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ABSTRACT Objectives Clinical Considerations Conclusions Clinical Significance These two clinical case reports show the use of the Triple Layer Graft procedure along with the Decoronation procedure to help restore normal contour and height of tissue The procedure was highly effective at restoring the esthetics that the patients needed on their implants. Short and long term results along with the step by step technique are shown.Two patients of 33 and 25 years of age both had significant reduction in the height over their implants in the #7 and #10 locations. The first patient had the implants placed 15 years ago and the second patient had them done 5 years before our treatment. Current techniques to remedy esthetic issues created by malpositioned implants consist of soft and/or hard tissue grafting but tend to be utilized independently of each other in discrete procedures as opposed to being combined in one surgical protocol. The Triple Layer Graft (TLG) surgical protocol is novel in that it incorporates all three layers of grafting to address both soft and hard tissue deficits in one procedure done at one time after doing a decoronation technique. The TLG surgical and prosthetic protocol has been previously published by these authors, but this article will discuss the rationale along with the technique and indications and contraindications, illustrated via case reports. The authors will also report on the long‐term results of this technique.The Triple Layer Graft TLG) in combination with the Decoronation technique is an effective method in managing mild as well as severe esthetic defects over the facial of previously placed implants.The Triple Layer Graft will allow implants that were previously removed in order to place a new implant along with ridge augmentation may be able to be saved. This is a wonderful procedure for the patient since the implant does not have to be removed and replaced. [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusions Previous work has identified several limitations in “Summaries of Product Characteristics” (SmPCs), which are associated with risks for patients. The aim of this study was to evaluate pharmacists' and physicians' interpretation of contraindications in SmPCs and reasons for their nonadherence in clinical routine.For 20 commonly missed or ignored absolute contraindications, an anonymous online survey providing 24 clinical example cases (one or two per contraindication) for physicians and pharmacists was developed. Experts in medication safety were asked whether the respective case fulfilled the definition of the contraindication in the SmPC: (a) formally, irrespective of the clinical relevance of the contraindication (17 cases), and (b) whether the contraindication was deemed clinically relevant in each respective case (24 cases).Twenty‐seven pharmacists and 27 physicians completed the survey. For only one case (1/17; 5.8%) did all experts agree on the same answer option regarding the formal fulfilment of a given contraindication statement. Experts gave heterogeneous answers regarding the interpretation of a contraindication. For instance, among 10 predefined answer options for the contraindication “active liver disease” in the SmPC of simvastatin, every option was selected by at least six experts. In 17/24 (70.8%) clinical example cases a majority of experts agreed on the clinical relevance of a given contraindication. Key reasons for nonadherence to contraindications were “patient monitoring possible”, “lack of alternative treatment” and “acute/severe situations”.Experts' disagreement on the interpretation of contraindications in SmPCs using clinical example cases indicates that further efforts are needed to improve their usability in clinical routine. [ABSTRACT FROM AUTHOR]

Since the advent of replantation techniques, there has been uneven progress in terms of success—even considering whether success is defined as continued perfusion of the digit or long term functional outcomes. Early enthusiasm and success have not been maintained despite increasing familiarity with microsurgical techniques and greater understanding of how to optimize outcomes for the individual components of replantation such as tendon repair, nerve repair, and osteosynthesis. Practitioners participating in the care of patients undergoing replantation should be familiar with the history and current understanding of both the indications and contraindications for the procedure, post-operative rehabilitation, and factors contributing to functional outcomes. A review of the literature from the first publications on the topic demonstrates evolution in practice and understanding of which patients should be indicated for replantation. Indications can be considered in three broad categories: injury factors, patient factors, and care context factors. These factors intersect with one another and can inform the surgeon pre-operatively regarding the most likely outcome for a given patient. This insight is critical to discuss pre-operatively with the patient in order to make a shared decision about how to manage their injury. [ABSTRACT FROM AUTHOR]

To evaluate the association, if any, between closure modality (surgical ligation SL vs. catheter CC) of a hemodynamically significant patent ductus arteriosus (PDA), after failure of or contraindication to medical therapy, and immediate procedural complications, and post-procedure physiologic status in preterm (gestational age < 32 weeks) infants. In this single-center retrospective cohort study, data were accessed on infants < 32 weeks gestation, who underwent SL or CC of PDA, born from 2019–2021. The choice of modality was determined by parents, after they were provided information on both procedures. Our cohort (n = 112) included 36 (32.1%) infants who underwent SL while 76 (67.9%) underwent CC. The SL group of infants were significantly more immature at birth, younger on admission to the level IV NICU and received more mean (SD) surfactant doses than the CC group. Higher proportions of infants in the SL group had 5-min Apgar scores ≤ 5, seizures, severe intracranial hemorrhage and had received medical therapy for PDA. Both procedures were highly efficacious, with 1 unsuccessful device placement attempt and had low associated adverse events. Two (2.6%) infants had device migration 24 h after CC. SL was associated with a higher rate of immediate postoperative hypothermia whereas, in the CC group, mean airway pressure was significantly lower 48 h after, compared to before the procedure. SL and CC are comparable in short-term efficacy and safety for PDA closure. Long-term outcomes data are needed following both procedures. [ABSTRACT FROM AUTHOR]

Copyright of Medicina Pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Besides lifestyle interventions, medication, and surgery, endoscopic options are becoming part of the current treatment landscape for people with obesity. With the POSE (Primary Obesity Surgery Endoscopic) procedure, endoluminal folds are created in the stomach with full-thickness sutures. Recently, the modified version, POSE-2, was introduced in clinical practice. This study aims to evaluate the safety and effectiveness of the POSE-2 procedure after one year in patients with obesity. Materials and Methods: All patients treated with the POSE-2 procedure between March 2019 and November 2022 in the Zuyderland Medical Center and the Dutch Obesity Clinic were included in this retrospective data study. Inclusion criteria are as follows: age between 18 and 65 years and a BMI > 30 kg/m2. All patients with contraindications for the POSE-2 procedure were excluded. Results: Forty-nine patients were included of which 86% were female, with a mean age of 46 years and mean BMI of 34.6 kg/m2. Total weight loss was evaluated at 3, 6, and 12 months and was 11.5%, 13.2%, and 14.8%, respectively. A median of 14 anchor sutures was used in a median procedure time of 50 min. All patients except one had same day discharge. Postprocedural complaints were mild and consisted of nausea and vomiting (36.7%) and pain (54.2%). No complications were recorded in this group. One week postprocedure, most patients (95.9%) reported feeling satisfied between meals. Conclusion: The POSE-2 procedure can be applied as a safe and effective treatment for people with obesity. This study presents a positive effect on weight reduction and no complications after 1 year of follow-up. [ABSTRACT FROM AUTHOR]

Use of venovenous extracorporeal membrane oxygenation (ECMO) is increasing, but candidacy selection processes are variable and subject to bias. What are the reasons behind venovenous ECMO candidacy decisions, and are decisions made consistently across patients? Prospective observational study of all patients, admitted or outside hospital referrals, considered for venovenous ECMO at a tertiary referral center. Relevant clinical data and reasons for candidacy determination were cross-referenced with other noncandidates and candidates and were assessed qualitatively. Eighty-one consultations resulted in 44 noncandidates (54%), 29 candidates (36%; nine of whom subsequently underwent cannulation), and eight deferred decisions (10%). Fifteen unique contraindications were identified, variably present across all patients. Five contraindications were invoked as the sole reason to deny ECMO to a patient. In patients with three or more contraindications, additional contraindications were cited even if the severity was relatively minor. All but four contraindications invoked to deny ECMO to a patient were nonprohibitive for at least one other candidate. Contraindications documented in noncandidates were present but not mentioned in 21 other noncandidates (47%). Twenty-six candidates (90%) had at least one contraindication that was prohibitive in a noncandidate, including a contraindication that was the sole reason to deny ECMO. Contraindications were proposed as informing three prognostic domains, through which patterns of inconsistency could be understood better: (1) irreversible underlying pulmonary process, (2) unsurvivable critical illness, and (3) clinical condition too compromised for meaningful recovery. ECMO candidacy decisions are inconsistent. We identified four patterns of inconsistency in our center and propose a three-domain model for understanding and categorizing contraindications, yielding five lessons that may improve candidacy decision processes until further research can guide practice more definitively. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: This study is describing subjects with migraine interrupting or not receiving triptans for acute treatment and providing a national-level estimate of people who might benefit from different therapeutic approaches. Methods: This is a retrospective analysis using IQVIA Longitudinal Patient Database. Starting from 18 + years old individuals with migraine, we selected two cohorts: subjects with triptans prescriptions before and no triptans prescriptions after Index Date (triptan withdraw) and subjects without triptans prescriptions both before and after Index Date (no triptan prescriptions). Index Date was the first record of a health encounter for migraine in 2019. Individuals with cardiovascular disease (CVD) within no triptan prescriptions group were also quantified. Results: Triptan withdraw and no triptan prescriptions cohorts numbered 605 and 3270, respectively, 5% and 29% of subjects with migraine. Mean age was 47 and 51 years respectively; women were more represented (~ 80%). Hypertension and thyroid disease were most frequent comorbidities; non-steroidal anti-inflammatory drugs were among most frequently recorded treatments. Subjects with CVD within no triptan prescriptions cohort were 621 and with triptan withdraw cohort subjects represented the basis to estimate those who might benefit from alternative options for the acute treatment of migraine, who were around 60,000 and accounted for 11% of subjects seeking primary care due to migraine. Conclusions: This analysis provides a real-word estimate of Italian people that might benefit from different therapeutic approaches as an alternative to triptans, which sometimes might be not effective and/or poorly tolerated. Such estimate should be intended as the lower limit of a wider range due to strict criteria adopted. [ABSTRACT FROM AUTHOR]

To describe the use of non-steroidal anti-inflammatory drugs (NSAID), opioids, and physiotherapy (PT) among persons with newly diagnosed knee or hip osteoarthritis (OA) with and without NSAID contraindications or precautions. We used population-based register data to identify adults aged ≥35 as of January 1, 2014, residing in Skåne region (Sweden) between 2004 and 2013, without a previous knee or hip OA diagnosis. Among this cohort, we identified people with incident knee or hip OA diagnosis between 2014 and 2018 and the presence of contraindications to or precautions for oral NSAIDs at the time of OA diagnosis. We estimated the risk of 1) regular oral NSAID use, 2) regular opioid use, and 3) PT during the first year after diagnosis among those with vs. without contraindications or precautions using confounder-adjusted logistic regression with standardization. We identified 35,173 persons with newly diagnosed OA, of whom 3257 and 8351 had ≥1 contraindication to oral NSAIDs and ≥1 precaution, respectively. Overall, 27% of individuals used oral NSAIDs (with or without opioids or PT), 10% used opioids, and 57% attended PT. Among patients with contraindications, 21% used oral NSAIDs compared to 31% without (absolute adjusted difference −0.06 (95% CIs: −0.08, −0.05)), 53% vs 59% used PT (adjusted difference −0.03 (−0.05, −0.01)), while 14% vs. 8% had prescribed dispensed opioids (adjusted difference 0.02 (0.01, 0.03)). Similar results were observed for those with precautions. We highlight the need for safer treatment options. People with OA and contraindications/precautions to NSAIDs have a higher risk of opioid use, slightly lower risk of PT use, and continue to be prescribed NSAIDs. [ABSTRACT FROM AUTHOR]

In terms of its composition, wine is considered the second liquid after blood. The average is wine contains 85% water, 12% alcohol, and the remaining 3% contains 1000 other elements such as residual sugar, potassium, magnesium, sodium, iron, calcium, iron, phosphorus, as well as polyphenols, sulfates, nitrates, lactic acid. Amino acids are almost everything the human body needs to function properly. The purpose of the study is to identify the composition of wine, vitamins and minerals in wine, as well as the effect of drinking wine on the human body, in order to present it to the general public present during trips to wineries and cellars. The scientific study included various discussions and reports on the benefits, risks and contraindications of drinking wine. This was done on the basis of scientific works of various scientists on the world map, encyclopedic information and Internet publications. The main results concern the beneficial and unfavorable effects of drinking wine on the health of the human body, which are summarized in the tables and conclusions of this article.

Purpose: This study investigated the influence of cleanroom conditions on the discard rates of donor corneas in a German university eye bank. Methods: Discard rates were analysed from 2017 to 2020 at the LIONS Cornea Bank at Saarland University Medical Center. 1941 corneas from 971 donors were included. 1262 corneas (65.1%) were stored in a class D cleanroom from 2017 to 2019 and processed in a cleanroom class A sterile bank (group 1). 679 corneas (34.9%) were continuously stored in a class B cleanroom and processed in a class A cleanroom safety cabinet in the same room from 2019 to 2020 (group 2). The target parameter of this work was the number of contamination‐related discards. Although they cannot be influenced by the spatial conditions, the discards due to insufficient endothelial quality, serology, contraindications, scars and technical causes were also recorded. Statistical analysis was performed using SPSS and various testing procedures. Results: In group 1, significantly more corneas were discarded due to positive serology (6.9%|3.8%, p = 0.020). There was no significant change between both groups for either contamination or the other reasons for discard. Conclusion: Optimization of hygiene standards from cleanroom class D to B did not reduce contamination. Serology, endothelial quality, medical contraindications and the presence of scars cannot be influenced by cleanroom conditions. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy and tolerability of a progestin-only pill containing 4 mg drospirenone (DRSP) as a hormonal therapy for the management of endometriosis-associated symptoms in adolescents and young adults. Retrospective cohort study. A retrospective chart review was performed of all adolescents who were prescribed DRSP continuously (without placebo) for treatment of endometriosis at a single pediatric tertiary care center between 2019 and 2022. Electronic medical records were reviewed to obtain demographics and clinical characteristics of the patients. Measured outcomes included symptom resolution and medication discontinuation. The study was deemed IRB exempt. A total of 61 patients with endometriosis were prescribed DRSP during the study period, with a median age of 18.9 years (SD 2.3). The majority (97%) were laparoscopically confirmed to have endometriosis, and 85% had stage I disease. Before DRSP use, the most common medications trialed were norethindrone (57%) and norethindrone acetate (68%), and 56% had at least one medical contraindication to receiving estrogen-containing therapy. Of those with follow-up, 52% established an absence of bleeding/spotting, and 67% reported less pain at follow-up. One in 4 patients discontinued DRSP during the study period, most commonly due to breakthrough bleeding. DRSP is a well-tolerated and effective option for the treatment of endometriosis-associated symptoms in adolescents and young adults. [ABSTRACT FROM AUTHOR]

Background: Late infantile neuronal ceroid lipofuscinosis type 2 (CLN2) is a rare neurodegenerative disease that generally appears in children between 2 and 4 years old, leading to seizures and a progressive loss of language and motor functions. As the disease progresses, affected individuals typically experience blindness and ultimately pass away in late childhood. Treatment with intracerebroventricular cerliponase alfa has been shown to slow the deterioration of motor and language functions compared to the natural progression of the disease. We aim to highlight the early symptoms of CLN2 which help with early diagnosis and timely treatment initiation in children with specific medical indications, as well as identify medical contraindications for enzyme replacement therapy. Methods: We describe five Croatian patients and one Bosnia and Herzegovinian patient with CLN2 disease, analyzing the clinical characteristics, neuroimaging findings, electroencephalogram results, genetic analysis, treatment indications and contraindications, and disease progression. Results: All six patients presented with seizures: focal seizures (n = 1), myoclonic–atonic seizures (n = 1), febrile seizures (n = 2), and tonic–clonic seizures (n = 2), along with language delay (n = 6). Despite this, one patient refused treatment, two were initially included in the clinical trial and then continued treatment, one did not indicate starting treatment, and three continued treatment. One patient, after 4.5 years of treatment, no longer had medical indications for the therapy, which was discontinued. The other two patients who received treatment had a significant slowing of disease progression. Conclusions: The early onset of seizures between ages 2 and 4, alongside delayed language development, is a defining characteristic of CLN2 disease. Enzyme replacement therapy using cerliponase alfa represents the initial treatment for neuronal ceroid lipofuscinosis type 2, targeting the underlying cause of the disease. It effectively delays the progression of language and motor decline in patients diagnosed with this condition. [ABSTRACT FROM AUTHOR]

The article focuses on a study which aims to report the reliability of emergency physician identified congestive heart failure, hypertension, prior stroke/transient ischemic attact age 65 and older (CHADS65) items and contraindications to the prescription of a direct oral anticoagulant (DOAC). Results of the study revealed that emergency physician and medical record agreement on indications and contraindications to initiating anticolagulation in adult atrial fibrillation (AF) patients varied.

Hip replacement is a common orthopedic surgery in the aging population. With the rising incidence of prostate cancer, metallic hip prosthetics can cause considerable beam hardening and streak artifacts, leading to difficulty in identifying the target volumes and planning process for radiation treatment. The growing use of Stereotactic Body Radiation Therapy (SBRT) to treat prostate cancer is now well established. However, the use of this treatment modality in the presence of a hip prosthesis is poorly understood. There is enough literature on planning for external beam radiation treatment without any difficulties in the presence of hip prosthesis with conventional or Hypofractionated treatment. However, there is a shortage of literature on the impact of the prosthesis in SBRT planning, and there is a need for further understanding and measures to mitigate the obstacles in planning for SBRT in the presence of hip prosthesis. We present our review of the intricacies that need to be understood while considering SBRT in the presence of hip prostheses in prostate cancer treatment. [ABSTRACT FROM AUTHOR]

Background: Partner support is associated with better weight loss outcomes in observational studies, but randomized trials show mixed results for including partners. Unclear is whether teaching communication skills to couples will improve weight loss in a person attempting weight loss (index participant). Purpose: To compare the efficacy of a partner-assisted intervention versus participant-only weight management program on 24-month weight loss. Methods: This community-based study took place in Madison, WI. Index participants were eligible if they met obesity guideline criteria to receive weight loss counseling, were aged 18–74 years, lived with a partner, and had no medical contraindications to weight loss; partners were aged 18–74 years and not underweight. Couples were randomized 1:1 to a partner-assisted or participant-only intervention. Index participants in both arms received an evidence-based weight management program. In the partner-assisted arm, partners attended half of the intervention sessions, and couples were trained in communication skills. The primary outcome was index participant weight at 24 months, assessed by masked personnel; secondary outcomes were 24-month self-reported caloric intake and average daily steps assessed by an activity tracker. General linear mixed models were used to compare group differences in these outcomes following intent-to-treat principles. Results: Among couples assigned to partner-assisted (n = 115) or participant-only intervention (n = 116), most index participants identified as female (67%) and non-Hispanic White (87%). Average baseline age was 47.27 years (SD 11.51 years) and weight was 106.55 kg (SD 19.41 kg). The estimated mean 24-month weight loss was similar in the partner-assisted (2.66 kg) and participant-only arms (2.89 kg) (estimated mean difference, 0.23 kg [95% CI, -1.58, 2.04 kg], p=0.80). There were no differences in 24-month average daily caloric intake (estimated mean difference 50 cal [95% CI: -233, 132 cal], p=0.59) or steps (estimated mean difference 806 steps [95% CI: -1675, 64 steps], p=0.07). The percentage of participants reporting an adverse event with at least possible attribution to the intervention did not differ by arm (partner-assisted: 9%, participant-only, 3%, p = 0.11). Conclusions: Partner-assisted and individual weight management interventions led to similar outcomes in index participants. Trial registration: Clinicaltrials.gov NCT03801174, January 11, 2019. [ABSTRACT FROM AUTHOR]

SUMMARY: Eye movement desensitisation and reprocessing (EMDR) is an established psychotherapy developed in the late 1980s to treat post-traumatic stress disorder (PTSD). It involves the use of repetitive eye movements or other bilateral stimulation to aid in the reprocessing of traumatic memories. It is unique in that it does not require extended exposure to or discussion of distressing memories and may result in symptom resolution in fewer sessions than other psychotherapies. In the decades since its initial development, a wealth of high-quality evidence has suggested that EMDR is a safe and effective treatment for trauma- and stress-based conditions, resulting in its inclusion in various treatment guidelines. This article reviews the theory behind how EMDR works, how it is conducted, the evidence supporting its use in the treatment of PTSD and its approved indications and contraindications. [ABSTRACT FROM AUTHOR]

Endoscopic posterior cervical foraminotomy is gaining popularity among endoscopic spine surgeons for the treatment of radiculopathy caused by foraminal stenosis. This study describes a technique using the lateral decubitus position for endoscopic posterior cervical foraminotomy under monitored anesthesia care and local anesthesia only. A total of 10 patients with contraindications to general anesthesia underwent the procedure, resulting in improvement in cervical radicular pain with no perioperative complications. The findings suggest that this approach is a viable alternative for patients at high risk of general anesthesia care, expanding the surgical options for the treatment of radiculopathy. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of compression therapy (CT) and the best compression modality choice are questioned in many clinical stages of chronic venous disease (CVD). This work aims to obtain information on indications, contraindications, and the best treatment option for CT in different clinical scenarios of CVD. Method: An online survey was made among members of the International Compression Club, experts in CT. Results: The experts apply CT in all clinical stages of CVD, even when evidence is missing. Regarding compression materials, experts use inelastic materials in the advanced stages of CVD and compression stockings in the early or chronic stages of CVD. Conclusion: The authors highlight the gap between experts' practical use of CT and evidence-based medicine results. They also suggested that, given the cost of randomized clinical trials aimed at specifying specific indications for different devices, artificial intelligence could be used for large-scale practice surveys in the future. [ABSTRACT FROM AUTHOR]

• There is a disproportion between supply and demand for organs. • It is important to study the causes of medical refusal. • There are several problems in the genesis of the lack of supply of organs. Obtaining organs for transplants through a deceased donor occurs exclusively through donation. However, some open protocols with potential donors do not become effective donors due to medical refusal. Our aim was to identify the profile of non-donors of organs and tissues due to medical refusal in a state reference service for transplants. This is a cross-sectional study with retrospective data collection from medical records of patients who died and had a protocol opened to evaluate brain death and procurement of organs and tissues in 2019. The sample consisted of 27 patients, the majority of whom were female, aged over 71 years, had primary education, and were married. The main causes of medical refusal were age above the recommended age and septicemia. Brain death was mostly confirmed within 12 hours, and the main cause of hospitalization was a vascular event. Identifying the profile of non-donors due to medical refusal is necessary for services to identify possible misattributed medical contraindications and thus contribute to reducing the disproportion between supply and demand for organs and tissues for transplants. [ABSTRACT FROM AUTHOR]

Background: Healthcare professionals' misjudgment of contraindications to vaccination can lead to unnecessary delays or missed vaccinations. It is essential to evaluate the knowledge and attitudes of healthcare professionals towards this issue. Methods: A two-phase cross-sectional study was conducted among healthcare professionals in vaccination clinics in Ningbo in 2022. The study data were collected using questionnaires evaluating the knowledge and attitudes of contraindications and precautions to vaccination. Knowledge scores were calculated and a cutoff of 75 was defined for adequate knowledge scores. Results: A total of 761 participants completed the questionnaire on attitudes. The majority of participants (86.20%) considered screening for vaccination contraindications to be the most important aspect of the vaccination administration process. A higher level of work stress was observed among full-time personnel engaged in this work. A total of 301 participants completed the questionnaire on relevant knowledge and practical experience. The median (IQR) total score was 75.00 (21.88). The lowest median score was observed for questions pertaining to disease diagnosis and classification (median: 40.00; IQR: 40.00). Regarding knowledge about vaccination contraindications, the scores for questions regarding national guidelines or vaccine package inserts (median: 85.71; IQR: 14.29) and guidelines from the WHO or ACIP (median: 100.00; IQR: 0.00) were higher than those derived from expert consensuses or literature findings (median: 71.43; IQR: 28.57) (p < 0.001). Higher scores were observed in the age group of 50–59 years, which included those who had received training twice or more times and those with relevant work experience. Conclusions: The knowledge of healthcare professionals working in vaccination clinics related to contraindications and precautions to vaccination is not sufficient, particularly regarding disease diagnosis and classification. Knowledge enhancement through repetitive skill training is required. [ABSTRACT FROM AUTHOR]

The article discusses the safety aspects and contraindications related to whole-body electromyostimulation (WB-EMS) in commercial and medical settings. It addresses the controversy surrounding the classification of tumor and cancer as relative contraindications for WB-EMS application. The authors emphasize the importance of evidence-based and consensus-driven approaches to ensure the safety of vulnerable clients and the need for medical supervision in WB-EMS facilities. The article highlights the differences in risk assessments between commercial and medical settings and the role of medical gatekeepers in determining the eligibility of patients for WB-EMS. [Extracted from the article]

To avoid inhalational anesthetics, total intravenous anesthesia (TIVA) is required in patients with a predisposition to malignant hyperthermia (MH). However, propofol, which is frequently used, may be avoided in patients with egg allergies because of the contraindications in the drug information. Furthermore, some patients may not consent to the use of propofol. We report a case of TIVA using midazolam and dexmedetomidine as substitutes for propofol in a pediatric patient with egg allergy and a predisposition to MH. A 10‑year‑old boy was scheduled to undergo perforated drainage of an epidural abscess. He had egg allergy, and his uncle had been diagnosed with MH. He also developed a generalized drug eruption caused by antibiotics. Concerned about allergic reactions, he and his parents did not consent to administrating propofol. The patient’s perioperative course was uneventful. The combination of midazolam and dexmedetomidine may be a useful option as substitutes for propofol. [ABSTRACT FROM AUTHOR]

Minor and self-limiting illnesses are often suitable for treatment with medicines available over-the-counter in the community pharmacy. The pharmacist's assistant under the supervision of the pharmacist needs to assess, by careful questioning, if the illness or symptom is suitable for treatment with a nonprescription medicine or if the patient should be referred to the doctor for further evaluation. Some patients are at higher risk for medication-induced diseases or adverse events. The more common medicine contraindications/warnings of two classes of medicines available without a doctor's prescription, namely the oral decongestants and nonsteroidal anti-inflammatory drugs, are briefly reviewed. [ABSTRACT FROM AUTHOR]

First step in every endovascular procedure is obtaining a vascular access. Interventional radiologists usually use femoral access. Axillary and brachial access is used less often. In many cardiac catheterization labs, the radial access is the first line approach. Radial access brings better postprocedural comfort for the patient and when used in compliance with the guidelines, it has less local complications than femoral, axillary and brachial access. Interventional procedures using radial access can be performed in a day-case setting and patients themselves usually prefer radial access over femoral. The radial access is gaining momentum also in interventional radiology, event though it has some limitations because of the distance from the access to the target vessel. When respecting the contraindications there will always be a group of patients, who should not be offered the radial access because of high complication risk. Radial access definitely has a bright future in interventional radiology. [ABSTRACT FROM AUTHOR]

This research aimed to identify the victory in the Holy Qur'an, its concept, causes and obstacles facing the Islamic nation today and then reach proposals for solutions and urge Muslims to what brings victory and its models from the life of the Prophet peace be upon him and the lives of the Companions may God be pleased with them all. The research relied on the historical and inductive method. [ABSTRACT FROM AUTHOR]

In terms of its composition, wine is considered the second liquid after blood. The average is wine contains 85% water, 12% alcohol, and the remaining 3% contains 1000 other elements such as residual sugar, potassium, magnesium, sodium, iron, calcium, iron, phosphorus, as well as polyphenols, sulfates, nitrates, lactic acid. Amino acids are almost everything the human body needs to function properly. The purpose of the study is to identify the composition of wine, vitamins and minerals in wine, as well as the effect of drinking wine on the human body, in order to present it to the general public present during trips to wineries and cellars. The scientific study included various discussions and reports on the benefits, risks and contraindications of drinking wine. This was done on the basis of scientific works of various scientists on the world map, encyclopedic information and Internet publications. The main results concern the beneficial and unfavorable effects of drinking wine on the health of the human body, which are summarized in the tables and conclusions of this article. [ABSTRACT FROM AUTHOR]

Cochlear implantation has emerged as a transformative intervention in addressing profound hearing loss, offering a paradigm shift in auditory rehabilitation for individuals with restricted auditory function. Throughout its history, the understanding of contraindications for cochlear implant (CI) surgery has evolved significantly. This review comprehensively analyzes the chronological advancements in the understanding of CI contraindications, examining studies conducted from historical timelines to the present. Recent research has revealed significant developments in the field, prompting a reevaluation of established criteria and resulting in expanded indications for CI. The chronological evolution of contraindications underscores the transformative nature of the field, offering potential improvements in outcomes and enhancing the quality of life for individuals with profound hearing loss. In conclusion, this narrative review emphasizes the dynamic nature of the field, where the reevaluation of contraindications has created new opportunities and broader indications for CI. The emerging prospects, including improved outcomes and enhanced quality of life, hold promise for individuals with profound hearing loss. [ABSTRACT FROM AUTHOR]

This publication presents the first Ukrainian translation of the thirteenth chapter of the first part of the fundamental Sanskrit treatise on Ayurveda (traditional Indian medicine) Charaka Samhita. (For previous chapters, see 2017 issues of The World of the Orient). As it exists today, this text is thought to have arisen in the 1st century CE. The translation is of great importance for acquaintance of the Ukrainian readers not only with medical conceptions and life of Ancient India, but also with respective religious and philosophical doctrines. The subject of the thirteenth chapter is such Ayurvedic procedure as snehana or oleation, which means anointing the body with fatty substances or taking them orally. Both oils and animal fats are used and both are applied in their pure form or with vegetable or mineral additives. The chapter begins with questions asked by the student Agnivesha to the teacher Atreya. It is noteworthy that the last was sitting with adepts of Sankhya or one of the six "orthodox schools of Indian philosophy". This is evidence of respect of the author (or ancient editors) of Charaka Sam- hita for this branch of ancient Indian science. Agnivesha's questions actually form the scheme of the chapter. The chapter outlines indications and contraindications for oleation therapy and lists substances for oleation. A description of their properties and seasonal indications for different types of unctuous substances and contra-indications is given. Significant attention is paid to the dosage and the regimen that a patient may follow. Side reactions of oleation are named and their managements are advised. It is noted that oleation should precede fomentation therapy to which the next chapter is devoted. [ABSTRACT FROM AUTHOR]

Copyright of Magyar Radiológia Online is the property of Society of Hungarian Radiologists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Retinoblastoma is the most common eye malignancy in children that if left untreated can invade intraocular structures, metastasize, and rarely lead to death. Traditionally treated with systemic chemotherapy, Intra-arterial chemotherapy is gaining popularity as it allows for the direct administration of chemotherapy through the ophthalmic artery, thus reducing systemic side effects. Intra-arterial chemotherapy procedures have evolved, with refinements to reduce risks and radiation exposure. Intra-arterial chemotherapy boasts an impressive technical success rate and one year ocular survival even amongst advanced cases. This review offers a thorough examination of the technique, indications, contraindications, outcomes, and alternative options for Intra-arterial chemotherapy. [ABSTRACT FROM AUTHOR]

Psychological, social, and biological aspects contribute synergistically to the maintenance and chronicity of pain in primary headaches. An integrated intervention seems to be the most appropriate in the management of these conditions, taking advantage not only of pharmacological strategies, but also of different approaches according to the global assessment and patient necessities. In this perspective, non-pharmacological treatments are becoming increasingly used to overcome these issues also in paediatric migraine treatment. Particularly, nutraceuticals, non-invasive neuromodulation, and behavioural approaches are well tolerated and of potential interest. This paper aims to present the main approaches reported in the literature in the management of migraine in children and adolescents presenting an up-to-date review of the current literature. We therefore performed a narrative presentation for each of these three categories: nutraceuticals (riboflavin; magnesium; melatonin; vitamin D; coenzyme Q10; and polyunsaturated fatty acid); non-invasive neuromodulation (trigeminal nerve stimulator; non-invasive vagal nerve stimulation; transcranial magnetic stimulation; and remote electrical neuromodulation), and behavioural therapies (biofeedback; cognitive behavioural therapy; and mindfulness-based therapy). These approaches are increasingly seen as a valid treatment option in primary headache management also in paediatrics, avoiding medication overuse and drug treatment contraindications. [ABSTRACT FROM AUTHOR]

Copyright of Summa, Animali da Compagnia is the property of Point Veterinaire Italie s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Spontaneous vaginal delivery in a tracheostomised woman is rare and literature concerning the same is also very limited, hence this might help in considering vaginal delivery at term as an option in such patients when there are no medical or obstetrical contraindications for the same. We present a case of a 24 years female patient hailing from Tamil Nadu in South India, who was tracheostomised secondary to subglottic stenosis, presented to Otorhinolaryngology department at thirty-eight weeks of gestation to know the possibility of a vaginal delivery at term. Since the patient had an uneventful obstetrical history and no medical or obstetrical contraindications for a vaginal delivery, patient was advised breathing exercises including Valsalva manoeuvre and kept under close follow up. Patient went to labor at term at thirty-nine weeks and five days of gestation, and with the help of a panel of senior doctors underwent spontaneous vaginal delivery with no complications. Vaginal delivery can be attempted in tracheostomised women, in the absence of any medical or obstetrical contra indications, if the patient is motivated and we have a panel of expert doctors from all concerned departments. [ABSTRACT FROM AUTHOR]

Pulp revascularization is an emerging treatment modality in endodontics aimed at preserving the vitality and function of immature permanent teeth with necrotic pulp and apical periodontitis. This review provides a comprehensive examination of the current state of pulp revascularization, encompassing its rationale, clinical procedures, indications, contraindications, advantages, limitations, and potential future prospects. By critically analyzing the existing literature and clinical experiences, this review aims to offer insights into the efficacy, challenges, and potential advancements in the field of pulp revascularization. [ABSTRACT FROM AUTHOR]

This paper explores the use of ultrasound therapy in dentistry, focusing on its working principle, various applications, advantages, limitations, precautions, contraindications, and future directions. Ultrasound therapy presents a promising non‑invasive treatment modality with a wide range of applications within the field of dentistry. [ABSTRACT FROM AUTHOR]

BACKGROUND: Clinical pharmacists identified contraindications in two cases concerning the co-administration of cefoperazone and ambroxol hydrochloride injection, prompting a thorough investigation. CASE PRESENTATION: Clinically, two cases of contraindications for the co-administration of cefoperazone and ambroxol hydrochloride injection were discovered. After the intervention and analysis by clinical pharmacists, the possible reason could be the precipitation of free alkali due to the immediate administration of ambroxol after the infusion of cefoperazone. Clinical pharmacists suggested avoiding the co-administration of the two and recommended flushing the intravenous lines with 5% glucose injection or 0.9% sodium chloride injection during intravenous infusion to prevent direct drug interaction causing precipitation, thereby reducing the occurrence of adverse events. No adverse events occurred after the intervention, and no harm was caused to the patients. CONCLUSIONS: The co-administration of cefoperazone and ambroxol hydrochloride injection can lead to the precipitation of free alkali, posing a risk of adverse events. Clinical pharmacists' intervention could prevent this interaction. This practice has been shown to be effective, with no subsequent adverse events reported. [ABSTRACT FROM AUTHOR]

• Lower education level, cesarean delivery, and receipt of antibiotics per physician discretion were predictive of peripartum infection. • Cesarean remains the largest risk factor for peripartum infection among high risk laboring patients. • Strategies to identify patients at highest risk for infection are needed, in order to intervene with prophylaxis or treatment. To develop a predictive model for peripartum infection among high risk laboring patients in Cameroon, Africa. We conducted a secondary analysis of the Cameroon Antibiotic Prophylaxis Trial (NCT 3248297), a multicenter 3-arm double-blind randomized controlled trial of oral azithromycin ± amoxicillin among term pregnancies with prolonged labor or rupture of membranes in Cameroon 1/2018–5/2020. Patients with chorioamnionitis prior to randomization, study drug contraindications, or planned cesarean were excluded. The outcome of interest was a composite of maternal peripartum infection (chorioamnionitis, endometritis, sepsis by World Health Organization criteria, wound infection/abscess) diagnosed up to 6 weeks postpartum. Potential predictors were compared between patients with and without the composite outcome, and evaluated at a 0.05 alpha level. Statistically significant exposures were analyzed using multivariable regression (to generate adjusted odds ratios and 95 % confidence intervals) with backwards selection to generate a parsimonious model. Receiver operating characteristic curves with associated area under the curve assessed the model's predictive ability. A nomogram based on the final best fit multivariable model was constructed. Of 756 patients in the parent trial, 652 were analyzed: 45 (7 %) had peripartum infection. Those with infection were more likely to be nulliparous, lower education level, higher gestational age, receive antibiotics per hospital protocols, and undergo cesarean. In our best-fit multivariable model, none/primary education (vs university), cesarean birth, and antibiotic receipt per physician discretion (vs for cesarean prophylaxis) were significantly associated with increased infection risk. This model was moderately predictive (AUC = 0.75, 95 % CI 0.67–0.82). When using this 3 factor model, for a patient with a cesarean birth, receipt of antibiotics per physician discretion, and university education, the probability of peripartum infection was 35 % (95 % CI 0.11–0.73). While several variables such as parity are associated with infectious morbidity within 6 weeks among high risk laboring patients in Cameroon, only education level, antibiotic indication, and cesarean birth were independently associated, and a model including these 3 factors was moderately predictive. Validation of our findings in a larger population is warranted. [ABSTRACT FROM AUTHOR]

Heart transplantation (HTx) remains the last therapeutic resort for patients with advanced heart failure. The present work is a clinically focused review discussing current issues in heart transplantation. Several factors have been associated with the outcome of HTx, such as ABO and HLA compatibility, graft size, ischemic time, age, infections, and the cause of death, as well as imaging and laboratory tests. In 2018, UNOS changed the organ allocation policy for HTx. The aim of this change was to prioritize patients with a more severe clinical condition resulting in a reduction in mortality of people on the waiting list. Advanced heart failure and resistant angina are among the main indications of HTx, whereas active infection, peripheral vascular disease, malignancies, and increased body mass index (BMI) are important contraindications. The main complications of HTx include graft rejection, graft angiopathy, primary graft failure, infection, neoplasms, and retransplantation. Recent advances in the field of HTx include the first two porcine-to-human xenotransplantations, the inclusion of hepatitis C donors, donation after circulatory death, novel monitoring for acute cellular rejection and antibody-mediated rejection, and advances in donor heart preservation and transportation. Lastly, novel immunosuppression therapies such as daratumumab, belatacept, IL 6 directed therapy, and IgG endopeptidase have shown promising results. [ABSTRACT FROM AUTHOR]

Alcohol content, proanthocyanins and anthocyanins influence wine quality. The composition of wine depends on the type of cultivar, location, environmental conditions, and management practices. Phenolic compounds have attracted considerable research interest due to their antioxidant properties and potential beneficial effects on human health. However, the low bioavailability of anthocyanins creates a major bottleneck in their ability to exert beneficial effects. Despite extensive research on the effects of wine on human health, no clear evidence has been obtained on the benefits of wine quality or geographic area of production on health conditions, such as metabolic syndrome. Five climatically and geologically distinct wines were evaluated. Based on recent studies, meta-analyses, and pooled analyses of wine composition, along with the predicted low bioavailability of polyphenol compounds, we estimated the efficacy of five geographically distinct wines according to gastrointestinal absorption and the effects of alcohol intake on both men and women, with a view to ascertaining whether geographical origin influences the antioxidant serum composition of wine. Data on the estimated consumption of wine suggest that the polyphenol contents are similar regardless of choice of wine/area, while different alcohol compositions affect the level of alcohol and calorie intake. Thus, moderate wine drinkers should be advised to control the habit, but without exceeding the dose considered a healthy threshold (up to 30–40 g of alcohol/day in men and 10–20 g of alcohol/day in women), given no medical contraindications are present. These results will add value to the framework of the last reform of the Common Agricultural Policy (CAP) adopted in December 2021, where the European Parliament and the Council introduced new labeling rules for the wine sector and aromatized wine products. [ABSTRACT FROM AUTHOR]

Purpose: To assess the presence and severity of acquired blepharoptosis (ptosis) among patients visiting an eye care clinic and the receptivity of eligible patients to pharmacologic treatment with oxymetazoline 0.1% ophthalmic solution. Patients and Methods: Patients aged 50 years or older who had a scheduled clinic appointment for any reason (eg, dry eye, cataract surgery consultation) were asked to respond to written questions about lid position and select whether their upper lid position most closely matched one of 4 images shown to them corresponding to no, mild, moderate, or severe ptosis. Patients selecting any of the mild, moderate, or severe ptosis were offered treatment with oxymetazoline 0.1% ophthalmic solution, barring any medical contraindications. The outcome measures were the proportion of patients with each self-reported lid position level (none to severe ptosis), the proportion of patients with asymmetric ptosis, and the proportion of patients willing to accept the treatment. Results: Data for 188 eyes of 94 patients were analyzed. Overall, 73.4% of patients had ptosis in at least one eye, and 25.5% had an asymmetric upper eyelid presentation. The proportions of patients with self-reported mild, moderate, or severe ptosis in at least one eye were 41.5%, 25.5%, and 6.4%, respectively. Among those patients eligible for treatment, 19.7% were willing to accept the treatment. Conclusion: Based on patients' self-assessment of lid position, this study suggests a higher prevalence of ptosis than reported previously. Evaluation of the eyelids should be a standard part of the comprehensive eye examination. [ABSTRACT FROM AUTHOR]

Purpose: Diabetic macular edema (DME) is a significant cause of vision impairment, posing challenges in its management due to variable responses and patient diversity. While anti-vascular endothelial growth factor (anti-VEGF) agents have revolutionized DME treatment, some patients are not suitable candidates for this therapy. Intravitreal corticosteroid therapy, such as the dexamethasone implant (DEX), has emerged as an alternative. This study aimed to comprehensively investigate the role of intravitreal DEX in treatment-naive DME patients with systemic contraindications to anti-VEGF therapy, administered one month before cataract surgery. Patients and Methods: A single-center retrospective study included 20 eyes with controlled diabetes, visually significant cataracts, untreated DME, and systemic contraindications for anti-VEGF therapy. Patients underwent DEX treatment followed by cataract surgery after one month. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were assessed at multiple time points. Results: BCVA significantly improved on days 30, 90, and 180 post-DEX (P< 0.00001). CMT showed a significant decrease at day 30 (P< 0.00001), which was sustained through days 90 and 180 (P< 0.00001). Recurrent DME was observed in 25% of eyes on day 90. IOP increased significantly at days 30 (P< 0.00001) and 90 (P=0.0006), returning to baseline by day 180. However, only two eyes needed topical anti-glaucoma treatment. No other ocular or systemic adverse events were noted. Conclusion: Intravitreal DEX administered one month before cataract surgery offers a promising treatment strategy for treatment-naive DME patients with systemic contraindications to anti-VEGF therapy. The study's findings provide insights into improving visual acuity and reducing macular thickness, along with manageable IOP changes. This personalized approach is a valuable addition to DME management, especially for complex medical cases, warranting further research and consideration for clinical practice. [ABSTRACT FROM AUTHOR]

Objective: This study aims to investigate whether advanced age is an absolute contraindication for radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC) through a single-center case series and a systematic review with meta-analysis. Materials and methods: In the single-center case series, 588 UTUC patients who underwent RNU between May 2003 and June 2019 in West China Hospital were enrolled, and cancer-specific survival (CSS) was the primary outcome of interest. In the systematic review with meta-analysis, PubMed, Scopus, Embase, and Cochrane databases were systematically searched for related articles for further analysis. The endpoints for meta-analyses were overall survival (OS) and CSS. Results: The single-center case series included 57 (9.7%) octogenarians. The CSS of octogenarians after RNU was comparable to that of younger people. Advanced age (≥80) was not an independent risk factor for poor CSS (HR, 1.08; 95% CI, 0.48, 2.40). In a systematic review with meta-analysis, the cut-off value of advanced age is 70, and the results showed that advanced age was associated with inferior OS (pooled HR, 1.55; 95% CI, 1.29, 2.01) and CSS (pooled HR, 1.37; 95% CI, 1.08, 1.65). However, the subgroup analysis of countries found no positive correlation between advanced age and CSS (pooled HR, 1.33; 95% CI 0.92, 1.74) in Chinese. Conclusions: Advanced age may no longer be an absolute contraindication for RNU. RNU can be safely and effectively performed on UTUC patients of advanced age after a comprehensive presurgical evaluation. [ABSTRACT FROM AUTHOR]

Copyright of Die Orthopädie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Whole-body electromyostimulation has proven to be a highly effective alternative to conventional resistance-type exercise training. However, due to adverse effects in the past, very extensive contraindications have been put in place for the commercial, non-medical WB-EMS market. Considering recent positive innovations e.g., federal regulation, mandatory trainer education, revised guidelines, and new scientific studies on WB-EMS application, we believe that a careful revision of the very restrictive contraindications on WB-EMS is needed. This applies all the more because many cohorts with limited options for conventional exercise have so far been excluded. During a first meeting of an evidence-based consensus process, stakeholders from various backgrounds (e.g., research, education, application) set the priorities for revising the contraindications. We decided to focus on four categories of absolute contraindications: “Arteriosclerosis, arterial circulation disorders”, “Diabetes mellitus” (DM), “Tumor and cancer” (TC), “Neurologic diseases, neuronal disorders, epilepsy”. Based on scientific studies, quality criteria, safety aspects and benefit/risk assessment of the category, DM and TC were moved to the relative contraindication catalogue, while arteriosclerosis/arterial circulation disorders and neurologic diseases/neuronal disorders/epilepsy were still considered as absolute contraindications. While missing evidence suggests maintaining the status of neurologic diseases/neuronal disorders as an absolute contraindication, the risk/benefit-ratio does not support the application of WB-EMS in people with arteriosclerosis/arterial circulation diseases. Despite these very cautious modifications, countries with less restrictive structures for non-medical WB-EMS should consider our approach critically before implementing the present revisions. Considering further the largely increased amount of WB-EMS trials we advice regular updates of the present contraindication list.

Abstract The monoclonal antibodies (mAbs) blocking the calcitonin-gene related peptide (CGRP) pathway, collectively called here “anti-CGRP/rec mAbs”, have dramatically improved preventive migraine treatment. Although their efficacy and tolerability were proven in a number of randomized controlled trials (RCTs) and, maybe even more convincingly, in real world settings, a number of open questions remain. In this narrative review, we will analyze published data allowing insight in some of the uncertainties related to the use of anti-CGRP/rec mAbs in clinical practice: their differential efficacy in migraine subtypes, outcome predictors, switching between molecules, use in children and adolescents, long-term treatment adherence and persistence, effect persistence after discontinuation, combined treatment with botulinum toxin or gepants, added-value and cost effectiveness, effectiveness in other headache types, and potential contraindications based on known physiological effects of CGRP. While recent studies have already provided hints for some of these questions, many of them will not find reliable and definitive answers before larger studies, registries or dedicated RCTs are available.