of N. aobensis, resulting in a diagnosis of pulmonary nocardiosis caused by N. aobensis. This diagnosis was also supported by Sanger sequencing of the BALF. After adjusting the antibiotic regimen to include TMP-SMZ in combination with imipenem, the patient’s condition significantly improved. She was finally discharged with instructions to continue oral treatment with TMP-SMZ and linezolid for 6 months. The patient’s first follow-up 1 month after discharge showed good treatment outcomes but with obvious side effects of the drugs. Consequently, the antibiotic regimen was changed to doxycycline, and the patient continued to improve.ConclusionWe report the first detailed case of pulmonary nocardiosis caused by N. aobensis diagnosed by mNGS. mNGS could be an effective method that facilitates early diagnosis and timely decision-making for the treatment of nocardiosis, especially in cases that involve rare pathogens.

Trends in malignant neoplasm of bone and articular cartilage related mortality among older adults in United States (1999-2020).

Malignant neoplasms of bone and articular cartilage, although rare, are associated with substantial morbidity and mortality, posing a serious health burden. Understanding the trends in mortality related to these cancers is crucial for developing targeted interventions and improving patient outcomes. This study aims to analyze long-term mortality trends, identify demographic and geographic disparities, and uncover potential factors driving changes in mortality rates. This retrospective study analyzed mortality rates among individuals aged 65 and older from 1999 to 2020 using CDC WONDER death certificate data, abstracting demographics, geographic factors, and urban/rural status. From 1999 to 2020, 18,205 adults aged 65 and older died from malignant neoplasms of bone and cartilage. The age-adjusted mortality rate (AAMR) started at 20 per 100,000 in 1999 and steadily declined until 2012 (APC: -1.12). However, from 2012 onwards, there was a notable reversal, with the AAMR rising sharply to 23.8 by 2020 (APC: 4.73). Men had higher mortality rates than women, with NH Black individuals showing the highest rates among races. Southern states and nonmetropolitan areas had elevated AAMRs, suggesting targeted interventions for better outcomes and lower death rates. The findings highlight significant inequities, with Southern states and nonmetropolitan areas showing elevated age-adjusted mortality rates (AAMRs). These geographic disparities underscore the urgent need for targeted public health interventions in these regions to improve cancer outcomes and reduce mortality. Addressing these gaps is essential for achieving more equitable health outcomes, particularly in high-risk populations.

Surgical treatment strategies for gastroesophageal reflux after laparoscopic sleeve gastrectomy.

Bariatric surgery has emerged as an effective therapeutic approach for combating obesity. As the most commonly performed bariatric surgery, laparoscopic sleeve gastrectomy (LSG) has a long-term and effective outcome in weight reduction. However, studies have reported an increased incidence of gastroesophageal reflux disease (GERD) among patients after LSG. For those who fail to respond to conventional oral acid-suppressing medication, surgical intervention comes into consideration. The most commonly performed revisional surgery for sleeve gastrectomy is the Roux-en-Y gastric bypass, which can effectively alleviate the symptoms of reflux in patients and also continues to promote weight loss in patients who have not achieved satisfactory results or have experienced weight regain. In addition to this established procedure, innovative techniques such as laparoscopic magnetic sphincter augmentation (MSA) are being explored. MSA is less invasive, has good reflux treatment outcomes, and its safety and efficacy are supported by the literature, making it a promising tool for the future treatment of gastroesophageal reflux. This article also explores the role of endoscopic interventions for GERD treatment of post-sleeve gastrectomy patients. Although these methods have shown some therapeutic effect, their efficacy still requires further study due to a lack of support from more clinical data. For patients with preoperative hiatal hernia or gastroesophageal reflux symptoms, some experts now consider performing LSG combined with hiatal hernia repair or fundoplication to alleviate or prevent postoperative reflux symptoms. Both of these surgical approaches have demonstrated favorable outcomes; however, the addition of fundoplication requires further investigation regarding its long-term effects and potential postoperative complications. This article gathers and examines the current laparoscopic and endoscopic treatments for refractory gastroesophageal reflux following LSG, as well as the concurrent treatment of LSG in patients with preoperative gastroesophageal reflux or hiatal hernia.

Vertical dysplasia

In orthodontics, vertical dysplasia is complex and the most difficult problem to treat because most methods to control vertical dimensions are patient-dependent. They have multifactorial etiology. Vertical dimension problems are the last to treat out of all the dimensions. Careful diagnosis and examination of this malocclusion will help the orthodontist to gain good treatment outcomes. Inadequate treatment mechanics leads to improper treatment outcomes. Thereby compromising the patient’s facial esthetics. This article reviews the detailed description of vertical dysplasia.

The Innate Immune Landscape of dMMR/MSI Cancers Predicts the Outcome of Nivolumab Treatment: Results from the Drug Rediscovery Protocol.

The treatment efficacy of nivolumab was evaluated in patients with advanced, treatment-refractory solid mismatch repair deficiency/microsatellite-instable (dMMR/MSI) tumors, and in-depth biomarker analyses were performed to inform precision immunotherapy approaches. Patients with dMMR/MSI tumors who exhausted standard-of-care treatment options were enrolled in the Drug Rediscovery Protocol, a pan-cancer clinical trial that treats patients with cancer based on their tumor molecular profile with off-label anticancer drugs (NCT02925234). Patients received nivolumab (four cycles of 240 mg every 2 weeks, thereafter 480 mg every 4 weeks). The primary endpoint was clinical benefit (CB: objective response or stable disease ≥16 weeks). Whole-genome sequencing and RNA sequencing were performed on pretreatment tumor biopsies. A total of 130 evaluable patients were enrolled with 16 different cancer types. CB was observed in 62% [95% confidence interval (CI), 53-70], with an objective response in 45% (95% CI, 36-54). After a median follow-up of 14.5 months (95% CI, 13-19), the median progression-free survival was 18 months (95% CI, 9-not reached), and the median overall survival was not reached. Whereas CB was not, or only weakly, associated with markers of adaptive immune cell infiltration, CB was strongly associated with expression of a broad set of innate immune receptors/ligands. This clearly contrasted findings in melanoma, in which markers of adaptive immunity dominated the biomarker landscape. Nivolumab proved highly effective in advanced dMMR/MSI tumors. Expression of key innate immune receptors/ligands was the main predictor of a good treatment outcome, contrasting findings in melanoma and strengthening the rationale for tumor type-specific biomarkers for guiding immunotherapy.

Treatment Outcomes of Tuberculosis Among Artisanal and Small-Scale Miners in Zimbabwe: A Follow-Up Observational Study Using Secondary Data.

In Zimbabwe, artisanal and small-scale miners (ASMs) are a key vulnerable group with high risk for tuberculosis (TB), HIV, and silicosis. The main purpose of this study was to investigate treatment outcomes of TB among ASMs. We conducted a follow-up observational study using secondary data. We analyzed data from 208 ASMs treated for TB at two occupational health clinics. We found a high treatment success rate of 87%, comparable to the national average for drug-sensitive TB. Unsuccessful outcomes were due to death (5%) and loss to follow-up (7%). Over a quarter of ASMs had unknown HIV status. Our study is the first to document treatment outcomes of TB among ASMs in Zimbabwe. Encouragingly, this study demonstrates the possibility of achieving good TB treatment outcomes even among highly mobile populations like ASMs. Further research is needed to analyze leakages across the whole TB patient pathway among ASMs. Additionally, addressing the high rate of unknown HIV statuses among ASMs is crucial to further improve overall TB treatment outcomes in this population.

The association between neurological symptoms and the outcomes of N-methyl-D-Aspartate receptor encephalitis treatment

Objective: To analyze the relationship between neurological symptoms and treatment outcomes of anti-NMDA receptor encephalitis at the Neurology Center of Bach Mai Hospital. Subjects: We selected 50 who were diagnosed with encephalitis at Bach Mai Hospital from January 1st, 2020, to October 31st, 2023. Methods: Cross-sectional descriptive study. Results: Among the 50 patients studied, 48% achieved good treatment outcomes, while 52% had poor outcomes. There was evidence of a significant difference in treatment outcomes between the group with symptoms such as consciousness disorders, dyskinesia and movement disorders, speech disorders, and dysautonomia compared to the group without these symptoms (p<0.05). There was no significant difference in treatment outcomes between the group with symptoms such as seizures, memory impairment, and sleep disorders compared to the group without these symptoms (p>0.05). Conclusion: In our study, 48% of patients achieved good treatment outcomes at discharge. Symptoms of consciousness disorders, dyskinesia and movement disorders, speech disorders, and dysautonomia were associated with treatment outcomes.

Colorectal cancer screening in Tuzla canton: Project and strategy for patients with average cancer risk

Background: Screening for colorectal cancer (CRC) can identify premalignant lesions and detect asymptomatic malignant tumors at an early stage that have a better chance of healing, but also longer-term better treatment outcomes. Screening has been shown to reduce mortality from CRC. The aim of this paper is comprehensive education of health care professionals in the Tuzla Canton about this disease, adoption of new guidelines and simpler route from diagnosis to surgical treatment,which ultimately leads to reduced mortality and better outcomes in treatment. Material and methods:The project included family medicine specialists, surgeons and gastroenterologists, 100 of them. The education project was led by two surgeons, who implemented the guidelines ofthe American College of Gastroenterology (ACG) 2021, when it comes to screening CRC. Results: None of the participants offered all correct answers in tests, prior to the training, in both groups of doctors. For a post-educational test, data suggest that there has been a noticeable improvement in the results. In a group of doctors with over 10 years of service, 71 (98.61%) answered correctly all the questions offered and only 1 (1.39%) between 5 and 9 correct answers. For a group of doctors with less than 10 years of service, 26 (92.86%) provided all correct answers and only 2 (7, 14%) between 5 and 9 correct answers.Conclusion: This project pointed to the necessary education of healthcare professionals in this area, who are involved in early detection programmes for CRC, especially family medicine specialists, surgeons and gastroenterologists.

Exploring perspectives on how to improve psychological treatment for women from minoritised ethnic communities: A qualitative study with service users.

Women are disproportionately impacted by depression and anxiety disorders and in particular, women from minoritised ethnic communities experience inequalities in access to outcomes of psychological treatment for these disorders. Better understanding from the views of service users about the factors that impact their access to, and experiences of care could help to optimise treatment for these groups. This study explored experiences of treatment and gathered suggestions about treatment improvement, from the perspectives of women currently using psychological therapy services. Semi-structured interviews were conducted with 12 female NHS Talking Therapies for anxiety and depression (NHSTTad) service users from minoritised ethnic communities. Data were analysed using thematic analysis. Four high-order themes were identified: (1) cultural identity and experiences of mental health and treatment, (2) challenges associated with treatment, (3) facilitators of good treatment experiences and outcomes and (4) improvements for women from minoritised ethnic communities. Findings showed that cultural sensitivity and awareness are important to minoritised ethnic women receiving therapy. Challenges included access difficulties and limitations of treatment options offered, alongside personal challenges of engaging in therapy. Facilitators of good treatment experiences and outcomes included flexibility on the part of the service, as well as therapist-related factors such as identity characteristics (age, gender and culture of therapist), a good therapeutic relationship and the therapist's ability to deliver person-centred care. Improvements included ensuring care is culturally sensitive, reducing waiting times or providing better support for people on waiting lists, providing a flexible service that takes individual needs into account, increasing workforce diversity and reaching out to underserved communities. Many of the suggested improvements are generalisable to underserved minoritised ethnic groups, regardless of gender and could be applied to other psychological therapies services other than NHSTTad.

Psychological Risk Factors for Delayed Recovery Among Active Duty Service Members Seeking Treatment for Musculoskeletal Complaints at a Navy Shore-Based Military Medical Treatment Facility.

Musculoskeletal injuries (MSIs) are a leading cause of separation from the U.S. Navy. Data have shown that several psychological responses to MSI are associated with treatment outcomes. Yellow flags are maladaptive psychological responses to injury and predict delayed recovery, whereas pink flags indicate resilience after MSI and are associated with good treatment outcomes. Identifying these factors in patients with MSI would permit early targeted care to address factors that may delay their readiness for deployment and enhance factors that support recovery. Active duty service members with MSI who reported to physical therapy outpatient services at a naval hospital were recruited for the study. Yellow flags were assessed at baseline as part of a larger study. Participants completed the Fear Avoidance Beliefs Questionnaire (with two subscales, physical activity and work), the Pain Catastrophizing Scale, and the Hospital Anxiety and Depression Scale. Clinically relevant cut-off scores were used to indicate risk factors of delayed recovery. Pink flags were assessed with the Pain Self-Efficacy Questionnaire and a measure of positive outcome expectations for recovery. Two hundred and ninety participants responded to some or all of the questionnaires. Of these, 82% exceeded the cut-off scores on the physical activity subscale of the Fear Avoidance Beliefs Questionnaire, and 39% did so on the work subscale. Pain catastrophizing exceeded the cut-off in only 4.9% of the sample. Forty-three percent of these exceeded the cut-off for the anxiety subscale of the Hospital Anxiety and Depression Scale; 27% exceeded the cut-off on the depression subscale of the Hospital Anxiety and Depression Scale. Additionally, 54% endorsed scores greater than 40 on the Pain Self-Efficacy Questionnaire, and 53% endorsed a high score on the positive outcome expectations. A substantial portion of the sample endorsed elevated scores on one or more indicators of delayed recovery from MSI. Most participants showed a fear of physical activity, and approximately half reported pain-related distress (anxiety and depression). In addition, feelings of self-efficacy and positive outcome expectations of treatment were endorsed by only about half of the participants, indicating that the remaining half did not report adaptive responses to MSI. Early identification of these risk factors will allow for targeted treatment approaches that incorporate these yellow flags into treatment and support a psychologically informed approach to physical therapy. This approach is likely to reduce delayed recovery and improve deployment readiness.

The implications of incorporating nutritional supplements into the treatment regimen for children aged 5-12 years with Visceral Leishmaniasis in Baringo and West Pokot counties in Kenya.

Purpose: The purpose of this article is to inform the Ministry of Health Management and all stakeholders in Kenya, the importance of the intervention, fills gaps, and provides guidance on future research direction to accelerate control and eventually eliminate Leishmaniasis. This will also shed new light on the importance of micronutrients and trace elements and their role in immunology, patient outcomes, and the physiology of Visceral Leishmaniasis (VL). The results of this study will also pave way to explore possibilities to fill the research gaps and address challenges like the resistance and relapse of the infection, in patients with VL. Furthermore, this study may help in developing evidence-based strategies related to malnutrition and trace elements, which may be implemented in the eradication program of VL. Materials and Methods: A quasi-experimental study design was conducted in Kenya from January 2022 to March 2022 in 204 VL-infected children aged 5-12 years. Demographic and clinical data were abstracted from questionnaires and lab forms. Descriptive and inferential analyses were conducted to determine the effect of the intervention on VL outcomes among the study children. Variables with a P-value < 0.05 were considered statistically significant. A total of 204 VL study participants, 102 in each intervention and comparison group were included in this study. Baseline characteristics of the study participants were taken and recorded. The treatment and intervention were started and the trend of BMI, body temperature, vitamins A, B12, C, and D together with minerals Zinc, iron, and iodine levels were monitored weekly for four weeks to determine their effect on the treatment outcomes. Findings: The results showed that the outcome of administering the micronutrients is significant at 5% level, indicating that the intervention has a favorable effect. The micronutrients increased their levels in the body by increasing BMI, reducing spleen size, and controlling the body temperature of the study participants. In conclusion, the intervention accelerated the recovery from VL. Implications to Theory, Practice and Policy: This study was informed by the previous researchers' outputs (Mashayekhi Goyonlo V, 2020) indicating that administering the anti-leishmaniasis treatment alone will not yield a favorable treatment outcome in Visceral Leishmaniasis patients and also a study by Nweze JA, Nweze EI (2019) which indicated that malnourished patients with VL had an unfavorable outcome, which was recurrence in 21.4% and also that serum micronutrients levels favor good treatment outcome in Visceral Leishmaniasis. It is therefore important to note that Baringo and West-Pokot Counties, where the present study was conducted, are the Counties in Kenya with the highest percentage of VL patients. The study’s outcomes highlight the potential benefits of micronutrients to improve treatment outcomes in this regard, we recommend that the MOH should encourage the integration of micronutrients with the VL treatment in Baringo and West Pokot Counties. This research provides this new insight indicating that micronutrients affect the nutritional status and the treatment outcomes of VL by controlling body temperature, improving BMI, decreasing spleen size, negative VL tests, and therefore there is need to incorporate micronutrients to the treatment of children with VL. This study also raises several questions that warrant further investigation, such as the research on all the other micronutrients that were not analyzed in this study.

Changes in the Expression of Inflammatory Genes Induced by Chronic Exercise in the Adipose Tissue: Differences by Sex.

The impact of obesity on adipose tissue function is well acknowledged, but the role of physical exercise in regulating inflammatory markers and gene expression in obese individuals remains uncertain. This study aims to investigate the effects of chronic exercise on inflammatory gene expression in adipose tissue and to explore sex differences in response to exercise. The study involved 29 obese participants (13 men, 16 women) aged 38 to 54 years with a mean BMI of 36.05 ± 4.99 kg/m2. Participants underwent an 8-week concurrent training program comprising three weekly sessions of ~60 min each. The sessions included joint mobility exercises, cardiovascular activation, and cardiorespiratory resistance exercises at medium to low intensity. A fine-needle aspiration biopsy of abdominal subcutaneous adipose tissue was performed for gene expression analysis using quantitative polymerase chain reaction (qPCR). The study demonstrated that chronic exercise modulates the expression of pro-inflammatory genes in subcutaneous adipose tissue, particularly ADIPOR2 (p = 0.028), leptin (p = 0.041), and IFNg (p = 0.040) (downregulated). Interestingly, regardless of sex, the exercise programs had an independent effect on pro-inflammatory genes. Overall, this study provides insight into the role of chronic exercise in modulating adipose tissue gene expression in obese individuals. Further research involving both sexes is recommended to tailor exercise interventions for better outcomes.

Pediatric keratoconus in a tertiary eye hospital in Eastern province, Saudi Arabia: Patient characteristics and management outcomes.

This study investigates pediatric keratoconus in a tertiary eye hospital in Eastern Province, Saudi Arabia, aiming to understand the presenting features and treatment outcomes in this high-prevalence region. The research addresses pediatric keratoconus clinical profile and management strategies. A retrospective cohort study was conducted from 2022 to 2023, reviewing medical records of pediatric keratoconus patients. Demographic data, clinical characteristics, risk factors, presenting symptoms, and treatment outcomes were recorded. Severity staging was performed based on Amsler-Krumeich's classification. The study included 218 eyes from 109 pediatric keratoconus patients, with 65% of male and 35% of female patients. Decreased vision was the most common symptom (92%), and risk factors included a family history of keratoconus (9%) and vernal keratoconjunctivitis (6%). Stage 1 was the most frequent in both age groups (<14 years and ≥ 14 years). Treatment strategies included corneal collagen cross-linking (CXL), hard contact lenses, corneal rings, deep anterior lamellar keratoplasty (DLK), and penetrating keratoplasty. Significant improvements were observed in visual acuity, refractive errors, and tomographic parameters following these interventions. This study provides valuable insights into pediatric keratoconus in Saudi Arabia, emphasizing the importance of early diagnosis and interventions for better outcomes. Larger, multicenter prospective studies are essential for a comprehensive understanding of pediatric keratoconus and its optimal management. The findings contribute to the knowledge base and guide future research to improve patient quality of life.

Preliminary Clinical and Radiological Outcomes of the "No-Punch" Decompression Techniques for Unilateral Biportal Endoscopic Spine Surgery.

To avoid the most offending surgical instrument for dural tears, we develop a "no-punch" decompression technique for unilateral biportal endoscopic (UBE) spine surgery. This retrospective study enrolled 68 consecutive patients with degenerative lumbar spinal stenosis segments. The treatment results were evaluated using the visual analogue scale (VAS) for low back and leg pain, the Japanese Orthopaedic Association (JOA) scores, and the Oswestry Disability Index (ODI). Radiological outcomes were evaluated using the preoperative and postoperative magnetic resonance imaging. This study included 36 male and 32 female patients who received 109 segments of decompression, with an average age of 68.7 (37-90 years). The average operation time was 52.2 minutes. The average hospital stay was 3.1 days. There were no dural tears but 3 minor surgical complications, all treated conservatively. The VAS for low back and leg pain improved from 4.6 and 7.0 to 0.8 and 1.2. The JOA score improved from 16.2 to 26.8, with an improvement rate of 82.0%. The ODI improved from 50.1 to 18.7. All these improvements were statistically significant. The cross-sectional dural area improved from 61.1 to 151.3 mm2, with an average increase of 90.2 mm2 and 205.3%. 87.1% of the ipsilateral facet joints and 84.7% of the contralateral facet joints were preserved. In 61% of the decompressed segments, the ipsilateral facet joints were preserved better than the contralateral facet joints. The UBE "no-punch" decompression technique effectively avoids the dural tears. It provides effective neural decompression, excellent facet joint preservation, and good treatment outcomes.

Does 3D simulation impact clinical reasoning for orthodontic treatment planning of impacted maxillary canines?

Clinical reasoning is an essential competence to develop in the diagnosis and treatment planning of impacted maxillary canines to ensure good treatment outcomes. It involves skills of radiographic interpretation and mental visualization. To master these, postgraduate students learn to interpret 2D and 3D X-rays to locate these canines accurately. This process demands the creation of mental models of the impaction and resolving it either by envisioning the canine's movement to its correct position or considering its removal. To facilitate this cognitive exercise, a 3D-printed simulator, derived from Cone Beam Computed Tomography scans, serves as a tool to allow students to experiment with various movement simulations, helping them select the most viable treatment approach.This project aimed to assess the differences in expert and novice orthodontists’ clinical reasoning for impacted maxillary canines, and whether the addition of a 3D simulator would affect their reasoning. Thirteen (13) novices randomly assigned to a control and intervention group and three (3) experts took part in a Think-Aloud exercise to diagnose and treatment plan a case of bilaterally impacted maxillary canines. Experts and intervention group novices had the 3D simulator in addition to standardized patient records. Their responses were recorded and analyzed according to a coding scheme reflecting the clinical reasoning process. While experts demonstrated quick clinical judgment and found the 3D simulator redundant, novices were more uncertain and required additional cues. Novices using the 3D simulator described more elaborate treatment plans and had increased awareness of potential complications as compared to the control group.

Amide proton transfer MRI at 9.4 T for differentiating tissue acidosis in a rodent model ofischemic stroke.

Differentiating ischemic brain damage is critical for decision making in acute stroke treatment for better outcomes. We examined the sensitivity of amide proton transfer (APT) MRI, a pH-weighted imaging technique, to achieve this differentiation. In a rat stroke model, the ischemic core, oligemia, and the infarct-growth region (IGR) were identified by tracking the progression of the lesions. APT MRI signals were measured alongside ADC, T1, and T2 maps to evaluate their sensitivity in distinguishing ischemic tissues. Additionally, stroke under hyperglycemic conditions was studied. The APT signal in the IGR decreased by about 10% shortly after stroke onset, and further decreased to 35% at 5 h, indicating a progression from mild to severe acidosis as the lesion evolved into infarction. Although ADC, T1, and T2 contrasts can only detect significant differences between the IGR and oligemia for a portion of the stroke duration, APT contrast consistently differentiates between them at all time points. However, the contrast to variation ratio at 1 h is only about 20% of the contrast to variation ratio between the core and normal tissues, indicating limited sensitivity. In the ischemic core, the APT signal decreases to about 45% and 33% of normal tissue level at 1 h for the normoglycemic and hyperglycemic groups, respectively, confirming more severe acidosis under hyperglycemia. The sensitivity of APT MRI is high in detecting severe acidosis of the ischemic core but is much lower in detecting mild acidosis, which may affect the accuracy of differentiation between the IGR and oligemia.

Minilaparotomy for cystic transformations of bile ducts in children

Aim. To improve treatment outcomes for children with common bile duct cysts. Materials and methods. The study enrolled children with common bile duct cysts (n = 84) examined from January 2010 to November 2023. All patients underwent cyst excision, Roux-en-Y hepaticojejunostomy laparoscopically or from a minilaparatomy access. A comparative analysis of the treatment outcomes was carried out to select the optimal access. The timing of surgery, as well as early and late postoperative complications were analyzed. Results. The timing of surgery from the minilaparotomy access was shorter. Defecation in children of the minilaparotomy subgroup appeared 3 times earlier than in children after laparoscopic hepaticojejunostomy, largely due to earlier enteral load. A good treatment outcome was observed in 92 % of patients who underwent intervention from a minilaparotomy access compared to 52.2 % of patients who underwent laparoscopic surgery. Conclusion. Currently, laparoscopic access is a non-optimal method for treatment of children with common bile duct cysts. Minilaparotomy appears to be a promising surgical access in children and may be proposed as a standard for common bile duct cysts.

EVALUATION OF EARLY OUTCOMES OF PERMANENT PACEMAKER IMPLANTATION IN HYPERTENSIVE PATIENTS WITH BRADYARRHYTHMIAS

Objective: This study aims to describe the clinical characteristics and the features of bradyarrhythmias on 24-hour Holter monitoring and to evaluate the early outcomes of permanent pacemaker implantation in hypertensive patients with bradyarrhythmias. Subjects and method: This cross-sectional study was conducted on 57 subjects with hypertension and bradyarrhythmias who were indicated for permanent pacemaker implantation. Results: The most common clinical symptoms recorded were fatigue, dizziness, and chest pain, accounting for 47.4%, 45.6%, and 42.1% respectively. The majority of patients had sinus node dysfunction (73.7%) and most underwent dual-chamber permanent pacemaker implantation (87.7%). The 24-hour Holter monitoring results showed that 42.1% had sinus atrial block - sinus pause in the sinus node dysfunction group and 15.8% of patients had third-degree atrioventricular block (AV block) in the AV block group. A good treatment outcome was observed in 72.0% of cases. Age &gt; 70 (OR: 6.1; 95% CI: 1.2-30.1), female gender (OR: 4.2; 95% CI: 1.2-15.4), and single-chamber pacemaker (OR: 8.9; 95% CI: 1.5-52.1) were associated with a higher risk of moderate to poor treatment outcomes. Conclusion: Permanent pacemaker implantation generally tends to have good short-term outcomes. However, it should be noted that older age, female, and single-chamber pacemaker implantation in association with worse outcomes.

Correlation of BMI With Educational Stress By Psychometric Analysis Via Perceived Stressed Scale In Non-State University Students

Overweight and Educational Stress had become two dominant problems in young population. We evaluated the effects of Educational Stress on BMI among non-state university students. Gender deference on stress and BMI, correlation between BMI and stress were determined. A google form was used for collection of data from 384 participants and stress was analyzed by Perceived Stress Scale (PSS). Majority of our study group 55.2% were female, and 44.8% were male. Mean BMI was 23.54kgm-2 (Overweight) and it was 24.70kgm-2 (overweight) in male and 22.60kgm-2 (normal) in female. As per the PSS, 52% of male participant showed moderate stress and 48% male showed high perceived stress. In female population, 50% showed moderate stress, 47% showed high perceived stress and 3% showed minimum stress. Results show that &gt;90% of students suffer from moderate to high perceived stress and it was positively correlated with BMI (p=0.01, r=0.239) seen in both genders. Educational stress can increase the students BMI and this finding is important for an institutional intervention for better outcome of the student performances. We recommend considering the program interventions to minimize the educational stress and to reduce the high BMI related non communicable diseases in future.

Systemic Inflammation Response Index (SIRI) and Monocyte-to-Lymphocyte Ratio (MLR) Are Predictors of Good Outcomes in Surgical Treatment of Periprosthetic Joint Infections of Lower Limbs: A Single-Center Retrospective Analysis.

Periprosthetic joint infection (PJI) is a devastating complication that develops after total joint arthroplasty (TJA), whose incidence is expected to increase over the years. Traditionally, surgical treatment of PJI has been based on algorithms, where early infections are preferably treated with debridement, antibiotics, and implant retention (DAIR) and late infections with two-stage revision surgery. Two-stage revision is considered the "gold standard" for treatment of chronic prosthetic joint infection (PJI) as it enables local delivery of antibiotics, maintenance of limb-length and mobility, and easier reimplantation. Many studies have attempted to identify potential predicting factors for early diagnosis of PJI, but its management remains challenging. In this observational retrospective study, we investigated the potential role of inflammatory blood markers (neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic inflammatory index (SII), systemic inflammatory response index (SIRI), and aggregate index of systemic inflammation (AISI)) as prognostic factors in two-stage exchange arthroplasty for PJI. A single-center retrospective analysis was conducted, collecting clinical data and laboratory parameters from patients submitted to prosthetic explantation (EP) for chronic PJI. Laboratory parameters (PCR, NLR, MLR, PLR, SIRI, SII, and AISI) were evaluated at the explantation time; at 4, 6, and 8 weeks after surgery; and at reimplantation time. The correlation between laboratory parameters and surgery success was evaluated and defined as infection absence/resolution at the last follow-up. A total of 57 patients with PJI were evaluated (62% males; average age 70 years, SD 12.14). Fifty-three patients with chronic PJI were included. Nine patients underwent DAIR revision surgery and chronic suppressive therapy; two patients died. Nineteen patients completed the two-stage revision process (prosthetic removal, spacer placement, and subsequent replanting). Among them, none showed signs of reinfection or persistence of infection at the last available follow-up. The other twenty-three patients did not replant due to persistent infection: among them, some (the most) underwent spacer retention; others (fewer in number) were submitted to resection arthroplasty and arthrodesis (Girdlestone technique) or chronic suppressive antibiotic therapy; the remaining were, over time, lost to follow-up. Of the patients who concluded the two-stage revision, the ones with high SIRI values (mean 3.08 SD 1.7 and p-value 0.04) and MLR values (mean 0.4 SD 0.2 and p-value 0.02) at the explantation time were associated with a higher probability of infection resolution. Moreover, higher variation in the SIRI and PCR, also defined, respectively, as delta-SIRI (mean -2.3 SD 1.8 and p-value 0.03) and delta-PCR (mean -46 SD 35.7 and p-value 0.03), were associated with favorable outcomes. The results of our study suggest that, in patients with PJI undergoing EP, the SIRI and MLR values and delta-SIRI and delta-PCR values could be predictive of a favorable outcome. The evaluation of these laboratory indices, especially their determination at 4 weeks after removal, could therefore help to determine which patients could be successfully replanted and to identify the best time to replant. More studies analyzing a wider cohort of patients with chronic PJI are needed to validate the promising results of this study.