University Clinic Research Articles

Efficacy and Durability of Faricimab in Naïve Eyes with Neovascular Age-Related Macular Degeneration

Introduction: The aim of the study was to evaluate functional and anatomical changes in patients with neovascular age-related macular degeneration (nAMD) treated with a loading dose of faricimab intravitreal injections (IVIs). Methods: Eighteen eyes of 18 patients with active macular neovascularization and nAMD were enrolled at the Ophthalmology Clinic of University G. D’Annunzio, Chieti-Pescara, Italy. All patients were scheduled for faricimab IVI as per label. Enrolled patients underwent complete ophthalmic evaluation, including optical coherence tomography, fluorescein angiography, and indocyanine green angiography. All measurements were evaluated at baseline (T0) and then monthly up to week 20 (T4). Main outcome measures were changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), pigment epithelial detachments (PEDs) presence and maximum height (PED-MH), intraretinal fluid (IRF) presence, subfoveal subretinal fluid (SSRF) presence and thickness. Results: BCVA improved and CMT reduced significantly during follow-up (p < 0.001). In addition, SFCT decreased significantly (p = 0.031). Between T0 and T4, SSRF presence reduced from 55.6 to 16.7% (p = 0.045); IRF presence changed from 50 to 22.2%, respectively (p = 0.074). PED-MH was reduced in 58.8% of patients at T4. At week 20, 72.3% of patients were in the q12/q16 interval. Conclusion: Faricimab showed efficacy in the treatment of naïve nAMD patients with an improvement of anatomical and functional parameters and a treatment interval after the loading phase equal or greater than 12 weeks in the majority of patients.

Postoperative recovery after suspension suture placement at the site of esophagojejunal anastomosis after total gastrectomy: Comparison of two surgical techniques.

Despite improvements, survival rates for gastric cancer remain low, even in developed countries, confirming the role of primary and secondary prevention. This study aims to demonstrate the role of additional suspension sutures on the esophagojejunal anastomosis (EJA) to strengthen the anastomosis, i.e., relieve the mechanical suture. A retrospective cohort study was conducted from 2011 to 2022 at the Clinic for Surgery, University Clinical Center Tuzla, Bosnia and Herzegovina. The experimental group consisted of patients placed with a suspension suture at the esophagojejunal anastomosis (EJA) site after total gastrectomy. The control group was patients without a suspension suture. The clinical and laboratory parameters available from the medical history were analyzed, X-ray passage, surgical complications, non-surgical complications, the length of hospitalization, the postoperative course, time of onset of postoperative complications, postoperative radiological follow-up and endoscopic postoperative follow-up were then analyzed. A total of 212 patients were included in the study: 87 in the experimental group with suspension sutures on the EJA and 125 in the control group without suspension sutures on the EJA. The two cohorts did not differ in other clinicopathologic parameters except perineural invasion, which was more prevalent in the control group. Patients in both groups were anemic and elevated values of C reactive protein (CRP) and decreased levels of proteins, albumin and globulin, with no significant difference between the two groups. The most common general complication was pleural effusion (28%), followed by pneumonia (∼22%). The most common complication in the experimental group was an intraabdominal abscess, while in the control group, it was a surgical wound infection. Our study did not show a statistically significant difference between the two analyzed EJA techniques created with a circular stapler, when it comes to postoperative course and outcome in patients with gastric cancer.

Ureter‐ileum‐interposition: Combined experience from two high‐volume centres

AbstractThe current study aimed to evaluate short‐ and long‐term complication rates and functional outcomes in a substantial cohort of patients undergoing ileal ureter interposition at two high‐volume medical centres.Materials and methodsA retrospective single‐arm analysis was conducted on patients who underwent ureter reconstruction using ileum between 2003 and 2022 at the University Clinic of Cologne and the National Cancer Institute of Ukraine. Data on aetiology, surgical techniques, pre‐ and postoperative kidney function changes, readmission rates and complication management were collected. Postoperative complications were classified according to Clavien–Dindo, and estimated glomerular filtration rate (eGFR) was calculated using the CKD‐EPI formula.ResultsResults revealed 107 cases with consistent data. Within 90 days post‐surgery, 53% experienced complications, mainly graded as I–II. Grade III complications were seen in 13%, with two cases of grade IV complications leading to extended hospitalisation and patient death. The 90‐day mortality rate was 1.8%. Over a mean follow‐up of 52 months, clinically significant vesico‐renal refluxes occurred in 28%, with only 5.4% leading to persistent urinary tract infection. Antireflux techniques appeared to reduce urine upflow incidence compared with conventional interposition. Anastomosis stricture occurred in 15% of patients, with 63% requiring permanent re‐stenting and 37% needing re‐anastomosis. Metabolic acidosis was clinically significant in 7.5% of cases. A slight improvement in renal function was observed during the first year post‐surgery (average postoperative eGFR = 76 ± 22 ml/min; Mann–Witney U test, p = 0,0198). Affected kidney function improved in 56 (52%), was stable in 41 (38%) and deteriorated in 10 (9.3%). Loss of kidney function on the surgery side was seen in 4 (3.7%) patients and resulted in nephrectomy in 3 (2.8%) cases.ConclusionIleal ureter interposition demonstrated a favourable safety profile and functional outcomes. This surgical intervention provides an effective tension‐free bypass, irrespective of healthy ureter length.

Childhood Trauma Questionnaire-based child maltreatment profiles to predict efficacy of the Cognitive Behavioral Analysis System of Psychotherapy versus non-specific psychotherapy in adults with early-onset chronic depression: cluster analysis of data from a randomised controlled trial

Child maltreatment is a broadly confirmed risk factor for mental and physical illness. Some psychological treatments specifically target mental health conditions associated with child maltreatment. For example, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) focuses on maladaptive interpersonal behaviours in chronic depression. However, how the assessment of child maltreatment could inform personalised treatment is unclear. We used data from a previously published clinical trial to investigate whether a pre-established child maltreatment clustering approach predicts differential outcomes after CBASP versus non-specific supportive psychotherapy in patients with early-onset chronic depression. We did a cluster analysis of data from a previous randomised controlled trial of unmedicated adult outpatients with early-onset chronic depression who were treated at eight university clinics and psychological institutes in Germany with 32 sessions of CBASP or non-specific supportive psychotherapy. Participants were eligible for the original trial if they were aged 18-65 years; had major depressive disorder (MDD) with an early onset and duration of at least 2 years, current MDD superimposed on a pre-existing dysthymic disorder, or recurrent MDD with incomplete remission between episodes as defined by DSM-IV; and had a score of at least 20 points on the 24-item Hamilton Rating Scale for Depression (HRSD-24). Participants were included in the current study if they had completed the short form of the Childhood Trauma Questionnaire (CTQ) at trial baseline. We used an agglomerative hierarchical clustering approach to derive child maltreatment clusters from individual patterns across the five domains of the CTQ. We used linear mixed models to investigate whether clustering could predict differential clinical outcomes (change in symptom severity on the HRSD-24) up to 2 years after treatment onset. People with lived experience were involved in the current study. 253 patients (129 [51%] treated with CBASP and 124 [49%] with supportive psychotherapy) had complete CTQ records and were included in the analysis. 169 (67%) participants were women, 84 (33%) were men, and the mean age was 45·9 years (SD 11·7). We identified seven child maltreatment clusters and found significant differences in treatment effects of CBASP and supportive psychotherapy between the clusters (F(6,948·76)=2·47; p=0·023); differences were maintained over the 2-year follow-up. CBASP was superior in distinct clusters of co-occurring child maltreatment: predominant emotional neglect (change in β -6·02 [95% CI -11·9 to -0·13]; Cohen's d=-0·98 [95% CI -1·94 to -0·02]; p=0·045), predominant emotional neglect and abuse (-6·39 [-10·22 to -2·56]; -1·04 [-1·67 to -0·42]; p=0·0011), and emotional neglect and emotional and physical abuse (-9·41 [-15·91 to -2·91]; -1·54 [-2·6 to -0·47]; p=0·0046). CTQ-based cluster analysis can facilitate identification of patients with early-onset chronic depression who would specifically benefit from CBASP. Child maltreatment clusters could be implemented in clinical assessments and serve to develop and personalise trauma-informed care in mental health. The German Research Foundation and the German Federal Ministry of Education and Research.

637. UPFRONT SURGERY IN ESOPHAGEAL CANCER: ACCURACY OF PREOPERATIVE CLINICAL STAGING

Abstract Background Treatment of locally limited esophageal cancer is still a frequently discussed topic. Especially, the inaccuracy of clinical staging in lymph node-negative T2-carcinomas has to be considered further in the treatment pathway. Aim of this study was to evaluate the accuracy of clinical staging in patients treated with esophagectomy without neoadjuvant treatment. Methods We conducted a retrospective multicenter analysis at the departments of surgery from two university clinics. All patients between January 2016 and December 2023, who underwent an esophagectomy because of an esophageal adenocarcinoma or squamous cell carcinoma without neoadjuvant treatment were included. Advanced tumor stage, T staging greater than T2, was defined as exclusion criteria. Results Fifty-three patients after upfront esophagectomy were included in the analysis. In 40 (75%) patients a gastroesophageal junction adenocarcinoma was diagnosed, and 13 (25%) patients were treated because of a squamous cell carcinoma of the esophagus. Clinical T staging was T1 or T2 and all lymph node stages were included. The endosonographic preoperative staging of invasion depth was accurate in 32 (60%) patients in comparison to the histopathological staging. In 7 (13%) cases the T-values were upstaged one level and in 5 (9%) cases one level downstaged after resection. The endosonographic preoperative staging of nodal spread was accurate in 32 (60%) patients. Furthermore, in 7 (13%) cases node status was upstaged and in 5 (9%) patients downstaged. Nine (17%) patients did not undergo a sufficient endosonographic staging, mainly due to prior endoscopic submucosal dissection or stenosis. In these patients, clinical lymph node staging was accurate in 4 patients. Conclusion Preoperative staging using endoscopic ultrasound and computed tomography is not accurate enough in a high number of patients, therefore we are seeking to identify other predictive factors underlying advanced stage esophageal cancer.

ИЗМЕНЕНИЯ ЭЛЕКТРОКАРДИОГРАФИЧЕСКИХ ПОКАЗАТЕЛЕЙ ДЕПОЛЯРИЗАЦИИ И РЕПОЛЯРИЗАЦИИ НА ФОНЕ ХИМИОТЕРАПИИ РАКА МОЛОЧНОЙ ЖЕЛЕЗЫ ДОКСОРУБИЦИНОМ

Aim. To study changes in electrocardiographic parameters of the myocardium in patients with verified breast cancer (BC) after completion of chemotherapy (CT) with doxorubicin. Material and methods. The study included 100 patients with a confirmed diagnosis of breast cancer who were treated at the healthcare institution “Grodno University Clinic” (Grodno, Belarus). A number of electrocardiographic parameters of the myocardium were measured in patients before and after chemotherapy using electrocardiography and Holter monitoring. Based on the echocardiography data and the selected threshold value for the relative decrease in GLS (more than 12%), the subjects were divided into two subgroups: those with the presence of cardiotoxicity – CTx+ (n=19) and those without it – CTx- (n=81). Results. An increase in electrocardiographic parameters of depolarization and repolarization (P, P-Q, QRSc, J-Tc, Tpic-Tendc, Q-Tc, Q-Tdc – p&lt;0.001; p&lt;0.001; p=0.005; p=0.023; p=0.009; p&lt;0.001; p=0.006, respectively), as well as in the number of supraventricular extrasystoles (p&lt;0.001) in the general group before and after chemotherapy was detected. The J-Tc and Q-Tc intervals (longer in the CTx- subgroup compared to the CTx+ subgroup: p=0.033 and p=0.037, respectively), the number and total time of sinus tachycardia episodes (p=0.011 and p=0.010, respectively) after chemotherapy differed statistically significantly in the cardiotoxicity subgroups. Conclusions. During chemotherapy with doxorubicin, an increase in the duration of the J-Tc and Q-Tc intervals was observed, the number and duration of episodes of sinus tachycardia also increased. Assessment of the dynamics of these indicators at the stages before/after chemotherapy can provide additional information about the state of the myocardium even before identifying functional disorders by echocardiography.

Clinical and hematological findings in alpacas (Vicugna pacos) with and without Candidatus Mycoplasma haemolamae infection

Anemia is a common problem in South American camelids (SACs). Infections with Candidatus Mycoplasma haemolamae (CMh), a cell-wall free, hemotropic bacterium, are often suspected to be an important cause of anemia, as the pathogen infects the erythrocytes and is found in the blood of up to 30% of SACs. The information on the clinical signs of animals infected with this pathogen vary widely. Most infections are clinically inapparent. Treatment is usually carried out with oxytetracycline. A detailed overview of the clinical and hematological findings in 13 alpacas infected with Candidatus M. haemolamae (CMh+), based on patients from our university clinic and comparing those findings with the results of 22 negative alpacas (CMh−) is provided. Assignment to both groups was based on the PCR result. No relevant clinical or hematological differences between CMh+ and CMh− were found, the clinical signs in CMh+ were usually due to comorbidities. The examination of a blood smear alone proved to be insufficient; a PCR test should be carried out to confirm or rule out an infection. A critical review of the need for antibiotic treatment on the basis of a positive test result alone is recommended.

CE-UV method for the determination of catecholamine metabolites from baby pee-covered diapers

A method has been developed for the analysis of vanillylmandelic acid, homovanillic acid, and 5-hydroxyindoleacetic acid from baby urine as biomarkers of neuroblastoma in infants. Disposable diapers were employed as sampling devices in order to guarantee a low invasiveness during this step. The proposed method consists on a simple extraction step with water from the used diaper followed by the measurement using capillary electrophoresis with UV detection. The Box-Behnken design (BBD) was utilized to optimize the process of extracting catecholamine metabolites from the examined samples. The variables of the sample preparation step were optimized and the method was validated obtaining limits of quantification of 1.65 μg mL−1, good intraday and inter-day precision with RSDs under 15 %. Finally the method was applied to real samples collected from the Department of Neonatology, University Clinical Centre (Gdańsk, Poland). The greenness of the proposed method was also evaluated with different tools (i.e., AGREEPrep and GAPI) with satisfactory results, which allow to state that the method can be considered green. Moreover, its practicality was evaluated by application of BAGI tool, proving to be a practical and economical method to be applied in routine laboratories for determination of catecholamine metabolites in urine-type samples.

Gut bacterial type III secretion systems aggravate colitis in mice and serve as biomarkers of Crohn’s disease

Mesenteric adipose tissue (mAT) hyperplasia, known as creeping fat, is a pathologic characteristic of Crohn's disease (CD). In our previously reported cohort, we observed that Achromobacter pulmonis was the most abundant and prevalent bacteria cultivated from creeping fat. A whole genomic sequencing and identification of T3SS orthologs of mAT-derived A. pulmonis were used. A functional type III secretion system (T3SS) mediated the pathogenic potential of A. pulmonis invitro and in mouse colitis model. Furthermore, a T3SS Finder pipeline was introduced to evaluate gut bacterial T3SS orthologs in the feces of CD patients, ulcerative colitis and colorectal cancer patients. Here, we reveal that mAT-derived A. pulmonis possesses a functional T3SS, aggravates colitis in mice via T3SS, and exhibits T3SS-dependent cytotoxicity via a caspase-independent mechanism in macrophages and epithelial cells, which demonstrated the pathogenic potential of the T3SS-harboring A. pulmonis. Metagenomic analyses demonstrate an increased abundance of Achromobacter in the fecal of Crohn's disease patients compared to healthy controls. A comprehensive comparison of total microbial vT3SS abundance in various intestine diseases demonstrated that the specific enrichment of vT3SS genes was shown in fecal samples of CD, neither ulcerative colitis nor colorectal cancer patients, and ten T3SS gene-based biomarkers for CD were discovered and validated in a newly recruited CD cohort. Furthermore, treatment with exclusive enteral nutrition (EEN), an intervention that improves CD patient symptomatology, was found associated with a significant reduction in the prevalence of T3SS genes in fecal samples. These findings highlight the pathogenic significance of T3SSs in the context of CD and identify specific T3SS genes that could potentially function as biomarkers for diagnosing and monitoring the clinical status of CD patients. This work is supported by the National Key Research and Development Program of China (2020YFA0907800), the China Postdoctoral Science Foundation (2023M744089), the National Natural Science Foundation of China (32000096), the Shenzhen Science and Technology Programs (KQTD20200820145822023, RCIC20231211085944057, and ZDSYS20220606100803007), National Key Clinical Discipline, Guangdong Provincial Clinical Research Center for Digestive Diseases (2020B1111170004), Qingfeng Scientific Research Fund of the China Crohn's & Colitis Foundation (CCCF) (CCCF-QF-2022B71-1), and the Sixth Affiliated Hospital, Sun Yat-sen University Clinical Research 1010 Program 1010CG(2023)-08. These funding provided well support for this research work, which involved data collection, analysis, interpretation, patient recruitment and so on.

Historical aspects of the creation and development of university clinics (literature review)

The study is relevant due to the special role of university clinics in maintaining and strengthening public health, since these medical institutions provide training future doctors, conduct clinical and scientific activities, develop and test advanced treatment methods. A systematic review of the literature sources (original research and reviews) selected using bibliographic and semantic search in the databases MedLine, The Cochrane Library, Global Health, Cyb,erLeninka, RSCI, devoted to the historical aspects of the creation and development of university clinics. The authors studied the specifics of the activities of university clinics, searched for solutions to the problem of improving the efficiency and quality of both medical and educational processes of their life. Despite the fact that university clinics originated in different ways, the main models of their activities are highlighted in the form of a single educational, scientific, and medical complex, which allows training of medical personnel at a qualitatively different level, providing practice-oriented training, as well as the possibility of developing scientific achievements of medical science. The literature data provided by the authors indicate university clinics today to be centers of advanced practical and scientific experience in providing medical care of the population. The study of historical patterns of development of university clinics makes it possible to use the most successful experience of their management in the structure of an educational institution and develop requirements that a university clinic must meet at the present stage to ensure strategic sectoral tasks of the state health system both within the framework of training medical personnel and in ensuring the process of providing medical care of the population in the Russian Federation.

Wellbeing in stroke and aphasia (WISA): protocol for a feasibility study setting up an accessible service offering psychological therapy to people with post-stroke aphasia

Background and aimFollowing a stroke, around a quarter of people will have aphasia, a language disability. Aphasia can have a devastating long-term impact on a person’s psychological wellbeing, yet their language difficulties make it challenging to access mental health care. The Wellbeing In Stroke and Aphasia (WISA) study aims to evaluate the feasibility of setting up an accessible psychological service for people with aphasia.MethodsThe service will be open to people with post-stroke aphasia (n = 30) who live in the UK, are able to access the service either in the university clinic or via telehealth and are not currently receiving therapy from a mental health professional. Participants will be offered up to 8 therapy sessions over 6 months, either one-to-one, with family, or in a group. The intervention is Solution Focused Brief Therapy (SFBT), a brief psychological therapy, delivered by speech and language therapists with training in SFBT under the supervision of a stroke-specialist clinical psychologist. As part of this service, a protocol for addressing mental health care has been developed. Feasibility will be assessed by monitoring referral rates, therapy received, discharge processes, resource capability, costs, challenges, and adverse events. Patient-reported outcome measures collected pre and post intervention will assess mental wellbeing, mood, participation, and satisfaction with therapy and the service. A purposive sample will take part in in-depth interviews following therapy.DiscussionGiven the high levels of psychological distress in this client group, there is a need to investigate innovative ways to provide accessible and acceptable psychological support.

The Psychological Impact of Anterior Teeth Caries and Treatment Needs Among Adults at King Saud University Clinics in Riyadh, Saudi Arabia.

Introduction Aesthetic dentistry has become increasingly important, as a smile is key to social and emotional well-being. Dental caries can greatly and persistently diminish overall oral health-related quality of life, impacting one's capacity to engage socially and maintain emotional health. The study aims to assess the psychological impact of anterior teeth caries and restorative treatment needs. Methodology A cross-sectional study was conducted at King Saud University clinics. The questionnaire used in this study was developed based on previous research and structured into three main domains: demographic data, psychosocial impact of dental aesthetics, and restorative treatment needs assessment. The statistical analysis of the study's Inter-rater reliability was assessed using the Fleiss kappa coefficient. The intra-rater reliability was evaluated for all raters using Cohen's kappa, with each rater showing almost perfect agreement in dental caries and treatment option measures (p < 0.001). Results The participants who perceived the presence of anterior caries had significantly worse overall psychological impact scores than those who did not perceive having anterior caries. The overall Psychosocial Impact of the Dental Aesthetics Questionnaire (PIDAQ) score shows a more negative psychosocial impact of dental aesthetics on those needing indirect restoration than those needing direct restorations. Conclusions Anterior teeth caries significantly impacts individuals' psychological well-being, particularly in emotional and social aspects. Those perceiving the presence of anterior caries experience more significant emotional distress and social implications. The need for restorative treatment, especially indirect restoration, is associated with higher psychosocial impact and lower dental self-confidence.

Blood reserves and availability of blood preparations in University Clinical Center Tuzla, Bosni and Herzegovina

INTRODUCTIONTransfusiontreatmentinmodernclinicalpracticeincludessubstitutiontherapy certaincomponentsoftheblood,whichadequatelyandeffectivelycontributetoquickrecoveryandhealing diseases[1].Almosteverybranchofmedicineistransfusion-dependent,startingwithsurgeryandinternalmedicine branchtodiagnosticones,wherethesafetyofthepatientisensuredbysubstitutionwithcertainblood preparations[2]. Bloodandbloodproductsdifferfromotherdrugsandpharmaceuticalpreparationswhile the only source is humanbloodfromvoluntarydonors[3].Inpractice theyusetwowaysofgettingblood,byvoluntarydonation,whenwholebloodistaken,whichisthemostcommon usedasastartingpointfortheproductionofotherdrugsfromblood,andbytheapheresisprocedureon cellseparator,whenonlyonebloodcomponentistaken,suchasplatelets,plasma, erythrocytes[1,4] Anadequatebloodtransfusionsupplyiscrucialforthefunctioningofthehealthsystem[5].Althoughtheyare bloodanditscomponentsrecentlyaddedtotheWHOessentialdruglist,insufficientbloodsuppliesinmost oflow-andmiddle-incomecountriesstillleadtomortalityandmorbidity,whichcan preventbyensuringsufficientbloodreserves[6,7]. Ensuringsufficientamountsofbloodimpliesstrategicconsiderationoflocal,epidemiological factors,demographicstructure,equipmentandabilitytoproducemedicinesfromwholeblood[8,9]. Currently,voluntaryblooddonationinmanylow-andmiddle-incomecountriesisnot adequately[10].Themainreasonsfortheunavailabilityofbloodisthehighprevalenceofviralhepatitisand inadequateproductionofbloodcomponents[11].Overallrelationsinsociety,socio-economicand demographicsareanimportantfactorforassessingthepossibilitiesofensuringstablereservesofsafeblood,which theyrepresentthenationalresourceofacountry[12].Theestimationofthedailyconsumptionofbloodproductsis unpredictablenature,duetopossibleincidentsituations,naturaldisasters,andlimited lifetimeofdifferentpreparations.Thelimitedlifespanofbloodincreasesthenumberofunuseddoses, resultinginadecreaseinstablereservesandhighcosts[6]. AccordingtoWHOguidelines,recommendationsforensuringstablebloodreservesinclude10to20 donationsper1000inhabitants[13].Theseassessmentsareimportantbecausetheycanservetoguidefurtherones investmentsinstrategiestoensuresufficientamountsofblood,thenanalysisofcurrenttransfusionpractice, introductionofrationalizationmeasuresduringtransfusiontreatmentandimplementationofthesystemfor bloodmanagement[14,15].IntheareaofTuzlaCanton,theannualblooddonationisapprox. 13000doses.Formorethanthreedecades,thePolyclinicforTransfusionhasbeenproducingvariousmedicinesfrom blood,whoselifespanandstoragemethodaredifferent,namely:wholeblood,erythrocyteconcentrate,concentrateerythrocyteswithareducednumberofleukocytes,irradiatederythrocyteconcentrate,freshfrozenplasma, plateletconcentrate,plateletconcentratewithreducednumberofleukocytes,irradiatedconcentrate platelets,plateletapheresisconcentrateandcryoprecipitate. MATERIALANDMETHODSThis retrospective study was carried out at the Polyclinic for Transfusion, University Clinical Center Tuzla data from the Renovatio information system in the period from July 1, 2022 to December 31, 2022. Data were analyzed on voluntary blood donors (age and gender), who donated blood during that period. Then data on the number of blood doses collected, as well as the number and type of medicines produced from blood (whole blood, erythrocyte concentrate, erythrocyte concentrate with reduced number of leukocytes, irradiated concentrate platelets, fresh frozen plasma, cryoprecipitate, platelet concentrate, platelet concentrate with a reduced number of leukocytes, irradiated platelet concentrate, irradiated platelet concentrate with reduced number of leukocytes, as well as platelet concentrate produced by the apheresis method using of the Amicus cell separator. Also, data was collected for patients who received blood preparations: age, gender, diagnosis, type of blood preparation indicated, name of the clinic where the patients were hospitalized, and the type and quantity of blood products issued. RESULTSThelargestnumberofdonatedbloodunitswasusedinthepreparationoffreshfrozenplasma,5742units,then5498unitsofplateletconcentrate,797unitsofcryoprecipitate,and308unitsofconcentrate plateletswithareducednumberofleukocytes,200unitsofirradiatedplateletconcentrateand119units irradiatedplateletconcentratewithareducednumberofleukocytes (Figure 1).

Smell and taste disorders in childhood: Diagnostic challenges and significant impacts on a child's well-being

AimSmell and taste are senses that contribute to a child's overall well-being. Disorders affecting these senses can impact a child's daily life from enjoying meals to detecting potential dangers through scent.The aim of this study is to describe patient characteristics and etiological causes of olfactory (OD) and/or gustatory disorders (GD) in children referred to a smell and taste clinic. Secondly, we aim to suggest a clinical work up. MethodsRetrospective study where data were collected from 57 children who were referred consecutively to the University Clinic for Flavour, Balance, and Sleep; Department of Otorhinolaryngology (ORL), Head and Neck Surgery; Goedstrup Hospital, Denmark, for assessment due to OD/GD from January 2017 to May 2023. ResultsMost of the children had anosmia (60 %), whereas sensation of the basic tastes was intact in all but eight children (16 %). The lowest TDI scores were in children with congenital OD. The underlying etiology was congenital followed by postinfectious mostly related to Covid-19. Picky eating including anorectic traits were seen in 16 % of patients. ConclusionThe focus on smell loss in pediatric population is low, and probably does not adequately reflect either underlying prevalence in this group or the possible consequences on a child's well-being. Moreover, increased awareness of children's smell and taste loss is needed, as it may be associated with eating disturbances.

Osteoporosis and Apical Periodontitis Prevalence: A Systematic Review.

Osteoporosis is a common systemic bone disorder in the elderly, characterized by low bone mineral density and deterioration of bone structure. Apical periodontitis is an inflammatory response to the microbial infection of root canals, typically characterized by apical bone destruction surrounding the tooth's apex. This systematic review aimed to determine if osteoporosis affects the prevalence of apical periodontitis in adults. PRISMA guidelines have been followed. It included randomized clinical trials, cross-sectional, cohort, and case-control studies, and excluded non-relevant investigations and various secondary sources. A comprehensive search was performed in PubMed, Scopus, and Web of Science, until 13 March 2024. The Newcastle-Ottawa Scale was used to assess the quality of the three selected studies: two cross-sectional studies and one case-control study. One investigation only included post-menopausal women recruited at a dental university clinic, the other integrated data from the total hospital patients' population, and the third selected patients referred to the university dental clinic from the university hospital. The findings varied: one study noted a marginal association between low bone mineral density and apical periodontitis, another found a significant association, and the third, with the lowest risk of bias, reported no link. The main limitations were the scarcity of eligible studies and their overall quality. The review was registered in the PROSPERO database (CRD42024523705), applied strict inclusion criteria and thorough searches by experienced and independent reviewers. There is no strong evidence that adult individuals with osteoporosis have a higher probability of developing apical periodontitis. However, clinicians should remain cautious of osteoporosis's potential impact on apical periodontitis development.

Evidence of an effect of statins on lesions originating from dental infection. A retrospective clinical investigation

BackgroundApical periodontitis (AP) is an inflammatory dental disease caused by bacterial infections of the endodontic system. The correlation between AP and cardiovascular diseases. (CVD) has been consistently investigated. Statins are a class of drugs that are used to treat hypercholesterolemia and prevent atherosclerotic vascular diseases. They have other beneficial pleiotropic effects such as anti-inflammatory, antithrombotic, and antioxidant activities. The aim of this study was to evaluate the oral health status and prevalence of AP in patients treated with statins (Group S) in comparison with untreated patients (Group C) to understand whether the anti-inflammatory action of these drugs can influence the prevalence of AP. MethodsThe records of seventy-nine patients (43 men and 36 women, mean age 68 ± 11 years, 1716 teeth) treated with statins and referred to the University clinic for dental evaluation were reviewed. Seventy patients free from systemic diseases and without therapy (39 men and 31 women, mean age 62 ± 9 years, 1720 teeth) constituted the control group. All subjects underwent complete oral, dental, and radiographic examinations to determine the presence and severity of AP. Periapical index (PAI) and decayed, missed, and filled teeth (DMFT) scores were obtained. ResultsAP was significantly less common in Group S (22,8%) than in Group C (50%) (P < 0.05). Furthermore, the mean value of the qualitative rank of the severity of AP (PAI score) was higher in Group C than in Group S (P ≤ 0.05). ConclusionsOur results suggest that statins can attenuate the prevalence of AP, which is associated to CVD.

Trends in the management of horses referred for colic evaluation preceding and during the COVID‐19 pandemic (2013–2023)

SummaryBackgroundThe COVID‐19 pandemic represented a significant source of anxiety and stress for equine veterinarians and clients, with the potential for measurable effects on caseload and owner economics.ObjectiveTo compare the number of horses presenting for emergency colic evaluation and treatment, as well as costs at two equine referral hospitals.Study designRetrospective cohort.MethodsMedical records of horses admitted to North Carolina State University (NCSU) and Bell Equine Veterinary Clinic (BEVC) were compared. Total equine accessions, number of horses referred for colic and patient age were recorded over an 11‐year period (2013–2023). Horses were categorised based on treatment as medical, surgical treatment with recovery, surgical exploration with intraoperative euthanasia, or euthanasia without surgery. Total invoice of each case was also recorded.ResultsTotal equine accessions, total number and proportion of horses presenting for evaluation of colic, and number of horses recovering from colic surgery at NCSU increased following onset of the pandemic, while they remained similar to pre‐pandemic levels at BEVC. The proportion of horses presenting for colic that received surgery decreased at both hospitals over the study period. Mean invoice totals for horses surviving colic surgery increased at both hospitals over the study period, but was not significantly associated with euthanasia. Age was not significantly different between categories of colic.Main limitationsRetrospective study design, differences in academic and private practices.ConclusionsThe decreasing proportion of horses admitted for colic that received surgery is likely due to the increased caseload of first‐opinion care at referral practices during the pandemic, as fewer options were available to owners. The increasing number of horses euthanised intraoperatively or euthanised without receiving surgery may be due to the dramatically rising costs of medical care, particularly surgery.

Untargeted stimulated and unstimulated salivary metabolomics and saliva flow rate in children.

The present study aimed to determine the salivary flow and metabolomic profile of stimulated and unstimulated saliva in children. Children who attended the Pediatric Dentistry Clinic of the State University of Rio de Janeiro -UERJ between 3 and 12 years of age were selected. Unstimulated and stimulated whole saliva, using mechanical stimulus, were collected. The samples were centrifuged at 12,000 g, 4oC for 1h. The 1H- NMR spectra were acquired in 500MHz equipment. The data were extracted into 0.03 ppm buckets in AMIX, and multivariate analysis (PLS-DA and O-PLS-DA) was performed in Metaboanalyst 2.0. For other analyses, such as salivary flow, the data was tabulated in the SPSS 20.0 statistical package, analyzed descriptively, and after applying the Wilcoxon test. The interval of confidence was set at 95%. The mean age was 7.5 (± 1.94), and 47.0% (n = 31) were female, 63.6% (n = 42). The median flow rate for stimulated saliva was 0.74 (IC 0.10-2.40) and was statistically higher (p < 0.001; Wilcoxon test) than unstimulated was 0.39 (IC 0.00-1.80). Children older than seven years old also presented a higher difference between unstimulated and stimulated saliva (p = 0.003; Mann-Whitney test). The PLS-DA and O-PLS-DA demonstrated a different profile in stimulated and unstimulated saliva. Acetate, glucose, propionate, and lysine were higher in the unstimulated whole saliva than in stimulated saliva. Isoleucine, N-acetyl sugar, hydroxybutyrate, glutamate, leucine, propionate, butyrate, valine, isoleucine, succinate, saturated fatty acid, and histidine were found in greater amounts in the saliva of patients with stimulated saliva. The stimulated saliva presented a higher flow rate, and older children exhibited a higher flow rate resulting from it's the stimulus. The mechanical stimulus increased the levels of the major metabolites.

Impact of Vitamin D Status and Nutrition on the Occurrence of Long Bone Fractures Due to Falls in Elderly Subjects in the Vojvodina Region of Serbia.

Bone fractures are a significant public health issue among elderly subjects. This study examines the impact of diet and vitamin D status on the risk of long bone fractures due to falls in elderly subjects in Vojvodina, Serbia. Conducted at the University Clinical Center of Vojvodina in autumn/winter 2022-2023, the study included 210 subjects >65 years: 105 (F: 80/M: 15) with long bone fractures due to falls and 105 (F: 80/M: 15) controls. Groups were similar regarding age and BMI. Dietary intakes (by two 24-h recalls) and serum vitamin D levels were analyzed. The fracture group had a significantly lower median daily vitamin D intake (1.4 μg/day vs. 5.8 μg/day), intake of calcium, energy, proteins, fats, fibers, dairy products, eggs, fish, edible fats/oils, and a higher intake of sweets (p < 0.001 for all). Serum vitamin D levels were significantly lower in the fracture group (40.0 nmol/L vs. 76.0 nmol/L, p < 0.001). Logistic regression identified serum vitamin D as the most important protective factor against fractures, and ROC curve analysis indicated that serum vitamin D levels > 50.5 nmol/L decreased fracture risk. Nutritional improvements (increased intake of vitamin D and protein sources such as fish, eggs, and dairy), increased sun exposure, and routine vitamin D supplementation during winter are advised.

Magnetic resonance imaging in pediatric epilepsy patients: two different protocols

AimThe magnetic resonance imaging (MRI) has a crucial position in the diagnostic routine of epilepsy patients. The aim of this study is to demonstrate, in pediatric epilepsy patients, the greater effectiveness of the HARNESS-MRI Protocol compared to the Standard 3 mm-MRI Protocol, in terms of acquisition times.Materials and methodsIn this study, 30 pediatric patients (17 males and 13 females) with clinical suspicion of epilepsy who underwent MRI (Achieva Philips 1.5 T) at the University Clinics of Sassari in the years 2021–2023 were evaluated. The duration of both MRI protocols was analyzed, and they were composed of specific MRI sequences characterized by three-dimensional (3D) volumetric and isotropic voxels, using the 1.5/3 Tesla (T) MRI scanners. If present, the epileptogenic focus has been highlighted.ResultsThe statistical analysis demonstrates a different time and standard deviation (sd) between the two study protocols: 36.93 ± 16.46 sd for “Standard 3 mm-MRI Protocol” and 29.93 ± 10.41 sd for the “HARNESS-MRI Protocol”. This analysis showed a difference between the acquisition times of 7 min in favor of the HARNESS-MRI Protocol, with the same diagnostic accuracy.ConclusionThe HARNESS-MRI Protocol would guarantee a greater patient comfort and the possibility of performing more MRI with reduced healthcare costs. Furthermore, the routine use of the same protocol and MRI sequences could guarantee better standardization and homogeneity of diagnostic procedures and the follow-up of epilepsy pediatric patients.