Retrospective Cohort Analysis Research Articles

Incidence and potential predictors of SGLT2 inhibitor initiation in acutely hospitalized patients with heart failure.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. The purpose of this study was to assess the incidence of sodium-glucose cotransporter 2 (SGLT2) inhibitor initiation in hospitalized patients with heart failure and determine what potential factors may influence use. A single-center, retrospective cohort analysis was conducted of hospitalized patients with heart failure. The primary outcome was the incidence of SGLT2 inhibitor initiation. Secondary outcomes included the rates of use of other guideline-directed medical therapy, identification of factors associated with initiation of SGLT2 inhibitors, and reasons why SGLT2 inhibitors were not initiated. A total of 503 patients were included. The overall incidence of SGLT2 inhibitor initiation was 18% across all heart failure types, with 30% incidence in heart failure with reduced ejection fraction, 2.2% incidence in heart failure with mildly reduced ejection fraction (HFmrEF), and 5.7% incidence in heart failure with preserved ejection fraction (HFpEF). Logistic regression analysis showed that older age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.95-0.99; P = 0.009) and the presence of HFpEF (OR, 0.37; 95% CI, 0.17-0.77; P = 0.007) or HFmrEF (OR, 0.22; 95% CI, 0.05-0.69; P = 0.02) were negatively associated with SGLT2 inhibitor initiation. Presence of an angiotensin-converting enzyme inhibitor, angiotensin 2 receptor blocker, or angiotensin receptor/neprilysin inhibitor (OR, 2.14; 95% CI, 1.16-4.05; P = 0.017) or a β-blocker (OR, 3.78; 95% CI, 1.62-10.37; P = 0.004) was positively associated with the addition of an SGLT2 inhibitor, as was a cardiology consult (OR, 8.29; 95% CI, 2.36-52.83; P = 0.005). Providers rarely documented the reason for not prescribing an SGLT2 inhibitor, but the most commonly cited reasons were deferral to the outpatient setting (5.6%) and concern for renal function (4.6%). Use of SGLT2 inhibitors remains low despite recommendations advocating for their use in heart failure, with these agents specifically underutilized in HFpEF and HFmrEF at this institution.

Pre-injury frailty and clinical care trajectory of older adults with trauma injuries: A retrospective cohort analysis of A large level I US trauma center.

Pre-injury frailty among older adults with trauma injuries is a predictor of increased morbidity and mortality. We sought to determine the relationship between frailty status and the care trajectories of older adult patients who underwent frailty screening in the emergency department (ED). Using a retrospective cohort design, we pooled trauma data from a single institutional trauma database from August 2020 to June 2023. We limited the data to adults 65 years and older, who had trauma injuries and frailty screening at ED presentation (N = 2,862). The predictor variable was frailty status, measured as either robust (score 0), pre-frail (score 1-2), or frail (score 3-5) using the FRAIL index. The outcome variables were measures of clinical care trajectory: trauma team activation, inpatient admission, ED discharge, length of hospital stay, in-hospital death, home discharge, and discharge to rehabilitation. We controlled for age, sex, race/ethnicity, health insurance type, body mass index, Charlson Comorbidity Index, injury type and severity, and Glasgow Coma Scale score. We performed multivariable logistic and quantile regressions to measure the influence of frailty on post-trauma care trajectories. The mean (SD) age of the study population was 80 (8.9) years, and the population was predominantly female (64%) and non-Hispanic White (60%). Compared to those classified as robust, those categorized as frail had 2.5 (95% CI: 1.86-3.23), 3.1 (95% CI: 2.28-4.12), and 0.3 (95% CI: 0.23-0.42) times the adjusted odds of trauma team activation, inpatient admission, and ED discharge, respectively. Also, those classified as frail had significantly longer lengths of hospital stay as well as 3.7 (1.07-12.62), 0.4 (0.28-0.47), and 2.2 (95% CI: 1.71-2.91) times the odds of in-hospital death, home discharge, and discharge to rehabilitation, respectively. Pre-injury frailty is a predictor of clinical care trajectories for older adults with trauma injuries.

Utility of Preoperative Hypoalbuminemia as Independent Predictor of Post-Conversion and Revisional Bariatric Surgery Outcomes: MBSAQIP Registry Analysis.

Anastomotic conversions and revisions remain crucial in addressing complications or sub-optimal outcomes following primary bariatric procedures. Preoperative malnutrition, proxied by hypoalbuminemia, has traditionally been considered a risk factor for postoperative morbidity. This study investigates the validity of this association in revisional and conversion metabolic/bariatric surgery (MBS). A retrospective cohort analysis was performed on 58,327 MBS revisions and anastomotic conversions from the 2020-2022 MBSAQIP registry. Approximately all cases studied were performed laparoscopically (98.8%). A preoperative albumin level of 3.5 g/dL was used as a threshold to identify patients with hypoalbuminemia. We utilized descriptive statistics, univariate and multivariable logistic regression, and 1:1 nearest neighbor matching in complete-case analyses to explore the relationship between albumin levels and postoperative outcomes. While univariate analyses illustrate an association between hypoalbuminemia and postoperative morbidity, multivariable regression and 1:1 matched analysis showed hypoalbuminemia is not an independently significant driver of 30-day overall postoperative complications (including leaks), reoperation, or reintervention. However, 1:1 matched analysis demonstrated significantly increased odds of 30-day postoperative superficial surgical site infection (SSI) (OR 8.138, p=0.049) and readmission (OR 1.75, p=0.045) associated with albumin levels lower than 3.5 g/dL. Following adjustment for confounding patient factors, hypoalbuminemia alone did not arise as an independent predictive factor for the 30-day major complications such as leak, reoperation, or re-intervention after revisional and anastomotic conversion MBS, although there maybe increase in SSI and readmission rates.

Robotic functional alignment in knee arthroplasty minimizes impact on ankle alignment: Role of MPTA and LDFA preservation.

Alignment strategies in knee arthroplasty have a profound influence not only on knee biomechanics but also on the biomechanics of adjacent joints, particularly the ankle. Functional alignment (FA) represents a flexible alignment strategy aimed at achieving patient-specific balance. However, predefined boundaries are often applied to ensure mechanical stability, leading to adjustments in the medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA) while still respecting the patient's native alignment as much as possible. FA is a patient-specific strategy that seeks to respect the patient's preoperative phenotype or constitutional alignment while achieving a balanced and stable knee. The hypothesis is that FA strategies can protect the ankle from excessive biomechanical stress. A retrospective cohort analysis was conducted on 300 consecutive patients who underwent robotic-assisted knee arthroplasty. Preoperative and 6-month post-operative radiographic evaluations measured key ankle parameters, tibial plafond inclination (TPI), talar inclination (TI) and Talar Tilt (TT). Statistical analyses evaluated the influence of alignment strategies on these parameters, with particular focus on whether MPTA and LDFA crossed the 90° threshold, indicating a shift from varus to valgus or vice versa. FA demonstrated smaller changes in ankle parameters compared to mechanical alignment (MA). In the FA group, mean changes were 1.8° for KTPA (standard deviation [SD] = 1.1°, p = 0.03), 2.4° for TPI (SD = 1.0°, p = 0.04), 2.1° for TI (SD = 1.3°, p = 0.05) and 1.7° for TT (SD = 0.9°, p = 0.04). The MA group showed greater deviations: 3.9° for KTPA (SD = 1.5°, p = 0.01), 5.2° for TPI (SD = 1.2°, p = 0.02), 4.8° for TI (SD = 1.4°, p = 0.03) and 3.6° for TT (SD = 1.1°, p = 0.04). Alterations in LDFA and MPTA exceeding 2° were significantly associated with worsening ankle alignment. Furthermore, FA, with its goal of maintaining Coronal Plane Alignment of the Knee (CPAK) classification, was associated with minimal modifications to ankle angles, suggesting potential biomechanical benefits as reported in the literature. FA was associated with smaller changes in ankle alignment parameters, indicating its ability to better preserve native joint positioning. Future research should focus on longitudinal studies to confirm these benefits and further establish the FA strategy as a standard in knee arthroplasty, particularly its capacity to maintain CPAK classification alignment. Level III.

Prognostic implications and therapeutic response in GNAS-mutated colorectal adenocarcinoma: A retrospective cohort analysis.

244 Background: GNAS, a key regulator of the G-protein signaling pathway, is frequently mutated in colorectal adenocarcinomas and other malignancies. Despite its role in tumorigenesis, GNAS mutations remain understudied, with no established targeted therapies. Exploring the impact of GNAS alterations on therapeutic response and outcomes in colorectal cancer (CRC) is crucial for developing effective treatment strategies. Methods: We reviewed 531 CRC cases from our institutional Molecular Tumor Board database, identifying 8 patients with GNAS mutations. The prevalence ofGNASmutations in our cohort was 1.5%, which aligns with reported rates of 2-5% in various CRC cohorts. Comprehensive clinicopathologic data, including tumor histology, staging, treatment outcomes, and response rates, were analyzed. A detailed evaluation was conducted on stage IV patients to assess their response, progression-free survival (PFS), and overall survival (OS) in comparison to historical stage IV CRC benchmarks. Results: The cohort included 8 patients with a median age of 61 years (range: 33-73 years), with balanced gender representation (50% male, 50% female). The racial distribution was 50% Black or African American, 25% White, and 12.5% Asian or Pacific Islander. The majority of patients (62.5%) were diagnosed at stage IV, with primary tumor sites predominantly in the sigmoid colon and cecum. Among the 5 stage IV patients, while no patients achieved a complete or partial response, 3 exhibited stable disease, resulting in a 60% disease control rate (including stable disease). The median progression-free survival (mPFS) was 9 months, reflecting the duration of disease control before progression, while the median overall survival (mOS) was 15 months. These outcomes are notably lower than historical benchmarks for stage IV CRC, where response rates typically range from 40-50% with mOS of 20-24 months, highlighting the potentially adverse prognostic impact of GNAS mutations. Conclusions: Patients with GNAS-mutated colorectal adenocarcinoma appear to represent a unique subset with poorer therapeutic outcomes, even when achieving stable disease. The observed disease control in the absence of objective responses underscores the complexity of treating GNAS-mutated tumors and highlights the urgent need for targeted therapies tailored to this molecular subtype. Further research into the biological mechanisms underlying GNAS mutations and their impact on CRC treatment resistance is warranted to improve patient outcomes.

A Retrospective Descriptive Study on Caesarean Isthmocele: A Delayed and Under-recognised Complication of Caesarean Section

Introduction: A caesarean scar defect (isthmocele) is an indentation that represents myometrial discontinuity in the anterior uterine wall, with the base communicating with the uterine cavity at the site of a previous caesarean section scar. It has been linked to a variety of gynaecological symptoms, including abnormal uterine bleeding and secondary infertility. Aim: To describe the demographic characteristics, clinical presentation, management and outcomes in patients with Caesarean Scar Defect (CSD). Materials and Methods: A retrospective cohort analysis was conducted in the Department of Obstetrics and Gynaecology, Gastrocare Hospital (tertiary care centre), Bhopal, Madhya Pradesh, India, from February 2020 to February 2023. Data were collected from the hospital records of 43 patients who presented with CSD. The recorded variables included demographic details, clinical presentations, prior treatments, diagnostic interventions, types of surgical procedures performed and patient outcomes. Descriptive statistics, such as means, standard deviations and frequencies, were used to summarise patient characteristics and outcomes. All statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) software version 29.0 software. Results: The majority of the women were in the age group of 30-40 years. Out of 43 patients, eight presented with Abnormal Uterine Bleeding (AUB), three had secondary infertility, and 32 presented with Caesarean Scar Ectopic Pregnancy (CSEP) and its complications. All cases were managed either by hysteroscopy or laparoscopy, based on the Residual Myometrium Thickness (RMT). Conclusion: Transvaginal Sonography (TVS) is an effective tool for diagnosing CSD and CSEP. Surgical management can be guided by the RMT as determined by TVS.

Theta-Alpha Variability on EEG Is Associated With Acute Brain Injury in Children and Young Adults With Liver Failure.

Patients with liver failure experience long hospitalizations and acute neurologic complications. Encephalopathy limits the bedside examination, rendering presenting signs of acute brain injury less specific. Seizures are common. Brain MRI is the gold standard for detecting acute brain injury, but intensive medical needs may preclude immediate transfer for imaging. EEG is a bedside test applied in cases of seizure or encephalopathy. We hypothesized that EEG variables can predict MRI signs of acute brain injury in children hospitalized with liver failure. In this retrospective cohort analysis, records were collected for patients admitted to a MedStar hospital between 2014 and 2022 with ICD-9/10 codes related to liver failure, who underwent brain MRI and EEG testing during the same admission. Exclusion criteria included age older than 24 years and >7 days elapsing between EEG and MRI testing. Clinical data of interest from chart review, reinterpreted MRI scans, reinterpreted EEG tracings, and quantitative EEG variables were compiled into a database. Quantitative EEG variables were processed using MNE-Python. Of 746 records screened, 52 patients met inclusion criteria comprising 63 EEG-MRI pairs. Univariate analysis of all quantitative EEG variables of interest showed depressed theta-alpha variability (TAV) when paired MRI involved abnormal restricted diffusivity in cortical or deep gray matter structures (TAV 0.705, SD 0.310; p < 0.001) compared with MRI with no abnormal restricted diffusivity (TAV 0.895, SD 0.095). Multilinear regression analysis including potential confounders demonstrated independent association of depressed TAV with this MRI finding, with an odds ratio of 4.0317 (95% CI 1.3868-11.7165; AUROC 0.83). Depressed TAV on EEG is associated with increased odds of abnormal restricted diffusivity in gray matter on brain MRI in children and young adults hospitalized with liver failure. This MRI finding is seen in scenarios where changes to medical management are time-sensitive (i.e., acute stroke and PRES) or where prognostic discussion may be influenced by MRI findings (hypoxic-ischemic injury). TAV thus has a potential role as an automated, bedside decision support tool for clinicians deciding on the urgency of brain MRI in critically ill patients.

Optimal cut-off value for lymph node harvesting in colon cancer based on tumor stage and sidedness: A retrospective analysis of a Japanese nationwide cohort.

149 Background: The presence of fewer than 12 harvested lymph nodes (LN) is currently considered a risk factor in stage II colon cancer (CC). However, this cut-off value does not take into consideration the biological differences associated with tumor sidedness. Moreover, the applicability of this cut-off value to stage III CC is unknown. Methods: Patients with pathological stage II/III CC who underwent curative surgical resection were assessed using data from the Japanese Society for Cancer of the Colon and Rectum database (2001–2015). The optimal cut-off value of harvested LN was evaluated by analyzing all cut-off values (i.e., 3–40), taking into account the point estimate of the hazard ratio (HR) and lower limit of the 95% confidence interval (CI), according to the tumor stage (II/III) and sidedness (right/left). A Cox proportional hazards model was used to investigate the impact of the number of harvested LN on overall survival, adjusting for age, sex, T stage, histology, size of tumor, sidedness, adjuvant chemotherapy and extent of colon resection. Multivariate analysis was also conducted. Results: From the data, 4249 (left/right; 3248/1001) and 3549 (left/right; 2798/751) patients with stage II and III CC, respectively, were identified. The median number of harvested LN was identical between stage II (18, interquartile range [IQR] (12–15)) and III (18, IQR (13–25)). However, this number was higher in right-sided CC (21, IQR (14–31)) versus left-sided CC (17, IQR (12–24)). In stage II, the conventional cut-off value (i.e., 12 LN) was identified as a prognostic factor in the multivariate analysis (HR 1.45; 95% CI: 1.20–1.75; p&lt;0.001). Nevertheless, the prognostic impact of the number of harvested LN was stronger when the optimal cut-off value was set to 7 (HR 1.88; 95% CI: 1.44–2.44; p&lt;0.001). In stage III, the optimal cut-off value was 12 (HR 1.88; 95% CI: 1.44–2.44; p&lt;0.001). When evaluated based on tumor sidedness, the optimal cut-off value differed, especially for stage III. Data are shown in the table. Similar results were obtained following the exclusion of the extent of bowel resection as variable in Multivariate analysis. Conclusions: While the presence of 12 harvested LNs remains a valid prognostic factor, the optimal cut-off value can be further evaluated based on tumor stage and sidedness. Stage II Stage III All Left Right All Left Right Cut-off value 12 12 12 12 12 12 N(&gt;cut-off/&lt;cut-off) 3209/1040 2371/877 838/163 2814/735 2181/617 633/118 HR(&gt;cut-off/&lt;cut-off)(95% CI) 1.45 (1.20-1.75) 1.49 (1.20-1.84) 1.31 (0.85-2.02) 1.30 (1.09-1.55) 1.27 (1.05-1.54) 1.43 (0.97-2.13) P value &lt;0.001 &lt;0.001 0.216 &lt;0.003 0.015 0.073 Cut-off value 7 7 10 20 13 N(&gt;cut-off/&lt;cut off) 3930/319 2977/271 889/112 1200/1598 609/142 HR(&gt;cut-off/&lt;cut-off)(95% CI) 1.88 (1.44-2.44) 2.07 (1.56-2.74) 1.39 (0.84-2.27) 1.35 (1.13-1.60) 1.59 (1.11-2.28) P value &lt;0.001 &lt;0.001 0.198 &lt;0.001 0.011

Anesthesia in mucopolysaccharidoses – Retrospective analysis and insights of a large cohort

Anesthesia in mucopolysaccharidoses – Retrospective analysis and insights of a large cohort

Abstract TMP90: Hidden Challenges: Mental Health Outcomes in Pediatric Stroke Survivors

Introduction: The burden of disease from pediatric arterial ischemic stroke (AIS) includes non-visible disability in the form of mental health conditions such as depression and anxiety which impact the quality of life of children and families affected by stroke. Objectives: To determine the scale of the mental health phenomenon in the pediatric AIS population in a large single-center study, and to educate clinicians about this significant risk in pediatric stroke survivors. Methods: A retrospective analysis of a prospective single-center cohort of school-aged children diagnosed with AIS, enrolled between 2002 and 2020 was conducted. Depression and anxiety were evaluated with the Behavior Assessment System for Children (BASC, versions 1 and 3). Prevalence and scores for depression and anxiety were ascertained children with AIS and compared with general pediatric population scores. Somatization, a third internalizing subscale in the BASC questionnaire, was also included in the analysis. Results: AIS patients (N=161, 98 male; median age and range at stroke 1.9 years [0 – 13.8 years]) were assessed with neuropsychological measures at median age and range 9.1 years (5.6 – 16.7 years). Clinical scores for depression, anxiety and somatization, i.e., T= ≥ 70 in the Depression (mean = 81.0, SD= 8.7), Anxiety (mean= 76.6, SD=8.3) and Somatization (mean= 81.9, SD= 11.0) subscales, were found in 13%, 13.7% and 17.4% of school-age children with AIS respectively, with the median age ranging between 8.5 and 9.6 years,representing the age of greatest vulnerability in our cohort. In AIS patients, mean scores for mood, anxiety and somatization were higher compared to the general pediatric population. Age at stroke in the children within the Somatization Clinical group were older than 2 years age at time of stroke(p=0.034). Conclusions: Mental health disorders represent a significant problem in pediatric stroke survivors, with the end of primary school appearing to be the time of greatest vulnerability. These mental health outcomes, (depression, anxiety, somatization) could be associated with age at stroke. The symptoms manifested due to these mental health challenges are frequently overlooked. Therefore, early detection and intervention are essential to change patient trajectories and improve outcomes and quality of life.

Predictors of Use of Individual Insulin and GLP-1 RA Products Versus Fixed Ratio Insulin/GLP-1 RA Combinations in Medicare Beneficiaries.

Background: In 2022, federal law capped insulin product costs at $35 per month for Medicare prescription drug plan recipients. However, this law did not address the high costs of other antihyperglycemic medications, such as glucagon-like peptide-1 receptor agonists (GLP-1RAs), with an average copay of $120 per month. Under the law, fixed-ratio insulin/GLP-1RA combination products are classified as "insulin products," making these effective medications more accessible to patients who might otherwise be unable to afford them. Patients may not be aware of the potential financial benefits of combination products, highlighting the need to identify those using them to better educate both patients and providers. Objectives: The primary objective was to identify predictors of use for the insulin/GLP-1RA combinations. The secondary objective was to determine if there was a difference in medication cost to patients between individual and combination product users and determine cost savings potential of switching. Design: This was a retrospective, observational cohort analysis. Setting: Prescription fill data were examined for antihyperglycemic medications filled between January 1, 2022, and December 31, 2022. Prescriptions were filled within one regional division of a large community-based pharmacy chain, encompassing 71 pharmacies within Kansas, Nebraska, and Missouri. Methods: This retrospective observational cohort analysis examined prescription fill data for antihyperglycemic medications for the calendar year 2022 across one regional division of a large community-based pharmacy chain. Included patients 65 years of age or older with a Medicare prescription drug plan, using any basal insulin and any GLP-1RA, including combinations, as well as metformin, with ≥ 80% proportion of days covered. Demographics, usage predictors, and cost differences were compared between patients using individual products and those using insulin/GLP-1RA combination products. Results: A total of 138 patients were analyzed. The use of insulin/GLP-1RA combination products was associated with increased likelihood of using sodium-glucose cotransporter-2 inhibitors (P = 0.022). Median annual out-of-pocket spending was significantly different between groups (P < 0.001), with most combination users paying more than $1,000 less per year than individual product users. Conclusion: Insulin/GLP-1RA combination products represent a cost-effective alternative to individual antidiabetic pharmacotherapy agents.

Abstract TP168: Automated CT perfusion Parameters as Predictors of Hemorrhagic Transformation After Mechanical Thrombectomy in Large Vessel Ischemic Stroke

Introduction: Hemorrhagic transformation is a common complication of mechanical thrombectomy (MT), often as a result of reperfusion injury. We investigated the correlation between automated CT perfusion (CTP) parameters and Hemorrhagic transformation after MT in acute ischemic stroke. Method: We conducted a retrospective cohort analysis of patients consecutively admitted to the Providence Health System between January 2018 and February 2022 with acute ischemic stroke who underwent MT and had a CTP on admission. We also addressed each CTP parameter’s predictive power through bivariate logistic regression and ROC/AUC analysis. We compared the median and IQR ranges of volumes of automated CTP parameters between patients with and without ICH. Any degree of hemorrhagic transformation in the ECASS II classification system was considered ICH. Symptomatic intracranial hemorrhage (sICH) was defined by The Heidelberg Bleeding Classification. (4 point increase in NIHSS, or 2 in one NIHSS subcategory, major medical/surgical intervention involved) Results: We included 513 patients with a ischemic stroke who had an MT. Median age was 75(63, 85) years old. Higher blood sugar (p=0.003) and chronic kidney disease (p=0.001) were significantly associated with sICH Table1. Cerebral blood flow( CBF)&lt;30%, cerebral blood volume (CBV)&lt;38%, CBV&lt;42%, mismatch ratio, and CBV index were associated to sICH as shown in Table 2. ROC analysis for CBV index showed an AUC of 0.64 in the bivariate analysis. Other CTP parameter logistic regression and an ROC/AUC analysis are shown in Table 3. Conclusion: Higher CBF&lt;30%, CBV&lt;38%, and CBV&lt;42% volumes were associated with an increased frequency of ICH and sICH. Higher mismatch ratios correlated with a lower frequency of ICH and sICH. Lower hypoperfusion index; and, elevated Tmax volumes &gt;10s and &gt;8s, were associated to a higher frequency of ICH. However, these parameters were insufficiently powered to show a significant association with sICH. CBV index outperformed the other CTP parameters in the ROC analysis. Larger studies are needed to clarify these associations.

Artificial intelligence-based prediction of second stage duration in labor: a multicenter retrospective cohort analysis

Artificial intelligence-based prediction of second stage duration in labor: a multicenter retrospective cohort analysis

Ethnic Inequity in the Current Approach to H. pylori Testing and Treatment: Linked Data Cohort Analysis.

As seen globally, there are up to sixfold differences in gastric cancer mortality by ethnicity in Aotearoa New Zealand, and H. pylori is the major modifiable risk factor. This study investigates whether current H. pylori testing and treatment approaches are equitable. The study design was a retrospective cohort analysis of linked administrative health data. Laboratory testing data and pharmacy dispensing were linked to the Northern region health user population dataset (1.9 million) from 2015 to 2018. We investigated an individual's first test for H. pylori. Regression analyses compared ethnic differences in rates of H. pylori testing, infection, treatment, and retesting, adjusted for age, sex, and calendar year. Ethnic inequities were present across the clinical pathway. Compared to sole-European, testing rates were lowest in Māori (OR 0.69) and Pacific (OR 0.81) and highest in Middle-Eastern/Latin-American/African (MELAA) (OR 2.21) and Asian (OR 2.02). Positivity rates were highest in MELAA (RR 2.96, 39%) and Pacific (RR 2.84, 38%) followed by Asian (RR 1.93, 26%) and Māori (RR 1.71, 23%). Treatment rates were similar for Asian (HR 1.05), MELAA (HR 1.03), and Māori (HR 0.98) compared to sole-European but lower in Pacific (HR 0.90). Māori and Pacific were half as likely to be retested as sole-European. Despite the higher prevalence of H. pylori and gastric cancer, Māori and Pacific are relatively underserved with lower rates of testing and treatment than sole-European. Improved guidelines and the consistent application of these along with an equity-focused test and treat program are likely to be particularly beneficial for Māori and Pacific in addressing inequities.

Associations between physical activities and self-harm behaviour in depression across the genotype: findings from the UK biobank.

Physical activities are widely implemented for non-pharmacological intervention to alleviate depressive symptoms. However, there is little evidence supporting their genotype-specific effectiveness in reducing the risk of self-harm in patients with depression. To assess the associations between physical activity and self-harm behaviour and determine the recommended level of physical activity across the genotypes. We developed the bidirectional analytical model to investigate the genotype-specific effectiveness on UK Biobank. After the genetic stratification of the depression phenotype cohort using hierarchical clustering, multivariable logistic regression models and Cox proportional hazards models were built to investigate the associations between physical activity and the risk of self-harm behaviour. A total of 28 923 subjects with depression phenotypes were included in the study. In retrospective cohort analysis, the moderate and highly active groups were at lower risk of self-harm behaviour. In the followed prospective cohort analysis, light-intensity physical activity was associated with a lower risk of hospitalisations due to self-harm behaviour in one genetic cluster (adjusted hazard ratio, 0.28 [95% CI, 0.08-0.96]), which was distinguished by three genetic variants: rs1432639, rs4543289 and rs11209948. Compliance with the guideline-level moderate-to-vigorous physical activities was not significantly related to the risk of self-harm behaviour. A genotype-specific dose of light-intensity physical activity reduces the risk of self-harm by around a fourth in depressive patients.

Retrospective comparative cohort analysis of Darn and Lichtenstein repair methods for bilateral inguinal hernias in adult males in a low-resource setting: a single-centre study in Sudan

Background: Inguinal hernias are a common surgical condition that, if untreated, can lead to severe complications. Bilateral inguinal hernias add challenges due to increased recurrence and postoperative risks. Although Lichtenstein repair, a mesh-based approach, is the gold standard for its low recurrence, Darn repair – a mesh-free technique – offers a cost-effective alternative in low-resource settings. This study assesses the applicability and effectiveness of both techniques for bilateral inguinal hernias in a resource-limited environment. Materials and methods: With Institutional Review Board (IRB) approval from Al-Waleedeen Specialized Hospital (IRB number WAD.12.01.2021), a retrospective cohort analysis was conducted on 75 adult males who underwent bilateral inguinal hernia repair from January 2021 to October 2023 in Sudan. Patients were divided into Group A (Lichtenstein, n = 30) and Group B (Darn, n = 45). Data on operative time, complications, hospital stay, return to normal activities, patient satisfaction, and economic impact were collected, with a three-month follow-up. Results: Darn repair showed fewer postoperative complications, particularly lower surgical site infections (SSI) (8% vs. 20%, P = 0.014). It also had shorter operative times (mean 30 minutes less), reduced hospital stays (1.5 vs. 2.8 days, P &lt; 0.0001), and lower costs. Recurrence rates were comparable across both groups. Conclusion: While both methods yielded similar recurrence rates, Darn repair showed advantages in resource-limited settings, with fewer complications, shorter hospital stays, and lower costs, making it a practical option when mesh is not readily available. Limitations include retrospective design, convenience sampling, and possible recall bias from phone follow-ups. The three-month follow-up may not capture long-term outcomes like chronic pain or late recurrences. Future studies should extend follow-ups and conduct prospective trials to optimize Darn repair across diverse settings

The Impact of Aging on Measurement of Continuity of Treatment Among Children Living With HIV in the PEPFAR Supported Program in Kenya.

To reduce HIV-related morbidity and mortality among children living with HIV (CLHIV), continuity of treatment is critical. We sought to understand how aging out among CLHIV in Kenya impacts estimates of treatment continuity. A retrospective cohort analysis was performed on deidentified individual-level data from the Kenya National Data Warehouse for all clients who initiated and/or received antiretroviral therapy between the periods of October 2018 and September 2022 [US Government fiscal years (FYs) 2019-2022]. CLHIV previously on treatment and those newly initiating treatment were included in the analysis. Outcomes included aging out of childhood (turning 15 years old), interruption in treatment, return to treatment and remaining active on treatment. The number of active CLHIV on treatment at the end of FY 2019 was 44,628. This changed to 48,218, 48,262 and 44,780 representing 8%, 0% and -7% cohort growth/reduction at the end of FYs 2020, 2021 and 2022, respectively. Among those who were on treatment at the beginning of each FY, aging out of childhood accounted for 53%, 61% and 72% of the total cohort reductions for the periods 2020, 2021 and 2022, respectively. Interruptions in treatment accounted for proportions ranging from 5% to 9% among those active on treatment, while those who aged out of childhood ranged between 11% and 13%. Among those who returned to treatment in each FY, the proportions who remained active at the end of the FY varied from 72% to 76%. Accounting for aging out of childhood can improve program estimates of their true rates of interruptions of treatment in children, as they work to achieve epidemic control among CLHIV.

Evaluating the brain injury guidelines (BIG) in an Australian trauma centre: A retrospective cohort analysis.

The Brain Injury Guidelines (BIG) were developed to improve resource utilisation for patients with traumatic brain injury (TBI). The original BIG have never been validated outside the USA. The unique challenges facing Australian healthcare warrant validation of the BIG in this setting. This study aimed to evaluate the current standard of TBI management, safety of the BIG, and hypothetical resource savings resulting from their implementation. A single institution, retrospective cohort study. Patients were identified by searching the database of radiology reports for computerised tomography (CT) studies, for patients presenting to the Princess Alexandra Hospital emergency department (ED) from 1 January 2018 to 1 January 2023. Chart review of the medical record was performed and patients were classified into BIG1, BIG2 or BIG3 based on neurological examination, intoxication, antiplatelet/anticoagulant use, and CT findings. The primary outcome was the need for neurosurgical intervention. Secondary outcomes were worsening neurological examination within 24h of admission, progression on repeat head CT (RHCT) and post-discharge ED visits and 30-day readmissions. The guidelines were considered to fail if any BIG1 or BIG2 patient required neurosurgical intervention or ICU admission. 878 patients were included, of which 106 (12.1%) were BIG1, 113 (12.9%) BIG2, and 659 (75.1%) BIG3. Subdural and subarachnoid haemorrhage were the most common intracranial haemorrhage (ICH) in all groups. No BIG1 or BIG2 patient showed neurological deterioration or required intervention. Radiological progression was seen in 7% and 3.4% of RHCT for BIG1 and BIG 2 patients respectively; in no case did this change management. There was 1 (0.9%) post-discharge ED visit in the BIG1 group. There were no 30-day readmissions in the BIG1 or BIG2 group. All patients needing intervention or readmission were BIG3. Current practice is not in line with the BIG, with excessive intervention performed in 97.2% of BIG1 patients and 96.5% of BIG2 patients. Agreement between the assigned and verified therapeutic plan was perfect (k=1.00), meaning no patient failed the BIG. Adoption of the BIG could have saved 101 RHCT, 208 neurosurgical consultations and 189 inpatient days. The BIG are safe in Australia and would significantly improve healthcare resource utilisation. Current practice regularly deviates from the BIG, suggesting significant resource saving to be realised. Future studies should prospectively validate the BIG so widespread adoption can be supported and implemented. Integration with allied health, long-term outcomes and potential modifications to the BIG remain to be explored.

Discussion of Geographic and Demographic Disparity in Firearm Injury: A 33-Year Retrospective Cohort Analysis of Florida Communities.

Discussion of Geographic and Demographic Disparity in Firearm Injury: A 33-Year Retrospective Cohort Analysis of Florida Communities.

Generalizability of Randomized Controlled Trials to Routine Clinical Care in Ulcerative Colitis.

Historically, randomized controlled trials (RCTs) have been criticized for being poorly generalizable to patients with ulcerative colitis (UC) evaluated in routine care. We aimed to evaluate the proportion of patients with UC starting an advanced therapy who would be eligible to participate in phase 3 registrational UC RCTs. We conducted a retrospective cohort analysis of UC patients starting vedolizumab, ustekinumab, or tofacitinib at 2 IBD clinics at the University of Calgary. Patient charts, endoscopy reports, and laboratory results were reviewed, and compared against the inclusion and exclusion criteria from 5 RCTs (GEMINI-I, UNIFI, OCTAVE, ELEVATE, and LUCENT). The proportion of patients who would have been deemed eligible versus ineligible for trial participation at the time of starting a new advanced therapy was determined. A total of 125 patients with UC were included: 78 (62.4%) would have been eligible for at least one of the considered RCTs. Trial-eligible patients were younger, less likely to be exposed to prior immunosuppressants, and had higher C-reactive protein and fecal calprotectin. The most common reason for trial ineligibility was having inadequate disease activity at baseline (Mayo endoscopy subscore <2 or absence of rectal bleeding). A significantly greater proportion of patients would have been eligible for LUCENT (45.6%) compared to GEMINI-I (24.8%), OCTAVE (35.2%), or ELEVATE (35.2%) (P < .01 for all comparisons). Half of patients with UC starting advanced therapy in routine care may be eligible for participation in phase 3 RCTs. Disease activity is the primary reason for trial exclusion.