Sixth Month Of Follow-up Research Articles

The role of hemoglobin A1c as a predictor of major adverse cardiovascular events in patients with type 2 diabetes mellitus after percutaneous coronary intervention: a case-cohort study

BackgroundFew studies have investigated the potential predictive value of glycosylated hemoglobin A (HbA1c) and clinical outcomes in diabetic patients after percutaneous coronary intervention (PCI), and the results of the reports have often been inconclusive and contradictory. We have organized a study to investigate the relationship between HbA1c and the occurrence of major adverse cardiovascular events (MACE) in diabetic patients after PCI.MethodsThis case-cohort study was conducted on 563 diabetic patients who underwent PCI. All studied patients had an HbA1c level measured within 24 h before angioplasty. All patients were followed for six months regarding the occurrence of MACE, and the HbA1c level was measured again at the end of the sixth month of follow-up. In the case of MACE, the subjects were considered the case group, and other non-MACE patients were included in the control group.Results505 patients remained in the study at the end of follow-up. MACE occurred in 23 (4.6%) patients during the first month and in 57 (11.3%) patients by the end of the sixth month. Baseline HbA1c was an independent predictor of MACE and mortality at the end of month-6 (P = 0.008 and 0.001, respectively).ConclusionsThe level of HbA1c at the time of admission has a significant predictive value for the occurrence of MACE in diabetic patients who undergo PCI. However, post-PCI glycemic control may not effectively reduce the risk of MACE in this population.Clinical trial registrationNot applicable.

Symptomatic spinal metastasis of a supratentorial glioblastoma in a pediatric patient: a case report and comprehensive review of the literature

Spinal metastasis of Glioblastoma is a rare occurrence, especially in pediatric patients, and extremely rare to become symptomatic. The pathology is poorly understood and remains with unclear dissemination mechanisms. The treatment approaches are varied and multimodal therapy (surgery, chemotherapy, and radiotherapy) can be employed to manage this type of metastasis. We report a case of a 17-year-old female who underwent a gross-total resection of a right frontal glioblastoma and had adjuvant therapy with chemo- and radiotherapy. In the sixth month of follow-up, the patient presented a paraparesis, and a distant recurrence at T7-T8 was detected. The patient was treated with gross-total resection of the tumor through a laminectomy. The histopathological results were consistent with an isocitrate dehydrogenase (IDH) wildtype GBM metastasis. The patient was treated with multimodal therapy, including surgery, radiotherapy, and chemotherapy. A complementary comprehensive review of current available literature on this topic is also presented.

Combined Robotic and Vaginal Surgery for Pelvic Exenteration Due to Vaginal Sarcoma Relapse in an Obese Woman

Pelvic exenteration (PE) is an aggressive surgical procedure that implies a large hard-to-fill pelvic defect. Different reconstruction techniques were proposed to improve abdominal organ support and reduce complications (infections, pelvic organs herniation, vaginal stump dehiscence, bowel prolapse and obstruction) [1], with conflicting results [2]. Because of young age and survival greater than 50% at 5 years in patients with no residual tumor after surgery [3], a new approach with better clinical results to pelvic reconstruction is needed. The aim of this surgical film is to present an unusual presentation of vaginal sarcoma, successfully managed with a minimally invasive approach, and to illustrate our contextual multilayer technique of pelvic reconstruction using a combination of pedicled omental flap (POF) and human acellular dermal matrix (HADM). Tertiary level academic hospital. A 42-year-old obese patient with recurrent and symptomatic myxoid leiomyosarcoma, previously underwent vaginal-assisted laparoscopic surgery at a primary care center for the removal of a vaginal swelling. The multidisciplinary board determined anterior PE as the optimal therapeutic approach. Given the patient's body mass index (33 kg/m2), young age, and the favorable outcomes of robotic surgery in obese patients compared with other approaches [3,4], we proposed a combined robotic and vaginal surgery for both exenteration and reconstructive procedures [5]. During surgery, we initially explored the abdominal cavity to exclude macroscopic metastasis, followed by anterior PE. Urinary diversion was achieved with a Bricker ileal conduit by means of an ileoileal laterolateral anastomosis and an uretero-ileo-cutaneostomy. The pelvic dead space was partially filled with a POF on the left gastroepiploic artery. Subsequently, the pelvic defect was covered by a 15 × 10 mm HADM inlay inserted circumferentially at the pelvic brim, fixed with a barbed thread suture on residual pelvic structures. The final pathology confirmed the recurrence of myxoid leiomyosarcoma and indicated tumor-free resection margins. The intraoperative and postoperative periods were uneventful. The patient was discharged 14 days after surgery and underwent adjuvant doxorubicin- and dacarbazine-based chemotherapy, which was initiated 45 days after the surgery. Currently the patient is asymptomatic and disease free at the sixth month of follow-up. Robotic PE proves to be a feasible technique in obese patients, reducing postoperative hospital stay and complications. The contextual pelvic floor reconstruction with a POF and HADM supports abdominal viscera, diminishing interorgan adhesions and bowel prolapse. VIDEO ABSTRACT.

The Health Outcomes of a Telegeriatrics Follow-Up Model on Dementia Patients and Their Caregivers in Cairo.

Background/Purpose: Older patients living with dementia and their caregivers are ideal beneficiaries of telemedicine, cost-effectiveness, caregiver satisfaction, and physician acceptance. The aim is to study the effect of a telemedicine dementia enabled program on the health outcome of dementia patients and their caregivers, as regard the patient outcome, caregiver stress, and caregiver satisfaction. Methods: Ninety-seven (n = 97) elderly subjects were recruited from the outpatient clinics and inpatient ward of Geriatrics Hospital, Ain Shams University Hospitals. Seventy subjects completed 6 months of follow-up using a telegeriatrics model. Patient outcomes (delirium, behavioral and psychological symptoms of dementia [BPSD], and need for home consultations, emergency room [ER] visits, clinic visits, and hospital admissions) were assessed and followed. Caregiver stress was evaluated and monitored using the abridged Arabic version of the Zarit Burden Interview ZBI-A. Caregiver satisfaction was assessed using dedicated satisfaction questionnaire designed by Ain Shams Virtual Hospital. Results: elirium episodes, BPSD episodes, and the need for home consultations, clinic visits, ER visits, and hospital admissions. This was statistically significant after the second, fourth, and sixth months of follow-up (p-value <0.001). In addition, the telegeriatrics follow-up model had a positive effect on both caregiver stress and caregiver satisfaction. Conclusions: The telegeriatrics follow-up model is a useful tool in the improvement of health outcomes of dementia patients, reduction of caregiver stress, and achievement of caregiver satisfaction.

Plasma SHBG Levels as an Early Predictor of Response to Bariatric Surgery.

Obesity is a growing global health problem, and currently, bariatric surgery (BS) is the best solution in terms of sustained total weight loss (TWL). However, a significant number of patients present weight regain (WR) in time. There is a lack of biomarkers predicting the response to BS and WR during the follow-up. Plasma SHBG levels, which are low in obesity, increase 1month after BS but there is no data of plasma SHBG levels at long term. We performed the present study aimed at exploring the SHBG role in predicting TWL and WR after BS. Prospective study including 62 patients with obesity undergoing BS. Anthropometric and biochemical variables, including SHBG were analyzed at baseline, 1, 6, 12, and 24months; TWL ≥ 25% was considered as good BS response. Weight loss nadir was achieved at 12months post-BS where maximum SHBG increase was reached. Greater than or equal to 25% TWL patients presented significantly higher SHBG increases at the first and sixth months of follow-up with respect to baseline (100% and 150% respectively, p = 0.025), than < 25% TWL patients (40% and 50% respectively, p = 0.03). Also, these presented 6.6% WR after 24months. The first month SHBG increase predicted BS response at 24months (OR = 2.71; 95%CI = [1.11-6.60]; p = 0.028) and TWL in the 12th month (r = 0.330, p = 0.012) and the WR in the 24th (r = - 0.301, p = 0.028). Our results showed for the first time that increase in plasma SHBG levels within the first month after BS is a good predictor of TWL and WR response after 2years.

Intragastric injection of botulinum toxin in the treatment of obesity: a single-center study.

In recent years, various novel surgical and non-surgical therapeutic options have been developed for treating obesity. Due to its disputed success, intragastric botulinum toxin A (BTX-A) injection is still being debated. We aim to contribute to this controversial issue in the literature by sharing our center's findings regarding intragastric BTX-A injections in the treatment of obesity. Patients with a body mass index (BMI) of greater than 25 kg/m2 and at least one obesity-related complication, or a BMI of greater than 30 kg/m2 without complications, were eligible for the study if they were between the ages of 18 and 65. Following the same procedure, two endoscopists administered BTX-A to all patients. All patients were evaluated for obesity by measuring their lipid profile, hormone profile, and insulin resistance level before treatment. In our study on 82 patients, we saw a significant mean weight loss (-9.2 kg, p < 0.001) in the second month, and there was no additional mean weight loss in the sixth month of follow-up. In addition, this result seems to be independent of the patient's insulin resistance. We did not see any serious side effects in any of the patients. Although the use of intragastric injection of BTX-A in the treatment of obesity is a controversial issue, we showed in our study that it causes significant weight loss. Further studies are needed on this subject, as it can be a safe method when the ideal dose and application site are combined with appropriate patient selection.

Association of Asthma With Patients Diagnosed With Metabolic Syndrome: A Cohort Study in a Tertiary Care Hospital.

Introduction Asthma is defined as a chronic inflammatory airway disease. The prevalence of both asthma and obesity has been rising simultaneously, demonstrating a parallel trend. Obesity is a significant factor in metabolic syndrome, and numerous studies have indicated a connection between metabolic syndrome and bronchial asthma. Aims and objectives The aim of this paper is to evaluate the association of asthma with patients diagnosed with metabolic syndrome. The main objectives were to analyze the clinical profile and spirometric indices in patients with metabolic syndrome and to assess asthmatic patients among them with spirometry and clinical parameters at a tertiary care hospital in Chennai. Materials and methods This hospital-based cohort study was conducted on 73 patients attending the outpatient department who had a known case of metabolic syndrome and were evaluated for asthma through history, physical examination, and a pulmonary function test. A history of cough, expectoration, shortness of breath, wheezing, chest tightness, allergy, seasonal variation, and smoking habits was asked, and a thorough physical examination was performed. Bronchial asthma was confirmed with airflow reversibility by spirometry as per the Global Initiative for Asthma Guidelines. Metabolic and spirometry parameters were examined, such as body mass index (BMI), waist circumference, waist-hip ratio, fasting blood sugar (FBS), postprandial blood sugar, hemoglobin A1C (HbA1C), serum insulin, lipid profile, C-reactive protein (CRP), forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and FEV1/FVC pre- and post-reversibility (baseline vs. six months). Results and discussion The average BMI of all participants was 29.6511 ±2.64564. The waist-hip ratio was 0.5512 ±0.43855, which decreased during the follow-ups, demonstrating a decline in the risk of obesity in study participants. The level of HbA1C showed a drop from 6.1% to 5.9% at the first follow-up. This exhibited a further reduction at the six-month follow-up in addition to a positive reflection in insulin sensitivity, indicating successful control of diabetes among study participants. It was discovered that this was statistically significant (p<0.001). At the third and sixth months of follow-up, the FEV1/FVC ratio increased by 38% and 37%, respectively, when metabolic syndrome was under control. The results show that controlling diabetes, hypertension, obesity, and triglyceride values improved asthmatic symptoms, and this was determined to be statistically significant (p<0.001). Conclusion The results of the current study demonstrated that the regulation and maintenance of metabolic parameters such as BMI, diabetes, hyperlipidemia, and hypertension aid in improving asthma control.

Surgical Management of Unstable Trochanteric Fractures of the Femur Using Cemented Hemi-Prosthesis in Elderly Patients: A Prospective Study.

Background In the case of elderly patients suffering from osteoporosis, the primary objectives of addressing comminuted intertrochanteric fractures are centered upon the recuperation of the patients' pre-fracture levels of activity, the expeditious promotion of full weight-bearing capacity, and the minimization of the likelihood of further surgical interventions. The adoption of hemiarthroplasty as a method for comminuted intertrochanteric fractures is proven as a means of hastening the recovery process, enabling early weight-bearing and mitigating the problems associated with extended bed rest. The outcomes that resulted from the application of this technique will be evaluated and analyzed as part of this study's objectives. Methodology A prospective study was conducted over the course of one year at a tertiary care hospital in the northern part of India. The study comprised a total of 30 individuals; however, unfortunately, one of the patients could not be located for further analysis. Patients of either gender in the age group of over 60 years old and with unstable osteoporotic intertrochanteric fractures were included (AO Foundation/Orthopaedic Trauma Association type 31-A2.2, A2.3, or 31-A3 group). Patients were observed at one, three, and six months after the surgical operation. The Harris Hip Score (HHS) was used for the functional outcome evaluation. Results Throughout the course of our analysis, we saw an increase in the overall HHS that was statistically significant. The HHS exhibited a mean value of 34.33 during the period of discharge, with a range of 32 to 39. It increased to 55.34 (range = 52-59) after one month of follow-up, and it continued to rise to 85.03 (range = 63-89) after three months of follow-up. It is important to note that the mean HHS reached 95.24 (range = 63-98) by the sixth month of follow-up. The study showed a statistically significant upward trend in HHS scores across all time periods (p < 0.001). Conclusions Early postoperative ambulation was made possible with the use of cemented prostheses, which contributed to patients' overall improvements in their functional results. Cemented primary bipolar hemiarthroplasty has emerged as a promising alternative for the treatment of unstable intertrochanteric fractures. The enhanced functional outcomes measured by the HHS provide evidence of this. The transtrochanteric technique has shown advantages in retaining the anatomical integrity of external rotators, minimizing the necessity for their resection, and reducing the danger of sciatic nerve injury. These advantages were displayed by the transtrochanteric approach. Moreover, owing to the implementation of wiring techniques, the larger trochanter could be conserved, resulting in enhanced postoperative recovery and expediting the return to the preoperative condition. When compared with other techniques of internal fixation, the utilization of cemented bipolar hemiarthroplasty demonstrated much-reduced rates of complications, such as the need for further surgery and implant failure.

Short-term changes of angiogenesis factors after transarterial radioembolization in hepatocellular carcinoma patients.

To analyze changes in angiogenesis factors after transarterial radioembolization (TARE) with Yttrium- 90-loaded resin microspheres in hepatocellular carcinoma (HCC) patients. Interleukin-6, interleukin-8, hepatocyte growth factor, platelet-derived growth factor, fibroblast growth factor, vascular endothelial growth factor-A (VEGF-A), and angiopoietin-2 levels in 26 patients were measured before TARE and on day 1, 7, 14, and 30 after TARE and evaluated regarding radiological response. In the sixth month of follow-up, 11 (42.30%) patients had a complete or partial response to treatment, while progressive disease was found in 15 (57.69%) patients. The percentage changes in VEGF-A in the non-responders on day 30 (P = 0.034) after TARE were significantly more obvious. Peak formation rates of VEGF-A were higher in non-responders (P = 0.036). Short-term changes in angiogenesis factors in HCC patients after TARE with Yttrium-90-loaded resin microspheres fluctuate with different amplitudes at different times. The upregulation of growth factors has a prognostic capacity. Changes in VEGF-A after TARE may be helpful for the early recognition of non-responders.

Carga cognitiva y retención de información mediante 2 técnicas de video en un aula invertida: estudio aleatorizado controlado

IntroductionLong-term information retrieval, based on the cognitive load derived from the instructional design for the delivery of information, is poorly understood. This study aims to compare the magnitude of three types of cognitive load (intrinsic, extraneous, and germane) and the retention of information generated by two video formats used in the virtual component of an inverted classroom: conventional (PowerPoint slides, Microsoft Corp) and non-conventional (Lightboard). MethodsIn this experimental study, 320 medical students were randomly assigned to one of the two formats. Cognitive load was evaluated at the end of the intervention using validated questionnaires. Immediate retention of information and retention at three and six months was assessed through multiple choice questions. ResultsThe germane load generated by the non-conventional format was significantly higher (p < 0.05). No differences were identified in overall, intrinsic, and extraneous load. Information retrieval was higher in the third month with the conventional format, but not differences were identified at the sixth month of follow-up. ConclusionsThe magnitude of the three types of cognitive load and the retention of information is similar when students interact with conventional and non-conventional formats for presenting information.

Intramuscular injections of human placental extract versus conventional symptomatic approaches in radiation-induced oral mucositis, in patients with head and neck cancers, on definitive chemoradiotherapy - A ray of hope?

Despite the availability of a wide range of agents, no single treatment exists for the management of radiation-induced oral mucositis, in patients, with head and neck malignancies, on radical chemoradiation; a debilitating and limiting sequela. Human placental extract is one option that has been proposed. This study aimed at evaluating the therapeutic benefits of human placental extract (Placentrex) in the management of radiation-induced oral mucositis in patients on curative intent treatment for head and neck cancers with concurrent chemoradiation, and to compare the observations with other conventional approaches. Patients presenting to the Department of Radiation Oncology, of a tertiary cancer care center, with biopsy-proven carcinoma of the oral cavity, oropharynx, and hypopharynx, planned for definitive, curative intent chemoradiation, between January 2020 and June 2021, were recruited for this study. The interventional group received a deep intramuscular injection of 2 ml of Placentrex to the deltoid muscle, once-a-day from the 11th fraction of radiation till completion, on treatment and non-treatment days. The control group received supportive, symptomatic, conventional treatments for mucositis. The response was assessed every week during treatment and at the third and sixth months of follow-up and was compared. The study comprised 26 patients, 15 in the interventional group and 11 in the control group. On completion of treatment, 40% in the interventional arm and 81.82% in the control arm had progressed to grade 2 and 3 mucositis (P < 0.05). Treatment interruption was seen in 13% in the interventional arm and 55% in the control arm (P < 0.001). Results from this study show that human placental extract, injection Placentrex, had a significant effect in decreasing the severity of radiation-induced mucositis and thereby reducing any interruption or delay in treatment when compared to other conventional methods.

Ophthalmic evaluation of drug-resistant tuberculosis patients taking linezolid as oral longer anti-tuberculosis regime

Aim: To document ocular toxicity if any in drug-resistant tuberculosis patients taking linezolid as an oral longer regime. Study and Design: Hospital-based Observational study. Methods and Material: The study was carried out in tertiary health care from January 2021- October 2022. A total of 94 participants above 18 years of age who were diagnosed with drug-resistant tuberculosis taking Linezolid and had pre-treatment best-corrected visual acuity (BCVA) of 6/6 and N6 with normal color vision were included in the study. Patients were called on follow-up on the 2nd, 4th, and 6th months of post-Linezolid therapy, and BCVA, color vision, anterior segment examination, and dilated fundus examination were done and documented. Results: Out of 94 participants 45 were males and 49 females. The mean age of participants was 27.41±9.22. We observed one patient developed a diminution of vision with fundus changes of optic disc edema in the second month of follow-up and the other patient also came with a diminution of vision with optic neuropathy on the sixth month of follow-up. The third patient developed nonsignificant RPE changes without diminution of vision. Conclusion: Ocular toxicity in three cases in form of Optic Neuropathy, optic disc edema, and nonsignificant RPE changes amongst 94 participants. In our study after the withdrawal of Linezolid therapy, the visual acuity and fundus changes reverted to normal. The study highlights the importance of regular ophthalmic follow-up in patients who were on long-term linezolid therapy.

Treatment of irreducible atlantoaxial dislocation by bony deformity osteotomy, remodeling, releasing, and plate fixating through transoral approach.

Investigate a novel method for treating irreducible atlantoaxial dislocation (IAAD) or with basilar invagination (BI) by bony deformityosteotomy, remodeling, releasing, and plate fixating through transoral approach. From March 2015 to December 2019, 213 consecutive patients diagnosed as IAAD/BI were treated with transoral bony deformity remodeling and releasing combined with plate fixation. The main clinical symptoms include neck pain, headache, numbness of the limbs, weakness, unstable walking, inflexible hand-held objects, and sphincter dysfunction. The bony factors that impact reduction were divided into as follows: type A1 (sloping of upper facet joint in C2), type A2 (osteophyte in lateral mass joints between C1 and C2), type A3 (ball-and-socket deformity of lateral mass joint), type A4 (vertical interlocking between lateral mass joints of C1-C2), type A5 (regional bone fusion in lateral mass joints), type B1 (bony factor hindering reduction between the atlas-dens gap), type B2 (uncinate odontoid deformity), and type B3 (hypertrophic odontoid deformity). All of them were treated with bony deformity osteotomy,remodeling, and releasing techs. The operation time was 144 [Formula: see text] 25min with blood loss of 102 [Formula: see text] 35ml. The average pre-operative ADI improved from 7.5 [Formula: see text] 3.2mm pre-surgery to 2.5 [Formula: see text] 1.5mm post-surgery (p < 0.05). The average VDI improved from 12.3 [Formula: see text] 4.8mm pre-surgery to 3.3 [Formula: see text] 2.1mm post-surgery (p < 0.05). The average pre-operative CMA improved from 115 [Formula: see text] 25° pre-surgery to 158 [Formula: see text] 21° post-surgery (p < 0.05); the pre-operative CAA changed from 101 [Formula: see text] 28° pre-surgery to 141 [Formula: see text] 10° post-surgery. After the operation, the clinic symptoms improved, and the JOA score improved from 9.3 [Formula: see text] 2.8 pre-operatively to 13.8 [Formula: see text] 2.5 in the sixth months of follow-up. In addition to soft tissue factors, bony obstruction was another important factor impeding atlantoaxial reduction. Transoral bony deformity osteotomy, remodeling, releasingcombined withplate fixating was effective in treating IAAD/BI with bony obstruction factors.

Semen Parameters Changes in Adolescents With Clinical Varicocele after Magnified Subinguinal Varicocelectomy: A Prospective Controlled Study.

Previously, we highlighted the benefits of magnified subinguinal varicocelectomy over conservative treatment on the semen of a small group of adolescents with varicoceles. In this report, we presented changes of semen parameters of 47 adolescents who underwent magnified subinguinal varicocelectomy (MSV) and followed-up for 6 months. The present prospective controlled study was conducted on 47 adolescents with varicocele who underwent MSV and were followed up for 6 months. In addition, age and sex-matched patients were added as control group. The primary outcome of this study was to assess the postoperative change in semen analysis parameters. A significant increase in sperm volume from 2.5 (1.9-3) to 3.2 (2.6-4) mL at the end of the sixth month of follow-up. Likewise, the sperm count increased from 10.8 (3.51-21.6) to 20.3 (9.6-35) million. Notably, the percentage of rapid and slow sperms increased significantly from a median of 5% (0%-10%) and 15% (10 -20%) to a median of 10% (5%-15%) and 17.5% (15%-25%), respectively. The percentage of sperm with progressive movement increased from 35% (30%-40%) to 59% (45%-69%). The vitality of the sperms increased significantly as well. While the percentage of sperms with abnormal morphology decreased significantly at the end of follow-up. Our findings support the safety and efficacy of MSV in patients with clinically detectable varicocele. MSV has improved the semen parameters of the included patients, including sperm motility, volume, count, and total progressive motility, which may positively impact their fertility potential.

Pediatrik Hastalarda Oküler Travmaların Etiyolojik Özellikleri ve Görsel Sonuçları

Objective: To investigate the demographic characteristics and prognostic factors of 60 pediatric patients who applied to our emergency clinic due to open globe injury (OGI) and were treated and followed up. Methods: The medical records of 69 patients aged 16 years and younger, who were operated for OGI between 2010-2021 and followed up for at least one year, were retrospectively reviewed. The patients’ demographic data, the type, cause and mechanism of injury, wound location and accompanying examination findings at the time of admission, time of admission to the hospital, first and last visual acuities (VA), additional surgeries were collected from the records. Results: The mean age was 11±5 years old. 17.4% were girls and 82.6% were boys. The most common shape of OGI was corneal incision, the most common etiological cause was sharp and penetrating objects (65.1%). Only zone 1 was affected in 87% of the cases, zone 2 in 40.6%, and zone 3 in 13%. Relative afferent pupil defect (RAPD) was present in 37.7% of the cases. Rupture was 5.8%, retinal detachment 8.7%, endophthalmitis 2.9%, perforating injury 4.3%. While VA cannot be evaluated in 7% of the cases at the time of admission, it is 0.1 or less in 60%, 0.1-0.6% in 25.7%. 4.3% had a VA better than 0.6. In the sixth month of follow-up, VA could not be evaluated in 2.9% of the cases, while VA was 0.1 or less in 11.4%, 0.1-0.6 in 25.7%, and better than 0.6 in 60%. Ocular trauma score (OTS) was 74±16 and pediatric ocular trauma score (POTS) was 64±19. OTS was moderately correlated with baseline VA (r=0.687, p&amp;lt;0.001) and moderately correlated with follow-up VA (r=0.611, p&amp;lt;0.001). Correlation values of pediatric ocular trauma score were lower (r=0.574, p&amp;lt;0.001) with baseline VA. Conclusion: Even though RAPD cannot be evaluated, OTS is a reliable tool to predict visual prognosis in pediatric OGI.

Refractory splenectomized immune thrombocytopenic purpura

Introduction The treatment options for patients with refractory splenectomized chronic immune thrombocytopenic purpura (ITP) are often unsatisfactory despite different lines of treatment, especially after thrombopoietin receptor agonist (TPO-RA) failure. Objective This study was done to assess the efficacy of vincristine in the treatment of patients with splenectomized chronic ITP who failed TPO-RA therapy as well as their 8-month follow-up following vincristine discontinuation. Patients and methods A total of 12 patients with splenectomized chronic ITP who failed to respond to TPO-RA were treated with vincristine 1–2 mg weekly for 6 weeks. Results The platelet count was evaluated during the treatment, and every 2 months for 8-month follow-up. The mean platelet count was significantly increased at the third, fourth, fifth, and sixth weeks during the treatment and persistently elevated during the second, fourth, and sixth months of follow-up when compared with the baseline platelet count, while decreasing at the 8-month follow-up, with no significant difference at their baseline. Conclusion Vincristine could be an effective treatment in patients with splenectomized ITP who failed to respond to TPO-RAs and in patients requiring a short-term increase in the platelet count.

Experience with Obese Patients Followed via Telemedicine in a Latin American Tertiary Care Medical Center.

Background: Obesity is a major public health concern worldwide. Latin America has experienced rapid growth in obesity incidence during the last few decades. Driven by confinement measures, a telemedicine program was implemented in March 2020 to give continuity to obese patients’ care through a weight loss program led by the endocrinology department in a tertiary care medical center in Latin America. Objective: This study aimed to describe the clinical experience of using digital health for monitoring and attention of obese patients and description of weight change outcomes of these patients followed via telemedicine during March 2020–December 2020. Methods: A retrospective cohort study was conducted including 202 patients. A Skillings-Mack test was performed to conduct a subgroup analysis of the medians of the weight over the follow-up period, and a mixed multiple linear regression model was performed to estimate the expected average change in weight over time Results: We observed good adherence to the program, represented by a weight loss of −4.1 kg at three months of follow-up, which was maintained even during the sixth month of follow-up. Conclusions: Digital Health strategies such as telemedicine can be a helpful tool for both patients and health care providers to support the continuity of care and showing satisfactory results in the management of obese patients.

Recovery of Renal Function in Clinical Patients with Acute Kidney Injury: Impact on Mortality.

Objective: To assess the different renal function recovery patterns and their impact on the mortality of non-critical patients with hospital-acquired Acute Kidney Injury. Design: A prospective cohort study was conducted from January 2017 to December 2019. Methods: The patients included were those with Acute Kidney Injury acquired during their hospitalization, identified from Kidney Disease: Improving Global Outcomes (KDIGO). Renal function recovery was calculated through the serum creatinine ratio in relation to baseline creatinine at the renal function evaluation moment. A descriptive analysis of the results was performed, and the Backward method was adopted for the multivariate analysis. Results: One-thousand five-hundred and forty-six patients were evaluated in the medical clinic and 202 (13.06%) were identified to have Acute Kidney Injury; among them, renal function recovery varied over the six months of follow-up with greater expressiveness in the second and third months (from 61.02% to 62.79%). Recovery was a protective factor against in-hospital death in the first (OR 0.24; 95% CI 0.09–0.61; p-value = 0.038) and sixth month of follow-up (OR 0.24; 95% CI 0.09–0.61; p-value = 0.003). Conclusions: The incidence of renal function recovery varied throughout the six months of follow-up and reached progressively high levels from the second to the third months. Renal recovery was a protective factor against mortality during the follow-up period.

Programming VDD leadless pacemakers: relation of algorithm settings of A3 and A4 signals with atrioventricular synchrony

Abstract Funding Acknowledgements Type of funding sources: None. Background The development of VDD mode in leadless pacemakers (Micra AV) has allowed the use of leadless pacing in patients with an atrioventricular (AV) block. Keeping AV synchrony (AVS) on pacing improves cardiac output and quality of life and reduces the risk of atrial fibrillation (AF) and PM syndrome. The AVS of the pivotal study with Micra AV (MARVEL2), in a post-implant situation of low activity was 89%. Methods Prospective single-center study of consecutive patients who received a VDD leadless pacemaker (Micra AV), and who remained in VDD mode throughout the follow-up. The initial programming changes were conducted following the standard recommendation for problems resolution, and further changes were made based on experience. Univariate association was tested for different programming parameters with the percentage of AVS. Our goal was to find the best possible programming for the Micra AV pacemaker with the scope of achieving high percentages of AVS in real life. Results We included 26 patients who received a VDD leadless pacemaker (Micra AV) between Jun/20 and Nov/21 and were kept in VDD mode at least during the first month of follow-up. We made an intermediate analysis from the first 18 patients who reached the first month after implant, and a significant association was found between the adjustment of the end of the window of A3 (VE) with the percentage of AVS: in the group in which automatic VE adjustment was maintained after implantation (4 patients), the mean AVS was 76.9 ± 6.0% (VE 702± 60 ms), while in the group in which the automatic adjustment was deactivated and the VE was set at 600-650 ms (14 patients), AVS was 84.9 ± 7.2% (VE 614 ± 23 ms), p = 0.04 (Figure 1). When discriminating by AVS ≥ 85%, the deactivation of the automatic adjustment of VE had an OR of 5.6 compared to maintaining automatic adjustment (p = 0.018), with a χ2 of 4.1 (p = 0.043). Moreover, when we analyzed the data until the sixth month of follow-up for those patients in VDD mode, we found that the shorter the interval of VE window we programmed, the larger the AVS percentage was (1st month, 26 patients: VE 631±46 ms, AVS 83.8±6.9%; 3rd month, 24 patients: VE 621±35 ms, AVS 86.2±6.6%; 6th month, 19 patients: VE 614±25 ms, AVS 88.3±6.5%, p&amp;lt;0.001; Figure 2). On the other side, there was no significant association between the modification of the A4 threshold (p = 0.104), adjustment of the rate smoothing (p = 0.331), or signal vector change (p = 0.276) with the percentage of AVS. Conclusions In real life, AVS percentages can vary considerably from the data obtained in resting situations and short follow-up time. Even though our series is not extensive, the preliminary data suggest the importance of adding modifications in the standard programming, especially in the algorithm for adjusting the A3 window, altogether with the standard recommendations for problem-solving to achieve high AVS percentages.

Metronidazole-Induced Toxic Neuropathy With the “Boomerang” Sign: A Case Report

Metronidazole has been used to treat a broad range of infections over the decades, and its safety profile has been presumably well studied. However, neurological severe adverse events after prescription and nonprescription use of metronidazole is well recognized but underdiagnosed. We report the case of a 48-year-old Indian man who presented with unremitting symptoms of peripheral neuropathy along with a silent callosal lesion in the splenium ("boomerang" sign). Because he had visited 3 neurologists previously, there were many targeted and nontargeted investigations, which failed to reach an etiological diagnosis and hence to provide relief. The patient was questioned about a potential neurotoxin exposure, and at that point, he said that he had been taking metronidazole for a long time, without any supervision, as an over-the-counter remedy for self-diagnosed "chronic amebiasis." On stopping metronidazole, he recovered gradually. In the sixth month of follow-up, brain magnetic resonance imaging showed disappearance of the callosal lesion and significant improvement in the nerve conduction studies. Clinicians should keep metronidazole toxicity in mind while dealing with a case of cytotoxic lesion of the corpus callosum with splenium involvement and peripheral neuropathy.