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Living donor kidney transplantation is the best type of renal replacement therapy for patients with end-stage renal disease. Living kidney donors (LKDs) undergo an extensive evaluation before donating, and many potential LKDs are declined. This study aimed to define the reasons for the decline in LKD candidates referred to our center. We retrospectively analyzed clinical data of all potential LKDs evaluated between January 2001 and December 2021 at our institution,Western National Medical Center, Pediatric Hospital. Data were obtained by review of an electronic database. A total of 1332 potential LKDs were evaluated, 796 (59.7%) successfully donated; 20 (1.5%) had a complete evaluation, were accepted for donation, and were on the waiting list for intervention; 56 (4.2%) continued in the evaluation process; 200 (15%) were discharged from the program due to administrative aspects, death (donor or receptor), or cadaveric renal transplantation in order of frequency; 56 (4.2%) withdraw by personal choice; and 204 (15.3%) were rejected for donation. Donor-related reasons included medical contraindications (n = 134, 65.7%), anatomic contraindications (n = 38, 18.6%), immunologic barriers (n = 18, 8.8%), and psychological reasons (n = 11, 5.4%). Despite the large number of potential LKDs, a significant proportion did not proceed for donation for different reasons; in our description, it represents 40.3%. The largest proportion is because of donor-related causes, and most of the reasons result from the candidate's unnoticed chronic diseases. [ABSTRACT FROM AUTHOR]

Purpose: Infections induced by multidrug-resistant (MDR) pathogens are one of the most common and serious complications in extracorporeal membrane oxygenation (ECMO) patients. However, there is currently little research about "ECMO and MDR bacteria". The purpose of our study was to clarify the epidemiological characteristics of MDR bacteria and provide references for empiric antibiotic treatments according to the drug susceptibility tests for ECMO patients.Patients and Methods: There were 104 patients admitted to our department and receiving ECMO treatments between January 2014 and December 2022. Altogether, 61 veno-arterial ECMO (VA-ECMO) and 29 veno-venous ECMO (VV-ECMO) patients enrolled. The data on other intensive care unit (ICU) patients in our department in the same period are summarized.Results: A total of 82 MDR bacteria were detected from ECMO patients, and most of these were MDR Gram-negative bacteria (MDR-GNB). There were also 5559 MDR-GNB collected from other patients in our department in the same period. We found that the distribution of MDR-GNB in ECMO patients was different from other critical patients. The proportion of Klebsiella pneumoniae (MDR-KP) in VV-ECMO patients was higher than other critical patients (35.1% and 21.3%, respectively). Moreover, the proportions of MDR Acinetobacter baumannii (MDR-AB) of VA-ECMO and VV-ECMO were higher than other critical patients (54.6%, 43.2% and 30.5%, respectively). In addition, MDR-AB and MDR-KP in ECMO patients exhibited higher percentages of drug resistance to possibly appropriate antibiotics for other critical patients, but showed better sensitivity to colistin.Conclusion: Infections induced by MDR-GNB in ECMO patients were serious and exhibited higher degrees of drug resistance compared with other ICU patients. Colistin might be an option to consider if there is no medical contraindication. However, widespread use of broad spectrum antibiotics is something that should be discouraged, and alternative options are being explored. [ABSTRACT FROM AUTHOR]

Introduction: Exercise is a bodily activity that improves or maintains physical fitness and overall health and wellness exercise during pregnancy is important and can help with some common discomforts of pregnancy and even help prepare the pregnant women body for labor and delivery, (6) Objective: To study the pregnant women knowledge regarding exercise during pregnancy. Methods This is a descriptive cross sectional hospital base study which was carried out in military hospital in Khartoum state -- Sudan, the data were collected by structured questionnaire and analyzed using the statistical program for social sciences (SPSS) version 21Convenient sampling technique was used and the samples were 70 pregnant women. The knowledge is categorized good (>60%), Moderate (50%-60%), poor (< 50%). A statistical significance was considered at p-value of < 0.05. Result: The study revealed that the total mean knowledge about type of exercise was (95.7%), walking was the most common exercise among the study sample, 90.0 believe that exercise during pregnancy facilitates normal delivery, and vaginal bleeding was considered as contraindication among (84.3%). factors influencing exercise during pregnancy (31.4%) said fear from complication is one of the factors influencing exercise during pregnancy The overall knowledge of pregnant women about exercise during pregnancy was poor (36.3%:). Conclusion: Nursing education is the major tasks of nursing profession. The study concluded that there is insufficient knowledge of pregnant women about exercise during pregnancy 52 (74.3%). Fallowed by no relation between educational level, age and knowledge about type of exercise, regarding benefits and contraindications to exercise during pregnancy (p. value < 0.05). so the study recommended to conduct more researches to enhance in increasing mother's knowledge about exercise during pregnancy. [ABSTRACT FROM AUTHOR]

Rehabilitation of endodontically treated molar still remains a controversial issue. Over the years, the use of postretained restorations has been questioned because of potential tooth weakening. Nowadays, endocrowns are considered as a reliable alternative technique to restore endodontically treated teeth with extensive coronal damage. This partial restoration requires specific preparation design and rigorous adhesion protocol. The present paper aimed to describe the preparation technique for endocrowns, indications, contraindications, and best material adapted for fabrication. This was illustrated through a clinical case to restore the first right mandibular molar by an endocrown fabricated from lithium disilicate-ceramic (IPS e-max CAD). [ABSTRACT FROM AUTHOR]

Purpose: It is known that electromagnetic fields and heat generated by shortwave diathermy (SWD) can have adverse effects on living tissue. The purpose of this research is to evaluate Jordanian physiotherapists' knowledge of pulsed and continuous SWD contraindications. And investigate the potential contraindications about which Jordanian physiotherapists may have limited knowledge. Subjects and Methods: This cross-sectional study investigates Jordanian physiotherapists' knowledge of SWD contraindications. In 38 private and public hospitals, a self-administered questionnaire survey was carried out. Participants were asked to classify 32 conditions as "always, sometime, or never" contraindicated or "I do not know". Participants are physiotherapists with two or more years of postgraduate experience. Two forms comprised the survey. The first consisted of assessing their reaction to the contraindications of pulsed shortwave diathermy (PSWD), while the second consisted of continuous shortwave diathermy (CSWD). Results: Approximately 270 physiotherapists were eligible to participate in this investigation. Only 150 questionnaires were distributed to the therapists who agreed to the study. One hundred twenty-eight were returned for an average response rate of 85.3% (128/150). Respondents had good agreement about using SWD for cardiovascular condition, however, 24 respondents (19%) thought PSWD can be used over venous thrombosis. Only 64% of the respondents was aware that pacemakers are contraindicated for PSWD. Approximately 14% to 32% seem unaware that tuberculosis and osteomyelitis are contraindicated for both CSWD and PSWD. About 21% to 28% have been unaware that the use of PSWD is contraindicated for specialized tissues (eg, eyes, gonads, or malignant tissues) and 29% during pregnancy. Conclusion: Jordanian physiotherapists generally agreed on the widely acknowledged contraindications of CSWD for specific conditions. However, there was considerable uncertainty among Jordanian physical therapists about the contraindications of PSWD. This discrepancy highlights the need to improve physiotherapist awareness and for more fact-based research to the contraindication of SWD modality. [ABSTRACT FROM AUTHOR]

Autologous ozonized blood transfusion(AOBT) is a therapy of re-transfusion of 100-200 mL of autologous blood after shaking and agitation with appropriate amount of oxygen-ozone in vitro. The oxidation of blood through the strong oxidation of ozone can enhance the non-specific immune response of the body, regulate the internal environment and promote health. This therapy has been increasingly applied in clinical practice, while no unified standard for the operation process in terms of ozone concentration, treatment frequency and treatment course had been established. This operation process of AOBT is primarily explored in order to standardize the operation process and ensure its safety and efficacy.

Recent studies have strongly confirmed the health benefits of a variety of probiotic microorganisms. However, some issues regarding the use of probiotics currently remain unresolved or ambiguous. This article highlights some controversial issues of probiotic use in clinical practice such as regulatory status of probiotics, co-administration of probiotics and antibiotics, potential impact of probiotics on antimicrobial resistance emergence and spread, dosing and duration of probiotic use, contraindications and some other debatable topics.

Background: Apical periodontitis as an endodontic diagnosis has attracted attention for the close relationship between the periodontal nature and the endodontic nature that this pathology represents. The appearance of pathology in periodontal tissues, but originating from the infected canal of the affected tooth, is caused by the passage of pulpal infection–inflammation products only between the apical foramen toward the periodontal tissues positioned at the exit of the tooth canal. Depending on the morphology of the canal, it can be one inflamed area, or several that form a whole, if the pulp has terminal branches, like "river delta," in its apical exit. The study aims to evaluate the clinical significance whether to treat or not with antibiotics of apical periodontitis. This study aims to look at this pathology from the perspective of the articles already published in the literature and after processing the conclusions of all the articles, come up with current recommendations on the treatment or not with antibiotics of the clinical cases presented with the pathology of the apical periodontium. Results: The classification of apical periodontitis occurs depending on the clinical signs visible with radiographs and the objective and subjective complaints of the patient. Regardless of subclassifications of apical periodontitis, the cause is bacteria or symbiosis of bacteria causing pulpitis, so as in any bacterial infection there is a tendency to treat them with antibiotics locally rather than in a systemic way, as long as the infection does not cause systemic symptoms such as fever, or massive swelling of the affected area. Short conclusion: From the analysis of the collected information, it is clear that the trend for treatment of apical periodontitis in the future does not lie in the application of antibiotics, but rather in irrigation solutions or the use of devices for the purpose of disinfecting the canal affected by the pathology. However, in no case is it indicated to eliminate the mechanochemical canal cleaning protocol before applying any type of treatment methodology. [ABSTRACT FROM AUTHOR]

Background: Sclerotherapy is a non-invasive procedure commonly used to treat superficial venous disease, vascular malformations and other ectatic vascular lesions. While extremely rare, sclerotherapy may be complicated by serious adverse events. Objectives: To categorise contraindications to sclerotherapy based on the available scientific evidence. Methods: An international, multi-disciplinary panel of phlebologists reviewed the available scientific evidence and developed consensus where evidence was lacking or limited. Results: Absolute Contraindications to sclerotherapy where the risk of harm would outweigh any benefits include known hypersensitivity to sclerosing agents; acute venous thromboembolism (VTE); severe neurological or cardiac adverse events complicating a previous sclerotherapy treatment; severe acute systemic illness or infection; and critical limb ischaemia. Relative Contraindications to sclerotherapy where the potential benefits of the proposed treatment would outweigh the risk of harm or the risks may be mitigated by other measures include pregnancy, postpartum and breastfeeding; hypercoagulable states with risk of VTE; risk of neurological adverse events; risk of cardiac adverse events and poorly controlled chronic systemic illness. Conditions and circumstances where Warnings and Precautions should be considered before proceeding with sclerotherapy include risk of cutaneous necrosis or cosmetic complications such as pigmentation and telangiectatic matting; intake of medications such as the oral contraceptive and other exogenous oestrogens, disulfiram and minocycline; and psychosocial factors and psychiatric comorbidities that may increase the risk of adverse events or compromise optimal treatment outcomes. Conclusions: Sclerotherapy can achieve safe clinical outcomes provided that (1) patient-related risk factors and in particular all material risks are (1a) adequately identified and the risk benefit ratio is clearly and openly discussed with treatment candidates within a reasonable timeframe prior to the actual procedure; (1b) when an individual is not a suitable candidate for the proposed intervention, conservative treatment options including the option of ' no intervention as a treatment option ' are discussed; (1c) complex cases are referred for treatment in controlled and standardised settings and by practitioners with more expertise in the field; (1d) only suitable individuals with no absolute contraindications or those with relative contraindications where the benefits outweigh the risks are offered intervention; (1e) if proceeding with intervention, appropriate prophylactic measures and other risk-mitigating strategies are adopted and appropriate follow-up is organised; and (2) procedure-related risk factors are minimised by ensuring the treating physicians (2a) have adequate training in general phlebology with additional training in duplex ultrasound, procedural phlebology and in particular sclerotherapy; (2b) maintain their knowledge and competency over time and (2c) review and optimise their treatment strategies and techniques on a regular basis to keep up with the ongoing progress in medical technology and contemporary scientific evidence. [ABSTRACT FROM AUTHOR]

In recent decades, concerns about safety of synthetic non-absorbable materials transvaginally implanted emerged. We aim to define the actual role of synthetic non-absorbable transvaginal mesh (TVM) for pelvic organ prolapse (POP) and mid-urethral sling (MUS) for stress urinary incontinence (SUI), in relation with the worldwide legislative evolution. While in the United Kingdom MUS is not considered the first-line surgical option, other countries adopt MUS as the main procedure. United States, United Kingdom, Australia, New Zealand, France banned or paused TVM use for POP repair. At the same time, Germany, Asian, and South American countries adopt TVM after adequate counseling for selected populations such as women affected by or at high risk of POP relapse and contraindication for other surgical routes. The worldwide evolution of recommendations determined deep modification of clinical practice, with native tissue repair returning to forefront when the vaginal route is indicated. A more careful evaluation of the safety and efficacy profile of meshes' materials and the assessment of the minimal surgeon's expertise in performing TVM procedures became crucial. A multidisciplinary approach and a high specialization of the hospitals both in performing mesh procedures and in managing complications are mandatory. [ABSTRACT FROM AUTHOR]

The article presents data on the most commonly used antiarrhythmic drugs of subclass IC: propafenone, flecainide, and a drug manufactured in Latvia — ethacizine. The features and priority areas of each drug use were identified. The author conducted a critical analysis of the results of Cardiac Arrhythmia Suppression Trials (CAST)-I and CAST-II and suggested ways to further study of subclass IC antiarrhythmic drugs in the context of current treatment strategies. The results of CAST-I and CAST-II should be interpreted in view of the heterogeneity of the subclass IC antiarrhythmic drugs and the fact that among the drugs of this subclass that are currently registered and approved for use in Ukraine, only flecainide was studied in CAST-I, and none of these drugs — in CAST-II. Ethacizine has a special position as a promising drug, especially effective in the treatment of vagus-induced heart rhythm disorders, with a small number of contraindications and drug interactions compared with propafenone and flecainide. Despite many years of use in several countries, this drug remains "invisible" to researchers around the world due to a limited number of international studies. The author draws attention to the need to re-evaluate antiarrhythmic drugs with an outdated evidence, in some cases quite limited, and to plan new experimental studies to clarify the possibility of subclass IC drugs to influence new pharmacological targets in arrhythmology, as well as large-scale well-planned studies of the safety and efficacy of subclass IC antiarrhythmic drugs in real present-day clinical practice. [ABSTRACT FROM AUTHOR]

The preoperative examination for refractive surgery is of extreme importance for ensuring optimal outcomes and preventing complications. Aim of this study was to point out the most common contraindications for refractive surgery, laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). The study included patients in the process of preoperative examination for refractive surgery who underwent complete standard ophthalmic examinations, as well as corneal topography and ocular biometry. Additional examinations were performed in cases of suspected specific ocular or systemic disease. Out of 1,238 patients (646 males and 592 females; mean age 32±10.4 years), refractive surgery was performed in 743 patients (60%), LASIK 367 (30%) and PRK in 376 patients (30%). Refractive surgery was contraindicated in 327 patients (26%) while 102 patients cancelled surgery. The most common reasons for not performing surgery were irregular cornea in 106 patients (32%), too steep or too flat corneal curvature in 71 patients (22%), insufficient corneal thickness in 62 patients (19%), high myopia in 28 patients (9%), high hyperopia in 19 patients (6%), dry eye in 13 patients (4%), incipient cataract in 10 patients (3%) and less common ocular and systemic diseases in 18 patients (6%). According to obtained results, irregular corneal topography, corneal curvature and insufficient corneal thickness are the most common reasons for not performing refractive surgery. [ABSTRACT FROM AUTHOR]

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Background: Increased lifespan and the improvement of medical treatment have given rise to research in reconstructive procedures in elderly patients. Higher postoperative complication rates, longer rehabilitation, and surgical difficulties remain a problem in the elderly. We asked whether a free flap in elderly patients is an indication or a contraindication and performed a retrospective, monocentric study. Methods: Patients were divided into two groups (YOUNG 0–59 years; OLD > 60 years). The endpoint was the survival of flaps and their dependence on patient- and surgery-specific parameters using multivariate analysis. Results: A total of 110 patients (OLD n = 59) underwent 129 flaps. The chance of flap loss increased as soon as two flaps were performed in one surgery. Anterior lateral thigh flaps had the highest chance for flap survival. Compared with the lower extremity, the head/neck/trunk group had a significantly increased chance of flap loss. There was a significant increase in the odds of flap loss in linear relation to the administration of erythrocyte concentrates. Conclusion: The results confirm that free flap surgery can be indicated as a safe method for the elderly. Perioperative parameters such as two flaps in one surgery and transfusion regimens must be considered as risk factors for flap loss. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) is often accompanied by a variety of comorbidities that require several medications thus, polypharmacy is unavoidable. One of the consequences of polypharmacy is the occurrence of potential drug-drug interactions (DDI). The aim of this study is to evaluate the profile of DDI in pre-dialysis CKD patients and to identify the possible adverse drug reactions (ADR) due to DDI. Methods: This cross-sectional study includes stage 3-5 pre-dialysis CKD patients at a referral hospital in Indonesia in 2019 – 2020. Data were collected from the electronic health record and the hospital’s medical record. The prescriptions were analysed for potential DDI using Micromedex software and ADRs assessment through clinical symptoms and laboratory data abnormalities. Results: A total of 106 patients were included in the study, around 60 (56.6%) patients received more than six medications. There were 111 types of medications prescribed with the most frequently prescribed drug was bisoprolol (36.5%). The proportion of patients who received treatment with a potential DDI was 76% (81 patients), while the proportion of patients who experienced ADR was 28% (23 patients). The most prevalent ADRs were hyperglycaemia, hypertension, hyperkalaemia, and hypotension. Cardiovascular disease had a statistically significant relationship with ADR suspected due to DDI (p = 0.03). Conclusion: A significant number of potential DDI were seen in the prescriptions of stage 3-5 pre-dialysis CKD patients at a referral hospital in Indonesia between 2019 – 2020. Cardiovascular disease was identified as the most common risk factor for ADR suspected caused by DDI.

Background Guidelines recommend using multiple drugs in patients with heart failure (HF) with reduced ejection fraction, but there is a paucity of real‐world data on the simultaneous initiation of the 4 pharmacological pillars at discharge after a decompensation event. Methods and Results A retrospective data mart, including patients diagnosed with HF, was implemented. Consecutively admitted patients with HF with reduced ejection fraction were selected through an automated approach and categorized according to the number/type of treatments prescribed at discharge. The prevalence of contraindications and cautions for HF with reduced ejection fraction treatments was systematically assessed. Logistic regression models were fitted to assess predictors of the number of treatments (≥2 versus

Prenatal yoga is a practice to create a sacred time and space for both the expecting mother and the baby. The practice of yoga is an invitation to connect the mother's vibrant generative life force to that of the growing life force inside her. It offers an environment in which the mother can cultivate a deeper connection to the process of transformation that is occurring. The time spent in a prenatal yoga class empowers a woman to create a connection with her baby, and the poses support easier labor and delivery as well as postpartum recovery. It is important for mothers to work with a teacher who is knowledgeable and certified in teaching yoga to the pregnant population. [ABSTRACT FROM AUTHOR]

» The use of preoperative antibiotic prophylaxis is not supported for elective cases of patients undergoing soft-tissue hand procedures that are ≤2 hours in length. » The use of preoperative antibiotic prophylaxis is not supported for patients with diabetes undergoing elective, soft-tissue hand surgical procedures. » There is a paucity of literature evaluating the use of preoperative antibiotic prophylaxis in patients with rheumatoid arthritis, those with cardiac valves, and those taking corticosteroids; because of this, there is no evidence to vary from our general recommendations.

ObjectivesTo assess the prevalence of combined hormonal contraceptives (CHCs) in reproductive-age women with SLE with and without possible contraindications and to determine factors associated with their use in the presence of possible contraindications.MethodsThis observational cohort study included premenopausal women ages 18-45 years enrolled in the SLICC Registry ⩽15 months after SLE onset, with annual assessments spanning 2000-2017. World Health Organization Category 3 or 4 contraindications to CHCs (e.g. hypertension, aPL) were assessed at each study visit. High disease activity (SLEDAI score >12 or use of >0.5 mg/kg/day of prednisone) was considered a relative contraindication.ResultsA total of 927 SLE women contributed 6315 visits, of which 3811 (60%) occurred in the presence of one or more possible contraindication to CHCs. Women used CHCs during 512 (8%) visits, of which 281 (55%) took place in the setting of one or more possible contraindication. The most frequently observed contraindications were aPL (52%), hypertension (34%) and migraine with aura (22%). Women with one or more contraindication were slightly less likely to be taking CHCs [7% of visits (95% CI 7, 8)] than women with no contraindications [9% (95% CI 8, 10)].ConclusionCHC use was low compared with general population estimates (>35%) and more than half of CHC users had at least one possible contraindication. Many yet unmeasured factors, including patient preferences, may have contributed to these observations. Further work should also aim to clarify outcomes associated with this exposure.

Persons living with HIV (PLWH) are at an increased risk of contraindicated drug-drug interactions (XDDIs), which may result in deleterious outcomes. Study objectives were to (1) compare the frequency of hospitalizations between patients with and without XDDIs and (2) determine if XDDIs are independently associated with hospitalizations in PLWH. A retrospective cohort study was performed among PLWH receiving care at the Upstate New York Veterans' Healthcare Administration or University of New Mexico Truman Health Services from 2000 to 2013. Hospitalization was defined as an admission to an inpatient hospital facility for ≥24 h. Of the 1329 patients evaluated, 149 (11.2%) patients were hospitalized within 1 year of antiretroviral therapy initiation. A significantly higher proportion of patients with XDDIs were hospitalized compared with those who did not have XDDIs (20.3% vs. 10.2%, risk ratio: 1.98, 95% confidence interval [CI]: 1.35-2.91, p = .001). In the multivariate Cox proportional hazards regression analyses, XDDIs were independently associated with hospitalizations (hazard ratio [HR]: 1.58; 95% CI: 1.00-2.48; p = .05), after adjustment for CD4

OBJECTIVE:To characterize the graft survivorship and clinical outcomes of osteochondral allograft transplantation (OCA) of the knee in patients with an elevated body mass index (BMI). DESIGN:Prospective data on 38 consecutive patients with a BMI ≥30 kg/m2 treated with OCA from 2000 to 2015 were reviewed. Complications, reoperations, and patient responses to validated outcome measures were examined. Failures were defined by any removal/revision of the allograft or conversion to arthroplasty. RESULTS:Thirty-one knees in 31 patients (mean age, 35.4 years [range, 17-61 years]; 87% male) met the inclusion criteria. Mean BMI was 32.9 kg/m2 (range, 30-39 kg/m2). Mean chondral defect size was 6.4 cm2 (range, 1.0-15.3 cm2). Prior to OCA, 23 patients (74%) had undergone previous surgery to the ipsilateral knee. Mean duration of follow-up was 4.1 years (range, 2-11 years). After OCA, 5 knees (13%) underwent conversion to unicompartmental (1) or total (4) knee arthroplasty. Two- and 5-year graft survivorship were 87% and 83%, respectively. At final follow-up, clinically significant improvements were noted in the pain (49.3-72.6) and physical functioning (52.9-81.3) subscales of the Short Form-36 ( P ≤ 0.001), International Knee Documentation Committee subjective form (43.5-67.0; P = 0.002), Knee Outcome Survey-Activities of Daily Living (58.2-80.4; P = 0.002), and overall condition subscale of the Cincinnati Knee Rating System (4.7-6.9; P = 0.046). CONCLUSIONS:OCA can be a successful midterm treatment option for focal cartilage defects of the knee in select patients with a BMI ≥30 kg/m2.

INTRODUCTION: In 2016, 2.1 million people in the United States were estimated to have an opioid use disorder. Although the disorder can be safely and effectively treated with prescription methadone, treatment is potentially long term and may span womens peak childbearing ages. Little is known about womens reproductive health needs while on methadone. METHODS: We interviewed 22 sexually active, nonpregnant women ages 21-39 years at two Los Angeles methadone clinics in 2016. The interviews were transcribed and coded by four researchers using thematic and open coding techniques. RESULTS: One-half of the women were nulliparous and 17 were in stable, monogamous relationships with men. Women reported a range of feelings and perceptions about pregnancy, but nearly all wanted to delay pregnancy until discontinuing methadone. However, many women indicated limited interest in preventing pregnancy because of the relative stability of their relationships, fear of infertility, and low perceived risk of pregnancy. These factors influenced contraceptive use. DISCUSSION: Women described mixed feelings about pregnancy and many ultimately felt that an unplanned pregnancy would be acceptable in the context of their relationships and uncertain fertility. These findings provide context for previous quantitative findings that women in methadone treatment have higher rates of unintended pregnancy and lower rates of contraceptive use than the general population. CONCLUSIONS: Accurate information about pregnancy in the context of methadone treatment may help women to make proactive family planning decisions. Health care providers should discuss the guidelines for pregnancy on methadone and offer a range of options to help women achieve their reproductive goals.

Absract. Having analyzed the data of scientific and methodological literature, information was presented on the status and topical trends in the development of physiotherapy. The principle of action, the effect on the human body, the main indications and contraindications of various methods of physiotherapy are considered. Nowadays, interest in methods of exposure to physical factors is growing significantly. This is due to the safety and availability of non-drug treatments. Of course, the importance of drug therapy cannot be denied. However, there are many contraindications to the use of drugs, including allergies and drug intolerances. In such cases physiotherapy as a method becomes one of the most important. The article presents data on the principle of magnetic stimulation, in particular transcranial magnetic stimulation, magnetic therapy and functional magnetic stimulation. Transcranial magnetic stimulation allows non-invasive action on the cerebral cortex with short-term magnetic impulses. The method of magnetic therapy is based on the effect of a magnetic field (constant or variable) on the human body. Using this technique it is possible to achieve analgesic, anti-inflammatory and anti-edematous effect. Functional magnetic stimulation is a unique method of nerve myostimulation that allows to affect the deepest muscles, inaccessible to other forms of action in the patient's body. Also TEСAR-therapy is considered: an approach that stimulates the regeneration and recovery of muscles with high-frequency electric stream that penetrates the tissues with electromagnetic waves and generates heat. The principle of action on the human body of the most common electrophysical device, therapeutic ultrasound, was analyzed. Ultrasound therapy can affect almost all body systems and has physicochemical, mechanical and thermal effects. Vibrotraction therapy (traction, spinal traction), which has an instant analgesic and long-term therapeutic effect on areas of spinal lesions, also has been analysed. In addition, the article concludes on the viability of physiotherapy techniques and the need for their improvement.

BackgroundPatient selection for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is critically important to optimizing outcomes. There is currently no literature regarding the safety of CRS/HIPEC in patients with cirrhosis. The aim of this case series is to report the outcomes of three patients with well-compensated cirrhosis who underwent CRS/HIPEC.MethodsPatients were identified from a prospectively maintained peritoneal surface malignancy database. Patient, tumor, and operative-related details were recorded as short-term postoperative outcomes. Results were analyzed using descriptive statistics.ResultsAll patients had well-compensated (Child-Pugh Class A) cirrhosis and Eastern Cooperative Oncology Group (ECOG) performance status of 0. One patient had preoperative evidence of portal hypertension. All safely underwent CRS/HIPEC with completeness of cytoreduction (CC) scores of 0. The postoperative morbidity profile was unique, but all complications were manageable and resulted in full recovery to preoperative baseline status.ConclusionsPatient selection for CRS/HIPEC is critical for optimization of short- and long-term outcomes. This small series suggests that well-compensated cirrhosis should not be an absolute contraindication to CRS/HIPEC.

Laser vision correction is a modern method of eliminating, not just correcting, vision defects. The laser results in the restoration of the patient's eyes, so that he or she gains visual acuity anew. This method is both effective and safe, however, it is not feasible for every person. There are certain restrictions regarding: age, health, type of defect, history of disease, corneal scarring, pregnancy (both during and planned), or breastfeeding. Other rather non-obvious limitations, often overlooked by patients at the qualifying examination, are a metal filing that once found its way into the eye, after which it was removed rather late by a specialist, or current dry eye syndrome. The procedure of laser vision correction, can be carried out only after obtaining both the consent of the doctor conducting the qualifying examination and the interested party himself.

Background: Induction of labour (IOL) at 39 weeks has been shown to decrease maternal and neonatal adverse outcomes. Given the growing demand for 39-week IOL, it is imperative that effective methods be assessed for induction in the outpatient setting. The aim of this study is to answer the clinical question as to whether Dilapan-S® vs Propess® as a method of cervical ripening is non-inferior in the outpatient setting at 39 weeks and to ascertain whether Dilapan-S® 12 h is non-inferior to Dilapan-S® 24 h. Methods: This study is an open-label parallel group single-centre randomised trial. Participants are normal risk nulliparous women who have no pregnancy-related or medical contraindication to IOL. Women will be randomised to one of three induction groups—Dilapan-S® (12-h insertion or 24-h insertion) or Propess. Induction will be initiated between 39+0 and 39+4 weeks' gestation and participants will return home for either 12 or 24 h. They will be readmitted 12/24 h later in order to continue with induction of labour. Patient recruitment will take place over 30 months within a single centre. The study will recruit a maximum 109 women for each study arm. Total duration of participants' involvement in the trial will be 8 weeks to allow for postpartum follow-up. Discussion: This study will definitively answer whether Dilapan-S is non-inferior to Propess® as a method of induction of labour in the outpatient setting and whether cervical ripening with Dilapan-S over a 12-h timeframe is non-inferior to cervical ripening with Dilapan-S over a 24-h timeframe. Trial registration: EudraCT Number 2019-004697-25 Registered 14 September 2020 [ABSTRACT FROM AUTHOR]

Background: Residual malaria transmission is the result of adaptive mosquito behavior that allows malaria vectors to thrive and sustain transmission in the presence of good access to bed nets or insecticide residual spraying. These behaviors include crepuscular and outdoor feeding as well as intermittent feeding upon livestock. Ivermectin is a broadly used antiparasitic drug that kills mosquitoes feeding on a treated subject for a dose-dependent period. Mass drug administration with ivermectin has been proposed as a complementary strategy to reduce malaria transmission. Methods: A cluster randomized, parallel arm, superiority trial conducted in two settings with distinct eco-epidemiological conditions in East and Southern Africa. There will be three groups: human intervention, consisting of a dose of ivermectin (400 mcg/kg) administered monthly for 3 months to all the eligible population in the cluster (>15 kg, non-pregnant and no medical contraindication); human and livestock intervention, consisting human treatment as above plus treatment of livestock in the area with a single dose of injectable ivermectin (200 mcg/kg) monthly for 3 months; and controls, consisting of a dose of albendazole (400 mg) monthly for 3 months. The main outcome measure will be malaria incidence in a cohort of children under five living in the core of each cluster followed prospectively with monthly RDTs Discussion: The second site for the implementation of this protocol has changed from Tanzania to Kenya. This summary presents the Mozambique-specific protocol while the updated master protocol and the adapted Kenya-specific protocol undergo national approval in Kenya. BOHEMIA will be the first large-scale trial evaluating the impact of ivermectin-only mass drug administration to humans or humans and cattle on local malaria transmission Trial registration: ClinicalTrials.govNCT04966702. Registered on July 19, 2021. Pan African Clinical Trials Registry PACTR202106695877303. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the intervention of irrational medical orders in inpatient pharmacy of the hospital, so as to provide reference for rational drug use in clinical psychiatry. METHODS: Intervention records of irrational medical orders in the inpatient pharmacy of the hospital from 2020 to 2021 were collected, and the types of irrational medical orders and intervention results were statistically analyzed. RESULTS: A total of 4 090 irrational medical orders were recorded, and the types were distributed as inappropriate usage and dosage, repeated administration and improper route of administration, among which inappropriate usage and dosage and repeated administration accounted for 23. 18% (948 irrational medical orders) and 26. 58% (1 087 irrational medical orders), respectively. Among all the irrational medication orders, 3 920 (95. 84%) pharmacists’ intervention suggestions were adopted by clinicians. The adoption rate of intervention suggestions in the medical medical orders of repeated administration was 99. 82% (1 085/1 087), while the adoption rate of intervention suggestions in the medical orders of contraindication population was only 57. 52% (88/153). CONCLUSIONS: The review and intervention of irrational medical orders by pharmacists in psychiatric hospitals can improve the safety, effectiveness and rationality of medication for inpatients. [ABSTRACT FROM AUTHOR]

Objectives: Our objective was to determine whether antiretroviral drugs (ARVs) were used according to the European AIDS Clinical Society (EACS) guidelines for people with HIV/hepatitis C virus (HCV) coinfection treated with direct‐acting antivirals (DAAs) between 30 November 2014 and 31 December 2019 in the pan‐European EuroSIDA study. Methods: At each publication date of the EACS guidelines, plus 3 and 6 months, we calculated the number of people receiving DAAs with potential and actual ARV contraindications ('red shading' in the EACS guidelines). We used logistic regression to investigate factors associated with using contraindicated ARVs. Results: Among 1406 people starting DAAs, the median age was 51 years, 75% were male, 57% reported injected drug use as an HIV risk, and 76% were from western Europe. Of 1624 treatment episodes, 609 (37.5%) occurred while the patient was receiving ARVs with potential contraindications; among them, 38 (6.2%; 95% confidence interval [CI] 4.3–8.2) involved a contraindicated ARV (18 non‐nucleoside reverse transcriptase inhibitors), 16 involved protease inhibitors, and four involved integrase strand transfer inhibitors. The adjusted odds of receiving a contraindicated ARV were higher (3.25; 95% CI 1.40–7.57) among participants from east/central east Europe (vs. south) and lower (0.22; 95% CI 0.08–0.65) for 2015–2018 guidelines (vs. 2014). In total, 29 of the 32 (90.6%) patients receiving a contraindicated ARV and 441 of the 461 (95.7%) with potential ARV contraindications experienced a sustained virological response ≥12 weeks after stopping treatment (SVR12; p = 0.55). Conclusion: In this large heterogenous European cohort, more than one‐third of people with HIV/HCV coinfection received DAAs with potential ARV contraindications, but few received a contraindicated ARV. Use of contraindicated ARVs declined over time, corresponding to the increased availability of ARV therapy regimens without interactions with DAA across Europe. Participants who received a contraindicated DAA and ARV combination still had a high rate of SVR12. [ABSTRACT FROM AUTHOR]

Botulinum toxin (BoNT) is an anaerobic rod-shaped-neurotoxin produced by Clostridium botulinum, that has both therapeutic and lethal applications. BoNT injection is the most popular cosmetic procedure worldwide with various applications. Patients with dynamic wrinkles in areas such as the glabella, forehead, peri-orbital lines, nasal rhytides, and perioral rhytides are indicated. Excessive contraction of muscles or hyperactivity of specific muscles such as bulky masseters, cobble stone chins, gummy smiles, asymmetric smiles, and depressed mouth corners can achieve esthetic results by targeting the precise muscles. Patients with hypertrophic submandibular glands and parotid glands can also benefit esthetically. There are several FDA-approved BoNTs (obabotuli-numtoxinA, abobotulinumtoxinA, incobotulinumtoxinA, letibotulinumtoxinA, prabotulinumtox-inA, daxibotulinumtoxinA, rimbotulinumtoxinB) and novel BoNTs on the market. This paper is a narrative review of the consensus statements of expert practitioners and various literature on the injection points and techniques, highlighting both the Asian and Caucasian population separately. This paper can serve as a practical illustrative guide and reference for optimal, safe injection areas and effective doses for application of BoNT in the face and oral and maxillofacial area. The history of BoNT indications, contraindications, and complications, and the merits of ultrasonography (US)-assisted injections are also discussed. [ABSTRACT FROM AUTHOR]

There are different types of the ketogenic diet (KD) and the choice of one or the other is determined by the type of disease, the age of the patients, some of their individual characteristics and social factors. The original version of KD, now known as classic KD, is still the standard in the treatment of childhood epilepsy. Over time, new effective options are introduced such as the Modified Atkins Diet, Medium Chain Fatty Acid (MCT) Diet; Low glycemic KD, etc. The review discusses the differences between them, the principles for choosing one type of KD over another, as well as some new formulas and supplements for optimizing ketosis. Contraindications to the use of the diet and the possible side effects, are discussed. [ABSTRACT FROM AUTHOR]

With the consistently increasing number of transplant patients in hospital and medical settings, providing clinically relevant, engaging Horticultural Therapy activities for this growing population has become necessary. An increase in literature and analysis of such activities would be beneficial and timely for the creation of clinical practice guidelines in this specified subfield of the profession. Here is one such analysis of a sleep pouch activity along with specific alternate variations for interest, ability and clinical goals respectively. Special considerations, knowledge and experience pertaining to materials, instructions, budgeting and contraindications (along with participation encouragement tips) are included based on initial trials with this activity. [ABSTRACT FROM AUTHOR]

Objectives General dental practitioners (GDPs) are faced with increasing numbers of patients requesting dental implants (DI) to replace missing teeth. Being the first dental professional consulting with the patient, being knowledgeable about DI contraindications (DIC) would support the development of appropriate treatment plans. This study aimed to investigate the GDPs level of knowledge of a number of DICs. The study was done in Riyadh, KSA. Materials and Methods A structured electronic questionnaire was distributed to GDPs who consented to participate. Participants were asked whether certain systemic and local conditions were considered DIC, and whether such DIC were considered absolute or relative. Descriptive statistics, t -tests, or one-way analysis of variance, and multiple linear regression were used for the statistical analysis (p ≤ 0.05) to assess the association between the sample characteristics and knowledge of DICs. Results Less than half (42%) of the respondents scored 25 to 50%, and only 2% scored 75 to 100%. The highest proportion of correct responses was related to questions regarding old age (74.09%), glycemic categories (68.52%), active chemotherapy (64.07%), and intravenous bisphosphonates (49.86%). The responses were significantly associated with the years of experience, place of graduation, and highest qualification in DI. Based on the linear regression analysis, higher years of practice were associated with less knowledge of DIC (inverse relationship), graduates of Saudi governmental universities scored higher than the other groups of graduates, and holders of a master's degree in DI scored higher compared to holders of other qualifications. In addition, respondents who received lectures and/or laboratory training as part of their undergraduate curriculum had higher scores than the group who did not. Conclusion The level of DIC-related knowledge of the GDPs in Riyadh is generally good but incomplete; it is significantly influenced by the GDPs' years of practice, place of graduation, qualifications, and receiving didactic and laboratory training in the undergraduate programs. More emphasis on DI and DIC is required to improve treatment planning and patient referral. [ABSTRACT FROM AUTHOR]

Vaccination coverage in Ecuador has decreased since 2013, falling short of the World Health Organization's vaccination goal. There are several causes for this deficiency in coverage, one of these are lost vaccination opportunities, which are caused when a patient without contraindications postpones, or for other reasons fails to receive a recommended immunization. The objective of this study was to determine the state of knowledge regarding vaccination contraindications among the Metropolitan District of Quito health personnel to assess missed vaccination opportunities. Through this cross-sectional descriptive study, health personnel were surveyed online and asked 18 clinical scenarios which were created to evaluate their knowledge of the true contraindications of vaccination, and measure missed opportunities. A total of 273 surveys were collected; 74% belonged to the public health system, and the rest represented by private practitioners. Of those surveyed, 98.2% of health personnel had improperly denied vaccination at least once. We specifically found vaccinations were incorrectly denied more frequently in cases where the hypothetical patient presented mild or moderate fever cases. The use of corticosteroids, autoimmune diseases, and egg allergy were also incorrectly denied (89%, 71.4%, 72.9%, and 58.6%, respectively). Among the health personnel surveyed, there is an apparent lack of knowledge of the true contraindications of vaccination and differences in knowledge about contraindications according to personnel in charge of administering immunization to children. Our preliminary results suggest that lack of education related to side effects could be biasing medical professionals' decisions, causing them to unnecessarily delay or deny vaccinations, which likely contributes to explaining low overall vaccination coverage in Quito, the capital city of Ecuador. [ABSTRACT FROM AUTHOR]

Background: Endoscopic transpapillary gallbladder stenting (EGBS) is considered for patients with contraindications to early surgery for acute calculus cholecystitis. However, evidence regarding the long-term outcomes of EGBS is insufficient to date. The aim of the study was to evaluate the feasibility of EGBS as a bridge to or alternative to surgery when there are contraindications. Methods: We reviewed the cases of patients who underwent EGBS using a novel spiral-shaped plastic stent for acute calculus cholecystitis between January 2011 and December 2019. We retrospectively evaluated the long-term outcomes of EGBS using a novel spiral-shaped plastic stent. Results: Forty-nine patients were included. The clinical success rate of EGBS was 97%. After EGBS, 25 patients (surgery group) underwent elective cholecystectomy and 24 patients did not (follow-up group). In the surgery group, the median period from EGBS to surgery was 93 days. There was a single late adverse event with cholecystitis recurrence. In the follow-up group, the median follow-up period was 236 days. Late adverse events were observed in eight patients, including recurrence of cholecystitis (four patients), duodenal penetration by the distal stent end (two patients), and distal stent migration (two patient). In the follow-up group, the time to recurrence of biliary obstruction was 527 days. Conclusions: EGBS with a novel spiral-shaped plastic stent is safe and effective for long-term acute calculus cholecystitis. There is a possibility of EGBS to be a bridge to surgery and a surgical alternative for acute calculus cholecystitis in patients with contraindications to early cholecystectomy. [ABSTRACT FROM AUTHOR]

Objective: Zoledronic acid (ZA) is an antiosteoporotic drug that has been proven to reduce mortality after a hip fracture (HF). ZA is however underused with older HF patients. One possible cause may be the high prevalence of severe renal failure and hypocalcemia which contraindicate ZA administration. The aim of this study was to assess the prevalence of these 2 contraindications in patients aged 75 years or older admitted into an orthogeriatric (OG) unit after a low-energy HF. The secondary objective was to assess the prevalence of situations in which ZA must be used with caution.Methods: Our retrospective descriptive monocentric study was performed in an OG unit on a cohort of elderly patients hospitalized for HF from August 2015 to August 2017. Prevalence of hypocalcemia lower than 2 mmol/L and Cockcroft creatinine clearance lower than 35 mL/min was recorded.Results: Among the 194 patients admitted for HF, 136 patients (mean age 86 ± 5.6 years; 101 women) were included. The mean length of hospital stay was 15 ± 9 days. 111 (81.5%) had no contraindications to ZA administration. More than 80% presented situations in which ZA had to be used with caution, including 25(OH)D deficiency (20%).Conclusion: The majority of subjects aged 75 years or older admitted to hospital after an HF seem to have no contraindication for ZA administration during their immediate postoperative hospital stay. The hospitalization period after HF repair gives the opportunity to give most of them this treatment to improve their prognosis, taking into account situations in which ZA must be used with caution. [ABSTRACT FROM AUTHOR]