Group Of Adult Patients Research Articles

Multicentered analysis of percutaneous sclerotherapies in venous malformations of the face.

To evaluate the safety and outcome of image-guided sclerotherapy for treating venous malformations (VMs) of the face. A multicenter cohort of 68 patients with VMs primarily affecting the face was retrospectively investigated. In total, 142 image-guided sclerotherapies were performed using gelified ethanol and/or polidocanol. Clinical and imaging findings were assessed to evaluate clinical response, lesion size reduction, and complication rates. Sub-analyses of complication rates depending on type and injected volume of the sclerosant as well as of pediatric versus adult patient groups were conducted. Mean number of procedures per patient was 2.1 (±1.7) and mean follow-up consisted of 8.7 months (±6.8 months). Clinical response (n = 58) revealed a partial relief of symptoms in 70.7% (41/58), 13/58 patients (22.4%) presented symptom-free while only 4/58 patients (6.9%) reported no improvement. Post-treatment imaging (n = 52) revealed an overall objective response rate of 86.5% (45/52). The total complication rate was 10.6% (15/142) including 4.2% (7/142) major complications, mostly (14/15, 93.3%) resolved by conservative means. In one case, a mild facial palsy persisted over time. The complication rate in the gelified ethanol subgroup was significantly higher compared to polidocanol and to the combination of both sclerosants (23.5 vs. 6.0 vs. 8.3%, p = 0.01). No significant differences in complications between the pediatric and the adult subgroup were observed (12.1 vs. 9.2%, p = 0.57). Clinical response did not correlate with lesion size reduction on magnetic resonance imaging (MRI). Image-guided sclerotherapy is effective for treating VMs of the face. Clinical response is not necessarily associated with size reduction on imaging. Despite the complex anatomy of this location, the procedures are safe for both adults and children.

Analysis of Tonsil Tissues from Patients Diagnosed with Chronic Tonsillitis-Microbiological Profile, Biofilm-Forming Capacity and Histology.

Chronic tonsillitis (CT) is a global health issue which can impair patient's quality of life and has an important socioeconomic impact due to the nonrational use of antibiotics, increased antimicrobial resistance and frequent need for surgical treatment. In order to isolate and identify the causing agents of CT, a total of 79 postoperative palatine and adenoid tissue samples were obtained from the ENT Clinic, KBC Zvezdara, Belgrade, Serbia. Culture identification was performed by MALDI-TOF MS and the Staphylococcus aureus isolates were tested for biofilm forming capability and antibiotic susceptibility. Additionally, a histological examination of palatine and adenoid tissue was performed in order to detect the presence of CT-causing bacteria. The slight majority of participants were females with median age of 28 years for adult patients (group I) and 6 years for children (group II). Analysis of the incidence of bacteria isolated from tissue samples in both groups showed the highest prevalence of S. aureus, Streptococcus oralis and Streptococcus parasanquinis. In addition to interfollicular hyperplasia, colonies of species S. aureus were detected in histological material. The presence of biofilm might be the reason for the recurrence of infection. Therefore, searching for a new treatment of CT is of great importance.

Virological and histological evaluation of intestinal samples in COVID-19 patients.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the pathogen responsible for pandemic coronavirus disease 2019 (COVID-19). It is a highly contagious virus which primarily affects the respiratory tract, nevertheless, the lungs are not the only target organs of the virus. The intestinal tract could represent an additional tropism site for SARS-CoV-2. Several observations have collectively suggested that enteric infections can occur in COVID-19 patients. However, the detection of viral RNA in gastrointestinal (GI) tissue samples has not been adequately investigated and results are conflicting. To detect the presence of SARS-CoV-2 RNA in intestinal mucosa samples and to evaluate histological features. The COVID-19 patients hospitalized at an Italian tertiary hospital from April 2020 to March 2021 were evaluated for enrollment in an observational, monocentric trial. The study population was composed of two groups of adult patients. In the first group (biopsy group, 30 patients), patients were eligible for inclusion if they had mild to moderate disease and if they agreed to have a rectal biopsy; in the second group (surgical specimen group, 6 patients), patients were eligible for inclusion if they underwent intestinal resection during index hospitalization. Fifty-nine intestinal mucosal samples were analyzed. Viral RNA was not detectable in any of the rectal biopsies performed (0/53). Histological examination showed no enterocyte damage, but slight edema of the lamina propria with mild inflammatory lymphoplasmacytic infiltration. There was no difference in inflammatory infiltrates in patients with and without GI symptoms. SARS-CoV-2 RNA was detected in fecal samples in 6 cases out of 14 cases examined (42.9%). In the surgical specimen group, all patients underwent emergency intestinal resection. Viral RNA was detected in 2 surgical specimens of the 6 examined, both of which were from patients with active neoplastic disease. Histological examination also pointed out abundant macrophages, granulocytes and plasma cells infiltrating the muscular layer and adipose tissue, and focal vasculitis. Mild-moderate COVID-19 may not be associated with rectal infection by the virus. More comprehensive autopsies or surgical specimens are needed to provide histological evidence of intestinal infection.

The effectiveness of using a homeopathic preparation containing calendula, witch hazel, aesculus, menthol and zinc oxide in patients with nasal obstruction in vasomotor and chronic subatrophic rhinitis

Introduction. In recent years, the world has seen an increase in the number of patients with difficulty in nasal breathing due to nasal obstruction, one of the causes of which are functional disorders of the nasal mucosa in various forms of rhinitis. Frequent use of intranasal decongestants among the population further contributes to the lack of effectiveness of conservative treatment and the need for surgical correction to restore free nasal breathing. This article discusses the possibility of using a homeopathic preparation containing calendula, witch hazel, aesculus, menthol and zinc oxide in patients with nasal obstruction in vasomotor and chronic subatrophic rhinitis to stop the clinical manifestations of the disease and improve the quality of life of patients. Аim. Тo evaluate the effectiveness of a drug containing calendula, witch hazel, aesculus, menthol and zinc oxide in patients with vasomotor and chronic subatrophic rhinitis in the complex treatment of nasal obstruction. Мaterials and methods. The study involved 48 adult patients of both sexes, aged 20 to 50 years, diagnosed with vasomotor (idiopathic) rhinitis in 24 and chronic subatrophic rhinitis in 24 patients. The studied preparation containing calendula, witch hazel, esculus, menthol and zinc oxide was smeared on the mucous membrane of the nasal cavity by laying gauze turundas for 5 minutes, 3 times a day, while the course of treatment was 10 days. The efficacy and safety of the drug was assessed by the dynamics of the severity of subjective symptoms, objective clinical data during control examinations by an otorhinolaryngologist in points, as well as by the presence of side effects in the treatment of the disease. Results. Results of the study showed a pronounced positive trend in the form of relief of subjective complaints and the main clinical manifestations of the disease, accompanied by an improvement in the quality of life in patients in both groups examined during treatment. Side effects were not observed in patients in both study groups. Conclusions. Based on the results of the study, conclusions were drawn about the efficacy and safety of using a complex homeopathic preparation containing calendula, witch hazel, esculus, menthol and zinc oxide in an adult group of patients with nasal obstruction, which makes it possible to recommend it for widespread use for the complex treatment of nasal syndrome. obstruction in vasomotor and chronic subatrophic rhinitis, as well as other forms of rhinitis accompanied by nasal obstruction syndrome.

Ruxolitinib in Acute and Chronic Graft-Versus-Host Disease: Real Life Experience in a Multi-Centre Study

Introduction The JAK1/2 inhibitor ruxolitinib has been approved for the treatment of adults and paediatric patient ≥12 years with steroid refractory graft-versus-host disease (GvHD) based on the REACH-2 and 3 studies. However, real-life studies are needed to validate the results of clinical trials and assess its efficacy in specific organs, particular population groups such as paediatric patients, and possibility to reduce immunosuppression. Moreover, these pivotal studies focused on ruxolitinib after failure to corticosteroids and showed no data about its efficacy after more than one previous line of treatment. Methods A descriptive, retrospective, multi-centre study of adult and paediatric patients (<14 years) treated with ruxolitinib for steroid-refractory acute or chronic GvHD from 16 Spanish hospitals belonging to the Spanish Transplantation Group (GETH) between October 2015 and June 2022. The severity of GvHD was evaluated according to the Glucksberg/Magic/Harris criteria for acute GvHD and according to the international consensus of National Institutes of Health (NIH) for chronic GvHD. Results A total of 366 patients were analysed: 324 adults and 42 paediatric patients. Their baseline characteristics and response and toxicity data are described in Tables 1 and 2. Adult patient group. In acute GvHD, overall response (OR) was observed in 57.6% of patients after a median of 2 weeks of treatment, and 30.7% achieved complete remission (CR). Dose of corticosteroids was reduced in 63.5% of patients. Cytopenias grades ≥3 were observed in 11.3% of patients. Infections included CMV replication (51%), fungal infection (19.2%) and herpes zoster (6.7%). Twelve patients relapsed of their underlying disease. Sixty-six patients died due to: GvHD 17 (25.7%), relapse 4 (6%), infection 36 (54.5%) and other 9 (13.6%). The median overall survival (OS) was 4.1 months, and at 2 years the OS was 28.8% (95%CI: 19.1-39.2). Median follow-up was 2.8 months (range: 0.1-71.6). In chronic GvHD, the OR was 65.6% and was obtained after a median of 4 weeks of treatment; 18% achieved CR. OR in patients with scleroderma, gastrointestinal tract (GI) or lung involvement was 66.6%, 76% and 42%, respectively. The dose of corticosteroids was reduced in 68.3% and ruxolitinib was tapered in 37.9% of patients. Cytopenias grades ≥3 were observed in 5% of patients. Infections included CMV replication (14%), fungal infection (11.3%) and herpes zoster (5%). Seventeen patients relapsed of their underlying disease. Fifty-three patients died due to: GvHD 13 (24.5%), relapse 4 (7.5%), infection 23 (43.3%) and other 12 (22.6%). The median OS was not reached, and at 2 years the OS was 78.9% (95%CI: 72.5-84). Median follow-up was 26.8 months (range: 0.4-77). Paediatric patients. In acute GvHD, 82.7% of patients with aGvHD responded after a median of 2 weeks of treatment and 51.7% achieved CR. Corticosteroids were reduced in 79.3% and ruxolitinib in 34.4% of patients. Cytopenias occurred in 3.4% of patients. Infections included CMV replication (34.5%), fungal infection (10.3%) and herpes zoster (17.2%). Four patients relapsed of their underlying disease. Eleven patients died due to: GvHD 3 (27.2%), relapse 2 (18.8%), infection 3 (27.2%) and other 3 (27.2%). The median OS was not reached, and at 2 years the OS was 59.2% (95%CI: 38.2-75.1). Median follow-up was 8.9 months (range: 0.4-59.5). In chronic GvHD, OR was 100% after a median of 4 weeks of treatment and 23% achieved CR. Corticosteroids and ruxolitinib were reduced in 69.2% and 23% of patients, respectively. Cytopenias occurred in 7.7%. Infections included CMV replication (23.1%), fungal infection (15.4%) and herpes zoster (7.7%). Only 1 patient died due to relapse of the underlying disease; there were 2 relapses in total. The median OS was not reached, and at 2 years the OS was 100%. Median follow-up was 43.1 months (range: 0.9-59.6). Conclusions 1. Ruxolitinib in the real world setting, showed similar results in terms of responses to clinical trials. In the paediatric population, the data are more favourable: Acute GvHD: 7%; chronic GvHD: 100%. 2. Results seems not be influenced by line of treatment (≥3). 3. By organ, main benetifs in cGvHD were seen in scleroderma (66.6%) and GI (76%) of the affected patients. 4. 5% of adult patients and 79.3% of children with acute GVHD were able to reduce the dose of corticosteroids, while these figures were 68.3% and 69.2% for chronic GvHD. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Determination of pain intensity, pain-related disability, anxiety, depression, and perceived stress in Polish adults with temporomandibular disorders: A prospective cohort study.

There is a need to assess a relationship between the psychoemotional state of patients and the occurrence and the intensity of pain and temporomandibular disorders (TMD) in relation to a Polish population. There are no such precision data in the literature relating to the population of big Eastern European country. The study conducted by the authors refer to a large group of male and female adult patients of the Polish population in a different age profile. As a result, this study provides a picture of the situation that also takes into account population characteristics that may affect the clinical situation of patients. The aim of the study was to assess the pain intensity, pain-related disability, anxiety, depression, and perceived stress among Polish adults with TMD as well as the association between psychosocial impairment and TMD. This prospective cohort study included 219 adult patients from the Outpatient Clinic for Temporomandibular Disorders at the Academic Dental Polyclinic in Wroclaw. The patients completed validated questionnaires, and received a TMD diagnosis based on a standardized examination (Diagnostic Criteria for Temporomandibular Disorders) performed by a qualified dentist. A statistical analysis was carried out on the collected data. Myalgia was the most commonly diagnosed condition among the TMD patients. Furthermore, the prevalence of perceived stress, anxiety, and depression was high in the studied sample. Females showed more depression symptoms than males, while the level of anxiety and stress was similar in both groups. The most statistically significant correlation was observed between the group of masticatory muscle disorders and the level of depression, stress, pain intensity, and pain-related disability. Due to the high prevalence of increased levels of anxiety, depression, and perceived stress, it is essential to screen the psychosocial status of Polish TMD adult patients. Psychosocial status may have an impact on a studied patient's response to treatment and pain intensity, and pain-related disability. Therefore, Polish TMD adult patients should be provided with management based on an interdisciplinary approach. [https://clinicaltrials.gov/], identifier [NCT05183503].

Review of 20 years of Adult Medulloblastoma Treatment at a High-Volume Center – Chemotherapy Prescription Trends and Survival

<h3>Purpose/Objective(s)</h3> Medulloblastomas are WHO grade 4 tumors and represent less than 1% of adult brain malignancies. Standard of care is maximal safe resection follow by craniospinal and primary site radiation – the role for chemotherapy has been unclear. The objective of this study was to review 20-year chemotherapy prescribing trends in adult medulloblastoma patients at a high-volume center, with secondary objectives assessing overall and progression free-survival. We hypothesized that primary chemotherapy (concurrent or adjuvant) would be associated with prolonged survival and that patients treated in the most recent decade would have received chemotherapy more often. <h3>Materials/Methods</h3> A retrospective review was performed of adult medulloblastoma patients at a high-volume center from 1999-01-01–2020-12-31. Eligible patients were 18 years and older with a pathologic diagnosis of medulloblastoma – those with supratentorial primitive neuroectodermal tumors were excluded. Descriptive statistics were used to present population data and Kaplan–Meier estimators for survival analysis. <h3>Results</h3> Forty-nine patients were eligible; median age was 30 and male: female ratio was 2:1. Desmoplastic and classical histologies were the most common. Molecular subgroup was available for 6 patients, with SHH predominating. Of all patients, 47% (23/49 were classified as high risk – most commonly due to large cell/anaplastic histology or large residual. Only 10 (20%) received primary chemotherapy, 70% of which had high risk disease. Of the patients who received primary chemotherapy, 30% went on to receive chemotherapy for recurrence or metastases; of the entire population, this was only 39%. Primary regimens were mainly cisplatin/lomustine/vincristine, while recurrence regimens were often cisplatin/etoposide. The majority who received primary chemotherapy were treated from 2010–2020. Median overall survival was 7.8 years (95% CI 5.7–∞), with 1-, 5-, and 10-year survival 95.8%, 67.5% and 42.2% respectively. Overall survival was marginally better for those who did not receive primary chemotherapy (8.5 years) vs those who did (7.4 years) <i>but this was non-significant</i>. The main chemotherapy toxicity was hematologic and neuropathy - 90% of primary chemotherapy patients experienced toxicity <h3>Conclusion</h3> This study reviewed 20 years of treatment trends for a group of adult medulloblastoma patients at a high-volume center. We found only a small proportion of patients received chemotherapy as their primary treatment with surgery and radiation. Patients who received primary chemotherapy had marginally worse overall survival, but this was non-significant – perhaps due to baseline worse clinical status not captured by the definition of high vs. intermediate risk disease. Despite calls for adjuvant chemotherapy for all adult medulloblastoma patients, there is clinical equipoise and future randomized trials are needed.

Reducing postoperative fasting times by implementing a food service in the Post Anaesthesia Care Unit (PACU).

Early oral postoperative nutrition is a proven beneficial element of postoperative care, resulting in improvement in quality of life and a shorter hospital stay. Guidelines state that postoperative oral nutrition can safely be started within the first hours after surgery. However, oral nutrition is mainly investigated starting from postoperative day one (POD1). This pragmatic study assessed whether a food service in the Post Anaesthesia Care Unit (PACU) may reduce postoperative fasting times on postoperative day zero (POD0) early after surgery on this high care unit. The primary outcome was postoperative fasting time in the PACU. Secondary outcomes were postoperative patient experiences and nutritional tolerance. This pragmatic prospective before-after study, included adult patients with a planned overnight stay in the PACU, and without anticipated postoperative dietary restrictions. A food service was developed, allowing re-uptake of oral nutrition early after surgery, already at POD0. Postoperative fasting time in the PACU was defined as the duration of time between the moment of arrival at the PACU, until first postoperative intake or until 9 a.m. on POD1, when most patients were discharged to the surgical ward. Secondary outcomes such as postoperative patient experiences and nutritional tolerance were scored on POD0 at 8 p.m. and on POD1 at 8 a.m. A total of 235 patients were included, 119 in the pre-implementation (control) and 116 in the post-implementation (intervention) group. Mean postoperative fasting time was reduced by a mean of 6.0h (95% CI 4.8-7.4, p-value ≤ .001), from 17.5h in controls to 11.5h in the intervention group. In the intervention group, 45% of patients had nutritional intake on POD0 (8 p.m.), increasing to 80% of patients on POD1 (8 a.m.), compared to no intake at both time-points in the control group. In the intervention group, average patient satisfaction increased over time. Flatus frequency was higher in the intervention group on POD1 (45% vs. 22%, p-value ≤ .001), while postoperative nausea and/or vomiting, and usage of anti-emetic medication were not different between groups. In a heterogeneous group of adult post-surgical patients with a planned overnight stay in the PACU, implementation of a food service resulted in a significant and clinically relevant reduction of postoperative fasting time, and increased patient satisfaction without compromising nutritional tolerance. Registered at www.isrctn.org with study ID ISRCTN17976930.

Length of hospital stay and complications of mini-facelift versus modified Blair incision for parotid abscess drainage.

To compare the length of hospital stay (LHS) and complications between minifacelift (MFL) and modified Blair incisions (MBI) for adult patients undergoing parotid abscess drainage (PAD). A retrospective cohort study design was utilized comprising 2 groups of healthy adult patients (American Society of Anesthesiology [ASA] status I-II) who underwent PAD during a 7-year interval. The primary predictor variable was incision type (MFL vs. MBI). The primary outcomes were LHS and adverse complications resulting from the incision type. Other study variables were grouped into demographic, clinical, microbiological, and therapeutic categories. Difference in the cohort characteristics were analyzed using appropriate descriptive and uni- and bivariate statistics. Multivariate logistic regression was used to measure the effect of the incision type had on the LHS and adverse complication rates. The sample included 120 subjects (50% females) with a mean age of 41.7±18.3 years. Patients in the MFL group were hospitalized for 8.2±7.7 days, and the other group stayed in the hospital for 10.2±8 days (adjusted odd ratio [OR] 1.19, 95% confidence interval [95% CI] 0.52 to 2.7; p=0.8). In comparison with MBI, MFL did not significantly increase complication risks in term of facial paralysis (adjusted OR 0.93, 95% CI 0.06 to 15.29; p=1.0) and necessity of re-operation (adjusted OR 0.61, 95% CI 0.1 to 3.8; p=0.7). Given no different LHS and complication risks, MFL can replace MBI for ASA I-II adult patients undergoing PAD.

Levels of Anxiety in Patients Undergoing Simple Tooth Extraction: The Possible Contributing Factors.

Aims: The current study aims to assess the levels of patients’ anxiety towards simple tooth extraction, and the difference in pre-extraction anxiety levels; if present; between genders and among different age groups. Materials and Methods: Two hundred and ninety-two patients who presented for simple tooth extraction were recruited. Each participant filled a self-administrated questionnaire; the tooth-extraction anxiety (TEA) scale and asked to rate the amount of their anxiety toward tooth extraction on 11- point Numeric Rating Scale (NRS). Results: Two hundred and sixty-three patients (90.07%) filled-out the questionnaire completely. Cronbach’s α for the present sample was 0.84 correlated significantly with NRS (0.48, P<0.01). Anxiety among patients was moderate, and mean scores of 4.68 and 2.76 were recorded on NRS and TEA scale respectively. The scores of anxiety in female patients was slightly higher than in male patients but without statistical significance. When considering the age groups of participants, significantly higher anxiety was depicted in the young and old adult age groups than in middle-age adult group of patients. Conclusions: Anxiety may be more predicted in female, young, and old-adult patients.

Lengths of inpatient stay and sick leave of patients with mental diseases: disorder-specific effects of flexible and integrated treatment programs in Germany

Mental disorders pose a worldwide growing public health burden. One of the major challenges for healthcare systems remains to respond to the need of patients with mental disorders for continuous and flexible treatment. The EVA64 study evaluates novel programs of flexible and integrative treatment (FIT) in hospitals. This manuscript presents results from the evaluation of FIT hospitals in comparison to hospitals from regular routine care. In addition to data from adult patients, we also present data from affiliated child and adolescent psychiatric wards employing FIT programs. Using comprehensive claims data, primary outcomes are the utilization of inpatient care and sick leave for a priori defined clusters of mental disorders. We stratify between patients already under treatment (ongoing treatment) and patients with incident treatment cases (initial treatment) at the point of inclusion in the study. In the initial treatment group, we found a significant reduction in the length of inpatient stay of 4.1 days in FIT hospitals compared to routine care. While patients with mood affective disorders (−1.8 days) and patients with neurotic, stress-related, and somatoform disorders (−3.6 days) showed an even stronger effect of the reduction of inpatient lengths of stay, the effect was significantly weaker in patients with mental and behavioral disorders due to use of alcohol (+3.3 days). Regarding the duration of sick leave, we found no significant treatment effect of FIT programs compared to routine care. In the ongoing treatment group of adult patients, we found a significantly lower utilization of inpatient treatment by 1.3 days as well as a shorter duration of sick leave by 4.3 days in FIT hospitals compared to routine care. In the cohort of children and adolescent patients, we also did not observe a significant treatment effect in either the initial treatment group or the ongoing treatment group. Registration: this study was registered in the database “Health Services Research Germany” (trial number: VVfD_EVA64_15_003713).

How do Patients Diagnosed with Dissociative Identity Disorder Experience Conflict? A Qualitative Study

ABSTRACT The role and nature of conflict in the development and manifestation of dissociative identity disorder (DID) remains underexplored beyond theoretical deduction. In this qualitative instrumental case study, we explored the subjective experience and nature of conflict in a group of adult psychiatric patients diagnosed with DID. We purposively selected typed transcriptions of 28 previously recorded in-depth individual interviews with 15 patients, their audio recordings and associated field notes. The data were thematically analyzed and constant comparison was applied. Two main themes emerged from the transcriptions, namely, participants’ experiences of having one or more incompatible and conflicting worldviews about their DID, and the type and nature of conflict that arises between dissociative identities, i.e., conflict of information in awareness, conflicting actions or behaviors, conflicting emotions, conflicting goals, conflicting values, and a battle of wills. Patients with DID have contextually and culturally variable comprehension of the origin of their DID. Conflict between dissociative identities was pervasive, multifaceted, and exacerbated by a lack of awareness between identities. The study provides insight into the complexities of conflict between dissociative identities, as well as highlights the role of inter-identity awareness in conflict.

Physiologically Based Pharmacokinetic (PBPK) Modeling of Lornoxicam: Exploration of doses for CYP2C9 Genotypes and Patients with Cirrhosis

Lornoxicam physiologically based pharmacokinetic (PBPK) models were developed and validated on the basis of clinical pharmacokinetic results obtained by considering CYP2C9 genetic polymorphisms in healthy adult populations. PBPK models were extended to predict lornoxicam pharmacokinetics for patients with cirrhosis by quantitatively examining the pathophysiological information associated with cirrhosis. The predicted plasma exposure to lornoxicam was approximately 1.12–2.83 times higher in the CYP2C9*1/*3 and *1/*13 groups than in the CYP2C9*1/*1 group of healthy adult populations and patients with cirrhosis. The predicted plasma exposure to lornoxicam was approximately 1.28–3.61 times higher in patients with cirrhosis than in healthy adult populations. If the relationship between lornoxicam exposure in plasma and drug efficacy was proportional, then the proposed adjusted doses of lornoxicam for each group varied from 1.25 mg to 8 mg. As the severity of cirrhosis increased, or when the CYP2C9 genotype was *1 heterozygous, the dose adjustment range of lornoxicam increased. Therefore, the effect of pathophysiological factors (cirrhosis severity) on the pharmacokinetics of lornoxicam might be more important than that of CYP2C9 genetic factors. These results could be useful for broadening the scope of clinical application of lornoxicam by enabling dose selection based on CYP2C9 genotypes and liver cirrhosis degree.

Cost-effectiveness of brentuximab vedotin in treating increased risk of relapse/progression of classical hodgkin lymphoma patients post autologous stem cell transplant

Objective: Hodgkin lymphoma patients who relapsed/progressed early after autologous stem cell transplant (ASCT) usually have poor prognoses. Results from clinical trials have demonstrated Brentuximab vedotin (BV)’s significant clinical effectiveness for consolidation therapy after ASCT for patients who have high risk of relapse/progress. An economic evaluation study for Vietnamese CHL patients is necessary and can provide useful evidence for policymakers. Methods: A multi-stage economic evaluation model consisting of two partitioned survival models was used to estimate incurring costs and effectiveness from health insurance perspective for two hypothetical groups of Vietnamese adult CHL patients who have high risk of relapse/progression, one received standard care and the other received BV consolidation plus standard care as post-ASCT care. Necessary healthcare services were identified via Ministry of Health guidelines and Vietnamese clinical opinions. Efficacy parameters were taken from published systematic review and randomized controlled trials results. Model costs and utility inputs were adapted for Vietnamese context via relevant published literature, guidelines, regulations, and clinical opinions. Model cycle of 1 week and life-time horizon was used. Discounting rate of 3% was applied for cost and effectiveness. Results: Consolidation with BV post-ASCT was estimated to increase treatment cost by 654,502,745 VND per patient, increased 1.295 life years and 2.153 QALYs. Incremental cost-effectiveness ratios were estimated at 505,465,854 VND/LY and 304,045,395 VND/QALY. Conclusions: BV consolidation was not cost-effective compared to 3GDP threshold, however, with an appropriate risk-sharing mechanism, the intervention can be cost-effective, improve patients access to the effective treatment and maintain equity in healthcare.

Young Adult Male Patients With Childhood-onset IBD Have Increased Risks of Compromised Cortical and Trabecular Bone Microstructures.

Young adults with childhood-onset inflammatory bowel disease (IBD) have increased risks of low areal bone mineral density and low skeletal muscle mass. Volumetric BMD (vBMD), bone geometry and microstructures, in addition to possible associations with skeletal muscle index (SMI) and physical exercise have been scarcely studied in this patient group. In total, 49 young adult male patients with childhood-onset IBD and 245 age- and height-matched young adult male controls were scanned with high-resolution peripheral quantitative computed tomography. Bone geometry, vBMD, and bone microstructures were calculated as median values and compared between the patients and controls. Multivariable linear regression analyses were performed to determine the independent associations among IBD diagnosis, SMI (kg/m2), and physical exercise. The group of young adult patients had, in comparison with the controls, significantly smaller median cortical area (126.1 mm2 vs151.1 mm2, P < .001), lower median total vBMD (296.7 mg/cm3 vs 336.7 mg/cm3, P < .001), and lower median cortical vBMD (854.4 mg/cm3 vs 878.5 mg/cm3, P < .001). Furthermore, the patients compared with the controls had lower median trabecular volume fraction (16.8% vs 18.2%, P < .001) and thinner median trabeculae (0.084 mm vs 0.089 mm, P < .001). The differences between the patients with IBD and controls persisted in multivariable analyses that included adjustments for SMI and physical exercise. Young adult men with childhood-onset IBD are at increased risk of having reduced bone quality in both the cortical and trabecular bone structures compared with normative matched controls.

Physical Performance Tests in Adult Neck Pain Patients with and without Clinical Myelopathic Signs: A Matched Case-Control Study.

Patients with neck pain may experience cervical myelopathy, this may be detected by clinical myelopathic signs, although they did not have any symptom of myelopathy, except having neck pain. Decreasing physical performance is one symptom of cervical myelopathy that can lead to reduced quality of life in the elderly, however, in adult neck pain with clinical myelopathic signs have not been evaluated. Therefore, this research aimed to compare physical performance in two groups of adult patients with neck pain: those with and without clinical myelopathic signs. A total of 52 participants, gender, age, and body mass index (BMI) matched were allocated into 2 groups of 26 subjects with neck pain, those with, and without, clinical myelopathic signs. The grip and release test, nine-hole peg test, ten second step test and foot-tapping test were evaluated. The group of neck pain participants with clinical myelopathic signs exhibited greater impairment in all the tests than the group without clinical myelopathic signs (p < 0.001). Effect sizes (Cohen’s d) were grip and release test: 2.031, nine-hole peg test: 1.143, ten second step test: 1.329, and foot-tapping test: 0.798. Neck pain participants with clinical myelopathic signs demonstrated reduced physical performance. Physical performance tests may need to assessed in adult patients with neck pain who had clinical myelopathic signs.

Elicitors and phenotypes of adult patients with proven IgE-mediated food allergy and non-immune-mediated food hypersensitivity to food additives.

Food allergy is a growing health concern with a prevalence of 2%-3% in the adult population in Europe. Non-immune-mediated food hypersensitivities, which include reactions after ingestion of food additives, affect 1% of adults and may resemble IgE-induced allergic reactions without identifiable immunologic sensitization. A double-blind placebo-controlled food challenge (DBPCFC) is the gold standard for the diagnosis of any food hypersensitivity. We analysed a large group of adult patients with suspected food hypersensitivity, who had undergone DBPCFC, to better understand IgE-mediated food allergy and non-immune-dependent food hypersensitivity to food additives in adults regarding elicitors, symptoms and positivity rates of oral challenges. Data from 541 patients with suspected food hypersensitivity were analysed, who underwent an oral food challenge between 2010 and 2019. IgE-dependent food allergy was confirmed in 114 of 329 adult patients (34.6%). The confirmation rate was lower in the group of patients with suspected non-immune-mediated reactions to food additives (65 of 286, 22.7%). Urticaria and angioedema appeared more frequently in patients with IgE-mediated food allergies. By contrast, flush and diarrhoea were the most frequent symptoms after a challenge in the group with the non-immune-mediated reactions to food additives. Wheat and celery were the most frequently identified food allergens in adults, whereas colourings and preservatives were the most frequent elicitors of non-immune-mediated food hypersensitivity. The importance of oral food challenges for the diagnosis of food hypersensitivity is confirmed. IgE-dependent food allergy is more frequently proven, reaching a positivity rate of one-third and only about 20% for non-immune-mediated hypersensitivity. Future studies should elaborate on the mechanisms of non-immune-mediated food hypersensitivity and the clinical impact of cofactors in this setting.

Maladaptive Personality Traits in a Group of Patients with Substance Use Disorder and ADHD.

Background and Objectives: the comorbidity of personality disorders in patients who use psychoactive substances is common in psychiatric practice. The epidemiology of disharmonious personality traits in patients with ADHD and addictions in adulthood is still insufficiently researched. The study investigated the typology of personality traits in a group of adult patients consuming psychoactive substances, in whom symptoms of ADHD were identified. Materials and Methods: the study evaluates a group of 104 patients with chronic psychoactive substances abuse, in whom symptoms of ADHD were identified in early adulthood, in terms of comorbid personality traits. Results: statistically significant data have been obtained regarding the presence of clinical traits characteristic for cluster B personality disorders, the patients presenting lower levels of self-control, self-image instability, difficulties in the areas of social relationships and own identity integration. Conclusions: ADHD symptomatology precedes the clinical traits of personality disorders in patients with addictions, negatively influencing chronic evolution and quality of life.

Deep learning accurately classifies elbow joint effusion in adult and pediatric radiographs

Joint effusion due to elbow fractures are common among adults and children. Radiography is the most commonly used imaging procedure to diagnose elbow injuries. The purpose of the study was to investigate the diagnostic accuracy of deep convolutional neural network algorithms in joint effusion classification in pediatric and adult elbow radiographs. This retrospective study consisted of a total of 4423 radiographs in a 3-year period from 2017 to 2020. Data was randomly separated into training (n = 2672), validation (n = 892) and test set (n = 859). Two models using VGG16 as the base architecture were trained with either only lateral projection or with four projections (AP, LAT and Obliques). Three radiologists evaluated joint effusion separately on the test set. Accuracy, precision, recall, specificity, F1 measure, Cohen’s kappa, and two-sided 95% confidence intervals were calculated. Mean patient age was 34.4 years (1–98) and 47% were male patients. Trained deep learning framework showed an AUC of 0.951 (95% CI 0.946–0.955) and 0.906 (95% CI 0.89–0.91) for the lateral and four projection elbow joint images in the test set, respectively. Adult and pediatric patient groups separately showed an AUC of 0.966 and 0.924, respectively. Radiologists showed an average accuracy, sensitivity, specificity, precision, F1 score, and AUC of 92.8%, 91.7%, 93.6%, 91.07%, 91.4%, and 92.6%. There were no statistically significant differences between AUC's of the deep learning model and the radiologists (p value > 0.05). The model on the lateral dataset resulted in higher AUC compared to the model with four projection datasets. Using deep learning it is possible to achieve expert level diagnostic accuracy in elbow joint effusion classification in pediatric and adult radiographs. Deep learning used in this study can classify joint effusion in radiographs and can be used in image interpretation as an aid for radiologists.

Immunological differences between atopic dermatitis, psoriasis, and their combination in adult patients.

The simultaneous occurrence of psoriasis (PS) dominated by Th1 lymphocytes and atopic dermatitis (AD) driven by Th2 cells is rare. This study analyzed a group of adult patients with concomitant PS and AD (ADPS) and compared the cytokine profiles of these patients with those of subjects with homogenous PS or AD and healthy controls. All patients underwent dermatological examinations, including assessment of Scoring Atopic dermatitis (SCORAD) index and Psoriasis Area Severity Index (PASI) scores, TNF-α, IFN-γ, Il-2, Il-4, Il-5, Il-6, Il-8, Il-12, I-17A, Il-18, Il-22, Il-33, and T. There were 39 patients with a diagnosis of ADPS, 45 patients with PS, 47 patients with AD, and 42 healthy controls. Patients with ADPS were mainly men with a proportional distribution of skin lesion areas. Significant differences were observed in the concentration of Il-17A between patients with ADPS and those with AD or PS and controls, which were as follows: 16.1 ± 5.4, 5.8 ± 2.1, 5.0 ± 3.1, and 3.3 ± 1.8 pg/mL, respectively. In conclusion, AD and PS might coexist as a combination disease. The role of T helper 17 cells may be more essential than previously thought.