Retrospective Review Research Articles

Clinical Efficacy of Therapeutic Agents for Clostridioides difficile Infection Based on Four Severity Classifications.

Japanese guidelines recommend metronidazole (MNZ) and vancomycin (VCM) for non-severe and severe cases of Clostridioides difficile infection (CDI), respectively. In the present study, we investigated the use of CDI antimicrobials and evaluated their clinical efficacy and validity using four severity classifications. A retrospective chart review was conducted using the data of 137 inpatients with initially positive C. difficile toxin test results and the initiation of CDI antimicrobials between April 2015 and March 2019. Patients treated with VCM or oral MNZ were included for clinical efficacy analysis of CDI antimicrobials and validation of severity classifications. The endpoints were CDI recurrence, 30-day mortality, and diarrhea cure rates. No significant differences were found between the VCM and oral MNZ groups in the CDI recurrence rate (10.4% vs. 12.7%, P = 0.707), 30-day mortality rate (12.5% vs. 5.6%, P = 0.162), and diarrhea cure rate (61.9% vs. 72.7%, P = 0.238), regardless of severity. Treatment with oral MNZ for non-severe cases was promising, confirming its usefulness according to Japanese guidelines. Further investigation of the clinical efficacy of oral MNZ in patients with first-episode CDI and evaluation of the preferred severity classification are warranted.

Psychometric Validation of the Brief Outcome Survey: A Transdiagnostic Tool for Measurement-Based Care

ABSTRACT Background Measurement-based care (MBC) is a fundamental component of evidence-based psychotherapy that has the potential to improve the landscape of behavioral and mental health (BMH) care for youth and families. Objective The purpose of this study was to assess the reliability, validity, and clinical utility of the Brief Outcome Survey (BOS) when used as part of a comprehensive MBC approach during a course of evidence-based psychotherapy. Method The BOS is a three-item transdiagnostic tool designed to measure the impact of youth’s symptoms/conditions on functioning. Demographic and clinical data were obtained via a retrospective chart review of 75,000+ unique patient encounters over a period of 15 years. Internal consistency, test re-test reliability, construct validity, validity generalization, and clinical utility were assessed. Results Data were analyzed from 8,665 youth (Mage = 11.8 years; 57.2% biological female). The internal consistency coefficient (e.g. Cronbach’s alpha) ranged from 0.80–0.83 (first and second BOS administration). The single measure intraclass correlation coefficient was 0.66 (p < .001). Intraclass correlations between the BOS and the PHQ-9, GAD-7, and CY-BOCS were moderate. No significant differences were found by age. Cronbach’s alphas for the age groups ranged from 0.79–0.82. BOS scores were higher at baseline for biological females compared to males, t(8235) = 2.29, p < .001. Similarly, BOS scores were higher at baseline for youth receiving public versus private health insurance benefits, t(8032) = 2.29, p < .05. A one-way ANOVA revealed significant differences in BOS scores by diagnosis group and Cronbach’s alpha for the BOS was above 0.80 across all five diagnosis groups analyzed. Conclusions The BOS demonstrated evidence of strong psychometric properties and clinical utility, as a session-by-session transdiagnostic MBC tool.

Mesh exposure after ventral hernia repair with onlay biosynthetic mesh: a retrospective review of associated risk factors and management strategies

Mesh exposure after ventral hernia repair with onlay biosynthetic mesh: a retrospective review of associated risk factors and management strategies

Feasibility, Safety, and Factors Predicting Completion of CROSS Protocol–Based Neoadjuvant Chemoradiotherapy for Esophageal Squamous Carcinoma: Experience from an Indian Tertiary Care Cancer Center

Background Neoadjuvant chemoradiotherapy (NACRT) using the ChemoRadiotherapy for Oesophageal cancer followed by Surgery Study (CROSS) protocol has improved esophageal cancer outcomes. This study reports the real-world experience of the CROSS regimen for esophageal squamous cell carcinoma (ESCC) regarding its feasibility, safety, and predictors of treatment completion from an Indian tertiary center. Methodology A retrospective review was conducted for patients with ESCC receiving CROSS (radiation dose: 41.4 Gy) or a modified CROSS (mCROSS; radiation dose: 45 Gy) protocol NACRT between 2015 and 2022. We studied the treatment tolerability, factors predicting NACRT completion, and the effect of completion of its chemotherapy component on the pathological outcomes. Results Of the109 patients (68.8% males; mean age, 56 ± 9 years; Charlson's comorbidity index [CCI] &gt;2, 19.3%; stage III–IVA, 58%; mean tumor length, 5.5 ± 2.1cm; CROSS, 70.6%; mCROSS, 29.4%), all except 4 completed radiotherapy but only 58 (53.2%) patients completed ≥4 cycles of chemotherapy. Forty-nine patients belonged to the “extended” CROSS trial inclusion criteria. Among the 60 patients who fulfilled the CROSS inclusion criteria, only 51.7% were able to complete ≥4 chemotherapy cycles. The commonest reason for noncompletion of chemotherapy was the occurrence of neutropenia (60.8%). Pretreatment hemoglobin (≥12 vs. &lt;12 g%; odds ratio [OR]: 2.76; 95% confidence interval [CI]: 1.10–6.96; p = 0.031), a low CCI (≤2 vs. &gt;2; OR: 2.98; 95% CI: 1.02–8.73; p = 0.047), and radiation therapy techniques (conformal vs. conventional; OR: 3.29; 95% CI: 1.14–9.50; p = 0.028) were associated with completion of chemotherapy (≥4 cycles). Although there was a trend toward improved R0 resection (95.7 vs. 91.4%), reduced node positivity (17.0 vs. 31.4%), and a high pCR (57.4 vs. 48.6%) in patients completing chemotherapy (≥4 cycles) compared with those not completing chemotherapy (&lt;4 cycles), these differences were statistically nonsignificant. Conclusion In this study, ESCC patients receiving the CROSS protocol NACRT could complete their radiotherapy component, but a significant proportion exhibited poor chemotherapy tolerance. Neutropenia was a major factor limiting chemotherapy delivery, but anemia, high CCI, and conventional radiation techniques were also associated with noncompletion of chemotherapy. The omission of a few chemotherapy cycles had no significant effect on the pathological response; however, its impact on cancer survival requires further evaluation.

Prevalence, causes and factors associated with vision impairment in Limpopo province

Background: Epidemiological data on the prevalence, causes and risk factors associated with vision impairment (VI) is necessary to evaluate the effectiveness of eye care services.Aim: To determine the prevalence, causes and factors associated with VI among patients presenting to public hospitals of Limpopo province, South Africa.Setting: This study was conducted in public hospitals.Methods: A retrospective chart review of patients seen from April 2019 to March 2022 in 29 public hospitals was conducted. The following information was extracted: demographic information, medical history, visual acuity (VA), refractive and ophthalmoscopy findings.Results: Of the 1140 participants, 56.1% were women. Participants’ ages ranged from 5 to 94 years. The prevalence of VI was 61.5%. Most had moderate-severe VI (57.3%), followed by blindness (22.7%) and mild VI (20.0%). The leading causes of VI were uncorrected refractive error (URE) (28.1%), cataract (26.0%) and glaucoma (25.0%). The main causes of blindness were glaucoma (42.8%) and cataract (32.1%); while URE (7.5%), retinal anomalies (7.5%) and corneal anomalies (6.9%) accounted for almost equal proportions of blindness. Participants aged 50–64 years (odds ratio [OR]: 1.7; 95% confidence interval [CI]: 1.2–2.6); 65 years and older (OR: 6.6; 95% CI: 4.3–10.2); and those diagnosed with systemic hypertension (OR: 2.5; 95% CI: 1.9–3.2) and diabetes mellitus (OR: 2.9; 95% CI: 1.9–4.4) had increased risk of VI.Conclusion: The prevalence of VI in this population is relatively high. The main causes of VI are correctable, suggesting the need for improved measures to prevent avoidable VI.Contribution: The study addresses the gap in the province’s current prevalence, causes and factors related to VI.

The effect of plerixafor on autologous stem cell mobilization, cell viability, and apheresis challenges

Abstract Objective The aim of this study was to determine the efficacy of plerixafor for hematopoietic stem cell (HSC) mobilization prior to autologous stem cell transplantation (aSCT) for patients with multiple myeloma (MM) and various lymphomas, using an oncologist-guided HSC collection goal and markers of cell viability. Methods A retrospective chart review of all aSCT patients at Yale New Haven Hospital between 2017 and 2021 who met diagnostic criteria for MM, non-Hodgkin, or Hodgkin lymphoma (n = 382) was undertaken. Logistic regression evaluated plerixafor’s effect on meeting the individual’s HSC goal. The use of t-tests determined plerixafor’s relationship to HSC yield and analysis of variance testing assessed its effect on cell viability. Results Mobilization with granulocyte colony–stimulating factor (G-CSF) and plerixafor (odds ratio [OR] = 0.08; P &amp;lt; .05) relative to G-CSF alone was negatively associated with meeting the individual’s HSC goal. Diffuse large B-cell lymphoma in patients mobilized with plerixafor yielded fewer HSCs than those without plerixafor (t = –2.78; P = .03). Mobilization regimen (P = .13) had no association with HSC viability. Mobilization failure with plerixafor was rare but occurred in patients with multiple risk factors, including exposure to several rounds of HSC-affecting chemotherapy. Conclusion Plerixafor is effective across multiple diagnoses using an oncologist-driven HSC collection endpoint. Its association with mobilization failure is likely attributable to its use in patients predicted to be poor mobilizers.

Premature ovarian insufficiency in pediatric cancer patients: a 10 year Rady Children's hospital experience.

To highlight the occurrence of premature ovarian insufficiency in pediatric cancer patients and determine which patient characteristics or treatment modalities are associated with ovarian failure and recovery. Between August 2011-August 2021, 36 of 2,661 patients with cancer were identified to have subsequent ovarian failure. Data collected included cancer type, diagnosis age, types of chemotherapy, bone marrow transplant or radiation treatment, peak FSH, peak AMH, GnRHa treatment, type of hormone replacement therapy, and if ovarian function recovery occurred. The most common cancer type identified was ALL. The mean age of diagnosis was 8.5±4.3 years and mean age of peak FSH value was 12.6±2.8 years. Most patients (97.2 %) were treated with alkylating agents and 72.2 % received radiation. Most patients (72.2 %) received hormone therapy, and 15.8 % of patients received GnRHa Lupron. Ten patients (27.8 %) had ovarian function recovery. Diagnosis age and treatment type were recovery predictors in multivariate regression modeling. Each year older in age was associated with a 30 % decrease in odds of recovery (OR: 0.7, CI: 0.5-0.95, p=0.035), and alkylating agent treatment without transplant was associated with a 3-fold increase in odds of recovery (OR: 3, CI: 2.7-564, p=0.007). This retrospective review demonstrates that POI can occur in pediatric cancer survivors, emphasizing the importance of educating patients on potential long-term effects of cancer treatment and importance of routine surveillance. This study confirmed that recovery of ovarian function is possible, especially when diagnosed at a younger age, making continued monitoring essential.

The Epidemiology of Syphilis and Co-infection with HIV in a Tertiary Care Center in Lebanon: A Retrospective Review

Introduction: Syphilis is an ancient STI causing a new worldwide outbreak in general and in Lebanon specifically. Methods: We conducted a retrospective chart review to assess the rate of syphilis increase in an infectious diseases clinic in Lebanon from 2006 to 2023. We studied the epidemiology of these cases, stage and treatment response and their association to HIV infection and its control. Results: There was an 862% increase in syphilis cases from 2006 to 2019.Most of our cases were middle aged men living with HIV. Most of them had well-controlled HIV infection with good CD4 counts. Most of the diagnosed cases of syphilis were primary and secondary, responding to penicillin G. Discussion: Our data mostly parallels international data, except for gender distribution. Despite successful treatment of most cases in our clinic, the alarming rise of new cases highlights the urgent need for public health measures to mitigate this epidemic. Conclusion: Inclusive awareness is needed to stop syphilis spread in Lebanon, and more screening is key in identifying new cases early for a successful eradication.

Barriers to Offering Organ Preservation for Rectal Cancer in a Predominantly Hispanic Safety Net Hospital.

Total neoadjuvant therapy (TNT) for locally advanced rectal cancer (LARC) has shown promise in achieving pathologic complete response (pCR) and enabling organ preservation through watch-and-wait (WW) strategies. However, implementation of WW protocols in diverse patient populations and safety-net hospitals faces unique challenges. The objective of this study is to evaluate TNT outcomes and identify barriers to WW implementation in a predominantly Hispanic safety-net hospital in South Texas. A retrospective review was conducted of 40 LARC patients treated with TNT at an academic tertiary referral center in South Texas between 2018 and 2023. Patient demographics, disease characteristics, and pCR rates were analyzed. A survey of multidisciplinary providers assessed perceived institutional and patient-related barriers to WW implementation. The cohort was 70% Hispanic, with a median age of 54 years. Most patients had advanced disease at diagnosis (57.5% T4, 65% N2). The pCR rate was 18.5% (5/27) among patients undergoing surgery. Re-review of MRIs for pCR patients revealed that 2/5 had minimal residual disease. The provider survey identified MRI quality variability, lack of dedicated treatment coordinators, and concerns about patient compliance and financial barriers as key obstacles to WW implementation. Despite advanced disease presentation in a predominantly Hispanic population, TNT achieved pCR rates comparable to international trials. Institutional and patient-level barriers to WW were identified, informing the development of a tailored WW protocol for this unique patient population.

Sedation of Adults with Orally Administered Midazolam in Dentistry – A Retrospective Study

Objective: The use of midazolam (MZ) has increased in dentistry, but the effect in adults is sparsely studied. The aim of this study was to investigate doses, effects, and side effects of orally administered MZ as a sedative for adults in a dental care organization. Material and methods: A retrospective record review was performed including all adult patients in the dental care organization ≥20 years receiving MZ, identified through a logbook for addictive drugs, during 2020. From patients’ records, the following data were extracted: age, gender, medical history, reason for sedation, performed treatments, doses, effects, and side effects of MZ. Results: In total, 265 patients on 418 occasions had been sedated, which constituted 2.3 sedations per 1,000 visits and 3.3 sedations per 1,000 treated patients. Mean age was 40.8 years and 67.7% were females. The most common reason for sedation was anxiety. Mean dose in primary dental clinics was 7.9 mg and in specialist clinics, 6.8 mg (p &lt; 0.001). Older patients (&gt;70 years) had lower doses than younger (p &lt; 0.001), while no difference was found between ages 55–70 years and those who were younger. Dental treatment was completed in 91.9% of occasions, and side effects were registered in 2.2%. Successful dental treatment was related to type of treatment performed. Conclusions: Sedation is rarely used, particularly in primary dental care, and the use varies widely between clinics. MZ administered by dentists seems to be safe and effective. A sedation record should be used to make patient data such as weight and medical conditions available.

The effectiveness of vedolizumab in advanced therapy-experienced ulcerative colitis patients: Real world data from the Inflammatory Bowel Disease of the Middle East (IBD-ME) Registry group.

Vedolizumab is an approved ulcerative colitis (UC) treatment. Multiple large randomized clinical trials have demonstrated the drug's efficacy and safety. However, real-world data from Middle Eastern countries are spare. The study aims to evaluate the clinical efficacy of vedolizumab (VDZ) therapy in advanced therapy experienced UC patients. A retrospective electronic chart review of a cohort study of 153 moderately to severely active UC patients who failed or were intolerant to TNF antagonists and received vedolizumab from two large tertiary care centers was performed. Rates of clinical response and remission were retrospectively evaluated at 3,6, and 12 months post VDZ therapy using Patient Simple Clinical Colitis Activity Index (P-SCCAI); clinical response was defined as a decrease in P-SCCAI ≥3, and clinical remission was defined as a P-SCCAI score of ≤3 points. Logistic regression analysis was used to identify predictors of response to vedolizumab. A total of 153 UC patients had sufficient data for analysis. Clinical remission rates were 61.9% for patients on vedolizumab every 8 weeks and 89.3% for those receiving every 4 (Q4) weeks dosing. A significant reduction in CRP and improvement of albumin post vedolizumab treatment were observed, and corticosteroids were stopped in most patients. In a multiple logistic regression analysis, several factors were found to influence the clinical effectiveness of VDZ in inducing remission. Female gender was associated with a higher likelihood of remission [OR =3.09, 95% CI = (1.05-9.13), P = 0.04]. Conversely, a greater number of biologics used prior to VDZ treatment was associated with a lower likelihood of remission [OR =0.418, 95% CI = (0.203-0.859), P = 0.017]. Patients with extensive disease (E3) had an increased likelihood of remission [OR =3.81, 95% CI = (1.32-10.97), P = 0.0129]. Additionally, a VDZ dosing frequency of Q4 weeks was associated with a significantly higher likelihood of remission [OR =6.08, 95% CI = (1.73-21.39), P = 0.0049]. No significant safety signals were reported. In this current real-world study, vedolizumab effectively achieved clinical response and remission in most advanced therapy experienced UC patients treated for up to 12 months. Future studies with larger sample sizes and more robust study designs should be conducted to further validate the results of this study.

Lessons learnt from the first two SARS‐CoV‐2 Omicron waves of the COVID‐19 pandemic in six remote Aboriginal and Torres Strait Islander communities in Queensland, Australia: a retrospective epidemiological review

Lessons learnt from the first two <scp>SARS</scp>‐<scp>CoV</scp>‐2 Omicron waves of the <scp>COVID</scp>‐19 pandemic in six remote Aboriginal and Torres Strait Islander communities in Queensland, Australia: a retrospective epidemiological review

Clinico-genetic profile of seven patients with PARK-PINK1: A case series from a tertiary care centre from India and review of literature.

Recessive variants in the PINK1 gene is a known cause of early-onset Parkinson's disease (EOPD). To describe the clinical features and genetic profile of patients of PARK-PINK1. Retrospective chart review of demographic, clinical and genetic details of patients carrying biallelic PINK1 variants from our database. Seven cases were recruited with median age at onset 33 years (Range: 20-49). All had asymmetrical onset, tremor in four, abnormal posturing in two and slowness in one patient. Parkinsonism phenotype was noted in six patients (with dystonia in four) and isolated dystonia in one. Among 6 patients with parkinsonism, five had rest tremor, all had good levodopa-response, and four had motor-fluctuation with choreiform-dyskinesia. Exome-sequencing revealed bi-allelic pathogenic/likely pathogenic variants in all of which five were novel. PARK-PINK1 presents as an EOPD with tremor-predominant phenotype, good levodopa-responsiveness, early motor fluctuation and dyskinesia. We describe five novel variants in PINK1 gene.

Evaluation of voriconazole therapeutic drug monitoring in malignant hematology patients.

Malignant hematology (MH) patients are susceptible to invasive fungal infections due to prolonged neutropenia and immunosuppressive therapies, which may require voriconazole therapy. Although voriconazole therapeutic drug monitoring (TDM) is common, evidence describing this practice is limited. The primary objective of this study was to describe the current practice of voriconazole TDM in MH patients at the Princess Margaret Cancer Centre (PM). A retrospective chart review was conducted for MH inpatients initiated on voriconazole at PM between November 1st, 2019 and November 13th, 2020. Data regarding voriconazole doses, levels, dose changes, and adverse effects were collected. The primary endpoint was the proportion of patients with initial voriconazole levels within therapeutic range (1-5 mg/L). Fifty-six patients were included in the study. The most common reason for starting voriconazole was possible invasive fungal infection (44 patients, 78.6%). Fifty-one patients (91.1%) received a loading dose of voriconazole, averaging 386.5 ± 78.5 mg. The average maintenance dose was 242.1 ± 45.7 mg. An average of 2.6 ± 2.9 levels were drawn per patient with an average level of 3.2 ± 2.4 mg/L. Forty-one patients (73.2%) had an initial voriconazole level within therapeutic range and 90 out of 145 total levels (62.1%) were within therapeutic range. There were 52 dose modifications made; 31 (60.8%) doses adjusted, 12 (23.5%) doses held, and 9 (17.6%) doses discontinued. For the 31 dose adjustments, 26 (83.9%) had a level redrawn and 17 (65.4%) of those levels were within therapeutic range. Twenty-three (41.1%) patients developed adverse effects, 8 (34.8%) of which were associated with supratherapeutic levels. Of these 23 patients, 19 (33.9%) experienced transaminitis, 3 (5.4%) experienced both transaminitis and neurotoxicity, and 1 (1.8%) experienced photopsia. Overall, 41 (73.2%) patients achieved an initial voriconazole level within therapeutic range. Of these 41 patients, 30 (73.2%) remained within therapeutic range for the duration of their inpatient voriconazole therapy. These findings suggest that the current practice of voriconazole TDM at our institution is yielding largely positive results, but still has room for improvement.

Proportion of Patients With Ductal Carcinoma In Situ That Qualify for Observation Criteria Set Forth by Clinical Trials.

The COMET, LORD, and LORIS clinical trials are investigating the role of active surveillance in low-risk ductal carcinoma in situ (DCIS). The objective of this study was to identify the proportion of patients eligible for these trials amongst a cohort of patients treated at our institution. Retrospective chart review was performed of patients diagnosed with DCIS who were treated from 2013 to 2022. Clinical, tumor, and imaging inclusion and exclusion criteria of the aforementioned observation trials were applied to determine the proportion of patients eligible for each trial. Upgrade rate to invasive cancer were examined across all three groups. Of 1223 patients diagnosed with DCIS, applying the criteria of each trial, 245 (20%), 238 (19.4%), and 264 (21.6%) patients were eligible for the COMET, LORD, and LORIS trials, respectively. High-grade DCIS and mass on imaging had the largest impact on exclusion. Nineteen (7.8%) of women who qualified for COMET were upgraded to invasive disease at excision, compared to 18 (7.6%) for LORD, and 19 (7.2%) for LORIS. One in five patients diagnosed with DCIS at our institution would qualify for observation with current trial eligibility. Observation of DCIS may have limited impact on all DCIS patients.

A Real-World Comparison of Drug Trough Levels between Patients Experiencing a Secondary Non-Immune Loss of Response and those Maintaining a Response to Infliximab on Long-Term Maintenance Therapy for Inflammatory Bowel Disease

Introduction: A secondary loss of response (LOR) to Infliximab (IFX) therapy for inflammatory bowel disease (IBD) is typically associated with low IFX trough levels, often with high levels of neutralizing antibodies to infliximab (ATI). A small subset of patients on long term therapy experience a “non-immune” LOR, without ATI and with desired IFX trough levels ≥5 mcg/ml, regarded as a LOR to the mechanism of action of IFX. However, this currently accepted IFX goal level is largely derived from observations of patients within the first year of therapy and may not apply to those on treatment beyond 1 year. Methods: Retrospective review of all IBD patients receiving IFX infusions for ≥12 months with at least 1 IFX trough and ATI measurement beyond 12 months. Chart review of all patients with absent ATI and an IFX trough ≥ 5 mcg/ml, classify as LOR vs. non-LOR based on physician assessment, with a comparison of IFX troughs between the two groups. Results: Of 167 patients using IFX ≥ 12 months, 13 (7.8%) experienced a non-immune secondary LOR. The mean duration of IFX use was over 3 years for both LOR and non-LOR patients. The mean IFX trough for those with LOR was greater than for those without LOR, 18.5 mcg/ml vs. 13.1 mcg/ml, p =0.110. Conclusion: Our results did not demonstrate lower IFX levels among patients experiencing secondary non-immune LOR on long term therapy. Our results do not redefine the therapeutic IFX goal levels for those patients on long term therapy and suggest that underdosing of IFX is not the cause of secondary LOR.

Survivorship and Functional Outcomes After Complex Primary Total Knee Arthroplasty With Contemporary Rotating-Hinge Implants

Background: Initial fixed-bearing hinge designs for primary total knee arthroplasty (TKA) had high rates of aseptic loosening. There are limited data on contemporary rotating-hinge implants. Purpose: We sought to determine survivorship and functional outcomes of contemporary rotating-hinge implants used in primary TKA. Methods: Retrospective review identified 54 primary rotating-hinge TKAs implanted in 49 patients from 2014 to 2018 at a single institution. Patients identified were 76% women, the mean body mass index was 29 kg/m2, the mean age was 65 years, and the mean follow-up was 3 years. The primary diagnosis for TKA in all cases was severe instability and ligamentous compromise. Secondary diagnoses included post-traumatic osteoarthritis (11, 20%), neurologic disease (10, 19%), inflammatory arthritis (10, 19%), connective tissue disease (3, 6%), valgus deformity (16, 30%), varus deformity (2, 4%), and recurvatum (2, 4%). Preoperative, postoperative (within 6 weeks), and most recent radiographs were reviewed. In this study, we collected preoperative, 1-year, and 2-year patient-reported outcome measures (PROMs) for patients with primary rotating-hinge TKA. Patient-reported outcome measures were prospectively collected, including the Knee Injury and Osteoarthritis Outcome Survey for Joint Replacement (KOOS JR) scores and the Mental (MCS) and Physical Component Scores (PCS) of the Veterans RAND 12-Item Health Survey (VR-12). Kaplan-Meier analysis was used to determine implant survivorship. Results: Reoperation was required in 6% (3/54); indications included periprosthetic joint infection (1), peripatellar fibrosis (1), and periprosthetic femur fracture (1). At both 2 and 5 years, survivorship free from all-cause reoperation was 95% and from revision for aseptic loosening was 100%. Mean KOOS JR scores increased from 47 preoperatively to 65 at 2 years postoperatively. On radiographic review, there were no progressive radiolucent lines consistent with aseptic loosening at final follow-up. Conclusion: The findings of this single-center, multi-surgeon retrospective case series on the use of rotating-hinge implants for primary TKA suggest excellent 2-year survivorship free from reoperation and no revisions for aseptic loosening. We report modest improvement in a variety of PROMs at 1-year and 2-year follow-up. Despite improvement, clinical outcomes were poor for a primary implant. Longer-term follow-up is required to monitor the durability of primary hinges.

Toward an assessment of the relevance of proposed public policy in contemporary African society: A retrospective review of Kenya's now‐defunct building bridges initiative, with special reference to post‐election violence

AbstractWhereas competing interests characterize the African public policy sphere today, the lens of mass‐elite differences has hardly been employed to study electoral violence. Accordingly, this article juxtaposes the lived experiences of ordinary Kenyan citizens, obtained through focus groups, with the content of the now‐defunct Building Bridges Initiative (BBI), a comprehensive set of public policy changes proposed by Kenya's political protagonists Uhuru Kenyatta and Raila Odinga in 2017. It poses the following broad question: did the BBI proposals truly intersect with the opinions and lived experiences of the masses? I find that various factors, including the lack of electoral and judicial integrity, and a winner‐takes‐all democratic system, are responsible for post‐election violence according to citizens. A comparative analysis of citizen perspectives and the BBI Report reveals considerable congruence in the understanding of the causes of post‐election violence. The study partly concludes that African leaders should continue to engage in policy entrepreneurship.Related ArticlesHodzi, Obert. 2020. “African Political Elites and the Making(s) of the China Model in Africa.” Politics &amp; Policy 48(5): 887–987. https://doi.org/10.1111/polp.12380.Kouladoum, Jean‐Claude. 2023. “The Role of Freedom of Communication in Modulating the Effect of Political Participation on Electoral Outcome in Africa.” Politics &amp; Policy 51(4): 588–613. https://doi.org/10.1111/polp.12539.Onyango, Gedion. 2024. “DHR‐PA—Democracy and Human Rights in Public Administration in Africa.” Politics &amp; Policy 52(2): 426–49. https://doi.org/10.1111/polp.12584.

Attributes of Pathological Fractures in a Nigerian myeloma cohort

Multiple Myeloma (MM) is a plasma cell tumor usually characterized by lytic bone lesions. Pathological Fracture (PF) is a debilitating condition that usually affects a patient’s psychomotor functions, treatment modality, morbidity, and outcome. We evaluated the associations, characteristics, and impact of PF on survival in a group of Nigerian myeloma cohort. A 10-year (2011-2021) retrospective review of MM data from Nigerian tertiary hospital haemato-oncology unit to evaluate attributes of PFs in myeloma cohort. Sixty-six patients had MM of which 23 had PF while forty-three had no fractures. Of the number with PF, 18 had lytic bone lesions, while 20 had bone pains. Monoclonal Immunoglobulin G was predominant followed by Immunoglobulin A. Significant correlations existed between hemoglobin level (r=0.446, p=0.002); platelet count (r=-0.347, p=0.041), serum calcium (r=0.471, p=0.006) and bone pains; as well as between urea level (r=-0.787, p=001), creatinine level (r=-0.853, p=0.001) and renal impairment respectively. PFs are associated with diabetes, peptic ulcer disease, hypertension, nephropathy, and arthritis. Bortezomib-based regimen was the choice treatment. Overall survival was 16 (69.6%) with 7 (30.4%) mortality. PF is common amongst the myeloma cohort with the spine being the most common site. It is associated with significant comorbidities like hypertension, diabetes, peptic ulcer disease, and paraplegia and is characterized by severe debilitating bone pains, anemia, hypercalcemia, raised plasma monoclonal immunoglobulin, renal impairment, loss of man-hour at work, and psychosocial imbalance. The impact of the fracture has increased morbidity and mortality and has reduced the median survival duration to as low as 4 years.

Laser Ablation of Periventricular Nodular Heterotopia for Medically Refractory Epilepsy

ObjectivePeriventricular nodular heterotopia (PVNH) is the most common neuronal heterotopia, frequently resulting in pharmaco‐resistant epilepsy. Here, we characterize variables that predict good epilepsy outcomes following surgical intervention using stereo‐electroencephalography (SEEG) ‐informed magnetic resonance‐guided laser interstitial thermal therapy (MRgLITT).MethodsA retrospective review of consecutive cases from a single high‐volume epilepsy referral center identified patients who underwent SEEG evaluation for PVNH to characterize the intervention and outcomes.ResultsThirty‐nine patients underwent SEEG‐guided MRgLITT of the seizure onset zone (SoZ) in PVNH and associated epileptic tissue. PVNH and polymicrogyria (PMG) were densely sampled with a mean of 16.5 (SD = 2)/209.4 (SD = 36.9) SEEG probes/recording contacts per patient. Ablation principally targeted just the PVNH and cortex that was abnormal on imaging was ablated (5 patients) only if implicated in the SoZ. Volumetric analyses revealed a high percentage of PVNH SoZ ablation (96.6%, SD = 5.3%) in unilateral and bilateral (92.9%, SD = 7.2%) cases. Mean follow‐up duration was 31.4 months (SD = 20.9). Seizure freedom (ILAE 1) was excellent: unilateral PVNH without other imaging abnormalities, 80%; PVNH with mesial temporal sclerosis (MTS) or PMG, 63%; bilateral PVNH, 50%. SoZ ablation percentage significantly impacted surgical outcomes (p &lt; 0.001).InterpretationPVNH plays a central role in seizure genesis as revealed by dense recordings and selective targeting by LITT. MRgLITT represents a transformative technological advance in PVNH‐associated epilepsy with seizure control outcomes consistent with those seen in focal lesional epilepsies. In localized unilateral cases and otherwise normal imaging, PVNH ablation without invasive recordings may be considered, and this approach deserves to be explored further. ANN NEUROL 2024