Specific Patient Groups Research Articles

Methods of Assessment of Physical Capacity in People with Diabetes Mellitus Type 1.

The article aims to present the most popular methods of assessing physical capacity. Moreover, the article sheds light on the beneficial impact of improving physical capacity in people with Diabetes Mellitus type 1 (DM1). A computer-based literature search of PubMed, SCOPUS and Web of Science included studies up to September 2022. The significant role of regular physical exertion could be observed in the group of people suffering from DM1, which implicates a positive correlation between the activity and the remission time. A suitable and objective indicator of sport influence on the organism is physical capacity (PC), which describes the efficiency of the cardiovascular system and its correlation between BMI, sex, and age. PC is mostly shown as VO2max. Well metabolically controlled DM1 is not a contraindication to stress test. Even though physical activity is closely related to human history, the range of research into the importance of PC is still limited to particular groups of patients, which presents an opportunity for further research and future conclusions. Undertaking physical activities has a multidirectional influence on the organism. According to up-to-date knowledge, various methods of PC assessment are available. Patients can choose more easily accessible, simpler, and cheaper options like CRT, RT, and HST which do not need specialized equipment and skills. They can also decide on more advanced examinations like ergospirometry, where direct measurements of VO2max and other cardiorespiratory parameters are made.

Prevención y detección precoz del cáncer de páncreas

In western countries, pancreatic ductal adenocarcinoma (PDAC) has shown a rising incidence and is currently one of the leading causes of cancer related mortality. Due to its aggressive biology, most patients diagnosed with PDAC present with advanced disease not suitable for curative treatment. An early detection strategy could potentially improve results by detecting more PDAC patients within the initial stages of the disease.Currently, diagnosis of PDAC is mostly based in cross sectional imaging, including computed tomography and magnetic resonance imaging (MRI) as well as biomarkers such as CA 19-9. Selected cases might be further studied using endoscopic ultrasound (EUS) with the option of EUS guided biopsy if histology is needed to confirm diagnosis.Due to its low incidence, screening general population for PDAC has been shown to be an ineffective and expensive approach. For this reason, efforts have shifted towards surveillance of specific groups of patients known to be at risk for development of PDAC. In these groups, screening has shown to have a higher yield for early cases and improved results in terms of resection rates and survival. These groups include carriers of certain oncogenic germline mutations, patients with strong family history for PDAC, and patients diagnosed with mucinous cystic neoplasms of the pancreas. Patients over 50 years old diagnosed with new-onset diabetes and patients living with chronic pancreatitis are also considered to be at risk for PDAC development. Patients selected for surveillance should be included in screening protocols including periodic imaging with MRI or EUS.Development of biomarkers is an area of active research in the field of pancreatic cancer. New genetic or molecular biomarkers, to be measured in an isolated or combined manner, are an interesting approach looking to improve current diagnostic capabilities and to provide new tools for effective screening in wider groups of patients.The aim of this article is to describe strategies currently available for early detection of PDAC, including promising research areas for the near future.

From Pixels to Diagnosis: Algorithmic Analysis of Clinical Oral Photos for Early Detection of Oral Squamous Cell Carcinoma.

Oral squamous cell carcinoma (OSCC) accounts for more than 90% of oral malignancies. Despite numerous advancements in understanding its biology, the mean five-year survival rate of OSCC is still very poor at about 50%, with even lower rates when the disease is detected at later stages. We investigate the use of clinical photographic images taken by common smartphones for the automated detection of OSCC cases and for the identification of suspicious cases mimicking cancer that require an urgent biopsy. We perform a retrospective study on a cohort of 1470 patients drawn from both hospital records and online academic sources. We examine various deep learning methods for the early detection of OSCC cases as well as for the detection of suspicious cases. Our results demonstrate the efficacy of these methods in both tasks, providing a comprehensive understanding of the patient's condition. When evaluated on holdout data, the model to predict OSCC achieved an AUC of 0.96 (CI: 0.91, 0.98), with a sensitivity of 0.91 and specificity of 0.81. When the data are stratified based on lesion location, we find that our models can provide enhanced accuracy (AUC 1.00) in differentiating specific groups of patients that have lesions in the lingual mucosa, floor of mouth, or posterior tongue. These results underscore the potential of leveraging clinical photos for the timely and accurate identification of OSCC.

Oral health assessment in institutionalized elderly: a scoping review

When elderly become frail and in need for complex care, they can no longer live independently at home and may be admitted to nursing homes. Various studies have shown that oral health in this population is remarkably poor, which may lead to distressing situations and impacts quality of life. A variety of definitions or descriptions for oral health is used. Without a uniform parameter, it is impossible to determine whether oral health in institutionalized elderly is actually improving or deteriorating over time, as well as the effect of (preventive) interventions. In search for an adequate and clinically applicable parameter to determine oral health in this specific patient group, this scoping review aims to give an overview of the currently used parameters for determining oral health in institutionalized elderly. Ninety different parameters were identified, and 50 parameters were solely used by one study. Only 4 parameters were frequently used (in > 20 studies). The relevance of these parameters for this specific patient group is discussed. To aid the planning and commissioning of future research and patient care, there is an urgent need for an adequate and uniform parameter for oral health determination in institutionalized elderly.

Normative body mass-adjusted reference ranges of magnetic resonance imaging signs commonly used in diagnosing idiopathic intracranial hypertension in a healthy standard population

Patients with chronic daily headaches (CDH) are often a diagnostic challenge and frequently undergo neuroimaging. One common underlying cause of CDH is idiopathic intracranial hypertension (IIH). However, certain neuroimaging abnormalities that suggest IIH, such as optic nerve sheath diameters (ONSD), pituitary gland height, and venous sinus diameter, require interpretation due to the absence of established normative values. Notably, intracranial pressure is known to varies with age, sex and weight, further complicating the determination of objectively abnormal findings within a specific patient group. This study aims to assist clinical neuroradiologists in differentiating neuroimaging results in CDH by providing weight-adjusted normative values for imaging characteristics of IIH. In addition to age and BMI we here assessed 1924 population-based T1-weighted MRI datasets of healthy participants for relevant MRI aspects of IIH. Association to BMI was analyzed using linear/logistic regression controlled for age and stratified for sex. ONSD was 4.3 mm [2.8; 5.9]/4.6 mm [3.6; 5.7] and diameter of transverse sinus was 4.67 mm [1.6; 6.5]/4.45 mm [3.0; 7.9]. Height of pituitary gland was 5.1 mm [2.2;8.1]/4.6 mm [1.9;7.1] for female and male respectively. Values generally varied with BMI with regression slopes spanning 0.0001 to 0.05 and were therefor presented as normative values stratified by BMI. Protrusion of ocular papilla, empty sella and transverse sinus occlusion were rare in total. Our data show an association between BMI and commonly used MRI features for diagnosing IIH. We provide categorized normative BMI values for ONSD, pituitary gland height, and transverse sinus diameter. This distinction helps objectively identify potential IIH indicators compared to regular population norms, enhancing diagnostic accuracy for suspected IIH patients. Notably, optic nerve head protrusion, empty sella, and transverse sinus occlusion are rare in healthy individuals, solidifying their importance as imaging markers regardless of BMI.

Why do people get burned? Qualitative analysis of the causes of burns in a large survey of burn survivors

BackgroundUnderstanding the national epidemiology of burns is necessary for effective planning of prevention and treatment services. However, epidemiological studies of burns have often focused on short-term and retrospective investigations of a specific group of burned patients in Iran. Therefore, we conduct a comprehensive study from August 2016 to October 2017, in the Burn Research Center of Iran University of Medical Sciences on approximately 1700 hospitalized burn patients at Motahari Hospital to identify the underlying causes of burns. In this study, an open-ended question was asked about how the burn occurred in the patients. The current study was designed and conducted for the qualitatively analyzing of the responses to this question, using the content analysis method, in order to maximize its use in policymaking and prevention. MethodsContent analysis of written responses to open-ended questions was done as a part of a large questionnaire survey. This survey was conducted by face-to-face interview at a national referral center for burn injuries. ResultsAnswers from 1595 patients were coded and the underlying causes of injury were categorized into three themes and 43 subthemes. These underlying causes were lack of knowledge and awareness, inappropriate equipment, and inevitable accidents. The underlying cause of lack of knowledge and awareness had the highest proportion in causing burns in both men and women. The most common subthemes in descending order included lack of skills, dangerous actions, improper location of hot liquids, individual mistakes, and improper use of flammable materials. The top five subthemes with the highest average percentage of burn in patients in descending order were deficiency of residential equipment, self-immolation, accidents, inappropriate location of flammable materials, and unsafe kitchen appliances. ConclusionThe focus of prevention programs on educating and increasing awareness of individuals, preferably women, is suggested. Educational programs, tailored to occupational standards and workplace and household equipment, are recommended for men in work environments.

Urological Guidelines for Kidney Stones: Overview and Comprehensive Update.

Evidence-based guidelines are published by urological organisations for various conditions, including urolithiasis. In this paper, we provide guidance on the management of kidney stone disease (KSD) and compare the American Urological Association (AUA) and European Association of Urologists (EAU) guidelines. We evaluate and appraise the evidence and grade of recommendation provided by the AUA and EAU guidelines on urolithiasis (both surgical and medical management). Both the AUA and EAU guidelines provide guidance on the type of imaging, treatment options, and medical therapies and advice on specific patient groups, such as in paediatrics and pregnancy. While the guidelines are generally aligned and based on evidence, some subtle differences exist in the recommendations, but both are generally unanimous for the majority of the principles of management. We recommend that the guidelines should undergo regular updates based on recently published material, and while these guidelines provide a framework, treatment plans should still be personalised, respecting patient preferences, surgical expertise, and various other individual factors, to offer the best outcome for kidney stone patients.

Unmasking pancreatic cancer: Advanced biomedical imaging for its detection in native versus arterial dual‐energy computed tomography (DECT) scans

AbstractThis study investigates the potential of a machine learning classifier using dual‐ energy computed tomography (DECT) radiomics to differentiate between malignant pancreatic lesions and normal pancreas tissue. A total of 100 patients who underwent third‐generation DECT between November 2018 and October 2022 were included, with 60 patients having pancreatic cancer and 40 normal pancreatic tissue. Radiomics features were extracted from non‐contrast and arterial‐enhanced DECT scans with stepwise feature reduction used to identify relevant features. Thetrained machine learning classifiers achieved a diagnostic accuracy of 0.97 in the arterial‐enhanced model and 0.88 in non‐contrast scans with sensitivities of 0.97 and 0.96, respectively. Areas under the curve were 0.97 (95% CI, 0.92–1.0, p < 0.001) and 0.96 (95% CI, 0.90–1.0, p < 0.001), respectively with no significant differences between both models (p= 0.52). This approach shows promise in enhancing pancreatic cancer detection and improving patient diagnoses, particulary in specific patient groups.

IMPROVING THE ACCURACY OF CALCULATION WEIGHTS BY VISUAL INPUT: A PILOT STUDY IN THE EMERGENCY DEPARTMENT OF A LOW MIDDLE-INCOME COUNTRY

Accurate weight estimation is critical in emergency medical scenarios requiring immediate interventions. This pilot study explores the feasibility of improving weight calculation accuracy through visual input, focusing on height-based estimations. The research aims to contribute valuable insights to weight estimation methodologies, particularly in resource-constrained settings. The objective of the pilot study is to explore the feasibility of improving weight calculation accuracy through visual input, focusing on height-based estimations. Data was collected encompassing diverse height ranges from 1.45 to 1.94 meters. Comprehensive datasets included actual body weights, estimated weights, standard deviation, and standard error. eBW(kg) = (N− 1)100 is the estimated body weight method, where "N" is the height measured in meters. Body weight classifications were employed to analyze the accuracy of estimations further. Correction factors for everyone were computed. The correction factor separates the obtained data into underweight, close to actual weight, and overweight. Following optimization, the average correction factor for every category is updated. These updated correction factors improve weight estimation precision. Linear regression analyses were conducted to compare actual and estimated weights, visually representing the discrepancies. The calculated correction factors are essential to improving weight calculations in medicine. The thorough research and improvement procedure resulted in revised correction factors significantly improving the precision of weight estimates in the medical field. We can say that the following equation provides a more accurate weight estimate. Wt corrected = (N-1) x 100 x Correction Factor. This revised weight is an enhanced estimate that considers the updated correction factors. The calculated correction variables are essential to improving weight estimations in medicine. The thorough research and improvement procedure resulted in revised correction factors that significantly improved the precision of weight estimations in the medical field. The derived correction factors demonstrate their effectiveness in enhancing weight estimations, notably in specific patient groups. The investigation classifies patients and delivers precise modifications to improve weight estimations, ensuring safer prescribing procedures. The proposed correction variables will be critical in evaluating emergency medicine doses for individuals.

Standardization of the protocol for oral cavity examination and collecting of the biological samples for microbiome research using the next-generation sequencing (NGS): own experience with the COVID-19 patients

To date, publications have shown that compositions of oral microbiota differ depending on their habitats (e.g. tongue, tonsils, pharynx). The absence of set standards for the choice of the areas and conditions of material collection makes the oral microbiome one of the most difficult environments for a comparative analysis with other researchers, which is a meaningful limitation during an assessment of the potential effects of microorganisms as biomarkers in the courses of various human diseases. Therefore, standardisation of basic conditions of a dental examination and collection of material for the next generation sequencing (NGS) is worth attempting. The standardisation of the dental exam and collection of the clinical materials: saliva, swab from the tongue ridge, hard palate, palatine tonsils and oropharynx, supragingival plaque and subgingival plaque. Protocol involved the patients (n = 60), assigned to 3 groups: I—COVID-19 convalescents who received antibiotics, n = 17, II—COVID-19 convalescents, n = 23 and III—healthy individuals, n = 20. The collected biological samples were used to conduct NGS (16S rRNA). The conditions of patient preparation for collecting biological materials as well as the schedule of dental examination, were proposed. Based on the research conducted, we have indicated the dental indicators that best differentiate the group of COVID-19 patients (groups I and II) from healthy people (group III). These include the DMFT, D and BOP indices. The use of alpha and beta diversity analysis provided an overall insight into the diversity of microbial communities between specific niches and patient groups. The most different diversity between the studied group of patients (group II) and healthy people (group III) was noted in relation to the supragingival plaque. The order of activities during the dental exam as well as while collecting and securing clinical materials is particularly important to avoid technical errors and material contamination which may result in erroneous conclusions from the analyses of the results of sensitive tests such as the NGS. It has been shown that the dental indices: DMFT, D number, PI and BOP are the best prognostic parameters to assess the oral health. Based on beta diversity the most sensitive niche and susceptible to changes in the composition of the microbiota is the supragingival plaque. The procedures developed by our team can be applied as ready-to-use forms in studies conducted by other researchers.

Estimation of racial and language disparities in pediatric emergency department triage using statistical modeling and natural language processing.

The study aims to assess racial and language disparities in pediatric emergency department (ED) triage using analytical techniques and provide insights into the extent and nature of the disparities in the ED setting. The study analyzed a cross-sectional dataset encompassing ED visits from January 2019 to April 2021. The study utilized analytical techniques, including K-mean clustering (KNN), multivariate adaptive regression splines (MARS), and natural language processing (NLP) embedding. NLP embedding and KNN were employed to handle the chief complaints and categorize them into clusters, while the MARS was used to identify significant interactions among the clinical features. The study also explored important variables, including age-adjusted vital signs. Multiple logistic regression models with varying specifications were developed to assess the robustness of analysis results. The study consistently found that non-White children, especially African American (AA) and Hispanic, were often under-triaged, with AA children having >2 times higher odds of receiving lower acuity scores compared to White children. While the results are generally consistent, incorporating relevant variables modified the results for specific patient groups (eg, Asians). By employing a comprehensive analysis methodology, the study checked the robustness of the analysis results on racial and language disparities in pediatric ED triage. The study also recognized the significance of analytical techniques in assessing pediatric health conditions and analyzing disparities. The study's findings highlight the significant need for equal and fair assessment and treatment in the pediatric ED, regardless of their patients' race and language.

Mechanical thrombectomy for the treatment of large vessel occlusion due to cancer-related cerebral embolism: A systematic review.

Cancer-related cerebral embolism due to direct tumor embolization results in a rare acute ischemic stroke with large vessel occlusion (LVO). Despite the established status of mechanical thrombectomy (MT) in LVO management, its effectiveness and safety remains inadequately explored in this specific patient group. We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using the Nested Knowledge AutoLit software, encompassing databases like Embase, PubMed, Scopus, and Web of Science, from their inception up to 9 May 2023. In the review of 35 studies encompassing 37 cases, mean patient age was 52 years, and 30% were female. Cardiac myxoma (29.7%), cardiac papillary fibroelastoma (16.2%), and squamous cell carcinoma of the lung (8.1%) were the most frequent underlying cancers. The left middle cerebral artery was the most commonly affected occlusion site (24.3%). Of the patients, 67.5% underwent MT alone, while 32.5% received MT combined with intravenous thrombolysis. Successful reperfusion (thrombolysis in cerebral infarction (TICI) 2b-3) was achieved in 89.1% of cases, with 59.4% reaching TICI 3. Functional independence was observed in 29.7% of patients. While limitations exist, this comprehensive study highlights the potential benefits of MT in a patient group historically excluded from major trials, warranting further investigation.

The potential role of precision medicine to alleviate racial disparities in prostate, bladder and renal urological cancer care.

Racial disparities in oncological outcomes resulting from differences in social determinants of health (SDOH) and tumour biology are well described in prostate cancer (PCa) but similar inequities exist in bladder (BCa) and renal cancers (RCCs). Precision medicine (PM) aims to provide personalized treatment based on individual patient characteristics and has the potential to reduce these inequities in GU cancers. This article aims to review the current evidence outlining racial disparities in GU cancers and explore studies demonstrating improved oncological outcomes when PM is applied to racially diverse patient populations. Evidence was obtained from Pubmed and Web of Science using keywords prostate, bladder and renal cancer, racial disparity and precision medicine. Because limited studies were found, preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were not applied but rather related articles were studied to explore existing debates, identify the current status and speculate on future applications. Evidence suggests addressing SDOH for PCa can reverse racial inequities in oncological outcomes but differences in incidence remain. Similar disparities in BCa and RCC are seen, and it would be reasonable to suggest achieving parity in SDOH for all races would do the same. Research applying a PM approach to different ethnicities is lacking although in African Americans (AAs) with metastatic castrate-resistant prostate cancer (mCRPCa) better outcomes have been shown with androgen receptor inhibitors, radium-223 and sipuleucel. Exploiting the abscopal effect with targeted radiation therapy (RT) and immunotherapy has promise but requires further study, as does defining actionable mutations in specific patient groups to tailor treatments as appropriate. For all GU cancers, the historical underrepresentation of ethnic minorities in clinical trials still exists and there is an urgent need for recruitment strategies to address this. PM is a promising development with the potential to reduce inequities in GU cancers, however, both improved understanding of race-specific tumour biology, and enhanced recruitment of minority populations into clinical trials are required. Without this, the benefits of PM will be limited.

Comparative Study of the Quality of Life and Coping Strategies in Oncology Patients.

Despite the current data on morbidity and mortality, a growing number of patients with a diagnosis of cancer survive due to an early diagnosis and advances in treatment modalities. This study aimed to compare the quality of life and coping strategies in three groups of patients with cancer and identify associated clinical and sociodemographic characteristics. A comparative study was conducted with outpatients at a public hospital in the state of São Paulo, Brazil. The 300 participants were assigned to three groups: patients in palliative care (Group A), patients in post-treatment follow-up with no evidence of disease (Group B), and patients undergoing treatment for cancer (Group C). Data collection involved the use of the McGill Quality of Life Questionnaire and the Ways of Coping Questionnaire. No generic quality-of-life assessment tool was utilized, as it would not be able to appropriately evaluate the impact of the disease on the specific group of patients receiving palliative care. Coping strategies were underused. Participants in the palliative care group had poorer quality of life, particularly in the psychological well-being and physical symptom domains. Age, currently undergoing treatment, and level of education were significantly associated with coping scores. Age, gender, income, and the absence of pharmacological pain control were independently associated with quality-of-life scores. Moreover, a positive association was found between coping and quality of life. Cancer patients in palliative care generally report a lower quality of life. However, male patients, those who did not rely on pharmacological pain control, and those with higher coping scores reported a better perception of their quality of life. This perception tended to decrease with age and income level. Patients currently undergoing treatment for the disease were more likely to use coping strategies. Patients with higher education and quality-of-life scores also had better coping scores. However, the use of coping strategies decreased with age.

Vaccinations in Pregnancy. A Comprehensive Overview

Introduction and purpose
 Pregnancy is associated with many changes in the mother's body, allowing for the proper development of the fetus, but unfortunately it also predisposes many potentially harmless infections to become much more severe during pregnancy. Therefore, vaccinations during pregnancy play a very important protective role both for the mother, her unborn child and to the child immediately after birth. Immunization during pregnancy and in the preconception period protects against many infectious diseases and related complications. By receiving the vaccine, specific antibodies are synthesized and transported across the placenta to the fetus. They protect the baby during the first months of life, when the baby cannot receive vaccinations due to its age yet. Vaccinations during pregnancy can be divided into necessary, possible and recommended. Recommended vaccinations include against diphtheria, tetanus, pertussis, influenza, Covid19 and RSV. They are especially recommended for every pregnant woman who has no permanent or temporary contraindications. A special group of vaccinations are those necessary to perform, which play the main role as post-exposure prophylaxis and must be administered immediately after exposure to the agent causing the infection. These include mainly vaccination against tetanus and rabies. The vaccinations that can be performed include those targeted at a specific group of patients with various chronic diseases who are at risk or traveling to countries where there is an increased risk of illness. During a doctor's visit to a woman planning a pregnancy, it is important to collect a detailed interview regarding vaccination history, past infectious infections and chronic diseases. This allows us to prepare an individualized vaccination schedule recommended both before and during pregnancy.

Pre-surgical factors related to latent trajectories of 5-year weight loss for a diverse bariatric surgery population

BackgroundAnalyzing trajectories of weight loss may address how particular groups of patients respond to metabolic and bariatric surgery. ObjectivesThe Bariatric Experience Long Term (BELONG) study was designed to use a theoretical model to examine determinants of weight loss and recurrence. SettingLarge integrated health system in Southern California with 11 surgical practices and 23 surgeons. MethodsA total of n = 1338 patients who had metabolic and bariatric surgery were surveyed before surgery to measure factors related to median percent total weight loss (%TWL) over 5 years. Longitudinal weight data were available for n = 1024 (76.5% of the sample). Data were analyzed using latent growth mixture models (GMM) to estimate trajectories of weight change separately for gastric sleeve and bypass operations. These trajectories were then described using relevant variables from the baseline survey. ResultsFor both gastric sleeve (n = 733) and bypass (n = 291) operations, 3 latent trajectories of median %TWL were found corresponding to most, moderate, and least %TWL. Sleeve trajectories were distinguished by body mass index at surgery and geocoded environmental factors. Bypass trajectories varied by self-reported and geocoded environmental factors, comorbidity burden, race, experiential avoidance, and weight control strategies. ConclusionsFuture research should examine the role of the built and perceived environment in surgical weight loss. Bariatric practices should focus less on the presurgical period for predictors of long-term weight loss and begin efforts to monitor real-time patient-reported outcomes to help tailor intervention strategies for patients who either do not lose an expected amount of weight or who begin to experience weight recurrence.

Assessing the hazard of death, cardiac tamponade, and pericardial constriction among HIV and tuberculosis pericarditis patients using the extended Cox-hazard model: Intervention study.

Tuberculous (TB) pericarditis (TBP), a TB of the heart, is linked to significant morbidity and mortality rates. Administering glucocorticoid therapy to individuals with TBP might enhance overall results and lower the likelihood of fatality. However, the actual clinical effectiveness of supplementary glucocorticoids remains uncertain. This study specifically evaluated the effects of prednisolone, prednisolone-antiretroviral therapy (ART) interaction, and other potential risk factors in reducing the hazard of the composite outcome, death, cardiac tamponade, and constriction, among TBP and human immunodeficiency virus (HIV) patients. The data used in this study were obtained from the investigationof the Management of Pericarditis trial, a multicentre international randomized double-blind placebo-controlled factorial study that investigated the effects of two TB treatments, prednisolone and Mycobacterium indicus pranii immunotherapy in patients with TBPin Africa. This study used a sample size of 587 TBP and HIV-positivepatients randomized into prednisolone and its corresponding placebo arm. We used the extended Cox-proportional hazard model to evaluate the effects of the covariates on the hazard of the survival outcomes. Models fitting and parameter estimation were carried out using R version 4.3.1. Prednisolone reduces the hazard of composite outcome (hazrad ratio [HR] = 0.32, 95% confidence interval [CI] = , p < 0.001), cardiac tamponade (HR = 0.14, 95%CI = 0.05, 0.42, p < 0.001) and constriction (HR = 0.81, 95%CI = 0.41, 1.61, p = 0.55). However, prednisolone increases the hazard of death (HR = 1.58, 95%CI = 1.11, 2.24, p = 0.01). Consistent usage of ART reduces the hazard of composite outcome, death, and constriction but insignificantly increased the hazard of cardiac tamponade. The study offers valuable insights into how prednisolone impact the hazard of different outcomes in patients with TBP and HIV. The findings hold potential clinical significance, particularly in guiding treatment decisions and devising strategies to enhance outcomes in this specific patient group. However, there are concerns about prednisolone potentially increasing the risk of death due to HIV-related death.

Mobile Critical Care Recovery Program for Survivors of Acute Respiratory Failure

Over 50% of Acute Respiratory Failure (ARF) survivors experience cognitive, physical, and psychological impairments that negatively impact their quality of life (QOL). To evaluate the efficacy of a post-intensive care unit (ICU) program, the Mobile Critical Care Recovery Program (m-CCRP) consisting of a nurse care coordinator supported by an interdisciplinary team, in improving the QOL of ARF survivors. This randomized clinical trial with concealed outcome assessments among ARF survivors was conducted from March 1, 2017, to April 30, 2022, with a 12-month follow-up. Patients were admitted to the ICU services of 4 Indiana hospitals (1 community, 1 county, 2 academic), affiliated with the Indiana University School of Medicine. A 12-month nurse-led collaborative care intervention (m-CCRP) supported by an interdisciplinary group of clinicians (2 intensivists, 1 geriatrician, 1 ICU nurse, and 1 neuropsychologist) was compared with a telephone-based control. The intervention comprised longitudinal symptom monitoring coupled with nurse-delivered care protocols targeting cognition, physical function, personal care, mobility, sleep disturbances, pain, depression, anxiety, agitation or aggression, delusions or hallucinations, stress and physical health, legal and financial needs, and medication adherence. The primary outcome was QOL as measured by the 36-item Medical Outcomes Study Short Form Health Survey (SF-36) physical component summary (PCS) and mental component summary (MCS), with scores on each component ranging from 0-100, and higher scores indicating better health status. In an intention-to-treat analysis among 466 ARF survivors (mean [SD] age, 56.1 [14.4] years; 250 [53.6%] female; 233 assigned to each group), the m-CCRP intervention for 12 months did not significantly improve the QOL compared with the control group (estimated difference in change from baseline between m-CCRP and control group: 1.61 [95% CI, -1.06 to 4.29] for SF-36 PCS; -2.50 [95% CI, -5.29 to 0.30] for SF-36 MCS. Compared with the control group, the rates of hospitalization were higher in the m-CCRP group (117 [50.2%] vs 95 [40.8%]; P = .04), whereas the 12-month mortality rates were not statistically significantly lower (24 [10.3%] vs 38 [16.3%]; P = .05). Findings from this randomized clinical trial indicated that a nurse-led 12-month comprehensive interdisciplinary care intervention did not significantly improve the QOL of ARF survivors after ICU hospitalization. These results suggest that further research is needed to identify specific patient groups who could benefit from tailored post-ICU interventions. ClinicalTrials.gov Identifier: NCT03053245.

Extensive red blood cell matching considering patient alloimmunization risk.

Red blood cell (RBC) transfusions pose a risk of alloantibody development in patients. For patients with increased alloimmunization risk, extended preventive matching is advised, encompassing not only the ABO-D blood groups but also the most clinically relevant minor antigens: C, c, E, e, K, Fya, Fyb, Jka, Jkb, S and s. This study incorporates patient-specific data and the clinical consequences of mismatching into the allocation process. We have redefined the MINimize Relative Alloimmunization Risks (MINRAR) model to include patient group preferences in selecting RBC units from a finite supply. A linear optimization approach was employed, considering both antigen immunogenicity and the clinical impact of mismatches for specific patient groups. We also explore the advantages of informing the blood bank about scheduled transfusions, allowing for a more strategic blood distribution. The model is evaluated using historical data from two Dutch hospitals, measuring shortages and minor antigen mismatches. The updated model, emphasizing patient group-specific considerations, achieves a similar number of mismatches as the original, yet shifts mismatches among patient groups and antigens, reducing expected alloimmunization consequences. Simultaneous matching for multiple hospitals at the distribution centre level, considering scheduled demands, led to a 30% decrease in mismatches and a 92% reduction in shortages. The reduction of expected alloimmunization consequences by incorporating patient group preferences demonstrates our strategy's effectiveness for patient health. Substantial reductions in mismatches and shortages with multi-hospital collaboration highlights the importance of sharing information in the blood supply chain.

The Ross Procedure: Imaging, Outcomes and Future Directions in Aortic Valve Replacement.

The Ross procedure is gaining recognition as a significant option for aortic valve replacement (AVR), and is particularly beneficial in specific patient groups. Although categorized as a class IIb recommendation in the 2020 American College of Cardiology (ACC)/American Heart Association (AHA), and the European Society of Cardiology (ESC) management guidelines on valvular heart disease, recent studies bolster its credibility. Research, including a propensity-matched study, underlines the Ross procedure's association with enhanced long-term survival and reduced adverse valve-related events compared to other AVR types. This positions the Ross procedure as a primary option for AVR in young and middle-aged adults within specialized centers, and potentially the only choice for children and infants requiring AVR. This review meticulously examines the Ross procedure, covering historical perspectives, surgical techniques, imaging, and outcomes, including hemodynamic performance and quality of life, especially focusing on pediatric and young adult patients. It explores contemporary techniques and innovations like minimally invasive approaches and tissue engineering, underscoring ongoing research and future directions. A summarization of comparative studies and meta-analyses reiterates the Ross procedure's superior long-term outcomes, valve durability, and preservation of the left ventricular function, accentuating the crucial role of patient selection and risk stratification, and pinpointing areas for future research.