Institutional Review Research Articles

The Effects of the COVID-19 Mask Mandate on Complication Rates in Postmastectomy Tissue Expansion.

Tissue expansion is a commonly used breast reconstructive strategy. Although the procedure is regarded as safe, tissue expander to implant-based breast reconstruction is reported to have the highest rates of postoperative infection among plastic surgery operations. During the COVID-19 pandemic, face masks were required at all hospital facilities at our institution. The purpose of this study is to investigate the effects of COVID-19 mask mandate on in-office breast tissue expansion procedures. An institutional review board-approved, retrospective review was completed on all patients who underwent unilateral or bilateral tissue expansion following mastectomy at a single institution in 2017 (prior to the COVID-19 mask mandate) and 2021 (following implementation of the mandate). Variables included were demographics, procedure information, and postoperative outcomes. The analysis included 118 patients in the premandate group and 147 patients in the postmandate group. There was no difference in age, body mass index, smoking status, or diabetes mellitus between the 2 groups (P > 0.05). More patients in the postmandate group underwent bilateral reconstruction as opposed to unilateral when compared with the premandate group (70.7% vs 55.9%, P = 0.014). There were no differences in major complication rate (26.3% vs 30.6%, P = 0.495) or minor complication rate 30.5% vs 26.5%, P = 0.495) between the pre-mask and post-mask mandate groups. Our results demonstrated that the use of face masks did not play a significant role in complication rates relating to in-office tissue expansion procedures. It remains up to the discretion and comfortability of the provider if masks should be worn during the procedure.

INhaled Sedation versus Propofol in REspiratory failure in the Intensive Care Unit (INSPiRE-ICU1): protocol for a randomised, controlled trial

IntroductionSedation in mechanically ventilated adults in the intensive care unit (ICU) is commonly achieved with intravenous infusions of propofol, dexmedetomidine or benzodiazepines. Significant limitations associated with each can impact their...

Single institution review of operative management of giant omphalocele

PurposeOperative management of giant omphalocele that cannot be closed primarily varies based on several factors, and there is little data to guide choice of operative approach and how this impacts long-term outcomes. We aimed to characterize whether surgical approach – staged closure during the neonatal period, or delayed closure – affects outcomes. MethodsWe conducted a retrospective review of children treated for giant omphalocele who did not undergo primary closure at Children's Hospital Colorado from 2010–2022. We included patients with giant omphalocele who underwent treatment at the study site. Data collected included patient characteristics, clinical course, and outcomes. Comparisons were made based on type of closure, delayed versus staged. ResultsWe identified 24 patients; 6 delayed and 16 staged. 2 patients died prior to closure. Delayed and staged groups did not differ regarding demographics. Infants undergoing staged repair tended to have more total hospital and total ventilator days, and more post-closure ventral hernia requiring repair; short-term outcomes were otherwise comparable. There was no difference between groups in long-term outcomes, including neurodevelopmental milestones and mortality. ConclusionsLong term outcomes are equivalent between staged repair and delayed repair of giant omphalocele. However, staged repair may be associated with more ventilator days, total hospital days and higher risk of ventral hernia.

Role of Humour in Nursing Pedagogy.

To explore nursing educators' perceptions about using humour as a teaching strategy in the classroom setting. Qualitative study. Place and Duration of the Study:Shifa College of Nursing, Shifa Tameer-e-Millat University, Islamabad, Pakistan, from September 2021 to January 2022. Twelve educators from the Bachelor of Science in Nursing (BScN) programme were purposefully selected for their rich and expressive insights. Institutional Review Board approval was obtained, and participants provided informed consent with the option to terminate interviews at any time. Data were collected and analysed simultaneously using content analysis, with rigour maintained per Lincoln and Guba's 1985 trustworthiness framework. The study revealed four key categories from educators' perspectives on using humour as a teaching strategy. First was the humour and learning, with innate vs. acquired competency and teaching phases. Second was the inside track, encompassing revitalisation, critical thinking, eco-friendliness, encouragement culture, self-esteem, and confidence. Third was provocation; with subcategories of language and student diversity. Fourth was the way forward addressed humour applicability and classification. The study explored the importance of humour as a teaching strategy in the classroom, stressing the need to consider context, subject matter, and diverse student needs. It underscores a balanced approach that engages students and fosters inclusivity. The findings are individual differences. Future research should explore the long-term impact and how training can help teachers effectively using humour as a teaching tool. Humour teaching strategy, Nursing, Nursing educator, Learning, Pedagogical tool.

Effectiveness of meaning in life intervention programme in young and middle-aged cancer patients: study protocol for a randomised controlled trial

IntroductionDiminished levels of meaning in life can have a range of detrimental effects on cancer patients, including heightened anxiety, depression, psychological distress, reduced quality of life and, in severe cases,...

Thriving Through Pain: A Whole-Person and Resilience Comparative Study Using Mobile Health Application Technology for Individuals With Self-Reported Pain Challenges

BackgroundPain is a complex condition and affects one's life beyond physical symptoms. National pain management recommendations include a whole-person approach that includes strengths (or resilience). PurposeThe purpose of this study was to examine de-identified data from the MyStrengths+MyHealth application to examine, Strengths, Challenges, and Needs for the population and a subset of the data for those with and without self-reported Challenges in the Pain concept. DesignThis cross-sectional comparative study used de-identified consumer-generated whole-person strengths data from the MyStrengths+MyHealth (MSMH) application. MethodsData was collected from various community settings between 2019 and 2023 and approved by the University's Institutional Review Board. From the sample population (N=1737), we identified those with self-reported Pain (n=1280) and without self-reported Pain (n=457) and compared Strengths, Challenges, and Needs. ResultsThe sample population (N=1737) was largely in the age range of 45-64 years (51.2%), Male (56.4%), White (90.5%), non-Hispanic/Latino (86.6%), and Married (74.2%). The Pain group (n=1280) reported significantly fewer Strengths (p<0.001) and more average Challenges and Needs (p<0.001) than the Without Pain Group (n=457) across all concepts. For the Pain Group, the most frequent Strength reported was Role Change (70.5%), the most frequent Challenge Nutrition (96.1%), and the greatest Need was Income (89.9%). ConclusionsDespite reporting Challenges and Needs, the Pain Group identified many Strengths. The Pain Group identified Role Change (70.5%) as a top Strength was surprising and may suggest adaptability to chronic pain. MSMH has potential to empower individuals to provide a comprehensive whole-person assessment and resilience which may be particularly useful for those living with chronic pain. Clinical ImplicationsThis study has clinical implications for supporting the use of digital health tools such as mobile applications for capturing contextual data directly from patients to enable nurses to provide more accessible and personalized care to patients.

Diaphragm-sparing efficacy of subparaneural upper trunk block for arthroscopic shoulder surgery: A randomised controlled trial.

Inter-scalene block (ISB) is associated with an inevitable risk of hemi-diaphragmatic paresis (HDP). To reduce the risk of HDP, an upper trunk block (UTB) has been proposed at the brachial plexus division level. We hypothesised that UTB would be associated with a lower incidence of HDP than ISB while providing sufficient analgesia following arthroscopic shoulder surgery. Randomised controlled trial. A tertiary teaching hospital. Seventy patients aged 20 to 80 years undergoing arthroscopic rotator cuff repair. Ultrasound-guided ISB or UTB was performed with 5 ml 0.75% ropivacaine. The primary outcome was the incidence of complete HDP, assessed by diaphragm excursion using ultrasound, defined as a decrease to 25% or less of baseline or occurrence of paradoxical movement. Postoperative pulmonary function change, pain scores, opioid consumption and pain-related outcomes were the secondary outcomes. The UTB group had a significantly lower incidence of complete HDP than the ISB group [5.9% (2/34) vs. 41.7% (15/36); absolute difference, 35.8%; 95% confidence interval (CI), 17.8 to 53.7%; P < 0.001]. The postblockade decline in pulmonary function was more pronounced in the ISB group than that in the UTB group. The pain score at 1 h postoperatively was not significantly different between the groups (ISB vs. UTB group: median 0 vs. 1; median difference, -1; 95% CI, -2 to 0.5). No significant difference was observed in any other secondary outcomes. UTB was associated with a lower incidence of HDP compared with ISB while providing excellent analgesia in arthroscopic shoulder surgery. Clinical Trial Registry of Korea ( https://cris.nih.go.kr ) identifier: KCT0007002. Chungnam National University Hospital Institutional Review Board No. 2021-12-069.

Risk Factors for Delayed Treatment of Gonorrhea and Chlamydia in Active-Duty Service Members.

Sexually transmitted infections including gonorrhea and chlamydia are common in the active-duty military population, with historically higher rates than their civilian counterparts. Prevention and screening are 2 of the main strategies used to reduce the chronic medical complications and costs associated with untreated gonorrhea and chlamydia; however, there is little information in the literature regarding treatment time after a positive screening. To our knowledge, there has not yet been a study regarding delayed treatment of gonorrhea and chlamydia in the active-duty population. We performed a population-based retrospective observational study on active-duty service members (ADSMs) diagnosed with gonorrhea and chlamydia from 2010-2019. Statistical analysis was performed to determine differences in treatment times for key demographics. This study was reviewed and approved by the Brooke Army Medical Center Institutional Review Board. Average treatment time was 3.5 days for individuals with chlamydia and 5 days for those with gonorrhea. Treatment within 2 weeks was met for 94% of people diagnosed with chlamydia and 91% of people diagnosed with gonorrhea. Delay in treatment times for chlamydia were seen in men, ages 25-34, full-time active-duty service members, those with a history of prior infection, and soldiers in the Army. Gonorrhea treatment times were delayed in men, members of the Coast Guard, ages 35-44, and those with a history of prior infection. Significant differences in treatment time were seen based on sex, age, branch of service, rank, and history of prior infection.

Morphometric analysis of pituitary gland using magnetic resonance imaging in Indian subjects

Background: Before the advent of magnetic resonance imaging (MRI), the radiological assessment of the hypothalamic-pituitary region relied on plain radiographs and computed tomography scans. However, contemporary medical practice now widely recognizes MRI as the preferred imaging modality for this purpose. The objective is to investigate variations in size and morphology of the pituitary gland associated with age and gender. Aims and Objectives: (a) The aims of this study were as follows: To establish normative measurements of pituitary gland in South Indian population. (b) To evaluate the relationship between gender, weight, height, and body mass index in different patients using conventional MRI sequences. Materials and Methods: This cross-sectional study, approved by the Institutional Review Board, included the enrolment of 140 normal individuals. The dimensions of the pituitary gland were assessed in 140 individuals exhibiting apparently normal pituitary gland function. The height and length of the pituitary gland were measured utilizing mid-sagittal T1-weighted images (T1-WI) obtained through MRI. The width of the pituitary gland was determined using coronal T1-WI, and the pituitary gland volume was subsequently calculated. Results: This study comprised 98 females and 102 males. The anteroposterior dimension, height, and volume of the pituitary gland showed statistically significant correlations with age (P&lt;0.05), while the transverse dimension did not show a significant correlation with age (P&gt;0.05). The shape of the pituitary gland was found to have statistically significant correlations with age and gender. Conversely, the transverse diameter, height, and volume of the pituitary gland showed no significant correlations. Conclusion: The findings underscore the importance of considering pituitary size, shape, and volume in the evaluation of neuroendocrine disorders.

Posttransplant Lymphoproliferative Disorder in Pediatric Solid-Organ Transplant Recipients: A 7-Year Single-Center Analysis.

Posttransplant lymphoproliferative disorder is a consequential complication following solid-organ transplant, particularly associated with the Epstein-Barr virus. We studied a single center's cases of pediatric posttransplant lymphoproliferative disorder for a 7-year period and focused on incidence rates, anatomic sites involved, and correlation with clinical outcomes. We explored clinical features and treatment outcomes in patients with pediatric posttransplant lymphoproliferative disorder, with emphasis on patient survival and associated clinical ramifications. This was a retrospective analysis of medical records from pediatric solid-organ transplant recipients (liver or kidney) at Baskent University Ankara Hospital Organ Transplantation Center between January 1, 2017, and January 1, 2024, approved by the Institutional Review Board (KA24/63). We identified cases based on pathology-confirmed persistent lymphadenopathy or tumorous lesions. Patient categorization distinguished between malignant and benign groups. Early posttransplant lymphoproliferative disorder was defined within the initial year after transplant. Epstein?Barr virus association was determined through in situ hybridization, and patient characteristics were reviewed comprehensively. In 7 years, 10 pediatric patients (9 liver transplants, 1 kidney transplant) were diagnosed with posttransplant lymphoproliferative disorder, with an incidence of 8.7% for pediatric liver transplants. Mean age at diagnosis was 46.4 months, and mean time from transplant to diagnosis was 21.2 months. The most common complaints at diagnosis included fever, lymphadenopathy, hepatosplenomegaly, dyspnea, and diarrhea. Treatment modalities included rituximab, immunosuppression reduction, intravenous immunoglobulin therapy, and chemotherapy (NHL Berlin-Frankfurt-Münster 90 protocols). All patients achieved remission (mean follow-up, 22.9 mo). Early diagnosis of posttransplant lymphoproliferative disorder is important, and rituximab with immunosuppression reduction is effective to achieve complete remission, particularly in early polymorphic cases. Despite challenges, all patients achieved remission, signaling improved outcomes in pediatric posttransplant lymphoproliferative disorder. Active monitoring of Epstein?Barr virus infection may further reduce posttransplant lymphoproliferative disorder complications in pediatric solid-organ transplant; hence, early diagnosis is crucial.

Chain community pharmacists’ requests for patient information during routine care

BackgroundTo optimize service provision, community pharmacists need information (e.g., laboratory values and updated medication lists), which can be difficult to obtain. Contacting prescriber offices is a common approach to obtain information but is often ineffective. Health information exchange (HIE) is one potential solution to this problem, and recent survey research has identified the information needs of independent pharmacists that could be addressed through HIE. However, the information needs of chain community pharmacists are unknown. ObjectivesThe objective of this study was to characterize the patient information requests made by chain community pharmacists during routine practice. MethodsThis electronic card study captured cross-sectional observational data on patient information requests made by chain pharmacists in central Indiana during routine practice. Only one pharmacist meeting eligibility criteria per pharmacy could submit data. Pharmacists were randomized to a two-week data collection period. In real-time, pharmacists recorded the following: type of information requested, reason for request, information source, whether initial or follow up request, modality of communication, and the time required to make the request. Data analysis occurred via descriptive statistics. The Indiana University Institutional Review Board approved all study procedures. ResultsNineteen of the 33 eligible pharmacists (57.6%) consented to the study. Most participants held a PharmD degree (78.9%) and were the pharmacy manager (89.5%) at their location. Updated medication orders/lists (41.3%) and insurance (33.3%) were the most common type of requested information and was primarily used for prescription clarification/filling (93.4%). The prescriber office (53.6%), as well as the patient/caregiver (39.8%), were the most frequent source of this information. Requests were largely completed by telephone (61.2%) and averaged 6.0 minutes (SD: 4.8). ConclusionCommunity pharmacists require key patient data during routine practice. There is a need to develop mechanisms, like HIE, to address gaps in needed information in the community pharmacy setting, regardless of the offered services.

The Quality Improvement Review Board: An Innovative Approach to Oversight of Projects That Do Not Meet Criteria of Human Subject Research.

This article describes the development of an institutional quality improvement review board (QIRB) as an effective and efficient method for reviewing and overseeing institutional quality improvement (QI) initiatives. QI projects involve the systematic collection and analysis of data and the implementation of interventions designed to improve the quality of clinical care and/or educational programs for a distinct population in a specific setting. QI projects are fundamentally distinct from human subjects research (HuSR); however, the differences between them are subtle and highly nuanced. Determining whether a project meets the definition of QI or qualifies as HuSR, thus requiring institutional review board (IRB) review, can be confusing and frustrating. Nevertheless, this distinction is highly consequential due to the heavy regulatory requirements involved in HuSR and IRB oversight. Making the correct determination of a project's regulatory status is essential before the project begins. Project leaders may not realize that their work meets the definition of HuSR and, therefore, might conduct the project without appropriate IRB review. Therefore, best practices dictate that project leaders should not decide which type of institutional review is appropriate for their projects. In addition, when QI project teams attempt to disseminate the results of their work, documentation of formal review and approval is generally required by peer-reviewed journals and professional organizations. However, institutional review mechanisms are rarely available. Projects that do not meet the definition of HuSR fall outside the purview of IRBs and most institutions do not have an alternative review body. This creates frustration for both project leaders and IRB administrators. Apart from IRB review, a separate process for reviewing QI projects offers several benefits. These include (1) relieving the burden on busy IRB staff; (2) promoting scholarly activity; (3) protecting the institution, project leaders, and participants from HuSR conducted outside of appropriate IRB review; and (4) promoting rigorous QI methods.

Institutional Topography: A Review of Subnational Institutions

Research on subnational institutions is largely motivated by the observation that formal and informal institutions within countries are unevenly configured over geographical space. Although diverse, this relatively nascent body of work has yet to explicate firm activity across subnational locales that exhibit institutional dissimilarity and isomorphism with both proximate and distant centers of political-economic power. To characterize firm activity over such spatially continuous institutional landscapes within countries, we synthesize insights from the subnational institutions literature by introducing a topography framework with its characteristic dimensions comprised of (1) polycentricity, (2) elevation, and (3) slope. We discuss theoretical contributions from using this framework to review 92 articles in the period 1999 to 2024 from 24 journals before concluding with directions for future research. This work integrates knowledge on subnational institutions across management sub-fields, including, but not limited to, international business, strategic management, and entrepreneurship.

Prevalence of depression among Geriatric Population in a Rural Municipality of Nepal: A Descriptive Cross-sectional Study

Introduction: Depression is a major public health concern among the elderly, affecting their quality of life and overall well-being. Despite the increasing elderly population in Nepal, data on the prevalence of depression in rural areas is limited. Therefore, this study aims to assess the prevalence of depression among the geriatric population.Methods: A cross-sectional study was conducted among individuals aged 60 years and above in three randomly selected wards of Shivapuri Rural Municipality. Respondents were selected using consecutive sampling. The Nepali version of the Geriatric Depression Scale (GDS-15) was administered through face-to-face interviews. Ethical approval was obtained from the Institutional Review Committee (Reference number 080/81-437). Descriptive analysis was conducted for categorical variables using the Statistical Package for the Social Sciences (SPSS).Results: The overall prevalence of geriatric depression was 115 (28.75%; 95% CI: 24.36%-33.46%), with a mean depression score of 3.54 ± 3.17. Among those with depression, majority reported mild depression 79 (68.70%) reported mild depression, 79 (31.22%) were male, 88 (30.66%) were under 75 years of age, 46 (35.66%) self-rated their health as not good, 16 (32.66%) had COPD and 33 (30%) were hypertensive elderly.Conclusions: About one third of the elderly reported of having depression and more than 50% had mild depression. The depresson was more in age group less than 75 years, male, married and in nuclear family.

Arthroscopic Debridement and Proximal Fibular Osteotomy in the management of knee Osteoarthritis: A Descriptive Longtudinal Study

Introduction: Knee osteoarthritis commonly occurs in the medial compartment. Arthroscopic debridement eases pain by irrigating debris and inflammatory cytokines. Proximal fibular osteotomy shifts the loading force more laterally from the medial compartment, eliminating pain and delaying degenerative progression. This study aims to evaluate pain relief by combining both procedures in knee osteoarthritis of the medial compartment. Methods: The study was conducted in Nepal Medical College Teaching Hospital from November 2021 to December 2022 after the ethical approval from institutional review committee (IRC Ref. No. 025-078/079). The outcome was assessed by visual analog score and knee society scores, who underwent a combined procedure of arthroscopic debridement and proximal fibular osteotomy during a study period of 12 months.Results: Diagnostic arthroscopy was done in 32 patients, out of which, 27 patients underwent combined procedure with arthroscopic debridement and proximal fibular osteotomy. The mean visual analog score in combined procedure was 6.89 ± 0.93 initially and 3.11 ± 0.69 at 12 months follow up. The mean knee society score in combined procedure was 46.85 ± 6.1 preoperatively and 84.26 ± 8.27 postoperatively at 12 months follow up. Common peroneal nerve neuropraxia was observed in 8 (29.62%) patients, which resolved spontaneously during 6 months of time period. Conclusions: Combined arthroscopic debridement and proximal fibular osteotomy procedure is effective in treating knee osteoarthritis of the medial compartment, as it decreases pain and improves knee society score.

Standardized Ultrasound Protocol for Peripherally Inserted Central Catheters in Neonates: A Retrospective, X-ray Controlled Observational Study.

Objectives: Ultrasound (US) has been reported to be a reliable imaging modality for locating the tip of peripherally inserted central venous catheters (PICC) in neonates. However, its use requires a certain level of expertise, which may limit its application. Standardization of US examinations using designed protocols may improve their efficiency and ease of use. The objective of our study is to evaluate the effectiveness of introducing a standardized US protocol for PICC guidance. Methods: An expert panel was formed in order to develop a standardized US protocol for PICC assessment. Institutional review board agreement was obtained. This protocol was then used by participating clinicians to assess PICC position. Every assessment was followed by a radiographic control. The study group consisted of 262 US examinations of PICC lines in a level III neonatal intensive care unit (NICU) performed according to the designed protocol. Subsequent statistical analysis was made with the RStudio software, R version 4.3.1 (2023-06-16 ucrt). Results: Compared to the X-ray control, standardized US examinations showed 100% sensitivity, 81% specificity, an accuracy of 98% and a 98% precision for assessing catheter placement. The Cohen's Kappa value for the comparison of X-ray and US studies was 0.88, indicating good agreement between the two methods. Conclusions: Standardized US examinations have shown similar potential for evaluating the location of PICC lines when compared with radiographic studies. Implementing a standardized protocol in the NICU may facilitate the ultrasound assessment of PICC lines and reduce exposure to ionizing radiation.

Assessment of Quality of Sleep and Daytime Sleepiness in Medical Professionals and Students in a Medical College: A Descriptive Cross-Sectional Study

Introduction: Poor sleep quality is a global public health issue particularly more prevalent in medical professionals and students. Despite various health and occupational risks, research is still lacking regarding the quality of sleep and its irelated factors among medical professionals and students in our region. Therefore, our study aimed to estimate the prevalence of poor sleep quality in this population.Methods: This observational, cross-sectional study was conducted among medical professionals and students of Devdaha Medical College from December 2023 to June 2024 after ethical approval from the Institutional Review Board. Data regarding sleep quality and excessive daytime sleepiness were collected using the Pittsburg Sleep Quality Index (PQSI) and Epworth Sleepiness Scale with pre-made questionnaires in Google Forms.Results: Among 395 participants, 260 (65.83%) were in the age group 20-25 years and 200 (50.63%) were nursing students. The prevalence of poor sleep quality was 146 (36.96%; 95% CI: 32.19%-42.93%) and the global mean score of PSQI was calculated to be 5.12. Out of the total participants, 255 (64.55%) had excessive daytime sleepiness, 84 (21.26%) participants had one or more sleep problems out of which, snoring was in 40 (10.12%) participants.Conclusions: About one-third of the study population poor sleep quality and day time sleepiness was reported in more than half of the respondents.

Pattern of Mortality among Patients Admitted in Medical Wards in a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study

Introduction: Most developing regions of the world are undergoing gradual epidemiological transition resulting in high burden of both communicable and noncommunicable diseases. Morbidity and mortality pattern is a reflection of disease burden. Detailed assessment of these parameters tends to aid in formulating pivotal aspects of in-hospital policies, standards of care and so consequently promoting efficient work systems. The aim of this study is to identify the pattern of mortalities in medical wards in a tertiary care hospital.Methods: This retrospective descriptive cross-sectional study was conducted in National Academy of Medical Sciences, Bir hospital focusing on all patients admitted to the medical wards (General Medical, Hepatology, Nephrology, Neurology, Endocrinology, Pulmonology, Cardiology and Gastrology) between January 1 to December 31, 2023 after obtaining ethical approval from Institutional Review Committee (Reference Number: 390/2080/81). Total population sampling was done. Data were analyzed using Microsoft Excel and SPSS.Results: Among 10124 admitted patients in medical wards, mortality was reported in 732 (7.22%). The number of deaths seen in general medical ward was 389 (53.14%) and in liver ward was 85 (11.61%). Systemic cause of death due to respiratory diseases was 157 (21.5%) and liver disease was 143 (19.6%).Conclusions: The respiratory disease is responsible for a higher proportion of deaths among admitted patients. However, the deaths due to liver disease are increasing because of the rise in cirrhosis of the liver in the younger age group.

Superselective ablative chemo-ethanol embolization for recurrent single hepatocellular carcinoma: a 6-month outcome analysis.

To evaluate the safety and effectiveness of superselective ablative chemo-ethanol embolization (SACE) for the treatment of patients with recurrent single hepatocellular carcinoma (rHCC). This retrospective study included 22 patients (19 men; median age, 63 years [range, 38-86]) with Child-Pugh class of A/ B/C (16/3/3) that underwent SACE between January and June 2023 for recurrent single HCCs measuring ≤5 cm in diameter using a mixture of 99% ethanol and ethiodized oil/doxorubicin emulsion. The primary endpoint was the 6-month tumor response, and the secondary endpoints were the 1-month tumor response and treatment-related safety. This study was approved by our institutional review board, and the requirement for informed consent was waived. SACE was successfully performed in 22 patients (95.2%). The complete response rates at 1-month and 6-month after treatment were 100.0% and 83.3%, respectively. At 6-month, local tumor progression occurred in one patient and intrahepatic distant metastasis was found in six patients (30.0%). No 6-month mortalities were reported. No adverse events greater than grade 2 or laboratory deteriorations were observed. Biliary complications or liver abscesses were not observed. SACE for a single rHCC was highly effective in achieving a favorable 6-month tumor response and showed acceptable adverse events. However, further prospective studies are required to verify these findings.

A potential marker for increased LDL and hypertriglyceridemia risk

Background and objectives. Serum uric acid (SUA), traditionally associated with gout, is increasingly recognized for its potential role in cardiometabolic disorders, including dyslipidemia. Elevated SUA levels may influence lipid metabolism, thus enhancing cardiovascular disease risk. This study aims to explore the association between SUA levels, dyslipidemia, and related risk factors in a cohort of patients, contributing to a better understanding of their interplay and implications for cardiovascular health. Material and methods. We conducted a retrospective case series involving 30 participants selected from the outpatient Department of General Medicine. The study was approved by the Institutional Review Board, and informed consent was waived due to the retrospective design and use of de-identified data. Participants were aged 18 or older with available data on SUA, LDL cholesterol, and triglycerides, excluding those with a history of gout, renal impairment, or current use of urate-lowering medications. Data were analyzed using descriptive statistics, chi-square tests, and Mann-Whitney U tests, with significance set at p &lt;0.05. Results. The study population had a mean age of 54.7 ± 6.3 years and a mean BMI of 28.4 ± 2.4 kg/m². The mean SUA level was 6.9 ± 0.8 mg/dL, LDL cholesterol was 138 ± 13 mg/dL, and triglycerides were 162 ± 25 mg/dL. Dyslipidemia was present in 60% of the participants. Significant associations were found between hyperuricemia and dietary habits, family history of gout, CVD, and dyslipidemia, as well as the duration of hyperuricemia. Conclusion. Elevated SUA levels are significantly associated with dyslipidemia and other cardiovascular risk factors. The findings suggest the importance of managing SUA levels and lipid profiles concurrently to reduce cardiovascular risks. Further research is needed to explore the long-term cardiovascular outcomes of persistent hyperuricemia and dyslipidemia.