Mean Time Period Research Articles

Clinical and Sociodemographic Characteristics that May Affect Delays in Child Sexual Abuse Disclosures: Ten Years in Practice.

This study covers Child Sexual Abuse (CSA) survivors who had never disclosed the abuse until their psychiatric interview. There is a clear lack of understanding of which factors contribute to delays in the disclosure of CSA. Thus, we aimed to examine the risk factors and sociodemographic variables that may inhibit CSA disclosures. We retrospectively analyzed the files of patients who presented to a child and adolescent psychiatry clinic with diferent complaints between 2010 and 2020 in a tertiary hospital. All of these sexual assaults were ofcially reported by a child and adolescent psychiatrist to the competent authorities. The mean period of time from abuse to disclosure was 28.4 ± 32.5 months. The time from abuse to disclosure was significantly negatively correlated with mothers' education years (r=-.430, P < .01) and with the age of onset of sexual abuse (r=-.589, P < .001). Results of multiple linear regression showed that female sex and the earlier age of onset of sexual abuse were significant predictors of increased duration from abuse to disclosure. Our results provide insights into several risks that may afect the time from abuse to disclosure for CSA survivors. Studies with larger samples are needed to understand the factors afecting the time from abuse to disclosure.

Mid- to long-term outcome of reverse total shoulder arthroplasty as revision procedure for failed hemiarthroplasty after proximal humerus fracture

BackgroundInsufficient tuberosity healing is the most common reason for poor outcome after treatment of proximal humerus fractures (PHFs) using hemiarthroplasty (HA). In these cases, revision to reverse total shoulder arthroplasty (RTSA) can improve function and reduce pain in the short term, however, long-term results remain scarce. Aim of this study was to evaluate the clinical and radiological mid- to long-term results in patients with a revision RTSA after failed HA for PHF.MethodsIn this retrospective study all patients that received a revision to RTSA after failed fracture HA between 2006 and 2018 were included. A total of 49 shoulders in 48 patients (38 female, 10 male; mean age 82 ± 9 years) were identified in our database. A total of 20 patients (17 female, 3 male; mean age was 79 ± 9 years) were available for follow-up examination after a mean time period of approximately eight years (3–14 years) after revision surgery. At final follow-up, patients were assessed using a subjective shoulder value (SSV), range of motion (ROM), visual analogue score (VAS), the Constant Score (CS) and the 12-Item Short Form Survey (SF-12).ResultsAt final follow-up, mean CS was 55 ± 19 (19–91), VAS averaged 3 ± 3 (0–8) and mean SSV was 61 ± 18% (18–90%). Mean SF-12 was 44 (28–57) with a mean physical component summary (PCS) of 38 (21–56) and a mean mental component summary (MCS) of 51 (29–67). On average active forward flexion (FF) was 104° (10–170°), active abduction (ABD) was 101° (50–170°), active external rotation (ER) was 19° (10–30°) and active internal rotation (IR) of the lumbosacral transition was reached. Three patients presented with a periprosthetic humeral fracture after RTSA implantation and underwent a reoperation (15%) during follow-up period.ConclusionsRevision RTSA results in promising clinical results in patients after initial failed HA after PHF. A complication and reoperation rate of 15% is tolerable in consideration of satisfactory functional and psychological outcome.Trial registrationRetrospectively registered.

Transarterial Coil Embolization for Type II Endoleak After Endovascular Aneurysm Repair (EVAR).

Background Endovascular aneurysm repair (EVAR) has evolved into treatment of choice for infrarenal abdominal aortic aneurysms (AAA). Type II endoleaks, although frequently benign, can lead to sac enlargement and rupture. Management of these endoleaks by endovascular means can be quite challenging and may require complex techniques and assistance of interventional radiologists, not always available in all vascular units. This is a single-center study of management of type II endoleaks with transarterial coil embolization performed by vascular surgeons and with minimum requirements regarding the necessary equipment. Methods From 2017 to 2022, 13 patients with type II endoleak were treated. Local anaesthesia and transfemoral or transbrachial approach was used. The superficial mesenteric artery (SMA) was catheterized and through the Riolan arch, coiling of the inferior mesenteric artery and/or the sac aneurysm was performed. Results The mean time period between the primary EVAR procedure and the transarterial intervention for the endoleak was 3.9 years. Primary technical success was achieved in 11 (84.6%) patients, whilesecondary technical success was 12 (92.3%). In the mean follow-up period, which was 2.6 years, the endoleak was treated successfully in 11 (84.6%) patients. Conclusions Transarterial coil embolization of type II endoleaks is a minimal low-cost procedure, with small percentage of complications, high technical and treatment success rates. It could be considered as a first-line treatment of unresolvable type II endoleaks, minimizing the need for open repair.

Clinical feature of omicron infection in children with inborn errors of immunity in China.

SARS-CoV-2 infection is hypothesized to be more severe in immunocompromised patients; however, clinical outcomes in children with inborn errors of immunity (IEI) during the Omicron pandemic in China have not been reported. This cohort study retrospectively reviewed 71 SARS-CoV-2-infected children with IEI using nationwide data from the National Center for Children's Health of China. COVID-19 was diagnosed by a positive rapid antigen or nucleic acid test result. Among 71 SARS-CoV-2-infected children with IEI, male preponderance (male: female ratio of ~1.8:1), a median age of 8 years (IQR 3-11), and a predominance of antibody deficiency (19/71, 26.8%) were detected. Most of the patients got infected through household transmission, while a small proportion of them did so during hospital visits. The mean time periods were 3.3 days (n=44) for incubation, 8.4 days for symptoms (n=69), and 8.8 days for viral shedding (n=37). The time to viral shedding was proportional to the symptomatic period (R2 = 0.1243, p=0.0323) and prolonged in children with X- linked agammaglobulinemia. The most common symptoms of COVID-19 were fever, and some children showed only aggravation of the underlying disease. 15% of IEI children progress to pneumonia, 85% require medication, 17% are admitted to hospital, and 4.1% are classified as critical. Previously application of anti- infective medications was associated with an increased risk of hospitalization after COVID-19 infection. Of the 71 children with IEI, all recovered from COVID- 19. Overall, Omicron variant did not cause significant life-threatening infections among children with IEI in China, and most of them had a good clinical outcome. Nevertheless, these children exhibit an increased vulnerability to higher hospitalization rates, pneumonia, and severe illness compared to the general pediatric population.

Two-Year Clinical Outcomes of the PAUL Glaucoma Implant in White Patients With Refractory Glaucoma.

This prospectively collected case series of 56 eyes having PAUL glaucoma implant (PGI) surgery is the first to demonstrate its medium-term safety and effectiveness in what is essentially an exclusively Caucasian population. To report 2-year outcomes from a single-center cohort undergoing PGI surgery. Prospectively collected data on patients undergoing PGI surgery at the University Eye Hospital Bonn, Germany, from April 2021 to September 2021. Of 53 patients, 56 eyes were included. Complete and qualified success rates (95% CI) were 52% (37-66) and 89% (80-96) for criterion A ( intraocular pressure [IOP]≤21mm Hg), 48% (36-61) and 79% (67-88) for criterion B (IOP≤18mm Hg), 45% (32-57) and 64% (52-77%) for criterion C (IOP≤15mm Hg) and 27% (16-40) and 38% (25-50) for criterion D (IOP≤12mm Hg), respectively. Mean IOP decreased from 25.43mm Hg (7-48mm Hg) to 11.25mm Hg (3-24mm Hg) (reduction of 50%) after 24 months with a reduction of IOP-lowering agents from 3.50 (1-5) to 0.46 (0-3). One eye needed an injection of viscoelastic due to significant hypotony with AC shallowing; 3 eyes received a Descemet membrane endothelial keratoplasty because of persistent corneal decompensation; 9 eyes developed tube exposure which required conjunctival revision with additional pericardial patch graft, with 5 of these eyes eventually needing tube explantation. An intraluminal prolene stent was removed in 24 eyes (42.9%) after a mean time period of 5.67 months (2-15m). Mean IOP before removal was 21.4mm Hg (12-40mm Hg) and decreased to 11.15mm Hg (6-20mm Hg). PGI surgery is an effective procedure for reducing IOP and pressure-lowering therapy. The use of an intraluminal prolene stent impedes hypotony in the early postoperative phase and enables further noninvasive IOP lowering during the postoperative course.

The state of the reproductive system of adolescent girls after vaccination against human papillomavirus using a quadrivalent vaccine

Background. Currently, oncological diseases and their possible prevention are being actively studied. Cancer mortality remains high. A national project “Healthcare” has been started in Russia, including the Federal projects “Fighting Cancer” and “Development of Children’s Health Care, including the creation of a modern infrastructure for providing medical care to children”. In a number of regions, girls can be vaccinated against the human papillomavirus (HPV). The main reason for refusing HPV vaccination is an unfounded fear of negatively affecting the fertility and other bad data. The aim of the study is an investigation of the reproductive system of adolescent girls with completed course of vaccination against HPV using quadrivalent vaccine. Methods. We selected 65 schoolgirls in Moscow by analyzing medical documentation data. All of them were vaccinated against HPV and examined by a gynecologist. The state of their reproductive system was assessed. Results. Most girls received the vaccine at the age of 12–13, according to the regional vaccination calendar of the city of Moscow. They were vaccinated with the quadrivalent vaccine twice with an interval of 6 months; no adverse event was noted. The mean period of time since vaccination was 2.7 ± 1.1 years. The mean age of menarche, mean menstrual cycle length, and mean bleeding time were normal in girls vaccinated against HPV. Among menstrual disorders, dysmenorrhea and oligomenorrhea were most often observed, but the data did not differ from the population average. The incidence of abnormal uterine bleeding and breast pathology was lower. No papillomas were detected. Pubertal development corresponded to age of all girls. Conclusion. It has been established that vaccination against the human papillomavirus does not have a negative impact on the reproductive system of teenage girls. However, additional dynamic studies are needed at different age periods of girls and women vaccinated against HPV to confirm the positive effect on the sexual sphere and formation of strong adherence to vaccination.

Cancer-Chemotherapy-Related Regimen Checks Performed by Pharmacists of General Hospitals Other than Cancer Treatment Collaborative Base Hospitals: A Multicenter, Prospective Survey.

Although prescription review is an important role for pharmacists in anticancer drug therapy, there are no guidelines in Japan that specify what pharmacists should check for in chemotherapy regimens. This prospective multicenter survey aimed to investigate the implementation of chemotherapy regimen checks by pharmacists in general hospitals by focusing on 19 recommended confirmation items designed to enhance chemotherapy safety. This study involved 14 hospitals within the National Hospital Organization in different regions of Japan. The top five cancers in Japan (gastric, colorectal, lung, breast, and gynecological) were targeted and specific chemotherapy regimens were analyzed. This study assessed the amount of time required for regimen checks, the number of confirmation items completed, the number and the content of inquiries raised regarding prescriptions, and the pharmacists' opinions using a questionnaire that had a maximum score of 10 points. Pharmacists checked 345 and 375 chemotherapies of patients in the control group (CG) and recommended items group (RIG), respectively. The mean time periods required for completing a chemotherapy regimen check were 4 min and 14 s (SD ±1 min and 50 s) and 6 min and 18 s (SD, ±1 min and 7 s) in the CG and RIG, respectively. The mean of the recommended items for the CG = 12.4 and for the RIG = 18.6. The items that the pharmacists did not confirm included urine protein (sixty-nine cases, 18.4%), allergy history (four cases, 1%), previous history (two cases, 0.5%), and a previous history of hepatitis B virus (sixty-nine cases, 18.4%). The number of inquiries for a doctor's prescription order was higher in the RIG than in the CG (41 vs. 27 cases). This multicenter survey demonstrated the potential effectiveness of implementing 19 recommended confirmation items in the regimen checks by pharmacists in general hospitals other than cancer treatment collaborative base hospitals.

Long-term outcomes and prognostic factors of surgical treatment of peri-implantitis - A retrospective study.

To evaluate long-term outcomes and prognostic factors of non-reconstructive surgical treatment of peri-implantitis. One hundred forty-nine patients (267 implants) were surgically treated for peri-implantitis and followed for an average of 7.0 (SD: 3.6) years. The primary outcome was implant loss. Additional bone loss and surgical retreatment were secondary outcomes. Patient/implant characteristics, as well as clinical and radiographic parameters collected prior to initial surgery, were evaluated as potential predictors of implant loss. Flexible parametric survival models using restricted cubic spline functions were used; 5- and 10-year predicted rates of implant loss were calculated according to different scenarios. Fifty-three implants (19.9%) in 35 patients (23.5%) were lost during the observation period. Implant loss occurred after a mean period of 4.4 (SD: 3.0) years and was predicted by implant surface characteristics (modified surface; HR 4.5), implant length (HR 0.8 by mm), suppuration at baseline (HR 2.7) and disease severity (baseline bone loss: HR 1.2 by mm). Estimates of 5- and 10-year implant loss ranged from 1% (best prognostic scenario; initial bone loss <40% of implant length, turned implant surface and absence of suppuration on probing (SoP)) to 63% (worst prognostic scenario; initial bone loss ≥60% of implant length, modified implant surface and SoP) and from 3% to 89%, respectively. Surgical retreatment was performed at 65 implants (24.3%) in 36 patients (24.2%) after a mean time period of 4.5 (3.1) years. In all, 59.5% of implants showed additional bone loss, were surgically retreated or lost. Recurrence of disease is common following surgical treatment of peri-implantitis. The strongest predictor for implant loss was implant surface characteristics. Implant length as well as suppuration and disease severity at baseline were also relevant factors.

Magnetic Compression Anastomosis of Benign Short-Segment Ureteral Obstruction

PurposeTo investigate the feasibility, safety, and effectiveness of magnetic compression anastomosis of benign short-segment ureteral obstruction. Materials and MethodsPatients referred for failure of ureteral double-J stent placement because of impassable benign ureteral obstruction were included. Eleven patients (11 ureters) with a mean age of 57.5 years (range, 19–85 years; 8 women) underwent ureteral magnetic compression anastomosis. All patients had indwelling nephrostomy catheters. In all patients, anterograde and retrograde ureteral stent placements were unsuccessful using either interventional or cystoscopic access. Ureteral magnetic compression anastomosis was performed as a 2-step procedure. In the first step, magnets were placed. In the second step, the stricture was traversed via magnetic compression anastomosis. Successful establishment of anastomosis and ureteral double-J stent placement were considered technical success. The mean time for complete magnetic adherence and fluoroscopy time for each procedure were recorded. ResultsFive patients (45%) had an ileal conduit. The technical success rate was 91% (n = 10/11). The mean time for magnetic adherence was 5.7 days (SD ± 1.3). The mean single-rotation fluoroscopy times during the first and second steps of the procedure were 9.45 minutes (SD ± 2.09) and 15.70 minutes (SD ± 2.62), respectively. Magnets were removed with the support of either balloon catheters (n = 9) or biopsy forceps (n = 2). No procedure-related adverse events occurred. ConclusionsMagnetic compression anastomosis of benign ureteral obstruction is feasible and safe and can be performed in an interventional radiology (IR) suite without the need for endoscopy.

Abstract 17598: Low Socioeconomic Status Leads to Higher Cardiovascular Mortality in the United States

Introduction: Lower socioeconomic status can lead to chronic disease. However, there is a dearth of information as to how it pertains to organ-specific mortality. Hypothesis: In this study, we determined if there was a connection longitudinally between poverty-income-ratio (PIR) and cardiovascular mortality Methods: We conducted a study which assessed for all adult (≥ 20 years) individuals from the 1999-2010 National Health and Nutrition Examination Survey, which is a population-based survey conducted with cardiovascular mortality data obtained through December 2019. All individuals from this were living in the United States. Socioeconomic status was determined using total family income divided by the poverty threshold (≤1 versus &gt;1). Comparisons were analyzed using Complex Samples Cox regression to determine the relationship of poverty-income-ratio and cardiovascular mortality. Results: Data was available for 13,680 adults in the United States population. Mean time period of males (8.3 years (CI 8.0-8.5) who experienced death was higher than the mean time period among females 8.8 years (CI 8.6-9.0). The overall age-adjusted, sex-adjusted hazard ratio for high PIR to low PIR is 1.73 (1.39-2.16, p &lt; 0.01). The adjusted HR remained strong at 1.98 (CI 1.18-3.33, p &lt; 0.01) among adults after the results were controlled for medical (obesity, depression) and demographic (gender, age, and ethnicity) risk factors. Conclusions: There is a significant relationship between low socioeconomic status and cardiovascular mortality among all adults. Consequently, individuals with cardiovascular disease need to be better screened for social determinants of health.

SAT467 Monitoring TSH Over Time May Not Be Necessary in Patients With Thyroid Nodules

Abstract Disclosure: S. Kaul: None. A. Gupta: None. Introduction: A substantial number of patients with thyroid nodules receive monitoring of blood thyroid stimulating hormone (TSH) levels after the initial diagnosis. There is not enough literature supporting long-term monitoring of blood TSH levels in these patients with thyroid nodules. The objective of this study was to evaluate the change in blood TSH level in patients with known thyroid nodules over time and to determine if repeat blood TSH testing is required in these patients. We hypothesized that monitoring of blood TSH level is not warranted in patients with thyroid nodules in the absence of a history of medical conditions or medications that are known to affect thyroid hormone levels. Methods: We studied 100 patients aged 18 to 99 years at the Dayton VA Medical Center with at least one thyroid nodule on imaging studies from January 2010 to December 2016 with normal blood TSH level at time of the diagnosis of the thyroid nodule. Subjects with abnormal thyroid hormone level, history of hot thyroid nodule, autoimmune thyroid disease (on imaging or blood work), thyroid or pituitary surgery, radioactive iodine treatment, neck irradiation, or usage of thyroxine or any other medications known to affect thyroid hormone levels were excluded. Blood TSH level at the time of diagnosis of thyroid nodule and after were retrospectively studied and analyzed for 100 subjects. Normal blood TSH level range at time of diagnosis was noted to be 0.35-5.50 uIU/mL or 0.35-4.00 uIU/mL depending on the assay method used. Normal repeat blood TSH level range was noted to be 0.35-5.50 uIU/mL, 0.35-4.00 uIU/mL, or 0.55-4.78 uIU/mL depending on the assay method used. Results: 100 subjects with normal blood TSH at the time of diagnosis of their thyroid nodule had blood TSH level monitoring for an average time period of 5.74 years. Out of the 100, six subjects (6%, 95% CI [2.52%, 12.73%]) developed an abnormal blood TSH level in a mean time period of 6.94 years. One subject’s initial blood TSH level increased from 3.38 uIU/mL to 7.76 uIU/mL after 8.52 years. This subject did not receive treatment with thyroxine. In the other five subjects, blood TSH level decreased to below normal range in a mean time period of 6.63 years and ranged from 0.25-0.52 uIU/mL. Blood TSH level remained within normal range for 94 subjects in a mean time period of 5.67 years. Conclusion: Monitoring of blood TSH level over time may not be required in most patients with thyroid nodules in the absence of symptoms, medical conditions, or medications that are known to affect thyroid hormone levels. Presentation Date: Saturday, June 17, 2023

The effect of an herbal agent “Tutukon®” on the spontaneous passage rates of ureteric stones

Objective:: The objective of this study is to assess the efficacy of an herbal agent (Tutukon®) on the spontaneous passage rates of ureteral calculi 5-10 mm. Materials and Methods: 96 patients having a single radio-opaque ureteral stone 5-10 mm were randomized into two groups. Group 1 (n = 51) received Tutukon®, 45 mg/day (three times) in addition to conservative approach and Group 2 patients (n = 45) were followed with classical conservative approach during 4 weeks follow-up. The stone passage rates, stone expulsion time, change in weekly colic episodes and hospital readmission rates for colicky pain were compared. Results: Stone expulsion rates showed statistically significant difference between the two group (66.7 % vs 46.7 %, p = 0.048). Additionally mean time period required for the spontaneous passage of the calculi was meaningfully short in those cases receiving Tutukon® when compared with Group 2 patients undergoing conservative measures only (5.79 ± 2.39 vs 8.82 ± 3.48 days, respectively) (p = 0.001). Similarly, the mean renal colic episodes during follow-up period were significantly diminished in Group 1 patients (66.6 vs 36%, p = 0.001, respectively). Lastly, colic pain attacks were noted to be less in Group 1 and another advantage of“Tutukon®” was the relocation of the stones to a more distal part of ureter (35.2 vs 4 %). Conclusion: Use of Tutukon® in the medical management of ureteral calculi can accelarate the spontaneous passage rates and also relocate them into the lower portion of the ureter. Keywords: herbal agents, medical therapy, spontaneous passage, ureteral stones

Clinical outcomes of the PAUL® glaucoma implant: One-year results.

To report one-year outcomes from a single-centre cohort undergoing PAUL® Glaucoma Implant (PGI) surgery. Retrospective review of patients undergoing PGI surgery at the University Eye Hospital Bonn, Germany, from April 2021 to September 2021. Forty-five eyes of 41 patients were included. Qualified and complete success rates (95% CI) were 95.6% (88.9%-100%) and 73.3% (60%-86.7%) for Criterion A (IOP ≤ 21 mmHg), 84.4% (73.3%-93.3%) and 74.4% (51.1%-80.0%) for Criterion B (IOP ≤ 18 mmHg), 62.2% (48.9%-75.6%) and 46.7% (31.2%-62.2%) for Criterion C (IOP ≤ 15 mmHg) and 26.7% (13.3%-40.0%) and 22.2% (11.1%-33.3%) for Criterion D (IOP ≤ 12 mmHg), respectively. Mean IOP decreased from 26.1 mmHg (7-48 mmHg) to 12.0 mmHg (3-24 mmHg) (reduction of 48.83%) after 12 months with a reduction of IOP-lowering agents from 0.5 (0-3). One eye (2.2%) needed an injection of viscoelastic due to significant hypotony with AC shallowing, and four eyes (8.9%) developed choroidal detachments due to hypotony which resolved without further interventions after 6 weeks. Three patients (6.7%) developed tube exposure which required conjunctival revision with an additional pericardial patch graft. An intraluminal prolene stent was removed in 19 eyes (42.2%) after a mean time period of 8.4 months (2-12 m). Mean IOP before the removal was 21.9 mmHg (12-38 mmHg) and decreased to 11.3 mmHg (6-16 mmHg). PGI surgery is an effective procedure for reducing IOP and pressure-lowering therapy. An intraluminal prolene stent impedes hypotony in the early postoperative phase and enables further IOP lowering without additional interventions during the postoperative course.

Characteristics of Asthma Exacerbations in Emergency Care in Switzerland-Demographics, Treatment, and Burden of Disease in Patients with Asthma Exacerbations Presenting to an Emergency Department in Switzerland (CARE-S).

Emergency care for asthma is provided by general practitioners, pulmonologists, and emergency departments (EDs). Although it is known that patients presenting to EDs with acute asthma exacerbations are a vulnerable population and that this mode of presentation is a risk marker for more severe complications, research on this population is scarce. We conducted a retrospective study on patients with asthma exacerbations who presented to the ED of the University Hospital Basel, Switzerland, during 2017-2020. Of the last 200 presentations, 100 were selected and analyzed to assess demographic information, the use of previous and ED-prescribed asthma medication, and clinical outcomes after a mean period of time of 18 months. Of these 100 asthma patients, 96 were self-presenters, and 43 had the second highest degree of acuity (emergency severity index 2). Global Initiative for Asthma (GINA) step 1 and step 3 were the most common among patients with known GINA levels, accounting for 22 and 18 patients, respectively. A total of 4 patients were undergoing treatment with oral corticosteroids at presentation, and 34 were at discharge. At presentation, 38 patients used the combination therapy of inhaled corticosteroid/long-acting β2-agonist (ICS/LABA), and 6 patients underwent ICS monotherapy. At discharge, 68 patients were prescribed with ICS/LABA. At entry to the ED, about one-third of patients did not use any asthma medication. In total, 10 patients were hospitalized. None of them needed invasive or non-invasive ventilation. A follow-up for the study was precluded by the majority of patients. This group of asthma patients seemed particularly vulnerable as their asthma medication at presentation was often not according to guidelines or even lacking, and almost all the patients had self-presented to the ED without any reference from a physician. The majority of patients did not give consent to the collection of any follow-up information. These medical shortcomings reflect an urgent medical need to improve care for patients at high risk of asthma exacerbations.

Abnormal right ventricular echocardiographic findings in recovered patients associated with severe acute respiratory syndrome in COVID-19.

Right ventricular (RV) echocardiographic changes such as dilation or systolic dysfunction, and pulmonary arterial hypertension were observed in patients with COVID-19. The aim of our study was to determine the frequency of RV echocardiographic changes in patients who have recovered from COVID-19 and to verify the association between severe acute respiratory syndrome (SARS) and echocardiographic findings. Patients who had recovered from COVID-19 undergoing outpatient follow-up underwent transthoracic echocardiography, and based on the findings, were divided into two groups: normal and abnormal. It was then verified whether there is an association between SARS and RV echocardiographic abnormalities in recovered patients. The study included 61 patients, with a mean age of 54.2±12.0 years, 57.4% had presented with SARS. The mean period of time between COVID-19 and the echocardiographic examination was 11.9±7.0 months. Patients presented normal left ventricular systolic function. The frequency of RV echocardiographic changes in patients who had recovered from COVID-19 was 44.3%. RV systolic dysfunction was identified in 31.1%, followed by ventricular dilation in 14.7% and pulmonary hypertension in 9.8%. An association was observed between SARS and RV echocardiographic changes in recovered patients during outpatient follow-up (OR: 4.96; 95% CI: 1.37-17.9; p=0.015). An association was also demonstrated between SARS and RV dilation (p=0.007) and between SARS and systolic dysfunction (p=0.028). SARS is a risk factor for abnormal RV echocardiographic findings in patients recovered from COVID-19.

Endoscopic vs microscopic facial nerve decompression for traumatic facial nerve palsy: a randomized controlled trial.

To explore a minimally invasive trans-canal endoscopic facial nerve decompression for traumatic facial nerve palsy and compare it with microscopic facial nerve decompression. 35 and 38 patients underwent endoscopic and microscopic facial nerve decompression, respectively, for traumatic facial nerve palsy. Onset of symptoms, type of temporal bone fracture, day of surgical intervention following trauma, ossicular chain status and nature of insult to facial nerve were observed. Time period for recovery (House Brackmann grade ≤ 3), long term recovery rates, pre- and post-operative hearing status, surgical time and post-operative pain were compared between groups. Maximum patients in endoscopic and microscopic groups (77.1% and 76.3%, respectively) had acute onset of symptoms. 57.1% (20/35) had longitudinal, 17.1% (6/35) had transverse and 25.7% (9/35) had mixed fractures in endoscopic group. In the microscopic group, 57.9% (22/38) had longitudinal, 18.4% (7/38) had transverse and 23.7% (9/38) had mixed fractures. The mean (± S.D.) post-operative air-bone gap in endoscopic and microscopic group were 16.47 ± 4.5dB and 19.4 ± 5.2dB, respectively, which was statistically significant. The mean (± S.D.) time period for recovery of endoscopic and microscopic groups were 14.4 ± 5days and 22.5 ± 7days, respectively (p value < 0.05). The difference in post-operative pain between the two groups was also statistically significant. The difference in long term recovery rates was not statistically significant (p > 0.05). Endoscopic facial nerve decompression results in early recovery, less post-operative pain and better post-operative air-bone gap closure when compared to conventional microscopic technique.

An Outbreak of Fungal Endophthalmitis After Cataract Surgery in South Korea

Fungal endophthalmitis caused by contaminated medical products is extremely rare; it follows an intractable clinical course with a poor visual prognosis. To report the epidemiologic and clinical features and treatment outcomes of a nationwide fungal endophthalmitis outbreak after cataract surgery as a result of contaminated viscoelastic agents in South Korea. This was a retrospective case series analysis of clinical data from multiple institutions in South Korea conducted from September 1, 2020, to October 31, 2021. Data were collected through nationwide surveys in May and October 2021 from the 100 members of the Korean Retinal Society. Patients were diagnosed with fungal endophthalmitis resulting from the use of the viscoelastic material sodium hyaluronate (Unial [Unimed Pharmaceutical Inc]). Data were analyzed from November 1, 2021, to May 30, 2022. The clinical features and causative species were identified, and treatment outcomes were analyzed for patients who underwent 6 months of follow-up. The fungal endophthalmitis outbreak developed between September 1, 2020, and June 30, 2021, and peaked in November 2020. An official investigation by the Korea Disease Control and Prevention Agency confirmed contamination of viscoelastic material. All 281 eyes of 265 patients (mean [SD] age, 65.4 [10.8] years; 153 female individuals [57.7%]) were diagnosed with fungal endophthalmitis, based on clinical examinations and supportive culture results. The mean (SD) time period between cataract surgery and diagnosis was 24.7 (17.3) days. Patients exhibited characteristic clinical features of fungal endophthalmitis, including vitreous opacity (212 of 281 [75.4%]), infiltration into the intraocular lens (143 of 281 [50.9%]), and ciliary infiltration (55 of 281 [19.6%]). Cultures were performed in 260 eyes, and fungal presence was confirmed in 103 eyes (39.6%). Among them, Fusarium species were identified in 89 eyes (86.4%). Among the 228 eyes included in the treatment outcome analysis, the mean (SD) best-corrected visual acuity improved from 0.78 (0.74) logMAR (Snellen equivalent, 20/120 [7.3 lines]) to 0.36 (0.49) logMAR (Snellen equivalent, 20/45 [4.9 lines]) at 6 months. Furthermore, disease remission with no signs of fungal endophthalmitis (or cells in the anterior chamber milder than grade 1) was noted in 214 eyes (93.9%). This was a retrospectively reviewed case series of a fungal endophthalmitis outbreak resulting from contaminated viscoelastic material. Findings of this case series study support the potential benefit of prompt, aggressive surgical intervention that may reduce treatment burden and improve prognosis of fungal endophthalmitis caused by contaminated medical products.

Bilateral Achilles Tendon Ruptures in the NFL

Category: Sports Introduction/Purpose: Achilles tendon ruptures (ATR) can have devastating results for athletes in the National Football League (NFL). Although NFL athletes who suffer an ATR are successfully treated with surgery and rehabilitation, this potentially career- ending injury has demonstrated a decrease in return to play, playing time, and performance for athletes. With a mean career length of 3.3 years for NFL athletes, the ATR injury and subsequent 9 to 11 month rehabilitation period could adversely limit the impact athletes make both individually and at the team level. Although previous research has examined the effects of a unilateral ATR in athletes, the purpose of this study was to determine the effects of bilateral ATRs on the health, productivity, and career longevity of NFL athletes. Methods: Publicly available online injury data for NFL athletes who sustained bilateral ATRs between the start of the 2007 season and the start of the 2021 season were queried using online news and sports analysis web sources. Inclusion criteria consisted of NFL athletes who sustained two independent, contralateral ATRs and exclusion criteria were NFL athletes who only sustained a single ATR or athletes who subsequently reinjured the same tendon. Specific dates for the first ATR (ATR1), return to play after ATR1, second ATR (ATR2), return to play after ATR2, as well as most recent game played were recorded. NFL preseason, regular season, and postseason (playoff, wild card, Pro Bowl, and Super Bowl) games were used to tabulate the total number of games missed or played. Descriptive and univariate statistics were performed. Results: When analyzing five NFL athletes with bilateral ATRs, mean BMI was 33.4+-4, an average of 5.8+-4 seasons were completed before ATR1, and three athletes currently play. There was a significant decrease in Pro Bowl nominations with each successive ATR (p=0.027). A significant difference was observed for mean age at tendon rupture when comparing ATR1 and ATR2 (27.8+-4 vs 30.4+-4 years, p&lt;0.01). Rehabilitation periods after ATR1 and ATR2 (9.3+-2 vs.10.9+-2 months), as well as number of games missed during rehabilitation periods for ATR1 and ATR2 (9.8+-4 vs.12.8+-6) were not significantly different. The mean time period after returning from ATR2 was 22.0+-16 months, with a mean number of 39.3+-24 games played (Table 1). When analyzing performance metrics of four defensive NFL athletes, forced fumbles was the only defensive metric to demonstrate significant change across ATRs (p=0.02). Conclusion: This case series investigated NFL athletes who sustained bilateral ATRs, demonstrating a significant difference in age at the time of each rupture along with a decreasing trend in the number of Pro Bowl nominations following successive Achilles injuries. Upon analyzing defensive NFL athletes, forced fumbles was the only performance metric that significantly changed across successive Achilles injuries. This case series is the first study to review the effect of bilateral ATRs in NFL athlete performance and further research should be conducted to continue analyzing how these injuries affect the health, productivity, and career longevity of NFL athletes.

Computed tomography evaluation of diaphragm alterations in 20 critically ill COVID-19 positive patients

Abstract Objective: Diaphragmatic dysfunctions are multiple and critical illnesses often lead to the muscular atrophy that affects respiratory and peripheral muscles. The primary objective was to investigate diaphragm thickness in hospitalized patients. Secondary objectives were to assess clinical evolution and outcome. Methods: In a mean time period of 7.9 days, two different chest computed tomographies were used in order to examine diaphragm alterations of right and left diaphragm in 20 critically ill patients tested Real-Time Polymerase Chain Reaction positive to Severe Acute Respiratory Syndrome Coronavirus-2. Patients were divided in two groups (one group &lt;5% decrease in diaphragm thickness and another group ≥5% decrease in diaphragm thickness). Results: Results showed that patients presented low 10 years predicted survival rate (Charlson Comorbidity Index &gt; 7.7±3.08), marked inflammatory status (C-Reactive Protein = 98.22±73.35, Interleukine-6 = 168.31±255.28), high physiologic stress level (Neutrophil/Lymphocyte Ratio = 31.27±30.45), respectively altered acid-base equilibrium. Half of the investigated patients had decrease in diaphragm thickness by at least 5% (right diaphragm = −7.83%±11.11%, left diaphragm = −5.57%±10.63%). There were no statistically significant differences between those with decrease of diaphragm thickness and those without diaphragm thickness, regarding length of stay in Intensive Care Unit and in hospital, inflammatory markers, and acid-base disorders. Conclusions: Patients were admitted in Intensive Care Unit for acute respiratory failure and half of the investigated patients displayed diaphragm alterations at CT scan.

Subacute Thyroiditis—Still a Diagnostic Challenge: Data from an Observational Study

Background: Subacute thyroiditis (SAT) is a relatively common cause of thyroid disease. However, only a few studies evaluating SAT have been published in recent years with varying diagnostic criteria. We evaluate the clinical presentation and long-term outcome of isotope scan-confirmed SAT. Methods: A retrospective study of 38 patients with isotope scan-confirmed SAT was performed at a single isotope department. All patients were contacted for long-term follow-up. Results: The female/male ratio was 1.4:1, and mean age was 47 ± 14 years and 62 ± 12 years in women and men, respectively (p = 0.002). Almost half of the cases (42%) occurred during the summer. The most common symptoms were neck pain (74%) and weakness (61%). Palpitations, weight loss, heat intolerance, and sweating appeared in 50%, 42%, 21%, and 21%, respectively. Only half of the patients reported fever. TSH level was low in all patients, and mean FT4 and FT3 level were about twice the upper limit of normal range. Elevated CRP and ESR occurred in the majority (88%) of patients. The mean time period between the first clinic visit and performing thyroid function tests was 8 ± 7 days. One-third of the patients initially received a diagnosis of upper respiratory tract infection (URI). NSAIDs and steroids were prescribed to 47% and 8% of patients, respectively. Long-term follow-up of 33.5 months (range 9–52) revealed that 25% remained with subclinical or overt hypothyroidism. Conclusions: These data demonstrate that although SAT is a common entity, there is still a significant delay in diagnosis, and in a third of our patients, the initial diagnosis was URI, with 25% developing long-term hypothyroidism.