Ten-year Study Research Articles

Clinical profile and outcomes of tetanus patients in a tertiary hospital in the Philippines: a ten-year retrospective study

BackgroundTetanus is a life-threatening but preventable neurologic disorder characterized by trismus and muscle spasms. Despite its decreasing global incidence, it remains to be endemic in resource-limited settings such as the Philippines. This study aimed to determine the incidence, demographic characteristics, risk factors, clinical presentation, management, complications, and outcomes of non-neonatal tetanus cases in a tertiary hospital in the Philippines. It also aimed to compare the clinical profile and outcomes between the adult and pediatric subgroups.MethodsThis study used a retrospective cross-sectional design including all adult and pediatric non-neonatal tetanus patients admitted at the University of the Philippines - Philippine General Hospital from January 2012 to June 2023. Data was extracted from department censuses and inpatient charts.ResultsOne hundred thirty-eight cases were included. The incidence rate was 0.03%, while mortality rate was 29%. Majority of patients were males presenting with trismus and spasms after sustaining a puncture wound. Chronic hypertension was associated with an increased hazard of death by 4.5 times (p = 0.004), while treatment with magnesium sulfate was associated with a decreased hazard of death by 35 times (p = 0.005). The mode of infection and the medications administered differed between the adult and pediatric subgroups.ConclusionsAlthough the total number of cases has decreased over the past decade, tetanus remains to have a high incidence and mortality rate in the Philippines. Increasing vaccination coverage, improving public awareness, and educating health professionals can help reduce morbidity and mortality from this disease.

Is Joint Management between Conservationists and Farmers Sustainable and Biodiversity-friendly? A Ten-year Study in Residual Grasslands of a Protected Area.

In recent decades, there has been a discernible reduction in temperate and Mediterranean grasslands with consequences on the decline of biodiversity and landscape heterogeneity. When this decline is due to agricultural abandonment, a renewed joint management, combining bush clearing by conservationists and grazing by farmers, should favor the maintenance of grasslands, their protected habitats and species and forage production. Rainfall irregularity explains part of the variation of these parameters. To verify these hypotheses, we conduct a comprehensive, multi-scale, multi-taxa study over a ten-year period in a Mediterranean protected area. At the regional scale, experimental plots in which this joint management was implemented are representative of residual managed grasslands of the protected area. At the mesoscale, rainfall irregularity is the main factor explaining inter-annual differences in the biomass of open landscapes, while fauna depends on management, tree cover and trophic resources. At the local scale, in a representative experimental plot, clearing had an immediate negative impact on plant richness and bird and positive on forage. Over a decade, plant biodiversity increased while forage, specialist plants and bird maintained, despite the regrowth of bush. Drought had a negative impact on richness, plant and forage abundance and phenological asynchrony on butterflies. In conclusion, joint management has positive, neutral and negative impacts to be considered before implementing this strategy. This long-term monitoring study draws important lessons for designing a sustainable management of grasslands under abandonment and irregular climate, that should be applied in temperate and Mediterranean regions that are increasingly vulnerable to these trends.

Omalizumab as a long-term treatment for patients with severe asthma. Is it safe?: A ten-year study

Abstract Background anti-IgE (Omalizumab) is one of the targeted therapies for severe bronchial asthma. Its real-life safety is still under scrutiny. The aim of the study was to evaluate the persistent efficacy and safety of Omalizumab as a long-term treatment of severe bronchial asthma. Patients and methods A prospective cohort study was conducted on 74 patients who had severe bronchial asthma eligible for Omalizumab subcutaneous treatment with a long-term regular follow-up to evaluate the long-term safety and efficacy of Omalizumab. Results This study was conducted on 74 patients who had severe bronchial asthma: 33 patients (44.6%) were males with a mean±SD (37.2 ± 4), and 41 females (55.4%) with a mean±SD (35.9 ± 6). Those patients were eligible for Omalizumab treatment with a long-term regular follow-up (from 7 to 10 years) to assess the long-term safety of Omalizumab. Omalizumab treatment has a significant improvement in the clinical condition of severe bronchial asthma as it decreased the number of patients who used oral steroids from 63 patients (before starting treatment) to 6 patients after 6 months of treatment, and 2 patients after 12 months of the dose. The use of tiotropium bromide had a significant decrease because the number of patients fell from 61 patients (before the start of treatment) to 13 patients after 6 months. It also reduced the number of acute exacerbations of bronchial asthma from 7 times per year (before the start of treatment) to 3 times after 6 months, and 2 times after 12 months of treatment. Patients’ pulmonary functions (FEV1, FEV1/ FVC, PEFR) improved significantly from (43.7 ± 9, 52.3 ± 11, 51.1 ± 4) before starting Omalizumab treatment to (64.1 ± 11,71.3 ± 13, 68.2 ± 7) after 6 months of usage; and to (69.4 ± 12, 73.3 ± 14, 72.1 ± 6) after 12 months of treatment. Long-term use of Omalizumab has less severe side effects as 70% of patients had injection site reactions in the form of local tenderness and swelling, 24.3% had a headache, 12% had nausea, 9.4% had myalgia, and 17.5% had a fever while the serious side effects as cancer, anaphylaxis or myocardial infarction has not recorded. All the side effects occurred in the first year of treatment. Conclusion Long term use of Omalizumab in severe bronchial asthma management has persistent efficacy and no serious side effects such as cancer, myocardial infarction or anaphylaxis and has only minimal side effects that occurred mostly in the first year of Omalizumab treatment, meaning that the physician cannot stop giving patients the medication.

Characteristics of anaphylaxis from tertiary-care hospital in lower northern Thailand: A ten-year retrospective cross-sectional study.

The prevalence and etiology of anaphylaxis vary based on geographic regions, study design, and definition used. Anaphylaxis leading to emergency department visits and hospitalizations has increased worldwide. The prevalence and etiology of anaphylaxis vary based on geographic regions, study design, and definition used. Anaphylaxis leading to emergency department visits and hospitalizations has increased worldwide. A cross-sectional retrospective analysis of medical records from patients with ICD-10 confirmed anaphylaxis was performed at Naresuan University Hospital between March 2011 and February 2021. We identified 439 anaphylaxis episodes in 381 patients within 10 years. The average annual occurrence rates of anaphylactic episodes were 25.0 per 100,000 outpatient and emergency department visits and 11.2 per 100,000 inpatient visits. Both pediatric and adult anaphylaxis events increased annually, from 13.3 (children: 20.5, adults: 12.4) in 2012 to 46.6 (children: 52.6, adults: 46.1) episodes per 100,000 visits in 2021. Peak incidence was observed in adolescents and young adults. Food was the most common trigger, with shrimp and fried insects being predominant. Risk factors for severe anaphylaxis were underlying cardiovascular diseases, drug triggers, and wheezing. Epinephrine was administered in 98.4% of all episodes. Although, there were no fatalities, only 11.4% of patients received prescriptions for self-injectable epinephrine. The study underscores an increasing trend of anaphylaxis affecting both children and adults in lower northern Thailand, with shrimp and fried insects as common triggers.

Ten-Year Follow-Up of Women at High Risk for Familial Breast and Ovarian Cancer in Otago and Southland, New Zealand.

Care for families affected by Familial Breast and Ovarian Cancer (FBOC) is challenging as a broad range of professions and specialties are involved. The aim was to review management and outcomes for a cohort of women at high risk for familial breast and ovarian cancer. Ten-year retrospective follow-up study of individuals in Southern New Zealand assessed by Genetic Health Service New Zealand to be high risk for FBOC and without a personal cancer diagnosis at time of consultation. Twenty women were identified; twelve underwent genetic testing, and a pathogenic BRCA variant was identified in eleven. Eight women had no testing, as no index case was available. Guidelines had been fully adhered to in 55% of women, regardless of BRCA status. Six did not undergo appropriate breast surveillance. To date, seven of the 11 patients who tested positive for a pathogenic BRCA variant (64%) had risk-reducing surgeries. Two women were diagnosed with breast cancer on surveillance imaging; none were diagnosed with ovarian cancer. Four women were lost to follow-up, one of whom subsequently presented with a symptomatic breast cancer. To our knowledge, this is the first study providing long-term data for FBOC in New Zealand. Overall, guidelines were followed satisfactorily, but some women did not receive appropriate surveillance or referrals. An integrated interdisciplinary long-term care provision model in New Zealand might help to address gaps in FBOC surveillance and management.

Pathological migrating intramural hematoma in stenting for carotid artery dissection: A ten-year consecutive cohort study

ObjectiveTo study the phenomenon, incidence and management of pathological migrating intramural hematoma in stenting for carotid artery dissection. MethodsWe consecutively enrolled CAD patients with stenting treatment over 10-year period, and retrospectively analyzed the pathological migrating intramural hematoma (PMIH) incidence of these CAD patients. Besides, we also explored the related factors with PMIH and provided an appropriate management strategy. ResultsA total of 67 CAD underwent stenting. PMIH occurred in 7 cases (10.4%). The median time from onset of symptoms to stenting was 5 days (3 to 11 days). There were 4 cases of PMIH in the proximal segment of stent and 3 cases of PMIH in the distal segment of stent. All the patients presented with new stenosis and no patient presented with dissecting aneurysm. Through proper management, none of the patients had occurred clinical complications. ConclusionPathological migrating intramural hematoma phenomenon exists in the stenting for carotid artery dissection, rescue angioplasty or stenting is needed for early treatment of moderate and severe stenosis due to migrating intramural hematoma on preventing further ischemic events.

Neonatal bacteraemia in Ireland: A ten-year single-institution retrospective review.

Neonatal sepsis is a catastrophic condition of global concern, with reported mortality rates exceeding 10%. Bloodstream infections are an important cause of sepsis, and epidemiological studies of these infections are crucial for predicting the most common aetiological agents and antimicrobial susceptibility patterns and for developing antimicrobial guidelines. For the ten-year study period from July 2013 to June 2023, all neonatal bacteraemia cases were reviewed prospectively using an enhanced surveillance protocol. The patients were stratified according to their age at the time of blood culture collection: early onset if diagnosed in the first 72 hours of life, and late onset if diagnosed after that time. During the study period, 170 blood cultures were positive from 144 patients, of which 89 specimens from 64 patients represented the growth of significant pathogens. Coagulase-negative staphylococci (CoNS) were the most common pathogens identified (52%, 33/64), followed by Escherichia coli (14%, 9/64), Group B Streptococcus (GBS: 11%, 7/64) and Staphylococcus aureus (11%, 7/64). GBS was more commonly identified in early onset patients, while CoNS were predominantly associated with late onset. The presence of an intravascular catheter, maternal urinary tract infections and the receipt of total parenteral nutrition or transfused blood were identified as significant risk factors. The fatality rate was 8% (5/64). in summary, this study provides a detailed overview of the epidemiology of neonatal bacteraemia in a large teaching hospital in the Midwest of Ireland over a decade.

Comparison of Three Methods, “Pap Smear, Conization and LEEP” in Women with Abnormal Pap Smear: A Ten-Year Retrospective Analytical Study

Aim: Considering that many cases of abnormal pap smears are reported, which lead to more aggressive procedures such as colposcopy and cervical Loop Electrosurgical Excision Procedure conization, therefore, we tried to investigate the results of conization and compare them with the results of pap smears, so that perhaps more aggressive procedures can be avoided. Methods: This cross-sectional retrospective analytical study was conducted on women who underwent pap smear and cervical conization in Mortaz and Shahid Sadoughi hospitals from 2011 to 2020. All data including age, Pap smear, and conization pathology results were extracted from medical records. P-value Results: Totally 1306 patients were included in this study. The mean age was 40.74±9.73 years old. The most commonly reported pap smear tests and loop electrosurgical excision procedure conization were atypical squamous cells of undetermined significance with 912 (69.8%) patients for a pap smear and chronic cervicitis with 860 (65.8%) patients for loop electrosurgical excision procedure, respectively. A significant difference was seen between the distribution of conization findings and the pap smear test. In addition, no significant difference was observed between the distribution of findings of pap smear tests and cervical conization in terms of age. Conclusion: According to the results, it can be said that there was no significant difference between different age groups, but there is a significant difference between the results of pap smear and cervical conization, it seems that pap smears should be reported more accurately to avoid unnecessary conization. Keywords: uterine cervical neoplasms, papanicolaou test, conization, cervix uteri

Ten-Year Minimum Follow-up Study of First Metatarsophalangeal Joint Fusion in Young vs Old Patients.

Painful degenerative joint disease (DJD) of the first metatarsophalangeal joint (MTP I), or hallux rigidus, mainly occurs in later stages of life. For end-stage hallux rigidus, MTP I arthrodesis is considered the gold standard. As young and active patients are affected considerably less frequently, it currently remains unclear, whether they benefit to the same extent. We hypothesized that MTP I arthrodesis in younger patients would lead to an inferior outcome with decreased rates of overall with lower rates of patient postoperative pain and function compared to an older cohort. All patients aged <50 years who underwent MTP I arthrodesis at our institution between 1995 and 2012 were included in this study. This group was then matched and compared with a group of patients aged >60 years. Minimum follow-up was 10 years. Outcome measures were Tegner activity score (TAS), a "Virtual Tegner activity score" (VTAS), the visual analog scale (VAS), and the Foot Function index (FFI). Sixty-one MTP I fusions (n = 28 young, n = 33 old) in 46 patients were included in our study at an average of 14 years after surgery. Younger patients experienced significantly more pain relief as reflected by changes in VAS and FFI Pain subscale scores. No difference in functional outcomes was found with change in the FFI function subscale or in the ability to have desired functional outcomes using the ratio of TAS to VTAS. Revision rate did not differ between the two groups apart from hardware removal, which was significantly more likely in the younger group. In patients below the age of 50 years with end-stage DJD of the first metatarsal joint, MTP I arthrodesis not only yielded highly satisfactory postoperative results at least equal outcome compared to an older cohort of patients aged >60 years at an average 14 years' follow-up. Based on these findings, we consider first metatarsal joint fusion even for young patients is a valid option to treat end-stage hallux rigidus. Level III, a case-control study.

Within-host genetic diversity of extended-spectrum beta-lactamase-producing Enterobacterales in long-term colonized patients

Despite recognition of the immediate impact of infections caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales (ESBL-PE) on human health, essential aspects of their molecular epidemiology remain under-investigated. This includes knowledge on the potential of a particular strain to persist in a host, mutational events during colonization, and the genetic diversity in individual patients over time. To investigate long-term genetic diversity of colonizing and infecting ESBL-Klebsiella pneumoniae species complex and ESBL-Escherichia coli in individual patients over time, we performed a ten-year longitudinal retrospective study and extracted clinical and microbiological data from electronic health records. In this investigation, 76 ESBL-K. pneumoniae species complex and 284 ESBL-E. coli isolates were recovered from 19 and 61 patients. Strain persistence was detected in all patients colonized with ESBL-K. pneumoniae species complex, and 83.6% of patients colonized with ESBL-E. coli. We frequently observed isolates of the same strain recovered from different body sites associated with either colonization or infection. Antimicrobial resistance genes, plasmid replicons, and whole ESBL-plasmids were shared between isolates regardless of chromosomal relatedness. Our study suggests that patients colonized with ESBL-producers may act as durable reservoirs for ongoing transmission of ESBLs, and that they are at prolonged risk of recurrent infection with colonizing strains.

Housing conditions, cooking fuels, and health-related quality of life among rural middle-aged and elderly in northwest China: A ten-year balanced panel study

ObjectiveTo investigate the impacts of improving housing conditions and transitioning to clean cooking fuels on health-related quality of life (HRQOL) among middle-aged and elderly populations in rural China. Methods: Using a 10-year longitudinal follow-up study, we examined changes in housing conditions, cooking fuel use, and HRQOL among 690 Chinese adults aged 45 above in rural areas. HRQOL was assessed using the European Quality of Life-5 Dimensions 3 Levels (EQ-5D-3L) questionnaire. Generalized estimating equations were utilized to analyze correlations between variables. Results: Using four-period balanced panel data of 10 years, there were significant differences in the self-reporting of mobility, self-care, usual activities, pain / discomfort and anxiety / depression in rural middle-aged and elderly people (p < 0.05). In terms of the EQ-5D index score and EQ-VAS score, showed a decreasing trend (p < 0.05). The housing area, housing material type, utilization of sanitary toilets, separation of housing and kitchen were separated and non-solid fuels used as cooking fuel were significantly associated with high HRQOL (p < 0.05). Conclusions: This study found that good housing conditions and the use of non-solid cooking fuel had positive effects on health-related quality of life of middle-aged and elderly people in rural areas of northwest China.

A Critical and Comprehensive Study on Paddy Market Trends, Predictive Models, and Stability for Agricultural Revenue Enhancement

The way agricultural commodities' prices behave indicates how prices occasionally fluctuate between markets [1]. Comprehensive analysis provides valuable insights into the dynamics of paddy prices in Gujarat, emphasizing the importance of considering both short-term fluctuations and long-term trends. The findings contribute to a better understanding of market behaviour, aiding stakeholders in informed decision-making within the agricultural sector. In order to provide farmers with the knowledge of how much prices fluctuate over time in commodity markets and so increase their revenue, a ten-year study on the price behaviour of paddy was conducted inside the borders of the state of Gujarat (2009-2019). In order to gather statistics, three paddy markets in the state of Gujarat were specifically chosen based on the paddy arrivals that were highest. The trend diagram of the wholesale prices' yearly index number showed constant price fluctuations across the study period. Cuddy Dell Valle Index (CDI) was calculated to measure the instability in yearly and monthly prices. Based on the investigation, it was determined that paddy displayed a poor stability index within their respective marketplaces. The trend in paddy prices was measured using the linear and quadratic models. For paddy markets, the coefficient of multiple determination (R2) was greater than 70%. Thus, it can be said that a significant portion of the changes in paddy prices over the chosen study period can be attributed to the linear model. In keeping with the quadratic trend, the markets for paddy, or Ahmedabad and Gandhinagar, also showed a positive coefficient of the quadratic term, or T2. Comparing the quadratic and linear model for the markets of paddy the quadratic model performed better in Gandhinagar than the linear model did in Ahmedabad and Surat. Compound rate of increase in annual prices were analysed by exponential model. The rates of growth in the prices of Paddy in Ahmedabad, Surat, and Gandhinagar were 5.80 percent, 5.84 percent, and 4.68 percent, respectively. To separate seasonal variation from the original composite data, a multiplicative model was applied. To arrive at the twelve-month total of 1200 points, these ratios were averaged for each of the twelve months for the whole period. The Ahmedabad market's paddy produced the highest coefficient of seasonal variation (25.84 percent).

Urban Streetscape Changes in Portland, Oregon: A Longitudinal Virtual Audit

Streetscape imagery has considerable potential for observing urban change. The literature lacks sufficient longitudinal studies, however, on urban change considering human perception and activities. We conducted a longitudinal virtual audit to observe the change in urban liveliness, human activities, and built environment by examining streetscape imagery taken in the late 2000s and the late 2010s in Portland, Oregon. Eleven untrained crowd workers were recruited to provide liveliness ratings of 24,242 streetscape images for both periods. Tabulation, mapping, and multilevel regression analyses were conducted to observe the distribution, changes in liveliness, and the factors affecting these changes. The results confirmed that the city had become livelier during the ten-year study period, which was spatially associated with the increase in pedestrians and cyclists and particular elements of the built environment, such as mid- and high-rise buildings and sidewalk signs. Although these results were somewhat expected, this study’s value lies in confirming the potential of virtual audits conducted using Google Street View Time Machine for retrospectively examining subjective and objective urban change. Caution should be exercised, though, while interpreting urban change as temporal conditions (e.g., season, weather, and irregular events) can potentially bias the results in longitudinal studies.

Risk factors and survival of triple-negative breast cancer among breast cancer patients: Ten-year cross-sectional study in the southwestern Iranian population.

Breast cancer results from genetic and epigenetic mutations, contributing significantly to cancer-related morbidity and mortality. This study aimed to determine the prevalence and survival rates of triple-negative breast cancer (TNBC) among breast cancer patients in southwestern Iran over a ten-year period. This retrospective cross-sectional study aims to assess prognostic factors associated with survival in women diagnosed with breast cancer in Iran's southwestern region over a ten-year period (2007-2017). Data were collected from patients who visited the Clinical Oncology Department at Golestan Hospital in Ahvaz (the breast cancer center of the Southwestern country). The study enrolled women diagnosed with TNBC using a census method and data from medical records. The primary outcome (survival rates) and secondary outcomes (demographic data, diagnostic stages, and three receptors estrogen receptors [ER], progesterone receptor [PR], human epidermal growth factor receptor 2 [HER2] status) were collected. Breast cancer was diagnosed in 2641 women over ten years; TNBC was diagnosed in 227 individuals (8.59%). Statistical analysis revealed a significant correlation between negative ER status and TNBC (p > 0.05). Furthermore, the prevalence of TNBC differed significantly from that of other types of breast cancer (p = 0.0001). The variables of age, HER2, PR, and TNBC grade did not differ significantly (p > 0.05). The overall disease-free survival rate over 5 years was 88.1%, while the rate for individuals without recurrence was 77.97%. This study highlights a differentially low incidence of TNBC in the southwestern part of Iran when compared to other regions; genetic or epigenetic influences may explain this discrepancy. ER-negative status is a crucial prognostic indicator in diagnosing TNBC. The incidence of this disease is expected to rise by 100% in 2 years and 77.97% in 5 years.

Predicting anal cancer recurrence after radical chemoradiotherapy: a ten-year study based on tumour growth kinetics

Predicting anal cancer recurrence after radical chemoradiotherapy: a ten-year study based on tumour growth kinetics

Development of Organ-on-Chip for the Study of Placental Pathologies: A Ten-Year Study of Literature Published

Context: The placenta performs a crucial function in nutrient exchange, but studying this tissue poses a number of challenges. Utilizing microfluidic and microfabrication technologies, a 3D placenta-on-a-chip model provides a biomimetic alternative for studying placental diseases and treatments.&#x0D; Objectives: Aim: To review and analyze the currently available placenta-on-chip data to study placental pathologies in patients.&#x0D; Methods: By systematically searching the PubMed, Scopus, and Science Direct databases, research papers that employed 3D printing techniques for the development of organoids and Organ-on-Chip (OoC) systems for in vitro experiments were gathered and scrutinized.&#x0D; Results: When exposed to glucose transfer, placenta-on-a-chip mimics the features of an in vivo human placenta. Microchips have the potential to become a platform for diagnostic purposes for placental diseases and a model for duplicating the important features of these diseases.&#x0D; Conclusions: The microfluidic placenta-on-a-chip platform holds promise as an affordable solution with versatile applications. However, research is essential to develop a comprehensive in vitro pregnancy model in the future to expand our understanding of feto-maternal communication.

Influenza vaccination mitigates severe complications in hospitalized patients: A ten-year observational study, Spain, 2009-2019

Influenza epidemics annually impact a substantial portion of adults worldwide, leading to numerous hospitalizations and fatalities. While the primary goal of vaccination is to prevent influenza virus infection, breakthrough infections can still occur despite vaccination. Evaluating the vaccine effectiveness in preventing severe cases among hospitalized patients is crucial for enhancing vaccination strategies. This single-center, observational, cross-sectional, and retrospective study analyzed data from 1,357 patients admitted to La Paz University Hospital for influenza infection between 2009 and 2019. Patients' demographics, clinical variables, comorbidities, vaccination status, and influenza-related outcomes were assessed. Logistic regression analysis was performed to determine the vaccine-independent protective effects. Influenza vaccination independently prevented severe complications, including pneumonia, bacterial superinfection, acute respiratory distress syndrome, and multiple organ failure in hospitalized patients (odds ratio=0.61, 95% confidence interval: 0.47-0.76). Vaccinated patients had significantly lower intensive care unit admission rates (odds ratio=0.42, 95% confidence interval: 0.18-0.92). However, there were no significant differences in mortality rates between vaccinated and unvaccinated patients (P=.385). Our study provides robust evidence supporting the influenza vaccine protective effect against severe outcomes in hospitalized patients during epidemic flu. Vaccination is associated with a significant reduction in severe complications and intensive care unit admissions, emphasizing its importance as a preventive measure. Improving vaccination coverage, especially in specific comorbidities and age groups, could further enhance the vaccine effectiveness in preventing severe influenza cases.

Dose escalation in intrathecal baclofen therapy based on disease etiology: Can an a priori target dose be established? A ten-year follow-up study

Context Intrathecal baclofen (ITB) therapy is administered for severe, persistent spasticity that cannot be addressed by oral medication or other treatments. Objective We aimed to evaluate the target dose of ITB for severe, persistent spasticity based on disease etiology. Methods Data at baseline (discharge), 1, and 10 years from 102 patients who received ITB therapy between 1985 and 2011 were retrospectively collected. Patients were divided based on disease etiology (cerebral, spinal, or multiple sclerosis [MS]) to evaluate differences in dose requirements. A comprehensive literature review of the dose trends in ITB therapy was conducted. Results Patients with cerebral spasticity (n = 62) required the highest dose after discharge (102.66 ± 30.9 µg), 1 (402.29 ± 300.2 µg), and 10 years (578.74 ± 421.2 µg). Patients with spinal spasticity (n = 19) required an average of 82.89 ± 30.7 µg baclofen at discharge, 296.3 ± 224.6 µg after 1 year, and 522.63 ± 425.97 µg after 10 years. Patients with MS-related spasticity (n = 21) had a dose of 82.73 ± 39.3 µg baclofen at discharge, 226.95 ± 193.3 µg after 1 year, and 320.6 ± 261.4 µg after 10 years. The differences among the categories were significant after 1 and 10 years of therapy. Conclusions The largest dose escalation occurs within the first year of ITB therapy. Our work provides a guideline for the initial dose setting during the inpatient stay after implantation and potentially expected dosage over the years thereafter, although this must always be adjusted individually.

Demographic, Clinical Symptoms, Imaging and Pathology Characteristics of Patients with Adnexal Torsion: A Ten-Year Study

Demographic, Clinical Symptoms, Imaging and Pathology Characteristics of Patients with Adnexal Torsion: A Ten-Year Study

A Ten-Year Retrospective Cohort Study on Neck Collar Immobilization in Trauma Patients with Head and Neck Injuries.

Background and Objectives: In the context of prehospital care, spinal immobilization is commonly employed to maintain cervical stability in head and neck injury patients. However, its use in cases of unclear consciousness or major trauma patients is often precautionary, pending the exclusion of unstable spinal injuries through appropriate diagnostic imaging. The impact of prehospital C-spinal immobilization in these specific patient populations remains uncertain. Materials and Methods: We conducted a retrospective cohort study at Taipei Tzu Chi Hospital from January 2009 to May 2019, focusing on trauma patients suspected of head and neck injuries. The primary outcome assessed was in-hospital mortality. We employed multivariable logistic regression to investigate the relationship between prehospital C-spine immobilization and outcomes, while adjusting for various factors such as age, gender, type of traumatic brain injury, Injury Severity Score (ISS), Revised Trauma Score (RTS), and activation of trauma team. Results: Our analysis encompassed 2733 patients. Among these, patients in the unclear consciousness group (GCS ≤ 8) who underwent C-spine immobilization exhibited a higher mortality rate than those without immobilization. However, there was no statistically significant difference in mortality among patients with alert consciousness (GCS > 8). Multivariable logistic regression analysis revealed that advanced age (age ≥ 65), unclear consciousness (GCS ≤ 8), major traumatic injuries (ISS ≥ 16 and RTS ≤ 7), and the use of neck collars for immobilization (adjusted OR: 1.850, 95% CI: 1.240-2.760, p = 0.003) were significantly associated with an increased risk of mortality. Subgroup analysis indicated that C-spine immobilization was significantly linked to an elevated risk of mortality in older adults (age ≥ 65), patients with unclear consciousness (GCS ≤ 8), those with major traumatic injuries (ISS ≥ 16 and RTS ≤ 7), and individuals in shock (shock index > 1). Conclusions: While our findings do not advocate for the complete abandonment of neck collars in all suspected head and neck injury patients, our study suggests that prehospital cervical and spinal immobilization should be applied more selectively in certain head and neck injury populations. This approach is particularly relevant for older individuals (age ≥ 65), those with unclear consciousness (GCS ≤ 8), individuals experiencing major traumatic injuries (ISS ≥ 16 or RTS ≤ 7), and patients in a state of shock (shock index ≥ 1). Our study employs a retrospective cohort design, which may introduce selection bias. Therefore, in the future, there is a need for confirmation of our results through a two-arm randomized controlled trial (RCT) arises, as this design is considered ideal for addressing this issue.