Duration Of Symptoms Research Articles

Binocular loupe assisted mini-lateral and medial incisions in lateral position for release of elbow stiffness

To analyze the effectiveness of binocular loupe assisted mini-lateral and medial incisions in lateral position for the release of elbow stiffness. The clinical data of 16 patients with elbow stiffness treated with binocular loupe assisted mini-internal and external incisions in lateral position release between January 2021 and December 2022 were retrospectively analyzed. There were 9 males and 7 females, aged from 19 to 57 years, with a median age of 33.5 years. Etiologies included olecranon fracture in 6 cases, elbow dislocation in 4 cases, medial epicondyle fracture in 2 cases, radial head fracture in 4 cases, terrible triad of elbow joint in 2 cases, supracondylar fracture of humerus in 1 case, coronoid process fracture of ulna in 1 case, and humerus fracture in 1 case, with 5 cases presenting a combination of two etiologies. The duration of symptoms ranged from 5 to 60 months, with a median of 8 months. Preoperatively, 12 cases had concomitant ulnar nerve numbness, and 6 cases exhibited ectopic ossification. The preoperative range of motion for elbow flexion and extension was (58.63±22.30)°, the visual analogue scale (VAS) score was 4.3±1.6, and the Mayo score was 71.9±7.5. Incision lengths for both lateral and medial approaches were recorded, as well as the occurrence of complications. Clinical outcomes were evaluated using Mayo scores, VAS scores, and elbow range of motion both preoperatively and postoperatively. The lateral incision lengths for all patients ranged from 3.0 to 4.8 cm, with an average of 4.1 cm. The medial incision lengths ranged from 2.4 to 4.2 cm, with an average of 3.0 cm. The follow-up duration ranged from 6 to 19 months and a mean of 9.2 months. At last follow-up, 1 patient reported moderate elbow joint pain, and 3 cases exhibited residual mild ulnar nerve numbness. The other patients had no complications such as new heterotopic ossification and ulnar nerve paralysis, which hindered the movement of elbow joint. At last follow-up, the elbow range of motion was (130.44±9.75)°, the VAS score was 1.1±1.0, and the Mayo score was 99.1±3.8, which significantly improved when compared to the preoperative ones ( t=-12.418, P<0.001; t=6.419, P<0.001; t=-13.330, P<0.001). The binocular loupe assisted mini-lateral and medial incisions in lateral position integrated the advantages of traditional open and arthroscopic technique, which demonstrated satisfying safety and effectivity for the release of elbow contracture, but it is not indicated for patients with posterior medial heterolateral heterotopic ossification.

Influence of preoperative symptom duration on effectiveness of cervical disc arthroplasty in cervical spondylotic radiculopathy patients

To investigate the influence of preoperative symptom duration on effectiveness of cervical disc arthroplasty (CDA) in cervical spondylotic radiculopathy (CSR) patients. The clinical data of 90 CSR patients who underwent single-segment CDA between January 2008 and March 2020 and met the selection criteria were retrospectively analyzed. Based on preoperative symptom duration, patients were divided into an early intervention group (preoperative symptom duration <24 months) and a late intervention group (preoperative symptom duration ≥24 months). There was no significant difference in baseline data between the two groups ( P>0.05), including age, gender, body mass index, smoking status, surgical segment, preoperative neck disability index (NDI), visual analogue scale (VAS) score, cervical lordosis (CL), C 2-C 7 range of motion (ROM), disc angle (DA), disc ROM (DROM), and disc intervertebral height (DIH). The early intervention group had a slightly higher preoperative Japan Orthopedic Association (JOA) score than the late intervention group ( P<0.05). Perioperative indicators such as operation time, intraoperative blood loss, and postoperative hospital stay were recorded. The changes of JOA score, NDI, and VAS score at last follow-up compared with those before operation were used to evaluate the clinical efficacy, and the imaging evaluation of CL, C 2-C 7 ROM, DA, DROM, and DIH was performed before operation, immediately after operation, and at last follow-up. The incidence of prosthesis-related complications, including heterotopic ossification (HO), anterior bone loss (ABL), and prosthesis subsidence, was also assessed at last follow-up. Patients in both groups were followed up 24-120 months, with an average of 53.4 months. There was no significant difference in operation time, intraoperative blood loss, or follow-up duration between the groups ( P>0.05). However, the late intervention group had significantly longer postoperative hospital stay compared to the early intervention group ( P<0.05). At last follow-up, there was no significant difference in the changes of JOA score, NDI, and VAS score between the two groups before and after operation ( P>0.05). During the follow-up, there was no surgical revision in the two groups, and there was no significant difference in the incidence of HO, ABL, and prosthesis subsidence between the two groups at last follow-up ( P>0.05). Imaging evaluation showed that there was no significant difference in CL, C 2-C 7 ROM, DA, DROM, and DIH between the two groups at each time point before and after operation ( P>0.05). The intra-group comparison showed that the early intervention group could maintain the immediate postoperative CL at last follow-up, while the late intervention group had recovered to the preoperative level. Additionally, the C 2-C 7 ROM, DROM, and DA had all recovered to preoperative levels at last follow-up in both groups; meanwhile, the DIH significantly increased immediately after operation and sustained until the last follow-up. Preoperative symptom duration significantly affects the effectiveness of CDA in CSR patients. Patients with preoperative symptom duration ≥24 months have longer postoperative hospital stays and potentially poorer ability to maintain CL compared with patients with preoperative symptom duration <24 months.

A48 PARENT-REPORTED HEALTH RELATED QUALITY OF LIFE CARING FOR CHILDREN WITH PEDIATRIC FEEDING DISORDERS IN ALBERTA

Abstract Background Children with pediatric feeding disorders (PFD), including those requiring tube feeding, need significant care. Caregiver burden includes time, cost, as well as worry over patient morbidity and mortality (1). This project used a validated health-related quality of life (HRQoL) tool for caregivers of children with PFD: the Feeding/Swallowing Impact Survey (FS-IS). The FS-IS has three subscales related to daily activities, worry, and feeding concerns, scored 1-5 with 5 being the most adverse. Prior studies have shown both the total sub-scale scores and the total score correlate with generic quality of life instruments for pediatric caregivers (2). Data was obtained from a provincial quality improvement initiative, the Alberta Provincial Pediatric Eating and Swallowing (PEAS) Project. Aims 1. To determine the HRQoL reported by caregivers of children with PFD in Alberta. 2. To determine if tube-feeding is associated with worse reported HRQoL. Methods Caregivers receiving feeding and swallowing services in Alberta were offered the opportunity to complete the FS-IS online or by phone at baseline and 12 months later. All demographic data was self-reported. Results In total 52 caregivers completed the surveys once and 16 at follow-up. Average baseline FSIS was 3.1 (range 1.2-4.7) and at follow up was 3.0 (range 1.5-4.2). There was no difference between the scores of those completing at both time points (p=0.78). At all time points, only 15% of the cohorts reported scores ≤2. As shown in Table 1, children who were tube-fed were older with a longer duration of PFD symptoms, however, HRQoL scores were not different to children not ever tube-fed. Conclusions Caregivers of children with PFD face challenges, which do not abate over time. Surprisingly, in our cohort, this is independent of the need for tube feeding and of the duration of PFD symptoms, although we acknowledge the small sample size of those who were never tube-fed. Longitudinal follow-up studies and strategies to improve quality of life are needed. * FS-IS Global Score (1=never to 5=almost always) Funding Agencies Alberta Health Services Maternal Newborn Child &amp; Youth Strategic Clinical Network

Outcomes in Lumbar Fusion Patients Stratified by the Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) Classification System.

Background and objective The Meyerding classification system remains the most common classification system for spondylolisthesis based on the percentages of vertebral translation. However, the majority of patients with degenerative disease fall into Grade 1, limiting its utility in this subset of patients. The Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) classification system provides a simple radiographic framework for classifying degenerative lumbar spondylolisthesis (DLS) patients by incorporating disc height, kyphosis, and anterior translation. The purpose of this study was to evaluate how clinical characteristics, treatments, and outcomes vary across different CARDSgroups in patients undergoing one- or two-level lumbar fusion for DLS. Methods The patients were classified into one of the following four CARDS groups - Type A: advanced disc space collapse with no evidence of kyphosis; Type B: partially preserved disc space with less than 5.0 mm of translation; Type C: partially preserved disc space with greater than 5.0 mm of translation; and Type D: kyphotic alignment. Univariate analyses were performed to compare demographics, symptoms, clinical outcomes, and Patient-Reported Outcomes Measurement Information System (PROMIS) physical (PH) and mental health (MH) scores across groups. Results Ninety-one patients were included in the study. Based on the CARDS classification, there were three (3%) Type A patients, 25 (28%) Type B, 58 (64%) Type C, and five (5%) Type D. No significant differences in baseline demographics, symptom duration, or PROMIS scores were observed across groups. Interbody utilization varied, ranging from 19% in CARDS C (n=11) to 60% in CARDS B (n=15) and D (n=3) patients (p=0.005). Thirty-day clinical outcomes were similar across groups. At an average follow-up of 8.9 months, improvements in PROMIS PH and MH scores and rates of clinically significant improvement were similar across groups. Conclusions Based on our findings, patients undergoing lumbar fusion for DLS present with similar demographic and clinical characteristicsand experience similar clinical and patient-reported outcomes when stratified using the CARDS classification system. Posterolateral fusion (PLF) can be effective for various radiographic presentations of DLS. Further research is warranted to assess the utility of CARDS in preoperative planning.

A144 ZENKER’S PERORAL ENDOSCOPIC MYOTOMY (Z-POEM) OUTCOMES IN TREATMENT OF ZENKER’S DIVERTICULUM: A RETROSPECTIVE CASE SERIES

Abstract Background Zenker’s diverticulum (ZD) is an outpouching of tissue in an area of the posterior hypopharynx called the Killian triangle. ZD is associated with dysphagia, regurgitation, cough and recurrent aspirations. Open surgical repair has been the traditional treatment approach but has high morbidity (0-40%) and mortality (0-9.5%). Endoscopic intervention with septotomy is a less invasive approach with lower complications and shorter recovery times. However, technical success rates range between 56.4-100%, and recurrences occur in 0-32% of patients. Recent studies have shown promising results for peroral endoscopic myotomy treatment of ZD (Z-POEM), although data is limited. Aims In this first Canadian case series, we assess the safety and efficacy of Z-POEM, a novel approach for managing ZD. Methods This is a retrospective case series of all patients who underwent Z-POEM for ZD at Kingston Health Sciences center between July 2021-2023. Data collected included patient demographics, symptoms [Kothari Haber Score (KHS)] pre and post Z-POEM, ZD size and prior treatments. Technical outcomes were also analyzed including the procedure time and the Z-POEM Difficulty Score (ZPDS), which ranges from 0-3 based on maneuverability, fibrosis, and oozing. Clinical success was defined as complete or near-complete resolution of symptoms (i.e. KHS ampersand:003C2), and recurrence was defined as KHS of 3 or more. Lastly, we recorded adverse events and hospital length of stay. Results This case series included 9 patients (6 males and 3 females). The mean age ± standard deviation (SD) was 66.1 ± 10.64 years. One patient had two separate Z-POEM procedures and those were analyzed separately (total sample size = 10). The mean duration of symptoms before the procedure was 31.2 ± 10.12 months and the mean size of ZD was 2.25 ± 1.10 cm. Two patients had prior treatments before their Z-POEM procedure. The median preprocedural KHS was 6 (range 3-10) with dysphagia being the most commonly reported symptom in 80% of patients. In terms of technical outcomes, the mean procedural time was 32.3 ± 13.21 mins, and the median ZPDS score was 2. Most patients required 4-6 clips, with one patient requiring 11 clips for closure. No adverse events or periprocedural complications were reported. 9/10 patients (90%) were discharged one day after the procedure, and one patient required a longer stay (4 days) for observation. Clinical success was achieved in 8/10 patients (80%) of patients with a KHS score of 0 at mean 12 months follow-up. The remaining two patients (20%) had a KHS score of 3 at follow-up suggesting some persistent symptoms. Conclusions Z-POEM is safe and effective in management of ZD with high technical and clinical success rates in the short-term. Larger-scale studies are required to determine the long-term clinical efficacy of Z-POEM in treatment of ZD. Funding Agencies None

Impact of the COVID-19 Pandemic on People Living With Rare Diseases and Their Families: Results of a National Survey.

With more than 103 million cases and 1.1 million deaths, the COVID-19 pandemic has had devastating consequences for the health system and the well-being of the entire US population. The Rare Diseases Clinical Research Network funded by the National Institutes of Health was strategically positioned to study the impact of the pandemic on the large, vulnerable population of people living with rare diseases (RDs). This study was designed to describe the characteristics of COVID-19 in the RD population, determine whether patient subgroups experienced increased occurrence or severity of infection and whether the pandemic changed RD symptoms and treatment, and understand the broader impact on respondents and their families. US residents who had an RD and were <90 years old completed a web-based survey investigating self-reported COVID-19 infection, pandemic-related changes in RD symptoms and medications, access to care, and psychological impact on self and family. We estimated the incidence of self-reported COVID-19 and compared it with that in the US population; evaluated the frequency of COVID-19 symptoms according to self-reported infection; assessed infection duration, complications and need for hospitalization; assessed the influence of the COVID-19 pandemic on RD symptoms and treatment, and whether the pandemic influenced access to care, special food and nutrition, or demand for professional psychological assistance. Between May 2, 2020, and December 15, 2020, in total, 3413 individuals completed the survey. Most were female (2212/3413, 64.81%), White (3038/3413, 89.01%), and aged ≥25 years (2646/3413, 77.53%). Overall, 80.6% (2751/3413) did not acquire COVID-19, 2.08% (71/3413) acquired it, and 16.58% (566/3413) did not know. Self-reported cases represented an annual incidence rate of 2.2% (95% CI 1.7%-2.8%). COVID-19 cases were more than twice the expected (71 vs 30.3; P<.001). COVID-19 was associated with specific symptoms (loss of taste: odds ratio [OR] 38.9, 95% CI 22.4-67.6, loss of smell: OR 30.6, 95% CI 17.7-53.1) and multiple symptoms (>9 symptoms vs none: OR 82.5, 95% CI 29-234 and 5-9: OR 44.8, 95% CI 18.7-107). Median symptom duration was 16 (IQR 9-30) days. Hospitalization (7/71, 10%) and ventilator support (4/71, 6%) were uncommon. Respondents who acquired COVID-19 reported increased occurrence and severity of RD symptoms and use or dosage of select medications; those who did not acquire COVID-19 reported decreased occurrence and severity of RD symptoms and use of medications; those who did not know had an intermediate pattern. The pandemic made it difficult to access care, receive treatment, get hospitalized, and caused mood changes for respondents and their families. Self-reported COVID-19 was more frequent than expected and was associated with increased prevalence and severity of RD symptoms and greater use of medications. The pandemic negatively affected access to care and caused mood changes in the respondents and family members. Continued surveillance is necessary.

JAUNDICE IN PATIENTS WITH GALL BLADDER CANCER- A SURROGATE MARKER OF ADVANCED DISEASE

Background: Gall bladder cancer (GBC) is most common cancer of biliary tract. R0 resection is the most important predictor of survival. Patients with GBC and jaundice do worse than those without jaundice.Methods: Retrospective analysis of prospectively kept data of patients with GBC admitted to the department of Surgical Gastroenterology at a tertiary care hospital in northern India over10 years from 2011 to 2020. Data on patient demography, clinical profile, imaging characteristics, clinical course, staging, and operative procedures was extracted and analyzed to compare the experience of patients with GBC with jaundice and GBC without jaundice.Results: There were 401 patients with GBC; 75 with jaundice and 326 without jaundice. Patients with GBC and jaundice had a significantly higher incidence of pain abdomen, loss of appetite, loss of weight and presence of an abdominal lump, gastric outlet obstruction and hypoalbuminemia, a shorter duration of symptoms, more number of hospital admissions, a less frequent (4% vs 10.7%) incidental diagnosis of GBC and a higher incidence of GB neck tumors (80% vs 20%). In patients with GBC and jaundice detection of metastatic or locally advanced unresectable disease on imaging (31%), laparoscopy (11%) or laparotomy (31%) precluded resection in majority of patients. Only 2.6% patients with GBC and jaundice could undergo definitive surgery as compared to 71.2% of patients without jaundice.Conclusion: Patients with GBC and jaundice are very likely to have advanced, unresectable disease. Chances of complete resection are slim even after extensive preparation requiring more extensive, time-consuming, costly, multidisciplinary interventions.

TWO YEARS DESCRIPTIVE STUDY OF MACULAR HOLE PATIENTS OPERATED IN DR. KARIADI GENERAL HOSPITAL, SEMARANG

Introduction and Objective: Macular hole (MH) is vitreomacular interface disorder that could cause visual impairment. Clinical characteristics of MH are important for predicting MH treatment outcomes. This study purpose was to describe MH patients’ characteristics and postoperative outcomes in Dr. Kariadi Hospital.&#x0D; &#x0D; Method: A retrospective study held on January 2021–December 2022 utilizing patients’ medical records. Preoperative data: sex, age, symptoms, duration of symptoms, origin, preoperative visual acuity (VA), modified Gass classification stage, macular hole index (MHI), and hole forming factor (HFF) were obtained. Postoperative outcomes data: postoperative VA and anatomical closure were also collected.&#x0D; &#x0D; Result: 20(20 eyes) patients were obtained, with 14(70%) female, 12(60%) aged &gt;60 years old, 13(65%) metamorphopsia, 12(60%) central visual loss, 10(50%) preoperative VA 6/24-6/60, 10(50%) duration of symptoms &lt;3 months, and 16(80%) idiopathic origin. OCT (Optical Coherence Tomography) findings revealed base diameter mean was 780,7 um(+ SD 312). 13 patients (65%) stage 3 of MH, 12(60%) MHI &lt;0,5, 12(60%) HFF &gt; 0,9. All patients underwent MH surgery procedures. Postoperative examination showed 10 patients(50%) with VA 6/6-6/20. 11(100%;p&lt;0,001) with preoperative VA&gt;6/60, 10(100%;p&lt;0,001) with duration of symptoms &lt;3 months, 8(100%;p=0,012) with MHI &gt; 0,5, and 11(100%;p&lt;0,001) with HFF &gt; 0,9 (p&lt;0,001) had improved visual acuity and anatomical closure. It also revealed 17(85%) had anatomical closure.&#x0D; &#x0D; Conclusion: The most common characteristics found in MH patients were female sex, age &gt;60 years old, and disorder of idiopathic origin. Preoperative VA, duration of symptoms &lt;3 months before surgery, MHI &gt; 0,5, and HFF &gt; 0,9 were positive prognostic factors for better postoperative functional and anatomical outcomes.

TWO YEARS DESCRIPTIVE STUDY OF MACULAR HOLE PATIENTS OPERATED IN DR. KARIADI GENERAL HOSPITAL, SEMARANG

Introduction &amp; ObjectivesMacular hole (MH) is a vitreomacular interface disorder that could cause visual impairment. Clinicalcharacteristics of MH are important for predicting MH treatment outcomes. This study purpose wasto describe MH patients’ characteristics and postoperative outcomes in Dr. Kariadi Hospital.&#x0D; MethodsA retrospective study held on January 2021–December 2022 utilizing patients’ medical records.Preoperative data: sex, age, symptoms, duration of symptoms, origin, preoperative visual acuity(VA), modified Gass classification stage, macular hole index (MHI), and hole forming factor (HFF)were obtained. Postoperative outcomes data: postoperative VA and anatomical closure were alsocollected.&#x0D; Results20(20 eyes) patients were obtained, with 14(70%) female, 12(60%) aged &gt;60 years old, 13(65%)metamorphopsia, 12(60%) central visual loss, 10(50%) preoperative VA 6/24-6/60, 10(50%) durationof symptoms &lt;3 months, and 16(80%) idiopathic origin. OCT (Ocular Coherence Tomography)findings revealed base diameter mean was 780,7 um(+ SD 312). 13 patients (65%) stage 3 of MH,12(60%) MHI &lt;0,5, 12(60%) HFF &gt; 0,9. All patients underwent MH surgery procedures.Postoperative examination showed 10 patients(50%) with VA 6/6-6/20. 11(100%) with preoperativeVA&gt;6/60, 10(100%) with duration of symptoms &lt;3 months, 8(100%) with MHI &gt; 0,5, and 11(100%)with HFF &gt; 0,9 had improved visual acuity and anatomical closure. It also revealed 17(85%) hadanatomical closure.&#x0D; ConclusionThe most common characteristics found in MH patients were female sex, age &gt;60 years old, anddisorder of idiopathic origin. Preoperative VA, duration of symptoms &lt;3 months before surgery, MHI&gt; 0,5, and HFF &gt; 0,9 were positive prognostic factors for better postoperative functional andanatomical outcomes.

VISUAL OUTCOME BETWEEN EARLY AND DELAYED VITRECTOMY IN ENDOPHTHALMITIS PATIENTS OPERATED IN KARIADI GENERAL HOSPITAL, SEMARANG : TWO YEARS DESCRIPTIVE STUDY

Introduction &amp; ObjectivesEndophthalmitis is a medical emergency caused by infection of tissue or fluids inside the eyeball.Vitrectomy for endophthalmitis is one of the treatment choice and leads to VA gains in some cases.Timing of surgery and visual outcome after surgery are vital to acknowledge. This study aims toanalyze the difference of visual outcome between early and delayed vitrectomy in endophthalmitispatients operated in Dr. Kariadi General Hospital&#x0D; MethodsA Retrospective study held from medical record of patients with endophthalmitis underwentvitrectomy surgery from January 2021 – January 2023 in Dr. Kariadi General Hospital, Semarang.Endophthalmitis patients caused by trauma were excluded. All of the patients had immediatevitrectomy, and based on duration of symptoms, the patients were divided into two groups, earlyvitrectomy (duration of symptoms ? 7 days) and delayed vitrectomy (duration of symptoms &gt; 7days). Independent t- test method was used to analyze the data (significant if p&lt;0.05)&#x0D; ResultsTotally 30 endophthalmitis patients (30 eyes) were obtained. There were 18 patients (60%) had earlyvitrectomy and 12 patients (40%) had delayed vitrectomy. Postoperative examination showed 13(72%) patients with early vitrectomy had improved VA, and 5 (28%) had constant VA. On the otherhand, patients with delayed vitrectomy showed 5 (42%) had improved VA, 6 (50%) had constant VA,and 1 (8%) had decreased VA. The difference between two groups was significant (p=0.014)&#x0D; ConclusionThis study found endophthalmitis patients with early vitrectomy had significant better visualoutcome than delayed vitrectomy

A nomogram for predicting risk factors of testicular salvage after testicular torsion in children.

This study aimed to establish a nomogram for predicting the probability of testicular salvage after testicular torsion in children. We retrospectively collected data of children with testicular torsion who were treated at Shenzhen Children's Hospital between September 2005 and August 2022. Of the training cohort, 113 patients who underwent orchiectomy and five with testicular atrophy after orchiopexy were included in the failed testicular salvage group. Additionally, 37 patients who underwent orchiopexy without postoperative testicular atrophy were included in the successful testicular salvage group. The predictive factors affecting testicular salvage were determined using univariate and multivariate logistic regression analyses; a nomogram was constructed. The nomogram was verified using data from the validation group. Using multivariate logistic regression analysis, the independent risk factors of testicular salvage after testicular torsion were symptom duration (p = 0.034), intratesticular blood flow (p = 0.003), spermatic cord torsion degree (p = 0.037), and monocyte count (odds ratio: 0.012, p = 0.036). A nomogram was established based on these four risk factors. In the training cohort, the area under the receiver operating characteristic curve was 0.969. The area under the receiver operating characteristic curve of the verification cohort was 0.965, indicating good discrimination ability of the nomogram. Increased symptom duration without intratesticular blood flow increased the monocyte count and spermatic cord torsion degree and decreased the success rate of testicular salvage. This prediction model could obtain the corresponding probability of testicular salvage according to the clinical characteristics of different patients with testicular torsion, providing reference for clinicians and parents.

The impact of "long COVID" on menstruation in Chinese female college students and the intervention of acupuncture.

This study aimed to explore the potential application value of acupuncture in alleviating the impact of long COVID on women's menstrual cycles, by investigating the occurrence of long COVID among female college students, its effects on menstruation, and the intervention of acupuncture. This cross-sectional study surveyed female college students with a history of coronavirus disease 2019 (COVID-19) before April 10, 2023. A questionnaire was used to analyze demographic characteristics, post-COVID sequelaes, duration of symptoms, and treatments received during that period. Among the 731 participants enrolled in the survey, 468 were female undergraduate students who met the analysis criteria. Among them, 85 individuals fit the definition of "Long COVID" (18.16%). Within the group of patients with long COVID, 69 individuals experienced changes in their overall menstrual patterns compared to the 6 months prior to contracting the novel coronavirus (81.18%). Additionally, 17 individuals opted for acupuncture treatment following the onset of COVID-19 (20.00%), which resulted in less impact on their menstrual cycle (41.18% vs 64.71% without receiving acupuncture, OR = 2.62), menstrual period duration (41.18% vs 64.71%, OR = 2.62), menstrual flow (47.06% vs 69.18%, OR = 2.52), and the color of menstrual blood (41.18% vs 63.24%, OR = 2.46) among these patients. Long COVID had a certain impact on menstruation. Acupuncture potentially alleviates the clinical symptoms of long COVID and reduces its impact on women's menstrual cycle, thus having potential therapeutic value in the treatment of long COVID.

Are gout patients with negative dual-energy computed tomography for monosodium urate crystal deposition easy to treat?

Abstract Objectives To determine the clinical associations and predictive value of two thresholds of negative dual-energy CT (DECT) for MSU crystal deposition in gout patients initiating urate-lowering therapy (ULT) and identify which threshold is more clinically relevant. Methods Patients from the CRYSTALILLE cohort with a diagnosis of gout naïve to ULT with baseline DECT scans of the knees and feet were selected. Two thresholds of positivity for DECT detection of MSU crystal deposition were considered (&amp;lt;0.01 cm3 and &amp;lt;0.1 cm3). Baseline characteristics and the prediction of key outcomes after ULT initiation, including reaching serum urate (SU) levels &amp;lt;6.0 and 5.0 mg/dl and occurrence of flares at 6, 12 and 24 months, associated with both thresholds of negative DECTs were compared with those of patients having positive DECT scans. Results A total of 211 patients, median age 66.2 years [interquartile range (IQR) 57–75.8], with a median symptom duration of 3 years (IQR 0–7.8) were included. A total of 38/211 (18%) and 90/211 (43%) had negative DECT scans for the 0.01 and 0.1 cm3 thresholds, respectively. Factors associated with negative DECT scans were younger age, shorter symptom duration and an absence of cardiovascular disease for both volume thresholds. A total of 9/39 (23.1%), 3/26 (11.5%) and 1/18 (5.6%) patients with &amp;lt;0.1 cm3 MSU crystals had flares at 6, 12 and 24 months, respectively, compared with 18/45 (40.0%), 9/36 (25.0%) and 2/18 (11.1%) patients with ≥0.1 cm3 (P &amp;gt; 0.05). Overall, 95 patients (68.3%) reached SU levels &amp;lt;6.0 mg/dl and 68 (48.9%) reached levels &amp;lt;5.0 mg/dl, without any difference between positive and negative DECTs, with ULT dosages that tended to be lower in patients with negative DECTs. Conclusion The 0.1 cm3 threshold was better correlated with clinical presentation and evolution than the 0.01 cm3 threshold. Gout patients with negative DECTs exhibit milder disease and a lower comorbidity burden. They do not exhibit particularly easy-to-treat hyperuricaemia but they may have a lower risk of flares.

Factors associated with false lumen changes in patients with superior mesenteric artery dissection.

False lumen changes (FLCs) are the main reference for the prognosis judgment and treatment plan selection for type IIa superior mesenteric artery dissection (SMAD). For this retrospective study, 55 patients with symptomatic type IIa SMAD were included. Computational fluid dynamics (CFD) analysis was used to explore the hemodynamic basis of FLCs. Correlation and multiple linear regression analyses were performed to identify clinical, morphological and hemodynamic factors associated with FLCs. The FLCs of patients with successful conservative treatment (n = 29) are significantly higher than those with failed conservative treatment (n = 26) (58.5 ± 21.1% vs 10.9 ± 17.4%, p < 0.0001). Positive correlations were seen between FLCs and the morphological parameters false lumen length (FLL)/dissection entrance length (DEL) and FLL. In terms of hemodynamic parameters, negative correlations were seen between FLCs and time-averaged wall shear stress (TAWSS), vorticity, and high areas of TAWSS and vorticity, whereas positive correlations were seen between FLCs and oscillatory shear index (OSI), relative residence time (RRT), and high areas of OSI and RRT. Multiple linear regression analysis identified symptom duration (odds ratio [OR], 0.93; 95% CI, 0.91-0.96; p < 0.0001), FLL/DEL (OR, 1.30; 95% CI, 1.01-1.67; p = 0.044), and high RRT area (OR, 2.03; 95% CI, 1.48-2.78; p < 0.0001) as predictors of FLCs. The clinical predictor symptom duration, morphological factor FLL/DEL, and the hemodynamic factor high RRT area can serve as predictors of FLCs in patients with symptomatic type IIa SMAD.

Capillaroscopic differences between primary Raynaud phenomenon and healthy controls indicate potential microangiopathic involvement in benign vasospasms.

For primary Raynaud phenomenon (PRP), an otherwise unexplained vasospastic disposition is assumed. To test the hypothesis of an additional involvement of distinct ultrastructural microvascular alterations, we compared the nailfold capillary pattern of patients with PRP and healthy controls. A total of 120 patients with PRP (with a median duration of vasospastic symptoms of 60 [IQR: 3-120] months) were compared against 125 controls. In both groups, nailfold capillaroscopy was performed to record the presence of dilatations, capillary edema, tortuous capillaries, ramifications, hemorrhages, and reduced capillary density and to determine a semiquantitative rating score. Further, the capacity of finger skin rewarming was investigated by performing infrared thermography in combination with cold provocation. Unspecific morphologic alterations were found in both, PRP, such as controls, whereby the risk for PRP was four times as high in the presence of capillary dilations (CI: 2.3-7.6) and five times as high if capillary density was reduced (CI: 1.9-13.5). Capillary density correlated with thermoregulatory capacity in both hands in the PRP group, but not in controls. In addition, a negative correlation between the microangiopathy score and the percentage degree of rewarming in both hands was found for patients with PRP only. We found specific differences within the microvascular architecture between patients with PRP and controls. As a conclusion, PRP may not be an entirely benign vasospastic phenomenon, but might be associated with subtle microcirculatory vasculopathy. In addition, we suggest that the implementation of a scoring system might serve as guidance in the diagnostic process at least of patients with long-standing PRP.

Navigating Uncharted Waters: Comparative Analysis of Clinical Progression and Outcomes in Vestibular Schwannoma Patients with Papilledema and without Hydrocephalus, Versus Those without Papilledema and Hydrocephalus: A Comprehensive Institutional Insight

Papilledema's association with hydrocephalus (HCP)-linked larger vestibular schwannoma (VS) is established but cases lacking concurrent HCP require further investigation. This retrospective comparative observational study, conducted from July 2018 to July 2023, examined 120 VS patients undergoing surgery. Patients were categorized into Group 1 (papilledema without HCP) and Group 2 (no papilledema or HCP), with comprehensive data analyzed. In this study, Group 1 (14 patients with papilledema) and Group 2 (106 patients without papilledema or HCP) were compared. Group 1 was younger (mean age 27.21±11.73years) than Group 2 (mean age 54.66±11.44years). Both groups had similar symptom durations and tumor detection times. Group 1 had increased vascularity (P= 0.001), elevated cisterna magna protein levels (P= 0.001), and a higher incidence of neurofibromatosis 2 (P= 0.003). They also experienced longer surgeries (P= 0.001) and more blood loss (P= 0.001), leading to extended postoperative complications. Group 2 showed improved postsurgery visual outcomes (P= 0.001), better Glasgow Outcome Scores (P= 0.001), enhanced facial nerve preservation (P= 0.002), and improved hearing on follow-up (P= 0.003). Logistic regression analysis highlighted prolonged surgery duration (P= 0.057) and papilledema (P= 0.0001) as significant factors influencing visual improvement. Patients with VS require preoperative fundoscopy evaluation due to potential visual loss and papilledema, even without HCP. Early treatment initiation enhances visual and hearing outcomes. Meticulous surgery is vital given the lesion's hypervascular nature and adherence to surrounding structures. Preoperative embolization may aid in preserving neurovascular structures. In developing countries with higher blindness rates, judicious noncontrast computed tomography brain evaluation is crucial for timely detection and treatment initiation of lesions like VS.

Evaluating the Therapeutic Effect of Sofosbuvir in Outpatients with COVID-19: A Randomized Clinical Trial Study

Background: The coronavirus disease 2019 (COVID-19) pandemic has engendered scores of deaths worldwide. Just as the development of varying procedures during the pandemic has helped inhibit the disease, none is considered a definitive treatment protocol for this problem, as each induces some clinical complications pertinent to the disease. This study thus assessed the early use of sofosbuvir in outpatients with mild COVID-19. Materials and Methods: This randomized clinical trial study was conducted on 360 patients with mild COVID-19 infection at 17 Shahrivar Ahvaz Health Center. These patients were randomly divided into the intervention and control groups. Both the control and intervention groups received 400 mg of sofosbuvir and a placebo for seven days, respectively. After 14 days from the onset of the treatment, the duration of symptoms, the necessity of hospitalization, the mean of hospitalization duration, and mortality were assessed.Results: The most common symptoms in the intervention and control groups were coughs with a frequency of 46 (25.6%) and 54(30%), respectively.The two groups showed no statistically significant difference in the frequency of the first observed clinical symptom related to the disease (P=0.2). The mean days that the patients were symptomatic in the control group were 14±4.17, whereas, in the intervention group, it was 12.12±3.15 (P=0.08). The frequency of hospitalization in the control and intervention groups was 7 (3.8%) and 4 (2.22%), respectively (P=0.11). Moreover, the mean days of hospitalization in the control and the intervention groups were 4±1.1 and 3±0.8, respectively (P=0.15). In addition, the two groups had a similar frequency of hospitalization in the ICU (0) and mortality rate (0). Conclusion: Sofosbuvir alone cannot play a significant role in the treatment of outpatients with mild COVID-19.

Relation between metabolic syndrome and psychiatric symptoms severity in women with premenstrual syndrome

BackgroundPremenstrual syndrome (PMS) is a clinical condition characterized by recurrent moderate-to-severe affective, physical, and behavioral symptoms during the menstrual cycle. The present study aimed to assess the relation between metabolic syndrome (MetS) and symptoms severity in patients with premenstrual syndrome (PMS). This multicentric propensity score matched analysis included 300 women with PMS. They comprised 150 women with MetS and 150 women without MetS. Diagnosis of PMS was based on the validated Arabic version of Premenstrual Symptoms Screening Tool (PSST). For the diagnosis of MetS, we adopted the Harmonized Joint Scientific Statement (HJSS) on metabolic syndrome recommendations.ResultsThe present study included 300 patients with PMS. They comprised 150 patients with MetS and 150 patients without MetS. Comparison between the studied groups regarding the demographic and clinical data showed that patients with MetS had significantly higher BMI (30.5 ± 3.0 versus 25.2 ± 3.5 kg/m2, p < 0.001) and longer symptoms duration (4.4 ± 0.9 versus 3.3 ± 1.1 days, p < 0.001). Patients with MetS included higher frequency of moderate-to-severe PMS (35.3% versus 20.7%, p = 0.005). In patients with MetS, it was found that patients with moderate-to-severe PMS have significantly higher BMI, younger age at menarche and longer symptoms duration. Multivariate logistic regression analysis identified age at menarche [OR (95% CI): 0.7 (0.55–0.9), p = 0.005], PMS symptoms duration [OR (95% CI): 4.45 (3.0–6.6), p < 0.001] and MetS [OR (95% CI): 1.67 (1.34–2.53), p = 0.017] as significant predictors of moderate-to-severe PMS.ConclusionsMetS is related to symptoms severity in PMS patients.

Charting a path forward: Promising outcomes of convalescent plasma therapy in the care of severely B-cell depleted patients with persistent COVID-19.

Patients with severe B-cell depletion related to hematological malignancies or B-cell targeted therapy suffer from impaired antibody responses to SARS-CoV-2 and are at risk for prolonged COVID-19. In this population, COVID-19 convalescent plasma (CCP) may provide passive immunity, enhance immune response, and promote virus neutralization. This study evaluated outcomes of B-cell depleted patients with persistent COVID-19 treated with CCP. This analysis included all consecutive severely B-cell depleted patients with persistent COVID-19, receiving CCP at Rambam between 01.2022-02.2023. Persistent COVID-19 was defined as the presence of symptoms for ≥14 days in patients with negative SARS-CoV-2 nucleocapsid antibody test results. Twenty patients met inclusion criteria, 17 of whom had hematological malignancies, two suffered from rheumatoid arthritis and one had both. Twelve patients received anti-CD-20 treatment, one - CAR-T cells and three underwent stem cell transplantation. The median duration of COVID-19 symptoms was 27.5 days (range 14-97); 12 patients had mild-to-moderate COVID-19 and 8 had severe infection. Sixteen patients required hospitalization. The majority of patients received other COVID-19 therapies before CCP. Within a median of two days (range 1-16) post-infusion, 19/20 patients clinically improved. No CCP-associated adverse events were documented. COVID-19 symptoms recurred in 3 of the improved patients. Two patients died from COVID-19 on days 1 and 90 following the first CCP infusion. In severely B-cell depleted patients with persistent COVID-19, CCP is safe and associated with rapid clinical improvement. This subset of immunocompromised patients could particularly benefit from CCP administration.

Evaluation of primary acquired nasolacrimal duct obstruction: Comparison of CT-DCG and dacryoendoscopy in accurately localizing the lacrimal drainage obstructions.

To correlate and evaluate the power and limitations of CT-DCG in determining the level and type of lacrimal duct obstruction in comparison to dacryoendoscopy in patients clinically suspected to be having partial or complete primary acquired nasolacrimal duct obstruction (PANDO). A retrospective chart review was performed on 1232 lacrimal drainage systems of 957 patients who suffered from primary acquired nasolacrimal duct obstruction (PANDO) at Shanghai Ninth People's Hospital. Patients were examined with CT-DCG and correlated with dacryoendoscopy and the findings of clinical examination. Of the studied patients, 173 were men and 784 were women with an age range of 18-93 years. Of the 1232 lacrimal pathways, good CT-DCG images could be obtained in 980 cases and dacryoendoscopy in 957 cases. Of these complete obstructions were noted in 81% (794/980), and partial obstructions were identified in 19% (186/980) with CT-DCG. CT-DCG and dacryoendoscopy showed 68.4% agreement for the type of the obstruction and 63% for the level of the obstruction. The majority of the obstructions occurred at the sac-duct junction (62.5%) followed by the upper half of the nasolacrimal duct (27.5%). There was a significant difference in the correlation of the obstruction type with age group and with the duration of symptoms. As the duration of symptoms increased, the proportion of complete lacrimal duct obstructions as shown on CT-DCG images increased and the proportion of incomplete obstruction decreased (p = 0.015). The junction of lacrimal sac and nasolacrimal duct was the most common obstruction site. Age and the duration of symptoms influenced the type of obstruction noted. The degree and level of agreement between the investigations was moderate. A combination of CT-DCG and Dacryoendoscopy could together identify the location more accurately.