Retrospective Cross-sectional Study Research Articles

Bacterial resistance in urine cultures during a decade

Introduction: Bacterial resistance to antibiotics is a global problem; Due to its great variability, each hospital should carry out its own microbiological surveillance. Objective: To identify changes in bacterial resistance in urine cultures with Gram-negative isolation from the urology department over a decade. Material and methods: Analytical, retrospective cross-sectional study, 1072 urine cultures requested by the urology department of Hospital Juárez de México were collected between 6/01/2012 and 5/31/2022. The percentage of resistance by germ and antibiotic was divided into three periods: initial, intermediate and final to compare with X2 trends. According to the sensitivity report, high resistance >16 and high sensitivity ≤2 were defined. Statistical analysis was performed using IBM SPSS V.25 software and Epi Info Companion V.5.5.10 software. Results: For a decade, the urology service of Hospital Juárez de México has a total of 1072 records in the database, initial date 6/01/2012 and end date 06/01/2022. The most frequent germs were Escherichia coli 709 (66 %), Klebsiella pneumoniae 61 (6 %) and Pseudomonas aeruginosa 56 (5 %). The majority of antibiotics showed persistence in the percentage of resistance. Amoxicillin with clavulanate had a significant decrease (X2 Tend=13.17, p=0.0003). Cefepime (X2 Tend=4.84, p=0.027) and amikacin (X2 Tend=5.76, p=0.016) had a slight significant increase. Cefazolin (X2 Tend=5.00, p=0.025), Levofloxacin (X2 Tend=7.81, p=0.005), Ceftazidime (X2 Tend=3.74, p=0.05) significantly increased the percentage of resistance. Conclusion: Dividing the patterns of bacterial resistance by uropathogens, family of antibiotics, levels of resistance and sensitivity, improves knowledge and favors a better selection of treatments in the population attended by the urology service of the Hospital Juárez de México.

Low adherence to a new guideline for managing febrile infants ≤59 days.

Management of young febrile infants is challenging. Therefore, several guidelines have been developed over the last decades. However, knowledge regarding the impact of introducing guidelines for febrile infants is limited. We assessed the impact of and adherence to a novel guideline for managing febrile infants aged ≤59 days. This retrospective cross-sectional study was conducted in 2 pediatric emergency departments in Sweden between 2014 and 2021. We compared the management of infants aged ≤59 days with fever without a source (FWS) and the diagnosis of serious bacterial infections (SBIs) before and after implementing the new guideline. We included 1,326 infants aged ≤59 days with FWS. Among infants aged ≤21 days, urine cultures increased from 49% to 67% (p = 0.001), blood cultures from 43% to 63% (p < 0.001), lumbar punctures from 16% to 33% (p = 0.003), and antibiotics from 38% to 57% (p = 0.002). Only 39 of 142 (28%) infants aged ≤21 days received recommended management. The SBI prevalence was 16.7% (95% CI, 11.0-23.8) and 17.6% (95% CI, 11.7-24.9) before and after the implementation, respectively. Among infants aged ≤59 days, there were 3 infants (0.6%; 95% CI, 0.1-1.7) in the pre-implementation period and 3 infants (0.6%; 95% CI, 0.1-1.7) in the post-implementation period with delayed treated urinary tract infections. Investigations and antibiotics increased significantly after implementation of the new guideline. However, doing more did not improve the diagnosis of SBIs. Thus, the low adherence to the new guideline may be considered justified. Future research should consider strategies to safely minimize interventions when managing infants with FWS.

Pattern of hysterosalpingographic findings among women with infertility in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Hysterosalpingography (HSG) is a radiological procedure that is routinely done for female fertility workup in most clinical settings. Hysterosalpingography (HSG) is primarily done to assess tubal patency, but it can detect cervical, uterine, and peritoneal diseases. As such, it remains a valuable tool in the evaluation of female infertility in our environment, where the high prevalence of infertility has been largely attributed to tubo-peritoneal factors. It was a retrospective cross-sectional descriptive study. A total of 215 HSG reports of women with infertility at the Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, were reviewed retrospectively. Data on sociodemographic profile, reproductive profile, infertility profile, and HSG reports were obtained from the case records and archives of the Department of Radiology on a proforma. The obtained data was analyzed using SPSS version 20. Most of the clients were within the age range of 35 to 44 years. Secondary infertility accounted for 58.6% of cases of infertility. Abnormal HSG was reported in 70.2% of cases. Tuboperitoneal pathology was the most common abnormality, detected in 46% of cases. Uterine and cervical pathologies were seen in 38.1 and 15.3% of cases, respectively. A total of 116 (53.9%) of the cases had a combination of abnormalities. Abnormal HSG was significantly associated with secondary infertility and a history of induced abortion (p=0.006 and ˂0.001, respectively). Tuboperitoneal pathologies are still a common cause of infertility in our environment. HSG remains a valid tool for female infertility workup.

The relation between serum ferritin level and echocardiographic findings in transfusion dependent thalassemic patients in Slemani City, Kurdistan Region of Iraq.

Background and objectives: Thalassemia patients are at risk of iron overload. Those with transfusion-dependent thalassemia are more likely to experience cardiac problems because repeated blood transfusions cause iron accumulation in the cardiac myocyte. Thus, this study aims to determine the relationship between serum ferritin levels and echocardiographic findings in transfusion-dependent thalassemia patients. Methods: This retrospective analytical cross-sectional study was conducted on 131 patients with transfusion-dependent thalassemia between 1stDecember 2021 to 1stJuly 2022 at the Center for Thalassemia and Congenital Blood Disorder, Slemani, Iraq. The participant’s information, including sociodemographic characteristics such as age, gender, body weight, height, hemoglobin level, serum ferritin, type and duration of chelation therapy, and echocardiographic findings, were collected from the hospital database using a questionnaire. Then, the correlation between serum ferritin levels and echocardiographic results was determined. Results: The mean age of the patients was 21.24 ± 6.28 years, and most of them were males (55.7%), from the urban region (71%) and had an average body weight (68.7%). The mean serum ferritin level was 1876±1743.63 µg/L. The interpretation of the echocardiography results showed 38 patients (29%) had valvular heart diseases. Body mass index has a reverse linear relationship with ejection fraction(P=0.038) and a direct relationship with age(P&lt;0.001). However, no significant association was found between echocardiographic findings and serum ferritin(P=0.83). Conclusions: We found valvular heart diseases among the most common heart disorders in the patients. Suitable interventions and measures can significantly help manage the condition and reduce illness complications.

Predictive Characteristics of Childhood Emergency Injury Presentations in a Non-Urban Area of Victoria, Australia

Injury is the leading cause of death and disability amongst those between 0 and 16 years of age. Routinely associated with a social gradient of health, childhood injury is reportedly higher in rural and regional areas. A retrospective cross-sectional study collected deidentified emergency injury presentation data from nine health services in regional Victoria for children aged 0–14 years between 2017 and 2022. Emergency injury presentation incidence rates and predictor variables were analysed using hierarchical multiple regression. Significance was determined at p &lt; 0.05. Amongst the 15,884 emergency injury presentations, 35.2% (n = 5597) occurred at health services that did not routinely report data to government datasets. Although some findings are consistent with current research, this study highlights specific factors that are predictive of injury amongst 0–4-year-old children who require deeper investigation, including general practitioner access and health literacy-related elements such as preschool health assessment attendance rates, parent education levels, and overseas birth. These findings provide more comprehensive insights for healthcare workers and policymakers as they seek to support people with injuries and accurately address health inequities.

Perceptions in Orthopedic Surgery on the use of cannabis In Treating pain: A survey of musculoskeletal trauma patients - Results from the Canadian POSIT Study

OBJECTIVES: To evaluate the patient-reported expectations regarding cannabis for pain following musculoskeletal (MSK) trauma and patients’ perceptions and attitudes regarding its use. METHODS: Design: A cross-sectional retrospective survey-based study. Setting: Three orthopaedic clinics in Ontario (Level-1 trauma center, Level-2 trauma center, rehabilitation clinic). Patients Selection Criteria: Adult patients presenting to the clinics from January 24, 2018, to March 7, 2018, with traumatic MSK injuries (fractures/dislocations and muscle/tendon/ligament injury) were administered an anonymous questionnaire on cannabis for MSK pain. Outcome Measures and Comparisons: Primary outcome measure was the patients’ perceived effect of cannabis on MSK pain, reported on a continuous pain scale (0-100%, 0 being no pain and 100 unbearable pain). Secondary outcomes included preferences, such as administration route, distribution method, timing, and barriers (lack of knowledge, concerns for side-effects/addiction, moral/religious opposition, etc.) regarding cannabis use. RESULTS In total, 440 patients were included in this study, 217 (49.3%) of whom were female and 222 (50.5%) were male, with a mean age of 45.6 years old (range 18-92, SD 15.6). Patients estimated cannabis could treat 56.5% (95% CI 54.0-59.0%) of their pain and replace 46.2% (95% CI 42.8-49.6%) of their current analgesics. Nearly one-third (131/430, 30.5%) reported they had used medical cannabis and more than a quarter (123/430, 28.6%) used it in the previous year. Most felt cannabis may be beneficial to treat pain (304/334, 91.0%), and reduce opioid use (293/331, 88.5%). Not considering using cannabis for their injury (132/350, 37.7%) was the most common reason for not discussing cannabis with physicians. Higher reported pain severity (β=0.2/point, 95% CI 0.1-0.3, p=0.005) and previous medical cannabis use were associated with higher perceived pain reduction (β=11.1, 95% CI 5.4-16.8, p&lt;0.001). CONCLUSION: One in three orthopaedic trauma patients used medical cannabis. Patients considered cannabis could potentially be an effective option for managing traumatic MSK pain and believed cannabis could reduce opioid usage following acute musculoskeletal trauma. This data will help inform clinicians discussing medical cannabis usage with orthopaedic trauma patients moving forward. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Can the analysis of chromatin texture and nuclear fractal dimensions serve as effective means to distinguish non-invasive follicular thyroid neoplasm with papillary-like nuclear features from other malignancies with follicular pattern in the thyroid?: a study

ABSTRACT Objective Thyroid carcinoma ranks as the 9th most prevalent global cancer, accounting for 586,202 cases and 43,636 deaths in 2020. Computerized image analysis, utilizing artificial intelligence algorithms, emerges as a potential tool for tumor evaluation. Aim This study aims to assess and compare chromatin textural characteristics and nuclear dimensions in follicular neoplasms through gray-level co-occurrence matrix (GLCM), fractal, and morphometric analysis. Method A retrospective cross-sectional study involving 115 thyroid malignancies, specifically 49 papillary thyroid carcinomas with follicular morphology, was conducted from July 2021 to July 2023. Ethical approval was obtained, and histopathological examination, along with image analysis, was performed using ImageJ software. Results A statistically significant difference was observed in contrast (2.426 (1.774–3.412) vs 2.664 (1.963–3.610), p = .002), correlation (1.202 (1.071–1.298) vs 0.892 (0.833–0.946), p = .01), and ASM (0.071 (0.090–0.131) vs 0.044 (0.019–0.102), p = .036) between NIFTP and IFVPTC. However, morphometric parameters did not yield statistically significant differences among histological variants Conclusion Computerized image analysis, though promising in subtype discrimination, requires further refinement and integration with traditional diagnostic parameters. The study suggests potential applications in scenarios where conventional histopathological assessment faces limitations due to limited tissue availability. Despite limitations such as a small sample size and a retrospective design, the findings contribute to understanding thyroid carcinoma characteristics and underscore the need for comprehensive evaluations integrating various diagnostic modalities.

PERFORMANCE ASSESSMENT OF AN ARTIFICIAL INTELLIGENCE CHATBOT IN CLINICAL VITREORETINAL SCENARIOS.

To determine how often ChatGPT is able to provide accurate and comprehensive information regarding clinical vitreoretinal scenarios. To assess the types of sources ChatGPT primarily uses and to determine whether they are hallucinated. This was a retrospective cross-sectional study. The authors designed 40 open-ended clinical scenarios across four main topics in vitreoretinal disease. Responses were graded on correctness and comprehensiveness by three blinded retina specialists. The primary outcome was the number of clinical scenarios that ChatGPT answered correctly and comprehensively. Secondary outcomes included theoretical harm to patients, the distribution of the type of references used by the chatbot, and the frequency of hallucinated references. In June 2023, ChatGPT answered 83% of clinical scenarios (33/40) correctly but provided a comprehensive answer in only 52.5% of cases (21/40). Subgroup analysis demonstrated an average correct score of 86.7% in neovascular age-related macular degeneration, 100% in diabetic retinopathy, 76.7% in retinal vascular disease, and 70% in the surgical domain. There were six incorrect responses with one case (16.7%) of no harm, three cases (50%) of possible harm, and two cases (33.3%) of definitive harm. ChatGPT correctly answered more than 80% of complex open-ended vitreoretinal clinical scenarios, with a reduced capability to provide a comprehensive response.

Evaluating prescription of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in patients with diabetes and albuminuria.

Although guidelines recommend the use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB) in patients with diabetes, hypertension, and albuminuria, their use remains suboptimal in several developed countries. Limited data are available on ACEi/ARB use in developing countries. Here, we assessed the use of ACEi/ARB and identified factors contributing to their underutilization at Hatyai Hospital, Thailand. This retrospective cross-sectional study was conducted using data from the Hatyai Hospital database. Adult patients with diabetes, hypertension, and albuminuria were included. Clinical data and laboratory results were extracted. Furthermore, this study recorded pre-specified conditions that influenced physicians' decisions regarding the prescription of ACEi/ARBs in patients who did not adhere to guidelines. Of 4,655 eligible patients, 500 patients were selected. The average age of the patients was 66.3 years, and 59.6% were female. The adherence rate was 72.4%. Multivariate logistic regression analysis found a significant association between non-adherence and chronic kidney disease (CKD) stage (OR = 1.29, 95% CI: 1.04-1.60, p = 0.019). The most common pre-specified condition contributing to non-adherence was "no condition identified" (69.8%). Among the cases of non-adherence, 21.7% were due to ACEi/ARB discontinuation after acute kidney injury, followed by hyperkalemia (5.1%) and a moderate increase in serum creatinine (4.3%). ACEi/ARB therapy was suboptimal in patients with diabetes, hypertension, and albuminuria. Non-adherence was associated with CKD stage, possibly because of concerns about adverse events and healthcare-related factors.

Appropriate pelvic obliquity measurement method in Lenke type 5C adolescent idiopathic scoliosis: a preliminary study.

Although pelvic obliquity (PO) is a risk factor for postoperative coronal decompensation in corrective surgery in adolescent idiopathic scoliosis (AIS), especially Lenke 5C, methods of measuring PO are controversial. This study aimed to establish an appropriate measurement method using multiplanar reconstructed computed tomography (MPR-CT) images instead of standing posteroanterior (PA) whole-spine radiographs to evaluate PO in patients with Lenke 5C AIS. This study was a retrospective cross-sectional study. Twenty-five patients who underwent corrective surgery for AIS in Osaka University Hospital from August 2014 to February 2023 were included. Cobb angle, L5 tilt, C7 plumb line to center sacral vertebral line (C7PL-CSVL), and leg length discrepancy (LLD) were measured on standing PA whole-spine radiographs preoperatively. Sacral obliquity (SO), the slope of the upper endplate of S1, and iliac obliquity (IO), the tilt of the line connecting the iliac crests, were measured on standing PA whole-spine radiographs and MPR-CT (SO/IO-X-ray, SO/IO-CT, respectively). S1 angle and S2 angle were measured on CT. The mean age of the patients was 18.7±3.9 years and all of them were females. SO-X-ray and SO-CT were larger than IO-X-ray and IO-CT, respectively. SO-X-ray was highly correlated with SO-CT (r=0.838, P<0.001). L5 tilt had higher correlation with SO-CT (r=0.884, P<0.001) than with SO-X-ray (r=0.726, P=0.001) and IO-CT (r=0.550, P=0.22). L5 tilt was correlated poorly with IO-X-ray (r=0.104, P=0.69). The S1 angle was 4.5±3.5° meanwhile the S2 angle was 1.2±2.1°, the sacral deformity was mainly due to the S1 vertebral wedging. Given the asymmetric sacral morphology, SO is more appropriate pelvic parameter than IO to represent the sacral tilt of Lenke 5C AIS, especially when measured using CT images to overcome the poor visibility on PA whole-spine radiographs.

Evaluation of Paxillin Expression in Odontogenic Cysts and Tumors.

Paxillin (PXN) is one of the proteins involved in cell adhesion. PXN and integrins constitute a key site for the focal adhesion between the cell and extracellular matrix. Several studies have shown that PXN is a factor in tumor formation, progression, invasion, and metastasis. This study evaluated PXN expression in four types of odontogenic lesions with different aggressive behaviors. In this retrospective cross-sectional study, PXN expression was immunohistochemically assessed in 68 paraffin-embedded tissue samples from patients with the confirmed diagnosis of four types of odontogenic lesions, including 14 dentigerous cysts (DC), 20 odontogenic keratocyst (OKC), 16 unicystic ameloblastoma, and 18 solid ameloblastoma. The PXN expression in these samples were scored based on the percentage and intensity of immunoreactivity, and compared among the groups by Chi-square test. The PXN marker was detected in the cytoplasm of tumor cells (unicystic and solid ameloblastoma) and the epithelial layer of cysts (DC and OKC). The intensively stained marker of PXN was observed in 9 cases (64.3%) of the DC, 14 cases (70%) of OKC, 12 cases (75%) of unicystic ameloblastoma, and 13 cases (72.2%) of solid ameloblastoma. However, there was not statistical difference of PXN protein expression between DC and OKC (p Value = 0.51) and unicystic and solid ameloblastoma (p = 0.58), also the same was true for cysts and tumors (p = 0.37). The expression of PXN is not related to the biological behaviors of odontogenic lesions.

Validation of the Ocular Trauma Score and Identification of Additional Prognostic Factors in Open-Globe Injuries

ObjectiveThis study's aim was to validate the Ocular Trauma Score (OTS) for open globe injuries and to identify additional pre-operative factors that may affect the final visual acuity outcomes of patients with open globe injuries. DesignThis was a retrospective cross-sectional study done via chart review. MethodsThis was a single center study of patients who presented to VCU Medical Center from 2013-2020. A total of 140 patients with open globe injuries were included in the study. OTS was calculated for each patient based on the initial study by Kuhn et al. OTS predicted visual acuities were compared with the actual final visual acuities using Mann Whitney U test. The distribution of visual acuities in each OTS category was also compared with the original study by Kuhn et al. using Chi square analysis. The effects of lens involvement, presence of an intraocular foreign body, zone of injury, and time of surgery on the final visual acuity outcomes were also analyzed using Mann Whitney U test. The main outcome measure was the final visual acuity in Snellen and LogMAR equivalents. ResultsLP/HM was the most common presenting visual acuity category (59%) and OTS 1 was the most common OTS (45%). OTS reliably predicted final visual acuity in most cases, except for OTS 1 and 4, where there were significant differences between our study and the Kuhn et al. study. Of the four pre-operative factors analyzed, lens status and foreign body had significant effects on final visual acuity outcomes – injuries with an atraumatic lens or without an IOFB had better final VAs than predicted by OTS. Zone of injury and time of surgery had no significant effects. ConclusionOur study finds that OTS is overall a reliable predictor of final visual acuity and further validates it as a tool for open globe injury prognostication. However, our investigation showed that certain factors were not adequately accounted for by OTS, demonstrating the importance of considering other pre-operative factors when using OTS.

Presentation, Management, and Child Protective Service Reporting of Children Who Test Positive for Cannabis in an Emergency Room Setting.

Rates of cannabis ingestion among young children are increasing. Small studies have evaluated symptomatology of these children. The literature lacks research regarding factors influencing medical management. Our goal was to 1) understand circumstances leading to exposure over time and 2) gain insight into factors that may influence emergency room management and Child Protective Services reporting over time. Retrospective cross-sectional study on children younger than 10 years with cannabis-positive urine drug screens in the emergency room setting. Single-factor analysis of variance and Fisher exact tests were used to assess for trends. Two-tailed t tests and Fisher exact tests were used to compare management of children presenting to the emergency room with chief complaint (CC) "ingestion" versus those without. Of the 179 children, the mean age was 3.7 years and 48% were boys. We observed a significant increase over time in cannabis-positive children. The most common location of exposure was the primary residence (54%), with parents as the most frequent users (46%). In the emergency department, the most common CC was ingestion followed by altered mental status and fatigue. Children with an "ingestion" CC were managed with less testing than those with other CCs. They received fewer needle sticks (43% vs 91%), less imaging (5% vs 56% computed tomography heads), and fewer procedures (0% vs 8% lumbar punctures). Children with "ingestion" CC were less likely to be reported to Child Protective Services. Pediatric cannabis exposures are increasing and have a wide array of clinical presentations that complicate emergency room management. Parental report of cannabis ingestion seems to impact and reduce potentially unnecessary testing.

Clinical Presentations, Diagnosis, and Genetic Features of Hemophagocytic Lymphohistiocytosis: A Single Institutional Experience With the Saudi Population.

Background Hemophagocytic lymphohistiocytosis (HLH) is an uncommon, potentially fatal condition caused by high immune activation. The present study aimed to identify the clinical manifestations, geographic distribution, and associated pathogenic genetic mutations of HLH in Saudi Arabia. Method A retrospective cross-sectional study was conducted at King Fahad Medical City (KFMC), with a total of 59 patients diagnosed with HLH in the period between 2006 and 2018. All genetic results and clinical and biochemical data were retrieved and statistically analyzed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). Results The results revealed that 48 patients (81.4%) had 15 pathogenic mutations of primary HLH whereas 8 (13.6%) patients had no genetic mutation. The most common variant mutation identified was c.1430C>T of the STXBP2 gene (42.4% of total patients), followed by c.1122G>A of the PRF1 gene (10.2% of patients), which demonstrated a distinctive geographic and tribal association. Patients with RAB27A mutation tend to present at an older age than the others with a median age of presentation of 5.5 months vs 2 months for patients with PRF1 mutations. No significant differences in clinical features were observed among the various groups. Conclusion This study highlights the incidence of genetic mutations among the Saudi population with HLH. The STXBP2 is the most common mutation followed by PRF1 mutations, many mutation variants are associated with a distinctive tribal and geographic association.

A Cone-Beam Computed Tomography-Based Evaluation of Root Dilaceration in Permanent Premolars: A Retrospective Study.

As a developmental disorder characterized by an abnormal bend and angle in the longitudinal axis of the tooth root, dilaceration can cause complications in routine dental procedures such as endodontics, orthodontics, and surgical treatments. The purpose of this study was to investigate the prevalence of dilaceration in maxillary and mandibular premolar teeth in a population of Shiraz city based on cone-beam computed tomography (CBCT). This is a retrospective cross-sectional study on 927 premolar teeth and 132 CBCT radiographs of patients obtained from four private radiology clinics in Shiraz (Iran). In this study, the presence, location, direction, and severity of dilaceration in premolar roots as well as its relationship with gender were investigated. Chi-square and Fisher tests were used to analyze the data. The results showed that 17% of the studied 927 teeth had dilaceration. The prevalence of dilaceration was significantly higher in women than in men (20.3% vs. 13.6%, p= 0.005). The dilaceration rates were significantly higher in the mandibular first and second premolar teeth (31.6% and 26%, p= 0.002) than in the other teeth. In addition, the highest prevalence was in the distal direction with mild severity in the apical third of the root (p< 0.001). According to the results of this study, the prevalence of dilaceration was relatively high in mandibular premolar teeth especially in women.

Hematological parameters to predict post-COVID-19 immune response among vaccinated and nonvaccinated individuals: a retrospective cross-sectional study

Background: This study finds the changes in the hematological parameters of healthy individuals to predict the immune status against coronavirus disease 2019 (COVID-19) among COVID -19 vaccinated and nonvaccinated individuals. Methods: A comparative cross-sectional study among 210 healthy individuals was conducted. All individuals were divided into three groups, that is, IgG positive, IgG negative, and IgG and IgM positive, based on ELISA. Data analysis was done using SPSS version 25 for Windows. Results: A statistically significant effect was found among the three groups in terms of mean levels of hemoglobin (Hb), hematocrit (Hct), mean corpuscular hemoglobin concentration (MCHC), red blood cells (RBC), RDW-CV, lymphocyte, neutrophil, eosinophils, and basophil count. The study also showed that 52.8% (n=74) had neither taken vaccination nor had any history of previous COVID-19 infection but were IgG antibody positive. Conclusion: There was a statistically significant difference among hematological parameters between immune and nonimmune groups, and it can predict the COVID-19 immune status.

Harmony between spinopelvic mismatch and sagittal hip alignment contributes to upright standing in females: a cross-sectional study.

In upright standing, spinopelvic mismatch is compensated by hip extension. However, few studies have investigated the reciprocal relationship between the sagittal alignment of the hip joints and spinopelvic mismatch during upright standing in humans. Our study aims to investigate (I) the relationship between spinopelvic mismatch and hip extension and (II) whether insufficient hip extension against spinopelvic mismatch, i.e., pelvic incidence (PI)-lumbar lordosis (LL), affects trunk inclination in upright standing. This study was a retrospective cross-sectional study. We included 398 consecutive female patients treated for osteoporosis at our outpatient department between November 2017 and June 2022. Patients with any of the following were excluded from the study: (I) those whose plain whole-spine radiographs did not cover the femurs, (II) those with fractures in the vertebrae or lower extremities, (III) those with a history of surgery of the spine or of the lower extremities, (IV) those with scoliosis with a Cobb angle ≥10° in the anteroposterior radiograph, and (V) those with transitional vertebrae. Sixty-two patients were divided into normal and malalignment groups based on their sagittal spinal alignment. The patients underwent plain whole-spine radiography as a routine examination. A linear approximation between the pelvic femoral angle (PFA), representing hip extension, and PI-LL was obtained in both groups. The optimal PFA of each patient was obtained by substituting the PI-LL into the linear approximation of the normal group. The difference between the optimal and measured PFA was defined as the ΔPFA for each patient. The correlation between the ΔPFA and sagittal vertical axis (SVA) was evaluated in both groups. The PFA and PI-LL were correlated in both groups. The malalignment group had a significantly greater ΔPFA than the normal group. ΔPFA was correlated with SVA only in the malalignment group. The magnitude of the ΔPFA indicated insufficient hip extension to compensate for the spinopelvic mismatch during upright standing.

Characteristics and Risk Factors of Central Nervous System Infection in Children With Febrile Seizures.

The aim of the present study is to evaluate the necessity of performing lumbar puncture in patients experiencing febrile seizures, considering the epidemiology specific to Brazil. A retrospective cross-sectional study was performed from January 2017 to December 2021. A total of 469 children with seizure and fever were analyzed. The identified event was the first in 65.9% (n = 309). A total of 54.2% (n = 254) of patients had a simple febrile seizure. Infectious focus, excluding previous central nervous system (CNS) infection, was identified in 35.6% (n = 167) patients. Meningitis was identified in 7.7% (n = 36) patients, all of them were viral. Patients with CNS infection had a higher frequency of symptoms such as nausea and vomiting, drowsiness, headache, and higher level of leukocytosis. A longer duration of fever was found to be more strongly associated with CNS infection. When considering the use of lumbar puncture in febrile seizure, it is important to conduct a comprehensive evaluation that considers multiple factors, including clinical signs, symptoms, and the overall clinical context. Meningeal signs may be less prominent, and other symptoms such as lethargy, irritability, and vomiting may serve as more reliable indicators. Although clinical examination suggestive of meningitis remains an important factor, the recurrence of febrile seizures and a longer length of fever can provide additional insights and aid in decision-making regarding lumbar puncture.

Characteristics associated with perceived level of confidence managing diabetes among United States adults with diabetes: A retrospective cross-sectional study.

Identifying characteristics associated with patients' confidence managing diabetes may aid the primary care provider in offering diabetes self-management education and support to patients. This analysis assessed the relationship between demographic, health, economic, access to care, satisfaction with care, and healthcare utilization characteristics with patients' confidence managing diabetes. United States adults with diabetes in the 2020 Medical Expenditure Panel Survey were included in this retrospective cross-sectional analysis. Characteristics related statistically to patients' confidence managing diabetes in multivariable logistic regression analysis were reported. Among the 1,516 eligible individuals, 76.3% stated they were very confident/confident with their diabetes management. Adults who perceived their health positively (odds ratio 2.3, 95% confidence interval [CI] 1.3-3.9), completed ≥30 min moderate/vigorous exercise five times weekly (odds ratio 1.6, 95% CI 1.0-2.6), had at least one inpatient discharge in 2020 (odds ratio 3.5, 95% CI 1.5-8.1), said it was not difficult to telephone their usual provider (odds ratio 3.3, 95% CI 1.4-7.8), and had no emergency room visits in 2020 (odds ratio 2, 95% CI 1.1-3.3) had higher odds of stating they were very confident or confident with their diabetes management. The characteristics associated with being very confident/confident managing diabetes should be considered by primary healthcare physicians and other healthcare professionals when helping patients manage diabetes.

Steroid Profiling in the Differential Diagnosis of Cushing's Syndrome and Diagnosis of MACS

Abstract Background Cushing's Syndrome (CS) is the consequence of the exposure of tissues to extremely high levels of glucocorticoids. Early diagnosis and treatment are the mainstay of optimizing patient outcomes and improving their quality of life. In the recent years steroid profiling by LC-MS sheds more light on the diagnosis of CS. Materials and methods This was a retrospective cross-sectional study. Objective To investigate serum steroid precursor differences between different etiological forms of CS and to suggest a steroid panel for the diagnosis of MACS in patients with adrenal incidentalomas. Results Our studied patients with CD had significantly lower levels of 11-deoxycorticosterone (p = 0.047) and 17 OH progesterone (p = 0.024) compared to those with adrenal forms of CS. In out cohort of patients with adrenal incidentalomas, those with MACS had significantly lower levels of androgens (DHEA, p = 0.001) and cortisone (p = 0.015) and higher levels of 11-deoxycortisol (p = 0.039) compared to the patients with non-secreting adenomas (NSA). Conclusion Introducing LC-MS based steroid profiling would be very helpful in the diagnostic process of patients with CS.