Normal Status Research Articles

Experimental data-driven model development for ESP failure diagnosis based on the principal component analysis

The reliable diagnosis of electrical submersible pump (ESP) failure is a vital process for establishing of the optimal production strategies and achieving minimum development costs. Although traditional ammeter charts and nodal analysis are commonly used for ESP failure diagnosis, the techniques have limitations, as it requires manpower and is difficult to diagnose the failure in real-time. Therefore, in this study, ESP failure diagnosis was performed using the principal component analysis (PCA). First, 11 types of 9,955 pieces of data were acquired from a newly constructed ESP experimental system for 300 days. During the experimental period, ESP failure occurred twice with a significant drop in performance: first on day 112 and second on day 271. The PCA model was constructed with the 8,928 pieces of normal status data and tested with the 1,027 pieces of normal and failure status data. Three principal components were extracted from the measured data to identify the patterns of the normal and failure status. Based on the logistic regression method to analyze the efficiency of the PCA model, it was found out that the developed PCA model showed an accuracy of 93.3%. Therefore, the PCA model was found to be reliable and effective for the ESP failure diagnosis and performance analysis.

Correlation of the Endoscopic Gastroesophageal Flap Valve with Pathologic Reflux.

The Hill classification characterizes the geometry of gastroesophageal junction and Hill grades (HGs) III and IV have a high association with pathologic reflux. This study aimed to understand the use of the Hill classification and correlate the prevalence of pathologic reflux across different HGs. A retrospective review of 477 patients who underwent upper endoscopy and BRAVO pH monitoring between August 2018 and October 2021 was performed. These charts were reviewed for endoscopic findings for hiatal hernia and association of HGs with pathologic reflux, defined as an abnormal esophageal acid exposure time (AET) of ≥4.9%. Of 477 patients, 252 (52.8%) had an HG documented on the endoscopy report. Of the 252 patients, 61 had HG I (24.2%), 100 had HG II (39.7%), 61 had HG III (24.2%), and 30 had HG IV (11.9%). The proportion of patients with abnormal AET increases with increasing HGs (p < 0.001) as follows: I (39.3%), II (52.5%), III (67.2%), and IV (79.3%). The mean overall AET is as follows: HG I (5.5 ± 6%), HG II (7.0 ± 5.9%), HG III (10.2 ± 10.3%), and HG IV (9.5 ± 5.5%). The proportion of patients with hiatal hernia was 18% for HG I, 28% for HG II, 39.3% for HG III, and 80% for HG IV. Use of the Hill classification in clinical practice is low. There is an association of increasing HGs with increasing proportion of patients with abnormal AET. There is a high proportion of patients within HGs I and II with documented pathologic reflux and the presence of a hiatal hernia as observed on endoscopic examination. Our study suggests that endoscopic grading of the gastroesophageal junction may not adequately differentiate between normal vs abnormal reflux status, particularly for HGs I and II.

Acute sodium bicarbonate administration improves ventilatory efficiency in experimental respiratory acidosis: clinical implications.

Administering sodium bicarbonate (NaHCO3) to patients with respiratory acidosis breathing spontaneously is contraindicated because it increases carbon dioxide load and depresses pulmonary ventilation. Nonetheless, several studies have reported salutary effects of NaHCO3 in patients with respiratory acidosis but the underlying mechanism remains uncertain. Considering that such reports have been ignored, we examined the ventilatory response of unanesthetized dogs with respiratory acidosis to hypertonic NaHCO3 infusion (1 N, 5 mmol/kg) and compared it with that of animals with normal acid-base status or one of the remaining acid-base disorders. Ventilatory response to NaHCO3 infusion was evaluated by examining the ensuing change in PaCO2 and the linear regression of the PaCO2 vs. pH relationship. Strikingly, PaCO2 failed to increase and the ΔPaCO2 vs. ΔpH slope was negative in respiratory acidosis, whereas PaCO2 increased consistently and the ΔPaCO2 vs. ΔpH slope was positive in the remaining study groups. These results cannot be explained by differences in buffering-induced decomposition of infused bicarbonate or baseline levels of blood pH, PaCO2, and pulmonary ventilation. We propose that NaHCO3 infusion improved the ventilatory efficiency of animals with respiratory acidosis, i.e., it decreased their ratio of total pulmonary ventilation to carbon dioxide excretion (VE/VCO2). Such exclusive effect of NaHCO3 infusion in animals with respiratory acidosis might emanate from baseline increased VD/VT (dead space/tidal volume) caused by bronchoconstriction and likely reduced pulmonary blood flow, defects that are reversed by alkali infusion. Our observations might explain the beneficial effects of NaHCO3 reported in patients with acute respiratory acidosis.

A Case of Corneal Ulcer Caused by Stenotrophomonas maltophilia in a Healthy Patient

Purpose: To report a case of corneal ulcer caused by &lt;i&gt;Stenotrophomonas maltophilia&lt;/i&gt; monomicrobial infection in an otherwise healthy patient, devoid of underlying medical conditions or predisposing factors.Case summary: A 48-year-old male patient, who was normally healthy without a history of systemic disease, eye trauma, and eye surgery, presented with acute left eye pain that had manifested one day prior. Ophthalmic examination revealed conjunctival injection, corneal edema, and localized corneal ulceration in the left eye. Suspecting infectious keratitis, diagnostic procedures including gram staining, bacterial and fungal cultures, and antibiotic susceptibility testing were promptly instituted. Bacterial culture identified &lt;i&gt;S. maltophilia&lt;/i&gt;, prompting an eight-week course of topical gatifloxacin therapy. The subsequent clinical course exhibited improvement, with lingering corneal haziness and the restoration of visual acuity to 1.0.Conclusion: The case featuring the single detection of &lt;i&gt;S. maltophilia&lt;/i&gt;, known to cause hospital-acquired opportunistic infections, emphasizes the importance of culture and antibiotic susceptibility testing in the treatment of keratitis. Remarkably, in a patient with a normal immune status and in the absence of factors predisposing to &lt;i&gt;S. maltophilia&lt;/i&gt; infections, there were no discernible causative factors damaging the ocular surface environment.

Prevention of dialysis disequilibrium syndrome in children with advanced uremia with a structured hemodialysis protocol: A quality improvement initiative study.

Dialysis disequilibrium syndrome (DDS) is a rare but significant concern in adult and pediatric patients undergoing dialysis initiation with advanced uremia or if done after an interval. It is imperative to gain insights into the epidemiological patterns, pathophysiological mechanisms, and preventive strategies aimed at averting the onset of this ailment. Prospective observational quality improvement initiative cohort study. A prospective single-center study involving 50 pediatric patients under 18 years recently diagnosed with chronic kidney disease stage V with blood urea ≥200 mg/dL, admitted to our tertiary care center for dialysis initiation from January 2017 to October 2023. A standardized protocol was developed and followed for hemodialysis in pediatric patients with advanced uremia. This protocol included measures such as lower urea reduction ratios (targeted at 20%-30%) with shorter dialysis sessions and linear dialysate sodium profiling. Prophylactic administration of mannitol and 25% dextrose was also done to prevent the incidence of dialysis disequilibrium syndrome. Incidence of dialysis disequilibrium syndrome and severe dialysis disequilibrium syndrome, mortality, urea reduction ratios (URRs), neurological outcome at discharge, and development of complications such as infection and hypotension. Long-term outcomes were assessed at the 1-year follow-up including adherence to dialysis, renal transplantation, death, and loss to follow-up. The median serum creatinine and urea levels at presentation were 7.93 and 224 mg/dL, respectively. A total of 20% of patients had neurological symptoms attributable to advanced uremia at the time of presentation. The incidence of dialysis disequilibrium syndrome was 4% (n = 2) with severe dialysis disequilibrium syndrome only 2% (n = 1). Overall mortality was 8% (n = 4) but none of the deaths were attributed to dialysis disequilibrium syndrome. The mean urea reduction ratios for the first, second, and third dialysis sessions were 23.45%, 34.56%, and 33.50%, respectively. The patients with dialysis disequilibrium syndrome were discharged with normal neurological status. Long-term outcomes showed 88% adherence to dialysis and 38% renal transplantation. This study is characterized by a single-center design, nonrandomized approach, and limited sample size. Our structured protocol served as a framework for standardizing procedures contributing to low incidence rates of dialysis disequilibrium syndrome.

Association of serum protein electrophoresis with clinicopathological characteristics and its prognostic relevance in chronic lymphocytic leukaemia patients.

To assess the association of serum protein electrophoresis abnormalities with clinicopathological characteristics, and its impact on overall survival in chronic lymphocytic leukaemia patients. The prospective study was conducted at Haematology and Immunology departments of the University of Health Sciences, Lahore, Pakistan, from 2019 to 2022, and comprised newly diagnosed chronic lymphocytic leukaemia patients. Lactate dehydrogenase and beta-2 microglobulin levels were measured by spectrophotometric principle, whereas serum protein electrophoresis was determined through commercially available capillary electrophoresis systems. Patients were followed up for 2 years post-diagnosis. Data was analysed using SPSS 21. Of the 50 patients, 40(80%) were males and 10(20%) were females. The overall mean age was 60±11 years. Serum protein electrophoresis was available for 40(80%) patients, and, among them, 12(30%) patients had abnormal levels, while 29(72.5%) required treatment. Overall response rate was 25(86.2%), and median two-year overall survival was 16.5 months (95% confidence interval: 10-20 months). Abnormal serum protein electrophoresis was significantly associated with Binet stage C, lower mean haemoglobin levels and higher median levels of lactate dehydrogenase and beta-2 microglobulin (p<0.05)). Regarding overall survival, the survival curves of chronic lymphocytic leukaemia patients with normal and abnormal serum protein electrophoresis status differed significantly (p=0.04). Abnormal serum protein electrophoresis could be considered a surrogate marker for advanced chronic lymphocytic leukaemia disease.

Dental health status of children with diabetes in Riyadh, Saudi Arabia

ObjectiveThe impact of diabetes on oral diseases remains debatable. We aimed to determine the prevalence of dental caries, gingival health status and knowledge, and oral hygiene level and practice in children with type 1 diabetes mellitus in Riyadh, Saudi Arabia. MethodsThe teeth of Sixty children with diabetes (33 males and 27 females; age 11.3 ± 2.2 [7–14] years) were examined for dental caries following the modified World Health Organization criteria. Data on age, sex, medical history, gingival health status and knowledge, and oral hygiene level and practice were collected from parents. ResultsIn this study, 53 % of the children had dental caries with decayed, missing, and filled primary and permanent teeth scores of 5.6 ± 3.8 and 3.6 ± 3.2, respectively, with similar scores for male and female children. Children with and without caries had similar oral hygiene practices and oral health knowledge but differed in the rates of good or fair oral hygiene status (89.2 vs. 56.6 %; P = 0.024) and normal gingival health status or mild gingivitis (96.5 vs. 81.3 %; P = 0.010). ConclusionsWe found that the oral hygiene status and rate of gingivitis differed in children with type 1 diabetes mellitus with or without dental caries.

Abstract P514: Association Between Glycemic Disorder and Acute Coronary Syndrome Among Patients With Stable Coronary Artery Disease: A Propensity Score Matching Analysis

Background: Type 2 diabetes mellitus is known as a major risk factor of acute coronary syndrome (ACS) as previous studies reported. However, the association between prediabetes and ACS is not fully investigated among patients with stable coronary artery disease (CAD). Furthermore, no study has examined whether there’s effect modification by sex, age and BMI in the association between glycemic disorder and ACS. Our study aimed to evaluate the role of glycemic disorder in ACS occurrence among patients CAD. Methods: In this cross-sectional study based on electronic medical records (EMR), participants with CAD after elective coronary artery angiography (CAG) during 2016-2020 were enrolled. Diagnosis of prediabetes was based on patients’ HbA1c level ranging from 5.7% to 6.4% or fasting plasma glucose (FPG) level between 5.6 - 6.9 mmol/L. The diabetes diagnosis was defined as HbA1c ≥6.5% or fasting plasma glucose (FPG) ≥7.0 mmol/L. Multivariable logistic regression models were built to evaluate the association between prediabetes, diabetes and ACS, adjusting for age, body mass index (BMI), hypertension, low density lipoprotein, triglyceride level, statin and anti-platelet medication use. Subjects with prediabetes were matched 1:1 to healthy controls using propensity score matching to test the robustness of the result. In the subgroup analysis, we examined the heterogeneity of age, sex and BMI in the association between glycemic disorders and ACS. Results: Among 1525 participants, 1158 were male and 367 were female. Compared to participants with no diabetes, those with prediabetic were not significantly associated ACS, after adjusting for potential confounders. The result persisted after 1:1 propensity score matching. There was effect modification by sex in the association between glycemic disorders and ACS (P glycemic disorder*sex = 0.012). Female participants with diabetes, compared to those without diabetes, were positively associated with ACS (OR 2.00, 95% CI 1.00 - 3.98). The association between glycemic disorders and ACS remained stable among those with severe coronary stenosis. Conclusions: Our finding suggested that the association between prediabetes and ACS did not differ from those with normal glycemic status and CAD. The association remained consistent among those with severe coronary stenosis. Besides, sex modifies the association, and female participants with diabetes should be paid attention to their higher risk of ACS.

Comparative Demographic and Clinical Profile of Preeclamptic and Normal Pregnant Women in the Third Trimester

Background: Preeclampsia is a pregnancy-specific, multi-system disorder characterized by elevated blood pressure and proteinuria after 20 weeks of gestation. Its exact etiology remains unknown, and globally, it stands as a prominent cause of maternal and infant morbidity and mortality. This study aimed to assess the comparative demographic and clinical profile of preeclamptic and normal pregnant women in the third trimester. Methods: This case-control study took place in Bangabandhu Sheikh Mujib Medical University Hospital and Dhaka Medical College Hospital, Dhaka, Bangladesh, spanning from July 2011 to June 2012. The study enrolled 100 pregnant women, with 50 cases diagnosed with preeclampsia and 50 controls representing normal pregnant women. Data analysis was conducted using SPSS version 23.0. Results: The mean ages of cases (25.8 ± 4.4 years) and controls (27.1 ± 3.1 years) were similar (P=0.177). A predominant proportion of cases (74%) and controls (66%) belonged to a lower social class (P=0.383). BMI assessment showed no significant difference (P= 0.645). Most participants in both groups were preterm (P=0.235) and primigravida (P= 0.422). The case group exhibited significantly higher mean serum ferritin than the control group (P&lt;0.001). Hemoglobin and hematocrit levels showed no significant differences (P=0.761 and P=0.231, respectively). Elevated serum ferritin (&gt;20 ng/ml) was prevalent in 76% of cases and 44% of controls (P=0.001). The odds of elevated serum ferritin in preeclampsia were approximately 4 times higher than in normal pregnancies (95% CI=1.7–9.5). Variations in serum ferritin levels across gestational ages are illustrated. Conclusion: The study found no significant correlation between preeclamptic and normal pregnant women's demographic and clinical status in the third trimester, except for serum ferritin levels. Further research is needed to obtain a clearer understanding of these relationships.

Extreme Connectedness Across Chinese Stock and Commodity Futures Markets

This study examines the price spillovers and connectedness among stock markets, the Shanghai Stock Exchange Composite (SSEC) index, Hang Seng index, Shenzhen Stock Exchange (SZSE) index, commodity futures markets, Aluminum (AL), Gold (AU), Copper (CU), Zinc, Steel Rebar, and Natural Rubber in bearish and bullish market situations. We use the quantile connectedness approach of Ando et al. (2022) to calculate hedge coverage ratios, optimal portfolio weights, and hedge coverage effectiveness. Our empirical analysis yields several important results. First, there is no difference in the results of the TVP-VAR-DY and TVP-VAR models in relation to the magnitude of return transmission during the sample period. Second, CU is the main transmitter and AU is the main receiver of shocks from the network. Third, under the QVAR method estimations, the CU (AU) is the major (minor) contributors to the network during the normal, bearish, and bullish market statuses. Fourth, the results of the hedge ratio strategy confirm that CU and AU are respectively the most and the least expensive assets for a long-term investment in the Chinese stock market in different market conditions.

Is it time to end the use of base deficit for fetal well-being assessment?

Authors have expressed reservations regarding the use of base deficit measured in umbilical artery blood samples to assess fetal well-being during the course of labor and to predict neonatal neurologic morbidity. Despite its integration into clinical practice for more than 50 years, obstetricians and maternal-fetal medicine specialists may not realize that this marker has significant limitations in accurately identifying neonatal metabolic acidosis as a proxy for fetal well-being. In brief, there are 2 large families of base deficit, namely whole blood and extracellular fluid. Both rely on equations that use normal adult acid-base characteristics (pH 7.40 and partial CO2 pressure of 40 mm Hg) that overlook the specificity of the normal in utero acid-base status of pH 7.27 and partial CO2 pressure of 54 mm Hg. In addition, it ignores the unique characteristic of the in utero fetal response to acute hypoxia. The dependence on placental circulation for CO2 elimination may lead to extremely high values (up to 130 to 150 mm Hg) during hypoxic events, a phenomenon that is absent in adults with acute metabolic acidosis who can hyperventilate. The dispute over if to include a correction for high partial CO2 pressure in the bicarbonate estimation, as presented in the Great Trans-Atlantic Debates, remains unresolved. The key constants computed for adult acid-base physiology in the current base deficit algorithms, without accounting for the impact of high partial CO2 pressure or other fetal characteristics of buffering capacity (eg, differences in body water content composition, plasma protein, and hemoglobin attributes), may lead to an overestimation of metabolic acidosis, especially in newborns who are experiencing hypercarbia during the early stages of the hypoxic response. These unrecognized limitations impact the base deficit results and may mislead clinicians on fetal well-being assessments when discussing the management of fetal heart rate monitoring and neonatal outcomes. Based on our arguments, we believe that it is prudent to consider an alternative to base deficit for drawing conclusions regarding fetal well-being during the course of birth management. We propose a marker specifically related to the newborn acid-base physiology--the neonatal eucapnic pH correction. This marker can be added to arterial cord blood gas analysis, and we have described how to interpret it as a marker of neonatal metabolic acidosis.

Current Practices and Attitudes of Cardiac Nurses Regarding Cognitive Screening in Patients With Acute Coronary Syndrome

Cognitive impairment (CI) is common in patients with acute coronary syndrome (ACS) but is often undetected and may affect recovery and secondary prevention uptake. Nurses play a crucial role providing care for patients with ACS and promoting secondary prevention. This study aimed to explore current nursing practices and barriers regarding CI screening in patients with ACS. Cardiac nurses were recruited from three metropolitan teaching hospitals and two professional associations in Australia and undertook a 38-question purpose-built survey. A total of 95 nurses participated (mean age 38±13 years; 78% [n=74] female): 69 were registered nurses, and 48% had received CI training. Only 16% of nurses in our sample reported that they regularly screen for CI, and 23% reported that they never screen; however, 59% believed screening should be part of everyday practice. Nurses mostly screened when ward policy required admission/daily cognitive screening (34%) or when they suspected cognitive problems or decline (39%). Nurses in acute settings (vs non-acute) were nine times more likely to screen when adjusting for confounders. The typically used screening instruments assessed delirium/confusion and dementia but not milder CI. Common barriers to screening included communication difficulties, patients too unstable/unwell, time constraints requiring clinical care prioritisation, and being unaware of patients' normal cognition status. Screening practices for CI in the context of ACS were found to be suboptimal, with only 16% of nurses in our sample reporting regularly screening. The most used methods focus on screening for delirium. Given current practice, many CI cases will be missed, especially mild CI, which will negatively affect secondary prevention efforts. Further research is required to identify appropriate methods to implement routine screening within the nursing clinical workflow and establish a suitable screening tool.

Hand skeletal features of children and adolescents with different growth statuses and periods.

The hand skeletal features of children and adolescents at different growth statuses and development periods, and the correlation between these skeletal features and hand asymmetric force are currently unclear. Thus, this study sought to investigate the hand skeletal features of children and adolescents at different growth statuses and at different periods of development, and the correlation between these skeletal features and asymmetric force in hands. A retrospective study was performed on subjects aged 4-20 years with good growth status (group A) or short stature (group B). Additional subjects aged 4-20, 21-40, and >40 years were enrolled in groups C, D, and E, respectively. All the subjects underwent left-hand posteroanterior X-ray radiography. Brachymesophalangia-V (BMP-V), conical epiphysis, epiphysis/metaphysis symmetry of the proximal phalanx (ESP), and the angle of the metacarpal-phalangeal axis were analyzed. Of the 654 children and teenagers aged 4-20 years (median: 11 years) enrolled in the study, 432 were allocated to group A, of whom 237 (54.9%) were male and 195 (45.1%) were female, and 222 matched cases were allocated to group B, of whom 112 (50.5%) were male and 110 (49.5%) were female. The first to third ESPs were significantly (P<0.05) greater in group A than in group B, while the first to third angles of the metacarpal-phalangeal axis were significantly (P<0.05) smaller in group A than in group B. The correlation analysis revealed a highly significant (P<0.01) negative correlation between the ESP and angle of the metacarpal-phalangeal axis (r=-0.948, -0.926, -0.940, -0.885, and -0.848, respectively). The incidence of BMP-V was 15.4% in all patients, while that of conical epiphysis was 19.5%. The incidence of BMP-V and conical epiphysis was significantly (P<0.05) smaller in group A than in group B (11.1% vs. 23.8% for BMP-V and 16.6% vs. 25.2% for conical epiphysis, respectively). Additionally, 216 subjects were enrolled in group C (108 male and 108 female), 185 subjects were enrolled in in group D (93 male and 92 female), and 176 subjects were enrolled in in group E (104 male and 72 female). The second to fifth ESPs in group C were significantly (P<0.05) smaller than those in both groups D and E, while the second to fifth angles of the metacarpal-phalangeal axis were significantly (P<0.05) larger in group C than in both groups D and E. A BMP-V was present in 35 (16.2%) patients in group C, 8 (4.3%) in group D, and 2 (1.1%) in group E, and the difference among the three groups was statistically significant (P<0.05). The epiphyseal symmetry of the proximal phalanges is poor in short stature children and adolescents, and the angle between the metacarpal and phalangeal axes is larger in children and adolescents with short stature than those with normal height and good growth status. A negative correlation was found between the epiphyseal symmetry of the proximal phalanges and asymmetrical stress.

Predictive Factors for the Formation of Viable Embryos in Subfertile Patients with Diminished Ovarian Reserve: A Clinical Prediction Study

This study aims to construct and validate a nomogram for predicting blastocyst formation in patients with diminished ovarian reserve (DOR) during in vitro fertilization (IVF) procedures. A retrospective analysis was conducted on 445 DOR patients who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) at the Reproductive Center of Yulin Maternal and Child Health Hospital from January 2019 to January 2023. A total of 1016 embryos were cultured for blastocyst formation, of which 487 were usable blastocysts and 529 did not form usable blastocysts. The embryos were randomly divided into a training set (711 embryos) and a validation set (305 embryos). Relevant factors were initially identified through univariate logistic regression analysis based on the training set, followed by multivariate logistic regression analysis to establish a nomogram model. The prediction model was then calibrated and validated. Multivariate stepwise forward logistic regression analysis showed that female age, normal fertilization status, embryo grade on D2, and embryo grade on D3 were independent predictors of blastocyst formation in DOR patients. The Hosmer–Lemeshow test indicated no statistical difference between the predicted probabilities of blastocyst formation and actual blastocyst formation (P > 0.05). These results suggest that female age, normal fertilization status, embryo grade on D2, and embryo grade on D3 are independent predictors of blastocyst formation in DOR patients. The clinical prediction nomogram constructed from these factors has good predictive value and clinical utility and can provide a basis for clinical prognosis, intervention, and the formulation of individualized medical plans.

Efficacy of Oral Sarolaner in Canine Demodicosis

Dogs presented to small animal dermatology unit of Veterinary Clinical Complex, Rajendranagar with a comprehensive history of widespread itching, alopecia, thickened skin, skin discoloration, formation of scales and crusts with normal deworming and vaccination status were taken for the study. Clinical examination was carried out and dogs having signs of lichenified skin, alopecia, erythema, papules, comedones, as well as the presence of Demodex mite on skin scrapping were included in the study. these dogs were treated by randomly dividing them into two groups, viz., group I (n=28) treated with tab. ivermectin (400 mcg/kg, PO, SID) until two successive negative scrapings and group II (n=28) treated with tab. Sarolaner, an iso oxazoline-class parasiticide administered orally at a dosage of 2 mg/kg once a month. Mites were counted once in 15 days in both groups. Parasitological cure in group I was 60.71, 78.57 and 92.85 percent respectively, in subsequent months, whereas in group II 67.85 and 100 percent respectively, after the first and second month of therapy. Remarkably, the dogs of group II exhibited complete clinical recovery by the second month of treatment without any relapse. Additionally, all the dogs were also managed with chlorhexidine shampoo bath weekly once and immune-boosting syrup once a day.

Surgical management of cranial thoracolumbar stenosis and concurrent kyphoscoliosis in a dog by dorsal vertebral stabilisation using low‐profile three‐dimensional printed patient‐specific drill guides

AbstractThe study described the clinical and imaging findings, treatment and outcome for a British bulldog with cranial thoracic vertebral canal stenosis and thoracolumbar kyphoscoliosis. Data on clinical presentation, diagnostic imaging, surgical procedure, complications and outcome were evaluated. Multiple thoracic vertebral body and dorsal arch malformations were detected by computed tomography and magnetic resonance imaging, resulting in spinal cord compression due to vertebral canal stenosis at T5–T6 and T9–T10, as well as kyphoscoliosis. Surgical vertebral stabilisation between T2 and T10 was performed by using a novel design of unilateral three‐dimensional printed patient‐specific drill guides, to preserve the dorsal spinous processes. Neurological signs had completely resolved 2 months after surgery. Follow‐up examination and computed tomography scan 15 months postoperatively revealed normal neurological status, implant stability and no progression of kyphoscoliosis. This novel design of unilateral three‐dimensional printed patient‐specific drill guides allowed dorsal thoracic vertebral stabilisation without resection of dorsal spinous processes and multiple‐level stabilisation.

Prevalence and co-incidence of geriatric syndromes according to the ECOG performance status in older cancer patients.

Geriatric syndromes may be more common in older cancer patients than in those without cancer. Geriatric syndromes can cause poor clinical outcomes. The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) is often used as a clinically reported functional status score in oncology practice. Our study was designed as a cross-sectional study and included 218 older cancer patients. This study aimed to determine the prevalence and relationship of geriatric syndromes according to the ECOG-PS in older cancer patients. The mean age of 218 participants was 73.0 ± 5.6 years, with 47.7% being women and 52.3% men in our study. ECOG-PS 0, 1, and 2 groups contained 51, 39, and 10% of the patients, respectively. The mean number of geriatric syndromes in the ECOG 0, 1, and 2 groups was 2.3 ± 2.2, 4.3 ± 2.4, and 5.7 ± 2.1, respectively (p < 0.001). After adjusting for age and sex, it was determined that dynapenia was 2.9 times, probable sarcopenia was 3.5 times, frailty was 4.2 times, depression was 2.6 times, malnutrition was 3.3 times, insomnia 2 was.2 times, falls was 2.5 times, and the risk of falling (TUG) was 2.4 times more likely in those with ECOG-PS 1 compared to those with ECOG-PS 0. In addition, it was found that dynapenia was 6 times, probable sarcopenia was 6.8 times, frailty was 10.8 times, depression was 3.3 times, malnutrition was 6.3 times, the risk of falling (Tinnetti Balance) was 28 times, and the risk of falling (TUG) was 13.6 times more likely in those with ECOG-PS 2 compared to those with ECOG-PS 0. Our study found that the prevalence of geriatric syndromes increased as the ECOG-PS increased. Geriatric syndromes and their co-incidence were common in older cancer patients, even in normal performance status. Oncologists should incorporate geriatric syndromes into the decision-making process of cancer treatment to maximize the impact on clinical outcomes in older patients with cancer.

Relationship between Lifestyle Determinants and Perceived Mental and Physical Health in Italian Nursery and Primary School Teachers after the COVID-19 Lockdown.

The COVID-19 lockdown and the consequent distance school learning made epochal changes in children's lifestyles; however, little is known about the lockdown effects on school teacher habits. The aim of this observational study is to examine differences in the lifestyle of nursery (NS) and primary (PS) school teachers after one of the COVID-19 lockdowns and investigate the relationship between perceived physical/mental health and demographics, weight status and lifestyle determinants, such as adherence to the Mediterranean Diet (MD) and physical activity level (PAL). A total sample of 265 participants (49.22 ± 6.95 years) filled out an online information questionnaire and standardized questionnaires to collect data on the Physical Component Summary (PCS), Mental Component Summary (MCS), PAL and MD-adherence. A t-test or ANOVA analysis was used to assess differences between quantitative variables: Mann-Whitney U or Kruskal-Wallis tests for qualitative variables. Spearman's correlations and multinomial logistic regression analyses were performed to identify categorical factors associated with classes of PCS and MCS. Teachers showed sufficient/high PAL, with a significantly higher level in the PS group (p < 0.05). This last showed a higher PCS score (p < 0.05). No differences between groups were found for MD-adherence, which was moderate/fair in both groups, and MCS, which was sufficient/good. Logistic regression showed that the only positive predictor of a high PCS was being physically active (OR 2.10, 95%CI 1.05-4.2, p < 0.05), while MCS was positively associated with normal weight status (OR 0.48, 95%CI 0.33-0.78, p = 0.020). This study highlights that PS teachers are more active than the NS group and perceive a higher physical health level. Mere predictors of physical and mental well-being are PA practice and being normal weight, respectively. This suggests that interventions to improve perceived health in this work category should be focused on the promotion of physical activity practice and on the maintenance of an optimal weight status.

Differences in [123I]Ioflupane Striatal Binding Between African American and White Patients.

Ethnic differences exist among patients with Parkinson disease (PD). PD is more common in the White than the African American population. This study aimed to explore whether differences exist in [123I]ioflupane binding, which reflects dopamine transporter binding, between African American and White individuals. Methods: Medical charts were reviewed for patients who underwent [123I]ioflupane SPECT imaging as part of routine practice in a single academic medical center. All images were visually graded as showing normal or abnormal presynaptic dopaminergic function (normal or abnormal scan status). Quantitative [123I]ioflupane uptake as measured by the specific binding ratios in the right and left striata and their subregions (caudate nucleus and anterior and posterior putamen) and by bilateral putamen-to-caudate ratios were compared between African American and White patients using multiple linear regression adjusted for age, sex, and abnormal scan status. Additional models included an ethnicity-by-abnormal-scan-status interaction term to determine whether abnormal scan status was modulated by ethnicity effect. Results: The percentage of patients with abnormal scan status was comparable between African American and White patients. Compared with White patients (n = 173), African American patients (n = 82) had statistically significantly higher uptake as measured by specific binding ratios in the right and left striata and some of their subregions (right and left caudate nuclei and right posterior putamen). Ethnicity-by-abnormal-scan-status interactions were not statistically supported for any models. Conclusion: We observed differences in [123I]ioflupane binding between African American and White patients independent of presynaptic dopaminergic dysfunction status. Future studies are needed to examine whether and how ethnicity affects dopamine transporter binding activities and its clinical relevance.

(070) Androgen Status in Men and Risk Of COVID-19 Complications: An Analysis of United States Claims Data

Abstract Introduction Biological males have had worse COVID-19 outcomes compared to females. Yet, the impact of hypogonadism (HG) on COVID complications remains unclear. Objective We sought to compare COVID complications in males with various androgen status (eugonadal, treated HG, untreated HG) to females to evaluate the effect of testosterone levels on COVID outcomes. Methods We used the IBM MarketScan database of commercial claims encounters to identify patients ages 18+ with a COVID diagnosis (n=756,855). We compared eugonadal males (no HG diagnosis), untreated HG males (HG diagnosis without therapy), treated HG males (HG diagnosis and testosterone prescription within 180 days before COVID diagnosis) to females. Rates of intensive care unit (ICU) admission co-occurring with initial COVID diagnosis were modeled using logistic regression. Acute respiratory distress syndrome (ARDS), acute respiratory failure (ARF), and use of critical care services (CCS) were modeled using Cox proportional hazards models. Outcomes were regressed against group, age, rurality, and Charlson Comorbidity Index. Results Eugonadal males (n=315,050) were at higher odds of ICU admission (OR: 1.611, 95% CI: 1.549-1.676), having ARDS (HR 1.766, CI: 1.670-1.868), having ARF (HR 1.609, CI: 1.575-1.644), and needing CCS (HR 1.696, CI: 1.652-1.742) compared to females. Treated HG males (n=2,343) and untreated HG males (n=22,614) were also more likely to experience all adverse outcomes compared to females. For untreated HG males the effect was less pronounced compared to eugonadal males and treated HG males for all outcomes (Figure 1). There were no differences in odds of all outcomes for castrate males (n=89) compared to females due to small sample size. Conclusions Eugonadal males, treated HG males, and untreated HG males were more likely to have adverse COVID outcomes compared to females. This effect was most pronounced for eugonadal and treated HG males compared to untreated HG males, suggesting normal androgen status is detrimental to COVID-19 outcomes. This is one of the largest studies to show a complex relationship between testosterone and COVID outcomes. Disclosure No.