Profile Outcomes Research Articles

BHSo4 Improving the quality of parastomal hernia care through a dedicated clinic

Abstract Parastomal hernia (PSH) affects more than 50% of ostomates, but are frequently managed conservatively. The majority of colorectal surgeons do fewer than 3 PSH repairs annually and very few would declare a specialist interest in them. In May 2022, we set up a dedicated monthly clinic for the assessment and management of PSH. Patients selected by our stomacare team are seen by two surgeons with a declared PSH interest. The purpose was to concentrate expertise and provide MDT decisions in clinic. From February 2023, 27 patients reported symptoms using the Measure Yourself Medical Outcome Profile (MYMOP2). Since inception we have seen 78 new referrals (35 male, mean age 63), with the majority of stomas being end colostomies (50%). 50% had a tobacco use history with 18% being current smokers. 56% were obese (BMI > 30) with 24% being morbidly obese (BMI > 35). 45% (13% recurrent) presented with early, symptomatic, PSH (EHS grade 1), and 31% had concomitant midline hernias (EHS grades 2 & 4). MYMOP2 scores showed pain & discomfort as the most frequent symptom. Over 2 years, 27% have been listed for surgery with 7 undergoing repair. 7% were discharged after initial assessment with 6% after one follow up. 50% have been managed conservatively and 3 died after referral. Since this clinic was set up no other surgeons are performing PSH repair with all new cases referred to it. Dedicated PSH clinics concentrate expertise, provide excellent multidisciplinary team working and identify PSH symptoms early allowing consideration of effective early repair.

Good Equivalence Between Electronic and Paper Versions of the Measure Yourself Medical Outcome Profile 2 and the Measure Yourself Concerns and Wellbeing: A Mixed Methods Study

Good Equivalence Between Electronic and Paper Versions of the Measure Yourself Medical Outcome Profile 2 and the Measure Yourself Concerns and Wellbeing: A Mixed Methods Study

Diffusion changes in minimally invasive parafascicular approach for deep-seated tumours: impact on clinical outcomes.

Minimally invasive parafascicular surgery (MIPS) with the use of tubular retractors achieve a safe resection in deep seated tumours. Diffusion changes noted on postoperative imaging; the significance and clinical correlation of this remains poorly understood. Single centre retrospective cohort study of neuro-oncology patients undergoing MIPS. The impact of surgical approach-transsulcal (TS) versus transgyral (TG) - and respective entry points in clinical and imaging outcomes was assessed. 82 patients (35 male; 47 female, average age 43.94 ± 22.85years) were included. 84% presented with neurological deficit and glioblastoma was the commonest diagnosis (38.24%). Surgical approach was not relevant for the number of patients that showed postoperative peritubular injury (TS: 20 (37.74%) versus TG: 8 (27.59%), p = 0.354) or its volume (TS: 0.95 ± 1.82cc versus TG: 0.43 ± 1.32cc, p = 0.1435). When adjusted for preoperative volume and depth of tumour, TS approach was associated with less diffusion restriction (p = 0.030). Temporal lobe access points had the highest volume of diffusion restriction (temporal lobe-2.50 ± 3.54cc versus frontal lobe - 1.15 ± 1.53 versus parietal lobe-0.51 ± 0.91cc, p = 0.0096), particularly in the TS approach (p = 0.0152). Superior motor outcomes were demonstrated in the TS versus the TG approach (postoperative improvement: TS: 14.63% versus TG: 6.9%, p = 0.015), especially for parietal approaches (p = 0.039). TS approach was related with a significantly decreased length of stay (TS-11.67 ± 14.19days versus TG - 23.97 ± 18.01days, p = 0.001). Transsulcal approach demonstrated abetter motor outcome profile, particularly in parietal lobe, and shorter length of stay. The superior temporal sulcus was more susceptible to ischaemic changes. Therefore, transgyral route can be considered in temporal lobe MIPS.

Presurgical anxiety and acute postsurgical pain predict worse chronic pain profiles after total knee/hip arthroplasty.

Total joint arthroplasties generally achieve good outcomes, but chronic pain and disability are a significant burden after these interventions. Acknowledging relevant risk factors can inform preventive strategies. This study aimed to identify chronic pain profiles 6 months after arthroplasty using the ICD-11 (International Classification of Diseases) classification and to find pre and postsurgical predictors of these profiles. Patients undergoing total knee/hip arthroplasty (n = 209, female = 54.5%) were assessed before surgery, 48h and 6 months postsurgery for sociodemographic, pain-related, disability and psychological characteristics. K-means-constrained cluster analysis identified chronic pain profiles based on 6-month pain intensity, pain interference and disability. Chi-square tests or one-way ANOVA explored between-cluster differences. Multinomial regression identified predictors of cluster membership. Separate models analyzed presurgical (model 1), postsurgical (model 2) and a combination of previously significant pre and postsurgical (model 3) variables. A three-cluster solution was selected, translating increasingly worse chronic pain severity: cluster 1 (C1, n = 129), cluster 2 (C2, n = 60) and cluster 3 (C3, n = 20). There were presurgical differences among clusters in the presence of other painful sites (p = 0.013, ϕc = 0.20), pain interference (p = 0.038, η2 = 0.031), disability (p = 0.020, η2 = 0.037), pain catastrophizing (p = 0.019, η2 = 0.060), anxiety (p < 0.001, η2 = 0.087), depression (p = 0.017; η2 = 0.039), self-efficacy (p = 0.018, η2 = 0.038) and satisfaction with life (p = 0.034, η2 = 0.032), postsurgical pain frequency (p = 0.003, ϕc = 0.243) and intensity (p < 0.001, η2 = 0.101). In model 1, disability predicted C2 (OR = 1.040) and anxiety predicted C3 (OR = 1.154) membership. In model 2, pain intensity predicted C3 (OR = 1.690) membership. In model 3, presurgical anxiety predicted C3 (OR = 1.181) and postsurgical pain intensity predicted C2 (OR = 1.234) and C3 (OR = 1.679) membership. Most patients had low chronic pain severity at 6 months, but a relevant percentage exhibited poor outcomes. Membership to different outcome profiles was predicted by presurgical anxiety and acute postsurgical pain. These seem promising targets to prevent pain chronification that should be optimized for better surgical outcomes.

Profiles of physician follow-up care, correlates and outcomes among patients affected by an incident mental disorder

ObjectivesThis study identified profiles of outpatient physician follow-up care and other practice features, mostly after detection of incident mental disorders (MD), and associated these profiles with patient characteristics and subsequent adverse outcomes.MethodsA cohort of 170,957 patients age 12 + with a new or recurrent MD detected in 2019-20 was investigated based on data from the Quebec Integrated Chronic Disease Surveillance System. Latent class analysis was performed to identify follow-up care profiles, mostly within one year of MD detection. Bivariate analyses tested associations between profiles and patient characteristics; logistic regressions examined relationships between profiles and adverse outcomes after one year.ResultsFive profiles were identified: Profiles 2 and 5 (64%) offered low mental health (MH) outpatient follow-up care, while the others dispensed higher MH follow-up care. Profiles differed in patient characteristics and related outcomes. Labelled “Follow-up care by usual psychiatrist”, Profile 1 (1% of sample) included younger patients with the most health and social issues. Profile 2 (50%), “Low MH follow-up care but high prior consultations for physical reasons”, mostly integrated older patients with chronic physical illnesses. Profile 3 (11%), “Follow-up care by general practitioners (GP) and psychiatrists”, referred to physicians other than the usual ones (e.g., walk-in practice) and encompassed patients with severe MD conditions. Profile 4 (23%), “High follow-up care by usual GP and prior consultations for physical reasons”, showed the typical characteristics of patients treated in primary care (more common MD, women, less materially and socially deprived). Profile 5 (15%), “Low MH follow-up care and prior consultations for physical reasons”, integrated more younger men, materially deprived patients, and with substance-related disorders (SRD) or co-occurring MD-SRD. More Profile 1 and 3 patients lived in university regions – those of Profile 4 were the least numerous in such regions. More Profile 5 patients lived in metropolitan and rural areas. Risk of death was higher in Profiles 5, 2, 3, and risk of frequent ED use and hospitalization higher in Profiles 1, 3, and 5 – patients with severe health and social issues.ConclusionThe study confirmed the need to improve prompt, adequate and continuous follow-up care for patients with incident MD.

Dual pathway inhibition in patients with peripheral artery disease in Germany.

Background: Dual-pathway inhibition (DPI) with aspirin and rivaroxaban exhibited a net clinical benefit for patients with cardiovascular disease in the randomized COMPASS trial. The non-observational, international XATOA registry showed that the COMPASS results can be reproduced in clinical practice in patients with coronary artery disease (CAD) and peripheral artery disease (PAD). Here we report patient characteristics and clinical outcomes for the subgroup of German PAD patients of the XATOA registry and compare them to COMPASS PAD patients. Patients and methods: XATOA was an international prospective registry of patients receiving DPI with a mean follow-up period of 15 months. The subgroup of German patients with PAD in XATOA comprised 1,819 patients, of which 925 patients (50.9%) had only PAD and 894 patients (49.1%) had both CAD and PAD. Patient characteristics such as prior medical history and prior medications as well as clinical outcomes such as incidences of major adverse limb events (MALE), major adverse cardiovascular events (MACE) and major bleeding events were assessed. Results: DPI was well-tolerated in clinical practice. Patient characteristics and clinical outcomes especially for patients with only PAD differed from characteristics and outcomes of the overall German XATOA population as well as the PAD subgroup of COMPASS. Patients with only PAD were markedly less supplied with lipid-lowering agents and betablockers. Incidences of MALE were high in German PAD patients of XATOA (9.0%) and markedly higher than in the PAD subgroup of COMPASS (1.2%). Incidences of MACE and major bleeding events were lower in German PAD patients of XATOA (MACE: 2.9%, major bleeding: 1.4%) than in PAD patients of COMPASS (MACE: 5.1%, major bleeding: 3.1%). Conclusions: DPI with rivaroxaban and aspirin is well-tolerated by PAD patients in German clinical practice. PAD patients in Germany exhibit different characteristics and show a different clinical outcome profile than PAD patients in COMPASS.

Impact of Perampanel for First-Episode Seizures versus Usual Care on Clinical Outcome and Safety Profile Aspects of the Thai Experience

Background and Purpose: Epilepsy increases poor outcomes in patients with post-traumatic brain injury and brain tumor-related epilepsy, for whom early seizure control is essential. Perampanel (PER) was a known third-generation antiepileptic drug for treatment all types of seizures. The objective of the study is to compare clinical outcomes and safety of PER administration as monotherapy.Methods: A prospective study of all 84 patients assigned to PER monotherapy (PER group, n=36) and other first-line antiepileptic drugs (n=48). Clinical outcomes parameters were measured by the prevalence of patients with a diminish in seizure frequency at 50% in 28 days. From November 1, 2020 to April 30, 2024, comparing the PER group with usual care. Clinical outcomes included adherence rate and seizure-free proportion at 28 days and 6 months. Adverse drug reactions were recorded in both groups.Results: There was no difference in demographic data and incidence of adverse drug reactions between two groups. Median PER dosage was 4 mg (range, 2-12 mg). Compared to other antiepileptic drugs, the PER group had a prevalence of 50% responder rate at 28 days and 6 months significantly were 75%, 81%, 65%, and 51% respectively. Common adverse drug reactions were somnolence and dizziness.Conclusions: PER administration as monotherapy demonstrated good efficacy and less adverse drug reactions. Low dosages helped to decrease adverse drug reactions andimproved retention rate.

Thoracic surgeons have better outcome profiles following esophagectomy: an ACS-NSQIP study

Thoracic surgeons have better outcome profiles following esophagectomy: an ACS-NSQIP study

AB031. Clinical outcome and serum cytokinome profile in patients with thymic epithelial tumors

AB031. Clinical outcome and serum cytokinome profile in patients with thymic epithelial tumors

An Observation of Outcome in Association with Spontaneous Onset of Labor and Induced Labour of Primigravida at Term

Introduction: Labour is a usual physiological process considered by progressive rise in frequency, intensity and duration of uterine contractions resulting in effacement and dilatation of the cervix with descent of the fetus over the birth canal. Initiation of labour is defined as iatrogenic stimulation of uterine reductions to cause the delivery of fetus before the onset of spontaneous labour. Aim of the study: To observe the outcome in association with spontaneous onset of labor and induced labour of primigravida at term. Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynecology in Ashiyan Medical College Hospital, Barua Khilkhet, and Dhaka, Bangladesh during the period from January 2018 to December 2018. Initially, all pregnant mothers at term (410/7 – 416/7 Weeks) were enrolled by purposive sampling. Thereafter, they were scrutinized according to the eligibility criteria. Finally, 80 participants were grouped in each category; namely spontaneous labor group. Thereafter, they were explained regarding the study procedure and informed written consent was charted on the partograph. A structure data sheet was used to obtain socio-demographic profile, obstetric profile, maternal and neonatal outcome profile were recorded using a pre structured, peer reviewed, interview and observation-based data collection sheet. All data were recorded, managed and analyzed using software Statistical Package for Social Science (SPSS) version 20.

Theory driven psychological therapy for persecutory delusions: trajectories of patient outcomes

Abstract Background We aimed to identify the common types of outcome trajectories for patients with psychosis who take up specialist psychological therapy for persecutory delusions. Knowing the different potential responses to therapy can inform expectations. Further, determining predictors of different outcomes may help in understanding who may benefit. Methods We analyzed delusion conviction data from 767 therapy sessions with 64 patients with persistent persecutory delusions (held with at least 60% conviction) who received a six-month psychological intervention (Feeling Safe) during a clinical trial. Latent class trajectory analysis was conducted to identify groups with distinct outcome profiles. The trajectories were validated against independent assessments, including a longer-term follow-up six months after the end of therapy. We also tested potential predictors of the trajectories. Results There were four outcome trajectories: (1) Very high delusion conviction/Little improvement (n = 14, 25%), (2) Very high delusion conviction/Large improvement (n = 9, 16%), (3) High delusion conviction/Moderate improvement (n = 17, 31%) and (4) High delusion conviction/Large improvement (n = 15, 27%). The groups did not differ in initial overall delusion severity. The trajectories were consistent with the independent assessments and sustained over time. Three factors predicted trajectories: persecutory delusion conviction, therapy expectations, and positive beliefs about other people. Conclusions There are variable responses to psychological therapy for persecutory delusions. Patients with very high delusion conviction can have excellent responses to therapy, though this may take a little longer to observe and such high conviction reduces the likelihood of positive responses. A trajectory approach requires testing in larger datasets but may prove highly informative.

Scalable Technology for Adolescents and Youth to Reduce Stress in the Treatment of Common Mental Disorders in Jordan: Protocol for a Randomized Controlled Trial.

Young people in low- and middle-income countries encounter significant barriers to accessing mental health support due to various factors, including a substantial treatment gap and limited health care budgets allocated to mental health. Using innovative strategies, such as scalable digital self-help psychological interventions, offers a potential solution for improving access to mental health support. However, digital mental health interventions come with their own set of challenges, including issues related to low user engagement. Chatbots, with their interactive and engaging nature, may present a promising avenue for the delivery of these interventions. This study aims to explore the effectiveness of a newly developed World Health Organization (WHO) digital mental health intervention, titled Scalable Technology for Adolescents and Youth to Reduce Stress (STARS). A single-blind, 2-arm randomized controlled trial will be conducted nationally across Jordan. Participants will include 344 young adults, aged 18-21 years, currently residing in Jordan. Inclusion criteria are heightened levels of psychological distress as determined through the 10-item Kessler Psychological Distress Scale (≥20). Assessment measures will be conducted at baseline, 1-week post intervention, and 3-month follow-up. Following baseline assessments, eligible participants will be randomized to receive STARS or enhanced usual care. The primary outcomes are the reduction of symptoms of depression and anxiety (Hopkins Symptom Checklist, 25 subscales) at 3-month follow-up. Secondary outcomes include general functioning (WHO Disability Assessment Schedule 2.0), well-being (WHO-5 Well-Being Index), personal problems (Psychological Outcomes Profile), and agency (State Hope Scale subscale). The study was funded in January 2020 by the Research for Health in Humanitarian Crises Programme (Elhra) and recruitment for the trial started on July 16, 2023. As of November 15, 2023, we randomized 228 participants. This trial intends to contribute to the growing digital mental health evidence base by exploring technological solutions to address global public health challenges. Given the widespread use of technology globally, even in resource-constrained settings, and the high adoption rates among adolescents and young individuals, digital initiatives such as STARS present promising opportunities for the future of mental health care in low- and middle-income countries. ISRCTN Registry ISRCTN10152961; https://www.isrctn.com/ISRCTN10152961. DERR1-10.2196/54585.

Clinical Outcome and Molecular Profile in Patients with DDX41 Mutation Hotspots: A Retrospective Study of 82 Patients

Clinical Outcome and Molecular Profile in Patients with DDX41 Mutation Hotspots: A Retrospective Study of 82 Patients

Epidemiology, clinical features, and outcome of the hospitalized patients with Kerion in Fars Province, Iran: an eleven-year retrospective study

BackgroundKerion, a severe inflammatory type of tinea capitis, presents with purulent, boggy swelling and alopecia. Few articles in the literature provide information on this uncommon manifestation of tinea capitis (TC). This study aimed to determine the epidemiological and clinical characteristics of patients with Kerion over an 11-year period in an inpatient setting.MethodsIn this retrospective cross-sectional study, we enrolled all the admitted patients with inflammatory TC in the dermatology department of Shahid Faghihi referral hospital during 2011–2022. The data included demographic factors, animal contact, treatment, outcome, and past medical profiles. We used STATA 14.2 to analyze the data.ResultsOne hundred and thirty-two patients with Kerion were enrolled in to the study. the mean age of patients was 7.6 ± 5.8 years. Boys (82.5%, n = 109) significantly outnumbered girls (17.5%, n = 23), and 82.2% of patients were under 11 years of age. Eight patients were one to two years old, two were infants under one year old, and five were adults. More than half (52.2%) of the patients were from rural areas. Most of the cases had heavily utilized systemic antifungal therapy, antibiotics, and corticosteroids. In addition, 43 patients reported positive animal contact. Over the course of an eleven-year period, there was a downward trend in the number of hospitalized patients.ConclusionWe report one of the largest studies on Kerion patients over an eleven-year period. We have expanded the information on Kerion patients’ epidemiology, transmission mode, and clinical outcomes. To develop preventative strategies for Kerion, future studies should focus on additional risk factors and individual susceptibilities.

The impact of ethnicity on clinical outcomes in patients with heart failure and atrial fibrillation

Abstract Introduction Heart failure (HF) and atrial fibrillation (AF) are increasingly prevalent and associated with substantial morbidity (1,2). When HF and AF co-exist, the outcome profile is significantly worse than for either condition in isolation (3). Ethnic background is known to influence disease outcomes and treatment efficacy (4), but there is limited knowledge about how HF, AF and ethnicity interact on mortality and hospital admission. Purpose This study aims to address the null hypothesis of no difference in death and cardiovascular events comparing non-white and white patients with HF and concomitant AF, and assess the differential impact of ethnicity in patients with these conditions. Methods Individual patient data were obtained from 12 randomized controlled trials (RCTs) in patients with HF. RCT data were harmonised and meta-analysed to investigate the interaction of baseline heart rhythm (sinus rhythm versus atrial fibrillation) and ethnicity (non-white versus white). The primary outcome of all-cause mortality and secondary outcome of cardiovascular (CV)-related mortality were analysed using adjusted Cox regression models and propensity-score matching. Results 16,713 HF patients were included of which 1,899 (11%) were non-white, median age 66 (interquartile range [IQR] 57-73) and 4,703 (28%) women. During median follow-up of 1.4 years (IQR 0.8-2.3), death occurred in 394 (21%) non-white patients and 2,142 (15%) white patients; adjusted hazard ratio (HR) 1.36, 95% CI 1.20-1.54; p&amp;lt;0.001. The impact of ethnicity was greater in patients with coexisting HF and AF (non-white versus white HR 2.05; 95% CI 1.55-2.70; p&amp;lt;0.001), than in those with HF in sinus rhythm (non-white versus white HR 1.24; 95% CI 1.08-1.41; p=0.002). A significant interaction was evident between ethnicity and rhythm status for all-cause mortality (p=0.003), with similar findings using propensity-score matching (Figure 1). An exploratory analysis of beta-blockers versus placebo demonstrated divergent efficacy with respect to mortality for non-white (HR 1.00, 95% CI 0.79-1.27; p=0.99) and white patients (HR 0.70, 95% CI 0.63-0.78; p&amp;lt;0.001); p-interaction=0.008 (Figure 2). For cardiovascular hospitalisation, the non-white cohort also had higher rates, with greatest disparity in patients with combined HF and AF (non-white versus white HR 1.80, 95% CI 1.63-2.37; p&amp;lt;0.001) compared to HF in sinus rhythm (non-white versus white HR 1.23, 95% CI 1.11-1.36; p&amp;lt;0.001); p-interaction=0.012 in propensity-matching. Conclusion Non-white patients with HF suffer from substantially higher rates of death and hospitalisation than corresponding white patients, with the presence of comorbid AF significantly worsening this ethnicity-related disparity. In those with HF in sinus rhythm, beta blockers were found to be significantly less effective at reducing mortality in non-white patients.Figure 1 Figure 2

Machine learning for prediction of incident heart failure and heart failure hospitalisation: multi-cohort development, validation and association with clinical phenotypes

Abstract Background Delayed heart failure (HF) diagnosis is associated with adverse outcomes and costs of hospitalisation.(1,2) Whilst previous tools have been developed to predict incident HF,(3) risk of HF incidence may correlate poorly with risk of HF hospitalisation, which may be more important in targeting diagnostics. Purpose To develop and validate a novel decision support tool for prediction of incident HF and HF hospitalisation, and investigate association of score with HF with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). Methods We developed the models (FIND-HF) in UK primary care health record data from individuals aged ≥40 years without known HF (Jan 2, 1998 to Feb 28, 2022), randomly divided into training (80%) and testing (20%) datasets. We evaluated logistic regression and supervised machine learning models for prediction of 1- and 5- year HF and HF hospitalisation risk in the testing dataset with internal bootstrap validation. Models were externally validated for HF hospitalisation in data from a Taiwanese university hospital. Association of FIND-HF score with HF phenotypes of HFpEF and HFrEF was assessed in two prospective cohorts, the MATCH registry of patients diagnosed with HFrEF and the FIND-AF cohort of individuals at higher predicted risk of atrial fibrillation who underwent echocardiography. Results Of 565 284 UK individuals (mean age 68.9 (SD 12.2) years, 49.2% women), incidence of HF and HF hospitalisation was 1.1% and 0.5% at 1-year, and 6.6% and 3.4% at 5-years, respectively. Prediction performance was superior for machine learning algorithms compared with logistic regression, with best performance for XGBoost (area under receiver operating characteristic curve (AUROC) at 1 and 5-years: 0.755 and 0.723 for incident HF, and 0.738 and 0.711 for incident HF hospitalization). On external validation in 106,026 individuals in Taiwan (mean age 64.7 (SD 10.6) years, 52.8 % women), HF hospitalisation incidence was 0.71%, and 2.46% at 1- and 5- years, respectively, and discrimination performance was excellent (AUROC at 1- and 5-years: 0.834 and 0.843). When the FIND-HF score was applied to individuals in the MATCH cohort (n = 133, mean age 69.0 (SD 11.7) years, 38.3% women) and FIND-AF cohort (n = 82, mean age 71.6 (SD 7.5) years, 50.0% women), the distribution of score to clinical phenotypes demonstrated a binomial distribution (Figure 1), and likelihood of HFpEF diagnosis correlated with the numeric score (Figure 2). Conclusions The machine learning FIND-HF decision support tool can accurately identify individuals at risk of incident HF and HF hospitalisation, to enable new approaches for early detection and prevention. The variation of score amongst high risk individuals with different HF clinical phenotypes emphasizes the distinct pathophysiological pathways but shared adverse outcome profile across the HF syndrome.Figure 1Figure 2

Endoscopic Re-Instrumentation of Intrabony Defect-Associated Deep Residual Periodontal Pockets Is Non-Inferior to Papilla Preservation Flap Surgery: ARandomized Trial.

Clinical practice guidelines suggest access flap surgery for managing deep residual pockets after steps 1 and 2 of periodontal therapy. Papilla-preservation flap surgery (PPFS) is the least invasive approach to access and instrument biofilm-contaminated root surfaces. Endoscopic-assisted subgingival debridement (EASD) may enhance the outcomes of repeated instrumentation and provide a minimally invasive non-surgical alternative. This was a single-blind, controlled, randomized, parallel-group, non-inferiority 12-month trial comparing EASD with PPFS. Male and female adults with generalized stage III periodontitis and persistent periodontal pockets associated with an intrabony defect after steps 1 and 2 of periodontal therapy were recruited at Prince Philip Dental Hospital. Inter-group differences in clinical attachment level (CAL) changes at 12 months were the primary outcome. Secondary outcomes included pocket resolution (no pocket > 5 mm and no pocket > 4 with bleeding on probing), radiographic bone changes, treatment time, early wound healing and quality-of-life measurements. Sixty-two subjects (30 EASD and 32 PPFS) were included in the intention-to-treat analysis. CAL gains were 2.0 ± 1.0 and 1.8 ± 1.0 mm for test and controls, respectively. The 95% CI of the inter-group difference was -0.3 to 0.8 mm and within the stipulated 1-mm non-inferiority margin. No inter-group differences were observed (i) in pocket resolution, which was achieved in more than 87% of cases for all groups/time points, and (ii) in radiographic bone healing. The treatment time was significantly shorter for EASD than for PPFS. Better early wound healing index scores were observed for EASD. No inter-group differences in pain, quality of life or safety were detected. EASD was not inferior to PPFS for managing residual pockets associated with intrabony defects. The observed outcome profile supports additional developments and studies to validate EASD as an alternative to surgery for isolated persistent pockets (ChiCTR-INR-16008407).

Clinical Outcome Profile Of Early Preterm Neonates In A NICU At Tertiary Care Center

Clinical Outcome Profile Of Early Preterm Neonates In A NICU At Tertiary Care Center

A Chart Review for Epidemiology and Outcome of Fungal Bloodstream Infections Among Neonates in a Tertiary Care Hospital at North India

Background and Aims The risk of fungal bloodstream infection (BSI) and accompanying mortality in neonates varies widely in between centres depending on the region, the population characteristics and the risk factors. Methods This chart review of neonatal cases with fungal BSI admitted in a tertiary care teaching hospital in North India aimed to comprehensively investigate the epidemiology, profile of fungal species (and their susceptibility to various antifungal agents), risk factors, clinical profile and outcomes in these neonates. The study spanned over a one-year period, from September 2022 to August 2023, included all symptomatic neonates with positive blood cultures for fungal pathogen. Results Over one year, 24 out of 1,174 neonates at risk were diagnosed with fungal BSI, with a cumulative risk of 2.0 per 100 neonates. A peak in cases occurred in February. Candida pelliculosa was the predominant species (75% of isolates), while Candida albicans constituted 4.2%. Most isolates were sensitive to fluconazole, except for some fluconazole-resistant Candida pelliculosa (5.5%) and Candida tropicalis (25.0%), which remained susceptible to amphotericin-B and voriconazole. Around 60% of neonates were preterm, 40% had very low birth weight and 37% were small for gestational age. Nearly all had received prior broad-spectrum antibiotics, with 92% receiving prolonged courses over five days. Respiratory support, including intubation and mechanical ventilation, was used in 83% before onset of fungal sepsis. Intriguingly, all neonates had some invasive device in place for more than seven days. Mortality rate of 25% was observed, with preterm birth and gastrointestinal anomalies contributing to adverse outcomes. Conclusions This study confirms the ongoing shift in trend from albicans to non-albicans Candida infections in our region as well. A seasonal peak of fungal sepsis noted in the month of February hinted at potential seasonal variation or lapses in infection control practices during colder months. The analysis of trends in fungal BSI might hold a significance within neonatal intensive care units (NICUs) for the prompt detection of outbreaks. Simultaneously, understanding and analysing risk factors associated with fungal BSI are essential for targeted prevention.

Cannabis Use and Postoperative Risks: A Comprehensive Analysis of Medical Complications Within 90 Days Following Ankle Fracture Fixation

Category: Ankle; Trauma Introduction/Purpose: As medical and recreational cannabis use continues to increase in prevalence across the United States, it is important to understand how cannabis can impact health. Though prior studies have shown that cannabis use can result in delayed bone healing, there is a paucity of literature examining the relationship between cannabis use and postoperative medical outcomes following fracture fixation. Therefore, the purpose of this study was to investigate the relationship between cannabis use and the incidence of medical complications within 90 days of surgical fixation of ankle fractures. Methods: A retrospective review of a national insurance claims database was performed from 2010 to 2022. Patients who underwent open reduction and internal fixation (ORIF) procedures for medial malleolus fractures, lateral malleolus fractures, distal fibula fractures, bimalleolar fractures, and trimalleolar fractures were identified using CPT codes. Of those patients, those with established diagnoses of cannabis use disorder, cannabis dependency, or cannabis addiction were identified using ICD-9 and -10 codes. This cannabis cohort was matched 1:4 on the basis of age, sex, and Charlson Comorbidity Index (CCI) to a control cohort without a history of cannabis use to remove potential confounding upon comparison. Demographic and comorbidity profiles, as well as medical and surgical post-operative outcomes were compared using Chi-square tests. Results: Out of 788,702 patients undergoing ankle fracture open reduction and internal fixation (ORIF) during the study period, 46,105 had documented cannabis use. Cannabis cohort, compared to controls, exhibited significant differences: younger age (mean 38.8 vs. 52.7 years; p&lt; 0.001), lower comorbidity-burden (mean CCI 1.58 vs. 1.68; p&lt; 0.001), and a higher proportion of male patients (51.1% vs. 33.2%; p&lt; 0.001). Following age, CCI, and sex matching, patients with cannabis use histories showed a significantly increased incidence of medical complications within 90 days post ankle fracture ORIF. Cannabis users displayed elevated rates of various complications compared to matched controls, including pneumonia, deep venous thrombosis, pulmonary embolism, myocardial infarction, stroke, surgical site infection, cardiac arrest, acute kidney injury, urinary tract infection, sepsis, and hypoglycemia (all p&lt; 0.001). Conclusion: Cannabis use is associated with increased incidences of many serious medical complications within 90 days of ankle fracture fixation procedures. These results underscore the importance of eliciting cannabis use history during preoperative patient evaluations so that physicians and patients can be better informed about the increased postoperative risks they may face, and so tailored perioperative care can be appropriately implemented. Further, these results emphasize the need for further research on the molecular mechanisms of cannabis to explain interactions that may predispose heavy cannabis users to this profile of adverse surgical outcomes.