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Pemphigus is an autoimmune blistering disorder characterized by the presence of intraepidermal blisters and erosions, primarily affecting the mucosa and/or skin. There are no established Indian guidelines for the management of pemphigus, and Western guidelines cannot be directly applied due to differences in clinicodemographic profiles, comorbidities, and resource limitations. These guidelines aim to provide Indian dermatologists with evidence-based and consensus-driven recommendations for the management of pemphigus vulgaris (PV) and pemphigus foliaceous (PF), taking into account the unique challenges posed by the Indian healthcare setting. The guidelines focus on the comprehensive management of PV and PF, addressing diagnosis, treatment, monitoring, and follow-up. It is intended for dermatologists working in both outpatient and inpatient settings across India. The first draft of the guidelines was prepared by the writing group and then reviewed by 19 national experts in pemphigus management, including inputs from allied specialties. Areas with limited evidence or anticipated variation in recommendations were subjected to rounds of voting, with responses categorized as "strongly agree," "agree," "neutral," "disagree," or "strongly disagree." Suggestions were incorporated, and statements were revised until a mean agreement score of 4 or higher was reached across 16 key areas after four voting rounds. These guidelines offer a structured approach to managing pemphigus in India, addressing the need for region-specific recommendations that account for unique challenges such as resource constraints and specific comorbidities in Indian patients. They serve as a valuable resource for dermatologists treating pemphigus in a range of clinical settings. [ABSTRACT FROM AUTHOR]

The objective of this literature review was to examine and summarize knowledge of best practices for the management of patients suffering traumatic brain injury based on studies using a variety of practices to improve outcomes published 2018 - 2021. From a clinical perspective, when a patient suffers an acute traumatic brain injury, providers and clinicians ask themselves and each other, "What else could we do? What could we have tried to improve the outcome with this patient?" Astute clinicians spend ample time reviewing contemporary studies to improve their patients' outcomes. This project aimed not to find all studies about a specific treatment, but to review all studies about a topic to evaluate the studies for rigor and results to improve bedside patient care in times of crisis. A quality assessment model was used in four domains: design, bias, synthesis, and dissemination with a Quality Assessment Score assigned for each of the four domains. Ten studies met the rigor of the quality assessment evaluation. The highest ranked studies indicate a common theme of prevention of extension of injury. [ABSTRACT FROM AUTHOR]

Background: The hospital emergency plan is an important tool for hospitals in the management of a mass casualty incident. It is a legal requirement for hospitals to have such plans in place and to carry out drills. Emergency drills are a useful tool for the training of staff and for the evaluation of existing structures. The emergency plan of the University Hospital Würzburg (UKW) was evaluated during a disaster drill based on predefined drill objectives. Methods: The procedures according to the emergency plan of the UKW were practiced during a large-scale disaster exercise. The exercise objectives were defined as: testing the management structure, deployment of personnel, physical organization, triage, patient flow and communication. Several exercise objectives were defined in advance. An anonymized questionnaire was used to evaluate the achievement of the exercise objectives. Results: When properly trained and practiced the UKW emergency plan is generally well-suited to managing a mass casualty event. Improvements need to be made in the communication structure, responsibilities in the treatment areas and staff knowledge of the existing emergency plans and available material. Discussion: Mass casualty drills are a good tool for the evaluation of hospital emergency plans. A critical and decisive element for success is the existence of a clear management and communication structure. A good knowledge of the available material, the contents of the emergency plan and the consistent application of the procedures defined in this plan are essential for a coordinated course of action. This can be achieved by means of regular and mandatory training sessions. [ABSTRACT FROM AUTHOR]

Background: Benign Liver and Pancreas (BLiPs) rounds, implemented in 2022 at our Canadian tertiary care center, are a novel concept of a multidisciplinary case conference (MCC) for discussion of benign hepatopancreatobiliary (HPB) disease. BLiPs Rounds are a monthly virtual meeting of surgeons, gastroenterologists, and interventional radiologists experienced in biliary and pancreatic disease. Methods: This case series was completed to review the patient cases discussed over the first year of BLiPs rounds, and to evaluate the effect of the multidisciplinary discussion on patient management plans. Meeting minutes were reviewed for BLiPs rounds between May 2022 and July 2023. Data were collected retrospectively on all discussed patients by review of the electronic medical record, and analyzed using frequencies and means with standard deviations. Results: Between May 2022 and July 2023, 56 cases were discussed at 12 case conferences. 68% of cases concerned pancreatic pathology, 25% concerned biliary pathology, the remainder liver or duodenal pathology. 49 cases (88%) were presented to discuss therapeutic options, and 7 presented as diagnostic challenges. Cases were usually presented once, but 7 patients were discussed at multiple conferences due to complex issues or ongoing symptomatology. 40 patients (71%) had undergone previous endoscopic, percutaneous, or surgical interventions prior to discussion. Endoscopic intervention was recommended in 32% of cases, percutaneous interventional approach in 13%, a combined endoscopic and percutaneous approach in 9%, and surgery in 18%. Repeat imaging or observation was recommended in 29% of cases. Discussion at rounds led to a change or adjustment in the proposed management in 46 cases (82%). The plan recommended by the MCC was carried out in 71% of cases. Conclusion: BLiPs case conference provides a valuable venue to discuss cases, encourage interdisciplinary collaboration, and refine treatment approaches, leading to a change in proposed management plan in over three-quarters of cases presented. [ABSTRACT FROM AUTHOR]

Aim: This study aims to determine smoking status among primary school parents and identify factors influencing smoking cessation. Additionally, the study seeks to increase awareness about the transtheoretical model and examine its role in the smoking cessation process. Materials and Methods: The study was conducted with 2,354 parents of students from a primary school in Konya. Participants completed surveys assessing smoking status, attitudes towards quitting, and levels of awareness. Factors related to smoking status, including age, gender, education level, occupation, and alcohol use, were analyzed. Smokers quit attempts were associated with the stages of the transtheoretical model, and whether they sought professional help was evaluated. Results: Of the participants, 33.1% (n=780) were smokers. The average age of smokers was 36.6±4.61, and the frequency of smoking was higher among men than women. 39% of the participants were low-level smokers. Significant associations were observed between smoking status and factors such as age, gender, education level, occupation, and alcohol use (p<0.001). The majority of smokers attempted to quit using the "sudden cessation" method, with a low rate of seeking professional help. Most of those who successfully quit also used the "sudden cessation" method. 31.4% of participants had never attempted to quit smoking. As the number of quit attempts increased, participants were observed to become more prepared to quit smoking (p<0.001). According to the transtheoretical model, most individuals were in the precontemplation stage. Conclusion: The frequency of smoking is higher among men and decreases as education level increases. Most participants attempted to quit smoking on their own, with a low level of seeking professional help. Multiple attempts to leave have been shown to increase the likelihood of success, and awareness of the harms of passive smoking has significantly influenced smoking behavior. [ABSTRACT FROM AUTHOR]

Aim: Pulmonary embolism (PE) is a disease that develops as a result of occlusion of the pulmonary artery or its divisions by thrombus deriving from the systemic deep venous system. PE ranks third among deaths caused by cardiovascular disease. PE is a preventable illness with elevated mortality and morbidity, repetitive and hard to diagnose. In this study, computed tomography angiography (CTA) images and blood parameters of patients who underwent CTA with a prediagnosis of PE in Adıyaman Training and Research Hospital between 01/03/2020-01/09/2022 were examined. Materials and Methods: Patients who underwent CTA with suspected PE were analyzed, and a comparison was made between the sociodemographic and laboratory data of those diagnosed with PE and those who were not. Results: The mean age of PE patients was importantly higher than non-PE patients, and there was no statistical variance in the gender distribution of the groups. Monocyte count was markedly higher in the PE group, and the CAR value remarkably higher in the non-PE group than in the PE group. According to the ROC analysis, the AUC value was the highest when the D-dimer and troponin I value were considered together. Two different cut-offs were found for D-dimer. When D-dimer was 655 mg/dL, the specificity was 96.5%, while when D-dimer was 438.5 mg/dL, the sensitivity was 92.2%. The highest specificity was found with troponin I (97.4%). The likelihood ratio (LR) was the highest, at 26.08, when D-dimer was 655 mg/dL and above. Conclusion: As a result, the main message of our study is that when making differential diagnosis in patients who apply to the emergency department with dyspnea and chest pain, better diagnostic accuracy can be achieved with the combined evaluation of tomographic findings and laboratory findings. Therefore, evaluation of laboratory values such as D-dimer, hemogram parameters and troponin I is important in diagnosis and risk classification. [ABSTRACT FROM AUTHOR]

Aim: Personalized medicine has increased the interest in polymer-drug conjugates. In recent years, many polymer-drug conjugates have been developed to increase the specificity and selectivity of drugs for diseases. Noradrenaline (NA) is involved in the pathophysiology of many different neurological, psychiatric, and peripheral conditions. Moreover, NA has been reported to play a role in angiogenesis and tumor development. The MAVA/NA conjugate, a maleic anhydride-vinyl acetate (MAVA) copolymer modification product, and the noradrenaline biomolecule were examined for their antiproliferative and antimicrobial properties. Materials and Methods: MAVA-NA conjugate was synthesized as the modification product between maleic anhydride-vinyl acetate (MAVA) copolymer and noradrenaline (NA) biomolecule. The conjugate was previously characterized in terms of chemical structure by Fourier Transform Infrared (FTIR) and Nuclear Magnetic Resonance (1H-NMR and 13C-NMR) spectroscopic methods, and its topographic properties were characterized by atomic force microscopy (AFM). The minimum inhibitory concentration (MIC) method evaluated the antimicrobial properties against gram-positive and gram-negative bacteria and fungi. Antiproliferative activity was determined by XTT assay on lung (A549), brain (C6), bone (MG-63), and breast (MCF-7) cancer cells and healthy fibroblast (WI-38) cell lines. Results: The MAVA-NA conjugate showed no toxicity within the 3.125-100 µg/mL dosage range in WI-38 cells. Compared to normal fibroblast cells, MAVA-NA exhibited selective toxicity against A549, C6, MG-63, and MCF-7 cancer cells. MAVA-NA showed high antibacterial activity on S. aureus and MRSA bacteria compared to standard antibiotics (S. aureus MIC=50 µg/mL, MRSA MIC=25 µg/mL). Conclusion: These results indicate that the newly synthesized and characterized MAVANA conjugate has antiproliferative and antimicrobial effects and may have a promising role in developing new anticancer drugs. [ABSTRACT FROM AUTHOR]

Aim: The anticancer effect of any Erica L. genus member has not yet been investigated. Hence, this study investigated the anticancer effect of Erica arborea, a high-level flavanone producer, in mouse breast cancer 67NR and 4T1 cells. Materials and Methods: Healthy mouse fibroblast L929, mouse primary breast cancer 67NR and mouse metastatic breast cancer 4T1 cells were treated with Erica arborea methanol and ethanol extracts to investigate the cellular toxicity, apoptosis, gene expression level and oxidative stress effect on cells. Results: According to our data, the methanol and ethanol extracts of Erica arborea caused apoptosis and G2/M cell cycle arrest. Also, the methanol and ethanol extracts of Erica arborea enhanced the level of reactive oxygen species (ROS), especially higher levels in mouse breast cancer 67NR and 4T1 cells, according to the healthy mouse fibroblast L929 cells. The treatment of the cells with Erica arborea extracts causes up-regulation of the pro-apoptotic Caspase-3, Caspase-9, Bax, and Bak genes and down-regulation of the anti-apoptotic Bcl-2 and Bcl-xL genes. Moreover, treatment with Erica arborea extract up-regulated the expression levels of cyclin-dependent kinase (CDK) inhibitor P21 and P27 genes while down-regulating the expression levels of cyclin B1 and cyclin A genes in cells. However, the mRNA expression level changes of these genes are significantly higher in breast cancer 67NR and 4T1 cells, according to the healthy mouse fibroblast L929 cells. Conclusion: The result of the present study indicated that Erica arborea stimulated apoptosis induction in mouse breast cancer 67NR and 4T1 cells, which was associated with G2/M cell cycle arrest by regulating the CDK signaling pathway through ROS generation. [ABSTRACT FROM AUTHOR]

Aim: Our aim is to evaluate the cases that are followed in our hospital and meet the maternal near miss (MNM) criteria and to contribute to the management of these cases in the light of this information. Materials and Methods: Our study was conducted retrospectively. Data of 50 pregnant women who were treated in intensive care between 2022 and 2024 and met the MNM criteria of the World Health Organization (WHO) were collected from the hospital registry system. Information about the cases, laboratory results, clinical follow-up data and newborn data were obtained from the hospital registry system. Descriptive statistics were used to evaluate the cases. Results: The mean maternal age was 30.55 ± 5.95 years, with a median BMI of 28 (IQR: 7). Most of the MNM cases occurred antenatally (46%) or intrapartum (34%). Hypertensive disorders, including gestational hypertension (42%), preeclampsia (40%), and HELLP syndrome (14%), were the leading causes of MNM, followed by hemorrhagic disorders such as postpartum atony (12%) and placenta previa (10%). Medical conditions, such as cardiovascular disease (18%) and diabetes (14%), were also significant contributors. Overall, 64% of patients recovered without sequelae, while 28% experienced long-term effects, and 3 patients (6%) died. The maternal mortality ratio (MMR) was 12.23 per 100,000 live births, and the maternal near miss ratio (MNMR) was 2.04 per 1,000 live births, with a mortality index of 5.66%. Conclusion: Consistent with previous results, hypertensive and hemorrhagic diseases were shown to be the most important causes of maternal near miss events. Maternal morbidity was also increasingly influenced by chronic medical disorders. However, high MNMR and mortality index indicate the need for effective management of serious maternal complications. The study underscores the importance of early detection, timely intervention, and multidisciplinary care in managing maternal near miss cases. To enhance maternal health outcomes, more work must be done. [ABSTRACT FROM AUTHOR]

Aim: It is aimed to evaluate our patients who were operated for Chiari type 1 malformation with the help of literature and to contribute to the literature. Materials and Methods: 14 patients who were operated on for Chiari type 1 malformation diagnosis between 2012 and 2022 were retrospectively examined. Results: The mean age of our 14 patients included in the study was 36.39 (5 months - 59 years). The postoperative intensive care unit stay was 2.57 days, and the total stay until discharge was 10.93 days on average. The mean cerebellar tonsil herniation in our patients was 13.36 mm. The female/male ratio was 1. Syringomyelia was detected in 78.6% of our patients. 13 of the 14 patients were discharged in good health, and 1 patient died in the postoperative period. Conclusion: In patients with Chiari type 1 malformation, the presence of syringomyelia in addition to tonsillar herniation has been noted as a valuable parameter in the decision to operate. Although the most common condition in symptomatic patients is headache, it should be kept in mind that atypical symptoms may also occur. Patients who have undergone surgery for Chiari type 1 malformation should be closely monitored postoperatively for possible complications. [ABSTRACT FROM AUTHOR]

Aim: Acute bronchiolitis is a clinical condition characterized by inflammation of the bronchioles, primarily caused by viral agents in children under two years of age. The cornerstone of treatment includes hydration and oxygenation, while patients should be closely monitored for potential complications. Our objective is to evaluate the impact of anemia on treatment outcomes in children diagnosed with acute bronchiolitis. Materials and Methods: Children aged 1-24 months diagnosed with mild or moderate acute bronchiolitis in a tertiary pediatric health and disease clinic were retrospectively included in the study. Demographic characteristics and bronchiolitis severity (mild/moderate) were recorded. Pre- and post-treatment clinical severity, respiratory rate, heart rate, oxygen saturation levels, and bronchiolitis clinical scores were analyzed. The clinical findings and treatment responses of anemic and non-anemic patients were compared. A p-value of <0.05 was considered statistically significant in all analyses. Results: A total of 85 patients with a median age of 5.4 months (52.9% male) were included in the study. Anemia was present in 25.9% of the patients. At admission, the respiratory rate (RR) was significantly lower in anemic patients compared to nonanemic patients (median 37 vs 41, p=0.003). No significant differences were observed between anemic and non-anemic groups for clinical respiratory scores (CRS) (median 4.7 vs 4.7, p=0.721), heart rate (HR) (median 135.6 vs 134.3, p=0.798), or oxygen saturation (SaO2) (median 93.1 vs 93.0, p=0.304) at admission. Post-treatment, both groups demonstrated significant improvements in CRS, HR, and SaO2 (p<0.05 for all). However, RR remained lower in the anemic group compared to the non-anemic group (median 32.1 vs 36, p=0.003). The overall change in CRS and other parameters between the anemic and non-anemic groups was not statistically significant (p>0.05). Conclusion: Mild anemia does not affect the response to treatment for hypoxia in children with mild to moderate acute bronchiolitis. [ABSTRACT FROM AUTHOR]

Aim: We aimed to evaluate the relation of BP recovery ratio (BPRR) and carotid intima media thickness (CIMT) in patients with metabolic syndrome. Abnormal blood pressure (BP) recovery after physical exercise is related with coronary artery disease, impaired left ventricular diastolic function and pulse wave velocity. Materials and Methods: Among patients who had negative elective exercise test, 109 patients with metabolic syndrome (MetS) were included (65 males, 44 females; mean age 54.8±8.3 years) in our study. Study population were divided into two groups as low carotid IMT (CIMT=0.9) and high carotid IMT (>0.9). The BPRR was computed by dividing the third minute systolic BP (SBP) by the peak exercise systolic BP. Results: The BPRR was 0.88 and 0.91 in the low and high carotid IMT group, respectively (p=0.008). Patients in increased carotid IMT group had lower values of septal e', higher creatinine values and higher rates of statin use (p<0.05 for all). BPRR was positively correlated with carotid IMT (r=0.251, p=0.009). Statin use (OR = 5.754, p<0.001) and BPRR (OR=3.036, p=0.008) were found as independent predictors of increased carotid IMT. Every 0.1 unit increment in BPRR was found to correspond to 203.6% higher risk for increased carotid IMT. The cut-off value of BPRR was 0,921 for predicting increased carotid IMT. The area under the curve (AUC) was 0.634 (p=0.018). Conclusion: We found a strong correlation between BPRR and carotid IMT. BPRR and carotid IMT, when performed together, may improve their predictive ability for detecting the patients with high CV risk. [ABSTRACT FROM AUTHOR]

Aim: Previous studies have indicated that definitive chemoradiotherapy and upfront surgery have comparable survival rates, and definitive chemoradiotherapy is a more applicable treatment option in resectable locally advanced esophageal squamous cell cancer (ESCC). We compared definitive chemoradiotherapy to upfront surgery for survival in locally advanced ESCC patients who denied the standard treatment approach, receiving definitive chemoradiotherapy or upfront surgery. Materials and Methods: One hundred eighty eight locoregional ESCC patients with thoracic and distal involvement who had upfront surgery were compared with those who received chemoradiotherapy but declined surgery, although their tumor was resectable at presentation. Patients who underwent upfront surgery with negative surgical margins were included. The upfront surgery group received no adjuvant treatment (chemotherapy or radiotherapy). The definitive chemoradiotherapy group received standard therapy with 50.4 Gray/28 fractions/6 weeks concomitantly with weekly Paclitaxel 50 mg/m2 and Carboplatin AUC 2 combination regimen. Results: A total of 102 patients (54.3%) underwent surgery up front, whereas 86 patients (45.7%) had definitive chemoradiotherapy. The median follow-up of the study was 31 months. Definitive chemoradiotherapy had a median disease-free survival (DFS) of 39 months compared to 16 months for upfront surgery (p:0.005). Median overall survival (OS) was 29 months in upfront surgery and 47 months in definitive chemoradiotherapy (p=0.01). Although the multivariate Cox regression analysis found no difference in DFS between upfront surgery and definitive chemoradiotherapy groups, OS was greater with the latter (HR, 0.69; 95% CI, 0.47 to 1.00; p=0.05). Conclusion: In this non-randomized retrospective analysis, definitive chemoradiotherapy improved overall survival compared to upfront surgery in locally advanced ESCC patients. [ABSTRACT FROM AUTHOR]

Aim: Developmental Hip Dysplasia (DDH) refers to a set of abnormalities involving the developing hip. These abnormalities range from mild instability to overt dislocation of the joint. It is important to treat this condition effectively to promote normal development of the hip and achieve good long-term results. Surgical and non-surgical methods are available as treatment methods. Closed reduction and casting in the "human position" under general anesthesia under operating room conditions are effective methods for DDH patients who fail with non-surgical methods. The purpose of this article is to share the clinical and radiological results of the patients we treated with closed reduction and casting in our clinic. Materials and Methods: Radiological and clinical evaluation of 176 hips of 117 patients who applied to İnönü University Faculty of Medicine Department of Orthopedics and Traumatology between January 2010 and October 2017 and were treated with closed reduction and pelvipedal casting was performed retrospectively. Results: The average preoperative acetabular index of the operated hips was 35.88 degrees, and the final follow-up acetabular index values were 22.09 degrees. Avascular necrosis was detected in 2 of the patients (1.7%). According to the modified McKay classification, very good results were obtained in 105 (90%) of 117 patients followed for closed reduction, good results were obtained in 11 (9%), and fair results were obtained in 1 (0.85%). Conclusion: Closed reduction and cast treatment in developmental hip dysplasia is an effective treatment method due to its low complication rate and high success rate in the appropriate patient group. [ABSTRACT FROM AUTHOR]

Aim: The COVID-19 pandemic, first originating in Wuhan, China in December 2019, has affected over 180 countries worldwide. The clinical spectrum of COVID-19 ranges from mild to severe pneumonia with acute respiratory distress syndrome. The sudden increase in COVID cases requiring hospitalization has made inpatient health institutions difficult to predict and manage. Machine learning models have been used to diagnose the disease, predict clinical course, and hospital stay. Materials and Methods: Data from 322 PCR-positive patients were analyzed, including demographics, comorbidities, laboratory values, and radiological results. Machine learning algorithms such as Logistic Regression, Support Vector Machine, Ensemble Methods, and K-Nearest Neighbor were used for classification. Results: Results showed that SVM provided the best classification performance. The model considered factors like age, gender, medical history, and test results to personalize treatment decisions. The study suggests that machine learning can improve patient care during the COVID-19 pandemic. Limitations include the need for validation with larger datasets from multiple centers. Conclusion: This study aimed to show whether machine learning techniques can be used to make decisions about the hospitalization of COVID-19 patients. [ABSTRACT FROM AUTHOR]

Introduction: Incidental pulmonary nodules (IPN) are common radiologic findings, yet management of IPNs is inconsistent across Canada. This study aims to improve IPN management based on multidisciplinary expert consensus and provides recommendations to overcome patient and system-level barriers. Methods: A modified Delphi consensus technique was conducted. Multidisciplinary experts with extensive experience in lung nodule management in Canada were recruited to participate in the panel. A survey was administered in 3 rounds, using a 5-point Likert scale to determine the level of agreement (1 = extremely agree, 5 = extremely disagree). Results: Eleven experts agreed to participate in the panel; 10 completed all 3 rounds. Consensus was achieved for 183/217 (84.3%) statements. Panellists agreed that radiology reports should include a standardized summary of findings and follow-up recommendations for all nodule sizes (ie, <6, 6-8, and >8 mm). There was strong consensus regarding the importance of an automated system for patient follow-up and that leadership support for organizational change at the administrative level is of utmost importance in improving IPN management. There was no consensus on the need for standardized national referral pathways, development of new guidelines, or establishing a uniform picture archiving and communication system. Conclusion: Canadian IPN experts agree that improved IPN management should include standardized radiology reporting of IPNs, standardized and automated follow-up of patients with IPNs, guideline adherence and implementation, and leadership support for organizational change. Future research should focus on the implementation and long-term effectiveness of these recommendations in clinical practice. [ABSTRACT FROM AUTHOR]

Nutritional care plays a critical role in patient recovery, and understanding its impact requires a biochemical perspective. This article proposes a nursing care intervention grounded in biochemical principles to improve patient outcomes. The intervention is informed by the Amalgamation of Marginal Gains (AMG) model, a performance improvement tool from sports and medicine, which focuses on identifying small, cumulative improvements to enhance overall outcomes. The present study evaluates current knowledge on nutritional care by reviewing relevant randomized controlled trials (RCTs) that examine multimodal, multidisciplinary approaches integrating biochemical and nutritional strategies. This study presents a nursing care intervention that incorporates the AMG model, emphasizing incremental improvements to optimize nutritional outcomes. The present study systematically reviews RCTs that explore the efficacy of multimodal therapies in nutritional care. It evaluates the methodologies used in these trials, including selection criteria, intervention protocols, and outcome measures, to better understand their impact on patient recovery. The RCTs review indicates that multimodal nutritional interventions have a positive effect on food intake, nutritional status, fall incidence, health outcomes, physical performance, and quality of life in elderly patients. However, results were not consistently reliable across studies, underscoring the challenges inherent in dietary treatment. The findings also highlight the growing importance of collaborative nursing care, with nurses playing a key role in patient education, self-management, and coordination of care to ensure effective nutritional support. By integrating biochemical principles into nutritional care, nurses can provide more tailored and effective support for patients during recovery. Comprehensive assessments, collaborative care plans, patient education, continuous monitoring, and advocacy are essential for optimizing nutritional interventions and improving patient outcomes [ABSTRACT FROM AUTHOR]

Autoimmune thyroid diseases (AITDs), including autoimmune thyrotoxicosis and autoimmune hypothyroidism, represent a significant clinical challenge, influencing patients' quality of life and requiring multifaceted diagnostic and therapeutic approaches. These diseases result from a complex interplay of genetic, immunological, and environmental factors, while advancements in diagnostic procedures and treatments have been made, the role of nursing interventions in managing AITDs remains crucial for ensuring optimal patient outcomes. This review aims to explore the biochemical mechanisms underlying autoimmune thyroid diseases and their implications for nursing interventions in diagnosis, management, and patient care. By understanding these mechanisms, healthcare providers, particularly nurses, can enhance their role in supporting patients with AITDs through effective care strategies. A comprehensive review of current literature was conducted, focusing on the AITDs pathophysiology, including autoimmune thyrotoxicosis, autoimmune hypothyroidism, and their clinical manifestations. Key diagnostic approaches, such as laboratory tests, ultrasound imaging, and nuclear medicine, were examined. The review also explored nursing care strategies and their potential to improve patient management. The relevant biochemical mechanisms and nursing implications were analyzed to provide insights into optimal patient care. The review highlighted that AITDs primarily arise from the immune system's abnormal attack on thyroid tissues, leading to thyroid dysfunction. Diagnostic methods such as the measurement of thyroid-specific autoantibodies, ultrasound imaging, and radioactive iodine uptake tests are essential for accurate diagnosis. Effective nursing care involves providing education about the disease process, managing medications, monitoring thyroid function, and offering emotional and psychosocial support to patients. AITDs present multifaceted challenges in terms of diagnosis, management, and patient care. The biochemical mechanisms underlying these disorders inform not only clinical treatment protocols, but also nursing interventions. Nurses are pivotal in managing AITDs by providing patient-centered care, promoting medication adherence, educating patients, and offering psychological support. As these diseases require lifelong management, continuous nursing support is crucial for improving long-term patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: While management protocols of pediatric esophageal foreign bodies (EFBs) are well‐delineated, resource utilization can be improved. This study's objectives were to explore hospital charges/costs for pediatric patients who present with EFBs and to identify patient risk factors associated with esophageal injury. Methods: A retrospective chart review of patients undergoing aerodigestive foreign body removal at a tertiary‐care children's hospital from 2018 to 2021 was conducted. Data collected included demographics, medical history, presenting symptoms, EFB type, surgical findings, and hospital visit charges/costs. Results: 203 patients were included. 178 of 203 (87.7%) patients were admitted prior to operation. Unwitnessed EFB ingestion (p < 0.001, OR = 15.1, 95% CI = 5.88–38.6), experiencing symptoms for longer than a week (p < 0.001, OR = 11.4, 95% CI = 3.66–38.6) and the following presenting symptoms increased the odds of esophageal injury: dysphagia (p = 0.04, OR = 2.45, 95% CI = 1.02–5.85), respiratory distress (p = 0.005, OR = 15.5, 95% CI = 2.09–181), coughing (p < 0.001, OR = 10.1, 95% CI = 3.73–28.2), decreased oral intake (p = 0.001, OR = 6.60, 95% CI = 2.49–17.7), fever (p = 0.001, OR = 5.52, 95% CI = 1.46–19.6), and congestion (p = 0.001, OR = 8.15, 95% CI = 2.42–27.3). None of the 51 asymptomatic patients had esophageal injury. The median total charges during the encounter was $20,808 (interquartile range: $18,636–$24,252), with operating room (OR) (median: $5,396; 28.2%) and inpatient admission (median: $5,520; 26.0%) contributing the greatest percentage. Conclusions: Asymptomatic patients with EFBs did not experience esophageal injury. The OR and inpatient observation accounted for the greatest percentage of the hospital charges. These results support developing a potential algorithm to triage asymptomatic patients to be managed on a same‐day outpatient basis to improve the value of care. Level of Evidence: 3 Laryngoscope, 134:4774–4782, 2024 [ABSTRACT FROM AUTHOR]

Background and Objectives: Surgeons have long been aware of Murphy's Law: "If anything can go wrong, it will". When applied to surgery, Murphy's Law suggests that if there is a way that an operation can be set up incorrectly then someday, somewhere, it will be set up incorrectly. This paper focuses on complications in medical doctor (MD) and VIPs during aesthetic surgery. Materials and Methods: We evaluated the clinical results of 368 MDs/VIPs (group 1) and 368 non-MDs/VIPs (group 2) who underwent aesthetic surgery (upper blepharoplasty, facelift, breast augmentation) between January 2010 and September 2021. The minimum follow-up after surgery was 2 years. Results: There was no statistically significant difference in the rate of complications between the two groups. Among the treated patients, the percentage of complications was similar to what has been reported in the literature. Interestingly, the time spent in surgery was longer, and there was an increased number of admissions to outpatient clinics in group 1. Conclusions: We suggest changing the current perception of Murphy's Law regarding complications in MD patients/VIPs undergoing aesthetic surgery. [ABSTRACT FROM AUTHOR]

Background: Research has demonstrated that the loss of one or more natural teeth can be an emotionally traumatic experience that mirrors processes associated with bereavement. There remains scant literature examining the role of emotions in dental encounters. One such exception is the literature on the idea of the 'treatment alliance' in dental encounters. The aim of this paper is to explore the role of the 'treatment alliance' in dentist–patient encounters. Methods: Data were collected from clinical observations, semi-structured interviews and focus groups exploring the experience of tooth loss and how the treatment alliance shaped the patient journey. Data analysis was conducted using the grounded theory method influenced by phenomenology. Coding was conducted using NVIVO and the unit of analysis was the treatment alliance. Results: Twenty participants took part in the interviews (eleven male; nine female; 22–86 years; mean age = 58.9 years). Observations were carried out with a further fourteen participants (seven male; seven female; 50–101 years; mean age = 62.2 years). The paper draws on four cases taken from the observational data to illustrate important dynamics underpinning how the treatment alliance varied. These case studies are then used as the basis for a critical discussion of the importance of the treatment alliance in dentistry. Conclusions: The treatment alliance acted as an important moderator in the clinical encounter, helping to influence successful outcomes. An important foundational component of the treatment alliance was the degree of emotional work the dental team conducted when 'getting to know' unfamiliar patients. Whilst emotions were an important factor in dental encounters, their acknowledgement and management were not essential to all successful outcomes. Much more research is therefore needed into the role of emotional labour in dental encounters. [ABSTRACT FROM AUTHOR]

Abstract Objective Epilepsy requires continuous medical attention from multiple healthcare specialists, specialized facilities, and community‐based care. In Spain, there is no standardized approach to epilepsy care. The aim of this study was to identify the factors impacting on the delivery of high‐quality care by exploring key steps and barriers along the patient journey through the Spanish National Healthcare System (NHS). Methods A qualitative study was conducted using opinions and experiences of neurologists, nurses, patients, and caregivers shared in discussion meetings. Using thematic content analyses, relevant aim‐focused statements were coded according to prespecified issues in a discussion map (i.e., key steps and barriers), and sub‐coded according to emerging issues. Thematic saturation and co‐occurrence of key steps/barriers were evaluated to identify the most relevant factors impacting on the delivery of high‐quality care. Results Sixty‐five stakeholders took part in discussion meetings (36 neurologists, 10 nurses, 10 patients, and nine caregivers). Six key steps on the patient journey were identified: emergency care, diagnosis, drug therapy, follow‐up, referral, and interventional treatment. Of these, follow‐up was the most relevant step impacting on the delivery of high‐quality patient care, followed by drug therapy and diagnosis. Emergency care was considered a hot‐spot step with impact throughout the patient journey. Communication (among HCPs and between HCPs and patients) was a barrier to the delivery of high‐quality care at several stages of the patient journey, including drug therapy, follow‐up, referral, and interventional treatment. Resource availability was a barrier for diagnosis (especially for confirmation), drug therapy (drug availability), and referral (lack of professionals and specialized centers, and long waiting lists). Significance This is the first study capturing perspectives of four key stakeholders involved in epilepsy care in Spain. We provide an overview of the patient journey through the Spanish NHS and highlight opportunities to improve the delivery of patient‐centered care with a chronicity perspective. Plain Language Summary Patients with epilepsy may require prolonged medical care. In Spain, care is provided by a range of specialist and non‐specialist centers. In this study, a team of Spanish neurologists, nurses, patients and caregivers identified barriers that affect the delivery of high‐quality care for patients with epilepsy at each stage of their journey through the Spanish NHS. Specific epilepsy training for healthcare providers, appropriate resources for diagnosing and treating patients, and good communication between healthcare workers and patients were identified as important factors in providing high‐quality care for patients with epilepsy.

Aim of the study: The emergence of the COVID-19 pandemic has catalyzed a paradigm shift in emergency dental care, prompting a reassessment of traditional approaches and the adoption of innovative strategies to address evolving challenges. Introduction: This comprehensive study explores the multifaceted landscape of emergency dental care amidst the COVID-19 pandemic, delving into the integration of tele-dentistry, advancements in point-of-care testing, optimization of aerosol-reducing techniques, enhancements in personal protective equipment (PPE), and the pivotal role of public health preparedness and education. Materials and Methods: Through a meticulous review of existing literature and analysis of pertinent studies, this study elucidates the transformative impact of these innovations on emergency dental care provision. Results: Tele-dentistry has emerged as a valuable tool for remote assessment, initial guidance, and triaging of cases, while advancements in point-of-care testing facilitate rapid and accurate diagnosis of COVID-19 infection in dental settings. Moreover, optimization of aerosol-reducing techniques and advancements in PPE design contribute to minimizing viral transmission risks during emergency procedures. Furthermore, this study underscores the importance of robust public health preparedness and education in fostering a proactive approach to dental emergencies and instilling confidence in patients to seek timely care. Collaborative efforts among dental professionals, researchers, and public health authorities are essential in navigating the complexities of the COVID-19 pandemic and fortifying preparedness for future crises. Conclusion: This study advocates for the continued integration of innovative solutions and adaptive strategies in emergency dental care, guided by a commitment to patient safety, evidence-based practices, and interdisciplinary collaboration. By embracing these advancements, the dental community can navigate the challenges posed by the COVID-19 pandemic and emerge stronger, more resilient, and better equipped to ensure the oral health and well-being of individuals for generations to come.

Abstract Background An increasing number of clinical trials for new therapeutic strategies are underway or being considered for dystrophinopathy. Having detailed data on the natural progression of this condition is crucial for assessing the effectiveness of new drugs. However, there’s a lack of data regarding the long-term data on the natural course and how it’s managed in China. In this study, we offer a comprehensive overview of clinical and molecular findings, as well as treatment outcomes in the Chinese population. Methods Institutional data on all patients with dystrophinopathy from August 2011 to August 2021 were retrospectively reviewed. The data included geographic distribution, age at diagnosis, molecular findings, and treatment options, such as corticosteroids, cardiac interventions, and clinical outcomes. Results In total, 2097 patients with dystrophinopathy, including 1703 cases of Duchenne muscular dystrophy (DMD), 311 cases of Becker muscular dystrophy (BMD), 46 cases of intermediate muscular dystrophy (IMD), and 37 cases categorized as “pending” (individuals with an undetermined phenotype), were registered in the Children’s Hospital of Fudan University database for dystrophinopathy from August 2011 to August 2021. The spectrum of identified variants included exonic deletions (66.6%), exonic duplications (10.7%), nonsense variants (10.3%), splice-site variants (4.5%), small deletions (3.5%), small insertions/duplications (1.8%), and missense variants (0.9%). Four deep intronic variants and two inversion variants were identified. Regarding treatment, glucocorticoids were administered to 54.4% of DMD patients and 39.1% of IMD patients. The median age at loss of ambulation was 2.5 years later in DMD patients who received glucocorticoid treatment. Overall, one cardiac medicine at least was prescribed to 7.4% of DMD patients, 8.3% of IMD patients, and 2.6% of BMD patients. Additionally, ventilator support was required by four DMD patients. Eligibility for exon skipping therapy was found in 55.3% of DMD patients, with 12.9%, 10%, and 9.6% of these patients being eligible for skipping exons 51, 53, and 45, respectively. Conclusions This is one of the largest studies to have evaluated the natural history of dystrophinopathy in China, which is particularly conducive to the recruitment of eligible patients for clinical trials and the provision of real-world data to support drug development.

ABSTRACT Objectives Design Sample Measure Results Conclusion: Compliance is crucial for patients to control and manage their high blood pressure. This study assesses the compliance levels of hypertensive patients in China and explores the factors influencing compliance.A descriptive, cross‐sectional design was conducted.A total of 371 hypertensive patients were recruited from six County hospitals and 12 township health centers in Zhejiang Province, China.Patient compliance was measured using the Hypertensive Patient Scale (CHPS). Independent‐sample T‐test or variance analysis was applied to analyze CHPS scores by sociodemographic factors, and linear regression was used to explore the significant correlates of the total CHPS score.The total score of CHPS was 50.18 ± 6.12. Among the seven domains, drug treatment and lifestyle had the highest and lowest average scores, 3.59 ± 0.87 and 2.74 ± 0.73, respectively. The total score of CHPS positively associated with age (β = 0.075, p = 0.028), > 7 years of hypertension (β = 1.896, p = 0.022; Ref: < 3 years), and negatively associated with males (β = −2.224, p = 0.001; Ref: female) and rural area (β = −2.008, p = 0.007; Ref: urban area).These findings highlight the importance of related measurements of the local “health‐oriented” healthcare system. Primary health professionals should strengthen their health behavior intervention capacity and improve hypertension management among their patients. [ABSTRACT FROM AUTHOR]

This study investigates the application of discrete event simulation in analyzing patient management and cost dynamics within a hospital system. A simulation that integrates machine learning models, specifically Decision Trees, Random Forests, Support Vector Machines, and Gradient Boosting methods, to predict treatment costs and appointment availability was developed. Conducted over 30 days, the simulation generates synthetic data for training the models. The results are assessed in terms of the total number of patients treated, cumulative costs incurred, and the cost-effectiveness of each predictive model. The findings reveal significant variations in the performance of different machine learning techniques, demonstrating that adopting advanced analytics can substantially improve hospital resource management. This research aims to develop more efficient patient care strategies, contributing to optimizing hospital operations and enhancing patient experiences. [ABSTRACT FROM AUTHOR]

Les troubles somatiques fonctionnels (TSF) sont fréquents et entraînent une détérioration significative de la qualité de vie. Leur origine est multifactorielle et mal comprise, mais leur prise en charge est relativement codifiée. Les traitements médicamenteux sont généralement peu efficaces tandis que les approches psychocorporelles jouent un rôle central, avec trois grands principes : une relation médecin–patient empathique, respectueuse et sincère, une activité physique régulière et graduelle, et une psychothérapie de type thérapie cognitive et comportementale (TCC). L'établissement d'une alliance thérapeutique repose sur la reconnaissance de la véracité et de la pénibilité des symptômes et la délivrance d'un diagnostic positif associé à un modèle explicatif rationnel. Les facteurs d'entretien cognitifs – focalisation attentionnelle et catastrophisme – et comportementaux doivent être recherchés et constituent des cibles thérapeutiques privilégiées. Les patients ont fréquemment des conduites d'évitement, notamment de l'effort physique. Il faut alors les inciter à reprendre une activité physique graduelle, en s'adaptant à leurs possibilités. Celle-ci a fait ses preuves dans l'amélioration de la fatigue, la douleur et la qualité de vie physique et mentale des patients. Parmi les approches psychothérapeutiques, le bénéfice d'une TCC est modeste mais bien démontré. L'association d'une activité physique graduelle et d'une TCC semble complémentaire. D'autres approches comme la méditation de pleine conscience ont un niveau de preuve plus faible. Étant donnée la fréquence des TSF dans la population générale, il semble nécessaire que l'ensemble des médecins soit formé à leur prise en charge. Functional somatic disorders (FSD) are common conditions that result in a significant deterioration of the quality of life. Their origin is multifactorial and poorly understood, and their management is often inadequately defined. Medications typically show limited effectiveness, while mind–body approaches play a central role, guided by three key principles: establishing an empathetic, respectful, and sincere doctor–patient relationship; promoting regular and gradual physical activity; and implementing cognitive behavioral therapy (CBT). Special attention must be devoted to establishing a trustworthy relationship between the physician and the patient. Recognizing the reality and severity of symptoms and providing a positive diagnosis as well as an explanatory model to account for them rationally are fundamental aspects of patient management. Cognitive and behavioral maintenance factors should be investigated and constitute therapeutic targets. Cognitive factors include focused attention on body functioning and catastrophizing. Patients frequently display avoidance behaviors, particularly in relation to physical exertion, and it is crucial to motivate them to reintroduce gradual physical activity customized to their abilities. This approach has demonstrated efficacy in improving fatigue, pain, and the physical and mental quality of life for patients with FSD. Among psychotherapeutic approaches, the benefit of CBT is well-established. The combination of gradual physical activity and CBT appears to be complementary. Other mind-body approaches such as mindfulness meditation might help although their level of evidence is weaker. Given the prevalence of FSD in the general population, it seems necessary for all physicians to be trained in managing this condition. [ABSTRACT FROM AUTHOR]

To support implementation of integrated behavioral health care (IBHC) models in local settings, providers may benefit from clinical decision-making support. The present analysis examines perspectives on patient characteristics appropriate or inappropriate for, and currently managed within, IBHC at a large medical center to inform recommendations for provider decision-making. Twenty-four participants (n = 13 primary care providers; n = 6 behavioral health providers; n = 5 administrators) in an IBHC setting were interviewed. Thematic analysis was conducted with acceptable interrater reliability (κ = 0.75). Responses indicated behavioral health symptom and patient characteristics that impact perceptions of appropriateness for management in IBHC, with high variability between providers. Many patients with characteristics identified as inappropriate for IBHC were nonetheless currently managed in IBHC. Interactions between patient ability to engage in care and provider ability to manage patient needs guided decisions to refer a patient to IBHC or specialty care. A heuristic representing this dimensional approach to clinical decision-making is presented to suggest provider decision-making guidance informed by both patient and provider ability. [ABSTRACT FROM AUTHOR]

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Background This study aimed to evaluate whether the systemic immune-inflammatory index (SII) can be used as a prognostic indicator in COVID-19 patients presenting to the emergency department. Given the high mortality and morbidity associated with COVID-19, identifying reliable prognostic markers is crucial for optimizing patient management. Methods This retrospective observational study included 639 COVID-19 patients admitted to our emergency department between February 1, 2022, and February 1, 2023. Patients' SII was calculated using complete blood count parameters (neutrophil, lymphocyte, and platelet counts). Data on patient outcomes, including intensive care unit (ICU) admission and in-hospital mortality, were analyzed using statistical methods such as receiver operating characteristic (ROC) curve analysis to assess the predictive power of SII, neutrophil-tolymphocyte ratio (NLR), and neutrophil-to-platelet ratio (NPL). Results Among the 639 patients, 136 died during hospitalization. Significant differences in SII, NLR, and NPL were observed between patients admitted to the ICU and those with less severe outcomes. The highest AUC (area under the curve) value was observed for NLR, with a cut-off value of >4.87, predicting mortality with a sensitivity of 72.79% and specificity of 77.73%. SII also demonstrated significant prognostic value with a cutoff of >806.03, predicting mortality with a sensitivity of 75.74% and specificity of 66%. Conclusion SII, NLR, and NPL are effective prognostic indicators in COVID-19 patients, particularly in predicting the need for intensive care and mortality risk. These findings suggest incorporating these markers into routine clinical practice could improve risk stratification and patient outcomes. However, further largescale studies are needed to validate these results and refine the use of these markers in clinical settings. [ABSTRACT FROM AUTHOR]

Objective: Epilepsy requires continuous medical attention from multiple healthcare specialists, specialized facilities, and community‐based care. In Spain, there is no standardized approach to epilepsy care. The aim of this study was to identify the factors impacting on the delivery of high‐quality care by exploring key steps and barriers along the patient journey through the Spanish National Healthcare System (NHS). Methods: A qualitative study was conducted using opinions and experiences of neurologists, nurses, patients, and caregivers shared in discussion meetings. Using thematic content analyses, relevant aim‐focused statements were coded according to prespecified issues in a discussion map (i.e., key steps and barriers), and sub‐coded according to emerging issues. Thematic saturation and co‐occurrence of key steps/barriers were evaluated to identify the most relevant factors impacting on the delivery of high‐quality care. Results: Sixty‐five stakeholders took part in discussion meetings (36 neurologists, 10 nurses, 10 patients, and nine caregivers). Six key steps on the patient journey were identified: emergency care, diagnosis, drug therapy, follow‐up, referral, and interventional treatment. Of these, follow‐up was the most relevant step impacting on the delivery of high‐quality patient care, followed by drug therapy and diagnosis. Emergency care was considered a hot‐spot step with impact throughout the patient journey. Communication (among HCPs and between HCPs and patients) was a barrier to the delivery of high‐quality care at several stages of the patient journey, including drug therapy, follow‐up, referral, and interventional treatment. Resource availability was a barrier for diagnosis (especially for confirmation), drug therapy (drug availability), and referral (lack of professionals and specialized centers, and long waiting lists). Significance: This is the first study capturing perspectives of four key stakeholders involved in epilepsy care in Spain. We provide an overview of the patient journey through the Spanish NHS and highlight opportunities to improve the delivery of patient‐centered care with a chronicity perspective. Plain Language Summary: Patients with epilepsy may require prolonged medical care. In Spain, care is provided by a range of specialist and non‐specialist centers. In this study, a team of Spanish neurologists, nurses, patients and caregivers identified barriers that affect the delivery of high‐quality care for patients with epilepsy at each stage of their journey through the Spanish NHS. Specific epilepsy training for healthcare providers, appropriate resources for diagnosing and treating patients, and good communication between healthcare workers and patients were identified as important factors in providing high‐quality care for patients with epilepsy. [ABSTRACT FROM AUTHOR]

Background: Pulmonary vein isolation (PVI) using cryoballoon (CB) ablation has comparable efficacy and safety to the gold standard of radiofrequency ablation in the treatment of symptomatic atrial fibrillation (AF). Initial randomized control trials were performed using Arctic Front Advance Pro™ (AFr) (Medtronic, Dublin, Ireland) CB system. Novel CB systems have recently become available, including the POLARx™ (Px) (Boston Scientific, Marlborough, Massachusetts, USA) system. We aimed to compare PVI using the Px and the AFr CB systems in our patient population in terms of efficacy, safety and procedure characteristics in a routine clinical setting. Methods: We performed a retrospective analysis of our internal AF ablation registry, containing 452 consecutive patients (pts) that underwent first procedure cryo-PVI for symptomatic AF. Primary endpoints were AF recurrence after 3 and 12 months, complication rate, procedure duration, fluoroscopy time and fluoroscopy dose. Secondary endpoints were minimal freeze temperature, time to isolation (TTI) and temperature at TTI for each of the pulmonary veins as well as minimal esophageal temperature during the procedure. Results: The primary efficacy endpoints of AF recurrence after 3 and 12 months were similar between the AFr and the Px systems (25.5% vs 21.3%, p = 0.416 and 22.2% vs 20.6%, p = 0.794, respectively). Complication rates were similar (3.9% vs 6.8%, p = 0.18) between groups and consisted mostly of mild vascular complications. The AFr group showed a significantly shorter procedural duration (68 (55–77) vs 73 (60–80) min, p = 0.002), and lower fluoroscopy dose compared to the Px system. Fluoroscopy times remained similar, however. Minimal freeze temperatures and temperatures at time of isolation were significantly lower in the Px group. However, the time to isolation and minimal procedural esophageal temperature were similar in both groups. Conclusion: PVI using the AFr and the Px systems showed comparable safety and efficacy. Procedural times were longer for the Px system. The Px system showed lower freeze temperature measurements but seemed to have a comparable biological effect. [ABSTRACT FROM AUTHOR]

Background: Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV2, first detected in China in 2019. This disease causes respiratory infections and significantly impacts global health. Purpose: This study aims to analyze the risk factors for mortality in COVID-19 patients at Universitas Airlangga Hospital in 2021. Methods: This observational analytical study uses a case-control design, including 168 samples with 64 cases and 64 controls. Secondary data from patient medical records at Universitas Airlangga Hospital, including age, gender, education, comorbidities, oxygen saturation, and length of stay. Chi-square tests analyzed the data with a 95% confidence level (a=5%). Results: The analysis revealed significant associations between COVID-19 mortality and several factors. Age (p=0.01; OR=3.24; 95%CI=1.57-6.65), gender (p=0.01; OR=2.2; 95%CI=1.17-4.02), education (p=0.00; OR=2.40; 95%CI=1.11-5.40), comorbidities (p=0.08; OR=2.50; 95%CI=1.26-4.91), and oxygen saturation (p=0.00; OR=5.40; 95%CI=117.10-2490.06) were significantly associated with COVID-19 mortality. Oxygen saturation was the most influential factor (p=0.00; OR=901.73; 95%CI=120.75-6733.48) associated with mortality. Conclusion: Age, gender, education, comorbidities, and oxygen saturation significantly affect COVID-19 mortality rates. This study highlights the importance of monitoring and managing these risk factors in managing COVID-19 at Universitas Airlangga Hospital. [ABSTRACT FROM AUTHOR]

Left ventricular assist devices (LVADs) are increasingly implanted in patients with advanced heart failure. Currently, LVAD care is predominantly concentrated at specialized tertiary care hospitals. However, the increasing workload and logistical burden for implanting centres pose significant challenges to accessing care for individual patients in remote areas. An emerging approach to LVAD patient management is the use of a shared care model (SCM), which facilitates collaboration between implanting centres and local non-implanting hospitals. This scoping review explores and synthesizes the current scientific evidence on the use of SCMs in LVAD care management. Eligible studies were identified in EMBASE, PubMed MEDLINE, Web of Science, Cochrane and Google Scholar. Findings were synthesized in accordance with PRISMA-ScR guidelines. Of the 950 records screened, five articles met the inclusion criteria. Four review articles focused on the proposed benefits and challenges of using SCMs. Main benefits included improved patient satisfaction and continuity of care. Important challenges were initial education of non-implanting centre staff and maintaining competency. One prospective study showed that absence of LVAD-specific care was associated with impaired survival and higher rates of pump thrombosis and LVAD-related infections. The use of SCMs is a promising approach in the long-term management of LVAD patients. However, sufficient evidence about the impact of SCMs on patients and the healthcare system is not currently available. Standardized protocols based on prospective studies are needed to develop safe and effective shared care for LVAD patients. [ABSTRACT FROM AUTHOR]

This case study documents the case of a 27-year-old female who presented with a complaint of left anterolateral thigh numbness, initially diagnosed as meralgia paresthetica with a differential diagnosis of lumbar radiculopathy. Over a span of two weeks, the patient endured emotional trauma and subsequently developed lesions in the area of complaint. The patient was diagnosed at a medical clinic with herpes zoster and was prescribed anti-viral medication which resulted in complete resolution. This case highlights the importance of considering herpes zoster as a differential diagnosis for nerve-related symptoms. Features of lumbar radiculopathy, meralgia paresthetica, varicella zoster and herpes zoster are discussed, as well as the defining characteristics and treatment options. Practitioners must remain vigilant in suspicion of viral infections such as herpes zoster even with lower incidence due to approved vaccines. [ABSTRACT FROM AUTHOR]

Radial artery spasm (RAS) is a common complication associated with transradial access (TRA) for coronary interventions, particularly affecting elderly patients in whom radial access is preferred due to its benefits in reducing bleeding complications, improving clinical outcomes, and lowering long-term costs. This review examines the incidence, prevention, and treatment of RAS. Methods included an online search of PubMed and other databases in early 2024, analyzing meta-analyses, reviews, studies, and case reports. RAS is characterized by a sudden narrowing of the radial artery due to psychological and mechanical factors with incidence reports varying up to 51.3%. Key risk factors include patient characteristics like female sex, age, and small body size as well as procedural factors such as emergency procedures and the use of multiple catheters. Preventive measures include using distal radial access, hydrophilic sheaths, and appropriate catheter sizes. Treatments involve the intraarterial administration of nitroglycerine and verapamil as well as mechanical methods like balloon-assisted tracking. This review underscores the need for standardizing RAS definitions and emphasizes the importance of operator experience and patient management in reducing RAS incidence and improving procedural success. [ABSTRACT FROM AUTHOR]

Introduction: This study analyzed oncologic patient management from initial tumor diagnosis to tumor follow-up in oral and maxillofacial surgery (OMFS) in Germany. Material and methods: A dynamic online questionnaire with a total of 44 questions was used to generate general and specific data regarding oncologic patient management with head and neck malignancies, supportive care, and (pre-) rehabilitation from initial tumor diagnosis to tumor follow-up and head and neck cancer center (HNCC) structures in OMFS in Germany. The questionnaire was sent to 81 OMFS departments affiliated with the German-Austrian-Swiss Working Group for Tumors of the Jaw and Facial Region (DÖSAK) and the German Association of Oral and Maxillofacial Surgery (DGMKG). Data analysis was conducted descriptively. Results: Forty-eight OMFS departments participated (response rate 59.26%), of which 36/48 (75%) were certified HNCC. 28/34 (82.4%) reported subjective improvements in oncologic care, most often interdisciplinary collaboration (21/33, 63.64%) and clinic structure changes (21/34, 61.76%). Nearly all OMFS departments present patients in multidisciplinary tumor boards (45/46, 97.83%) and aim for osseous reconstruction post-tumor resection (43/44, 97.73%). Significant discrepancies regarding the frequency of masticatory-functional dental rehabilitation following osseous reconstruction were observed. Before oncologic therapy, patients are offered various supportive services, mostly psychotherapy and psycho-oncological support (24/26, 92.31%). Post-therapy, speech therapy (43/43, 100%), physiotherapy (40/43, 93.02%), lymphatic drainage, and follow-up rehabilitation (39/43, 90.7%, respectively) are most often offered. 17/43 (39.53%) have oncological nursing staff. 36/40 (90%) manage patients and side effects during adjuvant therapy, while 5/41 (12.2%) provide proprietary palliative care. 36/41 (87.8%) offer counseling to patients and families. Conclusion: Oncologic patient care in OMFS is highly standardized and potentially attributable to many certified HNCCs in Germany. Certain treatment aspects are handled differently, possibly due to institution-specific reasons. Clinical relevance: The high homogeneity in treatment protocols reflects the widespread high and comparable treatment quality of head and neck malignancies in OMFS in Germany. [ABSTRACT FROM AUTHOR]

• Obstructive sleep apnea (OSA) is a frequent in pregnancy that may affect negatively maternal and fetal outcomes. • Limited diagnostic and screening tools restrict the practitioner ability to appropriately manage gestational OSA patients. • Current screening and treatment options are summarized, proposing a clinical approach for managing OSA in pregnancy. • Improved knowledge will allow the practitioner to better counsel toward mitigating the effects of OSA on mother and fetus. Obstructive sleep apnea (OSA) is a frequent condition during pregnancy and its occurrence is increased in obese women. There are growing concerns about both pre-existing OSA and the development of gestational OSA and their effect on maternal pregnancy outcomes, fetal development, and even early childhood. A strong body of research has revealed maternal complications of OSA, but far fewer studies explore its impact on the developing fetus, highlighting an important area of future research. As evidence in both areas mounts about the negative reproductive impact of OSA, studies have emerged that explore the limitations of current diagnostic criteria and screening tools for this disorder in pregnancy which, in turn, limit the practitioner's ability to appropriately refer patients for OSA diagnosis and treatment. This expert review summarizes the current data regarding OSA screening tools in pregnancy, the limitations of these tools, and available OSA treatments and their efficacies. Our objective is to develop recommendations for how to best screen and manage OSA in pregnancy. We conclude that improved understanding of available tools and treatments will allow the obstetric practitioner to better counsel patients and help mitigate the deleterious effects of OSA on mother and fetus. We herein propose a clinical approach for the screening and management of OSA in pregnancy. [ABSTRACT FROM AUTHOR]

Minimally Invasive Robotic Surgery (MIRS) has emerged as a transformative approach in surgical practice, offering reduced patient trauma and enhanced precision. However, challenges persist, including the loss of tactile feedback for surgeons. This study explores the application of machine learning algorithms, specifically variational autoencoders, in vibro-acoustic (VA) signal analysis to address this issue. Our comparative analysis evaluates the potential of supervised learning in surgical data analysis, contributing to advancements in surgical technology. Despite achieving an accuracy of 81%, our results indicate opportunities for further refinement, considering the superior accuracies reported in previous studies. This research underscores the importance of innovative approaches in medical data analysis for optimizing patient care in minimally invasive surgery. [ABSTRACT FROM AUTHOR]

This research aims to improve the quality of Telkomedika Telkom University Clinic services by developing a mobile application that is tailored to the personality type of patients with conscientiousness. This Mobile Application is designed to fulfill the patient's need for service information through the service information feature and streamline the queuing process through the online reservation feature. Through the use of the DISC personality type approach, this study focuses on the preferences and characteristics of patients to increase satisfaction. Users or patients with this conscientious personality type tend to be meticulous, systematic, and structured. Therefore, a structured interface design and also an easy-to-understand task flow will help users in using the application efficiently. The results of the study show the importance of understanding user preferences in designing applications. Usability Testing on the Telmed 2.0 application prototype resulted in a Single Ease Question (SEQ) score of 6.88, indicating ease of use. In addition, User Acceptance Testing showed that all features worked well, with a score of 91.5 on the System Usability Scale (SUS), indicating an excellent level of ease of use of the application. [ABSTRACT FROM AUTHOR]

Acalvaria is a rare congenital malformation of unknown etiopathogenesis that affects the development of the skull and surrounding muscular structures. There is scant literature regarding the pathophysiology, and no standardized guidelines exist for patient management. Herein, we present a case of acalvaria in a newborn and our multidisciplinary approach from diagnosis to 1 year of age. [ABSTRACT FROM AUTHOR]

Amyloidosis is defined as a rare group of 30 protein-folding diseases characterized by the extracellular deposition of a specific soluble precursor protein that aggregates in the form of insoluble fibrils. The gastrointestinal tract (GI) is a common site for amyloid deposits: Among patients with systemic amyloidosis, at least 70% present with gastrointestinal deposition. Rarely, the deposition is exclusively localized in this area, leading to various gastrointestinal symptoms (bleeding, weight loss, etc.). In this case report, we present a rare and unusual form of localized gastrointestinal amyloidosis, diagnosed after a post-mortem examination of an 83-year-old woman who died due to septic shock resulting from post-colonoscopy iatrogenic perforation of the sigma, in a suspected medical liability case. Morphological examination revealed AL amyloid deposits within the muscular wall of the submucosal vessels of the rectum, which caused increased friability of the vessels and ischemic changes in the intestinal mucosa. A renal cell carcinoma (RCC) was found, which might be related to amyloid deposits, as reported by the literature. Amyloid deposits are an unknown and unpredictable pathological substrate that increase the risk of iatrogenic perforation. Analysis of the medical documentation did not reveal any censurable conduct in terms of prescribing the procedure, technical execution, or subsequent management of the patient following the perforation. GI amyloidosis should be part of the risk stratification of patients with rectal bleeding and gastrointestinal symptoms, and awareness is essential to guide subsequent diagnostic and therapeutic approaches and investigate underlying causes. [ABSTRACT FROM AUTHOR]

Background: An increasing number of clinical trials for new therapeutic strategies are underway or being considered for dystrophinopathy. Having detailed data on the natural progression of this condition is crucial for assessing the effectiveness of new drugs. However, there's a lack of data regarding the long-term data on the natural course and how it's managed in China. In this study, we offer a comprehensive overview of clinical and molecular findings, as well as treatment outcomes in the Chinese population. Methods: Institutional data on all patients with dystrophinopathy from August 2011 to August 2021 were retrospectively reviewed. The data included geographic distribution, age at diagnosis, molecular findings, and treatment options, such as corticosteroids, cardiac interventions, and clinical outcomes. Results: In total, 2097 patients with dystrophinopathy, including 1703 cases of Duchenne muscular dystrophy (DMD), 311 cases of Becker muscular dystrophy (BMD), 46 cases of intermediate muscular dystrophy (IMD), and 37 cases categorized as "pending" (individuals with an undetermined phenotype), were registered in the Children's Hospital of Fudan University database for dystrophinopathy from August 2011 to August 2021. The spectrum of identified variants included exonic deletions (66.6%), exonic duplications (10.7%), nonsense variants (10.3%), splice-site variants (4.5%), small deletions (3.5%), small insertions/duplications (1.8%), and missense variants (0.9%). Four deep intronic variants and two inversion variants were identified. Regarding treatment, glucocorticoids were administered to 54.4% of DMD patients and 39.1% of IMD patients. The median age at loss of ambulation was 2.5 years later in DMD patients who received glucocorticoid treatment. Overall, one cardiac medicine at least was prescribed to 7.4% of DMD patients, 8.3% of IMD patients, and 2.6% of BMD patients. Additionally, ventilator support was required by four DMD patients. Eligibility for exon skipping therapy was found in 55.3% of DMD patients, with 12.9%, 10%, and 9.6% of these patients being eligible for skipping exons 51, 53, and 45, respectively. Conclusions: This is one of the largest studies to have evaluated the natural history of dystrophinopathy in China, which is particularly conducive to the recruitment of eligible patients for clinical trials and the provision of real-world data to support drug development. [ABSTRACT FROM AUTHOR]

Recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) is a challenging disease, requiring personalized management by a multidisciplinary team. The aim of this retrospective multicentric study was to characterize real-world healthcare resource use and patient care for R/M HNSCC in Portugal during the first year after diagnosis. A total of 377 patients ineligible for curative treatment were included, mostly male (92.8%), aged 50–69 years (74.5%), with heavy alcohol (72.7%) or smoking habits (89.3%). Oropharynx (33.2%) and oral cavity (28.7%) were primary tumor locations, with lung metastases being the most common (61.4%). Eligible patients for systemic treatment with palliative intent (80.6%) received up to four treatment lines, with varied regimens. Platinum-based combination chemotherapy dominated first-line treatment (>70%), while single-agent chemotherapy and anti-PD1 immunotherapy were prevalent in later lines. Treatment approaches were uniform across disease stages and primary tumor locations but varied geographically. Treated patients received more multidisciplinary support than those who were ineligible. This study provides the first Portuguese real-world description of R/M HNSCC patient characteristics, treatment patterns, and supportive care during the year after diagnosis, highlighting population heterogeneity and aiming to improve patient management. [ABSTRACT FROM AUTHOR]

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Introduction: The aim of this review is to identify common mood concerns in ICD patients and suggest brief psychological screeners essential for early detection and monitoring in patient care. Areas covered: Reliable and valid psychological assessment tools are reviewed, including those specifically designed for ICD patient populations. Expert opinion: Psychological assessment, in combination with cardiologic standard of care, can help overcome many barriers associated with poor implantable cardioverter-defibrillator (ICD) management and related cardiovascular outcomes. Earlier identification and treatment of mood concerns in ICD patients has been shown to improve quality of life (QOL) and patient outcomes. At this time, however, logistical challenges and time restraints, in addition to knowledge of appropriate treatment plans or referral options, remain central barriers to providing integrated, patient-centered care. Ultimately, all cardiology clinics would benefit from a collaborative care team that includes a mental health consultant or in-house psychologists who can provide consultations or referral services. Additionally, all patients that come to the clinics should complete proactive screening measures as routine component of care to assess the presence of mood concerns to improve patient outcomes and aid in treatment planning. [ABSTRACT FROM AUTHOR]

The article discusses the management of Pulmonary Thromboembolism (PTE) and the challenges arising from the conflicting perspectives of cardiologists and interventional radiologists. It highlights the importance of interdisciplinary collaboration in improving patient outcomes but points out the ego-driven dynamics and lack of clear protocols that hinder effective teamwork. The text emphasizes the need for clear protocols, joint training, case-led response teams, and a patient-centered culture to address these issues and ensure optimal care for patients with PTE. [Extracted from the article]