Standardized Scoring System Research Articles

Neoadjuvant Therapy and Lung Cancer: Role of Pathologists.

Recent neoadjuvant clinical trials in lung cancer have demonstrated the survival benefits in carefully selected patients. Standardization of the assessment of pathologic response to neoadjuvant therapy in surgically resected specimens is required. To review the current pathology practices in the gross processing and microscopic assessment of surgically resected non-small cell lung carcinoma specimens after neoadjuvant therapy. PubMed publications and experience of the author. Gross processing of the surgically resected lung carcinoma after neoadjuvant therapy needs further refinement and standardization in clinical trials and in a real-world clinical practice. Microscopic assessment of the response includes quantification of viable tumor, necrosis, and stroma. The best approach would be to use a single standardized and most reproducible scoring system. Published studies on gross processing of lung carcinoma specimens in the neoadjuvant setting and microscopic assessment of pathologic response provide a good foundation for the future standardization of pathology practice.

Identifying and Addressing Errors in Anatomical Pathology: A Survey Analysis

Abstract Introduction/Objective To get an update on potential sources of pre-analytical, analytical, post-analytical and other sources of errors in anatomic pathology and strategies to mitigate such errors. Methods/Case Report The authors designed a 5-question survey in Google software and shared it widely on social media platforms. Results (if a Case Study enter NA) The survey, which garnered 43 responses from staff across various areas of the anatomic pathology laboratory, revealed significant insights. Labeling and fixation/preservation errors emerged as the most prevalent pre-analytical errors, while discrepancies between gross and microscopic examinations were common analytical errors. Specimen handling, inadequate clinical information, and transportation were the most frequently perceived other potential sources of errors. The implications of these findings are clear: robust protocols with multiple identifiers, staff training, and barcode labeling can significantly reduce patient identification errors. Similarly, standardized collection instructions, pre-labeled containers, and meticulous verification processes can effectively minimize such errors. Validated tests, standardized scoring systems, and proper investigation of quality control discrepancies are key to reducing analytical errors. Documented procedures, staff training, regular equipment calibration, and reagent testing are also crucial. Conclusion This study contributes to the literature on the current state of potential sources of errors in anatomic pathology. The study findings and recommendations on strategies to address such errors would improve the performance of the anatomic pathology laboratory and eventually improve patient care.

Biomarker Profiles and Clinicopathological Features in Head and Neck Squamous Cell Carcinoma Patients.

Background and Objectives: Head and neck squamous cell carcinomas (HNSCCs) vary significantly in terms of invasiveness, growth rate, and metastatic potential. This study aimed to investigate the expression of several prognostic biomarkers (Ki67, p53, EGFR, COX-2, Cx43, and p16) in HNSCC from various anatomical regions and to correlate these expressions with clinicopathological parameters. Materials and Methods: We performed immunohistochemistry on 91 histologically verified HNSCC cases from the County Emergency Hospital, Targu Mures. Biomarker expression for Ki67, COX-2, and Cx43 was assessed using a standard immunoexpression scoring system: S1: 0-10%, S2: 11-25%, S3: 26-50%, S4 > 50%; EGFR was scored based on membrane staining intensity: 0, 1+, 2+, 3+; we classified p16 as positive or negative; p53 was grouped into mutant and wild-type; and we compared these across histopathological types, tumor grades, anatomical locations, gender, and different age groups. We performed a comparative analysis of Cx43 expression levels in relation to the expression of the rest of the markers. Statistical analysis was conducted using GraphPad InStat 3 software, version 3.06 (GraphPad Software Inc., San Diego, USA). Results: The majority of tumors were in males (95.6%) aged 51-60 years. Mutant p53 expression was prevalent in most cases. Elevated Ki67 and EGFR expression were associated with more aggressive tumors. COX-2 levels varied, with a higher proportion of moderate and high immunoexpression (S3 + S4) observed in patients under 70 years old. Cx43 expression was generally low, especially in extralaryngeal tumors. Conclusions: HNSCC primarily affects older males, with the larynx being the most common site. High levels of Ki-67 and EGFR suggest more aggressive tumors, while low COX-2 levels reflect varying prognoses. Women may develop more aggressive tumors, and extralaryngeal tumors often present with more challenging prognoses. Low Cx43 expression may be more likely to coincide with higher Ki67 and COX-2 levels, possibly indicating a link with more aggressive tumor behavior.

How much does an MRI change over a period of up to 2years in patients with chronic low back pain? Is a repeated MRI really necessary in the follow-up of patients with chronic low back pain?

Clinical practices vary between healthcare providers when it comes to asking for a Magnetic Resonance Imaging (MRI) during follow-up for chronic low-back pain (LBP). The association between progressive changes on the MRI and the clinical relevance of these findings is not clearly defined. The objective of our study is to investigate to what extent do MRI findings change during a period less than or equal to two years in patients with chronic LBP. We question the efficacy of its routinary use as a tool for follow-up and we also study the correlation between new changes on MRI and modifications in therapeutic attitude. Data was collected from 468 lumbar spine MRIs from 209 patients undergoing two or more MRIs between January 2015 and December 2019 with a mean of 2.24 MRIs per patient. The evaluated data included diagnosis, reason for request, MRI findings and treatment offered post-MRI. MRIs were assessed according to a standardized scoring system from 0 to 14 points according to the severity in findings (modified Babinska Score). Radiological changes were defined as increased severity of findings in the most affected segment. 51.06% of MRI requests had no documented reason to be asked for. The average score of the findings on the first MRI was 5,733 (SD 2,462) and 6,131 (SD 2,376) on the second, not reaching a statistically significant difference (p = 0.062). There was no difference on the findings between the first and the second MRI in 40, 15% (n = 104) and up to 89, 96% with only mild changes (-1/ + 2 points over 14 possibles). After repeating the MRI, no modification to the treatment plan was made in 44, 79% of patients (n = 116) and only in 11.58% (n = 30) was surgical treatment indicated. The rate of lumbar MRI has risen to an alarming pace without evidence of consequent improvements in patient outcomes. A significant number of repeated MRIs did not show radiological changes, nor did they give rise to further surgical treatment after obtaining these images. This study should help to review the real applications of clinical guides on the appropriate use for image tests.

Rhytidectomy Incision Techniques and Scar Outcomes: A Scoping Review.

Although scar outcomes in rhytidectomy are crucial to patients and surgeons alike, there is a lack of consensus on incision techniques for optimizing rhytidectomy scars. A comprehensive scoping review of the literature was performed on rhytidectomy incision techniques and associated scar outcomes.The PRISMA protocol was utilized to conduct a scoping review of the literature through MEDLINE, EMBASE, and Science Citation Index databases to identify articles discussing rhytidectomy incision techniques and scar outcomes.A total of 49 studies were included in this scoping review. Four themes were identified related to rhytidectomy scars within these studies: temporal incision placement, tragal incision placement, lobule management, and postauricular incision design. Techniques within each theme were described and reported scar outcomes summarized.There are many approaches to rhytidectomy incisions described in the literature, with reportedly low rates of scar complications for each of the techniques described. It cannot be elucidated which techniques are superior due to the heterogeneity of outcomes reported in the literature with significant variability in outcome measures, study design, and follow-up time. Future studies should focus on utilizing a standardized rating system to aid in objective determination of the superiority of one technique versus another. LEVEL OF EVIDENCE:: Level I.

A Review of the Vitiligo Literature to Standardize Expression of Disease Severity.

The literature on vitiligo is heterogeneous with limited standardization in vitiligo disease severity reporting. The IDEOM Vitiligo Workgroup initiated a project to develop an improved understanding of clinical reporting of vitiligo severity. A medical librarian-developed literature review identified 50 clinical trials treating vitiligo topically using topical corticosteroids or topical tacrolimus that included adult and pediatric patients, with 10 or more patients, with grading by SORT criteria. Grading systems used included body surface area scoring (BSA) clinically or via photography and mapping. Most studies create a grading system of repigmentation including G0- no change, G1- 1-25%, G2- 26-50%, G3- 51-75%, G4- 75-99%, and G5- 100%. Variations include reporting success as thresholds >25% (G2-G5), >50% (G3-G5), and >75% (G4-G5) repigmentation. Vitiligo Area Scoring Index (VASI), Dermatology Life Quality Index (DLQI), patient satisfaction, and the vitiligo noticeability scale are all standardized scoring systems that have been used in clinical studies. Other metrics reported include onset and maintenance of response, treatment burden, side effects, and cost-effectiveness. BSA total and quartiles of improvement are the most commonly reported metrics in studies with high-level evidence. The addition of categories of no improvement, complete clearance, spontaneous improvement, and worsening appears to enhance information collection. Collection of data using photographs or computer-assisted BSA monitoring enhances data reproducibility. Thresholds of success should include 25%, 50%, 75%, and adding 90% and 100% repigmentation. VASI represents a validated collection method, which can be modified for 50%, 75%, and 90% improvement. Newer metrics including treatment burden and cost effectiveness are emerging metrics under evaluation. J Drugs Dermatol. 2024;23(10):842-846. doi:10.36849/JDD.8049.

Vessel wall MRI in giant cell arteritis: standardized protocol and scoring approach developed by an international working group.

There are an increasing number of centers performing research on high-resolution vessel wall magnetic resonance imaging (VW-MRI) in giant cell arteritis (GCA). However, harmonized approaches to VW-MRI in GCA are lacking and are essential to performing multicentre studies. Using a data-driven, consensus-based approach, an international expert group developed a standardized MRI protocol and scoring system to advance multi-centered research in cranial GCA. A targeted literature review of VW-MRI in cranial GCA was conducted. A working group comprised of radiologists, rheumatologists, and ophthalmologists with expertise in VW-MRI and GCA reviewed the results of the literature search, presented relevant data and images from their respective centers, and then reached consensus on recommendations related to key MRI structures, MRI sequences, scoring system, and other important considerations. A total of 21 relevant articles were identified and reviewed. Based on published literature, structures to be evaluated on MRI were categorized based on anatomic location (extradural cranial, intradural cranial, and orbits) and prioritization (core vs elective). Essential and elective sequences to comprehensively image cranial and orbital structures while minimizing scan time were determined along with scoring systems to grade contrast enhancement. This report describes a standardized approach to facilitate research of VW-MRI in cranial GCA that is the result of a multi-disciplinary, international collaboration of experts in VW-MRI and/or GCA.

Preventing Recurrence of Crohn's Disease Post-Ileocaecal Surgery in Paediatric Patients: A Therapy Guide Based on Systematic Review of the Evidence.

Ileocaecal resection (ICR) is frequent in paediatric patients with Crohn's disease (pCD). Despite rates of reoperation being low, the risk of clinical or endoscopic post-operative recurrence (POR) is high; effective medical strategies to prevent POR are thus needed. The aim of this systematic review(SR) was to identify and evaluate the published literature on post-operative medical prevention of POR in pCD to draft a possible therapy guide for pCD patients undergoing ICR. We performed an SR according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards and registered it in the PROSPERO database (ID: CRD42024533855). The population, intervention, control, outcome (PICO) model was focussed on post-surgical medical prevention of POR in pCD with clearly expressed definition of recurrence (endoscopically using a standardized scoring system (e.g. Rutgeerts score) or by laboratory markers, for example, faecal calprotectin (F-CPT), C-reactive protein (CRP) or by histological findings or by clinical activity indexes [e.g. weighted paediatric Crohn's disease activity index - (w)PCDAI]. From inception until 29 February 2024, the following databases were searched: PubMed/MEDLINE, Scopus/Embase, Web of Sciences, Evidence-Based Medicine Reviews (including Cochrane), Cochrane Central Registrar of controlled Trials (CENTRAL), ClinicalTrials.gov and EudraCT. Retrieved articles were evaluated for eligibility and finally selected publications for risk of bias using ROBINS-I tool. Out of 811 publications identified by the search, only 5 fulfilled inclusion criteria of the SR. None of the studies fully answered our PICO question. The studies were overall of poor quality and the heterogeneity of the data did not allow us to perform meta-analysis, detailed statistical analysis or formal synthesis of data. Adverse events of post-operative medication were not described in any of the included studies. Existing guidelines of European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), North American Society for Paediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), European Crohn's and Colitis Organisation (ECCO) and American Gastroenterological Association (AGA) were reviewed and paediatric therapy guide for pCD undergoing ICR was drafted with respect to recent SRs and meta-analyses in adult population and including scarce paediatric data identified by our SR. As pCD patientsundergoing ICR are a high-risk population, they should not be left untreated post-operatively. Anti-tumour necrosis factor (anti-TNF) drugs should be considered as first-line therapy in the majority of patients. Non-anti-TNF biologics should be considered in case of anti-TNF failure. Regular endoscopic monitoring starting at 6 months after the surgery and supported by regular F-CPT evaluation should be used to identify early endoscopic recurrence and to escalate the treatment. Our SR revealed that there is wide variability in treatment strategies in children, and high-quality data are generally lacking. At the moment, paediatric prophylaxis of POR should be guided by available adult evidence with respect to the high-risk nature of pCD. Extensive research in pCD should be encouraged.

Prognostic Indicators of Reorientation of Care in Perinatal Hypoxic-Ischemic Encephalopathy Spectrum

ObjectiveTo investigate the clinical, electrographic, and neuroimaging characteristics in neonates with perinatal hypoxic-ischemic encephalopathy (HIE) who undergo reorientation of care (ROC) using standardized scoring systems. Study designA nested observational substudy within a prospective HIE cohort was conducted. Group 1 comprised infants whose parents received the medical recommendation for ROC, while Group 2 continued to receive standard care. Encephalopathy scores were monitored daily. Amplitude-integrated and continuous-video-integrated electroencephalogram (EEG) during therapeutic hypothermia were analyzed. Standardized scoring systems for cranial ultrasonography and post-rewarming brain MRI were deployed. ResultsThe study included 165 infants, with 35 in Group 1 and 130 in Group 2. By day 3, all infants in Group 1 were encephalopathic with higher Thompson scores (median 13 [IQR 10-19] vs. 0 [IQR 0-3], p<0.001). Electrographic background normalization within 48 hours occurred in 3% of Group 1 compared with 46% of Group 2 (p<0.001). Sleep-wake cycling was not observed in Group 1 and emerged in 63% of Group 2 within the first 72 hours (p<0.001). The number of anti-seizure medications received was higher in Group 1 (median 3 [IQR, 2-4] vs. 0 [IQR, 0-1], respectively; p< 0.001). Group 1 had higher cranial ultrasound injury scores (median 4 [IQR 2-7] vs. 1 [IQR 0-1], p<0.001) within 48 hours and post-rewarming brain MRI injury scores (median 33 [range 20-51] vs. 4 [range 0-28], p<0.001). ConclusionNeonates with perinatal HIE who underwent ROC presented with and maintained significantly more pronounced clinical manifestations, electrographic findings, and near-total brain injury as scored objectively on all modalities.

Prospective Assessment of Transforaminal Lumbar Interbody Fusion (TLIF) in Spondylolisthesis: A Radiological and Functional Outcome Study in an Indian Population.

Spondylolisthesis is a common spinal condition in which one vertebra slips over another, leading to pain and disability. Transforaminal lumbar interbody fusion (TLIF) has emerged as a surgical option for addressing spondylolisthesis; however, limited research exists, especially in the Indian context, evaluating its radiological and functional outcomes. The study aimed to evaluate the radiological and functional outcomes of TLIF in spondylolisthesis using standardized scoring systems, to evaluate the sagittal balance of the spine radiologically in patients who have undergone TLIF for spondylolisthesis, and to evaluate the correlation between the functional and radiological outcomes after TLIF. This prospective observational study included spondylolisthesis patients undergoing TLIF at SRM Medical College Hospital and Research Centre from August 2022 to August 2024. Criteria included Meyerding grade 1-4 spondylolisthesis, single-segment fusion, and willingness for 12-month follow-up. Forty-five patients were included with age 36.6 ± 12.2 years, with 73.3% being female. L4-L5 is the most common level affected in 21 patients (46.7%). Significant improvements were observed in pelvic tilt 19.07 ± 2.05, sacral slope 30.6 ± 4.4, segmental lordosis 18.4 ± 1.4, lumbar lordosis 57.1 ± 1.8, sagittal vertical axis (SVA) 2.5 ± 0.3, Visual Analog Scale for pain 0.4 ± 0.5, and Oswestry Disability Index (ODI) scores 5.23 ± 2.6 postoperatively (p < 0.05). At one-year follow-up, 84.4% of patients had good-to-excellent outcomes, and 44.4% had definitive fusion according to modified Lee criteria. However, there was no correlation between ODI score and grade of listhesis, pelvic incidence (PI), or SVA of the spine (p > 0.05). This study provides valuable insights into the effectiveness of TLIF surgery in addressing spondylolisthesis, both in terms of radiological and functional outcomes. However, there was no correlation between improvement in functional and radiological parameters (PI vs. ODI, SVA vs. ODI). TLIF appears to offer significant improvements in patient well-being and quality of life. These findings contribute to understanding TLIF's suitability as a treatment for spondylolisthesis and can inform clinical practice, ultimately benefiting patients suffering from this condition.

The association between histopathological growth patterns with tumor budding and poorly differentiated clusters in colorectal liver metastasis treated with preoperative systemic therapy.

The liver's unique cellular structure makes it a frequent site for metastatic cancer. In colorectal liver metastasis (CRLM), surgical resection is essential for long-term survival. Histopathological growth patterns (HGPs) in CRLM, including desmoplastic and nondesmoplastic patterns, provide critical prognostic information. Tumor budding (TB) and poorly differentiated clusters (PDCs), indicators of aggressive cancer behavior, are evaluated using standardized histological scoring systems and are linked to epithelial-mesenchymal transition. This study explored the correlation between HGPs, TB, and PDCs in CRLM. Archived data from Thammasat University Hospital, including resected CRLM specimens, were analyzed. This study evaluated 51 CRLM resection specimens treated with preoperative systemic therapy, finding most to be nondesmoplastic with low TB and grade 1 PDC. Desmoplastic growth was significantly more prevalent in cases receiving preoperative chemotherapy than those that did not. Higher 3-year mortality was noted in nondesmoplastic groups and those with higher TB and tumor regression grade (TRG) scores. Significant correlations were observed between HGPs, TB, and PDCs, despite challenges in assessing these parameters due to issues with noncancer cells, extracellular mucin, bile ductular proliferation, and retraction artifacts. This study underscores the prognostic significance of HGPs, TB, PDCs, and TRG scores in CRLM, highlighting the need for precise histopathological evaluation for more accurate prognostic implications.

Evaluation of different irrigation activation techniques for the removal of various medicaments from a simulated internal resorption cavity: an in vitro study.

This study aimed to assess the efficacy of different activation techniques in removing calcium hydroxide (Ultracal XS), Ledermix, and Bio-C Temp from simulated internal root resorption (IRR) cavities. 108 single-rooted maxillary incisors were prepared using Reciproc R50 files. Simulated IRR cavities, 2mm in diameter and located 8mm from the apex, were created. Ultracal XS, Ledermix, and Bio-C Temp were applied to the samples, grouped by irrigation activation techniques: Standard Needle Irrigation (SNI), EDDY, Passive Ultrasonic Irrigation (PUI), and XP-endo Finisher (XPF). Medicament removal efficacy was evaluated using a standardized scoring system. Statistical analysis was performed using the Kruskal-Wallis test. XPF and PUI were more effective than SNI in medicament removal across the groups, with no significant difference. EDDY showed no significant difference than other groups. Ledermix was more effectively removed in all activation groups compared to Bio-C Temp. The XPF was superior in removing Ultracal XS compared to Bio-C Temp. However, none of the groups achieved complete medicament removal. XPF and PUI techniques enhance medicament removal efficacy. Bio-C Temp was more difficult to remove from the IRR cavities than other medicaments. Bio-C Temp could be removed from the canals less effectively compared to calcium hydroxide and Ledermix. Among the tested irrigation activation methods, XPF and PUI were found to be more effective at removing the tested medicaments.

Scoring Criteria for Autoimmune Bullous Diseases: Utility, Merits, and Demerits.

Scoring systems play a crucial role in dermatology by providing objective measurements of disease severity, treatment efficacy, and outcome comparisons. In autoimmune blistering diseases (AIBDs), standardized scoring systems are essential for accurate evaluations; however, there is currently a lack of consensus on scoring methods. This literature review explores scoring systems in AIBDs by tracing their development, addressing challenges, and highlighting their role in defining endpoints, regulatory considerations, and clinical trials. Existing scoring systems for AIBDs, such as the Pemphigus Disease Area Index, Autoimmune Bullous Skin Disorder Intensity Score, Pemphigus Oral Lesions Intensity Score, Oral Disease Severity Score, and Pemphigus Vulgaris Activity Score, are examined for their validity, reliability, and responsiveness. The Bullous Pemphigoid Disease Area Index for bullous pemphigoid is also discussed. The concept of minimal clinically important differences is explored to determine clinically significant improvements in disease severity. This review provides a comprehensive understanding of the central role of scoring systems in dermatology and their implications for research and clinical practice in AIBDs.

Sedation Experiences of Pediatric Intensive Care Nurses: Exploring PICU Nurse Perspectives on Sedative Management and Communication.

Objective: This study's purpose is to better understand pediatric intensive care nursing perspectives on sedative management as a precursor to improving aspects of sedation assessment, titration, and communication. Methods/Design: We queried nurses in the pediatric intensive care unit at a 40+ bed quaternary care using an electronic survey about their experiences with sedation management. Data was collected using REDCap and statistical analyses were performed to assess for differences between experience levels in areas. Results: Seventy nurses responded with 42% response rate. More than 95% were comfortable calculating sedation and delirium scores. Those with less than 5 years' experience were significantly more likely to consider sedation scores helpful (P = .04) and also significant more likely to agree that delirium scores are used effectively (P = .01). Eighty-eight percent of respondents were comfortable raising concerns about sedation to the multidisciplinary team, but those with less than 5 years' experience were significantly less likely to express concerns to attending (P = .001). Conclusion: Newer nurses are more inclined to support use of standardized scoring systems for sedation and delirium, but less comfortable approaching attending clinicians with their concerns. Intensive care teams should pay careful attention to team dynamics, particularly as they apply to sedative management and work to improve communication, collaboration, and educational interventions to improve patient care. Further work understanding nursing perspectives and further attempts to improve interprofessional communication seems a wise investment and could obviate barriers that may exist.

United States newspaper and online media coverage of artificial intelligence and radiology from 1998 to 2023

ObjectiveTo evaluate the frequency and content of media coverage pertaining to artificial intelligence (AI) and radiology in the United States from 1998 to 2023. MethodsThe ProQuest US Newsstream database was queried for print and online articles mentioning AI and radiology published between January 1, 1998, and March 30, 2023. A Boolean search using terms related to radiology and AI was used to retrieve full text and publication information. One of 9 readers with radiology expertise independently reviewed randomly assigned articles using a standardized scoring system. Results379 articles met inclusion criteria, of which 290 were unique and 89 were syndicated articles. Most had a positive sentiment (74 %) towards AI, while negative sentiment was far less common (9 %). Frequency of positive sentiment was highest in articles with a focus on AI and radiology (86 %) and lowest in articles focusing on AI and non-medical topics (55 %). The net impact of AI on radiology was most commonly presented as positive (60 %). Benefits of AI were more frequently mentioned (76 %) than potential harms (46 %). Radiologists were interviewed or quoted in less than one-third of all articles. ConclusionPortrayal of the impact of AI on radiology in US media coverage was mostly positive, and advantages of AI were more frequently discussed than potential risks. However, articles with a general non-medical focus were more likely to have a negative sentiment regarding the impact of AI on radiology than articles with a more specific focus on medicine and radiology. Radiologists were infrequently interviewed or quoted in media coverage.

A protocol for scoping reviews on the role of whole-body and dedicated body-part magnetic resonance imaging for assessment of adult and juvenile idiopathic inflammatory myopathies.

Currently, standardized magnetic resonance imaging (MRI) scoring systems and protocols for assessment of idiopathic inflammatory myopathies (IIMs) in children and adults are lacking. Therefore, we will perform a scoping review of the literature to collate and evaluate the existing semi-quantitative and quantitative MRI scoring systems and protocols for the assessment and monitoring of skeletal muscle involvement in patients with IIMs. The aim is to compile evidence-based information that will facilitate the future development of a universal standardized MRI scoring system for both research and clinical applications in IIM. A systematic search of electronic databases (PubMed, EMBASE, and Cochrane) will be undertaken to identify relevant articles published between January 2000 and October 2023. Data will be synthesized narratively. This scoping review seeks to comprehensively summarize and evaluate the evidence on the scanning protocols and scoring systems used in the assessment of diagnosis, disease activity, and damage using skeletal muscle MRI in IIMs. The results will allow the development of consensus recommendations for clinical practice and enable the standardization of research methods for the MRI assessment of skeletal muscle changes in patients with IIMs.

Exploring the content of epilepsy fellowship program websites: an analysis of information available to applicants

BackgroundProgram websites are essential resources in the process of residency and fellowship application. We evaluated the information furnished on these resources by Epilepsy fellowship programs. The extent of information provided was compared across geographic zones, academic affiliation, and national ranking.MethodsA list of Epilepsy fellowship programs was derived from the Fellowship and Residency Electronic Interactive Database (FREIDA). Links to program websites were obtained directly from FREIDA or using Google’s search engine. Online data was categorized to reflect program information, education, recruitment, compensation, epilepsy center-specific information, and social media presence. Data points under each category were collected to develop a standardized scoring system. The frequency of criterion present was compared across geographic zones, academic affiliation, and national ranking using parametric and non-parametric statistical tests. Significance was determined at a p-value ≤ 0.05 for all cases. The study utilized IBM SPSS version 28 and Python 3.11.3.ResultsWe analyzed 80 Epilepsy fellowship programs. The most reported feature was the program director’s name and email (100.0%). The least reported features included board pass rates (1.3%), preparatory boot camp (8.8%), and post-fellowship placements (11.3%). Programs were found to be well-represented on X (88.8%), Facebook (81.3%), and Instagram (71.3%). Most (85.0%) of the programs were searchable through Google. The scores for program information, education, recruitment, compensation, epilepsy center-specific information, and social media visibility did not significantly vary based on location, academic affiliation, or rank status.ConclusionsOur results demonstrate that despite an online presence, there is much room for improvement in the content available to the applicant. To improve the Match process and attract a roster of well-informed fellows, Epilepsy fellowship programs should furnish program websites with up-to-date information relevant to program information, education, recruitment, compensation, and epilepsy center-specific information.

DISTAL TIBIA FRACTURE MANAGED BY EXPERT TIBIA NAIL: POSTOPERATIVE COMPLICATIONS

Distal tibial fractures present a significant challenge in orthopaedic surgery due to their complex nature and the risk of complications. Expert tibia nails (ETN) have emerged as a potential solution for improving functional outcomes and reducing complications in these fractures. Objective: To assess the complications and functional consequences of using expert tibia nails (ETN) in patients with distal tibial fractures. Methods: This prospective study included thirty patients with distal tibial fractures treated using expert tibia nails (ETN). The study was conducted from January 2023 to June 2023 at department of orthopedic surgery, Hayatabad Medical Complex, Peshawar. Functional outcomes were assessed using a standardised scoring system, and complications were monitored. Statistical analysis included descriptive statistics to summarise the data. Results: The mean age of the patients was 44.80 ± 9.50 years. The functional outcome was excellent in 21 patients (70%), good in 7 patients (23.3%), and fair in 2 patients (6.7%). Complications observed included malunion in 2 patients (6.7%), nonunion in 1 patient (3.3%), and infection in 3 patients (10%). Conclusion: The use of expert tibia nails (ETN) in treating distal tibial fractures resulted in excellent to good functional outcomes in most patients. The rates of complications such as malunion, nonunion, and infection were relatively low, indicating that ETN is a reliable method for managing distal tibial fractures.

Correlation Between Calcium Scoring and Abdominal Aortic Aneurysm Endovascular Repair Outcomes.

Endovascular aneurysm repair, though minimally invasive and has the benefit of relatively low perioperative complication rates, it is associated with significant long term reintervention rates related to endoleaks. Several variables have been studied to predict the outcomes of endovascular aneurysm repair, 1 of which is the calcium burden of the vasculature. This prompted us to study the association between calcium burden measured by the standardized Agatston scoring system and the outcomes of Endovascular aneurysm repair. This is a retrospective study of patients who underwent Endovascular aneurysm repair from 2008 to 2020 at our institution and who had a non-contrast computerized tomography scan preoperatively, accounting for 87 patients. The calcium burden of the vasculature was measured by the Agatston scoring system allowing for better reproducibility, and the outcome variables included mortality and endoleaks. Patients with higher median total calcium scores (≥12966.9) had significantly lesser survival (79.8% vs 52.3% (P = .002) at five years compared to patients with lower median total calcium score (<12966.9). Also, patients with type 2 endoleaks had higher calcium scores in above the aneurysm level ((1591.2 vs 688.2), P = .05)) compared to patients with no type 2 endoleaks. Calcium score assigned using a standardized Agatston scoring system can be used as a predictor of mortality risk assisting in deciding the treatment of choice for patients.

PROGNOSIS OF INHALATION INJURY MORTALITY RATE WITH REVISED BAUX SCORE AT DR. SOETOMO GENERAL ACADEMIC HOSPITAL, SURABAYA, INDONESIA (2019-2021)

Highlights: Fire is the most frequent cause of burns, while thermal contact is the least common. Mortality rate with revised Baux score in burn patients with inhalation injury showed a significant relationship. Abstract: Introduction: Burn trauma has quite a high mortality rate in Indonesia. One of the scoring systems that is straightforward to apply is the revised Baux score. However, there is no standardised scoring system that is currently in use in our institution. Therefore, the purpose is to determine the feasibility of using this scoring system in our population's features. Methods: This research is a retrospective study with research design case control design using secondary data in the form of medical record data from patients with acute burn trauma that were admitted to Burn Unit of Dr. Soetomo General Academic Hospital in Surabaya between January 2019 and December 2021. All the data will be divided by their group and analysed with SPSS software. Results: The study found significant relationships between several factors and mortality rates among burn patients. Age, total burn surface area percentage, presence of inhalation injury, and the revised Baux Score all showed significant correlations with mortality rate (p &lt; 0.005). Specifically, among burn patients with inhalation injury, the correlation between mortality rate and revised Baux score remained significant (p=0.002). Conclusions:The study revealed that age, the percentage of total burn surface area, and the presence of inhalation injury are significantly associated with mortality rate among burn patients. Additionally, the revised Baux Score was identified as a useful tool for predicting the prognosis of burn patients with inhalation injury. These findings emphasize the importance of these factors in assessing and managing outcomes for burn patients, particularly those with inhalation injury.