Three-month Follow-up Research Articles

A Novel Therapeutic Approach of 980 nm Photobiomodulation Delivered with Flattop Beam Profile in Management of Recurrent Aphthous Stomatitis in Paediatrics and Adolescents-A Case Series with 3-Month Follow-Up.

Background/Objectives: Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal lesions and a very debilitating lesion, especially in paediatric and adolescent patients. The current pharmacotherapy offers a pain relief but not without side effects, and therefore photobiomodulation (PBM) can be an alternative therapy. To the authors' best knowledge, no published study has explored the efficacy of λ 980 nm laser PBM in the management of all RAS subtypes in paediatric and adolescent patients, and therefore, this prospective observational clinical study was conducted to bridge this gap by evaluating λ 980 nm laser PBM efficacy in symptomatic RAS management in paediatric and adolescent patients. The objectives were to evaluate (1) pain intensity alleviation; (2) wound healing rate; (3) wound size closure; (4) a complete resolution; (5) evidence of recurrence; and (6) patients' treatment satisfaction. Methods: The study's variables were assessed at the following timepoints: T0: pre-treatment; T1: immediately after first PBM session; T2: 5 hours (h) post first PBM session (via telephone call); T3: immediately after second PBM session (three days post first PBM session); T4: three-day follow-up (after complete PBM treatments); T5: two-week follow-up; and T6: three-month follow-up. The following PBM dosimetry and treatment protocols were employed: λ 980 nm; 300 mW; 60 s; 18 J; CW; flattop beam profile of 1 cm2 spot size; 18 J/cm2; and twice-a-week irradiation (72 h interval). Results: At T1, significant immediate pain intensity relief was reported. 33.33% recorded "4" and 66.67% reported "5" on the quantitative numeric pain intensity scale (NPIS), and this continued to improve significantly (83.33%) at T2. All the subjects reported "0" on the NPIS at T3, T4, T5 and T6. There was a significant reduction in the lesion surface area (>50% complete healing) at T3 compared to T0. Complete healing (100%) with no evidence of scarring and lesion recurrence observed at T4, T5 and T6. Very good patients' satisfaction was reported at all timepoints. Conclusions: This is the first report demonstrating λ980 nm efficacy in all RAS subtype management in paediatric and adolescent patients with a 3-month follow-up, whereby its PBM dosimetry and treatment protocols were effective from scientific and practical standpoints, and hence multicentre RCTs with large data are warranted to validate its reproducibility and to enrich the knowledge of PBM application in all RAS subtypes.

Three Differing Methods of Treating Intraoperative Nondisplaced Calcar Fractures Demonstrate Similar Radiographic Stem Subsidence

BackgroundSeveral management strategies have been described to treat intraoperative calcar fractures during total hip arthroplasty (THA), including retaining the primary implant and utilizing cerclage cables (CCs) or switching the implant to one that bypasses the fracture and achieves diaphyseal fixation. However, the radiographic and clinical outcomes of these differing strategies have never been described and compared. MethodsWe retrospectively identified 50 patients who sustained an intraoperative calcar fracture out of 9,129 primary total hip arthroplasties (0.55%) performed by one of three surgeons between 2008 and 2022. Each of the three surgeons consistently employed a distinct strategy for the management of these fractures: retention of the primary metaphyseal-engaging implant and placement of CCs; exchange to a modular, tapered-fluted stem (MTF); or exchange to a fully-coated, diaphyseal-engaging stem (FC). Stem subsidence was then evaluated on standing anteroposterior pelvis radiographs at three months and one year postoperatively. Postoperative medical and surgical complication rates were evaluated. ResultsA total of fifteen patients were treated with CC, 15 with MTF, and 20 with FC. At three-month follow-up, mean stem subsidence was 0.43 ± 0.08 mm, 1.47 ± 0.36 mm, and 0.68 ± 0.39 mm for CC, MTF, and FC cohorts, respectively (P = .323). At one-year, mean stem subsidence was 0.70 ± 0.08 mm, 1.74 ± 0.69 mm, and 1.88 ± 0.90 mm for the CC, MTF, and FC cohorts, respectively (P = .485). Medical complications included 2 venous thromboembolic events (4%) within 90 days of surgery. There were 6 reoperations (12%); 3 (6%) for acute periprosthetic joint infection (all within the FC cohort); 2 (4%) for postoperative periprosthetic fractures (one fracture distal to the stem in the FC cohort and one fracture at the level of the stem in the MTF cohort), and 1 (2%) closed reduction for instability (within the CC cohort). ConclusionsThe three described methods of managing intraoperative nondisplaced calcar fractures demonstrated little radiographic stem subsidence; however, the risk of reoperation was much higher than expected.

Lower glomerular filtration rate after mild stroke induces cognitive impairment by causing endothelial dysfunction

The incidence of post stroke cognitive impairment (PSCI) is high in patients with mild stroke (MIS), and the risk factors and mechanism are uncertain. Increased cystatin C (CysC) levels after stroke may reflect lower glomerular filtration rate (GFR) and renal impairment. Previous studies have suggested endothelial dysfunction (ED) is closely related to renal impairment and cognitive impairment, respectively. We aimed to observe whether lower GFR estimated by CysC after MIS leaded to a high incidence of PSCI, and the role of ED in this process. 256 patients were enrolled in this prospective observational study. Renal function was assessed using GFR estimated by serum CysC. Endothelial function was evaluated by reactive hyperemia index (RHI) which calculated automatically by peripheral arterial tonometry (PAT). The cognitive function at baseline and 3 months was evaluated by MoCA score, and MoCA score ≤ 26 indicates the presence of PSCI. Spearman correlation analysis and linear regression were conducted to explore the factors affecting ED. Univariate and multivariate analysis was used to identify the independent risk factors of PSCI. The receiver operating characteristic (ROC) curve was applied to explore the optimal cutoff value of the independent risk factors levels for predicting PSCI. A total of 141 patients (55.1%) suffered from ED. Multiple linear regression analysis showed that there was a strong linear correlation between eGFRcys and RHI (p < 0.001). At the three-month follow-up, a total of 150 (58.6%) patients had been diagnosed with PSCI. Multivariate logistic regression analysis showed that RHI was an independent factor affecting the occurrence of PSCI (p < 0.05). ROC curve showed that the area under the curve was 0.724, and the optimal cut-off value of RHI was 1.655, with the sensitivity and specificity for PSCI were 72.7% and 73.6%, respectively. The lower eGFRcys level after MIS was significantly associated with ED, and ED may mediate the higher incidence of PSCI at 3 months after MIS.

Decision-Making Engagement Preferences among Older Adults with CKD.

Older adults with kidney failure face preference-sensitive decisions regarding dialysis initiation. Despite recommendations, few older patients with kidney failure experience shared decision-making. Clinician uncertainty about the degree to which older patients prefer to engage in decision-making remains a key barrier. Mixed-methods explanatory, longitudinal, sequential design at 4 diverse U.S. centers with patients (English-fluent, aged ≥70 years, CKD stages 4-5, nondialysis) from 2018 to 2020. Patient preferences for engagement in decision-making were assessed using the Control Preference Scale (CPS), reflecting the degree to which patients want to be involved in their decision-making: active (patient prefers to make final decision), collaborative (patient wants to share decision-making with clinician), or passive role (patient wants clinician to make final decision). Semi-structured interviews about engagement and decision-making were conducted in two waves (2019, 2020) with purposively sampled patients and clinicians. Descriptive statistics and ANOVA were used for quantitative analyses; thematic and narrative analyses were used for qualitative data. Among 363 patient-participants, mean age was 78 ± 6 years, 42% were female, and 21% had a high school education or less. CPS responses reflected that patients preferred to engage actively (48%) or collaboratively (43%) versus passively (8%). Preferred roles remained stable at three-month follow-up. Seventy-six participants completed interviews (45 patients, 31 clinicians). Four themes emerged: Control preference roles reflect levels of decisional engagement; Clinicians control information flow, especially about prognosis; Adapting clinical approach to patient preferred roles; and Clinicians' responsiveness to patient preferred role supports patients' satisfaction with shared decision-making. Most older adults with advanced CKD preferred a collaborative or active role in decision-making. Appropriately matched information flow with patient preferences was critical for satisfaction with shared decision-making.

Pediatric kidney transplantation: is it safe to perform during night-time or day-off?

PurposeTo investigate the impact of after-hours surgery on the outcomes of pediatric kidney transplantation (KT).MethodsMedical records of pediatric KTs performed at a single institution between 2013 and 2021 were retrospectively reviewed. The population was split into three groups according to the incision time and calendar: ordinary day (8.00 AM – 6.30 PM), day-off, and night-time (6.30 PM – 8.00 AM). The following endpoints were compared: ischemia times, length of surgery, complications, delayed graft function (DGF), primary graft non-function (PGNF), and eGFR at three-month follow-up.ResultsNinety-six non-living donor KTs were performed, median age 11 (IQR 4.3–14) years and median body weight 26 (IQR 13–50) kg. Forty-one (43%) were performed during night-time and 28 (29%) during day-off. Ischemia times were similar (p = 0.769, p = 0.536). Day-off KTs presented an extended length of surgery (p = 0.011). Thirty-two complications were reported in 31 KTs. No difference in the overall rate of complications, DGF, PNGF, and three-month eGFR was found (p = 0.669, p = 0.383, p = 0.949, p = 0.093). Post-operative bleedings were more common in days-off (p = 0.003).ConclusionThe number of pediatric KTs performed during after-hours was considerable. Even though similar outcomes were reported, more caution should be focused on the KTs performed in days-off to avoid severe complications.

Comparative Evaluation of a New Tricalcium Silicate Cement With Calcium Hydroxide as Direct Pulp Capping Agents: A Clinical Study.

Background and objectives Direct pulp capping (dPC) is a therapeutic process that involves the application of a protective chemical to an exposed pulp with the intent to facilitate the restoration and preservation of its vitality and function. Despite numerous proposed solutions, researchers have yet to find a dependable, non-absorbable bioactive pulp capping substance that constantly activates cellular healing processes, consequently preserving pulpal vitality over an extended period of time. The objective of this study was to assess and contrast the efficacy of a novel tricalcium silicate cement and calcium hydroxide in preserving the long-term health of the dental pulp following dPC using clinical and radiographic observations. Materials and methods A total of 60 individuals with symptoms of reversible pulpitis associated with deep carious lesions were chosen for dPC in the study. Two groups comprising 30 patients each underwent dPC using the novel tricalcium silicate cement (experimental group) and calcium hydroxide (control group) out of the total number of patients. A thin protective covering of self-curing glass ionomer base was applied on top of the capping material. The dentist provided instant permanent restoration employing direct posterior composite resin. Follow-up examinations were conducted three, six, nine, and 12 months after the procedure, during which assessments were performed using clinical and radiographic parameters. Results The minimum age of the study group was 16, and its maximum age was 34 (22.35 ± 2.3 years). The control group consisted of 12 males and 18 females, while the Biodentine group consisted of 13 males and 17 females. The age and gender distribution were determined to have insignificant statistical differences across the groups. The pain score exhibited statistical significance at both the three-month and six-month follow-up visits (p < 0.05). The pain score at the 12-month follow-up was 0.38 ± 0.52 in the case group and 0.42 ± 0.61 in the control group (p = 0.79). The average Periapical Index (PAI) score for the Dycal and Biodentin groups after the 12-month follow-up was 1.38 ± 0.97 and 1 ± 0.3, respectively. This difference was found to be statistically significant (p = 0.044). In addition, there was a statistically significant difference in the PAI score at the three-month, six-month, and nine-month follow-ups (p < 0.01). During the entirety of the follow-up duration, one individual in the Biodentine group had tenderness upon percussion, a negative reaction for pulp vitality, pulpal changes, and a widening of the periodontal space. Statistically significant differences were observed in pulpal changes and tenderness on percussion during the nine-month and 12-month follow-up periods (p < 0.05). After 12 months, the rate of success in the group treated with Dycal was 91.3%, while the success percentage in the group treated with Biodentine was 98.55%. This difference in outcomes was determined to be statistically significant (λ2 = 5.46; p = 0.019). Conclusion The study findings indicate that Biodentine, a novel tricalcium silicate cement, outperforms calcium hydroxide in preserving pulp vitality over the long term following dPC. The Biodentine group attained an overall success rate of 98.55%, whereas the Dycal group had a success rate of 91.3% following 12 months of subsequent follow-up visits.

Abstract P412: Exploration of Eating Disorder Behaviors in Adolescent Girls Engaged in a Cardiovascular Risk Assessment Study

Introduction: Cardiovascular disease risk factors and eating disorders are both common in young women. There is scant research regarding eating disorder behaviors within the context of cardiovascular health interventions focused on nutrition, physical activity, and weight reduction. This project explored eating disorder behaviors while developing a cardiovascular health promotion tool for young women. Methods: We used an exploratory sequential mixed-methods approach. We interviewed 10 young women about an existing adult cardiovascular risk assessment tool. Three independent coders analyzed the interview data for themes pertaining to weight, food, exercise, and eating disorder behaviors. We used this qualitative data to inform modifications to the adult tool and create the new tool, HerHeart, focusing on teen-friendly language that deprioritized feedback surrounding weight. We then recruited 60 young women ages 13-21 years to complete HerHeart during a clinical visit; 12 participants returned for a three-month follow-up visit. Participants completed the Eating Disorder Diagnostic Scale (EDDS; score ranges from 0-128) at the baseline and follow-up visits. Hypothesis: We hypothesized that there would be no deterioration in EDDS scores over the intervention phase of HerHeart. Results: We identified themes in interviews, such as the importance of word choice when discussing weight (“words can hurt […] especially if you're overweight”, "when you're telling somebody they [are] obese, I feel like [you] should word it differently”), influences on body image and dieting (“some people see people who are […] very fit and they're like, okay, I'm going to starve myself”), and emotional eating (“I shouldn’t be eating this much because I am emotional eater […] When I do get sad […] I mostly eat”). At baseline, one participant met criteria for binge eating disorder and one met criteria for night eating syndrome. At follow-up, a separate individual met criteria for night eating syndrome. The median EDDS composite score for these 12 participants changed from 19 (IQR 10.5, 24) to 21 (IQR 10.5, 26). Conclusion: In conclusion, there was no significant change in EDDS composite score for young adult participants in a cardiovascular health intervention; very few participants met criteria for eating disorders. This emphasizes the importance of thoughtful language surrounding weight, eating habits, and body image in interventions involving adolescents.

Atrial Pacing Negatively Affects Left Atrial Morphological and Functional Parameters Similarly to Atrioventricular Dyssynchrony.

Background and Objectives: Atrioventricular (AV) dyssynchrony as well as atrial and ventricular pacing affect left atrial (LA) function. We conducted a study evaluating the effect of atrial and ventricular pacing on LA morphological and functional changes after dual-chamber pacemaker implantation. Materials and Methods: The study prospectively enrolled 121 subjects who had a dual-chamber pacemaker implanted due to sinus node disease (SND) or atrioventricular block (AVB). Subjects were divided into three groups based on indication and pacemaker programming: (1) SND DDDR 60; (2) AVB DDD 60 and (3) AVB DDD 40. Subjects were invited to one- and three-month follow-up visits. Three subsets based on pacing burden were analyzed: (1) high atrial (A) low ventricular (V); (2) high A, high V and (3) low A, high V. LA function was assessed from volumetric parameters and measured strains from echocardiography. Results: The high A, low V group consisted of 38 subjects; while high A, high V had 26 and low A, high V had 23. A significant decrease in reservoir and contractile LA strain parameters were only observed in the high A, low V pacing group after three months (reservoir 25.9 ± 10.3% vs. 21.1 ± 9.9%, p = 0.003, contractile -14.0 ± 9.0% vs. -11.1 ± 7.8, p = 0.018). While the re-established atrioventricular synchrony in the low A, high V group maintained reservoir LA strain at the baseline level after three months (21.4 ± 10.4% vs. 22.5 ± 10.4%, p = 0.975); in the high A, high V group, a further trend to decrease was noted (20.3 ± 8.9% vs. 18.7 ± 8.3%, p = 0.231). Conclusions: High atrial pacing burden independently of atrioventricular dyssynchrony and ventricular pacing impairs LA functional and morphological parameters. Changes appear soon after pacemaker implantation and are maintained.

A pilot study of the Moving On In My Recovery program for people in recovery from substance use

Background: This study pilot tested Moving On In My Recovery (MOIMR), a 12-session, acceptance-based, cognitive-behavioral, manual-guided group program for individuals in recovery from substance use. MOIMR aims to bridge the gap between formal treatment and sustained recovery. Method: Participants were 61 people in recovery from substance use and in the catchment area of the Betsi Cadwaladr Health Board, North Wales, United Kingdom. Using a variety of questionnaires, participants’ psychological flexibility and wellbeing were assessed at baseline, post-treatment, and a three-month follow-up. Participants who dropped out were contacted at the follow-up and interviewed about their experience. Results: The study successfully recruited participants from real-world treatment services. During the study, significant improvements were observed in participants’ social functioning, experiential avoidance, recovery capital, low mood, and anxiety. The proportion of participants who achieved abstinence also improved. Qualitative feedback confirmed the benefits that participants derived from attending the MOIMR groups. Conclusion: The program offered significant benefits for the participants despite many of them having apprehensions about undertaking a group-based approach. The gains established by quantitative analysis appeared to be supported by the qualitative findings. These findings suggest that a full randomized controlled trial of MOIMR would be feasible.

Effect of Orem’s self-care model on discharge readiness of patients undergoing enterostomy: A randomized controlled trial

ObjectiveTo evaluate the effectiveness of Orem’s self-care model in preparing hospitals for the discharge of patients with colorectal cancer who undergo enterostomy. Methods92 patients with enterostomy were recruited between February 2022 and February 2023 from a general tertiary hospital. The participants were assigned to either the intervention group or the control group randomly. The intervention group received Orem’s self-care program and a three-month follow-up, whereas the control group received only routine care and a three-month follow-up. Discharge readiness, self-care ability, and stoma-quality-of-life data were collected at hospital discharge (T1), 30 days (T2), and 90 days (T3) after discharge. ResultsThe intervention group had substantially higher discharge readiness (knowledge, p < 0.001; coping ability, p = 0.006; personal status, p = 0.001; expected support, p = 0.021; total score, p < 0.001), better self-care ability at T1 (self-care knowledge, p < 0.001; self-care skills, p = 0.010), better total quality of life (QoL) at T1, T2, and T3 (p < 0.001; p = 0.006; p = 0.014); better stoma management and daily routine at T1 (p = 0.004; p < 0.001); and better daily routine at T2 (p = 0.009) than the control group. ConclusionsThe designed discharge readiness program based on Orem’s self-care could promote effective patient discharge readiness, self-care knowledge, self-care skills, and QoL. Trial registrationThe trial number ChiCTR2200056302 registered on ClinicalTrials.gov.

Recurrent syncope due to ischemia with non-obstructive coronary artery disease: a case report

BackgroundIschemia with non-obstructive coronary artery disease is a prevalent form of ischemic heart disease. The majority of ischemia with non-obstructive coronary artery disease cases are attributed to underlying factors such as coronary microvascular dysfunction (CMD) and/or coronary artery spasm. Ischemia with non-obstructive coronary artery disease can present with various clinical manifestations. Recurrent syncope is an atypical complaint in patients with ischemia with non-obstructive coronary artery disease.Case presentationThis case report describes the presentation of a 58-year-old Chinese male patient who experienced repeated episodes of syncope. The syncope was found to be caused by concomitant coronary artery spasm and presumptive coronary microvascular dysfunctionc suggested by “slow flow” on coronary angiography. The patient was prescribed diltiazem sustained-release capsules, nicorandil, and atorvastatin. During the three-month follow-up conducted on our outpatient basis, the patient did not experience a recurrence of syncope.ConclusionThis study highlights the importance of considering ischemia with non-obstructive coronary artery disease as a potential cause of syncope in the differential diagnosis. It emphasizes the need for early diagnosis of ischemia with non-obstructive coronary artery disease to facilitate more effective management strategies.

Cerebral Venous Thrombosis in Patients With Traumatic Brain Injury: Epidemiology and Outcome.

The natural history and epidemiological aspects of traumatic cerebral venous thrombosis (CVT) are not fully understood. Due to the concomitant occurrence with intracranial hemorrhages, guidelines for medical treatment have been highly controversial.In this study, our objective was to carry out an analysis description of the population and to conduct a literature review. A prospectively gathered radiology registry data of patients hospitalized at the tertiary hospital of Centro Hospitalar Universitário do São João, Porto, Portugal, between 2016 and 2021 was carried out. All patients with traumatic brain injury (TBI) and concomitant CVT were identified. CVT was confirmed by CT venogram. Demographic, clinical, and radiological data and their medical management were reported. In-hospital complications and treatment outcomes were compared between patients measured by the Glasgow Outcome Score Extended (GOSE) at discharge and GOSE at three months. There were 41 patients with traumatic CVT admitted to this study. The majority (45.2%) had a hyperdense signal near the lateral sinus at admission, and only 26.2% presented with skull fractures. Of this cohort, 95% had experienced lateral sinus thrombosis. Twenty-five patients (60%) had occlusive venous thrombosis. Venous infarct was the main complication following CVT.Thirty-two patients (78%) were anticoagulated after CVT and four developed complications. At the three-month follow-up after discharge, 28.2% had good recovery (GOSE > 6). This study revealed a higher incidence of CVT in severe TBI and a mild association with skull fractures. There is a higher incidence of CVT in the lateral sinus. Management was inconsistent, with no difference in outcome without or with anticoagulation. Larger, prospective cohort studies are required to better comprehend this condition and determine evidence-based guidelines.

The Effect of Telehealth Marriage Checkup on Improvement of Marital Quality in Newlywed Couples

This quasi-experimental study investigated the effects of a telehealth Marriage Checkup on improvement of marital quality among 98 newly married couples. We assigned couples to either an intervention) telehealth Marriage Checkup program (or a control group.The participants completed the Quality of Marriage Index (QMI), and the NEO Five-Factor Inventory (NEO-FFI) at baseline, post-intervention, and three-month follow-up. The telehealth Marriage Checkup significantly increased marital satisfaction and this effect persisted at the three-month follow-up. Our study demonstrates the importance of early preventive interventions for enhancing and maintaining marital satisfaction in the initial stages of marriage.

Predictors of angiographic resolution in patients with presumed reversible cerebral vasoconstriction syndrome.

Reversible cerebral vasoconstriction syndrome is a complex neurovascular syndrome that presents with varying neurological deficits as well as segmental vasoconstriction of the small and medium cerebral arteries. There is limited literature on pathologies that mimic reversible cerebral vasoconstriction syndrome, so this study aims to understand what factors may impact the angiographic confirmation of reversible cerebral vasoconstriction syndrome on follow-up and play a role in establishing the diagnosis. The Clinical Research Data Warehouse at this institution was employed to search the medical records for patients with diagnosis and treatment of reversible cerebral vasoconstriction syndrome between January 2010 and May 2021. After screening, 32 patients met the inclusion criteria for a presumed diagnosis of reversible cerebral vasoconstriction syndrome with both angiography on presentation and at three-month follow-up after treatment. Patients were divided into two categories: those with complete angiographic resolution, versus partial or no improvement on follow-up. Clinical and radiographic data were analyzed. Patients who had partial or no resolution were more likely to have a history of hypertension (p = 0.001), higher systolic blood pressure on admission (p = 0.047), and present with a recurrent thunderclap headache (p = 0.038). Binary logistic regression selected for hypertension (odds ratio [OR] 18.35 [95% CI, 1.37-245.1]) as predictive of not having reversible cerebral vasoconstriction syndrome, as can be seen by partial or no resolution on follow-up angiography (p = 0.028). Complete resolution on follow-up angiography is a distinguishing factor of reversible cerebral vasoconstriction syndrome. Our analysis revealed that a history of hypertension is the most significant predictor of confirming that a patient may not have reversible cerebral vasoconstriction syndrome. This is due, in part, to increased atherosclerotic or hypertensive cerebral arterial changes, which can mimic reversible cerebral vasoconstriction syndrome and present as partial or no resolution on angiography.

Investigating Neonatal Multisystem Inflammatory Syndrome Associated with COVID-19 in the Neonatal Intensive Care Unit: A Case Series

Background: The COVID-19 pandemic, caused by the novel SARS-CoV-2 virus, has presented significant challenges to global healthcare systems, affecting individuals of all ages, including neonates. Recent studies have identified a condition similar to Multisystem Inflammatory Syndrome in Children (MIS-C) occurring in neonates, termed MIS-N (Multisystem Inflammatory Syndrome in Neonates), linked to maternal infection with SARS-CoV-2. Understanding MIS-N's clinical manifestations, laboratory findings, and treatment outcomes is crucial for improving neonatal care during the ongoing pandemic. Objective: The objective of this study was to explore the clinical characteristics, laboratory diagnostics, and treatment outcomes of neonates diagnosed with MIS-N, aiming to contribute to better diagnostic and management approaches for this vulnerable population. Methods: This retrospective case series analyzed neonates admitted with suspected MIS-N to the Children's Medical Center in Tehran, Iran, from March to September 2020. Inclusion criteria encompassed neonates showing clinical signs suggestive of MIS-N, elevated inflammatory markers, and positive for SARS-CoV-2 antibodies. Key data points included demographic information, clinical presentation, laboratory results (including complete blood count, inflammatory markers, and specific COVID-19 serology), treatment modalities, and patient outcomes. The effectiveness of interventions was evaluated based on symptom resolution and normalization of lab values. Results: Two neonates were identified with MIS-N. Case I involved a 39-week-old male presenting with diarrhea, dehydration, fever, and a rash, with initial inflammatory markers showing a white blood count (WBC) of 23,000 cells/μL, C-reactive protein (CRP) of 93 mg/L, and serum IgG of 10 g/L. Following treatment with corticosteroids, the patient's condition stabilized, with a decrease in WBC to 18,000 cells/μL and CRP to 34 mg/L. Case II, a 38-week-old female, exhibited a cough, rashes, with WBC of 17,000 cells/μL, CRP of 2 mg/L, and serum IgG of 40 g/L. A single dose of hydrocortisone led to symptom resolution. Both cases had no significant adverse outcomes at a three-month follow-up. Conclusion: Our findings illuminate the clinical and laboratory characteristics of MIS-N in neonates, emphasizing the role of maternal SARS-CoV-2 infection in its etiology. The successful resolution of symptoms with corticosteroid treatment highlights the potential efficacy of this intervention in managing MIS-N. These insights contribute to the growing understanding of MIS-N and underscore the need for ongoing research to define optimal diagnostic criteria and treatment protocols.

Percutaneous CT-Guided Microwave Ablation for the Treatment of Osteoid Osteomas: A Single Center Experience

Rationale and ObjectivesThe aim of the current study was to evaluate the feasibility and effectiveness of CT-guided microwave ablation (MWA) in the treatment of osteoid osteomas (OO). Materials and methodsData from 59 consecutive patients who underwent percutaneous CT-MWA for OO treatment were examined in the current retrospective study. The period of this study spanned from January 2021 to May 2023 at a single institution. The study involved an evaluation of clinical and radiological characteristics, procedural data, Visual Analog Scale (VAS) pain scores, complication incidences, as well as clinical and technical success rates. Statistical analyses were performed by using the Wilcoxon test with Bonferroni correction, Friedman, Spearman, Mann-Whitney U test. Results59 patients with an average age of 17.31±8.53 years underwent CT-guided MWA for the treatment of OO. The procedure demonstrated a high success rate, with 96.6% of cases achieving both technical and clinical success. However, recurrence was observed in two patients (3.4%) at the three-month follow-up. These cases were successfully managed with a second MWA procedure. The median VAS pain scores reported by the patients was significantly improved post-procedure: from 8.64 ± 1.14 before treatment to 0.63 ± 0.98 in the first month, 0.41 ± 1.02 in the third month, and 0.15 ± 0.45 in the sixth month. Only one patient (1.7%) experienced a minor complication; no major complications were recorded in this study. ConclusionCT-guided percutaneous MWA is a minimally invasive and a highly effective and safe approach for the treatment of OO.

Sex differences in response to cognitive behavioural therapy for insomnia: A chart review of 455 patients with chronic insomnia

BackgroundInsomnia is more prevalent in females, however studies examining sex differences in response to insomnia treatment are scarce. This study assessed sex-specific differences in cognitive behavioural therapy for insomnia (CBT-I)-related changes in insomnia symptoms in a large clinical cohort. MethodsA chart review was conducted of a clinical cohort (females n = 305, males n = 150) referred to a sleep clinic. Participants had a registered psychologist confirm diagnosis of chronic insomnia according to DSM-IV/V criteria and a Level 1 or 2 sleep study. Daily sleep diaries and questionnaires including the Insomnia Severity Index (ISI), Flinders Fatigue Scale (FFS), the Daytime Feelings and Functioning Scale (DFFS), and the Depression, Anxiety and Stress Scale-21 items (DASS), were administered at baseline, post-treatment, and three-month follow-up. Linear mixed models determined interactions between sex and timepoint on symptoms. ResultsMean (SD) age was 51.7 yrs (15.7, range = 18-90 yrs), and mean BMI was 26.3 kg/m2 (4.9), neither of which differed by sex. At pre-treatment, females demonstrated higher objective total sleep time (min) [343.5 (97.6) vs 323.8 min (92.1), p = 0.044], ISI [19.7 (4.2) vs 18.6 (4.4), p = 0.033], and FFS scores [19.2 (6.0) vs 16.9 (7.2), p = 0.003]. Compared to males, females experienced a greater reduction in FFS and DFFS scores and DASS depressive symptoms (p for interaction: 0.017, 0.043, 0.016 respectively) from baseline to follow-up. The greater reduction in depressive symptoms did not persist after controlling for age, BMI, and sleep apnea severity. Subjective total sleep time similarly increased across treatment for both males [baseline: 335.7 (15.1), post: 357.9 (15.5)] and females [baseline: 318.3 (10.4), post: 354.4 (10.7)], p for interaction: 0.22. ConclusionFemales and males experience similar, substantial benefits from CBT-I after accounting for comorbidities, suggesting the same treatment can resolve insomnia in both sexes.

Comparison of prematurity-related outcomes and complications in very low birth weight (VLBW) neonates fed with mother`s own milk versus donor milk: a comparative study.

When mother`s own milk (MOM) is unavailable or insufficient, donor milk (DM) from a human milk bank serves as an alternative feeding option. Our study sought to investigate and compare the outcomes and complications of very low birth weight (VLBW) preterm infants who receive MOM versus DM. In this retrospective cohort study conducted between 2018 and 2022, we compared 70 VLBW preterm infants exclusively fed with DM to 70 randomly selected counterparts fed with MOM. Both groups began enteral feeding within 72 hours of birth. Various clinical outcomes were investigated during a three-month follow-up. The clinical outcomes were compared via independent t-tests, Mann-Whitney U, and Fisher`s exact test. The mean gestational age of the infants who were included was 29.6 ± 1.6 weeks, 84 (60%) were males, and the average birth weight was 1217 ± 151 grams. Both groups had similar baseline characteristics. The results of the study demonstrated no statistically significant differences between the groups in terms of hospital length of stay (37±16.3 days in MOM vs 40.3±16.9 days in DM group, P= 0.17), growth rate (13±4 gram/day in MOM vs 13±4 gram/day in DM group, P=0.51), growth velocity (9.8±3.0g/kg/d in MOM vs 9.5±3.2 g/kg/d in DM group), infants with in-hospital vomiting (51 cases in MOM vs 59 cases in DM group, P=0.15),vomiting frequency (1.3±1.1 times in MOM vs 1.5±1.0 times in DM group), incidence of retinopathy of prematurity (ROP) (4 cases in MOM vs 5 cases in DM group, P > 0.999) and incidence of bronchopulmonary dysplasia (BPD) (7 cases in MOM vs 6 cases in DM group, P > 0.999). Our study findings indicate that the utilization of DM didn`t have a substantial negative impact on infants` outcomes nor any complications in comparison with MOM.

Cardiac Autonomic and Endothelial Function in Acute Lymphoblastic Leukaemia Patients Immediately After Chemotherapy and at the Three-Month Follow-up.

Acute lymphoblastic leukemia (ALL) is a malignant uncontrolled overproduction of immature lymphoid cells in blood and bone marrow. The primary treatment of ALL is chemotherapy. Chemotherapy can have myriad systemic side effects, notably cardiovascular derangement. Autonomic derangement occurrence in cancer patients signifies cardiovascular risk in them and is a determinant of cardiovascular morbidity and mortality. Elevated soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesion molecule-1 (sICAM-1) levels implicated in the regulation of inflammation indicate endothelial dysfunction. High levels of high-sensitivity C-reactive protein (hsCRP) can be indicative of low-grade inflammation. Hence, in this study the cardiac autonomic function and endothelial and inflammatory biomarker levels in adult patients with ALLwere assessed immediately and three months after chemotherapy. In this longitudinal study, 30 ALL patients (23 males, seven females) aged between 18 to 50 years, who had completed chemotherapy regimens, and 30 age and gender-matched healthy participants (controls) were recruited. Cardiac autonomic function tests (short-term heart rate variability (HRV), 30:15 ratio, synaptic excitation and inhibition (E/I) ratio, diastolic blood pressure (DBP) response to isometric hand grip), endothelial markers (sVCAM-1 and sICAM-1), and inflammatory marker (hsCRP) were assessed immediately and at three months after chemotherapy. Magnitudes of time domain and frequency domain indices, conventional autonomic function test indices, and biomarkers were deranged in ALL patients immediately after chemotherapy. After three months, cardiac autonomic function parameters were found to improve in the form of increased root mean square of successive differences between normal heartbeats (RMSSD), standard deviation of the interbeat intervals of normal sinus beats (SDNN), total power, high-frequency (HF)nu, and decreased low-frequency(LF)nu & LF-HF ratio. Endothelial (sVCAM-1) and inflammatory markers (hsCRP) were lower in the patient group as compared to the controls immediately after chemotherapy. Three months after chemotherapy, the levels of endothelial and inflammatory markers did not show much change. In this study, we found ALL patients showed higher sympathetic drive, decreased parasympathetic modulation, and sympathovagal imbalance immediately after chemotherapy as compared to the controls, indicating cardiovascular risk. After three months, improvement in cardiovascular autonomic function was observed. ALL itself is a state of inflammation with elevated endothelial and inflammatory markers; thus, the decreased endothelial and inflammatory markers could be attributed to the immediate effect of chemotherapy.

A Distant Fasciocutaneous Chest Wall Skin Flap for Necrotic Finger Post Reimplantation: A Case Report

The hand is often compromised by scars or potentially necrotic wounds. Complete loss of index finger will result in impairment of 20% of hand and 11% of whole-person. One of the most influential factors in consideration of tissue loss are defect size, site, depth, and orientation. In our case study, a 16-year-old male presented with sensations of tingling and pain in his finger subsequent to an accidental laceration. Examination revealed a necrotic wound located on the distal phalanx of the index finger, accompanied by mild atrophy and discoloration. Subsequently, the patient underwent graft harvesting from the right chest wall flap, followed by primary closure of the donor site on the right chest wall. Upon a three-month follow-up, the patient expressed satisfaction, demonstrating proficient daily activities despite the injury being localized to the left hand. Utilizing a chest wall flap is less prevalent than employing regional or free flaps. Anterior chest wall flaps are specifically crafted on the anterolateral chest wall or within the infraclavicular region. The choice of a chest wall flap was determined to offer a less cumbersome graft and aligns with the patient's preference. The main goal of soft tissue reconstruction is to restore functionality, encompassing tasks such as exploration, sensation, and manipulation of objects, while simultaneously preserving the original length. Nonetheless, achieving this goal remains a complex challenge. Keywords: Necrotic finger, Reimplantation, Chest Wall Skin Flap, Soft Tissue Reconstruction