Antibacterials with Novel Chemical Scaffolds in Clinical Development

The rise of antimicrobial resistance represents a significant global health threat, driven by the diminishing efficacy of existing antibiotics, a lack of novel antibacterials entering the market, and an over- or misuse of existing antibiotics, which accelerates the evolution of resistant bacterial strains. This review focuses on innovative therapies by highlighting 19 novel antibacterials in clinical development as of June 2024. These selected compounds are characterized by new chemical scaffolds, novel molecular targets, and/or unique mechanisms of action, which render their potential to break antimicrobial resistance particularly high. A detailed analysis of the scientific foundations behind each of these compounds is provided, including their pharmacodynamic profiles, current development state, and potential for overcoming existing limitations in antibiotic therapy. By presenting this subset of chemically novel antibacterials, the review highlights the ability to innovate in antibiotic drug development to counteract bacterial resistance and improve treatment outcomes.

Pectin/caffeic acid nanoparticles in a poloxamer thermosensitive gel for the treatment of ulcerative colitis by inhibiting cGAS-STING pathway

Ulcerative colitis is a recurring condition that causes inflammation and sores in the digestive system. Current clinical treatments for ulcerative colitis have limitations due to side effects and poor patient compliance. This study investigates the therapeutic potential of a novel drug delivery system, CA-Gel, which comprises caffeic acid (CA) stabilized by pectin nanoparticles within a poloxamer thermosensitive gel for rectal administration. The system aims to provide controlled and sustained release of CA directly to the colon. In vitro studies demonstrated that CA-Gel exhibited excellent biocompatibility, cytoprotective effects, and reduced oxidative stress and cellular apoptosis. In vivo studies using a dextran sulfate sodium (DSS)-induced colitis mouse model showed that CA-Gel significantly alleviated colitis symptoms, as evidenced by improvements in body weight, disease activity index (DAI), colon length, and histopathological assessments. Additionally, CA-Gel modulated the Cyclic GMP AMP synthase (cGAS)-stimulator of interferon genes (STING) pathway, reduced mitochondrial DNA (mtDNA) release, and inhibited inflammatory cytokines, thereby demonstrating its therapeutic potential in ulcerative colitis. The study concludes that CA-Gel is a promising rectal treatment for ulcerative colitis, offering a safe and effective alternative to existing pharmacological therapies.

Maxillary sinus augmentation via the bone lid technique: A prospective, radiographic case series

BACKGROUND

Maxillary sinus augmentation is one of the most performed procedures to increase the bone quantity of the atrophic maxilla to allow implant placement. The aim of the present case series was to describe a surgical protocol to perform maxillary sinus augmentation with the "bone lid technique," and its outcomes in a cohort of patients eligible for the procedure.

METHODS

After the initial clinical evaluation, a cone-beam computed tomography (CBCT) examination was performed for preoperative assessment. Patients were then scheduled for surgical intervention. At 6-9 months follow-up, patients underwent a second CBCT scan to evaluate bone height following bone graft and to schedule implant placement.

RESULTS

A total of 11 patients were enrolled in the study with a total of 13 sinus lift procedures. Membrane perforation was registered in 4 cases (30.76%). Mean surgical time was 67.69 min (SD 6.51). Postoperative period was uneventful in all patients, in the absence of complications. The mean graft volume increase was 2.46 cm3 (SD 0.85), and the mean height increase was 14.27 mm (SD 3.18). Mean membrane thickness was 1.40 mm (SD 0.75). In all the 4 cases with sinus membrane perforation, the membrane had a thickness lower than 1 mm.

CONCLUSIONS

The present study highlights that the maxillary sinus augmentation with bone lid repositioning could provide repeatable results in terms of bone height increase. The technique appears reliable both in terms of bone gain and absence of complications.

KEY POINTS

The bone lid technique for maxillary sinus augmentation provides repeatable results in terms of bone height increase. The favorable clinical outcomes can be related to an enhancement of bone formation due to the unique osteoconductive and osteoinductive properties of autogenous bone, along with a reduction of soft tissue ingrowth. Complications were not observed in any of the patients following the surgical procedures. The risk of Schneiderian membrane perforation is inversely proportional to membrane thickness; the thinner the membrane is, the higher the risk to perforate it.

Perioperative Management of the Patient with Diabetes Mellitus

Perioperative evaluation and management of diabetes mellitus is vital to minimize adverse complications before, during, and after surgery. It requires a multidisciplinary approach including the surgery team, anesthesia, endocrinology or internal medicine, and other specialties as needed. This article will discuss the effects of surgery and anesthesia on blood glucose, preoperative evaluation of the person with diabetes, glycemic targets for surgery, adjustment of diabetes medications the day before surgery, in the preoperative, intraoperative, and postoperative areas, management of blood glucose in the preoperative, intraoperative, and postoperative periods, and management of hypoglycemia.

Considerations for Anthropometry Specific to People with Disproportionate Short Stature

In the clinical care of people with disproportionate short stature, healthcare practitioners need to accurately collect anthropometric measurements over time, including height, weight, head circumference, and lengths of affected limb and body segments. Accurate anthropometric measurements are important for diagnostic evaluation, tracking growth, measuring response to pharmacologic therapies or surgeries, and monitoring for potential complications. However, for this clinical population, anthropometric measurements may need to be adjusted or modified to accommodate characteristics such as body disproportions, joint contractures, long bone deformities, spinal deformities, or muscle hypotonia. This article provides guidance for key anthropometric measurements in children and adults with disproportionate short stature, with a focus on people with achondroplasia. The measurements described in this article and illustrated in the infographics can be performed without expensive specialized equipment and are suitable for a variety of clinical settings.

A Case Report of Cutaneous Larva Migrans Treated With Naakupoochi Kudineer, a Traditional Siddha Medicine

Cutaneous Larva Migrans (CLM) is a helminthic infection that is prevalent in tropical and subtropical regions. It is caused by zoonotic hookworms, predominantly the Ancylostoma species, which infrequently infect humans. Hookworms primarily inhabit the small intestine of canines and felines, where adult worms release eggs that are excreted in the host's feces into the environment. Human infections occur through direct contact with contaminated soil, with humans serving as dead-end hosts for parasites. Clinically, CLM presents as erythematous, serpiginous, and intensely pruritic cutaneous eruptions caused by penetration and migration of larvae. Although the infection is generally confined to the skin, rare instances of larval migration to the lungs can result in more severe complications. A 71-year-old male presented with a progressive, curvilinear, erythematous track in the left upper quadrant region of the abdomen, accompanied by intense pruritus, a burning sensation, and a localized nodular lesion. Erythema was observed approximately 3-4 cm from the site of larval penetration, with the serpiginous tract extending approximately 10 cm in length. The diagnosis of cutaneous larva migrans (CLM) was established based on the characteristic clinical presentation. The Siddha herbal formulation Naakupoochi Kudineer was administered 60 ml twice after meals for seven days, resulting in gradually reducing symptoms and resolving the tract over the following weeks. This study highlights the safety and effectiveness of a Siddha herbal formulation in the treatment of CLM.

Transforming Healthcare in Low-Resource Settings With Artificial Intelligence: Recent Developments and Outcomes

BACKGROUND

Artificial intelligence now encompasses technologies like machine learning, natural language processing, and robotics, allowing machines to undertake complex tasks traditionally done by humans. AI's application in healthcare has led to advancements in diagnostic tools, predictive analytics, and surgical precision.

AIM

This comprehensive review aims to explore the transformative impact of AI across diverse healthcare domains, highlighting its applications, advancements, challenges, and contributions to enhancing patient care.

METHODOLOGY

A comprehensive literature search was conducted across multiple databases, covering publications from 2014 to 2024. Keywords related to AI applications in healthcare were used to gather data, focusing on studies exploring AI's role in medical specialties.

RESULTS

AI has demonstrated substantial benefits across various fields of medicine. In cardiology, it aids in automated image interpretation, risk prediction, and the management of cardiovascular diseases. In oncology, AI enhances cancer detection, treatment planning, and personalized drug selection. Radiology benefits from improved image analysis and diagnostic accuracy, while critical care sees advancements in patient triage and resource optimization. AI's integration into pediatrics, surgery, public health, neurology, pathology, and mental health has similarly shown significant improvements in diagnostic precision, personalized treatment, and overall patient care. The implementation of AI in low-resource settings has been particularly impactful, enhancing access to advanced diagnostic tools and treatments.

CONCLUSION

AI is rapidly changing the healthcare industry by greatly increasing the accuracy of diagnoses, streamlining treatment plans, and improving patient outcomes across a variety of medical specializations. This review underscores AI's transformative potential, from early disease detection to personalized treatment plans, and its ability to augment healthcare delivery, particularly in resource-limited settings.

Breaking bad news: Comparing the perception of the role, barriers and experiences of neonatal intensive care and well-baby nursery nurses

BACKGROUND

Nurses accompany patients throughout the breaking bad news process.

AIM

The aim of the research was to compare neonatal intensive care unit (NICU) nurses and well-baby nursery (WBN) nurses on their role, barriers and experiences in breaking bad news to parents/relatives during hospitalization.

STUDY DESIGN

A cross-sectional comparative study.

RESULTS

Two medical centres in Israel were employed. A 39-item questionnaire was distributed with 140 nurses participating in the study. STROBE Checklist was used. A total of 140 nurses participated in this study. There was no significant overall difference (p ≤ .45) between NICU and WBN nurses in their perception of their role in breaking bad news. Differences were found in barriers to the role which included a lack of information, lack of time and communication issues. No differences were found in the nurses' experiences in breaking bad news. NICU and WBN nurses reported that they received no support (n = 40, 58.8%; n = 45, 64.3%, respectively). No breaking bad news specialty team existed in either unit (NICU: n = 64, 91.4%; n = 60, 87.0%).

CONCLUSIONS

Nurses in the WBN and NICU are involved in breaking bad news. The role of the nurse has not been fully acknowledged making it difficult to perform. Nurses' experiences in breaking bad news were varied. Nurses facing challenges should be provided guidance and support. This needs to be implemented.

RELEVANCE TO CLINICAL PRACTICE

The role played by nurses in breaking bad news has not been fully acknowledged making it difficult to perform. Nurses need to receive formal training and support in order to improve this practice.

The efficacy of sodium-glucose transporter 2 inhibitors in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis

The efficacy of sodium-glucose transporter 2 (SGLT-2) inhibitors for nonalcoholic fatty liver disease (NAFLD) is unclear. Therefore, we conducted a systematic review and meta-analysis to evaluate SGLT-2 inhibitors efficacy for NAFLD treatment. We systematically searched major electronic databases (PubMed, Cochrane Library, Web of Science, Embase) from inception until 11/2023, identifying randomized controlled trials (RCTs) of SGLT-2 inhibitors treatment for patients with NAFLD. The mean differences (MD or SMD) and 95 % confidence intervals (CIs) were calculated via random-effects models. Eleven articles (n = 805 patients with NAFLD) were included in this study. Of these, 408 participants received SGLT-2 inhibitors, while 397 participants were in the control group. SGLT-2 inhibitors significantly reduced liver enzyme levels, including aspartate alanine aminotransferase (ALT) (MD [95 % CI]; -9.31 U/L [-13.41, -5.21], p < 0.00001), aspartate aminotransferase (AST) (MD [95 % CI]; -6.06 U/L [-10.98, -1.15], p = 0.02), and gamma-glutamyltransferase (GGT) (MD [95 % CI]; -11.72 U/L [-15.65, -7.80], p < 0.00001). SGLT-2 inhibitors intervention was also associated with significant reductions in body weight (MD [95 % CI]; -2.72 kg [-3.49, -1.95], p < 0.00001) and BMI (MD [95 % CI]; -1.11 kg/m2 [-1.39, -0.82], p < 0.00001) and improvements in glycaemic indices, triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C). However, no significant changes in total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C) were observed. The meta-analysis revealed a beneficial effect of SGLT-2 inhibitors on liver functions and body weight, BMI, TG, HDL-C, and glucose homeostasis in patients with NAFLD, indicating that SGLT-2 inhibitors might be a clinical therapeutic strategy for these patients, especially individuals with concurrent type 2 diabetes mellitus (T2DM).

The impact of motor, non-motor, and social aspects on the sexual health of women living with Parkinson's disease

BackgroundSexual health is influenced by a complex interplay of biological, psychological, and social factors, all of which can be impacted by Parkinson's disease (PD). Female sexual dysfunction includes reduced sexual desire and/or arousal, pain during sexual activity, or difficulty achieving orgasm. Despite its impact on quality of life, sexual health in women with PD remains poorly understood.ObjectiveTo investigate the impact of motor, non-motor, and social PD aspects on sexual health of women with PD.MethodsWe conducted a cross-sectional study with 100 women with PD (Hoehn and Yahr stages 1-3) who reported an active sex life in the last six months. Data were collected via remote interviews and included demographic and clinical features, cognitive capacity, motor and non-motor experiences, fatigue, self-esteem, sleep disorders, couple relationship quality, depressive symptoms, and sexual health assessments using the Female Sexual Function Index (FSFI) and Sexual Quotient-Female (SQ-F). Multiple regression models were used to identify predictors of FSFI and SQ-F scores.ResultsResults indicated that while several motor, non-motor, and social factors correlated with sexual health, only couple relationship quality and sleep quality significantly predicted both short-term (FSFI) and long-term (SQ-F) sexual health. No significant associations were observed with age, disease onset, postmenopausal status, or daily medication dosage.ConclusionsThe present study's evidence identifies multiple key areas, such as couple's relationship quality and sleep quality that could be targeted for intervention to improve sexual health in women with PD.

Global prevalence of excessive daytime sleepiness among nurses: A systematic review and meta-analysis

BACKGROUND

Nurses face significant risks of excessive daytime sleepiness (EDS), which adversely affects workplace safety and productivity. Yet, the extent of EDS in this workforce remains inadequately characterized.

AIM

The aims of this systematic review were to assess the pooled prevalence of EDS among nurses.

METHODOLOGY

We systematically searched PubMed, Embase, Scopus, and ISI Web of Science for observational studies reporting the prevalence of EDS, as measured by the Epworth Sleepiness Scale (ESS), from database inception to May 1, 2024, with no language restrictions. Study quality was evaluated using JBI's critical appraisal tool. Pooled estimates were calculated through random-effects meta-analysis, with subgroup and meta-regression analyses assessing associations between EDS prevalence and study-level factors. Linear regression modeling was used to assess time trends. This study was registered with PROSPERO (CRD42024535109).

RESULTS

We included 36 unique studies encompassing 2677 nurses from 20 countries. EDS occurred in 14.0%-55.6% of nurses. The results of the meta-analysis showed a pooled prevalence of EDS of 32.2% (95% confidence interval [CI]: 28.5-36.1; I2 = 92.6). Prevalence estimate did not vary substantially in terms of study-level data (i.e., region, country income, pre/post covid era, hospital type, proportion of female nurse, average nursing experience, or proportion of married nurses). The prevalence of EDS in nurses has remained unchanged over time.

CONCLUSIONS

This meta-analysis identifies a high global prevalence of EDS among nurses, affecting nearly one-third of this workforce. The findings underscore the urgent need for targeted interventions to mitigate EDS across diverse geographic and economic contexts.

IMPLICATION FOR NURSING AND NURSING POLICY

This study highlights the pervasive issue of EDS among nurses worldwide, necessitating comprehensive strategies to address this challenge across all regions, income levels, hospital settings, and demographic groups.

Barriers and facilitators in implementing intra-abdominal pressure measurement by nurses in paediatric intensive care units: A qualitative study

BACKGROUND

Intra-abdominal hypertension has been proven to be an independent risk factor for death in critically ill patients. Accurate monitoring of intra-abdominal pressure is of great significance for early identification and timely intervention of intra-abdominal hypertension to prevent further progression to abdominal compartment syndrome. Paediatric critical care nurses play an important role in constant observation and recognition of subtle and dynamic changes in intra-abdominal pressure of critically ill children.

OBJECTIVES

The objective of this study was to explore paediatric critical care nurses's views on the barriers and facilitators in clinical practice of intra-abdominal pressure measurement.

METHODS

A qualitative, open-ended, and exploratory study was conducted in the paediatric intensive care unit of a tertiary hospital in China. Semistructured interviews were conducted with nurses and nursing managers who were involved in the management of intra-abdominal pressure. The interview guide was developed using the Theoretical Domains Framework to explore the barriers and facilitators to intra-abdominal pressure measurement in the paediatric intensive care unit. Data analysis followed the framework approach, drawing on the Theoretical Domains Framework.

RESULTS

Fourteen participants (10 nurses and four nursing managers) were interviewed. We identified seven domains related to intra-abdominal pressure measurement mapping to six "barrier" domains and four "facilitator" domains. The six "barrier" domains were knowledge, social influences, behavioural regulation, beliefs about consequences, beliefs about capabilities, and environmental context and resources, and the four "facilitator" domains were social influences, beliefs about consequences, environmental context and resources, and social/professional role and identity.

CONCLUSIONS

The findings confirm the need for interventions to support paediatric critical care nurses in their intra-abdominal pressure measurement practices, with a particular focus on increasing knowledge, improving skills and measurement equipment, promoting nurse-physician interprofessional collaboration, providing a standardised measurement process, and establishing a supportive environment. Using the Theoretical Domains Framework will enhance the design of a targeted intervention, which should facilitate the standardised management of intra-abdominal pressure in the paediatric intensive care unit.

Impact of [18F]FDG PET/CT Radiomics and Artificial Intelligence in Clinical Decision Making in Lung Cancer: Its Current Role

Lung cancer remains one of the most prevalent cancers globally and the leading cause of cancer-related deaths, accounting for nearly one-fifth of all cancer fatalities. Fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ([18F]FDG PET/CT) plays a vital role in assessing lung cancer and managing disease progression. While traditional PET/CT imaging relies on qualitative analysis and basic quantitative parameters, radiomics offers a more advanced approach to analyzing tumor phenotypes. Recently, radiomics has gained attention for its potential to enhance the prognostic and diagnostic capabilities of [18F]FDG PET/CT in various cancers. This review explores the expanding role of [18F]FDG PET/CT-based radiomics, particularly when integrated with artificial intelligence (AI), in managing lung cancer, especially non-small cell lung cancer (NSCLC). We review how radiomics and AI improve diagnostics, staging, tumor subtype identification, and molecular marker detection, which influence treatment decisions. Additionally, we address challenges in clinical integration, such as imaging protocol standardization, feature reproducibility, and the need for extensive prospective studies. Ultimately, radiomics and AI hold great promise for enabling more personalized and effective lung cancer treatments, potentially transforming disease management.

Mechanical chest compression increases intrathoracic hemorrhage complications in patients receiving extracorporeal cardiopulmonary resuscitation

Background

Mechanical cardiopulmonary resuscitation (CPR) devices address the limitations of manual CPR, but their impact on intrathoracic injuries during extracorporeal CPR (ECPR) remains unclear. This study investigated the relationship between mechanical CPR and severe intrathoracic hemorrhage during ECPR compared to manual CPR.

Methods

We conducted a single-center retrospective study of consecutive patients who underwent ECPR from April 2017 to March 2024 according to a standard institutional protocol. Patients were divided into a mechanical CPR group (piston-driven compressions before veno-arterial extracorporeal membrane oxygenation [VA-ECMO]) and a manual CPR group. The primary outcome was intrathoracic hemorrhage requiring transcatheter arterial embolization (TAE). Secondary outcomes included other intrathoracic injuries and 180-day survival.

Results

A total of 91 patients were enrolled (mechanical n = 48, manual n = 43). Intrathoracic hemorrhage requiring TAE occurred more frequently in the mechanical CPR group (18.8% vs. 2.3%, p = 0.030). On multivariate analysis, mechanical CPR was independently associated with this outcome (adjusted odds ratio 6.29; 95% confidence interval 1.20-65.10). In the mechanical group, older age and larger thoracic transverse diameter were significantly related to intrathoracic hemorrhage requiring TAE. Mediastinal hematoma (18.8% vs. 2.3%, p = 0.030) and hemothorax (20.8% vs. 4.7%, p = 0.049) were also more frequent in the mechanical group. The 180-day survival rates did not differ significantly between groups (27.7% vs. 25.0%, log-rank p = 0.540).

Conclusions

Mechanical CPR during ECPR is associated with an increased risk of severe intrathoracic hemorrhage. While mechanical CPR devices may provide benefits in certain scenarios, clinicians should carefully consider individual patient characteristics and closely monitor for complications.

Minimally Invasive Anterolateral Cervical Cordotomy for Intractable Cancer Pain Using Microtubular Retractors: A Single Institution Case Series

BACKGROUND AND OBJECTIVES

As advancements in cancer treatments have allowed patients with a high burden of disease to live longer, the number of patients who present with debilitating refractory pain has increased. Anterolateral cordotomy has long been used for the treatment of intractable unilateral cancer pain using either an imaging-guided percutaneous approach or an open surgical approach. In this report, we describe a novel minimally invasive modification to the open surgical approach. It combines the benefits of both approaches by providing direct visualization for lesioning without the collateral tissue damage of an open approach.

METHODS

This retrospective study evaluated medical records, operative reports, and imaging studies of patients who underwent a minimally invasive cordotomy at a single institute between 2018 and 2022. The surgical technique involved a microscope-assisted C2 hemilaminectomy using microtubular retractors followed by dural opening and anterolateral cordotomy under direct visualization and with intraoperative neurophysiological monitoring.

RESULTS

Eleven patients were included in the study. None were converted to an open approach, and no wound-related postoperative complications were observed. A clinically significant decrease in pain was observed after the procedure, and 10 of the 11 patients (91%) were ambulatory by the time of analysis.

CONCLUSION

Compared with image-guided percutaneous cordotomy, anterolateral cervical cordotomy with microtubular retractors potentially improves the safety of the procedure through direct visualization while being less invasive than a conventional open approach. Our preliminary experience with this technique demonstrates the feasibility of the approach, as it was both safe and effective.

Assessing the Capability of Large Language Model Chatbots in Generating Plain Language Summaries

Background Plain language summaries (PLSs) make scientific research accessible to a broad non-expert audience. However, crafting effective PLS can be challenging, particularly for non-native English-speaking researchers. Large language model (LLM) chatbots have the potential to assist in generating summaries, but their effectiveness compared to human-generated PLS remains underexplored. Methods This cross-sectional study compared 30 human-written PLS with LLM chatbot (viz., ChatGPT (OpenAI, San Francisco, CA), Claude (Anthropic, San Francisco, CA), Copilot (Microsoft Corp., Washington, DC), Gemini (Google, Mountain View, CA), Meta AI (Meta, Menlo Park, CA), and Perplexity (Perplexity AI, Inc., San Francisco, CA)) generated PLS. The readability of the PLS was checked by the Flesch reading (FR) ease score, and understandability was checked by the Flesch-Kincaid (FK) grade level. Three authors rated the text on seven-item predefined criteria, and their average score was used to compare the quality of the PLS. Results In comparison to human-written PLS, chatbots could generate PLS with lower FK grade levels (p-value < 0.0001) and except Copilot, all others had higher FR ease scores. The overall score of human-written PLS was 8.89±0.26. Although there was statistically significant variance among the scores (F = 7.16, p-value = 0.0012), in the post-hoc test, there was no difference between human-generated and individual chatbots-generated PLS (ChatGPT 8.8±0.34, Claude 8.89±0.33, Copilot 8.69±0.4, Gemini 8.56±0.56, Meta AI 8.98±0.23, and Perplexity 8.8±0.3). Conclusion LLM chatbots can generate PLS with better readability and a person with a lower grade of education can understand it. The PLS are of similar quality to those written by human authors. Hence, authors can generate PLS from LLM chatbots and it is particularly beneficial for researchers in developing countries. While LLM chatbots improve readability, they may introduce minor inaccuracies also. Hence, PLS generated by LLM should always checked for accuracy and relevancy.

Neglected obturator hip dislocation with associated avascular necrosis of the femoral head in adolescent, a rare case report

INTRODUCTION AND IMPORTANCE

Neglected obturator hip dislocation is rare and possesses a dilemma in management to an orthopedic surgeon however total hip arthroplasty yield good to excellent outcome.

CASE PRESENTATION

23 years male, with four-month history of painful right hip associated with limping and inability to use the right lower limp, following a motor traffic crush and managed traditionally prior visiting our clinic, he had no any other associated injuries and medical history was uneventfully. On clinical evaluation, he was alert and oriented, with stable vitals, limping on walking with a stick, his right hip joint was slightly flexed, abducted and externally rotated, with limited hip range of motion and discrepancy of 3 cm. Pelvis X-ray revealed anterior inferior right hip joint dislocation, shallow acetabula, and features suggestive of avascular necrosis of head and neck. A diagnosis of neglected right obturator hip dislocation with avascular necrosis of the head and neck was made and advised for Total Hip Arthroplasty; however, patient and family refused the plan due to their financial constraints and traditional believes in spite of proper discussion provided, he was advised on weight bearing as tolerated, using crutches, and follow up visits, however he was lost to follow up.

DISCUSSION

Our case report is unique due to its rarity in occurrence and it was neglected due to traditional believes in their family and poor health seeking behavior. Total hip arthroplasty was considered as a treatment of choice in our case; however, the patient and family refused the option due to financial constraints and traditional believe and trust to bone settlers.

CONCLUSION

A neglected obturator hip dislocation is very rare and in spite of a dilemma on treatment, total hip arthroplasty is recommended for this case. Community health education should be considered so that hip dislocation being managed as early as possible.

Global burden and risk factors of MASLD: trends from 1990 to 2021 and predictions to 2030

The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing globally, posing a major public health issue. This study analyzes the global, regional, and national burden of MASLD and its risk factors from 1990 to 2021, with projections to 2030. We obtained data on MASLD prevalence, deaths, and disability-adjusted life years (DALYs) from the Global Burden of Disease 2021 for 204 countries. Counts and rates per 100,000 population were calculated, and trends to 2030 were predicted using the Bayesian Age-Period-Cohort model. In 2021, there were 1,267.9 million MASLD cases globally, with 138.3 thousand deaths and 3667.3 thousand DALYs. The global age-standardized prevalence, death, and DALY rates were 15,018.1, 1.6, and 42.4 per 100,000 population, increasing by 24.3%, 5.5%, and 5.5% since 1990. North Africa and the Middle East had the highest prevalence, while Andean and Central Latin America had the highest death and DALY rates. Men aged 15-69 and 90-94 had higher DALY rates, while women aged 70-89 and 95+ had higher rates. A reversed V-shaped association was found between the sociodemographic index and DALY rate. High fasting plasma glucose (5.9%) and smoking (2.4%) were major risk factors. Public health efforts should prioritize early detection and management of MASLD in younger populations and develop targeted strategies for older adults, especially women, to reduce the disease burden. Effective policies to address high fasting plasma glucose and smoking can mitigate MASLD's impact.

Ultrasound radiomics and genomics improve the diagnosis of cytologically indeterminate thyroid nodules

Background

Increasing numbers of cytologically indeterminate thyroid nodules (ITNs) present challenges for preoperative diagnosis, often leading to unnecessary diagnostic surgical procedures for nodules that prove benign. Research in ultrasound radiomics and genomic testing leverages high-throughput data and image or sequence algorithms to establish assisted models or testing panels for ITN diagnosis. Many radiomics models now demonstrate diagnostic accuracy above 80% and sensitivity over 90%, surpassing the performance of less experienced radiologists and, in some cases, matching the accuracy of experienced radiologists. Molecular testing panels have helped clinicians achieve accurate diagnoses of ITNs, preventing unnecessary diagnostic surgical procedures in 42%-61% of patients with benign nodules.

Objective

In this review, we examined studies on ultrasound radiomics and genomic molecular testing for cytological ITNs conducted over the past 5 years, aiming to provide insights for researchers focused on improving ITN diagnosis.

Conclusion

Radiomics models and molecular testing have enhanced diagnostic accuracy before surgery and reduced unnecessary diagnostic surgical procedures for ITN patients.

Effectiveness of high-intensity interval training in rehabilitation nursing for mild-to-moderate stable COPD patients: a randomized controlled clinical trial

OBJECTIVE

The current study was conducted to explore the clinical impact of high-intensity interval training (HIIT) in rehabilitation nursing on improving cardiopulmonary function and exercise capacity in COPD patients.

METHODS

A total of thirty-one COPD patients underwent HIIT, while an equal number underwent moderate-intensity continuous training (MICT) were included in this randomized controlled clinical study. The randomization method used was stratified block randomization, stratified by center. During the 6 months follow-up period, the clinical data, including cardiopulmonary exercise testing (CPET) results, cardiopulmonary function index, quality of life, and follow-up outcomes, were collected before and after the interventions. The therapeutic effects of the two groups were compared.

RESULTS

After the intervention, the HIIT group exhibited significantly higher peak power, exercise test duration, anaerobic threshold, peak oxygen uptake, peak ventilation, FEV1/FVC ratio, FEV1% of expected value, LVEF (%), and SF-36 scores compared to the MICT group (P < 0.05). Moreover, LVEDD was significantly lower in the HIIT group compared to the MICT group (P < 0.05). At the 6-month follow-up, the incidence of COPD acute exacerbation in the HIIT group was significantly lower than in the MICT group (P < 0.05).

CONCLUSION

Implementation of HIIT in rehabilitation nursing effectively improved cardiopulmonary function and exercise capacity in COPD patients during clinical treatment, highlighting its promising application potential.

TRIAL REGISTRATION

This study was previously registered at Chinese Clinical Trial Registry (Date 11/05/2022 Number ChiCTR2200059764).

Engineered bacteria and bacterial derivatives as advanced therapeutics for inflammatory bowel disease

Inflammatory bowel disease (IBD), a chronic and relapsing-remitting condition, is inadequately managed by conventional therapies that often lack targeting specificity and carry significant side effects, particularly failing to address intestinal barrier repair and microbial balance. Probiotics, with their strong colonization capabilities, present a novel approach to drug delivery. Various engineering strategies have been developed to enhance the targeting ability of probiotics to inflammation sites, enabling precise delivery or in situ synthesis of therapeutic molecules to expand their multifunctional potential. This review discusses the recent advancements in bacterial modifications, including surface physico-chemical and biological coating, genetic engineering, outer membrane vesicles, minicells, and bacterial ghosts, all of which can enhance therapeutic localization. We also outline critical preclinical considerations, such as delivery frequency, systemic distribution, immune evasion, and gene contamination risks, for clinical translation. These engineered bacteria and bacterial derivatives hold great promise for personalized and sustained IBD treatments, providing a new frontier for therapy tailored to the complex inflammatory environment of IBD.

Long-Term Risk of Adjacent-Segment Disease in Isthmic Spondylolisthesis Treated with Posterior Interbody Fusion

OBJECTIVE

Posterior interbody fusion can be associated with adjacent-segment disease (ASD) some years after surgery. The aim of this study is to confirm the rate of ASD in isthmic spondylolisthesis treated by posterior fusion.

METHODS

The records of patients treated by posterior lumbar fusion between January 2014 and June 2022 were collected. Inclusion criteria encompassed adults diagnosed with isthmic spondylolisthesis and available preoperative, postoperative, and follow-up radiologic images.

RESULTS

Of the 140 patients included in the study, the majority were female (53.6%) with a mean age of 48.5 years. In 111 (79.3%) patients the spondylolisthesis was located at L5-S1; in 20 (14.3%) patients at L4-L5; 5 (3.6%) cases presented the defect at L4-L5-S1, and in 4 (2.8%) cases at L3-L4. In 75 (53.6%) patients, the listhesis was classified as grade I (Meyerding); in 50 (35.7%) cases as grade II; in 12 (8.6%) cases as grade III; and in 3 (2.1%) cases as grade IV. The average follow-up of this study was 67 (10-111) months. Two cases (1.43%, 95% confidence interval 0.17%-5.07%) of ASD were observed. Evaluations of clinical symptoms revealed a notable reduction in the average Numeric Rating Scale score from 8 to 1.9 at the last follow-up. Postoperative pelvic incidence-lumbar lordosis mismatch <10 correlating with a favorable outcome (Numerical Rating Scale ≤3).

CONCLUSIONS

This study confirms data already present in the literature regarding the low incidence of ASD in patients who underwent surgery for isthmic spondylolisthesis. The posterior approach seems to remain a safe and effective technique in these patients.

Accelerating Earlier Access to Anti-TNF-α Agents with Biosimilar Medicines in the Management of Inflammatory Bowel Disease

Data indicate that earlier initiation of anti-tumor necrosis factor alpha (anti-TNF-α) biologic medicines may prevent progression to irreversible bowel damage and improve outcomes for patients with inflammatory bowel disease (IBD), particularly Crohn's disease. However, the high cost of such therapies may restrict access and prevent timely treatment of IBD. Biosimilar anti-TNF-α medicines may represent a valuable opportunity for cost savings and optimized patient outcomes by improving access to advanced therapies and allowing earlier anti-TNF-α treatment initiation. Biosimilar anti-TNF-α medicines have been shown to offer consistent therapeutic outcomes to their reference medicines, yet despite entering the IBD treatment armamentarium over 10 years ago, their implementation in clinical practice remains suboptimal. Factors limiting the 'real' use of biosimilar anti-TNF-α medicines may include an ongoing lack of understanding and acceptance of biosimilars by both healthcare professionals (HCPs) and patients, as well as systemic factors such as formulary decisions outside of the control of the prescriber. In this review, an expert panel of gastroenterologists discusses HCP-level considerations to improve biosimilar anti-TNF-α utilization in IBD in order to support early anti-TNF-α initiation and maximize patient outcomes.

Left bundle branch pacing cardiac resynchronization therapy vs biventricular pacing cardiac resynchronization therapy–time to write a requiem for biventricular pacing-cardiac resynchronization therapy

Cardiac resynchronization therapy (CRT) reduces heart failure (HF) hospitalizations and all-cause mortality in patients with HF with reduced ejection fraction with left bundle branch (LBB) block. Biventricular pacing (BVP) is considered the gold standard for achieving CRT; however, approximately 30%–40% of patients do not respond to BVP-CRT. Recent studies have demonstrated that LBB pacing (LBBP) produces remarkable results in CRT. In this meta-analysis, LBBP-CRT showed better outcomes than conventional BVP-CRT, including greater QRS duration reduction and left ventricular ejection fraction improvement, along with consistently lower pacing thresholds on follow-up. Additionally, there was a greater reduction in New York Heart Association class and brain natriuretic peptide levels. This study contributes to the growing body of encouraging data on LBBP-CRT from recent years. With ongoing technological advancements and increasing operator expertise, the day may not be far when LBBP-CRT becomes the standard of care rather than the exception.

Paradigm Shift in Inflammatory Bowel Disease Management: Precision Medicine, Artificial Intelligence, and Emerging Therapies

Inflammatory bowel disease (IBD) management stands at the cusp of a transformative era, with recent breakthroughs heralding a paradigm shift in treatment strategies. Traditionally, IBD therapeutics revolved around immunosuppressants, but the landscape has evolved significantly. Recent approvals of etrasimod, upadacitinib, mirikizumab, and risankizumab have introduced novel mechanisms of action, offering renewed hope for IBD patients. These medications represent a departure from the status quo, breaking years of therapeutic stagnation. Precision medicine, involving Artificial Intelligence, is a pivotal aspect of this evolution, tailoring treatments based on genetic profiles, disease characteristics, and individual responses. This approach optimizes treatment efficacy, and paves the way for personalized care. Yet, the rising cost of IBD therapies, notably biologics, poses challenges, impacting healthcare budgets and patient access. Ongoing research strives to assess cost-effectiveness, guiding policy decisions to ensure equitable access to advanced treatments. Looking ahead, the future of IBD management holds great promise. Emerging therapies, precision medicine, and ongoing research into novel targets promise to reshape the IBD treatment landscape. As these advances continue to unfold, IBD patients can anticipate a brighter future, one marked by more effective, personalized, and accessible treatments.

Impact of BMI and Work Environment Circumstances on Prevalence and Severity of Chronic Pain among Nurses

PURPOSE

The objective of this study was to explore the relationship between workplace conditions, demographic characteristics, and physical attributes with the prevalence and severity of chronic pain among nurses. The goal was to gain insights into the factors contributing to chronic pain within the nursing profession.

METHODS

A cross-sectional descriptive-analytic study was conducted among 415 nurses in Turkey using purposive convenience sampling. Data collection instruments included the Graded Chronic Pain Scale, a body diagram, a pain exacerbator/alleviator inquiry, and a socio-demographic form. Data were analyzed using SPSS 25.

RESULTS

The majority of participants were female nurses (87.7%) with a mean age of 34.62 ± 9.32 and a body mass index (BMI) of 24.51 ± 4.32. Nearly half reported irregular exercise habits (49.9%), and 36.1% indicated high levels of work-related stress. A significant proportion exhibited moderate levels of work-related anxiety (39%), smoked (40%), and consumed alcohol (37.1%). Chronic pain was experienced by 40.9% on most days, with the head and lumbar regions being the most affected (45.5% and 44.1%, respectively). The study identified a significant association between BMI and pain frequency (p = .043) and severity (p < .014). Furthermore, pain localization and management strategies varied between male and female nurses.

DISCUSSION

The study's results underscore the substantial impact of chronic pain on nurses' quality of life, activity levels, and work attendance. Notably, the study provides results that support the relationship between BMI and chronic pain. The study revealed gender-specific differences in pain localization and management strategies among nurses, highlighting the importance of gender-tailored interventions in chronic pain management among nurses.

CONCLUSION

Addressing the interplay between BMI, work-related factors, and chronic pain is vital for nurses' well-being and a conducive work environment, potentially reducing financial costs associated with medical leave and absenteeism.

Innovative Gastrointestinal Drug Delivery Systems: Nanoparticles, Hydrogels, and Microgrippers

Over the past decade, new technologies have emerged to increase intrinsic potency, enhance bioavailability, and improve targeted delivery of drugs. Most pharmaceutical formulations require multiple dosing due to their fast release and short elimination kinetics, increasing the risk of adverse events and patient non-compliance. Due to these limitations, enormous efforts have focused on developing drug delivery systems (DDSs) for sustained release and targeted delivery. Sustained release strategies began with pioneering research using silicone rubber embedding for small molecules and non-inflammatory polymer encapsulation for proteins or DNA. Subsequently, numerous DDSs have been developed as controlled-release formulations to deliver systemic or local therapeutics, such as small molecules, biologics, or live cells. In this review, we discuss the latest developments of DDSs, specifically nanoparticles, hydrogels, and microgrippers for the delivery of systemic or localized drugs to the gastrointestinal (GI) tract. We examine innovative DDS design and delivery strategies tailored to the GI tract's unique characteristics, such as its extensive length and anatomical complexity, varying pH levels and enzymatic activity across different sections, and intrinsic peristalsis. We particularly emphasize those designed for the treatment of inflammatory bowel disease (IBD) with in vivo preclinical studies.

Evidence of rapid rise in population immunity from SARS-CoV-2 subclinical infections through pre-vaccination serial serosurveys in Pakistan

Background

Understanding factors associated with protective immunity against emerging viral infections is crucial for global health. Pakistan reported its first COVID-19 case on 26 February 2020, but experienced relatively low COVID-19-related morbidity and mortality between 2020 and 2022. The underlying reasons for this remain unclear, and our research aims to shed light on this crucial issue.

Methods

We conducted a serial population-based serosurvey over 16 months (rounds 1-4, July 2020 to November 2021) across households in urban (Karachi) and rural (Matiari) Sindh, sampling 1100 households and 3900 individuals. We measured antibodies in sera and tested a subset of respiratory samples for COVID-19 using polymerase chain reaction (PCR) and antigen tests, also measuring haemoglobin (Hb), C-reactive protein (CRP), vitamin D, and zinc in round 1.

Results

Participants showed 23% (95% confidence interval (CI) = 21.9-24.5) antibody seroprevalence in round 1, increasing across rounds 2-4 to 29% (95% CI = 27.4-30.6), 49% (95% CI = 47.2-50.9), and 79% (95% CI = 77.4-80.8), respectively. Urban residents had 2.6 times (95% CI = 1.9-3.6) higher odds of seropositivity than rural residents. Seropositivity did not differ between genders. Individuals aged 20-49 years had 7.5 (95% CI = 4.6-12.4) times higher odds of seropositivity compared to children aged 0-4 years. Most participants had no symptoms associated with COVID-19, with no reported mortality. Vitamin D deficiency was linked to seroprevalence. COVID-19 was confirmed in 1.8% of individuals tested via RT-PCR and antigen tests.

Conclusions

The data suggests a steady increase in humoral immunity in Pakistan, likely due to increased transmission and associated asymptomatic disease. Overall, this reflects the longitudinal trend of protection against severe acute respiratory syndrome coronavirus 2, leading to the relatively low morbidity and mortality observed in the population.

Comprehensive management of gastrointestinal fistulas in necrotizing pancreatitis: a review of diagnostic and therapeutic approaches

INTRODUCTION

Gastrointestinal fistula (GIF) is a rare but severe complication in patients with necrotizing pancreatitis (NP), significantly prolonging disease course and increasing morbidity and mortality. Its subtle and nonspecific early symptoms often delay diagnosis and intervention. Despite its clinical significance, the low incidence of GIF in NP has resulted in limited research and a lack of consensus on optimal diagnostic and therapeutic strategies.

AREAS COVERED

This review focuses on the epidemiology, pathophysiology, diagnostic approaches, and therapeutic management of GIF in NP patients. Imaging techniques, such as contrast-enhanced computed tomography and endoscopy, have been integral to early diagnosis. Advances in interventional and surgical techniques provide new avenues for treatment, but variability in clinical practice highlights the need for standardized protocols.

EXPERT OPINION

Recent advances in diagnostic imaging have improved the detection of GIF, while innovations in interventional and surgical treatments show promise. Current research is still insufficient and varied. Future research should focus on developing diagnostic methods and treatment measures for such complications. By improving early diagnosis and offering insights into effective management strategies, it is hoped that patient outcomes can be improved.

Violence Against Healthcare Workers in a University Hospital of Central Italy: How Risk Management Interventions Can Help Change a Trend

Background/Objectives: Violence against workers (physical, verbal, or psychological abuse), even if it affects all professional categories, is up to ten times higher in healthcare workers. A University Hospital of Central Italy has gradually implemented a series of preventive measures, which might have impacted the trend of the phenomenon. Methods: In order to monitor the episodes, an aggressive event reporting form was adopted throughout the hospital. Data extracted both from this form and the root cause analysis documentation regarding the period January 2019-December 2023 were used. Descriptive statistical analysis was performed using the Chi-squares test, while the join point regression program was used to analyze the trends. Results: The average age of the sample is 43.5 years, with twice as many female workers as male workers. Nurses are more frequently involved (76.6%), and 58% of the events involved 2 to 4 HWs. Verbal violence was reported by 51.2% of HWs, and over 35% of them did not suffer any damage, while 25% suffered mild to moderate damage (illness, injury, or material harm, whether physical or psychological). The hospital divisions which are primarily concerned are the Psychiatry department (36.2%) and the Emergency Room (33.4%). There is no difference in hospital management of aggressive events between males and females. Join point regression analyses showed that there was a significant increase in the reporting of episodes of aggression. Conclusions: The presence of a strong culture of reporting among HWs guarantees a seemingly constant increase in the reporting of nonphysical forms of violence. The statistically significant differences found will allow hospital management to categorize the risk levels and act accordingly.

CO2 and aerosol concentration during manual and mechanical chest compression while cardiopulmonary resuscitation

BACKGROUND

This study investigates the staff-to-staff transmission risk of Coronavirus disease 2019 during cardiopulmonary resuscitation in an ambulance vehicle.

METHODS

Comparing manual and mechanical chest compressions, CO2 concentrations were monitored as a proxy for infection risk.

RESULTS

Results suggest that mechanical chest compressions generate lower CO2 levels, indicating a reduced risk of infection among healthcare workers compared to manual compressions.

CONCLUSIONS

These findings highlight the potential benefits of employing mechanical chest compressions to mitigate staff-to-staff infections in small, confined spaces during aerosol-transmitted diseases.

Exploring the potential mechanism of B-phycoerythrin on DSS-induced colitis and colitis-associated bone loss based on network pharmacology, molecular docking, and experimental validation

B-phycoerythrin (B-PE), a pigment protein, has found extensive applications in the food, pharmaceutical, and cosmetic industries. However, the effects and potential mechanisms of B-PE on colitis and colitis-associated bone loss remain unclear. Thus, the aim of this study was to investigate the pharmacological mechanisms of B-PE against colitis and colitis-associated bone loss using network pharmacology analysis, molecular docking, and experimental validation. Based on public databases, 99 common targets of B-PE against inflammatory bowel disease and osteoporosis were predicted. The protein-protein interaction network identified 16 core targets, including TNF, AKT1, EGFR, etc., as hub targets. Additionally, functional enrichment analyses and molecular docking results revealed that the PI3K/AKT signaling pathway may serve as a potential signaling pathway for B-PE in the treatment of colitis and colitis-associated bone loss. Furthermore, pharmacological experiments indicated that B-PE not only reversed the elevated expression of TNF-α, IL-1β, MMP9, and CXCL8a, and the reduced expression of ZO-1, E-cadherin, COL1A1, and RUNX2 in the DSS-induced colitis zebrafish model, but also enhanced the phosphorylation of PI3K and AKT, thereby mitigating inflammatory response and promoting osteogenesis. In conclusion, this study provides a theoretical basis for considering B-PE as a promising candidate for the treatment of colitis and colitis-associated bone loss.

The association between early corticosteroid use and the risk of secondary infections in hospitalized patients with COVID-19: a double-edged sword. Results from the international SCCM discovery viral infection and respiratory illness universal study (VIRUS) COVID-19 registry

Background

Corticosteroids improve survival in hospitalized COVID-19 patients needing supplemental oxygen. However, concern exists about increased risk of secondary infections. This study investigated the impact of early corticosteroids use on these infections.

Methods

Data from the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 registry were analyzed for adult patients, stratified by early corticosteroid use (within 48 h of admission). The primary outcome was documented secondary infections, including bacteremia, bacterial pneumonia, empyema, meningitis/encephalitis, septic shock, and ventilator-associated pneumonia. Univariate and multivariable logistic regression models were used to assess the association between early corticosteroids and these outcomes.

Results

Among 17,092 eligible patients, with 13.5% developed at least one secondary bacterial infection during hospitalization. Patients receiving early corticosteroids were older (median 63 years) compared to those who did not (median 60 years), with a similar gender distribution (42.5% vs. 44.2% female). Unadjusted analysis revealed a higher risk for any secondary infection (OR 1.93, 95% CI 1.76-2.12). This association persisted for specific infections including bacteremia (OR 2.0, 95% CI 1.58-2.54), bacterial pneumonia (OR 1.5, 95% CI 1.27-1.77), and septic shock (OR 1.67, 95% CI 1.44-1.93). However, the effect on meningitis/encephalitis (OR 0.62, 95% CI 0.24-1.57) and ventilator-associated pneumonia (VAP; OR 1.08, 95% CI 0.75-1.57) was non-significant. Adjusted analysis maintained significance for any secondary infection (OR 1.15, 95% CI 1.02-1.29), bacteremia (OR 1.43, 95% CI 1.09-1.88), and infections with unknown sources (OR 1.63, 95% CI 1.31-2.02). Notably, the association weakened and became non-significant for bacterial pneumonia (OR 0.98, 95% CI 0.81-1.20) and septic shock (OR 0.94, 95% CI 0.79-1.11), while it became significant for meningitis/encephalitis (OR 0.26, 95% CI 0.08-0.82). VAP remained non-significant (OR 0.87, 95% CI 0.56-1.34).

Conclusion

Early use of corticosteroids increased overall secondary infection risk in hospitalized COVID-19 patients, but the impact varied. Risk of bacteremia was notably increased, while the association with bacterial pneumonia and septic shock weakened after adjustment becoming non-significant and surprisingly reduced meningitis/encephalitis risk was noted suggesting the complexity of corticosteroid effects. Further research is needed to understand how corticosteroids influence specific secondary infections, and thereby optimize the treatment strategies.

Cost outcomes of pituitary adenoma resection: The use of a hybrid microscopic/endoscopic surgery

Background

The pathogenesis, surgical techniques, and outcomes of pituitary adenomas (PAs) remain variable. We compared our surgical techniques and perioperative/long-term PA outcomes to highlight the hybrid microscopic/endoscopic technique used to optimize efficiency, cost savings, and outcomes in PA surgery.

Methods

Consecutive PA cases performed from January 2017 through February 2020 were evaluated retrospectively. A cost analysis by surgical approach was performed combining this primarily microscopic series, with endoscopic visual assist, and a separate cohort of consecutive intra-institutional endoscopic-only PA resections.

Results

Among 160 patients included in the main cohort analysis (mean age 51.5 ± 16.2; 89 females [55.6%]), a microscope was used in 81.9% of cases, with endoscopic assistance (hybrid) or the endoscope alone used in the remaining cases. Surgical complications occurred in 5 cases (3.1%): postoperative diabetes insipidus in 3 (1.9%), electrolyte imbalances requiring additional drug treatment in 3 (1.9%), and syndrome of inappropriate anti-diuretic hormone release in 2 (1.2%). Thirty-three additional patients were included in the cost analysis (193 total). Patients treated with a microscopic-only approach had the lowest operating time (mean normalized operating room costs 1.00 [95% confidence interval (CI) 0.95, 1.04], P < 0.001; mean normalized total direct costs 5.00 [95%CI 4.69, 5.31], P = 0.008), with hybrid and endoscopic-only approaches having higher comparable operating times and costs.

Conclusion

PA surgery using a primarily microscopic approach (with endoscopic assistance for complex cases) remains a safe, efficient, and cost-effective strategy and results in shorter anesthesia time to reduce patient complications while maintaining excellent endocrinologic outcomes.

Keywords

Endoscope, Hybrid approach, Microscope, Pituitary adenoma, Transnasal surgery, Transsphenoidal surgery.

Progressive role of artificial intelligence in treatment decision-making in the field of medical oncology

This article explores the role of artificial intelligence (AI) in medical oncology, emphasizing its impact on treatment decision-making for adult and pediatric cancer care. AI applications, including advanced imaging, drug discovery, and clinical decision support systems, enhance precision, personalization, and efficiency. Pediatric oncology benefits from improved diagnostics, risk stratification, and targeted therapies, despite unique challenges. AI-driven personalized medicine optimizes treatment strategies, improving patient outcomes and reducing costs. Ethical considerations, such as data privacy, algorithmic bias, and explainability, remain critical for responsible AI integration. Future advancements, including explainable AI and quantum computing, promise to redefine cancer care through data-driven insights.

A multimodal approach for sleep apnea detection: SpO2 and force sensitive sensors in a flexible 3D-printed wearable

. The diagnosis of sleep apnea relies on the evaluation of polysomnography (PSG) recordings by experienced health monitoring practitioners. The labor-intensive nature of PSG and it's required complex instrumentation limit its widespread use across the general population. This research inquest offers a wearable health monitoring device in response to these challenges. The device incorporates a custom-fabricated force sensor resistor (FSR) seamlessly integrated with a microcontroller and pulse oximeter (SpO2) within a 3D-printed enclosure. Real-time respiratory and oxygen saturation data are wirelessly transmitted to a web-based interface for comprehensive and automated sleep apnea diagnosis. This prototype provides a comfortable, easy-to-use solution capable of accurate and automated diagnosis of sleep apnea. The sensor is fabricated by spray-coated silver ink finger electrodes, which were characterized by scanning electron microscopy (SEM) and energy dispersive X-ray analysis (EDAX), confirming the presence of high silver content (97.6%) and low oxygen (2.4%), ensuring good electrical conductivity. Additionally, the designed finger electrode was simulated by COMSOL Multiphysics simulations software through repeated trials, suggesting a consistent and direct relationship between applied pressure and voltage output as per the Ohm's law. The sensor's voltage output varied linearly, with force (N) from 0 to 5 V and force (N) from 0 to 40 Newton. The COMSOL simulations uses electrostatic and moving mesh models matched with real-world experimental results further validated the sensor. The minimal non-linearity observed in practical scenarios proves the robustness of the sensor.

Hepatitis Associated with Catha edulis Consumption-A Single-Center Study

Background/Objectives:Catha edulis, also known as Khat, is a stimulant with hepatotoxic properties. Studies reporting laboratory patterns are scarce. The aim was to assess the patterns associated with hepatic dysfunction due to Khat usage. Methods: Patients with liver injury and self-reported Khat consumption presenting to the gastroenterology department at the King Fahad Central Hospital in Jazan between January 2017-May 2024 were retrospectively included in the study. Patients with any signs of cirrhosis or viral hepatitis were excluded to have a more homogenous inclusion. Normal distribution was not assumed; data were presented as the median (IQR or %). Results: Sixty-three patients (of which 62 (98.4%) were male) aged 35 (29-41) years were included in the study. An IgG > 20 g/L was present in 41 (61.5%) patients, and the majority (n = 48, 76.2%) had a hepatocellular injury pattern based on an R-factor > 5. Over half of the patients had at least one positive autoantibody(ANA 47.6%; SMA 55.6% and AMA 4.8%), while 57 (90.5%) patients received immunosuppressive therapy. Conclusions: Khat-induced liver injury seems to be predominantly AIH-like in nature, given the IgG elevation, hepatocellular injury pattern, and relatively high rate of autoantibody positivity.

Optimizing Obstructive Sleep Apnea Risk Assessment in Hypertension: Development of a Predictive Nomogram in China

Purpose

Obstructive sleep apnea (OSA) is common in patients with hypertension. Our study aims to construct and validate an objective nomogram that can accurately predict the risk of OSA in patients with hypertension.

Patients and Methods

Retrospective data were collected from patients with hypertension who underwent polysomnography (PSG) at the Sleep Medicine Center of the First Affiliated Hospital of Guangzhou Medical University, China. All participants were assigned to the training group (used to develop the predictive model). Similarly, data from patients with hypertension who underwent PSG at the Sleep Medicine Center of the Second Affiliated Hospital of Guangdong Medical University, China, were collected, and these participants were assigned to the validation group (used to test the model's performance). Logistic and LASSO regression analyses were used to identify factors and construct the nomogram. C-index, calibration curve, decision curve analysis (DCA) and clinical impact curve analysis (CICA) were used to assess the model. Finally, nomogram validation was performed in the validation group.

Results

This study included a training group of 303 patients and a validation group of 217 patients. Based on LASSO and Logistic regression analyses and clinical practicality, we identified gender, age, BMI (body mass index), NC (neck circumference) and ESS (Epworth Sleepiness Scale) as predictors for the nomogram. The C-index is 0.840 in the training group and 0.808 in the validation group. The area under the curve (AUC) of the predictive model and STOP-Bang at the three diagnostic cut-off points of the Apnea-Hypopnea Index (AHI) ≥ 5, AHI ≥ 15 and AHI ≥ 30 were 0.840 vs 0.778, 0.754 vs 0.740, and 0.765 vs 0.751 respectively. The AUC at each intercept point was higher than that of STOP-Bang. DCA and CICA showed that the nomogram is clinically useful.

Conclusion

The nomogram predictive model consisting of the five indicators (gender, age, BMI, NC and ESS) can be useful in determining OSA risk in patients with hypertension.

Illness perception, coping and psychological distress among patients with metabolic dysfunction-associated fatty liver disease (MAFLD) in China

OBJECTIVES

The study examined the effects of illness perception on mental health among patients with metabolic dysfunction-associated fatty liver disease (MAFLD) and the moderating role of coping style in this effect.

METHODS

The current study has collected the data of MAFLD patients at baseline and 8 months after. In both baseline and follow-up surveys, structural questionnaires were adopted to assess participants' illness perception (BIPQ), coping strategies (Brief COPE) and psychological distress (GHQ-12). A cross-lagged panel model was constructed to examine the associations between illness perception and psychological distress over 8 months. The moderating role of coping in the relationship between illness perception and psychological distress was addressed.

RESULTS

A total of 155 participants diagnosed with MAFLD were enrolled in the baseline survey, of which 71 patients engaged in the 8-month follow-up. The results showed that severe illness perceptions (perceiving MAFLD with more negative consequence, more negative emotions, lower coherence, and less treatment control) were associated with increased psychological distress 8 months later (β = 0.171, p < 0.05). Though approach coping showed an overall positive effect (β = 0.169, p < 0.05), people using it as a dominant strategy tend to be more subjected to the impacts of negative illness perceptions.

CONCLUSION

Threatening perceptions about MAFLD were associated with more psychological distress over time, and coping style has moderated the effects of illness perceptions. Healthcare providers should be aware of the impacts of negative illness perceptions, particularly when developing coping skill training programs to promote well-being and recovery.

Total active range of movement after treatment using a traction orthotic for extra-articular phalangeal fractures: A case series

BACKGROUND

The use of traction orthoses for complex finger fractures is not a common intervention though some research purports its efficacy as an alternative treatment approach to surgery in some scenarios.

PURPOSE

This study examined total active of range of movement (TAROM) outcomes achieved by patients on discharge from hand therapy after being treated using a traction orthotic following an extra-articular displaced proximal or middle phalangeal fracture.

STUDY DESIGN

A retrospective, consecutive longitudinal case series.

METHODS

Data was collected on the time from injury to traction, duration of traction, injury location (hand, digit, phalanx), fracture classification, age, sex, hand dominance, number of therapy sessions (mobilization phase of rehabilitation), duration from injury to discharge from hand therapy and TAROM at discharge. TAROM outcomes are categorized using the criteria recommended by the American Society of Surgery of the Hand. Categorical variables are summarized using frequency and percentages. Continuous data is summarized as mean and standard deviation or median and interquartile range. Any potential correlations between TAROM and time from injury to discharge were analyzed using Pearson's correlation (two-tailed).

RESULTS

Twenty-three patients were referred for traction (14 male: nine female). Three people went on to have surgery and two patients were lost to follow-up. Mean TAROM was 230.9º (SD 22.6º) indicating a good outcome using the American Society of Surgery of the Hand criteria. Mean time from injury to discharge was 65.6 (SD 30.4) days. There was no correlation observed between time from injury to discharge and TAROM on discharge (r = -0.18, p = 0.48).

CONCLUSIONS

Good and excellent TAROM was achieved following treatment using traction orthoses for extra-articular phalangeal fractures though further studies are necessary. Larger sample sizes will allow for more granular analysis of different fracture classifications.

Viable Ileosigmoid Knotting, A Very Phenomenon Finding and Rare Cause of Intestinal Obstruction: A Case Report and Literature Review

Introduction

Ileosigmoid knotting is the wrapping of an active component of either the ileum or the sigmoid colon over each other. It is an unusual cause of intestinal obstruction, accounting for 1-2% of cases of all mechanical obstruction in the majority published literatures. A viable knot is a unique phenomenon of this seldom cause of bowel obstruction.

Case Presentation

A sixteen-year-old female patient presents with a complaint of central abdominal distension and obstipation of 12-hour duration. Later, she also developed abdominal cramps and vomiting of ingested matter. Her vital signs were all in the normal range, and the abdominal examination was positive for a grossly distended abdomen with mild upper and central abdominal tenderness. The ileosigmoid knotting was clearly visible on the computed tomography. Emergency exploratory laparotomy was performed, and a viable ileosigmoid knot was identified. Unknotting, derotation, and decompression of the sigmoid colon were performed. The postoperative course was uneventful.

Discussion

Ileosigmoid knotting is a rare, life-threatening cause of intestinal obstruction with rapid progression to intestinal vascular compromise and gangrene. It is a hyperactive segment of ileum that winds around the pedicle of the redundant sigmoid colon, resulting in a closed-loop obstruction. There are different classification schemes of ileosigmoid knotting depending on the active component of the knot and based on the viability of the bowel and physiology of the patient. Preoperative diagnosis of this condition is often challenging and usually confirmed intraoperative.

Conclusion

A high index of suspicion and prompt surgical exploration are crucial for the best outcome of the patient. Despite being a rare cause of intestinal obstruction, ileosigmoid knotting poses a significant morbidity and mortality to the patient. Management of a patient with viable ileosigmoid knotting is controversial, as some scholars suggest non-resective options and others recommend resective treatment as a recurrence preventive measure.

Intussusception and Internal Hernia After Roux-en-Y Gastric Bypass Surgery in a Woman With Twin Pregnancy: A Case Report

Severe obesity is a global concern now, and bariatric surgery has been proven to be the best solution. Most candidates are women of reproductive age; therefore, an increasing number of pregnant women with the history of gastric bypass is noticed. A 33-year-old woman at 23 weeks' gestation with a twin pregnancy, with a history of bariatric surgery 2 years prior her pregnancy, presented to our hospital with small bowel necrosis due to internal hernia and intussusception, we proceeded to laparotomy and resection of the necrotic segment of the bowel. The patient underwent cesarean section on the 35 weeks of her pregnancy due to preterm labor and intra uterine growth retardation of the fetuses. Since the gravid uterus increases the intraabdominal pressure, the complications of bariatric surgery such as intussusception or internal hernia may occur even more frequently during pregnancy. Although computed tomography scan or ultrasound could assist clinicians for early diagnosis of complications, negative findings could not rule out small bowel obstruction; therefore, in a pregnant woman with persisting abdominal pain, obstipation, and vomiting, exploratory laparotomy or laparoscopy is mandatory. Pregnant women with a history of Roux-en-Y gastric bypass surgery (RYGB) should be considered high-risk obstetric, and symptoms like ongoing abdominal pain, and vomiting should be taken as alarm sign for small bowel obstruction. Computed tomography (CT) scan is the modality of choice for detecting the small bowel obstruction, and is mandatory, taking into consideration the considerable harms to the fetus.

Histomorphological Spectrum of Ovarian Tumours in a Tertiary Care Centre of North India: A Case Series

Ovarian tumours constitute the second most common tumour of the female genital tract after cervical cancers. The study describes the histological subtypes of ovarian neoplasms along with other parameters like age, laterality and consistency of lesion in a tertiary care centre in Uttarakhand. The retrospective data of ovarian tumours sent to the Department of Pathology was collected over a period of 4.5 years. They were classified into benign, borderline and malignant categories in the respective histological subtypes (surface epithelial, germ cell, sex cord stromal and metastatic) based on the latest WHO classification. The consistency of tumour, laterality and age of the patient were also evaluated. Of the 130 cases studied, 73 (56%) were benign, 13 (10%) were borderline and 44 (34%) were malignant. The majority of cases (73.1%) were surface epithelial tumours, followed by germ cell tumours (20.8%), sex cord stromal tumours (4.6%) cases and metastatic tumours (1.6%). Most cases (80.8%) showed unilateral involvement while 19.2% cases had bilateral involvement. The majority of cases in the present study were benign. Serous cystadenoma was the most common benign tumour with its malignant counterpart being the most common tumour in the malignant category.

SleepECG-Net: Explainable Deep Learning Approach With ECG for Pediatric Sleep Apnea Diagnosis

Obstructive sleep apnea (OSA) in children is a prevalent and serious respiratory condition linked to cardiovascular morbidity. Polysomnography, the standard diagnostic approach, faces challenges in accessibility and complexity, leading to underdiagnosis. To simplify OSA diagnosis, deep learning (DL) algorithms have been developed using cardiac signals, but they often lack interpretability. Our study introduces a novel interpretable DL approach (SleepECG-Net) for directly estimating OSA severity in at-risk children. A combination of convolutional and recurrent neural networks (CNN-RNN) was trained on overnight electrocardiogram (ECG) signals. Gradient-weighted Class Activation Mapping (Grad-CAM), an eXplainable Artificial Intelligence (XAI) algorithm, was applied to explain model decisions and extract ECG patterns relevant to pediatric OSA. Accordingly, ECG signals from the semi-public Childhood Adenotonsillectomy Trial (CHAT, n = 1610) and Cleveland Family Study (CFS,n = 64), and the private University of Chicago (UofC, n = 981) databases were used. OSA diagnostic performance reached 4-class Cohen's Kappa of 0.410, 0.335, and 0.249 in CHAT, UofC, and CFS, respectively. The proposal demonstrated improved performance with increased severity along with heightened cardiovascular risk. XAI findings highlighted the detection of established ECG features linked to OSA, such as bradycardia-tachycardia events and delayed ECG patterns during apnea/hypopnea occurrences, focusing on clusters of events. Furthermore, Grad-CAM heatmaps identified potential ECG patterns indicating cardiovascular risk, such as P, T, and U waves, QT intervals, and QRS complex variations. Hence, SleepECG-Net approach may improve pediatric OSA diagnosis by also offering cardiac risk factor information, thereby increasing clinician confidence in automated systems, and promoting their effective adoption in clinical practice.

Risk factors and significance of post-operative edema in Parkinson Disease patients submitted to deep brain stimulation. A ten-year case series

BACKGROUND

Peri-electrode edema after deep brain stimulation (DBS) surgery for Parkinson Disease (PD) has been reported in up to 100% of cases. The clinical significance of this finding is unclear, with most papers suggesting a benign course. The risk factors are also poorly defined. We aimed at defining the incidence rate, the clinical significance and the predictive factors of peri-electrode edema in patients undergoing DBS for PD.

METHODS

We reviewed data of 119 patients treated with frameless stereotactic DBS for PD between 2012 and 2022 at our Institution. A mixed-technique targeting was adopted. Awake surgery was used in 64.7% cases; in most cases, microelectrode recording (MER) was adopted. The target was the subthalamic nucleus (STN) in 91.2% cases.

RESULTS

Ninety patients were included. Postoperative edema related to lead placement was noticed in 40% patients after a median time of 2 days since surgery; in 88.9% of these cases, it was limited to subcortical white matter. Symptomatic edema was registered only in one case (1.1%), confirming previous reports on the benign clinical course. The only independent predictive factor for edema onset was asleep surgery (p = 0.0451). Notably, the use of directional electrodes was not associated with an increased risk of edema at multivariable analysis. Clinical parameters including age, and timing of CT scanning, did not affect edema onset.

CONCLUSIONS

We confirmed the very low rate of symptomatic edema in DBS for PD. When feasible, awake DBS using MER is the ideal technique to reduce the risk of radiologic postoperative edema.

Workplace Violence Is Home Now for Healthcare Workers: Spillover Theory Perspective

In recent years, workplace violence has become an escalating concern, particularly within the healthcare sector. Healthcare workers, who dedicate their lives to caring for others, are increasingly facing violence within their workplaces as evidenced by existing studies. However, literature overlooks complex associations between workplace violence, workplace stress, and domestic violence and stress. This article explores the phenomenon of workplace violence among healthcare workers through the lens of Spillover Theory and investigates impact of workplace violence on domestic stress with single and sequential mediation of workplace stress and domestic violence. Our findings of MEDTHREE analysis of time-lagged data indicate that individuals who experience workplace violence are more likely to exhibit stress, which ultimately becomes a cause of domestic violence. The study highlights how spillover theory can help to explain how workplace violence can trigger violence and stress in the home environment. The research highlights the need for a support system and targeted interventions to address the issue of workplace violence to mitigate its spillover effects into domestic violence. With the help of the findings, the organisational decision makers can develop comprehensive strategies to mitigate the harmful consequences of the workplace violence to provide safe and healthy environment at work and home settings.

Developing a tool for assessing and communicating the expected difficulty of performing a tracheostomy

There are no guidelines for assessing and communicating the expected difficulty of a tracheostomy, leading to difficulties planning a percutaneous approach in intensive care or referring onwards to surgical teams. A Delphi process was used to develop a tool containing metrics which are relevant for either specialty and can be universally assessed by both. Palpable tracheal rings, prior surgery or radiotherapy to the anterior neck, uncorrectable clotting or platelet dysfunction, ability to extend the neck freely, and overlying vessels visible, palpable or on imaging were all found to be relevant. It is hoped this tool will aid communication between specialties.

Percutaneous and endoscopic transpapillary cholecystoduodenal stenting in acute cholecystitis-A viable long-term option in high-risk patients?

BACKGROUND

The prolonged use of percutaneous cholecystostomy tubes (PCTs) in patients with acute cholecystitis, deemed inoperable, is fraught with complications. Transpapillary cholecystoduodenal stenting (TCDS) is an alternative technique that restores the physiologic outflow of bile, avoiding the need for an external drain. However, the long-term safety and efficacy of this approach remain unclear. We sought to prospectively assess the safety and efficacy of this procedure, performed via percutaneous or endoscopic approach, in high-risk patients presenting with acute cholecystitis.

METHODS

This prospective study included consecutive patients with acute cholecystitis and long-lasting, prohibitive surgical risk, in whom TCDS was offered at two partnering tertiary care centers between August 1, 2018, and December 31, 2022. Patients with a need for endoscopic retrograde cholangiopancreatography (ERCP) underwent ERCP-guided TCDS. In patients without a need for ERCP, a temporary PCT was followed by fluoroscopic-guided TCDS 4 weeks to 6 weeks later. Interval cholecystectomy was performed in patients who became surgical candidates later. All patients were followed up until January 1, 2023.

RESULTS

Transpapillary cholecystoduodenal stenting was successful in 67 (percutaneous in 45/50; endoscopic in 22/23) of 73 patients (92%) attempted. Over a median follow-up period of 17 months (7, 26), 10 patients (15%) developed stent blockage or migration; all but two had their stent successfully replaced. Five patients (7%) developed mild, self-limited pancreatitis. Five (7%) patients underwent interval cholecystectomy at a median time of 7 months.

CONCLUSION

Transpapillary cholecystoduodenal stenting is a safe and promising definitive alternative to chronic PCT in high-risk patients with acute cholecystitis that eliminates the discomfort and complications of long-term external drainage.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level II.