Inadequate Treatment Of Patients Research Articles

Complications of revision knee arthroplasty

Due to the growing scale of arthroplasty and the widening of indications for knee joint replacement, the durability of joint functioning has become a critical issue. Untimely diagnosis and inadequate treatment of patients with endoprosthesis component loosening leads to major bone defects. This problem arises from repeated joint interventions, large bone defects and duration of revision surgeries, that is fraught with catastrophic consequences for patients – revision prosthesis removal or even limb amputation. The project aims to improve the treatment for patients with instability of components after knee joint arthroplasty. The aim of the study is to analyze the results of revision knee arthroplasty and identify the causes of mistakes and complications of revision arthroplasty with the intention of prevention. Materials and methods. A retrospective analysis of 50 revision knee arthroplasties performed at the Centre for Arthroplasty of the State Institution “Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine” was conducted. Clinical and radiological findings were evaluated for all patients. All revision prostheses used in this study were of the semi-constrained type. Cementation technique was used for all implants. In the revision of the septic complication group, a full cementation technique with antibiotics according to a sensitivity profile were used, while in the aseptic complication group, a surface cementation technique with antibiotics according to sensitivities were used. Results. The authors of the project have analyzed the results of treatment of 50 revision arthroplasty procedures performed between 2013 and 2022 for instability of the endoprosthesis components. The structure of complications has been examined and the causes of failure in revision knee arthroplasty have been identified. This study has shown promise in preventing complications and developing personalized approaches to revision arthroplasty. Conclusions. The analysis of revision knee arthroplasty failure has shown the prevalence of septic complications (56.0 %). In the case of septic complications after revision arthroplasty, Staphylococcus aureus prevailed (57.1 %), gram (-) microorganisms were causative agents in other cases. Factors resulting in aseptic complications included those associated with the surgical intervention (81.8 %), the patient (45.4 %) and the combination thereof (72.7 %). Significant causes of the femoral revision component loosening were residual valgus deformity, medial instability in the frontal plane; significant causes of the tibial component loosening were residual varus deformity and lateral instability in the frontal plane.

Abstract C006: Combining the methylation and gene expression contiguous signals leads to better pancreatic cancer patient stratification and early detection

Abstract Background Pancreatic cancer (PAC) lacks methods for screening, patient stratification, resulting in late diagnosis and inadequate treatment of patients. Cell-free DNA (cfDNA) methylation patterns are signals representing real-time cancer characteristics such as early presence, tissue, and cell of origin. The aim of this study is to provide a better patient stratification based on differential patterns on the combined methylation and gene expression results in PAC and normal samples and provide proof-of-concept for early detection. Method Differential methylation region (DMR) analysis was performed on 180 TCGA PAAD and normal tissue samples using paired methylation and expression data. Validation was done on 143 Infiltrating duct carcinomas (IDC), (stage I, II, II), and 4 normal samples and the 4 probe clusters (FPC) were defined based on their methylation status: HM = high methylation, IM = intermediate methylation, LM = low methylation and MM = minimum methylation. 3-year and 5-year survival analysis with Kaplan-Meier was done. Gene ontology (GO) and Biological Pathway analyses (PA) were performed on DMRs of FPC. Integration analysis on paired methylation and expression data and the limma analysis was performed for significant genes in 5000 bp vicinities of the selected DMRs. Finally, selected 23 DMRs, were targeted in plasma cfDNA from 9 PAC patients (stage I-III) and 20 matching control samples. Results The survival analysis of FPC, shows the highest probability difference between HM and MM groups with p-values of 0.018 and 0.029 for 3-year and 5-year survival, respectively. Variability analysis shows 5740 significant CpG sites and 1135 significant DMRs comparing IDC tumor samples to controls. GO and PA on DRMs of FPC, indicated the most PAC specific pathways in the group of probes with MM status. Integration analysis on the methylation and mutation data of the selected genes of GO analysis shows potential to discriminate between normal and PAC patients and in between HM and MM groups and showed smaller mutation burden in MM and LM sample groups. Comparing MM to HM groups of patients, shows the highest significance in 5 downregulated genes in 5000 bp vicinity from Hypermethylated probes and 13 upregulated genes and 425 regions in 5000 base pairs vicinity from 170 hypomethylated probes. Survival analysis on the selected genes showed a very high correlation between the expression of the genes like SIX2, DNMT3A, ZFP91 and POR and the survival probability on FPC. Additionally, it has been shown that the selected DMRs, show good individual performance of AUC >0.95 in the in-house analysis of plasma cfDNA targeted data from 9 PAC patients (stage I-III) and 20 matching control samples. Conclusion Methylation markers carry distinct biological signals and combined with gene expression differentiate the PAC patient groups, showing potential of the methylation signals for better patient stratification outcomes for improved survival. High accuracy for cancer detection was observed for early-stage cancers when compared to cfDNA from matching controls. Citation Format: Pardis Saadatmand, Urban Kunej, Kristi Kruusmaa. Combining the methylation and gene expression contiguous signals leads to better pancreatic cancer patient stratification and early detection [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Pancreatic Cancer; 2023 Sep 27-30; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(2 Suppl):Abstract nr C006.

The consequences of Sudan’s armed conflict on public health: a closer look at the devastating impact

The consequences of Sudan’s armed conflict on public health: a closer look at the devastating impact

Ferraz de Vasconcelos syphilis: epidemiological profile, investigation and evolution of cases

Abstract The increased incidence of syphilis in Brazil can be explained by multiple reasons: increased reports of acquired syphilis, increased coverage of rapid tests in pregnant women provided by the Brazilian Ministry of Health, reduced condom use, inadequate treatment of patients and partners. In Ferraz de Vasconcelos, a city in the metropolitan region of São Paulo, an increasing elevation in syphilis cases in healthcare services and in the epidemiological surveillance system. In 2017, the city reported 148 cases from which 27 cases were congenital syphilis, with one death. The purpose of the survey was to evaluate the cases reported and describe the main sociodemographic, epidemiological, clinical, and syphilis investigation. A high incidence of syphilis in adults, pregnant women, and congenital syphilis was recorded with a detection rate of 45.0 per 100,000 in habitants and 12.4 and 9.3 per 1,000 live births, respectively. These rates reflect failures in the diagnosis, treatment, and follow-up of cases. Syphilis in adults was obtained in this study in a higher incidence in men 54.1%.Being 49.4% between brown and black people. It is noteworthy that more than 97% of the pregnant women reported with syphilis underwent prenatal care; however, 36.1% of them started from the second trimester, only 88.9% were given treatment, and 66.7% with record of healing. In addition, only in 27.8% pregnant women, the sexual partner underwent the specific treatment. Regarding congenital syphilis, only 81.5% newborns were given proper treatment and only 55.6% underwent laboratory investigation of cerebrospinal fluid. It is evident that these results expose the weaknesses of the municipal healthcare system. Greater coordination among services can contribute to early diagnosis and active search of cases. The epidemiological bulletin containing data from this study may enhance the organization of syphilis prevention, planning, and surveillance actions in the city. Key messages The increased incidence of syphilis in Brazil can be explained by multiple reasons: increased coverage of rapid tests on people, reduced condom use, inadequate treatment of patients and partners. Greater coordination among services can contribute to early diagnosis and active search of cases.

Healthcare Experiences of Men Who Have Sex with Men: Understanding Trauma, Patient-Provider Relationships, and the Lasting Impacts of the AIDS Crisis

Studies of patients’ health outcomes and the quality of healthcare services show that the patient-provider relationship is crucial, and further, that a patient-centered approach to care is essential for effective public reporting and ensuring high quality health-care results (Theis 2016). However, what might happen if a patient-provider relationship is undeveloped, or even hostile? Inadequate treatment of patients in medical settings is a common experience of sexual minorities, who have historically experienced greater burdens of disease and discrimination. This study explores the narratives and lived-experiences of MSM to better understand the patient-provider relationships for MSM, and to some extent queer people in general, given the growing social and political acceptance of queer identities. MSM is the population of interest because it is a historically marginalized group that reports significant incidence of stigma, especially surrounding their sexual health and sexual behaviors. In order to assess how the evolving social landscape has affected the experiences of MSM, 20 men were interviewed about their healthcare experiences; 10 of these men were between the ages of 18 and 49, and the remaining 10 men were 50 years old or older. Through a comparative analysis, this study assesses differences and similarities in healthcare experiences—as well as the subsequent health-related needs and preferences—of participants, particularly with regard to social trauma, medical trauma, and their proximity to the AIDS crisis of the 1980s. Studies of patients’ health outcomes and the quality of healthcare services show that the patient-provider relationship is crucial and that a patient-centred approach to care is essential for ensuring high-quality healthcare results. However, what might happen if a patient-provider relationship were undeveloped, or even hostile? Inadequate treatment of patients in medical settings is a common experience of sexual minorities, who have historically experienced greater burdens of disease and discrimination. This study explores the lived experiences of men who have sex with men (MSM) to better understand their patient-provider relationships. MSM are the population of interest because they are historically marginalised and stigmatised, especially surrounding their sexual health and sexual behaviours. In order to assess how an evolving social landscape has affected the experiences of MSM, 20 men were interviewed. Among them, 10 men were between the ages of 18 and 49, and 10 were 50 or older. Through a comparative analysis, this study assesses differences and similarities in healthcare experiences – and the resulting health-related needs and preferences – of participants, particularly with regard to social trauma, medical trauma, and their proximity to the 1980s AIDS crisis. Additionally, race, ethnicity, and language emerged during interviews with participants of colour as salient factors which impacted their healthcare experiences.

New Hampshire Hospital ‘Stays Safe’ Through Violence-Reduction Program

New Hampshire Hospital ‘Stays Safe’ Through Violence-Reduction Program

Better resource utilisation and quality of care for ovarian cancer patients using internet-based pathology review

Background:The current literature indicates that a considerable number of patients in ovarian carcinoma clinical trials have histopathological diagnoses in conflict with inclusion criteria. It has been suggested that specialised pathology review prior to randomisation should become the standard procedure in study protocols. We hypothesised that our new, internet-based high-throughput infrastructure would be capable of providing specialised pathology review within 10 working days (w.d.).Methods:Patients scheduled for the AGO OVAR17 ovarian carcinoma chemotherapy trial were registered for expert pathologic case review using a new internet-based central pathology review platform prior to randomisation. All original slides were requested from local pathologists. Slides were scanned and uploaded to a secured internet server. A network of experienced gynaecological pathologists was connected to the server through a custom-designed software platform. If deemed necessary by the expert pathologists, immunohistochemistry was available through a collaborating pathology lab.Results:A total of 880 patients with an original diagnosis of ovarian epithelial carcinoma were registered for expert pathology review from October 2011 to July 2013. For case review, five gynaecopathologists from Austria, Switzerland and Germany were available online. Median number of w.d. required to complete the whole process from patient registration to transmission of final review diagnoses was 4 (range 2–31) (w.d.), and in 848 out of 880 (97.5%) cases, it amounted to ⩽10 w.d. In 2.5% (n=22) of cases, a major diagnostic discrepancy of potential clinical relevance was found leading to exclusion from the chemotherapy trial.Conclusions:Our results show that the use of a new internet-based infrastructure makes timely specialised case review, prior to patient randomisation feasible within ⩽10 w.d. Our new approach helped to protect against overtreatment with chemotherapy of patients with ovarian borderline tumours and inadequate treatment of patients with ovarian metastases, as a result of their inappropriate entry into a clinical trial designed for patients with primary ovarian carcinoma.

PRIMARY IMMUNODEFICIENCY: STATUS OF A PROBLEM TODAY. RUSSIAN NETWORK OF JMF-CENTERS

The problems of primary immunodeficiency in Russia and the ways of solving of them are discussed in the article. Primary immunodeficiency is a group of rare diseases, so awareness of this pathology in the medical community and among patients is very low. This leads to late diagnosis and inadequate treatment of patients with such conditions. The result of the late beginning of treatment is early development of disability, and the high mortality rate of patients, as well as the high costs of the treatment of complications of primary immunodeficiency and sick-leave certificates for the government. Today in time and adequate therapy allows patients not only to reach adulthood without signs of disability, and to lead an active way of life, but to have healthy children. Given the high cost of therapy in many countries, the issue of providing patients with life-saving drugs remains unresolved. The global practice is to involve social organizations and funds. One of the foundations supporting educational programs, development of laboratories and research in the field of primary immunodeficiency is the Foundation of the Jeffrey Modell. A network of centres for primary immunodeficiency supported by the Jeffrey Modell Foundation (JMF-centers) has started its functioning over the territory of the Russian Federation since 2011 in order to improve diagnostics and treatment of patients with primary immunodeficiency. A brief description of activity of these centers is presented in the article.

Economic Analysis of the Use of Limited Coronal Computed Tomography Scans in the Management of Sinusitis

As medical costs increase, less expensive alternatives to standard diagnostic tests are sought to reduce the economic burden placed on society. One alternative is using limited, non-consecutive cut computed tomography (CT) scans for the evaluation of sinonasal disease. This study evaluates the cost-effectiveness of using limited CT scans instead of full sequence CT scans in the diagnosis and management of rhinosinusitis. A Medline search was performed to obtain data for the sensitivity and specificity of limited CT scans, the prevalence of abnormal CT scans, and recommendations on using limited CT scans for operative management. A standard cost-effectiveness analysis, including a sensitivity analysis, was performed using a hypothetical population of patients with sinus complaints who failed prior appropriate medical therapy. At baseline, the limited CT scan was found to be less cost-effective than the full CT scan, costing $217.13 more per correct diagnosis. The sensitivity analysis demonstrated that changes in the prevalence of abnormal CT scans and the percentage of surgeons who would operate using a limited scan had the greatest impact on cost, whereas changes in the price of the full CT or limited CT scan had the least effect. This study finds the use of limited CT scans to be economically unsound as a method to reduce costs in the defined population. Published literature recommends obtaining a full CT scan before operative management. Basing intervention on limited CT scans increases the possibility of erroneous diagnoses leading to either excessive or inadequate treatment of patients.