Significant Difference In Development Research Articles

OGBN P10 Fenestrating versus reconstituting subtotal cholecystectomy for difficult gallbladder: A systematic review and meta-analysis

Abstract Background To evaluate comparative outcomes of fenestrating and reconstituting subtotal cholecystectomy (STC) in patients with difficult gallbladder. Methods A systematic search of electronic data sources and bibliographic reference lists were conducted. All comparative studies reporting outcomes of laparoscopic fenestrating and reconstituting STC were included and their risk of bias were assessed using ROBINS-I tool. Results Seven comparative studies were included enrolling 590 patients undergoing laparoscopic STC using either fenestrating (n=353) or reconstituting (n=237) approaches. Although fenestrating STC was associated with a significantly higher rate of bile leak (OR:2.47, p=0.007) compared to reconstituting STC, both approaches were comparable in terms of resolution of bile leak without (RD:-0.02, p=0.86) or with (OR:1.84, p=0.40) postoperative ERCP. Moreover, there was no significant difference in development of bile duct injury (RD:-0.02, p=0.16), need for postoperative ERCP (OR:1.36, p=0.49), wound infection (RD:0.03, p=0.27), re-operation (OR:0.95, p=0.95), gallbladder remnant cholecystitis (OR:0.21, p=0.09) or need for completion cholecystectomy (RD:0.01, p=0.59) between two groups. Conclusions Although fenestrating STC increases risk of bile leak compared with the reconstituting approach, this can be managed successfully with postoperative ERCP if not resolved spontaneously. We encourage low threshold for fenestrating approach in difficult situations, considering its relatively benign postoperative course and long-term outcomes.

A retrospective evaluation of the effect of oclacitinib (Apoquel) administration on development of surgical site infection following clean orthopedic stifle surgery.

The aim of this study was to determine the effect of oclacitinib (Apoquel) on development of surgical site infections in canines following clean orthopedic stifle surgery. Medical records of dogs undergoing unilateral, clean orthopedic stifle procedures were retrospectively examined for development of post-operative surgical site infections. Data collected for statistical analysis included age, sex, body weight, current medications, anesthesia and surgery times, white blood cell count, and neutrophil count. Surgical site infections were identified in 8.7% (34/390) of stifle procedures- 8.0% (29/364) in dogs not treated with oclacitinib and 19.2% (5/26) in dogs treated with oclacitinib (p = 0.053). There was a significant difference in development of surgical site infection in dogs with longer anesthesia times (p = 0.003) and higher body weights (p = 0.037). Dogs being treated with oclacitinib at the time of clean, orthopedic stifle surgery did not have a significantly higher incidence of surgical site infections. However, client education regarding risk of infection and increased patient monitoring post-operatively are recommended, especially in patients with increased body weight or longer anesthetic times.

Ursodiol Prescriptions Following Bariatric Surgery: National Prescribing Trends and Outcomes.

Rapid weight loss after bariatric surgery is a risk factor for gallstone development. Numerous studies have shown that ursodiol after surgery decreases rates of gallstone formation and cholecystitis. Real-world prescribing practices are unknown. This study aimed to examine prescription patterns for ursodiol and reassess its impact on gallstone disease using a large administrative database. The Mariner database (PearlDiver, Inc.) was queried using Current Procedural Terminology codes for Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) between 2011 and 2020. Only patients with International Classification of Disease codes for obesity were included. Patients with pre-operative gallstone disease were excluded. The primary outcome was gallstone disease within 1 year, which was compared between patients who did and did not receive an ursodiol prescription. Prescription patterns were also analyzed. Three hundred sixty-five thousand five hundred patients fulfilled inclusion criteria. Twenty-eight thousand seventy-five (7.7%) patients were prescribed ursodiol. There was a statistically significant difference in development of gallstones (p < 0.001), development of cholecystitis (p = .049), and undergoing cholecystectomy (p < 0.001). There was a statistically significant decrease in the adjusted odds ratio (aOR) for the development of gallstones (aOR 0.81, 95% CI: 0.74, 0.89), development of cholecystitis (aOR 0.59, 95% CI: 0.36, 0.91), and undergoing cholecystectomy (aOR 0.75, 95% CI: 0.69, 0.81). Ursodiol significantly decreases the odds of development of gallstones, cholecystitis, or cholecystectomy within 1 year following bariatric surgery. These trends hold true when analyzing RYGB and SG separately. Despite the benefit of ursodiol, only 10% of patients received an ursodiol prescription postoperatively in 2020.

Impact of lenvatinib-induced proteinuria and renal dysfunction in patients with thyroid cancer.

Proteinuria is the most frequent adverse event of lenvatinib use. However, the association between lenvatinib-induced proteinuria and renal dysfunction remains unclear. We retrospectively reviewed medical records of patients with thyroid cancer without proteinuria treated with lenvatinib as a first-line systemic therapy at the initiation of treatment to assess the association between lenvatinib-induced proteinuria and renal function and the risk factors for the development of ≥3+ proteinuria on a dipstick test. Proteinuria was assessed by the dipstick test throughout the treatment in all cases. Of the 76 patients, 39 developed ≤2+ proteinuria (low proteinuria group) and 37 developed ≥3+ proteinuria (high proteinuria group). There was no significant difference in estimated glomerular filtration rate (eGFR) between high and low proteinuria groups at each time point, but there was a trend toward a significant decrease in eGFR of -9.3 ml/min/1.73 m2 in all patients after 2 years of treatment. The percentage of change in eGFR (ΔeGFR) significantly decreased in the high proteinuria group compared to that in the low proteinuria group (ΔeGFR: -6.8% vs. -17.2%, p=0.04). However, there was no significant difference in development of severe renal dysfunction with eGFR <30 ml/min/1.73 m2 between the two groups. Moreover, no patients permanently discontinued treatment because of renal dysfunction in both groups. Furthermore, renal function after completion of lenvatinib was reversible. There was no association between the degree of lenvatinib-induced proteinuria and renal function. Therefore, treatment should be continued with attention to renal function, regardless of the degree of proteinuria.

Abstract 10060: Racial Differences in Outcomes of Hypertensive Crisis in Women With History of Preeclampsia: A National Sample Study

Objective: Preeclampsia has been shown to put women at an increased risk of developing hypertension later in life. We aimed to determine racial differences in in-hospital outcomes of hypertensive crisis in women with history of preeclampsia in the United States. Methods: The national inpatient sample was retrospectively studied from 2012-2019 to identify hospitalizations for hypertensive crisis aged &gt;18. We further identified history of preeclampsia within each admission using ICD-10 codes. The primary outcome was hospital length of stay (LOS) and inpatient mortality rate. Secondary outcomes were chosen as a 3-point composite development of stroke, myocardial infarction (MI) or congestive heart failure (CHF). Demographic (age, sex, race) information was also recorded. Caucasian patients were chosen as baseline reference to compare other ethnicities with. Data was analyzed with STATA 16.0, and adjusted odds ratios (AOR) were calculated using multivariate logistic regression. Results: There were 531,432 hospitalizations for hypertensive crisis, out of which 11% (58,457) had history of preeclampsia. 65% of this subset was Caucasian, 21% were African American (AA) and 11% Hispanic. Inpatient mortality rate was higher in Hispanic patients with preeclampsia vs Caucasians [6.2% vs 4.3%; AOR: 1.56 (1.49 – 1.61, p&lt;0.001)]. AA patients had a longer LOS vs Caucasians [5.5 vs 3.2; AOR: 1.21 (1.19 – 1.25, p&lt;0.001)]. There was no significant difference in LOS in Hispanic patients (p=0.08). Hispanic women had increased odds of developing stroke while inpatient compared to their Caucasian counterparts (AOR: 2.31, p&lt;0.001). There was no significant difference in development of MI amongst the races (p=0.09). However, AA women with history of preeclampsia were more likely to develop CHF compared to Caucasians (AOR: 1.92, p&lt;0.001). Conclusion: Hispanic women with history of preeclampsia have higher mortality rate and incidence of stroke when admitted with hypertensive crisis. Similarly, African American women with preeclampsia have longer hospital stay when admitted with hypertensive crisis. Further research is needed to understand and alleviate these cardiovascular burdens in ethnic minorities.

S1021 Inflammatory Bowel Disease, Subclinical Atherosclerosis, and Cardiovascular Disease: A Case-Control Analysis

Introduction: Inflammatory Bowel Disease (IBD) is classified with other immune-mediated inflammatory diseases (IMID). Many IMID such as rheumatoid arthritis and systemic lupus erythematosus have been shown to predispose patients to atherosclerotic cardiovascular disease (ASCVD) even without traditional cardiovascular risk factors. An association between IBD and ASCVD has been reported, but is less well-defined. In addition, there is lacking data on risk of subclinical atherosclerosis in patients with IBD. Methods: We performed a case-control analysis of patients seen at a tertiary medical center who underwent coronary calcium scoring (CCS) as part of routine clinical care. Patients IBD were compared to patients without IBD for differences in CCS and development of cardiac events and/or death. Controls were randomly selected from age and sex matched lists of CCS and excluded if they had a prior history of ASCVD. The association of IBD status with time to cardiac events or death was compared using log rank tests, and Cox regression was used to estimate hazard ratios. Subjects were considered at risk from the time of CCS until they had the event of interest or were censored at last contact. Results: A total of 53 IBD case subjects [28 Crohn’s disease (CD); 24 Ulcerative Colitis (UC)] and 106 controls without IBD were included. There were no significant differences between the two groups regarding BMI, race, smoking status, statin use, diabetes, or aspirin use. The was no significant difference in CCS between the two groups (1.1 vs. 0, p = 0.59). Within the IBD population, there was no difference in the CCS between CD and UC (0 for CD and 7.5 for UC; p = 0.48). There was no significant difference in development of cardiac events or death between IBD cases and non-IBD controls (p = 0.37) during follow up. The hazard ratio for a doubling of the CCS and development of cardiac events or death was significant (HR 1.27, 95% CI 1.09-1.49; p = 0.003); however, IBD status was not found to be significant (HR 1.95, 95% CI 0.53-7.12, p =0.3). (Figure) Conclusion: IBD status does not appear to be associated with increased risk of subclinical atherosclerosis as measured by CCS. Elevation in the CCS is associated with risk of cardiac events and death; however, IBD status does not appear to be associated with risk of cardiac events and death. Larger studies are needed to further define the relationship between IBD, subclinical atherosclerosis, and ASCVD. (Table)Figure 1.: Cardiac event-free Survival in IBD cases vs. non-IBD Controls Table 1. - Demographics by IBD case/control status IBD n=53 Non-IBD n=106 P-value Age 55 56 0.97 Female 18 (34%) 34 (32%) 0.81 BMI 28 27 0.99 Race: Caucasian 53 (100% 100 (94%) 0.21 Smoker 14 (26%) 28 (26%) 1 Statin use 22 (42%) 57 (46%) 0.57 Diabetes 5 (9%) 10 (9%) 1 Aspirin Use 9 (17%) 26 (25%) 0.28

Treatment-Emergent Co-Morbidities and Survival in Patients With Metastatic Castration-Resistant Prostate Cancer Receiving Abiraterone or Enzalutamide.

Secondary hormone therapy, abiraterone and enzalutamide, has improved outcomes for metastatic castration-resistant prostate cancer (mCRPC) and prolonged patients’ lives significantly. Various studies have compared the cancer-related outcomes, adverse effects, and drug-induced comorbidities in patients with mCRPC who are treated with abiraterone or enzalutamide. However, few studies have explored associations between survival and comorbidities or comprehensive analyzed newly developed comorbidities during and after secondary hormone therapy. We attempted to clarify whether the Charlson comorbidity index (CCI) overall or itemized is predictive for overall survival, and we compared newly developed comorbidities between abiraterone and enzalutamide groups. We extracted data about expenses and comorbidities for patients who have mCRPC, received abiraterone and enzalutamide and met pre-examination operation criteria between September 2016 and December 2017 from the Taiwan National Health Insurance database. A total of 1153 patients with mCRPC who received abiraterone (n = 782) or enzalutamide (n = 371) with or without previous chemotherapy were included. We used the propensity score to match confounding factors, including age, pre-existing comorbidities, and precipitating factors for comorbidity (e.g., hypertension, hyperlipidemia), to eliminate selection bias in the comparison of newly developed comorbidities. Cox regression analysis was used for overall survival. We found that enzalutamide is superior to abiraterone with regard to overall survival. Our study revealed that there is no statistically significant difference in development of new comorbidities between abiraterone and enzalutamide group. Moreover, the CCI score, rather than any single item of the CCI, was a statistically significant predictor for overall survival.

TATHAWWUR MU’TAQADĀT AL-THULLĀB HAULA TA’ALLUM AL-LUGHAH FI BARNĀMAJ DAURAH AL-LUGHAH AL-ARABIYYAH AL-MUKATSTSAFAH ‘ABR AL-JINSI WA AL-KHALFIYĀTI AL-TARBAWIYYAH: DIRĀSAH MAQTA’IYYAH WA THŪLIYYAH

This study aims to investigate the development of students’ beliefs about learning Arabic in Intensive Arabic Course program at IAIN Palangka Raya across the educational backgrounds and gender. This study used a quantitative research approach by combining cross sectional and longitudinal research types. There are 214 (two hundred and fourteen) new students in Academic Year 2019 at IAIN Palangka Raya as participants of the study. Data were analyzed by using mean, independent sample test and ANOVA. The results showed that 1) the new students studying in the intensive Arabic course program had a strong belief about Arabic learning 2) there was no statistically significant difference between the students belief about Arabic learning across gender and the educational backgrounds at the beginning of the Intensive Arabic Course meeting, 3) there was no statistically significant difference between the students’ beliefs about Arabic learning across the educational backgrounds and the gender after the end of the Intensive Arabic course program, 4) there was no statistically significant difference in development of students' belief about learning Arabic between the beginning and the end of the Intensive Arabic Course program.&#x0D; &#x0D; Keywords: Arabic, beliefs about language learning, course, development

ISTIKHDĀM AL-KITĀB AL ‘ARABIYATI LĪ AL-NĀSYI'IN LI MAHMŪD ISMĀIL SHĪNĪ WA AL-ASHDIQĀ' FI TARQIYAT MAHĀRAT AL-LUGAT AL- ARABIYAT LADA AL-TULLĀBI FĪ AL-MADRASAT AL MUTAWASSITHAT AL-FAJAR MATARAM

This study aims to investigate the development of students’ beliefs about learning Arabic in Intensive Arabic Course program at IAIN Palangka Raya across the educational backgrounds and gender. This study used a quantitative research approach by combining cross sectional and longitudinal research types. There are 214 (two hundred and fourteen) new students in Academic Year 2019 at IAIN Palangka Raya as participants of the study. Data were analyzed by using mean, independent sample test and ANOVA. The results showed that 1) the new students studying in the intensive Arabic course program had a strong belief about Arabic learning 2) there was no statistically significant difference between the students belief about Arabic learning across gender and the educational backgrounds at the beginning of the Intensive Arabic Course meeting, 3) there was no statistically significant difference between the students’ beliefs about Arabic learning across the educational backgrounds and the gender after the end of the Intensive Arabic course program, 4) there was no statistically significant difference in development of students' belief about learning Arabic between the beginning and the end of the Intensive Arabic Course program.&#x0D; &#x0D; Keywords: Arabic, beliefs about language learning, course, development

Routine use of feeding jejunostomy in pancreaticoduodenectomy: A metaanalysis

AbstractAims and ObjectivesThe primary aim of our study was to evaluate morbidity and mortality following feeding jejunostomy in pancreaticoduodenectomy compared to the control group. We also evaluated individual complications like delayed gastric emptying; post operative pancreatic fistula, superficial and deep surgical site infection.Material and MethodsThe study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement and MOOSE guidelines. Heterogeneity was measured using Q tests and I2.the random‐effects model was used.ResultsFour studies including a total of 1639 patients were included in the analysis. A total of 843 patients were included in the feeding jejunostomy group and 796 patients included in the control group without feeding jejunostomy. Overall morbidity was significantly higher in the feeding jejunostomy group (P = .001). There was no significant difference in perioperative mortality between both the groups (P = .07). Delayed gastric emptying was significantly higher in the feeding jejunostomy group (P = .021). There was no significant difference in development of pancreatic fistula between the two groups. Deep surgical site infection was significantly higher in feeding jejunostomy group. (P = .013). Hospital stay was significantly more in feeding jejunostomy group (P &lt; .0001). There was no significant difference between readmission, TPN requirement and time to start oral feed.ConclusionFeeding jejunostomy seems to be associated with increased morbidity and increased length of stay.

Methodology for Identifying the Boundaries of Agglomerations based on Statistical Data

Significant difference in development between the municipalities is an obstacle for achieving economic sustainability in many Russian regions. Regional development strategies and plans of various municipalities often cannot be synchronised because of their incompatibility. Moreover, municipalities usually lack necessary resources to implement their strategies. To solve these problems, we identified groups of municipalities (key units of the settlement system (KUSS)) based on the existing socio-eco- nomic relations, common challenges and development potential. We propose a methodology for identifying KUSS and describe its application. This methodology relies on statistical data available at the municipal level. To assess the interconnection of municipalities, we used 6 statistical socio-economic indicators and 1 integrated index of Gross Municipal Product (GMP). The difference in the first 6 indicators of the development of municipalities demonstrated, that less developed municipalities tend to more developed ones. We used the values of gross municipal product to define high mutual attraction of large municipalities (similar to the gravity model). The distance between municipalities reduced their mutual influence. Due to the limited data set, it was necessary to consider the reliability of the identified inter-municipal relations. Thus, we compared the obtained results with empirical data on population distribution and circular migration between municipalities in the region. The comparison of our calculations and actual data showed high precision of the presented methodology. The resulting grouping of municipalities allowed identifying 21 key units of the settlement system in Sverdlovsk oblast. The proposed methodology can be used for deter- mining large groups of municipalities in Sverdlovsk oblast, as well as in other Russian regions.

Comparison of Harmonic Scalpel versus conventional hemostasis in Thyroid surgery in terms of per-operative and postoperative outcome.

Harmonic scalpel is popular for use in a variety of surgical procedures including thyroid surgery. Proposed advantages of the harmonic scalpel include less lateral thermal tissue damage with no electrical energy transferred to the patient, no neuromuscular stimulation, less smoke formation as compared with electrocautery. Objectives: Our aim was to compare outcomes following thyroid surgery in terms of operative time, postoperative pain, drainage volume, recurrent laryngeal nerve and parathyroid gland injury with the use of the Harmonic Scalpel compared to conventional methods of hemostasis. Study Design: Randomized control trial. Setting: Surgical Department Lahore General Hospital. Period: Twelve Months June 2016 to June 2017. Material &amp; Methods: 60 patients, 30 in each group. Patients were randomized in each group by balloting method. Operative time, postoperative pain and drainage volume was assessed during hospital stay. Recurrent laryngeal nerve and parathyroid gland injury was assessed during hospital stay and follow-up. Results: There was no significant difference in development of hoarseness of voice in both groups, p-value &gt; 0.05. The mean operative time for group A was 69.47 ± 15.44 minutes and for group B it was 54.93 ± 11.56 minutes, p-value &lt;0.05. The overall blood loss in group-A and group-B was 118.73 ± 50.72 ml and 44.60±10.70 ml, p-value&lt;0.05. The mean post-op pain observed at 2nd day for group B was 2.93 ±3.57 and for group A it was 3.57±0.77, p-value &lt; 0.05. Conclusion: Use of Harmonic Scalpel has better results in thyroid surgery in terms of less operative time, less postoperative pain, less drainage volume, while no RLN &amp; parathyroid injury detected in either group.

Ciprofloxacin: single versus multiple doses in transrectal ultrasound guided prostate biopsy.

IntroductionThere is rising concern regarding overuse of fluoroquinolones due to severe musculoskeletal and neurological side effects, and development of resistant microorganisms. In June 2019, the European Commission recommended fluoroquinolones should not be used routinely for prophylaxis in urological surgical procedures. Methods to reduce unnecessary exposure to fluroquinolones should be investigated.The aim of this article was to determine differences in hospital admission secondary to sepsis following transrectal ultrasound (TRUS) guided prostate biopsies between patients who received single vs. multiple doses of fluoroquinolones.Material and methodsA retrospective analysis (June 2017–September 2018) of 200 consecutive TRUS biopsies at a single centre was undertaken. Group 1 (n = 100) received 750 mg ciprofloxacin 1-hr before their procedure followed by 3 days of ciprofloxacin 250 mg BD. Group 2 (n = 100) received a single dose of 750 mg ciprofloxacin 1-hr before the procedure. Midstream urine (MSU) culture results were examined pre-biopsy and 7 days post-biopsy. Data was also gathered on readmission rates to hospital as a result of urosepsis.ResultsA total of 1% of patients in each group required hospital admission secondary to Escherichia coli sepsis. A further 4% (n = 4) in Group 1 developed a urinary tract infection requiring antibiotic treatment post biopsy compared with 1% (n = 1) in Group 2. There was no statistically significant difference in development of infectious complications post-biopsy between the two groups (p >0.05).ConclusionsA single prophylactic dose of 750 mg of ciprofloxacin 1-hour pre-biopsy is as effective as multiple doses for TRUS guided prostate biopsy. Avoiding an unnecessary and prolonged course of fluoroquinolones has advantages in reducing potential side effects and development of resistant pathogens.

Randomized controlled trial of high-dose versus standard-dose vitamin D3 for prevention of aromatase inhibitor-induced arthralgia

Half of hormone receptor-positive (HR+) breast cancer patients will develop joint pain, termed aromatase inhibitor-induced arthralgia (AIA), while taking aromatase inhibitor therapy. Though there is no universally accepted effective treatment for AIA, there has been some evidence to support high-dose vitamin D as a treatment. We randomized post-menopausal women who were beginning adjuvant AI therapy to receive standard-dose vitamin D3 (800IU daily for 52weeks), or high-dose vitamin D3 (50,000IU weekly for 12weeks, followed by 2000IU daily for 40weeks). The primary end point was development of AIA. The trial was designed to enroll 184 patients. This futility analysis was performed after 93 patients were enrolled. The high-dose vitamin D regimen was effective in raising serum vitamin D levels, but there was no significant difference in development of AIA between the two arms. In the high-dose arm, 25 patients (54%) developed AIA, compared to 27 patients (57%) in the standard-dose arm. The planned futility analysis was positive; thus, the study was terminated. Neither baseline vitamin D nor 12-week vitamin D level was predictive of AIA development. Although vitamin D levels were increased in the high-dose arm, there was no significant signal for benefit of high-dose vitamin D supplementation for AIA prevention in this unblinded trial. This study, along with several others, implies that vitamin D likely does not play a significant role in AIA for the majority of patients.

New-Onset Diabetes Mellitus in Patients with Idiopathic Membranous Nephropathy Undergoing Tacrolimus and Low-Dose Corticosteroid Therapy

Background: Idiopathic membranous nephropathy (IMN) is the most common cause of nephrotic syndrome in adults. Although various studies have demonstrated the efficacy of tacrolimus combined with corticosteroids for treating IMN, both tacrolimus and corticosteroids have been shown to be diabetogenic, particularly following organ transplantation. Furthermore, the frequency and risk factors for new-onset diabetes mellitus (NODM) in IMN patients treated with tacrolimus plus low-dose corticosteroids remain unclear. Objectives: To evaluate the incidence of NODM in IMN patients undergoing tacrolimus plus low-dose corticosteroid therapy and to confirm the risk factors for NODM development. Methods: This retrospective study recruited 72 eligible patients with biopsy-proven IMN from our center, between September 2013 and June 2018. All subjects were treated with tacrolimus plus low-dose corticosteroids for a minimum of 3 months. The primary outcome was NODM development during the follow-up period. The secondary outcome was complete or partial remission. Patients were divided into 2 groups: patients with NODM (NODM group) and those without NODM (No-NODM group). Demographic and clinical data at baseline and follow-up were assessed. Results: During follow-up, 31 of the 72 patients developed NODM (43.0%). The median time to occurrence was 3 months after treatment initiation. NODM patients were significantly older (median age 59 vs. 40 years) than No-NODM patients. Baseline fasting blood glucose levels were slightly higher in the NODM group; however, the difference was not significant (p = 0.07). Older age was an independent risk factor for NODM (OR 1.73 and 95% CI 1.20–2.47, p = 0.003). Overall kidney remission rates were 80.6%. There was no significant difference in remission rate between groups. There was a significant difference in development of pulmonary infection, which occurred in 7 NODM patients and only in 1 No-NODM patient (p = 0.018). IMN reoccurred in 5 NODM patients but only 1 No-NODM patient. Conclusions: Tacrolimus plus low-dose corticosteroid therapy was an efficient treatment for IMN; however, it was accompanied by increased NODM morbidity, which should be considered serious, due to the increased risk of life-threatening complications. Increasing age was a major risk factor for NODM in IMN patients treated with tacrolimus plus low-dose corticosteroid therapy.

The Other Adjacent Joint

Category: Ankle Arthritis Introduction/Purpose: Accepted surgical treatment options for end-stage ankle arthritis include total ankle arthroplasty (TAA) and ankle arthrodesis (AA). Although they have comparable clinical outcomes, TAA is growing in popularity and one reason for this is that TAA, compared to AA, better preserves range of motion and function at the ankle, and results in a gait pattern that more closely replicates normal controls. This has the theoretical benefit of protecting adjacent articulations and thereby limiting degenerative changes from occurring in other joints. Although multiple studies have analysed the impact of both TAA and AA on adjacent joint disease in the foot, little data exists on their impact on the knee. This study explored the relationships between knee pain, TAA and AA in patients with end-stage ankle arthritis. Methods: Prospectively collected data was used from the Canadian Orthopaedic Foot and Ankle Society (COFAS) database of ankle arthritis at a single institution by three fellowship-trained foot and ankle surgeons between January 2003 and July 2012. In total, 342 patients were studied, with patient demographics collected pre-operatively, and post-operative follow up performed at the 5 year mark. All patients were examined for the development or resolution of knee pain, as well as patient-reported outcome measures including the Ankle Osteoarthritis Scale (AOS). Using a linear regression model, a multivariate analysis was performed to examine the relationship between knee pain, TAAs and AAs. Results: In the 233 patients that presented without knee pain pre-operatively, 22% who underwent TAA developed knee pain at 5 years, compared to 16% of AA patients (p&gt;0.05). In this group, patients who underwent TAA had statistically significant better outcomes in terms of AOS Pain (p&lt;0.02), AOS Difficulty (p&lt;0.05) and AOS Total Scores (p&lt;0.02). In the 109 patients who presented with knee pain, knee pain resolved in 47% of TAA patients vs 38% of AA patients at 5 years (p&lt;0.05). There was no statistically significant difference in AOS outcomes (p&gt;0.05) between patients who underwent TAA and AA. Compared with patients who did not have knee pain pre-operatively, the presence of pre-operative knee pain resulted in worse AOS (p&lt;0.02), with no difference between TAA and AA. Conclusion: In those patients presenting without knee pain, TAA did result in more superior functional outcomes, with no significant difference in development of knee pain compared to AA. In patients with pre-operative knee pain, TAA had benefits of improved resolution of knee pain, with no difference in functional outcomes when compared with AA. Regardless of surgical technique, the presence of pre-operative knee pain was an independent adverse predictor of outcome in patients with tibiotalar arthritis.

The efficacy of omega-3 supplements in prevention of preeclampsia among pregnant women with high risk factors in Sulaymaniyah governorate

Hypertensive disorders of pregnancy, including preeclampsia, complicate up to 10% of pregnancies worldwide, constituting one of the greatest causes of maternal and perinatal morbidity and mortality worldwide. The aim of the current study is to evaluate the efficacy of omega-3 supplements in prevention of preeclampsia among women with high risk. This study was carried out at Shanroy Hospital in al –Sulaimanya city from January 2016 till December 2016.In a single blind clinical trial, a total of 100 pregnant women were divided into two groups, one group had received omega-3 1000 mg and another group receive capsule prefilled with glucose as placebo.&#x0D; Selection criteria include: primipara women, ages under than 20 and above 40 years, previous history of preeclampsia or positive family history, obesity, history of renal disease and hypertension. Demographic profile with pregnancy length and neonatal outcome were recorded. The result of this study showed there was significant difference in development of preeclampsia during current pregnancy between omega-3 and placebo groups and there was a significant relationship (p&lt;0.05) between both groups when compare the preeclampsia in its all forms. In conclusion, omega-3 deems promising drug for prevention of preeclampsia in pregnant women with high risk.

Arthroscopic debridement for septic arthritis of the shoulder joint: post-infectious arthritis is an inevitable consequence?

The purpose of this study was to compare clinical outcomes and development of post-infectious arthritis of the shoulder joint after single (Group S) or repeated (Group R) arthroscopic debridement surgeries. We hypothesized that (1) repeated surgeries might be attributable to initial subchondral involvement resulting from septic arthritis and (2) the repeated surgery group would exhibit a higher incidence of post-infectious arthritic changes and inferior clinical outcomes due to prolonged resolution of the infection. This study included 42 patients (single surgery, n = 29; repeated surgery, n = 13) who underwent arthroscopic debridement for septic arthritis and had a minimum of 2 years of postoperative follow-up data. All patients underwent preoperative magnetic resonance imaging (MRI) with gadolinium enhancement to evaluate subchondral bone involvement suspicious for osteomyelitis secondary to septic arthritis and extension of infection around the glenohumeral joint. Functional and radiological outcomes were assessed. Group S experienced a shorter duration (25.4 days) of infection than Group R (39.7 days) (p = 0.002). Increased signal intensity in the subchondral bone on preoperative MRI was identified in 9 patients (31%) in Group S and 5 patients (38%) in Group R. Post-infectious arthritic changes developed in 6 (21%) and 5 (38%) in Groups S and R, respectively. However, there were no significant differences between groups. At the final follow-up, there were no significant differences in functional assessments. Despite a prolonged period of infection in the repeated surgery group, there was no significant difference in development of post-infectious arthritic changes or clinical outcomes in patients requiring single or repeated surgeries. Retrospective comparative study, III.

Detection of Conversion from Mild Cognitive Impairment to Alzheimer's Disease Using Longitudinal Brain MRI.

Mild Cognitive Impairment (MCI) is an intermediate stage between healthy and Alzheimer's disease (AD). To enable early intervention it is important to identify the MCI subjects that will convert to AD in an early stage. In this paper, we provide a new method to distinguish between MCI patients that either convert to Alzheimer's Disease (MCIc) or remain stable (MCIs), using only longitudinal T1-weighted MRI. Currently, most longitudinal studies focus on volumetric comparison of a few anatomical structures, thereby ignoring more detailed development inside and outside those structures. In this study we propose to exploit the anatomical development within the entire brain, as found by a non-rigid registration approach. Specifically, this anatomical development is represented by the Stationary Velocity Field (SVF) from registration between the baseline and follow-up images. To make the SVFs comparable among subjects, we use the parallel transport method to align them in a common space. The normalized SVF together with derived features are then used to distinguish between MCIc and MCIs subjects. This novel feature space is reduced using a Kernel Principal Component Analysis method, and a linear support vector machine is used as a classifier. Extensive comparative experiments are performed to inspect the influence of several aspects of our method on classification performance, specifically the feature choice, the smoothing parameter in the registration and the use of dimensionality reduction. The optimal result from a 10-fold cross-validation using 36 month follow-up data shows competitive results: accuracy 92%, sensitivity 95%, specificity 90%, and AUC 94%. Based on the same dataset, the proposed approach outperforms two alternative ones that either depends on the baseline image only, or uses longitudinal information from larger brain areas. Good results were also obtained when scans at 6, 12, or 24 months were used for training the classifier. Besides the classification power, the proposed method can quantitatively compare brain regions that have a significant difference in development between the MCIc and MCIs groups.

Denver Developmental Screening Test in two-year old infants delivered by vacuum extraction

The aim of this study was to determine the developmental retardation of infants of two years of age who were delivered by vacuum extraction. This cross-sectional study examined 44 infants delivered by vacuum extraction, comprising 25 males and 19 females who were born in Tembakau Deli and St. Elizabeth Hospitals, between August 1993 until February 1994. The examination included interview and physical examination in the patient's house. Chi-square statistics analysis was used with a significant level of 95% (1'=0.05). The results showed Ihat of the 44 infants delivered by vacuum extraction. 28 (32%) had had were found with mild asphyxia, while 2 infants (5%). whose mothers work as private clerk and entrepreneur, had development retardation. We concluded that there was no significant difference in development between infants delivered by vacuum extraction and those who were born spontaneously. Developmental retardation was found in infants whose mothers lack time to communicate.