Retrospective Study Research Articles

Identifying optimal serum 1,3-β-D-Glucan cut-off for diagnosing Pneumocystis Jirovecii Pneumonia in non-HIV patients in the intensive care unit

BackgroundSerum (1,3)-β-D-glucan (BDG) detection for diagnosis of Pneumocystis jirovecii pneumonia (PJP) in non-human immunodeficiency virus (HIV) immunocompromised patients lacks intensive care unit (ICU)-specific data. We aimed to assess its performance and determine the optimal cutoff for PJP in ICU population.MethodsThis retrospective study included critically ill non-HIV immunocompromised patients admitted to a medical ICU with suspected pneumonia, undergoing simultaneous microbiological testing for P. jirovecii on lower respiratory tract specimens and serum BDG. Confounders affecting BDG positivity were explored by multivariable logistic regression. Optimal cut-offs were derived from Youden’s index for the entire cohort and subgroups stratified by confounders. Diagnostic performance of serum BDG was estimated at different cutoffs.ResultsOf 400 patients included, 42% were diagnosed with PJP and 58.3% had positive serum BDG. Serum BDG’s area under the receiver operating characteristic curve was 0.90 (0.87–0.93). At manufacturer’s 150 pg/ml cut-off, serum BDG had high sensitivity and negative predictive value (94%), but low specificity and positive predictive value (67%). Confounders associated with a positive serum BDG in PJP diagnosis included IVIG infusion within 3 days (odds ratio [OR] 9.24; 95% confidence interval [CI] 4.09–20.88, p < 0.001), other invasive fungal infections (OR 4.46; 95% CI 2.10–9.49, p < 0.001) and gram-negative bacteremia (OR 29.02; 95% CI 9.03–93.23, p < 0.001). The application of optimal BDG cut-off values determined by Youden’s index (252 pg/ml, 390 pg/ml, and 202 pg/ml) specific for all patients and subgroups with or without confounders improved the specificity (79%, 74%, and 88%) and corresponding PPV (75%, 65%, and 85%), while maintaining reasonable sensitivity and NPV.ConclusionsTailoring serum BDG cutoff specific to PJP and incorporating consideration of confounders could enhance serum BDG’s diagnostic performance in the ICU settings.

Simple endoscopic estimation to predict anastomotic complications after bronchoplastic procedures

Abstract OBJECTIVES Endoscopic evaluation of anastomosis is effective for the early detection of anastomotic complications after a bronchoplastic procedure. Herein, we aimed to clarify important findings for predicting anastomotic complications. METHODS This single-centre retrospective study included patients who underwent bronchoplastic surgery between April 2013 and September 2023. Only cases in which bronchoscopy was performed both 1 and 2 weeks after surgery were included. Endoscopic findings (classification by Ludwig and Stoelben, mucosa colour, oedema, slough area and colour, and depression) were reviewed for all cases. The accuracy of these findings for predicting anastomotic complications was evaluated. RESULTS Of the 190 patients included in this study, 14 (7.4%) experienced anastomotic abnormalities, 11 had fistulas (5.8%), and 7 had stenosis (3.7%). The onsets of fistula and stenosis were 20–28 and 20–44 days after surgery, respectively. In 102 patients (53.7%), the slough worsened from the first to the second week post-surgery. Therefore, it was easier to evaluate slough 2 weeks post-surgery rather than 1-week post-surgery. The positive/negative predicted values of anastomotic complications in endoscopic findings 2 weeks post-surgery were circular slough, 34.2%/99.3%; slough with dark colour, 39.3%/98.1%; and depression, 54.2%/99.4%. The incidence of anastomotic abnormalities was 0% in cases without the three findings, 10% in cases with at least one finding, and 67% in cases with all three findings. CONCLUSIONS The endoscopic findings of slough on the anastomosis 2 weeks after bronchoplasty can be easily evaluated and accurately predict complications. Three important endoscopic findings were circular slough, dark colour, and depression.

A Rapid Increase in Serum Lactate Levels after Cardiovascular Surgery Is Associated with Postoperative Serious Adverse Events: A Single Center Retrospective Study

A Rapid Increase in Serum Lactate Levels after Cardiovascular Surgery Is Associated with Postoperative Serious Adverse Events: A Single Center Retrospective Study

Seroprevalence of hepatitis B and hepatitis C virus among clinically suspected cases of viral hepatitis visiting Guhalla Primary Hospital, Northwest Ethiopia

Hepatitis B virus and hepatitis C virus remains one of the leading causes of morbidity and mortality worldwide, particularly in countries with limited resources. The two hepatotropic viruses have common mode of transmission. Hepatitis B virus and hepatitis C virus are the main causes of Cirrhosis, liver cancer and death. To determine the Seroprevalence of HBsAg and anti-HCV antibodies among clinically suspected cases of viral hepatitis visiting Guhalla Primary Hospital, Northwest Ethiopia. A hospital-based retrospective study was conducted at Guhalla Primary Hospital, Northwest Ethiopia. The study included serology registration logbook data from all patients who visited the hospital and were tested using a rapid test kit between September 1st, 2017 to August 30, 2021. Data were entered, cleaned, and analyzed using SPSS version 26 software. Bivariate analysis was computed and a multivariable analysis was conducted to provide an adjusted odds ratio (AOR). p-value < 0.05 at a 95% confidence interval was considered statistically significant. In this study, a total of 883(883 for HBV and 366 for HCV) study participants were included. The overall prevalence of HBsAg and anti-HCV were 124/883(14%) and 73/366 (19.9%), respectively. The prevalence of HBV and HCV among males from the total HBV and HCV screened was 70/410 (17.1%) and 53/366(14.4%) respectively. In this study, being female (AOR 1.53, 95% CI 1.03–2.27, p = 0.003) and age group of 31–40 years (AOR 2.85; 95% CI 1.56, 5.17, p = 0.001) were statistically significant factors to HBV infection. Similarly, being female (AOR 1.97, 95% CI 1.10–3.53, p = 0.02), age group of 21–30 years (AOR 2.71; 95% CI 1.15, 6.40, p = 0.02) and age group greater than 40 years (AOR 3.13; 95% CI 1.31, 7.44, p = 0.01) were significantly associated with HCV infection. In our study, high seroprevalence of HBV and HCV infection was detected among clinically suspected patients. Females and the age groups between 31 and 40 were more affected. Community awareness of the prevention and transmission of viral hepatitis infection should be strengthened through herd immunization and health education. The prospective study should be conducted in this area.

Moderate to severe anemia at admission increases the risk of complications in patients over 60 years with hip fracture

BackgroundAnemia frequently occurs in patients with hip fractures and represents a risk factor that can potentially be altered. To evaluate the association between admission anemia and complications in older hip fracture patients while exploring the potential impact of anemia on complications from the perspective of overall, operation and non-operation.MethodsThis retrospective study enrolled in-patients over 60 years old with hip fractures from January 2020 to November 2023. At admission, anemic patients were identified as having a hemoglobin level below 12 g/dL in females and 13 g/dL in males. Anemia was further classified as mild, moderate, or severe. Data encompassing demographics, comorbidities, medications, information on fracture and surgery, and complications were collected.ResultsA total of 462/679 patients had anemia, including 348, 105, and 9 with mild, moderate, and severe anemia, respectively. A total of 281 individuals experienced complications, including 212 and 69 with and without operation, respectively. Multivariate regression analysis identified anemia as a greater risk for acute heart failure (OR = 2.056, p = 0.037, 95% CI 1.043–4.052) than non-anemia. Moderate to severe anemia was a significant risk factor for any complication (OR = 1.584, p = 0.028, 95% CI 1.050–2.390), ≥ 2 (OR = 2.364, p = 0.001, 95% CI 1.443–3.872) or 3 (OR = 2.311, p = 0.022, 95% CI 1.131–4.720) complications, delirium (OR = 2.301, p = 0.018, 95% CI 1.156–4.579), venous thromboembolism (OR = 2.031, p = 0.042, 95% CI 1.025–4.025), and acute heart failure (OR = 2.095, p = 0.016, 95% CI 1.145–3.834), compared with mild to non-anemia. Similar results were observed in operated patients, while anemia and its severity were not associated with complications in non-operated patients.ConclusionModerate to severe anemia caused complications in elderly hip fracture patients, but it was not observed in non-operated individuals. These findings would support orthopedic physicians’ hierarchical management of anemic patients.

Myeloid sarcoma: A 7-year retrospective study from a tertiary cancer care center, illustrating the clinical, morphological, and immunohistochemical features

Myeloid sarcoma: A 7-year retrospective study from a tertiary cancer care center, illustrating the clinical, morphological, and immunohistochemical features

Prevalence and short-term clinical impacts of new-onset diabetes mellitus among patients with COVID-19 in jazan region, Saudi Arabia

BackgroundDiabetes Mellitus is a major predictor for severity and mortality that is increased by 50% in COVID-19 infection. The aim of this study is to estimate the prevalence of new-onset DM among patients with COVID-19 and examined the short clinical outcomes of the disease.MethodThis is a retrospective study of revising electronic medical records to assess the prevalence of new-onset DM in COVID-19 patients and its impact on the severity of the disease. Adult patients with confirmed COVID-19 during the period from June 2020 to December 2021 were enrolled.Results725 patients were included. 53.8% of them were males and 46.2 were females, the mean age was 43.35 ± 16.76. 13.2% were diabetics; 2.2% with preexisting DM and 11.0% had new-onset DM. 6.34% had coexisting medical conditions. DKA at presentation was observed in 6 patients (0.8%) of newly diagnosed DM. There is a significant correlation between age and family history (FH), and BMI and new-onset DM (P < 0.05). The overall mortality rate was 2.2%, and it was significantly higher in diabetics in comparison to non-diabetics (P < 0.001). 8.6% had persistent hyperglycemia after 4 months of follow-up.ConclusionThe prevalence of COVID-19 related new-onset DM was correlated significantly with disease severity and mortality rate. Age, FH, and BMI, were the major predictors. We recommend that frequent monitoring of blood glucose for patients with COVID-19 infections to detect DM, therefore, prompt treatment can be initiated.

Implementation of a New Classification and Stratification System for Solitary Bone Tumor: Osseous Tumor Radiological and Interpretation and Management System (OT-RIMS)

Abstract Objectives To propose a histological-grades-based Osseous Tumor Radiological Interpretation and Management System (OT-RIMS) that would simplify the radiological evaluation of bone tumors, categorize key radiological features into severity levels, and inform corresponding patient management actions. Methods This retrospective study between January 2015 and August 2022 evaluated patients with solitary bone tumors confirmed by pathology and imaging follow-up received two or three imaging modalities of radiographs, CT, or MRI. Three radiologists independently assessed radiological features, categorized bone lesions based on OT-RIMS criteria, and reached a consensus. Kappa statistics and observed agreement were calculated. Results A total of 341 patients (mean age, 26.0 years; 159 women) were included, with 102 malignant, 177 benign, and 62 intermediate or low-grade malignant bone lesions. Sensitivity and specificity of readers 1, 2, and 3, respectively, in the identification of malignant tumors into OT-RIMS 4 were 93.1% (95 of 102) and 93.3% (223 of 239), 96.1% (98 of 102) and 91.6% (219 of 239), 92.2% (94 of 102) and 89.5% (214 of 239). Inter-reader agreement of OT-RIMS category for three readers was considered excellent (Kendall’s W = 0.924, p &amp;lt; 0.001) with a kappa value of reproducibility in categories 1&amp;2, 3, and 4 of 0.764, 0.528, and 0.930, respectively. Conclusion The OT-RIMS category demonstrated excellent reproducibility despite the reader’s expertise level in categorizing the risk stratification of bone tumors and informing patient management, with histological grades used as the reference standard. Advances in knowledge The OT-RIMS category reliably stratifies bone tumors into four categories corresponding to histological grades and standardized patient management.

Prognostic value of ventricular arrhythmia in early post-infarction left ventricular dysfunction: the French nationwide WICD-MI study

Abstract Background and Aims Prophylactic implantable cardioverter–defibrillators (ICDs) are not recommended until left ventricular ejection fraction (LVEF) has been reassessed 40 to 90 days after an acute myocardial infarction. In the current therapeutic era, the prognosis of sustained ventricular arrhythmias (VAs) occurring during this early post-infarction phase (i.e. within 3 months of hospital discharge) has not yet been specifically evaluated in post-myocardial infarction patients with impaired LVEF. Such was the aim of this retrospective study. Methods Data analysis was based on a nationwide registry of 1032 consecutive patients with LVEF ≤ 35% after acute myocardial infarction who were implanted with an ICD after being prescribed a wearable cardioverter–defibrillator (WCD) for a period of 3 months upon discharge from hospital after the index infarction. Results ICDs were implanted either because a sustained VA occurred while on WCD (VA+/WCD, n = 72) or because LVEF remained ≤35% at the end of the early post-infarction phase (VA−/WCD, n = 960). The median follow-up was 30.9 months. Sustained VAs occurred within 1 year after ICD implantation in 22.2% and 3.5% of VA+/WCD and VA−/WCD patients, respectively (P &amp;lt; .0001). The adjusted multivariable analysis showed that sustained VAs while on WCD independently predicted recurrence of sustained VAs at 1 year (adjusted hazard ratio [HR] 6.91; 95% confidence interval [CI] 3.73–12.81; P &amp;lt; .0001) and at the end of follow-up (adjusted HR 3.86; 95% CI 2.37–6.30; P &amp;lt; .0001) as well as 1-year mortality (adjusted HR 2.86; 95% CI 1.28–6.39; P = .012). Conclusions In patients with LVEF ≤ 35%, sustained VA during the early post-infarction phase is predictive of recurrent sustained VAs and 1-year mortality.

Interaction between tumor stage and age on survival outcomes of patients with anaplastic thyroid cancer

BACKGROUND Anaplastic thyroid cancer (ATC) is an aggressive, rare malignancy associated with rapid growth and metastasis, and a very poor prognosis. We investigated the clinical characteristics, survival outcomes and independent prognostic factors associated with anaplastic thyroid cancer. AIM To assess to what extent the interaction between age and tumor stage affects mortality. METHODS A total of 622 patients diagnosed with anaplastic thyroid cancer, between 2010 and 2017 were enrolled in our study by retrieving data from the Surveillance, Epidemiology and End Results (SEER) database. We analyzed demographics, clinical characteristics, overall mortality (OM) and cancer specific mortality (CSM) of ATC. Variables with a P value &lt; 0.1 were incorporated into the multivariate cox model to determine the independent prognostic factors. Furthermore, we analyzed the interaction between age and tumor stage on mortality. RESULTS In the multivariate analyses, the divorced/separated population had a lower OM [hazard ratio (HR) = 0.63, 95%CI: 0.42-0.94, P &lt; 0.05] and CSM (HR = 0.61, 95%CI: 0.40-0.92, P &lt; 0.05). OM was higher in tumors with direct extension only (HR = 6.26, 95%CI: 1.29-30.42, P &lt; 0.05) and tumors with distant spread (HR = 5.73, 95%CI: 1.34-24.51, P &lt; 0.05). CSM was also higher in tumors with direct extension (HR = 5.05, 95%CI: 1.05-24.19, P &lt; 0.05) and tumors with distant spread (HR = 4.57, 95%CI: 1.08-19.29, P &lt; 0.05). Mortality was not adversely affected by lymph node involvement. OM was lower in patients who received radiation (HR = 0.66, 95%CI: 0.53-0.83, P &lt; 0.01), chemotherapy (HR = 0.63, 95%CI: 0.50-0.79, P &lt; 0.01) or surgery (HR = 0.53, 95%CI: 0.43-0.66, P &lt; 0.01). CSM was also lower in patient who received radiation (HR = 0.64, 95%CI: 0.51-0.81, P &lt; 0.01), chemotherapy (HR = 0.62, 95%CI: 0.50-0.78, P &lt; 0.01) or surgery (HR = 0.51, 95%CI: 0.41-0.63, P &lt; 0.01). There was no significant interaction between age and tumor stage that affected mortality. CONCLUSION In this large US SEER database retrospective study, we found the mortality to be higher in advanced stage tumors with direct extension and distant metastasis. However, patients who received aggressive therapy showed a better overall survival. The aim of our study is to emphasize the importance of detecting ATC at an early stage and provide aggressive therapy to these patients. Since advanced stage ATC is associated with a dismal prognosis, we emphasize the need for randomized control trials and development of novel therapies that will be used to treat ATC.

Bronchial branch tracing navigation in ultrathin bronchoscopy-guided radial endobronchial ultrasound for peripheral pulmonary nodule

BackgroundMost malignant peripheral pulmonary lesions (PPLs) are situated in the peripheral region of the lung. Although the ultrathin bronchoscope (UTB) can access these areas, a robust navigation system is essential for precise localisation of these small peripheral PPLs. Since many UTB procedures rely on automated virtual bronchoscopic navigation (VBN), this study aims to determine the accuracy and diagnostic yield of the manual bronchial branch tracing (BBT) navigation in UTB-guided radial endobronchial ultrasound (rEBUS) procedures.MethodsSingle-centre retrospective study of UTB-rEBUS patients with PPLs smaller than 3 cm over a two year period.ResultsOur cohort consisted of 47 patients with a mean age of 61.6 (SD 9.53) years and a mean target size of 1.91 (SD 0.53) cm. Among these lesions, 46.8% were located in the 6th airway generation, and 78.7% exhibited a direct bronchus sign. Navigation success using BBT was 91.5% based on positive rEBUS identification. The index diagnostic yield was 82.9%, increasing to 91.5% at 12 months of follow-up. Malignant lesions accounted for 65.1% of cases, while 34.9% were non-malignant. The presence of a direct bronchus sign was the sole factor associated with higher navigation success and diagnostic yield. Cryobiopsy outperformed forceps biopsy in non-concentric rEBUS lesions (90.9% vs. 50.0%, p < 0.05), but not in concentric orientated lesions. One pneumothorax occurred in our cohort.ConclusionsBBT as an exclusive navigation method for small PPLs in UTB-rEBUS procedures has proved to be safe and feasible. Combination of UTB with cryobiopsy remains efficient for eccentric and adjacently oriented rEBUS lesions.

Accessibility of neurotization in deep inferior epigastric perforator flap reconstruction: inequities and implications for pre-authorization.

Breast anesthesia and hypoesthesia occur commonly after mastectomy and negatively impact quality of life. Neurotization during deep inferior epigastric perforator (DIEP) breast reconstruction offers enhanced sensory recovery. However, access to neurotization for DIEP reconstruction patients has not been evaluated. This retrospective study included patients who underwent DIEP breast reconstruction between January 2021 and July 2022 at a tertiary-care, academic institution. Demographics, outcomes, insurance type, and Area Deprivation Index (ADI)were compared using two-sample t-test or Chi-square analysis. Of the 124 patients who met criteria, 41% had neurotization of their DIEP flaps. There was no difference in history of tobacco use (29% vs 33%), diabetes (14% vs 9.6%), operative time (9.43 hr vs 9.73 hr), length of hospital stay (3 d vs 3 d), hospital readmission (9.8% vs 6.8%), or reoperation (12% vs 12%) between to patients with and without neurotization. However, access to neurotization differed significantly by patient health insurance type. Patients who received neurotization had a lower median ADI percentile of 40.0 indicating higher socioeconomic advantage compared to patients who did not receive neurotization at 59.0 (p=0.01). Access to neurotization differed significantly by patient health insurance and by ADI percentile. Expanding insurance coverage to cover neurotization is needed to increase equitable access and enhance quality of life for patients who come from disadvantaged communities. Our institution's process for pre-authorization is outlined to enhance likelihood of insurance approval for neurotization.

Suspected poor-quality medicines in Kenya: a retrospective descriptive study of medicine quality-related complaints reports in Kenya’s pharmacovigilance database

Poor-quality, substandard and falsified, medicines pose a significant public health threat, particularly in low-middle-income countries. A retrospective study was performed on Kenya's Pharmacovigilance Electronic Reporting System (2014–2021) to characterize medicine quality-related complaints and identify associations using disproportionality analysis. A total of 2767 individual case safety reports were identified, categorized into medicines with quality defects (52.1%), suspected therapeutic failure (41.6%), and suspected adverse drug reactions (6.3%). Predominantly reported were antineoplastic agents (28.6%), antivirals (11.7%), and antibacterial agents (10.8%) potentially linked to non-adherence to good manufacturing practices, inappropriate usage and supply chain degradation. Notably, analgesics (8.2%), and medical devices (3.5%) notified had quality defects, predominantly from government health facilities (60.0%). Antineoplastic agents (20.2%) and antivirals (3.7%) were frequently reported from suspected therapeutic failures and suspected adverse drug reactions, respectively, across both private for-profit facilities (26.5%) and not-for-profit facilities (5.4%). Underreporting occurred in unlicensed health facilities (8.1%), due to unawareness and reporting challenges. Pharmacists (46.1%), and pharmaceutical technicians (11.7%) predominantly reported quality defects, while medical doctors (28.0%) reported suspected therapeutic failures. Orally administered generic medicines (76.9%) were commonly reported, with tablets (5.8%) identified as potential sources of suspected adverse drug reactions, while quality defects were notified from oral solutions, suspensions, and syrups (7.0%) and medical devices (3.9%). The COVID-19 pandemic correlated with reduced reporting possibly due to prioritization of health surveillance. This study provides valuable evidence to supporting the use of medicine quality-related complaints for proactive, targeted regulatory control of high-risk medicines on the market. This approach can be strengthened by employing standardized terminology to prioritize monitoring of commonly reported suspected poor-quality medicines for risk-based sampling and testing within the supply chain.

The impact of the COVID-19 pandemic on dyslipidemia in peritoneal dialysis patients.

The COVID-19 pandemic has had a profound impacted on various aspects of society, including the healthcare system and patient care. In this context, this study aims to evaluate the impact of COVID-19 control strategies on the lipid profile and blood sugar levels of peritoneal dialysis (PD) patients in Taiwan, a crucial focus for understanding the pandemic's influence on individuals with chronic kidney disease (CKD). A retrospective cohort study was conducted, analyzing data from the medical records of 170 PD patients who visited the nephrology division of Taipei Veterans General Hospital in 2021. The generalized estimating equations method was used to analyze the longitudinal data and assess the changes in biomarker levels over different periods. Covariates were taken into consideration in the statistical models. The data were analyzed using R 4.3.0. The study enrolled 70 males (41%) and 100 females (59%), with an average age of 56 years old. Over 12 months in 2021, from the first period (January-April: pre-COVID-19) to the second period (May-August: COVID-19 surge), there was a notable decline in both high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels, and a significant surge in triglyceride (TG) levels. However, total cholesterol (TC) and hemoglobin (HbA1c) levels remained stable. Furthermore, the TG to HDL, TG to LDL, TC to HDL, and TC to LDL ratios were analyzed, revealing a pronounced increase during the second period. Our findings underscore the significant impact of COVID-19 pandemic-related disruptions in the healthcare system and the subsequent management strategies on dyslipidemia in PD patients while not affecting dysglycemia. These results provide valuable insights for healthcare professionals to enhance their strategies and interventions for CKD patients undergoing PD during a pandemic.

Effectiveness of tramadol-including multimodal analgesia in spinal surgery: a single-center, retrospective cohort study

BackgroundMultimodal analgesia (MMA) is recommended for postoperative pain management; however, studies evaluating the effect of tramadol-including MMA on numerical rating scale (NRS)-based postoperative pain levels and the length of stay (LOS) in the hospital are limited. Therefore, this study aimed to compare the before and after effects of tramadol-including MMA application, and assess its effect on postoperative NRS scores and LOS.MethodsPatients who underwent spinal surgery under general anesthesia at the Rakuwakai Marutamachi Hospital in fiscal years 2020 and 2022 were included in this study. The outcomes between the pre- and post-intervention groups were compared through propensity score matching.ResultsFollowing propensity score matching, 249 patients were included in each group. MMA application significantly decreased the median LOS from 10 to 9 days (p < 0.001). Additionally, the median NRS scores exhibited a significant decrease from 4 to 3 on postoperative day (POD) 3 (p = 0.0109) and from 3 to 2 on POD 5 (p = 0.0087). Following MMA application, the number of patients receiving additional analgesics decreased significantly, from 38 to 6 (p < 0.001).ConclusionsThe introduction of tramadol-including MMA can effectively reduce postoperative pain and decrease the LOS for patients undergoing spinal surgery.

Real-World Comparison of Effectiveness, Treatment Persistence, and Safety of First-Line Advanced Therapies at 1 Year for Ulcerative Proctitis

Lay Summary In this retrospective cohort study, vedolizumab was associated with higher odds of steroid-free clinical remission at 1 year compared to anti-TNF agents for bio-naïve patients with ulcerative proctitis.

Comparison of Radiation Doses for Different Techniques in Fluoroscopy-Guided Lumbar Facet Medial Branch Blocks: A Retrospective Cohort Study

Chronic lumbar facet pain is commonly treated with fluoroscopy-guided facet medial branch blocks (FMBBs). However, the associated radiation exposure of both patients and clinicians is a growing concern. This study aimed to compare radiation doses and fluoroscopy times between two techniques, i.e., oblique and posterior–anterior (PA) fluoroscopic approaches, while also examining the impact of physician experience on these metrics. A retrospective analysis was conducted on 180 patients treated at Mersin University Hospital Pain Clinic between January and July 2024. Patients were divided into two groups: 90 received the oblique technique (Group O) and 90 received the AP technique (Group A). Radiation dose and fluoroscopy time data were collected for each patient. The AP technique was associated with significantly lower radiation doses (mean 66 mGy) and shorter fluoroscopy times (mean 28 s) compared to the oblique technique (mean radiation dose of 109 mGy and fluoroscopy time of 46 s) (p &lt; 0.001). Physician experience also influenced these outcomes, with more experienced physicians consistently using less radiation. The AP technique should be considered for FMBBs, as it reduces radiation exposure while maintaining procedural efficiency, highlighting the importance of experience in optimizing outcomes.

Determinants of Rabies Post-Exposure Prophylaxis Completion in Sarawak

Objective: Rabies remains persistent in Sarawak despite efforts to control its spread. This study investigates the determinants of rabies post-exposure prophylaxis (PEP) completion among individuals in Sarawak that have been exposed to potential rabies transmission through animal bites.Material and Methods: A retrospective cohort study, using a universal sampling approach was employed, utilizing data from the Sarawak i-Bite System. Binary logistic regression was used to identify significant variables: a p-value&lt;0.05 was considered as statistically significant.Results: The mean age of people having experienced animal bites was 38.1 (S.D.=22.4) years. Most were male (51.6%) and of Chinese ethnicity (37.2%). The predominant sites of animal bites were the upper (53%) and lower limbs (39.5%). Category 3 bite injuries and bites from fully confined pets were the most frequently reported (68.9% and 43.9%, respectively). In total 56.5% of the study population had a complete rabies vaccine regimen as post-exposure prophylaxis, while 5.4% had incomplete vaccinations, and 38% received no vaccination. The majority received treatment at government hospitals (59.1%). The significant determinants of rabies post-exposure prophylaxis completion in Sarawak were the Iban ethnicity (odd ratio (OR)=2.9, 95% confidence interval (CI):1.08-2.44, p-value=0.02), grade 3 bite (OR=3.9, 95% CI=,1.86-4.68, p-value&lt;0.001), pet mixed with stray (OR=2.41, 95% CI=1.32-2.33, p-value&lt;0.001), stray animals (OR=2.41, 95% CI=1.78-3.25, p-value,0.001) and treated in a government hospital (OR=0.63, 95% CI=0.47-0.83, p-value&lt;0.001).Conclusion: This study reported that only 56.5% of patients completed the rabies PEP series. The important determinants of PEP completion status were found to be the Iban ethnicity, bite severity, category of animal, and place of treatment. These findings offer valuable insights to assist the Sarawak State Health Department in prioritizing strategies to enhance the compliance rate, with the ultimate goal of eliminating dog-mediated Rabies deaths by 2030.

Evaluation of Sphenoid Sinus Variations in Cleft Lip and Palate Patients: A Comprehensive Cone Beam Computed Tomography Analysis.

This study aims to compare sphenoid sinus variations between unilateral and bilateral cleft lip and palate (CLP) patients and healthy controls using CBCT images. It is notable for its large sample size and comparison of unilateral and bilateral cleft patients, cleft and noncleft sides, and different age groups. Retrospective cohort study. University Hospital. CBCT images of 97 CLP patients (76 unilateral, 21 bilateral) and 97 healthy controls were evaluated.Main Outcome Measures: Sphenoid sinus main types, sellar subtypes, clival, and lateral extensions were assessed for all groups. A significant increase in the anterior type was observed in both unilateral and bilateral CLP groups. The bilateral CLP group had a higher prevalence of the lesser wing type. In CLP and control groups, lesser wing, combined type, and lateral type were statistically significantly lower under 13 years of age. The study highlights an elevated prevalence of anterior pneumatization in unilateral and bilateral CLP individuals, emphasizing its significance in surgery planning due to proximity to critical structures like the optic nerve and sphenopalatine artery. The increased prevalence of the lesser wing type in bilateral CLP patients requires extra caution during anterior clinoidectomy. Lower pneumatization rates in CLP patients under 13 suggest their sphenoid sinus development is similar to that of healthy individuals. Understanding these variations is crucial for appropriate surgical planning and avoiding complications during transsphenoidal surgery.

Exploring the internal medicine comorbidities associated with eating disorders: correlation between disease severity and cardiac abnormalities in adolescent patients with anorexia nervosa

ABSTRACT Anorexia Nervosa (AN) is a psychiatric disorder characterized by caloric restriction, weight loss, and fear of gaining weight. Cardiac complications are among the most severe medical consequences. Despite the importance of regular cardiac assessments, there is a lack of standardized protocols for timing and patient selection. This retrospective cohort study has aimed to assess the correlation between AN severity, Body Mass Index, weight loss percentage, and cardiac abnormalities in pediatric patients. A total of 123 patients admitted to a child and adolescent psychiatry unit between January 2019 and March 2022 were included. Data on demographics, clinical characteristics, cardiac evaluations were collected from electronic health records. The study revealed a prevalence of cardiac abnormalities in 57.7% of patients, with bradycardia being the most common (49.5%), followed by QTc prolongation (4%) and pericardial effusion (4%). However, no significant correlation was found between AN severity and cardiac alterations, suggesting that disease severity alone is not a reliable predictor of cardiac risk. The study highlights the need for individualized risk assessment and targeted cardiac evaluations based on specific risk factors rather than disease severity alone. Early diagnosis and comprehensive care contribute to better outcomes, emphasizing the importance of multidisciplinary approaches in managing AN.