Retrospective Cross-sectional Study Research Articles

Serum Vitamin D Level Is Unchanged in Equine Asthma

Vitamin D deficiency is associated with asthma development and severity of symptoms in humans, but whether the same occurs in horses is unknown. We aimed to determine whether the serum vitamin D levels differ in horses with asthma compared to control animals and, secondarily, to explore clinical, respiratory, and environmental parameters associated with its concentration in equids in a retrospective cross-sectional study. The total serum vitamin D (25(OH)D) was measured by radioimmunoassay in 45 serum samples from the Equine Respiratory Tissue Biobank (15 control animals, 14 horses with mild or moderate asthma (MEA), and 16 horses with severe asthma (SEA)). Descriptive clinical and environmental parameters, bronchoalveolar lavage fluid cytology, and lung function data were extracted. There was no difference in serum 25(OH)D levels between healthy controls, horses with MEA, and horses with SEA (respectively, means of 57.9 ± 11.6, 55.6 ± 20.0, and 64.6 ± 14.5 nmol/L; p = 0.3), suggesting that this micronutrient does not play a major role in equine asthma pathophysiology.

Associations Between Partial Common Extensor Tendon Tears and Clinical-Ultrasonographic Findings in Patients with Lateral Epicondylitis

Abstract Objective This study investigates the effect of partial common extensor tendon(CET) tears on demographic, clinical and ultrasound(US) parameters in patients with lateral epicondylitis(LE). The research aimed to provide a comprehensive understanding of how these US-detected partial tears, influence the clinical presentation and imaging findings associated with LE. Design Retrospective cross-sectional study. Records of 227 patients with LE met the inclusion-exclusion criteria were reviewed. The patient-rated tennis elbow evaluation(PRTEE) questionnaire was used as the primary outcome measure. Secondary outcome measures were visual analogue scale for pain, algometric measurements, hand grip strength, and US parameters(maximum tendon thickness measurements from the capitellar-radiocapitellar sides and presence of bone abnormalities). Results Partial CET tears detected using US were present in 22.7%(n = 54) of the patients. Patients with partial CET tears were older(50,31±9,22), had higher PRTEE scores(65,48±12,76), capitellar-radiocapitellar maximum tendon thickness measurements(0,60±0,80/0,60±0,72), and incidence of bone abnormalities(%40.7,n = 32)(p < .05). Logistic regression analysis identified age and PRTEE pain score as associative factors with partial CET tears. Capitellar-radiocapitellar maximum tendon thickness measurements greater than 0.55 cm were associated with an increased probability of partial CET tears. Conclusion US-detected partial CET tears may worsen the clinical and US parameters in patients with LE. Older age, higher PRTEE scores and higher maximum tendon thickness measurements were associated with partial CET tears.

Association between anaemia and aflatoxin B1 and fumonisin B1 exposure in HIV-infected and HIV-uninfected pregnant women from Harare, Zimbabwe.

Aflatoxin B1 (AFB1) and fumonisin B1 (FB1) are poisons that contaminate poorly stored staple foods in resource-limited settings. Antenatal AFB1 and FB1 exposure may cause anaemia. We aimed to determine the associations of urinary aflatoxin M1 (AFM1) and FB1, biomarkers of AFB1 and FB1 exposure, respectively, with erythrocyte parameters and anaemia. A retrospective cross-sectional study was conducted in 68 HIV-infected and 61 HIV-uninfected pregnant women ≥ 20 weeks gestational age in Harare, Zimbabwe. AFM1 and FB1 were measured in urine via competitive ELISA, and levels were grouped into tertiles. The erythrocyte parameters assessed were haemoglobin (Hb), mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, red blood cell (RBC), haematocrit (HCT), and red blood cell distribution width. Associations of urinary AFM1 and FB1 with erythrocyte parameters, and anaemia were assessed in a multiple regression controlled for potential confounders. The presence of FB1 in urine decreased Hb levels in all women (β= -0.98, 95% CI: -1.94, 0.02) and HIV-uninfected (β= -1.99, 95% CI: -3.71, -0.26). FB1 tertile 3 decreased Hb levels (β= -0.88, 95% CI: -1.74, 0.01) and HCT levels (β= -2.65, 95% CI: -5.26, 0.03) in HIV-infected. AFM1 tertile 2 decreased RBC levels in HIV-infected (β= -0.34, 95% CI: -0.71, -0.03). The presence of FB1 in urine increased anaemia risk in HIV-uninfected (OR: 10.68 95% CI: 1.02, 112.34). AFM1 tertile 2 increased macrocytic anaemia risk in HIV-infected (OR: 13.72, 95% CI: 0.92, 203.55). There is need to ensure food safety through monitoring and nutritional interventions to improve maternal-infant health outcomes.

American board of orthodontics- discrepancy index (ABO-DI) as prognostic factor for the duration of orthodontic treatment: A cross-sectional retrospective study

To evaluate American Board of Orthodontics-Discrepancy Index (ABO-DI) as a prognostic factor in predicting the duration of orthodontic treatment.This cross-sectional retrospective study was conducted on the pre-treatment and post-treatment records of 151 consecutively de-bonded cases, who were treated between January 2016 and September 2013 with comprehensive orthodontic therapy. The ABO-DI was used to assess the pretreatment severity of malocclusion. The sample was divided into three groups based upon the discrepancy score calculated from pretreatment study model and lateral cephalogram; Group-1 (DI score <16; n= 65), Group-2 (DI score 16-25; n= 49) and Group-3 (DI score> 25; n=37). The duration of orthodontic treatment was calculated as total treatment time (in months) from the date of placement of initial brackets and archwires to the date when orthodontic appliances were removed. Spearman’s correlation test and One way ANOVA analysis followed by Post-Hoc tests for multiple comparisons were used to assess the association between the ABO-DI scores and duration of orthodontic treatment.The mean duration of treatment for Group-1, Group-2 and Group-3 was found to be 25.83±8.42, 28.16±10.55 and 28.84±9.61 months respectively, but there was no statistically significant relationship between the severity of malocclusion on the duration of comprehensive orthodontic treatment (P>0.05). An insignificant correlation (P=0.102, r= -0.134) between different groups of severity of DI scores and treatment duration was revealed with Spearman test.The duration of orthodontic treatment increased with increase in severity of malocclusion, however, it is not a reliable tool for predicting the treatment duration.

Anxiety, depression, and headache-related disability in a large pediatric clinic-based sample.

To explore the relationships among anxiety, depression, and headache-related disability in a pediatric clinic-based retrospective cross-sectional study. Anxiety and depression are commonly considered comorbidities of headache disorders and are frequently seen in children and adolescents. These conditions can contribute to disability and may have a cumulative impact. In this study, we tested whether self-reported anxiety and/or depression in youth were associated with headache-related disability. This was a retrospective cross-sectional study of children ages 6-17 years old who completed a headache intake questionnaire at the time of a new outpatient neurology visit. Those who reported on behavioral health symptoms, involvement of a behavioral health provider (i.e., yes/no), and the PedMIDAS (a validated metric of headache-related disability) were included. The relationship between anxiety and/or depression and headache-related disability was examined. Of the 12,660 questionnaires queried, 9118 met criteria for inclusion. Respondents were 64.0% female and had a median age of 13.5 years (interquartile range [IQR] 10.3, 15.7). Compared to patients without self-reported anxiety/depression, patients with anxiety and depression reported higher headache-related disability (M = 17.0, [IQR 6.0, 41.0]) even after accounting for covariates (estimated difference = 6.0, 95% confidence interval [CI: 4.4-7.5]). For participants with anxiety and/or depression, having a behavioral health provider was associated with greater headache-related disability (estimated difference = 7.0; 95% CI 4.6-9.3). Patients with self-reported anxiety and/or depression reported higher headache-related disability. Having a behavioral health provider was associated with greater headache-related disability, indicating the complexity and high level of need for this population. Further research is needed to understand the directionality of these results; however, patients with headache as well as depression and or anxiety are a vulnerable group who may benefit from an integrated care model.

Patchy acute effluvium in and around the donor area following FUE hair transplant and its predilection for two-day session and high graft extraction cases

: With the advancements in Follicular unit extraction (FUE) technique of hair transplant (HT) advanced grades of baldness are taken up nowadays requiring higher donor grafts and surgery often extends to the second day. This has brought into light some lesser known complications of hair transplant like acute donor site effluvium (ADE).Data on ADE is scanty; more research is needed on associated clinico-etiological factors and presentations of the condition.of our study was to study various clinico-epidemiological factors in patients of acute donor effluvium and to assess the relationship of number of grafts extracted with severity of ADE. : It was a centre based retrospective cross sectional study in which 30 patients of ADE were enrolled. Clinical and photographic record of all patients of ADE presenting in the last 3 years was screened. Age, gender, co-morbidities, personal habits, grade of androgenetic alopecia, total graft extraction, severity of hair loss and duration of surgery was compiled along with photographs and follow up notes. Mean age of patients was 33.9±5.4 years. All patients were male. Out of 30 patients 5(16.6%) were smokers and 7(23.3%) alcoholic. In 22(73.3%) of the cases of ADE the HT lasted for more than a day. The maximum duration of surgery in all cases didn’t exceed 2 days. Out of 30 cases of ADE, total grafts extracted exceeded 4000 in 28(93.3%) of cases; only 2(6.7%) of the cases had a graft extraction of <4000. There was a significant and direct correlation between the severity of ADE hair loss (using SALT score) and the number of total scalp grafts extracted (r=0.657, p=0.024). ADE was seen more with advanced baldness requiring high scalp graft extraction of >4000 grafts and when surgery extended to second day. Hair loss in ADE correlated directly with the number of scalp grafts harvested.

The Correlation Between Static and Dynamic Facial Asymmetry in Unilateral Cleft Lip and Palate.

Assess the relationship between static and dynamic facial asymmetry in unilateral cleft lip and palate during maximum smile. Retrospective cross-sectional study. Multidisciplinary dentofacial planning clinic. Thirty-one surgically managed non-syndromic unilateral cleft lip and palate patients between the ages of 13 to 17 years. Dynamic three-dimensional (3D) facial images (four-dimensional [4D]) throughout the course of a maximum smile were captured using video stereophotogrammetry at a rate of 60 frames per second, which generated 180 3D images/expression. A generic facial mesh containing more than 7000 vertices was superimposed onto the 3D facial images to quantify and track facial asymmetry throughout the captured sequence. Partial ordinary Procrustes analysis was utilized to calculate an asymmetry score at the rest position, maximum smile, and at the point of maximum mathematical asymmetry. The relationships between the asymmetry at rest and the asymmetry at the point of maximum smile (static 3D), and the maximum mathematical asymmetry (dynamic 4D) were evaluated. Asymmetry scores were higher at maximum smile than at rest. Maximum mathematical asymmetry was observed in most cases during the relaxation phase. Static asymmetry at rest and maximum smile was strongly correlated with the maximum mathematical asymmetry (r = 0.941, P < .001). Static 3D asymmetry at both rest and maximum smile are strongly correlated with dynamic 4D facial asymmetry. The use of 4D imaging, combined with generic mesh conformation and dense correspondence analysis, provides a valid objective measure of facial asymmetry.

Chronic rhinosinusitis with nasal polyps: predictors of recurrence 5 years after surgery

Backgrounds Chronic rhinosinusitis with nasal polyps (CRSwNP) is a medical condition characterized by persistent inflammation of the nasal mucosa and sinuses, accompanied by the presence of nasal polyps. When medical treatments prove ineffective, endoscopic sinus surgery (ESS) is recommended, yielding variable outcomes and recurrence rates ranging from 5% to 60%. Aims/Objectives The primary objectives of this study were to evaluate the outcomes of ESS and to identify independent predictors of recurrence and revision surgery. Material and Methods Retrospective cross-sectional study, focusing on patients diagnosed with CRSwNP who underwent ESS with a minimum follow-up period of 60 months. Various variables were collected. Multivariate and regression analyses were employed to assess the predictors associated with both recurrence and revision surgery. Results The study analyzed 130 patients. The 5-year recurrence rate was 35.4%, and 17.7% of patients required revision surgery. These variables included asthma (p < 0.001), frontal sinus involvement (p < 0.001), Lund–Mackay score (p < 0.001), Endoscopic Nasal Polyps Score (p < 0.001), and eosinophilia in peripheral blood (p < 0.001). All the variables mentioned above were identified as predictors of recurrence and revision surgery. Conclusions and Significance Asthma, frontal sinus involvement, increased eosinophilia in peripheral blood, and a higher score on the LM system and NPS are poor prognostic factors in CRSwNP.

The radiological features of HPV-positive vs HPV-negative OPSCC at a South African hospital

Background: Studies have found that, at presentation, human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) has a less advanced primary tumour, more advanced lymph node spread and commonly has cystic metastatic lymph nodes in comparison to HPV-negative OPSCC.Objectives: To compare the radiological features of HPV-positive and HPV-negative OPSCC in South African patients.Method: A retrospective cross-sectional study was conducted at a large South African hospital. Eligibility required a histologically proven OPSCC between 2007 and 2023; a p16 antigen test and, if positive, a confirmatory HPV DNA PCR test and a baseline pre-treatment contrast enhanced neck CT scan. All eligible HPV-positive OPSCC patients and a random sample of eligible HPV-negative OPSCC patients were enrolled.Results: Twenty-one HPV-positive and 55 HPV-negative OPSCC patients were recruited. There was no statistically significant difference in the tumour epicentre location, local advancement (≥ T3 in 67% and 71%, respectively, p = 0.54), mean primary tumour size (41 mm vs. 39 mm, p = 0.73), lymph node spread (bilateral or more in 67% vs. 82%, p = 0.22) or morphologically cystic lymph nodes (10% and 4%, p = 0.61).Conclusion: There was no statistically significant difference in the CT imaging appearances of HPV-positive and HPV-negative OPSCC in the studied sample of South African patients.Contribution: This study documents the radiological features of OPSCC in a small South African sample population, where HPV-positive and HPV-negative OPSCC could not be distinguished on CT criteria and did not display the classic features described in the literature.

Pulpitis tendency in teeth with vital pulp restored with composite resins: a cross-sectional retrospective study

Background: This study evaluates pulpitis tendency in vital teeth restored with composite resin after at least one year, focusing on the effect of cavity depth and the use of a base material on pulp status. Methods: A retrospective analysis was conducted on 212 patients with one tooth restored by dental senior students. At the follow-up, periapical and bitewing radiographs, cold tests, percussion, and palpation were performed. Cavity depth was measured from bitewing radiographs, and the periapical index (PAI) was recorded. The restored teeth were compared with contralateral sound teeth to assess the impact of the resin on pulp tissue. Results: Composite resin restorations significantly affected pulp status compared to intact teeth (p=0.002). Five out of 212 teeth became necrotic, and four developed symptomatic irreversible pulpitis (SIP). Four necrotic cases occurred in cavities deeper than 3.60 mm, and all SIP cases were associated with cavities deeper than 3.10 mm. Cavity depth was a significant predictor of adverse pulpal outcomes. However, using calcium hydroxide as a base did not significantly affect pulp health. Conclusions: The study concludes that composite resin restorations, mainly in deep cavities, can negatively impact pulp vitality. Cavity depth is a key factor in the risk of pulp necrosis and SIP, while calcium hydroxide base did not reduce pulpitis incidence. Larger studies with longer follow-up periods are recommended to confirm these findings and explore potential protective factors.

BN O05 - Physiological Transit Assessment of the Oesophagus In Patients With Anti-Reflux Surgery

Abstract Background High-resolution manometry (HRM) is the gold-standard investigation for oesophageal motility in patients with dysphagia. The HRM findings may influence surgical decision for myotomy or anti-reflux surgery (ARS). However, HRM pitfall is the inability to measure oesophageal transit in parallel to the motility during physiology testing. Both transit and motility are complementary that offer insights in the pathophysiology and aetiology of the dysphagia symptoms. This research evaluates the multichannel intraoesophageal impedance transit (MIIT) concept [1] to assess the oesophageal transit in symptomatic patients who undertook the postoperative oesophageal physiology testing between January 2020 and June 2024. Method This cross-sectional retrospective study selected patients with intact Nissen fundoplication (NF) wrap on gastroscopy or with known LINX implant in-situ. HRM with Chicago Classification (version 4.0)[2] compared the ARS cases with augmented antireflux barrier [AARB] from the surgery to healthy treatment naïve controls. The multichannel impedance-pH studies assessed both reflux and the MIIT [1]. MIIT &amp;gt;0.76 minutes were considered positive and comparable to GOJ outflow obstruction [1]. This project was approved by the NHS institution and the local research ethics committee (REC 18/NW/0120)(IRAS 333800). Results 60 patients were found (NF 54, LINX implant 6)(females 30, mean age 51.3 years). 11 patients(18.3%) had pathological reflux despite ARS(DeMeester scores &amp;gt;14.72); 2 patients (18.2%) demonstrated hypotensive AARB. Conversely, 6 patients(10%) showed poor relaxation from the AARB and were compatible to outflow obstruction (5 patients [83.3%] showed conformation with MIIT &amp;gt;0.76 minutes). Patients with ineffective oesophagus (20%) and absent contractility(11.7%) showed MIIT &amp;gt;0.76 minutes in respectively two-thirds with ineffective oesophagus and in all patients with absent contractility. Normal HRM study was observed in 35 patients (58.3%) with 27 patients (77.1%) demonstrating MIIT &amp;gt;0.76 minutes. Conclusion MIIT was able to explain the post-surgical dysphagia in majority of patients from the equivalent transit to outflow obstruction (n=52 patients, 86.7%). Half of these cases had a normal HRM study and would have been perceived as having functional dysphagia. We would recommend performing MIIT adjunctive testing as part of postoperative oesophageal physiology assessment in symptomatic patients. Incidentally, we observed 16 patients (26.7%) having hypotensive AARB post ARS comparing to healthy treatment naïve controls with 2 patients (12.5%) having persistent pathological reflux who may still benefit from surgical revision.

Abdominal aortic aneurysm characteristics and outcomes: a single-center retrospective cross-sectional study

Abdominal aortic aneurysm characteristics and outcomes: a single-center retrospective cross-sectional study

PATH-67. THE ROLE OF STATUS OF HER-2, ESTROGEN-RECEPTOR, BRCA 1, AND BRCA 2, IN THE INCIDENCE OF BRAIN METASTASIS IN BREAST CANCER

Abstract Breast cancer (BC) is the most diagnosed tumor in women and the second-leading cause of brain metastasis (BM), with a prevalence ranging from 10-36%. According to the Epidemiological Strategy and Medical Economics research program, advanced BC patients face an estimated 25% risk of developing BM within 2-3 years after the initial diagnosis. The frequency of BM is significantly increased by the primary tumor profile, including larger tumors, higher nuclear grade, HER-2 positivity, estrogen-receptor negativity, and triple-negative status. A gap remains in the classification of the BM site relative to primary tumor biomarkers, and the absence of multimodality treatment methodologies poses challenges to survival rates and quality of life in BC patients. This retrospective cross-sectional study at Aga Khan University Hospital identified 52 cases of brain metastasis secondary to breast cancer over a 10-year period. The median age of patients was 55 years, ranging from 32 to 78 years. Primary breast tumors were predominantly high-grade ductal carcinomas (65%), followed by lobular carcinomas (25%) and other rare histological types (10%). Secondary brain metastases were primarily located in the cerebrum (60%), cerebellum (25%), and brainstem (15%). Tumor profiles indicated a significant correlation between HER-2 positivity and the development of brain metastasis, with 70% of HER-2 positive patients presenting with extensive brain metastasis. Tumor progression varied, with a median time to brain metastasis of 2.5 years from the initial breast cancer diagnosis. Despite aggressive multimodality treatments, including surgery, radiation, and chemotherapy, the overall prognosis remained poor. The study found that early detection of HER-2 positive and triple-negative tumors could potentially delay the progression of brain metastasis through targeted therapies. Mortality rates in this cohort were high, with a median survival of 8 months following the diagnosis of brain metastasis. These findings underscore the need for improved diagnostic, preventive, and therapeutic strategies to manage brain metastasis in breast cancer patients.

Improved visibility of palisade vessels within Barrett’s esophagus using red dichromatic imaging: a retrospective cross-sectional study in Japan

Improved visibility of palisade vessels within Barrett’s esophagus using red dichromatic imaging: a retrospective cross-sectional study in Japan

Venous thromboembolism among gynecologic cancer patients in Zaria

Cancer is one of the most important acquired risk factors for Venous Thromboembolism (VTE) including Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE). Patients with active malignancy have up to six-fold increased risk of symptomatic VTE than the general population. The risk of VTE in patients with gynecologic malignancy is especially high because of the nature of the tumor, its pelvic location, associated comorbidities, and systemic chemotherapy. The objective of this study was to determine other risk factors, incidence, clinical presentation, and immediate outcome of treatment of thromboembolism in patients with gynecologic cancers in Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria. It was a retrospective cross-sectional descriptive study of gynecologic cancer cases that were diagnosed with VTE while on admission from 2007-2016 in ABUTH. The overall prevalence of clinical VTE was 2.8% in gynaecologic malignancy. All were DVT. Most cases of DVT were present in ovarian cancers with left-sided preponderance. There is a need for the provision of modern imaging equipment to facilitate timely and highly sensitive diagnosis of VTE in low-resource settings. The main limitation of this study was the inability to find any confirmed case of PE.

A prediction model of echocardiographic variables to screen for potentially correctable shunts in adult ASD-PAH patients.

Atrial septal defect (ASD) is a prevalent congenital heart condition in adults that leads to pulmonary hypertension (PAH) and right heart failure if left untreated. During a routine follow-up of adult ASD-PAH patients, the suitability of shunt closure depends on the invasive right heart catheterization (RHC).Nevertheless, performing RHC at every follow-up is impractical and may be harmful. The present retrospective cross-sectional study was designed to investigate which echocardiographic variables are related to pulmonary vascular resistance (PVR) in adult ASD-PAH patients and proposed a model using these variables to screen for patients with a correctable shunt. A total of 530 adult ASD-PAH patients with pulmonary arterial systolic pressure (PASP) of ≥60 mmHg measured using transthoracic echocardiogram (TTE) were included in the study. All RHCs were performed within 3 months after TTE. The correctable shunt was defined as PVR ≤3 wood units (WU). Multivariate regressions were performed utilizing echocardiographic variables. A scoring system was constructed based on the predictors of PVR ≤3 WU using multivariate logistic regression analysis. The scoring system was then examined using a receiver operating characteristic (ROC) analysis. In addition, clinical utility of the model was determined based on decision curve analysis and a calibration curve was used to evaluate model conformity. Estimated pulmonary arterial systolic pressure, velocity through the pulmonary valve, tricuspid annulus early diastolic velocity, and maximum defect dimension were identified as independent predictors. The area under the ROC curve of the predictive value in the model was 0.905 [95% confidence interval (CI): 0.878-0.931, sensitivity: 84.3%, specificity: 83.6%]. The net benefit of the model was notable in terms of a wide-range probability threshold in decision curve analysis, indicating that the prediction model had good clinical applicability. The model's calibration curve was close to an ideal diagonal line, showing good predictive accuracy between the actual and predictive probabilities. The study model was demonstrated to be valuable in predicting adult ASD-PAH patients with a correctable shunt, which may help clinicians to make appropriate treatment decision for follow-up patients.

Management of COVID-19 in the community using virtual care: An Australian perspective.

Virtual care and remote monitoring were widely used during the COVID-19 pandemic. However, early evaluations of effectiveness were often inconclusive due to low rates of enrolment and limited data. The aim of this study was to evaluate the effectiveness of virtual care in managing individuals in community-based self-isolation and quarantine in Australia during this pandemic. A retrospective cross-sectional study was conducted of individuals admitted to a virtual hospital in Sydney who either tested positive for COVID-19 and required self-isolation, or tested negative but still needed to self-isolate, amidst the Delta wave of the COVID-19 pandemic. Outcome measures included health service utilisation, in-hospital mortality, patient-reported experience measures (PREM), and cost savings resulting from avoided emergency department (ED) presentations. Out of 9571 individuals admitted, 8544 (89.3%) had COVID-19. Clinical deterioration or acute illness occurred in 2477 (25.9%) individuals, of whom 890 (9.3%) were referred to ED for further assessment or investigation, and 614 (6.4%) were admitted for inpatient treatment. Overall mortality was 0.2%. Out of 1020 individuals who completed the PREM survey, 846 (82.9%) rated the overall virtual care experience as 'good' or 'very good'. Avoided ED presentations possibly resulted in cost savings estimated between AU$691,214 and AU$2,994,540. Virtual care was successfully used to manage a large number of individuals in community-based self-isolation and quarantine during the COVID-19 pandemic. Scalable pathways for triage, monitoring and clinical escalation via telehealth ensured patient safety and acceptability, and alleviated strain on the broader health system.

Diagnostic Value of Serum Sodium Level and Neutrophil-to-Lymphocyte Ratio in Predicting Severity of Acute Appendicitis: A Retrospective Cross-Sectional Two-Center Study

Background and Objectives: The best way to distinguish complicated acute appendicitis (CAA) from uncomplicated acute appendicitis (UCAA) is still under debate. The aim of this study was to investigate the potential use of the serum sodium (Na+) level and the neutrophil-to-lymphocyte ratio (NLR) to distinguish CAA from UCAA and to evaluate whether CAA is more reliably diagnosed using these two variables together. Materials and Methods: This was a retrospective, cross-sectional, two-center study of patients diagnosed with AA between 1 January 2016 and 31 December 2023. The demographic and analytical variables were analyzed. The NLR was defined as the quotient between the absolute values of neutrophils and lymphocytes. Hyponatremia was defined as a serum Na+ level of ≤135 mmol/L. The sensitivity and specificity of the NLR and the serum Na+ level in the diagnosis of CAA were determined by assessing the receiver operating characteristic curves. Results: Among the patients who underwent an appendectomy, 3066 histologically confirmed AA cases were identified and included in this study. The registered data revealed that 348 (11.3%) patients had CAA, and the remaining 2718 (88.7%) patients had UCAA. The mean ages were 49.47 ± 18.97 and 38.16 ± 14.50, respectively (p &lt; 0.001). The analysis revealed an exponential correlation between the NLR and the serum Na+ level with a moderate degree of agreement with CAA (Cohen’s Kappa: 0.461, p &lt; 0.001). For CAA, using the NLR and the serum Na+ level, the areas under the curve and the cutoffs were 0.664, 4.2 with a confidence interval (CI) of 0.647–0.681 and 0.727, 135 mmol/L with a CI of 0.711–0.742, respectively; all these values were significant with a p-value of &lt;0.001. Conclusions: Although the serum Na+ level is a more effective marker than the NLR, using these two variables together can help detect high-risk patients who may benefit from early management by limiting delays in surgery.

A rural ambulance service in Northern Togo improves access to emergency care for women with obstetric complications.

Maternal mortality remains high in sub-Saharan Africa, with little progress made in the last 20 years. The provision of emergency obstetric care has been shown to have the greatest effect in reducing maternal mortality in countries with high maternal mortality ratios, especially when paired with an emergency transport service. Integrate Health has partnered with the Togolese Ministry of Health to improve maternal and child health via the integration of a free ambulance service into a pre-existing primary care model. In this study, we aim to describe the implementation of this service and assess its effectiveness on access to emergency obstetric care by estimating its coverage of women with obstetric complications. This is a retrospective cross-sectional study using routinely collected data from ambulance logbooks. The study was restricted to pregnant or postpartum woman in four districts of Northern Togo. For each patient transported, the variables collected included date of transport, destination, patient information, kilometres travelled, and reason for transport. Complicated obstetric cases were defined by reason for transport and included maternal haemorrhage, complicated birth, and signs of danger. Estimated coverage of major obstetric complications was calculated using population estimates per fiscal year, the birth rate (3.7%) in Togo, and the assumption that 15% of pregnant women will have a complication. Between July 2020 and June 2023, there were 2926 maternal patients transported by the ambulance service. Of these, 1030 were reported as complicated obstetric cases. Estimated coverage of obstetric complications increased over time and as the programme expanded, from 18% in 2020 to 35.7% in 2021, and 66.5% in 2022. Our findings demonstrate that implementing a rural ambulance service in a region with historically high maternal mortality rates may improve maternal access to emergency obstetric care. The success of our ambulance service was likely due to the fact that it is free, available 24/7, easily accessible, operated by trained staff and community members, and integrated into a pre-existing primary care programme with well-resourced health care centres.

Traumatic Dental Injuries in Children and Adolescents from a Major Dental Clinic in Bosnia and Herzegovina: A 5-Year Retrospective Study

The aim of this study was to investigate the epidemiology of dental trauma in a public dental clinic in Banja Luka, Bosnia and Herzegovina, from 2019 to 2024. Methods: This research was conducted as a retrospective cross-sectional study. The data were analysed and compared between injured primary and permanent maxillary and mandibular teeth. Results: The review of the dental records revealed 73 patients (49 boys and 24 girls) with TDIs, involving 55 primary and 64 permanent teeth. Most of the patients (27 patients, 36.98%) were aged 7–9 years. The main cause of TDI was falls in both dentitions (81.81% of injured primary teeth and 73.43% of injured permanent teeth). The time of arrival after a TDI for assistance in the dental clinic for most cases was after 24 h in both dentitions, 45.45% of injured primary teeth and 48.43% of permanent teeth. For both dentitions, enamel fractures were the most common injury of hard dental tissues and the pulp, and the necrosis of the maxillary central incisor was the most common complication. Conclusions: It is very important to improve trauma management and increase public knowledge on the way parents seek proper treatment for the TDIs of their children, and in due time.