Significant Difference In Occurrence Research Articles

Safety of left atrial appendage amputation during cardiothoracic surgery

Abstract Background Patients with atrial fibrillation (AF) are at risk for ischemic strokes, often originating from the left atrial appendage (LAA). Preventive LAA amputation (LAAA) during cardiac surgery has been shown to reduce ischemic stroke risk, both in patients with and without AF. However, the short-term safety and functional implication of LAAA in non-AF patients remain poorly understood. Besides possible surgical complications, there are suggestions that LAAA could lead to postoperative AF or influence neurohumoral changes resulting in fluid overload. Purpose To evaluate the safety of LAAA in patients without a history of AF undergoing routine cardiac surgery. Methods Patients underwent elective cardiac surgery between May 5 2015 and April 18 2018 in two high volume centers. Main inclusion criteria were a CHA2DS2-VASc≥ 2 and no history of AF. Patients without a history of AF, that participated in the PREDICT-AF study underwent concomitant LAAA and were compared with patients undergoing cardiothoracic surgery who were approached for participation in PREDICT-AF, but declined and subsequently did not undergo LAAA. Informed consent for the retrospective use of data was obtained through an opt-out procedure in these patients. The primary outcome of this analysis was the number of patients with any serious adverse event within 30 days postoperatively. Secondary outcomes were AF within 30 days postoperatively, death, rethoracotomy, time on extra corporal circulation(ECC) and heart failure related symptoms assessed through congestion on x-chest and weight trends. Adverse events were independently adjudicated by a cardiothoracic surgeon using pre-specified definitions. Results 150 patients in PREDICT-AF underwent LAAA. 284 Eligible patients declined participation and formed the control group. Patients in the LAAA group were more frequently male (87.3% vs 72.5%; p=0.001), were taller (176.0cm ± 8.2 vs 172.6cm ± 9.9; p<0.001) and weighed more (86.1kg CI[80.0, 92.2] vs 81.6kg CI[71.9, 91.1]; p=0.001) compared to controls. There were no significant differences in occurrences of serious adverse events (8% vs 12%; p=0.265), deaths (1.3% vs 1.8%; p=1) or rethoracotomies (3.3% vs 1.8%; p=0.483) between the LAAA and control group. Also, there was no difference in the incidence of postoperative AF (57, 38% vs 90, 31.7%; p=0.225), ECC time (104.5 minutes CI[81.0, 129.0] vs 98.0 CI[80.0, 124.5] p=0.371) or the presence of chest x-ray congestion (26.0% vs 27.8%; p=0.771) between the groups (Figure 1A). The spline plot of perioperative weight change from baseline, reveals no notable differences between the two groups (Figure 1B). Conclusion LAAA during routine cardiothoracic surgery is not associated with more surgical complications, postoperative atrial fibrillation or heart failure related symptoms. Given the generally high AF risk in patients undergoing cardiothoracic surgery, a strategy to preemptively resect the LAA may be feasible and safe.Figure 1 A & B

Equal performance of the subcutaneous and transvenous implantable cardioverter defibrillator across all age groups in the PRAETORIAN trial

Abstract Introduction The subcutaneous ICD (S-ICD) is developed to overcome lead-related complications and systemic infections, inherent to transvenous ICD (TV-ICD) therapy. In the PRAETORIAN trial the S-ICD proved to be non-inferior to the TV-ICD with regard to inappropriate shocks (IAS) and complications. However, the S-ICD is still mainly the preferred choice in young patients with a long life expectancy and therefore higher risk for lead-related complications. We aimed to evaluate the impact of age on complications and IAS between the S-ICD and TV-ICD. Methods The PRAETORIAN trial is an investigator-initiated, international, multicenter, randomized, two-arm noninferiority trial that was conducted in the United States and Europe. In total 849 patients with a class I or IIa indication for ICD therapy and no pacing indication were randomized to receive an S-ICD (N=426) or TV-ICD (N=423) and followed for a median of 49 months. We compare the occurrence of complications and IAS between increasing quartiles of age. Results Quartile 1 (Q1) consisted of 203 patients aged <55 (109 S-ICD, 94 TV-ICD), Q2 of 199 patients aged 55-62 (100 S-ICD, 99 TV-ICD), Q3 of 232 patients aged 63-69 (111 S-ICD, 121 TV-ICD) and Q4 of 215 patients aged ≥70 (106 S-ICD, 109 TV-ICD). Between the quartiles, there were no significant differences in occurrence of device-related complications (P = 0.32) or IAS (P = 0.66). In Q1, there were 15 (7.4%) complications (5 S-ICD, 10 TV-ICD) and 13 (6.4%) IAS (7 S-ICD, 6 TV-ICD), compared to 20 (10.1%) complications (7 S-ICD, 13 TV-ICD) and 17 (8.5%) IAS (9 S-ICD, 8 TV-ICD) in Q2, 22 (9.5%) complications (12 S-ICD, 10 TV-ICD) and 19 (8.2%) IAS (11 S-ICD, 8 TV-ICD) in Q3 and 18 (8.4%) complications (7 S-ICD, 11 TV-ICD) and 21 (9.8%) IAS (14 S-ICD, 7 TV-ICD) in Q4 (Figure 1.). Figure 2. shows forest plots of the hazard ratios per quartile. Conclusions The S-ICD performed equal to the TV-ICD with regard to IAS and complications between quartiles of age, making the S-ICD a good alternative across all age groups.

Differences in incidence, nature of symptoms, and duration of long COVID among hospitalised migrant and non-migrant patients in the Netherland: a retrospective cohort study

Abstract Background and aim Comprehensive data on long-COVID across ethnic and migrant groups are lacking. We investigated incidence, nature of symptoms, clinical predictors, and duration of long-COVID among COVID-19 hospitalised patients in the Netherlands by migration background. Methods We used COVID-19 admissions and follow up data (January 2021-July 2022) from Amsterdam University Medical Centers. We calculated long-COVID incidence proportions by migration background and assessed for clinical predictors via robust Poisson regressions. We then examined associations between migration background and long COVID using robust Poisson regressions and adjusted for derived clinical predictors, and other biologically relevant factors. Results 1886 patients were included. 483 patients had long-COVID (26%, 95% CI 24-28%) at 12 weeks post-discharge. Symptoms like dizziness, joint pain, and headache varied by migration background. Clinical predictors of long-COVID were female sex, hospital admission duration, intensive care unit admission, and receiving oxygen, or corticosteroid therapy. Long-COVID risk was higher among patients with migration background than Dutch origin patients after adjustments for derived clinical predictors, age, smoking, vaccination status, comorbidities and remdesivir treatment. Conclusions There are significant differences in occurrence, nature of symptoms, and duration of long-COVID by migration background. Studies assessing functional limitations and access to post-COVID healthcare are needed to help plan for appropriate and accessible healthcare interventions.

Evaluation of posterior mitral isthmus ablation in the absence of a vein of Marshall.

Achieving acute and durable mitral isthmus (MI) block remains challenging using radiofrequency (RF) catheter ablation alone. Vein of Marshall (VoM) ethanolization results in chemical damage along the MI resulting in the creation of a durable transmural lesion with a very high rate of procedural block. However, no studies have systematically assessed the efficacy of MI ablation alone when no anatomical VoM is present. Thirty seven patients without VoM evidenced after careful angiographic examination were included. Ablation parameters and result were compared with a matched control group in whom the posterior MI line was performed without assessing the presence of the VoM. Mitral isthmus block was achieved in 36 out of 37 patients without VoM (97%), with endocardial ablation only in 5/37 (14%) and combined endocardial and coronary sinus ablation in 32/37 patients (86%). There was a significant difference in the occurrence of block between patients without a VoM and the control group (97.3% vs. 65% respectively, P < 0.01), with a trend towards less needed RF {26 [interquartile range (IQR) 20-38] vs. 29 [IQR 19-40] tags [P = 0.8], 611 [IQR 443-805] vs. 746 [IQR 484-1193] seconds [P = 0.08]}. The absence of a VoM is associated with a very high rate of procedural block during posterior MI ablation. The higher rate of MI block in this specific population would also suggest the crucial role of the VoM (when present) in resistant MI block.

Surgical Antibiotic Prophylaxis Practices and Occurrence of Surgical Site Infections Among Operated Patients at Dodoma Regional Referral Hospital, Tanzania

This study was conducted to determine association between perioperative antibiotic prophylaxis practices and occurrence of surgical site infections at Dodoma Regional Referral Hospital in Tanzania. Surgical site infections (SSIs) are preventable complications following surgery, but still cause significant burden in terms of patient morbidity, mortality and increased cost of treatment. A prospective cohort study was conducted among 162 operated patients. Patients with different trends of antibiotic prophylaxis were followed up for occurrence SSIs. Analysis of data was done by SPSS version 20 program using frequency tables, chi square test, Kaplan-meier and Cox regression methods. Significance level of &amp;lt; 0.05 was taken to establish associations between variables. It was found that, 60.5% of patients received preoperative antibiotic prophylaxis, the overall surgical site infections rate was 14.8%. There was no significant difference in occurrence of surgical site infections between patients who received and those who did not receive preoperative antibiotic prophylaxis (p=0.88). The study concluded that SSIs are significant complications. Perioperative antibiotic prophylaxis is commonly practiced. Establishment of local protocol on antibiotic prophylaxis and adherence to infection prevention can improve the prevailing situation.

Strategic administration of antioxidant multiminerals and vitamins to transitional buffaloes augments antioxidant and udder defense mechanisms in early lactation

The aim of the study was to examine the effects of repeated administrations of antioxidant multiminerals and vitamins in transition buffaloes on udder defense mechanism, antioxidant activity and occurrence of intramammary infection (IMI) in early lactation period. Forty clinically healthy pregnant buffaloes were enrolled 45 days before expected date of calving and randomly allocated into five different supplementation groups (n = 8): only basal ration (control), vitamin E and selenium (VES), multiminerals (MM), ascorbic acid (AA) and chromium (Cr) picolinate in basal diet. The udder defense mechanism was monitored by measuring phagocytic activity (PA), myeloperoxidase (MPO) and nitric oxide (NO) productions in milk leukocytes, antioxidant activity was evaluated by measuring total antioxidant capacity (TAC) in plasma and occurrence of IMI was assessed by milk cytology, bacterial count in milk and visible clinical signs of udder until day 28 post-calving. The results showed that the VES and MM supplementations exhibited significantly higher PA, MPO and NO productions of milk leukocytes till first week of lactation whereas, elevated mean TAC in plasma was maintained from day −7 to 1 of calving in MM supplementation group as compared to control group. Statistically, no significant difference in occurrences of subclinical or clinical IMI was noted across the groups until four weeks of lactation. Taken together, it is concluded that repeated administrations of VES and MM to transition buffaloes could be an effective strategy to maintain good udder health by augmenting milk leukocyte functions and antioxidant status and preventing incidence of IMI in early lactation.

Women at Altitude: Menstrual-Cycle Phase, Menopause, and Exogenous Progesterone Are Not Associated with Acute Mountain Sickness.

Gardner, Laurel, Linda E. Keyes, Caleb Phillips, Elan Small, Tejaswi Adhikari, Nathan Barott, Ken Zafren, Rony Maharjan, and James Marvel. Women at altitude: Menstrual-cycle phase, menopause, and exogenous progesterone are not associated with acute mountain sickness. High Alt Med Biol. 00:000-000, 2024. Background: Elevated progesterone levels in women may protect against acute mountain sickness (AMS). The impact of hormonal contraception (HC) on AMS is unknown. We examined the effect of natural and exogenous progesterone on the occurrence of AMS. Methods: We conducted a prospective observational convenience study of female trekkers in Lobuche (4,940 m) and Manang (3,519 m). We collected data on last menstrual period, use of exogenous hormones, and development of AMS. Results: There were 1,161 trekkers who met inclusion criteria, of whom 307 (26%) had AMS. There was no significant difference in occurrence of AMS between women in the follicular (28%) and the luteal (25%) phases of menstruation (p = 0.48). The proportion of premenopausal (25%) versus postmenopausal women (30%) with AMS did not differ (p = 0.33). The use of HC did not influence the occurrence of AMS (HC 23% vs. no HC 26%, p = 0.47), nor did hormonal replacement therapy (HRT) (HRT 11% vs. no HRT 31%, p = 0.13). Conclusion: We found no relationship between menstrual-cycle phase, menopausal status, or use of exogenous progesterone and the occurrence of AMS in trekkers and conclude that hormonal status is not a risk factor for AMS. Furthermore, women should not be excluded from future AMS studies based on hormonal status.

Microbiome markers in HPV-positive and HPV-negative women of reproductive age with ASCUS and SIL determined by V4 region of 16S rRNA gene sequencing.

Human papilloma virus (HPV) is the most common sexually transmitted infection worldwide. Cervicovaginal microbiota plays an important role in HPV infection and is associated with the development of squamous intraepithelial lesions (SIL). The natural history of cervical cancer involves reversible changes in the cervical tissue from a normal state, in which no neoplastic changes are detected in the squamous epithelium, to varying states of cellular abnormalities that ultimately lead to cervical cancer. Low-grade SIL (LSIL), like another cytological category - atypical squamous cells of undetermined significance (ASCUS), may progress to high-grade SIL (HSIL) and invasive cervical cancer or may regress to a normal state. In this work, we studied cervical canal microbiome in 165 HPV-positive and HPV-negative women of a reproductive age with ASCUS [HPV(+) n = 29; HPV(-) n = 11], LSIL [HPV(+) n = 32; HPV(-) n = 25], HSIL [HPV(+) n = 46], and the control group with negative for intraepithelial lesion malignancy (NILM) [HPV(-) n = 22]. HPV16 is the most prevalent HPV type. We have not found any differences between diversity in studied groups, but several genus [like Prevotella (p-value = 0.026), Gardnerella (p-value = 0.003), Fannyhessea (p-value = 0.024)] more often occurred in HSIL group compared by NILM or LSIL regardless of HPV. We have found statistically significant difference in occurrence or proportion of bacterial genus in studied groups. We also identified that increasing of the ratio of Lactobacillus iners or age of patient lead to higher chance to HSIL, while increasing of the ratio of Lactobacillus crispatus lead to higher chance to LSIL. Patients with a moderate dysbiosis equally often had either of three types of vaginal microbial communities (CST, Community State Type) with the prevalence of Lactobacillus crispatus (CST I), Lactobacillus gasseri (CST II), and Lactobacillus iners (CST III); whereas severe dysbiosis is linked with CST IV involving the microorganisms genera associated with bacterial vaginosis and aerobic vaginitis: Gardnerella, Fannyhessea, Dialister, Sneathia, Anaerococcus, Megasphaera, Prevotella, Finegoldia, Peptoniphilus, Porphyromonas, Parvimonas, and Streptococcus.

Evaluating Wall-Mounted Prompts to Facilitate Physical Activity-Related Discussion between Individuals with Cancer and Oncology Health Care Providers: A Pre-post Survey Study.

To evaluate the use of wall-mounted prompts in facilitating physical activity (PA)-related discussions between individuals with cancer and oncology care providers. Individuals with cancer were approached to participate in a survey-based pre-post study. Half of participants (n = 100) completed a survey prior to installation of wall-mounted prompts in clinic while the other half (n = 100) completed a survey following installation of the prompts. Survey questions included content of PA-related discussion, satisfaction with PA education across treatment, and current PA level. The post-prompt survey also asked questions related to the prompt. Survey responses were analyzed using descriptive statistics. Chi-squared tests were performed to determine significance between timepoints. One hundred participants completed the survey at each timepoint. A significant difference was found pre and post-prompt in the number of PA discussions occurring overall during care (p = 0.03). Some participants (53%) were satisfied with the PA education received during treatment. There was no significant difference in occurrence of PA discussion (p = 0.36) pre and post-prompt and no difference in PA behaviour was observed (p = 0.130). Wall-mounted prompts may be effective in increasing the frequency of PA-related discussions between individuals with cancer and their oncology team across treatment. Additional strategies, such as easy referral to rehabilitation professionals, are also needed to facilitate safe and effective PA behaviour during and after cancer treatments.

Clavicle fractures do not increase the occurrence of later subacromial pain syndrome. A registry-based case-control study with 15-25 years of follow-up of 131.838 persons from the Danish National Patient Register

BackgroundA clavicle fracture often changes the mechanical axes of the shoulder girdle due to displacement and shortening, potentially leading to scapular protraction and decreased subacromial space. If protraction of the scapula is a major risk factor for developing subacromial pain syndrome (SAPS), a previous clavicle fracture could increase the risk of later SAPS. The purpose of this study was to investigate if a previous clavicle fracture correlates with a higher occurrence or earlier diagnosis of SAPS. MethodsIn this retrospective case-control study with data from the Danish National Patient Register, all persons aged 18-60 years, with any hospital contact due to a clavicle fracture (DS420) between 1.1.1996 and 31.12.2005 were identified as cases. For each case, five controls, matched on age and sex, were identified. Primary outcome was the first hospital contact with a SAPS diagnosis (DM751-755) registered more than 180 days following fracture. Follow-up was until 01.11.2021. Results21.973 cases and 109.865 controls were included. The incidence of clavicle fractures was 76 fractures per 100.000 persons per years. 23% were female. 1.640 (7.46%) cases and 8.072 (7.35%) controls received a SAPS diagnosis within the following 15-25 years, demonstrating no significant difference in occurrence of SAPS (p=0.56).Mean time from fracture to SAPS diagnosis was shorter for cases compared to controls (4040 vs. 4442 days, p<0.001), and cases were slightly younger when receiving the diagnosis (51.3 vs 53.6 years, p<0.001).1614 cases underwent surgical fixation. This subgroup had a statistically significant higher occurrence of later SAPS diagnosis (205 cases, 13%, p<0.001). ConclusionPersons with a previous clavicle fracture did not have an increased occurrence of receiving a subacromial pain syndrome (SAPS) diagnosis compared to matched controls. However, the diagnosis was given 1-2 years earlier for people with a previous fracture. Based on these findings no strong argument for protraction of the scapula as a major risk-factor for the development of SAPS was found.

Efficacy and Safety of TLR2 Co-Stimulated CAR T Cells in CD19-Positive Lymphoid Malignancies with Central Nervous System Involvement

Background CD19 chimeric antigen receptor (CAR) T cell therapy showed remarkable remission rates in patients with refractory or relapsed (R/R) non-Hodgkin's lymphoma (NHL) and acute lymphoblastic leukemia (ALL). However, data on outcomes of CAR T cell therapy for patients with central nervous system (CNS) involvement are limited, as most of them have been excluded from most pivotal CAR-T studies because of concerns about treatment-related neurotoxicity. Here, we show results of a third generation of CD19 CAR T cells for patients with R/R B cell cancers with CNS involvement in a single-center cohort study. Methods A total of 21 patients with R/R B cell malignancies (including ALL and NHL) with CNS involvement were included in this study. Patients derived peripheral lymphocytes were collected through apheresis and lentivirally transduced with a 3 rd generation CAR containing CD28 and TLR2 co-stimulatory domains. The cells were expanded ex vivo and administered in a single infusion (1×10 6 or 2×10 6 CAR T cells per kilogram of body weight) after a conditioning regimen of cyclophosphamide and fludarabine. Results Of the 21 patients with CNS involvement, 11 patients with ALL and 10 with NHL were included in this study, with a data cutoff of July 2023. All 11 patients with ALL had both bone marrow (BM) and cerebrospinal fluid (CSF) involvement. Of the 10 patients with NHL, 5 of the 10 lymphoma patients had parenchyma involvement, 6 patients (6/10) had CSF infiltration and 1 had oculus sinister involvement; the majority of patients (8/10) were diagnosed with secondary CNS lymphoma, whereas 2 patient was primary CNS lymphoma. Of the 21 patients who were treated, the overall response rate (ORR) was 71% (15/21), with 73% (8/11) in ALL and 70% (7/10) in NHL. 67% of patients with ALL (7/11) had a complete remission in both BM and CSF, while 40% of NHL patients (4/10) had a complete response and 30% (3/10) received a partial response. The median overall survival (OS) of ALL was 14.3 months, with a median follow-up of 20.3 months, while the median OS of NHL was not reached with a median follow-up of 14.2 months. Median progression-free survival (PFS) of ALL and NHL were 11.1 months (95% CI, 0.7-29.9 months) and 4.8 months (95% CI, 1.0-15.3 months), respectively (P = 0.84). In the total CNS cohort, cytokine release syndrome (CRS) of any grade was seen in 20 patients (95%), grade 3 in 3 patients (14%). ICANS occurred in 9 patients (42.8%, including 5 ALL and 4 NHL patients), grade 3 in 5 patients (23.8%), and there was no grade 4 event. Median time to ICANS was 5 days (range, 2-10 days) after CAR-T infusion. All the CRS or ICANS were manageable. No significant difference in occurrence of and time to ICANS was seen between ALL and NHL patients (P = 0.22 and 0.96). CAR T cells were identified in CSF of patients following infusion, and the median time to peak CAR T cells in CSF of ALL and NHL were 6.5 days and 10 days post-infusion, respectively (P = 0.141). Median time to last documented follow-up of all patients (alive or dead) was 18.1 months (range 1.0-31.2 months). At the end point of observation, 5 of the 11 ALL patients and 5 of 10 NHL patients were still alive with sustained CR of CNS disease and systemic disease (Figure 1). Conclusion TLR2-costimulated CAR T cell therapy for patients with R/R B cell malignancies with CNS involvement is safe, feasible, and results in high response rates and durable remission in both ALL and NHL patients with CNS disease. The clinical trial was registered at www.clinicaltrials.gov as # NCT04605666.

The Role of EGFR Amplification in Deep Venous Thrombosis Occurrence in IDH Wild-Type Glioblastoma

Introduction: Glioblastoma (GBM) patients have a 20-30 incidence of venous thromboembolic events. EGFR is a widely used prognostic marker for many cancers. Recent lung cancer studies have described relationships between EGFR amplification and an increased incidence of thromboembolic complications. We aim to explore this relationship in glioblastoma patients. Methods: Two hundred ninety-three consecutive patients with IDH wild-type GBM were included in the analysis. The amplification status of EGFR was measured using fluorescence in situ hybridization (FISH). Centromere 7 (CEP7) expression was recorded to calculate the EGFR-to-CEP7 ratio. All data were collected retrospectively through chart review. Molecular data were obtained through the surgical pathology report at the time of biopsy. Results: There were 112 subjects who were EGFR-amplified (38.2%) and 181 who were non-amplified (61.8%). EGFR amplification status was not significantly correlated with VTE risk overall (p = 0.2001). There was no statistically significant association between VTE and EGFR status after controlling for Bevacizumab therapy (p = 0.1626). EGFR non-amplified status was associated with an increased VTE risk in subjects greater than 60 years of age (p = 0.048). Conclusions: There was no significant difference in occurrence of VTE in patients with glioblastoma, regardless of EGFR amplification status. Patients older than 60 years of age with EGFR amplification experienced a lower rate of VTE, contrary to some reports on non-small-cell lung cancer linking EGFR amplification to VTE risk.

Leukotriene A4 hydrolase (LTA4H rs17525495) gene polymorphisms and paradoxical reactions in extrapulmonary tuberculosis

Paradoxical reactions (PRs) are poorly studied complex immunological phenomena, among patients with tuberculosis (TB). When PRs involves critical structures like the central nervous system (CNS), immunomodulatory therapy is often required. Predictors for PRs in TB to pre-empt appropriate treatment strategies in high-risk groups are lacking. TT genotype of Leukotriene A4 hydrolase (LTA4H) promoter region rs17525495 polymorphisms are associated with exaggerated immune responses in Tuberculous meningitis (TBM), the most severe form of extrapulmonary tuberculosis (EPTB). The association of these polymorphisms with PRs is not known. We evaluated this plausibility among 113 patients with EPTB, at high risk of PRs. Majority [81 (71.7%)] had disseminated tuberculosis with prominent CNS [54 (47.8%)] and lymph node involvement [47 (41.6%)]. Human immunodeficiency Virus (HIV) co-infection was seen among 23 (20.3%) patients. PRs were noted in 38.9% patients, at a median duration of 3 months (IQR 2–4). LTA4H rs17525495 single nucleotide polymorphism (SNP) analysis showed 52 (46%) patients had CC, 43 (38.1%) had CT and 18 (15.9%) had TT genotypes. There was no statistically significant difference in occurrence [CC 38.5% vs CT 39.5% vs TT 38.7%] and time of onset [median (IQR)] of PRs across the genotypes [CC 3 (1–4.7), CT 3 (2–5), TT 2 (2–3)]. PRs was shown to be significantly linked with HIV co-infection (RR 0.6, 95% CI 0.29–1.28), culture positivity (RR 0.5, 95% CI 0.28–1.14), TB Lymphadenitis (RR 0.7, 95% CI 0.44–1.19) and CNS involvement RR 2.1, 95% CI 1.27–3.49) in the univariate analysis (p < 0.2). On multivariate analysis, CNS involvement alone was associated with PRs (aRR 3.8 (1.38–10.92); p < 0.01). PRs were associated with CNS involvement but not with LTA4H rs17525495 polymorphisms.

Efficacy and safety of the Arctic Sun device for hypoxic-ischemic encephalopathy in adult patients following cardiopulmonary resuscitation: A systematic review and meta-analysis.

The principal objective of this study was to carry out a comprehensive and thorough analysis to compare the safety and effectiveness of the Arctic Sun, a servo-controlled surface cooling device, with conventional cooling techniques for providing therapeutic hypothermia in adult patients who had experienced hypoxic-ischemic brain injury following cardiopulmonary resuscitation. In order to achieve our goal, we conducted an extensive search of multiple databases including PubMed, Embase, Cochrane, and ClinicalTrials.gov up to the date of July 30, 2021. We only included studies that compared the safety and efficacy of the Arctic Sun surface cooling equipment with standard cooling approaches such as cooling blankets, ice packs, and intravenous cold saline for treating comatose adult patients who had recovered after experiencing cardiac arrest. We evaluated various outcomes, including all-cause mortality, good neurological outcome at 1 month, and the occurrence of adverse effects such as infections, shock, and bleeding. We employed a random-effects meta-analysis to estimate the odds ratio (OR) with 95% confidence intervals (CIs) for dichotomous outcomes. One hundred and fourteen records were identified through our search; however, only three studies met our eligibility criteria, resulting in overall 187 patients incorporated in the meta-analysis. The findings indicated no significant difference in mortality rates among the Arctic Sun device and conventional cooling techniques (OR: 0.64; 95% CI: 0.34-1.19; P = 0.16; I2 = 0%). In addition, we found no significant difference in occurrence of good neurological outcomes (OR: 1.74; 95% CI: 0.94-3.25; P = 0.08; I2 = 0%) between the two cooling methods. However, the application of the Arctic Sun device was associated with increased incidence of infections compared to standard cooling methods (OR: 2.46; 95% CI: 1.18-5.11; P = 0.02; I2 = 0%). While no significant difference occurred in the incidence of shock (OR: 0.29; 95% CI: 0.07-1.18; P = 0.08; I2 = 40%), the use of the Arctic Sun device was linked to significantly fewer bleeding complications compared to standard cooling methods (OR: 0.11; 95% CI: 0.02-0.79; P = 0.03; I2 = 0%). After analyzing the results of our meta-analysis, we concluded that the use of the Arctic Sun device for targeted temperature management following cardiopulmonary resuscitation did not result in significant differences in mortality rates or improve neurological outcomes when compared to standard cooling techniques.

Occurrence of thermophilic Campylobacter spp. in chicken meat breeds from an organised farm in Thrissur district

Campylobacteriosis is one of the principal causes of gastroenteritis in the world. Poultry, being the natural reservoir, can harbour large number of Campylobacter in their caeca. The current study was carried out to assess the occurrence of thermophilic Campylobacter spp. in different meat type breeds in an organised farm. Out of the 120 cloacal swabs analysed, 31.67 per cent were found to be positive for Campylobacter spp. There was no significant difference in occurrence of Campylobacter spp. between different meat breeds. On molecular confirmation, majority of the isolates (71.05 per cent) were identified as Campylobacter jejuni and the rest as Campylobacter coli (28.95 per cent). The present study confirms a substantial degree of Campylobacter contamination in meat type chicken breeds in the farm. Good hygienic practices with better biosecurity measures and periodic screening of live poultry, poultry meat and its products are necessary to reduce the foodborne transmission of this pathogen to ensure safer food for consumers.

Surgical site complications of isolated salvage neck dissection post-radiotherapy and post-chemoradiotherapy – A cohort analysis (1997–2017)

IntroductionThis study aims to quantify surgical site complications (SSC) after isolated salvage neck dissection (ND) compared with primary ND. Patients and methodsBetween 1997 and 2017 in the Netherlands Cancer Institute - Antoni van Leeuwenhoek, a total of 323 isolated NDs were performed in 308 patients: primary ND (n = 144), post-radiotherapy (RT) ND (n = 53) and post-chemoradiotherapy (CRT) ND (n = 126). Patient, tumor and therapy characteristics were recorded. SSCs were scored according to the Clavien-Dindo Classification (CDC). Results101 NDs (31%) were complicated by at least one SSC. In total, 189 different SSCs occurred. Translated to CDC, 45 complications were grade 2, 25 grade 3a and 31 grade 3b. No significant difference in occurrence of SSC (CDC >1) was found between all groups. However, post-CRT, selective (SND) and modified radical ND and radical ND (MRND/RND) (p = 0.005), resection of sternocleidomastoid muscle (SCM) (p = 0.039) and duration of super selective ND surgery (p = 0.048) were significantly associated with more SSC. SCM muscle removal was associated with more surgical site infection (p = 0.045) and necrosis (p = 0.036). From week 10 post-RT/CRT, no difference in complication frequency with primary ND was seen. ConclusionPost-CRT SND, MRND/RND and SCM muscle resection were associated with an increased incidence of SSCs. If oncologically possible, limit the extent of ND and when an MRND is inevitable, preserve the SCM muscle for optimal prevention of SSC. Concerning SSC, optimal timing of salvage ND is minimal 10 weeks after RT/CRT.

Knee laxity after anterior tibial eminence fracture in children: A 35-case series

IntroductionAnterior tibial eminence (ATE) fractures are characterized by avulsion of the anterior cruciate ligament insertion. The aim of our study was to evaluate the long-term incidence of laxity and instability in the aftermath of these fractures. The secondary objective was to identify factors for instability. HypothesisATE fracture in children is responsible for laxity and instability in the medium and long term. Material and methodsThis retrospective, single-center study included 35 isolated fractures of the tibial intercondylar eminence during skeletal growth between January 2006 and January 2020. Analysis comprised demographics, laxity measured by GNRB™, range of motion and IKDC and Lysholm scores. Clinical reassessment was performed in 24 patients, the other 11 being interviewed by telephone. ResultsMean laxity on GNRB™ was 1.46mm, and 3 patients had>3mm differential with respect to the healthy knee. Mean IKDC score was 92.2 and mean Lysholm score 93.1. Four patients showed instability, 2 of whom required surgical management. There was no significant difference in occurrence of laxity according to fracture type or reduction quality. Mean follow-up was 5.9years (range, 1.1–14.8). DiscussionOur clinical and functional results were in accordance with the literature. The long-term clinical results were satisfactory. ATE fractures require long-term follow-up to screen for instability and laxity on GNRB™. Level of evidenceIV, retrospective study.

Prevalence and risk factors for seizures in stage-2 of rhodesiense human african trypanosomiasis in zambia from january 2013 to july 2022

Introduction: Human African Trypanosomiasis (HAT) is a parasitic disease caused by an invasive parasite called the human trypanosomes. The disease is divided into two stages, namely stage-1 and stage-2. The aim of this study was to determine the prevalence and risk factors for seizures in stage-2 of Rhodesiense HAT (rHAT) in Zambia from January 2013 to July 2022.&#x0D; Methodology: This was a retrospective cross-sectional study. All case files of patients that were laboratory diagnosed with rHAT from endemic hospitals in Zambia from January 2013 to July 2022 were reviewed.&#x0D; Results: A total of 54 casefiles of all HAT patients from January 2013 to July 2022 were reviewed. There were 2 cases with history of seizures in stage-2, one Caucasian and one black Zambian out of 5 and 49 patients, respectively. There was a statistically significant difference in the prevalence rate of seizures between Caucasian and black patients (P&lt;0.05). There was no statistically significant difference in age in occurrence of seizures between patients less than 30 years of age and those 30 years and above (P&gt;0.05). In addition there was no statistically significant difference in occurrence of seizures between sexes (P&gt;0.05).&#x0D; Conclusion: Being a Caucasian is probably a risk factor for seizures in stage-2 of Rhodesiense HAT in Zambia.

Haematological Variables of Patients with Amoebic Dysentery

Differential diagnosis of protozoan parasite Entamoeba histolytica is of great clinical and epidemiological importance in the case of acute dysentery by microscopy. The present study was carried out from October 2009 to February 2010. This study focused on relationship between some parasitic infestations, anemia and blood picture. A total of 424 fecal samples were collected from patients. The stool specimens were examined by light microscopy (Direct slide smear, Iodine wet mount) to distinguish E. histolytica. Also venous blood sample collected from each patient was tested for hemoglobin concentration (Hb%), packed cell volume (PCV) and leukocyte count (WBCs differential). Overall 16% ( 68/424) of the examined patients had parasitic infestation with E.histolytica . For each of E.histolytica infestation , ≥ 65% of the infested patients were anemic.The results showed that the higher infection and the lower hemoglobin rate (anemia) in age (under 10 years old).The male was predominant. There was no significant difference in occurrence of anemia between genders ( X² = 0.58, P &lt; 0.05). This study has shown that some parasitic infestations, at least , contribute to anemic in Wasit province

Retrospective review of vancomycin monitoring via trough only versustwo-point estimated area under the curve in pediatric and adult patients with cystic fibrosis.

The primary objective of this study was to compare the occurrence of acute kidney injury (AKI) in patients with cystic fibrosis (CF) receiving intravenous (IV) vancomycin monitored through single serum trough concentrations and two-point estimated area under the curve (AUC). Time to next exacerbation and return to baseline lung function were also assessed. A retrospective review was conducted in patients of all ages with CF admitted to the University of Kentucky who received IV vancomycin between October 2015 and January 2021. Patients were excluded if they received less than 5 days of IV vancomycin therapy. A total of 113 adults and 42 pediatric encounters met the inclusion criteria. There was no statistically significant difference in occurrence of AKI, however, all grade 2-3 AKIs were in the serum through the monitoring group. Adult patients monitored with AUC also had a higher return to baseline lung function over trough monitoring (86% vs. 57%) (p = 0.002). There was not a statistically significant difference in time to the next exacerbation in either group. Adult patients with CF experienced less severe AKIs when monitored with AUC versus trough. The results of this study indicate that AUC monitoring may enhance the efficacy of IV vancomycin in adult patients with CF.