Retrospective Descriptive Observational Study Research Articles

Epidemiological profile of neuroendocrine tumors in adults in Brazil.

Neuroendocrine tumors (NETs) are a set of diseases that originate from neuroendocrine cells, which comprises a diffuse endocrine system present in various organs of the body. These tumors are more frequent in the gastrointestinal tract (70%) and the bronchopulmonary system (20%-30%). A NET incidence rate of 1-5 per 100,000 inhabitants has been estimated for several European countries and the USA employing 20 years of data. However, no comprehensive studies on this rare neoplasm are available in Brazil. In this context, the aim of this study was to characterize the epidemiological NET profile in the country. This is a retrospective descriptive observational study based on data from Hospital Cancer Records available at the Brazilian National Cancer Institute and the São Paulo Oncocentro Foundation. Demographic, clinical and treatmentrelated variables were analyzed from selected cases employing descriptive statistics. A total of 15,859 cases were identified, most occurring in males (53.4%) and in individuals under 65 years old (63.3%). Small cell carcinoma was the most frequent histological type (46.7%). Bronchopulmonary tumors were the most frequent NETs, followed by pancreatic tumors, with cases mostly concentrated in high complexity centers in the Brazilian Southeast and treated mainly with surgery and chemotherapy, with over half of the patients diagnosed in advanced stages of the disease.

The Relationship between Breast Cancer Subtypes, Prognostic Factors, and Apparent Diffusion Coefficient Histogram Analysis.

Diffusion Magnetic Resonance Imaging (MRI) is a useful method to evaluate tumor biology and tumor microstructure. The apparent diffusion coefficient (ADC) value correlates negatively with the cellular density of the tumor. This study aimed to investigate the effectiveness of the ADC histogram analysis in showing the relationship between breast cancer prognostic factors and ADC parameters. This study is a retrospective observational descriptive study. ADC histogram parameters were evaluated in all tumor volumes of 67 breast cancer patients. Minimum, 5, 10, 25, 50, 75, 90, 95 percentiles, maximum, mean, median ADC values, kurtosis, and skewness were calculated. Breast MRI examinations were performed on a 3T MR scanner. We evaluated the fibroglandular tissue density of bilateral breasts, background enhancement, localization of masses, multifocality-multicentricity, shape, rim, internal contrast enhancement, and kinetic curve on breast MRI. BIRADS scoring was performed according to breast MRI. Pathologically, histologic type, histologic grade, HER 2, Ki 67, ER-, and PR status were evaluated. A significant correlation was found between tumor volume and ADC scores. There is a significant correlation between min ADC values (p< 0.031), max ADC (p< 0.001), and skewness (p< 0.019). A significant correlation was found between tumor kurtosis and lymph nodes (p< 0.029). There was a significant difference in ADC <sub<mean</sub<, ADC<sub<10%</sub<, ADC<sub<25%</sub<, ADC<sub<50%</sub<, ADC<sub<75%</sub<, ADC<sub<90%</sub<, ADC <sub<95%</sub< and ADC<sub<max</sub> values depending on ER-and PRstatus. (for ER p = 0.004, p = 0.018, p = 0.010, p = 0.008, p = 0.004, p = 0.004, p = 0.02, p = 0.02 and p = 0.038, for PR p &#60; 0.001, p = 0.028, p = 0.011, p = 0.001, p < 0.001, p =<0.001, p < 0.001, and p < 0.001, respectively; p < 0.05). These values were lower in ER-and PR-positive status than in ER-and PR-negative receptor status. According to HER2 status, there was a statistically significant difference in ADC<sub<5%</sub< and measurements of the lesions (p = 0.041; p < 0.05). Our study found no significant correlation between other prognostic factors, such as histological grade, Ki-67 indices, and ADC values. Our study found a significant difference between tumor volume, ER- and, PR status, HER2, and lymph node involvement, and some ADC values among prognostic factors for breast cancer. Furthermore, ADC histogram analysis can provide additional value in predicting some prognostic factors.

DISE with CPAP: a useful procedure to evaluate upper airway collapsibility.

Drug-induced sleep endoscopy (DISE) is commonly performed in patients suffering obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) intolerance. We aimed to evaluate the effects of adding CPAP to DISE to provide understanding of the reason of its failure and better guidance in future therapeutic decisions. A retrospective observational descriptive study was conducted on CPAP-intolerant patients with moderate-severe OSA. DISE was used to evaluate upper airway collapsibility, and CPAP was tested to better describe anatomical sites of obstruction and to measure the opening pharyngeal pressure. Sample size consisted of 38 patients with a mean age of 49 ± 9years. Mean BMI was 28.4 ± 2.4kg/m2, mean apnea-hypopnea index (AHI) was 35.4 events per hour ± 20.1, and mean saturation under 90% (TSat90) was 14.5%. In DISE we found a collapse at Velum in 92% of patients, at Oropharyngeal level in 89%, at tongue in 42%, and at epiglottis in 36%. In the subgroup of patients with clinical failure with CPAP, we observed 100% of epiglottic collapse and 50% of tongue obstruction. In this specific population, we recommended personalized surgery and myofunctional therapy. DISE-CPAP is a useful tool to select the treatment that better fits to each patient taking care all information available. It improves our ability to prescribe a multilevel treatment with an exhaustive topographic evaluation of upper airway collapsibility that complements CPAP classic titration, and it can be helpful to distinguish better candidates for surgery, myofunctional therapy or CPAP.

Functional outcomes following surgery for spastic hip adductor muscles in ambulatory and non-ambulatory adults.

To evaluate functional outcomes of surgery of spastic hip adductor muscles (obturator neurotomy with or without adductor longus tenotomy) in ambulatory and non-ambulatory patients, using preoperatively defined personalized goals. Retrospective observational descriptive study. Twenty-three patients with adductor spasticity who underwent obturator neurotomy between May 2016 and May 2021 at the Clinique des Cèdres, Cornebarrieu, France, were included. Postoperative functional results were evaluated in accordance with the Goal Attainment Scaling method. Patients were considered "responders" if their score was ≥ 0. Secondary outcomes included spasticity, strength, hip range of motion and change in ambulatory capacity. When data were available, a comparison of pre- and postoperative 3-dimensional instrumented gait analysis was also performed. Among the 23 patients only 3 were non-walkers. Seventeen/22 patients achieved their main goal and 14/23 patients achieved all their goals. Results were broadly similar for both walking goals (inter-knee contact, inter-feet contact, fluidity, walking perimeter, toe drag) and non-walking goals (intimacy, transfer, pain, posture, dressing). Surgery of spastic hip adductor muscles results in functional improvement in ambulation, hygiene, dressing and posture and can be offered to patients with troublesome adductor overactivity. The use of a motor nerve block is recommended to define relevant goals before the surgery.

Clinical presentation and management of multisystem inflammatory syndrome in children associated with covid-19: a retrospective observational descriptive study in a pediatric hospital in Syria

ObjectiveMultisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 is a rare and serious medical condition. This study aims to review the clinical presentation, laboratory parameters, outcomes, and management of MIS-C cases in a pediatric hospital in Syria.MethodsThis retrospective observational study aimed to investigate MIS-C between May 2020 and October 2021. Data collection involved extracting information from medical records, and patients were identified based on the case definition established by the World Health Organization (WHO). Various laboratory investigations, diagnostic evaluations, clinical presentations, and treatments were performed to assess patients. Descriptive statistical analysis was conducted using Microsoft Excel.ResultsA total of 232 COVID-19 cases were reported with COVID-19 Infection. Among these cases, 25 (10.77%) were identified as MIS-C. The median age of the patients was 5.5 years, with the majority being male patients (72%). Patients experienced fever (100%), bilateral conjunctivitis (88%), rash (84%), gastrointestinal symptoms (76%), and cardiac dysfunction (72%). Other notable findings included oral cavity changes (64%), edema (36%), cervical lymphadenopathy (36%), and neurological manifestations (28%). Respiratory symptoms were uncommon (16%). All patients recovered, with no recorded deaths.ConclusionThe predominant presence of positive SARS-CoV-2 IgG in the majority of patients in this study supports the post-infectious nature of MIS-C. Respiratory symptoms were less prevalent in both pediatric COVID-19 and MIS-C patients. Early supportive care is crucial in management, although additional research is needed to establish definitive guidelines. Larger studies are necessary to overcome the limitations of this study and to enhance our understanding of MIS-C in pediatric COVID-19 patients.

Perfil de los pacientes pediátricos con diagnóstico de infección de vías urinarios en el Hospital Departamental Universitario del Quindío San Juan de Dios entre 2017 y 2019

Objective: Urinary tract infection is the second most frequent infectious pathology in childhood. This study seeks to establish the clinical and microbiological profile of urinary tract infections in pediatric patients at the Hospital Departamental Universitario del Quindío San Juan de Dios.&#x0D; Materials and methods: Retrospective descriptive observational study. By reviewing the medical records of patients between 0 and 16 years old with a diagnosis of urinary tract infection. Clinical, paraclinical and microbiological variables were obtained. An exploratory analysis was initially performed, followed by a multivariate analysis.&#x0D; Results: Data from 200 patients were included, predominantly female and infants patients. The main symptom at the time of consultation was fever. The main pathogen causing the infection was E. coli. The most used antibiotic was Amikacin (60.7%). ESBL was the most commonly found resistance profile (42.5%). 11 patients required antibiotic therapy guided by antibiogram, Amikacin being the most used (41.7%).&#x0D; Conclusions: Escherichia coli is the most isolated microorganism, presenting a low profile of bacterial resistance, which allows a better orientation of empirical antibiotic therapy. Amikacin was the most widely used antibiotic, showing very low resistance rates. Longer-duration regimens showed similar characteristics to shorter-duration regimens, which could support shorter regimens, but higher studies are required to prove this.

Profil Penyakit Kulit Penduduk Perkampungan Terapung Kepulauan Tihi-tihi dan Selangan, Bontang, Kalimantan Timur, Indonesia

Introduction: Tihi-tihi and Selangan Islands, floating village areas in Bontang, East Kalimantan, are remote areas in Indonesia, which can only be accessed by sea route. The research was conducted to describe skin diseases in those islands. Method: Retrospective observational cross-sectional and descriptive analysis study on floating communities in Tihi-tihi and Selangan Island, Bontang Lestari Village, South Bontang District, Bontang City, East Kalimantan, Indonesia. Results: The study was conducted on 95 subjects, mostly female (53%), and the largest age group was 26-45 years (29%), followed by the 5-11 years group (24%). Skin infection diseases (58.96%) were dominated by scabies (67.9% of the skin infection disease group). The second highest was allergic contact dermatitis (41%) from the non-infection group. There is an association between age and disease group (p&lt;0.05), with an odds ratio of 3.164. Conclusion: Skin diseases in Tihi-tihi and Selangan Islands are dominated by scabies, followed by allergic contact dermatitis. The pediatric age group is at a three-fold greater risk of developing skin infections than non-infection skin diseases.

Clinical-epidemiological profile of vestibular migraine patients: Indian scenario

Background: The main objective of this study was to observe the Indian clinical scenario and analyse the clinical and epidemiological profile of patients with vestibular migraine. Methods: This is a retrospective observational descriptive study. The outpatient records of the vertigo clinic at Department of Otorhinolaryngology of SGT medical college, Budhera, Gurgaon, Haryana was assessed from April 2023 to July 2023. Patients who were diagnosed with vestibular migraine based on ICD classification as follows was included in the study. Results: Study population predominantly comprised of 77% (17) females and 23% (5) of males. Almost 80% of the study population belonged to age group 31-40 years. Each episode of vertigo lasts for seconds in 50% of the patients and minutes in 45% of the patients. All patients had episodic vertigo.59% of patients described the vertigo as rotatory,18 % of the study population reported imbalance,18 % described swaying and 5% reported blackouts. Most of the examination was normal except 5 out of 22 patients reported giddiness on testing vertical saccades. Conclusions: Vestibular migraine is an underdiagnosed condition in India, there’s not much research and awareness, hence this study aims to overcome these limitations. Most of the patients were middle aged women. The physical and audiological examination of most patients were normal but showing abnormalities on testing saccades.

P1114 Integral care of the non-Spanish speaking migrant population in inflammatory bowel disease units

Abstract Background In recent years, given the change in the paradigm of management of Inflammatory Bowel Disease (IBD), the different societies have been working to ensure continuous, homogeneous, multidisciplinary social and health care with the patients and their autonomy as the central axis; promoting the creation of Integrated Care Units for IBD patients (ICU-IBD). In the latest analyses of our ICU, attention was drawn to the progressive increase in the demand for care from non-Spanish-speaking migrant patients. This prompted us to carry out this study, with the aim of finding out how this population uses our unit and how it responds to their needs. Methods A retrospective longitudinal descriptive observational study with analysis of demographic, clinical and care variables of all non-Spanish-speaking migrant patients followed in the ICU-IBD of our centre until 30 June 2023. Results Thirty patients of 14 different nationalities were included, with Moroccan being the most frequent (43.3%); only one of them (3.3%) was fluent in Spanish. Other clinical and demographic characteristics of note were: mean age at follow-up of 43.2 years, predominantly female (66.6%) and predominantly Crohn's disease (63.3%) (Table 1). A total of 86.7% of the patients were referred to our ICU-IBD from the Emergency Department, which they attended due to symptoms related to flare-ups of their intestinal disease. After the initial assessments, we observed that 73.3% did not attend for check-ups, 83.3% of the patients attended the emergency department in the event of a clinical flare-up, and 93.3% showed irregular adherence to treatment. In the subsequent follow-up, we observed a significant change, 76.7% regularly attended consultations, 76.7% consulted the unit in the event of an outbreak and 60% followed treatment regularly (Figure 1). These changes coincide with a socio-health intervention carried out by the specialised nurse; in which patients and their environment were provided with information regarding their disease, treatment and use of the UAI-EII; as well as addressing socio-health problems in order to facilitate their wellbeing and integration into the community. Conclusion In view of our results and the data published in other studies, we suggest that the language barrier, the social and healthcare culture of the country of origin, the socioeconomic situation and integration into the new social environment are factors to be taken into account in order to achieve adequate comprehensive care for this migrant population. The role of the IBD nurse is fundamental in the daily work of offering individualised, continuous and comprehensive care to both the patient and their environment; even more so in this population with marked socio-cultural barriers.

Characteristic of Subcutaneous Mycosis Patients at Prof. Dr. I.G.N.G Hospital, Denpasar, Bali: An Observational Retrospective Study

Introduction: Subcutaneous mycosis infections can occur in tropical and subtropical countries. Indonesia’s geographic location is in a tropical country and is a developing country with the majority of its population working in agriculture, which is a risk factors associated with subcutaneous mycosis. Methods: This is a retrospective observational descriptive study with a cross-sectional design. Data were obtained through medical records from all patients who came for treatment in Prof IGNG Ngoerah General Hospital Denpasar from January 2018 to December 2023. The inclusion criteria in this study were all patients diagnosed with subcutaneous mycosis. The variables studied were age, gender, occupation, comorbidities, first symptoms, skin efflorescence, dermatoscopy finding, and type of mycosis based on yeast culture. Results: A total of 21 cases of subcutaneous mycosis within 5 years. The majority of patients were female, (67%), with the most common age group being 45-64 years (57%). Based on occupation, farmers account for at most (33%). The majority of patients had itchiness (33%) and redness (33%) as the first symptoms, nodule erythema was the most common skin efflorescence (57%), and the most common dermatoscopy finding was yellow dots (57%). The most common fungal infection based on culture was chromoblastomycosis (71%). Conclusion: The majority of patients of subcutaneous mycosis were female, with age group 45-64 years old, and farmers. Itchiness and redness were the common symptoms of the disease. On examination, nodule erythema is the most common skin efflorescence. Chromoblastomycosis was the most common type of infection.

Double positivity for rheumatoid factor and anti-CCP autoantibodies: improving referral from primary care of patients suspected of having rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic progressive autoimmune inflammatory disease with significant morbidity and mortality. The course of the disease can be modified if diagnosis is early and treatment appropriate. In this study, we aimed to evaluate a new strategy for early identification of RA patients in primary care settings (the 'diagnostic bottleneck') based on serological biomarkers and to manage inappropriate rheumatoid factor (RF) laboratory test requests. A two-arm study was carried out. The first arm corresponded to a retrospective observational descriptive study of patients referred for RF testing from primary care using the current laboratory workflow. The second arm included the following prospective interventions: cancelation of RF requests corresponding to patients with previous negative results for RF over a one-year period; and automatic reflex testing antibodies against cyclic citrullinated proteins (anti-CCP) for patients displaying RF values >30IU/ml. Outcomes from both arms were then compared. As double positivity for RF and anti-CCP notably increases the positive likelihood ratio of RA. The intervention enabled a reduction of 2813 tests in 22 months. Moreover, the frequency of unnecessary referrals was reduced from 22% to 8.2%, while that of missed patients decreased slightly (from 21% to 16%), with the number of patients diagnosed per RF request remaining unchanged. In terms of costs, we saved 19.4 RF tests per anti-CCP test added.We developed a simple and cost-effective strategy for reducing the time to diagnosis of RA that can improve patients' quality of life. This approach was supported by primary and specialised care.

Metabolic and Bariatric Surgery Utilization Trends in the United States: Evidence From 2012 to 2021 National Electronic Medical Records Network.

Bariatric surgery has evolved over the past 2 decades yet assessing trends of bariatric surgery utilization in the growing eligible population is lacking. This study aimed to update the trends in bariatric surgery utilization, changes in types of procedures performed, and the characteristics of patients who underwent bariatric surgery in the United States, using real-world data. This retrospective descriptive observational study was conducted using the TriNetX, a federated electronic medical records network from 2012 to 2021, for adult patients 18 years old or older who had bariatric surgery. Descriptive statistical analysis was conducted to assess patients' demographics and characteristics. Annual secular trend analyses were conducted for the annual rate of bariatric surgery, and the specific procedural types and proportions of laparoscopic surgeries. A steady increase in the number of procedures performed in the United States over the first 6 years of the study, a plateau for the following 2 years, and then a decline in 2020 and 2021 (during the coronavirus disease 2019 pandemic). The annual rate of bariatric surgery was lowest in 2012 at 59.2 and highest in 2018 at 79.6 surgeries per 100,000 adults. During the study period, 96.2% to 98.8% of procedures performed annually were conducted laparoscopically as opposed to the open technique. Beginning in 2012, the Roux-en-Y gastric bypass (RYGB) procedure fell to represent only 17.1% of cases in 2018, along with a sharp decline in the adjustable gastric band (AGB) procedure, replaced by a sharp increase in the sleeve gastrectomy (SG) procedure to represent over 74% of cases in 2018. Bariatric surgery utilization in the United States showed a moderate decline in the number of RYGB procedures, which was offset by a substantial increase in the number of SG procedures and a precipitous drop in the annual number of AGB procedures.

Outcomes of Chronic Myeloid Leukemia Patients after Therapeutic Failure to Asciminib, a Multicenter Observational Study

Introduction: Asciminib has recently entered the market as a promising option for patients with chronic myeloid leukemia (CML) and therapeutic failure to ³ 2 tyrosine kinase inhibitors (TKIs). It presents a relevant rate of therapeutic success thanks to its different mechanism of action, being the first in its class to produce an allosteric inhibition on the myristoylated pocket of ABL. However, a percentage of patients fail this drug due to intolerance or resistance. This group constitutes a highly polytreated population with few therapeutic options. The aim of this analysis is to determine the most frequent treatment strategies in this setting, as well as to ascertain the prognosis in this difficult to treat group. Material and methods: a retrospective descriptive multicenter observational study was carried out. Eligible patients were those with a diagnosis of CML, &amp;gt;18 years and who had presented a therapeutic failure to asciminib, due to resistance or intolerance. Patients were selected from a cohort of 85 CML patients who received asciminib through a managed-access program. Results: A total of 19 patients were recruited from 17 centers in Spain. Median age at the time of therapeutic failure to asciminib was 61.7 years. Median time from diagnosis to asciminib failure was 7.9 years (range 1.7-25.5), median number of previous lines was 5. 47% of patients had previously received ponatinib and 15.8% (3/19) had received an allogeneic hematopoietic stem cell transplantation (allo-HSCT) prior to asciminib. Median time on asciminib was 5.6 months (range 0.7- 40.9). 42% of patients (8/19) failed treatment due to intolerance and 58% (11/19) due to resistance. Four of them had progression to accelerated/blastic phase at the time of withdrawal. Of the intolerant patients, the most frequent reason for discontinuation was pancreatitis (50%, 4/8). The remaining causes were renal failure (1), pleural effusion (1), fatigue (1), and neurological symptoms (1). Regarding the intolerant group, 2 patients did not require restart of treatment due to a sustained deep molecular response (MR). The rest (6/8) required treatment, which in all cases involved restarting a classic TKI that they had already received (2 imatinib, 2 dasatinib, 2 nilotinib). In 50% (3/6) dose reductions were used to control adverse events (AEs), which in 2/3 patients compromised efficacy. In another case, low-dose corticosteroid therapy was used for the management of pleural effusion, maintaining standard dose. Only 1/8 intolerant patients required an additional change of treatment, and all of them are still alive and without progression to advanced stages at the last follow-up. Regarding the patients that required treatment change due to progression to advanced phases, one patient underwent allo-HSCT. The rest were not candidates due to age or clinical impairment (1 received dasatinib, 1 hydroxyurea (HU), 1 without treatment). Only the patient who underwent HSCT is alive more than one year after the procedure with a grade 5 MR. In the rest the median overall survival (OS) was less than 1 month. Of the remaining resistant patients, 4/7 (57%) received ponatinib (1 of 4 had received it previously), 1 imatinib, 1 allo-HSCT and the other patient received cytarabine + interferon + HU. Three of 7 patients required additional lines including change of TKI (asciminib, nilotinib, dasatinib) and other strategies (HU, busulfan, interferon, cytarabine). In terms of response, only the patient undergoing HSCT maintained a mayor MR (1/7). One patient maintained a complete cytogenetic response and the other 2 patients were unable to improve response despite treatment (maintaining worse response than CHR at the end of follow-up). Two patients died (1 acute myocardial infarction, 1 digestive neoplasia). With a median follow-up of 11.2 months, OS of the global cohort is 73%; 100% for intolerant patients, 71% for resistant patients and 25% for those in accelerated/blastic phase. Conclusions: Patients who fail asciminib are a particularly difficult to manage group. In intolerant patients, dose reductions and symptomatic management of AEs may be an appropriate strategy. Resistant patients currently represent an unmet therapeutic need, with low cytogenetic and molecular response rates and poor survival with current strategies. Patients with progression to advanced phases have a dismal prognosis, HSCT may be the only option that provides long-term survival in this group.

Patient characteristics and treatment patterns for patients with advanced/metastatic gastric cancer (including gastroesophageal junction cancer) or esophageal cancer in Puerto Rico.

537 Background: The aim of the study was to describe patient characteristics and treatment patterns across lines of therapy in patients with advanced/metastatic Gastric Cancer -including gastroesophageal junction cancer- (GC/GEJC) or Esophageal Cancer (EC) in Puerto Rico (PR). Methods: This was a descriptive retrospective observational cohort study using Flatiron Health Oncology EHR database. Eligible PR adults diagnosed with advanced/metastatic GC/GEJC/EC were required to have ≥ 1 months of medical data from January 1, 2011, through April 30, 2022 (index period). The index date was defined as the date of advanced/metastatic GC/GEJC/EC diagnosis. Patients who were enrolled in clinical trials any time during the study period and with other primary cancers prior to the index date were excluded. The demographics, clinical characteristics, treatment regimen received and duration of therapy (DoT) across lines of therapy were assessed for patients categorized into GC/GEJC and EC subgroups. Results: A total of 206 patients were included in the GC/GEJC (n= 115) and EC (n=91) subgroups. The mean follow-up time from index date was 15.6 and 15.7 months (GC/GEJC and EC, p=0.977). Patients in both subgroups had a similar mean age of 66.8 and 68.3 (GC/GEJC and EC; p=0.328). Among patients who had a ECOG evaluation the 0-1 status was similar 88.5% and 87.1% (GC/GEJC and EC; p=0.297). Patients (GC/GEJC vs EC for all) differed in the percentage of males (59.1% vs 81.3%, p=0.001), stage IV at initial diagnosis (57.4% vs 37.4%, p=0.003) and smoking history (30.4% vs 52.7%, p=0.005). Most patients received at least one line of therapy 79.1% and 84.6% (GC/GEJC and EC, p=0.313). 89.9% of patients in first line (1L) therapy received chemotherapy either as monotherapy or in combination. 32.2% vs 39.6% (p=0.271) GC/GEJC and EC patients received second line (2L) therapy while 12.2% vs 13.2% (p=0.828) received third line (3L) and beyond. The median DoT in 1L was 3.1 and 2.3 months, for 2L was 2.1 and 3.6 months; and for 3L or more, 1.7 and 3.2 months for GC/GEJC and EC, respectively. Conclusions: Most patients in PR with advanced/metastatic GC/GEJC or EC received first-line treatment while only a third of patients received second line. In all lines of therapy, the duration of treatment for both cohorts was short.Future studies with a larger sample are warranted.

Persistence of secukinumab in patients with psoriasis, psoriatic arthritis, and ankylosing spondylitis

ObjectiveTo determine persistence of treatment with secukinumab across its different indications. MethodThis is a retrospective descriptive observational study including adult patients treated with secukinumab in its different indications from the drug's introduction in November 2015 to October 2019. The variables included were sex; age; diagnosis; initiation date; line of treatment; number of patients who discontinued treatment and reason for discontinuation; overall persistence at 12 months; distribution of patients; and persistence according to indication, line of treatment and reason for suspension. ResultsOne-hundred forty-three patients were started on secukinumab, but only patients who had been in treatment at least 12 months before the end of the study were included. Mean patient age was 49.8 years (±12.6); 52.9% were men. Fifty-six patients (53.8%) had discontinued treatment by the end of the study, with a mean duration of treatment of 12.7 months (±10.2). The other patients (n = 48) continued with their therapy. Mean duration of treatment in these patients was 25.7 months (±9.9). Overall persistence at 12 months was 10.0 months (±3.3) with a discontinuation rate at 12 months of 31.7%. Persistence at 12 months was 10.7 months (±2.9) for patients with psoriasis, 9.7 months (±3.4) for patients with psoriatic arthritis, and 8.8 months (±3.8) for those with ankylosing spondylitis. Of the 48 patients who continued with their treatment after completion of the study, 22 (45.8%) received the drug as first-line treatment. Of the 56 discontinuations, 15 (26.8%) were due to primary failure (persistence: 3.8 months [±1.1]) and 27 (48.2%) were due to secondary failure (persistence: 18.6 months [±9.6]). Persistence in patients who continued treatment was higher in psoriasis (28.8 months [±10.3]). In those who discontinued due to secondary failure it was higher in the group with ankylosing spondylitis (28.0 months [±4.2]). Persistence among patients on first-line secukinumab was higher than for other patients: 21.2 months (±7.2) if they stayed on treatment, 3.5 months (±0.5) if they presented with primary treatment failure, and 8.3 months (±2.5) in those with secondary treatment failure. ConclusionsOur data show slightly higher persistence levels in patients with psoriasis and lower discontinuation rates in those without previous exposure to biological therapy. Long-term studies are needed to confirm these findings and to gain a better understanding of the factors that can influence persistence of secukinumab.

Relationship Between Sonographic Findings, Fine Needle Aspiration, and Histopathological Findings of Post-thyroid Surgery.

Thyroid diseases can affect various bodily functions and often go unnoticed. Tools such as sonography and fine needle aspiration (FNA) puncture are necessary to diagnose diseases that require surgical intervention. These tools help identify signs of malignancy or benignity and obtain further data to guide therapeutic decisions. This study aims to validate the relationship between sonographic results, FNA, and final thyroid pathology. This research describes the level of correlation between sonographic findings and FNA, the sonographic and final pathology reports, and the FNA and final pathology reports. Additionally, this research aims to identify the most common diagnoses in the final pathology. A retrospective descriptive observational study was carried out with a sample of 95 patients who underwent thyroid surgery at the National Institute of Diabetes, Endocrinology, and Nutrition (INDEN), Dominican Republic, in 2019 to determine whether a relationship exists between the sonography findings, FNA, and the final pathology in surgical thyroid pathologies. A total of 95 patients were studied. The success rate of the sonography results compared with the benign final biopsy result was 100% and 45.9% with the malignant final biopsy result. The success rate of the fine needle biopsy results was 95.9% for the benign final biopsy and 28% for the malignant final biopsy. Of the malignant final biopsy reports, 84.6% were papillary carcinomas, 7.7% were follicular carcinomas, and 7.7% were medullary carcinomas. The relationship between the sonographic results, FNA, and histopathological findings of surgical thyroid diseases is validated. The sonographic findings are specific for diagnosing benignity and malignancy. A fine needle biopsy is useful for diagnosing benignity, and the final biopsy is the standard for confirming both benign and malignant pathologies.

Investigation of morbidity, length of stay, and healthcare costs of inpatient paediatric burns.

Burn injuries are the third most common cause of death in children due to trauma. Hospitalizations related to burn injuries are common. Prolonged hospitalization associated with burn treatment can result in increased resource utilization, leading to higher costs. Thus, it is essential to investigate these areas to reduce costs. The study investigated the morbidity and length of hospital stay of paediatric burn patients, as well as calculated the social security costs of hospitalization and treatment. The retrospective observational descriptive study examined the medical records of 774 paediatric patients treated in a burn intensive care unit at a tertiary medical faculty hospital between 01 March 2019 and 31 March 2022. The invoice records of payments made by the Social Security Institution to the hospital in return for health services provided to patients were examined. The healthcare costs were calculated. A total of 57.6% of the participants were boys and 79.2% were between the ages of 1-4. About 90% of the cases involved burns with a total body surface area (TBSA) of less than 20% and a 2nd-degree burn depth. Scalding was the most common cause of burns (88.2%). Among all patients, the mortality rate was 2.1% (n = 16). The mean length of hospital stay was 10.29 ± 9.59 days. The mean cost per day was 212.02 ± 190.94 US dollars ($US), and the cost per 1% TBSA was 241.70 ± 301.32 $US. According to the causes of burn injury, the mean cost of electricity was 5000.77 ± 8101.85 $US, fire 4818.02 ± 5852.22 $US, and chemical 3285.49 ± 4503.2 $US were observed in the first 3 ranks respectively. According to this study, paediatric burn cases occur due to preventable causes, and even though the mortality rate was low, the severity of burns, TBSA%, and presence of complications caused prolonged lengths of hospital stays, which caused social security costs to rise.

Clinical laboratory testing in the emergency department: a six-year analysis

Abstract Objectives This study aimed to examine the utilization of clinical laboratory services in the emergency department and to identify the changes in their usage over six years. Methods Our study is a retrospective descriptive observational study. The study includes emergency room visits between January 01, 2016, and January 01, 2022, and the analysis of the tests requested during this period. Results When the number of tests requested among the patients in the emergency departments was considered, the highest rate belonged to complete blood count (109,696,468), which was followed by creatinine (98,027,489) and potassium (94,583,831). In addition to an increase in the number of C-reactive protein (CRP) tests (118.82 %), coagulation parameters such as D-dimer (1,180.95 %) and fibrinogen (315.25 %) showed an increasing trend after the onset of pandemia. Conclusions The most frequently used tests in the emergency department were complete blood count, creatinine, potassium, blood urine nitrogen (BUN), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and Na, ferritin, fibrinogen, CRP, and D-dimer have increased over the last two years due to their clinical use in predicting the outcome of COVID-19.

Outbreak of Gastrointestinal Infections Caused by Yersinia enterocolitica in Children, Medellín, Colombia

Abstract Objective In this study, we describe the clinical and epidemiological characteristics of a cluster of children with acute gastrointestinal (GI) infection caused by Yersinia enterocolitica in Medellín, Colombia. Methods A retrospective descriptive observational study was performed with the information recorded in clinical charts of GI infection cases caused by Y. enterocolitica in pediatric population of two hospital institutions in Medellín, Colombia. The microorganism identification was performed directly from stool samples using molecular biology techniques and from stool cultures using mass spectrometry. Space-time simulations and antibiotic susceptibility profiles were performed using Whonet 5.6 and Clinical and Laboratory Standards Institute 2020 guide. Results A total of 37 cases were identified in children younger than 15 years; between November 2020 and January 2021, 45.9% of cases were in children aged 1 to 5 years. Most children had diarrhea (97.3%) and fever (67.6%), 21.6% had abdominal pain and vomiting, and 13.5% had hyporexia. Sixteen of the patients (43.2%) received azithromycin, 24.3% (n = 9) received ceftriaxone, and 13.5% (n = 5) received a combined treatment of ceftriaxone and azithromycin or azithromycin and metronidazole. Based on space-time simulations, the clonality analysis and the characteristics of the cases suggest a community outbreak of unknown origin. Conclusion Our findings confirm the occurrence of an outbreak related to Y. enterocolitica from the community whose source could not be identified. Although it is presumed that the frequency of this microorganism is low in these regions, the use of new diagnostic tools in clinical microbiology allowed the early identification of the epidemiological event.

Étude exploratoire de la mise en place de l’Early Start Denver Model en France

BackgroundThe Early Start Denver model is one of the interventions recommended by the French High Authority on Health since 2012 for the very early care of children with Autism Spectrum Disorders. This program, developed in the United States, has shown the best evidence of effectiveness in an intensive form of delivery that is difficult to generalize to other culturally different contexts. Consequently, its implementation in the French health care system has required some adaptations that have not yet been evaluated. After a summary of the method's features and the results of studies of its effectiveness, this first retrospective descriptive observational study aims to characterize the implementation and practice of this intervention in France. In doing so, it also aims to better understand the potential obstacles to the implementation of early intervention and thus propose avenues for improvement. Material and methodA census of French units offering the Denver model was conducted from June to October 2020. A questionnaire sent to the participating units made it possible to explore different dimensions: first, the characteristics of these units, including their composition. Secondly, their integration into the care network and the children's care pathway. Practice and delivery modalities were also assessed. Finally, the objective was to highlight the difficulties that the teams may have faced when implementing the model. The data were collected in Microsoft Excel® software in order to perform a descriptive statistical analysis. ResultsIn total, 92% of the units surveyed participated in the study and returned the questionnaire. Our results highlight a significant heterogeneity in the deployment of the Denver method at the national level and underline the limit of resources available in the territory, particularly in its intensive delivery form. ConclusionFurther research is still needed to study the feasibility and effectiveness of ESDM interventions deployed in the specific context of the French healthcare system. In addition, significant work remains to be done to establish rapid and identifiable pathways for early intervention in young children with ASD.