Delayed grip relaxation is a common symptom of myotonic dystrophy type 1 (DM1), differing from other muscle diseases. Preclinical studies suggest myotonia may reverse quickly with targeted treatment and video hand opening time (vHOT) could be a straightforward method for assessing myotonia in multicenter trials, but few studies have evaluated vHOT in large DM1 cohorts. This study aimed to evaluate how vHOT performs and relates to other disease aspects in a large, well-characterized DM1 population. The vHOT was conducted in the END-DM1 natural history study across 22 international sites, including adult DM1 patients with a genetic or research criteria diagnosis. The primary outcome involved video-recorded hand opening after a maximum 3-second grip, performed twice at each study visit with 5-minute rest between trials, and blinded scoring at a central site. Muscle strength and function were assessed by myometry, timed functional tests, and patient-reported outcomes. Procedures were repeated after 1 year for a subset of participants. Wilcoxon signed-rank was used to evaluate differences and Spearman correlation for associations. A total of 591 patients with DM1 (mean age 43.7 ± 12.9 years, 57% female) were included, showing a broad spectrum of vHOT severity (median 3.9 seconds, interquartile range 1.8-7.9 seconds). At a single study visit, there were no systematic difference and good agreement between trials (mean difference 0.1 ± 3.7 seconds [p = 0.05], intraclass correlation coefficient 0.84 [95% CI 0.81-0.86]). vHOT correlated relatively weak with self-reported myotonia (ρ = 0.39), and even lower for other measures of muscle impairments such as grip strength (ρ = -0.21) or 9-hole pegboard (ρ = 0.12). 270 patients completed the 1-year follow-up, with vHOT showing no progression (mean difference 0.4 ± 4.7 seconds, p = 0.34). The vHOT procedure was performed successfully in a large international study, with grip relaxation delay varying from minimal to highly prolonged in an unselected cohort. The weak correlation with grip weakness supports the notion that myotonia and weakness are mechanistically distinct. Study limitations include underrepresentation of congenital DM1 and lack of other myotonia measures (e.g., handgrip relaxation myometry). It seems that vHOT is not suitable to assess disease progression, but stability over 1 year may support its use to assess improvement. The END-DM1 observational study is registered with number NCT03981575.

Steroid hormone profiles in affective disorders suggest hypothalamic-pituitary-adrenal (HPA) axis dysregulation and may reveal novel therapeutic targets. However, most existing studies focus narrowly on glucocorticoids. This study aims to comprehensively characterize alterations in the steroid metabolome of adolescents with depressive symptoms. This cross-sectional study analyzed the urinary excretion of 39 steroid metabolites (via gas chromatography-mass spectrometry) from 75 adolescent psychiatric patients with depressive symptoms (63 females, age 15.6 ± 1.3 years) and 75 healthy controls (64 females, age 15.3 ± 1.3 years), matched for age, sex, and pubertal status. Patients exhibited significantly elevated excretion rates (μg/24h) of corticosterone metabolites (median = 608.4, interquartile range (IQR): 342.4 - 1208.2 vs. controls: median = 321.0, IQR: 243.9 - 443.8), dehydroepiandrosterone (DHEA) metabolites (median = 1253.8, IQR: 569.8 - 2796.2 vs. median = 519.5, IQR: 254.0 - 1028.7), androgen metabolites (median = 6721.0, IQR: 4185.6 - 9395.8 vs. median = 3680.4, IQR: 2510.8 - 5419.0), and individual progesterone and glucocorticoid metabolites, while estradiol excretion was lower (median = 4.0, IQR: 2.9 - 5.8 vs. median = 5.8, IQR: 4.3 - 7.7). Analyses of enzyme activities via multivariate machine learning identified the tetrahydrated urinary metabolite ratio of 11-deoxycorticosterone (TH-DOC) to corticosterone metabolites as a biomarker to distinguish patients from controls (AUC = 0.800, 95%-CI [0.702 - 0.882]). Elevated excretion rates of ACTH-dependent hormones indicate chronic stress in adolescents with depressive symptoms. The TH-DOC-to-corticosterone metabolite ratio may help identify at-risk patients or guide personalized therapies.

Esophagectomy is a key treatment for esophageal cancer but carries a high risk of postoperative complications, some of which are potentially preventable through optimized hemodynamic management. Goal-directed fluid therapy individualizes cardiac output targets but often applies fixed blood pressure thresholds and is discontinued before major postoperative fluid shifts occur. Extending goal-directed fluid therapy into the postoperative period with individualized blood pressure thresholds may address these limitations. In this single-center, prospective, blinded, randomized controlled trial, patients undergoing esophagectomy were randomized 1:1 to either extended goal-directed fluid therapy or standard care. In the extended goal-directed fluid therapy group, cardiac output was optimized and mean arterial pressure threshold was the individual patient's nighttime baseline. The protocol continued from tracheal intubation through to 7:00 am the following morning. The primary outcome was total postoperative morbidity, measured by the Comprehensive Complication Index at day 30. Of 100 patients (49 extended goal-directed fluid therapy group, 51 standard group), extended goal-directed fluid therapy was associated with a higher fluid balance (2,517 ± 1,194 ml vs. 2,001 ± 1,114 ml; mean difference, 516 ml; 95% CI, 57 to 974; P = 0.028), increased norepinephrine use (median, 7,894 μg [interquartile range, 3,946-13,793] vs. 4,611 μg [interquartile range, 2,138 to 7,296]; P < 0.001), and higher mean arterial pressure (mean difference, 3 mmHg; 95% CI, 1 to 5; P = 0.011). At day 30, the mean Comprehensive Complication Index did not differ between groups (39.0 ± 20.0 vs. 39.2 ± 21.0; mean difference, -0.2; 95% CI, -8.6 to 8.1; P = 0.95). Despite achieving protocol-driven treatment differences, extended and individualized goal-directed fluid therapy did not reduce postoperative complications after esophagectomy.

Long-term parietal complications following surgery for inflammatory colitis: An underestimated issue.

Canine naturally occurring Cushing's syndrome (CS) is usually caused by a pituitary tumor (pituitary-dependent hypercortisolism; PDH) or a functional adrenocortical tumor (adrenal-dependent hypercortisolism; ADH). Although endogenous adrenocorticotropic hormone (eACTH) measurement combined with imaging tests is one of the most reliable methods for differentiating PDH from ADH, it has some limitations. In humans, dehydroepiandrosterone sulfate (DHEAS) levels may help determine CS etiology. This study aimed to assess the role of DHEAS concentrations in differentiating PDH from ADH in dogs and correlate DHEAS and eACTH concentrations. A multicenter, retrospective, cross-sectional study was conducted, including dogs diagnosed with CS. They were divided into groups according to suspected CS etiology, sex and neutered status. A total of 38 dogs were included; 33/38 (87 %) were classified as having PDH and 5/38 (13 %) ADH. There were 19 females and 19 males, of which 16 and 9 were neutered, respectively. Median DHEAS concentrations were significantly higher in intact males (2.45 ng/mL; interquartile range 1.02-7.80 ng/mL) than in neutered males (0.68 ng/mL; interquartile range 0.42-2.03 ng/mL; p = 0.017). Females showed a positive correlation between DHEAS and eACTH levels (r = 0.588; p = 0.008). There were no significant differences in DHEAS concentrations between PDH and ADH (p = 0.645). Moreover, ROC curve analysis demonstrated poor ability of DHEAS to differentiate PDH from ADH (AUC 0.430). In conclusion, DHEAS does not appear to be a relevant biomarker for determining CS etiology in dogs and ACTH may not be a major driver for its synthesis.

Infants who are HIV-exposed uninfected (HEU) are at greater risk of death compared with infants who are HIV-unexposed, particularly in the first 6 months of life. We investigated the causes of death (CoD) of HEU and HIV-unexposed infants using postmortem minimally invasive tissue sampling. This prospective, observational study enrolled decedents less than 6 months of age at a secondary-tertiary level care hospital in Soweto, South Africa. The minimally invasive tissue sampling included needle core-biopsy sampling for histopathology of brain, lung and liver tissue. Microbiologic culture and/or molecular tests were performed on lungs, liver, blood and cerebrospinal fluid. Underlying, immediate and antecedent CoD were determined by a multidisciplinary team of medical experts. The median age (9 [interquartile range 3, 30] vs. 8 [interquartile range 3, 22] days) and sex distribution (female 58.5% vs. 47.9%) were similar between HEU (n = 65) and HIV-unexposed (n = 119) decedents. A larger proportion of HEU decedents (60%, 39/65) compared with HIV-unexposed decedents (44.5%, 53/119; P = 0.045) had preterm birth as an underlying CoD. Among HEU infants compared with HIV-unexposed infants, sepsis was attributed as an immediate or antecedent cause of death in 46.2% (30/65) versus 36.1% (43/119), respectively. Of the 30 HEU infants with sepsis, 76.7% (23/30) were classified as presumed hospital acquired, most commonly associated with Acinetobacter baumannii (56.5% [13/23]) and Klebsiella pneumoniae (13.0% [3/23]). Similarly, among HIV-unexposed infants with sepsis (n = 43), 72.3% (31/43) were classified as presumed hospital acquired, with A. baumannii (38.9% [12/31]) and K. pneumoniae (38.9% [12/31]) as the predominant pathogens. Pneumonia was attributed as an immediate or antecedent cause of death in 32.3% (21/65) of HEU and 36.1% (43/119) of HIV-unexposed infants. Among those with pneumonia, presumed hospital-acquired pneumonia was identified in 47.6% (10/21) of HEU and 72.1% (31/43) of HIV-unexposed infants (P = 0.035), most frequently due to A. baumannii (50.0% [5/10] HEU; 41.9% [13/31] HIV-unexposed) and K. pneumoniae (30.0% [3/10] HEU; 19.4% [6/31] HIV-unexposed). Presumed community-acquired pneumonia was identified in 52.4% (11/21) of HEU and 27.9% (12/43) of HIV-unexposed infants (P = 0.035). The predominant community-acquired pathogens were respiratory syncytial virus (36.4% [4/11] HEU; 25.0% [3/12] HIV-unexposed) and K. pneumoniae (36.4% [4/11] HEU; 8.3% [1/12] HIV-unexposed). Our study highlights preterm birth as an important underlying CoD among HEU and HIV-unexposed decedents. There was a larger proportion of presumed community-acquired pneumonia deaths in HEU compared with HIV-unexposed decedents. Further research is warranted to explore these differences and develop effective preventive strategies.

Health-related quality of life (HRQoL) is a central aspect of overall health and a crucial factor in dietary interventions, as it may determine both dietary compliance and sustained adherence. We assessed the effect on HRQoL between: 1) the low-carbohydrate high-fat (LCHF) diet and 2) the high-carbohydrate low-fat (HCLF) diet and evaluated the impact on dietary compliance and sustained adherence. This is a prespecified secondary analysis from a randomized controlled trial in people with type 2 diabetes. Participants were randomly assigned 2:1 to follow either LCHF or HCLF for 6 mo with a postintervention visit 9 mo after inclusion. Liver biopsies were performed at baseline and after 6 mo, the Diabetes-39 HRQoL questionnaire, standard clinical and compliance assessments were conducted at baseline, 3 mo, 6 mo, and 9 mo (postintervention). Sustained adherence was assessed at the postintervention visit. We randomly assigned 165 participants; 96 (58%) were female. At baseline, the median age was 56 [interquartile range (IQR) 50-63] y, mean body mass index was 33 + 7 kg/m2, total median HRQoL score was 88 (IQR, 70-111), mean hemoglobin A1c was 56+10 mmol/mol, and 141 (88%) had metabolic dysfunction-associated steatotic liver disease. After 6-mo intervention, HRQoL improved in both groups {LCHF: -14.5 [95% confidence interval (CI): -20.7, -8.36]; P < 0.001; HCLF; -13.7 (95% CI: -22.7, -4.6); P = 0.003} with no mean difference in change between groups (Δ) P = 0.855. Higher improvements in HRQoL were associated with a higher compliance with the diets (Spearman's rho; -0.183; P = 0.0378) and increased the likelihood of sustained adherence to the LCHF diet. HRQoL improved in both dietary intervention groups with no difference between groups. Dietary compliance was associated with improved HRQoL and may play a role in sustained adherence to the LCHF diet. This trial was registered at clinicaltrials.gov as NCT03068078.

A host-protein test's diagnostic accuracy for discriminating bacterial from viral infections [MeMed BV (MMBV)] was established at emergency departments and urgent care settings. We determined its performance in children postadmission and in subcohorts stratified according to timing of the blood draw. We analyzed postadmission MMBV data from children (3 months to 17 years) with suspected acute infections recruited across 5 previous studies. MMBV results were interpreted as bacterial/viral/equivocal according to the manufacturer's instructions. Reference standard infection etiology was as assigned in the original studies, where adjudicators were provided comprehensive patient data but blinded to MMBV. We calculated diagnostic performance by comparing MMBV to the reference standard. The study population comprised 1059 children, encompassing 659 patients sampled on admission day (day = 0), 69 patients sampled on day ≥1 of hospital stay and 331 with blood drawn postadmission without recorded timing. Median age was 1.9 years (interquartile range 1.0, 4.0), with 51.5% males. The most prevalent discharge diagnoses were systemic viral infections (29.7%), upper respiratory tract infection (17.6%) and lower respiratory tract infection (14.4%). MMBV attained comparable area under the receiver operating characteristic curves ( P > 0.9) of 0.92 (95% confidence interval: 0.90-0.94) for the study population, 0.92 (0.89-0.94) for those sampled on day = 0, 0.92 (0.82-1.0) for those sampled on day ≥1 of hospital stay and 0.92 (0.88-0.96) for those with sampling time unknown. These data support MMBV's performance in hospitalized children. Real-world studies are warranted to establish MMBV's utility postadmission.

Association of body mass index and length of stay in patients undergoing minimally invasive surgery for uterine cancer: a National Surgical Quality Improvement Program (NSQIP) study.

Pain in Parkinson's disease (PD) manifests clinically in a variety of ways and several pain types have been identified, however, their characteristics have not been extensively studied. To describe the characteristics of common pain types in people with PD. A survey of people with PD that experience pain symptoms was conducted. Participants were recruited using a combination of sampling methods. The survey questions focused on collecting information about the topographical, sensory, and temporal characteristics of pain. Descriptive statistics were used to report results. Two hundred and sixteen participants were included in the data analyses. A median of 5 (interquartile range [IQR] 4-7) pain types were experienced by participants. Pain was commonly localized in the lower limbs but often affected several different body segments. Acute attacks of pain were characteristic for many participants in most pain types and were typically frequent (two to six times per week or more) and prolonged (minutes to hours). Periods of pain accentuation were most likely to occur in the morning, evening, and night and appear to be associated with PD medication pharmacology and a variety of exacerbating and ameliorating factors. Fluctuations in pain were found to range from mild to severe in all pain types. This study makes a valuable contribution to the existing literature by providing the most detailed assessment of the topographical, sensory, and temporal characteristics of common PD pain types to date that may be used to guide clinical diagnosis and treatment.

Disease clearance may represent the ultimate treatment target in ulcerative colitis, but is seldom achieved in clinical practice. A treatment escalation strategy based on fecal calprotectin may potentially improve these results. Case cohort study including 108 ulcerative colitis patients with severe endoscopic activity at baseline (Mayo endoscopic subscore = 3) and a follow-up endoscopy with histologic assessment. For each elevated fecal calprotectin (≥250 μg/g) between endoscopic evaluations, we identified any adjustment of medical treatment performed. The ratio of treatment escalation per elevated fecal calprotectin (Te/eFc) was correlated with disease clearance rates at the follow-up endoscopic evaluation. In addition, we compared the rates of negative outcomes (clinical relapse, treatment discontinuation, surgery, and colorectal cancer) in patients with and without disease clearance. Thirty-three (30.5%) patients reached disease clearance over a median follow-up of 21.5 months [interquartile range (IQR): 15-40 months]. Quartile analysis demonstrated that a ratio Te/eFc greater than 50% resulted in higher rates of disease clearance compared with a ratio Te/eFc less than or equal to 50% (51.5 vs. 20.0%; P = 0.001). In multivariate analysis, a ratio Te/eFc greater than 50% was independently associated with disease clearance (odds ratio: 4.47, 95% confidence interval: 1.79-11.15, P = 0.001). Patients with disease clearance presented lower chances of reaching any negative outcome (37.5 vs. 67.1%; P = 0.006). A Te/eFc greater than 50% improved the chances of obtaining disease clearance in ulcerative colitis. Disease clearance is associated with better long-term outcomes.

This study examines practices in laboratory evaluation and transfusion therapy for pediatric epistaxis in the emergency department (ED). We conducted a single-center retrospective study of children (<21 years) evaluated in the ED for epistaxis from 2013 to 2023. Extracted data included demographics, medical history, laboratory evaluation, and treatments. Laboratory testing included complete blood count (CBC) and coagulation tests. We performed descriptive analyses to describe factors associated with laboratory testing and transfusion therapy. Of 944 children (median age 8.8 years; interquartile range, 4.2-14.2 years), 296 (31.4%) underwent laboratory testing. Among recipients, 119 (40.2%) received a CBC alone and 174 (58.7%) received both CBC and coagulation tests. Factors associated with laboratory testing included older age, White race, use of antiplatelet medications, recent nasal procedures, and sinonasal vascular malformations. Transfusions were administered to 46 children (4.9%), including blood (n = 9, 19.6%), platelets (n = 10, 21.7%), factor replacement (n = 11, 23.9%), and multiple products (n = 16, 34.8%). Factors associated with undergoing both laboratory evaluation and transfusion included prolonged epistaxis, active bleeding at presentation, recurrent epistaxis within 24 hours, a known bleeding disorder, an existing oncological condition, anticoagulant use, a prior history of epistaxis, and nasal interventions performed in the ED. Laboratory evaluation and transfusions are infrequently performed in pediatric epistaxis. However, prolonged or recurrent bleeding, underlying bleeding disorders, existing oncological conditions, anticoagulant use, and nasal interventions performed to control bleeding are associated with an increased likelihood of laboratory testing and transfusion therapy in the ED.

High treatment success among individuals with rifampicin-resistant tuberculosis in Botswana: A retrospective cohort study.

Family history enrichment in Non-Small cell Lung Cancer: A cross-sectional - prospective study to inform referral for germline testing.

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma affecting children and young adults, but few reports describe its presentation and outcomes in Africa. We conducted a retrospective chart review of patients of all ages with RMS presenting to the Butaro Cancer Center of Excellence in Rwanda between July 2012 and June 2022. Fifty-nine patients with histopathologically confirmed RMS were treated using Intergroup RMS Study Group protocols adapted to the local context. Median age was 9.1 years (interquartile range [IQR] 3.5-16.6); 54.2% were female. Median duration from symptom onset to presentation was 5 months (IQR 4-7). Most had embryonal histology (66.1%), followed by alveolar (20.3%), pleomorphic (6.8%), and anaplastic (1.7%). At presentation, 16 patients (27.1%) had stage I, 3 (5.1%) had stage II, 22 (37.3%) had stage III, and 14 (23.7%) had stage IV disease; 4 (6.8%) were unstaged. Of the 39 patients treated with curative intent, 25 (64.1%) received local control and 16 (41.0%) completed all planned therapy. Two-year event-free survival was 23.3% (95% CI 13.5%-34.8%, n=55) overall and 61.4% (95% CI 33.3%-80.5%, n=16) among those who completed treatment. Treatment of RMS in a rural district hospital is feasible. Although outcomes remain lower than in high-income countries, survival was markedly higher in patients who completed therapy. Future efforts should focus on earlier diagnosis and support for timely transitions between specialties with the goal of optimizing completion of planned care.

Opioids are widely prescribed after colorectal surgery but may cause adverse events, misuse, and addiction. Despite growing interest in opioid-free analgesia, the rate and characteristics of patients undergoing colorectal surgery who consume no opioids postdischarge remain uncertain. This study aimed to (1) estimate the rate of patients who consume no opioids postdischarge after colorectal surgery and (2) identify patient and care characteristics associated with opioid-free analgesia. This prospective cohort study enrolled adults (aged ≥18 years) undergoing elective colorectal surgery at 2 academic hospitals. Self-reported analgesic consumption was assessed weekly for 1 month postdischarge. Rates of opioid-free analgesia were analyzed descriptively. Predictors were identified using Bayesian model averaging, with higher posterior effect probability reflecting stronger association. A total of 344 participants were included (mean age: 58 ± 15 years; 54% male; 65% laparoscopic surgery; 31% rectal procedure; median hospital stay: 3 days [interquartile range: 1-5 days]). Discharge prescriptions included nonopioids (92% acetaminophen, 38% nonsteroidal anti-inflammatory drugs, and 2% gabapentinoids) and opioids (92%). At 30 days, 51% used no opioids postdischarge (47% after open surgery, 51% after laparoscopic surgery, 52% after procedures via stoma [ie, loop ostomy reversal]). Opioid-free analgesia was associated with older age (odds ratio: 1.04, posterior effect probability = 100%), fewer opioid pills prescribed (odds ratio: 0.92, posterior effect probability = 100%), no postdischarge cannabis use (odds ratio: 0.09, posterior effect probability = 96%), and high patient activation (ie, confidence for self-managing care; odds ratio: 2.20, posterior effect probability = 67%). Approximately half of patients undergoing colorectal surgery do not use opioids postdischarge. Older patients, those with higher patient activation, those who did not use cannabis, and those with fewer opioids prescribed were more likely to rely on opioid-free analgesia. Opioid-free postdischarge analgesia may be feasible after colorectal surgery and should be further investigated.

Sub-optimal sleep, whether insufficient, excessive, or poor-quality, is an independent risk factor for obesity, largely through influencing energy intake via altered appetite and reward processing. Less is known about its influence on real-world dietary behaviours. We examined associations of self-reported sleep quality and duration with dietary eating behaviours in a large UK adult cohort. 27,263 adults (median (interquartile range): age, 51.0 (16.0) years; BMI, 25.2 (5.3) kg/m2; 40.5% female) completed a standardised health assessment, including self-reported sleep quality (1-10 scale) and duration. Thirteen eating behaviours broadly reflecting emotional/reward-driven eating, dietary disinhibition, food preferences, and meal patterns were assessed via questionnaire. Regression models examined associations between sleep characteristics and eating behaviours, adjusting for age, sex, socioeconomic status, assessment year, and region. Odds ratios (OR) are presented for ordinal/binary outcomes and rate ratios (RR) for count outcomes. Poor sleep quality and short sleep duration were associated with an eating profile suggestive of heightened emotional/reward-driven eating and reduced dietary restraint. This included higher odds/frequency of eating out of boredom, stress, or anger, overeating, skipping meals, and consuming energy-dense foods (OR/RR range: 1.08-3.50, P≤0.018). Long sleep duration was linked to higher emotional eating (OR range: 1.16-1.19, P<0.001) but showed fewer signs of impulsivity or disinhibited intake. Some behaviours, like adding sugar to food and snacking, were not consistently related to sleep characteristics. In conclusion, short and poor-quality sleep are associated with eating patterns that may increase obesity risk. Interventions targeting sleep extension and quality could support healthier dietary behaviours and appetite regulation.

To assess the effectiveness of nitinol-constrained balloon (NCB; Chocolate; Medtronic, Dublin, Ireland) percutaneous transluminal angioplasty (PTA) for treating Diameter reduction, Spiral shape, Flow impairment, or adverse Morphology (DISFORM) III postangioplasty dissections in chronic total occlusions (CTOs) of the femoropopliteal segment. The CHOCOlate-STABilization (CHOCO-STAB) study was conducted from February 2019 to February 2022. It included patients with peripheral arterial disease affected by chronic limb-threatening ischemia. This study specifically included patients with DISFORM III postangioplasty dissections who were treated using NCB angioplasty after initial PTA. The main outcomes assessed in this study were technical success and the occurrence of major adverse events. This study included 68 patients with a mean age of 72 years (SD ± 10), of whom 39% had diabetes. The initially treated CTOs had a mean length of 10.32 mm (SD ± 5; interquartile range, 5-15 mm), with moderate or severe calcification in 28%. Forty-seven (69%) patients received initial treatment with drug-coated balloons (DCBs). NCB angioplasty was feasible in all patients, achieving technical success in 62 (91%). Stent placement was required in the remaining 6 (9%) cases. Three-year estimated overall survival was 98.5%, primary patency was 88.2%, freedom from major amputation was 94.1%, and freedom from clinical target lesion revascularization was 94.1%. Postangioplasty dissections represent a relevant adverse event that necessitates scaffolding in moderate and severe grades. The CHOCO-STAB study demonstrated the safety and potential of NCB angioplasty to reduce stent placement in patients treated with DCB and plain old balloon angioplasty who present with postangioplasty dissections.

Dysphagia is commonly associated with intensive care unit-acquired weakness (ICUAW), with oropharyngeal muscular weakness considered a major precipitating factor. Unfortunately, evidence for effective rehabilitation of dysphagia associated with ICUAW is lacking. The aim of this study was to examine the feasibility, safety, and effectiveness of a strength-based dysphagia treatment protocol for patients with dysphagia associated with ICUAW. A prospective pilot cohort study was conducted on all critically ill patients admitted to an Australian tertiary referral intensive care unit (ICU) over a 3-year period, diagnosed with dysphagia and ICUAW. A strength-based dysphagia treatment protocol was implemented incorporating expiratory muscle strength training and swallowing exercises to target the tongue base, pharyngeal, suprahyoid, and respiratory muscles. A regime of five sets of five repetitions, conducted 5 days per week, was employed. Treatment commenced in the ICU, continuing until swallowing recovery or swallowing function plateaued. Key swallowing and respiratory outcomes were collected weekly: clinical swallow examination (Functional Oral Intake Scale [FOIS]: 1-7), flexible endoscopic evaluation of swallowing (New Zealand Secretion Scale: 0-7, Penetration-Aspiration Scale: 1-8] Yale Pharyngeal Residue Scale [Yale]: 1-5), peak expiratory flow (PEF), and maximum expiratory pressure (MEP). Thirteen participants (11 male, median age = 52 years) were recruited. Medical diagnoses included severe burn injury, influenza-A, necrotising pancreatitis, sepsis, and COVID-19 infection. Median mechanical ventilation was of 19 days (interquartile range [IQR] = 16-36 days), ICU length of stay was of 34 days (IQR = 21-43 days), and hospital length of stay was of 71 days (IQR = 43-86 days). Four required tracheostomy (median: 18 days, IQR = 13-24 days). All participants exhibited profound dysphagia (FOIS = 1-3, New Zealand Secretion Scale = 3-7, Penetration-Aspiration Scale = 3-8, Yale Pharyngeal Residue Scale = 2-5) and respiratory impairment at baseline (MEP = 21-114 cmH2O, PEF = 80-310 L/min). All completed the treatment protocol and achieved premorbid diet and fluids (FOIS = 7) and functional respiratory status (MEP = 62-178 cmH2O, PEF = 260-520 L/min) by hospital discharge. No adverse events were recorded. Pilot study findings suggest that a strength-based dysphagia treatment protocol for patients with ICUAW and dysphagia is safe and feasible with promising outcomes indicating that it may support dysphagia recovery in this challenging population.

When Infections Hurt More: Black Patients Experience More Severe Surgical Site Infections Following Lower Extremity Bypass.