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Purpose: Post-operative hyperglycemia is a known risk factor for post-surgical complications. The predictive value of pre-operative blood glucose levels, however, is less understood. This study aimed to determine if pre-operative screening blood glucose levels affect the rate of post-operative infection or wound complications. We also investigated if case urgency or anatomic location alters this relationship. Methods: A single-institution retrospective chart review was performed to evaluate patients treated between 2018 and 2021. Subjects ≥ 18 years with closed, non-infected orthopaedic diagnoses requiring surgery were included. Case urgency, demographics, comorbidities, blood glucose level within twelve h prior to surgery, and hemoglobin A1c level within 3 months of surgery, were collected. Infections and wound complications were recorded as outcomes. Results: A total of 775 subjects with a mean age of 61 (range 18–96) were identified, including 543 elective and 232 trauma patients, with a mean pre-operative fasting glucose value of 127.7 mg/dL (range, 49–388 mg/dL) and average HbA1c of 6.9%. The odds of infectious complications were increased by a factor of 1.01 for every 1-point increase in blood glucose (95% CI 1.01–1.02; p < 0.01). Conclusions: Pre-operative blood glucose levels greater than 137 mg/dL were associated with an increase in wound complications, but not deep infections. Infection rates stratified by anatomic site and case urgency were not impacted by pre-operative glucose levels. The increased risk of poor wound healing in patients with pre-operative hyperglycemia demonstrates that day of surgery point-of-care blood glucose screening can be a useful risk stratification tool. [ABSTRACT FROM AUTHOR]

Introduction: Kidney transplantation has emerged as a preferred method for improving survival and quality of life for patients with end‑stage renal disease in comparison with dialysis. Living donation provides a better patient and allograft survival when compared with deceased‑donor transplantation, specifically when the live donor transplant is accomplished before the onset of dialysis. The present study aimed to create and add data for the long‑term survival, complications occurred in donor as well as in recipient both in single study in India. Materials and Methods: We performed a retrospective cohort study of all adult patients undergoing renal transplantation. Data on kidney transplantation and operative variables, as well as follow‑up data, were obtained retrospectively from the Internal Medical Record Department. The primary outcomes examined were both donor and recipient and graft survival after 2 years and 5 years. Secondary outcomes included the presence of acute rejection and delayed graft function, as well as the rate of postoperative complications. Results: A total of 500 donors and 500 recipients participated in the research overall. The mean warm ischemia time was 3.1 ± 1.4 min and cold ischemia time was 44.3 ± 23.4 min. Surgical complications were encountered in 32.8% (164/500) of patients. The 2‑year and 5‑year graft survival rates were 90.2% and 84.8%, respectively. Conclusion: Our patients’ rate of complications was not greater than that noted in the previous publications. A thorough and meticulous medical assessment of the donor and recipient is required, as well as a rigorous and responsible evaluation of the indications. [ABSTRACT FROM AUTHOR]

The article discusses the BEST-CLI International Collaborative, which aims to improve care and outcomes for patients with chronic limb-threatening ischemia (CLTI) globally. The article highlights the increasing prevalence of peripheral arterial disease (PAD) and the need for evidence-based treatment strategies for CLTI. The BEST-CLI trial, funded by the National Heart, Lung, and Blood Institute, compared open surgery and endovascular therapy for CLTI patients. The article also mentions the BASIL-2 trial, which compared different revascularization strategies for CLTI. The BEST-CLI International Collaborative seeks to interpret the trial results, identify gaps in CLTI care, disseminate evidence-based medicine, and identify future research priorities. The text discusses the findings of a survey conducted among vascular specialists from 22 countries regarding the treatment of chronic limb-threatening ischemia (CLTI). The survey revealed wide disparities in the management of CLTI, including variations in patient demographics, diagnostic classification, treatment approaches, and costs. The text emphasizes the need for global education and collaboration to promote best practices in CLTI treatment and ensure equal access to evidence-based care. It also highlights the importance of considering local contexts and health economics when implementing treatment strategies. Additionally, the text mentions the potential of new technologies to improve revascularization outcomes and the importance of training programs to enhance physician skills in CLTI interventions. The text discusses the evolution of new technology in caring for patients with critical limb-threatening ischemia (CLTI) and emphasizes the importance [Extracted from the article]

Background: Healthcare providers working with victims of physical trauma are exposed to significant human suffering at work. This may place them at risk of burnout, secondary traumatic stress (STS), and other psychological disturbances. This study aimed to evaluate the professional quality of life and psychological well-being among trauma professionals. Methodology: This was a cross-sectional study conducted among 153 staff members (nursing officers, resident doctors, and faculty) of a Level 1 trauma center in North India. The Professional Quality of Life (ProQoL-5) and Depression, Anxiety, and Stress (DASS-21) Scales were used. Results: More than 50% of the participants had a moderate risk of burnout and STS. In addition, 54% of participants reported having anxiety, 40% stress, and 36% depressive symptoms. Depression, anxiety, and stress were all strongly predicted by burnout and STS. Conclusion: Psychological distress symptoms were seen in a significant portion of professionals working in the trauma center. Workplace interventions for the promotion of psychological well-being among trauma professionals are recommended. [ABSTRACT FROM AUTHOR]

Aims. To explore the relationship between determinants and posttransplant medication nonadherence (MNA) in adult kidney transplant recipients, and to examine the relationship between posttransplant MNA and clinical outcomes. Methods. Using the World Health Organization's model, this retrospective, multicenter, correlational study examined the relationship between determinants, posttransplant MNA, and clinical outcomes in 16,671 adult kidney transplant recipients from the Cerner Health Facts national data warehouse. Results. With 12% MNA, those who were nonadherent were more likely to have the social/economic factors of being younger, single, Caucasian versus Hispanic race, have the condition-related factor of mental health/substance use disorder, and have the healthcare system-related factor of government/health maintenance organization/managed care insurance (p ′ s < 0.05). Bivariate correlations indicated both age (OR = 1.006, p = 0.01) and mental health or substance use disorder diagnosis (OR = 1.26, p = 0.04) were significant predictors of MNA. Patients were 0.6% more likely to be medication adherent for each year they increased in age and 26% more likely to be MNA if they were diagnosed with a mental health/substance use disorder. Nonadherent patients were less likely to be readmitted, but more likely to have complications after transplant and medication side effects (p ′ s < 0.01). Conclusions. Using one of the largest samples of adult kidney transplant patients, our findings support the WHO model and move the body of medication adherence intervention research forward by clarifying the importance of focusing interventions not only on the patient but on multilevel determinants. Consistent with previous studies, MNA negatively impacts transplant outcomes. [ABSTRACT FROM AUTHOR]

Background: Discuss the role of ultrasound in detecting various gallbladder and biliary tract pathologies in patients presenting as right upper quadrant/epigastric pain/obstructive jaundice especially in emergency situations and demonstrating the incidence of various gallbladder and biliary tract pathologies. Material And Methods: A retrospective observational study of 85 patients having upper abdominal/epigastric pain/obstructive jaundice was carried out at SVP Hospital, ahmedabad. Ultrasound was performed by using MINDRAY RESONA 6 machine. Both curvilinear and linear probes were used for the scanning. Result: The study included 85 patients with 50 female patients and 35 male patients. Most common pathology found was gallbladder calculus (47%). Female gender (72.5%) was more prone for having gallstones than male gender (27.5%). Gallstones were commonly associated with diffuse wall thickening and most common pathology associated with diffuse wall thickening was acute calculus and a calculous cholecystitis with both having a frequency of 30 % each. Gallstones were found a common risk factor for gallbladder perforation as well as gallbladder malignancy. Common pathologies presenting with obstructive jaundice were CBD stones and CBD stricture in which distal CBD was the commonest site for the stones (39%) as well as stricture (50%). In paediatric age group presenting with jaundice common pathologies were choledochal cyst and biliary atresia. Conclusion: Ultrasound is a non-invasive, least expensive, highly sensitive imaging modality and free from radiation for the assessment of the gallbladder and biliary tree pathologies especially in emergency situations. [ABSTRACT FROM AUTHOR]

Background: Patient-related risk factors for the development of postoperative pulmonary complications (PPCs) include age ≥ 60-years, congestive heart failure, hypoalbuminemia and smoking. The effect of obesity is unclear and has not been shown to independently increase the likelihood of PPCs in trauma patients undergoing trauma laparotomy. We hypothesized the likelihood of mortality and PPCs would increase as body mass index (BMI) increases in trauma patients undergoing trauma laparotomy. Methods: The Trauma Quality Improvement Program (2010–2016) was queried to identify trauma patients ≥ 18-years-old undergoing trauma laparotomy within 6-h of presentation. A multivariable logistic regression analysis was used to determine the likelihood of PPCs and mortality when stratified by BMI. Results: From 8,330 patients, 2,810 (33.7%) were overweight (25–29.9 kg/m2), 1444 (17.3%) obese (30–34.9 kg/m2), 580 (7.0%) severely obese (35–39.9 kg/m2), and 401 (4.8%) morbidly obese (≥ 40 kg/m2). After adjusting for covariates including age, injury severity score, chronic obstructive pulmonary disease, smoking, and rib/lung injury, the likelihood of PPCs increased with increasing BMI: overweight (OR = 1.37, CI 1.07–1.74, p = 0.012), obese (OR = 1.44, CI 1.08–1.92, p = 0.014), severely obese (OR = 2.20, CI 1.55–3.14, p < 0.001), morbidly obese (OR = 2.42, CI 1.67–3.51, p < 0.001), compared to those with normal BMI. In addition, the adjusted likelihood of mortality increased for the morbidly obese (OR = 2.60, CI 1.78–3.80, p < 0.001) compared to those with normal BMI. Conclusion: Obese trauma patients undergoing emergent trauma laparotomy have a high likelihood for both PPCs and mortality, with morbidly obese trauma patients having the highest likelihood for both. This suggests obesity should be accounted for in risk prediction models of trauma patients undergoing laparotomy. [ABSTRACT FROM AUTHOR]

Access to pediatric surgical intervention in low-income countries is expanding, but investments in post-surgical care have received less attention. This study explored the barriers and supports for school-aged children to access post-surgical, community-based follow-up care in Uganda as perceived by community stakeholders. This qualitative exploratory case study used in-depth, semi-structured interviews and in-country site visits among Ugandan organizations providing follow-up care to school-aged children in Uganda after surgery. Data from eight interviews and eight site visits were coded, analyzed, and cross-tabulated with a modified grounded theory approach. Four key barriers to community-based follow-up care were identified: discrimination, financial barriers, geographical barriers (including transportation), and caregiver limitations to support recovery. Three key supports to successful access to and participation in community-based post-surgical recovery were identified: disability awareness, the provision of sustained follow-up care, and caregiver supports for reintegration. Increasing awareness of disability across local Ugandan communities, educating caregivers with accessible and culturally aware approaches, and funding sustainable follow-up care programming provide promising avenues for pediatric post-surgical recovery and community reintegration in contemporary Uganda. Multiple, intersecting factors prevent or promote access to post-surgical community-based services among school-aged children in Uganda. The most prominent barriers to pediatric community reintegration in Uganda include discrimination, lack of financial resources, geographical factors, and caregiver limitations. Community and interprofessional alliances must address disability awareness and sources of stigma in local contexts to promote optimal recovery and reintegration after surgery. Collaborative efforts are needed to develop sustainable funding for community-based care programs that specifically support pediatric post-surgical recovery and reintegration. Efforts to provide appropriate and empowering caregiver education are critical, particularly in geographical regions where ongoing access to rehabilitation professionals is minimal. [ABSTRACT FROM AUTHOR]

The aim of our study was to assess the age and gender distribution in root canal failure cases with two different tapered gutta percha obturation techniques. Patients who had reported with symptoms post root canal treatment at a private institution in Chennai from June 2019 to March 2020 were recruited in our study. A total of 278 patients with root canal failures were reported. Data regarding age, gender and previous obturation technique (2% taper or 6% taper) were collected. Previous obturation technique was evaluated using intraoral RVG. The collected data was tabulated using Microsoft excel and analysed using SPSS. Differential (frequency distribution and percentage) and inferential (chi-square test) statistics were done. Our study included 278 patients with root canal failed teeth. In the age group below 30 years and 30 to 60 years, upper anterior teeth were most commonly involved in root canal failure and lower anterior teeth least commonly involved. In the age group above 60 years, lower posterior teeth were most commonly involved and upper anterior teeth were least commonly involved in root canal failure. In all age groups, 2% taper obturation was the most common. Lower posterior teeth were commonly involved in root canal failure among females and upper anterior teeth were commonly involved among males. Within the limitations of the study, the root canal failure teeth with 2% obturation taper had higher incidence of failure. Also, males between the age group of 30 to 60 years had higher incidence of endodontic failures. [ABSTRACT FROM AUTHOR]

Objectives: Although traumatic injuries to the superior mesenteric vein (SMV), portal vein (PV), and hepatic vein (HV) are rare, their impact is significant. Small single center reports estimate mortality rates ranging from 29% to 100%. Our aim is to elucidate the incidence and outcomes associated with each injury due to unique anatomic positioning and varied tolerance of ligation. We hypothesize that SMV injury is associated with a lower risk of mortality compared to HV and PV injury in adult trauma patients. Methods: The Trauma Quality Improvement Program database (2010-2016) was queried for patients with injury to either the SMV, PV, or HV. A multivariable logistic regression model was used for analysis. Results: From 1,403,466 patients, 966 (0.07%) had a single major hepatoportal venous injury with 460 (47.6%) involving the SMV, 281 (29.1%) involving the PV, and 225 (23.3%) involving the HV. There was no difference in the percentage of patients undergoing repair or ligation between SMV, PV, and HV injuries (P > .05). Compared to those with PV and HV injuries, patients with SMV injury had a higher rate of concurrent bowel resection (38.5% vs 12.1% vs 7.6%, P < .001) and lower mortality (33.3% vs 45.9% vs 49.3%, P < .01). After controlling for covariates, traumatic SMV injury increased the risk of mortality (odds ratio [OR] 1.59, confidence interval [CI] = 1.00-2.54, P = .05) in adult trauma patients; however, this was less than PV injury (OR = 2.77, CI = 1.56-4.93, P = .001) and HV injury (OR = 2.70, CI = 1.46-4.99, P = .002). Conclusion: Traumatic SMV injury had a lower rate of mortality compared to injuries of the HV and PV. SMV injury increased the risk of mortality by 60% in adult trauma patients, whereas PV and HV injuries nearly tripled the risk of mortality. [ABSTRACT FROM AUTHOR]

Purpose: To compare a general vision-specific patient-reported outcomes (PRO) instrument, National Eye Institute Visual Function Questionnaire-25 (NEIVFQ-25) with two disease-specific PRO instruments, Glaucoma Quality of Life-15 (GQL-15), and Viswanathan 10 in patients with varying severity of primary open angle glaucoma (POAG).Methods: This hospital-based, prospective study enrolled 140 glaucoma patients. The patients were classified into mild, moderate, and severe glaucoma based on visual field defects. All these patients were administered the three PRO instruments and the results were statistically analyzed.Results: All the three instruments showed high internal consistency (Cronbach's alpha for GQL-15, NEIVFQ-25, and Viswanathan 10 were 0.918, 0.937, and 0.929, respectively) There was a statistically significant difference between patients with mild, moderate, and severe POAG with all instruments (P ≤ 0.001). The instruments correlated well across several parameters especially the peripheral vision and glare/dark adaptation. The disease-specific scales however are simpler and faster to administer.Conclusion: All three instruments were reliable in assessment of mild, moderate, and severe glaucoma. They correlated strongly with each other in most of the related subscales, domains, and questions. NEIVFQ-25 additionally gave information regarding the general, psychological, and social effects of the disease. [ABSTRACT FROM AUTHOR]

Background: The word "Diet" means the food and drink that we habitually consume did not appear in English until thirteen century, but it also had another sense, meaning "a way of life". The second meaning is more in line with the word's origins, as it comes from the Greek "diaita via diaitan". Diaita was a noun that meant a way of living, and also had a more specific meaning, signifying a way of living as advised by a physician, which could include a "food" diet and other daily habits. The literature is increasing on the dietary management for common gallbladder disease issues. Inappropriate knowledge leads to inappropriate practice of diet which increases the problems in gallbladder disease conditions. Objective: The main objective of the study was to assess the knowledge and practice on dietary management among gallbladder disease patients. Method: A quantitative study based on descriptive research design. Patients were recruited from hospital. 124 patients affected with gallbladder disease were included in the study. Knowledge and practice were assessed by using self structured knowledge questionnaires and practice checklist. Data was analyzed by using a thematic analysis. Results: Poor knowledge and practice were present among the patients regarding dietary management of gallbladder diseases. Conclusion: Patients were having low knowledge regarding dietary management for gallbladder diseases which leads them to poor practice. Although they were aware that proper diets give them proper health but they are unaware with the appropriate diet used during gallbladder disease conditions. [ABSTRACT FROM AUTHOR]

Background: Proprioception is a specialized sensory modality encompassing the movement of the joint and its position in space. Reconstruction of the anterior cruciate ligament (ACL) does not always yield expected outcome, suggesting that successful reconstruction depends on not only the ultimate strength of the graft but also recovery of proprioception. Treatment delay is a significant concern in developing countries, e.g., in Asia. Thus, presence of mechanoreceptors is one of the factors having paramount importance for successful outcome. We conducted this study to identify mechanoreceptors via immunohistochemical staining and correlate their presence with duration of injury.Materials and Methods: A total of 38 injured native ACL stumps were harvested from patients undergoing ACL reconstruction and stained with neurofilament protein stain to detect functional mechanoreceptors.Results: Of the specimens, 44.7% stained positive for monoclonal antibody. No association was found between duration of injury and presence of mechanoreceptors (p = 0.897). No correlation was seen between age and side.Conclusions: No correlation was found between duration of injury and presence of viable mechanoreceptors, hence it is beneficial to preserve the native ACL stump irrespective of the time interval between injury and surgery.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Introduction: Ahmed Glaucoma Valve (AGV) is a modality to surgically manage patients of glaucoma who are refractory to conventional intraocular pressure lowering drugs. Aim: To evaluate the success rate and safety profile of AVG in patients of refractory glaucoma. Materials and Methods: This study is a retrospective review of 30 eyes with refractory glaucoma that were implanted AGV over a period from January 2012 to November 2014. The collected data was analysed using SPSS Version 21.0, ANOVA and Kaplan-Meier survival analysis to evaluate surgical success and rate of complications. Results: The AGV reduced the preoperative mean Intraocular Pressure (IOP) of 33.47±6.19 mmHg to 12.36±3.55 mmHg at last follow up after surgery (p-value=0.001). The dependency on antiglaucoma drugs decreased from 2.43±1.1 to 1.1±0.5 at the last follow up visit (p-value=0.65). AGV implantation was successful in 90% eyes at 12 months (n=30), 86.7% at 24 months (n=26) and 70% eyes at 36 months (n=21). Complications requiring intervention were found in seven (23.33%) eyes. Conclusion: Ahmed Glaucoma Valve is a reliable and safe alternative for IOP control in patients with refractory glaucoma. [ABSTRACT FROM AUTHOR]

Purpose: Glaucoma significantly affects the quality of life (QoL) of a patient. Despite the huge number of glaucoma patients in India, not many, QoL studies have been carried out. The purpose of the present study was to evaluate the QoL in Indian patients with varying severity of glaucoma.Methods: This was a hospital-based, cross-sectional, analytical study of 180 patients. The QoL was assessed using orally administered QoL instruments comprising of two glaucoma-specific instruments; Glaucoma Quality of Life-15 (GQL-15) and Viswanathan 10 instrument, and 1 vision-specific instrument; National Eye Institute Visual Function Questionnaire-25 (NEIVFQ25).Results: Using NEIVFQ25, the difference between mean QoL scores among cases (88.34 ± 4.53) and controls (95.32 ± 5.76) was statistically significant. In GQL-15, there was a statistically significant difference between mean scores of cases (22.58 ± 5.23) and controls (16.52 ± 1.24). The difference in mean scores with Viswanathan 10 instrument in cases (7.92 ± 0.54) and controls (9.475 ± 0.505) was also statistically significant. QoL scores also showed moderate correlation with mean deviation, pattern standard deviation, and vertical cup-disc ratio.Conclusion: In our study, all the three instruments showed decrease in QoL in glaucoma patients compared to controls. With the increase in severity of glaucoma, corresponding decrease in QoL was observed. It is important for ophthalmologists to understand about the QoL in glaucoma patients so as to have a more holistic approach to patients and for effective delivery of treatment. [ABSTRACT FROM AUTHOR]

Objectives:Clostridium difficileinfection (CDI) may worsen outcomes in patients with inflammatory bowel disease (IBD), but large database-driven studies have conflicting results. The study objective is to analyze clinical features and outcomes in patients with CDI and IBD using the National Hospital Discharge Survey (NHDS) database from 2005 to 2009. Materials and methods:NHDS collects the clinical information on patients dismissed from non-Federal short-stay United States hospitals. CDI and IBD patients were identified using ICD-9 codes. Demographics, diagnoses, procedures, length of stay (LOS) and dismissal information were abstracted. Results:Of an estimated 162 million hospitalizations; 5.62 × 105were for IBD (0.35%); 53.2% were female. CDI developed in 3.7% of hospitalized IBD patients as compared to 0.78% of all adults (OR, 3.9; 95% CI, 3.3–4.6;p < .0001). African-Americans with IBD had a higher likelihood of CDI compared to Caucasians with IBD (OR, 1.67; 95% CI, 1.59–1.75;p < .0001). After adjusting for age, sex and comorbidities, IBD patients with CDI had a longer LOS (mean difference 1 day,p < .0001), higher all-cause, in-hospital mortality (adjusted OR, 4.5; 95% CI, 4.2–4.9;p < .0001), and a higher risk of dismissal to a care facility (adjusted OR, 2.3; 95% CI, 2.2–2.4;p < .0001). Conclusions:CDI in IBD patients prolonged hospitalization and increased in-hospital mortality and likelihood of dismissal to a care-facility as compared to IBD patients without CDI. CDI was more common among African-American IBD patients compared to IBD patients of other races. [ABSTRACT FROM PUBLISHER]

Objective: The optimal resuscitation approach during the initial treatment of hypotensive trauma patients remains unknown, but some clinical trials have observed a survival benefit from restricting fluid administration prior to definitive hemorrhage control. We sought to characterize emergency medical services (EMS) protocols for the administration of intravenous fluids in this setting. Methods: Publicly accessible statewide EMS protocols for the treatment of hypotensive trauma patients were included and characterized by: 1) goal of fluid administration, 2) dosing strategy, 3) maximum dose, 4) type of fluid, and 5) specific protocols for head trauma, if present. Results: Of the 27 states with a publicly available, statewide protocol, 21 have a numeric systolic blood pressure (SBP) target for resuscitation. Of these, 16 describe a goal of maintaining SBP ≥90 mmHg with or without additional goals, three specify a goal that is less than 90 mmHg, and two specify a goal ≥100 mHg. Dosing strategies also vary and include both standard bolus strategies (200 mL, 250 mL, 500 mL, and 1 L with repeat) as well as weight-based strategies (20 mL/kg). Nine states specify a maximum dose of 2 L without medical control. Fifteen protocols recommend the use of normal saline, 1 recommends the use of lactated Ringer's, and 11 recommend the use of either normal saline or lactated Ringer's. Nine states have distinct protocols for patients with head trauma, all of which indicate maintaining a higher SBP than for trauma patients without head trauma. Conclusion: State EMS protocols for fluid administration for hypotensive trauma patients vary in regard to SBP goal, fluid dose, and fluid type. Clinical trials to determine the optimal use of intravenous fluids for hypotensive trauma patients are needed to define the optimal approach. [ABSTRACT FROM AUTHOR]

Background: Administrative databases that include diagnostic codes are valuable sources of information for research purposes.Aim: To validate diagnostic codes for hepatocellular carcinoma (HCC) in chronic hepatitis B patients.Methods: We conducted a retrospective study of patients with chronic HBV seen in the national Veterans Administration (VA). HCC cases were identified by the presence of ICD-9 code 155.0. We randomly selected 200 HBV controls without this code as controls. We manually reviewed the electronic medical record (EMR) of all cases and controls to determine HCC status. We calculated the positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity for the HCC code. We conducted an implicit review of the false-positive cases to determine possible reasons for the miscoding.Results: Of the 8350 patients with HBV, 416 had an ICD-9 code for HCC. Of these 416, 332 patients had confirmed HCC and 61 did not; HCC status was indeterminate for 23 patients. Of the 200 controls, none had HCC confirmed in the EMR. The PPV ranged from 85.3 to 80.0% and specificity ranged from 99.2 to 99.0% based on classification of indeterminate cases as true versus false positives, respectively. The NPV, sensitivity, and specificity were 100%. Two-thirds of false-positive cases were diagnosed with HCC prematurely as a workup of liver mass and latter imaging and/or biopsy were not diagnostic for HCC.Conclusion: The diagnostic code of HCC in chronic HBV patients in the VHA data is predictive of the presence of HCC in medical records and can be used for epidemiological and clinical research. [ABSTRACT FROM AUTHOR]

Background: To evaluate results of a technique for treating neglected epiphyseal injuries of the distal radius with ulnar impaction.Materials and Methods: This retrospective study involved six cases (four males; two females), all of whom sustained the primary injury during childhood (range 9-12 years of age). All presented with wrist deformity and ulnar-sided wrist pain. They were managed with osteotomy of the distal radius, osteotomy and shortening of the ulna, harvesting the bone grafts, and distal radioulnar joint (DRUJ) reduction performed simultaneously through a dorsal midline approach. Mean follow-up was 30 months (range 24-36).Results: Deformity correction and pain relief was observed in all patients. Flexion arc increased from an average of 60° to 102.5°, supination from an average of 31.67° to 67.50°, and pronation from an average of 30.83° to 61.67°. The mean preoperative DASH score was 87.5, which improved to 18.72 postoperatively.Conclusion: Neglected epiphyseal injuries of the distal radius are difficult to manage and many variations are described for handing each of the associated problems. Our technique provides an option for managing this injury with an easy surgical approach, single incision, and cost effectiveness. All the four components of the surgery, which include osteotomy of the distal radius, osteotomy of the ulna, harvesting the bone grafts, and DRUJ reduction were done through a single incision and in a single sitting. Level of evidence IV. [ABSTRACT FROM AUTHOR]

BACKGROUND: In biliary system, Gall bladder diseases (GBD) are the most common disorder, and most of the cases are asymptomatic. It is also one of the most common diseases affecting 10-15 % of Caucasian adults (racial group having light-colored skin; white) in developed countries have GBD. OBJECTIVE: To explore the evidence on patients’ knowledge on common gallbladder diseases, as well as their practice regarding dietary management of GBD. METHOD: Pub Med and EBSCO were searched for reviews on knowledge and practice regarding dietary management among patients affected with GBD. RESULTS: The accessible literature refines to get 7 qualitative studies. In this narrative review, 6 research studies supported that dietary management is helpful in gallbladder diseases and may provide proper health, if it is followed. 1 research study shows that there is no remarkable result of low-fat diet in the prevention of gastrointestinal symptoms and specially gallstones. CONCLUSION: Gallbladder diseases can not only be treated with medicines, but it actually requires dietary management so that it can be treated with diet. [ABSTRACT FROM AUTHOR]

A 30-year-old male with bilateral acute visual loss presented with retinal edema in the posterior pole and peripapillary region with extensive retinal hemorrhages. Fluorescein angiography revealed delayed arterial filling in the right eye and absent arterial filling in the left eye, suggesting bilateral central retinal artery occlusion. Systemic evaluation revealed a history of chronic low-grade fever and generalized lymphadenopathy. HIV (ELISA) was positive, and other systemic comorbidities were ruled out. Cervical lymph node biopsy stained positive for acid-fast bacilli, with large areas of necrosis, palisaded by epithelioid cell granulomas, macrophages, and multinucleated giant cells, suggesting lymph node tuberculosis. Despite antiretroviral and antitubercular therapy, he developed optic atrophy at 4 weeks. [ABSTRACT FROM AUTHOR]

A young male presented with diminution of vision left eye, attributable to full-thickness macular hole, and submacular hemorrhage, following closed globe injury 2 weeks ago. The patient was managed successfully with 25-gauge vitrectomy, subretinal injection of tissue plasminogen activator and aspiration of liquefied blood through the macular hole, internal limiting membrane peeling, short-acting gas tamponade, and prone positioning. This resulted in good visual improvement, type 1 macular hole closure, and restoration of foveal architecture. The outcome and rationale of treatment in this unique scenario is discussed. [ABSTRACT FROM AUTHOR]

In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients. [ABSTRACT FROM AUTHOR]

Objectives: Patients with profound cardiovascular compromise have poor prognosis despite inotropic and intra-aortic balloon pump (IABP) support. Peripheral venoarterial extracorporeal membrane oxygenation (V-A ECMO) offers these patients temporary support as a bridge to various options including the 'bridge to recovery'. Methods: We studied the outcomes of 135 patients who underwent peripheral V-A ECMO and concomitant IABP implantation in our hospital from 2007 to 2012 for various clinical indications. The ECMO circuit consisted of a centrifugal pump and an oxygenator. Results: V-A ECMO was implanted in the cardiac catheterization laboratory in 51 patients (37.8%), at the bedside in 5 (3.7%) and in the operating room in 79 (58.5%). Mean duration of support was 8.5 ± 7.1 days. Median length of stay was 28 days (interquartile range 14-62). Complications included bleeding at the access site in 14.1%, stroke in 11.1% and vascular complications requiring intervention in 16.3%. Overall inhospital survival was 57.8% with outcomes including heart transplantation (3%), implantable left ventricular assist device (8.1% as bridge to transplantation and 6.7% as destination therapy), surgery (7.4%) and myocardial recovery (40.7%). Prior IABP use and axillary cannulation were independent predictors of reduced inhospital mortality, stroke or vascular injury. Conclusions: Peripheral V-A ECMO with IABP is an effective therapy for patients with severely compromised cardiovascular function. It offers reasonable survival and a spectrum of definitive options from 'bridge to recovery' to heart transplantation for the management of this critically ill population. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objectives The influence of admission source (nursing home [NH] versus community-dwelling) on treatment strategies and outcomes among elderly patients with ST-elevation myocardial infarction (STEMI) has not been investigated. Participants Nationwide Inpatient Sample databases from 2003 to 2010 were used to identify 270,117 community-dwelling and 4082 NH patients 75 years of age or older with STEMI. Design Retrospective observational study. Measurements Propensity scores for admission source were used to assemble a matched cohort of 3081 community-dwelling and 3132 NH patients, who were balanced on baseline demographic and clinical characteristics. Bivariate logistic regression models were then used to determine the associations of NH with in-hospital outcomes among matched patients. Results In-hospital mortality was significantly higher in patients with STEMI presenting from a NH as compared with community-dwelling patients (30.5% versus 27.6%; odds ratio [OR] 1.15, 95% confidence interval [CI] 1.03-1.29; P = .012). Overall, NH patients were less likely to receive reperfusion (thrombolysis, percutaneous coronary intervention, or coronary artery bypass grafting) (11.5% versus 13.4%; OR 0.84, 95% CI 0.72-0.98; P = .022). However, rates of percutaneous coronary intervention alone were similar in both groups (9.9% in NH versus 9.1% in community-dwelling; OR 1.10, 95% CI 0.93-1.30; P = .276). Mean length of stay was also similar in both groups (5.68 ± 5.40 days in NH versus 5.69 ± 4.98 days in community-dwelling, P = .974). Conclusion Compared with their community-dwelling counterparts, older NH patients are less likely to receive reperfusion therapy for STEMI and have higher in-hospital mortality. [ABSTRACT FROM AUTHOR]

The current American Heart Association/American College of Cardiology guidelines for patients with stable angina pectoris recommend β-blockers as the initial drug therapy for prevention of angina pectoris (class I B indication). Long-acting nitrates or calcium channel blockers should be prescribed for prevention of angina when β-blockers are contraindicated or not tolerated secondary to side effects (class I B indication). Long-acting nitrates or calcium channel blockers in combination with β-blockers should be prescribed for angina prevention when initial treatment with β-blockers is unsuccessful (class I B indication). Only sublingual nitroglycerin or nitroglycerin spray should be used for immediate relief of angina pectoris (class I B indication). Ranolazine with β-blockers can be used for prevention of angina when initial treatment with β-blockers is not successful (class IIa A indication). If angina persists despite treatment with β-blockers, long-acting nitrates and calcium channel blockers, we recommend the addition of ranolazine for prevention of stable angina pectoris. This editorial discusses the contemporary role of ranolazine in the management of patients with stable angina pectoris. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

We analyzed the Nationwide Inpatient Sample database from 2002 to 2010 to examine the temporal trends in incidence of acute kidney injury (AKI), AKI requiring dialysis, and associated in-hospital mortality in patients ≥75 years of age hospitalized with acute myocardial infarction and undergoing early (within 24 hours) percutaneous coronary intervention. Of 2,225,707 patients ≥75 years of age with acute myocardial infarction, 233,508 (10.5%) underwent early percutaneous coronary intervention, of which 21,961 (9.4%) developed AKI and 1,257 (0.54%) developed AKI requiring dialysis. From 2002 to 2010, the incidence of AKI increased from 5.6% to 14.2% (p for trend <0.001) and that for AKI requiring dialysis decreased (0.6% to 0.4%; p for trend 0.018). Compared with 2002, multivariable-adjusted odds ratios and 95% confidence intervals for AKI, AKI requiring dialysis, and in-hospital mortality in 2010 were 1.87 (1.71 to 2.05), 0.20 (0.15 to 0.27) and 0.74 (0.60 to 0.90), respectively. In conclusion, among hospitalized adults ≥75 years of age, from 2002 to 2010, there was an increase in AKI, but there was paradoxical decrease in AKI requiring dialysis and in-hospital mortality, potentially reflecting increased health-care provider awareness resulting in early recognition and implementation of renal-protective strategies and diagnosis-related group creep. [ABSTRACT FROM AUTHOR]

Objective: To investigate recent trends in surgical volume and associated patient outcomes in the treatment of acoustic neuromas. Methods: A retrospective analysis was performed using the Nationwide Inpatient Sample database from 2000–2007; cases from 2005 were excluded because of coding inconsistencies. Univariate and multivariate analyses were used to describe surgical trends and analyze inpatient outcomes. Results: Among 14,928 patients studied, 87.1% were treated at large (based on number of beds) hospitals. Cases at these hospitals declined progressively from 2054 to 1467 cases (a 28.6% decrease) from 2000–2007; a 40.8% (178 cases per year, R 2 = 0.73) reduction in surgeries was observed from 2001–2007. Although mortality remained steady at 0.3%, nonroutine discharge (increase from 10.9% to 19.1%) and complication rates (increase from 21.5% to 23.3%) increased in recent years. Patients without private insurance had an increased risk of nonroutine discharge (odds ratio [OR] 1.7, P = 0.0033; OR 1.5, P = 0.0382), and patients with more comorbidities had an increased risk of complications (OR 1.8, P < 0.0001; OR 1.5, P < 0.0001). High surgical caseload reduced nonroutine discharge by 30% (OR 0.7, P < 0.0001) and complications by 10% (OR 0.9, P < 0.0281). Conclusions: A 41%, or 178 cases per year, reduction in surgical excision of acoustic neuroma cases was observed during the period 2001–2007. A possible explanation for this trend includes increased use of stereotactic radiosurgery. Nonroutine discharge and complications after surgical excision have increased perhaps because of surgery being used for larger tumors. [Copyright &y& Elsevier]

Abstract: Objectives: To investigate the etiologies of syncope and predictors of all-cause mortality, rehospitalization, and cardiac syncope in consecutive elderly patients presenting with syncope to our emergency department. Participants: Participants were 352 consecutive patients aged 65 years or older with syncope admitted to hospital from the emergency department. Design: Observational retrospective study. Measurements: Review of medical records for history, physical examination, medications, and tests to determine causes of syncope. Cox stepwise logistic regression analysis was performed to identify significant independent prognostic factors for rehospitalization with syncope, all-cause mortality, and cardiac syncope. Results: Of 352 patients, mean age 78 years, the etiology of syncope was diagnosed in 243 patients (69%). Vasovagal syncope was diagnosed in 12%, volume depletion in 14%, orthostatic hypotension in 5%, cardiac syncope in 29%, carotid sinus hypersensitivity in 2%, and drug overdose/others in 7% of patients. During a mean follow-up of 24 months, 10 patients (3%) were readmitted to the hospital for syncope and 39 (11%) died. Stepwise logistic regression analysis identified history of congestive heart failure (OR 5.18; 95% CI 1.23–21.84, P = .0257) and acute coronary syndrome (OR 5.95; 95% CI 1.11–31.79, P = .037) as independent risk factors for rehospitalization. Significant independent prognostic factors for mortality were diabetes mellitus (OR 2.08; 95% CI 1.09–3.99, P = .0263), history of smoking (OR 2.23; 95% CI 1.10–4.49, P = .0255), and use of statins (OR 0.37; 95% CI 0.19–0.72, P = .0036). Independent risk factors for predicting a cardiac cause of syncope were an abnormal electrocardiogram (OR 2.58; 95% CI 1.46–4.57, P = .0012) and reduced ejection fraction (OR 2.92; 95% CI 1.70–5.02, P < .001). The San Francisco Syncope Rule and Osservatorio Epidemiologico sulla Sincope nel Lazio scores did not predict mortality or rehospitalization in our study population. Conclusions: Significant independent risk factors for rehospitalization for syncope were congestive heart failure and acute coronary syndrome. Significant independent risk factors for mortality were diabetes mellitus, history of smoking, and use of statins (inverse association). [Copyright &y& Elsevier]

The article presents a case study of a 43 year old male reported with the chief complaint of swelling on left mandibular anterior region since 2 years which upon further investigation was found to be a rare case of Odontogenic Myxoma of Mandible.

A letter to the editor in response to a research article related to the effectiveness of rectal vancomycin therapy in patients With clostridium difficile infection (CDI) published in a previous issue is presented.

The article focuses on the case of a 50 year old male who was a chronic smoker and alcoholic. It mentions that the patient undergo magnetic resonance imaging (MRI) which revealed abnormal signal intensity in his genu and in the body of corpus callosum. It states that the patient was diagnosed with Marchiafava-Bignami disease (MBD) which is a rare disorder associated with chronic alcohol abuse.

Abstract: Estimates of T regulatory cell populations in the periphery of patients with Crohn’s disease are confounded by disease activity and concomitant immunotherapeutic agents known to affect T cell proliferation and survival. We performed deuterium pulse/chase experiments in patients with quiescent Crohn’s disease on no immunotherapy and healthy control subjects to estimate T regulatory cell kinetics. Quantification of deuterated DNA isolated from T cell subsets over 10days was determined by mass spectrophotometry. We demonstrate enhanced proliferation within the T regulatory cell population from patients with Crohn’s disease when compared to non-T regulatory cells and T regulatory cells from healthy control subjects. We speculate that T regulatory cells isolated from the periphery of patients with Crohn’s disease experience persistent antigen stimulation resulting in excess proliferative rates. [Copyright &y& Elsevier]

Objectives: The study aimed to assess the impact of therapeutic hypothermia (TH) on bleeding and in-hospital mortality among patients with coagulation disorders (CD).Background: TH affects coagulation factors and platelets putting patients at risk for bleeding and worse outcomes. Effect of TH among patients with CD remains understudied.Methods: Between 2009 and 2014, a total of 6469 cases of TH were identified using the National Inpatient Sample out of which 1036 (16.02%) had a CD. The incidence of bleeding events, blood product transfusion and in-hospital mortality was compared between patients with and without CD using one to one propensity score matching.Results: Proportion of patients with CD increased during study duration from 13.0% to 17.4% from 2009 to 2014. Propensity matching was performed to adjust for baseline differences with 799 patients in both groups depending on presence or absence of CD. Patients with CD had a higher rate of bleeding events (13% vs. 8.5%; adjusted odds ratio 1.60; 95% confidence interval 1.16-2.23; P = 0.004), and blood product transfusion (25.0% vs. 14.1%; aOR 2.03; 95% CI 1.56-2.63; p < 0.001) compared to those without CD. There was no difference in rate of intracranial bleeding or hemorrhagic strokes between those with and without CD (3.3% vs. 3.2%; p = 0.88). There was no difference in mortality between patients with CD and those without (74.5% vs. 74.8%, aOR 0.98, 95% CI 0.78-1.23; P = 0.86).Conclusions: Use of TH with CD resulted in more bleeding events and blood product transfusion but there was no difference in hospital mortality. [ABSTRACT FROM AUTHOR]

BACKGROUND: Thirty-day readmission rates have gained increasing importance as a key quality metric. A significant number of patients are hospitalized for the management of critical limb ischemia (CLI), but limited data are available on the incidence, predictors, and causes of 30- day readmission after hospitalization for CLI. METHODS: Hospitalizations for a primary diagnosis of CLI during which patients underwent endovascular or surgical therapy (revascularization and/or amputation) and were discharged alive were identified in the 2013 to 2014 Nationwide Readmissions Databases. Incidence, reasons, and costs of 30-day unplanned readmissions were determined. Hierarchical logistic regression models were used to identify independent predictors of 30-day readmissions. RESULTS: We included 60 998 (national estimate, 135 110) index CLI hospitalizations (mean age, 68.9±11.9 years; 40.8% women; 24.6% for rest pain, 37.2% for ulcer, and 38.2% for gangrene). The 30-day readmission rate was 20.4%. Presentation with ulcer or gangrene, age ≥65 years, female sex, large hospital size, teaching hospital status, known coronary artery disease, heart failure, diabetes mellitus, chronic kidney disease, anemia, coagulopathy, obesity, major bleeding, acute myocardial infarction, vascular complications, and sepsis were identified as independent predictors of 30-day readmission. Mode of revascularization was not independently associated with readmissions. Infections (23.5%), persistent or recurrent manifestations of peripheral artery disease (22.2%), cardiac conditions (11.4%), procedural complications (11.0%), and endocrine issues (5.7%) were the most common reasons for readmission. The inflation-adjusted aggregate costs of 30-day readmissions for CLI during the study period were $624 million. CONCLUSIONS: Approximately 1 in 5 patients hospitalized for CLI and undergoing revascularization is readmitted within 30 days. Risk of readmission is influenced by CLI presentation, patient demographics, comorbidities, and in-hospital complications, but not by the mode of revascularization. [ABSTRACT FROM AUTHOR]

Acute myocardial infarction in patients with end-stage renal disease (ESRD) is associated with increased risk of morbidity and mortality. Limited data are available on the contemporary trends in management and outcomes of ST-elevation myocardial infarction (STEMI) in patients with ESRD. We analyzed the 2003 to 2011 Nationwide Inpatient Sample databases to examine the temporal trends in STEMI, use of mechanical revascularization for STEMI, and in-hospital outcomes in patients with ESRD aged ≥18 years in the United States. From 2003 to 2011, whereas the number of patients with ESRD admitted with the primary diagnosis of acute myocardial infarction increased from 13,322 to 20,552, there was a decrease in the number of STEMI hospitalizations from 3,169 to 2,558 (ptrend <0.001). The overall incidence rate of cardiogenic shock in patients with ESRD and STEMI increased from 6.6% to 18.3% (ptrend <0.001). The use of percutaneous coronary intervention for STEMI increased from 18.6% to 37.8% (ptrend <0.001), whereas there was no significant change in the use of coronary artery bypass grafting (ptrend = 0.32). During the study period, in-hospital mortality increased from 22.3% to 25.3% (adjusted odds ratio [per year] 1.09; 95% confidence interval 1.08 to 1.11; ptrend <0.001). The average hospital charges increased from $60,410 to $97,794 (ptrend <0.001), whereas the average length of stay decreased from 8.2 to 6.5 days (ptrend <0.001). In conclusion, although there have been favorable trends in the utilization of percutaneous coronary intervention and length of stay in patients with ESRD and STEMI, the incidence of cardiogenic shock has increased threefold, with an increase in risk-adjusted in-hospital mortality, likely because of the presence of greater co-morbidities. [ABSTRACT FROM AUTHOR]

Background Acute myocardial infarction is a recognized complication in patients with hypertrophic cardiomyopathy. However, limited data are available on outcomes of patients with hypertrophic cardiomyopathy and acute myocardial infarction. Methods We analyzed the 2003-2011 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years with a principal diagnosis of acute myocardial infarction. Patients with a concomitant diagnosis of hypertrophic cardiomyopathy were then identified and analyzed as a separate cohort. Multivariate logistic regression was used to compare outcomes in patients with acute myocardial infarction with and without hypertrophic cardiomyopathy. Results Of 5,901,827 patients with acute myocardial infarction, 5688 (0.1%) had a diagnosis of hypertrophic cardiomyopathy. Patients with hypertrophic cardiomyopathy were older, more likely to be female, and less likely to have traditional cardiovascular risk factors. Compared with patients without hypertrophic cardiomyopathy, patients with hypertrophic cardiomyopathy were less likely to present with ST-elevation myocardial infarction and more likely to present with non-ST-elevation myocardial infarction. Patients with hypertrophic cardiomyopathy with ST-elevation myocardial infarction or non-ST-elevation myocardial infarction were less likely to receive revascularization. In the overall population with acute myocardial infarction, there was no difference in risk-adjusted in-hospital mortality between patients with and without hypertrophic cardiomyopathy (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.84-1.11; P = .59). In the population with ST-elevation myocardial infarction, patients with hypertrophic cardiomyopathy had lower risk-adjusted in-hospital mortality than those without hypertrophic cardiomyopathy (OR, 0.75; 95% CI, 0.63-0.91; P = .003), whereas in the population with non–ST-elevation myocardial infarction, there was no difference in risk-adjusted in-hospital mortality between patients with and without hypertrophic cardiomyopathy (OR, 0.97; 95% CI, 0.84-1.11; P = .63). Conclusions Patients with hypertrophic cardiomyopathy represent a small proportion of patients with acute myocardial infarction and are less likely to receive revascularization. Compared with patients without hypertrophic cardiomyopathy, patients with hypertrophic cardiomyopathy with ST-elevation myocardial infarction have lower risk-adjusted in-hospital mortality. [ABSTRACT FROM AUTHOR]