Tertiary Medical Center Research Articles

Clinical and hematological profile of patients with pancytopenia at a tertiary medical center in Ethiopia.

Pancytopenia is an important hematological problem encountered in routine clinical practice associated with a multitude of disease states. The possible causes of pancytopenia can be influenced by geography, socioeconomic conditions, and endemic illnesses. Information regarding the underlying clinical conditions and morphologic features of blood cells of pancytopenia is limited and varied across different regions. Thus, this study was designed to assess the peripheral morphologic features of blood cells and the underlying clinical causes of pancytopenia. A facility-based cross-sectional study was conducted at the Jimma Medical Center hematology laboratory from June 13 to November 13, 2022. A total of 3mL of whole blood was collected from each subject for complete blood count analysis and peripheral blood morphology examination. Data on sociodemographic and clinical conditions were collected from medical records using a checklist. The data were analyzed using Statistical Package for the Social Sciences version 26. A total of 163 patients with pancytopenia were identified within the 5 months. Hyper-reactive malarial splenomegaly was the most prevalent cause (29.4%), followed by megaloblastic anemia (20.2%), chronic liver disease (10.4%), and acute leukemia (8.6%). Anisocytosis was the predominant peripheral blood morphology finding (82.2%), along with microcytosis (49.7%), ovalocytosis (31.3%), and macrocytosis (30.7%). Severe anemia was observed in 57% of cases, whereas the majority (92%) exhibited moderate leukopenia. A significant proportion (42.3%) had a platelet count below 50,000/μL. Unlike previous studies conducted in other parts of the world, this study showed that hyperreactive malarial splenomegaly was the leading cause of pancytopenia. This emphasizes the necessity of considering this condition as a possible cause for pancytopenia, particularly in malaria-endemic areas. The findings of the hematological profiles and peripheral blood morphology strongly suggest that early identification and prompt management of patients with pancytopenia require collaboration between clinical and laboratory investigations.

Triple therapy boosts survival in NSCLC patients with brain metastases: a retrospective cohort study of chemotherapy, ICIs, and antiangiogenic agents

BackgroundTreatment of brain metastases (BMs) in non-small cell lung cancer (NSCLC) patients, especially those with non-sensitive genetic mutations, is hindered by limited drug delivery through the blood–brain barrier (BBB). This retrospective study explores the efficacy of systemic treatments during brain metastasis to radiotherapy evaluation window in improving patient survival.MethodsIn this retrospective cohort study, we evaluated 209 NSCLC patients with non-sensitive mutations and BMs, treated between 2016 and 2023 at two tertiary medical centers (Chongqing University Cancer Hospital and Guangxi Medical University Cancer Hospital). The patients were divided into three groups, namely chemotherapy alone (C; n = 95), chemotherapy plus immune checkpoint inhibitors (ICIs) (C + I; n = 62), and chemotherapy with ICIs and antiangiogenic therapy (A) (C + I + A; n = 52). Statistical analyses were performed using R software, version 4.3.3. Categorical variables were compared using Fisher’s exact test, and survival curves were estimated with the Kaplan–Meier method and compared via the log-rank test. Univariate and multivariate Cox regression models were used to assess factors associated with overall survival (OS). Bayesian model averaging (BMA) was employed to address model uncertainty and improve result robustness. Subgroup analyses evaluated treatment-related mortality risk.ResultsFrom an initial cohort of 658 NSCLC patients with BMs, 209 were analyzed with a median age of 59; the majority were male (80.9%) and diagnosed with adenocarcinoma (78.9%). Univariate analysis identified significant variables influencing outcomes, including BMs radiotherapy EQD2, BMs count, local thoracic treatment, BMs radiotherapy field, intracranial response, and systemic treatment post-BMs diagnosis. The C + I + A regimen significantly improved median OS to 23.6 months compared to 11.4 months with C and 16.2 months with C + I, with a hazard ratio (HR) of 0.60 (95% CI: 0.43–0.82; P < 0.0001). The two-year OS rate was highest in the C + I + A group at 38.5%, versus 10.5% in C and 20.4% in C + I (P < 0.001). Cox regression and BMA analyses confirmed the stability of BMA in providing HR estimates, yielding area under the curve (AUC) values of 0.785 for BMA and 0.793 for the Cox model, with no significant difference in predictive performance. Subgroup analysis revealed a 71% mortality risk reduction with C + I + A (HR: 0.29; 95% CI: 0.18–0.47; P < 0.0001), showing consistent benefits regardless of patient sex, BMs count, extracranial metastases presence, and local thoracic treatments. Treatment sequence analysis indicated a median OS of 33.4 months for patients starting with A, though not statistically significant (HR: 0.59; P = 0.36). The overall incidence of radiation-induced brain injury was low at 3.3%, with rates in the C, C + I, and C + I + A groups being 3.2%, 4.8%, and 1.9%, respectively (P = 0.683).ConclusionOur study demonstrates the significant benefit of the C + I + A combination therapy in improving OS and reducing mortality risk in NSCLC patients with non-sensitive gene-mutated BMs. The sequential administration of A followed by ICIs shows a promising synergistic effect with cranial radiotherapy, highlighting the potential for optimized treatment sequencing. These findings emphasize the efficacy of tailored combination therapies in complex oncological care and suggest that our approach could lead to meaningful improvements in clinical outcomes for this challenging patient population.

Idiopathic intracranial hypertension in Asians: a retrospective dual-center study

BackgroundThere have been limited data on idiopathic intracranial hypertension (IIH) in Asians and there remain uncertainties whether a cerebrospinal fluid (CSF) pressure of 250 mm CSF is an optimum diagnostic cutoff. The aims of the present study included (1) characterization of IIH patients in Taiwan, (2) comparisons among different diagnostic criteria for IIH, and (3) comparisons between patients with CSF pressures of > 250 and 200–250 mm CSF.MethodsThis retrospective study involved IIH patients based on the modified Dandy criteria from two tertiary medical centers in Taiwan. Clinical manifestations were retrieved from electronic medical records, and findings on ophthalmologic examination and magnetic resonance images (MRIs) were reviewed.ResultsA total of 102 patients (71 F/31 M, mean age 33.4 ± 12.2 years, mean CSF pressure 282.5 ± 74.5 mm CSF) were identified, including 46 (45.1%) with obesity (body-mass index ≥ 27.5), and 57 (62.6%) with papilledema. Overall, 80 (78.4%), 55 (53.9%), 51 (50.0%), and 58 (56.9%) patients met the Second and Third Edition of International Classification of Headache Disorders, Friedman, and Korsbæk criteria, respectively. Patients in the 200–250 mm CSF group (n = 40) were less likely to have papilledema (48.5% vs. 70.7%, p = 0.035), transient visual obscuration (12.5% vs. 33.9%, p = 0.005), and horizontal diplopia (10.0% vs. 30.6%, p = 0.006), and had fewer signs on MRIs (2.2 ± 1.3 vs. 2.8 ± 1.0, p = 0.021) when compared with those with CSF pressures > 250 mm CSF (n = 62). However, the percentages of patients with headache (95.0% vs. 87.1%, p = 0.109) at baseline, chronic migraine at six months (31.6% vs. 25.0%, p = 0.578), and visual field defect (86.7% vs. 90.3%, p = 0.709) were similar.ConclusionsIt was found that obesity and papilledema were less common in Asian IIH patients when compared with Caucasian patients. Although patients with CSF pressures of 200–250 mm CSF had a less severe phenotype, the risks of having headache or visual loss were comparable to those in the > 250 mm CSF group. It is possible that a diagnostic cutoff of > 200 mm CSF could be more suitable for Asians, although further studies are still needed.

Rethinking Surgical Margins: A New Approach to Predict Outcomes in Oral Squamous Cell Carcinoma.

The traditional categorical division of surgical margins using a 5 mm cutoff in oral cavity squamous cell carcinoma (OCSCC) is controversial. The primary aim of this study was to investigate the presence of an optimal cutoff point or, alternatively, assess the potential improvement in predictive value by considering the surgical margins as a continuum. Retrospective analysis of OCSCC patients at a tertiary medical center in 1995-2020. Clinical, pathological, and surgical data were evaluated for effect on survivability by regression analyses. The cohort included 266 patients (48.1% male, mean age 65.4 ± 17.7). Patient stratification by categorical margin status yielded no significant between-group differences in survival (p = 0.54). Significance was achieved when margin distance was reevaluated as a continuous variable (p = 0.0018). Similar results were shown in local control (categorical p = 0.59 vs. continuous p = 0.06). Multivariate model excluded possible confounders. A predictive model was created to provide a more accurate prediction of survival. The continuum spectrum of margin distance better predicts survival outcomes and locoregional control in OCSCC. 3 Laryngoscope, 2024.

Low-Dose Metformin and Profibrotic Signature in Central Centrifugal Cicatricial Alopecia

Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia predominantly affecting Black female individuals. Current conventional treatments target inflammation but not the underlying fibrotic processes, often leading to permanent hair loss. To investigate the associations of low-dose oral metformin, an antidiabetic medication with antifibrotic properties, with clinical symptoms and scalp gene expression patterns in patients with CCCA. This retrospective clinical case series and transcriptomic analysis included patients treated at a single tertiary academic medical center between January 2023 and March 2024. All patients had biopsy-confirmed CCCA refractory to standard treatments. Transcriptomic analysis was performed on patients with previously banked, paired scalp biopsies before and after treatment with adjuvant metformin for at least 6 weeks. Extended-release metformin, 500 mg, once daily was added to participants' baseline CCCA treatment regimens. Clinical assessments included pruritus, inflammation, scalp resistance, and hair regrowth. Gene expression profiling via bulk RNA sequencing analysis evaluated differential gene expression and pathway enrichment. A total of 12 Black female participants were included in the study, and transcriptomic analysis was performed in 4 participants. After at least 6 months of metformin treatment, 9 participants experienced improvement in disease, including scalp pain, inflammation, and/or pruritus, and 6 demonstrated clinical evidence of hair regrowth. The addition of metformin led to reversal of many prominent gene pathways previously identified in CCCA. Transcriptomic analysis revealed upregulation of pathways and genes (keratin-associated proteins [KRTAPs]) involved in keratinization, epidermis development, and the hair cycle (absolute log2-fold change > 4), with concomitant downregulation of fibrosis-related pathways and genes (eg, MMP7, COL6A1) (fold change >1.5; all false discovery rate <.05). Gene set analysis showed reduced expression of helper T cell 17 and epithelial-mesenchymal transition pathways and elevated adenosine monophosphate kinase signaling and KRTAPs after metformin treatment. In this case series of patients with treatment-refractory CCCA, low-dose oral metformin was associated with symptomatic improvement and dual modulation of gene expression, stimulating hair growth pathways while suppressing fibrosis and inflammation markers. These findings provide a rationale for future clinical trials studying metformin as a targeted therapy for CCCA and other cicatricial alopecias.

Clinical Decision Support as a Prevention Tool for Medication Errors in the Operating Room: A Retrospective Cross-Sectional Study.

Medication errors in the operating room have high potential for patient harm. While electronic clinical decision support (CDS) software has been effective in preventing medication errors in many nonoperating room patient care areas, it is not yet widely used in operating rooms. The purpose of this study was to determine the percentage of self-reported intraoperative medication errors that could be prevented by CDS algorithms. In this retrospective cross-sectional study, we obtained safety reports involving medication errors documented by anesthesia clinicians between August 2020 and August 2022 at a 1046-bed tertiary care academic medical center. Reviewers classified each medication error by its stage in the medication use process, error type, presence of an adverse medication event, and its associated severity and preventability by CDS. Informational gaps were corroborated by retrospective chart review and disagreements between reviewers were resolved by consensus. The primary outcome was the percentage of errors that were preventable by CDS. Secondary outcomes were preventability by CDS stratified by medication error type and severity. We received 127 safety reports involving 80 medication errors, and 76/80 (95%) of the errors were classified as preventable by CDS. Certain error types were more likely to be preventable by CDS than others ( P < .001). The most likely error types to be preventable by CDS were wrong medication (N = 36, 100% rated as preventable), wrong dose (N = 30, 100% rated as preventable), and documentation errors (N = 3, 100% rated as preventable). The least likely error type to be preventable by CDS was inadvertent bolus (N = 3, none rated as preventable). Ninety-five percent of self-reported medication errors in the operating room were classified as preventable by CDS. Future research should include a randomized controlled trial to assess medication error rates and types with and without the use of CDS.

Assessment of sociodemographic and psychiatric characteristics of transgender adults seen at a Midwest tertiary medical center.

The National Academy of Medicine has formally identified transgender adults as an understudied population in critical need of health research. While national surveys, like the US Transgender survey, have characterized higher rates of depression, anxiety, suicidality and socioeconomic need in the transgender community, studies have not examined the impact of sociodemographic and clinical characteristics on mental health related outcomes. To describe the sociodemographic and mental health characteristics of transgender adults seen at a large Midwest transgender clinic and to determine factors associated with self-reported mental health conditions. Descriptive, retrospective, cross-sectional study of new transgender patients 18 years and older seen at a large Midwest transgender clinic between December 2019 and June 2022. A total of 482 charts were reviewed. During their initial evaluation, 11.6% (56/482) reported having a history of suicide attempt and 81.3% (392/482) reported a mental health diagnosis with the most common being depression, anxiety, attention deficit disorder, and post-traumatic stress disorder. Multivariable logistic regression results show no single factor was significantly associated with mental health diagnosis after adjusting for the effect of age and race. Patients who were new to gender affirming hormone therapy (54%, 254/468) are 2.0 (95% CI 1.4-2.9) times more likely to report having a mental health care provider than patients who were seen for continuation of therapy (46%, 214/468). Ten records with race not disclosed, 3 records with gender identity "other" and 2 records with gender identity not disclosed were excluded from analysis. This study reinforces the finding that transgender adults have an increased lifetime prevalence of mental health conditions. The higher prevalence of mental health conditions in our clinic was not associated with sociodemographic factors included in the study. Furthermore, transgender patients are less likely to have seen mental healthcare providers after initiation of gender affirming hormone therapy.

High Postreperfusion Pulmonary Artery Pressure Is Associated With Increased 30-Day Mortality in Liver Transplantation

Objective: Mean pulmonary artery pressure (mPAP) is frequently elevated after graft reperfusion during liver transplantation (LT), but its influence on clinical outcomes remains unclear. In this retrospective study, we aimed to explore the incidence, risk factors, and impact of elevated mPAP on 30-day mortality in LT. Design: A retrospective study. SettingUniversity tertiary medical center. ParticipantsAdult patients who underwent LT from 2013 to 2023. InterventionNo intervention. Measurements and Main ResultsData of consecutive adults who underwent LT (n=1243) between 2013 and 2023 were extracted from our institutional Discovery Data Repository. Elevated mPAP was defined as ≥40 mmHg or a ≥20% increase from baseline during the first hour following reperfusion. The 30-day mortality rate was recorded. Risk factors were identified using multivariable logistic regression. Patients were 55.2±11.9 years old and had a mean MELD-Na score of 34.8±6.1. Ninety-one patients (7.3%) developed an elevated postreperfusion mPAP. Multivariate logistic regression revealed that preoperative elevated PAP estimated by echocardiogram, preoperative creatinine, and the use of epinephrine during LT were significant risk factors. Thirty-two patients (1.9%) died within 30 days after LT. Elevated postreperfusion mPAP was significantly associated with 30-day mortality (odds ration: 6.056, 95% confidence interval: 2.349–15.611, p<0.001). Conclusions: In this retrospective study, we observed a rate of 7.3% occurrence of high PAP following reperfusion in LT and high postreperfusion PAP was associated with 30-day mortality.

Outcomes of Common Peroneal Nerve Decompression.

Common peroneal nerve (CPN) neuropathy is the most common lower extremity mononeuropathy. When delayed or no recovery from CPN neuropathy is suspected, surgical CPN decompression (CPND) is considered to relieve symptoms. This study aimed to evaluate patient outcomes post-CPND performed by a single surgeon at a tertiary medical center. Patient outcomes after CPND performed by a single surgeon were reviewed. Motor, sensation, and pain scores post-CPND were assessed in 47 of the 46 patients. Patient demographics, including age, concomitant morbidities, time from injury to surgery, and body mass index (BMI), were also analyzed for correlations with outcomes after CPND by logistic regression. 29/34 patients with impaired motor function improved by at least one motor grade, 19/42 with altered sensation reported restored normal sensation, and 31/37 reported improved pain after CPND. No correlation of patient demographic factors with motor or pain improvement after CPND was observed. However, a BMI greater than 29.15 and a time between injury and surgery exceeding 506 days were associated with lower odds of reporting restored sensation. Operative decompression of CPN neuropathy improves objective motor scores and subjective sensation and pain scores.

EXPRESS: The Scientific Value of Medical Student Research: The Experience at the Arrow Program for Medical Research Education.

This study presents a comparative analysis of the publications of students participating in the Arrow Research Program in comparison to those of attending physicians and researchers at the same tertiary medical center in order to assess the impact of the Arrow Research Program on the students' scientific achievements. The study encompassed 90 Arrow Research Program students that were involved in the program at the Sheba Medical Center between 2019 and 2021. As a comparison group, 2082 attending physicians and researchers affiliated with the same center during the same period of time were considered. Publications were collected from the Web of Science Database, and the publication data parameters of each group were compared to assess scientific outcomes. The Arrow Research Program students collectively published 67 articles, and the 2082 physicians and researchers in the comparison group produced 4283 papers during the study timeframe. Similarly, the average impact factor of the journals in which the Arrow Research Program papers were published was 4.16 ± 2.68, similar to the average impact factor of 4.74 ± 6.26 in the comparison group (p = 0.388). Likewise, the average quartile of the journals in which the Arrow Research Program articles were published was 1.39 ± 0.59, which is similar to the comparison group's average quartile of 1.39 ± 0.63 (p = 0.997). In conclusion, the Arrow Research Program demonstrates its effectiveness in empowering young students to execute successful research projects. This study may help develop educational programs worldwide.

Outcomes from a Multidisciplinary Otolaryngology and Rheumatology Clinic for the Management of Chronic Sialadenitis.

Determine the outcomes in children with recurrent sialadenitis after establishment of a multidisciplinary pediatric otolaryngology and rheumatology clinic. Retrospective review. Single-center tertiary medical center. We reviewed all children presenting to a multidisciplinary pediatric otolaryngology/rheumatology clinic with recurrent parotitis between December 2019 and April 2023. Thirty-three children presented with recurrent parotitis to a multidisciplinary clinic. Seventy-seven percent of those with childhood Sjögren's disease (cSjD) had xerophthalmia, and 67% had xerostomia. The cSjD group was more likely to have both abnormal parotid and submandibular findings when compared to the non-cSjD group (P < .001). Sixteen percent of the cSjD group had a positive SSA/SSB autoantibody and 47% were antinuclear antibody positive. Fifty percent of the cSjD cohort had a focus score of ≥1 from a minor salivary gland biopsy. There were no significant differences from sialendoscopy outcome between the 2 groups. Seventy percent with juvenile recurrent parotitis showed partial response (PR) or complete response (CR) to sialendoscopy. In the cSjD cohort 3 (27%) reported a CR and 5 (45%) reported a PR. In the non csSjD cohort 5 (42%) reported a CR and 3 (25%) reported a PR. Ten of the 12 cSjD patients on hydroxychloroquine have shown symptom improvement. The establishment of a multidisciplinary otolaryngology and rheumatology clinic can provide a more comprehensive evaluation and treatment of the child with recurrent or persistent parotitis than from a regular ENT clinic.

Perceptions of Care and Perceived Discrimination: A Qualitative Assessment of Adults Living with Sickle Cell Disease.

Sickle cell disease (SCD) is a major public health concern with significant associated economic costs. Although the disease affects all ethnic groups, about 90% of individuals living with sickle cell disease in the USA are Black/African American. The purpose of this study was to assess the health care discrimination experiences of adults living with SCD and the quality of the relationship with their health care providers. We conducted six focus groups from October 2018 to March 2019 with individuals receiving care at a specialized adult sickle cell program outpatient clinic at a private, nonprofit tertiary medical center and teaching hospital in the northeastern USA. The sample of 18 participants consisted of groups divided by gender and current use, past use, or never having taken hydroxyurea. Ten (56%) participants were males; most were Black/African American (83%) and had an average age of 39.4years. This study reports a qualitative, thematic analysis of two of 14 areas assessed by a larger study: experiences of discrimination and relationships with providers. Participants described experiences of bias related to their diagnosis of SCD as well as their race, and often felt stereotyped as "drug-seeking." They also identified lack of understanding about SCD and poor communication as problematic and leading to delays in care. Finally, participants provided recommendations on how to address issues of discrimination.

Sequential use of capsular typing and whole-genome sequencing-based analysis for transmission of carbapenem-resistant Acinetobacter baumannii in a tertiary medical center

BackgroundDuring the COVID-19 pandemic, there has been an increasing trend in healthcare-associated infections (HAIs) caused by carbapenem-resistant Acinetobacter baumannii (CRAB), posting a global public health concern. The heightened sensitivity of whole-genome sequencing (WGS) renders it an optimal and potent tool for monitoring outbreaks and tracing the transmission routes of nosocomial pathogens. MethodWe collected CRAB isolates from March 1, 2023, to April 6, 2023 in Chang Gung Memorial Hospital Lin Kou branch, a tertiary medical center in northern Taiwan. Any two or more isolates with the same identifiable capsular K-locus (KL) types were selected, and analyzed via WGS to identify putative transmission clusters, combined with epidemiologic and retrospective analysis on medical records to confirm risk factors and hidden transmission chains. ResultA total of 48 non-redundant CRAB isolates were collected, belonging to ST2 of Pasteur MLST scheme and identifiable KL types of KL2, KL3, KL9, KL10, KL22, KL52. Excluding the KL types that was only found in 1 case, KL2 (n = 9, 22.5 %), KL3 (n = 24, 60 %), KL9 (n = 3, 7.5 %), and KL10 (n = 4, 10 %) were selected for further WGS analysis. Four distinct transmission clusters comprised of 2, 3, 10, and 23 cases were identified on a basis of phylogenetic status. 12 probable transmission chains were revealed, and 2 hidden transmission routes can be speculated. ConclusionThis study referred to some hidden transmission chains that may be missed from traditional surveillance measures. Despite its low prevalence and high cost currently, implementing WGS could be a efficient, prompt, and unequivocal option for future MDRO infection control.

Bariatric Surgery Underutilization in Young Postadolescent Population With Obesity

PurposeBariatric surgery is an established treatment option for adolescent patients struggling with obesity, yet it remains underutilized. We aimed to gain insight into patients’ views of bariatric surgery and identify the strategies for improved utilization of the procedure in early postadolescence. MethodsThe electronic medical records of patients diagnosed with obesity at a tertiary medical center, ages 18–22 years old, were examined. Patients participated in a follow-up survey related to obesity treatment. FindingsWhile 20% of patients had BMIs ≥ 35 kg/m2 in adolescence, more than half (54%) of patients with obesity reached BMIs ≥ 35 kg/m2 after 18 y/o, thus potentially qualifying for bariatric surgery. A minority of patients (6/280, 2%) underwent bariatric surgery and experienced substantial weight loss in early postadolescence. Most remaining surgery-eligible patients (141/152, 93%) noted a BMI increase (0.05–28.6 kg/m2) during the immediate young adult study period without surgical intervention. While 66.7% of patients who recall receiving surgery-specific counseling would consider surgery as a part of their treatment, only 4.6% of patients who did not recall counseling would consider undergoing bariatric surgery. ImplicationsIn the absence of provider referral during adolescence, bariatric surgery remains underutilized in early postadolescence. Provider counseling is an essential component of patients’ willingness to consider bariatric surgery.

199. YOUNGER AGE AS AN INDEPENDENT FACTOR FOR SUBSEQUENT HEAD AND NECK CANCER AFTER CURATIVE ESOPHAGECTOMY FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Abstract Background Post-operative survival of esophageal cancer patients has improved with advances in technology and treatment modalities. However, squamous cell carcinoma often affects the esophagus together with the head and neck regions, with second primary head and neck cancer (SPHNC) adversely influencing the patients’ quality of life. Therefore, patients with esophageal squamous cell carcinoma (ESCC) should be carefully followed up post-operatively. This study evaluated the risk of developing SPHNCs after an esophagectomy for ESCC. Methods Patients with ESCC who underwent curative esophagectomy from January 2008 to December 2017 from two tertiary medical centers, Taipei Veteran General Hospital and Kaohsiung Veteran General Hospital, were retrospectively reviewed. SPHNC development was documented according to anatomic region and the cumulative incidence rate and risk factors were analyzed. Results The median observation time of the 435 patients included in our study was 48.5 months [interquartile range (IQR) 16.7–92.4 months]. Among the ESCC patients after curative esophagectomy, younger age &amp;lt;50 [hazard ratio (HR) 4.13, 95% CI: 2.53–6.75, p &amp;lt; 0.001) was the only independent factor for developing SPHNCs in the multivariable analysis. The cumulative incidence rate of SPHNCs of patients aged &amp;lt; 50 years old was 14.3%, 22.1%, and 34.2% after 3, 5, and 10 years, respectively. Conclusion There was a high risk of secondary cancer after ESCC in the upper aerodigestive tract, especially the head and neck regions, therefore active surveillance is strongly recommended, especially in younger patients.

Investigation of the knowledge, attitude and practice regarding nutrition in older adults with tuberculosis and diabetes: a cross-sectional study in Eastern China

ObjectivesOlder adults with tuberculosis and diabetes have special needs regarding dietary nutrition. This study aimed to investigate the knowledge, attitude and practice (KAP) regarding dietary nutrition among older adults with...

Predictive values of methicillin-resistant Staphylococcus aureus nasal swabs for pneumonia in burn ICU patients

Introduction/ObjectiveThis retrospective cohort study aimed to determine the sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) of MRSA nasal swabs for pneumonia in burn-injured intensive care unit (ICU) patients. MethodsPatients 18 years or older admitted to the Burn ICU at a tertiary medical center from 2016 to 2021 were included if they had any burns, a pneumonia ICD-10 code, an MRSA nasal swab obtained during admission, and any respiratory cultures associated with at least five consecutive days of antibiotics. ResultsThere were 267 occurrences of pneumonia across 136 patients. MRSA nasal swabs had an overall sensitivity of 39 %, specificity of 98.7 %, PPV of 84.2 %, and NPV of 89.9 %. MRSA nasal swabs obtained less than seven days from antibiotic initiation had a specificity of 98.6 % and NPV of 98.6 %; meanwhile, swabs obtained at least seven days from antibiotic initiation had a specificity of 98.7 % and NPV of 86.4 %. ConclusionsThe high specificity and NPV indicate that negative MRSA nasal swabs obtained less than seven days from antibiotic initiation may be used to de-escalate anti-MRSA antibiotics in clinically stable burn-injured patients with suspicion of pneumonia. The decrease in NPV suggests that it may be beneficial to obtain a repeat swab periodically.

The Viability and Success of Noncemented Kinematic Total Knee Arthroplasty.

The prevalence of noncemented total knee arthroplasty (TKA) is increasing as personalized knee alignment strategies deviate from implanting components on a strict mechanical axis. This retrospective study evaluated the outcomes of 74 consecutive noncemented unrestricted kinematic TKA procedures. This study included 74 consecutive noncemented kinematic TKAs performed by one surgeon at a tertiary academic medical center from 2021 to 2023. The technique used was unrestricted femur-first caliper kinematic TKA. The outcomes included revision, pain scores, and radiographic measurements. Of the 74 procedures performed, there were no revisions or readmissions for problems related to TKA. The mean follow-up was 17.6 months, with 74% of patients being followed up for more than 1 year postoperatively. On the day of surgery, postoperative measurements showed that the average tibial mechanical, distal femoral, and anatomic tibiofemoral angles were 3.3°, 7.7°, and 5.8°, respectively. 5 knees were observed initially with signs of radiolucency, which all resolved by the most recent appointment. None of the knees was radiographically loose. Of the patients, 65%, 19%, and 16% reported no pain, minimal pain, and some pain, respectively, at the 6-week follow-up visit. This improved to 78%, 19%, and 3% at the most recent follow-up. Combining kinematic alignment with noncemented fixation showed excellent clinical and radiographic outcomes with short-term survivorship. Although the use of both kinematic alignment and noncemented TKAs has been controversial, these early data suggest that noncemented kinematic TKA is safe and effective.

Nurses' cultural competence and its impact on work engagement and teamwork in community medical centers healthcare network in Central California, USA

This study explores the relationship between nurses' cultural competence and their work engagement and teamwork in hospitals at a tertiary private medical center in Central California. Using a correlational method, data were collected from 357 nurses, primarily female, aged 37-38, and of Asian descent. The Self-Assessment Cultural Competence Checklist, Utrecht Work Engagement Scale (WES-9), and Nursing Teamwork Scale (NTS) were used to measure these variables. Pearson’s correlation analysis revealed a positive association between cultural competence, work engagement, and teamwork, indicating that differences in beliefs can enhance collaboration and team cohesion among healthcare workers from diverse backgrounds. These findings highlight the importance of cultural competence in fostering effective teamwork and relationships in a multicultural healthcare environment.

A clinical comparative study on carbamylated haemoglobin as a surrogate marker to differentiate acute kidney injury from chronic kidney disease.

Carbamylated haemoglobin is the result of reaction of isocyanate with N-terminal valine residues of the α and β chains of haemoglobin. Carbamylated haemoglobin concentration is dependent on the degree and duration of uraemia and thus may potentially serve as a marker to differentiate acute kidney injury (AKI) and chronic kidney disease (CKD). A hospital-based prospective clinical comparative study was conducted in an urban tertiary medical care centre. Carbamylated haemoglobin was estimated in a total of 60 patients, 30 each of chronic kidney disease and acute kidney injury. The comparison of the carbamylated haemoglobin levels among the CKD and AKI groups was done using Mann-Whitney test. The mean value of carbamylated haemoglobin among the CKD group was 240.71 ± 75.64 μgVH/g, whereas among the AKI group, it was 67.15 ± 17.05 μgVH/g. These values are statistically significant with P < 0.001. Carbamylated haemoglobin values were elevated in relation to renal dysfunction, and it significantly correlated with chronicity of kidney disease. Mean CarHb among the CKD group was significantly high in comparison to the AKI group with statistical significance, with a P value of <0.001. It was significantly attributed in this study that carbamylated haemoglobin >100 μgVH/g is diagnostic of CKD and a value <100 μgVH/g is diagnostic of AKI. Thus, in this study, it can be concluded that carbamylated haemoglobin is a useful marker to differentiate AKI from CKD.