High Percentage Of Patients Research Articles

Talquetamab plus Teclistamab in Relapsed or Refractory Multiple Myeloma

BackgroundTalquetamab (anti–G protein–coupled receptor family C group 5 member D) and teclistamab (anti–B-cell maturation antigen) are bispecific antibodies that activate T cells by targeting CD3 and that have been approved for the treatment of triple-class–exposed relapsed or refractory multiple myeloma.MethodsWe conducted a phase 1b–2 study of talquetamab plus teclistamab in patients with relapsed or refractory multiple myeloma. In phase 1, we investigated five dose levels in a dose-escalation study. Talquetamab at a dose of 0.8 mg per kilogram of body weight plus teclistamab at a dose of 3.0 mg per kilogram every other week was selected as the recommended phase 2 regimen. The primary objective was to evaluate adverse events and dose-limiting toxic effects.ResultsA total of 94 patients received treatment, with the recommended phase 2 regimen used in 44. The median follow-up was 20.3 months. Three patients had dose-limiting toxic effects (including grade 4 thrombocytopenia in 1 patient with the recommended phase 2 regimen). Across all dose levels, the most common adverse events were cytokine release syndrome, neutropenia, taste changes, and nonrash skin events. Grade 3 or 4 adverse events, most commonly hematologic events, occurred in 96% of the patients. Grade 3 or 4 infections occurred in 64% of the patients. With the recommended phase 2 regimen, a response occurred in 80% of the patients (including in 61% of those with extramedullary disease); across all dose levels, a response occurred in 78%. The likelihood of patients continuing in response at 18 months was 86% with the recommended phase 2 regimen (82% among those with extramedullary disease) and 77% across all dose levels.ConclusionsThe incidence of grade 3 or 4 infections with talquetamab plus teclistamab was higher than has been observed with either therapy alone. A response was observed in a high percentage of patients across all dose levels, with durable responses with the recommended phase 2 regimen. (Funded by Janssen Research and Development; RedirecTT-1 ClinicalTrials.gov number, NCT04586426.)

Drug Therapy-related Problems Detected by Clinical Pharmacists in a Closed Loop Medication Management; A Cross-sectional Study in UAE.

Drug therapy-related problems (DTRP) can lead to avoidable negative health consequences, particularly during hospital admissions. This study aimed to assess the frequency, causes, and associated factors of DTRPs, which are detected by clinical pharmacists' interventions. This is a prospective cross-sectional study of patients admitted to the medical wards of Fakeeh University Hospital, UAE, over a three-month period from September 2022 to December 2022. The data of patients who were assessed by clinical pharmacists regarding the pretense and causes of DTRPs were collected and analyzed using SPSS version 27.0. 310 patients with the mean age of 33.43 ± 19.98 years were studied (53.9% male). The highest percentage of patients were Asian (31.0%) and Arabs (30.6%). 79 (25.4%) cases had no DTRPs, while 231 (74.6) had DTRPs. The surgical ward had the highest frequency of DTRPs (41.0%). Improper drug selection with 79 cases, drug use without indication with 73 cases, and sub-therapeutic dosage with 26 cases were among the most common causes of DTRPs. Alcohol intake (p= 0.03), food allergy (p = 0.02), age group 31-40 years (p = 0.04), presence of co-morbidities (p = 0.01), family history of diseases (p = 0.02), and admission to the intensive care unit (ICU) (p = 0.01) were amongst the significantly associated factors of DTRPs. The acceptance status for clinical pharmacists' interventions were complete in 90.0% of cases, partial in 4.1 %, and rejection in 5.9%. The study findings show a high prevalence of DTRPs due to drug/dose selection and drug use without indication. It seems that the participation of clinical pharmacists in multidisciplinary teams together with the presence of closed loop medication management facilitates the detection and correction of DTRPs.

Epidemiologic characteristics of 22,086 patients discharged from the Department of Orthopaedic Trauma at a military hospital between 2013 and 2022: a retrospective real-world study

Background To analyse the epidemiological characteristics of orthopaedic trauma patients and thereby optimize healthcare resource allocation and improve treatment efficiency. Materials and Methods Relying on the hospital information system (HIS) database, we retrospectively analysed the epidemiological characteristics of orthopaedic trauma inpatients in our hospital between 2013 and 2022, including patient demographic information, causes of injury, location of injury and hospitalization costs. Results The median age of the patients was 36 (26–47) years old; the age stratification of the patients was highest in the proportion of patients aged 40–50 years old (29.23%); hypertension was the most common among the patients’ comorbidities (1.29%); patients’ occupation was highest in heavy labourers such as farmers and workers, about 63.04% (n = 13923); patients’ admissions were mainly in the form of emergencies (n = 16875, 76.41%); and patients’ median hospitalization time was 7 (5, 12) days. The highest percentage of the cause of injury was due to exposure to inanimate mechanical forces (75.4%), followed by falls (16.14%) and traffic accidents (6.49%). The highest percentage of cause of injury in all age groups was due to inanimate mechanical force, and the percentage of patients with falls increased with age, and there was a positive correlation between age groups and the percentage of patients with falls (r = 0.964, p < 0.01). The highest percentage of patients with injuries to the upper extremities was about 74%. The distribution of injury sites in all age groups was highest in the upper extremities. Age was positively correlated with trunk injuries (r = 0.469, p = 0.203). The median hospitalization cost for patients over a 10-year period was approximately $1,100. Conclusions By analysing the epidemiological characteristics of patients, a general profile of local orthopaedic trauma patients was established, which can help in the development of disease prevention and interventions.

Efficacy and Safety of a Mixture of Microencapsulated Sodium Butyrate, Probiotics, and Short Chain Fructooligosaccharides in Patients with Irritable Bowel Syndrome—A Randomized, Double-Blind, Placebo-Controlled Study

Objective: Biotics are increasingly being used in the treatment of irritable bowel syndrome (IBS). This study aimed to assess the efficacy and safety of a mixture of microencapsulated sodium butyrate, probiotics (Lactocaseibacillus rhamnosus DSM 26357, Lactobacillus acidophilus DSM 32418, Bifidobacterium longum DSM 32946, Bifidobacterium bifidum DSM 32403, and Bifidobacterium lactis DSM 32269), and short-chain fructooligosaccharides (scFOSs) in IBS patients. Methods: This was a randomized, double-blind, placebo-controlled trial involving 120 adult participants with IBS. The primary outcome of the 12-week intervention was the improvement in IBS symptoms and quality of life (QOL), assessed with the use of IBS-Adequate Relief (IBS-AR), IBS-Global Improvement Scale (IBS-GIS), IBS-Symptom Severity Score (IBS-SSS), and IBS-QOL. Secondary outcomes were the number and type of stools (assessed via the Bristol Stool Form scale), patient-recorded symptoms, anthropometric parameters, and levels of selected inflammatory cytokines. Results: As early as at 4 weeks, there was a higher percentage of patients in the biotic group reporting adequate relief of symptoms (based on IBS-AR) than in the placebo group (64.7% vs. 42.0%, respectively, p = 0.023). At 12 weeks, fewer patients in the biotic group reported a ‘worsening of symptoms’ (based on IBS-GIS) than in the placebo group (5.9% vs. 16.0% respectively, p = 0.015). There were no significant differences between groups in IBS-QOL or IBS-SSS or any of the secondary outcome measures except the patient-recorded ‘urgency to defecate’ (p = 0.015) at week 12, which was significantly lower in the biotic group. The intervention was safe and well tolerated. Conclusions: A biotic mixture consisting of microencapsulated butyrate, probiotics, and small amounts of scFOSs is safe and effective in improving gastrointestinal symptoms in patients with IBS.

Hospitalized children with influenza A before, during and after COVID-19 pandemic: a retrospective cohort study

ContextSince the outbreak of COVID-19 in late 2019, the transmission dynamics and clinical presentation patterns of influenza A (Flu A) virus have undergone changes.ObjectivesThis article conducted a comparative analysis in clinical characteristics and laboratory results of pediatric patients with Flu A before, during, and after the COVID-19 pandemic.MethodsThe medical records of 885 children hospitalized with Flu A virus infection at a tertiary hospital in Guangdong Province, China, were retrospectively analyzed. Flu A was confirmed in these cases using a direct immunofluorescence antigen assay. The clinical data for this study span from January 1, 2018, to May 31, 2023.ResultsIn our study, we observed a total of 340 cases before the COVID-19 pandemic, 196 cases during the pandemic, and 349 cases after the pandemic. Patients after the pandemic had a higher median age on admission (5.66 years, range 3.41–7.70) and exhibited more respiratory symptoms such as cough, sore throat, and nasal stuffiness. The length of hospital stay was longer, and there was a higher percentage of patients with fever duration ≥ 5 days among Flu A patients during the pandemic. Compared to before and during the COVID-19 pandemic, Flu A patients after the pandemic showed significantly reduced white blood cell (WBC) and platelet (PLT) counts (P < 0.001), along with elevated levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in laboratory indexes (P < 0.001). Furthermore, more hospitalized children after the pandemic were diagnosed with benign acute childhood myositis (BACM).ConclusionOur research results indicates a significant decrease in Flu A cases during the COVID-19 pandemic, and hospitalized children with Flu A have more severe clinical symptoms after the COVID-19 pandemic. These findings have implications for public health policy and clinical management of Flu A cases.Clinical trial numberNot applicable.

2021 trends in the treatment of patients with strabismus in Japan.

To clarify the actual status of strabismus surgery and botulinum toxin (BTX) therapy in Japan in the year 2021. Cross-sectional study. We conducted a national survey of strabismus treatment in 2021 using a questionnaire consistent with a previous 2013 survey, incorporating additional questions about BTX therapy. Among the 378 responding institutions, strabismus surgery or BTX therapy, or both, was performed at 185 institutions (49%; total cases, 10,767). In 151 (40%), 32 (8%), and 2 (1%) institutions, surgery only, surgery and BTX therapy, and BTX therapy only were performed, respectively. The distribution of institutions where strabismus surgery was performed consisted of 4 prefectures, accounting for 48% of the total, whereas no strabismus surgery was performed at any institution in 3 prefectures. Although the highest percentage of patients (23%) was aged between 10 and 19 years, 48.2% of the patients were aged 20 years or older, and 17% of them were aged 60 years or older. Exotropia (XT) was the most common type of strabismus (55%) followed by esotropia (ET) (24%). In terms of complex surgeries, 80.2% (more than 100 cases) were performed at institutions with more than 100 cases. Of the 34 institutions where BTX therapy was performed, 52% were performed at a single institution, and 18% were performed at 2 institutions where no strabismus surgery was performed. Patients with scarring in the extraocular muscles, such as thyroid eye disease, were the most treated, followed by those with ET, who were mainly given injection treatment. Institutions where strabismus surgery and BTX therapy could be performed were concentrated and limited.

State of Knowledge About Thyroid Cancers in the Era of COVID-19-A Narrative Review.

Thyroid cancer (TC), due to its heterogeneous nature, remains a clinical challenge. Many factors can initiate the carcinogenesis process of various types of TC, which complicates diagnosis and treatment. The presented review gathers current information on specific types of TC, taking into account the effects of the COVID-19 pandemic. It is likely that COVID-19 has influenced and continues to influence the function of the thyroid gland. A high percentage of patients with COVID-19 showing simultaneous pathological changes in the thyroid suggests that SARS-CoV-2 may disrupt the function of this gland and initiate pro-oxidative mechanisms, inflammatory states, and autoimmune diseases, thereby promoting the formation of neoplastic changes. Furthermore, changes in the expression of the ACE2, TMPRSS2, CLEC4M and DPP4 genes, observed in TC, also occur in COVID-19. Therefore, it is probable that the interaction of SARS-CoV-2 with thyroid cell receptors may initiate carcinogenesis in this gland. Additionally, some drugs used in TC therapy (e.g., levothyroxine) may increase the affinity of SARS-CoV-2 for cells, which could contribute to a more severe course of COVID-19 and the emergence of long-term symptoms (post-COVID-19). Moreover, the consequences of sanitary restrictions (limited access to medical services, reduction in endocrinological and oncological procedures) that took place in many countries during the COVID-19 pandemic may lead in the future to an increased number of missed diagnoses and the emergence of aggressive cancers.

Survival of HIV associated diffuse large B-cell lymphoma and Burkitt lymphoma in China

Combination antiretroviral therapy (ART) has improved outcomes for human immunodeficiency virus (HIV) associated non-Hodgkin lymphoma. This is an analysis of 127 patients with HIV with Burkitt lymphoma (HIV-BL) and diffuse large B-cell lymphoma (HIV-DLBCL) treated at the Zhongnan Hospital of Wuhan University over a 17-year period during the ART and rituximab era. The median CD4 count for the cohorts was 0.141 × 109/L (range, 0.001-0.861 × 109/L). DA-EPOCH ± R (54%) were most commonly used in HIV-BL. CHOP± R (42%) was most commonly used to treat HIV-DLBCL. The complete response rate after first-line curative therapy was 10/28 (36%) in HIV-BL and 25/57 (44%) in HIV-DLBCL. The 2-year progression-free survival (PFS) and overall survival (OS) for the HIV-BL cohort was 50% and 41% respectively. The 2-year PFS and OS for the HIV-DLBCL cohort was 55% and 47% respectively. Current China practice favours the treatment of HIV-BL and HIV-DLBCL similarly to the HIV-negative population with the use of concurrent ART. However, due to the extremely low percentage of patients receiving ART prior to the lymphoma diagnosis, the high percentage of patients with poor performance status, and the advanced stage at diagnosis, the treatment of HIV-related lymphoma remains the major challenge in China.

Epidemiological features and clinical profile of patients with thalassemia

Objectives: Thalassemia is the most common genetic disorder globally. In Afghanistan, the epidemiology and clinical characteristics of the disease are not studied officially. This study aims to explore the epidemiological pattern and clinical profile of thalassemia patients registered in the National Blood Bank (NBB), Kabul, Afghanistan. Material and Methods: A retrospective medical record review was conducted to analyze registries and conduct phone calls for follow-up patients registered in the NBB during 2019–2020 in Kabul. The confirmed case was any patient tested for fetal hemoglobin and blood film. Data were collected using a form matching the patient’s registers. Epi Info v.7 was used for data management and descriptive measures analysis. Results: Totally 411 patients with thalassemia were enrolled in the analysis. Out of all patients, 225 (54.61%) were male, with an overall mean age of 6.89 (±4.06) years. The highest proportion of patients was clustered around age groups of 2–8 years (56%). Pashtuns’ ethnicity had the highest percentage of patients (63%) and Hazara the lowest (1%). Almost the majority of cases under management were thalassemia major (98.8%), and just one case was recorded as intermedia and four cases as minor. According to laboratory tests, 88 (21.4%) were positive for hepatitis C, 2 (0.5%) positive for hepatitis B, and 1 (0.2%) for human immunodeficiency virus. As a whole, 251 (61.67%) had a type of consanguinity marriage. In patients, the blood groups of A+ (27%), B+ (27%), and O+ (25%) were almost equally distributed, while AB+ (10%), O negative (4%), A negative (2%), and AB negative (0.2%) had low proportions. The residency of the majority (87.13%) was Kabul. Totally, 18 (4.36%) had surgical operations, and 11.8% reported children died due to thalassemia. Conclusion: Thalassemias are common in Afghanistan, and facility for management is lacking. Consanguineous marriage was more common and probably a contributing factor to disease. The establishment of more centers and a full review of factors are recommended.

Matrix-assisted autologous chondrocyte transplantation is effective at mid/long-term for knee lesions: A systematic review and meta-analysis.

This systematic review with meta-analysis evaluates the long-term efficacy of matrix-assisted autologous chondrocyte transplantation (MACT) in terms of functional scores using scaffolds made of hyaluronic acid (HA) or collagen (C). Nineteen articles met the eligibility criteria for the analysis. Fourteen studies focused on patients treated with MACT with HA-based scaffolds, four studies with C-based scaffolds, and one study compared both scaffold types. A higher percentage of patients in the HA subgroup had undergone previous cartilage repair procedures, whereas multiple lesions were more common in the C subgroup. Both HA- and C-treated patients showed significant functional improvement in terms of International Knee Documentation Committee with overall mean differences at 2 and 5 years, and for HA-treated patients at 10 years. Likewise, concerning the Tegner activity scale, both subgroups demonstrated significant improvement at 2 years, with the HA subgroup showing more sustained improvement up to 10 years. The HA subgroup also had EQ-VAS reduction at 2, 5 and 10 years. Failure rates were similar between and within groups, with a range from 0% to 42% at different follow-ups. Patients experienced mid-term benefits from MACT, using both HA-based and C-based scaffolds, and long-term benefits from using HA-based scaffolds. The low failure rate and the fact that most patients did not require knee replacement surgery are encouraging. Accordingly, despite their complexity and high costs, regenerative techniques like MACT are effective, as they can significantly delay or even prevent the need for total knee replacement. Level IV.

Pelvic floor muscle pain is associated with higher symptom scores and bladder pain perception in women with interstitial cystitis and bladder pain syndrome.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a heterogeneous, multifactorial disease with a high prevalence of somatic symptoms. A high percentage of women with IC/BPS also experience pelvic floor muscle pain (PFMP). This study investigated he association between PFMP and clinical characteristics in patients with IC/BPS. This study evaluated the extent and severity of PFMP in women with IC and BPS. Demographics, sexual condition, IC symptom index (ICSI), IC problem index (ICPI), and Beck anxiety inventory and depression inventory were assessed. The objective assessment items included bladder wall thickness in computed tomography, urodynamic parameters, maximum bladder capacity (MBC) and glomerulation grade after cystoscopic hydrodistention, urine inflammatory proteins, and oxidative stress biomarkers. A total of 9 women with IC and 83 with BPS were enrolled. A total of 85.8% of patients had PFMP. Patients with PFMP had higher rates of dyspareunia (p = 0.005), lack of sexual activity (p < 0.001), more comorbidities (p = 0.039), pain-predominant IC/BPS phenotypes (p = 0.04), higher IC symptoms (ICSI, p = 0.003; ICPI, p < 0.001), and higher levels of urinary biomarker MIP-1β (p = 0.004) than patients without PFMP. However, no significant correlation was found between PFMP and the bladder wall thickness, urodynamic parameters, MBC, or glomerulation grade. PFMP is present in a high percentage of patients with IC and BPS and associated with higher IC/BPS symptom score and dyspareunia, but not with MBC or glomerulation grade in patients with BPS.

Ocular Myasthenia gravis: determining the predictive factors of secondary generalisation.

Myasthenia gravis (MG) can be classified according to clinical features into ocular MG (OMG) and generalised MG (GMG). However, OMG carries the risk of conversion to GMG. In this study, we aimed to determine the predictive factors for the secondary generalisation of OMG patients. OMG patients followed-up in our hospital from January 1999 to November 2023 were retrospectively reviewed. Demographic and clinical characteristics data were collected from medical records. OMG patients with follow-up of < 2 years were excluded. Of the 122 patients included, 87 (71.3%) remained as OMG and 35 (28.7%) had converted to GMG. The median time taken for generalisation was 12 months (IQR 6-30). 73.5% of patients had converted to GMG within 2 years. In univariate analysis, a significantly higher proportion of patients with positive anti-AChR antibodies (94.1% vs. 67.1%, p = 0.002), higher antibody titre (8.0 vs. 1.6 nmol/L, p < 0.001), positive repetitive nerve stimulation (RNS) (54.5% vs. 15.9%, p < 0.001), positive single-fibre electromyography (96.7% vs. 76.0%, p = 0.013) and the presence of thymic abnormalities (35.3% vs. 3.5%, p < 0.001), specifically thymoma (29.4% vs. 1.2%, p < 0.001) were associated with secondary generalisation. Conversely, higher percentage of patients who were treated with corticosteroid remained as OMG (37.9% vs. 17.1%, p = 0.026). However, in multivariate analysis, only positive anti-AChR antibodies (ORadj 9.6, 95% CI 1.7-56.1), positive RNS (ORadj 4.0, 95% CI 1.3-12.5) and the presence of thymoma (ORadj 29.5, 95% CI 2.5-351.1) were independently associated with secondary generalisation. The presence of anti-AChR antibodies and thymoma with positive RNS were the predictive factors of secondary generalisation in OMG.

Prescribing Trends of Fixed-Dose Combination Antibiotics Not Recommended by the WHO (FNRs) for ICU Patients in Six Major Areas of China During a Seven-Year Period.

To evaluate the prescribing trends of fixed-dose combination antibiotics not recommended by the WHO (FNRs) for intensive care unit (ICU) patients in six major areas of China from 2013 to 2019. A descriptive analysis was conducted using the pharmacy prescription data. Prescription data for patients admitted to the ICU were extracted from the Hospital Prescription Analysis Cooperative Project. Trends in FNR use were analyzed over a seven-year period, and the trends were further analyzed at the specific drug and hospital levels. A total of 15,596,620 prescriptions were eligible for analysis, and 1,492,793 patients were included. Among these patients, 91,515 (6.13%) received FNRs. The annual number of ICU patients who received FNR showed an increasing trend (P=0.007), but the percentage per year did not (P=0.764). The FNR use was usually higher in male patients than in female patients (P<0.001). Patients aged > 60 years had the highest percentage of patients who received FNRs (P<0.001). Among the eight FNRs identified in this study, cefoperazone/sulbactam was the most commonly used FNR in both patient numbers and prescribed hospitals, followed by piperacillin/sulbactam. The use of cefotaxime/sulbactam was less common but showed an increasing trend. There were significant differences among the regions. This study investigated the national landscape of FNR use among ICU patients. Attention should be given to the frequent use of FNRs in these patients. Data on the real-world effectiveness and safety of FNRs are urgently required.

Clinical, Radiological and Pathological Features of a Large American Cohort of Spinocerebellar Ataxia (SCA27B).

Spinocerebellar ataxia 27B due to GAA repeat expansions in the fibroblast growth factor 14 (FGF14) gene has recently been recognized as a common cause of late-onset hereditary cerebellar ataxia. Here we present the first report of this disease in the US population, characterizing its clinical manifestations, disease progression, pathological abnormalities, and response to 4-aminopyridine in a cohort of 102 patients bearing GAA repeat expansions. We compiled a series of patients with SCA27B, recruited from 5 academic centers across the United States. Clinical manifestations and patient demographics were collected retrospectively from clinical records in an unblinded approach using a standardized form. Post-mortem analysis was done on 4 brains of patients with genetically confirmed SCA27B. In our cohort of 102 patients with SCA27B, we found that SCA27B was a late-onset (57 ± 12.5 years) slowly progressive ataxia with an episodic component in 51% of patients. Balance and gait impairment were almost always present at disease onset. The principal finding on post-mortem examination of 4 brain specimens was loss of Purkinje neurons that was most severe in the vermis most particularly in the anterior vermis. Similar to European populations, a high percent of patients 21/28 (75%) reported a positive treatment response with 4-aminopyridine. Our study further estimates prevalence and further expands the clinical, imaging and pathological features of SCA27B, while looking at treatment response, disease progression, and survival in patients with this disease. Testing for SCA27B should be considered in all undiagnosed ataxia patients, especially those with episodic onset. ANN NEUROL 2024;96:1092-1103.

User-Friendliness Evaluation of Handling pMDI with Various Add-on Devices in Asthmatic Patients

The objective of this study was to assess the use of pMDI alone and pMDI with different spacers in asthmatic patients and to identify any associations between errors in handling the device for the first time and the sessions needed to reach the correct handling method, considering patient demographics and clinical characteristics. A total of 150 Asthmatic patients were crossed over to handle pMDI alone and with add-on inhalable devices (Aerochamber plus, Tips Haler, Able, Dispozable and Aer-8) randomly, without receiving verbal or demonstrative instruction (baseline assessment). The assessment of the inhaler technique was performed using checklists that had been set beforehand. Subsequently, the proper utilization of the inhaler was exhibited, and the patient's inhaler usage was reassessed. The demonstration was repeated until an optimal technique was attained. The number of counselling attempts required to achieve successful management, together with patient demographics and clinical factors, were documented. The mean percentage of total errors at baseline shows that pMDI alone is significantly higher than pMDI attached to add-on devices (53.90 ± 9.71, 32.54 ± 13.93, 24.53 ± 14.93, 21.6 ± 14.48, 25.14 ± 10.99, 27.47 ± 10.28) for pMDI alone, Aerochamber plus, Tips Haler, Able, Dispozable and Aer-8 respectively at p < 0.01. Able and Tips Haler spacers are significantly lower than other spacers with pMDI and pMDI alone in terms of total sessions needed to attain the complete optimal handling technique at p < 0.01. Weak and very weak correlations were observed between the percentage of total errors at baseline and the total sessions with education years, Montreal Cognitive Assessment, and age as well as some demographics and clinical variables. Handling pMDI can be challenging however the introduction of spacers simplifies this procedure. Different spacers cannot be treated as a homogeneous group due to variations in handling techniques and ease of use. the Able spacer requires the fewest handling steps of any spacer and has the highest percentage of patients who can use it without assistance.Graphical

Incidence of catheter-association bloodstream infection among hemodialysis patients at Erbil Teaching Hospital.

The study objectives were to analyze catheter-associated bloodstream infection (CABSI) risk factors in chronic kidney disease on regular hemodialysis and identify the bacterial species responsible for this by molecular analysis. This research was conducted in Erbil Teaching Hospital-Dialysis Unit in Erbil City-Kurdistan Region-Iraq from January to June 2024. It has been performed on 100 hemodialysis samples from both males and females. The investigation showed that the prevalence of CABSI among hemodialysis patients was 44 (44%) out of 100 (100%). The highest percentage of patients were aged between 60-69 years (32%, OR= 0.9, 95%CI [0.1-2.4], P< 0.001) and also male (66%, OR=2.7, 95%CI [0.9-9.4], P< 0.032). Additionally, the patients with Diabetes Mellitus were 70%, (OR= 6.3, 95%CI [0.3-10.4], P< 0.031), and with hypertension was 92%, (OR= 3.1, 95%CI [0.21-5.4], P<0.02. However, the dialysis duration of most patients was between 1-3 months (60%, OR=0.1, 95%CI [0.1-3.2], P<0.006) and the majority used two catheters (52%, OR= 0.6, 95%CI [0.1-3.2], P<0.012). The most common pathogens identified were Staphylococcus epidermis (44 cases, 100%), Pseudomonas aeruginosa (29 cases, 66%), and, Acinetobacter baumanni (24 cases, 55%). Thirteen bacterial species were recorded in the NCBI GenBank database. The phylogenetic tree demonstrated the distribution and relationship between these bacteria in hemodialysis patients. It showed that the bacterial species were closely related. To lower the risk of catheter-associated bloodstream infection, medical staff should actively develop countermeasures and gain a thorough understanding of the risk factors, which include age, diabetes, length of catheterization, and catheterization site.

The impact of dual-enrolee (Medicare/Medicaid) status on venous leg ulcer outcomes: a retrospective study.

To quantify race, sex, comorbidities, Medicaid status, and compare health outcomes for Medicare-only versus Medicare/Medicaid dual-enrolees who developed a hard-to-heal venous leg ulcer (VLU). Medicare Limited Data Standard analytic hospital inpatient and outpatient department files were used to follow episodes of medical care for a VLU from 1 October 2015-2 October 2019. In an earlier study, patients diagnosed concurrently with chronic venous insufficiency and a VLU were propensity-matched. In this current work, cohorts were split into patients enrolled in Medicare-only and those enrolled in Medicare and Medicaid (dual-enrolees). Treatment methods were compared and the most commonly used cellular, acellular and matrix-like product (CAMP) among Medicare beneficiaries-dehydrated human amnion chorion membrane (DHACM)-was evaluated. Episode claims were used to document demographics, comorbidities and treatments of Medicare enrolees who developed VLUs and outcomes such as time to ulcer closure, rates of complications and hospital usage rates. Quality of life (QoL) metrics, such as pain and time to VLU closure, were compared across the groups. Of the 555,284 Medicare beneficiaries evaluated in this analysis, 27% were Medicare/Medicaid dual-enrolees and 73% were Medicare-only enrolees. To qualify for Medicaid, patient income had to be ≤133% of the federal poverty level. Only 3% of Medicare-only patients and 6% of dual-enrolees had an Advantage plan, a lower rate than the general Medicare population. Dual-enrolees, compared to those covered by Medicare-only, demonstrated: a Charlson Comorbidity Index (CCI) score one point greater (p<0.0001); a higher percentage (16%) of patients from minority ethnic backgrounds; and significantly higher rates of emergency department visits (p<0.0001) and cellulitis (p=0.034). Dual-enrolees who received early and regularly applied CAMPs also reduced their treatment time by 21 days (p=0.0027), all of which can impact costs. The socioeconomic status of dual-enrolees included near poverty status, a higher percentage of patients from a minority ethnic background, and high rates of comorbidities compared to their Medicare-only counterparts. The VLUs of dual-enrolees took longer to close, developed more complications, and used significantly more hospital resources and expenses. Outcomes significantly improved when VLU episodes were treated with a CAMP, such as DHACM, while following parameters for use. Socioeconomic variables are associated with poor outcomes for patients with hard-to-heal (chronic) wounds. This should be tracked to find cost-effective interventions throughout their journey to provide equitable care and ensure they are not left behind. Greater access for dual-enrolees to CAMPs has the potential to improve clinical outcomes and patient QoL, while concomitantly reducing overall healthcare expenditure.

Subtle bradykinesia features are easier to identify and more prevalent than questionable dystonia in essential tremor.

Essential tremor (ET) is characterized by upper limbs action tremor, sometimes extending to other body parts. However, ET can present with additional neurological features known as "soft signs." These signs of uncertain clinical significance are not sufficient to suggest an alternative neurological diagnosis, and include, among others, questionable dystonia and subtle voluntary movement alterations, i.e., bradykinesia and related features. This study aimed to explore the prevalence and relationship between questionable dystonia and subtle bradykinesia features in ET. Forty ET patients were video-recorded during clinical examination. Five movement disorder experts reviewed the videos to identify soft motor signs, i.e., dystonia and movement alterations during finger-tapping namely, (i) bradykinesia (reduced velocity), (ii) dysrhythmia, and (iii) sequence effect. Inter-rater agreement was quantified using the Fleiss' Kappa index. Data analysis was performed using nonparametric tests. We found a fair inter-rater agreement for upper limb dystonia (Fleiss' K = 0.27). Inter-rater agreement was higher (moderate) for head dystonia (Fleiss' K = 0.49) and finger-tapping assessment (Fleiss' K = 0.45). Upper limb dystonia was identified in 70% of patients, head dystonia in 35%, and finger-tapping alterations (in variable combinations) were observed in 95% of individuals (P < 0.001 by Fisher's exact test), including subtle bradykinesia and related features. No significant concordance or correlation was found between the soft signs. Subtle bradykinesia and related features are the most easily identifiable and frequent soft signs in ET, appearing in a higher percentage of patients than subtle dystonia. These findings provide insights into the clinical and pathophysiological understanding of ET.

Nursing Home Staffing Levels and Resident Characteristics in Larger Versus Smaller Chains

ObjectivesTo analyze patient and facility characteristics associated with smaller versus larger nursing home (NH) chains. DesignThis study used a cross-sectional study design. Setting and ParticipantsNHs affiliated with multi-facility chains in the United States. MethodsUsing nationally representative data from LTCFocus 2021 Facility-Level File and the June 2023 Centers for Medicare and Medicaid Services (CMS) Affiliated Entity Performance Measures, we assessed differences in facility and patient characteristics among categories of NH chains size based on the number of certified beds (smallest to largest quintile of NH chain size) using one-way analysis of variance testing. We conducted linear regression analyses to examine the association between the quintile of chain size and staffing outcomes. ResultsAmong the 9348 NHs associated with 610 chains in our sample, the smallest quintiles of NH chains had the lowest percentage of for-profit facilities, a higher percentage of patients with Alzheimer's and dementia-related diseases, and higher percentages of long-stay residents needing assistance with activities of daily living (ADLs). The largest chain quintile was associated with fewer staffing hours per resident day (HPRD) for all total nurse staff −0.69 (95% CI, −0.86 to −0.52; P < .001), registered nurses (−0.25 HPRD; 95% CI, −0.32 to −0.17; P < .001), certified nursing assistants (CNAs) (−0.37 HPRD; 95% CI, −0.48 to −0.26; P < .001), and weekend total nurse staff (−0.57 HPRD; 95% CI, −0.71 to −0.42; P < .001]). The CMS staffing rating was also lower in larger NH chains (−0.73 for quintile 5; 95% CI, −0.98 to −0.48; P < .001). Conclusions and ImplicationsLarger NH chains tended to treat less clinically complex patients and were associated with lower staffing ratios. Given increased attention and stricter rules regarding staffing by government agencies, increased monitoring of staffing in NHs affiliated with large chains by policymakers, antitrust agencies, and regulators is warranted.

Managing High Anisometropia with Blended Refractive Surgery: A Comparative Study on Patient Outcomes

Purpose: To compare patient-reported outcomes (PROs) and satisfaction results after blended refractive surgery with one eye Lasik laser/ PRK and another eye ICL. Patients and Methods: A Quality of life and Patient reported spectacle independence (PRISQ) questionnaire was administered to patients who had undergone blended Refractive surgery at 2 months of follow-up. Results: Overall PROs and satisfaction was similar among all the groups. Refractive outcome and accuracy were similar among the groups, Refractive outcome differences were not meaningful among the groups and were not a differentiating factor in PROs. Substantially fewer patients in the third group noticed glare and halo compared with the 3.0/3.0 group (P&lt;0.0001. chi-square test). No new safety concerns were reported. Conclusion: The choice of blended refractive surgery resulted in a higher percentage of patients who were deemed unfit for LVC being satisfied with Near, intermediate, and distance vision, overall the fewer PRO differences were not statistically significant.