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BACKGROUND: Despite the proven effectiveness of endovascular therapy (EVT) in acute ischemic strokes (AIS) involving anterior circulation large vessel occlusions, isolated posterior cerebral artery (PCA) occlusions (iPCAo) remain underexplored in clinical trials. This study investigates the comparative effectiveness and safety of EVT against medical management (MM) in patients with iPCAo. METHODS: This multinational, multicenter propensity score-weighted study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, involving 37 centers across North America, Asia, and Europe. We included iPCAo patients treated with either EVT or MM. The primary outcome was the modified Rankin Scale (mRS) at 90 days, with secondary outcomes including functional independence, mortality, and safety profiles such as hemorrhagic complications. RESULTS: A total of 177 patients were analyzed (88 MM and 89 EVT). EVT showed a statistically significant improvement in 90-day mRS scores (OR = 0.55, 95% CI = 0.30-1.00, p = 0.048), functional independence (OR = 2.52, 95% CI = 1.02-6.20, p = 0.045), and a reduction in 90-day mortality (OR = 0.12, 95% CI = 0.03-0.54, p = 0.006) compared to MM. Hemorrhagic complications were not significantly different between the groups. CONCLUSION: EVT for iPCAo is associated with better neurological outcomes and lower mortality compared to MM, without an increased risk of hemorrhagic complications. Nevertheless, these results should be interpreted with caution due to the studys observational design. The findings are hypothesis-generating and highlight the need for future randomized controlled trials to confirm these observations and establish definitive treatment guidelines for this patient population.

Objective: To determine whether readily available patient, ultrasound and treatment outcome data can be used to develop, validate and externally test two machine learning (ML) models for predicting the success of expectant and medical management of miscarriage respectively. Methods: A retrospective, multi-site study of patients opting for expectant or medical management of miscarriage was undertaken. A total of 1075 patients across two hospital early pregnancy units were eligible for inclusion. Data pre-processing derived 14 features for predictive modelling. A combination of eight linear, Bayesian, neural-net and tree-based machine learning algorithms were applied to ten different feature sets. The area under the receiver operating characteristic curve (AUC) scores were the metrics used to demonstrate the performance of the best performing model and feature selection combination for the training, validation and external data set for expectant and medical management separately. Results: Parameters were in the majority well matched across training, validation and external test sets. The respective optimum training, validation and external test set AUC scores were as follows in the expectant management cohort: 0.72 (95% CI 0.67,0.77), 0.63 (95% CI 0.53,0.73) and 0.70 (95% CI 0.60,0.79) (Logistic Regression in combination with Least Absolute Shrinkage and Selection Operator (LASSO)). The AUC scores in the medical management cohort were 0.64 (95% CI 0.56,0.72), 0.62 (95% CI 0.45,0.77) and 0.71 (95% CI 0.58,0.83) (Logistic Regression in combination with Recursive Feature Elimination (RFE)). Conclusions: Performance of our expectant and medical miscarriage management ML models demonstrate consistency across validation and external test sets. These ML methods, validated and externally tested, have the potential to offer personalised prediction outcome of expectant and medical management of miscarriage. [ABSTRACT FROM AUTHOR]

Simple Summary: This review examines the surgical management of recurrent ovarian cancer, which remains complex and non-standardized. Analysis of five randomized trials (GOG-0213, DESKTOP III, SOC 1, HORSE, CHIPOR) highlights the importance of a personalized approach taking into account various factors including the timing of recurrence and the patient's general condition, previous treatments and tumor/genetic characteristics. The results of the DESKTOP III and SOC 1 trials show a survival benefit for secondary surgery, whilst the GOG-0213 trial did not show an improvement in overall survival, underlining the need for careful patient selection using evidence-based selection criteria including the AGO or iMODEL scores. In patients with a negative score, there may be a place for cytoreductive surgery plus HIPEC in BRCA-negative cases following a course of chemotherapy, although current evidence shows no additional benefit of HIPEC when cytoreductive surgery is performed as an adjuvant procedure. This article provides a summary of the results of these major studies, whilst also addressing the issues that remain unresolved in the surgical management of recurrent ovarian cancer. Background: The surgical and medical management of recurrent ovarian cancer is complex and requires a personalized approach based on several factors, including the timing of recurrence, the patient's performance status, previous treatment regimens, and the tumor's histology and molecular characteristics. Objectives: Five randomized trials—GOG-0213, DESKTOP III, SOC 1, HORSE, and CHIPOR—have been conducted and shed light on our practice. Results: Both the DESKTOP III and the SOC 1 trials support the benefit of secondary surgery. The GOG-0213 trial, however, did not show an overall survival benefit, confirming that surgery should not be offered to all patients with platinum-sensitive recurrent ovarian cancer and highlighting the importance of strict patient selection using evidence-based selection criteria including the AGO or iMODEL scores. In patients with a negative score, there may be a place for cytoreductive surgery plus HIPEC in BRCA-negative cases following a course of chemotherapy, although current evidence shows no additional benefit for HIPEC when cytoreductive surgery is performed as an adjuvant procedure. Conclusions: Secondary surgery is recommended for platinum-sensitive patients when respecting AGO or iModel criteria. In addition, surgery plus HIPEC can be considered in BRCA-negative patients with an initial negative AGO or iMODEL score who show sufficient response following a course of neoadjuvant chemotherapy to then be considered operable. [ABSTRACT FROM AUTHOR]

The primary objective of this study was to review a methotrexate 90-mg fixed-dose protocol for treatment of ectopic pregnancy, and to evaluate if any characteristics were associated with ectopic pregnancy treatment failure. This was a single arm retrospective cohort study conducted at Kaiser Permanente Colorado. The primary outcome was to describe rates of ectopic pregnancy treatment failure among patients who received fixed dose(s) of methotrexate for ectopic pregnancy between January 1, 2007 and August 31, 2017. Women were eligible for inclusion if they received outpatient treatment with methotrexate for an ectopic pregnancy during this time frame. Electronic administrative databases were queried to identify eligible patients and gather patient data, then patients were categorized based on success or failure of treatment. Ectopic pregnancy treatment failure was defined as the requirement for any additional intervention to terminate the pregnancy. A total of 259 patients were included in the final analysis. Overall, 210 (81.1%) ectopic pregnancies were successfully treated with methotrexate alone, and 49 (18.9%) required additional intervention. Baseline human chorionic gonadotropin (hCG) of less than 1000 mIU/ml was associated with treatment success (odds ratio for ectopic pregnancy treatment failure = 0.07 (95% confidence interval: 0.03-0.19)). Treatment of ectopic pregnancy with this fixed-dose methotrexate protocol is a reasonable alternative to weight-based dosing. Consistent with previously published studies, baseline hCG less than 1000 mIU/ml was associated with a high rate of treatment success. [ABSTRACT FROM AUTHOR]

Management of the patient with moderate to severe brain injury in any environment can be time consuming and resource intensive. These challenges are magnified while forward deployed in austere or hostile environments. This Joint Trauma System Clinical Practice Guideline provides recommendations for the treatment and medical management of casualties with moderate to severe head injuries in an environment where personnel, resources, and follow-on care are limited. These guidelines have been developed by acknowledging commonly recognized recommendations for neurosurgical and neuro-critical care patients and augmenting those evaluations and interventions based on the experience of neurosurgeons, trauma surgeons, and intensivists who have delivered care during recent coalition conflicts. [ABSTRACT FROM AUTHOR]

The 2024 EACTS Guidelines on perioperative medication in adult cardiac surgery offer evidence-based recommendations for managing medications before, during, and after cardiac surgery. The guidelines stress the need for a multidisciplinary approach to enhance patient outcomes and minimize complications. Topics covered include anticoagulation therapy, antithrombotic drug use, postoperative atrial fibrillation management, and antibiotic prophylaxis to prevent surgical site infections. The document aims to improve patient care and outcomes in cardiac surgery through the implementation of recommended medication strategies and calls for further research to address knowledge gaps in the field. [Extracted from the article]

Background: The pre-treatment characteristics of the patient and ectopic pregnancy to determine the patients who are likely to successfully respond to methotrexate (MTX) therapy remain controversial. This study investigated the outcomes of ectopic pregnancy after one and two MTX doses and their independent predictors. Methods: Retrospective cross-sectional study of women who consented to MTX treatment in 2017–2018 at our institution (N = 317). Of these, patients with Caesarean scar pregnancies were excluded because they require different treatment protocols (n = 25). All patients were treated according to our institution's protocol based on international guidelines and standardised across the three hospitals included in the current study. We retrieved patients' demographics, laboratory, ultrasonography, and clinical characteristics from our hospital database. Serum β-human chorionic gonadotropin (β-hCG) was measured using electrochemiluminescence immunoassay; ectopic pregnancy was diagnosed using ultrasonography (transvaginal probe). Results: Two ninety-two patients were included in the current analysis. Age, pre-treatment β-hCG levels, sonographic presence of yolk sac, presence of foetal cardiac activity, and pelvic pain were significantly different between patients with successful and unsuccessful outcomes. Younger age (adjusted odds ratio [aOR] 2.33, 95% confidence interval (CI) 1.16–4.66, p =.017), no pelvic pain (aOR 2.65, 95%CI 1.03–6.83, p =.043), lower initial β-hCG level (aOR 1.32, 95%CI 1.08–1.59, p =.005), and absence of foetal cardiac activity (aOR 12.63; 95% CI 1.04–153.6; p =.047) were independently associated with success. Treatment failure odds were >2 folds higher for each 10-year age increase (p =.017), 32% higher for each 1000 IU/L increase in initial β-hCG level (p =.005), and >2 folds higher in presence of pelvic pain (p =.043). Conclusions: MTX is effective in most patients, averting invasive surgery, which might affect fertility. Pre-treatment β-hCG levels, age, pelvic pain, and foetal cardiac activity was independently associated with outcomes. Research should assess the relationship between the ectopic pregnancy size and treatment outcomes and refine β-hCG titres where treatment would be ineffective. PLAIN LANGUAGE SUMMARY: Ectopic pregnancy is a pregnancy that occurs outside the uterus. It needs to be identified and treated quickly to prevent serious health complications. Ectopic pregnancies can be treated surgically or medically using a drug called methotrexate. Medical treatment of ectopic pregnancy is not always successful. Identifying the factors that predict the failure of medical treatment helps patients and doctors to choose more accurately between surgical and medical treatment options. A total of 292 women who received methotrexate for ectopic pregnancy and the factors that influence the outcomes of treatment were examined, 39 patients had treatment failure and required surgery. Older age, higher initial levels of β-human chorionic gonadotropin (β-hCG) hormone, the presence of pelvic pain, and foetal cardiac activity had increased risk of treatment failure. In the future, research could consider the relationship between the size of the ectopic pregnancy and the treatment outcomes and refine the β-hCG level cut-off for better treatment effects. [ABSTRACT FROM AUTHOR]

Introduction: 15.3% of pregnancies result in miscarriage, management options include expectant, medical, or surgical. However, each patient has a range of variables, which makes navigating the available literature challenging when supporting individual patient decision‐making. This systematic review aims to investigate whether there are any specific predictors for miscarriage management outcome. Material and Methods: The following databases were searched, from the start of each database up to April 2023: PubMed, Medline, and Google Scholar. Inclusion criteria were studies interrogating defined predictors for expectant or medical management of miscarriage success. Exclusion criteria were poor quality, review articles, trial protocols, and congress abstracts. Data collection was carried as per PRISMA guidelines. Quality assessment for each study was assessed using the QUIPS proforma. Results: Relevant predictors include demographics, ultrasound features, presenting symptoms, and biochemical markers. Across the 24 studies there is heterogeneity in miscarriage definition, predictors reported, and management outcomes used. Associations with certain variables and miscarriage management outcomes are described. Ten studies assessed the impact of miscarriage type on expectant and/or medical management. The majority found that a diagnosis of incomplete miscarriage had a higher success rate following expectant or medical management compared to missed miscarriage or anembryonic pregnancy. Conclusions: We conclude that there is evidence supporting the possibility to offer personalized miscarriage management advice with case specific predictors. Further larger studies with consistent definitions of predictors, management, and outcomes are needed in order to better support women through the decision‐making of miscarriage management. [ABSTRACT FROM AUTHOR]

Pituitary apoplexy (PA) is a clinical syndrome caused by acute hemorrhage and/or infarction of the pituitary gland, most commonly in the setting of a pituitary macroadenoma. PA generally presents with severe headache, nausea, vomiting, visual disturbance, and, in more severe cases, altered mental status. Many factors have been attributed to the risk of developing PA, including most recently, numerous reports showcasing an association with COVID-19 infection or vaccination. Initial management of PA includes evaluation and correction of deficient hormones and electrolytes and an assessment if surgical decompression to relieve pressure on optic nerves and other brain structures is needed. While prompt recognition and treatment are crucial to avoid morbidity and mortality, in the modern era, PA is less commonly considered a true neurosurgical emergency requiring immediate (< 24 h) surgical decompression. Traditionally, surgical decompression has been the standard of care for significant mass effects. However, several studies have shown similar outcomes in visual and hormonal recovery with either surgical decompression or conservative medical management. Unfortunately, most evidence on optimal management strategies is limited to retrospective case series, small prospective studies, and one multi-center observational study. This review aims to provide the most up-to-date evidence on the role of COVID-19 in PA and best management strategies. [ABSTRACT FROM AUTHOR]

Conservative treatments for minimally symptomatic chronic subdural hematoma (cSDH) are debated, with surgery as the primary option. To assess failure rates of a conservative approach for management of cSDH. We searched PubMed, SCOPUS, Web of Science, and ClinicalTrials.gov for studies on conservative management of cSDH and analyzed the data using R (version 4.1.2). A total of 35 studies including 2095 patients were analyzed: 950 (45%) of the patients were in the observation group, 671 (32%) in the corticosteroid group, 355 (17%) in the atorvastatin group, 43 (2%) in the mannitol group, 52 (2.5%) in the tranexamic acid group, and 24 (1.1%) in the etizolam group. Our pooled analysis showed that 19.82% of patients required rescue surgery (95% confidence interval [CI]: 12.98% to 26.66%, P < 0.0001). The overall pooled risk ratio (RR) for the effect of interventions on the need for rescue surgery was 0.2424 (95% CI: 0.1577 to 0.3725, Iˆ2 = 90.5%, P < 0.0001). Subgroup analysis showed varied effects: observation group (RR = 0.3482, 95% CI: 0.1045 to 1.1609, Iˆ2 = 94.0%), corticosteroids (RR = 0.2988, 95% CI: 0.1671 to 0.5344, Iˆ2 = 90.8%), atorvastatin (RR = 0.1609, 95% CI: 0.0985 to 0.2627, Iˆ2 = 53.2%), mannitol (RR = 0.0370, 95% CI: 0.0009 to 1.5244), and tranexamic acid (RR = 0.0585, 95% CI: 0.0026 to 1.2924). The rate of rescue surgery in conservatively managed cSDH patients remains high. Corticosteroids or atorvastatin demonstrates some potential benefit in reducing the failure rate but collective effectiveness is unknown. [ABSTRACT FROM AUTHOR]

Background Racial and ethnic minoritized groups report disproportionately lower trust in the health-care system. Lower health-care system trust is potentially related to increased exposure to racial discrimination in medical settings, but this association is not fully understood. We examined the association between racial discrimination in medical care and trust in the health-care system among people with and without a personal cancer history. Methods We examined racial discrimination and trust in a nationally representative American adult sample from the Health Information National Trends Survey 6. Racial discrimination was defined as any unfair treatment in health care on the basis of race or ethnicity. Trust in the health-care system (eg, hospitals and pharmacies) was grouped into low, moderate, and high trust. Multinomial logistic regression models were used to compare low and moderate trust relative to high trust in the health-care system and estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results A total of 5813 respondents (15% with a personal cancer history) were included; 92% (n = 5355) reported no prior racial discrimination experience during medical treatment. Prior experiences of racial discrimination were positively associated with low (OR = 6.12, 95% CI = 4.22 to 8.86) and moderate (OR = 2.70, 95% CI = 1.96 to 3.72) trust in the health-care system relative to high trust. Similar associations were observed when stratifying by personal cancer history. Conclusion Respondents who reported racial discrimination during medical encounters had lower trust in the health-care system, especially respondents with a personal cancer history. Our findings highlight the need to address racial discrimination experiences during medical care to build patient trust and promote health-care access. [ABSTRACT FROM AUTHOR]

OBJECTIVES To investigate sex-based differences in presenting characteristics and early outcomes of type A intramural haematoma. METHODS Patients with type A intramural haematoma in an institutional cohort were consecutively enrolled between December 2013 and July 2022. Presenting characteristics, morphological progression and all-cause death during hospitalization were evaluated according to patient sex. RESULTS Among 473 patients, 48.0% were female. Females were older (65.9 ± 9.1 vs 58.5 ± 11.5 years, P < 0.001) with larger ascending aortic diameters (52.2 ± 6.6 vs 48.3 ± 6.1 mm, P < 0.001), thicker haematomas (11.5 ± 4.9 vs 9.5 ± 3.4 mm, P < 0.001) and more frequent focal intimal disruptions (45.4% vs 29.7%, P < 0.001). Within 30 days of initial medical therapy, 89.8% of males vs 70.1% of females showed morphological regression or stable condition on repeat computed tomography angiography. The in-hospital mortality was 9.7% in females (n  = 22) and 2.8% in males (n  = 7). Kaplan–Meier analysis revealed higher early mortality in females (P = 0.002). Multivariable Cox regression showed female sex as an independent risk factor for early death (hazard ratio: 2.8, 95% confidence interval: 1.2–6.8, P = 0.021). Subgroup analysis revealed no heterogeneity according to subgroups including older age (71–90 years), ascending aortic diameter ≥50 mm, presence of focal intimal disruption, presence of pericardial effusion, haematoma thickness ≥11 mm and hypertension. CONCLUSIONS Female patients with type A intramural haematoma presented with worse characteristics, higher early morphological progression and an increased risk of early death compared to males. [ABSTRACT FROM AUTHOR]

Since the first identification of Tetralogy of Fallot in 1671, consisting of a combination of anatomical defects including biventricular origin of the aorta, maligned ventricular septal defect, overriding aorta, and narrowing or atresia of the pulmonary outflow tract. The first successful operation consisted of a shunt between the left subclavian artery and pulmonary artery. Following this palliative procedure, complete repair is performed once the patient reaches indicative criteria. Since the first attempts at surgical palliation and repair, techniques and outcomes have improved drastically. Definitive repair of Tetralogy of Fallot consists of a multi-patch closure of any Ventricular Septal Defect along with clearance of any muscular obstructions of the Right Ventricular Outflow Tract and reconstruction of the outflow tract. Current results of Tetralogy of Fallot palliation yield excellent long and short-term results with 5-year freedom from reintervention of 90%. The iterative improvement of repair techniques has greatly reduced intraoperative and postoperative complications. Future innovations such as increased use of percutaneous repair methods and additional data on the benefits of primary repair as opposed to staged palliation will continue to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background The veterinary workplace carries a high risk of staff accidents and injuries, yet there is scant research exploring it in comparison with other comparable fields, such as human medicine. Aims To understand how veterinary professionals define injuries and to understand what injuries they do, or do not, deem reportable. Methods A cross-sectional survey comprising demographic questions and open-text questions was shared with veterinary practice staff across the UK. Data were analysed descriptively and using an inductive content analysis. Results There were 740 respondents, who were broadly representative of the veterinary profession. There were differences in how injuries were defined; for example, small animal veterinarians expected injuries to involve blood, while equine and production animal veterinarians were more likely to expect injuries to reduce their ability to perform work and require medical treatment. Many suggested that 'all' workplace injuries should be reported; however, 'minor' injuries were often overlooked, for example, needlestick injuries did not always meet the criteria of being an 'injury'. Injuries caused by staff themselves (e.g. trips) were less likely to be reported than injuries that could be blamed on an external factor (e.g. dog bite). Conclusions Collectively, the data suggest a wide-ranging perception of risk of injury in practice, with some harms seen as 'everyday norms'. Veterinary practices should interpret their injury statistics with a high degree of caution. They should explore the microcultures within their practices relating to worker perception of risk, injury and barriers to reporting. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic situation has emphasized the need for accessible drug information in primary healthcare, mainly owing to limited hospital visits. Patients with chronic illnesses experience difficulties obtaining regular medications, and this problem is worsened by the unavailability of drugs and prescriptions shared via mail. Hospitals are actively working to develop user-friendly drug information databases to enhance medication management in their facilities. Objective: In this study, we aimed to establish a hospital database for improved medication management that can serve the purposes of both healthcare providers and patients. Methods: This study comprised two parts: 1) the development of drug information and image database websites, involving the survey of user needs, designing the website, compiling drug lists and related data, recording images of tablets and capsules, creating the website, and testing its functionality; 2) the evaluation of the user interface satisfaction with the drug database website. Results: Part 1: A database was developed using comprehensive details of 710 hospital drugs, including tablets, capsules, and liquids. Images of the medications were integrated to enable users to search for drug information. Three types of reports are generated to fulfill the user requirements. Part 2: Thirty-one pharmacy staff members evaluated satisfaction across four aspects; high mean scores (± standard deviations) for attitude and intention to use (4.33 ± 0.067), searching and display (4.32 ± 0.000), display results (4.30 ± 0.042), and structure and operation (4.12 ± 0.097) indicated high user satisfaction. Conclusion: A comprehensive hospital-based drug database has been developed. This database is associated with a user-friendly website with robust search capabilities. The three report types cater to diverse user requirements. Further analyses of this database revealed high user interface satisfaction across various aspects, particularly in terms of clarity, ease of use, search efficiency, and image quality. [ABSTRACT FROM AUTHOR]

Background: As the risk factors and prevalence of hypertension continue to increase in Pakistan, it is imperative to understand the perceptions of patients about its prevention, symptoms, diagnosis, treatment, and management to inform the design of programmes to improve management. Objective: To explore patients' perceptions about the treatment, management and control of hypertension in an urban population in Pakistan. Methods: Using a semi-structured questionnaire, we conducted one-on-one interviews with 30 hypertensive patients at 2 urban government tertiary care hospitals in Lahore and Sargodha. The patients were aged 35--70 years, diagnosed with hypertension by a registered medical doctor, and being treated with anti-hypertensive medication. The interviews were recorded, transcribed and analysed using Quirkos. Results: Almost all the patients recognized the potential long-term consequences of hypertension. Most of them said regular use of prescribed medication was beneficial, including for blood pressure control and relief of symptoms. They understood the benefits of lifestyle modification, such as engaging in physical activity, for the management of blood pressure. They however had inadequate knowledge of their treatment regimens; some of them took their medications irregularly, while some took them only when they felt symptoms. Most patients relied solely on medical management. Conclusion: We identified major challenges with the management of hypertension among the study population. Patients and caregivers relied mostly on medical management, with insufficient follow-up after initiating treatment. There is a need to improve patient follow-up and provide better patient education on the benefits of adhering to treatment regimens and adopting lifestyle changes including dietary and exercise management. [ABSTRACT FROM AUTHOR]

Purpose of Review: The purpose of this review is to discuss medical management of patients with left ventricular assist devices (LVADs) and to summarize recent advancements, specifically focusing on medications for anticoagulation, blood pressure, and heart failure. Recent Findings: Omission of aspirin in LVAD recipients is not associated with an increased risk of pump thrombosis, stroke, or peripheral arterial thromboembolism. Early data from small studies suggest that direct oral anticoagulants can be safely used in patients with the newer generation HeartMate 3 devices. Data supports a mean arterial blood pressure goal of 75-90 mmHg, with avoidance of hypotension. Finally, retrospective studies demonstrate that quadruple guideline-directed medical therapy can be used in patients on LVAD support without an increased risk of adverse events. Summary: Management of LVAD patients is complex, requiring ongoing active decision-making for titration of medications. Larger studies of medical management are needed to further reduce the incidence of gastrointestinal bleeding, right ventricular failure, and increase the potential for myocardial recovery. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the efficacy of a new drug combination in the medical management of oral submucous fibrosis (OSMF) patients. Materials and Methods: This retrospective cohort study included 89 patients who were clinically diagnosed of having OSMF (grade I, II, III). These patients had been administered the new drug combination for 6 months and clinical parameters such as burning sensation score, mouth opening and tongue protrusion were evaluated at 1 month, 3 months, 6 months and 12 months post-medication retrospectively. Results: Out of the total 89 patients included in the study, 18 patients had Grade-I, 50 patients had Grade-II and 21 patients had Grade-III OSMF. A significant improvement was observed in the mouth opening and tongue protrusion in all the three grades of OSMF from baseline to 1 month, 3 months, 6 months and 12 months after treatment (p < 0.0001) on intra- and intergroup comparison. A significant reduction in the burning sensation score from baseline to 1 month, 3 months, 6 months and 12 months after treatment was observed (p < 0.0001) in all the three grades on intra group comparison. Conclusion: This retrospective study showed that this novel drug combination is significantly effective in improving burning sensation score, mouth opening and tongue protrusion in OSMF grade I, II and III patients with results consistent after 1 year of follow-up. [ABSTRACT FROM AUTHOR]

Introduction: Bronchoscopy is frequently performed in the management of patients with acute leukemia due to their high susceptibility to infections. In this setting, it is performed in the context of lung infiltrates on imaging and persistent fever in immunocompromised subjects. This study aimed to evaluate the utility of bronchoscopy in patients with acute leukemia, its diagnostic yield, and its impact on management decisions. Methods: This is a single-center cross-sectional study that included patients diagnosed with acute leukemia of any phenotype who received intensive chemotherapy. Consecutive patients who underwent bronchoscopy as part of a work-up for associated infections were selected, while patients who had undergone bone marrow transplant were excluded. This study investigated patient characteristics and the impact of bronchoscopy on changes in clinical management. Results: Seventy-nine patients who underwent bronchoscopy at various stages of treatment were analyzed. The most frequent type of acute leukemia was acute myeloid leukemia, accounting for 68.3 % of cases. The induction phase was the most prevalent (29.1 %) treatment stage. Bacterial cultures were positive in 17 out of the 74 patients evaluated, with Pseudomonas aeruginosa being the most frequently identified microorganism. A change in medical management was observed in 18.2 % of cases, and only six patients experienced secondary complications. Conclusions: This is the first Brazilian study to evaluate the utility of bronchoscopy in managing infectious complications in patients with acute leukemia. The impact of bronchoscopy on clinical management was less than anticipated, largely due to its low yield in identifying causative agents. Nevertheless, it remains a safe procedure and can be useful in specific situations.

Introduction The ongoing conflict in Ukraine from Russian invasion presents a critical challenge to medical planning in the context of multi-domain battle against a peer adversary deploying conventional weapon systems. The potential escalation of preventable morbidity and mortality, reaching a scale unprecedented since World War II, underscores the paramount importance of effective phases of care from Point of Injury (PoI)/Point of Wounding (PoW) or Point of Exposure (PoE) to Role 1 (R1) and Role 2 (R2) echelons of care. The NATO Vigorous Warrior (VW) Live Exercise (LIVEX) serves as a strategic platform for NATO and its partners, providing an opportunity to challenge operational concepts, experiment, innovate life-saving systems, and foster best practices across the Alliance. Materials and Methods This study delineates the strategic application of the VW LIVEX platform for the adaptation of the computational simulation software Simulation for the Assessment and Optimization of Medical Disaster Management (SIMEDIS) within the context of Large-Scale Combat Operations (LSCO). The SIMEDIS computer simulator plays a pivotal role by furnishing real-time insights into the evolving injury patterns of patients, employing an all-hazards approach. This simulator facilitates the examination of temporal shifts in medical timelines and the ramifications of resource scarcity against both morbidity and mortality outcomes. The VW LIVEX provides a unique opportunity for systematic validation to evaluate the results of the computer simulator in a realistic setting and identify gaps for future concepts of operations. Results We report the process and methodologies to be evaluated at the VW LIVEX in far forward and retrospective medical support operations. Using the SIMEDIS simulator, we can define battlefield scenarios for varied situations including artillery, drone strikes, and Chemical, Biological, Radiological, Nuclear, and explosive (CBRNe) attacks. Casualty health progressions versus time are dependent on each threat. Mortality is computed based on the concepts found in Tactical Combat Casualty Care (TCCC) of "self-aid"/"buddy-aid" factoring in the application or absence of definitive traumatic hemorrhage control and on the distribution policy of victims to medical treatment facilities through appropriate Command and Control (C2) ("Scoop and Run" versus "Stay and Play"). The number of medical supplies available along with the number of transport resources and personnel are set and are scalable, with their effect on both morbidity and mortality quantified. Concept of Medical Operations can be optimized and interoperability enhanced when shared data are provided to C2 for prospective medical planning with retrospective data. The SIMEDIS simulator determines best practices of medical management for a myriad of injury types and tactical/operational situations relevant to policy making and battlefield medical planning for LSCO. Conclusions The VW LIVEX provides a Concept Development and Experimentation platform for SIMEDIS refinement and conclusive insights into medical planning to reduce preventable morbidity and mortality. Recommending further iterations of similar methodologies at other NATO LIVEXs for validation is crucial, as is information sharing across the Alliance and partners to ensure best practice standards are met. [ABSTRACT FROM AUTHOR]

Introduction Musculoskeletal injuries (MSIs) are a leading cause of separation from the U.S. Navy. Data have shown that several psychological responses to MSI are associated with treatment outcomes. Yellow flags are maladaptive psychological responses to injury and predict delayed recovery, whereas pink flags indicate resilience after MSI and are associated with good treatment outcomes. Identifying these factors in patients with MSI would permit early targeted care to address factors that may delay their readiness for deployment and enhance factors that support recovery. Materials and Methods Active duty service members with MSI who reported to physical therapy outpatient services at a naval hospital were recruited for the study. Yellow flags were assessed at baseline as part of a larger study. Participants completed the Fear Avoidance Beliefs Questionnaire (with two subscales, physical activity and work), the Pain Catastrophizing Scale, and the Hospital Anxiety and Depression Scale. Clinically relevant cut-off scores were used to indicate risk factors of delayed recovery. Pink flags were assessed with the Pain Self-Efficacy Questionnaire and a measure of positive outcome expectations for recovery. Results Two hundred and ninety participants responded to some or all of the questionnaires. Of these, 82% exceeded the cut-off scores on the physical activity subscale of the Fear Avoidance Beliefs Questionnaire, and 39% did so on the work subscale. Pain catastrophizing exceeded the cut-off in only 4.9% of the sample. Forty-three percent of these exceeded the cut-off for the anxiety subscale of the Hospital Anxiety and Depression Scale; 27% exceeded the cut-off on the depression subscale of the Hospital Anxiety and Depression Scale. Additionally, 54% endorsed scores greater than 40 on the Pain Self-Efficacy Questionnaire, and 53% endorsed a high score on the positive outcome expectations. Conclusions A substantial portion of the sample endorsed elevated scores on one or more indicators of delayed recovery from MSI. Most participants showed a fear of physical activity, and approximately half reported pain-related distress (anxiety and depression). In addition, feelings of self-efficacy and positive outcome expectations of treatment were endorsed by only about half of the participants, indicating that the remaining half did not report adaptive responses to MSI. Early identification of these risk factors will allow for targeted treatment approaches that incorporate these yellow flags into treatment and support a psychologically informed approach to physical therapy. This approach is likely to reduce delayed recovery and improve deployment readiness. [ABSTRACT FROM AUTHOR]

Purpose: To describe the characteristics and outcomes of eyes with idiopathic fullthickness macular holes that underwent initial medical management. Methods: This retrospective study included eyes with full-thickness macular holes that were initially managed with 1 month of topical therapy. Eligible subjects were treated with dorzolamide 2% three times a day, nepafenac 0.1% twice a day, and prednisolone acetate 1% four times a day. The primary end points was hole closure at one month and secondary end point was change in best-corrected visual acuity. Results: Ten subjects (mean age: 62.80 years; female: 50%) with unilateral full-thickness macular holes were studied. The mean basal diameter of the entire cohort at baseline was 824.1 mm (median 828 mm). Four (40%) of the smaller holes (mean 698 mm; median 698.50 mm) closed after 1 month of topical therapy, whereas larger holes (mean 908.17 mm; median 889.50 mm) did not close. In one eye, the hole reopened 4 months after stopping the medication but closed again at 1 month after restarting the topical treatment. Median best-corrected visual acuity improved from 0.35 logMAR at baseline to 0.05 logMAR in eyes that closed but remained at 0.70 logMAR at 1 month in eyes that did not close. Conclusion: Topical corticosteroid, nonsteroidal antiinflammatory, and carbonic anhydrase inhibitor therapy may promote closure of small full-thickness macular holes, but large holes are less likely to respond. One month of topical therapy might avoid subjecting some patients to complex vitreoretinal surgery without compromising visual outcomes. Macular hole may reopen after stopping the topical therapy. [ABSTRACT FROM AUTHOR]

This article discusses the global rise in type 2 diabetes and the associated cardiovascular complications. It emphasizes the importance of addressing these complications through a comprehensive approach that includes lifestyle changes, medical management, and community support. The article also highlights recent advances in biomarker research for early detection and prevention of diabetes-related complications. It concludes by emphasizing the need for personalized medical management to improve patient outcomes. The article also explores the incidence and presentation of cardiovascular events in individuals with type 2 diabetes, highlighting sex and age-related differences. It emphasizes the importance of effective medical management, including regular monitoring and control of blood glucose, blood pressure, and cholesterol levels, as well as the use of medications that provide cardiovascular benefits. Managing comorbidities and addressing mental health issues are also crucial. The article calls for a collaborative effort among healthcare professionals, policymakers, and communities to promote heart health and diabetes management. [Extracted from the article]

Background: Return to play (RTP) in elite rugby is managed using a 6-stage graduated RTP protocol, which can result in clearance to play within 1 week of injury. We aimed to explore how symptom, cognitive, and balance presentation and evolution during concussion screens 2 h (head injury assessment (HIA) 2) and 48 h (HIA3) after injury were associated with time to RTP) to identify whether a more conservative graduated RTP may be appropriate. Methods: A retrospective cohort study was conducted in 380 concussed rugby players from elite men's rugby over 3 consecutive seasons. Players were classified as shorter or longer returns, depending on whether RTP occurred within 7 days (allowing them to be considered to play the match 1 week after injury) or longer than 8 days, respectively. Symptom, cognitive, and balance performance during screens was assessed relative to baseline (normal or abnormal) and to the preceding screen (improving or worsening). Associations between sub-test abnormalities and RTP time were explored using odds ratios (OR, longer vs. shorter). Median day absence was compared between players with abnormal or worsening results and those whose results were normal or improving. Results: Abnormal symptom results during screens 2 h and 48 h after concussion were associated with longer return time (HIA2: OR = 2.21, 95% confidence interval (95%CI): 1.39–3.50; HIA3: OR = 3.30, 95%CI: 1.89–5.75). Worsening symptom number or severity from the time of injury to 2 h and 48 h post-injury was associated with longer return (HIA2: OR = 2.49, 95%CI: 1.36–4.58; HIA3: OR = 3.34, 95%CI: 1.10–10.15. Median days absence was greater in players with abnormal symptom results at both HIA2 and HIA3. Cognitive and balance performance were not associated with longer return and did not affect median days absence. Conclusion: Symptom presentation and evolution within 48 h of concussion were associated with longer RTP times. This may guide a more conservative approach to RTP, while still adhering to individualized concussion management principles.

摘要： 目的 开发轻型急性缺血性卒中（acute ischemic stroke，AIS）患者院内神经功能恶化的预测模型，为AIS的院内分层管理提供科学依据。 方法 选取中国国家卒中登记Ⅲ（China national stoke registry Ⅲ，CNSR Ⅲ）中发病24 h内的轻型AIS（NIHSS评分≤5分）且未接受rt-PA静脉溶栓或血管内治疗的患者作为研究对象。开发队列为CNSR Ⅲ 2015—2016年入组的2256例患者，验证队列为CNSR Ⅲ 2017—2018年入组的1775例患者。应用LASSO回归筛选预测因子，并参考既往研究确定最终预测因子。院内神经功能恶化定义为出院时NIHSS评分较入院时NIHSS评分增加≥4分。基于logistic回归开发预测模型，分别使用C统计量和Brier得分对模型的区分度和校准度进行评价。 结果 本研究共纳入4031例患者，开发队列2256例患者中有58例（2.6%）发生院内神经功能恶化，验证队列1775例患者中有63例（3.5%）发生院内神经功能恶化。两个队列在人群特征上基本一致。预测模型最终基于年龄、性别、吸烟情况、收缩压、IL-6、hs-CRP、入院NIHSS评分、糖尿病及梗死模式共计9个预测因子开发。模型的C统计量在开发队列中为0.69（95%CI 0.62～0.76），在验证队列中为0.73（95%CI 0.67～0.80）；模型的Brier得分在开发队列中为0.025，在验证队列中为0.033。 结论 本研究基于常规住院数据建立了一个轻型AIS患者院内神经功能恶化预测模型，有较好的区分度和校准度，但是外推性需要外部数据进一步验证。 Abstract: Objective To develop a prediction model of in-hospital neurological deterioration for patients with minor acute ischemic stroke (AIS), and to provide scientific basis for stratified in-hospital management. Methods Patients with minor AIS (defined as NIHSS score≤5) enrolled in the China national stroke registry Ⅲ (CNSR Ⅲ) and arriving within 24 hours from onset while without taking rt-PA intravenous thrombolysis or endovascular treatment were selected as the study subjects. The derivation cohort was consisted of 2256 patients enrolled from 2015 to 2016, and the validation cohort was consisted of 1775 patients enrolled from 2017 to 2018. The predictors were finally determined by LASSO regression and reviewing of previous studies. In-hospital neurological deterioration was defined as 4 points or more increase in NIHSS score at discharge compared with the NIHSS score at admission. A logistic regression model was used to develop the prediction model. Discrimination and calibration were evaluated using C statistic and the Brier score, respectively. Results A total of 4031 patients were included in the study, with 58(2.6%) of 2256 patients from the derivation cohort and 63(3.5%) of 1775 patients from the validation cohort encountered in-hospital neurological deterioration. The population characteristics were similar between the two cohorts. The prediction model was developed based on 9 predictors, including age, gender, smoking, systolic blood pressure, IL-6, hs-CRP, NIHSS score on admission, diabetes mellitus and infarction pattern. The C statistic for the model was 0.69 (95%CI 0.62-0.76) in the derivation cohort and 0.73 (95%CI 0.67-0.80) in the validation cohort. The Brier score of the model was 0.025 in the derivation cohort and 0.033 in the validation cohort. Conclusions This study developed a prediction model for the risk of in-hospital neurological deterioration for patients with minor AIS based on routine hospitalization data, and the prediction model achieved acceptable levels of discrimination and calibration, yet the extrapolation needs to be further verified by external data.

AIM: The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia). METHODS: A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate. STRUCTURE: Recommendations from the "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed. [ABSTRACT FROM AUTHOR]

Acute severe ulcerative colitis (ASUC) is a life-threatening medical emergency with considerable morbidity. Despite recent advances in medical IBD therapy, colectomy rates for ASUC remain high. A scoping review of published articles on ASUC was performed. We collected data, such as general information of the disease, diagnosis and initial assessment, and available medical and surgical treatments focusing on technical aspects of surgical approaches. The most relevant articles were considered in this scoping review. The management of ASUC is challenging; currently, personalized treatment for it is unavailable. Sequential medical therapy should be administrated, preferably in high-volume IBD centers with close patient monitoring and indication for surgery in those cases with persistent symptoms despite medical treatment, complications, and clinical worsening. A total colectomy with end ileostomy is typically performed in the acute setting. Managing rectal stump is challenging, and all individual and technical aspects should be considered. Conversely, when performing elective colectomy for ASUC, a staged surgical procedure is usually preferred, thus optimizing the patients' status preoperatively and minimizing postoperative complications. The minimally invasive approach should be selected whenever technically feasible. Robotic versus laparoscopic ileal pouch–anal anastomosis (IPAA) has shown similar outcomes in terms of safety and postoperative morbidity. The transanal approach to ileal pouch–anal anastomosis (Ta-IPAA) is a recent technique for creating an ileal pouch–anal anastomosis via a transanal route. Early experiences suggest comparable short- and medium-term functional results of the transanal technique to those of traditional approaches. However, there is a need for additional comparative outcomes data and a better understanding of the ideal training and implementation pathways for this procedure. This manuscript predominantly explores the surgical treatment of ASUC. Additionally, it provides an overview of currently available medical treatment options that the surgeon should reasonably consider in a multidisciplinary setting. [ABSTRACT FROM AUTHOR]

Nonoperative management (NOM) of uncomplicated appendicitis (UA) has been increasingly utilized in recent years. The aim of this study was to describe nationwide trends of sociodemographic characteristics, outcomes, and costs of patients undergoing medical versus surgical management for UA. The 2018-2019 National (Nationwide) Inpatient Sample was queried for adults (age ≥18 y) with UA; diagnosis, as well as laparoscopic and open appendectomy, were defined by the International Classification of Diseases, 10th Revision, Clinical Modification codes. We examined several characteristics, including cost of care and length of hospital stay. Among the 167,125 patients with UA, 137,644 (82.4%) underwent operative management and 29,481 (17.6%) underwent NOM. In bivariate analysis, we found that patients who had NOM were older (53 versus 43 y, P < 0.001) and more likely to have Medicare (33.6% versus 16.1%, P < 0.001), with higher prevalence of comorbidities such as diabetes (7.8% versus 5.5%, P < 0.001). The majority of NOM patients were treated at urban teaching hospitals (74.5% versus 66.3%, P < 0.001). They had longer LOS's (5.4 versus 2.3 d, P < 0.001) with higher inpatient costs ($15,584 versus $11,559, P < 0.001) than those who had an appendectomy. Through logistic regression we found that older patients had up to 4.03-times greater odds of undergoing NOM (95% CI: 3.22-5.05, P < 0.001). NOM of UA is more commonly utilized in patients with comorbidities, older age, and those treated in teaching hospitals. This may, however, come at the price of longer length of stay and higher costs. Further guidelines need to be developed to clearly delineate which patients could benefit from NOM. • NOM of UA continues to be increasingly utilized. • Between 2018 and 19, 17.6% of UA were found to undergo NOM. • Older patients have up to 4.03 times greater odds of undergoing NOM for UA. • Patients with higher comorbidities have 1.36 times greater odds of undergoing NOM for UA. [ABSTRACT FROM AUTHOR]

To compare the success rates of medical management using a combined mifepristone and misoprostol protocol in cases of early pregnancy loss (EPL) between women who conceived without medical assistance and those who conceived through in vitro fertilization (IVF), after fresh or frozen embryo transfer, and evaluate for the predictive factors of success, time to first passage of tissue, and time to complete resolution of pregnancy. Retrospective cohort study. University hospital. Women who presented with EPL below 13 weeks of gestation between June 2013 and July 2021 who were managed medically with mifepristone 200 mg orally and misoprostol 800 mcg vaginally were included in the study. Medical management with mifepristone and misoprostol; conception without medical assistance vs. post-IVF, after fresh or frozen embryo transfer. We evaluated overall success and performed subgroup analysis according to the mode of conception and compared fresh vs. frozen-thawed embryo transfers for IVF pregnancies. In all groups, we also calculated success according to gestational age and compared the time to first passage of tissue. The potential predictive factors of treatment success were analyzed. The side effects and complications of treatment were recorded. A total of 930 women were included in the study, 99 (11%) of whom achieved pregnancy after IVF. The overall success of medical treatment was 89% with no statistically significant difference according to the mode of conception (89% vs. 89%) or type of transfer (fresh 89% vs. frozen 89%). Only lower gestational age by sonography was independently predictive of treatment success, showing a negative regression coefficient of β = −0.333 and an odds ratio of 0.717. The mean time to first passage of tissue was 5.0 ± 2.1 hours. Altogether, 666 women (72%) showed pregnancy resolution on the day of medication administration, an additional 110 women at 1-week follow-up, and a further 74 women after ≥4 weeks on ultrasound. Medical management of EPL with mifepristone and misoprostol is a highly successful treatment option that results in completed abortion in a timely fashion in both pregnancies conceived without medical assistance and those conceived after IVF. [ABSTRACT FROM AUTHOR]

Introduction Emergent clinical care and patient movements through the military evacuation system improves survival. Patient management differs when transporting from the point-of-injury (POI) to the first medical treatment facility (MTF) versus transporting from the Role 2 to the Role 3 MTF secondary to care rendered within the MTF, including surgery and advanced resuscitation. The objective of this study was to describe care provided to patients during theater inter-facility transports and compare with pre-hospital transports (POI to first MTF). Materials and Methods We performed a retrospective chart review of patients with the Role 2 to the Role 3 transports in Afghanistan and Iraq from 2007 to 2016. Data collected included procedures and events at the MTF and during transport. We compared the intra-theater transport data (Role 2 to Role 3) to data from a previous study evaluating pre-hospiital transports (POI to first MTF). Results We reviewed the records of 869 Role 2 to Role 3 transport patients. Role 2 to Role 3 transports were longer in duration compared to POI transports (39 minutes vs. 23 minutes) and were more likely to be staffed by advanced personnel (nurses, physician assistants, and physicians) (57% vs. 3%). The sample primarily consisted of military-aged males (mean age 27 years) who suffered from explosive or blunt force injuries. Procedures performed during each phase of care reflected the capabilities of the teams and locations. Pain and cardiac events were more common in POI evacuations compared to the Role 2 to Role 3 transports, but documentation of respiratory events, hemodynamic events, neurologic events, and equipment failure was more common during the Role 2 to Role 3 transports. Survival rates were slightly higher among the Role 2 to Role 3 cohort (98% vs. 95%, difference 3% [95% confidence interval of the difference 1-5%]). Conclusions Inter-facility transports (Role 2 to Role 3) are longer in duration, transport more complex patients, and are staffed by more advanced level provider types compared to transports from POI. [ABSTRACT FROM AUTHOR]

• Return-to-play time in concussed Rugby Union players depends on the presentation of symptoms at 2 and 72 h after injury. • When symptoms worsen between the time of injury and 3 days post, return-to-play time is significantly longer than when symptoms improve or remain stable. • Balance and cognitive function in the 72 h after injury are not associated with delayed recovery time. • Individualized management of concussed players is possible with stratification based on initial symptom presentation using standardized screening tools. Return to play (RTP) in elite rugby is managed using a 6-stage graduated RTP protocol, which can result in clearance to play within 1 week of injury. We aimed to explore how symptom, cognitive, and balance presentation and evolution during concussion screens 2 h (head injury assessment (HIA) 2) and 48 h (HIA3) after injury were associated with time to RTP) to identify whether a more conservative graduated RTP may be appropriate. A retrospective cohort study was conducted in 380 concussed rugby players from elite men's rugby over 3 consecutive seasons. Players were classified as shorter or longer returns, depending on whether RTP occurred within 7 days (allowing them to be considered to play the match 1 week after injury) or longer than 8 days, respectively. Symptom, cognitive, and balance performance during screens was assessed relative to baseline (normal or abnormal) and to the preceding screen (improving or worsening). Associations between sub-test abnormalities and RTP time were explored using odds ratios (OR, longer vs. shorter). Median day absence was compared between players with abnormal or worsening results and those whose results were normal or improving. Abnormal symptom results during screens 2 h and 48 h after concussion were associated with longer return time (HIA2: OR = 2.21, 95% confidence interval (95%CI): 1.39–3.50; HIA3: OR = 3.30, 95%CI: 1.89–5.75). Worsening symptom number or severity from the time of injury to 2 h and 48 h post-injury was associated with longer return (HIA2: OR = 2.49, 95%CI: 1.36–4.58; HIA3: OR = 3.34, 95%CI: 1.10–10.15. Median days absence was greater in players with abnormal symptom results at both HIA2 and HIA3. Cognitive and balance performance were not associated with longer return and did not affect median days absence. Symptom presentation and evolution within 48 h of concussion were associated with longer RTP times. This may guide a more conservative approach to RTP, while still adhering to individualized concussion management principles. [Display omitted] [ABSTRACT FROM AUTHOR]

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

Hidradenitis suppurativa (HS) is an autoinflammatory skin disease with a high unmet need for effective medical management. Clinically, it is characterized by inflammatory nodules that may progress into abscesses, draining tunnels and extensive scarring, mainly affecting apocrine gland-bearing areas. Treatment options include topical and systemic medications and a variety of surgical procedures. The anti-TNF-α antibody adalimumab and the anti-IL-17 secukinumab are the only two approved biologics for HS, showing moderate efficacy. HS research is a rapidly growing field, with a wide range of agents leveraging distinct mechanisms of action currently under development. Drugs targeting the IL-17 and Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathways are the most advanced in both ongoing and completed Phase 3 studies, promising deeper levels of response. Use of other, off-label biologics is also discussed. A therapeutic algorithm is proposed based on comorbidities and existing evidence. Patient-tailored combinations between biologics and other biologics or small molecules will hopefully allow clinicians to target most events in HS pathophysiology in a complementary way while obtaining a meaningful effect on their devastating manifestations. [ABSTRACT FROM AUTHOR]

Hypertrophic cardiomyopathy (HCM) is a heterogeneous genetic heart disease with an estimated prevalence in the general population of 0.2% to 0.6%. Clinically, HCM can range from no symptoms to severe symptoms such as heart failure or sudden cardiac death. Currently, the management of HCM involves lifestyle modifications, familial screening, genetic counseling, pharmacotherapy to manage symptoms, sudden cardiac death risk assessment, septal reduction therapy, and heart transplantation for specific patients. Multicenter randomized controlled trials have only recently explored the potential of cardiac myosin inhibitors (CMIs) such as mavacamten as a directed pharmacological approach for managing HCM. We will assess the existing medical treatments for HCM: beta-blockers, calcium channel blockers, disopyramide, and different CMIs. We will also discuss future HCM pharmacotherapy guidelines and underline this patient population's unfulfilled needs. Mavacamten is the first-in-class CMI approved by the FDA to target HCM pathophysiology specifically. Mavacamten should be incorporated into the standard therapy for oHCM in case of symptom persistence despite using maximally tolerated beta blockers and/or calcium channel blockers. Potential drug-drug interactions should be assessed before initiating this drug. More studies are needed on the use of CMIs in patients with kidney and/or liver failure and pregnant/breastfeeding patients. [ABSTRACT FROM AUTHOR]

The present article focuses both on the standardized medical management, on the dental management of patients diagnosed with Alzheimer’s disease, but also insists on the presentation of some historical aspects about the one who discovered and gave the name to the neurological disease: Alois Alzheimer. Practically, many of the details presented in this material could clarify certain historical curiosities regarding the background and life of Alois Alzheimer, both for students and practitioners in the field of general medicine (general medicine, general medicine assistance etc.), as well as for students and practitioners in the field of dentistry (dental medicine and dental technology). [ABSTRACT FROM AUTHOR]

Canine cystic endometrial hyperplasia-pyometra complex (CEH-P) is a hormonal and bacteria mediated reproductive disorder of intact, sexually mature bitches. Though, ovariohysterectomy (OHE) is considered as the treatment of choice in CEH-P, the advent of novel therapeutics and need for conservation of breeding potential in the affected bitch, led to the exploration of medical management as an alternative option of treatment. Ultrasonography serves as an adjunct tool to diagnose and evaluate the condition. It can also be used to grade the affected uterus on the basis of endometrial changes. The present article investigates the efficacy of medical management in different grades of CEH-P, as assessed by ultrasonography. It was observed that though bitches with severe endometrial changes recovered clinically following medical management, the endometrial changes, as could be assessed with ultrasonography, persisted. The ultrasound grading of uterus could thus be used to assess the suitability of medical management in CEH-P affected bitches. [ABSTRACT FROM AUTHOR]

The modern healthcare environment is subject to rapid transformations due to technological progress, the introduction of electronic management systems, changes in the funding structure, etc. These aspects significantly affect medical management and require appropriate personnel to effectively manage these changes. The dynamic nature of the development of the medical field makes it necessary to improve the qualifications of medical personnel at all levels. Management in the field of healthcare requires specific knowledge and skills. The growing volume of work and the constant challenges associated with the treatment of new diseases require qualified managers who can effectively cope with various tasks. The introduction of conceptions such as the patient-centered model or other innovative approaches may require a review of the structure and management strategies of healthcare organizations. As a result, staff are needed who can effectively adapt to the new realities. With the emergence of new technologies such as telemedicine, artificial intelligence in diagnostics, and the development of medical applications and management systems, managers need to be innovation-oriented and ensure that innovations are implemented in medical practice. Technological innovations in the healthcare sector are closely linked to globalization and the exchange of experience. The growing global interdependence of the healthcare industry requires managers to understand not only national but also international aspects of healthcare management. This approach allows to reveal current problems, propose effective strategies for responding to challenges and identify key areas for the development of management personnel in healthcare management. The purpose of the article is to identify current trends in various forms of personnel policy in medical management, their advantages and disadvantages, and to consider innovations in this area aimed at optimizing personnel management in a modern medical enterprise.

Purpose: This study aimed to report the strategies that evolved in managing Mooren's ulcer (MU) at a resource-limited center in rural India during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This study includes a retrospective analysis of clinically diagnosed MU cases from January 2021 to August 2021 wherein strategies for management were developed. The demographic profile, ulcer clinical features, treatment algorithms (medical and surgical), complications encountered, referral to a higher center, and compliance with medication and follow-up were studied. Results: The mean age of presentation was 68.1 years (range, 62–73 years), and 90% were men. The median best-corrected visual acuity (BCVA) was 1.26 logarithm of the Minimum Angle of Resolution (LogMAR) (interquartile range (IQR), 0.00–5 logMAR) in the affected eye on presentation, which improved to 0.69 logMAR (IQR, 0.00–3 logMAR) at resolution (P = 0.442). The first-line management was conjunctival resection and tissue adhesive application (90%). 70% of cases were unilateral, 50% of cases had less than 2 clock hours of involvement, and 50% had less than 50% stromal involvement. Confounding factors included infectious keratitis (2) and corneal perforation (3). The mean duration of follow-up was 96 (1–240) days. The average follow-up visits per patient were 8.8 (1–22). 90% of cases could be managed successfully at the secondary center level with two cases needing a tertiary care referral. Conclusion: MU can be managed effectively by following a systemic strategy of early diagnosis, surgical therapy, and rapid institution of systemic immunosuppression in a remote location-based secondary center. The strategies developed can be a guide for ophthalmologists at remote centers managing patients or who are unable to travel to tertiary institutes.