Routine Follow-up Research Articles

P297 Differences in disease characteristics and treatment exposures between pediatric- and adult-onset Ulcerative Colitis

Abstract Background previous studies highlighted differences between pediatric-onset ulcerative colitis (pUC) and adult-onset UC (aUC), showing a more severe phenotype in pUC. However, most studies lacked prolonged follow-up, and some were conducted prior to the biologic era. We utilized a large cohort database to compare disease characteristics and treatment exposures between pUC and aUC. Methods Single-center IBD registry from the Sheba Medical Center was used and included aUC (age ≥ 18 years) and pUC (age ≥ 6 and < 18 years) patients diagnosed between 2000 and 2022. Data were retrieved from the medical record to a computerized and periodically updating registry in a unified manner. Retrieved data included demographics, clinical disease characteristics and phenotype, and prescribed treatments during routine clinical follow-up. We used descriptive statistics, T-test, and chi-square test for between-group analyses. Results This study included 1332 UC patients, of them 682 were females (51.2%, Table 1). The cohort comprised 1058 aUC and 274 pUC patients. The median (IQR) age at diagnosis for pUC was 14.9 (12.5-16.8) years and 31.7 (23.6-48.9) years for aUC. Disease duration and the interval from diagnosis to last follow-up were similar between pUC and aUC, with a median (IQR) disease duration of 8.9 years (4.6-14.2) in pUC and 8.5 (4.5-14.1) in aUC, and a median interval from diagnosis to last follow-up of 7.3 years (3.5-12.3) in pUC and 7.3 years (3.4-13.0) in aUC. Significantly more pUC presented with pancolitis: 59.1% vs. 39.4% in aUC (p<0.00001), (Table 1). During long-term follow-up, treatment exposures also varied significantly between pUC and aUC (Figure 1); 61.3% of pUC were treated with systemic steroids vs. only 42.4% in the aUC group. Thiopurines were used in 40.5% of pUC vs. only 16.7% of aUC, and biological therapy was used in 46.0% of pUC vs. 34.1% of aUC. Time to initiation of biologic treatment was shorter in pUC with a median (IQR) of 33.0 months (15.0-71.3) vs. 36.6 months (15.8-96.1) in aUC (p=0.04). Finally, the number of biologics lines used was also higher in pUC vs. aUC ((mean of 2.1±1.4 vs. 1.8±1.0, p=0.01). Limiting the comparison to only UC patients who presented with pancolitis included 163 pUC and 417 aUC. Within this more severe UC phenotype, exposure to steroids and thiopurines was still significantly higher in pUC vs. pUC, but exposure to a biologic was similar with 54.6% of pUC vs. 50.1% of aUC. Conclusion pUC presents with more pancolitis, considered a more severe form of UC. This more aggressive presentation at diagnosis likely leads to a higher rate of exposure to systemic steroids, thiopurines, and biologics during a median of ~7 years of follow-up.

Natural history of gastric leiomyoma.

262 Background: Most gastric leiomyomas are asymptomatic and benign subepithelial tumors (SETs); however, some may increase in size or become symptomatic. Understanding their natural history is therefore important to their management. We investigated the natural history of histologically proven gastric leiomyomas. Methods: We retrospectively reviewed histologically proven gastric leiomyoma cases at a tertiary center. The baseline characteristics of these cases were analyzed, and those with a follow-up period of at least 12 months without immediate resection were evaluated. The primary outcome was the frequency of size increase of more than 25% during the follow-up period, and the secondary outcome was the histopathologic results in cases that underwent resection. Results: Among the 231 patients with histologically proven gastric leiomyomas, the most frequent location was the cardia (77.1%), and the median size was 3 cm (IQR 2–4 cm). Eighty-four cases were followed up over a median period of 50.8 months (IQR 27.2–91.3 months). During the follow-up period, tumor size increased in two cases (2.4%). Surgical results showed that one case was leiomyoma, and the other was leiomyosarcoma. Among the remaining cases without change in size, 15 underwent surgical resection (n = 10) or endoscopic resection (n = 5), and all cases were confirmed as leiomyoma. Conclusions: Most gastric leiomyomas are benign SETs, and an increase in size is not frequent, even in large-sized cases. Close monitoring with routine follow-up without resection may be sufficient in cases of histologically proven gastric leiomyoma. However, in cases of ulceration or size increase, resection may be beneficial.

Local Flaps in Breast-Conserving Surgery in Early Breast Cancer Patients: Armamentarium for Breast Surgeon.

To describe the technique and outcome of local perforator arteries advancement flap in breast-conserving surgeries (BCS) in patient of early breast cancer as our initial experience and review of literature on it. Patients who underwent (BCS) with local perforator artery flap reconstruction were reviewed in terms of their clinical, surgical, and post-operative follow-up details after taking written and informed consent. We have described 4 patients of early breast cancer out of which one patient was post-NACT while 3 were for upfront BCS. We have performed LICAP in 2 patients, AICAP in 1 patient, and IMAP in one patient, depending on the location of primary tumors. None of the patients had any major or minor surgical complications in the post-operative period and drains were removed on post-operative day 2. All patients received post-operative radiotherapy and tolerated well without any loco-regional complications. Patients are in routine follow-up with cosmetic satisfaction without any local recurrence over 1year. The main advantages of pedicled perforator flaps are well-vascularized tissue, spares underlying muscle leading to lesser donor site morbidity like muscle function and seroma formation, easily reach the breast area with good match in terms of skin and subcutaneous tissue, faster recovery, and shorter learning curve in comparison to free flaps. Knowledge and skill about these flaps will help surgeon to give better surgical outcomes and satisfaction to patients.

Direct discharge for children with a greenstick or torus fracture of the wrist is a non-inferior satisfactory solution to traditional treatment.

Direct Discharge protocols (DD) can alleviate strain on healthcare systems by reducing routine outpatient follow-up. These protocols include low-complex musculoskeletal injuries, such as isolated greenstick fractures or torus fractures of the wrist in children. While there is consensus on the effectiveness of DD, there is a lack of injury-specific powered studies. This study compares treatment satisfaction between DD and traditional treatment in children with a greenstick fracture or torus fractures of the wrist. Children with isolated torus or greenstick fractures of the distal radius or ulna were eligible for inclusion before (pre-DD cohort) and after (DD cohort) the implementation of DD in four hospitals. Traditionally, patients receive a (soft) cast and minimally one routine outpatient follow-up appointment. With DD, patients are discharged directly from the ED after receiving a brace and information, summarized in a smartphone app and a helpline for questions during recovery. The primary outcome was patient or proxy treatment satisfaction (0 to 10), and a power analysis was performed to assess non-inferiority. Secondary outcomes included complications, functional outcomes measured in Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE), primary healthcare utilisation, and secondary healthcare utilisation (follow-up appointments and imaging). In total, 274 consecutive children were included to analyse the primary endpoint. Of these, 160 (58%) were male with a median age of 11years (IQR 8 to 12). Pre-DD and DD treatment satisfaction did not vary statistically significantly for greenstick fractures (p = 0.09) and torus fractures (p = 0.93). No complications were observed. PROMIS UE showed no statistically significant differences before and after implementation of direct discharge protocol for torus (p = 0.99) or greenstick (p = 0.45) fractures. Secondary healthcare utilisation regarding follow-up was significantly lower in the DD-torus cohort compared to the pre-DD torus cohort, with a mean difference (MD) of -1.00 follow-up appointments (95% Confidence Interval (CI) -0.92 to -1.13). Similar results were found in the pre DD-greenstick cohort compared to the pre-DD-greenstick cohort (MD): -1.17 follow-up appointments, 95% CI -1.09 to -1.26). Direct Discharge is non-inferior to traditional treatment in terms of treatment satisfaction for paediatric patients with greenstick or torus fractures of the wrist compared to children treated with rigid immobilisation and routine follow-up. Furthermore, the results demonstrate no complications, comparable functional outcomes, and a statistically significant reduction of secondary healthcare utilisation, making DD a good solution to cope with strained resources for children with an isolated greenstick fracture or torus fracture of the wrist.

Arrhythmias in children undergoing orthotopic heart transplantation.

Heart transplantation (HT) is the only treatment option in children with heart failure secondary to cardiomyopathies and non-reparable congenital heart diseases. We performed a retrospective clinical data review of all consecutive pediatric patients (aged 2-18 years) who underwent orthotopic HT for advanced heart failure at our institution between January 2007 and January 2023. Clinical, procedural, and follow-up data were collected and comprehensively analyzed. We identified 27 children (66.7% males) with a median age of 15 years (IQR: 7-16) and a median weight of 45 kg (IQR: 22-66) at the time of the intervention. 24 patients (88.8%) were diagnosed with dilated cardiomyopathy, 2 (7.4%) with restrictive cardiomyopathy, and 1 (3.7%) with hypertrophic cardiomyopathy. On a median follow-up of 35.07 months (IQR: 13.13-111.87), arrhythmias were detected in 9 (33%) patients. Three patients developed symptomatic sinus node dysfunction at 18, 25, and 38 days and received permanent pacemakers. One patient developed a complete AV block during acute rejection at 76 months and received a temporary pacemaker. Two patients developed chronic sinus tachycardia at 4 and 16 months and were treated with Beta-blockers after eliminating all causes of sinus tachycardia. One patient developed a complete right bundle branch block at 12 months. One patient developed ventricular extrasystole at 10 months and was found to have grade 2 rejection. An Atrial extrasystole was detected in one patient at 96 months. We did not identify significant risk factors for arrhythmias post-HT. After pediatric HT, early-onset rhythm disturbances, often attributed to surgery-related issues such as sinus node dysfunction, may necessitate invasive treatments like permanent pacemaker therapy. Close monitoring post-transplantation is crucial, and routine follow-up with Holter ECG is necessary to identify potential rhythm disorders even in the absence of symptoms. Rhythm disturbances that develop during follow-up can serve as early indicators of graft rejection and should be carefully evaluated.

Utilization of third-trimester fetal transcerebellar diameter measurement for gestational age estimation: a comparative study using Bland-Altman analysis

BackgroundSeveral studies show that gestational estimation during third trimester using fetal transcerbellar diameter (TCD) is superior to that measured by fetal biometry (BPD, HC, AC, and FL). However, the conclusions of studies stem from findings of correlation and regression statistical tests, which is not the recommended statistical analysis method for comparing the values of one variable as measured by two different methods. ObjectiveTo compare the accuracy of gestational age estimation by TCD to that by fetal biometry during the third trimester using Bland-Altman statistical analysis. MethodsThis was a cross-sectional study on pregnant women who presented for routine antenatal care follow-up in the third trimester (28-41 weeks) at St. Paul's Hospital Millennium Medical College (Ethiopia) between November 1, 2020, and February 28, 2021. Data were collected prospectively using a structured questionnaire on Open Data Kit (ODK). The primary outcome of our study was mean bias of gestational estimation (error in estimating gestational age) using TCD and fetal biometry (composite GA). Data were analyzed using STATA 15.p.l.c. Simple descriptive analysis, Bland-Altman(B&A) analysis, and Kendall's τa discordance measurement were performed as appropriate. Mean bias(error) and limits of agreement were used to present the finding significance. ResultsA total of 104 pregnant women in the third trimester were included in the study. The mean error(bias) when TCD was used to estimate the gestational age was 0.65 weeks versus a bias of 1.1 weeks by composite biometry, compared to gold standard method from crown-lump length (CRL) (in both cases). The calculated estimated limits of agreement was narrower in the case of TCD than by composite-fetal biometry (-3.56 to 2.25 vs -4.73 to 2.53). Kendall's τa discordance measurement revealed that gestational age estimation using composite biometry and that calculated from CRL were 51% to 70% more likely to agree than disagree whereas gestational age calculated from TCD and CRL were 62% to 77% more likely to agree than to disagree (P-value= <0.001). ConclusionGestational age calculation using TCD is more accurate than using composite gestational age (BPD, HC, FL, and AC) and it should be utilized to date third trimester pregnancies with unknown gestational age (unknown LNMP with no early ultrasound milestone).

Familial Adenomatous Polyposis within the Pediatric Hereditary Polyposis Registry

Background/Objective: &#x0D; Familial Adenomatous Polyposis (FAP) is a condition characterized by values exceeding hundreds of colorectal adenomatous polyps. FAP has a prevalence of 1 in 8,300 people, demonstrating an autosomal dominant inheritance pattern. This condition follows a pathogenic variation of the Adenomatous Polyposis Coli (APC) gene, located on chromosome 5q21-22. These mutations are heavily correlated with the incidence of colorectal carcinoma, requiring prophylactic colectomy. The management and treatment of FAP requires routine surveillance to reduce gastrointestinal polyp burden. The objective for this study is to characterize the current patient population at Riley with polyposis syndromes and assess clinical surveillance in patients diagnosed with FAP. &#x0D; Methods: &#x0D; Historical data from 2020-2022 GI clinical visits were reviewed using the diagnostic codes Family history of colonic polyps, Benign neoplasm of colon unspecified, and Other phakomatoses not elsewhere classified. These criteria identified 93 patients of which 64 patients were diagnosed with a hereditary polyposis syndrome for inclusion within the registry. Of the 64 patients, 42 had a diagnosis of FAP. Clinical data reviewed included the patient’s age of diagnosis, completion of genetic testing and follow-up, surgical treatment, routine endoscopic surveillance, and modes of imaging. &#x0D; Results: &#x0D; Results indicated a median age of diagnosis of 10 years, lower than previously reported national averages of 13.5-17 years. Evaluation of routine follow-up indicated a rate of endoscopy at 0.822 scopes per year and demonstrated that abdominal CT scans as well as abdominal X-rays were the most common supplemental modes of imaging. &#x0D; Conclusion/ Future Directions: &#x0D; The data from this registry will help direct care of patients with FAP, ensuring they receive treatment in accordance with national guidelines for routine surveillance and prophylactic colectomy. Moving forward, the intention is to expand the registry's date range to incorporate more patients and elaborate further on endoscopic findings for the specific subtypes of FAP.

The COVID-19 pandemic and its effects on follow-up of patients with early breast cancer: A patient survey.

Despite limited evidence supporting its effectiveness, most guidelines recommend long-term, routinely scheduled in-person surveillance of patients with early breast cancer (EBC). The COVID-19 pandemic led to increased use of virtual care. This survey evaluated patient perspectives on follow-up care. Patients with EBC undergoing surveillance were surveyed about follow-up protocols, perceptions, and interest in clinical trials assessing different follow-up strategies. Of 402 approached patients 270 completed the survey (response rate 67%). Median age 62.5 years (range 25-86) and median time since breast cancer diagnosis was 3.8 years (range < 1-33 years). Most (n = 148/244, 60%) were followed by more than one provider. Routine follow-ups with breast examination were mostly conducted by medical/radiation oncologists every 6 months (n = 110/236, 46%) or annually (n = 106/236, 44%). Participants felt routine follow-up was useful to monitor for recurrence, manage side effects of cancer treatment and to provide support/reassurance. Most participants felt regular follow-up care would detect recurrent cancer earlier (n = 214/255, 96%) and increase survival (n = 218/249, 88%). The COVID-19 pandemic reduced the number of in-person visits for 54% of patients (n = 63/117). Patients were concerned this reduction of in-person visits would lead to later detection of both local (n = 29/63, 46%) and distant recurrences (n = 25/63, 40%). While many felt their medical and radiation oncologists were the most suited to provide follow-up care, 55% felt comfortable having their primary care provider (PCP) conduct surveillance. When presented with a scenario where follow-up has no effect on earlier detection or survival, 70% of patients still wanted routine in-person follow-up for reassurance (63%) with the goal of earlier recurrence detection (56%). Despite limited evidence of effectiveness of routine in-person assessment, patients continue to place importance on regularly scheduled in-person follow-up.

The development and validation of a needs assessment tool for use with YOUng adult survivors of a CentrAl Nervous system tumor (YOU-CAN).

Adolescent and young adult (AYA) survivors of a central nervous system (CNS) tumor represent a vulnerable group who can experience: social isolation, low rates of employment, and achieving independence can be compromised, leading to poorer quality of life compared with survivors of other cancer types. The aim of this study is to develop and evaluate the validity of a needs assessment tool (NAT) for AYA survivors of a CNS tumor. Items generated using data from 29 qualitative studies and cognitive interviews (n = 8) produced NAT V1.1 (49 items). 128 of 316 eligible participants attending neuro-oncology clinics at 4 NHS sites between June 2022 and March 2023 completed the NAT V1.1 to allow for item reduction and refinement and to evaluate reliability and validity. A pilot study (n = 6) using YOU-CAN in routine follow-up concluded the study. Hierarchical analysis and Rasch analysis identified 18- and 15-items for removal, respectively. YOU-CAN, comprised of the remaining 16 items, demonstrates excellent test-retest reliability (intra-class correlation coefficient, 0.901, n = 40) and sufficient correlation with the European Quality of Life questionnaire and Supportive Care Needs Survey (Pearson r = 0.433 and 0.590, respectively). Pilot testing showed YOU-CAN triggered discussions of unmet needs in consultations and highlighted the importance of multidisciplinary support. YOU-CAN is a valid and reliable instrument containing items related to concerns about physical and emotional health; family and relationships; self-acceptance; and independence. Future efforts should examine YOU-CAN's feasibility, and develop guidance for managing unmet needs. Routine use of YOU-CAN may improve the identification of otherwise undiscussed unmet needs and opportunities to deliver personalized support.

Screening for dysphagia in patients with relapsing-remitting multiple sclerosis

BackgroundIn multiple sclerosis (MS), dysphagia is an important and common clinical symptom. Although often overlooked and underdiagnosed, it can have a significant impact on a patient's life, including social integration, and it can lead to malnutrition, aspiration pneumonia, and suffocation, i.e., life-threatening complications. Early detection of dysphagia is essential to prevent these risks. However, the optimal screening method and the inter-relationship between different methods used for dysphagia screening are not clear. The aim of this study was to compare the diagnostic performance of a simple question about swallowing problems, the DYsphagia in MUltiple Sclerosis (DYMUS) swallowing questionnaire, and the Timed Water Swallowing Test (TWST) to detect dysphagia in people with relapsing-remitting MS (RRMS). MethodsPatients with MS were asked about subjective swallowing difficulties and, regardless of their response, completed the DYMUS questionnaire and underwent the TWST at their routine follow-up visit. Patients with at least one positive screening method were offered an objective assessment of swallowing function using the Fiberoptic Endoscopic Evaluation of Swallowing (FEES). The results were statistically analyzed and correlated with demographic and MS-related parameters. ResultsOf the 304 people with RRMS enrolled in the study, 46 (15.1 %) reported having subjective difficulty swallowing when asked a simple question. The DYMUS questionnaire was positive in 59 (19.4 %) of the 304 patients; 51 (16.8 %) had an abnormality on the TWST. A clear correlation (r = 0.351, p < 0.01) was found between the DYMUS and TWST results, but a significant proportion of patients (about half) had an abnormality on only one of these tests. The positivity of at least one of the screening methods used (DYMUS or TWST) had a better chance of identifying a patient with dysphagia than a simple question (p < 0.001). Of the patients with a positive result for difficulty swallowing, 37 underwent FEES, which confirmed dysphagia in 94.6% of this subgroup. Patients with higher Expanded Disability Status Scale (EDSS) scores, female gender, and older age were at higher risk of developing dysphagia. ConclusionThe DYMUS questionnaire and TWST had a confirmed potential to identify more patients with dysphagia than a simple question about swallowing problems. However, our study found only a partial overlap between DYMUS and TWST; a combination of these two methods was more sensitive in identifying patients with MS at risk of dysphagia. Furthermore, the screening showed excellent specificity: almost 95 % of the positively screened patients had dysphagia confirmed by objective methods. Age, female gender, and a higher EDSS score appear to be potential risk factors for dysphagia in patients with MS.

The Utility and Necessity for Radiographic Follow-Up After Arthroplasty for Geriatric Neck of Femur Fractures.

Hip fractures are a common and debilitating condition posing not only a huge health care but also socioeconomic burden. Surgical management for a neck of femur fracture is typically with arthroplasty in the form of total hip arthroplasty or hip hemiarthroplasty. Serial radiographs are typically performed routinely as part of follow-up to look for complications, although their clinical utility in asymptomatic patients is yet to be validated. Our paper therefore aims to review the utility and necessity of radiographic follow-up following arthroplasty for NOF fractures. Patients who underwent operative management for acute fragility neck of femur fractures in the year from 1st January 2018 to 31st December 2018 at the author's institution were identified. All patients who underwent surgery, and had at least one pre and one post-operative plain film radiograph of the affected hip were included in this study. Exclusion criteria included patients who had undergone surgery for chronic fractures, avascular necrosis of the femoral head, mortality within 1 year, peri-prosthetic fractures, pathological fractures from metastases, had concomitant injuries, or had inaccessible or incomplete records. Clinical records were assessed for the number of visits, an abnormal presenting history or clinical examination, as well as changes in management of the patient. The number and type of radiographs were also assessed, and each radiograph analyzed for abnormal findings. A total of 157 patients were included in our study with a mean age of 79.5 at the time of surgery, and a mean follow up of 17.3 months. Data was collected from 626 clinical visits and a total of 973 radiographs. The 3 abnormal radiographic series identified with a corresponding normal consult did not result in a change of management for the patient. A negative change in management was only observed in 1 patient with an abnormal consult and a corresponding normal radiograph. Post-operative complications following arthroplasty for NOF fractures are likely to result in a symptomatic presentation of the patient. Routine radiographic follow-up provides limited utility in asymptomatic patients and should only be performed if clinically indicated.

Achilles tendon thickness and serum asprosin level significantly increases in patients with polycystic ovary syndrome.

In our study, we aimed to investigate the Achilles tendon thickness (ATT) and asprosin levels in patients with polycystic ovary syndrome (PCOS) and to evaluate the relationship of these parameters, which may be related to cardio-metabolic diseases. In our prospective cross-sectional study, 45 female patients with PCOS and 30 female healthy individuals similar in age were included. Serum dehydroepiandrosterone sulfate (DHEAS), total testosterone, anti-Müllerian hormone (AMH) and asprosin levels were measured using appropriate kits and homeostatic model assessment of insulin resistance (HOMA-IR), luteinizing hormone (LH) to follicle-stimulating hormone (FSH) ratio was calculated. ATT measurements were performed by two radiologists using a high-resolution ultrasound doppler system. Serum DHEAS, total testosterone, AMH and asprosin levels, HOMA-IR value, LF/FSH ratio, and ATT values were higher in patients with PCOS compared to healthy controls. Correlation analysis was performed between ATT and other parameters in patients with PCOS. In univariate analysis, parameters associated with ATT were detected as asprosin, DHEAS and AMH. In the linear regression analysis performed with significant parameters, asprosin and DHEAS levels were found to be associated with ATT. ATT values and serum asprosin levels were found to be significantly increased in patients with PCOS, and there is a very close positive relationship between ATT and serum asprosin levels. For this reason, it was thought that ATT measurement could be a cheap, simple and non-invasive monitoring parameter that can be used in the routine cardiometabolic follow-up of patients with PCOS.

Internet + wearable device training effects on limb function recovery and serum neurocytokine content in stroke patients.

The traditional method of post-hospital intervention and guidance of stroke patients has some limitations. To investigate the effects of Internet + wearable device training on limb function recovery and the levels of serum neurocytokines (BDNF, NT-3, and NGF) in stroke patients. 80 stroke patients with hemiplegia were randomly selected from the Department of Neurorehabilitation, Affiliated Rehabilitation Hospital of Chongqing Medical University. They were divided into a control group and an observation group, with 40 patients in each group. The control group received routine post-hospital follow-up guidance, while the observation group received Internet remote home rehabilitation guidance combined with wearable device training. The interventions were compared between the two groups. At 4 weeks and 12 weeks after discharge, the observation group showed higher scores on the Fugl-Meyer scale (FMA), Berg Balance Scale (BBS), modified Barthel Index (MBI), stride length, gait speed, gait frequency, and higher levels of BDNF, NT-3, and NGF. Additionally, the observation group had lower scores on the Hamilton Anxiety and Depression Scale (HADS) (P < 0.05). The application of Internet remote home rehabilitation guidance combined with wearable device training in stroke patients with hemiplegia can improve limb function recovery. It effectively increases the levels of BDNF, NT-3, and NGF, promoting the nutritional repair of damaged nerves. These findings hold clinical significance.

A Rare Variant of Ameloblastoma of the Oral Cavity: A Review and Case Report

Abstract Ameloblastoma is a very rare odontogenic tumor of the oral cavity, with different histologic variants. One of the types of ameloblastoma is desmoplastic ameloblastoma (DA) which has 4%–5% of incidence. Here, we review and reported the DA is the least of occurrence of all the variants of ameloblastoma. The uniqueness of this lesion can be further enlightened with respect to its site of occurrence, the radiographic feature and the histological appearance different from the classical type of ameloblastoma. This case report focuses on a DA that occurred in the maxilla of a 35-year-old woman and explains about clinical, radiographic findings, histopathologic findings, and treatment plan. The patient is undergoing routine follow-up and is presently free of disease. From this case, the clinicians should remember to consider the DA as differential diagnosis, if a patient complaints of swelling in and around the premolar region of maxilla.

Dilated cardiomyopathy in patients with hypoparathyroidism: A narrative review.

Hypoparathyroidism is a rare endocrine disorder characterized by low blood calcium levels, elevated phosphorus levels, and insufficient parathyroid hormone production. It can lead to dilated cardiomyopathy (DCM), a cardiac condition characterized by enlarged ventricles and reduced heart function. This review aims to explore the relationship between hypoparathyroidism and DCM, the impact of calcium on cardiac function, and the potential for DCM reversal with calcium supplementation. A comprehensive literature search was conducted using PubMed, Google Scholar, and relevant keywords and Mesh terms. Case reports evaluating dilated cardiomyopathy in patients with Hypoparathyroidism were included in the study. Additionally, references cited in each study were carefully examined to identify relevant reports. The cases included in the review were analyzed, and common cardiac manifestations, diagnostic approaches, and management were identified. DCM in hypoparathyroidism presents with symptoms of heart failure, reduced ejection fraction, and impaired left ventricular function. Laboratory tests show low serum calcium levels and elevated phosphate levels. Prompt diagnosis and treatment with calcium and vitamin D supplementation can lead to improvements in cardiac function. Hypoparathyroidism-induced DCM is reversible with timely calcium and vitamin D supplementation. Patient compliance with prescribed medications and supplements is crucial to prevent and manage cardiac complications. Regular follow-up check-ups and monitoring of calcium levels can aid in early detection and improve patient outcomes. Educating patients about the importance of treatment adherence can significantly reduce the risk of developing DCM and other cardiac symptoms associated with hypoparathyroidism. Routine follow-up of DCM among patients with endocrine disorders is recommended.

Vision impairment among patients attending Al-Aqiq Hospital, Saudi Arabia

Objective: This study aimed to assess the most common types of vision impairment (VI) and their incidence in patients who attended the Al-Aqiq Hospital (AqH) eye clinic and to compare the results with other clinics inside and outside Saudi Arabia (KSA). Methods: This was a retrospective study conducted using the recorded data of patients who visited the AqH eye clinic for eye care from 2021 to 2022. Results: The study sample included 1,711 patients; among them, female responses (n = 879, 51.4%) outnumbered male responses (n = 832, 48.6%). Most patients were Saudi (n = 1,403, 82.0%), with a mean age of 34.63 ± 21.90 years in women and 36.15 ± 23 years in men. Refractive error (RE) was the most common VI (31%), followed by red eye and allergy (15.7%). Blindness, amblyopia, and age-related macular degeneration were the least common disorders (2%). Other presentations of VI such as corneal dystrophies and infections, constituted 10.5% of patients, while 9.1% of patients did not have VI. In the defined data, presbyopia was the most common type of RE (9.8%), followed by stigmatism (4%). Among female patients, RE, dry eye (DR), trauma, DR, and glaucoma were more common among male patients. Conclusions: The incidence of VI was higher among female and Saudi patients at the AqH eye clinic. The most common cause of VI was RE, while amblyopia was the least common cause. The rate of routine follow-up was higher than elsewhere in KSA, indicating a high level of knowledge about eye health care.

Pilot Study of Intelligent Office Blood Pressure Measurement Model in Shanghai, China, 2022.

An intelligent office blood pressure measurement (IOBPM) model for community-based hypertension management was piloted in Shanghai, China, to overcome the conventional blood pressure management (CBPM) model's deficiencies. We selected adults aged 35-89 years who were being treated and managed for hypertension in two community health centers for the IOBPM and CBPM models. The IOBPM model consisted of two or three consecutive blood pressure (BP) measurements using a pre-programmed and validated automatic device. The BP data for the CBPM model were obtained from the routine follow-up records of hypertensive patients and derived from the Shanghai Non-communicable Diseases Management Information System. Subjects in the IOBPM model were selected by a simple random sampling method, and propensity score matching was used to select a comparable control population from the CBPM model based on important covariables. The BP levels, end-digit preferences, frequency distribution, and BP control were compared between the two models. We selected 2,909 patients for the IOBPM model and 5,744 for the CBPM model. The systolic BP in the CBPM model was 12.3 mmHg lower than in the IOBPM model. In the CBPM model, there were statistically significant end-digit preferences (P < 0.001), with zero being the most reported end-digit (23.3% for systolic BP and 27.7% for diastolic BP). There was no significant end-digit preference in the IOBPM model. Certain BP values below 140/90 mmHg in the CBPM model were more frequent, while the IOBPM model showed a normal distribution. The BP control in the CBPM model was significantly higher than the IOBPM model (P < 0.001). The IOBPM model appears to overcome the deficiencies of the CBPM model, leading to more accurate and reliable BP measurements.

Ocular lesions in patients with ulcerative colitis.

Aim: To analyze the data and evaluate the prevalence of ocular lesions in patients with moderate ulcerative colitis. Materials and Methods: We observed 112 patients aged 18-75 years old with clinically, endoscopically and histologically confirmed moderate ulcerative colitis which lasted at least 6 months. An ophthalmologic exam was performed to determine the presence of ocular symptoms. Results: Of the 112 patients with moderate ulcerative colitis, 21 (18,75%) had the following ocular lesions: episcleritis - 7 patients (6,25%), keratopathy - 5 patients (4,46%), uveitis - 5 patients (4,46%), cataract - 2 (1,78%) and scleritis - 2 (1.78%). Conclusions: Because ocular symptoms in patients with UC are often nonspecific, it may be beneficial to perform ophthalmologic examinations as a routine follow-up component of in such patients.

PEMBERDAYAAN KADER DETEKSI DINI GANGGUAN PERTUMBUHAN ANAK DENGAN METODE TIKAR STUNTING SEBAGAI UPAYA PENCEGAHAN STUNTING DI KELURAHAN TAPA, KECAMATAN SIPATANA, GORONTALO

Gorontalo Province is one of the areas that has a fairly high prevalence of stunting. Several ways that can be done to reduce the risk of stunting is through early prevention which is carried out routine screening and follow-up on children's growth. This community service aims to increase cadres' knowledge about preventing and handling stunting as well as improving cadres' skills in carrying out early detection of stunting. The activities were done with a target of 20 health cadres in Tapa Village during July-September 2023 which consisted of 2 stages as follows: 1. Education and training of health cadres using lecture methods, procedure demonstrations, and examination simulations followed by question-and-answer discussions accompanied by pre-tests and post-tests to measure achievement targets. The measuring tool uses a questionnaire. 2. Cadre assistance is carried out by supervising procedures and mentoring health cadres in carrying out screening using stunting mats. The results of the activity showed that there was an increase in cadres' knowledge about stunting prevention in the post-test by 20 people (100%) with an average increase of 46 scores and an increase in cadres' skills in screening using the stunting mat method by 20 people (100%) with an average increase 81 scores. It can be concluded that this service activity has had an impact in increasing cadres' knowledge and skills regarding stunting prevention and screening. The cadres then apply their skills to the people in their area so that in the future the stunting rate in the Tapa sub-district can be reduced.

The application of 5E rehabilitation management mode in the nursing of patients with aortic dissection complicated by obstructive sleep apnea

ObjectiveThis study was designed to explore the effect of 5E rehabilitation mode (encouragement, education, exercise, employment, and evaluation) in patients with aortic dissection (AD) complicated by obstructive sleep apnea (OSA).MethodsPatients with Stanford type B AD (TBAD) complicated by OSA were admitted to Guangdong Provincial People’s Hospital from January 2019 to December 2020. They were randomly divided into an experimental group and a control group. After discharge, patients in the control group were given routine nursing and follow-up education, whereas patients in the experimental group were given 5E rehabilitation management mode–based nursing and follow-up education. Upon the nursing intervention, the differences in polysomnography (PSG) parameters, medication adherence, quality of life, blood pressure, and heart rate of patients between the two groups were compared. Logistic regression analysis was performed to evaluate the risk factors for the occurrence of adverse aortic events.ResultsA total of 89 patients were enrolled, 49 in the experimental group and 40 in the control group. After the intervention, the control of heart rate, systolic blood pressure, medication adherence, PSG parameters, and quality of life scores in the experimental group were significantly better than those in the control group (P<0.05). The incidence of adverse aortic events including aortic rupture and progressive aortic dilation in the experimental group was significantly lower than that in the control group (P < 0.05). Logistic regression analysis revealed that acute TBAD [odds ratio (OR) = 15.069; 95%confidence interval (CI), 1.738–130.652; P=0.014], history of chronic kidney disease (OR=10.342; 95%CI, 1.056–101.287; P=0.045), and apnea hypopnea index (AHI) ≥ 30 (OR=2.880; 95%CI, 1.081–9.51; P=0.036) were adverse factors affecting adverse aortic events; while 5E rehabilitation management mode (OR=0.063; 95%CI, 0.008–0.513; P=0.010) was a favorable factor for occurrence of adverse aortic events.ConclusionThe findings suggest that continuous nursing based on information carrier 5E rehabilitation management significantly enhanced medication adherence, improved patients’ overall quality of life, and decreased the incidence of adverse aortic events in patients TBAD patients and OSA.