Retrospective Study Research Articles

Outcomes of prophylactic fasciotomy in patients with non-traumatic acute limb ischemia.

Post-reperfusion compartment syndrome is an emergency consequence following revascularization of acute limb ischemia. Fasciotomy is the gold standard treatment for acute compartment syndrome. Some surgeons perform prophylactic fasciotomy (PF) during the same operation; however, fasciotomy may lead to wound complications and an increased length of hospital stay. This study aims to evaluate the outcomes of prophylactic fasciotomy in our hospital. This is a retrospective observational cohort study. We reviewed the data of acute limb ischemia patients at Maharaj Nakorn Chiangmai Hospital, who were diagnosed with non-traumatic acute limb ischemia and received revascularization between January 2006 and August 2022. The primary outcomes are 30-day amputation-free survival (AFS) and overall survival (OS). Propensity score weighting with confounder adjustment was used to balance peri-operative confounders. From our data, there were 56 patients in the PF group and 301 in the non-prophylactic fasciotomy (NPF) group. The 30-day amputation rates were 12.5% and 10% in the PF and NPF groups, respectively (p-value 0.895). The 30-day AFS was similar between the PF and NPF groups, with a hazard ratio (HR) of 0.93, 95% confidence interval (CI) 0.32-2.45, and a p-value of 0.882. The 30-day OS in the PF group was statistically lower than that in the NPF group, HR 4.09, 95% CI 1.55-10.77, and a p-value of 0.004. The 1-year and 5-year AFS were not significantly different between the PF and NPF groups. However, the 1-year and 5-year OS were lower in the PF group compared to the NPF group, with HR 3.44, 95% CI 1.37-8.65, and a p-value of 0.009, and HR 3.04, 95% CI 1.24-7.45, and a p-value of 0.015, respectively. Fasciotomy wound infection rates were higher in the PF group compared to the NPF group, 5.5% versus 1.7%, respectively, p-value 0.017. Other clinical outcomes did not show significant statistical differences. Prophylactic fasciotomy may not improve amputation-free survival (AFS) but increases mortality, particularly within the first 30 days, even in some high-risk patients. The use of prophylactic fasciotomy should be limited to cases where it is clearly indicated.

Effectiveness of spinal cord stimulation in diabetic patients with chronic limb-threatening ischemia: small cohort study

BackgroundChronic limb-threatening ischemia (CLTI) is the most severe form of peripheral artery disease (PAD). Patients with diabetes mellitus (DM) have a faster progression of PAD and a fourfold increased risk of CLTI compared to patients without DM. Epidural spinal cord stimulation (SCS) has been used as a method to improve microcirculation, relieve ischemic pain and reduce the number of amputations in patients with PAD. This is a retrospective small cohort analysis of patients with diabetes and the long-term treatment effect of spinal cord stimulation.MethodsAs the main outcome of the study, we evaluated the survival and amputation of 13 diabetic patients with chronic lower-limb ischemia who were not eligible for surgical or interventional therapy. Secondary outcomes included ankle-brachial index (ABI), ischemic pain intensity, quality of life, use of analgesic medications and skin wound outcomes analyzed during long-term follow-up.ResultsBetween January 2010 and January 2017, 13 patients underwent SCS implantation in our vascular center. At 1-year follow-up, the limb salvage rate was 92.3% (12 of 13 patients), and limb ulcers healed in 75% of patients (6/8). No patient died during the one-year follow-up. A total of 4 of patients (31%) experienced major amputation during long-term follow-up, all of them were Fontaine stage IV. Pain intensity and quality of life improved significantly at 6-month follow-up (p < 0.05). ABI measurements were unaffected by SCS treatment. There were no complications related to the procedure or device.ConclusionsSCS is a promising treatment option for diabetic patients unsuitable for endovascular or surgical revascularization. The method improves limb survival in diabetic patients with critical limb ischemia, provides significant pain control, and improves patients' quality of life. However, more studies are needed to clarify the indications for SCS and clarify its effects on the vascular system.

Incidence of adverse events related to intravenous immunoglobulin therapy in children.

Intravenous immunoglobulin (IVIG) therapy is used in the treatment of pediatric diseases, although data about IVIG-related adverse events (IVIG-AEs) are limited. Objectives of this study were to document the incidence of IVIG-AEs in pediatric hospitalized patients and to identify risk factors for IVIG-AEs. This retrospective cohort study included patients <18 years old who received IVIG therapy while admitted at a Canadian pediatric tertiary care center between 2016 and 2020. Patients and IVIG-perfusions characteristics were collected, as well as IVIG-AEs. Bivariate and multivariable logistic regressions were used to explore predictors of IVIG-AEs. We included 228 children, totaling 478 IVIG perfusions. Indications included treatment for inflammatory (52.6%), autoimmune disorders (35.5%), and immunoglobulin replacement (11.8%). A total of 213 IVIG-AEs were reported. Fever (13.6%) and headache (6.7%) were the most frequent IVIG-AEs. Most IVIG-AEs were mild (57%) or moderate (31%) in severity, but 12% were severe reactions. The following factors were predictive of IVIG-AEs in univariate analyses: older age (OR 1.14 [95% CI: 1.07-1.21]), dehydration (OR 2.55 [95% CI: 1.43-4.55]), concurrent allergies (OR 2.87 [95% CI: 1.26-6.56]), first perfusion (OR 1.53 [95% CI: 1.02-2.30]), and higher dosage (OR 2.14 [95% CI: 1.39-3.33]). Concurrent steroids decreased the risk of IVIG-AEs (OR 0.43 [95% CI: 0.19-0.96]). Older age and higher IVIG dose remained independent predictors of IVIG-AEs in multivariable analyses. Mild IVIG-AEs are frequent in children, and serious reactions may occur. Prospective studies are needed to confirm risk factors for IVIG-AEs and to evaluate how to best prevent them.

Socioeconomic, Demographic, and Behavioral Factors Associated with Dengue Outbreak: An Observational Study from Eastern Uttar Pradesh, India.

Background: Clinical and epidemiological aspects of dengue have extensively been studied in India. However, limited data are available on social and behavioral aspects of dengue outbreak. We aimed to fill this gap and wish to study socioeconomic, demographic, and behavioral factors associated with dengue outbreak in the Gorakhpur region of eastern Uttar Pradesh, India. Methods: This retrospective observational study was conducted among dengue patients discharged from hospital. Data on sociodemographic, economic, and behavioral factors of dengue were collected telephonically using a structured questionnaire. Continuous and categorical variables were reported as mean ± SD and numbers (%), respectively. Logistic regression analysis was done to establish association between patient's characteristics, awareness, and preventive behavior. Results: Age group 19-45 years 156/232, males 159/232, urban residents 142/232, residing in pucca house 187/232, and from lower-income families 149/232 were mostly affected in this outbreak. Patients spent a median of Indian national rupees 20,000 on treatment. Only 10.8% of patients had Ayushman health insurance cards. Awareness about dengue infection was found in∼43% patients. Literates, middle income group, and professionals/semiprofessionals were significantly more aware about dengue disease, mosquito bite, and treatment than their counterparts. Travel history was significantly associated with dengue infection in the males of 19-45 years age group belonging to rural areas. Use of mosquito repellent, nets, wearing full sleeve clothes were significantly less in rural residents while barefoot walking was more frequently observed in this population. Use of mosquito repellent was significantly associated with income, and these were observed more in the middle-income group. Conclusion: People with low education level, residing in urban areas, residing in pucca houses, who travel frequently, and who belong to lower-income groups were majorly affected by this dengue outbreak. Less dengue awareness and not following preventive practices were found in them. Targeted health education campaigns in urban setting could prevent dengue and economic burden on these vulnerable groups.

Amplitude-integrated electroencephalography showed alterations in cerebral activity in monochorionic twins with twin-to-twin transfusion syndrome.

Monochorionic twins are at higher risk of perinatal mortality and morbidity, primarily due to pregnancy-related complications, such as twin-to-twin transfusion syndrome (TTTS). We aimed to investigate whether amplitude-integrated electroencephalography (aEEG) signals are different between monochorionic twins with and without TTTS. This was a retrospective single-centre study conducted at Innsbruck Medical University Hospital, Austria. Preterm infants born before 32 weeks of gestation between 6 November 2010 and 6 December 2022 were eligible. The aEEG was analysed for the total maturation score, its component scores and the number of sleep-wake cycles per hour. We enrolled 79 monochorionic twin infants (48% male) and 157 dichorionic (62% male) twin infants. We found no differences between these two groups of preterm infants regarding the total maturation and component scores, or the number of sleep wake cycles. Monochorionic twins with TTTS showed significantly lower total maturation scores and individual component scores compared to monochorionic twins without TTTS. Preterm infants with TTTS showed differences in neonatal aEEG signals. Whether these differences are caused by prematurity-related or TTTS-related factors, such as hemodynamic and metabolic changes due to placental anastomoses, should be investigated in future prospective studies, to gain more insight into this important topic.

Pediatric gastrostomy tube referral patterns and postoperative use: A single-center experience.

Practice variability exists regarding the timing of gastrostomy tube (GT) placement in patients unable to maintain adequate oral nutrition. We sought to assess patient factors predictive of longer surgical GT use to inform patient selection. We conducted a single-center, retrospective cohort study including children ≤18 years who underwent surgical GT placement from June 1, 2018 to June 1, 2021 at a children's hospital. Bivariate and logistic regression analyses were performed to assess the impact of referral patterns, operative indications, and patient comorbidities on the length of GT use. Four hundred fifty-eight children underwent GT placement. Median age at placement was 5 months (interquartile range [IQR]: 2-12) and 52% were male. Fifty-six percent were referred from a neonatal intensive care unit;/cardiovascular intensive care unit provider before initial hospital discharge and 19% were outpatient referrals. Forty-six percent were premature and 50% exhibited oropharyngeal dysphagia. The median duration of nasogastric feeding before GT placement was 36.5 days (IQR: 16-64). In those with GT removal (n = 140), the median duration of use was 269 days (IQR: 144-474), with 23% of the cohort no longer utilizing the GT within 12 months of placement. Patients with congenital lung disease (odds ratio [OR]: 3.03, p = 0.002) and genetic anomalies excluding isolated Trisomy 21 (OR: 3.57, p = 0.003) were more likely to require prolonged GT use. Nearly a quarter of children attain full oral feeding within a year of GT placement. The identified factors predictive of prolonged GT use suggest early placement in these patients. Continuing nasogastric feeds in other patients may decrease the morbidity of unnecessary GT placement.

Evaluating the Effect of Climate on Viral Respiratory Diseases Among Children Using AI

Background: Respiratory viral infections (RVIs) exhibit seasonal patterns influenced by biological, ecological, and climatic factors. Weather variables such as temperature, humidity, and wind impact the transmission of droplet-borne viruses, potentially affecting disease severity. However, the role of climate in predicting complications in pediatric RVIs remains unclear, particularly in the context of climate-change-driven extreme weather events. Methods: This retrospective cohort study analyzed 1610 hospitalization records of children (0–18 years) with lower respiratory tract infections in Rome, Italy, between 2018 and 2023. Viral pathogens were identified using nasopharyngeal molecular testing, and weather data from the week preceding hospitalization were collected. Several machine learning models were tested, including logistic regression and random forest, comparing the baseline (demographic and clinical) models with those including climate variables. Results: Logistic regression showed a slight improvement in predicting severe RVIs with the inclusion of weather variables, with accuracy increasing from 0.785 to 0.793. Average temperature, dew point, and humidity emerged as significant contributors. Other algorithms did not demonstrate similar improvements. Conclusions: Climate variables can enhance logistic regression models’ ability to predict RVI severity, but their inconsistent impact across algorithms highlights challenges in integrating environmental data into clinical predictions. Further research is needed to refine these models for use in reliable healthcare applications.

Barnidipine as a potential alternative treatment for Raynaud's phenomenon secondary to systemic sclerosis: a retrospective pilot study.

To assess short-term barnidipine efficacy and tolerability on Systemic Sclerosis (SSc)-Raynaud's phenomenon (RP). We retrospectively evaluated patients with SSc starting barnidipine 10mg/day. Raynaud's Condition Score (RCS) and mean blood pressure (MBP) were assessed at baseline and 6-month follow-up. Discontinuation rates and adverse events (AEs) were compared with retrospectively evaluated patients who started MR-nifedipine 20mg/day at our centre. Sixty-four patients (29 barnidipine, 35 MR-nifedipine) were evaluated. Most patients starting barnidipine had a previous CCB exposure (69%; 57.9% of these were withdrawn for AEs). During follow-up, RCS decreased significantly (6.6 ± 1.8 vs 4.4 ± 1.8, p < 0.001), while the MBP did not change significantly (86.4 ± 8.4 vs 85 ± 7.3mmHg; p = 0.36). Nine patients (31%) discontinued barnidipine during the follow-up (AEs 6/9, inefficacy 3/9). Previous CCB failure did not predict barnidipine withdrawal (OR = 0.188 95%CI [0.02-1.8]; p = 0.147). No predictors of barnidipine withdrawal were found, and no clinical or demographic differences were found between patients withdrawing and continuing barnidipine. The 6-month retention rates of barnidipine and MR-nifedipine did not differ significantly (69 vs 80%; log-rank p = 0.23), and the two groups had a similar incidence of AEs leading to discontinuation (20.1 vs 17%; p = 0.48). Barnidipine could be an effective and well-tolerated therapeutic option to treat SSc-RP, even in patients previously failing other CCBs. Key Points •Calcium channel blockers (CCBs) currently represent the first-line treatment forRaynaud's phenomenon secondary to Systemic Sclerosis (SSc-RP). However, littledata exists about using novel CCBs, such as barnidipine, in this condition. •This study retrospectively evaluated patients with SSc-RP treated with barnidipine toassess its short-term efficacy. To serve as a control group for tolerability, weretrospectively compared these patients with others starting modified release-nifedipine (MR-nifedipine). •In patients treated with barnidipine, we observed a significant decrease in Raynaud's condition score at the 6-month follow-up without substantial changes in mean blood pressure. •The proportion of adverse events and drug withdrawal rate between patients starting barnidipine and MR-nifedipine did not differ significantly, even in patients starting barnidipine after previously failing other CCBs.

Clinical features, radiological findings and prognosis of microscopic polyangiitis with interstitial lung disease: a retrospective matched control study

BackgroundThe association between interstitial lung disease (ILD) and microscopic polyangiitis (MPA) has received increasing attention in recent years. However, there are still no studies comparing clinical characteristics and prognoses between MPA-ILD patients and patients with ANCA-negative ILDs. Therefore, the purpose of this study was to analyse a group of patients presenting MPA-ILD matched with patients exhibiting ANCA-negative ILDs to identify differences in their clinical characteristics and survival.MethodsThis study retrospectively reviewed the data of 60 patients with MPA-ILD and 60 patients with ANCA-negative ILDs who were matched for age, sex, and patterns on chest high-resolution CT (HRCT) images. The baseline clinical information, laboratory parameters and chest CT data were collected and analysed at each patient’s initial diagnosis.ResultsSixty of the 682 (8.8%) ILD patients were diagnosed with MPA-ILD. MPA-ILD patients tended to be older and have higher CRP and ESR levels. ILD antedated MPA in 61.7% (37/60) of the patients, and MPA occurred on average (45.1 ± 33.4) months after the ILD diagnosis. Compared with matched ANCA-negative ILD patients, MPA-ILD patients had higher CRP and serum creatinine levels and lower haemoglobin levels. UIP (63.3%) was the most common chest HRCT pattern, and the proportion of patients with oddly shaped cysts (P = 0.04) was significantly greater in the MPA-ILD group than in the matched ANCA-negative ILD group. The number of MPA-ILD patients was significantly shorter than that of ANCA-negative ILD patients (P = 0.005). Survival analysis revealed that acute exacerbation (AE) of ILD (HR 2.40, 95% CI 1.03–5.59, P = 0.043) and diffuse alveolar haemorrhage (HR 3.42, 95% CI 1.09–10.73, P = 0.036) were independently associated with shorter survival and that receiving glucocorticoids combined with immunosuppressants (HR 0.11, 95% CI 0.03–0.37, P < 0.001) was independently associated with prolonged survival in MPA-ILD patients.ConclusionsThe proportion of MPA-ILD patients with total ILD is not low, and ANCA testing of ILD patients is necessary. Oddly shaped cysts with a UIP pattern may be a characteristic chest imaging manifestation of MPA-ILD. The prognosis of MPA-ILD is poor, especially for patients who are older, have DAH, and have experienced AEs.

Association of herpes simplex virus infection and vitiligo: a nationwide retrospective cohort study.

Several studies have proposed viral infection with herpes simplex virus (HSV) as a probable cause of vitiligo. We aimed to examine the association between HSV infection and vitiligo. We used the National Health Insurance Research Database of Taiwan to perform a comparative analysis of the study population with or without a diagnosis of HSV infection. The study period was from January 1st, 2008, to December 31st, 2019. The primary outcome was the date of first vitiligo diagnosis, death, withdrawal from the National Health Insurance Program, or end of the study. We performed 1:1 propensity score matching based on age, sex, and comorbidities, resulting in 1,009,445 matched pairs of patients with and without HSV infections. The adjusted hazard ratio for developing vitiligo in the HSV cohort was 1.71 (95% confidence interval, 1.59 - 1.83; P < 0.001). An age-dependent pattern was also observed among HSV-infected patients with vitiligo (P for interaction < 0.001). Both sexes exhibited a significantly higher risk of developing vitiligo in the presence of HSV infection. The HSV cohort significantly increased cumulative vitiligo risk compared to the non-HSV cohort in a 12-year follow-up (log-rank P < 0.001). The result of sensitivity analysis was compatible with that of primary analysis. Patients with HSV infection had a considerably increased vitiligo risk within the 1-year follow-up than the non-HSV cohort (adjusted hazard ratio, 4.83; 95% confidence interval, 4.04 - 5.77, P < 0.001). This nationwide population-based study demonstrated an association between HSV infection and an increased risk of vitiligo. Further investigation of HSV DNA in the affected regions of vitiligo lesions may help to establish causality.

Spatial patterns of colorectal cancer survival rates in Malaysia, 2013-2018.

Large geographical variations in colorectal cancer (CRC) survival rates have been reported across regions. Poorer survival rates were mainly found in socioeconomically deprived areas, highly dense areas, and areas lacking healthcare accessibility. The objective of this study was to identify, compare, and contrast the spatial patterns of 5-year CRC-specific survival rates and identify high-priority areas by districts in Malaysia. This retrospective cohort study utilized secondary data from the National Cancer Registry. CRC patients (ICD10 C18-21) diagnosed between 2013 and 2018 were selected. Patient addresses were geocoded into districts and states via geospatial data from the National Geospatial Centre, whereas district population density data were gathered from the Population Census of Malaysia. Kaplan‒Meier survival analysis and log-rank test were conducted to determine and compare the 5-year CRC-specific survival rates, and the spatial distribution of CRC survival by district was determined via ArcGIS software. A total of 18,513 CRC patients were registered from 143 districts, with 10,819 deaths occurring during follow-up. The national 5-year CRC-specific survival rate was 42%, with median survival time of 36months (95% CI: 34.46, 37.54). The eastern region (Kelantan, Terengganu, and Pahang) had the lowest survival (38.0%). Among the 143 districts, eighty-one (56.6%) reported survival rates below the national average while thirty-six (25.2%) were identified as high-priority districts. The differences in CRC survival rates were evident according to geographical location. Area-based targeted interventions to improve CRC detection, management, and access to healthcare are imperative to address cancer survival disparities and help effectively allocate resources.

Comparison of open and laparoscopic appendectomy according to the trimester of pregnancy: A nationwide observational study.

To compare the outcomes of open appendectomy (OA) and laparoscopic appendectomy (LA) for acute appendicitis during pregnancy by trimester. We conducted a nationwide retrospective cohort study using the Diagnosis Procedure Combination database in Japan. We identified pregnant women diagnosed with appendicitis who underwent OA or LA from 2010 to 2022. Pathological confirmation of appendicitis was not required for inclusion. The patients were categorized by the trimester of pregnancy. Outcomes were compared using multivariate analysis with generalized estimating equations. A total of 1624 patients were included. In the first trimester, 64.2% patients underwent OA, whereas 35.8% patients underwent LA; in the second trimester, 59.1% patients had OA and 40.9% patients had LA; and in the third trimester, 72.8% patients had OA and 27.2% patients had LA. LA was associated with a higher rate of preterm labor, preterm delivery, or abortion in the second (odds ratio, 3.37; 95% confidence interval, 1.76-6.47; and p<0.001) and third trimesters (odds ratio, 2.57; 95% confidence interval, 1.15-5.70; and p=0.021) but not in the first trimester. The duration of surgery was longer across all trimesters in patients who underwent LA. Additionally, the postoperative hospital stay was shorter in patients who had LA than in those who had OA in the second trimester. In-hospital outcomes vary by trimester, and our results suggest that LA does not consistently lead to better outcomes than OA. Based on our findings, treatment options for appendicitis during pregnancy must be carefully selected.

Demographic characteristics associated with a penicillin allergy label during pregnancy

IntroductionPenicillins and other beta-lactam antibiotics are used in greater than one-third of pregnant women as treatment for Group B Streptococcus colonization and prophylaxis for Caesarean sections. Penicillin allergy labels have been associated with increased morbidity in the pregnant population, and penicillin allergy evaluation during pregnancy is now recognized as safe and effective. Yet, demographic characteristics associated with having a penicillin allergy label during pregnancy have not been studied. We aimed to evaluate factors associated with having a penicillin allergy label in a diverse population of pregnant patients.MethodsWe performed a retrospective observational study of pregnant patients who had an outpatient visit with Obstetrics and Gynecology and a delivery encounter from 1/1/2020 through 6/30/2022 using electronic health record data in a large health system. We used a multivariable logistic regression model to evaluate factors associated with having a penicillin allergy label.ResultsWe identified 10,969 pregnant women of whom 940 (8.6%) had a penicillin allergy label. In the multivariable analysis, having a penicillin allergy label was positively associated with age 32−34 years [odds ratio (OR) = 1.31 vs. 18−27 years, p = 0.02], 35−51 years (OR = 1.41 vs. 18−27 years, p = 0.002) and having rhinitis, asthma, or eczema (OR = 1.55 vs. none, p &amp;lt; 0.0005); and negatively associated with Black race (OR = 0.59 vs. White, p &amp;lt; 0.0005).DiscussionThis study found that Black race was associated with lower likelihood of penicillin allergy label, while older age and atopic conditions were associated with a higher likelihood. This finding may impact health outcomes and interventions related to penicillin allergy in pregnant women.

Update on the evolution of World Cup soccer: men and women

ABSTRACT A retrospective correlational study was used to determine evolutionary game trends of men’s and women’s FIFA World Cup finals. Broadcast footage of finals games 2014–2022 for men (n = 3) and 1991–2023 for women (n = 9) was used to assess trends in game structure and playing styles. These recent men’s data were combined with our previous evolution study results and reanalysed (1966–2022; total 15 finals games). Computer-based ball tracking using TrakPerformance software (https://trak-performance.software.informer.com/) and notational analyses were used to quantify play and stop periods, ball speed and passing rates. Linear regression was used to track changes in these variables across time. Total stoppage time, ball speed and passing rates increased significantly (p < 0.05) for both men and women. Ball speed increased faster for women than men as speeds converge. Women’s play percentage decreased significantly across time from an average of 65% to 55% of total game time to match current men’s finals games. Median duration of stoppages have increased for men and women. Longer stoppage time facilitates greater physiological recovery. While cause and effect cannot be established, the additional stoppage time is paralleled by elevated intensity of play such as faster ball speed and higher passing rates.

Effectiveness of oral health care intervention for stroke patients following the introduction of Oral Health Assessment Tool.

This study aimed to evaluate the effectiveness of oral health assessment tools in facilitating oral health care interventions by dental care providers for acute stroke patients within 48 h of admission, following a reform of the nursing system. Data were gathered from a retrospective cohort study conducted at a stroke center, comparing 10 months before and after the implementation of the reformed system, with a 2-month interval. Parameters assessed included stroke type, severity measured using the National Institutes of Health Stroke Scale, stroke history, stroke-related factors, number of teeth, hospitalization cost and duration, occurrence of fever and pneumonia, stroke treatment, days from admission to dental intervention, and intervention frequency. Implementation of the new system significantly reduced the time before dental intervention (P < 0.001), increased the frequency of interventions (P < 0.001), and allowed for the management of more severe cases (P = 0.007). However, there was a slight increase in the occurrence of fevers and the days of fever (P = 0.039 and P = 0.015, respectively). Multiple regression analysis showed that fever days were positively correlated with stroke severity and the number of days from admission to dental intervention (P < 0.001 and P = 0.013, respectively). Even after propensity score matching adjusting for stroke severity, these associations persisted. Additional multiple regression analysis was performed after this, but fever days were positively correlated with stroke severity and sex (P < 0.001 and P = 0.008, respectively), as well as with the presence of other factors affecting the occurrence of fever. Although the frequency and duration of fevers increased slightly, this approach, incorporating oral health assessment tools, made it possible to provide early dental intervention, particularly for patients with severe strokes. Geriatr Gerontol Int 2024; ••: ••-••.

Patient centered outcomes of transoral robotic surgery for obstructive sleep apnea: a retrospective analysis.

Obstructive Sleep Apnea (OSA) is usually caused by collapse of the base of tongue (BOT) and impacts patients' overall health. Despite current conventional therapies, some patients do not achieve satisfactory results. Reduction of BOT using Trans Oral Robotic Surgery (TORS) emerges as a promising treatment. We evaluated the patient reported and clinical outcomes of TORS for OSA. We performed a retrospective cohort study of patients treated from 2018 to 2021 in a non-academic general hospital. Patients were eligible for TORS when apnea hypopnea index (AHI) was >5 in combination with obstruction at BOT level. Patients were included when 1-year follow up respiratory polygraphy was available. Changes in Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ-35), MD Anderson Dysphagia Inventory (MDADI) scores and postoperative complications were evaluated. Surgical success rates were obtained. Out of 56 patients, 28 patients of which 22 (78.6%) males and 6 (21.4%) females, with OSA severity ranging from mild to severe and mean age of 49 (SD 11.8) with a median BMI of 28.1 (IQR 26.9-32.1) were included. ESS score declined from mean 5.9 (SD 3.8) to 2.2 (SD 2.0) (p<0.00). FOSQ-35 scores were all declined (p<0.05). MDADI scores were in normal range (80-100) and remained stable (p = 0.44). In 23 (82.1%) patients no postoperative complications were observed. Surgical success rates were 86%. TORS demonstrate to be effective and safe in OSA patients, and it can be used in both patients who are unresponsive to conventional therapies or as a primary therapy.

Association Between Patient Portal Engagement and Weight Loss Outcomes in Patients After Bariatric Surgery: Longitudinal Observational Study Using Electronic Health Records.

Bariatric surgery is an effective intervention for obesity, but comprehensive postoperative self-management is essential for optimal outcomes. While patient portals are generally seen as beneficial in engaging patients in health management, the link between their use and post-bariatric surgery weight loss remains unclear. This study aimed to investigate the association between patient portal engagement and postoperative BMI reduction among patients after bariatric surgery. This retrospective longitudinal study included patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy at Vanderbilt University Medical Center between January 2018 and March 2021. Patient portal engagement was measured during 4 stages: early (within 3 months after surgery), early midterm (3-6 months), late midterm (6-9 months), and late (9-12 months). Using generalized estimating equations, we estimated the associations between patients' portal engagements at these stages and the percentage of BMI reduction (%BMIR) at 3, 6, and 12 months after surgery. Covariates included duration since surgery, patient's age at the time of surgery, sex, race and ethnicity, type of bariatric surgery, severity of comorbid conditions, and socioeconomic disadvantage. The study included 1415 patients, predominantly female (n=1145, 80.9%), with a racial composition of 76.9% (n=1088) White and 19.9% (n=282) Black. Overall, 805 (56.9%) patients underwent Roux-en-Y gastric bypass and 610 (43.1%) underwent sleeve gastrectomy. By 1 year after surgery, the median %BMIR was 31.5% (IQR 25.2%-36.8%), and the median number of active days on the patient portal was 54 (IQR 33-80). Early portal engagement was significantly associated with %BMIR at various postoperative times. Specifically, each additional 10 days of early portal engagement was associated with a 0.37% (95% CI -0.55% to -0.18%; P<.001) lower expected %BMIR at 3 months, a 1.11% (95% CI 0.82%-1.41%; P<.001) higher expected %BMIR at 6 months, and a 0.78% (95% CI 0.25%-1.31%; P=.004) higher expected %BMIR at 12 months. Furthermore, early midterm portal engagement was associated with a 0.36% (95% CI -0.69 to -0.03; P=.03) lower expected %BMIR at 6 months, but it was not significant at 12 months (P=.88). Late midterm and late portal engagement were not significantly associated with %BMIR at 12 months (P=.27 and P=.12, respectively). Furthermore, early engagement in various portal functions, such as messaging and accessing medical records, was significantly associated with a lower %BMIR at 3 months and a higher %BMIR at both 6 and 12 months (all P<.05). Higher patient portal engagement within 3 months after surgery-suggestive of stronger adherence to postoperative instructions and improved communication with care teams-is associated with less favorable weight loss immediately after surgery but enhanced postoperative weight loss outcomes at 6 and 12 months. However, the limitations of retrospective data-driven studies highlight the need for future intervention-based studies to validate these associations and establish causality.

Timing of Surgery for Elbow Fractures (OTA 13 A-C and 21 A-C) and Patient Outcomes.

To determine if there is a correlation between time to surgery (TTS) and outcomes following repair of elbow fractures. Design: Retrospective comparative study. A single, urban hospital system. Patients from March 2011 to September 2022 who sustained an isolated fracture about the elbow joint (AO/OTA 13-A, B, and C and 21-A, B, and C), underwent surgical repair, and had at least 6 months of post-operative follow up identified from an Institutional Review Board-approved database. Time to surgery, in days, was recorded. Radiographic and clinical follow up was obtained at all visits and a Mayo Elbow Performance Index (MEPI) was calculated based on the latest follow up. Complications recorded: elbow contracture, infection, early hardware failure, reoperation, and fracture nonunion. Multivariable regression and Spearman correlation analysis were used to determine any significant outcome differences based on time to surgery. 351 patients included with a mean age of 54.8 (range: 18 - 86) years with 217 females (61.8%) and 134 males (38.2%). Eighty-two patients (23.4%) developed at least one complication while 269 patients (76.6%) did not. As a continuous variable, TTS was not correlated with arc of motion at any follow up visit nor with the latest recorded MEPI score (p > 0.05). Mean TTS for patients who did and did not experience a complication was 6 (range: 0-24) and 10 (range: 0-38) days, respectively, and this was not significantly different (p = 0.217). Complication rate and any of the individual complications were not associated with TTS following a multivariable analysis controlling for age, sex, injury mechanism, open fracture, Charlson Comorbidity Index, and AO/OTA classification (p > 0.05 for all). Timing of surgery following OTA 13 A-C and 21 A-C elbow fractures was not associated with differences in post-operative complications or range of elbow motion. Level III.

Optimal Treatment for Post-Surgical Cicatricial Alopecia: Autologous Hair Transplantation?

Scarring alopecia significantly impacts patients' appearance and psychological well-being. Surgery is a common cause of scarring alopecia, making positive treatment crucial for patients' overall health. To investigate the clinical efficacy of autologous follicular unit extraction (FUE) transplantation for postoperative secondary stable scarring alopecia and evaluate its effectiveness. A retrospective descriptive study was conducted, including 14 patients with postoperative secondary scarring alopecia. All patients underwent initial autologous FUE hair transplantation, and postoperative complications were monitored. Patient satisfaction surveys were also conducted. Satisfaction assessments were performed for all 14 patients. Two patients (14.3%) reported being very satisfied, 6 patients expressed satisfaction (35.7%), 4 patients reported being somewhat satisfied (28.6%), and 3 patients were dissatisfied (21.4%). Aesthetic complications included low follicular density post-transplantation, uneven density, and unnatural appearance. Solely using a single FUE hair transplantation for treating postoperative secondary scarring alopecia has limited effectiveness and may not always meet expectations, potentially requiring multiple transplantations. Further research is necessary to guide and improve follicular transplantation survival rates to ensure surgical efficacy.

Outcomes of retroperitoneal fibrosis-related hydronephrosis and its risk factors for poor prognosis: a multi-center retrospective cohort study in Chinese patients

ObjectiveRetroperitoneal fibrosis (RPF) is a rare disease characterized by the presence of fibroinflammatory tissue that surrounds the abdominal aorta and the iliac arteries and often entraps the ureters. Hydronephrosis is a common complication of RPF, however, its clinical features and outcomes have not been well elucidated.MethodsA total of 115 RPF-related hydronephrosis patients have been recruited from 9 clinical centers in China since March 2010. They were followed up until death or September 2021, whichever came first.ResultsThe mean age at diagnosis was 58.83 ± 12.13 years, and 80 patients (69.57%) were men. The median disease duration was 3.00 (1.00, 9.00) months. Renal impairment was observed in 88.35% of the patients, and 49.57% showed bilateral ureteral involvement. Elevated ESR and CRP were presented in 80.28 and 62.02% of the patients, respectively. Overall, 28.21% (11/39) of the patients had increased IgG4 levels, and 41.38% (12/29) showed positive pathological IgG4 staining (IgG4+/IgG+ ≥ 40% or IgG4+ ≥ 10/HPF). Among them, three patients were diagnosed as IgG4RD. After 60.43 ± 34.53 months of follow-up, 36 patients had poor prognosis, which was associated with severe kidney impairment, bilateral hydronephrosis and inflammation status (elevated ESR and IgG) at diagnosis by case–control study. eGFR and creatinine were independent risk factors after adjusting for all other significant associations (p = 0.002 and p = 0.067, respectively). Glucocorticoid-based therapy could reduce the time of stenting, decrease the need for long-term ureteral stenting/percutaneous nephrostomy (PNS)/ureterolysis, increase the rate of mass shrinkage, and reduce the new requirement of hemodialysis compared to surgery-only strategy for RPF-related hydronephrosis patients in need of renal drainage, but did not reduce new-onset renal atrophy.ConclusionSeverity of kidney dysfunction and inflammation status were related to the poor prognosis of hydronephrosis induced by RPF. More efficient interventions and strategies are needed to further improve outcomes.