Significant Difference In Incidence Research Articles

Safety and immunogenicity of an indigenously developed tetanus toxoid, diphtheria toxoid, and acellular pertussis vaccine (Tdap) in adults, adolescents, and children in India

ABSTRACTBackgroundThis study assessed safety and immunogenicity of Serum Institute of India Pvt Ltd (SIIPL)’s tetanus toxoid (TT), diphtheria toxoid (DT), and acellular pertussis booster vaccine (Tdap).Research Design and MethodsIn this Phase II/III, multicenter, randomized, active-controlled, open-label study, 1500 healthy individuals, aged 4–65 years, were randomized to receive a single dose of SIIPL Tdap or comparator Tdap vaccine (Boostrix®; GlaxoSmithKlines, India). Adverse events (AEs) during initial 30 minutes, 7-day, 30-day post-vaccination were assessed. Blood samples were taken before and 30 days post-vaccination for immunogenicity assessment.ResultsNo significant differences in incidence of local and systemic solicited AEs were observed between the two groups; no vaccine-related serious AEs were reported. SIIPL Tdap was non-inferior to comparator Tdap in achieving booster responses to TT and DT in 75.2% and 70.8% of the participants, respectively, and to pertussis toxoid (PT), pertactin (PRN), and filamentous hemagglutinin (FHA) in 94.3%, 92.6%, and 95.0% of the participants, respectively. Anti-PT, anti-PRN, and anti-FHA antibody geometric mean titers in both the groups, were significantly higher post-vaccination compared to pre-vaccination.ConclusionsBooster vaccination with SIIPL Tdap was non-inferior to comparator Tdap with respect to immunogenicity against tetanus, diphtheria, and pertussis and was well tolerated.

Treat-to-Target and Regular Surveillance of Inflammatory Bowel Disease Are Associated with Low Incidence and Early-Stage Detection of Malignancies: A Retrospective Cohort Study.

Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), increase the risk of malignancies, particularly colorectal cancer (CRC). We aimed to assess the incidence of malignancies in IBD patients managed using a treat-to-target approach and recommended surveillance. We retrospectively searched the electronic databases of two tertiary IBD centers in Milan from 2010 to 2019 for new diagnoses of malignancy in patients with pre-existing IBD. A total of 5239 patients with a follow-up of 19,820 years were included. In total, 71 malignancies were diagnosed in 70 patients (38 CD, 32 UC) with a mean age of 52.9 years, of whom 64% were former or active smokers. The annual incidence of all malignancies was 358 per 100,000 patient years (95% CI 275-444), and the standardized incidence rate (SIR) was 0.93 (95% CI 0.73-1.16). Gastrointestinal cancers were the most frequent (n = 17, 23.9%), in particular, CRC (n = 9), with an incidence of 45 per 100,000 (95% CI 15-74) and an SIR of 1.18 (95% CI 0.54-2.09). CRC occurred mainly in UC patients (6/8), while small bowel cancer was seen in CD patients (5/9). Melanoma and breast cancer (n = 8 each) were the most common non-GI cancers. No significant difference in incidence was found between CD or UC. Death occurred in nine patients (11%) and was due to cancer in eight of these cases, two of which were IBD-related. Most malignancies included in the surveillance were diagnosed at early (I-II) stages (20 vs. 4, p < 0.05). In patients with IBD, treat-to-target and strict surveillance were associated with a low incidence of cancer, similar to that of the general population, and the detection of malignancies at an early stage.

Granulocyte Colony-Stimulating Factor Use in Patients with Hemophagocytic Lymphohistiocytosis: A Single Center Experience

Background: Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening syndrome caused by activation of T cells that results in extreme inflammation. HLH is commonly associated with underlying conditions such as infection, autoimmune disease, or malignancy. HLH management includes treatment directed at the specific trigger, suppression of maladaptive cytokines, and inhibition of T cell and macrophage proliferation. Granulocyte colony-stimulating factor (GCSF) is a myeloid growth factor that stimulates the production, maturation, and activation of neutrophils. GCSF may theoretically promote production of inflammatory cytokines and enhance hemophagocytosis, thereby intensifying HLH. By contrast, GCSF could play a vital role in the treatment of granulocytopenia caused by HLH and thus limit the development of infections. There is a paucity of data examining the role of GCSF in patients with HLH. Current literature is limited to case reports of HLH exacerbated by GCSF administration. Practice patterns of GCSF use in HLH are highly variable, both within and between institutions. Aim: To compare the clinical course and overall survival of patients with HLH who received GCSF treatment and those who did not. Methods: We performed a retrospective, single-center cohort study of patients admitted with a diagnosis code of HLH from July 1997 through February 2023. Patients at least 18 years old with active HLH were included. Each case was reviewed to confirm the diagnosis of HLH based on available diagnostic evaluation and the final discharge diagnoses as documented by the primary treating team. In cases indeterminate for HLH, a second independent reviewer performed additional evaluation to reach consensus. The primary outcome was overall survival as determined by the Kaplan Meier method with statistical comparison using the log-rank test. Other examined outcomes included: incidence of infection, length of hospital stay (LOS), incidence of intensive care unit (ICU) admissions, length of ICU stay, incidence of 30-day re-admissions due to HLH, and time to first change in HLH-directed therapy. Results: Database analysis revealed 130 patients with a diagnosis code of HLH, of which 68 patients met inclusion criteria. The study cohort comprised 26 patients that received GCSF treatment and 42 patients that did not. The median follow-up time was 3.1 months (interquartile range [IQR] 0.6-29.4). The most common HLH triggers were infection (30.8% GCSF group vs 45.2% control, p=0.31) and malignancy (65.5% GCSF group vs 19% control, p&amp;lt;0.001). A median of 10 doses (IQR 6-16) of GCSF were administered per patient in the GCSF group, and the median time between diagnosis and the first administered dose was 6.5 days (IQR 2.25-18.75). Median overall survival in the GCSF group was 122.6 months compared to 1.5 months in the control group (p=0.02, Figure 1). There was a higher but statistically insignificant difference in infection rate in the GCSF arm (92.3%) compared to the control arm (71.4%, p=0.06). The median LOS was higher in the GCSF group (38 days vs 15 days, p&amp;lt;0.001). Rates of ICU admission (53.4% vs 62%, p=0.69), intubation and mechanical ventilation (34.6% vs 33.3%, p=1.0), and initiation of renal replacement therapy (23.1% vs 16.7%, p=0.74) were similar across the GCSF and control groups, respectively. Two patients in each group were re-admitted for HLH within 30 days of initial discharge. The median time to change in HLH-directed therapy was not reached in either group, and there was no significant difference in incidence of therapy change between groups at 1, 3, or 6 months (Figure 2). Conclusions: In this single center, retrospective cohort study of patients with HLH, treatment with GCSF was not associated with inferior overall survival. While over-representation of a malignancy-associated trigger in the GCSF group may confound interpretation of this result, it nevertheless reflects an important clinical finding that contradicts previously published case report-level evidence. This study highlights the need for further prospective investigation of GCSF administration in HLH.

Comparison of 1-year outcomes between Roux-en-Y gastric bypass and sleeve gastrectomy with Roux-en-Y duodenojejunal bypass in the patients of obesity with type 2 diabetes mellitus

Objective: To compare the 1-year effects of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy with Roux-en-Y duodenal bypass (SG+RYDJB) on weight loss, remission of diabetes, and postoperative complications in patients with obesity and type 2 diabetes. Methods: A single-center retrospective cohort study was conducted at the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2020. Sixty-four patients with type 2 diabetes and body mass index (BMI) of 27.5-40.0 kg/m2 were included in this study and divided into the RYGB group (n=34) and the SG+RYDJB group (n=30). In both procedures, the biliopancreatic branch was measured 100 cm distal to the Treitz ligament, and the food branch was measured 100 cm distal to the gastric or duodenojejunal anastomosis. Patients were followed up by telephone or WeChat, a free messaging and calling app at 1, 3, 6, and 12 months postoperatively to determine their weight loss and remission of diabetes. The primary outcomes were the weight loss and reduction in blood glucose concentrations at 1 year after surgery and postoperative complications. Other postoperative changes, including body weight, BMI, percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), glycated hemoglobin A1c (HbA1c), and fasting blood glucose at 1 year after surgery were also assessed. Results: There were no significant differences in baseline data between the two groups (all P>0.05). No conversion to open surgery or death occurred in either group. Operation time was longer in the SG+RYDJB than the RYGB group (137.8±22.1 minutes vs. 80.0±24.9 minutes, t=9.779, P<0.001) and the incidence of perioperative complications was higher in the SG+RYDJB than the RYGB group (20% [6/30] vs. 2.9% [1/34], χ2=4.761, P=0.029). However, the postoperative hospital stay was similar between the two groups [3.0 (3.0, 4.3) days vs. 3.0 (4.0, 6.0) days, U=641.500, P=0.071]. Perioperative complications comprised small gastric pouch anastomotic leakage in one patient in the RYGB group and leakage (three patients) and bleeding (two patients with gastrointestinal bleeding and one with trocar site bleeding) in the SG+RYDJB group. Long-term complications were as follows. The incidence of anemia was significantly higher in the RYGB than the SG+RYDJB group (26.5% [9/34] vs. 3.3% [1/30], χ2=6.472, P=0.011). However, there were no significant differences in incidences of postoperative reflux, dumping syndrome, alopecia, diarrhea, constipation or foul-smelling flatus between the two groups (all P>0.05). Compared with 1 year before surgery, the body weights and fasting plasma glucose concentrations of patients in the SG+RYDJB and RYGB group (72.4±10.6 kg vs. 98.5±14.2 kg, respectively; 68.2±10.0 kg vs. 91.9±14.8 kg, respectively), BMI (25.2±2.9 kg/m2 vs. 34.3±4.2 kg/m2, respectively; 24.3±2.4 kg/m2 vs. 32.7±3.7 kg/m2, respectively) (5.5±1.6 vs. 10.6±3.3, respectively; 5.8±2.1 vs. 9.0±3.4, respectively); HbA1c (5.7±0.8 vs. 9.7±1.2, respectively; 9.1±1.9 vs. 5.9±0.9, respectively) were significantly lower at 1 year after surgery (all P<0.05). However, the % TWL (26.5%±6.0% vs. 25.6%±4.4%, t=0.663, P=0.510) and % EWL (109.1%±38.2% vs. 109.4%±40.3%, t=-0.026, P=0.026), rate of complete remission of diabetes at 1 year (80.0% [24/30] vs. 82.4% [28/34], χ2=0.058, P=0.810] did not differ significantly between the two groups (all P>0.05). Conclusions: Although SG+RYDJB surgery compared with RYGB is more difficult to perform, it can achieve similar weight loss and remission of diabetes and is associated with a lower incidence of anemia because of the preservation of the pylorus.

A 15-year longitudinal study of search-and-rescue dogs identifies the musculoskeletal, integumentary, and gastrointestinal systems as commonly affected.

A longitudinal study followed search-and-rescue (SAR) dogs for 15 years to determine the incidence of health events and whether factors of deployment during 9/11, breed, or sex altered the risk of specific events. 150 SAR dogs: 95 dogs deployed to the September 11 terrorist attack sites and 55 SAR dogs not deployed. Each year, a survey was sent to the handler to collect health information until the dog died or the handler withdrew from the study. The reported health events were then categorized according to the body system affected and etiology. Incidence risk rates, with 95% CIs, were calculated for the most common types of health events. Incidence rate ratios were calculated stratified by deployment status, sex, and breed and significance assessed. 1 or more health event was recorded in 96 of the 150 enrolled dogs. The most affected systems were the musculoskeletal (31%; CI, 24 to 39), integumentary (22%; CI, 15 to 29), and gastrointestinal (20%; CI, 14 to 26). The health events were most commonly reported as inflammatory (45%; CI, 37 to 53) and degenerative (28%; CI, 21 to 35) in nature. There were no significant differences in incidence of health events based on deployment status to the September 11, 2001, terrorist attacks. Additionally, there was no significant effect of breed or sex on incidence of health events. To improve the health and longevity of SAR dogs, disease prevention and management programs should focus on reducing the health problems involving the musculoskeletal system as well as the integumentary and gastrointestinal systems.

Long-term clinical outcomes of EVAR within IFU compared to outside IFU

Abstract Background Endovascular aneurysm repair (EVAR) has been used worldwide to treat abdominal aortic aneurysm (AAA). Outcomes after EVAR between within instruction for use (IFU) and outside IFU are still controversial. We analyzed long term outcomes of EVAR within IFU compared to EVAR outside IFU and baseline clinical/anatomical characteristics that influence outcomes of EVAR. Methods We collected data from 766 patients (mean age 71.0 ± 12.5 years, male 90.2%) who underwent EVAR for infrarenal AAA between August 1997 and July 2021 at two centers in Korea. The primary endpoint was aneurysm related mortality (ARM) during follow up. The secondary outcomes were endoleak, reintervention and aneurysm sac enlargement. Results The mean AAA diameter is 59.0 ± 12.2 mm. The proportion of patients underwent EVAR outside IFU was 62.7% (n=466). Neck angle &amp;gt; 60 degree was the most common outside IFU criterion (n=210, 27.4%). The median clinical and imaging follow-up duration was 36.5 and 51.0 months, respectively. Total 110 patients (14.8%) had complications during follow up. The outside IFU group had more complications compare to the within IFU group (p=0.033). Overall mortality rate was 8.8% (n=60). ARM occurred in 0% of patients with EVAR within IFU and in 7 (1.5%) of patients with EVAR outside IFU (p=0.041), respectively. There was no significant difference in incidence of endoleak (28.5 vs. 23.1%, p=0.173), reintervention rate (8.4 vs. 9.3%, p=0.688) and aneurysm sac enlargement (23.6 vs. 23.4%, p=0.957) between patients underwent EVAR within IFU and outside IFU group. In multivariate analysis, proximal neck diameter &amp;gt; 28 mm was independent risk factor for ARM (HR, 9.132; 95% CI, 1.684 – 49.516, P=0.010). In addition, proximal neck angle &amp;gt; 60 degree was independent risk factor for endoleak (HR, 1.553; 95% CI, 1.042 – 2.314, P=0.031) and reintervention (HR, 2.297; 95% CI, 1.333 – 3.955, P=0.003). Neck length &amp;lt; 10 mm and neck diameter &amp;gt;28 mm were risk factors for aneurysm sac enlargement (HR, 4.363; 95% CI, 1.252 – 15.211, P=0.021 and HR, 3.148; 95% CI, 1.261 – 7.859, P=0.014). Age over 75 was also a risk factor for endoleak (HR, 2.491; 95% CI, 1.666 – 3.726, P=0.000) and aneurysm sac enlargement (HR, 3.150; 95% CI, 1.536 – 6.458, P=0.002). Conclusions Our study showed EVAR outside IFU is associated higher ARM compared to EVAR within IFU. In addition, neck angulation was risk factor for endoleak and reintervention. Clinicians should be caution when they perform EVAR outside IFU and select optimal patient for successful EVAR.

Abstract 16782: Depression and Its Relationship With Uncontrolled Hypertension: A Single Urban Center Experience

Introduction: Depression and hypertension (HTN) contribute to cardiovascular risks with studies showing that depression increases the risk of developing HTN. However, the impact of depression on blood pressure control in patients with HTN remains unclear. The study aimed to investigate the incidence of depression in patients with uncontrolled HTN. Methods: A matched-pair analysis was conducted on 9,046 patients with diagnosis of HTN at a single-center Internal Medicine clinic between 2019 and 2022. Demographic variables, co-morbidities, blood pressure and PHQ 9 scores were recorded. Uncontrolled HTN was defined as BP ≥140/90 mmHg, and PHQ-9 scores ≥ 4 indicated depression. Age- and gender-matched patients with controlled HTN were included for comparison. Results: Among 9,046 patients with HTN, 1,886 (20.4%) had uncontrolled HTN. Patients with uncontrolled HTN were older (57.43 ±17.02 vs 46.68 ± 18.6, p=0.000) and more likely to be black (34.1 % vs 29.1%, p&lt;0.000) compared to those with controlled HTN. In the matched-pair analysis (3,660 patients), no significant difference in incidence of depression was observed in patients between uncontrolled and controlled HTN (389 vs 377, p=0.626). Patients with uncontrolled HTN had a higher prevalence of congestive heart failure (150 vs 113, p=0.018) and chronic kidney disease (211 vs 167, p=0.017). Conclusions: This single-center matched-pair analysis suggest that depression is not associated with inadequate blood pressure control, despite its role in increasing the risk of developing HTN in prior studies. Optimal blood pressure control plays a crucial role in preventing development of co-morbid conditions as seen in our study. A holistic approach to HTN management and factors beyond depression should be considered. Further research is warranted to gain a deeper understanding of the relationship between depression, HTN, and cardiovascular outcomes, enabling more targeted interventions and improved patient care.

Large common bile duct stones in high-risk elderly patients: Immediate endoscopic stone removal or elective stone removal? A single-center retrospective study

Background and objectiveFor high-risk elderly patients with chronic diseases, endoscopic stone removal for large common bile duct stones is associated with a high risk of adverse events and incomplete stone removal. The aim of this study was to investigate whether the treatment strategy of short-term biliary plastic stent placement followed by elective endoscopic stone removal is more effective and safer than immediate endoscopic stone removal.MethodsThe data of 262 high-risk elderly patients who received endoscopic retrograde cholangiopancreatography (ERCP) for large common bile duct (CBD) stones from 2017 to 2022 were retrospectively analyzed. The patients were divided into group A (immediate stone removal) and group B (stent drainage + elective stone removal). The baseline data of the 2 groups were matched 1:1 by propensity score matching. The stone clearance rate, ERCP procedure time, total hospital stay, and procedure-related adverse events were compared between the matched groups. In group B, stone size before and after stent placement, hospital stay, procedure time and adverse events of two ERCPs were compared.ResultsA total of 57 pairs of patients were successfully matched between the 2 groups. The stone clearance rate in group B was higher than that in group A (89.5% vs. 75.3, P = 0.049). The total hospital stay in group B was longer than that in group A (11.86 ± 3.912 d vs. 19.14 ± 3.176 d, P<0.001). The total adverse event rate in group A was higher than that in group B (29.8% vs. 12.3%, P = 0.005). The incidence of cholangitis/cholecystitis after ERCP was significantly higher in group A than in group B (7.0% vs. 0.9% P = 0.029). There was no significant difference in the incidence of post-ERCP pancreatitis, bleeding, pneumonia, and cardio-cerebrovascular events between the 2 groups. There were no perforation cases in either group. After plastic biliary stent placement in group B, the stone size was significantly smaller than before stent placement (1.59 ± 0.544 cm vs. 1.95 ± 0.543 cm, P < 0.001), and there was no significant difference in the total adverse event incidence between the two ERCP procedures (18.8% vs. 10.9%, P = 0.214).ConclusionFor high-risk elderly patients with large CBD stones, the treatment strategy involving temporary placement of plastic stent and elective endoscopic stone removal is safer and more effective than immediate stone removal.

Incidence of melanoma and non-melanoma skin cancer in patients with celiac disease: a systematic review and meta-analysis.

There is conflicting observational evidence regarding the association between skin cancer and celiac disease (CD). The purpose of this review was to investigate the incidence rate ratio (IRR) of skin cancer incidence between patients with and without CD. MEDLINE and EMBASE databases were searched on October 27th, 2021 and eight articles were identified for review. Quality assessment was conducted using the Newcastle Ottawa Scale. Seven articles were included in meta-analysis for a pooled estimate of IRR across all skin cancers, malignant melanoma (MM), and non-melanoma skin cancers (NMSC). In total, 74,860 CD patients were followed for 710,214 person-years in the meta-analysis. Overall combined incidence was 99.8 cases per 100,000 person-years. Meta-analysis of all skin cancer incidence showed no significant difference in CD patients compared to controls (IRR: 1.06; 95% CI: 0.95, 1.17; p=0.29; I2: 0%). Five studies reported on MM incidence; there was no significant difference in incidence compared to controls (IRR: 0.87, 95% CI: 0.72, 1.06; p=0.22; I2: 9%). Five studies reported on NMSC incidence, revealing a significantly increased risk of NMSC in CD patients (IRR: 1.14; 95% CI: 1.01, 1.28; p=0.04; I2: 0%). Our findings suggest a significantly increased incidence of NMSC in CD patients compared to control data and no significant association between CD and MM incidence. The findings are limited by the quantity and quality of the evidence. Nonetheless, clinicians should emphasize the importance of sun protection, such as sunscreen usage and self-examination for patients with CD.

Disparities in Acute Radiation-Related Pain and Dermatitis between Black and White Patients with Early-Stage Breast Cancer Receiving Adjuvant Radiation Following Breast Conserving Surgery

Historically, black patients with cancer experience poor clinical outcomes and low quality of life due to inadequate screening and management of cancer-related treatment toxicities. There are limited data documenting racial disparities in acute radiation-related toxicities (ARRTs) for patients with early-stage breast cancer. Therefore, we compared ARRTs between Black (B) and White (W) patients receiving adjuvant radiation following breast conserving surgery (BCS). This retrospective analysis included 317 patients with stage 0/1 breast cancer treated with adjuvant radiation between October 2019 and February 2022. 29% (N = 81) were B and 71% (N = 236) were W, with an average age of 65 (range: 32-88) for both. We abstracted weekly on-treatment-visit clinical notes (OTVs) completed by a nurse and radiation oncologist who utilized the Common Terminology Criteria for Adverse (CTCAE) v4.0 to evaluate each patient's pain score (scaled 0-10, 0 = no pain and 10 = worst), radiation dermatitis (RD; Grade 0-4), as well as non-CTCAE descriptors of pain and presence of hyperpigmentation or pruritus. We compared onset and severity of pain and rates of RD and pruritus between B and W patients. The proportion reporting pain was significantly lower among B vs. W patients (43.8% vs. 63.6%; P = 0.002). Of patients qualitatively reporting pain, B patients were significantly more likely to have their pain scored as 0 than W patients (24.3% vs. 11.7%; P = 0.024). B patients had significantly lower median pain scores than W patients (P = 0.010), with a median score of 3 (interquartile range [IQR]: 0-5.5) vs. 5 (IQR: 4-8). B patients had a significantly longer time to pain identification than W patients (P = 0.027), with median time to pain of 10th fraction (IQR: 4-13.5) vs. 8th fraction (IQR: 4-11). Radiation dermatitis was graded as 0 (50.6% vs 8.5%; P<0.001), 1 (44.4% vs 82.6%; P<0.001), 2 (14.8% vs 15.3%, P = NS), and 3 (3.7% vs 0.4%; P = 0.023), with no grade 4 RD, amongst B and W patients, respectively. Of note, B patients experiencing mild hyperpigmentation were graded as 0. We found no statistically significant differences in incidence of pruritus. Qualitative and quantitative analyses of ARRTs based on CTCAE v4.0 show discordance in pain scores and radiation dermatitis. The underscoring of pain amongst B patients suggests possible cultural hesitancy to report pain or implicit biases in evaluating pain suggesting the need for alternative ways to discuss and score pain in B patients. Our data suggests that CTCAE does not effectively assess radiation dermatitis in B patients. There are no descriptors of hyperpigmentation in grading of radiation dermatitis in CTCAE, which may lead to underreporting in dark-skinned individuals. Better assessment tools are needed to document ARRTs to ensure appropriate evaluation and treatment across all racial groups.

Electrophysiologic pattern of carpal tunnel syndrome among patients with and without diabetes mellitus

Background: Carpal tunnel syndrome (CTS) is the most common compression neuropathy in the upper limb in general population. Female gender, obesity, increase of age, diabetes mellitus (DM), hypothyroidism, pregnancy, rheumatoid arthritis, osteoarthritis and occupational factors like repetitive work are the main risk factors for CTS. The objective of this study was to determine whether the nerve conduction study measurement of the median nerve (MN) at the wrist differ between diabetic and non-diabetic CTS patients. Methods: This cross-sectional study was conducted at Electrodiagnostic Lab of BIRDEM General Hospital and Popular Medical College Hospital, Dhaka during the period of October 2017 to August 2019. Five hundred and seventeen hands from 377 patients were sampled according to inclusion criteria. Participants were assigned to two groups: Group 1 (CTS with DM) and Group 2 (CTS without DM). NCS study were performed using Nihon Kohden electrodiagnostic machine. Measurements at the MN was taken under consideration for study. Severity of CTS was graded according to Canterbury electrophysiologic grading scale and parameters were compared among diabetic and non-diabetic participants. Data were analyzed using Statistical Package for the Social Sciences SPSS version 23 (SPSS Inc., Chicago, IL, USA). Results: The 377 participants comprised 144 and 233 in Group 1 and Group 2, respectively. Out of 377 patients, 334 (88.59%) were females and there was no statistically significant difference between two groups. The average age was 50.66±10.2 years in diabetic participants and 43.34±10.7 years in non- diabetic participants. In the study population moderate CTS (Grade 3) was the most frequent (46.4%) followed by very severe (Grade 5) CTS. There was no statistically significant difference in incidence between diabetic and non-diabetic patients. Analysis of electrophysologic parameters of MN showed statistically significant difference in mean MN sensory nerve action potential (SNAP) amplitude (P 0.003), compound muscle action potential (CMAP) amplitude (p 0.05, right) and CMAP latency (p 0.02, right and 0.05, left) between diabetic and non –diabetic patients. Inter-group comparison revealed that impaired glycaemic status and duration of diabetes in diabetic population had a minimal influence in the electrophysiological severity of CTS in either hands. Conclusion: Some nerve conduction study parameters of the MN differ significantly between diabetic and non-diabetic patients with CTS and may provide both diagnostic and predictive results across the entire spectrum of CTS. BIRDEM Med J 2023; 13(3): 136-142

Co-occurring ASD Mediates Impact of ADHD on Atopic Dermatitis and Acne: A Retrospective Cohort Study

Background: ADHD and ASD are associated with dermatologic manifestations, yet little research investigates co-occurring ADHD/ASD and common dermatologic conditions. Objective: To investigate associations between ADHD, ASD, acne vulgaris, and atopic dermatitis. Methods: Using de-identified patient records from the TriNetX database, we created four cohorts on ADHD diagnosis, ASD diagnosis, both, neither. Cohorts were separated into males and females. We balanced each cohort based on age, sex, race, and ethnicity to the baseline cohort with neither ASD or ADHD. Finally, we examined prevalence of acne and eczema. Results: The cohort sizes varied from 19,764 to 345,626. Compared to matched peers, males with ADHD or ADHD/ASD had increased prevalence of acne, and all neurodivergent males had increased prevalence of eczema. Females with ADHD had an increase in both. Females with ADHD/ASD had no significant differences, and females with ASD had a decreased risk of eczema. Limitations: Due to database limitations, we are unable to: analyze symptom severity, skincare routine, or treatment adherence. Conclusions: The decreased risk of eczema in females with ASD and lack of significant difference in incidence of acne or eczema in females with ADHD/ASD compared to matched peers suggests research into approaches to skincare in males versus females with ASD may provide clinically relevant insights.

Effect of ginkgo leaf tablets combined with compound carbidopa on patients with Parkinson’s disease

Purpose: To determine the effect of a combination of ginkgo leaf tablets with compound carbidopa tablets on cognitive function, serum homocysteine (Hcy), malondialdehyde (MDA) and neuron-specific enolase (NSE) levels in patients with Parkinson's disease (PD).Methods: A total of eighty (80) PD patients admitted to The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China between December 2020 and December 2022 were randomly divided into two groups: Western medicine group (n = 40, using compound carbidopa tablets alone) and combination group (n = 40, using ginkgo leaf tablets combined with compound carbidopa tablets), and orally treated for 3 months. Mini-mental state examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to assess cognitive function before and after treatment. High-performance liquid chromatography was used to determine serum Hcy levels, while enzyme-linked immunosorbent assay (ELISA) was used to evaluate serum MDA and NSE levels. Adverse reactions were also recorded during treatment.Results: Total response rate following treatment in combination group was significantly higher than in Western medicine group (95.00 vs 80.00 %, p &lt; 0.05). After treatment, MMSE and MoCA scores in combination group were significantly higher (p &lt; 0.05) than those in Western medicine group, while serum Hcy, MDA and NSE levels in combination group were significantly lower than those in Western medicine group (p &lt; 0.05). During treatment, there was no significant difference in incidence of adverse reactions between the two groups (p &gt; 0.05).Conclusion: Ginkgo leaf tablets in combination with carbidopa significantly improve cognitive functions associated with PD with high safety, when compared to carbidopa tablets alone. However, further clinical trials are commended to validate these findings.

Testing the Induction of Metritis in Healthy Postpartum Primiparous Cows Challenged with a Cocktail of Bacteria.

Metritis is a postpartum uterine disease with greater incidence in primiparous than in multiparous cows. In primiparous cows, the impact on production and health is lessened, presumably due to a superior immune response. Here, we tested whether an in vivo model of clinical metritis induction developed for postpartum multiparous Holstein cows would produce similar results in primiparous cows. Thirty-six cows were randomly assigned to one of three groups and received intrauterine infusion within 24 h of parturition. The controls were infused with sterile saline; the low-dose group received a bacterial cocktail containing 103 cfu of Escherichia coli, Trueperella pyogenes, and Fusobacterium necrophorum; and the high-dose group were infused with 106 cfu of the same cocktail. Production, health traits, and the vaginal discharge culture were assessed daily, from enrollment until 14 d in milk. Clinical metritis occurred in 64% of high-dose cows, 33% of the controls, and 42% of low-dose cows, with no significant difference of incidence between groups. However, when accounting by time, high-dose cows had a 2.7 times greater hazard of metritis compared with the controls. The bacterial challenge affected milk production and dry matter intake tended to decrease. In the high-dose group, a greater growth of F. necrophorum in the selective medium was also observed, suggesting an association with metritis. Therefore, this study suggests intrauterine inoculation with 106 cfu of this bacterial cocktail elicits physical and clinical outcomes consistent with clinical metritis.

Risk Factors and Characteristics of Recalcitrant Osteomyelitis Following Initial Surgical and Antibiotic Treatment.

To evaluate the injury, patient, and microbiological characteristics that place patients at risk for recalcitrant fracture related infection and osteomyelitis despite appropriate initial treatment. Retrospective Chart Review. Three level I trauma centers. Two hundred and fifty-seven patients undergoing surgical debridement and antibiotic therapy for osteomyelitis from 2003 to 2019. Patients were categorized as having undergone serial bone debridement if they had two separate procedures a minimum of six weeks apart with a full course of appropriate antibiotics in between. Patient records were reviewed for age, injury location, body mass index (BMI), smoking status, comorbidities, and culture results including the presence of multidrug resistant organisms (MDRO) and culture-negative osteomyelitis. A total of 257 patients were identified; 49% (n=125) had a successful single course of treatment, and 51% (n=132) required repeat debridement for recalcitrant osteomyelitis. At the index treatment for osteomyelitis, the most common organisms in both groups were Methicillin-resistant (MRSA) and Methicillin-sensitive Staphylococcus aureus (MSSA). There was no significant difference in incidence of polymicrobial infection between the two groups (25% vs 20%, p=0.49). The most common organisms cultured at the time of repeat saucerization remained MRSA and MSSA, however, the same organism was cultured from both the index and repeat procedure in only 28% (n=37) of cases. Diabetic patients, IVDU, delay to diagnosis, and open fractures of the lower leg are independent risk factors for failure of initial treatment of post-traumatic osteomyelitis. Successful eradication of fracture related infection and post-traumatic osteomyelitis is difficult and fails 51% of the time despite standard surgical and antimicrobial therapy. While MRSA and MSSA remain the most common organisms cultured, patients who fail initial treatment for osteomyelitis often do not culture the same organisms as those obtained at the index procedure.

The impact of concurrent bacterial lung infection on immunotherapy in patients with non-small cell lung cancer: a retrospective cohort study.

To find out how bacterial lung infections (BLI) affect the effectiveness of therapy and the rate of pneumonia caused by pneumonia related to checkpoint inhibitors (CIP) in patients with non-small cell lung cancer (NSCLC) who are getting immunotherapy with checkpoint inhibitors (ICIs). 507 NSCLC patients who received at least two ICI treatments between June 2020 and December 2022 at the Affiliated Hospital of Kunming University of Science and Technology(AHKUST) were included in a retrospective cohort study. Based on whether there was a concurrent BLI diagnosis from high-resolution CT scans of the chest, the patients were divided into two groups: 238 in the NSCLC with BLI group (NSCLC-BLI group), and 269 in the NSCLC alone group. The collected therapeutic outcome measures included the objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and the incidence rate of CIP. We analyzed the effect of BLI on the therapeutic efficacy of ICI treatment and the incidence rate of CIP in NSCLC patients.Inclusion criteria based on NSCLC patients staged I to IV according to the 8th edition of the International Association for Lung Cancer Research (IASLC). The NSCLC-BLI group showed superior ORR to the NSCLC group when treated with ICIs. Multifactorial logistic regression and Cox analyses, adjusted for confounders, identified BLI as an independent positive prognostic factor for ORR (HR=0.482, 95%CI: 0.391-0.550; P<0.001) and PFS (HR=0.619; 95%CI: 0.551-0.771; P<0.001). No correlation between BLI and OS was found. Out of 26 cases of CIP, 12 were in the NSCLC-BLI group and 14 in the NSCLC group, with no significant difference in incidence (P=0.145). NSCLC patients with BLI receiving ICI treatment show superior ORR and PFS compared to NSCLC alone without an increased CIP risk, positioning BLI as a predictive factor for improved outcomes in NSCLC patients receiving ICIs. However, the study has limitations including its retrospective nature and lacking data on BLI bacteria types and levels, which could influence therapy outcomes.

Influence of Gender, Qualification and Experience on Incidence of Stress and Coping Strategies among Primary School Teachers in Ekiti State

The study explored the influence of gender, qualification and experience on incidence of stress and coping strategies among primary school teachers. This study adopted descriptive design of research type. The population for the study consisted of primary schools in Ekiti State. The sample consisted of 21 primary schools, 378 teachers participated. Two instruments were used for the study. They are the sources of stress and coping strategies adapted from Ugwuja (2009). When validated by Ugwuja, the instrument yielded the reliability co-efficient indices of .73 for sources of stress, .71 for stress management, and .81 for overall instrument respectively. The data collected were analysed using using Analysis of Variance (ANOVA). The result indicated that significant difference existed in the incidence of stress among primary school teachers in Ekiti state based on gender with male teacher having highest incidence of stress, no significant difference in incidence of stress among primary school teachers in Ekiti state based on teacher qualification and there is no significant difference in incidence of stress among primary school teachers in Ekiti state based on teaching experience. The study recommended that marital counselling should be organized for both the divorcee and married in order to reduce their stress level. The school management should look for a way to reduce the work load of the teachers generally. In addition to this, the government should make teaching more attractive by increasing teacher salary

Early versus Delayed Enteral Nutrition after Gastrointestinal Anastomosis in Children: A Systematic Review and Meta-Analysis

Abstract Background Elective intestinal anastomosis is a frequently used surgical procedure in pediatric surgery. This option is used to restore intestinal continuity (ileostomy or colostomy closure), resolve an inflammatory disease or functional or anatomic congenital malformation. It is a common practice to avoid oral feeding in children after intestinal anastomosis surgery, traditionally from 3-5 days. Recently, interest has increased in the concept of early enteral nutrition (EEN) in abdominal surgery in adults, but it needs further research in children. Aim of the Work The aim of this study is to determine whether early enteral nutrition following elective gastrointestinal anastomosis surgery in children leads to improved patient outcome measures and to assess whether this practice increases the risk of postoperative complications, according to literature published in the period from 2010- 2020 Patients and Methods We searched PubMed, Cochrane, Embase, Google scholar, Egyptian Knowledge Bank including Science Direct, Scopus and Web of Science. Data from 2010 – 2020 were obtained using the following Medical Subject Headings (MeSH) terms. For the early aspect of nutrition, we used the MeSH terms ‘‘early’’ or ‘‘enhanced recovery’’ and ‘‘enteral nutrition’’ or ‘‘feeding’’. For the surgical background, we used the MeSH terms ‘‘gastrointestinal’’ or ‘‘bowel/intestinal’’ or ‘‘colorectal’’ and ‘‘surgery’’ or ‘‘anastomosis’’ or ‘‘resection,’’ while for the population we used the terms ‘‘child’’ or ‘‘pediatric’’ or ‘‘infant’’. Multiple outcomes were used. The softwares Review Manager (RevMan 5.3, The Cochrane Collaboration) and STATA (Stata Corp. 2007) were used to analyse the data and formulate the results. Results Seven RCT studies met the inclusion criteria, comprising 278 cases with EEF and 323 cases with DEF. Enteral feeding started significantly earlier in the EEF group compared to the DEF group (MD = -69.43; 95% CI -72.20 to -66.65; p &amp;lt; 0.0001). The EEF group had an earlier time to first bowel movement (MD -18.18; 95% CI -27.04 to -9.32; p &amp;lt; 0.0001), an earlier time to full diet intake (MD -103.50; 95% CI -126.63 to -80.37; p &amp;lt; 0.00001) and a shorter length of hospital stay (MD -3.57; 95% CI -4.4 to -2.74; p &amp;lt; 0.00001). There was no significant difference in incidence of nausea and vomiting (OR = 1.36; 95% CI 0.56, 3.30; p = 0.5), abdominal distension (OR = 1.68; 95% CI 0.80, 3.53; p = 0.17) or anastomotic dehiscence (OR = 0.58; 95% CI 0.19, 1.75; p = 0.34) between groups. There was significant difference between groups in surgical site infection (OR = 0.27; 95% CI 0.13, 0.57; p = 0.0005) and fever (OR = 0.32; 95% CI 0.16, 0.61; p = 0.0007) in favour of EEN. Conclusion When early enteral nutrition was compared to traditional delayed feeding, results showed that EEN is safe and effective in pediatric patients undergoing elective intestinal anastomosis.

Comparison of propofol-esketamine versus propofol for anesthesia in gastroscopy: a double-blind, randomized controlled clinical trial.

To compare the effects of propofol-esketamine and propofol in gastroscopy in adults. This randomized controlled clinical trial was performed from January 2021 to March 2021. Eighty patients were enrolled and allocated into normal saline group (group N) and esketamine group (group E). The primary outcome was total amount of propofol. Secondary outcomes included incidences of injection pain, involuntary movement, hemodynamic and respiratory adverse events during examination, total examination time, recovery time and postoperative adverse effects. Total amount of propofol was significantly smaller in group E (101.64 ± 32.64 mg) than in group N (129.55 ± 36.34 mg, p = 0.001). Incidences of injection pain, involuntary movement and hypotension was significantly lower in group E than in group N. Incidences of hypertension and tachycardia was higher in group E than in group N. There was no significant difference in incidences of laryngospasm or hypoxemia, total examination time, recovery time, incidences of postoperative adverse effects between two groups. Combination of propofol with 0.2 mg/kg esketamine reduced total amount of propofol, provided a more stable hemodynamic status and did not affect recovery time in gastroscopy. http://www.chictr.org, identifier ChiCTR2100042406.

Evaluation of etiology and clinical spectrum of respiratory distress in neonates admitted in tertiary care NICU

Background: Neonatal period is defined as up to first 28 days of life and further divided into very early (birth to &lt;24 h), early (birth to &lt;7 days), and late neonatal period (7 days to &lt;28 days). Neonatal period is the most vulnerable period of human life as it accounts for very high morbidities and mortalities and most of these are preventable. India contributes to one-fifth of global live births and more than a quarter of neonatal deaths. Respiratory distress is most common cause of NICU admission Aim of current study was to determine the etiology of respiratory distress in neonates presenting in NICU, clinical spectrum of respiratory problems in neonates having respiratory distress and the management of respiratory distress. Methods: The present study was a prospective, observational, comparative study. This study was conducted from January 2019 to October 2019 at Mata Channan Devi hospital Janakpuri, New Delhi. 80 patients were included in this study. Results: In our study 93.75% cases of respiratory distress was of respiratory origin, while 3.75% was due to cardiac cause and 2.5% was central nervous system due to birth asphyxia and in our study group most common clinical finding of respiratory distress was tachypnea found in 97.5% of patients. Result showed, overall incidence of respiratory distress among in borns was 10.34%. In our study TTNB was most common cause of respiratory distress among new born. Conclusions: There was no significant difference of incidence in male and female babies. The etiology varies with gestational age. In spite of all advances in primary maternal care, delivery and early new born care respiratory distress is still the most common cause of morbidity and NICU admission in newborn babies.