Mean Onset Time Research Articles

The potential of uroflowmetry to predict and detect hemorrhagic cystitis following hematopoietic stem cell transplantation

Hemorrhagic cystitis (HC) is a serious complication following hematopoietic stem cell transplantation (HSCT) associated with significant morbidity and mortality. Early identification of at-risk patients and prompt diagnosis are crucial for effective management. This prospective cohort study evaluated the potential of uroflowmetry as a predictive tool for detecting HC in pediatric HSCT patients. Thirty-one children who underwent allogeneic HSCT were enrolled. Uroflowmetry was performed on admission (Day 0), post-HSCT Day 1 and Day 15, and at HC onset. Uroflowmetric parameters, including maximum flow rate (Qmax), average flow rate (Qavg), voided volume (VV), and flow curve shape, were compared between HC and non-HC patients. The incidence of HC within 100 days post-HSCT was 58%, with a mean onset time of 35 days. At baseline (Day 0), HC patients had significantly lower Qmax (12.5 vs. 17.8mL/s), Qavg (6.8 vs. 9.5mL/s), and VV (185 vs. 245mL) compared to non-HC patients (all p<0.05). Age-stratified analysis revealed the observation of these differences across all age groups. At HC onset, compared to Day 0, patients experienced a significant decrease in Qmax (8.7 vs. 12.5mL/s) and Qavg (4.2 vs. 6.8mL/s) (both p<0.05). Flow curve analysis demonstrated a shift from bell-shaped to interrupted curves in HC patients over time. Uroflowmetry can potentially predict and detect HC in pediatric HSCT patients. Lower baseline uroflowmetric parameters may identify patients at higher risk for HC, while a significant decrease in these parameters from baseline may indicate HC onset. Uroflowmetry is a simple, non-invasive tool that can be performed at home and monitored remotely, facilitating early detection and intervention for HC in this population.

Oral/Perioral Reactions to Injectable Soft Tissue Fillers: A Clinicopathological Multicentric Study.

To analyze the characteristics of a series of oral reactions to injectable soft tissue fillers. Cases diagnosed as oral reactions to injectable soft tissue fillers were selected from eight Pathology laboratories. Information was retrieved from the laboratory charts and from the review of the hematoxylin and eosin-stained histological slides. The 151 patients showed a mean age of 54.9 years, and 136 (90.1%) were females. Mean time of onset was 20.4 months, and the lips were the most frequent location (72.8%). Most cases presented as asymptomatic isolated nodules, with a mean size of 17.4 mm. Silicone (38.5%), polymethylmetacrylate (33%), and hyaluronic acid (11.9%) were the three most common fillers. Granulomas, foamy macrophages, and multinucleated giant cells were observed in 44%, 51.5%, and 65.3% of the cases, respectively. Time of onset was shorter for males (p = 0.033), and symptoms were common in the upper lip, buccal mucosa, and lower vestibule (p = 0.010). Foamy macrophages were more common in association with silicone and collagen (p < 0.001), whereas multinucleated giant cells were more common in association with polymethylmetacrylate, hydroxiapatite, and polylactic acid (p = 0.012). Clinicians should consider reactions to injectable soft tissue fillers when evaluating asymptomatic submucosal nodules affecting the lips of adult/older females.

Magnesium Sulphate Versus Fentanyl as Adjuncts to Epidural Anaesthesia for Lower Limb Orthopaedic Surgeries: A Comparative Study

Abstract Introduction: Pain relief for lower limb orthopaedic surgeries is achievable with epidural anaesthesia. This study compared the analgesic effects of epidural anaesthesia with magnesium sulphate or fentanyl adjuvant in patients scheduled for elective lower limb orthopaedic surgeries. Patients and Methods: A double-blind randomisation study was carried out on 96 patients categorised into three groups; M, F, and C. All participants received 18 mL of 0.5% bupivacaine plus 1.5 mL of 75 mg magnesium sulphate in Group M or 50 mg of fentanyl in Group F or normal saline in Group C via the lumbar epidural route. Variables including the onset time of sensory and motor blockade, duration of anaesthesia, and time for postoperative Numerical Rating Scale (NRS) score of 3 were summarised using mean, median, standard deviation, and percentages as appropriate. A P value of &lt;0.05 was considered statistically significant. Results: Mean onset time for the sensory blockade at T8 was 23.7 ± 5.3, 20.5 ± 3.4, and 17.9 ± 5.6 min for groups C, F, and M, respectively (P = 0.001). The onset time for the motor blockade (Bromage score 3) was 29.8 ± 4.0, 26.6 ± 3.5, and 24.5 ± 5.3 min in groups C, F, and M, respectively (P = 0.001). The duration of epidural anaesthesia was 121.6 ± 31.5, 145.9 ± 29.6, and 167.0 ± 27.0 min in groups C, F, and M, respectively (P = 0.001). The time to attain an NRS pain score of 3 was 133.2 ± 27.7, 151.8 ± 32.4, and 172.0 ± 30.9 min in groups C, F, and M, respectively (P = 0.001). Conclusion: Magnesium sulphate is better as an epidural adjuvant compared to fentanyl in patients undergoing lower limb orthopaedic surgeries.

Real-World Large Sample Assessment of Drug-related Dry Eye Risk: Based on the FDA Adverse Event Reporting System Database

Purpose and designThis study aimed to evaluate the risk of drug-related dry eye using real-world data, underscoring the significance of tracing pharmacological etiology for distinct clinical types of dry eye. MethodsAnalyzing adverse event reports in the Food and Drug Administration Adverse Event Reporting System (FAERS) from January 2004 to September 2023, we employed disproportionality analysis and the Bayesian confidence propagation neural network algorithm. The analysis involved categorizing drugs causing dry eye, assessing risk levels, and conducting segmental assessments based on the time of onset of drug-related dry eye adverse reactions. ResultsIn the FAERS database, adverse reactions related to dry eye were linked to 1160 drugs. Disproportionality analysis identified 33 drugs with significant risk, notably in ophthalmic (brimonidine, bimatoprost), oncology (tisotumab vedotin, erdafitinib), and other medications (isotretinoin, oxymetazoline). The top three drugs with the highest risk of drug-related dry eye are isotretinoin (Bayesian confidence propagation neural network (BCPNN) = 6.88), tisotumab vedotin (BCPNN = 6.88), and brimonidine (BCPNN = 6.77). Among different categories of drugs, respiratory medications have the shortest mean onset time for drug-related dry eye, averaging 50.99 days. The prevalence skewed towards females (69.9 %), particularly in menopausal and elderly individuals (45–70 years old, mean age 54.7 ± 18.2). Reports of drug-related dry eye adverse reactions showed an annual increase. ConclusionInformed clinical decision-making is crucial for preventing drug-related dry eye. Assessing the risk of dry eyes associated with both local and systemic medications helps optimize treatment and provide necessary cautionary information.

Application of combined anesthesia with spontaneous breathing in the surgery of intertrochanteric fracture of femur in elderly patients.

This study aims to investigate the feasibility and safety of combined anesthesia with spontaneous breathing in the operation of intertrochanteric fracture of femur in the elderly. Between January 2020 and January 2023, a total of 141 elderly patients (45 males, 96 females; mean age: 72.5±6.8 years; range, 65 to 87 years) who underwent proximal femoral nail anti-rotation (PFNA) surgery for intertrochanteric fracture of femur were included in this single-blind, prospective, randomized-controlled study. The patients were randomly divided into three groups. Group A (experimental group) was a general anesthesia with laryngeal mask airway (LMA) group preserving spontaneous breathing, Group B (control group 1) was a general anesthesia with LMA group for mechanical ventilation, and Group C (control group 2) was a tracheal intubation anesthesia group for mechanical ventilation. The differences of related indexes among the three groups were compared. The mean onset time of anesthesia (6.23±1.45 vs. 12.78±2.78 vs. 13.73±2.43 min), postoperative recovery time of consciousness (8.13±0.83 vs. 11.34±0.89 vs. 12.45±0.86 min), and postoperative complete awakening time (10.45±2.34 vs. 18.87±2.56 vs. 19.62±2.93 min) were significantly shorter in Group A than in Groups B and C (p<0.05). The duration of analgesic effect was longer in Group A than in Groups B and C (p<0.05). After anesthesia, the Ramsay Sedation Scale and Visual Analog Scale (VAS) scores were significantly lower in Group A than the other groups (p<0.05). The mean Mini-Mental State Examination (MMS) scores were significantly higher in Group A than in Groups B and C (p<0.05). Hemodynamic parameters showed that blood pressure, heart rate, cardiac output, and cardiac index (CI) levels were significantly higher in Group A than the other groups (p<0.05). Our study results indicate that combined anesthesia preserving spontaneous breathing is safe and feasible in the operation of intertrochanteric fracture of femur in the elderly, with faster anesthesia recovery than the mechanical ventilation group.

Conjunctival keratoacanthoma: a clinical and histopathological case series

ObjectiveTo present a series of conjunctival keratoacanthomas and provide clinical, histopathological, immunohistochemical, and imaging results that characterize this rare entity. MethodsA retrospective chart review of records from 2005 to 2023 from the Florida Lions Ocular Pathology Laboratory was conducted. Nine patients with histologically proven conjunctival keratoacanthoma were identified. Data extracted includes demographics, clinical history, diagnostic testing, histopathological and immunohistochemical testing, treatment modalities, and recurrences. ResultsPatients’ mean age was 55.2 ± 21.1 years (range: 22–83). 77.8% (7/9) of patients were male. 55.6% (5/9) were Hispanic. 55.6% of lesions (5/9) were in right eyes. 55.6% of lesions (5/9) were on the temporal, bulbar conjunctiva. The lesions were rapidly growing, with mean onset time of 4.71 ± 3.30 weeks (range: 2–12). High-resolution anterior segment optical coherence tomography of three lesions revealed hyper-reflective, thickened epithelium with abrupt transition between normal and abnormal epithelium. Underlying disorganized subepithelial tissue was noted. However, the overlying abnormal epithelium caused considerable shadowing, which obscured subepithelial structures. Prominent, keratin-filled, cup-shaped lesions with faulty maturational sequencing that extend full thickness, variably pale cytoplasm, and foci of dyskeratosis and hyperkeratosis were present on all lesions’ histopathology.All lesions were surgically excised, but two demonstrated partial spontaneous resolution before surgery. Two patients were lost to follow-up; the remaining seven had no signs of recurrence at a of mean of 36.9 ± 45.4 months (range: 3 to 141 months) of follow-up. ConclusionsConjunctival keratoacanthomas are rare lesions of the ocular surface with distinct clinical, histopathologic, and diagnostic features.

Mismatch Negativity and P300 in the Diagnosis and Prognostic Assessment of Coma and Other Disorders of Consciousness.

The objective of this study was to investigate the value of mismatch negativity (MMN) and P300 event-related potentials for discriminating the consciousness state and predicting improvement of consciousness at 6months in patients with coma and other disorders of consciousness (DOC). We performed MMN and P300 on 42 patients with DOC with a mean onset time of 40.21 ± 19.43days. These patients with DOC were categorized into coma, unresponsive wakefulness syndrome (UWS), minimal consciousness minus (MCS-), and minimal consciousness plus (MCS +) groups according to neurobehavioral assessment and the Coma Recovery Scale-Revised score. The primary outcome was the improvement of consciousness at 6months in patients with DOC. We assessed the efficacy of MMN and P300 in quantitatively predicting the prognosis at 6months and the capability of MMN and P300 parameters to differentiate between DOC. At least one significant difference in either MMN or P300 parameters was displayed among the DOC groups, but not between the MCS- and MCS+ groups (significance level: 0.05). Both MMN and P300 amplitudes showed desirable predictive accuracy at 6months, with areas under the curve (AUCs) of 0.859 and 0.856, respectively. The optimal thresholds for MMN and P300 amplitudes were 2.044 and 1.095μV. However, the combined MMN-P300 amplitude showed better 6-month predictive accuracy (AUC 0.934, 95% confidence interval 0.860-1.000), with a sensitivity of 85% and a specificity of 90.9%. MMN and P300 may help discriminate among coma, UWS, and MCS, but not between patients with MCS- and patients with MCS+ . The MMN amplitude, P300 amplitude, and especially combined MMN-P300 amplitude at 6months may be interesting predictors of consciousness improvement at 6months in patients with DOC. Chinese Clinical Trial Registry identifier ChiCTR2400083798.

Incidence and Management of Pharyngo Cutaneous Fistula Following Total Laryngectomy - A Single Institutional 10 Years Experience.

Pharyngocutaneous fistula (PCF) is a common postoperative complication in patients undergoing laryngectomy. Many studies have focused on the predisposing factors and their treatment, but there is still controversy on how to identify high-risk patients.PCF is associated with delay in adjuvant treatment, prolonged hospital stay, and the requirement for additional surgical procedures. The increased incidence of post-laryngectomy PCF in the modern era of organ preservation therapy has driven considerable efforts to develop techniques to avoid and treat this complication. The study aims to analyze the incidence, predisposing factors, management, and outcome of PCF in post laryngectomy patients. We reviewed retrospectively the medical records of 72 patients who underwent total laryngectomy during the period from 2013 to 2022 at our institute. Details regarding age, gender, tumor site, comorbidities, radiotherapy, chemotherapy, duration of nasogastric tube feeding, the incidence of PCF and its management, and length of hospital stay. In our analysis of 72 patients, with 38 undergoing upfront laryngectomy and 34 salvage laryngectomy post-chemoradiation, we observed a 23% incidence of Pharyngocutaneous Fistula (PCF). Our univariate analysis revealed that low pre-op albumin levels and advanced stage significantly increased the risk of PCF. Specifically, PCF occurred in 16% of upfront laryngectomy patients and increased to 32% in salvage laryngectomy patients, though there was no significant association with pre-operative radiotherapy (RT).Among PCF cases, those from upfront laryngectomy had a mean onset time of 12 days, while salvage laryngectomy cases had a mean onset time of 8 days. The majority of PCF cases (64%) were managed conservatively, with 11% resolving through secondary suturing and 25% requiring surgical repair using local flaps. Notably, 80% of upfront laryngectomy PCF cases were managed conservatively, compared to 54% in salvage laryngectomy cases.The average hospitalization time for PCF patients was significantly longer at 35.6 days, compared to 12 days for non-PCF patients. Importantly, there were no fatal complications related to PCF in either group. Our study found that Pharyngocutaneous Fistula (PCF) occurs in both irradiated and non-irradiated patients, with T staging and pre-op albumin levels being significant risk factors. While PCF in non-irradiated patients can be treated conservatively, those in chemoradiation patients often require surgical intervention. Postoperative nutritional support like Feeding jejunostomy or Peg tube insertion aids in patient recovery from PCF.

#2724 Renal amyloidosis cohort registry in our health area

Abstract Background and Aims Renal amyloidosis is the pathological phenomenon of amyloid deposition in the kidney with marked differences in renal function impairment, proteinuria, need for renal replacement therapy (RRT) and exitus, depending on the protein involved. Light chain amyloidosis (AL) and serum protein A (AA) amyloidosis are the most common. Typical symptoms are severe proteinuria, nephrotic syndrome, and end-stage chronic kidney disease (ESRD). Method Retrospective study of a cohort of patients with renal amyloidosis. Data extracted from the biopsy registry of the HUVM Nephrology Service (2013-2022). We collected demographic, clinical, analytical, histological and clinical outcome variables (RTT, Exitus). Results are analyzed using Mayo Clinic staging criteria. Results 19 patients with a mean age of 63.4a; 57.9% male. Mean laboratory values at diagnosis: creatinine (Cr) 1.56 mg/dl and proteinuria 3.9 g/24 h. Abdominal fat biopsy in 13 cases; 3 (23%) tested positive. Comparative analysis of AL vs non-AL forms, Cr values (1.14 vs 2.27 mg/dl respectively) (p=0.57) differed. Proteinuria according to the histological location of the amyloid: 4.6 g/24 h in glomerular involvement vs. 0.3 g/24 h in those who did not present it (p&amp;lt;0.05). 31.6% required RTT with a mean onset time of 250.6 d from biopsy. Exitus of 21.1%: average time of 426.5 d. (See analysis in attached table). Conclusion We did not observe significant deterioration of renal function, which is greater in non-AL forms of amyloidosis. Fat biopsy was less cost-effective than reported in the literature. Significantly lower levels of proteinuria were found in the amyloidosis group without glomerular involvement. In our series, the prognostic capacity associated with the MAYO staging was confirmed.

EFFICACY OF SUBLINGUAL VERSUS ORAL PIROXICAM IN MANAGEMENT OF POST-SURGICAL PAIN, SWELLING AND TRISMUS AFTER LOWER 3RD MOLAR SURGERY- A RANDOMIZED CONTROL CLINICAL TRIAL

Background of the study: Third molar surgical removal is a common procedure in oral and maxillofacial surgery, causing moderate to severe pain, swelling, and trismus. Postoperative pain control improves patient recovery and oral function, with commonly used analgesics including Ibuprofen, Aceclofenac, Ketorolac, Tramadol, Paracetamol, Nalbuphine, Nimusulide, and Buprenorphine. Aim and Objective: The study compares oral and sub-lingual Piroxicam for managing post-surgical pain after extraction of impacted third molars, focusing on analgesia onset, pain intensity, swelling, and trismus degree. Materials and method: A randomized control trial was conducted on 30 patients who underwent surgical removal of mandibular impacted third molars. The patients were divided into two groups: Group I (Study) and Group II (Control). All patients underwent the procedure by a single surgeon. Post-operative medications were prescribed according to the study design, with Piroxicam 20mg administered sub-lingually (Group I) and 20mg orally (Group II). The parameters were assessed and measured for both groups, and the results and statistical analysis were compared. Result: The results revealed that the inter-group difference for the post-operative symptoms evaluated using a t-test for Equality of means by comparing the pre-op, POD 2, POD 7 values was statistically significant. Mean onset time taken and pain perception by Group I (Sub-lingual) in the first dose was 32.3 minutes and for Group II was 51.21 minutes which was established to be significantly (P&lt;0.05) low for the sub-lingual group by statistical analysis. Conclusion: The study found that the sublingual route of administering Piroxicam had a faster onset of action and better analgesia postoperatively compared to the oral route. This is crucial for patients and surgeons to improve compliance and comfort post-operatively after impaction surgery, as potent analgesics are essential for effective pain management.

A novel extraoral ultrasound-guided approach for mandibular nerve block in Rahmani sheep

BackgroundRegional anesthesia is the favored choice in ruminant animals compared to general anesthesia, primarily due to its high safety margin and reduced demand for cost-intensive equipment in addition to its field applicability. Ultrasound-guided nerve block has gained significant attention in the field of veterinary medicine. This study utilized twenty-seven sheep of the native Rahmani breed to both demonstrate and evaluate the effectiveness of the ultrasound guided inferior alveolar nerve block technique.MethodsThe research comprised three phases: Phase 1 involved an anatomical examination of mandibles and sheep heads to locate the mandibular foramen and delineate the mandibular nerve course. Phase 2 included ultrasound-guided injection of methylene blue dye at specific sites along the mandibular nerve in cadaveric sheep heads. In Phase 3, clinical implementation of ultrasound-guided inferior alveolar nerve blocks was conducted in 27 live sheep, assessing efficacy, onset, and duration.ResultsVertical extraoral ultrasound-guided nerve block was achieved successfully in 25 sheep (98%). A preliminary cadaveric study showed good distribution of the injectate at the mandibular nerve site. The mean onset time was 138 ± 18 s, and the mean duration time was 54 ± 4.1 min. Prominent analgesia of the ipsilateral mandible, medial surface of the cheek, and lateral border of the tongue was observed.ConclusionsUltrasound-guided mandibular nerve block holds promise as a technique for providing effective and safe anesthesia in sheep undergoing mandibular procedures.

A Short Fully Covered Self-Expandable Metal Stent for Management of Benign Biliary Stricture Not Caused by Living-Donor Liver Transplantation.

Background: This study evaluated the effectiveness of short fully covered self-expanding metal stents (FCSEMS) with an anti-migration design in treating benign biliary strictures (BBS) not related to living donor liver transplantation (LDLT). Methods: A retrospective analysis was conducted on 75 patients who underwent FCSEMS insertion for BBS management. Stents were initially kept for 3 months and exchanged every 3 months until stricture resolution. Adverse events and stricture recurrence after FCSEMS removal were assessed during follow-up. Results: The study outcomes were technical success, stenosis resolution, and treatment failure. Technical success was 100%, with stricture resolution in 99% of patients. The mean onset time of BBS post-surgery was 4.4 years, with an average stent indwelling period of 5.5 months. Stricture recurrence occurred in 20% of patients, mostly approximately 18.8 months after stent removal. Early cholangitis and stent migration were noted in 3% and 4% of patients, respectively. Conclusions: This study concludes that short FCSEMS demonstrate high efficacy in the treatment of non-LDLT-related BBS, with a low incidence of interventions and complications. Although this is a single-center, retrospective study with a limited sample size, the findings provide preliminary evidence supporting the use of short FCSEMS as a primary treatment modality for BBS. To substantiate these findings, further research involving multicenter studies is recommended to provide additional validation and a broader perspective.

Incidence and clinical impact of bile ducts changes after multibipolar radiofrequency ablation for hepatocellular carcinoma.

This study aimed to evaluate the incidence and clinical implications of bile duct changes following multibipolar radiofrequency ablation (mbpRFA) for hepatocellular carcinoma (HCC). Radiological, clinical, and biological data from consecutive cirrhotic patients who underwent first-line mbpRFA between 2007 and 2014 for uninodular HCC ≤ 5 cm were retrospectively collected. Follow-up imaging was reviewed to identify bile duct changes and factors associated with biliary changes were assessed using multivariable analysis. Baseline and 6-month liver function tests were compared in patients with and without bile duct changes. Complications, cirrhosis decompensation, and survival rates were compared in both groups. A total of 231 patients (mean age 68 years [39-85], 187 men) underwent 266 mbpRFA sessions for uninodular HCC (mean size 26 mm). Of these, 76 (33%) developed bile duct changes (upstream bile duct dilatations and/or bilomas) with a mean onset time of 3 months. Identified risk factors for these changes were the infiltrative aspect of the tumor (p = 0.035) and its location in segment VIII (p < 0.01). The average increase in bilirubin at 6 months was higher in the group with biliary changes (+2.9 vs. +0.4 µg/mL; p = 0.03). There were no significant differences in terms of complications, cirrhosis decompensation at 1 year (p = 0.95), local and distant tumor progression (p = 0.91 and 0.14 respectively), and overall survival (p = 0.4) between the two groups. Bile duct changes are common after mbpRFA for HCC, especially in tumors with an infiltrative aspect or those located in segment VIII. These changes do not appear to negatively impact the course of cirrhosis at 1 year or overall survival. Bile duct changes following mbpRFA for HCC are relatively common. Nevertheless, they do not raise clinical concerns in terms of complications, deterioration in liver function, or survival rates. Consequently, specific monitoring or interventions for these bile duct changes are not warranted. • Bile duct changes are frequently observed after multibipolar radiofrequency ablation for hepatocellular carcinoma, occurring in 33% of cases in our study. • Patients with bile duct changes exhibited a higher increase in bilirubin levels at 6 months but no more cirrhosis decompensation or liver abscesses. • Biliary changes following multibipolar radiofrequency ablation for hepatocellular carcinoma are not alarming and do not necessitate any specific monitoring or intervention.

Vogt–Koyanagi–Harada-like presentation: A short case series

We report a short case series of Vogt–Koyanagi–Harada (VKH)-like presentation in the eyes of Indian patients following vaccination. Patients with symptoms and signs of VKH that developed after coronavirus disease 2019 (COVID-19) vaccination, who presented with the first episode of the disease were included. There were five patients with four probable VKH and one incomplete VKH, with the mean time of onset being 5.4 ± 3.7 weeks. All patients had bilateral presentation. Steroid treatment was effective with no recurrence. Any vaccination can act as a trigger for the first episode of VKH presentation, and patient education on the same is needed.

Re-telling the story of aminoglycoside ototoxicity: tales from sub-Saharan Africa.

Aminoglycosides, such as Streptomycin, are cheap, potent antibiotics widely used Sub-Saharan Africa. However, aminoglycosides are the commonest cause of ototoxicity. The limited prospective epidemiological studies on aminoglycoside ototoxicity from Sub-Saharan Africa motivated this study to provide epidemiological information on Streptomycin-induced ototoxicity, identify risk factors and predictors of ototoxicity. A longitudinal study of 153 adults receiving Streptomycin-based anti-tuberculous drugs was done. All participants underwent extended frequency audiometry and had normal hearing thresholds at baseline. Hearing thresholds were assessed weekly for 2 months, then monthly for the subsequent 6 months. Ototoxicity was determined using the ASHA criteria. Descriptive statistics were used to analyze socio-demographic variables. Ototoxicity incidence rate was calculated, and Kaplan-Meier estimate used to determine cumulative probability of ototoxicity. Chi-square test was done to determine parameters associated with ototoxicity and Cox regression models were used to choose the predictors of ototoxicity. Age of participants was 41.43 ± 12.66 years, with a male-to-female ratio of 1:0.6. Ototoxicity was found in 34.6% of the participants, giving an incidence of 17.26 per 1,000-person-week. The mean onset time to ototoxicity was 28.0 ± 0.47 weeks. By 28th week, risk of developing ototoxicity for respondents below 40 years of age was 0.29, and for those above 40 years was 0.77. At the end of the follow-up period, the overall probability of developing ototoxicity in the study population was 0.74. A significant difference in onset of ototoxicity was found between the age groups: the longest onset was seen in <40 years, followed by 40-49 years, and shortest onset in ≥50 years. Hazard of ototoxicity was significantly higher in participants aged ≥50 years compared to participants aged ≤40 years (HR = 3.76, 95% CI = 1.84-7.65). The probability of ototoxicity at 40 g, 60 g and 80 g cumulative dose of Streptomycin was 0.08, 0.43 and 2.34, respectively. Age and cumulative dose were significant predictors of ototoxicity. The mean onset time to Streptomycin-induced ototoxicity was 28 weeks after commencement of therapy. Age and cumulative dose can reliably predict the onset of Streptomycin-induced ototoxicity. Medium to long term monitoring of hearing is advised for patients on aminoglycoside therapy.

1374. Foodborne disease outbreak at a delivery pizza and sushi restaurant, Kazakhstan, 2023

Abstract Background On February 3, 2023, the Kazakhstan Ministry of Health was notified of 71 hospitalized cases of acute gastointestinal illness among people who had ordered food from a delivery sushi and pizza restaurant in Talgar (population=50,000). We conducted an investigation from February 4 to 16 to identify risk factors. Methods We conducted a retrospective cohort study among people who consumed food from the sushi bar from January 31 to February 1, 2023. To find additional cases, we used a line list of orders made by customers provided by the restaurant. We interviewed customers by telephone and face-to-face. Patient gastric samples and food samples were submitted for microbial testing. We conducted an environmental assessment. We performed Poisson logistic regression using R software. Results Of 381 people identified, 364 were interviewed, of which 215 (59%) had become ill. Main symptoms were abdominal pain (98%), diarrhea (94%), nausea (94%), headache (91%), chills (82%), fever (81%), and vomiting (55%). Mean illness duration was 4 days (range=1-8). Mean onset time was 34 hours (range=6-91 hours) and 33% were hospitalized. Risk of illness was significantly higher among people who ate Caesar sushi rolls (1.55, 95% confidence interval [CI]=1.18-2.04), chicken and mushroom pizza (1.74, CI: 1.16-2.5), and "American" pizza (1.59, CI: 1.21-2.09). Among people who became ill, 60% had eaten Caesar sushi rolls and 40% american pizza. Attack rate was highest among those who had chicken pizza (97%). There was no common ingedient identified in the three foods. E.coli at concentration 103 and Enterococcus spp. were detected in Caesar rolls. Of 22 gastric samples tested, B. cereus was detected in 45%, Enterococcus in 50%, E. coli in 23%. Environmental assessment found several food safety violations including improper storage conditions, prepared foods being stored with raw materials, and missing or expired workers' health and food certifications. Factors associated with acute gastrointestinal illness, Talgar, Kazakhstan, 2023 Conclusion Because multiple pathogens were detected in food and patient samples and disease was associated with multiple foods, we suspect that food contaminated at different points in the preparation process was likely the source of the outbreak. The restaurant was closed and sanitized. We made recommendations to improve food handling and safety practices. Disclosures All Authors: No reported disclosures

Comparative Analysis of Local Anesthetic Techniques for Pain Management in Pediatric Dental Procedures: A Randomized Clinical Trial.

The present study aims to conduct a comparative analysis of different local anesthetic techniques for pain management in pediatric dental procedures. Goal is to evaluate and compare the efficacy and safety of various local anesthetic methods to identify the most effective approach in reducing pain and discomfort during dental treatments in children. A prospective, randomized clinical trial was conducted with 60 pediatric patients (aged 3 to 10 years) undergoing dental procedures in a single dental clinic. The participants were randomly assigned into three groups: Group A received conventional infiltration anesthesia (lidocaine 2% with epinephrine 1:100,000), Group B received topical anesthesia followed by the same infiltration anesthesia, and Group C received intraosseous anesthesia using articaine 4% with epinephrine 1:100,000. The patients' demographic data, treatment details, and pre-procedure anxiety levels were recorded. The study demonstrated that all three local anesthetic techniques effectively managed pain during pediatric dental procedures. However, Group C, which received intraosseous anesthesia, showed significantly lower pain scores (mean ± standard deviation) compared to Group A and Group B: 1.5 ± 0.6, 2.3 ± 0.8, and 2.1 ± 0.7, respectively (P < 0.05). Additionally, Group C exhibited a shorter onset of anesthesia compared to Group A and Group B, with mean onset times of 1.8 ± 0.4, 3.2 ± 0.6, and 2.9 ± 0.5 minutes, respectively (P < 0.001). No significant differences in adverse events or post-procedure complications among the groups. Intraosseous anesthesia (articaine 4% with epinephrine 1:100,000) was found most effective local anesthetic technique for pain management during pediatric dental procedures.

Physical discomforts, feeling of the high work intensity and the related risk factors of the frontline medical staff during COVID-19 epidemic: an early-outbreak, national survey in China.

Facing the unknown virus, COVID-19 medical staff kept wearing thick personal protective equipment during their work in the early stage of the outbreak. The survey was designed to investigate the physical discomforts, the feeling of the work intensity and the related risk factors of the frontline medical staff during COVID-19 epidemic in the early outbreak. An national survey was carried out in China from March 17th 2020 to March 20th 2020 by applying a standardized WeChat questionnaire survey. The doctors or nurses working in the wards for the confirmed COVID-19 patients on front-line were eligible to participate in the survey. Descriptive analysis and multivariate logistic regression analysis were used. A total number of 515 COVID-19 medical staff, including 190 physicians and 325 nurses participated in this survey. 375 medical staff (72.8%) experienced physical discomforts at work, mostly consist of dyspnea (45.8%), pain (41.0%), chest distress (24.1%), dizziness (18.8%), and weakness (17.5%), while wearing thick isolation clothes at work. The mean onset time and peak time of these symptoms were 2.4 h and 3.5 h after working, respectively. 337 medical staff (65.4%) suffered from sleep disorders. 51 medical staff (10%) were highly worried about being infected by COVID-19 even during their work breaks. 246 medical staffs (47.8%) felt high work intensity and the independent influential factors were the effective daily sleep time and anxiety levels at break time (p = 0.04). The frontline medical staff during COVID-19 epidemic felt different physical discomforts when they wear thick isolation clothes at work in the early outbreak and they felt high work intensity. These precious data will help optimize the work management strategy to ensure the physical and mental health of medical staff in the face of similar outbreaks in future.

THE CONCEPTS AND PROSPECTS OF NIMESULIDE INDUCED HEPATOTOXICITY

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most widely prescribed class of drug. The current study wascarried out to reveal the facts and prospects of Nimesulide, an over-the-counter NSAID drug. Around 57 cases ofhepatotoxicity collected from the DILI registry in Spain and Latin America were reviewed. Various causality cases wereassessed using the RUCAM scale, which revealed the mean age of 59 years of patients among the entire case series ofhepatotoxicity, out of which 86% were women, and the mean onset time of action was 40 days, while 46 patients, i.e.,81%, were also suffering from jaundice. Nimesulide-induced liver injury was found to be hepatocellular in 38 cases(67%), mixed type in 12 cases (21%), and cholestasis in 7 cases (12%). The reported incidence of NSAID-induced liverdisease in clinical trials was found to be fairly constant, ranging from 0.29 per 100,000 [95% confidence interval (CI):0.17-051] to 9 per 100,000 (95% CI: 6-15). Therefore, a higher risk of liver-related hospitalisation (32.3 per 100,000patients) was reported. The studies indicated that Nimesulide and other NSAIDs cause extensive liver damage, rangingfrom asymptomatic transient hyperaminotransducers to fulminant liver failure. However, various shortcomings inepidemiologic studies jeopardise the opportunity to determine the actual risk of hepatotoxicity. The drugs, such asBenoxaprofen and Bromfenac, have been withdrawn from the market due to their hepatotoxic behaviour. The presentreview was carried out to critically analyse the results currently available in the literature on NSAID-inducedhepatotoxicity and to create an overview of the most commonly used compounds of the NSAID groups.

S1 Transforaminal Epidural Anesthesia in Percutaneous Transforaminal Endoscopic Discectomy: A Case-Series Study.

Percutaneous transforaminal endoscopic discectomy (PTED) has become popular over the years due to its safety and low invasiveness. This surgery can be performed with different anesthesia techniques; however, the extent to which the surgeon and patient are satisfied with the analgesia is debatable. This study investigated the efficiency of the S1 transforaminal epidural block. This retrospective study was conducted on 60 patients with L4 - L5 lumbar disc herniation who underwent PTED under the S1 transforaminal epidural block. All patients had clinical symptoms associated with unilateral radiculopathy and were candidates for surgery. Percutaneous transforaminal endoscopy and S1 epidural block were performed by a surgeon for all patients. Of the 60 evaluated cases, 61.7% and 38.3% were female and male, respectively, with a mean age of 42.98 ± 10.79 years. The mean pain score before surgery was 7.83 ± 0.69, which decreased to 2.58 ± 0.65 during surgery and 0.50 ± 0.50 48 hours after surgery (P < 0.001). The mean duration of operation in these patients was 58.58 ± 16.95 minutes, and the mean onset time was 10.08 ± 3.12 minutes. Moreover, the mean bleeding was 124.17 ± 25.20 cc. The PTED with S1 epidural anesthesia is a simple, safe, and effective method that causes good analgesia during the operation and cooperates well with the surgeon in neurological monitoring due to patient consciousness.