Need For Medical Intervention Research Articles

Exploring the Ayurvedic Practice of Potaki Taila Pichu for Labor Facilitation among Rural Women in Northern Indi

Introduction: Childbirth is a profound experience in a woman's life, emphasizing the importance of promoting natural birthing processes to minimize discomfort and medical intervention. Ayurveda, an ancient holistic medical system, advocates for safe motherhood through herbal interventions like Potaki (Basella alba) Taila Pichu, which aims to alleviate imbalances in Apana Vayu and facilitate smooth labor. Methods: This study evaluated the efficacy of Potaki Taila Pichu in promoting easier labor by assessing its impact on cervical dilation and effacement. Sixty pregnant women meeting inclusion criteria were randomly assigned to a trial or control group. Various parameters, including cervical dilation, uterine contractions, and labor duration, were measured and compared between the two groups. Results: The trial group showed significant increases in cervical dilation and effacement compared to the control group, indicating the potential of Potaki Taila Pichu in facilitating labor progression. The intervention did not disrupt the natural rhythm of labor, as evidenced by consistent uterine contraction duration between groups. Moreover, the trial group experienced a significantly shorter latent phase of labor, suggesting accelerated onset of active labor. Discussion: These findings suggest that Potaki Taila Pichu may offer a safe and effective means of promoting smoother labor experiences while minimizing the need for medical interventions. Integrating traditional herbal remedies into modern obstetric care aligns with efforts to enhance maternal and neonatal outcomes. Conclusion: Herbal interventions like Potaki Taila Pichu hold promise in optimizing childbirth experiences by promoting natural labor progression. Further research is needed to validate these findings and explore long-term effects on maternal and neonatal health.

Sex disparities in short-term outcomes among patients with diffuse large B cell lymphoma undergoing chimeric antigen receptor T-cell therapy in the United States.

e19062 Background: Chimeric Antigen Receptor (CAR) T-cell therapy, a promising immunotherapy used in various cancers, including Diffuse large B cell lymphoma (DLBCL), can involve multiple complications and the need for medical interventions. Our retrospective study strives to gain up-to-date insight into sex-based differences among DLBCL patients undergoing CAR T-cell therapy. Methods: We focussed on DLBCL patients undergoing CAR T-cell therapy via the 2017-2020 National Inpatient Sample(NIS). The events of complications between males and females were examined via multivariate regression models. Since the ICD-10 code for cytokine release syndrome (CRS) involved cases between October and December 2020, we used samples for that timeline while evaluating that particular complication. Results: Our study involved 3280 adult cases of DLBCL undergoing CAR T-cell therapy, with 1930 (58.8%) males and 1350(41.2%) females. Age differences were seen as females were older(mean age 61.93 vs. 60.40 years, p<0.01). Females also had lower odds of atrial fibrillation (6.7% vs. 14.2%, aOR 0.440, p<0.01) and acute kidney injury (AKI) (10.0% vs. 18.4%, aOR 0.458, p<0.01), while having higher odds of use of invasive mechanical ventilation (5.6% vs. 5.2%, aOR 2.179, p<0.01), events of sepsis (9.6% vs. 7.8%, aOR 1.575, p<0.01), pancytopenia (69.6% vs. 64.0%, aOR 1.454, p<0.01), and cryoprecipitate transfusion (2.2% vs. 1.8%, aOR 2.325, p=0.041) than males. We did not find any statistically significant differences for events of gastrointestinal bleeding (GIB)(aOR 0.866, p=0.636), tumor lysis syndrome(aOR 0.980, p=0.890), acute pulmonary embolism(aOR 1.133, p=0.719), toxic encephalopathy(aOR 1.009, p=0.935), platelet transfusion(aOR 0.994, p=0.976), RBC transfusion(aOR 0.828, p=0.192), or all-cause mortality(aOR 1.829, p=0.064). In addition, while 51.6% of males and 51.7% of females reported CRS, it was not statistically valid (aOR 0.923, p=0.850). Conclusions: The sex of DLBCL patients undergoing CAR T-cell therapy can influence multiple complications, as described in our study. Further research and endeavors aimed to deepen our understanding of our findings will help bring changes in protocols by physicians to improve the quality of care and outcomes of these patients.

Association of somatic comorbidity and treatment adherence in patients with psychotic disorder

BackgroundIncreased risk for somatic comorbidity in individuals with schizophrenia has been well established. In addition, psychiatric patients with somatic illnesses are more likely to have more psychiatric readmissions. Increased burden of treatment related to chronic somatic comorbidities may be associated with lower adherence to psychiatric medication. MethodsCross-sectional study of 275 patients with schizophrenia spectrum disorder. A general practitioner performed a complete physical health checkup for all participants, including a complete medical examination and laboratory tests. Patients’ adherence, attitudes, insight, and side-effects were evaluated using the Attitudes toward Neuroleptic Treatment Scale. Overall symptomatology was measured using the Brief Psychiatric Rating Scale. Regression analysis was used to investigate interactions and associations among health beliefs, disease burden, and treatment adherence. Separate regression models were utilized to account for the complexity of health behavior and treatment adherence pathways. ResultsPatients’ somatic comorbidity and health behavior were not associated with adherence or attitudes toward antipsychotic treatment. High dose of antipsychotics and obesity were related to the need for medical interventions, while a healthy diet reduced the risk. Higher BPRS score and older age were associated with having somatic symptoms. Somatic comorbidities had no negative effects on treatment adherence or attitudes. ConclusionThis study focuses on exploring possible associations between health beliefs and treatment adherence pathways in patients with psychotic disorders. Contrary to our hypotheses, we found no evidence to support our health belief and diseases burden models and their associations.

Findings in chest angiotomographies with PET protocols

Objectives: To investígate and analyze the tomographic findings in AngioCT with PET protocol. Material and method: Tomography reports of patients undergoing AngioCT for suspected PE during the period from January 2020 to December 2022 performed at the high complexity hospital were analyzed. RESULTS: The analysis showed a significant increase in findings in 2021, associated with the frequency of pulmonary embolism (PE) in patients with SARS-CoV-2 infection. The predominant age range was 60 to 79 years. There was a slight predominance of male patients compared to female patients. Among the most common are pleural or pericardial effusion, atelectasis, and the ground glass or mosaic pattern. Conclusions: The results of this study demonstrate that CT angiography with a PET protocol is a valuable diagnostic tool in patients with suspected PE. Incidental detection of these injuries raises questions about appropriate management, follow-up, and the need for medical interventions. This phenomenon has led to a growing need to develop clear guidelines and criteria for the evaluation and management of incidentalomas found on chest PET scans. In this context, it is crucial to investigate and better understand the nature and clinical implications of these findings to improve medical decision making.

Development of a single-visit protocol for the management of pregnancy of unknown location following in vitro fertilization: a retrospective study.

Can women with pregnancy of unknown location (PUL) following in vitro fertilization (IVF) be risk-stratified regarding the subsequent need for medical intervention, based on their demographic characteristics and the results of serum biochemistry at the initial visit? The ratio of serum hCG to number of days from conception (hCG/C) or the initial serum hCG level at ≥5 weeks' gestation could be used to estimate the risk of women presenting with PUL following IVF and needing medical intervention during their follow-up. In women with uncertain conception dates presenting with PUL, a single serum hCG measurement cannot be used to predict the final pregnancy outcomes, thus, serial levels are mandatory to establish a correct diagnosis. Serum progesterone levels can help to risk-stratify women at their initial visit but are not accurate in those taking progesterone supplementation, such as women pregnant following IVF. This was a retrospective study carried out at two specialist early pregnancy assessment units between May 2008 and January 2021. A total of 224 women met the criteria for inclusion, but 14 women did not complete the follow-up and were excluded from the study. We selected women who had an IVF pregnancy and presented with PUL at ≥5 weeks' gestation. A total of 30/210 (14.0%, 95% CI 9.9-19.8) women initially diagnosed with PUL required surgical intervention. The hCG/C was significantly higher in the group of women requiring an intervention compared to those who did not (P = 0.003), with an odds ratio of 3.65 (95% CI 1.49-8.89, P = 0.004). A hCG/C <4.0 was associated with a 1.9% risk of intervention, which accounted for 25.7% of the study population. A similar result was obtained by substituting hCG/C <4.0 with an initial hCG level <100 IU/l, which was associated with 2.0% risk of intervention, and accounted for 23.8% of the study population (P > 0.05). A limitation of our study is that it is retrospective in nature, and as such, we were reliant on existing data. A previous study in women with PUL after spontaneous conception found that a 2% intervention rate was considered low enough to eliminate the need for close follow-up and serial blood tests. Using the same 2% cut-off, a quarter of women with PUL after IVF could also avoid attending for further visits and investigations. No external funding was required for this study. No conflicts of interest are required to be declared. N/A.

Highlight the Diseases Generated by Food Pathogens: A Review

Foods are exposing to infection with different types of pathogenic bacteria and fungi, and the emergence of many epidemics and cases of food poisoning in various regions of the world, particularly in developing countries. The article includes, causes of food disease, which is happening as a result of eating toxic substances with food that may be of microbial origin (bacteria, fungi, parasites, viruses), animal, plant or chemical origin, which generates food poisoning. Microbial poisoning may result either from ingestion of microorganism toxins like Staphylococcus aureus or as a result of infection like Campylobacter jejuni also, some cases of food poisoning with some types of bacteria may recover without the need for medical intervention like S. aureus, and others may be fatal even in low concentrations with a high mortality rate, such as Cl.botulinum. The article also, reviewed the dangers of mycotoxins as a global concern and more dangerous than bacterial toxins, as they have a cumulative toxic effect that does not appear until years later, and responsible for many different cancers. It is also impossible to avoid food contamination with mycotoxins even with the use of high technologies in food processing, and the best solution lies in preventing the growth of toxic molds that secrete these toxins on food, by using Good Agricultural Practices (GAP) and Good Manufacturing Practices (GMP).

Air Pollution and Meteorological Conditions Significantly Associated With Vernal Keratoconjunctivitis Exacerbations.

Vernal keratoconjunctivitis (VKC) is a severe chronic allergic inflammation of the ocular surface with episodes of acute exacerbations, that primarily affects children and young adults. Although the etiology and pathogenesis of VKC remain unclear, studies have suggested that environmental factors may be involved. This study aims to investigate the association between exposure to meteorological and environmental factors and the incidence of VKC exacerbations. This study was conducted in southern Israel, which is a semi-arid, hot, and dry climate with frequent dust storms. Patients diagnosed with VKC were recruited for the study. VKC exacerbations were identified as the need for medical intervention. Pollutants measured included nitrogen dioxide (NO2), ozone (O3), particulate matter (PM10 and PM2.5), sulfur dioxide (SO2), relative humidity (RH), temperature, and solar radiation (SR). To assess the association between VKC exacerbations and exposure to different pollutants, a case-crossover analysis was conducted. We also stratified the analysis by sex, age, ethnicity, immigration status, and social state score. Our results demonstrated that the pollutants NO2, O3, and PM10 were associated with VKC exacerbations with odds ratio (OR) = 2.17 (95% confidence interval [CI] =1.40 to 3.04), OR = 2.28 (95% CI = 1.30 to 3.39), and OR = 1.89 (95% CI = 1.06 to 2.74). Other pollutants PM2.5, temperature, and solar radiation were also independently associated with incidence of exacerbations with OR = 1.15 (95% CI = 0.87 to 1.50), OR = 1.75 (95% CI = 1.16 to 2.65), and OR = 1.37 (95% CI = 1.01 to 1.63) and had varying effects in different demographic strata. The environmental parameters, NO2, O3, PM10, PM2.5, temperature, and solar radiation were found to be significantly associated with VKC exacerbations, with NO2, O3, and PM10 showing the strongest associations. Our findings suggest that environmental factors should be considered when developing strategies to prevent and manage VKC exacerbations.

CO143 Impact of Investigational, at-Home, Self-Administered, Intranasal Etripamil on the Need for Additional Medical Intervention in Patients with Supraventricular Tachycardia

Paroxysmal supraventricular tachycardia (PSVT) causes economic burden due to a frequent need for medical interventions and emergency department (ED) visits with substantial costs. The NODE-301 study evaluated the efficacy and safety of the novel, fast-acting, investigational intranasal calcium channel blocker etripamil for conversion of PSVT in an at-home setting. This analysis assessed the impact of etripamil on the need for additional medical intervention.

Evaluating the utility of perioperative laboratory tests in primary shoulder arthroplasty

BackgroundThe rising incidence of primary total shoulder arthroplasty (TSA) predicts a $4 billion increase in cost associated with this procedure by 2030. Studies have evaluated sources of cost containment, including inpatient services, namely routine perioperative laboratory tests. This study evaluates the utility of routine perioperative complete blood count (CBC) and basic metabolic panel (BMP) in TSA and identifies predictors of abnormal postoperative laboratory results and the need for medical intervention (NMI). MethodsAll patients undergoing primary TSA from 2013 to 2020 at a single institution were included. Demographics, comorbidities, procedural details, and preoperative and postoperative CBC and BMP values were recorded. Abnormal values were identified for each laboratory parameter. NMI was defined as postoperative blood transfusion, electrolyte repletion, fluid resuscitation, and inpatient medical consultation. Univariate and multivariate analyses were performed to determine independent predictors for abnormal postoperative CBC and BMP (AbBMP) results and NMI. A P value < .05 was considered statistically significant. ResultsA total of 328 patients were included in the study, with 202 (61.6%) female patients and a median age of 70.5 years. Medical intervention was required in 115 (35.1%). There were no differences in rates of NMI based on patient demographics, comorbidities, and preoperative CBC and BMP results, although there was a significant difference in rates of NMI when comparing postoperative serum potassium (4.1 mmol/L in no NMI group; 3.9 mmol/L in NMI group; P = .039). Ultimately, there were no demographic, surgical, or laboratory factors associated with postoperative NMI on predictive modeling. Increasing body mass index (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.01-1.15, P < .03), preoperative serum glucose (OR 1.05, 95% CI 1.02-1.08, P = .003), and preoperative serum blood urea nitrogen (OR 1.12, 95% CI 1.05-1.12, P = .01) are associated with an 8.0%, 5.0%, and 12% increase in odds of an AbBMP, respectively. Preoperative potassium is inversely correlated with odds of AbBMP (OR 0.19, 95% CI 0.05-0.67, P = .01). ConclusionsAlthough postoperative laboratory tests were routinely obtained following primary shoulder arthroplasty, abnormal postoperative CBC and BMP were not associated with NMI. Postoperative BMP tests should be considered in patients with elevated body mass index, elevated preoperative serum glucose, elevated preoperative serum blood urea nitrogen, and those with preoperative serum hypokalemia. Postoperative CBC tests are likely not necessary after primary shoulder arthroplasty.

Comparative Risks of Electronic Versus Tobacco Cigarette Use During Pregnancy: Findings From a Low-Risk Sample [ID: 1374893

INTRODUCTION: Harms of tobacco use in pregnancy are well studied and include low birth weight, decreased newborn well-being, and need for medical interventions after birth. Less understood is the effect of noncombustible alternatives, including electronic cigarettes (ECs). We examined whether EC use during pregnancy also increases risk of adverse birth outcomes. METHODS: Data were from the Michigan Obstetrics Initiative (OBI), a quality improvement effort involving 75 maternity hospitals, focused on safely reducing cesarean delivery rates. Our participants were nulliparous, singleton pregnancy, term delivery, and vertex fetal positioning. Data were from medical records, entered locally, and compiled centrally by OBI. RESULTS: Participants delivered since January 1, 2021, with no known pregnancy alcohol and opioid use: controls (no EC/tobacco use [n=26,394], EC only [n=493], and tobacco only [n=2,126]). After control for confounding and comparison to controls, the EC group had significantly lower birth weight; the tobacco group had reduced birth weight, and greater rates of arterial cord pH less than 7.1, 5-minute Apgar scores less than 8, and neonatal intensive care unit admission. CONCLUSION: While EC use in pregnancy reduced birth weight, most newborn risks linked to tobacco exposure were not predicted by EC use. Additional study is needed, as nonsignificant trends toward poorer outcomes for EC users were evident, and potentially significant with larger samples or when amount/timing of EC exposure is considered. Further, given this sample was low risk, cases for whom EC use led to adverse outcomes were potentially eliminated. Growing evidence suggests pregnant patients should be counseled to avoid EC use.

A Suicide-Specific Diagnosis – The Case For

A Suicide-Specific Diagnosis – The Case For

A Suicide-Specific Diagnosis – The Case Against

A Suicide-Specific Diagnosis – The Case Against

Prenatal Congenital Heart Disease—It Takes a Multidisciplinary Village

Prenatal diagnosis of congenital heart disease (CHD) allows for thoughtful multidisciplinary planning about location, timing, and need for medical interventions at birth. We sought to assess the accuracy of our prenatal cardiac diagnosis, and postnatal needs for patients with CHD utilizing a multidisciplinary approach. We performed a retrospective chart review of fetal CHD patients between 1/1/18 and 4/30/19. Maternal and infant charts were reviewed for delivery planning, subspecialty care needs, genetic evaluation, prenatal and postnatal cardiac diagnoses, need for prostaglandin (PGE) and neonatal cardiac intervention. 82 maternal-fetal dyads met inclusion criteria during the study period and delivered at a median of 38w2d gestation. 32 (39%) dyads had CHD and other anomalies or genetic abnormalities. All dyads met with a genetic counselor and neonatologist. 11 patients delivered at outside hospitals as planned (all with isolated CHD not requiring neonatal intervention), and 5 chose a palliative delivery. 30 patients were counseled to expect a neonatal cardiac intervention and 25 (83%) underwent an intervention within the expected time period. No neonates required an uncounseled cardiac intervention. 29 patients planned for PGE at birth and 31 received PGE. Of the 79 postnatal echocardiograms, 60 (76%) were entirely consistent with the fetal diagnosis. A multidisciplinary approach to the prenatal diagnosis of CHD in maternal-fetal dyads is optimal and utilizing this method we were able to accurately predict postnatal physiology and ensure that patients delivered in the correct location with an appropriate supportive structure in place.

Alternative to Intensive Management of the Active Phase of the Second Stage of Labor: A Multicenter Randomized Trial (Phase Active du Second STade Trial) Among Nulliparous Women With an Epidural

ABSTRACT The optimal management of second stage of labor, with its passive and active phases, remains controversial. In France, delayed pushing during the active phase is recommended because of the belief that, based on older data, the fetus is at higher risk during the active phase. It is possible that uterine contractions combined with maternal pushing can lead to cord compression and reduce placental perfusion and oxygenation, which can induce acidosis and fetal heart rate abnormalities, resulting in the need for medical intervention, such as operative vaginal delivery (OVD) or episiotomy. In countries where the active phase is limited, women are encouraged to push as strongly as possible to speed delivery. However, if the active second stage of labor is prolonged, this intensive management may increase fetal hypoxia. The aim of this study was to examine the effect of moderate pushing versus intensive pushing in the second stage of labor on the risk of neonatal morbidity. This was a multicenter, randomized controlled trial at 13 French maternity units between January 2017 and May 2020. Included were nulliparous, adult women who had spontaneous or induced, uncomplicated delivery of a singleton fetus at ≥37 weeks of gestation. Excluded were women with a psychiatric condition, a disease contraindicating intensive expulsive efforts, or any uterine surgical scar, as well as those with a fetus that was small for gestational age, had congenital abnormalities, or had abnormal heart rate. Eligible women were randomized into 2 groups: the intervention group was instructed to push moderately only during the active phase of the second stage of labor, and the control group was instructed to push intensively during the same phase following French recommendations. Midwives asked the intervention group to push 2 times during each contraction and to take a break with no pushing in 1 of 5 contractions. No limit was set on pushing duration. The control group was asked to push 3 times per contraction without breaks. After 30 minutes of pushing, the midwife contacted an obstetrician to consider operative delivery. The primary outcome was a composite of neonatal acidosis, a 5-minute Apgar score &lt;7, and/or severe neonatal trauma. Secondary neonatal outcomes were transfer to the neonatology unit or intensive care unit need for resuscitation at birth and need for hypothermia. Secondary maternal outcomes were mode of delivery, postpartum hemorrhage (PPH), and severe PPH. The trial was stopped prematurely because of difficulties obtaining an adequate sample size. Of the 3380 women initially planned, 1710 (50.6%) were included. Ultimately, the intention-to-treat analysis included 809 women in each group. The neonatal morbidity rates for the intervention group and control group were 18.9% and 20.6%, respectively (risk ratio [RR] 0.92; 95% confident interval [CI], 0.75–1.12; P = 0.38). No significant differences were observed for neonatal transfer or need for resuscitation. All but 16 women delivered vaginally. The intervention or moderate pushing group had a longer pushing duration than the control or intensive pushing group (38.8 ± 26.4 vs 28.6 ± 17.0 minutes; P &lt; 0.001) and lower episiotomy rate (13.5% vs 17.8%; RR, 0.76; 95% CI, 0.60–0.95; P = 0.02). The rates of OVD were 21.1% in the intervention group and 24.8% in the control group (RR, 0.85; 95% CI, 0.71–1.02; P = 0.08). No significant differences were observed for PPH or severe PPH. During the active stage of labor, encouraging women to push moderately versus intensively was not associated with decreased neonatal morbidity. Although the pushing duration was longer among women instructed to push moderately, the rate of episiotomy was lower.

Effect of Lifestyle Modification Upon Dysmenorrhea and Pain Severity in University Students of Karachi- Prospective Study

Aim: To evaluate the effect of lifestyle modification upon dysmenorrhea and pain severity in university students of Karachi. Methodology: This is a prospective cohort study, the sample size was 383 participants, and data was collected from the Karachi institute of health sciences. Participants were followed after lifestyle modifications, weight reduction, stress management, physical exercise, and nutrition. Menstruation pain severity was measured by pain visual analog scale score (VAS) score, after 4 weeks and 8 weeks of modification follow-up, participants were asked to fill a validated questionnaire including pain VAS score again to assess the difference in dysmenorrhea and its associated symptoms. Results: Out of 383 study participants, the mean age was 22.2±1.9 years while the mean weight was 72.9±4.7 years, mean age of menarche was 13.4±0.7 years. Pain VAS score was categorized within mild and tolerable, moderate and Uncomfortable, and severe with an immediate need for medical intervention, indicating 82(21.4%), 195(50.9%) and 106(27.6%) frequencies respectively. The effect of lifestyle modification afterthe first menstruation cycle questionnaire was filled again, and results indicated mild, moderate, and severe results as 277(72.3%), 90(23.4%) and 16(4.1%) while on the second cycle 343(89.5%), 34(8.8%) and 6(1.5%) were identified respectively. Conclusion: Lifestyle modification, maintaining a healthy weight, having proper nutrition, and managing stress can sufficiently reduce the chances of dysmenorrhea and decreases the severity of menstrual pain. Keywords:Dysmenorrhea, Pain-vas score, lifestyle modification

Comparison of the efficacy of intravitreal Anti-VEGF versus intravitreal dexamethasone implant in treatment resistant diabetic Macular Edema

PurposeComparison of the efficacy of monthly anti-VEGF versus dexamethasone (DEX) implant in patients with diabetic macular edema (DME) whose macular edema persists despite three doses of anti-VEGF therapy.Materials and methodsThis retrospective study included 94 eyes of 94 patients with central macular thickness (CMT) > 300 μm despite previously receiving three doses of anti-VGEF (aflibercept or ranibizumab) injections between January 2014 and January 2019. The patients were divided into four groups. The first and second groups were the patients who received three more doses of initial anti-VGEF treatment after the initial anti-VGEF treatment. The third and fourth groups were patients switched to intravitreal dexamethasone implants. Patients were followed up every month for six months after the injection. The primary outcome measures were best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) at six months.ResultsThe mean age of the patients included in the study was 64.64 ± 7; there were 58 men (61.7%) and 36 women (38.3%). There was no statistically significant difference between the groups regarding age, stage of retinopathy, and lens status. When CMT, BCVA, and IOP were assessed among the four groups at the end of the sixth month, no statistical difference between the groups was found. There was no need for medical intervention despite the statistically significant increase in IOP at the end of the sixth month compared to the third month in the dexamethasone implanted groups. In contrast to the decrease in CMT, which was statistically significant in all four groups at the end of the sixth month compared to the third month, the increase in BCVA was not statistically significant in any of the four groups at the end of the sixth month.ConclusionAccording to the results of our study, there is no superiority between continuing with existing anti-VEGF or switching to a dexamethasone implant after three doses of anti-VEGF.

Health Conditions Associated with Alzheimer's Disease and Vascular Dementia.

We examined medical records to determine health conditions associated with dementia at varied intervals prior to dementia diagnosis in participants from the Baltimore Longitudinal Study of Aging (BLSA). Data were available for 347 Alzheimer's disease (AD), 76 vascular dementia (VaD), and 811 control participants without dementia. Logistic regressions were performed associating International Classification of Diseases, 9th Revision (ICD-9) health codes with dementia status across all time points, at 5 and 1 year(s) prior to dementia diagnosis, and at the year of diagnosis, controlling for age, sex, and follow-up length of the medical record. In AD, the earliest and most consistent associations across all time points included depression, erectile dysfunction, gait abnormalities, hearing loss, and nervous and musculoskeletal symptoms. Cardiomegaly, urinary incontinence, non-epithelial skin cancer, and pneumonia were not significant until 1 year before dementia diagnosis. In VaD, the earliest and most consistent associations across all time points included abnormal electrocardiogram (EKG), cardiac dysrhythmias, cerebrovascular disease, non-epithelial skin cancer, depression, and hearing loss. Atrial fibrillation, occlusion of cerebral arteries, essential tremor, and abnormal reflexes were not significant until 1 year before dementia diagnosis. These findings suggest that some health conditions are associated with future dementia beginning at least 5 years before dementia diagnosis and are consistently seen over time, while others only reach significance closer to the date of diagnosis. These results also show that there are both shared and distinctive health conditions associated with AD and VaD. These results reinforce the need for medical intervention and treatment to lessen the impact of health comorbidities in the aging population. ANN NEUROL 2023;93:805-818.

Priorities and overarching goals in the diagnosis and emergency treatment of patients with suspected ectopic pregnancy – retrospective study

Aim: Analysis of priorities in the emergency treatment of patients with ectopic pregnancy who are in a life-threatening condition. Observation of differences in the course of treatment depending on belonging to the age group. Material and methods: The study included 68 patients of the Gynaecological and Obstetric Specialist Hospital. E. Szczeklik in Tarnów, Małopolskie Voivode¬ship, who were diagnosed with ectopic pregnancy. The patients were divided into two groups according to age, counting 34 people in both cases.The study was retrospective and concerned patients hospitalized in the period 27.01.2016–01.08.2022. Results: The length of hospital stay due to ectopic pregnancy is not significantly longer in patients under 30 years of age compared to patients over 30 years of age. No significant relationship was observed between the patient’s age and the stage of pregnancy in which health collapse occurs and the need for medical intervention in connection with ectopic pregnancy occurs. Ectopic pregnancies are most often localized in the right fallopian tube. No significant differences between age groups were shown in laboratory tests of hCG, WBC, RGB, HGB, HCT, PLT levels. The most common treatment in both groups was surgical resection of the ruptured fallopian tube. No statistically significant differences were found between age groups and treatment. Conclusions: Ectopic pregnancy is a dangerous clinical situation for pregnant women regardless of their age. The intensity of haemorrhage as a result of rupture at the site of implantation of the embryo, assessed on the basis of laboratory tests, is comparable in both patients before and after 30 years of age.

Increased Susceptibility for Adverse Reactions to Ultrasound Enhancing Agents in Sickle Cell Disease

Pain-related adverse events (AEs) to ultrasound enhancing agents (UEAs) have been reported in patients with sickle cell disease (SCD). The aims of this study were to characterize the scope of these AEs in the SCD population and to investigate potential mechanisms on the basis of pathways involved in SCD vaso-occlusive crisis (VOC) and pain. The prevalence and classification of AEs were analyzed from two clinical trials in which high-dose Definity infusions were used in patients with SCD (n=55) or matched control subjects (n=43) to study muscle or myocardial microvascular perfusion. Because complement (C') activation can trigger VOC in SCD, C' activation and surface adhesion of C' proteins on lipid UEAs were studied invitro. C'-mediated UEA attachment to bone marrow immune cells was assessed using flow cytometry in a murine SCD model (Townes mice). Blood from patients receiving Definity was obtained to measure specific lysophospholipid metabolites of lipids in Definity thought to mediate SCD pain. Moderate or greater AEs, all of which were nociceptive (back or bone pain), occurred in one control subject and nine SCD subjects (2% vs 16%, P=.02). Patients with SCD who had AEs tended to have more severe manifestations of SCD. Three of the subjects with SCD had previously received Definity without complications. In patients with SCD, four AEs were classified as severe in intensity and as serious AEs on the basis of need for medical intervention. AEs were described to be similar to SCD-related pain, but there was no evidence for VOC, hemolysis, hypotension, or hypoxemia. At baseline, markers of C' activation were greater in patients with SCD than control subjects. However, after administration of lipid UEAs, SCD and control subjects were similar with regard to C' activation response, anaphylatoxin production, bone marrow microbubble retention, and production of lysophospholipids. There was a trend toward increased deposition of C3b and C3bi on lipid UEAs exposed to serum from patients with SCD. Patients with SCD are particularly susceptible to nociceptive AEs when given Definity at high doses. The mechanism for these AEs remains unclear but most are not related to the triggering of classic VOC.

Qualitative Findings for Supporting Newly Graduated Nurse and Teacher Sleep During Their First Year.

New graduate role transition for nurses and teachers is stressful. Poor adaptation may manifest as insomnia, which has implications for the new professionals, their employers, and the public served. This study examines factors that impact new graduate sleep, with the aim of identifying perceived helps and hindrances to sleep-during-transition. Targeted content analysis of transcripts from a larger longitudinal mixed methods study comparing new graduate sleep during their first year of practice. Study participants (N = 21) answered questions in the final interview regarding the most positive and negative impact(s) on sleep during the transition year. Transcripts were analyzed and compared based on the new graduate sleep typology (i.e., Got Better, Got Worse, Stayed Varied) which emerged from the parent study. Most participants, regardless of sleep type, identified a person/group as most positively impacting sleep. They identified work thoughts, stress/anxiety, people, work hours/sleep schedules, and environmental factors as negatively impacting sleep. Work thoughts and stress/anxiety were mentioned together and most frequently by participants in all three sleep types. This study provided insight into new graduate nurse and teacher sleep during transition. Support persons and/or groups may be essential regardless of sleep type. Thought management/stress mitigation strategies and good sleep hygiene may also improve the sleep experiences of these new professionals. Occupational health nurses can support sleep-during-transition among new nurses and teachers by acting as sleep advocates. They may also identify a need for medical intervention and/or sleep specialists and should promote fatigue risk mitigating policies.