Patient Reassurance Research Articles

Organ-confined prostate cancer with negative surgical margins in an entirely-embedded radical prostatectomy is essentially non-lethal-a retrospective single-institutional study of 520 patients.

There is no risk-based stratification in serum PSA monitoring in prostate cancer (PCa) patients following radical prostatectomy (RP). Those patients with minimal risk of recurrence may be subjected to unnecessarily rigorous monitoring as well as to increased anxiety disproportionate to their actual prognosis. This study aimed to investigate outcomes in PCa patients with favorable pathologic parameters to see whether they can be followed less rigorously than current practice recommendations dictate. 520 consecutive entirely embedded organ-confined RPs with negative margins and undetectable initial postoperative serum PSA at the University of Chicago Medical Center between 2005 and 2017 were retrospectively identified. Clinicopathologic parameters and follow-up data including serum PSA were analyzed. No patients, regardless of their grade group (GG), developed metastasis or succumbed to a PCa-specific death. These patients had a median postoperative follow-up of 109months. 2.2% (22/520) of the patients developed biochemical recurrence (BCR). There were 163, 279, 69, 4, and 5 RPs from GG 1 to 5, respectively. Of these, 0% (0/163), 1.8% (5/279), 18.8% (13/69), 0% (0/4), and 60% (3/5) developed BCR, sequentially. In this study, organ-confined PCa with negative margins in an entirely embedded RP carried no mortality risk. In particular, the patients with GG 1-2 disease may have benefited from less rigorous monitoring. Additionally, enhanced patient reassurance could play a role in reducing anxiety in this subset of patients.

MSK ultrasound imaging-assisted clinical examination.

Musculoskeletal disorders are a significant global health concern, affecting over 1.71 billion individuals worldwide, with a considerable impact on quality of life and economic burden due to healthcare costs and productivity losses. In the United Kingdom, approximately one-third of the population suffers from musculoskeletal disorders, underscoring the need for effective diagnostic and management strategies. Musculoskeletal ultrasound imaging emerges as a preferred diagnostic modality, offering a balance between technical capabilities and cost-effectiveness, owing to its non-invasive nature, portability and lack of radiation exposure. However, the operator-dependent nature of musculoskeletal ultrasound imaging necessitates specialised training for medical and healthcare professionals. The integration of musculoskeletal ultrasound imaging into traditional clinical examinations, known as ultrasound imaging-assisted clinical examination (UIACE), enhances traditional diagnostic processes by providing immediate visual feedback, facilitating a more accurate and comprehensive assessment of musculoskeletal conditions. This approach not only refines diagnosis in cases with ambiguous symptoms or overlapping signs but also significantly improves patient reassurance and management strategies. In addition, incorporating musculoskeletal ultrasound imaging into medical education through ultrasound imaging-assisted clinical examination offers students a dynamic, interactive learning experience, fostering a deeper understanding of clinical anatomy and examination skills. By advocating for its systematic inclusion in the undergraduate medical curriculum, the study highlights the potential to enhance the competence and confidence of future professionals in utilising ultrasound imaging, ultimately improving patient outcomes in musculoskeletal care.

Newer formulations of oral testosterone undecanoate: development and liver side effects.

Testosterone deficiency is a clinical disorder due to either failure of the testes to produce testosterone or failure of the hypothalamus or pituitary to produce sufficient gonadotropins. Previous formulations of oral testosterone therapy, particularly methyltestosterone, have been associated with adverse liver effects. Many different routes of testosterone delivery have been developed, each with their own administrative benefits and challenges. Newer formulations of oral testosterone undecanoate (TU) provide a convenient administration option, although their use has been limited by hepatotoxicity concerns based on older methyltestosterone data, and prescribing physicians may still be concerned about adverse liver effects. In this review, we discuss the history of oral testosterone development, clarify the mechanism of action of oral TU, and describe the relevant liver safety findings. Relevant literature was allocated to present a review on the history of oral TU development and the mechanism of action of oral TU. We pooled data from individual studies of oral TU products to present a safety summary. Overall, safety results from studies of the newer formulations of oral TU showed that increased liver function test values are not generally associated with oral TU formulations and that no clinically significant liver toxicities were noted in clinical trials of oral TU. Continued research into the safety of oral TU will contribute to a better understanding of the potential risks in patients receiving this therapy, an outcome that highlights the importance of providing patient education and reassurance regarding oral TU safety.

Impact of autoantibodies against myelin oligodendrocyte glycoprotein in paediatric acquired demyelinating disease: Intellectual functioning and academic performance

Paediatric acquired demyelinating syndromes (pADS) attack white matter pathways in the brain during an important period of development. Affected children can experience poor functional outcomes, including deficits in specific cognitive domains. Understanding risk factors for poor outcome will guide clinical management of these children. One clinical phenotype which may differentially impact cognitive outcomes is the presence of autoantibodies to myelin oligodendrocyte glycoprotein (MOG). Preliminary research has suggested that cognitive difficulties exist in paediatric patients who test positive for MOG antibodies or MOGAD (Myelin Oligodendrocyte Glycoprotein Associated Disease) however, they experience a less severe profile compared to seronegative counterparts. The current study assesses children diagnosed with pADS who tested positive or negative for MOG-ab using standardised assessments of both intellectual functioning and academic ability. The results show that a subset of MOGAD patients experience clinically significant sequalae in intellectual functioning and academic ability. The neuropsychological profile also differed between children with and without MOG-ab positivity, with seronegative patients more likely to show a clinically relevant difficulties at the individual patient level. Whilst no differences existed at the group-level; the current study demonstrates the relative additional risk of intellectual/academic difficulty associated with MOG-ab seronegativity. This research further supports the growing perspective that MOG-positivity confers a more favourable neuropsychological outlook than is the case for their seronegative counterparts. This broadening consensus offers reassurance for clinicians, families, and patients.

Perceptions of Antenatal Care among Ghanaian Mothers

In Ghana, some pregnant women may not seek antenatal care due to the unavailability of such services in their communities, although preventive service can help reduce maternal mortality with high-quality care. This study aimed to understand the antenatal care opinions of Ghanaian mothers who sought antenatal care, the barriers they faced, and their suggestions for improvement in antenatal care in Ghana. This study’s data were collected in the Central and Ashanti regions in Ghana from June 2023 to January 2024. Four hundred and fifty mothers in Ghana who indicated that they had given birth within the last 10 years of the data collection period took part in the study. Our findings revealed that 93.6% of Ghanaian mothers perceived their antenatal care to be of good quality due to proper examinations, friendly provider–patient interactions, reassurance, fair treatment, and proper education, whereas 6.5% of Ghanaian mothers perceived their care to be of poor quality due to long wait times, impersonal interactions, inadequate facility resources, and barriers to communication. For Ghanaian mothers to receive better outcomes for themselves and their children, it is worth improving healthcare facilities, healthcare provider preparedness, local transportation, and addressing financial constraints to go from suboptimal to optimal health services.

O-085 Oocyte cryopreservation: a comprehensive analysis of live birth rate by age and indication of treatment provides reassurance for young cancer patients

Abstract Study question Does the outcome of oocyte cryopreservation vary across different age groups and treatment indications, i.e. cancer diagnosis, other medical conditions or non medical fertility preservation? Summary answer Live birth rate (LBR) is significantly influenced by a woman's age, although not by indication of treatment. What is known already OC is increasingly applied in assisted reproduction, although little is about the outcomes, including livebirth according to indication. Study design, size, duration Retrospective cohort study analyzing all OC and subsequent warmed oocyte cycles in two fertility centers - Melbourne IVF and the Royal Women’s Hospital, Melbourne, Australia, between the years 2014 to 2022. Participants/materials, setting, methods Women undergoing autologous IVF treatment using vitrified and warmed oocytes. Outcome of stimulation cycles and warmed oocyte cycles were assessed according to women’s age at OCP (≤ 35 years, 35-40 years and ≥ 40 years) and treatment indication- cancer diagnosis, other medical conditions and non medical. Main results and the role of chance 2689 women underwent a total of 3801 cycles of OC, comprising 702 cycles for cancer diagnosis (18.6%), 1146 cycles for other medical (30.5%), and 1953 cycles for non-medical (50.9%). Regardless of indication, younger age groups exhibited a higher median number of mature oocytes: <35 (11, 8-17), 35-40 (9, 6-11), and >40 (6, 3-9) (H(2)=15.1, p < 0.05). Among 582 warmed oocytes cycles, the >40 group demonstrated lower rate cycles with at least one good-quality blastocyst (76.7%) compared to 35-40 (87.1%) and <35 (87.2%), p < 0.05. Cumulative live birth rates (cLBR) were also lower in the >40 age group (14.9%) compared to 35-40 (34.9%) and <35 (46.5%), p < 0.01. When analyzing cycles by indication, patients with cancer had lower oocyte survival rate (80.8% vs 84.8% in other medical and 82.1% in non medical, p < 0.01). Nonetheless, no differences in rate of cycles with at least one good quality embryo rates (cancer diagnosis 87.2%, other medical 82.1% and non medical 89.3%, p = 0.06). Patients with cancer diagnosis had higher clinical miscarriage rate (25%) compared with other medical (7%) and non medical (10.5%), p < 0.01. However, cLBR did not differ between the indication groups (29.7% in cancer diagnosis, 35% in other medical and 38.1% in non medical, p = 0.5. Limitations, reasons for caution Retrospective data collection. Wider implications of the findings Our study offers comprehensive data that may assist patients desiring OC, and provides reassurance that even with a cancer diagnosis, outcomes are as favorable as those having non-medical OC. Given the substantial impact of age, health care providers should, when possible, advise to complete this procedure at a young age. Trial registration number Not applicable

Prenatal exposure to benzodiazepine and z-hypnotics and fifth-grade scholastic skills – emulating target trials using data from the Norwegian Mother, Father and Child Cohort Study

Abstract Evidence is limited regarding the effect of prenatal benzodiazepine and z-hypnotic exposure and long-term neurodevelopment in childhood. The objective of this study was to investigate the effects of initiating benzodiazepine or z-hypnotic treatment in early, mid and late pregnancy on fifth-grade numeracy and literacy scholastic skills in children, by emulating three target trials. The trials are identical except for the timing of enrollment and the number of eligible individuals. Eligibility to the trials required a history of anxiety and/or depression prior to pregnancy. We used data from the Norwegian Mother, Father and Child Cohort Study, linked to the Medical Birth Registry of Norway, to emulate the trials. We adjusted for baseline covariates that were available at time 0 for each trial by inverse probability of treatment weighting using the propensity score. The findings of this study did not show any effect of mothers’ initiation of treatment with benzodiazepines or z-hypnotics in early, mid or late pregnancy on the children’s 5th grade test scores in numeracy and literacy. The study results provide reassurance for patients in need of benzodiazepines and z-hypnotics during pregnancy; however, these findings need to be interpreted with caution due to low study power in some of the analyses.

The acceptability of technology-enabled physical activity feedback in cardiac patients and health care professionals

PurposePhysical activity is a key component of cardiac rehabilitation (CR). Despite the widely reported benefits of CR, uptake in the United Kingdom is still low. Alternative home-based and technology-facilitated delivery models are needed to improve CR uptake and physical activity. This study set out to explore patient and clinician views of personalised, multidimensional physical activity feedback and its potential use within CR.MethodsWe developed graphics for the presentation of personalised multidimensional physical activity feedback from data collected through wrist-worn monitors. Thirteen cardiac patients and nine healthcare professionals recruited from South West England wore research grade physical activity monitors for seven days. Participants then attended semi-structured interviews during which personalised physical activity feedback was provided. Interviews were audio-recorded, transcribed, and analysed thematically.ResultsTwo main themes were derived from the data which covered: 1) the perceived value of multidimensional physical activity feedback, and 2) support needed to facilitate understanding. Within the first theme, participants acknowledged that multidimensional physical activity feedback was useful for monitoring progress, goal setting, and increasing self-awareness of physical activity behaviour among both patients and clinicians. Within theme two, the need for more guidance and support from clinicians to aid patient understanding and reassurance was highlighted, particularly for those with very low physical activity levels.ConclusionsMultidimensional physical activity feedback delivered using a technology-enabled approach was perceived as acceptable among patients and clinicians. This study provides insights into the potential novel use of technology-enabled physical activity feedback to support and expand the delivery of CR.

Comparison of the efficacy and safety of benzbromarone and febuxostat in gout and hyperuricemia: a systematic review and meta-analysis.

Urate-lowering therapy (ULT) is widely recognized as the primary treatment for hyperuricemia and gout. Xanthine oxidase inhibitors (XOI), particularly febuxostat, have gained popularity as a frontline approach. However, the divergent efficacy and safety between febuxostat and the traditional ULT drug, benzbromarone, remain poorly understood. This knowledge gap necessitates a comprehensive analysis and evidence update to guide drug selection for physicians and patients. We conducted a systematic analysis by extracting relevant clinical studies from four medical literature databases. Forest plots, funnel plots, sensitivity analysis, Egger's test, and subgroup analysis were utilized to compare relevant indicators. The advantages and disadvantages of the two drugs were evaluated based on various indicators such as serum uric acid (SUA), triglyceride (TG), urinary uric acid (UUA), white blood cell count (WBC), total cholesterol (TC), blood urea nitrogen (BUN), alanine aminotransferase (ALT), aspartate aminotransferase (AST), estimated glomerular filtration rate (eGFR), and serum creatinine (SC). Benzbromarone demonstrated better efficacy in rapidly reducing SUA levels and inhibiting inflammation for hyperuricemia and gout patients. Febuxostat was slightly less effective in lowering SUA, but there was no significant difference in its impact on liver and kidney function after long-term use. This study highlights the superiority of benzbromarone in rapidly reducing SUA and inhibiting inflammation. Febuxostat shows comparable effects on liver and kidney function after long-term use. These findings provide valuable insights for clinicians and patients in drug selection. Key Points • Benzbromarone stands out as a highly effective treatment for hyperuricemia and gout, offering rapid reduction of serum uric acid levels and potent anti-inflammatory effects. • When it comes to long-term use, febuxostat demonstrates comparable effects on liver and kidney function. This provides reassurance for patients who require extended treatment duration. • Moreover, our study goes beyond previous research by presenting a more comprehensive and detailed analysis.

Diagnosis and management of transient smartphone blindness: A literature review

The development of smartphones worldwide has rapidly increased the number of smartphone users. Although smartphones have many benefits, prolonged use causes various visual disorders, of which transient smartphone blindness (TSB) is one of the most important concerns. This study aims to analyse the phenomenon of TSB and explore its etiology, pathophysiology, symptoms, and examination to determine the diagnosis and management. Transient smartphone blindness is a new physiologic phenomenon caused by exposure to a certain level of smartphone bright light and the body posture of the smartphone user. It leads to the use of monocular vision to stare at the smartphone. By exploring recent literature, this study found that patients with TSB experienced retinal photopigment bleaching, which decreased light sensitivity. Typically, the sensitivity returned physiologically after several minutes. Patients with this blindness showed several symptoms. For example, they perceived shapes, outlines, or figures during the blackout. The diagnosis of TSB should be primarily based on a detailed history of smartphone use, with the differential diagnosis based on circumstance or occurrence. This diagnosis is useful to distinguish it from transient ischemic attack (TIA). Transient smartphone blindness is a basic monocular transient loss that does not require therapy or drugs. However, it was found that the reassurance of patients’ condition and suggestions on smartphone use were sufficient for the intervention. With a limited scientific study of TSB, this review is the first to raise the discussion topic. It is expected to help physicians to diagnose TSB significantly. In addition, this study will enrich the literature, particularly on the scientific and clinical mechanisms of recognising TSB for clinical diagnosis and management.

Patient anxiety and satisfaction towards magnetic resonance imaging in Asir region, Saudi Arabia

Background/aimMagnetic resonance imaging (MRI) is an important imaging modality for diagnosing various diseases. However, the closed MRI scanner is perceived as unpleasant, even though the examination is non-invasive. Providing patients with information about the MRI exam may improve patient anxiety before and after the test. This study aimed to determine patients’ level of anxiety and satisfaction regarding information provided in MRI departments. MethodsThis descriptive, cross-sectional study was conducted on 215 Saudi patients at three central MRI departments in Asir, Saudi Arabia. Data were collected using a questionnaire containing a visual analogue scale and Likert scale to assess anxiety and satisfaction before and after the MRI examination. The participants were divided into two groups to receive information explaining the MRI procedures; the intervention group received information about MRI before the examination, whereas the control group did not receive information. Appropriate statistical tests were used to analyse the data. ResultsA total of 215 patients responded to the questionnaire in the MRI departments. Overall, the mean levels of anxiety and satisfaction were 5 and 6.25 on a 10-point scale, respectively. The anxiety reported by patients who received information explaining the MRI procedure was significantly lower than the anxiety reported by patients who did not receive information (4.8 vs. 5.9, p = 0.024). Consequently, satisfaction was significantly higher among patients who received the information than those who did not (6.77 vs. 4.0, p < 0.001). Furthermore, there was an association between patient reassurance with the behaviour of the staff and having received information (p < 0.001). ConclusionMost patients expressed an average level of anxiety and satisfaction regarding MRI. Anxiety among patients is a persistent issue in MRI departments. The provision of information has significant effects on decreasing the level of anxiety and improving patient satisfaction. The findings of this survey can be used as a benchmark to improve satisfaction and anxiety during MRI procedures in the Asir region of Saudi Arabia.

An Assessment of the Public's Perceptions of Radiation Exposure and Risk Associated With Dental Radiographs: A Cross-Sectional Study.

Ionizing radiation exposure is an ever-present part of the dental diagnostic process. A public concern often exists due to the misunderstanding of the stochastic effects of dental X-rays. This information can be difficult to explain to the patient since many patients are apprehensive about the subject matter. This article aims to assess the public's knowledge of radiation exposure and estimate the general concern or apprehension about these diagnostic imaging modalitiesin an effort to understand and therefore ensure patient reassurance during treatment. A questionnaire was conducted asking adults between the ages of 18 to 74 in Jeddah, Saudi Arabia questions pertaining to radiation risk. There were 105 respondents; 21.9% showed concerns towarddental imaging, while 20% were skeptical. approximately 74% of respondents believed there was a limit to the amount of radiation exposure a patient could receive for diagnostic purposes, while only eight percentcorrectly identified that there was no set limit. Only 21.9% knew that a breastfeeding mother could have dental X-rays if need be; 33.3% understoodthat ionizing radiation from an intra-oral dental X-raycaused less exposure than natural background radiation froma return flight from Jeddah to Dammam. Conclusions: Patients are not aware of ionizing radiation exposure equivalencies between different imaging modalities. A more effective approach to convey exposure risk would be relating the radiation doses to natural background radiation as comparators.

Hydroxychloroquine-Chloroquine, QT-Prolongation, and Major Adverse Cardiac Events: A Meta-analysis and Scoping Review.

We aimed to evaluate the high-quality literature on the frequency and nature of major adverse cardiac events (MACE) associated with either hydroxychloroquine (HCQ) or chloroquine (CQ). We searched Medline, Embase, International Pharmaceutical Abstracts, and Cochrane Central from 1996 onward using search strategies created in collaboration with medical science librarians. Randomized controlled trials (RCTs) published in English language from January 1996 to September 2022, involving adult patients at least 18 years of age, were selected. Outcomes of interest were death, arrhythmias, syncope, and seizures. Random-effects meta-analyses were performed with a Treatment Arm Continuity Correction for single and double zero event studies. By study drug, there were 31 HCQ RCTs (n = 6677), 9 CQ RCTs (n = 622), and 1 combined HCQ-CQ trial (n = 105). Mortality was the most commonly reported MACE at 220 of 255 events (86.3%), with no reports of torsades de pointes or sudden cardiac death. There was no increased risk of MACE with exposure to HCQ-CQ compared with control (risk ratio [RR] = 0.90, 95% CI = 0.69-1.17, I2 = 0%). These findings have important implications with respect to patient reassurance and updated guidance for prescribing practices of these medications. Despite listing as QT-prolonging meds, HCQ-CQ did not increase the risk of MACE.

Retinal Microvasculature Image Analysis Using Optical Coherence Tomography Angiography in Patients with Post-COVID-19 Syndrome.

Several optical coherence tomography angiography (OCT-A) studies have demonstrated retinal microvascular changes in patients post-SARS-CoV-2 infection, reflecting retinal-systemic microvasculature homology. Post-COVID-19 syndrome (PCS) entails persistent symptoms following SARS-CoV-2 infection. In this study, we investigated the retinal microvasculature in PCS patients using OCT-angiography and analysed the macular retinal nerve fibre layer (RNFL) and ganglion cell layer (GCL) thickness via spectral domain-OCT (SD-OCT). Conducted at the Manchester Royal Eye Hospital, UK, this cross-sectional study compared 40 PCS participants with 40 healthy controls, who underwent ophthalmic assessments, SD-OCT, and OCT-A imaging. OCT-A images from the superficial capillary plexus (SCP) were analysed using an in-house specialised software, OCT-A vascular image analysis (OCTAVIA), measuring the mean large vessel and capillary intensity, vessel density, ischaemia areas, and foveal avascular zone (FAZ) area and circularity. RNFL and GCL thickness was measured using the OCT machine's software. Retinal evaluations occurred at an average of 15.2 ± 6.9 months post SARS-CoV-2 infection in PCS participants. Our findings revealed no significant differences between the PCS and control groups in the OCT-A parameters or RNFL and GCL thicknesses, indicating that no long-term damage ensued in the vascular bed or retinal layers within our cohort, providing a degree of reassurance for PCS patients.

Safety of colchicine and NSAID prophylaxis when initiating urate-lowering therapy for gout: propensity score-matched cohort studies in the UK Clinical Practice Research Datalink

ObjectivesTo determine the risk of adverse events associated with colchicine or non-steroidal anti-inflammatory drug (NSAID) prophylaxis when initiating allopurinol for gout.MethodsWe conducted two matched retrospective cohort studies in linked UK...

The Underreported Postoperative Suffering after Thyroid Surgery: Dysphagia, Dysphonia, and Neck Pain-A Cross-Sectional Study.

Postoperative voice change, difficulty of swallowing, throat pain, and neck pain are the most commonly complaint after thyroid surgery. However, little emphasis is given to the problem, especially a place where the surgical and anesthesia services' unmet need is highly observed, i.e., the problem gets little attention especially in the countries where the gaps of surgery and anesthesia services are observed. Hence, this study aims to determine the magnitude and associated factors of voice change and related complaints after thyroid surgery. A cross-sectional study was conducted on 151 patients who had had thyroid surgery from June 1 to December 30, 2021. Data were retrieved during the postoperative period after the patient regains consciousness. Out of 151 participants, 98 (64.9%) patients complained of either voice change or difficulty of swallowing and neck pain after thyroid surgery within 24 hours. Majority (58.3%) of the participants aged more than 30 years with a mean age of 33.7 ± 8.3 years and females 102 (67.5%). Neck pain is the most (52.3%) complained suffering after thyroid surgery, followed by voice change 38.4% and difficulty in swallowing 37.7%. Difficulty in swallowing after thyroid surgery significantly associated with a patient who frequently experience intraoperative hypotension (AOR = 23.24, 95% CI 4.6-116.7, and p = 0.01), type of surgical procedure (total thyroidectomy) (AOR = 8.62, 95% CI 1.21-61.50, and p = 0.03), and larger ETT size (AOR = 4.92, 95% CI 1.34-18.01, and p = 0.02). Postoperative voice change is associated with larger endotracheal tube (AOR = 15.47, 95% CI 3.4-69.5, and p ≤ 0.001), surgery lasting more than 2 hours (AOR = 7.34, 95% CI 1.5-35.1, and p = 0.01), and intraoperative hypotension (AOR = 23.24, 95% CI 4.6-116.7, and p ≤ 0.001). The complaint of postthyroidectomy neck pain and throat discomfort is higher than 64.9%. Intraoperative hypotension, blood loss, higher ETT size utilization, and duration of surgical procedure are the identified possible risk factors and have to be minimized as much as possible. Patient reassurance has to be considered during the postoperative time.

Postoperative throat discomfort and associated factors among surgical patients at Ethiopian Teaching Hospitals: cross-sectional study

BackgroundThroat pain and airway discomfort are the most commonly upsetting conditions for patients’ wellbeing after surgery. However, little is known about the problem and associated factors, especially in developing countries like Ethiopia. Therefore, this work determined the magnitude, severity, and associated factors of throat discomfort within 24 h after elective surgery.ResultsThe majority (63.2%, or 211) of the participants were female, with a mean age of 35.7 ± 9.7 years. The overall postoperative throat discomfort was observed in 122 (36.5%) patients, and it was severe in 20.5% of them. However, the severity level declined over time to 21.9% (21/96), 15.3% (18/118), and 5.6% (5/89), respectively, on the 1st, 6th, and 24th hours, as indicated by participants. Utilization of a larger ETT (AOR = 6.26, CI 2.13–18.43, P = 0.001), surgery lasting two or more hours (AOR = 11.20, CI 3.53–35.50, P = 0.000), awake extubation (AOR = 0.16, CI 0.05–0.43 P = 0.000), frequent episodes of hypotension (AOR = 12.85, CI 4.56–36.18, P = 0.000), and a less experienced anesthetist (AOR = 18.10, CI 6.51–50.31, P = 0.000) were significantly associated with throat discomfort.ConclusionsPost-extubation throat discomfort complaints are high (36.5%). Due attention has to be given to minimize or prevent perioperative frequent episodes of hypotension, higher ETT size utilization, blood loss, and the duration of surgery as much as possible. Postoperative throat discomfort should not be ignored. And we recommend that patient reassurance and orientation with analgesia has to be considered during the postoperative period.

Risk of Herpes Zoster Ophthalmicus After COVID-19 Vaccination in a Large US Health Care Claims Database

Purpose: Herpes zoster ophthalmicus (HZO) after COVID-19 vaccination has been reported in numerous case studies. However, no large-scale epidemiologic studies have been conducted to date. The purpose of this study was to determine whether COVID-19 vaccination is associated with an increased risk of HZO. DesignRetrospective before-and-after risk interval analysis. Methods: Setting: Optum Labs Data Warehouse, a US national de-identified claims-based database.Study Population: Patients without a prior history of HZO who received any dose of a COVID-19 vaccine from December 11, 2020 to June 30, 2021.Intervention: Any dose of a COVID-19 vaccine in the defined risk periods.Main Outcome Measure(s): HZO, defined by an International Classification of Disease 10th revision code and a prescription or escalation of antivirals. Incidence rate ratios (IRR) were calculated to compare the risk of HZO in the risk intervals after vaccination to the risk of HZO during the control interval. Results: There were 1,959,157 patients who received a dose of a COVID-19 vaccine during the study period and met eligibility criteria. A total of 80 individuals without prior history of HZO were included in the analysis because they developed HZO in the risk or control period. Patients had a mean age of 54.0 years (standard deviation = 12.3). There were 45 cases of HZO in the risk interval following COVID-19 vaccination. There was not an increased risk of HZO following vaccination with BNT162b2 (IRR = 0.90, 95% CI: 0.49 - 1.69, p = 0.74), mRNA-1273 (IRR = 0.74, 95% CI: 0.36 - 1.54, p = 0.42), or Ad26.COV2.S (IRR = 0.50, 95% CI: 0.07-2.56, p = 0.42). ConclusionsThis study found no evidence of increased risk of HZO following COVID-19 vaccination, providing reassurance for patients and providers who may be concerned about the safety profile of the COVID-19 vaccines.

P-518 The effect of inactivated SARS-CoV-2 vaccination on the outcome of the first frozen-thawed embryo transfer cycle

Abstract Study question Is there an effect of inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination on the outcome of the first frozen-thawed embryo transfer(FET) cycle. Summary answer Inactivated SARS-CoV-2 vaccination did not affect the outcome of the first FET cycle, including clinical pregnancy rate, early miscarriage rate and newborns’ birth weight. What is known already SARS-CoV-2 vaccination can significantly reduce the risk of severe disease and death after SARS-CoV-2 infection. However, due to the lack of vaccine safety data, the infertile population who plan to undergo ART treatment have high concerns about the safety of vaccine vaccination. To date, there are merely few researches aimed to determine the impact of inactivated SARS-CoV-2 vaccination on reproductive and neonatal outcomes of women attempting FET. Study design, size, duration This was a retrospective cohort study of patients who underwent the first FET cycle in the Reproductive Center of Ningbo Women and Children Hospital from November 1st 2021 to December 19th 2022. All patients were followed up until January 19th 2023. Patients whose age was &amp;gt;40 years old were excluded. The patients were organized into groups based on age, anti-Müllerian hormone (AMH) levels, antral follicle count (AFC), body mass index (BMI), and vaccination or not. Participants/materials, setting, methods Patients fully vaccinated with two doses of Sinopharm or Sinovac inactivated vaccines(Group A, n = 452) were compared with unvaccinated patients(Group B, n = 452) who were matched by age, AMH, AFC and BMI. The baseline characteristics and clinical outcomes of each group were compared.SPSS version 26.0 (SPSS Inc., USA) was used for all data analyses. Main results and the role of chance There were no statistically significant differences in age, AMH, AFC, BMI, infertility duration, infertility type, infertility causes, fertilization type, ovarian stimulation protocol, number of oocytes retrieved(9.24 vs 9.92, p = 0.102), endometrial preparation protocol, endometrial thickness(9.40 vs 9.29mm, p = 0.344), embryo stage, number of embryos for transfer(1.4 vs 1.42, p = 0.589) between two groups. No difference was found between vaccinated and unvaccinated patients in clinical pregnancy rate(55.31% vs 57.52%, p = 0.502), early miscarriage rate(10.4% vs 11.54%, p = 0.681). The newborns’ birth weight were comparable between two groups(2971.44 vs 3156.83g, p = 0.66). Limitations, reasons for caution This is a single-center retrospective study and further accumulated data is warranted to validate the findings. Because of the short follow-up time, some patients are still pregnant, hence we await live birth outcomes. Wider implications of the findings These findings contribute to the evidence regarding the reproductive safety of inactivated SARS-CoV-2 vaccination for fertility-seeking women, and it can provide further theoretical reassurance for doctors and patients to vaccinate before pregnancy. Trial registration number not applicable

Linezolid-induced black hairy tongue in a patient treated for idiopathic granulomatous mastitis: a case report.

In this article, the authors report a case of BHT in a 28-year-old female following 5 days of therapy with linezolid. The patient recovered well within few days of discontinuation of the drug and maintaining oral hygeine. Patient reassurance and counselling was integral to the management. This case report and review depict a rare adverse effect of linezolid and discuss its clinical implications aiding healthcare professionals in an early diagnosis and cromulent management strategy. The authors also present a compilation of previously reported literature on linezolid-induced BHT to support the discussion.