Previous History Research Articles

A rare case report of tyrosinemia type I

Tyrosinemia type I is a rare genetic disorder that occurs due to the deficiency of enzyme Fumarylacetoacetate hydrolase, resulting in elevated levels of tyrosine in the bloodstream. This case study focuses on a 4-year-old boy with a previous medical history of tyrosinemia type I, who has been admitted to the hospital multiple times due to this condition. The objective of presenting this case is to bring awareness regarding the challenges encountered while managing tyrosinemia, specifically medication adherence and dietary restrictions, which play a crucial role. This case report intends to provide education to medical professionals, healthcare advisors, family members, and caregivers about the rare and severe nature of tyrosinemia type I, while emphasising the importance of implementing an appropriate treatment strategy along with dietary modifications.

IntraCranial pressure prediction AlgoRithm using machinE learning (I-CARE): Training and Validation Study.

Elevated intracranial pressure (ICP) is a potentially devastating complication of neurologic injury. Developing an ICP prediction algorithm to help the clinician adjust treatments and potentially prevent elevated ICP episodes. Retrospective study. Three hundred thirty-five ICUs at 208 hospitals in the United States. Adults patients from the electronic ICU (eICU) Collaborative Research Database was used to train an ensemble machine learning model to predict the ICP 30 minutes in the future. Predictive performance was evaluated using a left-out test dataset and externally evaluated on the Medical Information Mart for Intensive Care-III (MIMIC-III) Matched Waveform Database. None. Predictors included age, assigned sex, laboratories, medications and infusions, input/output, Glasgow Coma Scale (GCS) components, and time-series vitals (heart rate, ICP, mean arterial pressure, respiratory rate, and temperature). Each patient ICU stay was divided into successive 95-minute timeblocks. For each timeblock, the model was trained on nontime-varying covariates as well as on 12 observations of time-varying covariates at 5-minute intervals and asked to predict the 5-minute median ICP 30 minutes after the last observed ICP value. Data from 931 patients with ICP monitoring in the eICU dataset were extracted (46,207 timeblocks). The root mean squared error was 4.51 mm Hg in the eICU test set and 3.56 mm Hg in the MIMIC-III dataset. The most important variables driving ICP prediction were previous ICP history, patients' temperature, weight, serum creatinine, age, GCS, and hemodynamic parameters. IntraCranial pressure prediction AlgoRithm using machinE learning, an ensemble machine learning model, trained to predict the ICP of a patient 30 minutes in the future based on baseline characteristics and vitals data from the past hour showed promising predictive performance including in an external validation dataset.

Osteonecrosis of the Femoral Head: Another Legacy of COVID-19?

Background. Recovery from COVID-19 does not always proceed without complications, especially in patients who have suffered severe forms of the disease. Most researchers confirm a significant increase in the incidence of osteonecrosis of the femoral head (ONFH) after COVID-19. However, there is no clear opinion on the individual aspects of the development and course of the disease. This is an extremely important issue that allows us to identify the main risk groups for the development of post-COVID-19 osteonecrosis and, consequently, to perform the earliest possible screening of this complication.
 Aims of the study: 1) To evaluate the impact of the past COVID-19 on epidemiologic parameters and clinical course of osteonecrosis of the femoral head in patients; 2) to study the causes of its development.
 Methods. We have analyzed the data of medical histories of 674 patients diagnosed with osteonecrosis of the femoral head who sought medical care in 2018 and in 2022. Patients were divided into 4 groups according to the presumed causes of development of the disease. The first group enrolled 183 patients who underwent COVID-19 and received steroid therapy (ST). The second group included 78 patients who underwent COVID-19 without ST therapy. The third group consisted of 103 patients with ONFH that manifested in 2022 without COVID-19 in the previous medical history. The comparison group was made up of 310 patients who developed ONFH in 2018 before the appearance of the SARS-CoV-2 virus.
 Results. The sample of patients with COVID-19-associated osteonecrosis differed significantly from patients without COVID-19, in terms of gender, age, time of disease onset, extent of the femoral head damage, and disease progression rate (p0.001). The level of early ONFH diagnosis was extremely low, not differing from that in the pre-pandemic period.
 Conclusion. The COVID-19 pandemic has increased the incidence of ONFH, significantly modifying both its epidemiology and clinical picture. Nevertheless, the vigilance of practitioners remains extremely low, which affects the timely diagnosis of the disease.

A case report on the simultaneous occurrence of cancer in The Tongue and Breast

Squamous cell carcinoma (SCC) affecting the tongue commonly emerges along its lateral border, yet occurrences specifically on the dorsum, especially at the midline, are notably rare. This study delves into the incidence rates of SCC localized on the tongue, alongside an investigation into simultaneous lesions of the breast. 50-year-old female presented with an ulcerative growth on the left side of the tongue, accompanied by speech difficulty and chewing discomfort persisting for a month. Previous history included breast surgery five years prior, along with ongoing diabetes medication. No history of habits, trauma, or prior ulcer formation was reported. Clinical examination revealed a whitish-yellow, firm, ulcerative lesion extending on the left lateral tongue surface, measuring 7.2x3.1x2.5cm with an exophytic growth of 4.7x2.1cm. The lesion, extending to the dorsal tongue surface, displayed erythematous flooring interspersed with slough and pale mucosa. Limited tongue movement and palpable submandibular nodes were noted. Initial diagnostic findings indicated stage IV metastatic carcinoma of the tongue (T4aN2M1). pathology revealed severe epithelial dysplasia with an invasive pattern in the form of islands, demonstrating altered cellular features, pleomorphism, inflammatory infiltrate, vascularity, and areas of hemorrhage. Lymph nodal analysis showed metastatic deposits in one of three left level II B lymph nodes.

Pre-consultation history taking systems and their impact on modern practices: Advantages and limitations

The practice of gathering a patient's medical history has been a cornerstone of healthcare for centuries, providing the foundation for accurate diagnoses and effective treatment plans. However, traditional face-to-face consultations have limitations, including incomplete histories due to time constraints and potential communication barriers. To address these challenges, pre-consultation history taking systems emerged as a transformative solution, leveraging technology to optimize data collection and patient engagement. This review article explores the evolution, benefits, limitations, and impact of pre-consultation history taking systems on modern healthcare practices. These systems enable patients to respond to questionnaires or surveys before their scheduled appointments, empowering them to provide comprehensive medical histories at their own pace. Consequently, healthcare providers gain deeper insights into patients' health status, previous medical conditions, family history, lifestyle choices, and medication history. The significance of pre-consultation history taking lies in its potential to improve the quality of healthcare services. By obtaining more detailed and accurate medical histories before appointments, healthcare providers can optimize consultation time, enabling them to focus on addressing specific concerns and making informed decisions. Furthermore, patient engagement is enhanced, fostering a sense of collaboration between patients and healthcare professionals. Despite the advantages, the article addresses certain limitations, such as the digital divide and data accuracy concerns. Ensuring accessibility for all patient populations and maintaining robust data security measures are essential considerations. However, as technology continues to advance, pre-consultation history taking holds the promise of transforming the healthcare landscape and improving patient outcomes.

Comparative observational study between Atorvastatin and Rosuvastatin based on HbA1c levels of patients diagnosed with acute coronary syndrome and heart failure

Background: Our study aims to compare HbA1c levels in hospitalized acute coronary syndrome and heart failure patients treated with atorvastatin versus rosuvastatin Methods: This is a retrospective, prospective observational study in which the study population includes ACS and HF Hospitalized patients, the study subjects are divided based on patients prescribed with Atorvastatin and Rosuvastatin based on the medication chart, and those patients' previous history of statin use is collected from history chart, patient case notes, doctors notes, laboratory data is collected and documented in data collection form, lab data includes HbA1c, finally compared Atorvastatin and Rosuvastatin using excel and JASP descriptive analysis. Results: Overall, we collected data for 132 cases, of which 55% are males and 45% females, 59.10% are above 61 years of age, 39.39% are diagnosed with ACS and 23.48% are diagnosed with HF, among 67 patients who are using Atorvastatin, there was a significant mean decrease in HbA1c% from 8.359% to 7.901%, and among 65 Rosuvastatin users there was an increase in mean HbA1c% from 8.386% to 8.389%. Additionally for non-diabetic individuals, there was an increase in Hba1c% from 6.339% to 6.387%. Conclusions: We concluded that Atorvastatin is a more effective statin than Rosuvastatin which will reduce the risk of new-onset Diabetes Mellitus in non- diabetic individuals and reduce the risk of increasing complications of diabetes mellitus in patients who are Diabetic.

Endometrioid type adenocarcinoma in situ as a potential precursor lesion for extremely rare invasive endometrioid type adenocarcinoma of the cervix

HPV-independent in situ adenocarcinomas have been only recently added to the WHO 2020 classification. To date, little information has been published about HPVindependent precursor lesions. In particular, regardiong the extremely rare cervical endometrioid type adenocarcinoma thought to arise in the setting of cervical endometriosis, a premalignant lesion is still not well defined. In this short communication we describe a possible precursor to invasive cervical endometrioid type adenocarcinoma in a 39-yr-old patient, with a previous history of breast cancer.

Association between circadian physical activity patterns and cancer incidence through regulation of inflammation: A UK biobank study

BackgroundPhysical activity (PA) has been linked with cancer incidence. However, the effects and mechanisms underpinning circadian PA trajectories on cancer remain elusive. This study aimed to explore the optimal PA patterns in reducing cancer incidence and the associated potential mediators. MethodsBetween 2006 and 2010, 502,400 participants were recruited from the UK Biobank. Out of these, 102,323 participants wore accelerometers, which allowed for collecting acceleration data continuously over 7 days. After excluding participants with previous cancer history, 96,687 participants were included in K-means cluster analysis to identify PA trajectories. The association between PA and cancer incidence was assessed using Cox regression analysis. Additionally, we investigated the mediating role of inflammation. ResultsA total of 5995 cancer cases were recorded during a median follow-up of 7.1 years. Four distinct PA trajectories (persistent low, single peak, double peak, and vigorous) were identified. The ideal PA patterns reduced the risk of 7 out of 17 site-specific cancers, with the lowest hazard ratios and 95% confidence intervals of cancer for bladder (0.59, 0.40–0.86), breast (0.73, 0.60–0.89), kidney (0.45, 0.26–0.78), lung (0.59, 0.41–0.84), myeloma (0.49, 0.27–0.88), and oral & pharynx (0.51, 0.26–0.98) in the vigorous pattern and for colorectal (0.71, 0.54–0.93) in the double peak pattern. Moreover, the mediating effects of inflammation were significant. ConclusionOptimal PA trajectories reduced cancer incidence, especially in double peak and vigorous patterns. The protective effect was associated with both intensity and circadian rhythm. Crucially, this protection was mediated by inflammation regulation.

Association between cigarette smoking and Acne Vulgaris

Acne is a disease involving pilosebaceous unit commonly affecting adolescents. Acne has a multifactorial aetiology but in recent years, studies have shed some light in the relationship between cigarette smoking and acne. As previous studies linking cigarette smoking and acne had produced conflicting results, we conducted this study to provide comprehensive information of cigarette smoking and its association with acne in Nepalese population. The study comprised all participants who met the inclusion criteria as well as a control group that was age and sex matched. The demographic profile, smoking history, previous history, drug history, and examination results were entered into a pre-set proforma. There were a total of 100 cases of acne patients (Group A) with age and sex-matched 100 controls (Group B). There were 69% females and 31% males. The majority of the acne patients (Group A) were students in 65%, as compared to 42% in control group. In group A, 95% never smoked and 5% were smokers (cigarettes). In group B, 98% never smoked and 2% were smokers (cigarettes). The commonest site of acne lesions was in face 64. Among the acne patients there were 27% mild acne, 58% moderate acne and 15% severe acne. There was no association found between cigarette smoking and acne (OR- 2.57, 95% CI -0.4884 to 13.6173, P>0.05). There was no correlation between acne and smoking in Nepalese population. However, a larger sample size is recommended to confirm the correlation.

Üreterde Cut-off İşareti

Obstructive uropathy occurs due to common causes such as kidney stones, vesicoureteral reflux, posterior urethral valve and urothelial tumors. In addition, there are rare causes such as solid tumors, retroperitoneal fibrosis, primary lymphomas (Non-Hodgkin lymphomas etc.). A 20-year old male with lower back pain underwent a bone scan for differential diagnosis of back pain. The bone scan findings were normal, except for the presence of unilateral renal stasis accompanied by a short segment ureteral stasis. Due to the abrupt termination of the ureteral activity, namely the “cutoff sign”, a subsequent SPECT/CT imaging was focused for differential diagnosis of ureteral stasis. Non-diagnostic CT sections revealed a para-aortic soft tissue mass compressing the ureter. This case underlines the added value of SPECT/CT imaging in subtle scintigraphic findings. The abrupt termination of stasis in the ureter may warrant the application of SPECT/CT in cases with no previous history of urinary tract pathology. SPECT / CT may provide additional benefits of clarifying the etiology.

Scabies prevalence and its associated factors among prisoners in southern Ethiopia: An institution-based analytical cross-sectional study.

Scabies is an ectoparasitic infestation that can easily spread during close human contact and in overcrowded areas such as prisons and public places where sanitation is a problem. Globally, as many as 300 million people are infested with scabies each year. Within Ethiopia, its burden in institutions like prisons is not well-studied. As a consequence, we sought to estimate the prevalence of scabies and also identify factors associated with it among prison inmates in southern Ethiopia. An institution-based analytical cross-sectional study design was employed. We used, a simple random sampling technique to select 422 prisoners. A pretested-structured questionnaire was used to collect the necessary information. EpiData version 4.2.0.0 and Statistical Packages for Social Science version 25 software were used for data entry and analysis respectively. Both descriptive and inferential statistics were computed. The model fitness was checked using the Hosmer-Lemeshow and omnibus tests. The association between the independent and outcome variables was presented in the form of a table showing the crude odds ratio and adjusted odds ratio (AOR) along with their 95% confidence interval (CI). The level of statistical significance was declared at P.value ≤ 0.05. A total of 418 prisoners were interviewed, yielding a 99.1% response rate. The age of the participants ranged from 17 to 60 years. As many as 381 (91.1%) participants were male. The prevalence of scabies was found to be 8.9%. A history of sexual contact in the past two months, before imprisonment (AOR: 9.92 (95% CI 3.07, 32.02), P <0.001), a period of stay less than two months duration in the prison (AOR: 4.54 (95% CI 1.51, 13.54), P = 0.007), poor ventilation (AOR: 3.36 (95% CI 1.07, 10.58), P = 0.038), lack of hygiene soap (AOR: 5.53 (95% CI 1.45, 21.17), P = 0.012), and sharing clothes among each other (AOR: 3.81 (95% CI (1.09, 13.29), P = 0.036) were factors independently associated with a scabies infestation. In this study, we found the prevalence of scabies was high among prison inmates in Wolaita Zone prison. Furthermore, scabies infestations were associated with a previous history of sexual contact, poorly ventilated rooms, lack of hygiene soaps for washing, and sharing clothes amongst the inmates. Prison administrations should be encouraged to improve sanitary and screening and isolation of prisoners during imprisonment.

Efficacy and safety of extended duration letermovir prophylaxis in recipients of haematopoietic stem-cell transplantation at risk of cytomegalovirus infection: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial

In a pivotal phase 3 trial of cytomegalovirus prophylaxis with letermovir for up to 100 days after allogeneic haematopoietic stem-cell transplantation (HSCT), 12% of participants developed clinically significant cytomegalovirus infection after letermovir was discontinued. We aimed to evaluate the efficacy and safety of extending the duration of letermovir prophylaxis for clinically significant cytomegalovirus infection from 100 days to 200 days following HSCT. We conducted a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial at 32 sites in six countries (France, Germany, Italy, Japan, the UK, and the USA). Cytomegalovirus‑seropositive HSCT recipients (aged ≥18 years) who had received letermovir prophylaxis for up to 100 days following HSCT and who remained at high risk of late clinically significant cytomegalovirus infection (with no previous history of clinically significant cytomegalovirus infection, defined as initiation of pre-emptive therapy for documented cytomegalovirus viraemia, onset of cytomegalovirus end-organ disease, or both) were eligible. Participants were randomly assigned (2:1) to receive either an additional 100 days (ie, a total of 200 days; letermovir group) of oral or intravenous letermovir 480 mg once daily, adjusted to 240 mg once daily for participants on cyclosporin A, or 100 days of a placebo comparator for letermovir (ie, a total of 100 days of letermovir; placebo group), following HSCT. Randomisation was done using a central interactive response technology system, stratified by study centre and haploidentical donor (yes or no). Participants, investigators, and sponsor personnel were masked to the treatment allocation. The primary efficacy endpoint was the proportion of participants from randomisation to week 28 (200 days after HSCT) with clinically significant cytomegalovirus infection, analysed using the full analysis set population (ie, those who received at least one dose of study intervention). Safety was analysed in all participants as treated (ie, those who received at least one dose according to the study intervention they were assigned to). This study is registered with ClinicalTrials.gov, NCT03930615, and is complete. Between June 21, 2019, and March 16, 2022, 255 patients were screened for eligibility and 220 (86%) were randomly assigned (145 [66%] in the letermovir group and 75 [34%] in the placebo group). Between randomisation and week 28, four (3%) of 144 participants in the letermovir group and 14 (19%) of 74 in the placebo group developed clinically significant cytomegalovirus infection (treatment difference -16·1% [95% CI -25·8 to -6·5]; p=0·0005). The most common adverse events among participants in the letermovir group versus the placebo group were graft-versus-host disease (43 [30%] vs 23 [31%]), diarrhoea (17 [12%] vs nine [12%]), nausea (16 [11%] vs 13 [18%]), pyrexia (13 [9%] vs nine [12%]), and decreased appetite (six [4%] vs nine [12%]). The most frequently reported serious adverse events were recurrent acute myeloid leukaemia (six [4%] vs none) and pneumonia (three [2%] vs two [3%]). No deaths were considered to be drug-related by the investigator. Extending the duration of letermovir prophylaxis to 200 days following HSCT is efficacious and safe in reducing the incidence of late clinically significant cytomegalovirus infection in patients at risk. Merck Sharp & Dohme LLC.

Acute Corneal Melting Induced by the Concomitant Use of a Non-steroidal Anti-inflammatory Agent with an Antiseptic Eye Drop.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly employed perioperatively to reduce intraoperative prostaglandin release, diminishing pain, preventing miosis, modulating postoperative inflammation, and reducing the incidence of cystoid macular edema (CME). A 70-year-old female patient without previous history of ocular or systemic disease was urgently referred to our hospital because of a sudden corneal perforation concerning her left eye (OS). The patient had instilled bromfenac eye drops and antiseptic eye drops twice and four times daily, respectively, for 2days only, in preparation of scheduled cataract surgery. Slit-lamp examination revealed diffuse inferior corneal melting with a 1 × 2 mm area of full-thickness perforation and a very shallow anterior chamber. Both topical agents were immediately discontinued. Cyanoacrylate glue was applied to seal the perforation and a bandage contact lens was applied together with a topical antibiotic given hourly. Two hours later, the anterior chamber started to reform. The following day, the anterior chamber was fully reformed with a negative Seidel test. At her next follow-up appointment, 1month later, the glue was detached and the cornea was seen to have successfully healed with only some corneal thinning remaining inferiorly. Perioperative use of topical NSAIDs in combination with antiseptic eye drops may rarely elicit corneal perforation in certain susceptible elderly individuals. Their use should therefore be carefully monitored.

Musculoskeletal, Functional and Performance Impairment in Female Overhead Athletes with a Previous Shoulder Injury.

Shoulder injuries are substantial problems in overhead athletes, and more studies are necessary to deepen the knowledge on this type of injury. The objective of this study was to compare the overall function and performance of female overhead athletes with and without a previous history of shoulder injuries. In this cross-sectional study, female overhead athletes with and without a previous shoulder injury were included. Muscular impairment, the stability of the shoulder, strength, scapular dyskinesia, functionality and sports performance were evaluated. A total of 50 females were included. There were significant differences in strength (p = 0.046) and stability (p = 0.039) between groups, with a poorer score in the group with a history of shoulder injury. Regarding scapular dyskinesia, significant differences were also observed between groups (p = 0.048), with higher levels of dyskinesia in the group with previous shoulder injury. Also, muscular impairment showed significant differences between groups for the three muscles evaluated (p < 0.005). Additionally, the group without a previous shoulder injury presented with a significantly greater score in functionality (p = 0.046) and sports performance (p = 0.004). In conclusion, previous shoulder injuries are an important factor to take into account in female overhead athletes. Players with a history of shoulder injury present clinical impairments during the game, leading to poorer functional status and performance in sport.

Ondansetron in the Prevention of Post Cardiotomy Delirium after Coronary Artery Bypass Grafting Surgery

Objective: To determine the efficacy of Ondansetron as a prophylctic agent in patients undergoing Coronary Artery Bypass Grafting. Study Design: Quasi-experimental study. Place and Duration of study: Adult Cardiac Surgery Department, AFIC/NIHD Rawalpindi Pakistan, from Nov 2022 to Feb 2023. Methodology: A total of 156 patients undergoing Coronary Artery Bypass Grafting Surgery irrespective of age and gender were included in the study via nonprobability consecutive sampling. Patients who had a previous history of psychiatric illness, and those in whom delirium could not be reliably tested were excluded from the study. The study population was divided into two groups (group A and group B). Those in the group A received 8mg Ondansetron intravenously on zero, first and second post-operative day. Group B did not receive any intervention. Descriptive statistics were used to measure percentages, frequencies and Mean±SD. Comparison between variables was made by Chi-square test for categorical variables and t-test for continuous variables. p&lt;0.05 was considered statistically significant. Results: Total 156 patients were included in the study and mean age of the patients was 59.47±10.98 years. A total of 3(14.3%) patients who had been given Ondansetron compared to 18(85.7%) patients who were not given Ondansetron developed delirium (p&lt;0.001). Other factors significantly associated with post cardiotomy delirium were age (p&lt;0.001), hypertension (p&lt;0.001), and diabetes (p=0.03). Conclusion: Our study revealed that Ondansetron can be used effectively to reduce the incidence of post cardiotomy delirium in patients of coronary artery bypass grafting.

Cancer-Chemotherapy-Related Regimen Checks Performed by Pharmacists of General Hospitals Other than Cancer Treatment Collaborative Base Hospitals: A Multicenter, Prospective Survey.

Although prescription review is an important role for pharmacists in anticancer drug therapy, there are no guidelines in Japan that specify what pharmacists should check for in chemotherapy regimens. This prospective multicenter survey aimed to investigate the implementation of chemotherapy regimen checks by pharmacists in general hospitals by focusing on 19 recommended confirmation items designed to enhance chemotherapy safety. This study involved 14 hospitals within the National Hospital Organization in different regions of Japan. The top five cancers in Japan (gastric, colorectal, lung, breast, and gynecological) were targeted and specific chemotherapy regimens were analyzed. This study assessed the amount of time required for regimen checks, the number of confirmation items completed, the number and the content of inquiries raised regarding prescriptions, and the pharmacists' opinions using a questionnaire that had a maximum score of 10 points. Pharmacists checked 345 and 375 chemotherapies of patients in the control group (CG) and recommended items group (RIG), respectively. The mean time periods required for completing a chemotherapy regimen check were 4 min and 14 s (SD ±1 min and 50 s) and 6 min and 18 s (SD, ±1 min and 7 s) in the CG and RIG, respectively. The mean of the recommended items for the CG = 12.4 and for the RIG = 18.6. The items that the pharmacists did not confirm included urine protein (sixty-nine cases, 18.4%), allergy history (four cases, 1%), previous history (two cases, 0.5%), and a previous history of hepatitis B virus (sixty-nine cases, 18.4%). The number of inquiries for a doctor's prescription order was higher in the RIG than in the CG (41 vs. 27 cases). This multicenter survey demonstrated the potential effectiveness of implementing 19 recommended confirmation items in the regimen checks by pharmacists in general hospitals other than cancer treatment collaborative base hospitals.

Humoral immune response in people living with HIV after administration of SARS-CoV-2 vaccine CoronaVac or BNT162b2 or CoronaVac/BNT162b2 booster sequence: A cross-sectional study

BackgroundThe evidence of SARS-CoV-2 vaccine effectiveness in people living with HIV (PLWH) is limited. This study evaluated the humoral immune response to CoronaVac™ (virus inactivated) and BNT162b2 (mRNA- based) vaccines in PLWH and HIV-negative controls, with and without a booster sequence. MethodsWe conducted a cross-sectional study on PLWH and HIV-negative controls who received CoronaVac or BNT162b2, with a subgroup receiving a CoronaVac/BNT162b2 booster. Blood samples were collected 4–6 months after primary vaccination and tested for anti-SARS-CoV-2 protein S (aSAb) and neutralizing antibodies (NtAb) using validated assays. Immune response was evaluated by age, sex, previous COVID-19 history, and CD4 + cell count. FindingsOne hundred and eighty nine participants were enrolled with 161 (85%) being PLWH. Among participants without previous known COVID-19, median aSAb levels were significantly lower in PLWH who received CoronaVac compared to BNT162b2 (32 U/mL vs. 587 U/mL, p < 0.001), with similar results in HIV-negative controls. NtAb presence was also significantly lower after CoronaVac compared to BNT162b2 (30% vs. 93%, p < 0.001). The booster sequence group showed a significant increase in aSAb titers in both PLWH and HIV-negative controls (from 33 U/ml to 2500 U/ml, p < 0.001), and NtAb positivity increased from 20% to 95 % in PLWH, and 27% to 100% in HIV-negative controls. Prior COVID-19 led to significantly higher post-vaccine antibody titers particularly in the BNT162b2 group. PLWH with CD4 + count < 200 cells/mL showed a weaker immune response to both vaccines. InterpretationCoronaVac resulted in a weaker immune response in both PLWH and HIV-negative controls compared to BNT162b2, particularly in immunosuppressed PLWH without prior COVID-19. Hybrid immunity and heterologous booster vaccination increased antibody levels. FundingLocal funding.

Indications and Complications of Emergency Hemodialysis Among Patients with Acute Kidney Injury Admitted in Hemodialysis Center at Bahri Teaching Hospital, Khartoum State, Sudan 2021 - 2022

BACKGROUND: AKI is defined as abrupt decline in renal functions either due to structural damage or loss of function , associated with poor clinical outcomes for hospitalized patients. In the context of Sudan, highlighting the most common indications and complications that may occur during emergency hemodialysis and describing their presentation , may offer measures to minimize them by provide specific interventions to prevent the consequences when such emergencies arise. AIMS: To study the indications, and complications of emergency haemodialysis among patients admitted in haemodialysis center at Bahry teaching hospital, Khartoum state, Sudan . The study also aimed to describes the pattern of presentation in term of symptoms and signs reported among patients. METHODS: It’s an observational descriptive cross sectional, hospital based study that was conducted at the renal haemodialysis center within the period from September 2021 to October 2022 and covered 149 patients with AKI who underwent emergency hemodialysis,this sample size was calculated using Epi calculator and then adjusted using the hospital records that described the frequency of admission of patients with AKI in the preceding 6 months and excluded obstetric AKI . Data was collected, prepared, entered and analyzed using SPSS version 25.0 in term of descriptive statistics and Bi-variable analysis to determine the associations between some relevant factors (demographic characteristics, indications and complications) with the occurrence of complications using Chi square test (for categorical variables) and t-test (quantitative variables). RESULTS: This study covered 149 participants. Nearly half of them 40.9% of the study participants were in the age group 30-60 years with male: female ratio of 2.3:1 and 44 % of the participants had co morbid illnesses with diabetes , hypertension and liver disease being the most common. Regarding the history of renal disease only 4.7 % had previous history and 10% had family history of renal disease .The most common indication for emergency haemodialysis was uremia 44%, followed by fluid overload that cannot be managed by diuretics 30%,worsening sever metabolic acidosis 10% and refractory hyperkalemia 4.7 % . Complications on the other hand occurred among 20% of the patients such as hypotension 8.7%, and hypoglycaemia 8.7%. There was significant association between certain social habits like smoking , middle age group as well as past history of renal disease with the development of complications (p value = 0.01 , 0.005 and 0.05 respectively). CONCLUSION: nearly half of the study participants were in the age group 30-60 years old with male: female ratio of 2.3:1. The most common indication for emergency haemodialysis was uremic gastropathy followed by Volume overload . Complications occurred among 20% of the participants such as hypotension and hypoglycaemia. Recommendation, Training of health care provider on how to deal with patient with AKI and when to include nephrologist in management to avoid dialysis and training of dialysis staff on early recognition and management of complication.

Risk of malignancy in incidental oropharyngeal lesions exhibiting fluorodeoxyglucose uptake which proceed to tissue biopsy.

Utilization of positron emission tomography/computed tomography (PET/CT) with fluorodeoxyglucose is increasing in use for a variety of indications, including surveillance of cancer patients. There is a paucity of evidence pertaining to the significance of incidental PET-avid oropharyngeal lesions. This study aims to examine the clinical and radiological features of these incidental oropharyngeal lesions in patients undergoing PET for indications other than head and neck cancer. Retrospective cohort study of three Australian tertiary hospitals, from 2015 to 2021, on adult patients undergoing biopsy of incidental PET-avid oropharyngeal lesions. Primary outcome of interest was the incidence of malignancy. Patients with a previous history of, or undergoing investigations for, head and neck cancer were excluded. Thirty-one patients were included, wherein 21 patients had tonsillar uptake, and 13 patients had base of tongue uptake. Tonsillar disease was mostly asymmetrical (n = 15/21), bilateral (n = 11/21), and had median SUVmax 9.35 (n = 12, IQR 7.4-11.15). Base of tongue was mostly asymmetrical (n = 7/13, 54%), bilateral (n = 8/13, 62%), and had median SUVmax 8.2 (n = 10, IQR 6.9-12.65). Seven patients had malignancy confirmed on tissue biopsy: five biopsies confirmed the tissue diagnosis of suspected lymphoma, and two incidental findings of unexpected malignancies: one p16 positive tonsillar squamous cell carcinoma, and one metastatic breast cancer. In 31 patients undergoing tissue biopsy for incidental PET-avid oropharyngeal lesions, there were two unexpected malignancies. Our study results indicate that although unexpected malignancies are uncommon, a malignant diagnosis cannot be excluded from clinical features alone.

Risk Factors of Roundhouse Kick Wushu Injury: Systematic Review and Meta-Analysis

The roundhouse kick is a basic kicking technique in martial arts which is very important in achieving victory. The roundhouse kick is a simple move, easier, faster and more powerful than any other foot action that is also easy to use for attack and for defence, therefore it is the move most used. The aim of this study was to identify and critically assess the evidence relating to risk factors for roundhouse kick injuries. A systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) framework. Articles were searched using Scopus, Google Scholar and PubMed. The results of the selected articles revealed that risk factors for injury in roundhouse kick wushu, namely competition experience, technique, history of previous injuries, age, overuse, physical fitness, warm-up and stretching. All risk factors for injury due to competition experience, technique, previous injury history, age, overuse, physical fitness, warm-up and stretching are things to consider. History of previous injuries is the most important factor that can cause injury. Handling and care need to be done optimally to minimize the occurrence of injuries or recurrence of old injuries. In addition, physical fitness, warming up and stretching also really need to be considered before doing sports activities, especially doing roundhouse kick wushu movements to reduce the risk of injury. All risk factors for injury due to competition experience, technique, previous injury history, age, overuse, physical fitness, warm-up and stretching are things to consider. History of previous injuries is the most important factor that can cause injury. Handling and care need to be done optimally to minimize the occurrence of injuries or recurrence of old injuries. In addition, physical fitness, warming up and stretching also really need to be considered before doing sports activities, especially doing roundhouse kick wushu movements to reduce the risk of injury. All risk factors for injury due to competition experience, technique, previous injury history, age, overuse, physical fitness, warm-up and stretching are things to consider. History of previous injuries is the most important factor that can cause injury. Handling and care need to be done optimally to minimize the occurrence of injuries or recurrence of old injuries. In addition, physical fitness, warming up and stretching also really need to be considered before doing sports activities, especially doing roundhouse kick wushu movements to reduce the risk of injury. History of previous injuries is the most important factor that can cause injury. Handling and care need to be done optimally to minimize the occurrence of injuries or recurrence of old injuries. In addition, physical fitness, warming up and stretching also really need to be considered before doing sports activities, especially doing roundhouse kick wushu movements to reduce the risk of injury. History of previous injuries is the most important factor that can cause injury. Handling and care need to be done optimally to minimize the occurrence of injuries or recurrence of old injuries. In addition, physical fitness, warming up and stretching also really need to be considered before doing sports activities, especially doing roundhouse kick wushu movements to reduce the risk of injury.