Study Of Patients Research Articles

Ability of CHA2DS2-VASc/R2CHA2DS2-VASc Scores to Predict Complications Related to Cardiac Implantable Electronic Devices.

Globally, the number of cardiac implantable electronic devices (CIEDs) is increasing. In our study, we aimed to investigate whether CHA2DS2-VASc and R2CHA2DS2-VASc scores are predictive of CIED-related complications. Our investigation was carried out with a multicenter retrospective design. Patients who underwent CIED surgery at two cardiac centers in Turkey between January 2011 and May 2023, 1676, were evaluated. The patients were divided into two groups according to their R2CHA2DS2-VASc scores. Patients with R2CHA2DS2-VASc ≥ 5 were included in group 1 (380 patients), and patients with R2CHA2DS2-VASc < 5 (1296 patients) were included in group 2. The primary outcome was defined as the cumulative events. Each component of cumulative events, such as hematoma, pericardial effusion, pneumothorax, and infection, was also defined as a secondary outcome. The study's patient population had an average age of 62.9 ± 14 years. Pneumothorax (1.8%vs. 1.3%, p = 0.444), pericardial effusion or tamponade (0.35%vs. 0.2%, p = 0.659), and clinically significant hematoma (1.1%vs. 0.6%, p = 0.376) were comparable between the groups. Infection-related devices and cumulative events classified as primary outcomes were higher in the R2CHA2DS2-VASc ≥ 5 group (6.1%vs. 1.2%, p < 0.001; 7.6%vs. 3.2%, p < 0.001, respectively). Modeling analyses showed that the CHA2DS2-VASc score and HT were also independent predictors of device-related infection and cumulative events. In the R2CHA2DS2-VASc ≥ 5 groups, infection related to the device system and cumulative events were higher. Patients with an R2CHA2DS2-VASc score of 5 or more and a high CHA2DS2-VASc score should be evaluated more carefully regarding infection and cumulative events before and after the operation.

Exploring General Practitioners' Management of Self-Harm in Young People: A Qualitative Study.

General practitioners (GPs) are key to the frontline assessment and treatment of young people after self-harm. Young people value GP-led self-harm care, but little is known about how GPs manage young people after self-harm. This study aimed to understand the approaches of GPs to self-harm in young people and explore their perspectives on ways they might help young people avoid repeat self-harm. We conducted semi-structured interviews with GPs from the National Health Service in England in 2021. GPs were recruited from four geographically spread clinical research networks and a professional special interest group. Data were analysed using reflexive thematic analysis. The study's patient and public involvement and community of practice groups supported participant recruitment and data analysis. Fifteen interviews were undertaken with a mean age of participants being 41 years and a breadth of experience in practice ranging from 1 to 22 years. Four themes were generated: GPs' understanding of self-harm; approaches to managing self-harm; impact of COVID-19 on consultations about self-harm; and ways to avoid future self-harm. Negative attitudes towards self-harm within clinical settings are well documented, but GPs said they took self-harm seriously, listened to young people, sought specialist support when concerned and described appropriate ways to help young people avoid self-harm. GPs felt that relationship-based care is an important element of self-harm care but feared remote consultations for self-harm may impede on this. There is a need for brief GP-led interventions to reduce repeat self-harm in young people. A study advisory group consisting of young people aged 16-25 years with personal experience of self-harm and parents and carers of young people who have self-harmed designed the recruitment poster of this study, informed its topic guide and contributed to its findings.

How GPs can help young people avoid future self-harm: a qualitative study.

Self-harm is a growing problem in young people. GPs are usually the first point of healthcare contact for young people aged 16-25 years, after self-harm. GPs can experience barriers to supporting young people and behaviour change theory can help to understand these, and the influences on, GP behaviour. To explore the capabilities, opportunities, and motivations (COM-B model of behaviour) of GPs, and their perceived training needs, to help young people aged 16-25 years avoid future self-harm. This was a qualitative study of GPs in England. Semi-structured interviews were conducted with NHS GPs who were purposively sampled. Interviews occurred in 2021. Data were analysed using reflexive thematic analysis and mapped onto the COM-B model domains. The study's patient and public involvement group supported data analysis. Fifteen interviews were completed. Four themes were generated. GPs described mixed capabilities, with many feeling they had the physical and psychological skills to support young people to avoid future self-harm, but some felt doing so was emotionally tiring. GPs identified opportunities to better support young people, such as use of electronic consultation tools, but cited lack of time as a concern. GPs reported motivation to help young people, but this can be influenced by their workload. Unmet training needs around communication, knowledge, and optimising safety were identified. GPs are supported by their practice teams to support young people after self-harm, but a lack of time hinders opportunities to do so. Future effective GP-led interventions may improve GP motivation to support young people after self-harm.

Endoscopic ear surgery in the treatment of chronic otitis media with atelectasis

PurposeAtelectasis otitis media (AtOM) is a chronic condition where the tympanic membrane (TM) becomes retracted towards the middle ear and the ossicular chain. Surgical treatment for this condition could be indicated based on stage of atelectasis, patient’s clinical condition and hearing loss. Over the years, AtOM has been treated with various types of tympanoplasty under microscopic view. The aim of this study is to present the results of endoscopic ear surgery in AtOM.MethodsForty-five patients who underwent endoscopic trans-canal tympanoplasty were included in the study. Preoperative features, intraoperative findings and postoperative outcomes were collected.ResultsPreoperatively, none of the study's patients were classified with a Sadè Grade I, whereas grades II, III and IV were 3 (6.6%), 23 (32.1%) and 19 (67.8%) respectively. The 3 patients with Sadè grade II showed a conductive hearing loss higher than 20 dB and a continuous ear fullness, therefore they were surgically treated. The postoperative graft success rate was estimated at 95.5%. During follow-up, 2 patients showed a TM perforation (at 6 and 12 months after surgery) whereas 1 patient experienced a recurrence of atelectasis in the TM (16 months after surgery). The overall success rate at the final follow-up was calculated at 88.8%. The average preoperative air-conduction threshold was 51.1 ± 21.5, which reduced to 34.6 ± 22.1 (p = 0.04) at follow-up. The preoperative air–bone gap decreased from 28 ± 7.2 to 11.8 ± 10 (p = 0.002) after surgery.ConclusionAtelectasis otitis media might be suitable for exclusive endoscopic surgical treatment, as it appears to exhibit a low recurrence rate and promising audiological outcomes.

Children With Type I Interferonopathy: Commonalities and Diversities in a Large Patient Cohort.

This study aimed to provide a comprehensive overview of the clinical features, laboratory and screening results, treatment options, and outcomes of patients with type I interferonopathy. Our secondary goal was to identify the predictors of long-term morbidity or mortality. We included children with genetically confirmed type I interferonopathies, with a follow-up duration of > 1 year. Data were obtained retrospectively from medical records. Of the 40 eligible patients for the study, 52.5% were female, with a median age of disease onset of 1.5 years (range 0.1-13.2 yrs). They were diagnosed at an average age of 6.8 (SD 4.6) years. Aicardi-Goutières syndrome was the most common diagnosis (n = 15, 37.5%). The central nervous system was the most frequently affected system (n = 27, 67.5%). Janus kinase inhibitors were administered to 17 (42.5%) patients. Twenty-five patients (62.5%) developed at least 1 permanent morbidity or died during follow-up; thus, they were included in the poor outcome group. Although younger age at disease onset, intracranial calcification (ICC), and lack of chilblains and elevated acute-phase reactants were significant in univariate logistic regression analysis, only ICC on magnetic resonance imaging at admission (adjusted odds ratio 19.69, 95% CI 1.08-359.05, P = 0.04) was found to be a significant predictor of poor outcomes in multivariate logistic regression analysis. For the first time, we evaluated the predictors of poor outcomes in patients with type I interferonopathy with a broad spectrum of subtypes. Further, our study's unique patient characteristics can provide valuable insights into these extremely rare conditions.

Investigating hematuria among young Indian adults using MDCT urography.

Hematuria may suggest bladder cancer, renal cell carcinoma, UUT-UCC, or urinary tract stones. Therefore, it is of interest to use Multi-Detector Computed Tomography (MDCT) to determine the cause of hematuria in children and connect MDCT results with cystoscopic and histological findings. The study included 110 young people under 40 with microscopic or macroscopic hematuria. A clinical exam and complete history were recorded. MDCT data from non-contrast and contrast-enhanced scans were properly documented. Histopathological and cystoscopic findings were noted alongside MDCT data when appropriate. The study's typical patient was 26 years old, 66% male. Eighty of the cases had hematuria as the cause. In 66 of 80 individuals, renal or ureteric calculi were the most common clinically relevant outcomes. There were four renal and four UB masses. Two cases of renal papillary necrosis and four of pyelonephritis/renal abscess were identified. MDCT diagnosed renal and vesical masses 100% accurately. MDCT can diagnose and treat hematuria, especially in young men, according to one study. The findings emphasize clinical awareness and targeted diagnosis. Further research is needed to determine hematuria causes and prevention across demographics.

Exploring Inflammatory Parameters in Lung Cancer Patients: A Retrospective Analysis.

Inflammation-related parameters serve as pivotal indicators in the prognosis and management of lung cancer. This retrospective investigation aimed to explore the relationship between inflammatory markers and diverse clinical variables in non-small-cell lung cancer patients. A cohort of 187 individuals undergoing elective lobectomy for lung cancer was retrospectively analyzed, spanning an 11-year data collection period. Six inflammation ratios derived from complete peripheral blood counts were assessed. Significantly elevated levels of neutrophil-to-lymphocyte ratio (NLR) (p = 0.005), platelet-to-lymphocyte ratio (PLR) (p = 0.001), Aggregate Index of Systemic Inflammation (AISI) (p = 0.015), Systemic Inflammation Response Index (SIRI) (p = 0.004), and Systemic Immune Inflammation Index (SII) (p = 0.004) were observed in patients with advanced T stages. Significantly, elevated values (p < 0.05) of these parameters were observed in the study's smoker patients compared to non-smokers. A statistically significant correlation was identified between the NLR parameter and tumor size (p = 0.07, r = 0.204), alongside a significant elevation in SIRI (p = 0.041) among patients experiencing postoperative complications. Inflammatory biomarkers emerge as invaluable prognostic indicators for patients with non-small-cell lung cancer, offering potential utility in forecasting their prognosis.

Risk factors for prolonged opioid consumption following hip arthroscopy: A secondary analysis of the Femoroacetabular Impingement RandomiSed controlled Trialand embedded cohort study.

The purpose of the study was to identify prognostic risk factors for prolonged opioid use at 2 and 6 weeks after hip arthroscopy using data from the Femoroacetabular Impingement RandomiSed controlled Trial and its external validation cohort study. Opioids were prescribed for postoperative pain management at the surgeon's discretion, with a majority being prescribed a combination of oxycodone and paracetamol (5/325 mg). Prolonged opioid use was defined as the ongoing use of any dosage of opioids reported at either 2 or 6 weeks after surgery to treat femoroacetabular impingement, as recorded in the patient's study medication log. Multivariable logistic regressions were performed to evaluate patient and surgical characteristics, such as preoperative opioid use, type of surgical procedure and intraoperative cartilage statethat may be associated with prolonged opioid use at either 2 and 6 weeks postoperatively. A total of 265 and 231 patients were included for analysis at 2 and 6 weeks postoperatively, respectively. The median age of participants was 35 years (interquartile range [IQR]: 27-42) and 33% were female. At 2 weeks postoperatively, female sex (odds ratio [OR]: 2.56; 95% confidence interval: [CI] 1.34-4.98, p = 0.005), higher body mass index (BMI) (OR: 1.10; 95% CI: 1.02-1.18, p = 0.009), active tobacco use (OR: 4.06; 95% CI: 1.90-8.97, p < 0.001), preoperative opioid use (OR: 10.1; 95% CI: 3.25-39.1, p < 0.001) and an Outerbridge classification of ≥3 (OR: 2.33; 95% CI: 1.25-4.43, p = 0.009) were significantly associated with prolonged opioid use. At 6 weeks postoperatively, only preoperative opioid use was significantly associated with prolonged opioid consumption (OR: 10.6; 95% CI: 3.60-32.6, p < 0.001). Preoperative opioid use was significantly associated with continued opioid use at 2 and 6 weeks postoperatively. Specific patient factors including female sex, higher BMI, active tobacco useand more severe cartilage damage should be considered in developing targeted strategies to limit opioid use after surgery. Level III.

GRAM-NEGATIVE BACTERIA IN SOME CLINICAL SPECIMENS AND THEIR ANTIBIOTICS RESISTANCE PROFILES, SANA’A, YEMEN

Gram-negative bacteria (GNB) have emerged globally as significant public health problems owing to their high resistance to antibiotics, particularly in developing countries such as Yemen. Therefore, this study aimed to determine the antibiotic resistance profile of GNB isolated from clinical samples in Sana’a City, Yemen. A total of 420 clinical samples, including vaginal swabs, urine, and pus, were collected from patients who attended some hospitals in Sana’a City, Yemen, in 2018. The collected specimens were examined according to standard microbiological methods, and the isolated bacteria were tested against some antibacterial agents using the Kirby-Bauer disc diffusion method on Mueller-Hinton agar. Among 420 specimens, the prevalence of gram-negative bacteria infections was 49.76%. A high rate of GNB was reported among the age group of 41–50 years old (57.97%), female patients (52.19%), those who came from rural areas (60.0%), and those who were uneducated (86.56%). The vaginal specimens exhibited a higher prevalence of bacterial bacteria (60.42%), followed by urine (51.28%) and pus (35.0%). Escherichia coli accounted for the greatest proportion of bacteria recovered from the study's patients (36.62%), followed by Klebsiella pneumoniae (18.66%), Enterobacter sp. (12.32%), Acinetobacter sp. (10.92%), Pseudomonas aeruginosa (9.15%), Citrobacter sp. (6.34%), and Proteus mirabilis (5.99%). E. coli was highly resistant to imipenem and enrofloxacin. Similarly, K. pneumoniae and P. aeruginosa were highly resistant to imipenem and norfloxacin. About 62.86% of Enterobacter sp. isolates were resistant to imipenem. In addition, 83.33–78.97% of Acinetobacter sp. isolates were resistant to imipenem and meropenem. Citrobacter sp. had high resistance to norfloxacin. Additionally, over 50% of P. mirabilis isolates were resistant to ofloxacin, norfloxacin, cefuroxime, and ceftizoxime. The conclusion is that there exists a significant proportion of GNB prevalence and antibacterial resistance among the study subjects. Therefore, multisectoral approach is needed for implementing effective strategies to reduce the transmission of antibiotic-resistant bacteria among the community.

Characteristics of Femur Fracture Patients at RSUD Sanjiwani from January - August 2023

Background: The causes of femur fractures are diverse and can be influenced by several factors. These bone fractures often occur due to high-impact trauma, such as car accidents, sports injuries, or other traumatic events that result in excessive stress on the bone. Another contributing factor is bone energy or strength reduction, which is frequently observed in the elderly population. Methods: This study is retrospective descriptive research with cross-sectional data collection. Data were obtained from the medical records of patients diagnosed with femur fractures who received treatment at RSUD Sanjiwani Gianyar in 2023. Results: The majority of patients experienced injuries due to falls (68.2%). Based on age, the study noted that 29.5% of patients were between 18 and 40 years old, 25% were between 40 and 65 years old, and 45.5% were over 65 years old. Most patients were female (72.7%), and the majority of patients had closed fractures (93.2%), while only a small percentage had open fractures (6.8%). Based on this data, the majority of fractures occurred in the proximal one-third of the femur bone (56.8%), followed by the medial one-third (20.5%) and the distal one-third (22.7%). Conclusion: There is a variation in patient age, with the majority being over 65 years old. Furthermore, most patients are female, with the majority experiencing closed fractures, and the most common location for fractures is the proximal one-third of the femur bone. These findings provide a general overview of the characteristics of this study's patient population with femur fractures. Keywords: Femur Fracture, Frailty, Pathological Fracture

Young people's priorities for the self-management of distress after stoma surgery due to inflammatory bowel disease: A consensus study using online nominal group technique.

The aim of this study was to gain consensus among young people with a stoma due to inflammatory bowel disease (IBD) on the priorities for the content of an intervention for the self-management of stoma-related distress. The current identification and management of distress in young people with a stoma is often suboptimal in clinical settings and there is a need for improved support resources. Two consensus group meetings were carried out via online video conferencing, using nominal group technique. Participants generated, rated on a Likert scale and discussed, topics for inclusion in a future self-management intervention. Nineteen young people, aged 19-33, with a stoma due to IBD took part in one of two group meetings. Participants were located across England, Scotland, and Northern Ireland. Twenty-nine topics were generated by participants, seven of which reached consensus of ≥80%, that is, a mean of ≥5.6 on a 7-point Likert scale. These were: receiving advice from young people with lived experience of stoma surgery; advice on/addressing concerns about romantic relationships, sex and intimacy; information about fertility and pregnancy related to stoma surgery; stoma 'hacks', for example, useful everyday tips regarding clothing, making bag changes easier and so forth; reflecting on and recognising own emotional response to surgery; tips on managing the stoma during the night; and processing trauma related to the illness and surgery journey. Findings extend previous research on young people's experiences of stoma surgery, by generating consensus on young people's priorities for managing distress related to surgery and living with a stoma. These priorities include topics not previously reported in the literature, including the need for information about fertility and pregnancy. Findings will inform the development of a self-management resource for young people with an IBD stoma and have relevance for the clinical management of stoma-related distress in this population. Three patient contributors are co-authors on this paper, having contributed to the study design, interpretation of results and writing of the manuscript. The study's Patient and Public Involvement and Engagement advisory group also had an integral role in the study. They met with the research team for four 2-h virtual meetings, giving input on the aims and purpose of the study, recruitment methods, and interpretation of findings. The group also advised on the age range for participants. The views of young people with a stoma are the central component of the study reported in this paper, which aims to gain consensus among young people with an IBD stoma on their priorities for the content of a resource to self-manage distress related to stoma surgery.

Clinical manifestations and genetic mutation analysis of patients with mucopolysaccharidosis type VII in China

ObjectiveThis study aimed to explore the clinical and genetic features of Chinese patients with mucopolysaccharidosis type VII (MPS VII), thereby improving early detection, disease management, and patient outcomes. MethodsA retrospective review of medical records for five patients presenting with coarse facial features, rib protrusion, chest deformities, and scoliosis was conducted. Exome sequencing was employed to identify causative genetic mutations. ResultsThe study comprised five patients (four males, one female) with disease onset at six months of age (range: 0–1.5 years). Common symptoms included coarse facial features, skeletal abnormalities, delayed motor and language development, and intellectual disability. Approximately 80% of the patients exhibited multiple skeletal dysplasias, enlarged adenoids or tonsils, and snoring; 60% had hernias; 40% reported hearing loss and hepatosplenomegaly. Less frequent manifestations were short stature, valvular heart disease, non-immune hydrops fetalis, and corneal opacity. All patients demonstrated elevated urine glycosaminoglycans levels and absent β-glucuronidase activity in leukocytes. Exome sequencing identified compound heterozygous mutations in the GUSB gene in all four tested patients, uncovering seven mutations in total, three of which were novel (c.189G > A, c.869C > T, and c.1745 T > C). Furthermore, prenatal diagnosis through chorionic villus sampling in subsequent pregnancies of one patient's mother revealed both fetuses had normal β-glucuronidase activity and no disease-causing mutations in the GUSB gene. ConclusionThe study's patients all presented with classic symptoms of MPS VII due to β-glucuronidase deficiency, with three new pathogenic mutations identified in the GUSB gene. Genetic counseling and prenatal testing were highlighted as crucial for disease prevention.

Impact of the National Suicide Hotline Number on Care of Outpatient Psychiatric Patients

Background: The Federal Communications Commission (FCC) has selected 988 as the number for mental health crisis and this came into effect in July 2022. It is not clear how aware psychiatric patients are of this event, and how much impact this will have on outpatient psychiatric care. Methods: Prior to the introduction of 988, the authors performed a study of patients attending the outpatient psychiatric clinic at the department of psychiatry’s outpatient services. The study comprised of a one-page questionnaire to acquire qualitative and quantitative data on patients’ knowledge and acceptance of the change in the access of the suicide prevention number. Results: A total of 74 outpatient psychiatric patients were surveyed during the course of the study. Most (87.8%) of surveyed individuals denied memorisation of their local mental health crisis or suicide prevention hotline number. Of the 24 individuals who reported previously having called a crisis hotline, over one-third (37.5%) reported difficulty remembering or finding the number. In response to the introduction of a three-digit crisis hotline number, 63.5% (47) of surveyed individuals reported both increased confidence in receiving prompt, effective psychiatric care, and greater likelihood of seeking help with the three-digit number. Finally, 77.0% (57) stated that a three-digit number would be more easily remembered than current options. The majority (89%) of responders were not aware of the 988 hotline number. Conclusion: Patients believe the 988 number will be a helpful tool in their care. One year after its introduction, awareness of 988 has barely changed.

Integrated Electronic Medical Record Design With Nutritional Screening System at NCC’s Teaching Factory

One of Politeknik Negeri Jember's Teaching Factories (TEFA) that offers community nutrition services is the Nutrition Care Centre (NCC). The design of electronic medical records (EMRs) for continuous care patients, especially those with non-communicable diseases, is being studied in order to meet the ever-increasing needs of health care, assist patients who require continuous care, and improve the way that modern medical technology serves humans. The Waterfall framework concept is used in the research process, and an electronic medical record system is designed in accordance with the goals and the overall architecture of the system. Black-box testing and white-box testing are then conducted to evaluate the features, dependability, and stability of the designed electronic medical record system. Furthermore, when combined with other research findings, the design's viability is demonstrated. It is evident that the electronic medical record system created for the study's patients who require ongoing care is entirely workable. As electronic medical records continue to develop, there will be more opportunities to research and enhance this system, which will benefit patients and hospitals alike in the long run.

Cannula Placement for Cerebral Protection Without Circulatory Arrest in Patients Undergoing Hemiarch Aortic Aneurysm Repair.

Aortic aneurysms involving the proximal aortic arch, which require hemiarch-type repair, typically require circulatory arrest with antegrade cerebral perfusion. Left carotid antegrade cerebral perfusion (LCP) via distal arch cannulation without circulatory arrest was used in this study's patient population. The goal was to assess the operative efficiency and clinical outcomes of using a distal arch cannulation technique that would not require any hypothermic circulatory arrest (HCA) time compared with more traditional brachiocephalic artery cannulation with right-sided unilateral antegrade cerebral perfusion (RCP) and HCA. A single-center retrospective review of patients with replacement of the distal ascending aorta involving the proximal arch was performed. Patients with an intramural hematoma or dissection were excluded. Between January 2015 and December 2019, 68 adult patients had undergone a hemiarch repair because of aneurysmal disease. Analysis of baseline demographics, operative data, and clinical outcomes was performed. Comparing the 68 patients: 21 patients were treated with RCP (via brachiocephalic artery graft with HCA), and 47 patients were treated with LCP (via distal aortic arch cannulation with cross-clamp between the brachiocephalic and left common carotid arteries without HCA). Baseline characteristics and outcomes were evaluated for both groups. The LCP group was younger (LCP median [IQR] age, 60 [53-65] years vs RCP median [IQR] age, 67 [59-71] years]. Sex, race, body mass index, comorbidities, and ejection fraction were similar between the groups. Cardiopulmonary bypass time (LCP, 123 minutes vs RCP, 149 minutes) and unilateral cerebral perfusion time (LCP, 17 minutes vs RCP, 22 minutes) were longer in the RCP group. Bleeding, prolonged ventilatory support, kidney failure, and length of stay were similar. In-hospital mortality was 2% in the LCP group vs 0% in the RCP group. Stroke occurred in 2 patients (4.2%) in the LCP group and in 0% of the RCP group. Mortality at 6 months in the LCP and RCP groups was 3% and 10%, respectively. Distal arch cannulation with LCP without HCA is a reasonable and safe alternative strategy for patients requiring hemiarch replacement for aneurysmal disease. This technique may provide additional benefits by avoiding circulatory arrest in these complex cases.

The Effectiveness of Telerehabilitation on Improving Knee Function in Patients with Osteoarthritis Knee: A Systematic Review and Meta Analysis

Knee Osteoarthritis (KOA) is one of the leading causes of limitations in performing activities that impact in impaired knee function and mobility, necessitating physiotherapy intervention. Advancements in current technology have made it possible to receive treatment without the need for in-person meetings. This study aims to assess the feasibility of telehealth physiotherapy in improving knee function in OA patients. The design of study is Systematic Review and Meta-Analysis, with study sources obtained from Scopus, ProQuest, and PubMed databases using keywords based on the PICO framework. Data analysis was performed using Review Manager. The study identified a total of 1.726 articles, with a final screening resulting in 5 articles that were further examined. Each study had a Randomized Control Trials (RCT) research design and was oriented towards comparing telehealth with face-to-face interventions. Telerehabilitation did not show significant changes due to various factors, including the study's duration, physiotherapist supervision, patient motivation and adherence, as well as the comprehensiveness of exercise instructions.

The Islanded Nasolabial Flap: A Versatile and Reliable Flap for Reconstruction in Cancers of the Oral Cavity

On the Indian subcontinent, oral cancer represents a significant health burden. Local flaps offer a viable alternative to free flaps in specific reconstructive scenarios where free flaps may not be feasible. The islanded nasolabial flap, based on the facial artery, proves to be a robust and versatile option for single-stage reconstructions of oral cavity defects. In this study, we share our experience employing the islanded nasolabial flap at a high-volume cancer center in Central India for reconstructing buccal mucosa and tongue defects. This prospective observational study focused on approximately 76 patients diagnosed with squamous cell carcinoma of the oral cavity (specifically, the anterior 2/3rd of the tongue and buccal mucosa) at our cancer hospital between August 2021 and January 2023. Initially, 76 patients were included; however, four patients were subsequently excluded due to inadvertent facial vein injury during neck dissection caused by level IB node invasion. Consequently, 72 patients underwent islanded nasolabial flap reconstruction and were monitored for postoperative complications and functional outcomes. Our study's patients fell within the age range of 24 to 81 years, with the majority between 40 and 50 years old. Most of our patients had carcinoma affecting the anterior two-thirds of the tongue (61.11%), followed by carcinoma of the buccal mucosa (38.88%). Surgical site infection occurred in four patients (5.55%) at the donor site, and one patient (1.38%) experienced flap necrosis after tongue carcinoma surgery. However, the majority of our patients (93.05%) experienced no postoperative complications. Speech intelligibility was good for all patients (100%) with buccal mucosa cancer. A significant portion of patients (78.57%) could tolerate a normal diet, while 21.42% required a soft diet. Among patients with tongue carcinoma, 56.81% had good speech intelligibility, and 43.18% had acceptable speech intelligibility. Regarding swallowing capacity assessment, 65.90% of patients tolerated a normal diet, and 34.09% could manage a soft diet. None of our patients had poor speech intelligibility, and none depended on a liquid diet or tube feeding. This study underscores the versatility of the islanded nasolabial flap in oral cancer resection reconstruction. The islanded nasolabial flap proves to be a straightforward, effective, and reliable technique with a low incidence of complications and exceptional functional outcomes, establishing it as a valuable reconstructive option for small-to-medium-sized oral defects. This is particularly noteworthy for high-volume centers and regions with limited resources.

Prognostic Nutritional Index and Systemic Immune-inflammation Index: Possible New Parameters for COVID-19 Severity

Background: The Prognostic Nutritional Index (PNI) parameter has been widely used in estimating the severity of COVID-19. In contrast, investigating the role of the Systemic Immune-inflammation Index (SII) in determining the COVID-19 severity is prospective. This study aimed to investigate the potential of PNI and SII parameters to distinguish the severity of symptoms of COVID-19. Methods: A retrospective observational study was conducted among 209 hospitalized patients with COVID-19. Data were collected from August 2021 to February 2022 in Indonesia's general COVID-19 referral hospital. Demographic and laboratory data, including PNI and SII, were analyzed and compared between the severe and non-severe symptoms of COVID-19 patients. The statistical analysis of the receiver operating characteristic curve (ROC) and area under curve (AUC) was conducted to predict the potential of these parameters in distinguishing the COVID-19 severity. Results: More than half of this study's patients (54.55%) were non-severe COVID-19. The SII values in patients with severe symptoms were significantly higher than in those with non-severe symptoms (2445.24 vs. 1423.28, p=0.005). In contrast, the PNI value in patients with severe COVID-19 symptoms was significantly lower than those with non-severe symptoms (38.04 vs. 33.93, p&lt;0.001). The area under the curve (AUC) value of PNI was 0.694, while the SII was 0.635. The optimum cut-off for the PNI was &lt;35,407, while the SII was &gt;2212,787. PNI and SII were the potential new diagnostic parameters for COVID-19 severity. Conclusion: PNI and SII parameters can potentially distinguish the severity of symptoms of COVID-19.

ASSOCIATION OF COMMUNITY-ACQUIRED PNEUMONIA (CAP) WITH INHALED CORTICOSTEROIDS (ICS) AMONG PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Background: Chronic obstructive pulmonary disease has a significant morbidity burden and adversely affects patient quality of life. According to research, inhaling steroids may raise the chance of developing community-acquired pneumonia (CAP). Since no research had been done in our local community, this study was conducted to determine the relationship between pneumonia and COPD patients. To determine the association of community-acquired pneumonia with inhaled corticosteroids among patients with chronic obstructive pulmonary disease (COPD). Material and Methods: In a cross-sectional study carried out between October 15, 2020, to April 14, 2022 (18 months) at Nishtar Hospital Multan, 300 COPD patients from the Department of Medicine and Pulmonology were selected after permission from concerned authorities and the Institutional Review Board (IRB). Once registered, all patients underwent clinical examination and chest X-Ray to diagnose pneumonia. Results: Out of these 300 research cases, our study's patients had an average age of 56.63 ±3.4 years. Out of them, 190 (63.3%) were male patients and 110(27.7%) were female. One hundred and fifty-five (51%) were from metropolitan regions, while 145 (48.3%) were from rural areas. 123 (41.0 percent) of the subjects had diabetes, and 117 (39%) had hypertension. Of these 300 study cases, 200 (66.6 %) were smokers, while dyslipidemia was noted in 136 (45.3 %). Among 300 patients, 247 (82.3%) were on ICS. Community-acquired pneumonia was noted in 43 cases (14.3%). There was a statistically significant association between ICS usage and CAP (P&lt;0.05). Post-stratification, CAP had a significant association (p-value ≤0.05) with older age (&gt;55 years), urban population, diabetes, smoking, and COPD duration of &gt;12 months. Conclusion: Our study noted a high CAP prevalence among COPD patients using ICS. Moreover, community-acquired pneumonia in patients with COPD using inhaled corticosteroids was strongly associated with old age, obesity, DM, smoking, and a long course of the illness. These may be considered as additional risk factors for CAP among ICS using subgroup. Keywords; Community-acquired pneumonia, CAP, Chronic obstructive pulmonary disease, COPD, Corticosteroids, ICS

Is the Pattern Changing? Atrial Fibrillation and Screening with Holter Electrocardiograms among Ischemic Stroke Patients in Greenland from 2016 to 2021.

A standardized examination regime for ischemic stroke (IS) patients was implemented in Greenland in 2010. Prevalence of atrial fibrillation (AF) of 32% was found among discharged IS patients from 2011 to 2012, and our study aims to estimate the use of Holter ECGs for AF diagnostics and the current prevalence of AF among IS patients in Greenland. Patients discharged from Queen Ingrid's Hospital in Nuuk between 2016 and 2021 with an ICD-10 diagnosis of IS or stroke without specification were included. Data on Holter recordings, age, gender, medical treatment with rivaroxaban or warfarin, and ICD-10 and ICPC codes for AF were extracted for each patient. The overall incidence of IS from 2016 to 2021 was 133/100,000 and unchanged since 2012. Sixty-eight of the study's IS patients (14.5%) had AF, and 46% of IS patients with Holter data accessible had a recording according to international recommendations. Our results indicate that fewer IS patients in Greenland have AF than previously. However, the insufficient use of Holter as a diagnostic tool may explain part of the drop, as well as improved preventive treatment with rivaroxaban among AF patients in Greenland. Regardless, IS remains common, and a focus on diagnostics and preventable risk factors should be maintained.