Patients Mean Age Research Articles

Surgical management and outcomes of corrosive esophageal injuries: a prospective study from Sana’a, Yemen

BackgroundCorrosive esophageal injuries pose a significant health burden in resource-limited settings like Yemen. This study evaluated the demographic patterns, clinical presentations, management strategies, and outcomes of patients with corrosive esophageal injuries at a tertiary hospital in Sana’a, Yemen.MethodsThis prospective single-center study at Al-Thawra Modern General Hospital, Sana’a, Yemen (January 2021–June 2024) enrolled 22 patients with corrosive esophageal injuries. Data on demographics, corrosive agents, clinical features, endoscopic findings, management, and outcomes were analyzed using chi-square tests and ANOVA (p < 0.05).ResultsThe mean patient age was 24.7 ± 17.0 years, with 40.9% (n = 9) under 20 years. Accidental ingestion, primarily acidic agents (68.2%, n = 15), accounted for 90.9% (n = 20) of the cases. Dysphagia was the most common symptom (90.9%, n = 20). Endoscopy revealed Grade 2B injuries in 59.1% (n = 13), using the endoscope unable to pass in 13.6% (n = 3). Strictures developed in 36.4% (n = 8) of patients. Endoscopic dilation (ED) was attempted in 77.3% (n = 17), achieving durable symptomatic improvement in 58.8% (n = 10/17). Surgical interventions, including colonic conduit (n = 6) and gastric pull-up (n = 2), were performed in 36.4% (n = 8). Complications occurred in 45.5% (n = 10), and mortality was 13.6% (n = 3), significantly associated with suicidal ingestion (p = 0.001).ConclusionCorrosive esophageal injuries in Yemen, mostly accidental, affect younger patients and result in high morbidity (45.5%). ED is effective for single strictures, but severe cases often require surgery. Gastric pull-up appeared to have lower complications than colonic conduit in this small cohort, although larger studies are needed to confirm this trend. The elevated mortality rate among suicidal cases highlights the need for mental health support. The small sample size (n = 22) and single-center design limit generalizability, necessitating larger multicenter studies to optimize management strategies.

Assessment of drug induced hyperuricemia and gout risk using the FDA adverse event reporting system

Hyperuricemia, the key pathological basis of gout, is increasingly prevalent worldwide. While lifestyle factors contribute, various medications also play a role. However, their specific risks and mechanisms remain inadequately studied. Disproportionality analysis (ROR, PRR, BCPNN) was used to assess drug-induced hyperuricemia and gout reports (Q1 2004–Q3 2023). Univariate analysis, LASSO, XGBoost, and multivariate regression identified independent risk factors. Time-to-onset analysis evaluated the occurrence timing post-drug initiation. A total of 18,531 reports related to hyperuricemia and gout were identified. Reports involving male patients were significantly more frequent than those involving female patients for both hyperuricemia and gout. The mean ages of patients were relatively high, at 58.7 years (standard deviation [SD] 18.6 years) for hyperuricemia and 64.6 years (SD 13.5 years) for gout. Signal detection identified 131 drugs associated with hyperuricemia and 177 drugs associated with gout. Among the hyperuricemia-related reports, telaprevir was the most frequently implicated drug, whereas lenalidomide ranked highest in the gout-related reports. Subsequent multivariate analysis following machine learning-based screening identified male sex and older age as independent risk factors for drug-induced hyperuricemia and gout. Specifically, peginterferon alfa-2b was found to be an independent risk factor for drug-induced hyperuricemia, while 20 drugs—including pegloticase, febuxostat, allopurinol, rofecoxib, and furosemide—were identified as independent risk factors for drug-induced gout. Furthermore, the median time to onset (TTO) of drug-induced hyperuricemia and gout was 11 days (interquartile range [IQR]: 2–63 days) and 31 days (IQR: 1–269 days), respectively. Notably, over 50% of cases occurred within the first 30 days after initiation of the implicated drug. By leveraging FAERS-based signal detection, this study systematically elucidated significant associations between various drugs and the risks of hyperuricemia and gout. Furthermore, key independent risk factors—including sex, age, and specific drugs—were identified through machine learning and multivariate analysis. These findings provide valuable insights for pharmacovigilance and clinical medication management.

ROLE OF EARLY ARTERIAL PHASE IMAGING IN ACCURATELY DIFFERENTIATING HEPATOCELLULAR CARCINOMA FROM DYSPLASTIC NODULES IN CIRRHOTIC PATIENTS

Objective: To determine the diagnostic accuracy of early arterial phase contrast-enhanced CT imaging in distinguishing hepatocellular carcinoma (HCC) from dysplastic nodules (DN) in cirrhotic patients. Study Design: Cross-sectional observational study conducted at a tertiary care hospital’s radiology department in Lahore. Methods: A total of 73 cirrhotic patients with focal liver lesions detected on screening were recruited using convenience sampling. Multi-phase contrast-enhanced CT scans were performed, with special focus on the early arterial phase (~30–35 seconds post-contrast injection). Imaging features assessed included lesion size, enhancement pattern, presence of washout, and stromal invasion. Lesions were categorized as HCC or DN based on imaging criteria and clinical/pathologic correlation. Chi-square analysis was used to evaluate associations between imaging features and lesion type, and diagnostic performance (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]) of early arterial phase imaging was calculated against the reference standard diagnosis. Results: The mean age of patients was 29±6 years, with 72.6% male. All patients had chronic liver disease (commonly hepatitis-related or alcohol-related cirrhosis). Early arterial phase CT revealed that both HCC and DN lesions predominantly showed heterogeneous enhancement (&gt;75% of lesions). However, hallmark features distinguishing HCC from DN were identified. Arterial-phase washout was observed in 61.6% of HCCs versus only 17.8% of DNs. Similarly, stromal invasion was evident in 82.2% of HCCs compared to 23.3% of DNs. These differences were statistically significant (p &lt; 0.001). Early arterial phase imaging correctly identified HCC with a sensitivity of 91.6% and specificity of 72.7%, while for DNs the sensitivity was 87.5% and specificity 72.7%. The PPV for HCC was 88% and NPV 80%, indicating high accuracy in confirming HCC and a reasonable ability to rule it out. Conclusion: Early arterial phase CT imaging provides high diagnostic sensitivity for HCC in cirrhotic patients and significantly aids in differentiating HCC from dysplastic nodules. Characteristic arterial-phase findings such as contrast washout and stromal invasion are much more frequent in HCC than in DN, improving confidence in non-invasive diagnosis. Incorporating an early arterial phase in routine liver imaging protocols is recommended to enhance early detection and proper characterization of HCC in at-risk cirrhotic populations.

Frequency of re-exploration for bleeding in ON PUMP versus OFF PUMP coronary artery bypasses grafting at Peshawar Institute of Cardiology

Background: Postoperative bleeding is a significant complication of on-pump coronary artery bypass grafting (CABG), due to an increased risk of coagulopathy compared to off-pump techniques. Due to limited local data, this study aimed to compare re-exploration rates for bleeding between on-pump and off-pump CABG. Methods: This cross-sectional study was conducted in the Department of Cardiac Surgery at the Peshawar Institute of Cardiology, enrolling 160 patients (80 per group) via consecutive sampling. Adults aged 30–80 years undergoing elective CABG were included. Patients with bleeding disorders, recent anticoagulant use, valvular disease, emergency, or re-do surgeries were excluded. Postoperative bleeding within 24 hours was assessed via clinical evaluation and drain output; re-exploration was defined as return to the OR within 24 hours. Data were analyzed using t-tests and chi-square tests, with significance set at p &lt; 0.05. Results: The mean patient age was 57.16 ± 8.95 years, and 80.00% were male. Both groups were statistically similar in baseline characteristics (p &gt; 0.05). Prior MI was noted in 12.5% (CABG) and 11.25% (OPCAB) of patients. Mean ejection fraction was 52.35 ± 7.23 (CABG) vs. 53.19 ± 6.73 (OPCAB). Triple-vessel disease was most common. CABG patients received more grafts (median: 3.0) compared to OPCAB (median: 2.0; p &lt; 0.001). Re-exploration for bleeding occurred in 3 patients, all in the CABG group. One death was reported postoperatively. Conclusion: Both CABG and OPCAB are effective in managing complex coronary disease with low short-term mortality. However, CABG is associated with a higher number of grafts and re-exploration rates, while off-pump coronary artery bypass (OPCAB) offers a less invasive alternative with fewer complications. OPCAB may be preferred in high-risk patients without compromising outcomes.

Organization of nephrological care for patients with terminal chronic kidney disease and concomitant SARS-CоV-2 infection under martial law: a retrospective study (2022–2024)

Background. Patients with chronic kidney disease (CKD) are one of the most vulnerable populations during pandemics due to impaired immune response, frequent hospitalizations, and dependence on life-sustaining renal replacement the­rapy. SARS-CoV-2 may directly affect renal structures via ACE2 receptors expressed in proximal tubules and indirectly through systemic inflammation and hypercoagulability. In dialysis patients, COVID-19 is associated with increased risk of complications, erythropoietin resistance, and high mortality. Since the beginning of the armed conflict in Ukraine in 2022, nephrological care has been complicated by logistical disruptions, threats to patient and provider safety, population displacement, resource scarcity, and reduced access to essential care. Ukrainian sources report adaptive strategies such as mobile dialysis teams, patient relocation, and emergency care protocols. However, issues of treatment effectiveness and clinical outcomes in CKD 5D patients with COVID-19 during wartime require systemic analysis. The purpose was to analyze the course of COVID-19 and organizational aspects of nephrological care for patients with CKD 5D receiving maintenance hemodialysis under martial law conditions in Ukraine. Materials and methods. A retrospective single-center study included 31 CKD 5D patients with laboratory-confirmed SARS-CoV-2 infection receiving hemodialysis from 2022 to 2024. Data on clinical severity, mortality, changes in erythropoietin resistance, dialysis efficacy, vaccination status, and logistic challenges were assessed. Results. The mean patient age was 64.2 ± 10.8 years. Mild, moderate, and severe COVID-19 courses were observed in 61.3, 25.8, and 12.9 % of patients, respectively. Mortality reached 6.5 %. Severe cases were more frequent among unvaccinated patients. Erythropoietin resistance increased in 45 % of cases. No dialysis interruptions occurred despite logistical difficulties related to wartime conditions. Conclusions. The findings demonstrate the feasibility of maintaining effective nephrological care in crisis settings. Vaccination and adaptive medical logistics contributed to lower complication rates and provided the continuity of treatment.

A simplified hydroxyurea dosing approach for paediatric sickle cell anaemia in nigeria: addressing emergency care burden and adherence barriers in low-resource settings

BackgroundSickle cell anaemia (SCA) is highly prevalent in sub-Saharan Africa and is characterized by frequent vaso-occlusive crises and other severe complications. Hydroxyurea has proven effective in reducing SCA complications by increasing foetal haemoglobin, but its use in low- and middle-income countries (LMICs) remains limited due to cost, need for regular laboratory monitoring, and concerns about safety. This study evaluates a simplified hydroxyurea dosing regimen as a practical approach to reduce emergency room visits and improve treatment adherence in paediatric SCA within a resource-limited setting.MethodsWe conducted a prospective open-label cohort study over two years (January 2022– January 2024) at a tertiary hospital in South East Nigeria. One hundred children aged 1–18 years with confirmed SCA (HbSS genotype) were started on a uniform dose of hydroxyurea (20 mg/kg/day, capped at 500 mg/day). Patients were followed monthly, and those experiencing “breakthrough vaso-occlusive crises” had their dose increased to 25 mg/kg/day (or from 500 mg to 750 mg for those at the capped dose). The primary outcome was the frequency of SCA-related emergency room visits. Secondary outcomes included treatment adherence (assessed via caregiver report of missed doses) and factors associated with adherence. Statistical analyses (t-tests, Mann–Whitney U, chi-square) were performed to compare clinical and demographic variables between adherence groups, with a significance threshold of p < 0.05.ResultsThe simplified hydroxyurea regimen dramatically reduced emergency room visits. Only one patient (1% of the cohort) required an emergency visit for a vaso-occlusive crisis during the two-year period, and this patient’s dose was successfully escalated to 750 mg/day with no further crises. Overall, treatment adherence was high: 84.2% reported consistent adherence to daily hydroxyurea. Younger children demonstrated better adherence than older children (mean age of adherent patients 8.5 ± 5.3 years vs. 11.6 ± 4.2 years for non-adherent, p = 0.027). Patients who were non-adherent tended to have older fathers (median paternal age 49 years vs. 44 years in adherent patients, p = 0.02). Other factors—sex, socio-economic status (social class), maternal age, weight, and baseline health status—showed no significant association with adherence (all p > 0.2). No severe adverse effects were observed, and the dosing approach was well-tolerated without routine laboratory monitoring.ConclusionA simplified hydroxyurea dosing strategy appears to be a safe, effective, and feasible strategy for managing paediatric SCA in a resource-limited setting. This approach resulted in a substantial reduction in vaso-occlusive crises requiring emergency care and high levels of treatment adherence. These findings suggest that simplified dosing protocols could be a valuable component of broader SCA care strategies in settings such as Nigeria. Validation through larger or comparative studies is encouraged, and we recommend that healthcare policy-makers consider piloting and supporting similar models as part of national sickle cell control efforts.

Photon-Counting Detector CTA in Standard and Ultrahigh-Resolution Modes for Diagnosing Coronary Artery Stenosis Using Invasive Angiography as the Reference: A Prospective Study.

Background: The literature reports excellent diagnostic performance of coronary CTA using photon-counting detector (PCD) CT, albeit obtained using various acquisition and reconstruction protocols. Objective: To assess the diagnostic performance for detecting significant stenosis of coronary CTA performed by PCD CT with various standard resolution (SR) and ultrahigh resolution (UHR) protocols, using invasive coronary angiography (ICA) as the reference standard. Methods: This prospective study enrolled inpatients undergoing coronary CTA between October 2023 and October 2024. Participants underwent coronary CTA by PCD CT, sequentially alternating between SR (collimation:120×0.2 mm) and UHR (144×0.4 mm) modes across participants. SR examinations were reconstructed into SRnormal and SRVNCa (virtual noncalcium) image sets, both using 0.6-mm slice thickness and Bv40 kernel. UHR examinations were reconstructed into UHRnormal (0.6-mm slice thickness, Bv40) and UHRthin (0.2-mm slice thickness, Bv64) image sets. Two radiologists independently measured diameter stenoses. Final analysis included patients who underwent ICA after CTA; a cardiologist reviewed ICA images to determine the reference standard. Stenoses were considered significant at a ≥50% threshold. Results: The SR group included 61 patients (mean age, 67±9 years; 46 male, 15 female; 788 segments analyzed). The UHR group included 61 patients (67±11 years; 43 male, 18 female; 825 segments analyzed). Per-segment sensitivity, specificity, and accuracy for reader 1 were 92.9%, 89.9%, and 90.5% for SRnormal; 92.9%, 91.6%, and 91.9% for SRVNCa; 96.0%, 92.4%, and 93.0% for UHRnormal; and 100.0%, 98.6%, and 98.8% for UHRthin; and for reader 2 were 92.9%, 88.8%, and 89.6% for SRnormal; 93.5%, 92.3%, and 92.5% for SRVNCa; 96.0%, 91.6%, and 92.2% for UHRnormal; and 100.0%, 98.9%, and 99.0% for UHRthin. Significant (p<.05) differences included SRVNCa versus SRnormal for specificity for both readers and accuracy for reader 2; UHRthin versus UHRnormal for sensitivity, specificity, and accuracy for both readers; and UHRthin versus SRVNCa for sensitivity, specificity, and accuracy for both readers. Conclusion: Coronary CTA performed by PCD CT achieved high diagnostic performance in SR or UHR mode. Performance was higher for SRVNCa than SRnormal and for UHRthin than either UHRnormal or SRVNCa. Clinical Impact: The findings will help to optimize protocols for coronary CTA performed by PCD CT.

Long-term Effects of Atrioventricular Junction Ablation on Symptom Burden, Functional Capacity, and Health-Related Quality of Life in Men and Women With Symptomatic Atrial Tachyarrhythmias: A Prospective Single Center Study.

Atrioventricular junction ablation can be used when maximal tolerable pharmacological therapy cannot relieve atrial tachyarrhythmia symptoms. However, this strategy requires lifelong pacemaker therapy. The aims in this study were to evaluate the long-term effects of atrioventricular junction ablation and explore the differences by sex on symptom burden, functional capacity, and health-related quality of life in patients with implanted pacemaker and symptomatic atrial tachyarrhythmia. In this prospective longitudinal study, 137 patients (mean age, 74 ± 8 years; 47 men) were included. Six-minute walk test, symptom-specific, and generic self-reported instruments for measuring symptom burden, functional status, and health-related quality of life were assessed at baseline, 6 and 12 months after ablation. Analysis was performed to explore the data in the total group and by sex. Baseline characteristics such as mean age, type of arrhythmia, ejection fraction, and cardiac resynchronization therapy differed statistically between the sexes (P < .05-.001). At the 12-month follow-up, the patients improved their mean walking distance by 56 m (P < .001). At the 12-month follow-up, both sexes showed significant improvement in symptom frequency and severity (P < .001), functional capacity (P < .05-.001), and health-related quality of life (P < .001). Both sexes benefited from this treatment. Specifically, their symptoms and physical and functional capacities improved, resulting in increased engagement in daily activities. In addition, these patients improved their health-related quality of life. The women experienced greater psychosocial effects than the men. If medical therapy fails to achieve adequate rate and symptom control for symptomatic atrial tachyarrhythmia, atrioventricular junction ablation combined with pacemaker is a safe and well-tolerated option.

A Histopathological and Surgical Analysis of Gastric Cancer: A Two-Year Experience in a Single Center.

Background: Gastric neoplasms remain pathologies of the malignant spectrum with high incidence and prevalence, with their management requiring a precise histopathological characterization for optimal treatment planning. Methods: The present study is a retrospective analysis that included 67 histopathologically confirmed gastric neoplasia subjects and was performed at a single surgical center from January 2020 to December 2021. Demographics, tumor characteristics, surgical procedures, and oncologic outcomes were included, filtered, and subsequently analyzed using SPSS Statistics 29.0. Results: This study involved 67 patients (mean age 65.7 years, 56.7% men), with adenocarcinoma being the most common histologic type (91.0%) and most tumors being diagnosed directly as Stage III (40.3%). Lauren classification revealed the intestinal type as the most common (49.2%), followed by diffuse (36.1%) and mixed (14.8%). Poorly differentiated tumors (G3) accounted for 53.7% of cases. The surgical team performed curative resection in 75% (n = 50) of patients, achieving R0 margins in 88% of these cases. Subtotal gastrectomy with D2 lymphadenectomy yielded the highest curative success rate with 96.6% R0 resection. Statistically, we identified two significant correlations between age and tumor grade (rho = 0.28; p = 0.021) and between the number of lymph nodes examined and the number of lymph nodes invaded (rho = 0.65, p < 0.001). This study again revealed that adenocarcinomas showed higher rates of lymph node invasion than other tumor types (p = 0.017). Conclusions: The analysis of patients with gastric neoplasms is vital for appropriate therapeutic management. Even though the study period included a pandemic, the analysis remained a complex one with high-quality surgical outcomes, confirming the importance of maintaining oncologic standards during medical crises.

First-day intracranial pressure correlates with ICU mortality in subarachnoid hemorrhage patients: an analysis of the MIMIC-IV database

BackgroundThe purpose of this study was to explore the optimal intracranial pressure (ICP) distribution of subarachnoid hemorrhage (SAH) patients on the first day in the intensive care unit (ICU) using data mining methods.MethodsContinuous ICP monitoring records of 176 SAH patients on the first ICU Day were collected from the MIMIC-IV database, comprising individuals treated at Beth Israel Deaconess Medical Center (Boston, MA) ICU between 2008 and 2019. Data underwent five-step processing: rounding (to hour point), missing value imputation, resampling, min-max normalization, and time-series clustering. Four unique clusters of the SAH cohort were identified, differing by daily average and variance of ICP. Propensity score estimation was used to determine the average treatment effect of ICP management on ICU mortality based on the X-tile recommended cut-off point.ResultsThe study cohort comprised 176 patients (mean age 58.8 ± 14.54 years; 58.0% [102/176] female) who met the inclusion criteria. The daily average was the only statistically significant factor in the propensity score estimation. A daily average ICP of 14 mmHg was identified as the cut-off point. The group with a daily average ICP above or below the cut-off point was an independent ICU mortality predictor in the multivariate analysis, with the largest odds ratio value among included variables. Notably, the daily average ICP was higher in ICU deaths than in survived patients under similar first-day fluid balance (ICU deaths vs. survived patients: PPearson = 0.002, R2 = 0.25; PPearson = 0.016, R2 = 0.04).ConclusionIn the study cohort collected from MIMIC-IV SAH patients, using 14 mmHg as the cut-off point for the daily average ICP on the first ICU Day demonstrated favorable ICU mortality outcomes.

Effectiveness of low-frequency magnetotherapy in rehabilitation of patients with combat injury sequelae

BACKGROUND: In recent years, the number of military personnel with mine-blast injuries sustained during the special military operation has significantly increased. These injuries often lead to severe damage, which leading to disability. The development and implementation of new medical rehabilitation methods for patients with combat injury sequelae using physical therapy modalities, such as low-frequency magnetotherapy, is a key priority in modern medicine. Low-frequency magnetotherapy is included in the rehabilitation recommendations for patients with combat injury sequelae by many experts. The International Classification of Functioning, Disability and Health (ICF) is currently recommended as a tool for objectively assessing patient health, predicting functional impairment, and evaluating rehabilitation measures. AIM: The work aimed to assess the effectiveness of low-frequency magnetotherapy in the rehabilitation of patients with combat injury sequelae in terms of the ICF. METHODS: The study included 95 patients (mean age 25.9 ± 2.1 years) with combat injury sequelae, accompanied by peripheral neuropathies, lower-limb fractures, and multiple shrapnel wounds. Group 1 (main) included 48 patients who received low-frequency magnetotherapy using the Polimag-02M device (Elamed, Russia) for 20 minutes daily for 14 sessions, in addition to standard therapy. Group 2 (control) included 47 patients who received standard therapy only. A comprehensive evaluation was conducted after the rehabilitation course, including the Visual Analog Scale (VAS) for pain, tape measurements of limb edema, Functional Independence Measure (FIM), Spielberger–Hanin anxiety scale, and Beck Depression Inventory. RESULTS: A 45.8% reduction in pain, a 42.7% decrease in edema, and an 11.5% improvement in FIM scores were observed in the main group. According to the Spielberger–Hanin scale, anxiety levels decreased by 10.9%, and depression levels by 30.5%. CONCLUSION: The application of the ICF tool demonstrated that low-frequency magnetotherapy effectively reduces pain and edema and improves quality of life in patients with combat injury sequelae.

Mesiodistal angulation change of the maxillary lateral incisor in the extraction treatment by clear aligner- a retrospective cone-beam computed tomography study

ObjectiveThis study evaluated changes in the mesiodistal angulation of the maxillary lateral incisors during extraction with clear aligners using panoramic images reconstructed from cone-beam computed tomography (CBCT) images and identified the main influencing factors for reducing the distal inclination of the maxillary lateral incisors during extraction.MethodsThis study analyzed 27 patients (mean age 21.1 ± 4.9 years; 18 women, 9 men) who underwent extraction with clear aligners. In total, 54 maxillary lateral incisors were included—each patient contributed two teeth. CBCT scans were obtained at pretreatment and refinement. The projection of the midpalatal suture on the panoramic image helped measure the axial angulation of the maxillary lateral incisors. Three-dimensional reconstruction was performed using Mimics, and the maxillary structure superimpose method was employed to measure the horizontal distance of the maxillary lateral incisors. Influencing factors, including lateral incisor attachment, lateral incisor horizontal movement distance, upper dentition retraction method, and lateral incisor crown-to-root ratio, were analyzed. P < 0.05 was considered statistically significant.ResultsMaxillary lateral incisors are prone to distal inclination during orthodontic extraction using a clear aligner (P < 0.001). Notably, the angulation of maxillary lateral incisors significantly decreased in both groups, with larger decreases in the nonattachment groups (P < 0.001). Significant differences were observed between different retraction methods (P < 0.05) and horizontal movement distances of the lateral incisors (P < 0.001), but none among the different crown-to-root ratios (P > 0.05).ConclusionsDuring extraction by clear aligner, changes in the mesiodistal angulation of the maxillary lateral incisor should be considered to ensure satisfactory treatment outcomes. By adding attachments and designing the canine first retraction method, the distal inclination of the lateral incisors can be reduced.

Orbital CT deep learning models in thyroid eye disease rival medical specialists’ performance in optic neuropathy prediction in a quaternary referral center and revealed impact of the bony walls

ABSTRACT Purpose To develop and evaluate orbital CT deep learning (DL) models in optic neuropathy (ON) prediction in patients diagnosed with thyroid eye disease (TED), using partial versus entire 2D versus 3D images for input. Methods Patients with TED ±ON diagnosed at a quaternary-level practice and who underwent orbital CT between 2002 and 2017 were included. DL models were developed using annotated CT data. The DL models were used to evaluate the hold-out test set. ON classification performances were compared between models and medical specialists, and saliency maps applied to randomized cases. Results 36/252 orbits in 126 TED patients (mean age, 51 years; 81 women) had clinically confirmed ON. With 2D image input for ON prediction, our models achieved (a) sensitivity 89%, AUC 0.86 on entire coronal orbital apex including bony walls, and (b) specificity 92%, AUC 0.79 on partial axial lateral orbital wall only annotations. ON classification performance was similar (p = 0.58) between DL model and medical specialists. Conclusions DL models trained on 2D CT annotations rival medical specialists in ON classification, with potential to objectively enhance clinical triage for sight-saving intervention and incorporate model variants in the workflow to harness differential performance metrics.

Ultrasound and functional evaluation of forearm circulation in patients with radial artery occlusion.

The transradial approach has recently gained popularity in invasive cardiology. Collateral circulation through the ulnar (UA) and anterior interosseous artery (AIA) compensates for radial artery (RA) occlusion (RAO). We evaluated arterial circulation in the forearm and hand in patients with RAO after coronary angiography (CA) and percutaneous coronary interventions (PCIs). This prospective observational study included 40 RAO patients (mean age, 71.22 ± 9.99 years) after CA/PCI. Collateral circulation was assessed using ultrasonography and the Barbeau test. Doppler ultrasound and anatomical parameters of RAO were evaluated. The RA, UA, and AIA differed in peak systolic velocity, end-diastolic velocity, arterial diameter, total flow volume, and stroke volume (p < 0.01). Pulse quality differed between the RA and UA (p < 0.0001). Blood flow direction in the distal RA divided patients into those with antegrade flow from the AIA and retrograde flow from the UA (50% each). In logistic regression, Barbeau test results for fingers 2 (p = 0.0006, OR = 0.1398) and 4 (p = 0.004, OR = 0.2843) predicted the direction of blood flow in the distal RA. Ultrasound and functional evaluation can be used to assess collateral circulation and predict blood flow direction in RAO patients. However, further research is needed to confirm these findings.

Hypokalemia in chronic migraine with medication overuse headache: a retrospective cross-sectional study

BackgroundPotassium may be involved in the pathogenesis of migraine. Patients with chronic migraine and medication-overuse headache (CM-MOH) appear to be at a high risk for hypokalemia.MethodsA retrospective cross-sectional study enrolled 139 consecutive patients with CM-MOH and 139 age- and sex-matched patients with healthy controls from our center. The demographic and clinical characteristics of the patients were recorded upon admission. The following morning, blood tests for potassium and magnesium concentrations were performed.ResultsThe mean age of patients in the two groups was 48.60 ± 11.81 (CM-MOH) vs. 48.69 ± 11.99 (control). Migraineurs had a significantly lower serum potassium level (3.76 ± 0.35 mmol/L vs. 4.03 ± 0.30 mmol/L p < 0.001) and a higher prevalence of hypokalemia (21.6% versus 2.2% p < 0.001) compared to controls. A positive association between potassium and magnesium levels was observed in patients with CM-MOH (r = 0.25, p = 0.004). A slightly higher level of Mg (0.90 ± 0.06mmol/L versus 0.89 ± 0.05mmol/L, p = 0.012) was detected in the CM-MOH group compared to controls. According to logistic regression models, BMI was associated with the presence of hypokalemia in patients with CM-MOH.ConclusionThe incidence of hypokalemia in the control group was similar to that in the general population. An increased incidence of hypokalemia and lower serum potassium levels were observed in patients with CM-MOH. It is important to monitor the serum potassium levels in these patients.

Prevalence of extra-articular deformity (EAD) and tibia vara (TV) in patients undergoing total knee arthroplasty (TKA) in Indian population.

Prevalence of extra-articular deformity (EAD) and tibia vara (TV) in patients undergoing total knee arthroplasty (TKA) in Indian population.

Long-term effect of anifrolumab on patient-reported outcomes in systemic lupus erythematosus (TULIP-LTE): a randomised, placebo-controlled, phase 3 long-term extension trial.

Long-term effect of anifrolumab on patient-reported outcomes in systemic lupus erythematosus (TULIP-LTE): a randomised, placebo-controlled, phase 3 long-term extension trial.

Safety Profile of Statins for Post-Marketing Adverse Cardiovascular Events: A Real-World Pharmacovigilance Analysis.

The purpose of this study was to comprehensively evaluate the association of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) with neurological adverse events using the US Food and Drug Administration Adverse Event Reporting System (FAERS) database, with the aim of guiding the rational use of statins. The number and clinical characteristics of adverse events (AEs) to statins in the FAERS database between 2012 and March, 2023, were extracted. Neurological AEs were defined by the system organ classes (SOCs) of "Nervous System Disorders (10029205)" and the corresponding PT. Disproportionality was calculated using the reporting dominance ratio (ROR), proportional reporting ratio (PRR), and information component (IC025). Between January, 2012 and March, 2023, a total of 90,357 AEs were reported for the three statins (atorvastatin, resuvastatin, and simvastatin). The majority of reports on AEs came from the United States (n = 7284). A total of 8409 reports described neurological AEs following the use of the three statins, with atorvastatin accounting for more than half of the reports (n = 4430). The mean age of patients who developed neurological AEs was 55 years and older. The prevalence was similar in female patients (2230/4480) and male patients (1999/4480). Disproportionate analyses showed that at the SOC level, only the correlation between atorvastatin and neurological AEs suggested a positive signal (ROR: 9.77 (9.56-9.99); IC025: 3.28; PRR (χ2): 9.76 (16.07)) and in total, there were 32 PTs with a positive signal. The median time for neurological AEs was 71 days (IQR: 14-559 days), and the most common AEs were other serious effects (important medical event) (OT) (n = 2283) and hospitalization (HO) (n = 715). This study suggests that atorvastatin may be associated with an increased risk of neurological AEs. This study provides realistic evidence of the potential risk of statin-related adverse events.

Splenic lacerations: a retrospective analysis of management strategies and clinical outcomes.

Splenic injuries are among the most frequently encountered conditions in abdominal trauma. In such cases, the treatment approach must be carefully determined based on the patient's hemodynamic stability, the severity of the injury, and the presence of associated intra-abdominal pathologies, typically requiring a choice between non-operative management (NOM) and surgical intervention. The decision-making process is primarily guided by hemodynamic status, injury grade, and imaging findings. This study evaluates clinical outcomes and the factors influencing treatment decisions in patients with splenic rupture who were referred from the emergency department to the general surgery unit. A retrospective cohort study was conducted on 42 patients diagnosed with splenic injury between June 2023 and February 2025. Patients were divided into two groups: those who received NOM (n=29, 69.0%) and those who underwent operative management (OM) (n=13, 31.0%). Demographics, mechanisms of injury, hemodynamic status, laboratory results, imaging findings, transfusion requirements, length of hospital stay, and mortality rates were analyzed. Statistical comparisons were made using appropriate tests, with significance set at p<0.05. The mean age of patients was 38.3±19.4 years, with 76.2% being male. The leading cause of injury was vehicular accidents (47.6%), followed by falls (21.4%) and penetrating trauma (11.9%). Operative management was more common in sharp object penetrating injuries (SOPI) (15.4%) and gunshot wounds (7.7%). Hemodynamic instability was more frequent in the OM group compared to the NOM group (30.8% vs. 10.3%, p=0.149). Splenectomy was performed in 76.9% of surgical cases (p=0.003). Computed tomography (CT) imaging revealed that Grade 1 injuries (55.2%) were predominant in the NOM group, while Grade 2 injuries (38.5%) were more common in the OM group (p=0.531). The OM group required more blood transfusions (2.6±3.0 units vs. 0.9±1.9 units, p=0.053) and had longer hospital stays (10.3±6.9 days vs. 5.7±4.9 days, p=0.042). Overall mortality was low (9.5%), with no significant difference between the groups (p=0.819). Non-operative management is the preferred approach for hemodynamically stable patients, offering favorable outcomes and shorter hospital stays. However, penetrating trauma and hemodynamic instability are strong predictors for surgical intervention. Early risk stratification and close clinical monitoring are essential in determining the most appropriate treatment strategy for splenic injuries.

Impact of Caregiver and Patient Age on Efficacy of Caregiver Interventions in Advanced Cancer: A Meta-Regression.

It has been shown that interventions to support caregivers of patients with advanced cancer improve caregiver wellbeing, but the possible additional influence of patient and caregiver age is unknown. We measured the impact of patient and caregiver age on the efficacy of caregiver interventions. We included all studies from a recent meta-analysis of randomized controlled trials of caregiver support interventions for adult caregivers of adults with advanced cancer that reported on outcomes of quality of life (QOL), anxiety, or depression. Random-effects meta regression was performed on each outcome for continuous variables of: 1) mean patient age, 2) mean caregiver age, and 3) mean age difference between mean age of patients and caregivers. Among study sets demonstrating statistically significant associations, we performed sensitivity analyses excluding influential outliers. Twenty-four studies reporting on 23 trials involving 3306 caregivers were included in this meta-regression. Interventions were associated with improved QOL, anxiety and depression. In studies with older mean patient age, interventions had a greater impact on QOL (P = 0.04). In studies with younger mean caregiver age, interventions had a greater impact on depression (P = 0.02). In studies with a larger patient-caregiver age difference, interventions had a greater impact on anxiety (P = 0.01), but this effect did not prevail on sensitivity analysis (P = 0.52). Age of patients with advanced cancer and their caregivers may influence the efficacy of caregiver support interventions, and should be taken into account when designing these interventions and interpreting their effect.