Patients Group Research Articles

The Impact of the Position of the Humeral Head Relative to the Glenoid on Iatrogenic Fractures During Shoulder Dislocation Reduction

Background and Objectives: The aim of this study was to investigate the relationship between the position of the humeral head relative to the glenoid and the occurrence of iatrogenic surgical neck fractures of the humerus during anterior glenohumeral dislocation reductions. Materials and Methods: Patients with first-time anterior shoulder dislocations without generalized joint hyperlaxity were included. The humeral head displacement ratio was calculated as the distance between the medial border of the humeral head and the anterior glenoid rim divided by the diameter of the humeral head. Demographic data, concomitant tuberculum majus fractures, and the deltoid tuberosity index were recorded. Patients were divided into three groups: Group 1 (iatrogenic fracture development during closed reduction (CR)), Group 2 (failed CR), and Group 3 (successful reduction without iatrogenic fracture). Complicated dislocations were included in Groups 1 and 2, while uncomplicated dislocations were those in Group 3. Results: The study included 89 patients with a mean age of 46.44 ± 19.02 years (64 males, 25 females). Concomitant tuberculum majus fractures occurred in 37 (41.6%) cases. Iatrogenic surgical neck fractures occurred in 10 patients (Group 1), and CR was unsuccessful in 8 patients (Group 2), totaling 18 cases of complicated dislocations. Reduction without iatrogenic fracture was achieved in 71 cases (Group 3). The mean humeral head displacement ratio was higher in the complex dislocation group (92.91 ± 15.34 vs. 75.01 ± 13.80; p < 0.001). Complicated dislocations were more frequent in patients with tuberculum majus fractures (p = 0.031). Subgroup analysis showed higher humeral head displacement ratios in Groups 1 and 2 compared to Group 3 (p = 0.010 and p = 0.06, respectively). Tuberculum majus fractures were more frequent in Group 1 compared to Group 3 (p = 0.013), with no significant difference between Groups 2 and 3. Conclusions: In patients experiencing first-time traumatic anterior shoulder dislocations, a greater medial displacement of the humeral head relative to the glenoid rim significantly increases the risk of iatrogenic humeral fractures and the likelihood of unsuccessful closed reduction attempts.

Efficacy of One Anastomosis Gastric Bypass Versus Sleeve Gastrectomy and Roux-en-Y Gastric Bypass for the Treatment of Type 2 Diabetes Mellitus: a Systematic Review and Meta-Analysis of Randomized Clinical Trials.

The worldwide prevalence of type 2 diabetes mellitus (T2DM) is increasing in parallel with obesity. One anastomosis gastric bypass (OAGB) is considered effective to treat both T2DM and obesity. The aim of this study was to evaluate the efficacy of OAGB versus sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for treatment of T2DM, analyzing data exclusively from randomized control trials (RCTs). Α systematic review of published RCTs comparing OAGB versus RYGB or SG (control groups) in T2DM patients regarding diabetes remission and weight loss was performed. Primary endpoints were T2DM remission rate and 1-year and 5-year % weight loss postoperatively. Initial search identified 39 references, of which 8 RCTs were considered eligible for meta-analysis inclusion, comprising 636 patients (311 OAGB, 122 RYGB, 203 SG patients). Main meta-analysis findings were: i) higher 1-year %EWL for OAGB than control group (p = 0.04); ii) higher 5-year %EWL for OAGB than control group (p < 0.01); iii) no difference in 1-year remission rate of T2DM between OAGB and control group (p = 0.14); iv) 28% higher 5-year remission rate of T2DM for OAGB than control group (p < 0.01). OAGB had statistically significant better outcomes compared to RYGB and SG regarding T2DM remission and %EWL at 5years. Further pathophysiologic studies are needed to indicate the most potent bariatric procedure in patients with T2DM and obesity.

The Significance of Albumin Concentration and some of its Altered Forms in Iraqi Patients with Chronic Hepatitis B Virus

Background: The liver synthesizes albumin, a pivotal protein with approximately 60-65% of total plasma proteins. During ischemic attacks linked to oxidative stress, reactive oxygen species, and acidosis, the properties of albumin undergo alterations. This leads to generation of ischemia-modified albumin, which is characterized by a diminished metal-binding capacity, particularly for transition metals like copper, nickel, and cobalt. Objectives: This study aimed to assess the significance of serum albumin and ischemia-modified albumin concentrations in Iraqi individuals with hepatitis B virus Methods: A case control study consisted of 50 patients with hepatitis B were recruited from Gastroenterology hospital in the Medical city/ Baghdad/ Iraq, during the period January to February in 2023, The patients group included males and females; whose ages ranged from 18 years to 77 years with a mean value 44 year. Meanwhile the study group consisted of 50 age- and sex-matched normal healthy individuals. Albumin concentration was determined in the serum samples, using a Biosystems kit, and ischemia modified albumin concentration were measured through the albumin cobalt binding test. The ischemia modified albumin/ [albumin] ratio and Ischemia modified albumin index were then calculated. Statistical Analysis: results were reported as a mean value ± standard deviation. The differences were considered highly significant if (p &lt; (0.001), and significant where (p = (0.002) and (p = (0.033) Results: lower serum albumin concentration was measured in the patients group, while the mean value of ischemia modified albumin concentration in the patients' group and healthy control were 0.466 ± 0.114 absorbance unit &amp; 0.395 ± 0.070 absorbance unit, respectively, with a statistically significant increase (P &lt; 0.001). The ischemia modified albumin ratio in the hepatitis B patients and control groups were 0.172 ± 0.073 and 0.117 ± 0.050, respectively, showing a significant increase as well (P &lt; 0.001). Additionally, the ischemia modified albumin index in the patients and the control groups were 0.491 ± 0.167 &amp; 0.390 ± 0.131, respectively, with a statically significant increase (p&lt;0.001) in the patients group. Conclusion: In the patients’ group with hepatitis B, serum albumin concentration is decreased, while the level of ischemia modified albumin, ischemia modified albumin ratio, and ischemia modified albumin index are increased. The elevation in ischemia modified albumin, ischemia modified albumin ratio, and ischemia modified albumin index were more prominent in younger patients and those with albumin concentration less than 4g/dl. Moreover, the prevalence of hepatitis B is higher in men compared to women.

Effectiveness of pulse methylprednisolone in patients with non-human immunodeficiency virus pneumocystis pneumonia: a multicentre, retrospective registry-based cohort study

BackgroundA recent database study and meta-analysis reported that adjunctive glucocorticoid therapy reduces mortality in patients with non-human immunodeficiency virus-associated (non-HIV) Pneumocystis jirovecii pneumonia (PCP), having hypoxemia. However, the optimal glucocorticoid dose remains unclear. Our study aimed to evaluate the effectiveness of pulse methylprednisolone compared with mild-to-moderate steroid doses in patients with non-HIV PCP.MethodsThis multicentre retrospective cohort study included adults with non-HIV PCP receiving adjunctive steroids at three Japanese tertiary care hospitals from June 2006 to March 2021. Patients were categorised into pulse methylprednisolone and mild-to-moderate dose groups. Pulse methylprednisolone involved an initial intravenous infusion of 500–1000 mg methylprednisolone daily, while the mild-to-moderate dose was lower. Primary and secondary outcomes were 30-day and 180-day mortality from treatment initiation. Patient characteristics were adjusted using propensity score analysis with overlap weighting. Subgroup analysis focused on patients with respiratory failure.ResultsThe study included 139 patients with non-HIV PCP: 55 in the pulse methylprednisolone group and 84 in the mild-to-moderate dose group. After adjusting for patient background, 30-day mortality (14.2% vs. 15.5%, P = 0.850) and 180-day mortality (33.5% vs. 27.3%, P = 0.516) did not differ significantly between groups. Subgroup analysis revealed no significant associations among patients with respiratory failure.ConclusionsAfter adjusting for patient characteristics, no difference in prognosis was observed between pulse methylprednisolone and mild-to-moderate dose groups in patients with non-HIV PCP. A mild-to-moderate dose of adjunctive corticosteroid may suffice for treating non-HIV PCP.

Prognostic impact of age on outcomes of hepatic decompensation in patients with compensated cirrhosis (CHESS2102): an international, multicenter cohort study.

Baveno VII criteria (B7C) and Baveno VI criteria (B6C) have been widely used to estimate the risk of hepatic decompensation. However, the impact of age on these criteria warrants further investigation. The international, multicenter cohort study included 1138 patients with compensated cirrhosis (median follow-up of 40.6 months), aiming to evaluate the value of age in predicting hepatic decompensation. We identified age as an independent predictor of hepatic decompensation, with 60 years determined as the optimal cut-off value. The occurrence of decompensation was 18.7% and 6.7% in the older (age ≥60 years) and younger (age <60 years) groups, respectively (p<0.001). We subsequently integrated age into the existing Baveno criteria. In patients not meeting Baveno criteria (defined as not meeting B6C or B7C), the older group exhibited a significantly elevated risk of decompensation compared to the younger group (p<0.05). However, no significant difference was observed between the older and younger groups in patients meeting Baveno criteria (p>0.05). In conclusion, our study demonstrated that integrating age into the Baveno criteria could enhance the assessment of hepatic decompensation. Age should be considered before discharging patients with compensated cirrhosis from the surveillance of hepatic decompensation.

Clinical effect and contributing factors of acupuncture for knee osteoarthritis: a systematic review and pairwise and exploratory network meta-analysis.

This study aims to evaluate (1) the effect and safety of acupuncture in patients with knee osteoarthritis (KOA) and explore (2) whether the effect of acupuncture differed according to acupuncture type, acupuncture dose and follow-up time. Systematic review and pairwise and exploratory network meta-analysis. PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals and Wanfang from inception to 13 November 2023. Randomised controlled trials comparing acupuncture with sham acupuncture, non-steroidal anti-inflammatory drugs (NSAIDs), usual care or waiting list groups, intra-articular (IA) injection and blank groups in patients with KOA. Eligible interventions included manual acupuncture (MA) and electroacupuncture (EA). The primary outcome was pain intensity at the end of treatment. 80 trials (9933 participants) were included. Very low certainty evidence suggested that acupuncture may reduce pain intensity compared with sham acupuncture (standardised mean difference, SMD -0.74, 95% CI -1.08 to -0.39, corresponded to a difference in Visual Analogue Scale of -18.50 mm, -27.00 to -9.75), NSAIDs (SMD -0.86 to -1.26 to -0.46, corresponded to -21.50 mm, -31.50 to -11.50), usual care or waiting list groups (SMD -1.01, -1.47 to -0.54, corresponded to -25.25 mm, -36.75 to -13.50) and blank groups (SMD -1.65, -1.99 to -1.32, corresponded to -41.25 mm, -49.75 to -33.00), but not IA injection. Similar results were also found in other outcomes. For most of the subgroup analyses, acupuncture type, acupuncture dose and follow-up time did not show a significant relative effect. Only when compared with NSAIDs, a higher dose of acupuncture may provide greater pain relief (interaction p<0.001). The network meta-analysis revealed that electroacupuncture (SMD -0.75, 95% CI -1.34 to -0.17) had a greater effect on pain relief in patients with KOA compared with manual acupuncture. The findings suggest that acupuncture may provide clinically important effects in reducing pain and improving physical function in patients with KOA, but the certainty of evidence was very low. Electroacupuncture and higher dose of acupuncture probably are two potential contributing factors. CRD42021232177.

Randomized trial of early exercise rehabilitation and its effects on patients with acute coronary syndrome

To assess the psychological and physiological benefits of early exercise rehabilitation in patients with acute coronary syndrome (ACS). Among 559 ACS-diagnosed patients at Fuzhou University Affiliated Provincial Hospital from January to December 2021, 200 eligible participants were assigned to two groups. The control group received standard care, while the experimental group received early exercise rehabilitation in addition to standard care. The outcomes measured included changes in depression levels (PHQ-9), fasting blood glucose, and troponin I (TnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. Data were analyzed using SPSS, with t tests and chi-square tests for group comparisons. In comparison to the control group, the experimental group demonstrated significant improvements in PHQ-9 scores (P < 0.001) and lower fasting blood glucose levels before discharge (P = 0.046). Additionally, the experimental group had notably reduced TnI levels at 72 h after admission (P = 0.001), especially among non-diabetic NSTEMI patients over 60 years old, who showed decreased TnI levels at the 48-hour mark (P = 0.016). However, there were no significant differences in NT-ProBNP change values between the two groups (P > 0.05). Subgroup analysis revealed enhanced outcomes in the intervention group for ACS patients without smoking or drinking history and no heart failure (P = 0.025,P = 0.014,P = 0.018). Early exercise rehabilitation has notable benefits for ACS patients, including reduced depression, improved blood glucose control, and enhanced myocardial protection, especially in nondiabetic NSTEMI patients aged 60 and above.

Efficacy and safety of tirofiban plus recombinant tissue plasminogen activator versus recombinant tissue plasminogen activator alone in acute ischemic stroke patients: a meta-analysis

ObjectiveTirofiban plus recombinant tissue plasminogen activator (rtPA) shows good efficacy and safety in treating acute ischemic stroke (AIS) patients, but there is a lack of comprehensive assessment. This meta-analysis aimed to compare the efficacy and safety of rtPA plus tirofiban with rtPA alone in AIS patients. MethodsThis meta-analysis retrieved studies comparing rtPA intravenous thrombolysis followed by tirofiban (rtPA+T group) versus rtPA intravenous thrombolysis alone (rtPA group) for AIS patients in Excerpt Medica Database, Web of Science, Cochrane, PubMed, China National Knowledge Infrastructure, Wanfang, and SinoMed until March 2024. ResultsTwenty studies with 2048 AIS patients were enrolled in this meta-analysis. National Institute of Health stroke scale (NIHSS) score after treatment was lower in the rtPA+T group than the rtPA group [standardized mean differences (SMD)=-1.41; 95% confidence interval (CI)=-1.83, -0.98; P<0.001]. The proportion of AIS patients achieving a favorable functional outcome (modified Rankin Scale score ≤2) was increased in the rtPA+T group versus the rtPA group [relative risk (RR)=1.13; 95% CI=1.05, 1.21; P=0.001]. The incidence of re-occlusion was lower in the rtPA+T group than in the rtPA group (RR=0.24; 95% CI=0.10, 0.59; P=0.002), but the incidence of intracranial hemorrhage (ICH) (RR=0.85; 95% CI=0.51, 1.43), symptomatic ICH (RR=1.10; 95% CI=0.43, 2.84), and mortality (RR=1.39; 95% CI=0.53, 3.65) was not different between the two groups (all P>0.05). The stability assessed by sensitivity analysis was good, and no publication bias was found. ConclusionrtPA plus tirofiban achieves superior efficacy with comparable safety profiles compared to rtPA alone in AIS patients.

Evaluation of A. actinomycetemcomitans and P. gingivalis from the mouth of patients irradiated in the head and neck region: a cross-sectional study.

This study aimed to quantify Aggregatibacter actinomycetemcomitans (A.a) and Porphyromonas gingivalis (P.g) from the mouth of head and neck irradiated and cancer-free patients. Information such as age, presence of tongue coating, salivary flow, and biofilm were collected from head and neck irradiated patients (Group 1) and compared the results with a group of cancer-free individuals (Group 2). The presence of tongue coating was clinically examined. Sialometry was performed through a stimulating technique by chewing paraffin. Microbiological samples were collected from buccal and labial mucosa and tongue dorsum. Subsequently, the samples were processed and analyzed by qPCR to detect the presence and quantify the bacteria. There was a statistical difference in the quantity of bacteria among the 24 individuals in Group 1 (A.a, 2817 ± 8718; P.g, 3145 ± 11297) and 26 individuals in Group 2 (A.a, 133996 ± 398545; P.g, 60 ± 195) regarding tongue coating (Group 1, A.a 2194.6 ± 4641.5; Group 2, A.a 92767.8 ± 333385.7) and salivary volume (Group 1, 0.69mL; Group 2, 3.09mL). The linear regression analysis found that the variable group was the main responsible for the difference in the quantity of periodontal pathogens (p-value < 0.001). There was no statistical difference in the amount of Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis between totally edentulous and partially edentulous (with 12 or fewer teeth) patients. Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis were present in significant amounts in patients of both groups, with a greater quantity in cancer-free individuals.

Comparison of The Postoperative Outcomes of Surgical Lateral Internal Sphincterotomy and Botulinum Toxin Injection in Patients Presenting With Chronic Anal Fissure At CMH, Rawalpindi

Objective: To compare the postoperative outcomes in Lateral Internal Sphincterotomy Group and in Botulinum toxin injection Group in patients managed for chronic anal fissure. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Aug 2021 to Feb 2022. Methodology: All patients of either gender, aged 30 to 70 years, who had presented to CMH, were included in this study. Block randomization was done to allocate half of them to Lateral Internal Sphincterotomy and half to Botulinum toxin injection. Patients in both Groups were followed for four weeks to assess and compare various short and long term post-surgical outcomes. Results: There were 82 patients in total with 41 in each treatment arm. In the Lateral Internal Sphincterotomy Group, 35 85(37%) of the patients reported postoperative pain relief at 24 hours, 39(95.12%) patients healed, only 2(4.88%) patients had a recurrence. In the Botulinum toxin Group, 29(70.73%) reported postoperative pain relief at 24 hours, 35(85.37%) patients healed, whereas 6(4.63%) had a recurrence. There was no statistical difference in any parameter between either Group. Conclusion: Both methods did not show any statistically significant difference in post-operative outcomes thus other parameters like patient’s choice, cost and expertise may be considered in treatment of chronic anal fissure.

Implementation of Disaster Preparedness in Hospitals by Emergency Department Nurses

Aims: The purpose of this study is to determine the preparedness of emergency room nurses in handling disasters in hospitals. Method: This study employs a qualitative research design, utilizing a single case study that focuses on the implementation of disaster preparedness by emergency room nurses in hospitals. The subjects of this case study are two nurses who meet the inclusion criteria: they have attended disaster preparedness training, work as emergency room nurses, have been part of the hospital disaster team for at least five years, and are considered reliable and competent sources of data related to the research objective. Purposive sampling was used to select the participants, and data was collected through in-depth interviews guided by an interview protocol. Results: Four themes were identified: disaster preparedness, the organizational structure of disaster management functions and tasks, patient grouping, and the communication of clear, effective information along with coordination among medical personnel. Conclusion: The study found that implementing preparedness among emergency room nurses in disaster management is crucial to ensure a prompt and effective response in emergency situations.

Inavolisib-Based Therapy in PIK3CA-Mutated Advanced Breast Cancer

BackgroundInavolisib is a highly potent and selective inhibitor of the alpha isoform of the p110 catalytic subunit of the phosphatidylinositol 3-kinase complex (encoded by PIK3CA) that also promotes the degradation of mutated p110α. Inavolisib plus palbociclib–fulvestrant has shown synergistic activity in preclinical models and promising antitumor activity in early-phase trials.MethodsIn a phase 3, double-blind, randomized trial, we compared first-line inavolisib (at an oral dose of 9 mg once daily) plus palbociclib–fulvestrant (inavolisib group) with placebo plus palbociclib–fulvestrant (placebo group) in patients with PIK3CA-mutated, hormone receptor–positive, human epidermal growth factor receptor 2 (HER2)–negative locally advanced or metastatic breast cancer who had had relapse during or within 12 months after the completion of adjuvant endocrine therapy. The primary end point was progression-free survival as assessed by the investigator.ResultsA total of 161 patients were assigned to the inavolisib group and 164 to the placebo group; the median follow-up was 21.3 months and 21.5 months, respectively. The median progression-free survival was 15.0 months (95% confidence interval [CI], 11.3 to 20.5) in the inavolisib group and 7.3 months (95% CI, 5.6 to 9.3) in the placebo group (hazard ratio for disease progression or death, 0.43; 95% CI, 0.32 to 0.59; P<0.001). An objective response occurred in 58.4% of the patients in the inavolisib group and in 25.0% of those in the placebo group. The incidence of grade 3 or 4 neutropenia was 80.2% in the inavolisib group and 78.4% in the placebo group; grade 3 or 4 hyperglycemia, 5.6% and 0%, respectively; grade 3 or 4 stomatitis or mucosal inflammation, 5.6% and 0%; and grade 3 or 4 diarrhea, 3.7% and 0%. No grade 3 or 4 rash was observed. Discontinuation of any trial agent because of adverse events occurred in 6.8% of the patients in the inavolisib group and in 0.6% of those in the placebo group.ConclusionsIn patients with PIK3CA-mutated, hormone receptor–positive, HER2-negative locally advanced or metastatic breast cancer, inavolisib plus palbociclib–fulvestrant led to significantly longer progression-free survival than placebo plus palbociclib–fulvestrant, with a greater incidence of toxic effects. The percentage of patients who discontinued any trial agent because of adverse events was low. (Funded by F. Hoffmann–La Roche; INAVO120 ClinicalTrials.gov number, NCT04191499.)

Association Between Prostatitis and Some Biochemical Markers in Patients of the AL-Najaf Province, Iraq

One of the most common clinical conditions in men is prostate disease, especially prostatitis, which causes various symptoms, that negatively affect patient life. Our current study investigated the relationship between prostatitis and IL-6, zinc, and ESR levels for patients who visited AL-Sader Medical City in the province of AL-Najaf, between March and November 2023. our study included 90 samples of people infected with prostatitis and 30 samples of healthy people between the ages of (20-40) years. The level of IL-6 was calculated using the ELISA technique, The level of zinc as an antioxidant asses by using the spectrophotometer and ESR was measured by using the Westergren technique to determine the inflammation case in patients and compared with the healthy group. The results showed an increase in the level of IL-6 in patients with prostatitis compared with a healthy group (908.72±140.19,214.16±85.56) pg/ml respectively. but showed a decrease in the level of Zinc in prostatitis patients compared with the healthy group (38.93±10.92U/ml, 89.36±9.61U/ml) respectively. Also showed an elevated level of ESR, where according to (48.41±13.49 ) mm/hour in patients group compared with a healthy group (14.60±4.14) mm/ hour. The data was analyzed by SPSS program version 23, where the factor effect was considered significant when p&lt;0.05. we conclude from our current study the significant relationship between IL-6, Zinc levels, and prostatitis, as well as the role of the ESR test as an indicator of prostatitis

Evaluation of nasal mucociliary clearance in patients with psoriasis.

Psoriasis is an autoimmune pathology characterized by chronic inflammation with known multiorgan involvement. In the literature, there are few studies investigating the effects of psoriasis on upper respiratory tract mucosa. Our aim in our study was to investigate the possible effect of psoriasis disease severity and duration on nasal mucosa. A study group was formed from patients with psoriasis and disease duration, Psoriasis Area Severity Index (PASI) and Nasal Obstruction Symptom Evaluation (NOSE) scores of these patients were recorded. Demographic data were noted in all participants with the participation of control group patients, saccharin test was performed to evaluate the nasal mucosa and nasal mucociliary clearance (NMC) times were measured. Psoriasis patients with pathology that may cause nasal obstruction were excluded from the study. A total of 59 people (30 patients and 29 controls) aged 20-65 years were included in the study. There was no difference in age and gender distribution between the two groups. No statistically significant difference in the NMC time between two groups. In the patients group, a correlation was observed between the NMC time to the NOSE test, but no correlation was observed between the NMC time to the duration of the disease and the PASI score. In our study, no difference was observed in NMC time between the two groups and according to the duration or severity of the disease. In addition, NOSE score of patients was also relatively low. No significant impact of psoriasis on nasal functions was found.

Use of a Facebook Support Group for Kidney Transplant Patients

Background: Facebook groups have been used to foster social support of transplant patients. Examining the use and content strategies for generating member interactions within transplant-specific groups can inform how we leverage these groups to expand access to social support resources. This study characterizes the use of a closed Facebook group for kidney transplant patient support linked to a hospital in Buffalo, NY to identify the most engaging content. Methods: The sample consisted of 387 individuals (372 patients/family, eight transplant professionals, and seven community advocates) and the administrator. Content analysis was conducted of posts and comments made to the group. Descriptive measures of post content associated with interactions (reactions and comments) were computed. Results: Between 5/2020 and 5/2023, there were 484 posts with 8233 interactions (2793 comments, 5440 reactions). Half of the posts (n = 241) were made by the administrator, 166 (34%) by patients/family, 70 (14%) by community advocates, and 7 (1%) by transplant professionals. Content analysis revealed that post types with the most interactions were personal experiences, monthly transplant volume, and monthly new members added; the least interactions involved posts about holidays, observances, and information. Conclusions: The interaction metrics varied according to the content strategies used by members and provided insights into the types of content members interact with.

Оцінка інформативності клініко-інструментальних та лабораторних показників у виявленні активності патогенетичних факторів, асоційованих зі змінами перебігу інфаркту міокарда в період воєнного стану

The aim – to establish markers of clinical and functional state development in patients with acute myocardial infarction inherent in wartime.Materials and methods. A cohort of 133 STEMI patients was examined (77.4 % men, 61.7±0.9 years). Part of the patients (group 1) was hospitalized from February to May 2019 (n=87), while the other part of them (group 2) was hospitalized in the period from February 24, 2022 to May 2023 (n=46) within the first 24 hours from the development of symptoms (average time of admission 5.2±0.4 hours). In order to eliminate discrepancies in indicators, which with a low probability are related to the action of wartime factors, comparable samples were made from groups 1 and 2 (52 patients and 17 patients, respectively). Comparison of groups was carried out based on clinical and anamnestic and laboratory parameters of the first day.Results and discussion. At the admission to the hospital, markers of a specific clinical and functional state in patients with STEMI due to the influence of wartime factors are: level of leukocytes &gt; 13.0 · 109/L, monocytes &gt; 0.5 · 109/L, lymphocytes &gt; 1.2 . 109/L, triglycerides &gt; 1.63 mmol/L, heart rate &gt; 76 beats/min, as well as criteria made up of these indicators (in particular, products of the level of monocytes or lymphocytes, the level of triglycerides and heart rate, as well as the 7-component scale, which takes into account heart rate, ESR, glucose and triglyceride levels, as well as the number of monocytes, lymphocytes and platelets). Moreover, the increase in the number of monocytes is not associated with hospital complications in these patients. Instead, the level of triglycerides, the number of lymphocytes and platelets are directly related both to the influence of wartime factors and to the complicated hospital course of STEMI.Conclusions. The influence of wartime factors in patients with STEMI is combined with the response to myocardial damage. It leads to an increase in the risk of a complicated course of the hospital stage, as well as to specific clinical and laboratory changes. These changes make it possible to recognize the impact of wartime factors and patients at high risk of hospital course of myocardial infarction.

Comparison of Tuberculosis Cases in Military Personnel Versus Civilians: A Retrospective Descriptive Study.

Tuberculosis (TB) remains a leading cause of death from infectious diseases worldwide. Military personnel are particularly vulnerable to TB because of the factors like deployments to endemic regions and close-quarters living. This study aims to compare the characteristics and outcomes of symptomatic TB cases between military and civilian patients treated at 2 French military hospitals, with a specific focus on diagnostic delay. This retrospective observational study included patients over 18 years old with culture-confirmed symptomatic TB treated between 2008 and 2021. Military patients (Group A) were compared to civilian patients (Group B), matched by age and sex. Data collected included demographic details, diagnostic delay, clinical presentations, and treatment outcomes. Statistical analyses were performed using chi-squared tests and Mann-Whitney tests, with significance set at P < .05. A total of 17 military and 38 civilian patients were included in the study. The median diagnostic delay was shorter for military patients at 49 days, compared to 64 days for civilians, although this difference was not statistically significant (P = .42). In the military group, 59% had been deployed to TB endemic regions, with 35% showing symptoms during operational missions. Clinical presentations and microbiological findings were similar between the two groups. Notably, two military patients were infected with Mycobacterium canettii, likely linked to deployments in Djibouti, where this strain is endemic. The military population showed a significant burden of physical sequelae, with 25% experiencing lasting physical impairments post-treatment. Tuberculosis presentation and outcomes in military and civilian patients were generally comparable. Early diagnosis remains essential to minimize disease severity and operational impact, particularly in military settings.

Scheduled Surgery and Antibiotic Therapy in Catarrhal Acute Appendicitis

&amp;lt;i&amp;gt;Introduction: &amp;lt;/i&amp;gt;Appendicitis is an acute inflammation of the appendix. Appendectomy remains one of the most frequently performed digestive surgeries in the world. The degree of urgency of this surgery and the increasingly proven efficacy of antibiotics still remains a debate. The main objectiveof our study is to compare the therapeutic results of a programmed appendectomy initially treated by antibiotic versus emergency appendectomies performed from the outset in casesof simple acute appendicitis. &amp;lt;i&amp;gt;Patients and method: &amp;lt;/i&amp;gt;Our comparative study was carried out at the Joseph Ravoahangy Andrianavalona University Hospital from 01th August 2021 to 31th July 2022. Group A included simple acute appendicitis patients who underwent emergency surgery, while group B included patients who had been treated with antibiotics for ten days before undergoing surgery. &amp;lt;i&amp;gt;Results: &amp;lt;/i&amp;gt;Our cohort of 95 patients comprised 70 patients (group A) versus 25 patients (group B). Twenty-three patients (92%) in group B had a Clavien-Dindo I score compared with 74.3% in group A. Parietal infections were 21% (group A) vs 4% (group B). There was no significant difference inpatient outcome between the two groups. &amp;lt;i&amp;gt;Conclusion: &amp;lt;/i&amp;gt;Antibiotic therapy has already proved effective in the treatment of simple acute appendicitisin recent years, and means that emergency surgery can be avoided. However, the timingof surgery remains debatable in fragile patients.

Efficacy and Safety of Ultrasound Renal Denervation on Office Blood Pressure of Patients with Resistant Arterial Hypertension: A Systematic Review and Meta-analysis.

Resistant arterial hypertension (RAH) is one of the main causes of increased cardiovascular risk around the world. The benefits of ultrasound renal denervation (uRDN) as a non-invasive treatment are still not fully clear. We aim to demonstrate the efficacy of uRDN in reducing office blood pressure of patients in treatment for RAH. PubMed, Embase, and Cochrane were searched for randomized trials comparing uRDN to sham or medical control groups in RAH patients undergoing renal denervation. Mean Differences (MD) with 95% confidence intervals (CIs) were calculated, and I2 statistics assessed heterogeneity. Statistical significance was set at p < 0.05. Statistical analysis was performed using R software version 4.2.3. It was included 5 studies with 709 patients, of which 395 (55.71%) received uRDN treatment and 314 (44.29%) in the sham group. Mean follow-up time ranged from 2 to 48 months and mean age ranged from 52.3 to 62 years. The uRDN decreased systolic blood pressure (SBP) and diastolic blood pressure (DBP) in all measures significantly, including reductions in Office SBP (MD -4.459 mmHg; 95% CI -7.710 to -1.208; p = 0.007; I2 = 47%) and Office DBP (MD -2.039 mmHg; 95% CI -3.975 to -0.102; p = 0.039; I2 = 27%). This meta-analysis highlights uRDN's superiority over the sham group in controlling SBP and DBP in RAH. However, further studies are needed to fully understand the efficacy of uRDN procedure in the management of RAH.

Temporal trends in treatment patterns, morbidity, and mortality in patients with new-onset heart failure compared to heart failure survivors: a nationwide 23-year perspective

Abstract Background New therapy options have improved the prognosis of heart failure (HF) over recent decades. However, temporal trends in the prognosis and treatment disparities between patients with new-onset HF and HF survivors remain unexplored. Purpose To investigate temporal trends in HF treatment patterns, worsening HF and all-cause mortality, in new-onset HF patients compared to HF survivors. Methods We defined two separate cohorts of patients with HF, using the Danish nationwide registers. One cohort comprised all patients with new-onset HF each year from 1996 to 2018, included at the date of HF diagnosis (new-onset HF patients). The second cohort comprised patients with HF who have survived at least three years since being diagnosed with HF, included on January 1st of each year from 1996 to 2018 (HF survivors). Patients were allowed to contribute in both cohorts. The proportion of patients in guideline recommended therapy and the absolute five-year risk of worsening HF and all-cause mortality were assessed in the two cohorts separately, accounting for competing risks where relevant. Results From 1996 to 2018, the proportion of HF survivors tripled, while the number of yearly new-onset HF patients remained constant (figure 1). The proportion of new-onset HF patients who redeemed a prescription of BB increased from 17.1% in 1996 to 78.2% in 2018, while it increased from 15.9% to 69.4% in HF survivors during the same period. The proportion of patients in ACEi/ARB therapy increased from 49.1% to 81.5% in the new-onset HF patients, while it increased from 37.8% to 69.0% in HF survivors. The proportion of patients in MRA therapy increased from 14.4 to 33.0% in those with new-onset HF, and from 19.1% to 24.8% in HF survivors. The absolute risk (AR)[±95CI] for all-cause mortality decreased from 68.4% [67.9-68.9] in the first year group (1996-2000) to 45.7% [45.0-46.3] in the latest year group (2013-2018) for new-onset HF patients, while it decreased from 58.4% [58.2-58.9] to 39.7% [39.4-40.0] for the HF survivors. Additionally, the AR for worsening HF went from 27.4% [26.9-27.8] in the first year group to 27.8% [27.3-28.2] in the latest year group for the new-onset HF patients, whereas it for the HF survivors decreased from 19.6% [19.3-20.0] to 16.7% [16.4-19.9]. Conclusions Over a 23-year period, the annual number of patients with incident HF has remained constant while the number of HF survivors has increased by 304%. Although HF survivors show a lower prescription redemption prevalence for essential HF medications compared to incident HF patients, they exhibit significantly lower risk of all-cause mortality and worsening HF.Figure 1:OverviewFigure 2:Prescription redememption rates