High Rate Treatment Research Articles

Evaluation of double-balloon enteroscopy in the management of type 1 small bowel vascular lesions (angioectasia): a retrospective cohort study

BackgroundSmall-bowel angioectasia is commonly diagnosed and managed using double-balloon enteroscopy; however, rebleeding rates can vary significantly. This study aimed to identify and evaluate the clinical predictors of rebleeding in patients with small-bowel angioectasia.MethodsThis retrospective study focused on adult patients who underwent endoscopic management for small bowel vascular lesions (SBVLs). A total of 67 patients were included in the study, all of whom were retrospectively analyzed. The SBVLs were classified using the Yano et al. classification system. Among these, 62 patients with angioectasia who received endoscopic treatment were specifically analyzed. To further investigate the clinical outcomes, the angioectasia group that required endoscopic treatment was divided into two subgroups based on the number of double-balloon enteroscopy (DBE) procedures performed. Univariate and multivariate binary logistic regression analyses were used to establish which predictor variables were significantly related to the recurrence.ResultsA total of 67 patients (mean age 68.1 ± 8.9 years; 44 males) with SBVL, angioectasia was diagnosed in 62 (92.5%) patients, dieulafoy lesion in 1 (1.5%) patient, and arteriovenous malformation in 4 (6%) patients. Similarly, the prevalence of chronic renal failure and diabetes mellitus were significantly higher in the multiple DBE endotherapy group compared to the single DBE endotherapy group (p < 0.001; p = 0.032, respectively). In multivariate logistic regression analysis, anticoagulant use (OR = 9.648, 95% CI: 1.729–53.817, p = 0.010), chronic renal failure (OR = 15.683, 95% CI: 2.727–90.203, p = 0.002), localization of duodenum (OR = 13.509, 95% CI: 1.598–114.168, p = 0.017), and localization of the ileum (OR = 17.100, 95% CI: 1.477–197.905, p = 0.023) were all independently associated with a higher risk of angioectasia recurrence.ConclusionsThe findings of this study demonstrates a high success rate of endoscopic treatment, with a rebleeding rate of 27%, highlighting the significance of this approach. Chronic renal failure, use of anticoagulant, and lesion localization in the duodenum or ileum were identified as independent risk factors for rebleeding, underscoring the need for careful patient monitoring and targeted intervention in these cases.

Real-World Treatment Patterns After Discontinuation of Venetoclax or BTKis in the Frontline Setting Among Older Adults With Chronic Lymphocytic Leukemia.

Venetoclax and Bruton's tyrosine kinase inhibitors (BTKis) are key treatment options for patients with chronic lymphocytic leukemia (CLL) in the frontline setting. This study characterized postdiscontinuation treatment patterns and hospitalization of frontline venetoclax and BTKis in a national sample of older adults with CLL. We identified 1,770 Medicare beneficiaries 66 years and older with CLL initiating venetoclax with obinutuzumab (VEN-O, n = 193) or BTKi treatment (n = 1,577) in the frontline setting between June 01, 2019, and June 30, 2020. Discontinuation was defined as a consecutive 90-day gap in treatment at any point over an 18-month follow-up. BTKi patients were expected to receive treatment continuously; VEN-O patients were expected to complete 11 months of treatment (12 cycles × 28 days = 336 days). The rates of subsequent CLL treatment and all-cause/CLL-related hospitalization were assessed. Over an 18-month follow-up, 102 (52.8%) VEN-O patients discontinued after completing the fixed-duration period; 597 (37.9%) BTKi and 57 (29.5%) VEN-O patients discontinued treatment prematurely. The median time to discontinuation was 11.9 months (VEN-O) and 4.0 months (BTKi patients), respectively. Few patients (n < 11) who discontinued VEN-O initiated another CLL treatment over a median postdiscontinuation follow-up period of 6.1 months. By contrast, 39.0% of discontinuers in the BTKi group had evidence of subsequent CLL treatment over a median 13.8-month postdiscontinuation follow-up period. Post-BTKi regimens included BCL-2 (35.6%), subsequent BTKi (31.8%), chemotherapy (14.6%), anti-CD20 monotherapy (9.9%), and other (8.2%). The rate of postdiscontinuation all-cause and CLL-related hospitalization per 100 patient-months was 2.0 and 1.5 for the VEN-O group and 3.3 and 2.9 for the BTKi group, respectively. In this real-world study, early discontinuation was more common in patients initiating a BTKi in contrast to VEN-O. Patients who initiated a BTKi also had high rates of subsequent treatment and hospitalization.

TREATMENT OF HYPOTHYROIDISM BY AGE AND SEX IN THE UNITED STATES: A NHANES AND OPTUM CLAIMS DATA ANALYSIS.

Recent data using NHANES and Optum Claims data (OCD) showed an increase in primary hypothyroidism (HT) prevalence in the United States following the 2002 NHANES III report. Using these data, we characterized treatment patterns of overt HT (OHT) in the US. Data on adults with OHT were collected from NHANES (2009-2012) and OCD (2012-2019). Disease status was determined from laboratory results or evidence of HT treatment (levothyroxine or liothyronine). OHT was defined as thyroid-stimulating hormone >4.0 mIU/L and free thyroxine <0.8 ng/dL or evidence of OHT treatment. Results were stratified by age group and sex. NHANES data were further stratified by insurance status (private/Medicare vs neither). Overall, >72% received treatment, with >80% of the OCD cohorts receiving treatment. Among the NHANES cohort, treatment rates increased with advancing age and were consistently higher in females than in males (age 18-44: 47.3% vs 39.9%; 45-59: 76.8% vs 51.1%; ≥60: 91.9% vs 65.6%, respectively). Among the OCD cohorts, treatment patterns were similar across age group and sex (>78% treated). Among the NHANES cohort that were not privately/Medicare insured, overall treatment rates were 50%, with those ≥60 having highest treatment rates (>75%). Moreover, <50% of reproductive-aged women in the NHANES dataset received treatment, which was reduced to 22% among uninsured patients. This study provides important updates regarding treatment of OHT and highlights treatment disparities, especially among men and women of reproductive age, using both total and insured population estimates.

Trends in Korean Medicine Utilization for Chronic Rhinosinusitis Using National Health Insurance Service Data (2012-2022)

Objectives: Chronic rhinosinusitis (CRS) is often treated with Korean medicine (KM), but comprehensive utilization data is lacking. This study aimed to analyze the patterns of KM use for CRS using National Health Insurance Service data from 2012 to 2022.Methods: We conducted a retrospective analysis of claims data for CRS patients (International Classification of Diseases code: J32) who visited KM institutions. We examined demographic characteristics, visiting patterns, medical costs, treatment modalities, and concurrent use of Western medicine.Results: Of 138,647 patients (52.2% male, mean age 23.8 years), 41.8% were under 10 years old. Annual patient numbers ranged from 14,595-17,242 (2012-2019), decreasing sharply from 2020. Average costs increased 5% annually. Acupuncture was the most common treatment (661,455, 50.5%). The most frequently prescribed insured herbal medicine was Hyeonggaeyeongyo-tang (48,494, 48.5%). Notably, 87.0% (120,610 patients) concurrently received Western medical treatment, indicating a prevalent integrative approach in CRS management. 77.8% received their initial diagnosis at Western institutions.Conclusion: This comprehensive analysis of KM utilization for CRS in Korea reveals significant patterns in patient demographics, treatment preferences, and integration with Western medicine. The high rate of concurrent KM and Western treatment highlights the integrative nature of CRS management in Korea, providing valuable insights for health policy and clinical practice.

Association between nighttime/weekend visits and patient outcomes in children with blunt liver and spleen injuries.

The "out-of-hours effect," which indicates hospital admittance during weekends or nighttime, has poorer outcomes for patients than for those admitted on weekdays and is widely documented in various medical conditions. However, this effect remains understudied in pediatric trauma cases, including blunt liver and spleen injuries (BLSIs). This was a secondary analysis of a nationwide multicenter retrospective study, focusing on pediatric patients with trauma (≤ 16years old) with BLSI admitted from 2008 to 2019. This study evaluated the association between out-of-hour admissions and outcomes. The primary outcome was the intervention rate and secondary outcomes were 30-day mortality and time from hospital arrival to the first intervention. This study identified 1414 pediatric patients with BLSI. In total, 681 events occurred during the daytime and 733 during the nighttime, with 927 weekday and 487 weekend events. Out-of-hour admissions did not significantly associate with a higher rate of intervention. This association remained after adjusting for five potential confounders and patient clustering within the hospital. In addition, Out-of-hour admissions did not significantly associated with 30-day mortality, or time from hospital arrival to the first intervention. The current study showed no significant difference in treatment strategy and outcomes between weekday and out-of-hour among children with BLSI.

Facial Fractures at the Armed Forces Capital Hospital of Korea: A 10-Year Study From 2013 to 2022.

The aim of this study was to analyze facial bone fractures at the Armed Forces Capital Hospital of Korea (AFCH) from 2013 to 2022. This review included individuals who visited AFCH for treatment. The inclusion criteria for the study were fractures resulting from external trauma, specifically coded as S02.1-4 and S02.6-9. The exclusion criteria comprised fractures caused by factors other than external trauma. This retrospective study of 178 facial bone fractures included 176 males (98.9%) and 2 females (1.1%) (22.5±5.1 years). The most common causes of injury were bumps (72.5%), followed by slips (7.3%), assaults (5.6%), and falls (5.1%). The majority of facial bone fractures occurred during sports activities (33.7%), training (31.5%), or everyday activities (28.7%). Nasal bone fractures were the most prevalent (47.7%), followed by fractures of the maxilla (19.2%), orbit (18.7%), mandible (10.3%), and zygoma (3.3%). The interval between the injury and hospital arrival was 6.0±8.0 days. Among the 164 patients, 110 (67.1%) underwent surgery. The overall complication rate was 8.9%. The highest complication rate was mandibular fractures (22.7%), followed by nasal bone fractures (9.8%). Among the 208 recorded facial bone fractures, 145 patients (69.7%) received treatment at AFCH, whereas 63 (30.3%) were treated in a civilian hospital; 59 patients (28.4%) by their own choice and 4 patients (1.9%) on a consignment basis. The average follow-up period was 202.0±183.2 days. The relatively high rate (28.4%) of treatment at civilian hospitals is attributable to legislation allowing injured soldiers the option to choose between military and civilian medical facilities.

OGC SO19 - Management and outcomes for Barrett’s oesophagus with dysplasia in a tertiary centre

Abstract Background Barrett’s oesophagus is a premalignant condition. Development of high-grade dysplasia (HGD) formerly was an indication for oesophagectomy, but endoscopic treatment (ET) is now recommended as first-line therapy: radiofrequency ablation (RFA) or endoscopic mucosal resection (EMR). Oesophagectomy is only considered for cases where ET was unsuccessful. Previous review of our institution’s outcomes between 2014 and 2017 showed a 54% complete EMR excision rate and 20% salvage oesophagectomy (n=25). Since then, RFA has been utilised in our institution. We aimed to review our recent data to assess current outcomes. Method Retrospective analysis was performed of patients identified via registration at the Hull University Hospital Trust oesophagogastric MDT between March 2017 and December 2023. Inclusion criteria was confirmed histology of HGD on 2 occasions by 2 specialist pathologists, 6 weeks apart. EMR was performed for focal oesophageal lesions and non-nodular segments were treated by RFA. Patients were included once they had at least one surveillance endoscopy and 6 months had passed following treatment. Patients who were either unfit for ET and managed medically (n=6), and those who were subsequently proven to have more advanced disease and treated surgically (n=4) were excluded. Results 35 patients were identified: 20 underwent EMR, 15 RFA. 55% of EMR patients had successful excision, 9 required additional RFA for residual low-grade dysplasia (LGD). 66% RFA patients had successful ablation. 3 patients required further EMR for residual LGD. Overall 82% had successful ET with no HGD on surveillance. 5 patients had persistent HGD and 1 T1b disease: 4 underwent oesophagectomy, 2 managed oncologically. Barrett’s tended towards being longer in patients where ET failed to eradicate HGD (median 6cm vs 3cm MWU p=0.07). No patient in the series died because of disease-related pathology. 1 patient developed stricture post-RFA requiring dilatation. Conclusion ET for HGD is effective with a high rate of successful treatment. It can be used as a single or dual modality. Salvage oesophagectomy rates are lower than previously reported (8% vs 20%) and complications are low (3% stricture rate). Longer segment Barrett’s may be less likely be responsive to ET, although not reaching significance in our series. ET should continue to be offered as the first-line treatment for oesophageal HGD.

Inequalities in internet use among older people between 2004 and 2021

Although research already examined sociodemographic profiles of older internet (non-)users, it is unknown how combinations of sociodemographic factors relate to internet (non-)use. Therefore, this study aims to investigate the cumulative impact of sociodemographic characteristics on internet (non-)use among people aged 60 and older between 2004 and 2021, using representative survey data derived from the Belgian Ageing Studies (n = 61 376). Logistic regression analyses consistently associated low education, age 80 or older, low income and female gender with higher probabilities of being internet non-user between 2004 an 2021. CHAID analysis revealed that education and age are the strongest predictors of non-use. The cumulative impact of sociodemographic factors enables to reveal subgroups where prevalence rates of non-use are almost three times higher than the prevalence reported in the population of older people in general. The result that 80.1 percent of individuals aged 80 and above with limited education did not use the internet underscores the need for a comprehensive digital inclusion approach, including strategies to overcome economic barriers to internet access and tailored internet training initiatives addressing digital skills and motivation. CHAID results help policymakers and internet training providers identify subgroups with high prevalence rates of non-users and target interventions to those at a high risk of digital exclusion.

Artemisia campestris L. as a promising source of potential antiviral drugs for SARS-CoV-2: Docking and dynamic simulation studies

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been considered as global public health security threats. Due to its rapid spread, high mortality rate and unavailability of treatment, we need to find a potent drug against SARS-CoV-2. Natural products are useful agents for the discovery of new potential drugs to combat coronavirus. Artemisia campestris, an aromatic plant widely used in traditional medicine, particularly in southern region of Algeria, is recognized for its essential oils and phenolics compounds possessing a wide range of biological activities. This study selected sixty-nine compounds from this plant to determine their binding interactions with the SARS-CoV-2 main protease (Mpro) and receptor-binding domain of the spike (S-RBD) protein, by using computational methods. Rutin, isoquercetin, and quercetin-3-O-glucuronide were shown to be the most potent inhibitors for Mpro and S-RBD with docking scores and Ki values ranging from -16.06 to -10.67 Kcal/mol and 0.005 to 30.01 nM, respectively. Evaluation of ADMET pharmacokinetic properties and the drug likeness in silico revealed that only 3,5-dicaffeoylquinic acid, 3–4–5-tricaffeoylquinic acid, isorhamnetin-3-O-glucoside, and rubescensin A could be more effective drugs against COVID-19. Molecular dynamics (MD) simulations (100 ns) and MM-GBSA calculations confirmed the stability of ligand-protein complexes via hydrogen bonding interactions with crucial residues. The analysis of structural parameters (RMSD, RMSF, H-bonds, Rg, and SASA) indicates that 3,4,5-tricaffeoylquinic acid and rubescensin A compounds have good stability and significant binding affinity with the Mpro and S-RBD protein. Taken together, our findings confirm that Artemisia campestris as a plausible source of anti-SARS-COV-2 phytochemicals and suggest that may play important role in this activity.

Assessment of the approach to managing medical emergencies during dental procedures.

This study aims to investigate the knowledge of dental interns and post-graduated doctors regarding dental emergencies and their occurrence in the clinic and examine the doctors' ability to intervene in these emergencies. Note that, 150 dental interns and 101 post-graduated doctors were surveyed with sixteen questions regarding their knowledge and experience with syncope, orthostatic hypotension, myocardial infarction, angina pectoris, asthma, and anaphylactic shock. Also, post-graduate doctors answered nine additional questions about their emergency response capabilities. This study found that interns and doctors exhibited similar knowledge about emergencies. Nonetheless, the count of dental interns encountering emergencies is relatively limited. Syncope was the most frequently encountered condition (61.8%). Doctors' increase in years of experience correlated positively with a higher rate of intervention in epilepsy, orthostatic hypotension, and anaphylactic shock (p=0.001, 0.024, and 0.02, respectively). The ability to check the carotid pulse and to perform intramuscular injections was high in post-graduated doctors (90.09% and 81.2%, respectively). Although interns believe their knowledge about emergencies to be sufficient, their intervention skills may need to be improved due to the low frequency of encounters. After graduation, their inability to intervene adequately during emergencies in the clinic can lead to fatal consequences. The lack of improvement in doctors' knowledge and intervention abilities with experience could be attributed to insufficient training after completing their formal education. To prevent such scenarios, regular training sessions should be provided to interns and doctors, focusing on the emergencies they may encounter.

Self-supporting three-dimensional CuNi–Sb–SnO2 anode with ultra-long service life for efficient removal of antibiotics in wastewater

Electrochemical ozone production (EOP) is a promising technology for the removal of contaminants in wastewater. However, traditional two-dimensional anodes for EOP are restricted by their reliance on substrates and limited surface area, thus exhibiting poor stability and efficiency. Herein, a novel three-dimensional Sb–SnO2 with Cu and Ni co-doped (3D CuNi-ATO) was synthesized via a facile pressing-sintering method without the Ti substrate. 3D CuNi-ATO had a specific surface area two orders of magnitude higher than conventional CuNi-ATO/Ti, as well as the significant capability of EOP that differs from intrinsic 3D ATO. This endowed 3D CuNi-ATO with the capability to remove tetracycline with a pseudo-first-order rate constant of 0.033 min−1 under a low current density of 5 mA cm−2 within 120 min, which was far more efficient than that by 3D ATO and other two-dimensional anodes reported. The 3D CuNi-ATO was confirmed stable in 100 cycles and had an accelerated service lifetime of over 1100 h versus 83 h of CuNi-ATO/Ti. The degradation of tetracycline in complex matrix and flow-through reactors further revealed the promising potential of 3D CuNi-ATO to be applied in scenarios of practical application and continuous high-rate treatment.

Appropriate Use of Antibiotics in Acute Pancreatitis: A Scoping Review.

While selective use of antibiotics for infected pancreatic necrosis (IPN) in acute pancreatitis (AP) is recommended, studies indicate a high rate of inadequate treatment. A search of PubMed, Scopus, and Cochrane databases was conducted, focusing on primary research and meta-analyses. Data were categorized based on core concepts, and a narrative synthesis was performed. The search identified a total of 1016 publications. After evaluating 203 full texts and additional sources from the grey literature, 80 studies were included in the review. The answers obtained were: (1) Preventive treatment does not decrease the incidence of IPN or mortality. Given the risks of bacterial resistance and fungal infections, antibiotics should be reserved for highly suspected or confirmed IPN; (2) The diagnosis of IPN does not always require microbiological samples, as clinical suspicion or computed tomography signs can suffice. Early diagnosis and treatment may be improved by using biomarkers such as procalcitonin and novel microbiological methods; (3) When indicated, early initiation of antibiotics is a key determinant in reducing mortality associated with IPN; (4) Antibiotics with good penetration into pancreatic tissue covering Gram-negative and Gram-positive bacteria should be used. Routine antifungal therapy is not recommended; (5) The step-up approach, including antibiotics, is the standard for IPN management; (6) Antibiotic duration should be kept to a minimum and should be based on the quality of source control and patient condition. Early antibiotic therapy is essential for the treatment of IPN, but prophylactic antibiotics are not recommended in AP. High-quality randomized controlled trials are required to better understand the role of antibiotics and antifungals in AP management.

Clinical characteristics of apical segment lung abscess: a 10-year retrospective study.

Lung abscess in the apical segment of the lung is not rare and is often underestimated in clinical practice. However, the clinical features of apical segment lung abscess (AL) have scarcely been reported. Hence, this study aimed to determine the clinical characteristics of AL and explore moderate therapeutic strategies. This was a retrospective, single-center cohort study. We reviewed the medical records of consecutive patients who were admitted to Shanghai Pulmonary Hospital in Shanghai, China, from January 2009 to December 2018. This study collected information on patients with lung abscess, including demographics, symptoms, clinical findings, and treatment. The statistical methods used were descriptive statistics, Chi-squared test, Fisher's exact test, t-tests, and logistic regression analysis. Of 824 patients, 431 with lung abscess were finally eligible after a review of medical records. The patients were divided into two groups: the AL group (n=68) and the non-apical segment lung abscess (NAL) group (n=363). Compared with patients in the NAL group, those in the AL group had lower rates of chronic obstructive pulmonary disease (COPD) (5.9% vs. 17.4%, P=0.02), diabetes (14.7% vs. 32.2%, P=0.004) and hypoprealbuminemia (10.3% vs. 25.3%, P=0.007). Regarding clinical symptoms, patients in the AL group exhibited lower fever (38.2% vs. 58.4%, P=0.002) and less purulent sputum (32.4% vs. 45.5%, P=0.045). Moreover, regarding radiological features, the AL group had a lower proportion of air-fluid level on chest computed tomography (CT) (7.4% vs. 16.8%, P=0.047). In addition, the study demonstrated that the AL group had a shorter duration of intravenous antibiotic treatment [8 (7-8) vs. 10 (8-12) days, P <0.001]. Surprisingly, the AL group had a high rate of surgical treatment (36.8% vs. 15.4%, P<0.001). In multivariate analysis, surgical treatment occurred more frequently in patients with AL [odds ratio (OR): 2.58, 95% confidence interval (CI): 1.40-4.77, P=0.002], lower in patients who had fever (OR: 0.55, 95% CI: 0.31-0.98, P=0.04), and imaging features of liquefaction necrosis (OR: 0.32, 95% CI: 0.15-0.69, P=0.004). Patients with AL presented with atypical and relatively mild clinical symptoms. However, the rate of surgical treatment was significantly higher. These data should be considered when managing the AL.

Surgical access route and choice of implant in the region of the clavicle shaft

Clavicle fractures are among the most frequent injuries of the shoulder girdle. Nondisplaced fractures are generally treated conservatively, whereas dislocated fractures require surgical reduction and stabilization. A variety of implants and surgical techniques with reliable results are available. While all techniques provide similar healing rates, they share acommon disadvantage with the high incidence of implant irritation and correspondingly high rates of second interventions for material removal. The various surgical techniques for clavicle shaft fractures with their specific areas of application as well as advantages and disadvantages are presented. This review also provides an aid for deciding which surgical technique is most appropriate based on the fracture morphology. Furthermore, an overview of current research activities is presented, with aspecific focus on new implants which could help to reduce implant irritation. Open superior and anteroinferior plate osteosyntheses each show similar reliable results. The minimally invasive plate osteosynthesis (MIPO) technique offers an alternative for multifragmented fractures as it has alower complication rate compared to the open procedure. Double plate osteosynthesis using minifragment plates shows promising results with respect to the incidence of implant-related irritation. Larger prospective studies are still pending. Intramedullary nailing offers agood alternative, especially if material removal is planned anyway, e.g., in the pediatric setting.

Diagnose Breast Cancer Using Two Machine Learning Methods andComparing and Analyzing Them

The breast cancer is currently the number one cancer in the world and has a high early treatment rate. Therefore, early screening and diagnosis of breast cancer is very important. Machine learning is very strong in analyzing and processing massive data. In this paper, we train and optimize decision tree and SVM models to identify malignant breast cancer and compare and analyze the performance of the two models. The accuracy of the earliest optimized models reaches about 98%, and it is found that the two models focus on different classification effects for the two samples, which can be further optimized by stacking and other ways. The dataset used to train the models in this paper is from the Wisconsin breast cancer database (WBCD), a benchmark dataset commonly used to compare different algorithms, which is of some significance for exploring the use of machine learning in the field of medical diagnosis.

Femoral Neck Fractures With Associated Ipsilateral Femoral Shaft Fractures in Young Adults

To analyze patients, injury patterns, and treatment of femoral neck fractures (FNFs) in young patients with FNFs associated with shaft fractures (assocFNFs) to improve clinical outcomes. The secondary goal was to compare this injury pattern to that of young patients with isolated FNFs (isolFNFs). Retrospective multicenter cohort series. Twenty-six North American level-1 trauma centers. Skeletally mature patients, <50 years old, treated with operative fixation of an FNF with or without an associated femoral shaft fracture. The main outcome measurement was treatment failure defined as nonunion, malunion, avascular necrosis, or subsequent major revision surgery. Odds ratios for these modes of treatment were also calculated. Eighty assocFNFs and 412 isolFNFs evaluated in this study were different in terms of patients, injury patterns, and treatment strategy. Patients with assocFNFs were younger (33.3 ± 8.6 vs. 37.5 ± 8.7 years old, P < 0.001), greater in mean body mass index [BMI] (29.7 vs. 26.6, P < 0.001), and more frequently displaced (95% vs. 73%, P < 0.001), "vertically oriented" Pauwels type 3, P < 0.001 (84% vs. 43%) than for isolFNFs, with all P values < 0.001. AssocFNFs were more commonly repaired with an open reduction (74% vs. 46%, P < 0.001) and fixed-angle implants (59% vs. 39%) (P < 0.001). Importantly, treatment failures were less common for assocFNFs compared with isolFNFs (20% vs. 49%, P < 0.001) with lower rates of failed fixation/nonunion and malunion (P < 0.001 and P = 0.002, respectively). Odds of treatment failure [odds ratio (OR) = 0.270, 95% confidence interval (CI), 0.15-0.48, P < 0.001], nonunion (OR = 0.240, 95% CI, 0.10-0.57, P < 0.001), and malunion (OR = 0.920, 95% CI, 0.01-0.68, P = 0.002) were also lower for assocFNFs. Excellent or good reduction was achieved in 84.2% of assocFNFs reductions and 77.1% in isolFNFs (P = 0.052). AssocFNFs treated with fixed-angle devices performed very well, with only 13.0% failing treatment compared with 51.9% in isolFNFs treated with fixed-angle constructs (P = <0.001) and 33.3% in assocFNFs treated with multiple cannulated screws (P = 0.034). This study also identified the so-called "shelf sign," a transverse ≥6-mm medial-caudal segment of the neck fracture (forming an acute angle with the vertical fracture line) in 54% of assocFNFs and only 9% of isolFNFs (P < 0.001). AssocFNFs with a shelf sign failed in only 5 of 41 (12%) cases. AssocFNFs in young patients are characterized by different patient factors, injury patterns, and treatments, than for isolFNFs, and have a relatively better prognosis despite the need for confounding treatment for the associated femoral shaft injury. Treatment failures among assocFNFs repaired with a fixed-angle device occurred at a lower rate compared with isolFNFs treated with any construct type and assocFNFs treated with multiple cannulated screws. The radiographic "shelf sign" was found as a positive prognostic sign in more than half of assocFNFs and predicted a high rate of successful treatment. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Clinical and Epidemiological Profile of Patients Presenting With Acute Abdomen to the Emergency Department of a Tertiary Care Hospital.

Acute abdomen is a common and urgent clinical condition requiring prompt diagnosis and treatment. This study determines the clinical and epidemiological profile of patients presenting with acute abdomen at a tertiary care hospital. To describe the demographic characteristics, provisional diagnoses, treatment modalities, and pain management effectiveness in patients with acute abdomen. This prospective observational study was conducted in the Emergency Medicine department at Dr. D. Y. Patil Medical College, Hospital & Research Center, Pimpri, Pune, over a specified period. The study included patients presenting with acute abdomen, aged above 14 years, excluding those with traumatic acute abdomen and pregnant patients. A sample size of 146 was calculated based on the proportion of ureteric colic cases, with a 95% confidence interval and a 6% margin of error; however, a total of 176 patients were included in the study. Data collection involved recording demographic details, clinical features, provisional diagnoses, and pain scores, as well as performing required blood investigations and ultrasonography. Pain scores were assessed before and after treatment. Patients will be given non-steroidal anti-inflammatory drugs(NSAIDs) or opioid analgesia, depending on the clinical severity. Emergency medicine residents, in consultation with the on-call consultant, determined the disposition of patients, deciding if they required surgical or conservative management. The study found that the majority of patients, n = 130 (73.86%), were aged 26-50 years, with cases n = 103 (58.52%) being males and cases n = 73 (41.48%) females. Acute appendicitis was the most common diagnosis, n = 41 (24.43%), followed by urolithiasis n = 33 (18.75%). Surgical interventions were required for n = 78 (45.08%) of patients, highlighting the urgent nature of these conditions. Pain management was effective, with significant reductions in pain scores post-treatment (mean visual analog score (VAS) decreased from 6.22 to 2.33, and mean numerical rating score (NRS) from 6.05 to 2.10; p < 0.001). The study underscores the high prevalence of gastrointestinal and renal conditions in patients with acute abdomen, particularly in middle-aged adults. The high rate of surgical interventions reflects the urgent nature of these conditions. Significant reductions in pain scores demonstrated effective pain management. Comprehensive care strategies are essential for optimizing patient outcomes. Future research with larger sample sizes and multi-center participation is recommended to validate these findings and enhance management protocols for acute abdomen.

Comprehensive assessment of male lower urinary tract symptoms at a tertiary care urology clinic: A prospective study

Introduction: Lower Urinary Tract Symptoms (LUTS) significantly impact men's quality of life, often due to benign prostatic occlusion. Therefore, the study aimed to assess the severity of LUTS associated with demographic and clinical factors. There is potential for tailored care and public health strategies to alleviate the burden of male LUTS (mLUTS).Methods: A one-year prospective cross-sectional study conducted at a urological clinic in a tertiary care centre, gathered data from male patients using self-reported questionnaires and investigator interviews on Lower Urinary Tract Symptoms and International Prostate Symptoms Score (IPSS). Statistical analysis, employing SPSS, utilized descriptive statistics and the Chi-square test, with significance set at P &lt; 0.05.Results: The total of 181 male patients participated in this study with mean age 66.65 years. The majority (80.7%) were over 60 , showing a mean IPSS score of 21.06 ± 7.8. BMI analysis revealed 58.6% normal and 41.4% overweight/obese, with distinct IPSS scores. Occupation significantly linked to LUTS severity (p=0.002), distinguishing employed and retired individuals. diabetes (p=0.047) and alcohol consumption (p=0.034) were significantly associated with LUTS severity. 44.2% had equally dominant voiding and storage symptoms, and 52.5% underwent surgical interventions, TURP being the most common (30.9%). Moderate and severe LUTS were associated with poor Quality of Life (p=0.0001)Conclusions: mLUTS associated with rising age (more mLUTS in &gt;60 years), obesity/ over weight, Diabetes and Alcohol consumption. Majority had moderated LUTS (IPSS) Study on individuals over 60 found occupation, diabetes, and alcohol consumption linked to severe Lower Urinary Tract Symptoms (LUTS). Coexistence of voiding and storage symptoms underscored complexity. High rates of medical interventions, notably Transurethral Resection of the Prostate, emphasized clinical impact and management challenges in this demographic.

Medication for Opioid Use Disorder After Serious Injection-Related Infections in Massachusetts

Serious injection-related infections (SIRIs) cause significant morbidity and mortality. Medication for opioid use disorder (MOUD) improves outcomes but is underused. Understanding MOUD treatment after SIRIs could inform interventions to close this gap. To examine rehospitalization, death rates, and MOUD receipt for individuals with SIRIs and to assess characteristics associated with MOUD receipt. This retrospective cohort study used the Massachusetts Public Health Data Warehouse, which included all individuals with a claim in the All-Payer Claims Database and is linked to individual-level data from multiple government agencies, to assess individuals aged 18 to 64 years with opioid use disorder and hospitalization for endocarditis, osteomyelitis, epidural abscess, septic arthritis, or bloodstream infection (ie, SIRI) between July 1, 2014, and December 31, 2019. Data analysis was performed from November 2021 to May 2023. Demographic and clinical factors potentially associated with posthospitalization MOUD receipt. The main outcome was MOUD receipt measured weekly in the 12 months after hospitalization. We used zero-inflated negative binomial regression to examine characteristics associated with any MOUD receipt and rates of treatment in the 12 months after hospitalization. Secondary outcomes were receipt of any buprenorphine formulation, methadone, and extended-release naltrexone examined individually. Among 8769 individuals (mean [SD] age, 43.2 [12.0] years; 5066 [57.8%] male) who survived a SIRI hospitalization, 4305 (49.1%) received MOUD, 5919 (67.5%) were rehospitalized, and 973 (11.1%) died within 12 months. Of those treated with MOUD in the 12 months after hospitalization, the mean (SD) number of MOUD initiations during follow-up was 3.0 (1.7), with 956 of 4305 individuals (22.2%) receiving treatment at least 80% of the time. MOUD treatment after SIRI hospitalization was significantly associated with MOUD in the prior 6 months (buprenorphine: adjusted odds ratio [AOR], 16.51; 95% CI, 13.81-19.74; methadone: AOR, 28.46; 95% CI, 22.41-36.14; or naltrexone: AOR, 2.05; 95% CI, 1.56-2.69). Prior buprenorphine (incident rate ratio [IRR], 1.17; 95% CI, 1.11-1.24) or methadone (IRR, 1.89; 95% CI, 1.79-2.01) use was associated with higher treatment rates after hospitalization, and prior naltrexone use (IRR, 0.86; 95% CI, 0.77-0.95) was associated with lower rates. This study found that in the year after a SIRI hospitalization in Massachusetts, mortality and rehospitalization were common, and only half of patients received MOUD. Treatment with MOUD before a SIRI was associated with posthospitalization MOUD initiation and time receiving MOUD. Efforts are needed to initiate MOUD treatment during SIRI hospitalizations and subsequently retain patients in treatment.

May Measurement Month 2021: an analysis of blood pressure screening results from Paraguay.

The aim of this study was to highlight the importance of measuring blood pressure (BP) to identify new, known, and treated individuals with hypertension and to raise awareness in the general population about the importance of good BP control. In Paraguay, 3663 individuals aged ≥18 years of both sexes were recruited from May to November 2021 as part of the May Measurement Month (MMM) campaign, which was initiated by the International Society of Hypertension in 2017. Volunteers of 18 regional health teams applied the questionnaire provided by the MMM 2021 organization throughout the country. Due to COVID-19 constraints, the majority of the questionnaires (52.2%) were administered in health centres of the Ministry of Health and concluded with three BP and pulse readings using OMRON-automated BP measurement devices. Hypertension was defined as a systolic BP ≥ 140 mmHg or as a diastolic BP ≥ 90 mmHg or taking antihypertensive medication. We found that 57.4% of screenees were hypertensive and 72.9% of these (82.3% of women and 59.4% of men) had known hypertension. Of patients with hypertension, 70.1% were on antihypertensive medication, and 40.9% had controlled BP (<140/90 mmHg). Among hypertensives detected, 79.7% of women were on antihypertensive medication and 44.1% had controlled BP, while 56.4% of men were on treatment and 34.3% had controlled BP. In summary, we found high levels of hypertension with high rates of awareness and treatment particularly among women, although control rates were low particularly among men. This may be because most screening was conducted predominately in hospital settings.