Management Of Patients Research Articles

Efficacy of Glucagon-Like Peptide 1 (GLP-1) Receptor Agonists for Weight Loss Management in Non-Diabetic Patients

Efficacy of Glucagon-Like Peptide 1 (GLP-1) Receptor Agonists for Weight Loss Management in Non-Diabetic Patients

Comparative Outcomes of Immediate and Delayed Wound Closure Techniques in Appendectomies for Gangrenous Appendicitis

Background: Post-operative medical complications are very common in patients with gangrenous nonperforated appendicitis, especially surgical site infections (SSIs). Currently no conclusive answers on the relative benefits of immediate vs delayed wound clear therefore a comparison is essential. Objectives: In order to compare the results of immediate versus delayed wound closure in patients with gangrenous appendicitis who underwent appendectomy, SSIs, wound healing, and general postoperative recovery will be assessed. Methodology: The present study is a retrospective cohort study, using data from 185 patients, operated for gangrenous appendicitis during the period between from January 2023 to February, 2024. Total patients were categorized into two groups based on the wound closure technique employed, immediate wound closure (IWC, n=105) and delayed wound closure (DWC, n=80). Specific dependent variables were the overall SSI rate, days to wound healing and days of hospitalization. Secondary endpoints included a return of symptoms and overall postoperative morbidity. Results: The study also revealed that the incidence of SSIs was relatively low in the DWC group at 8. 0% compared to the (22.0± 0.01) % in the IWC group, which was statistically significant (p<0. 001). The overall IWC time was significantly shorter in the IWC group (11 days) as compared to the DWC group (15 days) (P value = 0. 02). In our study, the DWC group was found to have a lower median LOS of 6 days as compared to IWC group that had a LOS of 8 days. When compared the two groups regarding readmission rates, the difference was not statistically significant (p-value = 0. 05). Conclusion: These delayed wound closure strategies in appendectomy for gangrenous appendicitis are a safe means of decreasing SSIs and hospital stay without a predisposing effect on wound healing and readmission. Based on these findings, it is recommended that DWC is the better approach in the management of such high-risk surgical patients.

Clinical Characteristics and Management of Patients with Esotropia and Moderate Myopia

ABSTRACT Although the incidence of acquired esotropia associated with moderate myopia is on the rise, there is minimal research on the clinical profile and pathophysiology of this condition. To gain deeper insights into the clinical characteristics and management of these patients, a literature search was conducted, resulting in the identification of six relevant studies. Collectively, these studies encompassed a total of 304 patients. The mean age of onset of esotropia across all studies was 37.52 years. The mean deviations for distance were not considerably larger than those reported at near, even though symptoms were reported more frequently at distance. The overall mean of the distance deviation was 25.16 prism diopters, and the overall mean of the near deviation was 20.82 prism diopters. There were very few reports of vertical deviations across all studies. Limited data suggests that increased near work may be associated with larger esodeviations. Only three articles assessed surgical management; however, it appears that surgical correction may need to be increased by approximately one-third compared to traditional surgical tables and smaller deviations may require even greater augmentation.

Deploying a metabolic dysfunction-associated steatohepatitis consensus care pathway: findings from an educational pilot in three health systems

BackgroundMetabolic dysfunction-associated steatotic liver disease (MASLD), formerly referred to as nonalcoholic fatty liver disease, impacts 30% of the global population. This educational pilot focused on the role primary care providers may play in the delivery of guidelines-based metabolic dysfunction-associated steatohepatitis (MASH) care.ObjectiveAccelerate the application of guidelines-based MASH care pathways to clinical workflows.MethodsA panel of six hepatologists was convened in 2021 to develop the care pathway and the subsequent pilot occurred between 2022 – 2023. The pilot was conducted across three U.S. health systems: Boston Medical Center (Boston), Methodist Health System (Dallas), and Weill Cornell Medicine (New York). Clinicians were educated on the care pathway and completed baseline/follow-up assessments. 19 primary care clinicians participated in the educational pilot baseline assessment, nine primary care clinicians completed the two-month assessment, and 15 primary care clinicians completed the four-month assessment. The primary endpoint was to assess clinician-reported adherence to and satisfaction with the care pathway. The pilot was deemed exempt by the Western Consensus Group Institutional Review Board.ResultsAt baseline, 38.10% (n = 8) of respondents felt they had received sufficient training on when to refer a patient suspected of metabolic dysfunction-associated liver disease to hepatology, and 42.86% (n = 9) had not referred any patients suspected of metabolic dysfunction-associated liver disease to hepatology within a month. At four months post-intervention, 79% (n = 15) of respondents agreed or strongly agreed they received sufficient training on when to refer a patient suspected of metabolic dysfunction-associated liver disease to hepatology, and there was a 25.7% increase in self-reported adherence to the institution’s referral guidelines. Barriers to care pathway adherence included burden of manually calculating fibrosis-4 scores and difficulty ordering non-invasive diagnostics.ConclusionsWith therapeutics anticipated to enter the market this year, health systems leadership must consider opportunities to streamline the identification, referral, and management of patients with metabolic dysfunction-associated steatohepatitis. Electronic integration of metabolic dysfunction-associated steatohepatitis care pathways may address implementation challenges.

Biomarkers in Cutaneous Keratinocyte Carcinomas.

Skin cancer is the most common cancer type in the USA, with over fivemillion annually treated cases and one in five Americans predicted to develop the disease by the age of 70. Skin cancer can be classified as melanoma or non-melanoma (NMSC), the latter including basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC). Development of BCC and SCC is impacted by environmental, behavioral, and genetic risk factors and the incidence is on the rise, with the associated number of deaths surpassing those caused by melanoma, according to recent reports. Substantial morbidity is related to both BCC and SCC, including disfigurement, loss of function, and chronic pain, driving high treatment costs, and representing a heavy financial burden to patients and healthcare systems worldwide. Clinical presentations of BCC and SCC can be diverse, sometimes carrying considerable phenotypic similarities to benign lesions, and underscoring the need for the development of disease-specific biomarkers. Skin biomarker profiling plays an important role in deeper disease understanding, as well as in guiding clinical diagnosis and patient management, prompting the use of both invasive and non-invasive tools to evaluate specific biomarkers. In this work, we review the known and emerging biomarkers of BCC and SCC, with a focus on molecular and histologic biomarkers relevant for aspects of patient management, including prevention/risk assessments, tumor diagnosis, and therapy selection.

International survey on invasive lobular breast cancer identifies priority research questions

There is growing awareness of the unique etiology, biology, and clinical presentation of invasive lobular breast cancer (ILC), but additional research is needed to ensure translation of findings into management and treatment guidelines. We conducted a survey with input from breast cancer physicians, laboratory-based researchers, and patients to analyze the current understanding of ILC, and identify consensus research questions. 1774 participants from 66 countries respondents self-identified as clinicians (N = 413), researchers (N = 376), and breast cancer patients and advocates (N = 1120), with some belonging to more than one category. The majority of physicians reported being very/extremely (41%) to moderately (42%) confident in describing the differences between ILC and invasive breast cancer of no special type (NST). Knowledge of histology was seen as important (73%) and as affecting treatment decisions (51%), and most agreed that refining treatment guidelines would be valuable (76%). 85% of clinicians have never powered a clinical trial to allow subset analysis for histological subtypes, but the majority would consider it, and would participate in an ILC clinical trials consortium. The majority of laboratory researchers, reported being and very/extremely (48%) to moderately (29%) confident in describing differences between ILC and NST. They reported that ILCs are inadequately presented in large genomic data sets, and that ILC models are insufficient. The majority have adequate access to tissue or blood from patients with ILC. The majority of patients and advocates (52%) thought that their health care providers did not sufficiently explain the unique features of ILC. They identified improvement of ILC screening/early detection, and identification of better imaging tools as top research priorities. In contrast, both researchers and clinicians identified understanding of endocrine resistance and identifying novel drugs that can be tested in clinical trials as top research priority. In summary, we have gathered information from an international community of physicians, researchers, and patients/advocates that we expect will lay the foundation for a community-informed collaborative research agenda, with the goal of improving management and personalizing treatment for patients with ILC.

Efficacy of modern methods for assessing the severity of alopecia areata

Purpose of the study. To evaluate the effectiveness of the standardized SALT scale to determine the severity of AA patients.Materials and methods. A one-time retrospective cohort study was conducted. There were 40 patients with AA under supervision. The gender distribution of the patients was as follows: 15 men (36.6%) and 25 (63.3%) women. The average age was 29.4 years in the 18–54 age range.Results. The AA debut varied widely in age range from 2 to 45 years. The average age at which the pathological process began was 18,2±4,4 years. 22.4% of patients with a scalp hair area of more than 25%, as well as hair loss in other areas of the body and changes in the nail.The beginning of AA is fixed to 10 years. More than two relapses occurred in 54.5% of patients with scalp hair lesions of more than 25% and only 9.2% of cases with foetal AA.The following clinical forms were diagnosed: foetal (12 patients), lenticular (ophiasis, inversive ophiasis) (7 patients), multi-focal (11 patients), total and universal (10 patients). According to the SBN Hair Loss State scale, S1 clinically corresponded to focal alopecia, S2 -S4 – ophazis, multi-focal alopecia, S5 – TA and UA. Partial or complete hair loss has been noted in these areas in 38% of patients with S2-S3 and 67% with S4-S5 clinical forms. The combination of different degrees of body hair loss and dystrophy of nail plates in examined AA patients was observed in 25% of cases.Conclusion. In determining the severity of alopecia nest principally not only the size and number of lesions on the skin scalp, but also the nature of hair loss on the skin of the eyebrows and eyelashes, as well as the possible combination of hair loss and dystrophic altered nail plates, which is considered an option for a more severe course of the disease. The SBN system effectively evaluates and describes the clinical variant of AA according to a standardized scale, which can help determine clinical management of patients with different manifestations, as well as predict the course of the disease.

How Integrating the 5 Pillars of Community Practice Can Transform Physical Therapist Education and Reduce Health Disparities.

Patient history assists clinicians in determining the most appropriate tests to identify the symptoms' source and select appropriate interventions. Therefore, a subjective history is an essential component of patient management. When physical therapist practitioners transition into academia, they must understand how the history of the education system may affect learners. Health disparities are related to the lack of workforce diversity and skills in cultural responsiveness, and the education system is critical in addressing the impact of future providers on health disparities. Developing a Doctor of Physical Therapy (DPT) program to address health disparities requires an analysis of the historical context of the United States (US) educational and health care systems, along with traditional components of physical therapist education. This country's education system was built upon a 2-tiered system, where minoritized individuals struggled to overcome barriers imposed by legislation and societal beliefs. Jim Crow laws continued this unequal access to education, and the recent Supreme Court ruling to deny race-based affirmative action continues these inequities. This historical context informed the construction of the College of Saint Mary (CSM) DPT Program. The program's mission led to using less traditional educational approaches; thus, the pillars of practice took form. The 5 pillars evolved to include social determinants, inclusive faculty and student recruitment and retention practices, equitable grading, culturally responsive pedagogy, and community development. The purpose of this paper is to present a historical overview of the United States education system and its influence on physical therapist education. Furthermore, it will illustrate how this historical context inspired the 5 Pillars of Community Practice from CSM and discuss the challenges and interventions related to these pillars. There are tremendous disparities in educational outcomes and patient services in the US. Disparities are most significant in those with historically marginalized identities. If those disparities are to improve, a change is required in the people providing care to patients. The best way to accomplish this is by transforming how future providers are educated.

The implementation of the acute care surgery model in the management of patients with acute appendicitis - A 5-year single-center, retrospective experience: An observational study.

We conducted this study to assess the effects of the acute care surgery (ACS) model in the management of patients with acute appendicitis (AA) based on our 5-year single-center, retrospective experience. The current single-center, retrospective, observational study was conducted in a consecutive series of the patients with AA who had been surgically treated at a tertiary referral hospital in Seoul, Korea, between January 2016 and December 2020. At our institution, the ACS model was first introduced in March 2018. Therefore, our clinical series of the patients were divided into 2 groups: the pre-ACS group (March 2014 to February 2018) and the post-ACS group (March 2018 to December 2022). Key time intervals include emergency department registration to request for surgical consultation, request for surgical consultation to decision on surgery, decision-to-operating room, time to decision on surgery and length of emergency department stay. Moreover, outcomes include rates of perforation and complications and discharge within 24 or 48 hours. We compared key time intervals, outcomes, and length of hospital stay between the 2 groups. A total of 900 patients with AA were finally included in the current study, 447 and 453 of whom were divided into the pre-ACS group (n = 447) and the post-ACS group (n = 453), respectively. There were significant differences in key time intervals, outcomes, and length of hospital stay between the 2 groups (P < .05). In conclusion, our results showed that the implementation of the ACS model was effective in improving key time intervals, rates of perforation, and discharge within 24 or 48 hours in the patients with AA.

Presentation, management, and early outcomes of young acute coronary syndrome patients- analysis of 23,560 South Asian patients from 2012 to 2021

BackgroundThere is dearth of literature addressing early outcomes of acute coronary syndrome (ACS) among young patients, particularly South Asians descent who are predisposed to premature coronary artery disease (CAD). Therefore, we compared presentation, management, and early outcomes of young vs. old ACS patients and explored predictors of in-hospital mortality.MethodsWe extracted data of 23,560 ACS patients who presented at Tabba Heart Institute, Karachi, Pakistan, from July 2012-June 2020, from the Chest pain-MI-Registry™. We categorized data into young ≤ 45 and old ACS patients > 45 years. Chi-sq/Fischer exact tests were used to assess the difference between presentation, disease management, and in-hospital mortality between both groups. Logistic regression was used to determine odds ratio along with 95% confidence interval of factors associated with early mortality.ResultsThe younger patients were 12.2% and women 23.5%. The prevalence of dyslipidemia (34.5% vs. 22.4%), diabetes (52.1% vs. 27.4%), and hypertension (68.3% vs. 42.9%) was higher in older patients. Family history of premature CAD (18.1% vs. 32.7%), smoking (40.0% vs. 22.9%), and smokeless tobacco use (6.5% vs. 8.4%) were lower in older patients compared to younger ones. Younger patients were more likely to present with STEMI (33.2% vs. 45%). The median symptom-to-door time was 125 min longer (p-value < 0.01) in the young patients compared to the older age group. In-hospital mortality (4.3% vs. 1.7%), cardiac arrest (1.9% vs. 0.7%), cardiogenic shock (1.9% vs. 0.9%), and heart failure (1% vs. 0.6%) were more common in older patients. After adjusting for other factors, younger age (AOR 0.6, 95% CI 1.5–3.7) had significantly lesser odds of in-hospital mortality. Other factors associated with early mortality included women, family history of premature CAD, STEMI, Killip class III and IV, coronary angiography, revascularization, CABG, and use of aspirin and beta blockers within the first 24 h.ConclusionWe found every tenth ACS patient was younger than 45 years of age despite a lesser number of comorbidities such as hypertension and diabetes. Overall, the in-hospital prognosis of young patients was more favorable than that of older patients. The study emphasizes the need for tailored primary prevention programs for ACS, considering the varying risks among different age groups.

Challenges with current diagnosis and treatment strategies for precipitated opioid withdrawal in the emergency department and the role of the pharmacist.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. To demonstrate the challenges with current diagnosis and treatment strategies for precipitated opioid withdrawal secondary to naloxone the emergency department (ED) setting and describe the role of the emergency medicine (EM) pharmacist in its management. There are no standardized criteria to define precipitated opioid withdrawal syndrome, so the diagnosis is typically based on sentinel signs and symptoms and time course. Complicating factors include a positive urine toxicology screen for nonopioid substances, comorbidities and associated medications prior to admission, medications given in the ED, and a fluctuating patient course during the ED stay that likely involves all these issues. Although buprenorphine is frequently recommended as the primary treatment for precipitated withdrawal, its use can be complicated if patients are on methadone maintenance or other long-acting opioids. The EM pharmacist plays a key role in managing patients with precipitated withdrawal. Practice changes related to the diagnosis and treatment of opioid use disorder (OUD) with precipitated withdrawal in the ED are needed. EM pharmacists as part of the interprofessional care team have an important role in the management of patients with OUD, including those patients undergoing possible precipitated withdrawal.

Managing Postoperative Delirium in Patients Receiving Head and Neck Surgery: An Educational Overview.

Postoperative delirium in patients receiving head and neck surgery is a pressing concern, affecting morbidity, mortality, and healthcare costs. With an aging population and about 65,000 new head and neck cancer diagnoses per year in the United States, surgery remains a primary treatment modality, regardless of age. This article offers an educational overview of postoperative delirium management in patients receiving head and neck surgery, summarizing incidence, etiology, pathophysiology, diagnostic tests, treatment, complications, and risk factors. A narrative literature review of articles published in the past 10 years was conducted to consolidate information on postoperative delirium in patients receiving head and neck surgery. Postoperative delirium is characterized by acute, fluctuating cognitive dysfunction within 30 days after surgery, with incidence ranging from 11% to 26%. Pathophysiology is multifactorial, and pharmacologic options are limited because of side effects and varying effectiveness. Nonpharmacologic management focuses on addressing underlying causes and early mobilization. Reducing postoperative delirium risk necessitates interprofessional, systemwide collaboration.

Maintaining Hygiene in Orthodontic Miniscrews: Patient Management and Protocols—A Literature Review

Maintaining Hygiene in Orthodontic Miniscrews: Patient Management and Protocols—A Literature Review

Contributing Factors to the Challenges of Patient Health Monitoring in Rural Healthcare Units: Basis for a Proposed Integrated Patient Management Portal

In the current era of abundant information, technological advancements have greatly impacted various fields particularly the healthcare sector. This research explores the difficulties encountered by rural healthcare facilities in Barangay Poblacion, Bacuag, Surigao del Norte, in monitoring patient health and suggests implementing a remote patient management platform to enhance healthcare delivery. Using a mixed-method approach, the study involved 37 participants, predominantly young females. The research identified key challenges such as limited access to healthcare facilities, a shortage of medical staff, communication issues, and insufficient healthcare resources. Although patient registration and monitoring of vital signs were relatively effective, challenges remained in scheduling appointments, availability of medical tests, and patient education. The overall positive perception of the current system (average weighted mean of 3.59) indicates room for improvement through the proposed remote patient management platform. This platform aims to improve real-time monitoring, data accuracy, and communication between patients and healthcare providers, thereby enhancing healthcare outcomes in rural areas

Mechanisms and management of thrombosis in cancer: focus on gastrointestinal malignancies.

Cancer patients have an increased risk of venous thromboembolism (VTE) which is their second cause of death after disease progression itself. Several thrombotic risk factors coexist in cancer patients, including the ability of both cancer and tumoral microenvironment's cells to directly or indirectly activate platelets and the enzymes of the coagulation cascade, resulting in a hyper-coagulable state of blood. This narrative review gives an overview of the main mechanisms leading to VTE in cancer patients, including the role that platelets and the clotting proteins may have in tumor growth and metastasis. Noteworthy, the haemostatic balance is altered in cancer patients who may, next to a thrombosis tendency, also have an increased risk of bleeding. To highlight the complexity and the precariousness of the haemostatic balance of these patients, we discuss two specific gastrointestinal malignancies: hepatocellular carcinoma, which is frequently associated with liver cirrhosis, a condition that causes profound alterations of haemostasis, and colorectal cancer, which is characterized by a fragile mucosa that is prone to bleeding. Understanding the molecular mechanisms of cancer-associated thrombosis may give a unique opportunity to develop new innovative drugs, acting differently on distinct pathways and potentially allowing to reduce the risk of bleeding related to antithrombotic therapies. Significance Statement The topic is significant because understanding the molecular mechanisms leading to cancer associated thrombosis and bleeding, focusing on gastrointestinal malignancies, enables the development of more rationale and innovative antithrombotic strategies for cancer associated thrombosis. Eventually, this will support an improved and patient-tailored antithrombotic management in vulnerable oncologic patients.

USP32 facilitates non-small cell lung cancer progression via deubiquitinating BAG3 and activating RAF-MEK-ERK signaling pathway

The regulatory significance of ubiquitin-specific peptidase 32 (USP32) in tumor is significant, nevertheless, the biological roles and regulatory mechanisms of USP32 in non-small cell lung cancer (NSCLC) remain unclear. According to our research, USP32 was strongly expressed in NSCLC cell lines and tissues and was linked to a bad prognosis for NSCLC patients. Interference with USP32 resulted in a significant inhibition of NSCLC cell proliferation, migration potential, and EMT development; on the other hand, USP32 overexpression had the opposite effect. To further elucidate the mechanism of action of USP32 in NSCLC, we screened H1299 cells for interacting proteins and found that USP32 interacts with BAG3 (Bcl2-associated athanogene 3) and deubiquitinates and stabilizes BAG3 in a deubiquitinating activity-dependent manner. Functionally, restoration of BAG3 expression abrogated the antitumor effects of USP32 silencing. Furthermore, USP32 increased the phosphorylation level of the RAF/MEK/ERK signaling pathway in NSCLC cells by stabilizing BAG3. In summary, these findings imply that USP32 is critical to the development of NSCLC and could offer a theoretical framework for the clinical diagnosis and management of NSCLC patients in the future.

Assessment of the pelvic pain experienced by infertile women is of prime importance for diagnosing endometriosis

To provide evidence regarding the significance of painful symptoms among women suffering from infertility. An observational retrospective cross-sectional study SETTINGS: University hospital-based research center PATIENTS: Infertile patients aged between 18-42 years surgically explored for benign gynecological conditions between 01-2004 and 12-2020. For each patient, a standardized questionnaire was completed during a face-to-face interview conducted by the surgeon in the month preceding the surgery. Preoperative assessment the pain symptoms was recorded. Pain intensity was assessed with a 10cm visual analog scale (VAS). The pain was considered to be severe when the VAS score was ≥ 7. Surgery was performed in 839 infertile women. 451 women had severe pelvic pain. Infertile patients with severe pain significantly more often had endometriosis (67.4% versus 30.7% respectively; p<0.001) than infertile women without severe pelvic pain, and especially deep infiltrating lesions (43.2% versus 8.5% respectively; p<0.001). Moreover, these women more often had intestinal endometriosis lesions (28.4% versus 1.8%; p<0.001). After multivariable regression analysis, the presence of endometriosis, irrespective of the phenotype (superficial lesions (OR1.84[1.19-2.86] and/or ovarian endometrioma OR 2.79[1.70-4.59] and/or deep infiltrating endometriosis OR 4.49[2.69-7.51]), and the presence of at least one intestine endometriosis lesion (OR6.49[2.69-7.51] were significantly associated with severe pelvic pain. Severe pelvic pain is significantly associated with endometriosis and especially deep infiltrating lesions in a population of infertile women. These results demonstrate the importance of thorough questioning regarding pelvic pain symptoms during the initial management of infertile patients.

Genetic testing in early-onset atrial fibrillation.

Atrial fibrillation (AF) is a globally prevalent cardiac arrhythmia with significant genetic underpinnings, as highlighted by recent large-scale genetic studies. A prominent clinical and genetic overlap exists between AF, heritable ventricular cardiomyopathies, and arrhythmia syndromes, underlining the potential of AF as an early indicator of severe ventricular disease in younger individuals. Indeed, several recent studies have demonstrated meaningful yields of rare pathogenic variants among early-onset AF patients (∼4%-11%), most notably for cardiomyopathy genes in which rare variants are considered clinically actionable. Genetic testing thus presents a promising opportunity to identify monogenetic defects linked to AF and inherited cardiac conditions, such as cardiomyopathy, and may contribute to prognosis and management in early-onset AF patients. A first step towards recognizing this monogenic contribution was taken with the Class IIb recommendation for genetic testing in AF patients aged 45 years or younger by the 2023 American College of Cardiology/American Heart Association guidelines for AF. By identifying pathogenic genetic variants known to underlie inherited cardiomyopathies and arrhythmia syndromes, a personalized care pathway can be developed, encompassing more tailored screening, cascade testing, and potentially genotype-informed prognosis and preventive measures. However, this can only be ensured by frameworks that are developed and supported by all stakeholders. Ambiguity in test results such as variants of uncertain significance remain a major challenge and as many as ∼60% of people with early-onset AF might carry such variants. Patient education (including pretest counselling), training of genetic teams, selection of high-confidence genes, and careful reporting are strategies to mitigate this. Further challenges to implementation include financial barriers, insurability issues, workforce limitations, and the need for standardized definitions in a fast-moving field. Moreover, the prevailing genetic evidence largely rests on European descent populations, underscoring the need for diverse research cohorts and international collaboration. Embracing these challenges and the potential of genetic testing may improve AF care. However, further research-mechanistic, translational, and clinical-is urgently needed.

Nutritionist’s Role in Dietary Management of Patients with Cancer

Nutritionist’s Role in Dietary Management of Patients with Cancer

Management of patients treated with oral anticoagulant therapy undergoing percutaneous coronary intervention with stent implantation: the PERSEO Registry.

In patients on oral anticoagulant (OAC) therapy undergoing percutaneous coronary intervention with stent (PCI), international guidelines endorse the use of direct oral anticoagulants (DOAC) rather than vitamin K antagonists (VKA) and dual antithrombotic therapy (DAT) rather than triple antithrombotic therapy (TAT). Aim of this study was to evaluate contemporary real-world data on antithrombotic regimens and outcome in patients on OAC undergoing PCI with stent. Consecutive patients on OAC undergoing PCI were enrolled in the multicentre, prospective, observational PERSEO registry (NCT03392948). Primary end-point was net adverse clinical events (NACE) with VKA vs DOAC, whereas a secondary pre-specified end-point was NACE with DAT vs TAT both at 1-year follow-up. From February 2018 to February 2022, 1234 consecutive patients were included. The main indication for OAC was atrial fibrillation (86%) and the mean CHA2DS2VASc and HAS-BLED scores were 4±2 and 3.6±1, respectively. Of the 1228 patients discharged alive, 222 (18%) were on VKA and 1006 (82%) on DOAC (p<0.01). DAT was employed in 197 patients whereas TAT in 1028. At follow-up, NACE rate was significantly higher with VKA compared to DOAC (23% vs 16%, p=0.013) and confirmed after propensity score adjustment. TAT and DAT did not differ as regards NACE rate (17% vs 19%, p=0.864) even though, compared to TAT, DAT was associated with less major bleedings (2% vs 5%, p= 0.014), confirmed after propensity score adjustment. In conclusion, in patients on OAC undergoing PCI, DOAC, compared to VKA, was associated with a significantly lower occurrence of NACE and DAT reduced bleedings compared to TAT.