High Percentage Of Patients Research Articles

A cross-Sectional Study of Psoriatic Arthritis in One Center in Baghdad

Abstract Background: Psoriatic arthritis is a chronic inflammatory illness. Nearly, 15% of psoriasis patients have undiagnosed psoriatic arthritis. Objective: The aim of this study was to investigate the prevalence of psoriatic arthritis and different clinical–epidemiological characteristics of the disease of patients. Materials and Methods: This cross-sectional study included psoriatic patients who attended Baghdad Teaching Hospital. Clinical examination, laboratory investigations including rheumatoid factor analysis and radiological examination of axial and peripheral skeleton were done. The prevalence of PsA, age, sex, clinical variants of PsA, and psoriasis type were assessed. Results: The prevalence of psoriatic arthritis was 0.02% during the period of study, mean age of participants was 44 ± 33. Obesity and overweight were reported by 34.75%, smoking by 24.58% with significant association with gender, also 28.81% with family history more in females. Regarding comorbidity, 33.9% of patients were suffering from metabolic syndrome, 23.72% with dyslipidemia, 22.88% with hypertension, and 17.8% with diabetes. Higher percentages (65.31%) of polyarthritis had family history followed by oligoarthritis (24.45%) and distal interphalangeal (10.20%). However, the association between types of arthritis was found to be statistically nonsignificant. Regarding the distribution of study sample according to the types of treatment, higher percentage of patients (72.88%) were on methotrexate (MTX) followed by NSAIDs (64.4%), while the lower percentage (4.7%) for Golimumab. Conclusions: A high percentage of comorbidities such as metabolic syndrome, diabetes mellitus, hypertension, dyslipidemia, and obesity were observed. Psoriasis vulgaris was the most common type of skin lesion associated with axial involvement. Family history was associated with oligoarthritis more than other types. The first choice of treatment was MTX.

Perlemakan Hati Non-Alkoholik dan Risiko Fibrosis Hati pada Pasien Hepatitis B Kronik

Introduction. Prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing throughout the world due to sedentary lifestyle and dietary habit, including in patients with chronic hepatitis B (CHB). In several studies, advanced of liver disease were more likely observed among those CHB patients with NAFLD. NAFLD might increase the risk of liver disease progression in CHB patients, but prior investigations were still limited. This study aimed to determine the association between NAFLD and risk of liver fibrosis in CHB patients. Methods. All patients with positive serum hepatitis B surface antigen in the Hepatobilier Data Registry, Cipto Mangunkusumo Hospital, were included in this study. Based on abdominal ultrasonography, patients were divided into two group (group I: non-NAFLD – hepatitis B patients vs. group II: NAFLD – hepatitis B patients). Data demographic and clinical examination were collected. Significant liver fibrosis was defined as stage liver fibrosis above 7 kPa (≥ F2). Logistic regression was used to identify NAFLD as risk factor for significant fibrosis. Variables were expressed as prevalence odd ratio (POR) with 95% CI. P values <0.05 were considered statistically significant. Results. Among 130 hepatitis B patients, 45 patients (34.6%) were diagnosed with NAFLD. Of 45 patients in group II, 36 patients (80%) had significant liver fibrosis. It was observed that a higher percentage of patients in group II were HBeAg negative compared to those in group I (66.7% vs. 35.9%; p=0.038). Furthermore, group II also displayed higher levels of liver stiffness compared to group I (12.22 (8.6 kPa) vs. 8.57 (7.8 kPa); p 0.016). In multivariate analysis, NAFLD was significantly associated with significant liver fibrosis (POR: 5.87; CI95%: 2.48 – 13.86; p < 0.001) after adjusted with HBeAg status. Conclusion. NAFLD associated with the higher risk of liver fibrosis in patients with hepatitis B. Modification of lifestyle and potential therapeutic intervention may help in reducing the progression of liver fibrosis.

Depression, anxiety, and quality of life in patients with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a multisystem disorder that can affect multiple organs; psychiatric manifestations including depression and anxiety are commonly seen in SLE. The aim of this study is to explore the prevalence of depression, anxiety, and stress, and assess the quality of life (QOL) in patients with SLE and also evaluate associated risk factors. In this cross-sectional study, adult patients with SLE were identified through our institution's SLE data registry. Participants were evaluated with three questionnaires: Depression, Anxiety, and Stress Scale (DASS-42), General Health Ouestionnaire-28 (GHQ-28), and World Health Organization quality of life instrument short form (WHO-QOL BREF). A total of 222 patients were included in the study, 203 (91%) of whom were female and 19 were male (9%). Participants had a mean age of 35.6 ±9.5 years. According to DASS-42 questionnaire, 22.1%, 28.7% and 20.3% of patients had varying degrees of depression, anxiety, and stress, respectively. Based on GHQ-28 questionnaire, 137 (62%) of patients reported some degree of distress. Quality of life score was 12.8, 13, 14.3, and 13.9 in physical health, psychological health, social relationships, and environmental health, respectively. We found that depression, anxiety, and stress are common in patients with SLE, and quality of life is significantly affected. A high percentage of patients with SLE deal with some degree of distress. Routine evaluation of the quality of life and psychological disturbances is recommended in patients with SLE. Non-pharmacological interventions as well as specialist referral should be considered in patients with anxiety, depression, or stress.

Droxidopa or Atomoxetine for Refractory Hypotension in Critically Ill Cardiothoracic Surgery Patients

To evaluate the effects of droxidopa or atomoxetine on intravenous (IV) vasoactive agent discontinuation in cardiothoracic intensive care unit (ICU) patients with hypotension refractory to midodrine. Single-center, retrospective cohort study. Tertiary- and quaternary-care university teaching hospital. Included patients who received at least 4 consecutive doses of droxidopa or atomoxetine and remained on concurrent midodrine. Patients were excluded if they received study medication before admission, had clinical deterioration after study medication initiation requiring additional vasoactives/escalation of IV vasoactive dosage for at least 12 hours, had a diagnosis of hepatorenal syndrome, were prisoners, or were pregnant. Droxidopa, atomoxetine, or both. The primary endpoint was time to discontinuation of IV vasoactive agents after initiation of study medication, analyzed usinga Kaplan-Meierestimate with the Wilcoxon method, censoring death within 24 hours of the last dose of study medication. Noadjustment for repetitive analyses wasmade, as the analysis was hypothesis-generating. Of the 72 charts reviewed, 45 patients met inclusion criteria (18 atomoxetine, 17 droxidopa, and 10 both). There were no differences in median time to discontinuation of IV vasoactive agents (21.9 days v 8.0 days v 13.9 days, respectively; p=0.259) or ICU or hospital length of stay between groups. A higher percentage of patients who survived to hospital discharge received both study medications or droxidopa alone (90% v 76.5%) than atomoxetine alone (44.4%, p=0.028). Droxidopa and atomoxetine are oral vasoactive agents with potential mechanisms to facilitate IV vasopressor weaning for patients in the ICU with hypotension refractory to midodrine, but further prospective research is needed.

Risk factors of peripheral venous catheter-related complication and infection in children with bronchopneumonia

ObjectiveTo investigate the risk factors associated with the peripheral venous catheter-related complication and infection in children with bronchopneumonia.MethodsA total of 185 patients were divided into case group (n = 114) and control group (n = 71) according to the presence of catheter-related infection and complications related to indwelling needle. We performed a multivariate logistic regression analysis to explore the risk factors associated with the infection.ResultsAge was divided into 4 categories (0 < age ≤ 1, 1 < age ≤ 3, 3 < age ≤ 6, age > 6). The case group had a higher percentage of patients with 0 < age ≤ 1 than the control group (21% vs. 9.7%) and the age distribution was significant different between the two groups (P = 0.045). The case group had a longer retention time than the control group (≥ 3 days: 56% vs. 35%, P < 0.001). The results of binary logistics regression analysis revealed that the indwelling time and indwelling site were the factors that influenced the complications or bacterial infection. Among the three indwelling sites, the hand is more prone to infection and indwelling needle-related complications than the head (OR: 2.541, 95% CI 1.032 to 6.254, P = 0.042). The longer the indwelling time, the more likely the infection and indwelling needle related complications (OR: 2.646, 95% CI 1.759 to 3.979, P< 0.001).ConclusionIndwelling time and indwelling site are the influencing factors of complications or bacterial infection, which should be paid more attention to prevent the catheter-related infection in children with bronchophenumonia.

Liver Involvement during SARS-CoV-2 Infection Is Associated with a Worse Respiratory Outcome in COVID-19 Patients.

Coronavirus disease of 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may be complicated by life-threatening interstitial pneumonia. SARS-CoV-2 infection may also damage several tissues and/or organs beyond the lungs, including the liver. However, controversy still exists as to whether SARS-CoV-2-induced liver alterations can have an impact on the outcome of COVID-19. The aim of this study was therefore to assess whether SARS-CoV-2-infected patients with liver abnormalities at the time of hospital referral had a worse outcome with respect to patients with no liver biochemistry alterations. To this end, the medical records of 123 patients admitted to our COVID center between the end of 2020 and spring 2021 were retrospectively reviewed. Patients were divided into two groups: those with normal liver biochemistries (group 1, 77 patients) and those with altered liver function tests (group 2, 46 patients). Serum levels of aminotransferases (AST and ALT) and bile duct cell injury markers (γ-GT and ALP) were used to dichotomize patients. A higher percentage of patients with liver enzyme alterations were found to develop COVID-19 pneumonia with respect to group 1 patients (74% vs. 65%); moreover, they needed more days of respiratory support and, more importantly, more intensive administration of supplemental oxygen. A statistically significant correlation was also found between aminotransferase levels and duration of respiratory support. The mortality rate was not superior in group 2 vs. group 1 patients. In conclusion, liver abnormalities on admission predisposed COVID-19 patients to development of more severe interstitial pneumonia, because of a longer requirement for supplemental oxygen and a more intensive respiratory support, indicative of a worse disease evolution in these patients.

Clinical characteristics and cytokine profiles of adult obese asthma with type2 inflammation

Obesity-related non-eosinophilic asthma has been identified as a phenotype of asthma. However, mepolizumab and omalizumab improve asthma control in severe asthma with obesity, implying that type-2 cytokines may be involved in the deterioration of control in obese asthma. Despite this, the clinical details of obese asthma with positive type-2 inflammation markers have not yet been reported. The objective of this study was to investigate the clinical characteristics of patients with obese asthma with positive type-2 inflammation markers. Adult obese asthmatic patients were enrolled and were classified into two groups: obese asthma with positive type-2 inflammation markers (T2) and obese asthma with negative type-2 inflammation markers (NT2), then data were compared. In total, 434 patients were enrolled (85% of patients were at GINA therapy step 4–5). The T2 group had a higher proportion of patients with persistent asthma since childhood and with allergic rhinitis. A higher percentage of patients used high-dose inhaled corticosteroids (ICS) and experienced acute exacerbations (annual exacerbation ratio ≥ 1) in the T2 group. Multivariate logistic regression analysis showed that the T2 group was independently associated with younger age, comorbidity of allergic rhinitis, persistent asthma since childhood, use of high-dose ICS, and acute exacerbation rate ≥ 1. Adipocytokine levels were similar between the groups. Collectively, obese asthma with positive type-2 inflammation markers is characterised by a higher percentage of persistent asthma since childhood and more severe asthma.

Glucocentric and cardiocentric approaches to achieving type 2 diabetes compensation

Background. Monotherapy for type 2 diabetes (T2DM) has been found to be effective only for a limited time. At the same time, the rationality of drug combinations remains an important component of successful management of T2DM. In this context, given the complex multifactorial pathogenesis of T2DM, it is optimal to influence various mechanisms of hyperglycemia. The purpose of the study is to determine the effectiveness and safety of additional administration of a combination of metformin and glimepiride in patients with type 2 diabetes with a glycated hemoglobin (HbA1c) level of 8.5–9.5 % who took dapagliflozin alone for at least three months. Materials and methods. Fourteen men (mean age 57.9 ± 8.4 years) and 18 women (mean age 58.2 ± 9.3 years) with T2DM were included in the study. The average duration of T2DM was 9.7 ± 4.2 years. The patients were in a state of decompensation of T2DM (HbA1c over 8.5 %) against the background of dapagliflozin monotherapy in the maximum dose for at least three previous months. In addition to dapagliflozin (10 mg/day), patients were prescribed a combination of metformin and glimepi­ride (Duglimax tablets, 500 mg/2 mg once a day) for three months. Results. The average level of HbA1c in 32 patients with T2DM was 9.72 ± 0.81 %, fasting plasma glucose was 10.71 ± 1.42 mmol/l. Three months after the start of a combined treatment, the HbA1c level decreased significantly to 7.54 ± 0.46 % (p &lt; 0.05). The average reduction in HbA1c after switching to additional metformin therapy with glimepiride was 1.48 ± 0.38 %. The proportion of patients who achieved HbA1c &lt; 7.5 % was 34.5 % after 3 months (p &lt; 0.05). The effectiveness of the additional administration of metformin and glimepiride is also confirmed by the high percentage of patients (12.5 %) who achieved HbA1c &lt; 7.0 % (p &lt; 0.05). The level of fas­ting plasma glucose decreased to an average of 7.19 ± 1.06 mmol/l after 3 months. The average decrease reached 3.06 ± 1.08 mmol/l, which in relative terms was 31.4 ± 8.7 % of baseline. No cases of hypoglycemia or other adverse events were registered during the entire study period. Conclusion. The analysis of indicators in 32 patients with type 2 diabetes who had a high level of HbA1c (over 9 %) against the background of dapagliflozin monotherapy allowed us to conclude that it is necessary to intensify the therapy by additionally prescribing a combination of metformin and glimepiride for achieving the target levels of HbA1c. Glucocentric and cardiocentric views on T2DM can be reconciled and integrated by using a combination therapy to address the different etiopathological features of the disease from the very beginning of treatment.

Health centres and social determinants of health: an analysis of enabling services provision and clinical quality

ObjectiveIt is well known that social determinants of health (SDOH), including poverty, education, transportation and housing, are important predictors of health outcomes. Health Resources and Services Administration (HRSA)-funded health centres...

A Comprehensive Study of the CA-72.4 Tumor Marker Utilization and Cancer Detection: Analysis Based on Ministry of Health Data

Background: This study aims to explore the relevance and utilization of the CA 72.4 tumor marker in cancer diagnosis, with a particular focus on gastrointestinal tumors and ovarian cancer, based on data from the Minis-try of Health. Materials and Methods: We conducted a retrospective analysis of health records from the Ministry of Health spanning over five years. The data, consisting of various demographics, including gender, age, and clinical service requests, was statistically analyzed. The rates of reference range exceedance for the CA 72.4 tumor marker, diagnosis times, the ratio of cancer diagnosis, and the cost distribution were among the key aspects evaluated. Results: The analysis revealed a significant increase in the request for CA 72.4 tests over the years. It was also observed that cancer detection rates slightly increased over time, with a higher percentage in patients testing positive for CA 72.4, primarily requested before diagnosis. The highest requests for the test were made by the Medical Oncology clinic. Furthermore, it was observed that gender and age groups played significant roles in the prevalence of cancer diagnoses. Conclusions: Our study indicates that the use of CA 72.4 as a tumor marker could be valuable, especially in the detection of certain types of cancer. However, the correlation between a positive CA 72.4 test and a definitive cancer diagnosis requires further investigation, as the sensitivity and specificity of this marker are still subjects of debate. Despite certain limitations, this study offers substantial insights into the utility of CA 72.4 in the current healthcare setting.

Microbial isolates and antibiotic sensitivity in patients hospitalized with odontogenic infections at a tertiary center over 10 years.

This study investigated causative strains and their antibiotic sensitivity in patients who were hospitalized for maxillofacial odontogenic infections at a tertiary center in South Korea over the past 10 years with the aim of providing guidelines for the selection of appropriate empirical antibiotics. Patients with head and neck fascial space abscesses due to odontogenic infections who underwent incision and drainage surgery with pus culture tests between 2013 and 2022 at the Department of Oral and Maxillofacial Surgery, Dankook University Hospital were included. The bacterial isolates and antibiotic sensitivity of each strain were analyzed for 2013-2022, 2013-2017, and 2018-2022. The affected fascial spaces were classified into primary, secondary, and deep neck spaces. In the 192 patients included in this study, 302 strains were detected. Viridans streptococcus had the highest frequency (51.7%), followed by Prevotella spp. (16.9%), Staphylococcus spp. (5.6%), and Klebsiella pneumoniae (4.6%). The identification rate of viridans streptococcus significantly increased from 41.8% in 2013-2017 to 60.9% in 2018-2022. Viridans streptococcus showed an antibiotic sensitivity of 80.5% to ampicillin; the sensitivity to penicillin antibiotics decreased over the study period. Antibiotic susceptibility was approximately 94% for third-generation cephalosporins. K. pneumoniae, which was identified at a high percentage in patients with deep neck space infection, showed increasing antibiotic resistance to most antibiotics over the study period. Viridans streptococcus was identified in head and neck fascial space abscesses with the highest frequency. Empirical antibiotics should be effective against this strain; penicillin antibiotics are considered inappropriate. For effective treatment of deep neck space abscesses, bacterial culture and antibiotic sensitivity tests performed as soon as possible are essential.

Machine learning identifies experimental brain metastasis subtypes based on their influence on neural circuits

A high percentage of patients with brain metastases frequently develop neurocognitive symptoms; however, understanding how brain metastasis co-opts the function of neuronal circuits beyond a tumor mass effect remains unknown. We report a comprehensive multidimensional modeling of brain functional analyses in the context of brain metastasis. By testing different preclinical models of brain metastasis from various primary sources and oncogenic profiles, we dissociated the heterogeneous impact on local field potential oscillatory activity from cortical and hippocampal areas that we detected from the homogeneous inter-model tumor size or glial response. In contrast, we report a potential underlying molecular program responsible for impairing neuronal crosstalk by scoring the transcriptomic and mutational profiles in a model-specific manner. Additionally, measurement of various brain activity readouts matched with machine learning strategies confirmed model-specific alterations that could help predict the presence and subtype of metastasis.

Left ventricular systolic function and initial exercise capacity—their importance for results of cardiac rehabilitation after acute coronary syndrome

Aim: The aim of this study was to compare initial and final exercise tolerance and to evaluate the determinants of exercise capacity improvement—after three weeks of inpatient cardiac rehabilitation. Methods: A cohort of 494 patients after acute coronary syndrome (ACS), treated with primary coronary angioplasty (age 60 years ± 10 years, 27.5% women) was studied retrospectively. Possible correlations between improvement and age, gender, body mass index (BMI), left ventricular ejection fraction (LVEF) and the initial exercise capacity (EXT1) were assessed. Results: The highest percentage of patients with improvement (43.6%) was in the medium tercile of LVEF (&gt; 42% but ≤ 50%) and was more likely in the medium tercile of initial exercise tolerance [&gt; 5.7 but ≤ 8.4 metabolic equivalent of tasks (METs)]. Receiver-operator characteristic (ROC) curves were developed and the following cut-off values were found: for LVEF &gt; 43% (this value had 69.6% sensitivity in predicting improvement; the chance of improvement was 2.67 higher than in patients with LVEF ≤ 43%); for EXT1 ≤ 8.4 METs (this value had 70.8% sensitivity, the chance of improvement was 1.86 higher than in the other subgroup). No significant relationship between improvement and gender, age or BMI was found. Conclusions: The combination of LVEF &gt; 43% and EXT1 ≤ 8.4 METs relates to the highest probability of exercise tolerance improvement after cardiac rehabilitation.

492. TYPES AND INCIDENCE OF POSTOPERATIVE ANEMIA AFTER ONCOLOGICAL ESOPHAGECTOMY AND GASTRECTOMY

Abstract According to current literature, anemias that develop after oncological esophageal and gastric resections are classified as deficiency anemias. Due to the surgery-related changes in the mechanical and biochemical conditions of the upper gastrointestinal tract, there is an alteration in the processing and absorption of hematopoietic-relevant vitamins and trace elements like iron, vitamin B6, vitamin B12, folic acid, copper and essential amino acids in the postoperative phase. Between January 2015 and December 2019, 232 patients underwent a (sub)total gastrectomy or esophagectomy at our center. In this monocentric retrospective analysis of prospectively collected follow-up data, 157 patients were included after applying the exclusion criteria: Age below 18, primary bone marrow disease, hereditary forms of anemia, postoperative tumor recurrence and R1/R2 situation. 103 patients (=66%) belonged to the esophagectomy group and 54 patients (=34%) to the (sub)total gastrectomy group. Preoperatively and three, six, twelve, 18, and 24 months postoperatively the following laboratory parameters were collected and descriptively analyzed: Hemoglobin, MCV, MCH, serum iron, ferritin, transferrin, and vitamin B12. Two years after the oncological resection 28% of patients with esophagectomy, EE, and 48% of patients with (sub)total gastric resection, (S)GE, show anemia. Normocytic anemia was the dominant type. The MCV distribution of anemic patients in the EE group was as follows: 3% microcytic, 77% normocytic, and 20% macrocytic. The anemic patients in the (S)GE group show the following MCV distribution: 16% microcytic, 81% normocytic, and 3% macrocytic. The (S)GE collective has more anemic patients in percentage terms than the EE collective throughout the whole follow-up period. This difference is significant at the 12th (p = 0.032) and 18th-month (p = 0.023) postoperative follow-up. A high percentage of patients with oncological resection of the upper gastrointestinal tract have a relevant postoperative anemia. The known postoperative iron and vitamin deficiencies, that would be associated with microcytic hypochromic and macrocytic hyperchromic anemia, are not the relevant causes for this anemia as it is predominantly a normocytic form. Normocytic anemia is an indication for an anemia of chronic disease. The reason for the predominance of normocytic anemia is not specifically known.

Study on clinical presentation of malaria and response to antimalarial treatment in children less than twelve years

Background: In the tropical country of India, malaria in pediatric age group is one of the most important cause of mortality and morbidity. The study aimed to identify the clinicoepidemiologic features and response to antimalarial treatment in the children. Methods: Prospective analytical study conducted for the same over the period of two years in tertiary care hospital (September 2019 to September 2021). All children under twelve years hospitalised with fever and were diagnosed to have malaria by Peripheral smear or RDT were included in the study after ethical clearance and parental consent. Total sample size was 90. Results: Incidence of the malarial disease among total admitted patients in our study period was found to be 3.5%. The highest percentage of patients with malaria belonged to age group of 13m to 5 years (40%) and least being the age group 10-12years (7.7%). In study fever was found to be the major chief complaint followed by chills and rigor. Bleeding diathesis was least common It was found out from our study that overall most common clinical finding in the study patients was anemia or pallor with an overall of 35 patients (38.8%). Almost 73.3% (66) patients had anemia out of which 14.4% (13 patients) overall where found to have severe anemia and 27.7% (25) had moderate anemia and 31.1% (28 patients) had mild anemia. 27.7% (25) cases satisfied one or more WHO criteria for severe malaria. Conclusions: The emergence of severe malaria caused by P. vivax could have significant implications in planning the malaria-control programmes for the community. The widespread use of ACT for severe malaria as per the guidelines of the WHO could result in the emergence of resistant parasite strains. It may be rational to continue the use of chloroquine for malaria due to P. vivax in chloroquine-sensitive areas. In places where both P. vivax and P. falciparum co-exist, measures need to be equally targeted to P. vivax to decrease morbidity and mortality due to severe malaria.

ThTP3.6 Patient-Reported Experience Measures: the impact of In-Person Surveys

Abstract Aims This study aimed to identify the impact of actively administering a survey to aid patients in completing patient-reported experience measure (PREM) surveys. We aimed to compare key domains' results to the national UK kidney PREM 2021 report and determine whether there is a difference between surveys administered by an in-person volunteer and self-administered surveys. Methods Our volunteers visited hospital renal and satellite dialysis units weekly from Aug to Oct 2022. All haemodialysis patients were offered to complete a 38-item survey covering 14 domains on their renal care experience using a 1-7 rating scale, 1 being the lowest rating and 7 the highest. We then compiled and compared our results to the 2021 report. Results 49 out of 82 patients completed the PREM survey. The completion rate increased from the previous year in hospital dialysis and satellite units. The patients’ experience domain score was lower than the 2021 report, with an average score of 5.66 compared to 6.24. A higher percentage of patients in our study (36.7%) reported never being asked about their emotions compared to 14.4% in 2021. This has led to a new referral pathway for seeking emotional counselling. Conclusions This year’s survey identified a felt need for emotional support and creation of a new referral pathway for the same. Administering surveys in person through volunteers increases patient engagement and receptiveness to engage, especially for patient groups that may have barriers such as language, disabilities and lack of access to technology.

Wilson's Disease: A Prevalence Study in a Portuguese Population.

Introduction Wilson's disease (WD) is a rare and underdiagnosed genetic disorder caused by anomalous tissue copper deposition, and for which epidemiological studies, specifically in Portugal, are scarce. Objectives This study aimed to evaluate the prevalence and incidence of WD and provide a description of its main clinical and laboratory features. Methods A retrospective study was carried out, with a search between 1995 and 2015, of all patients with a minimum follow-up of three months and birth confirmed in the northern region of Portugal, with an estimated population of 3,689,682 inhabitants. Database collection was based on the Portuguese National Health Service's clinical coding system, relying on clinical data from 13 northern Portuguese hospitals, liver biopsy histology results, and hospital prescription records. Clinical and biochemical correlations were statistically assessed using chi-square, Mann-Whitney U, Friedman, and Wilcoxon tests. Results Over the 20-year period, a prevalence of 1:37.000 and an incidence of one per million person-year was found. A total of 94 patients were analyzed, with a slight male predominance (53%), the majority with the onset of clinical manifestations in pediatric age (56%), with a median age at diagnosis of 16.6 years (interquartile range of 12.3-20,.8 years). Most patients presented with predominant liver disease (54.8%), with more than a third with cirrhosis; mixed hepatic and neurological manifestations in 17.9%; and mainly neurological symptoms in 10.7% of the patients. Neurological impairment was strongly associated with delayed development of the manifestations of the disease (p = 0.001) and also a higher detection of Kayser-Fleischer rings (p < 0.001), present in 27.0% of the patients. Regarding therapy, penicillamine has been the most widely used, with adverse reactions reported in 24.8%. At six and 12 months after initiation of therapy, a significant decrease in liver enzymes was found (ALT: p = 0.002; AST: p = 0.002, respectively), but no significant reduction was observed in urinary copper excretion. Conclusion This was one of the first studies regarding WD prevalence in a Portuguese population, contributing to a better understanding of the epidemiology, diagnosis, and management of WD in the northern region of Portugal. WD should be considered in any individual with unexplained hepatic or neurological manifestations, and initial symptoms may manifest at an early age, even in children less than five years old.A high percentage of patients were identified in the early stages of the disease by asymptomatic elevation of transaminases. Following copper chelation therapy, cytolysis markers appear to be more sensitive indicators of treatment response.

The contraceptive choice at the time of a surgical and pharmacological abortion: a possible and effective option thanks to a dedicate counselling

The percentage of repeat abortion in Italy is about 25%. It is therefore important to implement the strategies that can facilitate the adoption of the most effective contraceptive methods. Long-acting reversible contraceptive methods are currently considered the most effective and with the highest rates of 12-months continuation, with a reported reduction of recurrent abortion. Our study has the aim to evaluate the contraceptive choice of women requesting abortion, when an accurate and dedicate counselling is offered and the availability of a LARC method is given immediately after pregnancy termination, both in case of surgical and medical abortion. LARC methods were chosen both in case of surgical and medical abortion, by an high percentage of patients. We reported no differences between the surgical and pharmacological groups on the choice of LARC and SARC. Our observational study shows the feasibility to perform an accurate, dedicate, and personalised counselling on contraception at time of abortion. This approach has enabled a high number of women to have a LARC method inserted at the time of abortion, as a valid strategy to prevent the risk unplanned pregnancy.

Chronic thoracic pain after cardiac surgery: role of inflammation and biomechanical sternal stability.

The pathogenesis of chronic chest pain after cardiac surgery has not been determinate. If left untreated, postoperative sternal pain reduces the quality of life and patient satisfaction with cardiac surgery. The purpose of the study was to examine the effect of chest inflammation on postoperative pain, risk factors for chronic pain after cardiac surgery and to explore how chest reconstruction was associated with the intensity of pain. The authors performed a study of acute and chronic thoracic pain after cardiac surgery in patients with and without sternal infection and compared different techniques for chest reconstruction. 42 high-risk patients for the development of mediastinitis were included. Patients with mediastinitis received chest reconstruction (group 1). Their demographics and risk factors were matched with no-infection patients with chest reconstruction (group 2) and subjects who underwent conventional sternal closure (group 3). Chronic pain was assessed by the numeric rating scale after surgery. The assessment of the incidence and intensity of chest pain at 3 months post-surgery demonstrated that 14 out of 42 patients across all groups still experienced chronic pain. Specifically, in group 1 with sternal infection five patients had mild pain, while one patient experienced mild pain in group 2, and eight patients in group 3. Also, follow-up results indicated that the highest pain score was in group 3. While baseline levels of cytokines were increased among patients with sternal infection, at discharge only the level of interleukin 6 remained high compared to no infection groups. Compared to conventional closure, after chest reconstruction, we found better healing scores at 3-month follow-up and a higher percentage of patients with the complete sternal union. Overall, 14 out of 42 patients have chronic pain after cardiac surgery. The intensity of the pain in mediastinitis patients significantly decreased at 3 months follow-up after chest reconstruction. Thus, post-surgery mediastinitis is not a determining factor for development the chronic chest pain. There is no correlation between cytokines levels and pain score except interleukin 6 which remains elevated for a long time after treatment. Correlation between sternal healing score and chronic chest pain was demonstrated.

What is the ideal timing of cholecystectomy after percutaneous cholecystostomy for acute cholecystitis?

Acute cholecystitis (AC) is one of the most prevalent diseases in clinical practice. Poor surgical candidates may benefit from early percutaneous cholecystostomy (PC) drainage followed by interval cholecystectomy (IC), which is the definitive treatment. The optimal timing between the PC drainage and the IC has not been identified. This study aimed to investigate how the duration between PC and IC affects perioperative outcomes and identify the optimal IC timing to minimize complications. This retrospective cohort study included all adult patients diagnosed with AC who underwent PC followed by IC at a single institution center between 2014 and 2022. Patients with a history of hepatobiliary surgery, stones in the common bile duct, cirrhosis, active malignancy, or prolonged immunosuppression were excluded. The analysis did not include cases with major concurrent procedures during cholecystectomy, previously aborted cholecystectomies, or failure of the PC drain to control the inflammation. Linear and logistic regression models were used to analyze the impact of the interval between PC and IC on intra- and perioperative outcomes. One hundred thirty-two patients (62.1% male) with a mean age of 64.4 ± 15 (mean ± SD) years were diagnosed with AC (25% mild, 47.7% moderate, 27.3% severe). All patients underwent PC followed by IC after a median of 64 [48-91] days. Longer ICU stay was associated with longer time intervals between PC and IC (Coef 105.98, p < 0.001). No significant variations were detected in the intraoperative and perioperative outcomes between patients undergoing IC within versus after 8weeks from PC placement. However, a higher percentage of patients with delayed IC (after 8weeks) were discharged home (96.4% vs. 83.7%; p = 0.019). Patients may benefit from undergoing IC after the 8-week cutoff after PC. However, very long periods between PC and IC procedures may increase the risk of longer ICU stay.