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Primary central nervous system lymphoma-ophthalmic variant (PCNSL-O) is an ocular subset of PCNSL predominantly involving subretinal pigment epithelium space, retina, and vitreous. The ophthalmic manifestations can precede, occur simultaneously, or follow other compartments of the CNS. Clinical trials have resulted in a significantly improved outcome in PCNSL patients over the past 2 decades, with a higher proportion of patients receiving frontline high dose methotrexate-based polychemotherapy regimens with curative intent; however, the current management of PCNSL-O remains controversial owing to lack of prospective data. The goals of PCNSL-O treatment are both to achieve local (ocular) control and to prevent tumor-specific mortality from further CNS involvement. Despite achieving high rates of ocular control with intravitreal agents like methotrexate and rituximab, the overall survival is poor, as 65-85% of patients eventually succumb to CNS disease. Few studies define the role of systemic chemotherapy with/without local treatment as a first line induction treatment for PCNSL-O considering limiting factors such as ocular penetration of systemically administered drugs and treatment related neurotoxicity. Also, the role of adjuvant treatment for PCNSL-O to prevent CNS progression and to improve overall survival is unknown. In this systematic review of the literature, we analyze treatment outcomes of various regimens (local, systemic, and combination) in terms of local control, CNS progression, and overall survival.

Purpose The small bites (SB) technique for closure of elective midline laparotomies (EMLs) and a prophylactic mesh (PM) in high-risk patients are suggested by the guidelines to prevent incisional hernias (IHs) and fascial dehiscence (FD). Our aim was to implement a protocol combining both the techniques and to analyze its outcomes. Methods Prospective data of all EMLs were collected for 2 years. Results were analyzed at 1 month and during follow-up. The incidence of HI and FD was compared by groups (M = Mesh vs. S = suture) and by subgroups depending on using SB. Results A lower number of FD appeared in the M group (OR 0.0692; 95% CI 0.008–0.56; P = 0.01) in 197 operations. After a mean follow-up of 29.23 months (N = 163; min. 6 months), with a lower frequency of IH in M group (OR 0.769; 95% CI 0.65–0.91; P P P P Conclusion Following the protocol using PM and SB showed a lower rate of FD and HI. A PM is safe and effective for the prevention of both HI and FD after MLE, regardless of the closure technique used.

Historically, outcomes reporting for radioembolization with yttrium-90 (90Y) of hepatocellular carcinoma has included patients across the range of Barcelona Clinic Liver Cancer (BCLC) stages. With the potential for curative radiation segmentectomy for BCLC 0/A patients and evolution of systemic therapy for BCLC C patients, focused review by group is of increasing interest. In this review, we report on efficacy of 90Y in patients with intermediate (BCLC B) and advanced (BCLC C) hepatocellular carcinoma as well as expected toxicities. Additionally, we review existing trials comparing 90Y to transarterial chemoembolization and systemic treatments in these patient groups and outline future studies.

Despite the growing knowledge on the (epi)genetic background of facioscapulohumeral muscular dystrophy (FSHD), the substantial variability in disease severity that exists between FSHD patients is not fully understood. We hypothesized that smoking and alcohol consumption are disease modifiers in FSHD and contribute to the variability in disease severity, because they are both associated with higher levels of oxidative stress in muscle tissue. Oxidative stress is known to influence FSHD muscle tissue. One hundred and ninety-eight genetically confirmed FSHD patients completed a questionnaire from which the number of packyears of smoking and the lifetime cumulative alcohol units consumed were calculated. Disease severity was determined by the FSDH evaluation score. Multiple linear regression analyses showed that both the number of packyears and the amount of alcohol consumption did not influence disease severity (respectively B = 0.025, ΔR2=0.006, p = 0.231; and B = 0.000, ΔR2=0.004, p = 0.406). Although smoking and excessive alcohol consumption are unhealthy habits which should be discouraged, these results show that smoking and alcohol consumption have no clinically meaningful modifying effect on disease severity in FSHD patients. However, prospective data should show whether alcohol consumption and smoking influence disease progression rate.

ObjectivesIt has been suggested that diffusion tensor imaging (DTI) measures sensitive to white matter (WM) damage may predict future dementia risk not only in cerebral small vessel disease (SVD), but also in mild cognitive impairment. To determine whether DTI measures were associated with cognition cross-sectionally and predicted future dementia risk across the full range of SVD severity, we established the International OPtimising mulTImodal MRI markers for use as surrogate markers in trials of Vascular Cognitive Impairment due to cerebrAl small vesseL disease collaboration which included six cohorts.MethodsAmong the six cohorts, prospective data with dementia incidences were available for three cohorts. The associations between six different DTI measures and cognition or dementia conversion were tested. The additional contribution to prediction of other MRI markers of SVD was also determined.ResultsThe DTI measure mean diffusivity (MD) median correlated with cognition in all cohorts, demonstrating the contribution of WM damage to cognition. Adding MD median significantly improved the model fit compared to the clinical risk model alone and further increased in all single-centre SVD cohorts when adding conventional MRI measures. Baseline MD median predicted dementia conversion. In a study with severe SVD (SCANS) change in MD median also predicted dementia conversion. The area under the curve was best when employing a multimodal MRI model using both DTI measures and other MRI measures.ConclusionsOur results support a central role for WM alterations in dementia pathogenesis in all cohorts. DTI measures such as MD median may be a useful clinical risk predictor. The contribution of other MRI markers varied according to disease severity.

Our study aims were to identify the frequency of continued play following sport-related concussion (SRC), defined as continuing athletic activity on the same day following a suspected SRC, characteristics associated with continued play, and whether continued play was associated with worse outcomes. A prospective study of participants ages 13-18 years diagnosed with SRC at a pediatric sports medicine clinic over a 4-year period was conducted. A comparison was performed between athletes who reported continued play following SRC (PLAY) and those who did not (NO PLAY). Of 441 participants, 231 (52.4%) were in the PLAY group. The PLAY group recalled less severe balance problems from the day of injury (p = 0.02), but reported greater symptoms of trouble falling asleep, concentrating, and remembering at their initial clinic visit (p

There is a lack of consensus regarding the superiority of the common free flaps for the reconstruction of circumferential pharyngeal defects.A systematic literature search was conducted to identify studies reporting the complications of circumferential pharyngeal reconstruction between 2005 and 2020. Anterolateral thigh free flaps (ALTFF), jejunal free flaps (JFF), and radial forearm free flaps (RFFF) were compared. Various complications were compared by meta-analysis. Primary endpoints were fistula and stricture rates.Forty studies were included (2230 patients). Stricture rate was similarly low with tubed ALTFF (13.3%, n = 36/270) and JFF (13.2%, n = 176/1334). Fistula rate was the lowest with JFF (9.2%, n = 58/634). ALTFF was associated with the lowest rates of partial and complete flap failure (3.8%, n = 6/157, and 2.8%, n = 5/178), infection (2.8%, n = 3/106), donor site morbidity (3.9%, n = 5/130), and mortality (0%, n = 0/101) within 30 days. A meta-analysis demonstrated that there was no statistically significant difference in stricture and fistula rates between ALTFF and JFF. Moreover, JFF was associated with a significantly lower fistula rate than that of RFFF (p 0.001). ALTFF was associated with a significantly lower infection rate than that of JFF (p = 0.013).The data suggest the use of ALTFF for circumferential pharyngeal defects. In the absence of randomized, prospective data, the authors hope the results presented can be used as an evidence-based reference.

Objective The COVID-19 pandemic has forced the cancellation of planned surgery and led to significant surgical service reductions. Early intervention in aortovascular disease is often critical and cannot be deferred despite these reductions. There is urgent need to evaluate the provision and outcomes of thoracic aortovascular intervention during the peak of the pandemic. Methods Prospective data was collected for patients receiving open and endovascular thoracic aortovascular intervention over two-time points; January-May 2020 and January-May 2019 at three tertiary cardiovascular centres. Baseline demographics, cardiovascular risk and COVID-19 screening results were noted. Primary outcomes were median length of intensive care unit and hospital stay, intra-operative mortality, 30-day mortality, post-operative stroke, and spinal cord injury. Results Patients operated in 2020 (41) had significantly higher median EuroSCORE II than 2019 (53) (7.44 vs. 5.86, P = 0.032) and rates of previous cardiac (19.5% vs. 3.8%, P = 0.019), aortic (14.6% vs. 1.9%, P = 0.041), and endovascular (22.0% vs. 3.8%, P = 0.009) intervention. There was an increase in proportion of urgent cases in 2020 (31.7% vs. 18.9%). There were no intra-operative deaths in 2020 and 1 in 2019 (P = 1.00). There were no significant differences (P ≥ 0.05) in 30-day mortality (4.9% vs. 13.2%), median intensive care unit length of stay (72 vs. 70 hr), median hospital length of stay (8 vs. 9 days), post-operative stroke (3 vs. 6), or spinal cord injury (2 vs. 1) between 2020 and 2019 respectively. Conclusions Despite the increased mortality risk of patients and urgency of cases during COVID-19, complicated by the introduction of cohorting and screening regimens, thoracic aortovascular intervention remained safe with comparable in outcomes to pre-COVID-19.

Objective To examine the effect of an obstetric hemorrhage (OBH) safety bundle on health outcomes and to explore nurses’ and physicians’ perceptions of using the bundle. Design Descriptive longitudinal study, including review of electronic health records for 79,509 births, and clinician surveys. Setting Nine hospitals in the southwestern United States. Participants 685 maternity nurses and 210 obstetricians. Interventions/Measurements Retrospective and prospective data collection over 3.5 years to examine selected health outcomes before and after implementing an OBH bundle. A 10-item questionnaire was used to survey clinicians for their perceptions of bundle use. The Hospital Survey on Patient Safety Culture was used to explore nurses’ views of the safety climate before and after bundle implementation. Results Statistically significant decreases in mean documented blood loss were observed with bundle use. Blood loss rates of less than 500 ml and greater than 1,000 ml increased, and blood loss rates of 500 to 1,000 ml decreased. Use of postpartum hemorrhage medications increased. When adjusted for multiple tests, there was no statistically significant difference in the rates of postpartum hysterectomies or ICU admissions or in length of stay. Clinicians’ perceptions of bundle use were positive, with scores ranging from 6 to 8 on a scale of 1 to 10. However, Hospital Survey on Patient Safety Culture results indicated a decrease in nurses’ perceptions of safety after bundle implementation. Conclusion OBH bundles provide tools and guidance to improve perinatal care and outcomes. Our findings of lower mean blood loss, increased use of postpartum hemorrhage medications, and positive perceptions of the bundle differed from findings of previous studies. Nurses’ perceptions of safety decreased, yet clinicians reported that care was safer with the OBH bundle. Nurses’ commitment and collaboration are vital to the success of bundle implementation.

Prospective data are limited regarding dynamic adulthood weight changes and hepatocellular carcinoma (HCC) risk. We included 77,238 women (1980–2012) and 48,026 men (1986–2012), who recalled young-adult weight [age 18 years (women); 21 years (men)], and provided biennially updated information regarding weight, body mass index (BMI), and comorbidities. Overall adulthood weight change was defined as the difference in weight (kilograms) between young-adulthood and present. Using Cox proportional hazards models, we calculated multivariable adjusted HRs (aHR) and 95% confidence intervals (CI). Over 3,676,549 person-years, we documented 158 incident HCC cases. Elevated HCC risk was observed with higher BMI in both young-adulthood and later-adulthood [continuous aHRs per each 1 unit = 1.05; 95% CI = 1.02–1.09 (Ptrend = 0.019), and 1.08; 95% CI = 1.06–1.10 (Ptrend = 0.004), respectively]. Moreover, overall adulthood weight gain was also significantly associated with increased HCC risk (aHR per each 1-kg increase = 1.03; 95% CI = 1.01–1.08; Ptrend = 0.010), including after further adjusting for young-adult BMI (Ptrend = 0.010) and later-adult BMI (Ptrend = 0.008). Compared with adults with stable weight (±5 kg), the multivariable-aHRs with weight gain of 5– Prevention Relevance: Our data suggest that maintaining a stable weight during adulthood, specifically by preventing weight gain, could represent an important public health strategy for the prevention of hepatocellular carcinoma.

Compliance with taking medication is a problematic patients who get polypharmacy prescribing, this is because of the many drugs that must be consumed. As a result of the consumption of many drugs that cause sufferers of degenerative diseases are not compliant to take medication and health awareness decreases. This is not only experienced in elderly and geriatric patients but in adulthood also experience non-compliance with taking medication due to the many activities, lazy to take medication and also forget. This study was conducted to analyze the effect of age on adherence to taking oral antidiabetic drugs and oral antihypertensive drugs using the pill count method at the Regional Hospital of South Surabaya. The Pill Count method was chosen in this study with the aim of analyzing patient compliance in taking medication by calculating the remaining drug based on the rules of use and dosage when the patient returns to control. In addition, this study also aims to determine the effect of age on patient compliance in taking oral antidiabetic drugs and oral antihypertensive drugs. This research is descriptive observational with prospective data collection. Data analysis used descriptive and continued with statistical analysis using Chi-Square. The results of this study that adherence to take medication for elderly patients who received oral antidiabetic drug therapy obtained as much as 96.7% and 90% in adult patients. Compliance to oral antihypertension drugs in adult patients are 90% and 83.3% in elderly patients. Age does not effect compliance patients with Chi-Square analysis with p value = 0,301 and 0,448 > 0.05.

espanolLa identificacion de los diferentes factores de riesgo cardiovascular y su tratamiento es la mejor estrategia para prevenir la morbimortalidad de la enfermedad cardiovascular (ECV). Las principales sociedades cientificas recomiendan la evaluacion del riesgo cardiovascular total del paciente, mas alla de la evaluacion dicotomica sobre la presencia o ausencia de determinados factores de riesgo. De esta forma, se presenta el riesgo del individuo de una forma continua, facilmente interpretable y transmisible al sujeto. El metodo recomendado para la valoracion del riesgo en nuestro medio es el sistema SCORE, propuesto por la Sociedad Europea de Cardiologia y en el que evalua el riesgo cardiovascular en base a los datos prospectivos de 12 estudios europeos con mas de 200000 pacientes. En base a este riesgo calculado de forma individual, se podra planificar el grado de intensidad y la necesidad de intervencion farmacologica en cada individuo. En este protocolo, se expondran las caracteristicas y peculiaridades del sistema SCORE, asi como su forma de uso. EnglishIdentifying the different cardiovascular risk factors and their treatment is the best strategy to prevent cardiovascular disease (CVD) morbidity and mortality. The main scientific societies recommend assessing the patient's total cardiovascular risk, beyond the dichotomous assessment of the presence or absence of certain risk factors. Thus, the individual's risk is presented in a continuous form, easily interpretable and conveyable to the subject. The SCORE system is the recommended method for risk assessment in our setting, proposed by the European Society of Cardiology, which evaluates cardiovascular risk based on prospective data from 12 European studies with more than 200,000 patients. Based on this individually calculated risk, the degree of intensity and the need for pharmacological intervention can be planned for each individual. We shall outline in this protocol the characteristics and peculiarities of the SCORE system, and how it is used.

BACKGROUND: Recently, hoarseness affecting the supraglottic structure has been reported in Kawasaki Disease. The objective of this study was to characterize the frequency of hoarseness in acute KD patients in Latin America. METHODS: We used prospective data from the multinational REKAMLATINA Network (Red de Enfermedad de Kawasaki en America Latina) a total of 865 patients from 20 countries were enrolled during the 3-year study period. Data on hoarseness was available in 858 (99.2%) patients. The clinical and laboratory characteristics between hoarse and non-hoarse KD were compared. RESULTS: Hoarseness was documented in 100 (11.6%) patients. Hoarse patients were younger compared to KD without hoarseness (median age 18 vs. 26 months; p=0.002) and presented with a lower hemoglobin (10.7g/dL vs 11.3g/dL; p= 0.040) and hematocrit levels (32% vs 33%, p=0.048) . CONCLUSIONS: Hoarseness was found to be prevalent as a presenting sign of acute KD in younger children. Anemia may indicate the presence of active inflammation.

Background: Melanoma and non-melanoma skin cancers (NMSC) are the overall most common type of malignancy. Despite this fact, the use of sunscreen as a primary preventative measure for skin cancer is not ubiquitous. Objective: To review the literature regarding efficacy and safety of sunscreens and to process and condense data into overarching principles to provide guidance to the general public and improve outcomes for melanoma NMSC. Methods: A systematic review of the literature pertaining to sunscreen efficacy in the primary prevention of melanoma and non-melanoma skin cancer, safety in humans and environmental impact was conducted. Following a thorough review of the literature, the Skin Cancer Prevention Working Group (SCPWG), an expert panel consisting of dermatologists with specialized training in melanoma and NMSC diagnosis and management, employed a modified Delphi technique to reach consensus over the development of statements regarding the current level of evidence for sunscreen efficacy and safety. Final statements were only adopted after achieving a supermajority vote >80%. Results: 96 articles were identified for further review and discussion. The SCPWG developed 7 consensus statements regarding the efficacy and safety of sunscreens and their role in the prevention of melanoma and NMSC. Conclusion: The proven benefits of primary skin cancer prevention outweigh the potential/hypothetical risks of sunscreen use, especially given insufficient real-world, prospective data for the discussed risks. As experts in skin health and skin cancer pathophysiology, the SCPWG believes dermatologists are uniquely qualified to lead future studies investigating sunscreen efficacy and safety and should counsel patients and the public on skin cancer primary prevention strategies.

Background The treatment of esophagogastric junction outflow obstruction (EGJOO) currently mirrors that of achalasia, but this is based on only a few studies on small case series. The aim of this prospective, controlled study was to assess the outcome of laparoscopic Heller-Dor (LHD) in patients with EGJOO, as compared with patients with esophageal achalasia. Materials and Methods Between 2016 and 2019, patients with manometric diagnosis of idiopathic EGJOO and patients with radiological stage I achalasia, both treated with LHD, were compared. The achalasia group was further analyzed by subgrouping the patients based on the manometric pattern. Treatment failure was defined as the persistence or reoccurrence of an Eckardt score > 3 or the need for retreatment. Results During the study period, 150 patients were enrolled: 25 patients had EGJOO and 125 had radiological stage I achalasia (25 pattern I, 74 pattern II, and 26 pattern III). The median follow-up was 24 months (IQR: 34–16). Treatment was successful in 96% of patients in the EGJOO group and in 96% of achalasia patients with pattern I, 98.7% in those with pattern II, and 96.2% of those with pattern III (p=0.50). High-resolution manometry showed a reduction in the LES resting pressure and integrated relaxation pressure for all patients in all 4 groups (p Conclusion This is the first comparative study based on prospective data collection to assess the outcome of LHD in patients with EGJOO. LHD emerged as an effective treatment for EGJOO, with an excellent success rate, comparable with the procedure’s efficacy in treating early-stage achalasia.

Background and study aims Adenoma detection rate (ADR) appears to decrease as the number of consecutive hours performing procedures increases, and eye strain may be a contributing factor. Ambient light may improve symptoms of eye strain, but its effects have yet to be explored in the field of gastroenterology. We aim to determine if using ambient lighting during screening colonoscopy will maintain ADRs and improve eye strain symptoms compared with low lighting. Methods At a single center, retrospective data were collected on colonoscopies performed under low lighting and compared to prospective data collected on colonoscopies with ambient lighting. Eye fatigue surveys were completed by gastroenterologists. Satisfaction surveys were completed by physicians and staff. Results Of 498 low light and 611 ambient light cases, 172 and 220 adenomas were detected, respectively (P = 0.611). Under low lighting, the ADR decreased 5.6 % from first to last case of the day (P = 0.2658). With ambient lighting, the ADR increased by 2.80 % (P = 0.5445). The difference in the overall change in ADR between first and last cases with ambient light versus low light was statistically significant (8.40 % total unit change, P = 0.01). The average eye strain scores were 8.12 with low light, and 5.63 with ambient light (P = 0.3341). Conclusions Performing screening colonoscopies with ambient light may improve the differential change in ADR that occurs from the beginning to the end of the day. This improvement in ADR may be related to improvement in operator fatigue. The effect of ambient light on eye strain is unclear. Further investigation is warranted on the impact of ambient light on symptoms of eye strain and ADR.

COVID-19 has had an unprecedented impact on society, global healthcare and daily life. The redeployment of research staff to patient-facing roles in the NHS left a depleted workforce to deliver critical urgent public health research (UPHR). We aimed to support UPHR studies and medical student training by developing and implementing a medical student Volunteers in Research programme. We further sought to gain insights about medical students’ perceptions of this programme. We collected prospective data and conducted a retrospective survey as part of a service evaluation to assess the value of this clinical research experience to students, as well as motivators and barriers to taking part. The Volunteers in Research programme successfully supported UPHR studies during the COVID-19 pandemic. We generated important insights to help aid the wider implementation of this programme nationally to support essential research and medical student education.

Purpose:A paradigm shift in the management of small renal masses has increased utilization of active surveillance. However, questions remain regarding safety and durability in younger patients.Mate...

Introduction : L'objectif de cette étude était d'étudier la morbidité des enfants de 0 à 59 mois à la Mutuelle DEMBA NYUMAN en commune VI du district de Bamako. Matériel et méthodes : Il s'agissait d'une étude transversale avec recueil des données prospectives allant du 1er Janvier au 31 Décembre 2018. Nous avons recensé 430 patients répondant aux critères d'inclusion. Résultats : Les enfants âgés de 12 à 23 mois étaient les plus représentés soit 23,7% avec une prépondérance féminine (50,2%), la majorité habitait à Niamakoro (76%). La diarrhée associée aux vomissements constituait le motif de consultation le plus fréquent (22,1%), suivi de la rhinorrhée accompagnée de la toux (18,8%). Le Test de diagnostic (TDR) du paludisme était l'examen complémentaire le plus demandé soit 58,50%. Les principales pathologies responsables de morbidité étaient : le paludisme (34,88%), les infections respiratoires hautes (14,65%), et les infections respiratoires basses (13,26%). Le schéma thérapeutique utilisé, parmi les enquêtés atteints de paludisme, 31,33% ont été traité par principalement atrhemeter+antibiotique+antipyrétique ; et ceux atteints de gastroentérite par du métronidazole + Cotrimoxazole + SRO (35,19%). Conclusion : la morbidité chez les enfants de 0 à 59 mois était dominée par deux des quatre morbidités les plus fréquentes chez les enfants de cette tranche d'âge ; à savoir le paludisme suivi des infections respiratoires.Mots clés : Mutuelle DEMBA NYUMAN, enfants de 0 à 59 mois, morbidité

BACKGROUND. Retroperitoneal soft tissue sarcomas comprise a heterogeneous group of rare tumors of mesenchymal origin that include several well-defined histologic subtypes. In 2015, the Transatlantic Australasian RPS Working Group (TARPSWG) published consensus recommendations for the best management of primary retroperitoneal sarcoma (RPS). Since then, through international collaboration, new evidence and knowledge have been generated, creating the need for an updated consensus document. METHODS. The primary aim of this study was to critically evaluate the current evidence and develop an up-to-date consensus document on the approach to these difficult tumors. The resulting document applies to primary RPS that is non-visceral in origin, with exclusion criteria as previously described. The relevant literature was evaluated and an international group of experts consulted to formulate consensus statements regarding the best management of primary RPS. A level of evidence and grade of recommendation were attributed to each new/updated recommendation. RESULTS. Management of primary RPS was considered from diagnosis to follow-up. This rare and complex malignancy is best managed by an experienced multidisciplinary team in a specialized referral center. The best chance of cure is at the time of primary presentation, and an individualized management plan should be made based on the 29 consensus statements included in this article, which were agreed upon by all of the authors. Whenever possible, patients should be enrolled in prospective trials and studies. CONCLUSIONS. Ongoing international collaboration is critical to expand upon current knowledge and further improve outcomes of patients with RPS. In addition, prospective data collection and participation in multi-institution trials are strongly encouraged.

Peng Qi,1 Xin Feng,2 Jun Lu,1 Junjie Wang,1 Shen Hu,1 Daming Wang2 1Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 2Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China; Graduate School of Peking Union Medical College, Beijing, People’s Republic of ChinaCorrespondence: Daming WangGraduate School of Peking Union Medical College, No. 9 Dongdansantiao, Dongcheng District, Beijing, 100730, People’s Republic of ChinaTel +86 10-85136281Fax +86 10-85132621Email daming2000@263.comObjective: It remains unclear whether irregular morphological features of intracranial aneurysms (IAs) are associated with atherosclerosis. We investigated the effect of cerebrovascular atherosclerosis stenosis (CAS) on irregular morphology of IAs.Patients and Methods: This single-center case-control study included consecutive patients with IAs at our institution from September 2011 to September 2018. Cases were patients with irregular IAs, and age- and location-matched controls were patients with regular IAs. Conditional logistic regression models were used to assess the relationship between angiographic variables of CAS and aneurysmal irregularity.Results: A total of 140 cases of irregular IAs and 140 controls were included in the analysis. Sixteen patients with irregular IAs (11.4%) and eleven patients with regular IAs (7.9%) had > 50% parent artery stenosis; however, the differences were not statistically significant between these two groups. In addition, no significant between-group differences were observed in distributions of the cerebrovascular stenosis, number of arterial stenoses, and location of the stenosis. In the final adjusted conditional logistic regression model, only aneurysm size (≥ 7 mm) was significantly associated with irregular IA morphology (P = 0.022). Moreover, 89 cases of irregular IAs and 89 controls were included in the analysis of unruptured IAs (UIAs). In the final adjusted conditional logistic regression model, only aneurysm size (≥ 7 mm) was significantly associated with irregular UIA morphology (P = 0.020).Conclusion: Our findings indicate that the morphological irregularity of unruptured intracranial aneurysms is more related with aneurysm size rather than cerebrovascular atherosclerosis. Further studies are needed to use prospective data to identify causative factors responsible for aneurysmal irregularity.Keywords: atherosclerotic stenosis, intracranial aneurysms, irregular morphology, risk factors, aneurysm size

Background Although early autism spectrum disorder (ASD) detection strategies tend to focus on differences at a point in time, behavioral symptom trajectories may also be informative. Methods Developmental trajectories of early signs of ASD were examined in younger siblings of children diagnosed with ASD (n = 499) and infants with no family history of ASD (n = 177). Participants were assessed using the Autism Observation Scale for Infants (AOSI) from 6 to 18 months. Diagnostic outcomes were determined at age 3 years blind to previous assessments. Results Semiparametric group-based modeling using AOSI scores identified three distinct trajectories: Group 1 ('Low', n = 435, 64.3%) was characterized by a low level and stable evolution of ASD signs, group 2 ('Intermediate', n = 180, 26.6%) had intermediate and stable levels, and group 3 ('Inclining', n = 61, 9.3%) had higher and progressively elevated levels of ASD signs. Among younger siblings, ASD rates at age 3 varied by trajectory of early signs and were highest in the Inclining group, membership in which was highly specific (94.5%) but poorly sensitive (28.5%) to ASD. Children with ASD assigned to the inclining trajectory had more severe symptoms at age 3, but developmental and adaptive functioning did not differ by trajectory membership. Conclusions These prospective data emphasize variable early-onset patterns and the importance of a multipronged approach to early surveillance and screening for ASD.

Ear lidding is a cosmetic outer ear shape deformity commonly observed in newborns. Although lidding is considered a benign condition, psychological concerns such as bullying and depression have been observed in older children supporting correction of the condition. Nonsurgical correction of lidding using molding and splinting techniques has become increasingly popular, achieving successful outcomes in the majority of cases. Spontaneous resolution of the condition has also been reported in the literature however there is minimal prospective data available on the natural progression of ear lidding. In our case series of 11 closely followed newborns, we aimed to characterize the natural progression and resolution of lidding. Ten consecutive newborns participated in the observation plan and all 10 had complete spontaneous resolution of lidding within an average of 40 days. One other newborn's parents self-selected to have molding and splinting treatment. These results suggest that cosmetic treatment for less severe cases of ear lidding may be unnecessary as they have the potential to resolve on their own. Future research in this area could include controlled study designs and more work is needed to identify, which infants will require treatment. Our study may provide helpful reassurance to families and physicians that many newborns may see complete resolution of lidding without intervention.

Purpose Assessing cochlear implant (CI)-associated patient outcomes is a focus of implant research. Most studies have analyzed outcomes retrospectively with low patient numbers and few measurement time points. In addition, standardized CI-specific health-related quality of life (HRQoL) instruments have not been used. To address this, we prospectively assessed HRQoL in patients before and after implantation. Methods We assessed HRQoL using the Nijmegen Cochlear Implant Questionnaire (NCIQ), Abbreviated Profile of Hearing Aid Benefit (APHAB), Hearing Participation Scale (HPS), and the Visual Analogue Scale (VAS) in 100 deaf or severely hearing-impaired patients (57 unilaterally deaf and 43 bilaterally deaf) before and 3, 6, and 12 months after cochlear implantation. We compared the results of unilaterally and bilaterally hearing-impaired patients and patients with or without a hearing aid. Principal component (PCA) and exploratory factor analyses (EFA) were also conducted. Results The NCIQ measured improvements in all 6 domains after CI and correlated well with other QoL instruments. The PCA revealed that the NCIQ can be better explained by physical, physical advanced, and socio-psychological components. The APHAB score ameliorated over time, except for the background noise domain. The overall HPS score improved over time, but the hearing handicap subscore significantly decreased. Sociodemographic influences on the questionnaire scores were relatively weak. Conclusion Assessing HRQoL is essential for quantifying the patient outcome after CI. NCIQ scores in our patient cohort showed improved HRQoL in all domains and we recommend that the NCIQ be used as a first-line questionnaire for assessing QoL in hearing-impaired patients after CI.

Transoral robotic surgery (TORS) has shown promising results in the treatment of myriad head and neck pathologies but is now most commonly used in the investigation and management of oropharyngeal squamous cell carcinoma. The aim of this study was to report our cases of the newly introduced TORS, particularly its role in identifying primary of unknown origin and the potential implications for patients. A literature review and our early experience should begin to debunk some of the criticisms of TORS including setup times and cost. Prospective data was collected from all patients undergoing transoral robotic surgery including demographics, indication, histology results in primary of unknown origin and complications. We have performed 36 TORS procedures in total ranging from intermediate to major complex. Our complication rate is low, and this has improved with the passage of time. Haemorrhage rates remain at 5.6% (n = 2), and the average length of stay is 1 day. Successful identification of a primary tumour in cancer of unknown primary was 80% (n = 8). We anticipate the integration of TORS into routine practice in the investigation and management of a number of ENT pathologies following robust clinical trials.

There is a paucity of prospective data related to surgeon ergonomics, which affects career longevity. Robotic surgical systems may mitigate pain and workload. We hypothesized that ergonomic outcomes would vary based on surgeon height and gender, and the relative benefit of robotic surgery would vary based on these demographics. Surgeons received questionnaires to fill out immediately before and after surgery to enable calculation of pain scores and task load. Surgeons who were ≤ 66 inches tall were considered “short”. Univariable and multivariable regression analyses were performed where appropriate using Stata-MP version 14.2 (StataCorp LLC, College Station, TX). There were 124 questionnaires given to 20 surgeons; 97 (78%) were returned, and 12 (12%) laparoscopic operations were excluded, leaving 85 (69%) questionnaires for further analysis: 33 (38%) from short surgeons, and 24 (28%) from women, for 30 (35%) robotic and 55 (65%) open operations. There were 44/85 (52%) surgeons who reported worse pain after surgery. Overall pain scores (1.1 ± 2.6 vs 1.5 ± 2.6, p = 0.70) were similar for robotic and open operations. In multivariable analysis, greater surgeon pain scores were significantly associated with short surgeons (p

This review provides an overview of current applications of deep learning methods within breast radiology. The diagnostic capabilities of deep learning in breast radiology continue to improve, giving rise to the prospect that these methods may be integrated not only into detection and classification of breast lesions, but also into areas such as risk estimation and prediction of tumor responses to therapy. Remaining challenges include limited availability of high-quality data with expert annotations and ground truth determinations, the need for further validation of initial results, and unresolved medicolegal considerations. KEY POINTS: • Deep learning (DL) continues to push the boundaries of what can be accomplished by artificial intelligence (AI) in breast imaging with distinct advantages over conventional computer-aided detection. • DL-based AI has the potential to augment the capabilities of breast radiologists by improving diagnostic accuracy, increasing efficiency, and supporting clinical decision-making through prediction of prognosis and therapeutic response. • Remaining challenges to DL implementation include a paucity of prospective data on DL utilization and yet unresolved medicolegal questions regarding increasing AI utilization.

Background Children with severe falciparum malaria in malaria-endemic regions are predisposed to developing life-threatening bacterial co-infection. International guidelines therefore recommend empirical broad-spectrum antibacterial therapy in these children. Few studies have examined co-infection in adults, although it has been believed to be relatively rare; antibacterial therapy is therefore not routinely recommended in adults with falciparum malaria. Discussion However, the fundamental pathophysiology of falciparum malaria in adults and children is the same; it is therefore unclear why adults would not also be predisposed to bacterial infection. Indeed, recent studies have identified bacteraemia in >10% of adults hospitalized with malaria. Some have suggested that these adults probably had bacterial sepsis, with the parasitaemia an incidental finding. However, it is usually impossible in resource-limited settings to determine–at presentation–whether critically ill, parasitaemic adults have severe malaria, bacterial sepsis, or both. Given the significant case-fatality rates of severe malaria and bacterial sepsis, the pragmatic initial approach would be to cover both possibilities. Conclusions Life-threatening bacterial co-infection may be more common in critically ill adults with malaria than previously believed. While further prospective data are awaited to confirm these findings, it might be more appropriate to provide empirical aantibacterial cover in these patients than current guidelines suggest.

Purpose: To provide real-world data on the world-wide-web for patient and doctor awareness. Methods: From December 2017 to January 2020, consecutive patients with choroidal melanoma (CM), iris ciliary body melanoma (ICM), and ocular surface squamous carcinoma (OSSC) had specific outcomes recorded at each return visit. Each result was anonymized, entered in an online portal, and sent to a unique software program where it was used to create real-world data of number of patients, mean vision, local tumor control, eye salvage, systemic metastases, and length of follow-up for our eye cancer center. Results: A HIPAA compliant, internet-based software program was developed and linked to public access web page to collect and analyze near-real-time data pertaining to the treatment, vision, life, and follow-up time of patients. During this period, CM radiation plaque tumor control was 99.7%, median vision 20/25 (mean 20/50) and eye salvage 95.8%. ICM tumor control was 99.1% and the median vision 20/20 (mean 20/20). OSSC tumor control was 100% and the most common vision was 20/20 (mean 20/25). Rates of primary enucleation as treatment were 4.2% for CM, 2.8% for ICM, and 0% for OSSC. All patient results were updated by the ophthalmic oncology fellow at each patient visit as to reflect near-real-time outcomes at our center. Conclusion: Prospective data collection of returning patients was found to be a simple method to reflect patient care outcomes. This method of reporting doctor outcomes offers a measure of transparency for patients and an opportunity to compare results with other clinical practices.

Objective: The purpose of this study was to assess the risk factors associated with seat presentation and to determine the maternal-fetal prognosis of delivery in the presentation of the seat. Materials and methods: This was a descriptive, cross-sectional and analytical case-control study with prospective data collection, from January 1, 2018 to December 31, 2019, a 12-month period at Kayes Hospital, Mali. Results: During our study period we recorded 3820 deliveries, including 120 breos; a frequency of 3.14% of all deliveries. The 20 - 35 age group was the most represented in cases 61.7%. Of the cases 66.7% (n-80) were out of school, we note 75.8% (n-182) of out-of-school controls. Primiparaes were the majority among cases 39.2% (n-47), as were 39.1% of the controls (n-118). The cases had a history of caesarean section at 15% (n-18); 13, 3% (n-32). The most common mode of presentation was the 70% decomplete seat. It was mainly the anterior left sacro iliac variety (85.8%). The low pathway was preferred during these deliveries to 70% against 30% of caesarean section of which 28.3% of cases were carried out in an emergency. Several factors such as delivery pathway, mode of presentation, length of expulsion and obstetric manoeuvres used influenced fetal prognosis. Fetal complications were dominated by acute fetal suffering (15.8%), followed by dislocation of the shoulder (0.8%). The most common morbid maternal complications were soft part tears (15 cases or 12.5%) and parietal suppuration (1 case or 0.8%). We did not record any maternal deaths. Conclusion: Our results confirm that childbirth is a risky delivery, and must require careful selection of eligible cases and rigorous management of labour with trained teams. In these circumstances, it seems totally abusive to advocate as a single mode of delivery caesarean section in all presentations of the chair in the primigestes.

INTRODUCTION Data describing contemporary profile of infective endocarditis (IE) in the Czech Republic are lacking. The aim of this study was to describe the current profile and outcomes of IE patients. METHODS Prospectively collected data on consecutive patients admitted for IE diagnosis between April 2016 and March 2018 to 11 main tertiary care cardiac centers in the Czech Republic were used for this analysis. RESULTS Among 208 patients, 88 patients (42.3 %) had native valve IE (NVIE), 56 patients (26.9 %) had prosthetic valve IE (PVIE), and 57 patients (27.4 %) had intracardiac device-related IE (CDRIE). The mean age was 61.66±15.54 years. Staphylococcus aureus was the most common etiological agent of IE (27.4 %), whereas Culture negative IE was present in 26.4 % patients. Surgery was performed during hospitalization in 112 (53.8 %) patients. In-hospital death occurred in 21.2 % patients, while 1-year mortality was 40.3 %. In patients, who had an indication for surgery, but the procedure was not performed, mortality was significantly higher (p=0.002). CONCLUSION High proportion of culture negative IE and IE related to artificial intra-cardiac materials calls for action. Furthermore, we show that cardiac surgery should be more often contemplated, especially in the presence of risk factors as septic shock and congestive heart failure (Tab. 6, Fig. 1, Ref. 32).

Objective To evaluate the feasibility in children of an intensive prospective data monitoring methodology for identifying precipitating conditions for migraine occurrence. Background Migraine headaches are a common pain condition in childhood and can become increasingly chronic and disabling with repeated episodes. Identifying conditions that forecast when a child's migraine is likely to occur may facilitate next-generation adaptive treatments to prevent future migraine attacks. Methods In this cohort study of a sample of 30 youth (ages 10-17) with migraine recruited through a pediatric headache clinic, smartphones supplemented with wearable biosensors were used over a period of 28 days to collect contextual data thought to be potentially relevant to headache occurrence. Self-reported data on headache occurrence, lifestyle, and perceptions of the environment were collected in 4 epochs per day using custom real-time reporting software. Data derived from the wearable biosensor included information on autonomic arousal and physical activity. Built-in sensors on participants' own phones also were used to indicate location and to quantify the sensory environment (e.g., ambient noise and light levels). Data fidelity was monitored to evaluate feasibility of the methods, and participant acceptability was assessed via an end-of-study survey. Results Self-report data were obtained on a mean of 88.9% (24.9/28) of assigned days (SD = 22.4%) and at a mean of 68.9% (77.2/112) of assigned moments (SD = 24.5%). Data from the wearable biosensor were obtained for a mean of 18.7 hours per day worn (SD = 2.3 hours), with participants on average wearing the sensor on 20.3 days (SD = 9.9). Fidelity of obtaining objective data from phone sensors on the sensory environment and other environmental conditions was highly variable, with these data obtainable from 5 to 22/30 (16.7%-73.3%) of participants' own phones. Most participants (63.3%-100%) responded with at least "somewhat agree" to questions about acceptability of the study methods. However, 5 to 7/30 (16.7%-23.3%) patients indicated difficulties with burden and remembering to wear the sensor. Almost all participants (29/30, 96.7%) agreed that they would want information about when a migraine might occur. Conclusions A contemporary data sampling approach comprising ambulatory sensors and real-time reporting appears to be acceptable to most youth with migraine in this study. Reliability of acquiring some data sources from participants' own phones, however, was suboptimal. Further refining these data sampling methods may enable a novel means of predicting and preventing recurrences of migraine episodes in youth.

Background The association of treatment volume and oncological outcome of rectal cancer patients undergoing multidisciplinary treatment is subject of an ongoing debate. Prospective data on long-term local control and overall survival (OS) are not available so far. This study investigated the long-term influence of hospital and surgeon volume on local recurrence (LR) and OS in patients with locally advanced rectal cancers. Methods In a post-hoc analysis of the randomized phase III CAO/ARO/AIO-94 trial after a follow-up of more than 10 years, 799 patients with stage II/III rectal cancers were evaluated. LR-rates and OS were stratified by hospital recruitment volume (≤20 vs. 21–90 vs. >90 patients) and by surgeon volume (≤10 vs. 11–50 vs. >50 procedures). Results Patients treated in high-volume hospitals had a longer OS than those treated in hospitals with medium or low treatment volume (p = 0.03). The surgeon volume was adversely associated with LR (p = 0.01) but had no influence on overall survival. The positive effect of neoadjuvant chemoradiation (CRT) on local control was the strongest in patients being operated by medium-volume surgeons, less in patients being operated by high-volume surgeons and missing in those being operated by low-volume surgeons. Conclusions Patients with locally advanced rectal cancers might benefit from treatment in specialized high-volume hospitals. In particular, the surgeon volume had significant influence on long-term local tumour control. The effect of neoadjuvant CRT on local tumour control may likewise depend on the surgeon volume.

Background and Objectives: Large-scale prospective case series of tapentadol abuse or dependence in India is not available. Hence, we aimed to study the prevalence and profile of tapentadol users in a treatment-seeking population. Materials and Methods: The study had prospective and retrospective arms. We collected 8-month prospective data by face-to-face interviews (n = 70) and 8-year retrospective data from case notes (n = 26) with either tapentadol misuse/abuse or dependence in patients attending a de-addiction center. Results: The prevalence of tapentadol abuse or dependence was 25% among the pharmaceutical opioid users. Concurrent use of other opioids was seen in >80% of participants of both the arms. Major sources of tapentadol were chemists (without a prescription) (53%) and doctors (prescriptions) (40%). Patients in the tapentadol dependence group had a significantly higher dose, duration, and pharmaceutical opioid use. Conclusion: India needs awareness promotion, training, availability restriction, and provision of treatment for tapentadol abuse or dependence.

ObjectiveThis study aimed to evaluate surgical and functional outcomes, in a tertiary referral centre, of two different types of semi-implantable transcutaneous bone conduction devices.MethodThis study involved prospective data collection and review of patients implanted between November 2014 and December 2016. Glasgow Hearing Aid Inventory (Glasgow Hearing Aid Benefit Profile or Glasgow Hearing Aid Difference Profile) and Client Oriented Scale of Improvement were completed where appropriate. Surgical and audiological outcomes were recorded in the surgical notes.ResultsGlasgow Hearing Aid Difference Profile and Glasgow Hearing Aid Benefit Profile showed similar mean score in the active and the passive transcutaneous bone conduction devices. Client Oriented Scale of Improvement showed improvements in listening situations. Post-operative speech reception threshold showed better mean threshold in the active transcutaneous bone conduction devices group when compared with the passive transcutaneous bone conduction devices group. No device failures or surgical complications existed in either group, with the surgical time being less in the passive transcutaneous bone conduction devices group.ConclusionBoth devices are reliable semi-implantable transcutaneous bone conduction devices with excellent surgical and functional outcomes and patient satisfaction. Overall surgical time was much less in the passive transcutaneous bone conduction devices group with no necessity for pre-planning. This is much easier to remove with the possibility of conversion to other devices in the manufacturer’s portfolio and wide-ranging wireless accessories. Further studies are needed to assess the longer-term results in a bigger population.

Recent reports have suggested that there may be dermatologic manifestations of COVID-19. We searched 12 databases for peer-reviewed or pre-print published studies until July 15, 2020, for this PRISMA-compliant review (CRD42020182050). We used the Oxford Center for Evidence-Based Medicine Levels of Evidence to facilitate data synthesis. From 86 retrieved studies, we collated data on 2,560 patients with dermatologic manifestations of COVID-19. The most common findings were chilblains/pernio-like lesion (51.5%), erythematous maculopapular rashes (13.3%), and viral exanthem (7.7%). Average pediatric age was 12.9 years (SD 3.6) and adult was 34.2 years (SD 21.8). Average latency from time of upper respiratory illness symptoms to cutaneous findings was 1.5 days (SD 2.9) in children and 7.9 days (SD 10.7) in adults, ranging from -3 to 38 days. Roughly one-tenth in both populations were otherwise asymptomatic or presented with only skin findings for the entirety of the disease course; 13.3% (pediatrics) and 5.3% (adults) presented with skin issues first. Dermatologic findings may play an important role in identifying cases early and serve as an important proxy to manage spread. Further prospective data collection with international prospective registries is needed.

Endoluminal stenting serves as an essential tool in the gastroenterologist's arsenal to manage perforations, leaks, fistulas, and both benign and malignant strictures; however, the heterogeneity of stent design, indication, and location renders comprehensive and systemic comparison of their efficacy a perennial challenge, despite their widespread use. Appraisal of their associated risks faces similar obstacles. Given the lack of robust, randomized, prospective data, understanding the complications of stents, as well as prevention and management of these complications, becomes all the more critical for those who use stents and/or manage patients with these important therapeutic devices. Here, we present a review of the literature—primarily through the lens of esophageal stents—to describe strategies for mitigating and resolving 3 major stent-related adverse events: stent migration, stent in-growth, and respiratory-esophageal fistula formation.

Breast cancer patients receive treatment recommendations from multidisciplinary tumour boards. To determine the consequences of patients’ refusal of such recommendations, we analysed the database of the Centre for Breast Cancer at the Ortenau Clinic in Offenburg, Germany. A total of 4315 patients with non-metastatic primary breast cancer, treated between 1997 and 2019, were analysed with descriptive analyses, Kaplan–Meier survival analyses, and Cox regression analyses regarding the effects of their refusal. About 10.7% of the patients rejected the treatment advice. These were significantly elderly (F = 74.4; p

BackgroundUnintentional falls from windows and balconies pose a serious health risk to children. Limited Canadian data describing such falls currently exist. This study aimed to describe the frequency, demographic characteristics, injury patterns, and risk factors associated with paediatric falls from windows and balconies.MethodsThis study employed both prospective data collection and retrospective medical record review. Prospectively, consenting families were enrolled from February 2015 to February 2017; retrospectively, charts from January 2009 to December 2014 were reviewed. Children 0 to 16 years of age, who presented to the Stollery Children’s Hospital (Edmonton, Alberta) emergency department due to a fall from a window or balcony, were included.ResultsA total of 102 children were included; thirty were enrolled prospectively and 72 retrospectively. Median age was 4.5 years (interquartile range 2.83 to 6.83) with 63.7% (65 of 102) males. About 87.2% (89 of 102) of falls were from windows and 12.8% (13 of 102) from balconies. The median estimated height of fall was 4.1 m (interquartile range 3.04 to 4.73). About 58.4% (59 of 101) had at least one major injury (i.e., concussion, fractured skull, internal injury, fractured limb, severe laceration), 36.6% had minor injuries only (i.e., abrasions, contusions, sprains), and 5.0% had no documented injuries. There were no fatalities. About 30.4% (31 of 102) were admitted, with 48.4% of these children (15 of 31) requiring surgery.ConclusionMost falls from windows and balconies occurred in children under the age of 5 years and were associated with serious morbidity, high admission rates, and need for surgery. Child supervision as well as installation of key safety features in windows may help minimize paediatric fall-related injuries.

Purpose of review The traditional approach to sepsis treatment utilizes broad-spectrum antibiotics. Unfortunately, a significant proportion of infected patients have 'culture-negative' sepsis despite appropriate microbiologic assessment. Recent findings There has been increased interest in the past decade on the treatment of culture-negative sepsis. Outcome data comparing culture-negative sepsis with culture-positive sepsis are mixed and it is unclear if culture-negative sepsis is a distinct entity. Recent recommendations promoting antibiotic de-escalation in culture-negative sepsis can be difficult to implement. A variety of strategies have been suggested for limiting antibiotic courses among patients with negative cultures, including limiting antibiotic durations, use of antibiotic stewardship programs, early consideration of narrow antibiotics, rapid diagnostic technology, and eliminating anti-MRSA therapy based on surveillance swabs. Summary Owing to the difficulty inherent in studying the lack of positive data, and to the uncertainty surrounding diagnosis in patients with culture-negative sepsis, prospective data to guide antibiotic choices are lacking. However, antibiotic de-escalation in culture-negative sepsis is both recommended and feasible in patients showing clinical signs of improvement. Increased use of rapid diagnostics, careful consideration of antibiotic necessity, and antibiotic stewardship programs may result in less antibiotic days and better outcomes.

Neurogenic sphincter dysfunction in females will be discussed with reference to both foundational and contemporary research with an emphasis on tools for urologic management. The article will focus on both conservative and surgical options for patients broadly characterized with underactive or overactive sphincter dysfunction. There is limited recently published prospective data to guide management; however, there exist several insightful retrospective studies to guide practice. The bulk of literature for the management of sphincter dysfunction for this complex patient population remains retrospective, and choice of intervention continues to rely upon individual patient characteristics and goals of care to maintain safety and quality of life.

BACKGROUND: The Royal College of Ophthalmologists (RCOphth) recently produced new guidelines for the screening of hydroxychloroquine (HCQ) retinopathy. New imaging techniques have suggested an increased prevalence of retinopathy (7.5%) compared with previous studies (0.5%). METHODS: We collected prospective data from all patients referred to Sunderland Eye Infirmary, Sunderland for HCQ screening. Patients were screened according to RCOphth guidelines. In addition to retinal images, the data recorded included visual acuity, visual fields and multifocal electroretinography as appropriate, the patient’s age, diagnosis, weight, renal function and use of tamoxifen. RESULTS: Of the 678 patients screened, 333 were categorised to be at risk (251 patients had been on HCQ >5 years, 117 had an estimated glomerular function rate 5 mg/kg/day). Eighty patients had multiple risk factors, 31 had been on doses of >5 mg/kg/day for >5 years. One hundred and sixty-eight of these patients have now been screened twice. The prevalence of HCQ retinopathy was 2/678 (0.3%) of all screened, 2/333 (0.6%) of patients at risk. CONCLUSIONS: Our results show a far lower rate of retinopathy compared to the widely reported figure taken as standard by the RCOphth. This may be multifactorial: this prospective analysis has fewer patients taking higher doses of HCQ and shorter follow up, the comparison of serial images may highlight more cases and in addition, there are significant numbers of patients yet to be referred. Finally, the RCOphth’s diagnostic criteria is more exacting than that of the recent literature.

INTRODUCTION: Radial Neck fractures are rare injuries in children. There is controversy surrounding their prognosis and management. AIMS: This review aims to produce an up-to-date summary to clarify prognostic factors and management principles, in the light of recent, better-quality evidence. METHODS: A systematic review was undertaken in accordance to PRISMA guidelines, applying pre-defined selection criteria. 6 papers were found suitable after quality assessment. All were observational cohort studies, one prospective and the rest retrospective. A semi-qualitative review was undertaken as heterogeneity, especially in the fracture classification and outcome assessment tools used, prevented quantitative synthesis. RESULTS: Majority of these fractures occur at the metaphysis. Consistently good results are seen with simple immobilization in fractures angulated

Significance: Toxic epidermal necrolysis (TEN) and Steven–Johnson syndrome (SJS) are potentially fatal acute mucocutaneous vesiculobullous disorders. Evidence to date suggests that outcomes for patients with both TEN and SJS are largely dependent on stopping the causative agent, followed by supportive care and appropriate wound management in a specialized burns unit. These are life-threatening conditions characterized by widespread full-thickness cutaneous and mucosal necrosis. This article outlines the approach to holistic management of such patients, in a specialized unit, highlighting various practical aspects of wound care to prevent complications such as infection, mucosal and adhesions, and ocular scaring. Recent Advances: There is improved understanding of pain and morbidity with regard to the type and frequency of dressing changes. More modern dressings, such as nanocrystalline, are currently favored as they may be kept in situ for longer periods. The most recent evidence on systemic agents, such as corticosteroids and cyclosporine, and novel treatments, are also discussed. Critical Issues: Following cessation of the culprit trigger, management in a specialized burns unit is the most important management step. It is now understood that a multidisciplinary team is essential in the care of these patients. Following admission of such patients, dermatology, ear, nose, and throat surgery, ophthalmology, urology, colorectal surgery, and gynecology should all be consulted to prevent disease sequelae. Future Directions: Looking forward, research is aimed at achieving prospective data on the efficacy of systemic immunomodulating agents and dressing types. Tertiary centers with burns units should develop policies for such patients to ensure that the relevant teams are consulted promptly to avoid mucocutaneous complications.

Remdesivir is a nucleoside antiviral recently studied in several randomized trials for treatment of COVID-19. The available observational and prospective data are conflicting, requiring clinicians to critically evaluate and reconcile results to determine patient populations that may optimally benefit from remdesivir therapy, especially while drug supply is scarce. In this review, we analyze pertinent clinical remdesivir data for patients with COVID-19 from January 1, 2020, through May 31, 2020.

Aim. To create a calculator for the annual personalised risk assessment of adverse cardiovascular events in patients after acute ST-segment elevation myocardial infarction (STEMI).Materials and Methods. Here we performed a prospective data analysis of 1,000 patients diagnosed with STEMI during 2017 and 2018 and admitted to Regional Vascular Center. For evaluating the risk of adverse cardiovascular events after STEMI, we applied the GRACE scale. After 1 year of follow-up, the predicted outcomes were compared with the actual outcomes. We then created a personalised calculator of unfavorable outcome by using logistic regression.Results. The calculator included six indicators that significantly correlated with outcomes and poorly correlated with each other: left ventricular ejection fraction (LVEF) < 40%, anterior STEMI, tachycardia upon admission, fasting blood glucose, high-sensitive C-reactive protein (CRP), and patient age.Conclusion. We found a high reliability of our calculator for the annual personalised prognosis of adverse outcome in patients after STEMI.

Striving to avoid inferiority, fear of compassion from others, and self-criticism are all factors that have been linked to increased depressive symptoms. However, less is known about the mechanisms of their relationship with depression, and even less about their relationship and potential interaction with each other. This study aimed to investigate the potential moderating role of fear of compassion on the relationship between self-criticism and depression, and insecure striving and depression. A longitudinal survey design with non-probability sampling was employed. Participants were surveyed at two time points (time 1 and time 2) separated by a 2-week interval. Participants completed measures of depressive symptoms, self-criticism, insecure striving, and fear of compassion from others. The final sample was comprised of 93 individuals aged 19 to 60 years (M = 29.86, SD = 10.87). Using prospective data, this study replicated previous cross-sectional findings that high fear of compassion strengthens the relationship between self-criticism and depression. Fear of compassion was also found to be a significant moderator of the relationship between insecure striving at time 1 and depression at time 2, with low fear of compassion strengthening the relationship between insecure striving and depression. These findings may have important implications for how we understand and treat depression. They suggest that targeting both an individual’s fear of, and ability to effectively communicate needs for, compassion from others may be important in reducing depressive symptoms, particularly in individuals who are high in self-criticism and insecure striving beliefs.

Laximeters were designed to diagnose an anterior cruciate ligament (ACL) deficient knee, but their use has now focused on providing an objective assessment of the anterior translation (AT) of an intact and ACL-reconstructed knee. In this study we report the introduction and direct comparison of an automated and computerized AT measurement device, GNRB, with the device previously established by the institute and as the current literature standard, the KT1000. A prospective data collection was commenced upon introduction of the GNRB. The measurements of AT in each patient were performed by the same investigator with each device using 134 N applied to both knees, giving a side-to-side difference. The investigators were a sport scientist, a biomechanical engineer and a physiotherapist. Increased AT was defined as a difference > 3 mm. Three investigators performed the measurements in 122 patients, 9.8 (± 1.8) months after ACL reconstruction. Mean AT of the healthy knee was 5.7 mm with KT1000 and 4.4 mm with GNRB (p = 0.002). Mean AT of the ACL reconstructed knee was 7.0 mm with the KT1000 and 5.3 mm with the GNRB (p = 0.037). The KT1000 had a higher variance of results than the GNRB (p

Prospective data on infections in systemic lupus erythematosus (SLE) from India are scarce. We studied the frequency and predictors of infections in hospitalized SLE patients. All data on infections were prospectively recorded. During the study period, 212 SLE patients (91% women) were hospitalised. Sixty-three (29.7%) had infections. The most common infections were pneumonia, skin and soft-tissue infections and urinary-tract infections. Mortality was higher in the infection group compared to the no infection group (11.1% vs. 0.7%; p=0.01). At three months, 10/63 developed another episode of infection. On logistic regression, the predictors of infection were fever [odds ratio (OR) = 4.17], vasculitis (OR = 2.64), thrombocytopaenia (OR = 3.59), presence of co-morbidities (OR = 3.59) and duration of hospital stay >11 days (OR = 3.55); p

Background This is a report on percutaneous closure of patent ductus arteriosus (PDA) using Amplatzer Duct Occluder type two additional sizes (ADO II AS) in patients under 6 kg. Methods Prospective data were collected and a review of Patients' records was conducted. Demographics, and angiographic and clinical outcomes are reported in this article. Results During the period June 2011 to June 2017, of the 92 patients who underwent closure of the PDA using the ADO II AS device, 59 were under 6 kg. The median weight of the cohort at closure was 3.6 kg (range: 900 g - 5.8 kg). The median ductal diameter was 1.9 mm (range: 1.0-3.4 mm). Three embolisations in the cohort were all retrieved percutaneously. Two PDAs were closed percutaneously and one surgically. Four premature infants required blood transfusions. The closure rate was 96.6% before discharge. Conclusions PDA closure using ADO II AS in small infants is feasible, effective and has few complications.