Vulnerable Cohort Research Articles

Outcomes in patients with acute myeloid leukemia older than 70 years within the last 30 years, a single center experience.

As median age of patients with acute myeloid leukemia is 72 years, older patients continue to be a vulnerable cohort representing significant challenges in clinical practice. Patient-specific comorbidities as well as leukemia-specific unfavorable molecular- and cytogenetics confer even poorer outcomes. Treatment of AML therefore needs to be less toxic to prevent harm while lowering or eradicating leukemic burden to prolong survival. In this retrospective analysis we included 365 older AML patients from the Düsseldorf registry who were diagnosed and treated in our department of hematology over a period of 31 years. Most patients were treated with HMA (37.3%) followed by 35.3% of patients who received either low dose chemotherapy or BSC. 9% of patients were treated with induction chemotherapy while 8.5% of patients received a combination of HMA with venetoclax. 4.1% of patients underwent allografting. At the time of last follow up, 35 patients (9.6%) were still alive. Of those patients who were treated with induction chemotherapy or HMA + venetoclax, 18.2% and 29.0% were still alive, whereas 60% of the patients who underwent allogeneic stem cell transplantation were still alive (p < 0.001). Median overall survival of the entire patient population was 6 months. Longest survival was observed in patients who underwent aHSCT with an unreached median overall survival followed by patients who were treated with induction chemotherapy (21 months) or HMA plus venetoclax (11 months). The implementation of HMA + venetoclax and increasing numbers of aHSCT improved prognosis and survival even in older AML patients.

Fluid mechanical evaluation of in-line filter for fluid-handling systems by means of computational fluid dynamics (CFD)

Abstract Administering fluids and drugs intravenously is crucial in caring for vulnerable patient cohorts such as critically ill patients as well as neonatal and paediatrics patient populations. Studies have revealed severe contamination of infusion solution that could be avoided by utilizing in-line filters. The filtration performance consequently depends on the geometry of the filter housing. The purpose of our numerical study was to analyse the flow situation in filter housings depending on the geometry (diameter of the filter housing and distance between entrance and membrane). We compared the flow of two circular filter system with different housing width (D = 25 mm; L = 1.5 mm/3.0 mm) by means of computational fluid dynamics (CFD). The filter membrane was modelled by a porous jump condition. Both filter systems showed a highly reduced inflow on the membrane compared to the velocity in the Luer Lock ports. The wide filter housing facilitates a more homogenous inflow on the membrane (&gt;92% of the membrane area is applied within a range of 5% of the mean velocity) compared to the narrow filter housing. Despite that difference both filter housings induced a well distributed flow through the filter membrane. However, for large filter systems (&gt;50 mm diameter) the design of the filter housing could play a crucial role in optimising filter performance and therefore CFD should be considered.

Greater preservation of SARS-CoV-2 neutralising antibody responses following the ChAdOx1-S (AZD1222) vaccine compared with mRNA vaccines in haematopoietic cell transplant recipients.

Whilst SARS-CoV-2 mRNA vaccines generate high neutralising antibodies (nAb) in most individuals, haematopoietic stem cell transplant (HSCT) and chimeric antigen receptor T-cell (CAR-T) recipients respond poorly. HSCT/CAR-T treatment ablates existing immune memory, with recipients requiring revaccination analogous to being vaccine naive. An optimal revaccination strategy for this cohort has not been defined. Factors predicting immunogenicity following three ancestral SARS-CoV-2 vaccines were assessed in 198 HSCT/CAR-T recipients and 96 healthcare workers (HCWs) recruited to multicentre studies. Only 25% of HSCT/CAR-T recipients generated nAbs following one dose, with titres 167-fold and 7-fold lower than that in HCWs after the first and second doses, respectively. Lower post-second dose nAb titres were associated with older age, rituximab use, and previous HSCT. ChAdOx1-S recipients were more likely to generate nAbs compared with mRNA vaccines, with titres comparable to HCWs. In contrast, nAbs were significantly lower in HSCT/CAR-T recipients than HCWs after mRNA vaccination. The poor first-dose immunogenicity in HSCT/CAR-T recipients suggests a minimum licensed dosing interval could limit the period of vulnerability following HSCT/CAR-T. The relative preservation of nAbs with ChAdOx1-S vaccination highlights the importance of evaluating alternative platforms to mRNA vaccination within this highly vulnerable clinical cohort.

Microbial profile of burn wound injuries in the Northern West Bank − A retrospective cohort study

BackgroundDetermining frequently colonizing microorganisms and typical demographics affected by burns in the West Bank is essential to aid timely and effective injury management. MethodsThis study included n = 435 patients with burn injuries between January 2018-December 2021 at a tertiary center in Nablus. Eligible medical records were reviewed, and relevant data extracted. Resultsn = 244 males and n = 191 females, average age 14.5 years were included. n = 227 had wound swab cultures, n = 80 which were positive. Scald injuries were the most common mechanism of injury (n = 314, n = 162 in males (p < 0.001), average age of 10.5 years). The most common organisms isolated were Pseudomonas aeruginosa (n = 17) and Staphylococcus aureus (n = 18). n = 17 multidrug resistant (MDR) organisms were cultured, MRSA most commonly (n = 9), followed by K. pneumoniae (ESBL) (n = 5). Overall length of stay (LOS) was 17.27 days in all patients and 28.2 days in those with MDR, with increasing LOS significantly associated with positive culture and MDR development of MDR (p < 0.001). ConclusionsYounger male demographics and longer hospital admission increase the risk of burn wound colonization and MDR development in the Northern West Bank. Pseudomonas aeruginosa and Staphylococcus aureus were prevalent organisms isolated. MDR development represents a significant challenge in the effective management of injuries in an immunologically vulnerable cohort.

Listening to children with lower limb loss: Rationale, design, and protocol for delivery of a novel globally applicable research toolkit-Prosthetic user needs, quality of life, pain, and physical function.

Rehabilitation after childhood lower limb loss is complex and dependent on multiple stakeholders and environmental factors. While research with adults underscores the importance of involving prosthetic limb users and caregivers in discussions to drive innovation, children are often excluded or not effectively engaged. This protocol lays out the development and implementation protocol for an internationally applicable research toolkit which has been designed and evaluated around the essential presence of the child. Research domains span their unique prosthetic needs, quality of life, pain, and mobility. Cohorts of children in contrasting environments were identified (Cambodia, Gaza Strip, and the UK) to provide a comprehensive global understanding of the child with lower limb loss. A literature review revealed a lack of appropriate tools for identifying paediatric prosthetic user requirements leading to the development of novel interview guides for each key stakeholder: child, caregiver, and prosthetist. The child's guide centred around enjoyment and engagement using card games and activities. A panel of experts in paediatric limb loss and mental health rigorously reviewed the guides. Guides were integrated with existing validated measures for quality of life, pain, and mobility to form a comprehensive toolkit. The toolkit was successfully piloted with 5 children, their families, and 2 prosthetists. This protocol lays out the toolkit rationale and implementation plan (Jan 2023 to Dec 2025). This work offers the opportunity for this cohort to enjoyably engage with research that seeks to radically improve prospects for all children living with limb loss. The outlined best practices ensure ethical considerations when working with vulnerable cohorts. This study is approved to cover implementation at all geographical locations as well as the researcher institutions. Results will be disseminated through national and international conferences, as well as through manuscripts in leading peer-reviewed journals.

Trends and patterns in pulmonary arterial hypertension-associated hospital admissions among methamphetamine users: a decade-long study.

Pulmonary arterial hypertension (PAH) is a rare, chronic, progressive form of pulmonary hypertension in which increased arterial pressure causes remodeling of the arterial system and is associated with heart failure. Methamphetamine is a stimulant that has recently become a focus in PAH research, but the recent trends and demographics of this cohort of patients are not known. The study aimed to analyze the overall trends and demographics of PAH patients with and without concurrent methamphetamine usage. The study used the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), and Agency for Healthcare Research and Quality (AHRQ) from 2008 to 2020 to calculate nationally weighted estimates for both conditions by ICD-9 and ICD-10 diagnosis codes. We used several statistical measures, including descriptive statistics with design-based chi-square and t-tests, trend analysis with Cochran-Armitage test, generalized linear models, and other data preprocessing measures. A significant increase was evident in patients with pulmonary arterial hypertension (PAH) and concurrent methamphetamine use (9.2-fold). Most of the hospitalized patients were males (59.16%), aged 41-64 (45.77%), White (68.64%), from the West (53.09%), with Medicaid (50.48%), and with median income <$25,000. The rate of increase over the period was higher for males (11.8-fold), race (not sure which race; please check and modify), aged 41-64 (11.3-fold), and in the South (15.1-fold). An overall adjusted prevalence ratio (PR) for PAH hospitalizations among concurrent methamphetamine users was 32.19 (CI = 31.19-33.22) compared to non-users. With respective reference categories, the significantly higher PR was evident for males, patients aged 41-64, White, with Medicare, median income <$25,000, all regions compared to Northeast, length of hospital stays, and conditions, including chronic pulmonary disease, diabetes, hypertension, obesity, and peripheral vascular disorders. This study reveals a national overall and demographic-specific trend of increasing PAH with concurrent methamphetamine usage and associated factors. The findings may help to understand the current patterns and identify the vulnerable sociodemographic cohorts for further research and to take appropriate policy measures.

Nomogram-based prediction of MACE in older adults with STEMI

Abstract Introduction Despite the significant progress made in diagnosing and treating patients with ST elevation myocardial infarction (STEMI), high-risk subgroups such as older adults (those over 65 years-old) still face considerable residual risk of major adverse cardiovascular events (MACE) following treatment for their index event. Thus, it is crucial to create accurate, validated, and actionable tools to stratify patients according to their risk of MACE after admission for STEMI. Purpose Utilizing clinical data obtained from a registry of patients diagnosed with STEMI, this study aims to develop a nomogram that can reliably predict the likelihood of MACE incidence. Methods Using a large electronic single-center registry, all consecutive patients with STEMI, undergoing primary percutaneous coronary intervention (PCI), and aged 65 and above were identified. Demographic, laboratory, clinical and intra-procedural variables were examined. Univariate and multivariate logistic regression analyses were utilized to identify those factors which were independently associated with MACE incidence in the post PCI follow-up period. A nomogram was developed in a training set, and performance metrics such as receiver operating curves (ROC), calibration plots, and decision curve analysis were used for validation in a testing set. Analyses were performed using tidyverse and rms packages in R programming language. Results 1946 patients were included in the study and split into 70% training and 30% testing sets. Both groups were similar in terms of baseline demographic and clinical characteristics. Mean follow-up period was 17 months. Total MACE incidence in the post PCI follow-up period was 18%. Thirty-eight factors with limited missing information (&amp;lt;5%) were examined for their relationship with MACE incidence and after performing univariate and multivariate analysis 8 were selected for construction of the nomogram: left-ventricular ejection fraction (LVEF), serum creatinine, hemoglobin and fasting blood glucose levels, presence of valvular heart disease, post PCI TIMI flow grade, diameter of the stent placed in the culprit lesion, and presence of shock in the post PCI setting. The area under the curve (AUC) for MACE prediction in post PCI follow-up period showed acceptable discrimination (c-statistic=73%, 95%CI 71.2% to 76.3%). Calibration plots demonstrated that the nomogram model was well-calibrated, and its predictions were closely aligned with observed outcomes. Additionally, decision curve analysis indicated that the model exhibited strong discriminatory ability in predicting MACE. Conclusions A nomogram developed using a combination of laboratory, clinical, and procedural parameters reliably predicts future risk for MACE in older adults following STEMI. Future implementation of this model may identify the highest risk individuals to target more aggressive preventive efforts in a vulnerable cohort of patients.Plot 1Plot 2

Kangaroo mother care improves cardiorespiratory physiology in preterm infants: an observational study

ObjectivesTo evaluate whether kangaroo mother care (KMC) in preterm infants on non-invasive respiratory support improves indices of cardiorespiratory wellbeing.Study designProspective quasi-experimental observational study.SettingTertiary perinatal neonatal unit.Patients50 very preterm infants being...

Prediction of 90-day mortality risk after unplanned emergency department visits of advanced stage cancer patients

PurposeCancer represents the leading cause of mortality in high-income countries. In the last years, the rate of emergency department (ED) visits by cancer patients has increased 5.5-fold. These ED visits impose a significant economic burden and may indicate the progression of the oncologic disease. The goal of this retrospective study was to identify patient-derived risk factors, especially focusing on serum albumin and body mass index (BMI) for 90-day mortality following unplanned ED visits by cancer patients.MethodsA retrospective chart review of all patients with an ICD-10 diagnosis for cancer undergoing palliative treatment presenting at the ED between 2016 and 2018 at the General Hospital of Vienna was performed. Laboratory values, emergency severity index (ESI), and BMI were collected at the ED presentation. 90-day mortality (90MM) was calculated from the ED presentation.ResultsA total of 448 cancer patients were included. Lung cancer (19.2%) and pancreaticobiliary cancer (15.6%) were the most frequent diagnoses. The main reasons for ED visits were pain (20.5%) and fever (17.4%). Sixty-nine percent of patients had to be admitted and 17.5% of patients died during hospitalization. 90MM was highest for patients with low albumin (< 35 g/L vs. > 35 g/L: 60.4% vs. 31.4%; p < .0001). When incorporating albumin levels and BMI, patients with both values below the cutoff had the highest risk for death (HR 4.01, 95% CI 2.30–7.02).ConclusionCancer patients face a high risk for hospitalization when presenting at the ED. The 90MM rate is highest in patients with low BMI and albumin levels. This highlights an especially vulnerable cohort of cancer patients for whom supportive care and palliative care have to be optimized.

Human pegivirus -1 (HPgV-1) RNA frequency and genotype distribution in pediatric oncology patients with febrile neutropenia

Human Pegivirus-1, typically regarded as a commensal virus, exhibits high prevalence in humans. Its frequency and impact on oncologic pediatric patients with febrile neutropenia (FN), a frequent chemotherapy complication, remains unexplored. In this study, we assessed HPgV-1 RNA prevalence in pediatric patients experiencing FN. Blood samples were collected from 30 children, 15 presenting FN and 15 comprising a control group of either undergoing treatment or in remission. Overall, HPgV-1 RNA was detected in 23.3 % of samples (26.7 % among FN patients and 20.0 % among those under treatment or in remission). Phylogenetic analysis unveiled HPgV-1 genotype 2 predominance among these samples, the most prevalent strain circulating in Brazil. Our findings prompt crucial inquiries into the role of HPgV-1 RNA in FN: is it an incidental finding and if it can influences this clinical entity? Further investigation is imperative to elucidate HPgV-1 implications in vulnerable patients cohorts, potentially informing new approaches and understanding viral dynamics in immunocompromised populations.

Longitudinal Frailty Transitions in Adults Aging with Intellectual Disability

Abstract Background Adults with Intellectual Disability (ID) are a vulnerable population, experiencing high rates of polypharmacy and multimorbidity, and experiencing early mortality. Lifelong functional and intellectual disability can complicate frailty measurement. To date, no studies have examined long term frailty transitions in this complex group. The aim of this study was to examine longitudinal frailty transitions, with the hope of distinguishing frailty from disability. Methods This study was conducted using The Intellectual Disability Supplement to the Irish Longitudinal Study of Aging (IDS-TILDA). It followed 745 adults with ID across 4 waves of data collection between 2010 and 2021. Frailty was measured at each wave using an ID-specific Frailty Index. Scores were classified into the following states: Non-Frail, Pre-Frail, Frail, Missing and Dead. Transitions are demonstrated visually using alluvial plots, created using the ggalluvial package in R. Multistate Markov Modelling was used to calculate transition probabilities between states across subsequent waves. Results Frailty transitions were common across the 4 waves. Both positive (decreasing frailty) and negative (increasing frailty) transitions were seen. There was a 6.8% probability of transitioning from Frail to Pre-Frail, and a 10.5% probability of transitioning from Pre-Frail to Non-Frail. The probabilities of negative transitions were higher than positive transitions. The probability of transitioning to death was higher in higher frailty states: Non-Frail = 2.6%, Pre-Frail = 5.1%, Frail = 19.3%. Compared to the general population, positive transitions were less likely. Conclusion This is the first study to demonstrate transitions in frailty states in adults with ID. To date, singe time-point studies of frailty in ID have faced the struggle of distinguishing frailty from underlying disability. For adults with ID, lifelong disability is expected to be relatively static. The dynamism captured here points to frailty as a distinct entity experienced by this group. Efforts are needed to better manage frailty in this vulnerable cohort.

Characterisation of Patients with Self-Neglect – `Room to Improve' with a New Potential Geriatric Giant?

Abstract Background Self-Neglect is an under-reported and often veiled diagnosis which is defined as ‘an adult’s inability due to physical or mental impairment or diminished capacity to perform essential self-care tasks. Self-Neglect is an independent risk factor for death and is associated with morbidity, heavy utilisation of healthcare services and safeguarding issues. Self-Neglect affects more older persons and is more commonly seen in people with cognitive deficits and social isolation. Methods Using HIPE data, patients were selected for a Descriptive Retrospective Chart Review with a diagnosis of Self-Neglect and under the care of a Consultant Geriatrician within a 2-year timeframe from April 2022 to April 2024. Data was compiled and demographics were collated. Charlson Co-Morbidity Index, Adult Comorbidity Evaluation-27 and Clinical Frailty Scores were employed. Results Twenty patient's charts were reviewed retrospectively. Of the twenty patients 65% were male, 40% are rural dwelling and 70% live alone. 95% of patients have an underlying cognitive impairment, and over 90% have a current or remote history of substance abuse. All 20 patients had significant concerns highlighted about their housing and 60% of patients required alternative accommodation while their home was updated or cleaned. All 20 patients required discharge planning with many requiring complex multi-disciplinary input regarding their safe discharge and had prolonged inpatient stays. Conclusion Recognition and resourcing ‘Self Neglect’ pathways will remain an issue in the health service in Ireland and worldwide. Patients presenting to hospitals with Self-Neglect are multi-morbid, socially complex and tread the line between autonomy and public health issues. Creating a service pathway that puts this vulnerable cohort at the centre and that could span both inpatient and community streams would be beneficial to the over-stretched health service but most importantly to the patient.

«Железный занавес» антиэйджинга: что за ним скрывается?

Currently, the conditions associated with iron deficiency are one of the most pressing unresolved issue of anti-aging medicine. Female patients of late reproductive age and perimenopausal/postmenopausal patients represent the most “vulnerable cohorts” in terms of iron deficiency realization. To date, both short-term and long-term effects of iron deficiency associated with adverse consequences for health and the quality of life have been proven. The review considers the key determinants of iron deficiency development in female patients of late reproductive age and perimenopausal/postmenopausal patients, as well as clinical management of such patients based on domestic and international guidelines.

A green and sensitive electromembrane extraction (EME) method for the determination of dialkylphosphates in maternal urine and amniotic fluid

Organophosphates compounds are extensively used pesticides, whose metabolites, dialkyl phosphates, are considered as bioindicators of human exposure. Recently, research has indicated that they can affect thyroid endocrine function. Pregnant women are a particularly vulnerable cohort to these effects due to concerns about prenatal exposure to environmental pollutants. For the first time an electromembrane microextraction method is proposed for the simultaneous determination of seven dialkylphosphate metabolites in maternal urine and amniotic fluid, which is compatible with mass spectrometry detection and achieves highly sensitive levels of quantitation. Dialkylphosphates were extracted from a 10 mL donor solution at pH 7 into a 50 µL acceptor solution at pH 12 using 1-octanol as the supported liquid membrane and applying 60 V for 10 min at 600 rpm. The obtained extracts were analysed by ion pair liquid chromatography coupled to a triple quadrupole mass spectrometer, using an Acquity UPLC® BEH C18 column (100 mm × 2.1 mm i.d., 1.7 µm particle size) at 30 °C. Under optimal extraction conditions, the preconcentration factors were achieved were up to 178-fold, allowing for high sensitivity levels, in the order of ng mL−1. The limits of quantitation were within 0.075 ng mL−1 (diethyl thiophosphate) and 1.67 ng mL−1 (dimethyl phosphate) in maternal urine samples and within 0.015 ng mL−1 (diethyl thiophosphate) and 0.5 ng mL−1 (dimethyl dithiophosphate) in amniotic fluid samples. The comparative study revealed a significant improvement in terms of analysis time, sensitivity, greenness, and practicality. Finally, the applicability of the method for the determination of selected dialkylphosphates was demonstrated in paired maternal urine and amniotic fluid samples. These results suggest potential placental transfer to the offspring.

ESR Essentials: imaging of suspected child abuse-practice recommendations by the European Society of Paediatric Radiology.

The goal of this paper is to provide a useful desktop reference for the imaging of suspected child abuse with clear, age-specific pathways for appropriate evidence-based imaging and follow-up. We aim to provide a road map for the imaging evaluation and follow-up of this important and vulnerable cohort of patients presenting with signs and symptoms concerning forinflicted injury. As the imaging recommendations differ for children of different ages, we provide a flowchart of the appropriate imaging pathway for infants, toddlers, and older children, which allows ease of selection of which children should undergo skeletal survey, non-contrast computed tomography (CT) brain with 3-dimensional (D) reformats, and magnetic resonance imaging (MRI) of the brain and whole spine. For ease of review, we include a table of the common intracranial and spinal patterns of injury in abusive head trauma. We summarise search patterns, areas of review, and key findings to include in the report. To exclude skeletal injury, infants and children under 2 years of age should undergo a full skeletal survey in accordance with national guidelines, with a limited follow-up skeletal survey performed 11-14 days later. For children over 2 years of age, the need for skeletal imaging should be decided on a case-by-case basis. All infants should undergo a non-contrast-enhanced CT brain with 3-D reformats. If this is normal with no abnormal neurology, then no further neuroimaging is required. If this is abnormal, then they should proceed to MRI brain and whole spine within 2-5 days. Children older than 1 year of age who have abnormal neurology and/or findings on skeletal survey that are suggestive of inflicted injury should undergo non-contrast CT brain with 3-D reformats and, depending on the findings, may also require MRI of the brain and whole spine. We hope that this will be a helpful contribution to the radiology literature, particularly for the general radiologist with low volumes of paediatrics in their practice, supporting them with managing these important cases when they arise in daily practice. KEY POINTS: The choice of initial imaging (skeletal survey and/or brain CT) depends on the age of the child in whom abuse is suspected. A follow-up skeletal survey is mandatory 11-14 days after the initial survey. If an MRI of the brain is performed, then an MRI of the whole spine should be performed concurrently.

Femicide in Ireland 2012–2023

IntroductionFemicide represents the dramatic end-point on a spectrum of violence against women and is an increasingly prevalent medico-legal issue. Whilst there is no definition of femicide in the Irish legal system, femicide can be understood as the gender based killing of women or girls.1 The pervasiveness of gender-based violence against women is a growing cause for concern with 2018 estimates by the World Health Organisation (WHO) revealing that 1 in 3 women have experienced Intimate Partner Violence (IPV).2 Femicide remains poorly defined and underreported worldwide due to enduring stigmatisation, shame and a lack of official statistics addressing national femicide rates. AimThe aim of this study was to explore Irish cases of femicide, quantify the prevalence of femicide in Ireland and identify any emerging trends over a 12-year-period. MethodsAll homicides referred to the Office of the State Pathologist (OSP) from 2012 to 2023 were reviewed and a total of 97 cases of femicide were ?identified and included in this study. ResultsFemicide rates increased from 1 in 5 (19 %) homicides referred to the OSP in 2012–2020 to 3 in 10 from 2021 to 2023 (29 %). Domestic femicides accounted for 74 % of cases, with 41 % of women murdered in the home they shared with their killer. 56 % of women were killed by a current or former intimate partner and 20 % by a family member. Sharp force injuries were present in 75 % of femicides associated with a history of sexual violence. These cases had the highest average number of injuries per case (n = 30) and a significantly lower average age than that of the entire cohort (19 years versus 41 years). ConclusionThe true scale of gender-based violence against women remains largely hidden due to a lack of focused official statistics and a clear definition of femicide. As populations become more diverse, and displacement secondary to environmental, or humanitarian crises becomes more common, it is essential that official data is collected in order to understand and ultimately prevent gender-based violence in this vulnerable cohort.

Do not forget about transplant patients during disasters.

The frequency of natural disasters and man-made conflicts has risen significantly in the past two decades, coinciding with an increase in kidney transplant recipients globally. This review addresses the critical need for disaster preparedness to mitigate the severe impacts on this vulnerable patient cohort. Kidney transplant recipients are highly dependent on robust healthcare infrastructures for ongoing care, including specialized medical staff, advanced diagnostics, and a consistent supply of immunosuppressive medications. Disasters disrupt these essential services, leading to increased risks of organ rejection, infections, and other medical complications. Strategies at various levels, from government to individual patients, can help maintain care continuity during such crises. Effective disaster preparedness plans involving strategic medication stockpiling, emergency communication systems, and patient education are crucial to support kidney transplant recipients. By implementing these measures, healthcare systems can better protect the health and well being of transplant patients during and after disasters.

COVID-19 and Cancer Care: A Review and Practical Guide to Caring for Cancer Patients in the Era of COVID-19.

COVID-19, a novel infectious disease caused by the emergence of the SARS-CoV-2 virus in 2020, has had a profound impact on healthcare, both at the individual and population level. The impact at the population level was felt most acutely during the emergency phase of the pandemic, with hospital capacity issues leading to widespread disruptions and delays in the delivery of healthcare services such as screening programs and elective surgeries. While hospitals are no longer being acutely overwhelmed by COVID-19 patients, the impact of the virus on vulnerable patient populations such as cancer patients continues to be of ongoing consequence. Cancer patients remain at high risk of hospitalization, ICU admission, and death due to COVID-19, even in the era of vaccination. Infection prevention and risk mitigation strategies such air quality control, masking, testing, vaccination, and treatment should therefore be integrated into the usual care and counseling of cancer patients moving forward to avoid preventable morbidity and mortality from this infection and ensure the safety of this vulnerable cohort as they navigate their cancer diagnosis and treatment in the era of COVID-19.

Triple digital divide and depressive symptoms among middle-aged and older Chinese adults: a disparity analysis

BackgroundThe triple digital divide refers to the lack of internet access, use and knowledge among specific populations. In China, middle-aged and older adults and those living in rural areas or...

Antiresorptive therapy in combination with radiation results in enhanced risk for necrosis and associated complicatifions

Patients exposed to a combination of antiresorptive medication and radiotherapy of the head and neck area developing necrosis of the jaw in the course of treatment are extremely rare. Therefore the aim of this study was to identify outcome and complications in this highly vulnerable patient cohort. Patients and Methods: Seventeen patients who received both, antiresorptive treatment and radiotherapy (MRONJ/ORN-Group) in the head and neck area were enrolled in this study. Included patients were treated in our department between 2005 and 2022. 424 patients with medication-related osteonecrosis of the jaw (MRONJ-Group) and 138 patients with osteoradionecrosis of the jaw were enrolled as two control groups (ORN-Group). Demographic data, lesion localisation, date of primary diagnosis, clinical symptoms, type of therapy (surgical or non-surgical), details on antiresorptive treatment, outcome, and complications were recorded. Results: Pathological fractures, continuity resection and recurrence appear more often in patients who receive a combination of antiresorptive treatment and radiotherapy in the head and neck area compared to patients undergoing only one of these treatments. There was a statistically significant difference (p<0.001) between MRONJ/ORN-Group and MRONJ-Group and MRONJ/ORN-Group and ORN-Group considering recurrence, fracture and continuity resection. Patients with ORN combined with MRONJ have a 4-times higher risk for developing recurrence compared to patients with MRONJ and a 1.5-times higher risk for recurrence compared to patients with ORN. Jaw fracture and continuity resection appear more often in patients with MRONJ/ORN. Conclusion: Patients under antiresorptive therapy in combination with radiation therapy in the head and neck area have a higher risk for developing complications in case of osteonecrosis of the jaws. Therefore, a strict follow-up care schedule is highly recommended.