Percent Of Patients Research Articles

Loss of Independence in Older Adults With Operable Oral Cavity Cancer: A Retrospective Cohort Study.

To ascertain the effect of curative-intent surgery on loss of independence (LOI) in patients with oral cavity squamous cell carcinoma (OCSCC). Retrospective observational study of patients diagnosed from 2014 to 2021. Single tertiary care academic center. Patients having undergone curative-intent surgical treatment for OCSCC from 2014 to 2021 in the cancer registry. LOI as the primary outcome was measured based on a combination of decrease in activities of daily living (ADLs) and/or decline in mobility during treatment. Descriptive statistics were used to compare baseline demographics and multivariable logistic regression was used to assess the association between LOI and perioperative variables of interest. Of the 180 patients included in this study, 139 (79%) were fully independent in ADLs/instrumental ADLs prior to surgery. The average age of the cohort was 74 with 49% males. Thirty-seven(21%) experienced a decline in mobility or increased care needs following surgery, and 18 (10%) experienced an independent decline in functional status. Increasing age, osseous flap reconstruction, high Charlson Comorbidity Index, and major postoperative adverse events were associated with LOI. Fifty-five percentof patients with LOI had recovered to baseline within 7 months from surgery. LOI was associated with poor treatment tolerance (odds ratio: 4.77, 95% confidence interval: 1.87-12.2) while adjusting for multiple confounders. LOI is common in older adults undergoing curative-intent surgery for OCSCC and associated with poor treatment tolerance.

Mutations in the TP53, VEGFA, and CTH Genes as Key Molecular Markers for the Diagnosis of Glioblastoma.

Background Brain cancer, particularly glioblastoma (GBM), is a global health problem. Despite therapy advances, GBM patients have a poor prognosis. The progression and etiology of GBM may be linked to gene polymorphisms in the VEGFA, TP53, and CTHgenes, among others. However, the genetic variations and their interaction in GBM are not fully understood. This study examines the effects of mutations in the VEGFA, TP53, and CTH genes on GBM. Methodology Tissue and blood samples were obtained for hematological, biochemical, and genetic analysis from 18 patients diagnosed with GBM as well as 28 healthy individuals. Standard methods were adopted to perform hematological and biochemical analyses, whereas mutational landscape and expression profiles were obtained from publicly accessible databases. Tissue samples were processed for genomic DNA extraction, and genotype determination was carried out through conventional polymerase chain reaction (PCR) and Sanger sequencing. Results The study involved 18 patients with grade IV GBM beforetreatment and 28 healthy individuals. The patients consisted of11 men (61%) and seven females (39%), while healthy individuals included 14 (50%) males and 14 (50%) females. Sixty-seven percentof patients were under 50, 17% between 51 and 60, and 17% over 61, compared to healthy individualswho were 61% under 50, 7%between 51 and 60, and 32% over 60. GBM patients showed higher neutrophil and monocyte counts (median 81% (63.9, 83.5) and 4.2% (3.8-7.3)), respectively, and lower lymphocyte counts (median 13.4% (8.8, 28.40)) compared to controls. The median values of aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase (ALP) showed no significant differences between the control and GBM groups. GBM patients had significantly higher median CRP levels of 2.55 (1.6, 98) than controls. Analysis of databases revealed a high prevalence of mutations in TP53, with splice region variants, missense variants, and intron variants being the most common. VEGFA and CTH also displayed mutations, primarily missense and intron variants. Gene expression analysis showed significantly higher levels of TP53 and VEGFA in GBM patients compared to controls. CTH expression also exhibited a slight increase in GBM patients. Sanger sequencing identified three mutations in the TP53 gene, including a novel mutation (11915C>A) not previously reported in external databases. Additionally, novel mutations were found in the VEGFA (841G>GA, 919T>TG) and CTH (28398A>AC, 28399A>AT) genes. Conclusions This study highlights the immune dysregulation, inflammation, and genetic variations in GBM.The findings emphasize the potential importance of the TP53, VEGFA, and CTH genes as targets for therapies and diagnostic biomarkers of GBM. Further study is necessary to comprehend these genetic variations' functional implications and their use in personalized GBM treatment.

Clinical Outcomes of an Active, Transcutaneous, Bone Conduction Hearing Device: A Retrospective Study.

The purpose of this study was to review patient demographics, indications, intraoperative findings, complications/adverse events, and audiological outcomes related to the implantation of the Osia 2 device. Retrospective case series. Single tertiary institutional experience. Patients who had undergone Osia 2 implantation by the senior author were identified from 2019 to present. Information was extracted from patient charts concerning patient demographics, indications for implantation, surgical findings, audiological outcomes, and adverse events. Sixty patients and 67 implants were included. The median age was 51 years (R: 11-92). Fifty-five percentof patients had mixed hearing loss (HL), 30% had single-sided deafness, and 15% had conductive HL. The mean operative time was 53.9minutes. Only 4.5% of patients required bone polishing, and 3.0% required tissue thinning. Themean pure-tone averages 4 gain from unaided conditions was 41.2 dB. Mean gain at 6and 8 kHz from unaided conditions was 35.42and 40.67 dB, respectively. Mean improvement in speech recognition threshold and word recognition score was significant in noise and quiet conditions. The all-cause adverse event/complication rate in our series was 10.4%. The most common complications were infections (4.5%) and poorly controlled postoperative pain (3.0%). Hematomas occurred in 1.5% of patients. Reoperation was required in 4 patients; explant in 1. Use of the Osia 2 device in our series has resulted in good hearing outcomes, particularly in terms of high frequency gain. Complication rates were low. To our knowledge, this is the largest study to date reporting on Osia 2 outcomes.

A Single Center Description of Adult and Pediatric Endoscopic Posterior Costal Cartilage Grafting.

Posterior glottis impairment alters breathing, voicing, and swallowing. Bilateral vocal fold movement impairment (BVFMI) occurs when the vocal cords are fixed/remain midline. Studies inadequately assessed endoscopic posterior costal cartilage grafting (enPCCG) for BVFMI across broad ages. We aim to assess decannulation and prosthesis free airway in children and adults who have undergone enPCCG. Retrospective cohort. Referral center. This study included adults and children who received enPCCG for BVFMI (2010-2018) and were followed for 35 months on average. The main outcome was successful decannulation of patients, or airway improvement in those without tracheostomy. Data on comorbidities, surgical complications, and interventions following surgery were collected. Ten children and 11 adults underwent enPCCG for BVFMI. Eighty-one percentof patients had a tracheostomy at surgery; adults were more likely to have a tracheostomy at surgery (P = 0.035), and to undergo double-staged procedure (P = 0.035) and stent (P = 0.008). Average stent duration was 29.7 days. Overall decannulation rate was 76% (90% for children; 70% for adults). Children were more likely to receive postoperative intensivecareunit care (P = 0.004). Adults had mean 4.4 post-enPCCG interventions per patient compared to children's mean 3.91 interventions. The most common interventions were steroid injection (17.6%) and balloon dilation (16%). Preliminary analysis suggests postoperative dysphonia was reported in 66.7% of patients; postoperative dysphagia was rare. EnPCCG was more successful at achieving decannulation in children. Adults required additional interventions. A double-staged operation with prolonged stenting is recommended for adult patients. A majority of patients were decannulated at last follow-up.

Effect of probiotic incorporation on physicochemical attributes of yogurt during storage and influence on cholesterol assimilation.

This study aimed to evaluate the incorporation effect of probiotic culture (Lactobacillus acidophilus) in buffalo milk yogurt on stability and microbial survival rate during storage. In addition, the influence of probiotic culture on blood lipid profiles was investigated for a period of 6weeks. Yogurt was prepared with buffalo milk with different probiotic concentrations (0, 100, and 50%) and administered to subjects at 300g/day. All treatments showed a significant difference (p<0.05) in acidity and pH during storage for 21 days at refrigeration temperature, while treatment with 100% probiotic culture (G2) was most prominent. Physicochemical analysis demonstrated a maximum pH decline of 0.60 in G2, followed by 0.56 in the mix cultured (G3). However, increasing trend was observed in acidity, with highest increment of 0.89% followed by 0.54% in G2 and G3, respectively. Storage study of total viable count demonstrated the reduction in the enumeration of microbial population owing to the production of organic acids, while L. acidophilus had a high survival rate of 5.25 log 10 CFU/g. Probiotic culture produced significant results in the lipid profile of subjects. Treatments containing probiotic bacteria G2 and G3 showed the lowest total cholesterol (183.57 and 182.85mg/dL) and low density lipoproteins (LDL) (105.80 106.40mg/dL), respectively. In terms of high density lipoproteins (HDL), G2 showed a highest increment of 49.82mg/dL. Results of our study revealed that consumption of probiotic yogurt is beneficial for human health by improvement of blood lipid profiles and reduces cardiovascular patient's percentage around the globe. PRACTICAL APPLICATION: Experimental investigation of the effect of probiotic culture addition on the stability of buffalo milk yogurt. Assessment of the potential of Lactobacillus acidophilus on blood lipid profiles.

The use of prednisolone during Ramadan fasting in patients with adrenal insufficiency.

Once daily prednisolone taken at predawn has been proposed to be the glucocorticoid replacement of choice in patients with adrenal insufficiency (AI) who intend to fast for the month of Ramadan. However, the effects of prednisolone on metabolic parameters and quality of life during fasting for Ramadan are unknown. Patients with AI on twice-daily hydrocortisone, who had low or moderate risk and intended to fast, were recruited. Patients were converted to prednisolone 5 mg once daily taken at sahur (predawn) and Ramadan education given. Weight, sleep duration, biochemical parametersand quality of life measures (SF-36 questionnaire) were analysed at the end of Ramadan and compared against baseline. Twenty patients (13 men) were recruited, with a mean age of 59.9 ± 15.0 years. All patients were on hydrocortisone 15 mg daily (in divided doses) as pre-Ramadan glucocorticoid replacement. Half had type 2 diabetes with low IDF-DAR risk. Eighty-five percentof patients completed the full 29 days of fasting with no complications. There was a significant reduction in weight (-1.1 ± 1.6 kg, p = .005), with no significant change in blood pressure or sleep duration. There was a significant increase in urea (0.80 ± 1.1 mmol/L, p = .005) and haematocrit, (0.011 ± 0.019 L/L, p = .019) and decrease in serum sodium (-1.6 ± 3.0 mmol/L, p = .028), with no change in serum creatinine or liver function. Quality of life measures were preserved in all domains with significant improvement in role limitation due to physical health (15.3 ± 21.6, p = .005) and bodily pain (8.8 ± 16.3, p = .031). This study has demonstrated that converting patients with AI who are fasting for Ramadan from twice-daily hydrocortisone to prednisolone 5 mg daily at sahur was safe, with no major short-term adverse effects. Despite the higher equivalent glucocorticoid doses, patients experienced weight loss and no clinically significant change in blood pressure, sleep, biochemical parameters or quality of life. This study paves the way to trial even lower doses of prednisolone once daily in patients fasting for Ramadan with AI.

A Single-Arm, Open-Label, Multicenter Study to Assess Molecular Response of P1101 Therapy in Patients with Polycythemia Vera and Elevated Hematocrit: Results from 12-Month Core Study

Background: The treatment goals of Polycythemia Vera (PV) have been focused on reducing the thrombotic and hemorrhagic risks and preventing disease transformation. A short-term way to confirm the effect of treatment is to check peripheral blood count remission. Recently, published researches have demonstrated that JAK2 driver mutation is associated with not only disease progression but hematologic response. Although it is still controversial whether a decrease in JAK2 mutation should be one of the treatment goals or not, the molecular response (MR) is frequently assessed in clinical trials. Moreover, the interest in treatment is moving toward disease modification. Ropeginterferon alfa-2b(P1101) showed it was more effective in achieving durable hematological and molecular remissions than hydroxyurea and well tolerated during long-term application. However, there are limited data on the clinical relevance of MR during P1101 and the efficacy and safety of P1101 in Eastern Asians. Aims: The aim of this study is to evaluate clinical and molecular response, and the association between efficacy and MR. In addition, the safety and tolerability of P1101 were also collected. Methods: This single-arm, open-label study has been performed in 16 hospitals in Korea. Patients were eligible if 19 years or older with PV diagnosed by WHO's 2016 criteria, requiring cytoreductive therapy and elevated hematocrit (Hct) (&amp;gt;45%). Patients were treated with P1101, S.C. q2w, at a starting dose of 250 µg, followed by 350 µg(week 2), 500 µg(week 4), and thereafter until week 48 (core study period). The JAK2 Val617Phe allele burden was assessed every 3 months. The chi-square test was used to determine any association between complete hematologic response (CHR) and MR using the Phi coefficient as a measure of strength association. Results: With a data cut-off date of 10 Jul 2023, a total of 99 patients were enrolled and 77 patients are under treatment including extension period in the study. Twenty patients dropped out including 2 patients due to adverse events and 2 patients completed core study. Total 95 patients were included in this analysis as FA (full analysis) set: 52 (54.7%) patients was HU-naïve and 43 (45.3%) patients was HU-resistant/intolerant(R/I). The median age was 58 years (range, 26-81) and 53.7% were male. The percentagesof patients with low and high risk were 56.8% and 43.2%, repectively. Until now, 94, 87, 79, and 60 patients were evaluable at 3, 6, 9, and 12 months, respectively. CHR was achieved in 25 (27%) of 94, 40 (46%) of 87 patients, 45 (57%) of 79 patients, and 38 (63%) of 60 patients at 3, 6, 9, and 12 months, respectively. Twenty-eight (32%) of 88, 29 (36%) of 80 patients, 32 (52%) of 62 patients, and 23 (61%) of 38 patients achieved the MR at 3, 6, 9, and 12 months, respectively. The Phi Coefficient for determining of association between CHR and MR was 0.56 (P&amp;lt;0.0001), 0.48 (P&amp;lt;0.0001), 0.4735 (P=0.0002), and 0.4938 (P=0.0041) at each time point (Table 1). Regarding the calculated absolute change from baseline of JAK2 allele burden at each time point, a faster and deeper decreasing pattern was shown in CHR responders compared to non-responders (Table 2). Regarding the Hct, platelets, and WBC, the mean value of all parameters significantly decreased to the normal range after 6 months and were consistent in normal until 12 months. Moreover, there is also no significance difference between HU naïve vs R/I and low vs High risk. In terms of safety, a total of 160 treatment-emergent adverse events (TEAEs) and 84 treatment-related adverse events (TRAE) were reported. The most common TEAEs (%, n/95) were alopecia (18%, 17/95) and adverse events related to liver function (16%, 15/95), respectively. Onset time of TRAEs distributed 8, 22, 27, 18, and 8 during week 0-4, 4-12, 12-24, 24-36, and 36-48, respectively. There were no unexpected TEAEs. Two serious adverse drug reactions (1 hepatotoxicity and 1 bipolar disorder) were reported. Conclusion: The updated data showed consistent results with the previous 2022 ASH meeting abstract that ropeginterferon alfa-2b therapy, with rapid dose optimization, induced hematological response, reduced JAK2 allele burden, and was well tolerated in Korean patients. Moreover, we clarified the association between efficacy and MR as assessed by reduction in JAK2 allele burden. More data will be updated during the meeting.

Remote exercise testing in pulmonary hypertension (PHRET).

Remote exercise tests for patients with pulmonary hypertension (PH) would improve the telemedicine strategies in this disease. The PHRET study assessed the validity and feasibility of four remote exercise tests performed by PH patients at home. Participants undergoing diagnostic assessment for PH were included. At baseline, patients completed a 6MWT followed by a range of study tests including a Timed Up and Go (TUG) test, a Sit-to-Stand (STS), a Step Test (ST), and a tele-6MWT (T6MWT) performed outside using a GPS-enabled smartphone. Patients performed these tests at home following discharge and at first follow-up. Analysis focused on comparing the results of study tests to the standard 6MWT. The discontinuation rate was 15%. Ninety-seven percentof patients were able to complete a TUG, 92% a STS, 73% a ST, and 49% a T6MWT. At baseline, correlation between the standard 6MWT and study tests, respectively, wasT6MWT 0.93, ST 0.78, STS 0.71, and TUG -0.76 (p < 0.001). Direction of change in the study test agreed with the standard 6MWT in 68% of the follow-up ST, 68% of the STS, 71% of the TUG, and 79% of the T6MWT. Patients were able to complete the tests at home, there were no adverse incidents and ≥92% of patients were happy to continue performing home tests. Remote exercise testing is feasible. The T6MWT was a valid remote measure of exercise capacity, but could only be performed by a limited number of patients. The high discontinuation rate may impact the utility of remote tests.

Socioeconomic Influence on Speech Rehabilitation After Total Laryngectomy.

Speech rehabilitation following a total laryngectomy significantly impacts the quality of life. Indwelling prosthetic voice restoration provides optimal outcomes; however, the long-term maintenance of these devices carries considerable financial costs, which are not universally covered by insurance. This investigation aimed to analyze associations between socioeconomic factors and outcomes in postlaryngectomy speech rehabilitation. Retrospective cohort analysis. Academic tertiary-care center from May 2014 to September 2021. In patients undergoing total laryngectomy, the incidence of tracheoesophageal puncture with indwelling vocal prostheses (TEP-VP) placement within the first postoperative year was compared amonghousehold income, demographic factors, and disease characteristics. Functional and maintenance outcomes served as secondary endpoints. Seventy-seven patients were included. Forty-five (58%) underwent indwelling TEP-VP (41 primaries). Eighty-nine percentof patients with annual incomes greater than $50kunderwent TEP-VP compared to only 35% with incomes less than $50k/year. TEP-VP was performed in 85% of patients with commercial insurance, 70% with Medicare, 42% with Medicaid, and 0% with no insurance. On multivariate analysis, annual household incomes greater than $50k were predicted for TEP-VP placement (odds ratio: 12.7 [2.45-65.8], p = .002). The utilization of postoperative speech therapy and functional communication outcomes were similar amongsocioeconomic groups. Twelve patients were unable to afford supplies within the first year, with differences noted amonginsurance (p = .015) and income status (p = .003). Disparities in vocal and speech rehabilitation following laryngectomy may disproportionally affect underserved patients.

Evaluating Adult Idiopathic Scoliosis as an Independent Risk Factor for Critical Illness in SARS-CoV-2 Infection

Thoracic spinal deformities may reduce chest wall compliance, leading to respiratory complications. The first SARS-CoV-2 (L-variant) strain caused critical respiratory illness, especially in vulnerable patients. This study investigates the association between scoliosis and SARS-CoV-2 (COVID-19) disease course severity. Clinical data of 129 patients treated between March 2020 to June 2021 who received a positive COVID-19 polymerase chain reaction result from Mount Sinai and had a scoliosis ICD-10 code (M41.0-M41.9) was retrospectively analyzed. Degree of coronal plane scoliosis on imaging was confirmed by 2 independent measurers and grouped into no scoliosis (Cobb angle <10°), mild (10°-24°), moderate (25°-39°), and severe (>40°) cohorts. Baseline characteristics were compared, and a multivariable logistic regression controlling for clinically significant comorbidities examined the significance of scoliosis as an independent risk factor for hospitalization, intensive care unit (ICU) admission, acute respiratory distress syndrome (ARDS), mechanical ventilation, and mortality. The no (n= 42), mild (n=14), moderate (n=44), and severe scoliosis (n= 29) cohorts differed significantly only in age (P= 0.026). The percentage ofpatients hospitalized (P= 0.59), admitted to the ICU(P= 0.33), developing ARDS (P= 0.77), requiring mechanical ventilation (P= 1.0), or who expired (P=0.77) did not significantly differ between cohorts. The scoliosis cohorts did not have a significantly higher likelihood of hospital admission (mild P= 0.19, moderate P= 0.67, severe P= 0.98), ICU admission (P= 0.97, P= 0.94, P= 0.22), ARDS (P= 0.87, P= 0.74, P= 0.94), mechanical ventilation (P= 0.73, P= 0.69, P= 0.70), or mortality (P=0.74, P= 0.87, P= 0.66) than the no scoliosis cohort. Scoliosis was not an independent risk factor for critical COVID-19 illness. No trends indicated any consistent effect of degree of scoliosis on increased adverse outcome likelihood.

Perceived treatment satisfaction in patients with systemic rheumatic diseases treated with biologic therapies: results of a self-reported survey.

Biological agents are widely used for the management of systemic rheumatic diseases (SRDs) and their therapeutic implications have been expanded beyond inflammatory arthropathies to more complicated autoimmune disorders, such as systemic lupus erythematosus, vasculitis, and systemic sclerosis. The aim of this study was to investigate treatment satisfaction and overall experience of SRDs' patients receiving biologics as well as to explore patient's perspectives on the quality of services provided by rheumatology departments and to determine factors related to the level of satisfaction. We performed a synchronous correlation study. Patients with SRDs answered an anonymous questionnaire assessing their satisfaction and how treatment with biologics has affected their quality of life and functionality. Sample consisted by 244 patients (65.2% women), with mean age of 50.4years, and the most common diagnosis was rheumatoid arthritis (37.3%). Sixty one percentof patients received intravenous therapy and 39% subcutaneously. Overall, 80.5% of the patients reported a positive/very positive effect of their treatment on their life. The average total patient satisfaction from the unit was 79.8%. The presence of mental disease was significantly associated with less positive impact of the treatment on patients' life, worse quality of life, and greater pain. In conclusion, patients with a broad spectrum of SRDs were generally satisfied and treatment with biologic regimens appeared to have a positive impact on several aspects of their life. The majority of patients were at least satisfied with all the characteristics of the unit staff and better quality of life was associated with greater satisfaction about the Unit and more positive affect of the treatment in patients' life.

Comparison of the pharmacokinetics of continuous and intermittent infusions of ampicillin-sulbactam in dogs with septic peritonitis

To evaluate the time-course of ampicillin-sulbactam and percentage of time that its concentration is above a given MIC (T% > MIC) in dogs with septic peritonitis when delivered as either a continuous infusion (CI) or intermittent infusion (II). 11 dogs with septic peritonitis. Dogs were randomized to receive ampicillin-sulbactam as either CI or II. Continuous infusions were delivered as a 50 mg/kg bolus IV followed by a rate of 0.1 mg/kg/min. Intermittent infusions were administered as 50 mg/kg IV q8h. Serum ampicillin-sulbactam concentrations were measured at hours 0, 1, 6, and every 12 hours after until patients were transitioned to an oral antimicrobial equivalent. All other care was at the discretion of the attending clinician. Statistical analysis was used to determine each patient's percentage of time T% > MIC for 4 MIC breakpoints (0.25, 1.25, 8, and 16 µg/mL). No dogs experienced adverse events related to ampicillin-sulbactam administration. Both CI and II maintained a T% > MIC of 100% of MIC 0.25 µg/mL and MIC 1.25 µg/mL. The CI group maintained a higher T% > MIC for MIC 8 µg/mL and MIC 16 µg/mL; however, these differences did not reach statistical significance (P = .15 and P = .12, respectively). This study could not demonstrate that ampicillin-sulbactam CI maintains a greater T% > MIC in dogs with septic peritonitis than II; however, marginal differences were noted at higher antimicrobial breakpoints. While these data support the use of antimicrobial CI in septic and critically ill patients, additional prospective trials are needed to fully define the optimal doses and the associated clinical responses.

ESTIMATION OF SERUM CRP,FERRITIN,D-DIMER,LACTATE DEHYDROGENASE IN COVID 19 PATIENTS

Background: Severe COVID-19 illness is associated with intense inflammation, leading to high rates of thrombotic complications that increase morbidity and mortality . New laboratory tests capable of differentiating between severe and non-severe cases and appropriate management of COVID-19. Aims and Objective: Aim to investigate the association between several biomarkers, including serum C-reactive protein (CRP), Lactate Dehydrogenase, D-dimer, and serum ferritin, and COVID-19 severity. Methodology: The study was conducted during September 2020-Dec-2021 among Covid patients confirmed by RT-PCR and admitted to Government general hospital.LDH was estimated in semi-auto analyzer by UVkinetic method and serum Ferritin, CRP, D-dimer was estimated by Immunoturbidometric method. Results: Amongst 1200 SARS-CoV-2 patients, Elevated CRP levels were seen in 88 percent of patients, D-Dimer in 94 percent of patients, Ferritin in 83 percent of patients, LDH in 93 percentof patients. Discussion: Elevated serum CRP, D-dimer, and serum ferritin levels were associated withan increased poor outcome that comprises mortality, severe COVID-19, ARDS, and the need for ICU care in patients with COVID-19.

SELECTION OF OPTIMAL SURGERY IN THE TREATMENT OF CANCER OF THE DISTAL PARTS OF THE RECTUM

Despite the development of modern oncology, rectal cancer is a leader in morbidity andmortality. Effective treatment of rectal cancer is possible only with surgical treatment.Recently, more and more attention is paid to sphincter-preserving operations, whichallow to avoid colostomy, improving in addition to that the life quality of the patient andreturn to the usual social environment. However, after such operations, some patientshave complications, especially in the form of incontinence and feces, that significantlyaffects the life quality of patients.Carrying out a comparative analysis of the results of the surgical treatment of cancerof the distal part of the rectum after colostomy and sphincter-preserving surgery, willfacilitate the choice of optimal surgery for this oncological localization.The aim of the study - to determine the optimal colostomy or sphincter-preserving surgeryfor the treatment of the distal parts of the rectum cancer by examining the duration ofoperations, clinical features of the early postoperative period, as well as the life qualityof patients in the long terms.Material and methods. A retrospective analysis of 82 medical records of an inpatient witha diagnosis of cancer of the distal parts of the rectum, from 2017 to 2019.These medical cards, depending on the method of surgery were divided into two groups.The first group consisted of 23 people who underwent perineal extirpation of the rectumaccording to Kenyu Miles, the second group consisted of 59 patients who underwentabdominal and anal resection of the rectum with reduction of the sigmoid colon.Patients' quality of life was assessed within 1 year of surgery, during a follow-upexamination of patients, using the American Society of Colorectal Surgeons (ASCRS)questionnaire, which included the Cleveland Clinical Incontinence Scale.Statistical processing of the obtained research results was performed on a personalcomputer using Microsoft Excel spreadsheets, as well as IBM SPSS Statistics.Results. Summing up the results of the study, it should be noted that the patient's age doesnot affect the choice of surgery. The duration of abdominal-anal resection of the rectumwith reduction of the sigmoid colon is shorter and does not depend on the location of thetumor, but the duration of the early postoperative period does not differ.Excision of the excess intestine after abdominal-anal resection of the rectum with reductionof the sigmoid does not depend on the stage of the disease and is mostly performed on the12th day. The quality of the continent after sigmoid resection of the rectum improves withtime after surgery, to the end of one year term 40% of patients have good fecal retention,and the percentage of people with complete incontinence is likely decreases.Quality of life after Keny-Miles surgery improves faster, but over time, after abdominaland anal resection of the rectum with reduction of the sigmoid colon, the percentage ofpatients with mild impairment of the life quality becomes 4.3 times higher. This feature isexplained by the time required to adapt and restore the closing function of the preserved sphincter, where the quality of life directly depends on the quality of the continent.Conclusions:1. After Kenyu-Miles surgery, the quality of life of patients improves fasterthan after rectum with sigmoid reduction, but in due course (1 year), after the latter one,the number of people with mild impairment of quality of life becomes almost 2 timeshigher (p &lt;0, 01).2. In the treatment of distal rectal cancer, abdominal-anal resection of the rectum with asigmoid reduction should be preferred, but in patients with an unfavorable prognosis forlife expectancy, Kenyu-Miles surgery should be performed.

Insertional versus non-insertional tendoachilles tears: a comparative analysis of various predisposing factors and outcome following a repair.

Association of tendon degeneration, pre-existing posterior heel pain, Haglund's bump, retrocalcaneal spur, and mode of injury varies for the insertional and non-insertional type of tendoachilles tears(TA). The study compares the various predisposing factors that determine thedistinct type of TAtear and the outcome following a repair. This is a retrospective study of the patients who underwent tendoachilles repair during January 2012-June 2018. Patients above 18years with a minimum follow-up of twoyears were included. Patients with calcaneal tuberosity avulsions, prior surgeries, and open injuries were excluded. Patients were divided into groups 1 (insertional tears (IT)) and 2 (non-insertional tears (NIT)), and further subdivided based on the tendon degeneration (as D-degenerative and N-normal sub types) from ultrasound findings. AOFAS score and predisposing factors like degeneration, posterior heel pain, Haglund's bump, spur, and mechanism of injury were compared between the groups. The study included N = 146 with a mean age of 51.6years and mean follow-up of 38.6 (range 24 to 96) months. IT associated with degeneration (IT-D) had a trivial fall as the predominant mechanism (P < 0.001). All patients had significant postoperative improvement of scores with no significant difference between the groups (P = 0.59) and subgroups (P = 0.27).75.34% had degenerative tendon, of which 64.5% were in the IT group and the rest in the NIT group (P = 0.02). 51.4% patients had a Haglund bump in the IT group and n.s. (P = 0.9). Forty-seven percentof patients had pre-existing posterior heel pain, 68% in IT and 32% in NIT (P = 0.04). Subgroup analysis revealed 65% of patients were in the IT-D subgroup (P < 0.001). Predisposing factors like posterior heel pain, tendon degeneration, and trivial trauma have a strong propensity for insertional TAtear. In contrast, the prominence of Haglund's bump does not predispose to a distinct type of TA tears. The outcome following a surgical repair-yields good results with no difference between the two groups.

Management of acute kidney injury in frail patients with biopsy-proven cast nephropathy: a combined approach with chemotherapy plus Supra-hemodiafiltration with post-adsorption endogenous reinfusion.

Patients with multiple myeloma often have kidney involvement with acute kidney injury which is frequently due to cast nephropathy. Hemodiafiltration with endogenous reinfusion (HFR) allows removal from the circulation of significant amounts of free light chains (FLCs) responsible for tubular damage. Between 2014 and 2018, 13 patients affected bymultiple myeloma (64% λ chain and 36% k), including 10 caseswith biopsy-proven cast nephropathy, were treated with this technique. Each patient had high free light chains levelsat diagnosis: median 8586mg/l for λ and 4200mg/l for k, and stage III acute kidney injury (median serum creatinine 7.5mg/dl). We initially performed daily HFR-Supra sessions and then modulated them based on renal response (mean 10 sessions/patient). At the same time, the patients also received various chemotherapy regimens, depending on their hematological criteria. Forty-six percentof patients showed at least partialrenal functionrecovery within the third month, thus allowing dialysis discontinuation; 38% remained on dialysis. Two patients died. The mean reduction rate offree light chains at the end of the HFR-Supra cycle was 85% (k) and 40% (λ), respectively. Serum albumin remained stable during the whole treatment. In our experience, the synergistic effect of chemotherapy and HFR-Supra led to a recovery of renal function in 6 out of 13 patients presenting with severe dialysis-requiringacute kidney injury. HFR-Supraallowedstable albumin levels, withhigh free light chains removal rate, at arelatively low costs.

A Study of Iron Status in Pediatric Patients with large complex Vascular Malfomations

Abstract Background Complex vascular malformations involving the gastrointestinal tract (GIT) are expected to develop iron deficiency.However, the haemoglobin and iron status of vascular anomalies unrelated to GIT were not addressed. Our aim was to study the frequency of anemia and iron status among pediatric patients with large/complex vascular malformations without evident bleeding and to correlate the findings with the type, site, severity and extension of vascular malformationand treatment with sirolimus. Patients and method A case control study of participants with large complex vascular malformationregistered at Ain Shams University vascular anomalies clinic during the period from June 2019 to June 2020.They were compared to 20 age, sex and socioeconomic standard matched healthy controls. Clinical and laboratory studies for iron status were performed. Results fifty percentof patients were anemic versus 65% of the control group (p value = 0.33).As regards iron status of patients, 35% has combined iron deficiency versus 40% of controls, 20% has functional iron deficiency versus 20% of controls, 5% has absolute iron deficiency versus 10% of controls (p value = 0.90). There was no significant difference between patients receivingsirolimus and who are not as regards anemia and iron status (p value = 0.36, 0.84, respectively). Conclusion The frequency of anemia and it s iron related classification are comparable in children with large vascular malformations with no bleeding manifestations to normal children.

Impact and Modifications of In-Hospital Trauma Care Workflow Due to COVID 19 Pandemic: Lessons Learnt for the Future.

Objective:To describe the restructuring in-hospital systems of care at a Level -1 trauma center in India and to analyze an injury volume and patterns for future preparedness as well as to establish a specific injuries preventive measures during health emergencies like COVID-19.Methods:Data was extracted from a prospectively managed trauma registry at level-1 trauma center in India. We have compared the data in lockdown period with the same day’s number from the pre-lockdown period. Patients were categorized according to age, gender, injury cause, injury place, injury severity, and injury outcome to compare the statistical analysis between two periods.Results:Total emergency department (ED) trauma footfall decreased significantly by 73% during lockdown period. The injuries result increased significantly due to blunt forces. There was a significant decrease in the major injury of the patient’s percentage. The road traffic injuries (RTIs) in individuals were less than the reported falls number, which increased significantly during lockdown. The less number of patients significantly presented without receiving primary care. Majority of the patients had been transferred by using private cars, police vehicle, and two wheelers during lockdown; however, patients’ less number were transferred significantly by three wheelers as expected. The comparative analysis between quantitative data points shows significant differences in median Injury Severity Score (ISS) and length of stay during lockdown.Conclusion:This study highlighted that the preparedness should not focus solely on the response to treat infectious disease during health emergencies but also on ensuring access and provision of reasonable quality of care for non-infectious illnesses especially acute conditions like trauma.

Patient and radiographer acceptability of prophylactic skin care for breast patients receiving radiotherapy

IntroductionThis study aimed to:• Address the lack of information surrounding patient preference within radiotherapy skin care.• Identify if prophylactic skin care is the preferred approach of patients and staff.• Establish if patients and staff are accepting of the use of a type of barrier film, such as 3M™ Cavilon™ No Sting Barrier Film. MethodsTwelve patients undergoing standard whole breast radiotherapy and four staff members who were based mainly on a breast-specific treatment unit were interviewed using semi-structured techniques. The interview transcripts were coded for areas of interest and a thematic map generated using the qualitative data analysis software (NVivo V12, QSR International). ResultsOne Hundred percent of patients (n = 12) would have preferred a proactive approach to skin care management over the reactive one currently implemented. Staff were also in favour of a proactive approach to skin care with 100% (n = 4) supportive of a trial into the film's effectiveness.Three key themes were identified:• Theme 1: Patient Ownership of Own care – all patients identified they preferred a prophylactic approach and that more specific skin care guidance from healthcare professionals would be beneficial.• Theme 2: Product Practicality – 93% of patients and 100% of staff accepted the product and would be open to the use of it clinically.• Theme 3: Staff Acknowledgement of Skin Care – all staff identified a patient group in need of prophylaxis and that Cavilon No Sting may be a product of interest. ConclusionPatients and staff were in support of prophylactic skin care, both approved of the proposed product. However, there is a significant lack of clinical evidence to support the use of any topical products within radiotherapy skincare due to the lack of high-quality studies. Implications for practiceChanges to skin care practice could be considered due to patient preference in favour of proactive management.

Platelets in In-stent Restenosis: From Fundamental Role to Possible Prognostic Application.

Background Introduction of new generations of stents has decreased the percentage of patients experiencing in-stent restenosis (ISR) following the implantation of stent. However, a large number of patients are still afflicted with this phenomenon, which necessitates further study of ISR pathophysiology.Methods Relevant English literature was searched up to 2018 and retrieved form the PubMed database and Google Scholar search engine. The following keywords were used: “In-stent restenosis”, “Platelet”, “Chemokine”, “Inflammation”, “Vascular smooth muscle cell” and “Neointima”.Results Previous studies have shown that ISR is a pathophysiologic response to damage of the artery wall after its elongation and separation of the atherosclerotic plaque. Development of neointimal hyperplasia (NIH) following this pathophysiologic response is a function of inflammation caused by platelets, monocytes, macrophages, and lymphocytes, as well as rapid migration and proliferation of generally quiescent cells in the median layer of the artery wall.Conclusion After damage to the artery wall, platelets play an essential role in the incidence of NIH by contributing to inflammation and migration of vascular smooth muscle cells and extracellular matrix remodeling, especially via secretion of different chemokines; therefore, developing therapeutic strategies for platelet inhibition in a controlled manner could be the basis of preventive treatments in the near future. In this study, for the first time, we hypothesize that evaluation of platelet activity profile in patients before and after stent implantation may determine the prognosis and likelihood of ISR.