Optimal Management Strategy Research Articles

Urinary retention during and after labor with programmed intermittent epidural bolus (PIEB) analgesia: a prospective observational study.

This study investigates the incidence and risk factors for urinary retention during and after labor in women receiving programmed intermittent epidural bolus (PIEB) analgesia and evaluates the optimal bladder management strategy. This prospective observational study assessed urinary retention during voiding attempts every two to three hours during labor and postpartum, among women with labor epidural analgesia using PIEB. Urinary retention was defined as a post-void residual volume>150mL, determined by catheterization after spontaneous voiding. Among 137 women included, with 277 voiding attempts during labor, the urinary retention rate was 20.6%, occurring in 48 women (35%). When the spontaneously voided volume was>50mL, urinary retention was observed in less than 10% of attempts. Postpartum urinary retention occurred in nine women (6.7%) with a mean post-void residual volume of 1133±447mL; all were nulliparous, seven had induced labor, and five had an episiotomy. Women who are able to successfully void during labor have a low risk of intrapartum urinary retention. We would recommend considering catheterization every 3 to 4hours for women who are unable to urinate spontaneously, void less than 50ml, or experience complete motor blockade during labor.

Impact of lactate levels on admission in STEMI patients with cardiogenic shock treated with IMPELLA.

The concomitant use of IMPELLA and veno-arterial extracorporeal membrane oxygenation (V-A ECMO) (ECPELLA) has been increasingly used to treat severe cardiogenic shock. However, the relationship between severity of heart failure on admission and prognosis based on differences in the mechanical circulatory support (MCS) is not fully understood. This study evaluated the association between lactate levels on admission and clinical outcomes based on differences in MCS. We identified 852 patients (median age 71years; 78% male) with cardiogenic shock due to ST-elevation myocardial infarction (STEMI) from the Japanese Registry for Percutaneous Ventricular Assist Devices. The primary endpoint was the in-hospital mortality rate. Additionally, patients were classified into three groups based on lactate levels according to the SCAI SHOCK classification for the assessment of in-hospital mortality: group 1 (lactate level < 2mmol/L), group 2 (lactate level 2-8mmol/L), and group 3 (lactate level ≥ 8mmol/L). The in-hospital mortality rate was 41.8%. The rate of V-A ECMO combined with IMPELLA use was 37.6%. The in-hospital mortality rates of the IMPELLA alone and ECPELLA group were 30.1% and 61.3%, respectively. The median lactate level was significantly higher in non-survivors than in survivors (5.7mmol/L vs. 3.5mmol/L, p < 0.0001). The in-hospital mortality rate with IMPELLA alone was significantly higher in group 3 compared to groups 1 and 2; however, there was no difference in in-hospital mortality with ECPELLA among the three groups. A lactate cut-off value of 6.9mmol/L showed the best discrimination for in-hospital mortality. Patients classified as the SCAI SHOCK stage E have a higher mortality rate with IMPELLA support alone. Further research is needed to optimize management strategies for this high-risk group.

Advances in gastrointestinal vascular bleeding disorders: Successful sirolimus treatment in colonic angioectasia.

Gastrointestinal (GI) vascular bleeding disorders pose significant clinical challenges due to their complex pathogenesis and varied treatment responses. Despite advancements in diagnostic and therapeutic techniques, optimal management strategies remain elusive, necessitating further research. To assess research trends and clinical advancements in GI vascular bleeding disorders, highlighting key themes and therapeutic progress. A bibliometric analysis was conducted using the Web of Science Core Collection database, reviewing publications from 2000 to 2024 to identify trends, high-frequency keywords, and key contributions from leading research institutions. In addition, a case study highlighted the effective application of sirolimus in managing colonic angioectasia in a patient with recurrent GI bleeding who had not responded to previous treatments. The analysis reviewed 470 scholarly articles from 203 countries, involving 2817 authors across 1502 institutions. The United States led in publication contributions, with strong collaborations with countries like China, England, and Germany. A significant trend was observed in the shift from traditional endoscopic interventions to pharmacological therapies, particularly highlighting the successful use of sirolimus in treating colonic angioectasia. High-frequency keywords such as "angiodysplasia", "colon", and "management" were identified, indicating key research themes. The study also noted a growing interest in drug therapies, as evidenced by the increasing prominence of keywords like "thalidomide" since 2018. This study links bibliometric analysis and clinical insights, highlighting the shift to pharmacological management in GI vascular bleeding disorders to improve patient outcomes.

P1119 Distinct clinical features in IBD patients undergoing orthotopic liver transplantation: Associations with re-transplantation and overall survival

Abstract Background Orthotopic liver transplantation (OLT) in patients with inflammatory bowel disease (IBD) represents a special patient population with high heterogeneity. The management of IBD in liver transplant recipients is challenging due to the need to balance immunosuppressive therapy, IBD flares and graft survival. Therefore, detailed analysis of clinical parameters is essential to better understand outcomes and optimize management strategies in this unique cohort. Methods This monocentric, retrospective analysis included IBD patients with concomitant OLT at our tertiary referral center. We reviewed the local database for incident cases from January 2013 to December 2023. Identified patients have been evaluated based on demographic data, detailed IBD and OLT history, complications (including re-OLT), and overall survival. Results This study included 126 IBD patients with OLT, with a mean age of 37.3 years at transplantation and a mean age of 28.2 years at IBD diagnosis. The majority of patients were male (68.3%), and ulcerative colitis (UC) was the most common diagnosis (86.5%), followed by Crohn’s disease (CD) (11.9%). Among UC patients, 79.8% had extensive colitis (E3), while in CD patients, the distribution was 40% L1, 26.7% L2, and 33.3% L3. The most common indication for OLT in this cohort was PSC (74.6%), followed by PSC/AIH variants (13.5%). Before OLT, 42.1% of patients were treated with corticosteroids, while 56.8% continued steroid treatment after OLT. Aminosalicylates were prescribed to 69.2% of patients pre-OLT, but only 49.6% continued this treatment post-OLT. 90.4% of patients did not require advanced therapies after OLT, though biologics like vedolizumab and ustekinumab were used in a small subset. 27.2% of patients required re-OLT, with UC being the most prevalent IBD entity for re-transplantation (82.4%). Colectomy after OLT was performed in 12.7% of patients, and it was associated with a higher likelihood of re-OLT (p = 0.04; OR: 3.1; 95% CI: 1.06-9.1), while post-OLT 5-ASA therapy was associated with a reduced likelihood of re-OLT (p = 0.03; OR: 0.4; 95% CI: 0.17-0.9). Overall mortality post-OLT was 26.2%. A COX-Regression analysis further revealed significant associations with overall mortality and e. g. age at IBD diagnosis (p &amp;lt; 0.01; HR: 1.07; 95% CI: 1.04-1.11), male sex (p = 0.045; HR: 2.95; 95% CI: 1.02-8.52), steroid use post-OLT (p=0.04: HR: 2.6, CI: 1.06-6.43) and PSC (p=0.04: HR: 0.3, CI: 0.11-0.95). Conclusion To the best of our knowledge, this is the largest monocentric IBD OLT cohort. We identified 5-ASA and steroid therapy as modifiable risk factors for re-OLT and mortality in IBD patients after OLT. Further validation of these findings in a larger multicentric setting is recommended.

Pulmonary Atresia with Intact Ventricular Septum, an Evolving Strategy in the Era of PDA Stenting: Single Center Experience.

Repair or palliation of pulmonary atresia with intact ventricular septum (PA/IVS) often falls into one of 4 categories: cardiac transplant, 2-ventricular circulation, 1.5 ventricle circulation, or single ventricle circulation. The optimal management strategy has been an area of much debate. We sought to review the management strategy of patients with PA/IVS at our institution to better understand what metrics can be used to guide management and initial interventions. The study aims to examine the outcomes of a single-center approach to managing patients with PA/IVS. Our cohort included 29 patients; one patient underwent a planned transplant at ten days of life (3.4%), 12 underwent repair via a two-ventricle circulation (41.4%), 7 underwent repair with 1.5 ventricle circulation (24.1%), and 7 underwent repair with single ventricle circulation (24.1%). Survival was achieved in 93.1% with two patients (6.9%) expiring. The TV annulus z-score was significantly different between the three groups, with the 1V group having the smallest median TV annulus z-score at -4.04 (IQR -4.60- -3.60) and the 2V group having the largest median TV z-score at -1.4 (IQR -2.24- -0.12). Six patients underwent late right ventricular decompression. We present a post-hoc algorithm to help guide treatment strategies for patients with PA/IVS.

Retrospective observational study shows accelerometers can monitor effects of canine pruritus treatment.

To evaluate the use of collar-mounted accelerometers to objectively monitor treatment outcomes in canine pruritus. Observational data from 1,803 dogs from 2019 through 2023 were retrospectively analyzed to evaluate the efficacy of collar-mounted accelerometers to assess treatment efficacy for pruritic canine skin diseases. Accelerometer measurements were joined to electronic health records to establish symptoms, diagnoses, and interventions. A directed acyclic graph was used to identify relevant variables to control for, and linear regression was used to model the pruritic behaviors before and after intervention. Significant reductions in pruritic behaviors, particularly scratching and licking, were observed following interventions. Antibody and immunosuppressant treatments exhibited the most pronounced effects on scratching behavior, with a reduction in scratching of up to 40.9% and 23.4%, retrospectively, in the 30 days following intervention relative to the 14 days prior. Collar-mounted accelerometers used to measure pruritic behaviors can detect the effects of interventions for canine pruritus. Pruritus is a common symptom of canine skin diseases, such as atopic dermatitis or allergic dermatitis, which can be difficult to diagnose and manage. This study highlights the use of collar-mounted accelerometers to objectively monitor treatment outcomes for canine pruritus, providing valuable insights into treatment effectiveness that could allow veterinarians and pet owners to optimize management strategies to alleviate the burden of this challenging condition.

Fetal Bradyarrhythmias: A Comprehensive Update on Current Knowledge

Objective: This review aims to improve the accuracy and efficacy of ultrasound diagnosis of fetal bradyarrhythmias. Fetal arrhythmias represent 10% to 20% of referrals to specialized clinics for the evaluation of fetal heart rhythm abnormalities Mechanism: Various methods are available for assessing fetal heart rhythm through ultrasound and fetal echocardiography, which facilitate accurate diagnosis and help determine the optimal management strategies. Despite advancements in diagnostic techniques, the absence of studies with a substantial number of cases has resulted in significant variability in treatment approaches, influenced by local expertise and available resources. Findings in Brief: Fetal bradycardias can be transient or persistent conditions. Differentiating between them is critical for determining appropriate management. Second-trimester physiological transient bradycardia is characterized by temporary decelerations in fetal heart rate that resolve spontaneously to normal rhythm without requiring treatment or follow-up. In contrast, isolated or immune-mediated complete atrioventricular block may progress rapidly to hydrops, requiring close monitoring, medical intervention, and, in some cases, early delivery. Conclusion: In this review, we provide a comprehensive overview of all types of fetal bradycardias and the intrauterine management strategies used for their treatment.

Research on the Sustainability Strategy of Cogeneration Microgrids Based on Supply-Demand Synergy

With the continuous adjustment of energy structure and the improvement of environmental protection requirements, combined heat and power microgrids (CHP-MG) have received widespread attention as an efficient and economical way of utilizing energy. The complexity of energy supply relationships and energy coupling within the microgrid system necessitates optimizing the power output of each equipment unit. In this paper, an optimization strategy for a multi-energy microgrid system is proposed based on the efficient energy supply of cogeneration microgrids: decoupling the thermoelectric connection by using the energy storage equipment on the supply side, utilizing the flexibility of the electrical loads and the diversity of the system’s heating methods, and reducing the electrical loads and changing the selection of the heating methods on the demand side. The optimization model in the paper is mainly based on mixed-integer linear programming and demand-side management theory, which simulates the system operation under different scenarios so as to find the optimal equipment output and load management strategies. Simulation results show that the optimized CHP-MG system can ensure a reliable power supply while effectively reducing operating costs, improving energy utilization and promoting sustainable operation of the energy system. The optimized microgrid system offers significant advantages in terms of economic efficiency and energy management when compared to conventional CHP systems. These findings provide actionable insights for policymakers, system operators, and researchers aimed at driving the development of efficient and sustainable energy management solutions.

Postnatal management of preterm infants with congenital diaphragmatic hernia.

Congenital diaphragmatic hernia (CDH) in the preterm population is increasingly common in the current era of fetal endoluminal tracheal occlusion (FETO) therapy. There remains a lack of clinical guidance for clinicians and surgeons regarding optimal management strategies for such infants. We aimed to describe our experience in managing preterm CDH in a single quaternary neonatal intensive care unit (NICU). This was a retrospective single-center observational case series of preterm infants born between 2017 and 2024 at less than 37weeks of gestation and diagnosed with CDH (pre- or post-natally). Thirty-two infants with a median (range) gestational age of 33.9 (27.0-36.9) weeks and a birth weight of 1975 (1070-3290) grams. Twenty-two infants (68.8%) were diagnosed with CDH prenatally and 43.8% underwent antenatal FETO. The median time of surgical repair was at 10 (2-47) days of life. The duration of invasive mechanical ventilation was 11 (1-115) days. Nineteen infants (59.4%) survived to discharge with a median postmenstrual age at time of discharge of 40.6 (36.0-51.0) weeks. Two infants developed a grade 3 or 4 intraventricular hemorrhage. Five infants required home oxygen at discharge. Preterm CDH confers high morbidity and mortality. Robust clinical evidence, multicenter studies and standardized guidelines are needed to improve outcomes in this challenging patient population.

Intralesional steroid injection in keloid ear — a prospective observational study

BackgroundKeloid is a fibro-proliferative dermal benign growth affecting the Asian population. In India, ear keloids are common, often resulting from ear piercing, a prevalent cultural practice. The resultant ear keloids pose aesthetic concerns, leading to significant psychological distress, and necessitating effective treatment. While various treatment options are available, their outcomes and recurrence rates vary, highlighting the need for individualized and optimal management strategies. Our study aimed to observe the combined effect of intralesional triamcinolone with hyaluronidase on keloid regression.MethodsThis prospective observational study was conducted at our tertiary care institute over 1 and a half years. Fifty patients who met the inclusion criteria were enrolled and received intralesional triamcinolone injection with hyaluronidase. Keloid regression was assessed using the Vancouver Scar Scale (VSS), while the visual analogue score (VAS) and patient satisfaction score (PSS) provided subjective evaluations of symptom relief. All patients underwent compression therapy. Patients were evaluated at every visit and then at 1 year for symptom relief, keloid regression, and complications if any.ResultsDemographic data of all patients were recorded. Ear keloids were predominantly observed in females, with a male-to-female ratio of 18:32. The most common etiology was trauma following ear piercing, accounting for 46% of cases. All patients showed improvement in VSS, VAS, and PSS scores in the follow-up visits. A total of 98% of patients demonstrated a complete treatment response, with only a single instance of recurrence.ConclusionIntralesional triamcinolone with hyaluronidase provides satisfactory symptomatic relief and has lower recurrence rates. All patients showed improvement in the Vancouver Scar Scale and had enhanced VAS and PSS scores.

Obesity and Different Effect Between Exercise and Diet for Weight Loss

The worldwide increase in obesity has become a significant public health issue, linked to a range of chronic illnesses, including diabetes, heart disease, and some types of cancer. This study investigates the effectiveness of combined dietary and exercise interventions in promoting weight loss, drawing on a systematic literature review and case analysis of recent peer-reviewed research. By examining various dietary approachesincluding low-carbohydrate, Mediterranean, and calorie-restricted dietsalongside different exercise modalities such as aerobic training and high-intensity interval training (HIIT), this research aims to identify the optimal strategies for weight management. Findings indicate that individuals participating in combined interventions experience significantly greater weight loss and improvements in metabolic health compared to those following diet or exercise regimens alone. Moreover, the study emphasizes the importance of personalized interventions that consider individual preferences and psychological factors, suggesting that integrating social support mechanisms and technological tools can enhance adherence and long-term success. The results emphasize the need for comprehensive weight management strategies that address the interplay of dietary and exercise components, psychological support, and social influences to effectively combat obesity and promote overall health.

THE ROLE OF BREAST IMAGING MODALITIES IN THE DIAGNOSIS AND MANAGEMENT OF BENIGN BREAST DISEASES

Objective: Accurate diagnosis and management of benign breast diseases are crucial aspects of breast healthcare. Breast imaging modalities such as mammography, ultrasound, and magnetic resonance imaging (MRI) play a pivotal role in differentiating benign from malignant lesions and guiding appropriate management strategies. Methods: This retrospective study was conducted at [Institution Name] from January 2018 to December 2022. It involved a review of medical records, imaging results, and management outcomes of patients diagnosed with benign breast diseases. Imaging modalities included mammography, ultrasound, and MRI. The diagnostic accuracy of each modality was assessed by comparing imaging findings with histopathological results. Statistical analyses were performed using SPSS version 26.0. Results: A total of 200 patients were included, with a mean age of 45.3±12.6 y. Mammography showed a sensitivity of 85% and specificity of 78%, while ultrasound had a sensitivity of 92% and specificity of 84%. MRI exhibited the highest accuracy with a sensitivity of 95% and specificity of 90%. Combined imaging modalities achieved the highest diagnostic performance. Management strategies varied, with watchful waiting, medication, minimally invasive procedures, and surgical interventions employed based on the specific condition. Conclusion: Breast imaging modalities are indispensable in diagnosing and managing benign breast diseases. The integration of mammography, ultrasound, and MRI provides comprehensive diagnostic information, guiding optimal management strategies and improving patient outcomes. Future advancements in imaging technology promise to further enhance diagnostic capabilities.

Diagnostic modalities for ischemic heart disease: evaluating the role of stress echocardiography, cardiac CT, and myocardial perfusion scintigraphy in guiding coronary angiography

Cardiovascular diseases, particularly ischemic heart disease (IHD), are the leading cause of mortality globally, accounting for 16% of deaths. Effective management of ischemic cardiomyopathy (ICM) is crucial, as outlined in the latest European Society of Cardiology (ESC) guidelines for chronic coronary syndrome (CCS). The guidelines emphasize a structured approach comprising four key steps: a general clinical evaluation to exclude non-cardiac causes, cardiac examination, and likelihood estimation using echocardiography, diagnostic testing such as stress echocardiography and coronary CT angiography, and treatment involving lifestyle changes and medication, alongside potential revascularization. The review underscores the importance of coronary angiography and functional assessments in diagnosing ischemic heart failure (IHF) and guiding treatment strategies. Non-invasive imaging techniques, including stress echocardiography and myocardial perfusion scintigraphy, are valuable for assessing ischemia and myocardial viability while reducing unnecessary invasive procedures. Coronary CT angiography is also examined for its procedural advantages and risks. A comparative analysis of diagnostic modalities highlights the strengths and limitations of each technique, emphasizing the need for individualized approaches based on patient characteristics. The ESC 2024 guidelines advocate for a patient-centered imaging strategy based on the likelihood of coronary artery disease (CAD) while addressing the economic and environmental impacts of imaging practices. Overall, implementing these guidelines and leveraging diverse imaging modalities can optimize management strategies for IHD, ultimately improving patient outcomes.

Hyperacute silicosis after bronchoscopy-induced melanoptysis in a lung transplant patient. A first report in literature.

Silicosis, a fibrotic lung disease caused by crystalline silica inhalation, presents unique challenges in lung transplantation. This case reports an unprecedented complication in a lung transplant recipient with chronic silicosis. A man in his 60 s, post left single-lung transplantation for silica-induced pneumoconiosis, developed acute respiratory deterioration following routine bronchoscopy. Melanoptysis, followed by imaging showing extensive inflammatory involvement in the transplanted lung, required intubation and prone positioning. This case highlights the potential for residual silicotic material to trigger acute post-transplant complications. It underscores the importance of comprehensive pretransplant evaluation of occupational exposures and heightened awareness of silica-related complications in post-transplant care. The report emphasizes gaps in understanding long-term outcomes and optimal management strategies for lung transplant recipients with silicosis.

Impact of preoperative stenting in management of bilateral ureteral stones.

This study aims to evaluate the impact of preoperative stenting on surgical outcomes and complications in patients with bilateral ureteric stones, specifically assessing its role in reducing the need for subsequent interventions. A retrospective analysis was conducted at a tertiary center over eight years, involving 82 patients with bilateral ureteric stones. Patients were divided into two groups: Group 1 (no preoperative stenting) and Group 2 (preoperative stenting). Key data collected included demographics, preoperative stone sizes, preoperative serum creatinine levels, operative details, postoperative complications, and stone-free rates (SFR) at two weeks post-surgery. Statistical analyses were performed using SPSS 25.0. Of the 54 patients analyzed (27 in each group), the mean age was 48.8 ± 12.7 for Group 1 and 52.3 ± 15.2 for Group 2. Group 2 exhibited significantly higher preoperative serum creatinine levels (p = 0.016). Secondary interventions were needed for 8 patients in Group 1 versus 3 in Group 2 (p = 0.042). The SFR was 67% in Group 1 and 78% in Group 2 (p = 0.361), indicating no statistically significant difference. Preoperative stenting may enhance the success of surgical interventions for bilateral ureteric stones, potentially reducing the need for further procedures. Further prospective studies are needed to validate these findings and optimize management strategies.

Distal augmentation in unstable distal clavicle fractures: a retrospective cohort study of 101 cases.

The optimal management strategy for unstable distal clavicular fractures remains controversial. Recent studies on plate techniques have reported good-to-excellent outcomes with no serious complications. The questions are that: (1) Does the use of wire augmentation with locking plate in distal part (distal wire augmentation) reduce radiographic loss of reduction (RLOR) and get earlier bony union in distal clavicular fractures? (2) Which fixation methods are associated with a higher incidence of acromioclavicular (AC) joints arthritis or subluxation? We collected and analyzed clinical studies on different plate fixation methods for unstable fractures to identify the best surgical modality. This retrospective case-control study included 101 patients with Neer types IIB and V unstable distal clavicle fractures treated using plate techniques. The patients were divided into four groups according to the surgical procedure: hook plate (HP group) (n = 13), lateral locking plate alone (LP group) (n = 41), locking plate with coracoclavicular (CC) ligament suture repair (LPC group) (n = 26), and locking plate with distal wire augmentation (LPA group) without CC repair (n = 21). The clinical outcomes of shoulder function were the mean Constant score and the University of California-Los Angeles (UCLA) shoulder scale. The bony union time, loss of CC distance reduction, and AC joint condition were used to evaluate the radiographic results. One-way ANOVA, Kruskal-Wallis test, and chi-square test were performed to compare differences between groups. Multiple p-value comparison corrections were calculated using the Bonferroni method. There were no significant differences in the mean Constant and UCLA scores among the groups after 1 year of follow-up. All fractures healed. The LPA and HP groups achieved earlier bone union (LPA 8.4 weeks, HP 8.9 weeks, LP 12.6 weeks, and LPC 13.4 weeks, P = 0.000); however, the HP group had the highest complication rate and required bone removal (LPA 4.0%, HP 23.1%, LP 0.0%, LPC 0.0%, P = 0.003). A low rate of RLOR was observed in the LPA group (LPA 9.5%, HP 23.1%, LP 22.0%, LPC 30.8%, P = 0.362). The incidence of AC joint subluxation was higher in the Neer type V group and was unrelated to surgical methods. Hook plate and locking plate with distal wire augmentation in distal clavicle fractures result in an earlier time to bone union when compared with CC suture repair or non-CC suture repair techniques. However, HP may have the higher complication rate and require subsequent implant removal. The incorporation of distal wire augmentation appears to be beneficial in maintaining fracture reduction. In the future, larger prospective studies are needed to confirm these findings. Level III, therapeutic study.

What intensivists need to know about cytomegalovirus infection in immunocompromised ICU patients.

Advances in therapeutic care are leading to an increase in the number of patients living with overt immunosuppression. These patients are at risk of cytomegalovirus (CMV) infection and disease that can lead to or develop during ICU admission. This manuscript aims to describe the clinical presentation, risk factors, and management of CMV infection and disease in this patient population. We conducted a literature search in PubMed up to April 2024, focusing on CMV infection and disease in patients with overt immunosuppression (hematopoietic stem cell and solid organ transplantation, solid or hematologic malignancies, HIV infection, immunosuppressive drugs, including corticosteroids, and primary immunodeficiencies) admitted to the intensive care unit (ICU). As there is limited ICU-specific data on CMV in immunosuppressed patients, many of the findings were extrapolated from the general literature. CMV infection and disease in immunocompromised critically ill patients is associated with increased mortality and presents significant management challenges. Clinical manifestations are diverse, shaped by the underlying immune deficiency and primary disease. Pneumonia and encephalitis are among the most severe CMV end-organ diseases. CMV infection may also increase the risk of secondary infections and induce life-threatening conditions, such as thrombotic microangiopathy. Importantly, CMV reactivation is not synonymous with CMV disease, and qPCR testing of body fluids cannot reliably differentiate between viral shedding and tissue-invasive infection, which requires histopathological confirmation. Ganciclovir is commonly the first-line anti-viral, though maribavir shows potential for patients unresponsive to other antivirals. Identifying patients who require prophylactic or preemptive antiviral therapy is essential. CMV infection and disease in critically ill immunocompromised patients pose a unique challenge for intensivists. The broad spectrum of clinical presentations and the difficulty in distinguishing CMV-related symptoms from other causes require a high level of clinical suspicion. Accurate interpretation of nucleic acid load levels and careful evaluation of CMV's pathogenic role when it is found are critical. Further studies focusing specifically on CMV infection and disease in critically ill immunocompromised patients are needed to optimize management strategies.

Should all cervical cancer patients with positive lymph node receive definitive radiotherapy: a population-based comparative study.

The optimal initial management strategy for cervical cancer with lymph node metastases (LNM) remains a topic of ongoing debate. This study aimed to explore the correlation between surgery followed by postoperative radiotherapy (PORT) and definitive radiotherapy (RT), as well as their impact on the prognosis of patients with LNM. Patients with positive lymph nodes (PLNs) in 2009 FIGO stage I-III cervical cancer were selected from SEER database. Kaplan-Meier and log-rank analysis were utilized to assess survival outcomes. Cox and Interaction analyses were employed to compare the survival benefits. 2936 patients were included in this study. Multivariate analysis revealed the choice of primary treatment significantly impacted both cancer-specific survival (CSS) and overall survival (OS), serving as an independent prognostic factor for patients with LNM. After adjusting for imbalanced variables, surgery plus PORT exhibited significant improvements in CSS and OS in the stage I-II and PLNs ≤ 5 subgroups. However, no statistically significant difference was observed between the two treatment modalities in stage III and PLNs > 5 subgroups. Through interaction analysis, it was observed that stage I-II and PLNs ≤ 5 subgroups exhibited a significant survival benefit from surgery plus PORT. Surgery plus PORT could lead to improved outcomes for cervical cancer in patients with stage I-II or PLNs ≤ 5. However, this approach did not apply to patients with stage III or PLNs > 5. Therefore, a comprehensive assessment of LNM and local tumor spread should guide rationalized treatment modalities when managing patients presenting LNM.

Proteinuria's Influence on Clinical Outcomes and Prognostic Accuracy in Acute Ischaemic Stroke Patients Undergoing Reperfusion Therapy: A Comprehensive Meta-Analysis.

Proteinuria commonly accompanies acute ischaemic stroke (AIS) patients undergoing reperfusion therapies such as intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT). Understanding its influence on outcomes is crucial for prognosis and optimising management strategies. This study aims to elucidate proteinuria's role in mediating outcomes among reperfusion-treated patients. Through a random-effects meta-analysis, we analysed data to assess the association of proteinuria with functional outcomes, symptomatic intracerebral haemorrhage (sICH) and mortality. A total of 33 140 patients were included in the meta-analysis. Proteinuria demonstrated a pooled prognostic sensitivity of 58% (95% CI: [48%; 67%]; p < 0.001) for poor functional outcomes at 90 days. It was linked with increased odds of unfavourable functional outcome at 90 days in both IVT (OR 2.27; 95% CI: [1.95; 2.66]; p < 0.001) and EVT (OR 2.57; 95% CI: [2.16; 3.05]; p < 0.001) groups. Furthermore, it was associated with increased odds of 90-day mortality in IVT-treated patients (OR 2.31; 95% CI: [1.76; 3.02]; p < 0.001), while EVT-treated patients exhibited increased odds of in-hospital mortality (OR 2.71; 95% CI: [1.22; 6.04]; p < 0.05). The clinical significance of proteinuria is underscored by its impact on outcomes for AIS patients receiving reperfusion treatments. This awareness may guide individualised treatment by considering the intricate interplay between kidney function and its correlation with stroke. Consequently, this has the potential to improve prognosis and overall outcomes in AIS therapy.

Point shear wave elastography application in assessment pancreas tissue stiffness: A pilot study.

Recent advancements in medical imaging, such as point shear wave elastography (pSWE), offer non-invasive methods to assess tissue stiffness and structural changes. This study explores the use of pSWE to evaluate pancreatic stiffness and dimensions in three different pancreas parts. This study was conducted at diagnostic radiology department, King Abdulaziz University Hospital, Jeddah, between June 2022 and November,2022. Thirty-one diabetic patients and thirty-one healthy controls were included. Ultrasound pSWE examination was performed using a ultrasound system (Philips Elite Epic 7) to measure stiffness across different pancreatic parts. Pancreatic stiffness was quantified in meters per second (m/s), and the dimensions of each pancreatic part were recorded. Different parameters, including age, sex, height, weight, body mass index (BMI), and comorbidities, were collected and analyzed. Diabetic patients exhibited significantly higher shear wave velocities (SWVs) compared to healthy controls, indicating increased pancreatic stiffness. The mean shear wave velocity was 1.7m/s in diabetic versus 0.6m/s in controls (p<0.001). Additionally, the pancreatic head dimensions were significantly large in diabetic patients (2.1cm vs. 1.8cm; p=0.003), while the body and tail part showed no significant differences. A positive correlation was found between SWVs and BMI. The findings underscore the potential of pSWE as a non-invasive diagnostic tool for early detection and monitoring of diabetes-related pancreatic alterations. Assessing pancreatic stiffness and dimensions through pSWE can help in identify patients at risk for pancreatic complications and optimize management strategies. Point shear wave elastography (pSWE) could be a useful, non-invasive tool for early detection of pancreatic changes in diabetic patients, identifying those at risk for complications. Integrating pSWE into routine diabetes check may enhance early interventions and improve outcomes.