Retrospective Study Research Articles

Retrospective evaluation of the impact of atropine administration on incidence of post-operative colic in healthy, isoflurane-anaesthetised horses.

In anaesthetised horses, bradycardia secondary to high vagal tone can reduce cardiac output and blood pressure. The use of anticholinergics in horses is limited due to concerns about ileus and abdominal discomfort. This retrospective study sought to determine the prevalence of post-operative abdominal discomfort in healthy horses that received atropine under isoflurane anaesthesia. A retrospective evaluation of 222 general anaesthesia events between January 2019 and December 2019 was undertaken. One hundred and eleven horses that received atropine were identified, and 111 case match controls that did not receive atropine were also selected. Information gathered from the medical records included signalment, anaesthetic drugs, surgical procedures, duration of anaesthesia and surgery, dobutamine and atropine administration, and the occurrence of abdominal discomfort for 24 h after anaesthesia. After initial data analysis, a second cohort of records was assessed separately. The horses in this group were castrated under general anaesthesia (with or without atropine; n = 68). Logistic regression models and Fisher's exact tests were used to look for factors contributing to abdominal discomfort post-anaesthesia. The significance level was set to 5% (p < 0.05). Atropine administration was not associated with the development of post-anaesthetic abdominal discomfort (OR = 2.121, 95% CI [0.767, 5.869]; p = 0.2). Overall, 18/222 (8.1%) incidences of abdominal discomfort were identified. All incidents occurred in colts undergoing castration. In a separate analysis of only horses anaesthetised for castration, atropine was associated with developing abdominal discomfort (OR = 3.143, 95% CI [1.082, 9.132]; p = 0.04). Atropine was not associated with post-operative abdominal discomfort except in colts undergoing castration. All episodes of discomfort were mild and resolved with minimal intervention. The potential impact of insufficient analgesia in horses undergoing castration is a confounding factor and requires prospective investigation. Overall, atropine at a dose of 0.006 mg/kg IV appears to be a safe method to treat bradycardia in otherwise healthy horses anaesthetised for orthopaedic and upper airway procedures. Further work is required to determine if atropine is safe for colts undergoing castration.

Long-term recurrence risk, metastatic potential and length of cystoscopic surveillance of low-grade non-muscle invasive bladder cancer.

Patients with Ta low-grade (LG) non-muscle invasive bladder cancer (NMIBC) rarely develop metastases or die from it. Long-term data are scant and length of follow-up poorly defined. This retrospective study included 521 patients diagnosed with primary TaLG (n=491) or papillary urothelial neoplasm of low malignant potential (PUNLMP, n=30) from 1989-2019 at an Academic center. Patient data was acquired using patient records chart review and a bladder cancer informatics registry at the center. Risk of recurrence, progression in stage, to muscle invasion, metastases and death due to BC were analyzed. RNAseq assessed the transcriptomic profiles of four TaLG that metastasized. Interobserver variability in pathological grading (WHO 2004/2022 and 1973, n=80) was blindly assessed by three expert pathologists. Median follow-up was 9.6 (95%CI: 8.6-10.2) years. Among 521 patients (73% men, median age 67.0 years), 350 recurred, 57 progressed in stage, 20 developed metastases, and 15 died from BC (median of 9.6 years after diagnosis). Cancer-specific survival probabilities were 0.99, 0.98 and 0.96 at 5-, 10- and 15- years, respectively. Fifty patients who were recurrence-free for the first 5 years developed late recurrences and 2 of them died of BC. Metastatic TaLG had more adverse transcriptomic findings in keeping with higher grade tumors despite phenotypically similar to indolent tumors. Grading concordance for the 2004/2022 system and WHO 1973 was 0.78 (95%CI: 0.65-0.90) and 0.41 (95%CI: 0.32-0.50), respectively. This study with long-term data challenges the assumption that primary TaLG NMIBC nearly never progresses to lethal disease if followed long enough. However, the risk of BC-related mortality is extremely low in patients who are recurrence-free for the first 5 years. Minimizing variability in pathological grading remains an unmet need.

Retrospective Evaluation of Clinical Characteristics of Children with Cat Sensitivity

Aims: Cat allergy has an important place among allergic diseases and it is known that environmental factors as well as genetic factors affect sensitisation. It has been reported that having a cat at home increases the risk of sensitisation, especially in susceptible individuals. The aim of this study was to retrospectively evaluate the clinical features of cat sensitisation in children. Methods: In this descriptive retrospective study, children aged 0-18 years with cat sensitisation who were admitted to the clinic between June 2023 and December 2023 were examined. Clinical characteristics, total IgE, eosinophil count, specific IgE values and skin prick test results were retrospectively evaluated using data obtained from the hospital database. Results: The study included 76 children with cat sensitisation. The mean age was 7 years and 56.6% were male. The most common diagnoses were asthma (63.2%) and allergic rhinitis (31.6%). Cat sensitisation was positive in 100% of the patients, house dust mite sensitisation was found in 78.9% and pollen sensitisation in 14.5%. Total IgE levels of patients with multiple allergies were significantly higher than those without multiple allergies. Conclusion: The study showed that additional allergen sensitisation was common in children with cat sensitisation and the most common diagnoses were allergic rhinitis and asthma. The findings are consistent with the existing literature and emphasise the importance of total IgE in the clinical management of allergic diseases.

Factors impacting post-nephrostomy-tube removal urine leak after percutaneous nephrolithotomy: does the calyx of access make a difference?

BackgroundThe aim of this study was to identify the factors that impact the post- percutaneous nephrolithotomy (PCNL) urine leak (UL) following nephrostomy tube removal and to assess if the calyx of entry made any difference.Materials and methodsIn this retrospective study, from April 2016 to May 2019, all the patients undergoing conventional percutaneous nephrolithotomy by a single 24 Fr access with complete stone clearance were evaluated. Patients with urine leak for > 4 h after nephrostomy tube removal were included in the urine leak group (n = 18), while the non-urine leak group (n = 60) comprised patients with urine leak for < 4 h. These groups were compared for demographic, renal, stone-related and peri-operative factors with special stress on calyx of access.ResultsThe urine leak group had significantly older (mean 48 vs. 31 years, p = 0.003) patients with a higher proportion of diabetes mellitus (33% vs. 11%, p = 0.03). They also had a significantly greater (grade ≥ 3) hydronephrosis (55.5% vs. 10%, p < 0.001) and significantly reduced cortical thickness (mean 6.4 vs. 10.3 mm, p = 0.001). They had a nephrostomy tube in situ post-operatively for a longer duration (mean 52.3 vs. 34.5 h, p = 0.002). Interestingly 100% leaks happened from the middle/lower calyx tract and none from the upper calyceal access (p < 0.001). On multivariable regression analysis, grade ≥ 3 hydronephrosis with thin cortex, middle/lower calyceal access and keeping the nephrostomy tube for prolonged duration post-operatively were independent predictors of urine leak. There was no risk of leak from upper calyx access.ConclusionThere is negligible risk of urine leak from upper calyx access so the possibility of hydrothorax after nephrostomy tube removal is minimal.

Artificial Intelligence–based Software for Breast Arterial Calcification Detection on Mammograms

Abstract Objective The performance of a commercially available artificial intelligence (AI)–based software that detects breast arterial calcifications (BACs) on mammograms is presented. Methods This retrospective study was exempt from IRB approval and adhered to the HIPAA regulations. Breast arterial calcification detection using AI was assessed in 253 patients who underwent 314 digital mammography (DM) examinations and 143 patients who underwent 277 digital breast tomosynthesis (DBT) examinations between October 2004 and September 2022. Artificial intelligence performance for binary BAC detection was compared with ground truth (GT) determined by the majority consensus of breast imaging radiologists. Area under the receiver operating curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value (NPV), accuracy, and BAC prevalence rates of the AI algorithm were compared. Results The case-level AUCs of AI were 0.96 (0.93-0.98) for DM and 0.95 (0.92-0.98) for DBT. Sensitivity, specificity, and accuracy were 87% (79%-93%), 92% (88%-96%), and 91% (87%-94%) for DM and 88% (80%-94%), 90% (84%-94%), and 89% (85%-92%) for DBT. Positive predictive value and NPV were 82% (72%-89%) and 95% (92%-97%) for DM and 84% (76%-90%) and 92% (88%-96%) for DBT, respectively. Results are 95% confidence intervals. Breast arterial calcification prevalence was similar for both AI and GT assessments. Conclusion Breast AI software for detection of BAC presence on mammograms showed promising performance for both DM and DBT examinations. Artificial intelligence has potential to aid radiologists in detection and reporting of BAC on mammograms, which is a known cardiovascular risk marker specific to women.

Low-dose aspirin improves blood perfusion of obstetric anticardiolipin syndrome in China.

This study evaluates the endometrial receptivity of obstetric anticardiolipin syndrome (OAPS) patients using various ultrasound indicators and the efficacy of low-dose aspirin (LDA) treatment. This retrospective study recruited patients from Shanghai Ren Ji Hospital, China from January 2022 to December 2023. Doppler parameters of the endometrium and uterine artery blood flow were recorded to assess the endometrial receptivity of OAPS patients compared with normal pregnant women and an other immune diseases group. The receiver operating characteristic curve was used to predict the risk of OAPS patients. Doppler parameters of OAPS patients were conducted repeatedly after a 2-month period of treatment with LDA. Compared with normal pregnant women, the OAPS group showed remarkably increased endometrial perfusion resistance (PI, RI, S/D) and uterine artery perfusion resistance (RI and S/D) (P < 0.001) and had good predictive values (area under the curve = 0.806, 0.976, 0.942, 0.902, and 0.901, respectively). The endometrial thickness of the OAPS group was much thinner than that of the normal group (P < 0.001). Uterine blood flow impedance PI showed no difference in both groups (P = 0.68). In comparison to other autoimmune diseases, the OAPS group also showed an increasing trend in the resistance of endometrium and uterine artery blood flow. After LDA treatment, there was an obvious improvement in the endometrial blood flow perfusion in the OAPS group (P < 0.01). Compared with the normal group and other autoimmune diseases, the resistance of endometrial and uterine artery blood flow in the OAPS group was increased significantly. The Doppler index showed the predictive value of OAPS, and it was confirmed that LDA could enhance blood perfusion among OAPS women.

Retrosplenial hypometabolism precedes the conversion from mild cognitive impairment to Alzheimer's disease.

Not all individuals who experience mild cognitive impairment (MCI) transition through progressive stages of cognitive decline at the same rate, if at all. Previous observational studies have identified the retrosplenial cortex (RSC) as an early site of hypometabolism in MCI which seems to be predictive of later transition to Alzheimer's disease (AD). We examined N=399 MCI subjects with baseline 18F-fluorodeoxyglucose positron emission tomography. Subjects were classified based on whether their diagnosis converted from MCI to AD. Whole-brain metabolism was decreased in converters (MCI-AD). This effect was more prominent at the RSC, where MCI-AD subjects showed even greater hypometabolism. Observations of RSC hypometabolism and its utility in predicting transition from MCI-AD withstood statistical analyses in a large retrospective study. These results point to the utility of incorporating RSC hypometabolism into predictive models of AD progression risk and call for further examination of mechanisms underlying this relationship. Not all individuals who develop MCI will progress to AD. Individuals with MCI who progress to AD show early whole-brain hypometabolism. Early hypometabolism is particularly prominent at the RSC.

Rural-Urban Disparities in Mortality of Patients with Acute Myocardial Infarction and Heart Failure: A Systematic Review and Meta-Analysis.

Patients with cardiac disease living in rural areas may face significant challenges in accessing care and studies suggest that living in rural areas may be associated with worse outcomes. However, it is unclear whether rural-urban disparities have an impact on mortality in patients presenting with acute myocardial infarction (AMI) and heart failure (HF). This meta-analysis aimed to assess differences in mortality between rural and urban patients presenting with AMI and HF. A systematic search of the literature was performed using PubMed, Embase, MEDLINE and CENTRAL for all studies published until January 16, 2024. A grey literature search was also performed using a manual web search. The following inclusion criteria were applied: (i) studies must compare rural patients to urban patients presenting to hospital with AMI or HF; and (ii) studies must report on mortality. The primary outcome was all-cause mortality. Comprehensive data were extracted including study design, patient characteristics (sex, age and comorbidities), sample size, follow-up period and outcomes. Odds ratios (ORs) were pooled with random-effects model. A subgroup analysis was performed to investigate causes for heterogeneity in which studies were separated based on in-hospital mortality, post-discharge mortality, and region of origin including North America, Europe, Asia and Australia. In total, 37 studies were included (29 retrospective studies, 4 cross-sectional studies and 4 prospective cohort studies) in our meta-analysis; 24 studies for AMI, 11 studies for HF and 2 studies for both AMI and HF. This included a total of 21,107,886 patients with AMI (2,230,264 of which were in rural regions) and 18,434,270 patients with HF (2,655,469 of which were in rural regions). Rural patients with AMI had similar age (mean age 69.8 +/- 5.7; vs 67.5 +/- 5.1) and were more likely to be female (43.2% vs 38.5%) compared to urban patients. Rural patients with HF had similar age (mean age 77.1 +/- 4.4 vs 76.5 +/- 4.2) and were more likely to be female (56.4% vs 49.5%) compared to urban patients. The range of follow-up for the AMI cohort was 0 days to 24 months and the range of follow-up for the HF cohort was 0 days to 24 months. Compared with urban patients, rural patients with AMI had higher mortality rate at follow-up (15.5% vs 13.4%; OR 1.18, 95% CI, 1.13-1.24; I2 = 97%). Compared with urban patients, rural patients with HF had higher mortality rate at follow-up (12.3% vs 11.6%; OR 1.11, 95% CI, 1.11-1.12; I2 = 98%). To our knowledge, this is the first systematic review and meta-analysis assessing mortality differences between rural and urban patients presenting with AMI and HF. We found that patients living in rural areas had an increased risk of mortality when compared to patients in urban areas. Clinical and policy efforts are required to reduce these disparities.

Transferrin saturation is a superior prognostic biomarker for iron deficiency after acute decompensated heart failure: a retrospective clinical real-world cohort study

Abstract Background Iron deficiency (ID) is the most common extracardiac comorbidity in heart failure (HF) and associated with worse outcomes. While a uniform definition of ID in HF remains lacking, several biomarkers for ID, including ferritin and transferrin saturation (TSAT), are used in both clinical trials and clinical practice. However, which biomarker is a superior prognostic predictor for ID in HF remains unsettled. In addition, real-world clinical data on ID screening and intravenous (IV) iron treatment is largely missing. Purpose To determine which biomarker is a superior prognostic predictor for the composite endpoint of HF rehospitalisation (HHF) and all-cause mortality in a real-world cohort of patients with HF and coexisting ID, and to investigate frequency and predictors of ID screening and IV iron treatment. Methods In this retrospective cohort study, all patients aged 18-85 years hospitalised at a tertiary university hospital with new onset HF with reduced ejection fraction (HFrEF) in 2016-2020 were consecutively included from medical records by ICD-10 code I50.0-I50.9 and followed until 31 December 2021. Patient characteristics, comorbidities, medications, laboratory results and data on follow-up, including if ID was tested for, IV iron administration, HHF and all-cause mortality was collected. First available iron status after admission for index hospitalisation was used. Predictors for ID screening and IV iron use were identified with univariate logistic regression. The association between ID markers and the composite endpoint was analysed with Cox regression adjusted for age, sex, baseline anemia, estimated glomerular filtration rate (eGFR) &amp;lt;30 mL/min/1.73 m2 and N-terminal pro-B type natriuretic peptide (NT-proBNP) below median value with median ferritin and TSAT values set as references respectively. Results In all, 753 patients were included (66.5 ± 12.7 years, 508 (67.5%) men, ejection fraction 29.5 ± 6.9% and mean NT-proBNP 6241 ± 7183 ng/L). Of these, 484 (64.3%) were screened for ID and 235 (48.6%) fulfilled criteria for ID. Of these, 94 (40.0%) received IV iron. Of screened patients, 28.6% had ID with anemia and 20.8% ID without anemia (Table 1). Factors associated with screening for ID were follow-up at hospital, anemia, eGFR &amp;lt;30 mL/min/1.73 m2 and ischemic heart disease, and for IV iron additionally chronic kidney disease and peripheral artery disease. Median ferritin was 140 µg/L and TSAT 0.2. Both ferritin and TSAT displayed an inversely linear association with outcomes, while TSAT &amp;lt;0.2 showed a stronger association with increased risk of HHF and all-cause mortality compared to median values (Figure 1-2). Conclusions In a real-world clinical setting, TSAT was a superior prognostic biomarker for worse outcomes compared to ferritin in patients hospitalised for acute HF. While both ID screening and IV iron use remained greatly underutilised in clinical practice, identification of a reliable biomarker for ID is critical.

Cardiovascular risks of PD1 inhibitor therapy in cancer: impact of prior ischemic events on heart failure - a retrospective cohort study

Abstract Introduction Immune checkpoint inhibitors (ICIs) have transformed cancer therapy, but concerns remain about their cardiac risks. Limited recent basic evidence suggests a possible link between ICIs that target PD1 and adverse cardiac events such as heart failure. Purpose This study explores the connection between PD1 inhibitor therapy and incident heart failure in cancer patients. Methods In our retrospective study at a tertiary medical center, 1,671 cancer patients receiving PD1 inhibitors were analyzed. Individuals with a history of heart failure, who developed myocarditis on PD-1, or had missing data were excluded. Data from pharmacy records and the Research Patient Data Registry provided clinical and ICI-related details. Cases were defined as patients who developed incident heart failure after ICI started. Controls were patients who did not develop incident heart failure after ICI start. Sensitivity analyses, including propensity score matching and comparison with non-ICI-treated cancer patients, ensured result robustness. Multivariate logistic regressions were performed. Results Among 1,671 ICI treated patients, 109 (6.5%) developed heart failure without evidence of myocarditis over a median follow-up of 332.0 days. In both the full cohort and the 3:1 matched cohort (n=380), multivariate logistic regression showed increased odds of incident heart failure in patients with prior ischemic cardiac events: 2.34 (95%CI 1.26-4.16, p=0.005) and 2.11 (95%CI 1.05-4.2, p=0.033) respectively. Among the non-ICI treated cancer patients, multivariate logistic regression found no association between prior ischemic events and incident heart failure (1.23, 95%CI 0.53-2.63, p=0.6), but hypertension showed an association (1.74, 95%CI 1.07-2.87, p=0.027). Conclusion This study emphasizes vigilance for cardiovascular complications in PD1 inhibitor-treated cancer patients. The incidence of heart failure was 6.5% over a follow-up period of less than 1 year. Prior ischemic events correlate with increased heart failure risk, suggesting a need for nuanced patient management. Understanding ICIs' cardiovascular safety is crucial for risk assessment, treatment optimization, and patient well-being.

Prognostic parameters predict cardiac events in Brugada syndrome: a meta-analysis

Abstract Background Brugada syndrome (BrS) is recognized as a cause of sudden cardiac death (SCD), ventricular tachycardia or ventricular fibrillation (VT/VF). However, the prognosis varies among the patients with Brugada electrocardiograph (ECG) pattern. Furthermore, there is no prognostic tool to predict the worsening cardiac outcomes in BrS. Objectives Primary outcome was to assess the association between risks including patient history, ECG pattern, electrophysiology study (EPS) findings and cardiac events which is identified as VT/VF or SCD. Method We performed a meta-analysis of prospective and retrospective cohort studies which assessed the risks and cardiac events in patients with BrS. Pooled hazard ratios (HRs) was analyzed by using Random-effect model. Result A total of 27 studies involving 15,990 BrS patients. Of these, 17 were retrospective studies and 10 were prospective studies. In univariate analysis, the risks including male, aborted SCD, QRS duration≥120 msec, fragmented QRS (multiple spikes within the QRS complex in lead V1-V3), late potential (positive terminal filtered QRS complex of signal-averaged ECG), sinus node dysfunction or inducibility of ventricular tachyarrhythmias during EPS associated with a higher risk of cardiac events in BrS. In multivariate analysis, higher risks of cardiac events were associated in BrS patients with history of syncope (HR 2.65, 95% confidence interval (CI): 1.68-4.19, I2 = 54 %, p-value &amp;lt;0.001), family history of SCD (HR 2.64, 95%CI:1.39-5.01, I2 = 0%, p-value = 0.003), prior VF (HR 14.52, 95%CI: 3.36-62.84, I2 = 62%, p-value &amp;lt;0.001), type 1 Brugada ECG pattern (HR 2.07, 95%CI: 1.13-3.79, I2 = 0%, p-value = 0.018), spontaneous type 1 ECG pattern (HR 1.91, 95%CI: 1.01-3.61, I2 = 58%, p-value = 0.046), early repolarization pattern (HR 2.78, 95%CI: 1.9-4.07, I2 = 0%, p-value &amp;lt; 0.001) and history of atrial fibrillation before BrS diagnosis (HR 1.82, 95%CI: 1.03-3.23, I2 = 49%, p-value = 0.039) (Table 1). Conclusion Our findings suggest that patient history, ECG pattern, EPS findings can predict the cardiac events. Introducing a risk prediction model could aid in early management of BrS.

Lymphadenopathy in systemic lupus erythematosus: no microbial trigger found by shotgun metagenomics in a retrospective study on 38 patients.

Lymphadenopathy is a classical manifestation of systemic lupus erythematosus (SLE) flare, occurring in approximately half of patients during the course of the disease. Lymphadenopathy in SLE is frequently associated with fever. Microbial infection may play a role in SLE onset and flares. Objectives of this study were to describe lymphadenopathy in the course of SLE and identify potential infectious triggers using microbial metagenomic analysis. We performed a retrospective monocentric study of 38 patients with SLE who had lymph node biopsy at baseline or during follow-up. Shotgun metagenomics were performed in patient's lymph node biopsy to look for microbial RNA and/or DNA. Lymph node pathological analyses revealed follicular and/or paracortical hyperplasia 73.7% of patients and histiocytic necrotizing lymphadenitis 23.7%. At the time of biopsy, SLE patients exhibited fever in 29%, splenomegaly in 10%, cutaneous manifestations in 47%, polyarthritis in 32%, seritis in 13% and lupus nephritis in 18%. Half of patients (50%) had increased CRP level, 35% had low C3, 65% had hypergammaglobulinemia. Microbial metagenomic analysis of lymph node biopsy did not reveal the presence of microbial DNA in 92% of patients, the presence of CMV in very small quantities in 2 patients, and the presence of HHV-7 in low quantities in a single patient. Despite suggestion that certain microorganisms may play a role in the pathogenesis and flares of SLE, our microbial metagenomic analysis study did not highlight possible infectious triggering factors. Further and better-designed studies are needed to confirm these results.

Characteristics of adolescent and young adult patients with cancer receiving home-based palliative care: A retrospective study at a single center.

Adolescents and young adults (AYA) with cancer require highly individualized, age-specific end-of-life care. This study identified the characteristics of AYA patients with cancer receiving home-based palliative care and explored their unique needs and challenges compared with other age groups. This retrospective cohort study analyzed the medical records of AYA patients with cancer to compare home-based palliative care characteristics with those of older age groups. The study included 81 AYA patients with cancer aged 16-39years who had received home palliative care at a single institution from 2013 to 2023. They were compared with 5,017 patients with cancer aged 40years and older. Patient background, duration of home end-of-life care, sedation, and association with social factors were examined retrospectively from medical records. The median age of AYA patients with cancer was 34years; 65.4% were female. The primary cancer sites were gastrointestinal (34.6%) and thoracic (23.5%), with 80.0% at Stage IV. The median home care duration was 28.5days, shorter than that for older patients (40days) (p < 0.0001). Home care rates were similar between AYA and older patients (82.4% vs. 79.9%, p = 0.16). Sedation was more common in the 30-39 age group than in the 16-29 group (33.3% vs. 6.3%, p = 0.049). AYA patients with cancer achieved a high rate of end-of-life care at home, although their duration of home care was shorter. The characteristics of home care varied depending on the primary site and age, highlighting the importance of creating highly individualized care plans.

The Role of Ibuprofen and Midazolam in Pediatric Dentistry: A Retrospective Study and Neurophysiological Considerations

Background: Managing anxiety and behavior during pediatric dental procedures is challenging. This study examines the effects of combining ibuprofen with midazolam sedation using both behavioral management and clinical hypnosis to improve patient cooperation and reduce post-treatment pain. Methods: A retrospective cohort study of 311 children (mean age 74.2 months, standard deviation (SD) = 24.7) was conducted. Patients received either midazolam with ibuprofen (n = 156) or midazolam only (n = 155). Behavior was assessed using the Venham Behavior Rating Scale and anxiety with the Dental Subscale of Children’s Fear Survey Schedule (CFSS-DS) and the Inventory of Stressful Situations (ISS) questionnaires. Statistical analyses included Mann–Whitney U tests and correlation analyses. Results: Ibuprofen did not significantly improve behavior during procedures (drinking phase 0.61, SD 1.31, p = 0.13; before treatment 0.25, SD 0.93, p = 0.53, anesthesia 1.21, SD 1.55, p = 0.29; after treatment 0.51, SD 1.22, p = 0.68), indicating that pharmacological pain management alone is insufficient to address behavioral challenges. Ibuprofen significantly reduced post-treatment pain, with 7.2% of cases reporting pain in the non-ibuprofen group compared to none in the ibuprofen group (p &lt; 0.05). Conclusions: Ibuprofen had no effect on intraoperative behavior and only a limited effect on post-procedural pain, mainly for more invasive procedures. This study highlights the integration of sedation with behavioral strategies, such as clinical hypnosis, to manage anxiety and improve patient cooperation, aiming to enhance treatment outcomes using this integrative approach to pediatric dentistry. Further research is needed to optimize these strategies and verify them in a prospective setting.

Diffuse alveolar hemorrhage: a retrospective study from a tertiary care center.

Diffuse alveolar hemorrhage (DAH) is characterized by a syndrome of alveolar bleeding, a fall in hemoglobin, and respiratory failure. It can occur because of various immunologic and non-immunologic conditions. The etiology of DAH is important, as treatment varies with the etiology. This retrospective observational study evaluates the diverse etiologies, time to diagnosis from symptom onset, management strategies, and outcome of DAH in a span of 12 months at our tertiary care center. A total of 8 patients were identified with 8 different etiologies. 6/8 (75%) patients had immunologic causes, and 2/8 (25%) had non-immunologic causes of DAH. 6/8 (75%) patients were females, the mean time to DAH diagnosis was 4.25 months from symptom onset, 6/8 (75%) patients improved, and 2/8 (25%) died due to complications. It is necessary to differentiate between the etiologies of DAH and establish an early diagnosis to plan management and improve outcomes.

Is SNOT-22 a Reliable Tool During Periods of High Stress? A Retrospective Cohort Study.

To assess the impact of a major crisis, such as the October 7, 2023, terror attack, on SNOT-22 scores, especially the extra-rhinologic subdomains. This retrospective cohort study was conducted at the Rhinology Clinic in a Tertiary University Hospital. Patients who visit our Rhinology Clinic routinely complete the SNOT-22, a widely employed questionnaire designed for evaluating health-related quality of life in individuals with rhinologic conditions. Patients were divided into two groups: 5 weeks before the October 7 terror attack and 5 weeks after. Primary outcomes for analyses included the Sedaghat Subdomain model of the SNOT-22. Descriptive analysis and Welch's t-test were used to compare SNOT-22 subdomain scores between groups. A total of 159 patients completed the SNOT-22 questionnaire, with 60 before and 99 after October 7, 2023. A general decrease in average scores was observed across all subdomains, with a significant decrease in the Nasal subdomain (p = 0.0388). Subgroup analysis showed an increase in the Ear/Facial subdomain in Arabic and the Sleep and Function subdomains in English, though not statistically significant. In sex-based sub-analysis, female patients showed a significant decrease in the Emotions subdomain. Our study was unable to establish a direct link between the terror attack and specific SNOT-22 subdomains. However, the observed trends suggest that SNOT-22 may display variability or unreliability when used during periods of high stress. III Laryngoscope, 2024.

SGLT2 inhibitors in patients with amyloidosis and heart failure: a worldwide retrospective cohort study

Abstract Background Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the combined risk of death and hospitalization in patients with heart failure with reduced or preserved left ventricular ejection fraction. However, evidence of their impact on patients with heart failure due to amyloidosis is lacking. Purpose To evaluate the effects of SGLT2 inhibitors on mortality and hospitalization in patients with amyloidosis and heart failure. Methods In this retrospective cohort study, we used real-world data from 108 healthcare organizations worldwide from the global health research collaborative network TriNetX. We identified 24,619 patients with amyloidosis and heart failure without exposure to SGLT2 inhibitors (control group) and 2,988 patients with amyloidosis and heart failure under treatment with SGLT2 inhibitors (SGLTi group). We performed propensity score matching for demographic and clinical characteristics and Kaplan–Meier plots, log-rank tests, and Cox proportional hazard models were calculated. The outcomes were 12-month all-cause death and 12-month hospitalization. Results After propensity score matching, 2,237 patients were analyzed in each group. During the 12-month follow-up, 198 (8.8%) patients died in the SGLT2i group, and 431 (19.2%) patients died in the control group (hazard ratio 0.51, 95% CI 0.43-0.61). In the SGLT2i group, 974 (44.5%) patients were hospitalized, and in the control group, 1508 (53.5%) patients were hospitalized (hazard ratio 0,79, 95% CI 0.72-0.86). The Kaplan-Meier curves are shown in Figure 1. Conclusions In conclusion, in this retrospective cohort study with a large number of patients with amyloidosis and heart failure, SGLT2 inhibitors were associated with a lower 12-month all-cause mortality and hospitalization. Further evidence from randomized controlled studies are needed to confirm the efficacy of SGLT2 inhibitors in patients with cardiac amyloidosis.Figure 1.Kaplan-Meier curves

One year incidence of events after definite coronary stent thrombosis: a retrospective vs prospective comparison and a conglomerate determination of prognostic factors of mortality

Abstract Background Although many studies analysed the predictive factors of coronary stent thrombosis (ST), there are few data on prognostic factors of clinical outcomes after definite ST. The purpose of the current study was to analyse clinical presentation and outcomes at one year after definite coronary ST in two distinct cohorts: a retrospective cohort and a prospective cohort and to determine the prognostic factors. Methods Among 22’039 consecutive patients treated between January 2008 and December 2021, 275 patients presented a definite ST and were included in this study (retrospective cohort n=83 and prospective cohort n=192). Baseline characteristics, clinical ST presentation and 1-year outcomes were analysed between the two cohorts using SPSS Software. According to the obtained results data of both cohorts were pooled and prognostic factors of clinical outcomes determined using multivariate analysis. Results There was no statistical difference between the two cohorts concerning baseline characteristics and clinical ST presentation. All-cause mortality and MACE rate up to 1 year follow-up did not differ either among cohorts (16.9% vs 14.6%, p=0.764 for mortality (Figure 1) and 26.5% vs 24% p=0.766 for MACE). Multivariate analysis of the aggregated data of both prospective and retrospective cohorts revealed age (OR: 1.05 95% CI [1.02;1.09]; p=0.0016), early stent thrombosis (OR: 3.3 95% CI [1.52;7.15] p=0.002), severe renal failure (OR: 3.37 95% CI [1.35;8.42] p=0.009), clinical presentation (cardiogenic shock [OR: 2.92 95% CI {1.17;7.28} p=0.02] and cardiac arrest [OR: 15.3 95% CI {6.62;35.39} p&amp;lt;0.0001]) as strongly associated with a higher risk of death at 1 year whereas higher LVEF was a protective factor (OR: 0.922 95% CI [0.891; 0.955] p&amp;lt;0.0001). Conclusion Comparing retrospectively collected data versus prospectively collected data for definite ST showed very similar data concerning qualitative variables (e.g. baseline characteristics and clinical presentation of ST) suggesting feasibility of data pooling to determine prognostic factors of clinical outcome at one year. Prognostic factors influencing one-year all-cause mortality were age, early ST thrombosis, renal failure, residual LVEF and clinical presentation.Figure 1

Impact of obesity on pathological complete remission in early stage breast cancer patients after neoadjuvant chemotherapy: a retrospective study from a German University breast center.

Breast cancer is a primary cause of cancer-related death among women worldwide. Neoadjuvant chemotherapy (NACT) is a cornerstone treatment for locally advanced, non-metastatic breast cancer. Achieving pathological complete response (pCR) is often used as a surrogate marker for long-term outcomes. This study examines the impact of obesity, defined by a body mass index (BMI) over 30kg/m2, on achieving pCR in patients with early stage breast cancer (eBC) undergoing NACT. A retrospective analysis was conducted on patients with eBC treated with NACT at the University of Tübingen. The primary objective was to assess the impact of obesity on achieving pCR. Logistic regression analysis was used to determine the association between pre-treatment BMI and pCR, adjusting for covariates such as age, tumor stage, grading, and chemotherapy intensity. The study included 325 patients, with 24% classified as obese. While the univariate logistic regression analysis showed no significant impact of obesity on the odds ratio of achieving pCR, the multivariate analysis, accounting for covariates, demonstrated that obese patients had a significantly higher likelihood of achieving pCR. In this retrospective study, obesity significantly affected the likelihood of achieving pCR in patients with eBC cancer undergoing NACT after adjusting for covariates. While obesity is a known risk factor for breast cancer development and progression, its impact on the efficacy of NACT in terms of achieving pCR was positive in our study. These findings contribute to the ongoing debate in the literature, though the retrospective design and potential uncontrolled factors should be considered.

Clinical profile and outcomes of patients with chronic kidney disease on chronic hemodialysis hospitalized for acute coronary syndrome in a tertiary public hospital in the Philippines

Abstract Introduction Acute coronary syndrome (ACS) and end-stage renal disease (ESRD) are both prevalent globally. Of the many risk factors for ACS, chronic kidney disease (CKD) remains to be of great concern because the interplay of cardiac and renal disease is inherently complicated. Cardiovascular mortality rates are 10-30 times higher in the ESRD population. The risk for cardiovascular disease in CKD extends beyond the traditional risk factors. Purpose The guidelines for ACS may not be applicable to the ESRD population because the landmark ACS trials mostly excluded ESRD patients. Due to the gaps in knowledge regarding ACS in ESRD, our study sought to explore the clinical profile and outcomes of these patients in the our institution. Methods We did a retrospective cohort study among ESRD patients presenting with ACS in our institution from May 2021 to November 2023. The data was analyzed using univariate and bivariate statistics using PRISM software. Results A total of 48 patients with ESRD were admitted for ACS in this study - 8 with STEMI and 40 with NSTEMI. The mean age was 61 years old and 33 (68.8%) were male. The average length of hospital stay was 12 days. The most common comorbidities were hypertension (91.7%), heart failure (83.3%), and diabetes mellitus (60.4%). The most common cause of ESRD in our cohort is concomitant hypertensive and diabetic kidney disease (45.8%) with an average length of hemodialysis at 31 months. The most common chief complaints were chest pain (39.6%), dyspnea (29.2%), and decreased sensorium (10.4%). On admission, 18 (37.5%) presented with systolic BP &amp;gt;160mmHg, 7 (14.6%) presented with shock, and 4 (8.3%) presented with cardiac arrest. On electrocardiogram, 21 (43.8%) had left ventricular hypertrophy while 34 (70.8%) had cardiomegaly on chest radiography. On two-dimensional echocardiogram, the average left ventricular ejection fraction was 46% and 27 (90%) had segmental wall motion abnormalities. The most common angiographic finding was 3-vessel coronary artery disease (50%). Only 5 patients (10.4%) had an LDL-C greater than 55mg/dL. Among those with STEMI, 6 (75%) presented with Kilip II or more. While among those with NSTEMI, 27 (67.5%) had a TIMI risk score &amp;gt;2. Almost all patients received dual-antiplatelet therapy, high dose statin, and beta-blocker. The mortality rate was 43.8% with acute coronary syndrome being the most common cause of death. Conclusion Our study did not show significant associated predictors of mortality possibly due to the low sample size. Despite this, our study portrays that patients admitted for ACS with ESRD present with higher risk features reflected by derangement in vital signs, abnormal laboratories, significant imaging abnormalities, high prognostication scores, and high in-hospital morbidity.Predictors of Mortality