Prospective Case-control Study Research Articles

DNA repair efficiency in young hypertensive: Is lifestyle a prooxidant factor?

Background: High prevalence of hypertension (HTN) is of major concern among the middle-aged population of Kerala. Understudied in the context of HTN is oxidative damage to DNA, which is caused by free radical assaults. The modern lifestyle associated with an unhealthy diet and lack of exercise plays a key role in oxidative stress induction. Aims and Objectives: The objective of this study was to assess the significance of oxidative stress and the effectiveness of DNA repair mechanisms in young hypertensives along with how it correlates with aspects of lifestyle. Materials and Methods: This prospective case–control study enrolled clinically proven hypertensive patients referred from the outpatient department of Hridayalaya, Institute of Preventive Cardiology, Thiruvananthapuram, to Genetika, a research center for Cytogenetic Studies in South Kerala. Hypertensive patients (n=180) within the age group of 18–39 were compared with matched healthy controls (n=140). Associated lifestyle factors were determined. Results: In comparison to controls, cases had noticeably higher mean levels of malondialdehyde (MDA) and mean break per cell (P<0.05). There was a difference that was statistically significant (P<0.05) between the patients and controls in terms of diet, exercise, physical activity, obesity, mental stress, alcohol, and tobacco use. On comparing MDA and mean break per cell values with lifestyle factors, a statistically significant difference was detected (P<0.05). Observed a significant positive correlation of break per cell value with MDA (P<0.05). Conclusion: The current study demonstrated increased DNA damage and decreased DNA repair efficiency in young hypertensive and was strongly associated with lifestyle factors. Appropriate measures such as regular BP checkups, regular exercises, and abstinence from alcohol and smoking are to be taken for the prevention and control of HTN.

Bone conducted cervical vestibular evoked myogenic potentials: comparison of tone burst stimulus vs chirp stimulus.

Vestibular evoked myogenic potential (VEMP) is a test used to evaluate the function of otolith organs. In healthy individuals, air-conducted (AC) responses are obtained, whereas, in conductive hearing loss, the inability to transmit the signal well enough with AC stimuli has led to the need for bone-conducted (BC) stimuli. This study aimed to compare 500Hz Chirp and Tone Burst stimuli in terms of latency and amplitude in BC cVEMP. This prospective observational case control study included 35 healthy participants (70 ears) between the age of 20-50. Participants underwent VEMP testing with BC 500Hz Tone Burst stimulus and 500Hz narrow band Chirp stimulus without changing the position of the bone conducted vibrator. The intensity of the stimuli was 50 dB nHL. Response rate of 500Hz TB Stimulus was 51.4% and 95.7% in Chirp stimulus. It was observed that significantly more responses were obtained with Chirp stimulus than TB stimulus (p < 0.001). In terms of p1 latency, n1 latency, both latencies were significantly shorter in Chirp stimulus (p < 0.001). p1n1 amplitude was found significantly larger in Chirp stimulus (p < 0.001). Compared to 500Hz TB stimulus, 500Hz Chirp stimulus results in a higher response rate, larger p1n1 amplitude, and shorter p1 and n1 latency. A higher response rate may provide a more accurate assessment of otolith organs, reducing false negatives due to signal transmission in patients.

Presepsin in Human Milk Is Delivery Mode and Gender Dependent.

Breast milk (BM) is a unique food due to its nutritional composition and anti-inflammatory characteristics. Evidence has emerged on the role of Presepsin (PSEP) as a reliable marker of early sepsis diagnosis. In the present study, we aimed to investigate the measurability of PSEP in BM according to different maturation stages (colostrum, C; transition, Tr; and mature milks, Mt) and corrected for delivery mode and gender. We conducted a multicenter prospective case-control study in women who had delivered 22 term (T) and 22 preterm (PT) infants. A total of 44 human milk samples were collected and stored at -80 °C. BM PSEP (pg/mL) levels were measured by using a rapid chemiluminescent enzyme immunoassay. PSEP was detected in all samples analyzed. Higher (p < 0.05) BM PSEP concentrations were observed in the PT compared to the T infants. According to the grade of maturation, higher (p < 0.05) levels of PSEP in C compared to Tr and Mt milks were observed in the whole study population. The BM subtypes' degrees of maturation were delivery mode and gender dependent. We found that PSEP at high concentrations supports its antimicrobial action both in PT and T infants. These results open the door to further studies investigating the role of PSEP.

Cognitive dysfunction in older patients undergoing non-neurosurgery in the immediate postoperative period: A systematic review.

To explore the risk factors associated with postoperative cognitive dysfunction in older patients within the first 7 days after non-neurosurgical surgery and anaesthesia. A systematic review. Following, PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Checklist, a systematic review of studies published from January 2018 to January 2024. The literature search was conducted across six electronic online databases, including PubMed, EMBASE, Scopus, Ovid, MEDLINE and Science Direct, and the Johns Hopkins Nursing Evidence-Based Practice Evidence Rating Scale was used for study appraisal. The initial search yielded 1750 studies. The review included 19 studies which comprised prospective observational, case-control and retrospective studies. The prevalence of postoperative cognitive dysfunction ranged from 19% to 64% among older adults undergoing non-neurosurgery. The identified risk factors were classified into three phases including preoperative, intraoperative and postoperative. Preoperative risk factors were found in age, educational attainment, malnutrition, preoperative biomarkers and co-morbidities. Intraoperative risk factors were the duration of the operation, blood loss during the operation and anaesthesia used. Postoperative risk factors consisted of postoperative biomarkers and postoperative pain. The result from this review may assist researchers and healthcare providers in assessing the underlying causes and risk factors of postoperative cognitive dysfunction, and in formulating suitable preventative and therapeutic strategies for older adults with non-neurosurgery during the short-term postoperative period.

Re-exploration following caesarean birth: a prospective national case-control study using the United Kingdom Obstetric Surveillance System (UKOSS) data collection system.

Re-exploration following caesarean birth and the associated maternal morbidity has not been investigated in the UK. Our aims were to determine the national incidence and identify the associated risk factors. We conducted a prospective observational case-control study across 194 UK consultant-led maternity units in women whose caesarean birth was complicated by a re-exploration. Independent factors for re-exploration were analysed using multivariable multi-level mixed effects logistic regression. Over the study period (1 June 2021 and 31 May 2022) 238,423 caesarean births were recorded across the UK of which 187 women underwent re-exploration, giving an incidence of one re-exploration per 1282 caesarean births (95%CI 1:1099-1:1471). Haemorrhage (124/187, 66.3%) and sepsis (31/187, 16.6%) were the most common findings at re-exploration. Median (IQR [range]) time interval to re-exploration following the caesarean birth was 1 (0-4 [0-28]) day. Mechanical ventilation was required in 34 (18.6%) women, cardiac arrest was reported in 5 (2.7%) and 3 (1.6%) women died. Independent preceding factors associated with a re-exploration included: receipt of blood transfusion (adjusted OR (95%CI) 8.25 (2.66-25.61)); use of a general anaesthetic (adjusted OR (95%CI) 3.33 (1.61-6.88)); pre-eclampsia (adjusted OR (95%CI) 3.27 (1.55-6.91)); black ethnicity (adjusted OR (95%CI) 3.14 (1.39-7.11)); postpartum haemorrhage (adjusted OR (95%CI) 2.82 (1.81-4.37)); use of anticoagulants or antiplatelet drugs pre-caesarean birth (adjusted OR (95%CI) 2.26 (1.35-3.81)); and emergency caesarean birth (adjusted OR (95%CI) 1.89 (1.01-3.57)). Re-exploration following caesarean birth in the UK is uncommon but is associated with significant maternal morbidity and mortality. These study findings will help guide informed consent and encourage appropriate surveillance of high-risk women postpartum.

Value of serum muscular creatinine phosphokinase levels in patients with adenomyosis as a non-invasive diagnostic marker.

In the present study, we aimed to compare serum CK-MM levels in patients with and without adenomyosis and to investigate whether CK-MM level can be a non-invasive marker for myometrial damage due to adenomyosis. Our study was a prospective case-control study in a tertiary center and consisted of 40 patients with a clinical/ultrasonographic diagnosis of adenomyosis and 40 patients without a clinical/ultrasonographic diagnosis of adenomyosis as the control group based on recently published morphological uterus sonographic assessment (MUSA) criteria. Individuals of similar age who signed a voluntary consent form were included in our study. Demographic, clinical, and laboratory findings of the patients in both groups were recorded. Blood serum samples were used for the determination of serum CK-MM levels of the participants in our study. The samples were analyzed by using the human CK-MM enzyme-linked immunosorbent assay (ELISA) kit. In our study, the mean serum CK-MM level was 16.2 ± 21.7 (ng/dL) in patients with adenomyosis and 2.6 ± 2.2 (ng/dL) in patients without adenomyosis. Serum CK-MM level was statistically significantly higher in the patient group with adenomyosis than in the control group (p < 0.001). The CK-MM threshold value of 3.43 ng/mL, with a sensitivity of 82.5% and specificity of 85%, has been found to be a valuable distinguishing level in patients with and without adenomyosis. In this study, we demonstrated that serum CK-MM can be used as a non-invasive diagnostic method in patients with adenomyosis. As the number of studies around this subject in the literature is insufficient, larger studies are needed to use CK-MM as a diagnostic marker in adenomyosis.

The Neural Correlates of Central Auditory Dysfunction in Chronic Tinnitus: A Multimodal Approach.

It was aimed at assessing the connection between tinnitus and central auditory dysfunction using both central auditory tests (CATs) and diffusion tensor imaging (DTI) for brain regions that are crucial for central auditory processing. This prospective case-control study included 15 patients with persistent tinnitus and 20 healthy volunteers as controls. They underwent CATs for memory, attention, and DTI. The Tinnitus Handicap Inventory (THI) Questionnaire was applied as well. From several brain regions, the values of mean diffusivity (MD) and fractional anisotropy (FA) were determined. Comparing both groups, the tinnitus group showed statistically worse values as regards the CATs (memory for content, sequence memory, speech perception in noise (SPIN) at different signal-to-noise ratios, "SNRs") compared with the control group. As regards DTI, the tinnitus group showed decreased FA in several brain areas, including the cingulum, prefrontal-cortex (PFC), insula, and hippocampus. Furthermore, the tinnitus group showed significantly higher MD in the cingulum, BA-46, and amygdala compared with the control group. FA values of BA-46 were positively correlated with the SPIN-SNR-10 scores. Also, FA values of the middle cingulum were positively correlated with SPIN-SNRzero scores. MD values at BA-46 were negatively correlated with SPIN-SNR-10. THI scores were negatively correlated with FA at BA-46; however, they were positively correlated with MD at the amygdala. Central auditory dysfunction may be linked to the underlying neurophysiological changes in chronic tinnitus. Level 2 Laryngoscope, 2024.

A systematic review of sex and gender differences in treatment outcome of inflammatory skin diseases: Is it time for new guidelines?

Gender- and sex-specific differences in medicine were long-time disregarded. Despite numerous indications of gender- and sex-specific influences on the treatment of dermatological conditions, these have not yet been systematically investigated. To meet this unmet need, we conducted the present systematic review on the topic of gender and sex differences in the treatement outcome of skin diseases. Embase (via Ovid), PubMed Medline and Web of Science were searched, in between January 2001 and December 2022. English and german randomized controlled trials, prospective and retrospective cohorts and case-control studies that examined differences between men and women in treatment outcomes of skin diseases were included. Two authors independently screened the reports for eligibility, one extracted all data (the second double-checked) and critically appraised the quality and risk of bias of the studies. Eighty-three reports were included. The largest share of the identified publications focused on gender differences in psoriasis and psoriatic arthritis (n = 49), followed by melanoma (n = 8) and sporadic studies (n < 5) of inflammatory, infectious and autoimmune skin diseases. The main topics in which gender differences could be identified were choice of treatment, time to initiation of treatment, therapy response, adverse events, adherence and treatment satisfaction. For psoriasis, gender differences could be found in all aspects, while for the other skin diseases specific publications on gender differences are still missing. This systematic review shows numerous gender differences but also reveals major gaps in gender-specific care in dermatology which should be narrowed in the upcoming years to optimize a patient-centred, individualized, gender-equal healthcare. PROSPERO Registration: CRD42022306626.

Correlation between Serum Levels of HLA-G and Recurrent Implantation Failure During Implantation Window in Women Undergoing In Vitro Fertilization

Background: Recurrent implantation failure (RIF) during artificial reproductive techniques (ARTs) remains a health problem. Many physiopathological pathways have been proposed for RIF, but the causes are not yet clear. Thus, the purpose of the current study was to evaluate the possible correlation between human leucocyte antigen-G (HLA-G) serum levels and recurrent implantation failure during the implantation window in women undergoing In vitro fertilization (IVF). Materials and Methods: In this prospective case-control study, 39 patients with RIF and 20 cases with successful implantation were enrolled as the control group. HLA-G serum levels were measured using the sandwich ELISA method in both groups. Results: HLA-G serum levels in the RIF group were significantly higher than in controls (0.085 ± 0.019 compared to 0.073 ± 0.005, p = 0.024). Furthermore, by grouping patients based on age and BMI, we found that in the cases with ages above 30 years and with BMI more than 25 (kg/m2), HLA-G serum levels in the RIF group were remarkably greater than controls (0.088 ± 0.019 compared to 0.072 ± 0.004, p = 0.002 and 0.083 ± 0.012 compared to 0.072 ± 0.003, p = 0.021, respectively). Conclusion: Serum levels of HLA-G increase in the RIF patients, especially in cases of patients above 30 years old and those with BMI ≥ 25, which remains significant after eliminating confounding variables. These results may indicate the involvement of physiopathological pathways of HLA-G in the increasing risk of RIF.

Lens Thickness in Infants and Children with Cataracts

PurposeThe purpose of this study was to determine the association between lens thickness and cataract in subjects aged 0-5 years. DesignThis was a prospective multi-center case-control study. ParticipantsWe enrolled 118 participants (171 eyes) age 0-5 years old, mean age 14.6 ± 17.0 months, range 0 - 60 months. MethodsLens thickness was measured on 342 ultrasound biomicroscopy (UBM) images. Main Outcome MeasuresLens thickness; feasibility of lens thickness measurement from UBM images ResultsMean lens thickness among non-cataracts was 3.60 ± 0.17 mm, compared to 3.16 ± 0.61 mm among cataracts (p<0.0001). Lens thickness less than 3.5 mm was significantly associated with increased odds of cataract, adjusted OR=5.99 [2.41,14.88] (p=0.0003) among subjects age 0-7 months. Lens thickness was significantly associated with cataract laterality among subjects age 0-7 months (p<0.0001). ConclusionsQuantitative UBM can be used to evaluate lens thickness in infants and children with congenital cataracts. The lens in congenital cataract eyes was thinner than that of controls among infants. Abnormal lens thickness was significantly associated with cataract. Future longitudinal studies will examine the association between lens thickness and post-cataract surgery outcomes.

Emerging role of vitamin D deficiency as a risk factor for retinal venous occlusions and need for public health measures for its prevention.

To estimate levels of serum vitamin D in patients of retinal vein occlusion (RVO) and compare with age- and sex-matched controls. A prospective case-control study of 54 patients of RVO and 54 age- and sex-matched attendants of patients presenting to a tertiary care hospital in Delhi was performed. Patients on vitamin D supplementations and RVO due to infective or immunological causes or patients of glaucoma were excluded. Serum vitamin D levels of all the study participants along with relevant blood investigations with history and examination were documented. Vitamin D deficiency was defined as <20 ng/ml. The mean serum vitamin D levels seen in RVO patients and the control group were 14.19 ± 5.23 ng/ml and 19.42 ± 10.27 ng/ml, respectively (P value = 0.001) with an odds ratio of 10.558 (CI = 2.34-47.50), indicating vitamin D deficiency to be strongly correlated with RVO. Maximum patients of RVO (46.3%) were seen during the winter season. The study noted hypertension [odds ratio 20.22 (CI = 5.812-70.347)], dyslipidemia, and anemia [odds ratio 4.107 (CI = 0.62-26.90)] to be the risk factors for RVO as previously proved in the literature. Smoking, diabetes, alcohol intake, and body mass index did not emerge as risk factors for RVO. Vitamin D deficiency is associated with RVO; hence, estimation of serum vitamin D levels should be advised as a part of routine investigations while looking for the cause of RVOs. Public health measures like food fortification with vitamin D micronutrients and public awareness towards increased sunlight exposure in the community are simple, inexpensive measures that can decrease the burden of sight-threatening disease of RVO in the community.

Levels of a novel metabolic marker, spexin in patients with hirsutism: metabolic syndrome risk in idiopathic and polycystic ovarian syndrome (PCOS) hirsutism.

Polycystic ovarian syndrome (PCOS) disease the most common endocrinopathy among reproductive age women , and its association with metabolic syndrome is investigated in many reports. The most common cause of hirsutism worldwide is considered to be idiopathic hirsutism (IH) defined as clinical hirsutism without underlying hormonal imbalance. Spexin is a novel peptide and is mainly involved in energy homeostasis and, has not yet made its way into clinical practice. We aim to investigate spexin in an understudied population of hirsute patients. This prospective case-control study analysis involved 48 patients with hirsutism.and, was further divided into two groups: 26 had PCOS syndrome and 22 had IH. 40 healthy, age and BMI-matched non-hirsute women enrolled as the control group. The spexin level was determined using a human spexin ELISA kit. There was no statistically significant difference in spexin levels found between hirsutism and control patients 1514 vs 1425 ng/L, (p = 0.849). Spexin levels were found to be significantly higher in the PCOS hirsutism group than in the IH group (1668.5 ng/L vs 1021 ng/L), (p = 0.022). Correlations of spexin levels with total testosterone, low-density lipoprotein, and total cholesterol were found in hirsutism patients. Our findings conclude that both IH and PCOS hirsutism patients have an increased risk of metabolic syndrome; hyperandrogenemia and dyslipidemia contribute to the progression of upcoming research on metabolic syndrome. Low spexin levels in IH in hirsute patients Could potentially elucidate the pathogenesis of the condition, consequently assisting in diminishing the risk of associated complications.

Potential use of Oncostatin M in Critically ill Patients with acute Kidney Injury

BACKGROUND: Acute kidney injury (AKI) is one of the most common complications affecting patients admitted to intensive care unit (ICU) worldwide. In response to injury, both kidneys and liver secrete acute phase reactants as a mechanism of protection. Oncostatin M (OSM) is a member of the interleukin-6 family of cytokines which was found to be elevated during renal injury as in diabetic nephropathy, glomerulonephritis, and obstructive nephropathy. AIM: The study aimed to assess the role of OSM as an early biomarker of AKI in critically ill patients. PATIENTS AND METHODS: We conducted a prospective case–control study that included 202 patients admitted to ICU within Kasr El-Aini University hospitals during the period between January 2022 and August 2022. Eligible patients were divided into two groups according to the occurrence of AKI, and Oncostatin was assessed in the sera of the included patients. RESULTS: Our findings showed that the AKI group had statistically significant lower OSM levels compared to the control group, especially among those patients who had poor clinical outcomes and non-survivors. We also found that OSM is a good predictive tool for the prediction of mortality among patients admitted to ICU with sepsis complicated with AKI (Area under the curve = 0.673, 95% confidence interval: 0.532–0.814) with a sensitivity of 83.8% and specificity of 61.4%. CONCLUSION: OSM plays an important role among critically ill patients who are admitted to the ICU with sepsis, it can significantly predict AKI development and subsequent mortality.

Improvement of Breast Cancer Detection Using Dual-Layer Spectral CT.

This study aimed to investigate the diagnostic performance of breast mass detection on monoenergetic image data at 40 keV (MonoE40) and on iodine maps (IM) compared with conventional image data (CI). In this prospective single-center case-control study, 50 breast cancer patients were examined using contrast-enhanced dual-layer spectral CT. For qualitative and quantitative comparison of MonoE40 and IM with CI image data, four blinded, independent readers assessed 300 randomized single slices (two slices for each imaging type per case) with or without cancerous lesions for the presence of a breast mass. Detection sensitivity and specificity were calculated and readers rated their subjective diagnostic certainty. For statistical analysis of sensitivity and specificity, a paired t-test and ANOVA were used (significance level p = 0.05). A total of 50 female patients (median age 51 years, range 28-83 years) participated. IM had the highest overall scores in sensitivity and specificity for breast cancer detection, with 0.97 ± 0.06 and 0.95 ± 0.07, respectively, compared with 0.90 ± 0.04 and 0.92 ± 0.06 in CI. MonoE40 yielded a sensitivity of 0.96 ± 0.02 and specificity of 0.94 ± 0.08. All differences in sensitivity and specificity between MonoE or IM and CI were statistically significant (p < 0.001). The superiority of IM sensitivity and specificity was most pronounced in patients with dense breasts. Spectral CT improved the detection of breast cancer with higher sensitivity and specificity compared to conventional image data in our study.

Use of a poll-mounted accelerometer for quantification and characterisation of equine trigeminal-mediated headshaking.

Equine trigeminal-mediated (TGM) headshaking (HS) is a neuropathic facial pain syndrome characterised by varying intensity and frequencies of head movements and signs of nasal irritation. An accurate method for quantification and/or characterisation of HS severity is lacking. To develop and validate an objective measure of TGMHS. Prospective case control study. Horses presenting for investigation of HS were recruited alongside those presenting for forelimb lameness (LAME) and pre-purchase examination as well as healthy controls (CONTROL). Head movement data were collected for 5 min whilst trotting on the lunge using a tri-axial accelerometer, with a range of ±16 g and sampling rate of 800 Hz, attached to the bridle headpiece. Recordings were exported for processing. Peak detection was performed using minimum and maximum thresholds of -1 g and +1 g (corrected for gravity) and a minimum peak width of 10 samples. Fifty-six horses were included in the study; 18 TGMHS, 10 non-TGMHS, 12 LAME and 16 CONTROL. Characteristics and frequency of vertical (Z axis) head movements of TGMHS horses differed significantly from other horses. TGMHS horses had peaks with greater mean and maximum positive g-force (P < 0.005) and lower mean and minimum negative g-force (P < 0.001), greater frequency of peaks/min (P < 0.001) and over 12 times greater percentage of peaks >+2 g compared with other horses (P < 0.001). Receiver operator curve characteristics of percentage of peaks >+2 g (CI 0.72-0.95), percentage of peaks <-2 g (CI 0.66-0.92) and percentage of peaks <-2 g and >+2 g (CI 0.72-0.96) showed excellent discrimination of TGMHS horses from LAME, CONTROL and non-TGMHS horses. Referral population of horses, small sample size and control horses were not evaluated for orthopaedic disease. Accelerometer data from trotting exercise on the lunge provides an objective measure of HS and can differentiate between TGMHS, non-TGMHS, normal head movements and those associated with forelimb lameness. Accelerometer use may aid HS diagnosis and monitoring of management strategies.

Assessment of Post-traumatic Stress Disorder Risk Factors Among Law Enforcement Staff: A Case-Control Study

Background: Given the inherent nature of their job, law enforcement staff regularly confront major stressors. Objectives: The prevalence of post-traumatic stress disorder (PTSD) among law enforcement staff is about twice that of the general population. We conducted this study to assess PTSD risk factors among this population. Methods: This prospective case-control study was conducted on patients with PTSD working as law enforcement staff as the case group, and their comrades with no PTSD as the control group. We used a questionnaire, including possible factors contributing to the development of PTSD, to gather the data. Binomial logistic regression was used to calculate the odds ratio (OR) and 95% confidence intervals. Results: A total of 84 participants were included in the study. We found that some factors could be protective against PTSD, including marriage (OR: 0.270, 95% CI: 0.087 - 0.839, P-value: 0.024), having an academic degree (OR: 0.333, 95% CI: 0.114 - 0.978, P-value: 0.045), higher income (R2: 0.081; OR: 0.849, 95% CI: 0.721 - 1.000, P-value: 0.050), and receiving satisfactory family support (OR: 0.413, 95% CI: 0.171 - 0.999, P-value: 0.050). Furthermore, logistic regression showed that a positive psychological history (OR: 2.562, 95% CI: 1.025 - 6.406, P-value: 0.044), a positive familial psychological history (OR: 2.667, 95% CI: 1.099 - 6.406, P-value: 0.030), and encountering trauma (aside from the current trauma) after 18 years of age (OR: 2.643, 95% CI: 1.038 - 6.731, P-value: 0.041) are risk factors for PTSD. Conclusions: Our results showed that marriage, having an academic degree, higher income, and receiving satisfactory family support are protective factors. In addition, the risk factors for PTSD include a positive psychological history, a positive familial psychological history, and encountering trauma (aside from the current trauma) after 18 years of age. However, given our limitations, further studies should be conducted before drawing solid conclusions.

Preoperative optimization of modifiable risk factors is associated with decreased superficial surgical site infections after total joint arthroplasty: a prospective case-control study.

The aim of our study was to investigate change in modifiable risk factors following preoperative optimization and whether risk of superficial surgical site infection (SSI) after total joint arthroplasty (TJA) could be reduced. This is a prospective study of implementation of a preoperative optimization pathway for patients waiting for primary TJA. Information regarding the intervention arm was collected from January 2019 to January 2021, first at decision for operation and then at preoperative assessment 1 week prior to operation. The control arm was included between August 2018 and September 2020 after receiving conventional preoperative preparation and information gathered at preoperative assessment. Follow up occurred 6 weeks postoperatively for both groups. The primary outcome was postoperative superficial SSI. The optimization effort resulted in improvement of weight, anemia, HbA1c, vitamin D, and patient engagement. At preoperative assessment the baseline characteristics of the 2 groups were similar except that the intervention group had substantially more comorbidities. Regarding superficial SSI, association was found with BMI ≥ 30 and HbA1c ≥ 42 mmol/mol in the control group but not in the intervention group. When corrected for differences in ASA classification (reflecting comorbidities), age, and sex, being in the intervention group was associated with lower odds of occurrence of superficial SSI compared with the control group (OR 0.64, 95% confidence interval 0.42-0.97). We showed that preoperative optimization in a structured cooperation between hospital and primary care was associated with a reduced risk of superficial SSI.

Kynurenine Pathway Dysregulation and Pain Perception in Acute Pancreatitis: Has the Connection Unraveled?

AimTryptophan (TRP), an essential amino acid, undergoes catabolism through various pathways. Notably, the kynurenine pathway (KP), constituting one of these pathways, exhibits a unidirectional impact on immune response and energy metabolism. Nonetheless, its influence on pain sensation is characterized by biphasic dynamics. This study aims to scrutinize the influence of the KP pathway on pain sensation, particularly within the context of pancreatic inflammation. MethodsOur prospective case-control study involved individuals diagnosed with acute pancreatitis and a control group matched for gender and age. The patient cohort was subsequently subdivided into severe and non-severe subgroups. To assess metabolites within KP, two blood samples were collected from the patient cohort, one at the time of diagnosis and another during the recovery phase. Furthermore, for pain quantification, daily pain scores utilizing the Visual Analog Scale (VAS) were extracted from the patients’ medical records. ResultsThe study incorporated 30 patients along with an equivalent number of controls. A noticeable distinction was evident between the patient and control groups, characterized by an increase in kynurenine levels and a decrease in the tryptophan/kynurenine ratio. Throughout the process of disease recovery, a uniform decrease was observed in all KP metabolites, excluding 3-Hydroxykynurenine. Elevated levels of Kynurenic acid (KYNA) were correlated with increased pain scores. Critically, no apparent distinctions in KP metabolites were discerned concerning pain severity in patients with comorbidities characterized by neural involvement. ConclusionBased on our results, the kynurenine pathway (KP) is activated in instances of acute pancreatitis. Elevated levels of KYNA were found to be associated with heightened pain scores. The operative stages within the KP responsible for pain modulation are impaired in cases characterized by neuropathy-induced pain sensation.

Can Combination Therapy with Endothelin Receptor Antagonist and PDE5 Inhibitors Prevent Echocardiographic Findings Suspicious for Pulmonary Arterial Hypertension? Description of a Real-Life Case Series.

To retrospectively evaluate the incidence rate (IR) of elevated echocardiographic estimated systolic pulmonary artery pressure (sPAP), suspected for pulmonary hypertension (PH), in systemic sclerosis (SSc) patients after the introduction of a combination therapy with bosentan and sildenafil for treatment or prevention of digital ulcers. Patients attending the Scleroderma Unit of the Universital Hospital of Careggi from July 2010 to July 2023 were enrolled. Patients older than 18 years old with a history of digital ulcers, treated with bosentan and sildenafil in combination for at least 12 months, were included. Patients with a diagnosis of PH preceding the introduction of the therapy were excluded. Demographical data, disease duration, laboratoristic, and instrumental data (pulmonary function tests, echocardiographic estimation of sPAP, and ultrasonographic value of renal resistive index) were collected. The IR of echocardiographic signs suspected of pulmonary hypertension and their 95% confidence interval were calculated in events/1000 patients-years. Thirty-five patients were enrolled; the mean disease duration was 12.82 years (SD 5.92). The mean duration of the combination treatment was 81.03 (SD 43.1.3) months, and the total at-risk time was 2674 months. Two patients (5.7%) presented echocardiographic signs of PH (sPAP 50 mmHg and 40 mmHg); the IR was calculated to be 9/1000 patients-years (95% CI 7.95-10.12). In one of the two patients, right heart catheterism (RHC) excluded PAH, while the other patient refused to undergo RHC, and PAH could not be confirmed/excluded. The stability of PFTs and echocardiographic sPAP was observed during the observation time. The results of this retrospective study suggest that combination therapy with endothelin receptor antagonists and phosphodiesterase-5 (PDE5) inhibitors could help in preventing PAH in SSc; prospective case-control studies on a larger population are needed to improve knowledge in this field.

Anti-α-1,4-D-polygalacturonic acid antibodies as a new biomarker for juvenile idiopathic arthritis

ObjectiveDiagnosing juvenile idiopathic arthritis (JIA) is challenging. Our study aimed to investigate the clinical significance of anti-α-1,4-D-polygalacturonic acid (PGA) antibodies in JIA, focusing on their role in diagnosis and assessing disease activity.MethodsIn this prospective case–control study, we examined variations in serum levels of PGA-IgA and PGA-IgG among children with different types of JIA and healthy controls. Serum PGA-IgA and PGA-IgG levels were assessed concurrently in children with active and inactive JIA.ResultsThis study included 126 patients diagnosed with JIA, 13 neonates, and 76 healthy children. Serum PGA-IgA and PGA-IgG levels were assessed, which revealed significant differences in PGA-IgA levels between various JIA subtypes and controls. An analysis of PGA-IgA levels in various JIA states revealed a statistically significant difference. Receiver operating characteristic (ROC) analysis demonstrated the robust predictive capability of PGA-IgA, with an AUC of 0.879 (p < 0.001), along with a specificity of 0.842 and sensitivity of 0.848.ConclusionIncreased levels of anti-PGA antibodies, particularly PGA-IgA, were significantly associated with JIA. PGA-IgA may serve as a sensitive biomarker for disease activity in JIA and could potentially aid in the diagnosis of JIA.Key Points• This study found a significant correlation between blood levels of PGA-IgA and juvenile idiopathic arthritis (JIA), which may provide valuable diagnostic insights.• PGA-IgA shows potential as a sensitive biomarker for the assessment of disease activity in JIA patients, helping to determine disease activity.