Significant Statistical Difference Research Articles

Osteoperiosteal versus osteochondral for autologous transplantation in the treatment of large cystic osteochondral lesions of the talus

BackgroundOsteochondral lesions of the talus (OLTs) with a large subchondral cyst have been shown to have inferior clinical outcomes after reparative techniques. Replacement techniques such as autologous osteoperiosteal transplantation (AOPT) and autologous osteochondral transplantation (AOCT) are indicated for large lesions. The aim of the study was to compare the short-term clinical and radiographic outcomes between patients undergoing AOPT and those undergoing AOCT for large cystic OLTs.MethodsPatients who underwent AOPT or AOCT for medial large cystic OLTs between May 2019 and June 2023 were retrospectively evaluated. According to their characteristics, 1:1 propensity‐score matching was performed, and 65 pairs of patients with ages ranging from 18 to 60 years old were recruited. Clinical outcomes were compared between both groups with the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Visual Analogue Scale (VAS). The Ankle Activity Score (AAS), time to return to sports activity (RTA), rate of return to sports level, complications, and results of a subjective evaluation were also collected. The integrity of subchondral bone and the quality of repaired cartilage were evaluated using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score 12 months postoperatively. Second-look arthroscopy was performed 12 months postoperatively, and the cartilage repair was assessed with the criteria of the International Cartilage Repair Society (ICRS).ResultsThe within-group comparison showed significant improvements in pain severity and function in both groups post-treatment compared with pre-treatment. Between-group analysis, however, showed no significant statistical difference between groups in any of the variables for clinical and radiographic outcomes, except for donor-site morbidity of the AOPT group, which showed a better outcome compared to the AOCT group.ConclusionsIn the treatment of large cystic OLTs, for patients with a chondral lesion of the patellofemoral joint that is unsuitable for AOCT, AOPT may be a safe and effective choice, with lower donor-site morbidity of the normal knee joint.

Implications of five endoscopic and conventional open surgery on lateral neck dissection outcomes in patients with papillary thyroid carcinoma: a network meta-analysis and systematic review.

The efficacy and safety of different surgical approaches to thyroidectomy with lateral neck dissection remain unclear. This study aims to evaluate five endoscopic and open techniques for thyroidectomy with lateral neck dissection and identify the most effective method. A systematic search was conducted in PubMed, Web of Science, Embase, and the Cochrane Library for studies comparing different surgical approaches across multiple outcome indicators. The risk of bias was analyzed, and publication bias was assessed using funnel plot asymmetry tests. Both global and local inconsistency tests were performed to evaluate the agreement between direct and indirect comparisons. Pairwise and network meta-analyses were conducted for each outcome, with approaches ranked using Surface Under the Cumulative Ranking (SUCRA) values and curves. A total of 1251 patients across 13 clinical studies were included in the analysis. No significant statistical differences were found among the approaches for lymph node dissection and postoperative recurrence rates. The bilateral axillary breast approach yielded the highest number of lymph nodes (SUCRA value: 0.762). The suprasternal fossa approach had the lowest postoperative recurrence rate (SUCRA: 0.657) and performed well in metastatic lymph node dissection (SUCRA: 0.679). The bilateral axillary breast approach significantly reduced postoperative complication rates compared to the open and transaxillary approaches (mean differences: - 1.88 and - 0.23; 95% confidence intervals: - 3.87 to - 0.46 and - 0.62 to 0.29, respectively) and was the most effective in minimizing complications (SUCRA: 0.910). Open surgery demonstrated a significantly shorter operative duration. Endoscopic approaches are viable and safe alternatives to open surgery, with fewer postoperative complications, albeit at the cost of longer operative durations.

The additive diagnostic value of ultrasonic strain elastography in characterizing BI-RADS 4 breast lesions

BackgroundBreast cancer is a significant global health issue and is a leading cause of female deaths worldwide. Ultrasonography (US) is an adjunct technique for early diagnosis of breast cancer but has low specificity. So, researchers have suggested using US elastography to distinguish between benign and malignant breast lesions, which may lead to a decrease in unnecessary biopsy rates. We aimed to assess the diagnostic performance of strain elastography and if there was an increase in the diagnostic accuracy after adding it to conventional US results in BI-RADS 4 category breast lesions.ResultsThis cross-sectional study was carried out from June 2022 to June 2024 on 240 patients with 240 breast lesions that were diagnosed as BI-RADS 4 category by conventional US. All the cases were examined using conventional US and strain elastography. Out of the 240 lesions, 107 were benign (44.6%) and 133 were malignant (55.4%). There was a significant statistical difference in the mean age of patients with benign breast lesions (37.89 ± 13.42 years) than those with malignant lesions (48.83 ± 13.65 years) (p < 0.001). Lesions’ imaging characteristics detected by conventional US as shape, margin, aspect ratio, vascularity, and calcification all showed significant differences between benign and malignant breast lesions (p < 0.001). The diagnostic accuracy of conventional US alone was 73.3% and increased to 95.3% after combining it with strain elastography. The strain elastography score has a cutoff value of 4 in discriminating malignant from benign lesions (AUC = 0.9).ConclusionsStrain elastography provides an added diagnostic value in discriminating malignant breast lesions from benign lesions. The combination of strain elastography with US BI-RADS increases the diagnostic accuracy for the detection of malignant breast lesions which will decrease the need for unnecessary biopsy.

Wood dust effects on carpenters pulmonary function test parameters: a comparative study

BackgroundFew studies have investigated the effects of wood dust on carpenters, who are frequently exposed to this hazardous material. This study aimed to determine the effects of wood dust exposure on carpenters pulmonary function test (PFT) parameters.MethodsThis comparative cross-sectional community-based study included 130 participants; a group of carpenters and a matched cohort. Standard techniques were used to measure each participant’s force vital capacity (FVC), force expiratory volume in one second (FEV1), FEV1/FVC ratio, and peak expiratory flow rate (PEFR). Statistical tests were employed to investigate different variables. A P value of < 0.05 is considered significant.ResultsCarpenters had a mean age of 51.6 ± 19.9 years, whereas the matched cohort had a mean age of 49.8 ± 13.9 years. Approximately 23 (35.4%) carpenters experienced respiratory problems. Carpenters had significantly lower FEV1, FVC, FEV1/FVC%, and PEFR values than the matched cohort (P < 0.001). Additionally, the association between the carpenters duration of exposure to wood dust and their PFT values showed a significant statistical difference (P < 0.05). Likewise, the correlation between the duration of exposure to wood dust and their PFT values was significant (< 0.001).ConclusionsWood Dust’s Effects on carpenters’ respiratory systems are worth further discussion. Awareness campaigns should be undertaken to educate carpenters about lung health and preventative measures.

Whole-Body Vibration Without Visual Feedback on Postural Steadiness in Unilateral Trans-Femoral Traumatic Amputees: A Randomized Controlled Trial.

Unilateral traumatic trans-femoral amputees exhibit a higher incidence of falling and become physically asymmetrical because the side that was amputated has different feelings and less muscle. To explore the impact of Whole-body vibration Without Visual Feedback (VFDWBV) on postural steadiness in unilateral traumatic trans- femoral amputees. A double-blinded randomized controlled study of technology and information was conducted at a modern university. A total of 108 individuals, 40-55years who had experienced a traumatic amputation of one leg above the knee were divided into three groups: group A received whole body vibration (WBV) with their eyes opened, group B received (VFDWBV), and group C received conservative treatment only. The stability of the prosthetic leg, stability limit, and sway index (m-CTSIB) were assessed at the beginning and after 12weeks. Sessions occurred three times each week. Significant statistical differences were seen in the stability of prosthetic legs, the limit of stability, and (m-CTSIB) between groups A and B, considering the treatment interaction (F=24.8, p=0.001). Additionally, the group receiving VFDWBV showed a more significant improvement in postural steadiness than those receiving WBV and the control group. Utilizing VFDWBV at a frequency of 30 HZ can significantly enhance the stability of posture in individuals with unilateral traumatic trans-femoral amputations. The study was registered with the Clinical Trials.gov (NCT06284733).

Bone Resorption Assessment Following Zygomatic Implants Surgery over 10 Years of Follow-Up

The presence of sufficient bone volumes is one of the most important criteria for the success of oral implant osseointegration. Therefore, the rehabilitation of edentulous atrophic maxillae represents the greatest challenge in terms of oral rehabilitation. Techniques such as bone grafts, angled implants, short implants, tuberosity, and pterygoid implants may not always be a viable alternative in the subsequent rehabilitation of the posterior atrophic maxilla. A breakthrough occurred when Brånemark first introduced longer, custom-designed implants inserted into the zygomatic bone to support craniofacial prosthesis in the 1980s. When used in the treatment of atrophic jaws, zygomatic implants provide a safe and effective alternative, with stable long-term results. Objectives: We aimed to retrospectively evaluate zygomatic bone resorption ten years after the placement of zygomatic implants. Methods: A retrospective observational study was designed to evaluate bone resorption over ten years following the placement of zygomatic implants. In a study group of 50 patients, using Hounsfield scales, the area of the zygoma and its bone density were established and evaluated. The NewTom NNT Analysis software (NewTom®, Imola, Italy) was employed to trace the bone and implant limits on CBCT scans. Using this software, the three-dimensional information of the postoperative CBCT image was compared with the ten-year postoperative CBCT image, allowing for the assessment of the zygomatic bone resorption and bone density. Results: Highly significant statistical differences to an alpha level of 0.01 were identified between T0 (pre-op), T1 (12 months), and T2 (120 months) concerning zygomatic bone density, both in the first and in the second quadrants. The post hoc Bonferroni test revealed that significant statistical differences were observed between T0 and the remaining timepoints (T1 and T2), with the latter two exhibiting similar values. Conclusions: The evaluation of the resorption at the level of the zygoma, ten years after the placement of zygomatic implants, reveals that there are no significant losses between the initial and final controls. Therefore, it follows that this type of implant rehabilitation represents a viable alternative approach in patients with bone atrophy of the maxilla, offering a predictable therapeutic solution that enables immediate full function and excellent long-term success rates. However, we must not neglect the potential for future innovations in GBR involving the use of barrier membranes, either resorbable or non-resorbable, and even the application of titanium alveolar customized osteogenic scaffold, in conjunction with autologous bone grafts or biomaterials.

In Vitro Biological Evaluation and In Vivo Anti-inflammatory Effect of Chicozapote (Manilkara zapota (L.) P. Royen) Leaf Extracts in Mice with Internal Atrial Edema

Background In Mexico, the fruit of the Manilkara zapota (L.) P. Royen (Chicozapote) tree is widely consumed; however, numerous studies have identified bioactive compounds within its leaves. Purpose To evaluate the bioactive properties of M. zapota leaf extracts, focusing on their anti-oxidant, anti-diabetic, and anti-hypertensive potentials, and assessing their efficacy in mitigating inflammation. Materials and Methods This study evaluated the anti-oxidant properties of aqueous (AE), ethanolic (EE), and hydroalcoholic (HE) extracts, utilizing 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2′-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) assays. Anti-diabetic activity was assessed by inhibiting the enzymes α-amylase and α-glucosidase, while anti-hypertensive efficacy was measured via angiotensin-converting enzyme (ACE) inhibition. The anti-inflammatory potential was also examined in vivo using a murine model of 12- O-tetradecanoylphorbol-13-acetate-induced ear edema. Results The DPPH assay revealed that all extracts exhibited equivalent anti-oxidant capacities at the same concentration, with no significant statistical difference ( p &lt; 0.05). Conversely, the ABTS assay demonstrated that AE possessed superior activity (4.6−28.5%) across varying concentrations. EE exhibited the most potent inhibition of α-amylase, α-glucosidase, and ACE, with 81.8%, 58.9%, and 87.8%, respectively. In anti-inflammatory assays, EE at a 5 mg dosage significantly outperformed other extracts. Conclusion These findings suggest that M. zapota leaf extracts, mainly through EE, could offer a viable natural alternative for reducing inflammation and potentially managing diabetes and hypertension.

Incidence of eclampsia in low socio economic class.

Objective: To find out if there is a relationship among the expectant mother's ‘socioeconomic position’ and eclampsia, and evaluate if various ‘socioeconomic levels’ have an impact on the progression or seriousness of eclampsia. Study Design: Cross-sectional Research study. Setting: Health Net Hospital, Peshawar. Period: Jan 2024 to July 2024. Methods: The Sample size were 147 determined with a ‘95% Confidence Level’ (CL) using the ‘G Power Programme’. There are four parts to the investigation. The data was collected through a structured questionnaire that included questions about ‘individual’, ‘medical’, ‘obstetrical’, ‘clinical examinations’ for the identification of eclampsia, laboratory tests to verify the finding, and ‘socioeconomic status’ details created using the updated ‘Fahmy and El-Sherbini scale 2012’, which consists of ‘seven domains’. Results: There was a ‘significant statistical relationship between the severity of eclampsia and bronchial asthma’ (p=0.029), but there was ‘no significant statistical difference between the severity of eclampsia and maternal age’ (p=0.980), obstetric history, previous history of eclampsia (p=0.086), or other medical conditions like ‘essential hypertension’ (p=0.456) and ‘diabetes mellitus’ (p=0.427). Additionally, there is a ‘statistically significant correlation between the severity of eclampsia and family possessions’ (p=0.032), ‘education level’ (p=0.035), home cleanliness (p=0.025), and financial situation (p=0.041). However, ‘there is no statistically significant correlation between the severity of eclampsia and the family’, health care, or occupation domains (p=0.222, p=0.272, and p=0.328). Conclusion: Academic level, familial goods, house hygiene, and economic standing are all associated with the severity of eclampsia and socioeconomic position. The suggestion is: Pregnant women should be educated about potential risk factors of eclampsia, and workers should be educated about the same. Prenatal care for pregnant mothers in Pakistan should also be improved, and the health of families with low incomes should be improved. This will lower the risk of eclampsia and aid the initial determination, which will lower mortality among mothers and babies.

Preliminary assessment of heavy metal contamination in children's cereal bars: implications for consumer safety on the Polish market.

The primary objective of this study is to evaluate the content of heavy metals, including cadmium, lead, zinc, arsenic, copper and nickel, in cereal bars intended for consumption by children and adolescents. The study also aims to identify factors that differentiate the content of these products. The study material comprised 50 cereal bars, which were consumed by a population group of children and adolescents. The determination of zinc, arsenic, copper and nickel was accomplished through the utilisation of optical emission spectrometry with inductively coupled plasma excitation on a spectrometer, while cadmium and lead were ascertained by atomic absorption spectrometry with electrothermal atomization (ET-AAS) on an atomic absorption spectrometer. In the heavy metal analysis of the cereal bars, lead was not detected in contents above the limit of quantification (LOQ) of 0.10mg/kg. However, three samples exceeded the maximum permissible levels of cadmium, with contents of 0.046mg/kg in two cases and 0.043mg/kg in one case, while the minimum determined cadmium content was 0.011mg/kg. The arsenic content of the samples oscillated between 0.56 and 4.16mg/kg. Although there are no established standards for nickel, zinc and copper, their contents are of potential health significance in the context of chronic exposure, requiring detailed assessment. The results of the statistical analysis showed significant differences in copper and zinc depending on product composition (p ≤ 0.0001), suggesting higher contents of these metals in oatmeal-dominant products, possibly due to specific raw material sources or variation in the production process. The homogeneity of nickel, cadmium and arsenic contents regardless of product composition was confirmed by the absence of significant statistical differences (p > 0.05). The analysis of geographical variation showed that products of Polish origin were characterised by higher copper and cadmium contents compared to products from Germany, suggesting a potential influence of local environmental and technological conditions. Hazard quotient (HQ and HI) calculations for the analysed scenarios showed that the limits were exceeded, especially for products with a predominance of oatmeal and Polish production, highlighting the need for further research into the sources of these contaminants and their health implications.

The effect of genotype and sex on carcass characteristics and fatty acid profile of Pekin broiler ducks.

The aim of this study was to compare two different strains of Pekin duck and to answer one scientific hypothesis: 1) Strain and sex influence live body weight, hot and cold carcass weights and carcass portions weights and yields, fatty acid content, fatty acid total cholesterol and α-tocopherol contents of meat. The study used 50 individuals of each strain in comparison (Cherry Valley and Grimaud) equally divided between both sexes), raised in equal rearing and feeding conditions. The results show that, when raised in equal rearing and feeding conditions and slaughtered at matching age, the strain had no significant influence on live body weight at slaughter, warm and cold carcass weights. Moreover, the strain influence was quite limited to the weight of wings, feet and gizzard (P < 0.05). On the other hand, sex had a strong influence (P < 0.05) on live body weight at slaughter, warm and cold carcass weights and carcass portions weights, which were heavier in male than female ducks, except for neck and abdominal fat pad weights. Regarding duck's meat fatty acid (FA) composition: the sex had no significant influence in total FA content, FA partial sums, FA ratios and lipid quality indexes; the strain influence was limited to the total n-3 PUFA and the n-6/n-3 ratio and no other statistical significant difference (P < 0.05) was observed; the meat portion influence included all FA partial sums (when expressed as g/100 g of total FA), all FA ratios and all lipid quality indexes. The total cholesterol and α-tocopherol contents were not influenced by the sex, but were both influenced by the strain and meat portion (P < 0.05). The duck meat from both strains could be classified as an Extra lean meat, and regarded as a healthy option, since: 1) the PUFA is the predominant FA group; 2) presents low total cholesterol content; 3) includes plasmalogens, a class of phospholipids, regarded as important biomolecules with potential health attributes.

Optokinetic After-Nystagmus: A Marker for Migraine? A Prospective Observational Study.

Vestibular migraine (VM), particularly its chronic variant, poses a diagnostic challenge. Patients suffering from VM may not have the characteristic headaches associated with the dizziness. In these cases, a marker for migraine pathology in general could help appropriately diagnose certain types of dizziness as migrainous despite these patients not meeting current diagnostic criteria for VM. Migraine patients in general (headache and vestibular) are known to share a tendency toward intolerance of certain stimuli, including busy visual stimuli. True optokinetic stimulation, measured by the production of optokinetic after-nystagmus (OKAN) simulates these busy visual stimuli. Prospective observational study comparing response to optokinetic stimulation between migraine patients and controls. Questionnaires regarding general sensitivities to busy visual stimuli were completed prior to beginning the study. Both subjective and objective markers of stress were measured before and after exposure to the stimulus. Initial slow-phase velocity, slow cumulative eye position, and adjusted time constant of OKAN were compared between the 2 groups. The groups differed only with regard to sensitivity to blinking lights and history of motion sickness on initial questionnaire. Regarding subjective symptoms of discomfort, migraine patients tended to report higher scores than controls both before and after testing, but there was no significant difference from before to after stimulus in each group's scores. There were no statistically-significant differences between initial slow-phase velocity, slow cumulative eye position, and adjusted time constant of OKAN between groups. In this study, OKAN measurements were not useful in differentiating migraine patients at large from control subjects. We hypothesize that there may be a distinct subgroup of migraine patients that are more sensitive to visually-disturbing situations that may differ from other migraine sufferers. Future studies will aim to identify such patients and compare them to controls.

Context matters: Placing the sociopolitical context into research on enclave-health effects and immigration enforcement.

County governments across the U.S. adopt varied immigrant-related policies that facilitate or hinder immigrant inclusion. County-level social, economic, and geographic characteristics also differ by location-resulting in diverging immigrant inclusion goals and local contexts that disparately impact the lives and health of immigrants and their families. Although ethnic enclaves-communities where a large share of coethnic and immigrant residents live-are embedded within broader county governments, research on enclave-health effects have seldom considered the sociopolitical contexts, especially the immigration enforcement policies, in the settings where enclaves exist. This paper examines differences in immigration enforcement policies across U.S. counties. Data are from multiple sources, including the 2016-2020 American Community Survey, the National Center for Health Statistics, the Immigrant Legal Resource Center, the National Conference of State Legislatures, and the Kaiser Family Foundation. In a stepwise process, we generated nine county types using county-level social, economic, and geography-related characteristics. This resulted in 236 urban and suburban counties where Latino density was above 13.9%. In bivariate analyses comparing county types, we found significant statistical differences in the number of immigration enforcement (p<0.00) and immigrant inclusion (p<0.00) policies. There were also statistically significant demographic and diversity differences between county types (p<0.00). Our results suggest a need to examine the county-level immigration policy context in research on enclave-health effects, as such contexts shape immigrant inclusion, immigrant health, and community wellbeing. Integrating the sociopolitical context may help to clarify points of intervention that county governments and immigrant communities can lead.

Relationship Between Abdominal Circumference and Incidence of Hypotension During Caesarean Section in Pre-eclamptic and Non-pre-eclamptic Patients Under Spinal Anaesthesia

Background and Aims: Hypotension after spinal anaesthesia is a frequent problem in obstetric patients. Intra-abdominal volume and abdominal circumference (AC) are correlated. During pregnancy, maternal AC rises and is influenced by the uterus, amniotic fluid, and size of the foetus. Previous studies have demonstrated associations between larger AC and higher abdominal pressure and level of sensory block. Several studies have shown that the risk of hypotension in pre-eclampsia is less after spinal anaesthesia as compared to healthy parturient. Aims and Objectives: The aim of the study was to evaluate the relationship between the AC and incidence of hypotension during caesarean under spinal anaesthesia. We also wanted to compare the degree of hypotension post-spinal between pre-eclampsia and non-pre-eclamptic patients. Patients and Methods: This observational study was conducted at the Department of Anesthesiology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, with institutional ethical committee approval and written informed consent from the patients. Group 1 consisted of pre-eclampsia patients, and Group 2 comprised non-pre-eclampsia patients undergoing caesarean section. Observations and Results: AC of the patients in both groups showed no difference of statistical significance, but there was a significant statistical difference in the haemodynamics in patients of the two groups. Conclusion: We observed a higher incidence of hypotension in a non-pre-eclamptic group, which was statistically significant and not related to variations in AC. This implies that AC has no correlation with post-spinal hypotension.

Low levels of Plasmodium falciparum parasitaemia among patients receiving antiretroviral therapy at the treatment centre of the Regional Hospital Bamenda, Northwest Cameroon.

Malaria and HIV are leading causes of death in Africa, including Cameroon. Antiretroviral therapy (ART) is expected to boost immunity and reduce vulnerability to opportunistic infections. Reports on comorbidities including malaria are common in Cameroon. To determine the prevalence of malaria parasitaemia, clinical manifestations, treatment related factors and prevention methods associated with malaria parasitaemia as well as parasite density among HIV patients on ART. It was a cross-sectional study among HIV patients on ART at the Regional Hospital Bamenda. A pre-tested questionnaire was used to collect data on participants' socio-demographic characteristics, clinical manifestations, history of HIV treatment and malaria prevention methods. Microscopy was used for malaria parasite diagnosis and to determine white blood cell (WBC) count. Data was analysed using SPSS version 20. The study included 181 participants. The overall prevalence of malaria parasitaemia was 9.4%. Although there were no significant statistical differences, the following trends were observed in the results: 55-71 year old age group (14%) was most infected with malaria parasite with the highest prevalence among those on the 8A first-line ART (10.3%, 14/122); (χ2=1.03, p=0.96), only participants in the 8A and 12A ART protocols were infected; parasite prevalence was higher in patients with detectable viral load (14.3%, 3/21), (OR=.0.57 (CI: 0.15-2.2), p=0.41), while GMPD varied from 45.7-53.3-±23.1/μl of blood. Low malaria parasite prevalence and density were detected amongst HIV patients receiving ART. A systematic malaria test could be helpful to avert morbidity and improve the general health of patients on ART.

P-240. Comparing Infection Rates Against Mechanical Complications By Site of Placement of Central Venous Catheters in the ICU, a Moot Point Based on Excessive Mortality?

Abstract Background In the ICU the decision regarding site selection for central venous catheters (CVC) is largely influenced by the historic infection rates by site. It is thought that femoral placement has the highest incidence of line infections and therefore is often avoided. However, few studies have aimed to look at the overall risk to the patient regarding site placement taking not only risk of infection, but also risk of mechanical injury and complications into consideration. Methods We did a retrospective review of all patients who had a new central line (either triple lumen catheter or hemodialysis catheter) placed in the ICU for any indication between 1/31/2022 - 5/4/2023. Key information including demographics, Charlson Comorbidity index, type of catheter, site, date of insertion, and date of removal was obtained. Manual chart review was done for each patient in order to ascertain presence of CLABSI as well as mechanical complications. Results 472 lines were placed during the study period. The average age was 63.5 years. The average Charlson Comorbidity index was 5. There was no statistical significant difference in infection rates among femoral 5/196 (2.5%) and internal jugular (IJ) 9/247 (3.6%) CVCs, although IJ lines had a trend towards higher rates of mechanical complications 21/247 (8.5%) vs 11/195 (5.6%), respectively. Rate of infection was twice as high, 6/267 (2.3%) vs 9/205 (4.4%) in the BMI &amp;gt;30 group vs those with a BMI &amp;lt; 30. The 6-month all-cause mortality for patients requiring a central line in the ICU was &amp;gt;80%, regardless of the site of placement, presence of line infection, or mechanical complication. Conclusion Infection rates between IJ and femoral lines were comparable. Femoral lines had numerically less mechanical complications as compared to IJ lines. BMI &amp;gt; 30 had a trend towards an increased risk of CLABSI. Overall mortality was &amp;gt; 80% for patients who required a CVC for any reason in the ICU setting. Clinicians should take a balanced approach regarding infection and mechanical complication risk when placing a central line. Further research into determining infection rates for patients with higher BMI is needed. Intensivists should consider early palliative care consultation for patients requiring a central line. Disclosures All Authors: No reported disclosures

Association between vitamin levels and geriatric hip fractures: A cross-sectional study

ObjectivesGeriatric hip fractures, known as osteoporotic fractures, are associated with nutritional deficiencies such as vitamin D (VitD). However, the relationship between other vitamins besides VitD and fracture is still lacking. Therefore, we intended to identify various vitamin levels and deficiencies in elderly patients with hip fractures and compared those with healthy elderly individuals.MethodsA total of 210 geriatric hip fracture continuous patients and 402 healthy elderly individuals aged ≥65 years old and with complete serum vitamin records were enrolled in this study. The levels of serum VitA, VitB1, VitB2, VitB3, VitB5, VitB6, VitB9, VitE, VitK1, and 25-hydroxyvitamin D (25-HO-VitD) and nutritional markers, such as prognostic nutritional index (PNI), were compared between geriatric hip fracture patients and healthy control. The correlation between vitamin level and the nutritional markers was explored. A multiple linear regression analysis was conducted to assess the association between vitamin levels and hip fracture.ResultsThe levels of VitA, VitB1, VitB3, VitB5, VitB9, 25-HO-VitD, 25-HO-VitD3, E, and K1 were all lower in the hip fracture group (p &amp;lt; 0.05). More than 80% of older persons suffered 25-HO-VitD deficiency in both healthy and fracture groups. A positive correlation between levels of VitA and nutritional markers existed in the fracture and healthy groups. In regression analysis, the association strength between standardized vitamin levels and fracture was the most significant in VitB9 (β = −0.94; 95%CI, −1.15 to −0.73; p &amp;lt; 0.001), VitA (β = −0.83; 95%CI, −1.04 to −0.61; p &amp;lt; 0.001), and VitK1 (β = −0.80; 95%CI, −1.02 to −0.58; p &amp;lt; 0.001), with no significant statistic difference found in VitB2, VitB9, 25-HO-VitD2, and 25-HO-VitD3.ConclusionVitamin D deficiency is common in elderly people with or without fracture. The levels of VitA, VitB9, and VitK1, instead of VitD, were much lower in fracture patients than in the healthy control, even controlling age and gender. VitA is a potential target for hip fracture prevention.

Assessing Traumatic Brain Injury in Refugees: Feasibility, Usability, and Prevalence Insights From a US-Based Clinical Sample.

This study assessed (1) the feasibility and usability of traumatic brain injury (TBI) assessment using the Ohio State University TBI Identification Method (OSU-TBI-ID) in a sample of English and Spanish-speaking refugees and asylum seekers (hereafter refugees), and (2) the prevalence and characteristics of TBI in this population. Refugees seeking care from Massachusetts General Hospital (MGH) Asylum Clinic, the MGH Chelsea HealthCare Center, and other asylum programs in the Greater Boston Area. Bilingual clinical research coordinators screened 158 English and Spanish-speaking refugees using the OSU-TBI-ID. A "positive" screen for TBI was made if a participant reported loss of consciousness (LOC) or being dazed or confused following a head injury, with determinations of mild, moderate, and severe TBI based on established metrics of TBI severity using duration of LOC. We conducted descriptive statistics of the sample demographics and screening outcomes, including group comparisons between those with and without TBI and associated demographic characteristics. The mean age was 36.8years (SD: 9.1), with participants predominantly from Latin America and the Caribbean (51%), followed by Sub-Saharan Africa (35%). Less than half (43%) identified as men. The majority (59%) screened positive for having experienced at least 1 TBI in their lifetime. Among those with a TBI history, nearly three-quarters (73%) had a mild TBI, and about a third (38%) had sustained a moderate-to-severe TBI. A majority (56%) had more than 1 TBI and about 40% had sustained a childhood TBI. The most common mechanisms of injury were interpersonal assault (55%) and blunt trauma by an object (46%). There were no significant statistical differences in demographics and TBI characteristics. Our findings demonstrate the feasibility and usability of the OSU-TBI-ID in a sample of refugees. We call for greater and improved detection of TBI among refugees to ensure they receive the optimal care they need.

In vitro evaluation of hypochlorous acid-silver nanoparticle waterline disinfectant for dental unit waterline disinfection

BackgroundThis work intended to assess the disinfection efficacy of hypochlorous acid (HA) and silver nanoparticles (AgNP) disinfectants in disinfecting the dental unit waterlines (DUWL) during comprehensive oral treatment and explore their potential applications in the oral medical environment. Methods: Firstly, AgNP solution was prepared and evaluated through X-ray diffraction (XRD), field emission transmission electron microscope (FE-TEM), and stability tests. Subsequently, 15 dental units were selected and randomly assigned to three groups, each receiving a different disinfection method. Specifically, one group (5 units) received HA disinfectant (HA group), one group (5 units) received AgNP disinfectant (AgNP group), and another group (5 units) received a combination of HA and AgNP disinfectant (HA + AgNP group). Bacterial counts before and after disinfection were compared and analyzed at four sites on the dental units: high-speed handpiece tubing, mouthwash, ultrasonic scaler, and three-way syringe.ResultsThe growth of biofilm on the waterlines was observed using scanning electron microscopy (SEM) and laser confocal microscopy (LCM). The results indicated that AgNP solution was successfully prepared and demonstrated excellent stability. There was no significant difference in the average weekly number of patients treated across the three groups (P > 0.05). After disinfection, bacterial counts were significantly reduced in all groups. Compared to the HA and AgNP groups, the HA + AgNP group exhibited a markedly lower bacterial count, with statistical significance (P < 0.05). The compliance rates observed during the first disinfection and two weeks post-disinfection were slightly lower in the HA and AgNP groups compared to the HA + AgNP group, although no significant statistical difference was found (P > 0.05). SEM images revealed uneven biofilm plaques on the inner surface of the pipes prior to disinfection, embedded within a dense matrix, while the biofilm was visibly disrupted post-disinfection. LCM software analysis showed that, compared to the HA and AgNP groups, the HA + AgNP group had a significantly lower percentage of live bacteria on the biofilm post-disinfection (P < 0.05).ConclusionCompared to any single disinfectant regimen, the combined use of HA and AgNPs effectively inhibited bacterial growth and exerted a significant destructive effect on biofilms. Therefore, this combination is expected to be a viable option for disinfection of DUWL in the oral healthcare setting.Clinical trial numberNot applicable.

Enhancing Patient Safety: Assessing ICU Nurses' Knowledge and Compliance in Ventilator-Associated Pneumonia Prevention at King Fahad General Hospital, Saudi Arabia

Background: Ventilator-associated pneumonia (VAP) is a prevalent cause of morbidity and mortality in intensive care units (ICUs). Defined as a nosocomial pneumonia that occurs more than 48 hours after mechanical ventilation initiation, VAP poses significant clinical challenges. While awareness of evidence-based practices is crucial, a gap often exists between knowledge and actual practice among nursing staff. Enhanced adherence to VAP prevention protocols has been linked to reduced incidence rates. Purpose: This study aims to assess the level of nurses’ knowledge and compliance regarding the prevention of VAP in the intensive care unit of King Fahad General Hospital in Saudi Arabia. Method: A descriptive research design was employed, involving 120 ICU nurses selected through convenience non-probability sampling. Result: A total of 96 participants were recruited in this study. The level of knowledge about VAP prevention among ICU nurses was almost good as there were about 57.3% (n=55) of the nurse participants had a good and adequate information. There was significant statistical difference in the mean knowledge score based on the academic qualification but, there was no statistical difference in mean of compliance based on academic qualification. Conclusion: Insufficient nursing knowledge and compliance about VAP assessment and prevention is a serious safety concern in all healthcare settings. The study highlighted that ICU nurses showed (good) moderate knowledge towards VAP prevention.

Temporal Changes in Lead and Cadmium Levels in Amanita muscaria Samples Collected in Poland

In recent years, an increasing popularity of consuming Amanita muscaria has been observed in Poland, aimed at reducing various medical symptoms. However, there is a lack of data regarding the impact of variations in the content of toxic elements, such as cadmium (Cd) and lead (Pb), in Amanita muscaria collected during late summer and mid-fall. The aim of this study was to determine the concentrations of Pb and Cd in Amanita muscaria samples collected at different times of the year, compare the concentrations of these elements in samples with and without cap skin, and compare the obtained values to permissible limits in dietary supplements. A total of 44 Amanita muscaria samples were collected during three different harvesting periods (August, September, and October 2023) from Puszcza Biała, located approximately 80 km from Warsaw. The mushrooms were subjected to mineralization using concentrated nitric acid and hydrogen peroxide, followed by the determination of Pb and Cd concentrations using an atomic absorption spectrometer. Significant statistical differences were found in the Pb concentrations of samples collected in three different seasons (η2 = 0.67, p &lt; 0.001), with the concentration increasing progressively, reaching its highest value in October. Similarly, the Cd concentration also increased in the later collections, although the effect of time was weaker (η2 = 0.13, p = 0.03). No significant differences were observed in Pb and Cd concentrations between samples with and without cap skin. The average Cd concentrations in mushrooms were significantly higher than the permissible levels in dietary supplements; they were four times higher in August (p &lt; 0.001), six times higher in September (p &lt; 0.001), and nine times higher in October (p &lt; 0.001). The Pb concentration in the October samples was close to the permissible limit but did not exceed it in a statistically significant manner (p = 0.85). Due to the high Cd concentrations and potentially hazardous levels of Pb, the consumption of Amanita muscaria carries a significant risk of toxicity, which may lead to serious health hazards, particularly in the context of prolonged exposure.