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Context: Foot/ankle pain is common among runners. Inadequate management of runners with foot/ankle pain can lead to lost training time, competition removal, and other activity limitations. Neurodynamics, which refers to the integrated biomechanical, physiological, and structural function of the nervous system during movement, can be overlooked in patients with foot/ankle pain. Although a link between the cervical spine, neurodynamics, and upper quarter pain has been studied, less is known about the relationship between the lumbar spine and lower quarter. This case series describes the successful management of 3 runners with foot/ankle pain. Case Presentations: Three female runners (ages 23, 24, and 45 y) presented to physical therapy with foot/ankle pain and difficulty running. Each patient had positive examination findings with local foot/ankle testing. A comprehensive lumbar spine examination demonstrated impairments in range of motion and joint mobility that were hypothesized to be contributing. Positive lower quarter neurodynamic tests were also found. Management and Outcomes: All patients were treated with nonthrust lumbar spine mobilization and lower quarter neural tissue mobilization. Changes in the Patient-Specific Functional Scale, Numerical Pain Rating Scale, Lower Extremity Functional Scale, and Global Rating of Change occurred after intervention targeting the lumbar spine and lower-extremity neurodynamics in all patients. Conclusions: This case series demonstrates the importance of including a thorough lumbar spine examination and neurodynamic testing to identify appropriate interventions while managing patients with foot/ankle pain, even when patients have signs indicative of local ankle/foot pathology. These examination procedures should be performed particularly when a patient is not responding to management targeting local foot/ankle structures. [ABSTRACT FROM AUTHOR]

Altering baseball pitching mechanics affects both performance and the risk of injury. The purpose of this study is to investigate the relationships of shoulder external over internal rotation ratio (SEIR) and other shoulder rotational properties during physical exam and biomechanics of pitching for 177 collegiate baseball pitchers. The shoulder range of motion was quantitatively measured using a custom-made wireless device. Pitching motion data were collected at 240 Hz, and a custom program was created to calculate the throwing arm motion and loading during baseball pitching. Linear regression and analysis of variance tests were performed to investigate the relationships between the shoulder physical exam outcomes and throwing arm biomechanics. SEIR had significant correlations with shoulder horizontal adduction angle at foot contact, maximum shoulder external rotation angle, maximum shoulder linear velocity, and elbow angle at ball release. SEIR groups had significant differences in shoulder proximal force, adduction torque, internal rotation torque, and horizontal adduction torque, and in elbow medial force and varus torque. Glenohumeral internal rotation deficit and total rotational motion deficit had no relationships with throwing arm motions or joint loadings. Shoulder health should be monitored to improve understanding of pitching mechanics in collegiate baseball pitchers. [ABSTRACT FROM AUTHOR]

Purpose: The monitoring of training loads and quantification of physical performance are common practices in youth soccer academies to support coaches in prescribing and programming training for individuals. The interaction between training load and physical performance is unknown during a preseason period in youth soccer players. The current study assessed changes in training load and physical assessments across a 4-week preseason period. The relationship between physical performance and match playing time in youth male soccer players was also investigated. Methods: The training loads of 25 professional youth academy male soccer players were monitored throughout a 4-week preseason period. Assessments of power, agility, speed, and aerobic capacity were undertaken in the first training session. Session ratings of perceived exertion (sRPE) and well-being questionnaires were collected during all training sessions and preseason matches. Playing time during subsequent competitive matches was recorded. Results: T test and 30-m-sprint assessments, conducted on the first day of preseason, were predictors of sRPE throughout preseason (t test χ2/df = 2.895, poor adjustment; 30-m sprint χ2/df = 1.608, good adjustment). YoYo Test performance was related with changes in perceived fatigue (χ2/df = 0.534, very good adjustment). Faster players reported higher values of sRPE, and players with higher aerobic capacity reported higher levels of fatigue across preseason. Well-being, perceived fatigue and soreness, and sRPE decreased across preseason. Greater match durations were related to higher levels of fatigue during preseason (P <.05). Conclusion: The current study highlights the relationship between training load, physical assessments, and playing time. Coaches and practitioners can use physical test data at the start of preseason as an indication of players that report higher sRPE, perceived fatigue, and reduced well-being across preseason, supporting decisions around individualized training prescriptions. [ABSTRACT FROM AUTHOR]

Orofacial pain is a worldwide pain problem, with many patients unable to find appropriate diagnosis and treatment. Orofacial pain includes pain arising from the odontogenic and nonodontogenic structures in the head and neck region. Dental clinicians need to have a thorough knowledge and skill to diagnose, manage, and treat patients with odontogenic pain or refer patients for treatment of nonodontogenic pain to specialists such as orofacial pain specialists, neurologists, otolaryngologists, and rheumatologists. More often, dental practitioners diagnose patients with a temporomandibular disorder (TMD), and when treatment is ineffective, term it "atypical facial pain." The first requirement for effective treatment is an accurate diagnosis. Dental clinicians must be aware of giant cell arteritis (GCA), a chronic large-vessel vasculitis, primarily affecting adults over the age of 50 years, as it frequently mimics and is misdiagnosed as TMD. GCA is associated with loss of vision, and stroke and can be a life-threatening disorder. Therefore, diagnostic testing for GCA and differential diagnosis should be common knowledge in the armamentarium of all dental clinicians. Historically, temporal artery biopsy was considered the definitive diagnostic test for GCA. Temporal artery ultrasound (TAUSG), a safe and noninvasive imaging modality, has replaced the previous diagnostic gold standard for GCA, the temporal artery biopsy, owing to its enhanced diagnostic capabilities and safety profile. The present case report describes a patient with GCA, and the role TAUSG played in the diagnosis. Case report: A 72-year-old woman presented with left-sided facial pain, jaw claudication, dysesthesia of the tongue, and episodic loss of vision of 2 years' duration. She was diagnosed with and treated for a myriad of dental conditions including endodontia and temporomandibular joint therapy with no benefit. A thorough history and physical examination, combined with serologic analysis, led to the diagnosis of GCA and TAUSG, which confirmed the diagnosis. Conclusion: This report underscores the responsibility of differential diagnosis and early recognition of GCA facilitated by TAUSG in optimizing treatment outcomes as a viable, noninvasive diagnostic tool. [ABSTRACT FROM AUTHOR]

Two fractured maxillary central incisors were restored via the crown fragment reattachment technique with adhesive systems and composite resin material. A long-term successful outcome was achieved after 4 years of follow-up. The patient presented with fractured maxillary central incisors, and a comprehensive intraoral and radiographic examination revealed that both teeth had extended crown fractures with no pulpal exposure (Class II, Ellis and Davey). The tooth fragments were thoroughly cleaned and inspected before being repositioned. Both fragments were in excellent condition with almost no pieces missing. Therefore, the proposed treatment was fragment reattachment. After verifying the repositioning and adaptation of the fractured fragments, a flowable composite was used to perform the reattachment procedure under rubber dam isolation. With modern dental adhesives, the reattachment of tooth fragments in good condition is considered a more conservative option for restoring tooth morphology, esthetics, and function. Although one tooth showed signs of irreversible pulpitis and required root canal treatment 2 weeks after the restoration, the clinical and radiographic evaluations at the 4-year follow-up visits confirmed the success of the restorative treatment. The restorations showed good functional and esthetic outcomes after 4 years of follow-up. [ABSTRACT FROM AUTHOR]

Background and Purpose Ulnar collateral ligament (UCL) injury is a common elbow injury among overhead athletes, particularly baseball pitchers. However, limited research exists for non-throwing athletes, especially regarding rehabilitation. The purpose of this case report is to illustrate the use of early weight-bearing activities into the rehabilitation protocol for non-operative management of athletes with a UCL injury. Case Description The subject was a 17-year-old female competitive cheerleader. Two weeks prior, during the performance of an acrobatic skill in which she transitioned to full upper extremity (UE) weight-bearing, she sustained an injury to her right elbow. Physical therapy examination findings indicated a diagnosis of a UCL sprain. Self-reported outcome measures revealed a FOTO score of 69/100 and a Quick Dash score of 43/100. The subject attended 14 therapy sessions over nine weeks to address physical function and performance, which were assessed at intervals during her therapy program. Rehabilitation consisted of therapeutic exercise for the progression of UE functional weight-bearing including planks, ball push-ups, handstands, crab walks, stool pulls, handstand walks, and UE plyometric jumps. Outcomes Along with documented improvement of the standard musculoskeletal examination measures of range of motion, strength, and functional performance, the subject demonstrated no elbow instability and improved FOTO and Quick Dash scores of 98 and 0, respectively. The subject demonstrated 105% limb symmetry index with the return to sport (RTS) UE functional testing of one-armed seated shot-put throw (SSPT) and achieved normative values with the closed kinetic chain upper extremity stability test (CKCUEST). Conclusion This case report highlights the successful treatment of a subject with a UCL injury and the integration of therapy interventions with a focus on UE weight-bearing. Further research on performing high level UE weight-bearing activities during rehabilitation and RTS guidelines is needed. [ABSTRACT FROM AUTHOR]

Background: The Covid-19 pandemic led to a rapid increase in the use of virtual consultations across healthcare. Post-pandemic, this use is expected to continue alongside the resumption of traditional face-to-face clinics. At present, research exploring when to use different consultation formats for palliative care patients is limited. Aim: To understand the benefits and limitations of a blended approach to outpatient palliative care services, to provide recommendations for future care. Methods: A mixed-methods study. Component 1: an online survey of UK palliative care physicians. Component 2: a qualitative interview study exploring patients' and caregivers' experiences of different consultation formats. Findings from both components were integrated, and recommendations for clinical practice identified. Results: We received 48 survey responses and conducted 8 qualitative interviews. Survey respondents reported that face-to-face consultations were appropriate/necessary for physical examinations (n = 48) and first consultations (n = 39). Video consultations were considered appropriate for monitoring stable symptoms (n = 37), and at the patient's request (n = 42). Patients and caregivers felt face-to-face consultations aided communication. A blended approach increased flexibility and reduced travel burden. Conclusions: A blended outpatient palliative care service was viewed positively by physicians, patients and caregivers. We identified 13 clinical practice recommendations for the use of different consultation formats. [ABSTRACT FROM AUTHOR]

Background Stretching programs are designed to improve hamstring flexibility by attempting to mechanically increase the length of the target tissue. However, other manual treatment approaches such as those utilized in Total Motion Release (TMR®), could be beneficial by identifying body asymmetries to assess and treat soft tissue impairments leading to diminished extensibility. Purpose The purpose of this study was to determine the effectiveness of the TMR® Fab 6 assessment and treatment to increase hamstring flexibility in healthy participants following one session of TMR®. Study Design Observational Cohort study Methods A convenience sample of 20 healthy participants (10 males, 10 females) were recruited from three institutions. Following collection of demographic information and a brief medical history, each participant performed a five minute warm-up on the stationary bike at a moderate intensity (80-90 RPMs) followed immediately by the bilateral performance of the Active Knee Extension Test (AKET) and Passive Straight Leg Raise (PSLR) to assess hamstring muscle length. Participants were randomly placed in the TMR® or control group. The TMR® group completed the "Fab 6" evaluation and treatment, while the control group performed one repetition of standing active hip flexion every 30-seconds for 15-minutes with both knees in full extension. Upon completion of treatment, control and TMR® groups were immediately re-evaluated on the AKET and the PSLR in the same order and fashion as baseline testing. Participants were asked to return in 24-hours for the same objective measurements as previously described. Results A significant time by group interaction was identified across all variables (p < 0.001) for AKET and PSLR except the PSLR preferred leg from post-treatment to 24hr follow-up. The most significant increase in the AKET occurred in the TMR® group between baseline and post-treatment of the non-preferred leg (12.15°±2.94) when compared to the control group (7.15°±1.56). [ABSTRACT FROM AUTHOR]

Background and Purpose Conservative management of anterior shoulder dislocation (ASD) is associated with greater recurrence compared with surgical management. Current rehabilitation protocols may not adequately challenge shoulder stability to encourage adaptive coping strategies. Apprehension-based training (ABT) is a new treatment concept derived from the supine moving apprehension test (SMAT), a previously validated performance measure among patients with ASD. The purpose of this case report is to describe the application of ABT in a patient with recurrent ASD. Study Design Case report Case Description The subject was a 23-year-old male with bilateral recurrent ASD. The subject underwent a 17-week exercise program involving gradual exposure to increased anterior instability loads based on the SMAT movement pattern. The Western Ontario Shoulder Instability Index (WOSI), Patient-Specific Functional Scale (PFPS), Tampa Scale of Kinesiophobia, SMAT, shoulder internal and external rotation muscle strength were measured via hand-held dynomometry before and after training. Outcomes Following treatment, clinically meaningful gains in quality of life (WOSI) and shoulder function (PSFS) were noted. Kinesiophobia decreased, SMAT and shoulder internal rotator strength increased beyond their respective minimal detectable change. Four months after treatment, quality of life and shoulder function remained improved, and the subject reported a reduced rate of ASD. Discussion Apprehension-based training involving gradual exposure to shoulder instability loads may hold potential for improving the management of patients with ASD. Further testing of this concept is warranted. [ABSTRACT FROM AUTHOR]

The increasing incidence of surgical site infections (SSIs) following caesarean sections highlights the necessity for updated protocols that address risk factors throughout the preoperative, intraoperative, and postoperative stages. Negative Pressure Wound Therapy (NPWT) and hydrocolloid dressings have demonstrated potential for improving wound management and reducing complications, particularly by enhancing dressing integrity. Nevertheless, the application of NPWT requires careful consideration and adherence to local trust guidelines to ensure both its safety and efficacy. [ABSTRACT FROM AUTHOR]

Lower limb oedema is a common condition in clinical practice, frequently affecting the distal lower limbs. Whereas benign causes such as prolonged sitting or standing are typical, oedema can also indicate serious systemic diseases such as cardiac failure, liver disease, or renal impairment. Identifying the cause is crucial to prevent irreversible skin and tissue changes. This clinical review aims to increase the knowledge of advanced clinical practitioners (ACPs) and generalist practitioners, including practice and community nurses, by providing an overview of how to approach patients with lower limb oedema, encompassing history-taking, examinations, investigations, and management plans. The main focus is on lymphoedema, which can be primary or secondary. Primary lymphoedema results from genetic abnormalities, while secondary lymphoedema arises from acquired defects due to factors such as obesity, infections, neoplasms, and trauma. Effective management includes addressing the underlying cause, ensuring proper skin care, recommending appropriate exercises, and the use of compression garments. Referral to a lymphoedema specialist is recommended for patient education on managing and treating the condition when required. Additionally, the article discusses the importance of regular skin inspections, minor injury management, environmental considerations, and the critical role of compression garments in lymphoedema management. This comprehensive approach aims to enhance patient outcomes and provide a thorough strategy for ACPs and generalist practitioners. [ABSTRACT FROM AUTHOR]

Bicycle set-up dimensions and cycling kinematic data are important components of bicycle fitting and cyclist testing protocols. However, there are no guidelines on how bicycles should be measured and how kinematic data should be collected to increase the reliability of outcomes. This article proposes a consensus regarding bicycle set-up dimensions and recommendations for collecting cycling-related kinematic data. Four core members recruited panellists, prepared the document to review in each round for panellists, analysed the scores and comments of the expert panellists, reported the decisions and communicated with panellists. Fourteen experts with experience in research involving cycling kinematics and/or bicycle fitting agreed to participate as panellists. An initial list of 17 statements was proposed, rated using a five-point Likert scale and commented on by panellists in three rounds of anonymous surveys following a Delphi procedure. The consensus was agreed upon when more than 80% of the panellists scored the statement with values of 4 and 5 (moderately and strongly agree) with an interquartile range of less than or equal to 1. A consensus was achieved for eight statements addressing bicycle set-up dimensions (e.g. saddle height, saddle setback, etc.) and nine statements for cycling kinematic assessment (e.g. kinematic method, two-dimensional methodology, etc.). This consensus statement provides a list of recommendations about how bicycle set-up dimensions should be measured and the best practices for collecting cycling kinematic data. These recommendations should improve the transparency, reproducibility, standardisation and interpretation of bicycle measurements and cycling kinematic data for researchers, bicycle fitters and cycling related practitioners. [ABSTRACT FROM AUTHOR]

Introduction: To determine the frequency of superior cluneal nerve entrapment (SCN‐E) in patients who applied to our outpatient clinic with low back pain. Methods: Two hundred patients with mechanical low back pain persisting more than 3 months were included in our study. All patients were evaluated with detailed clinical history and physical examination. Ultrasound‐guided diagnostic injection was performed in patients who had tenderness on the posterior iliac crest and whose main complaint emerged by pressing on this point. Patients with 70% or greater pain relief 1 h after the injection were considered as SCN‐E. The frequency and clinical features of SCN‐E were determined and compared with other mechanical low back pain. Results: The mean age of the patients included in our study was 48.56 ± 14.11 years, with 138 female and 62 male patients. The diagnostic injection was performed on 31 patients and considered positive in 24 of them. The frequency of SCN‐E was determined as 12%. The Hip‐Knee Flexion Test was determined to be more specific for SCN‐E than other causes of low back pain, the sensitivity and specificity of the test were 41.67% and 88.64% (p = 0.001; p < 0.01). In addition, all demographic and clinical features in patients diagnosed with SCN‐E were found to be similar to other mechanical low back pain cases. Conclusions: In patients with chronic low back pain, SCN‐E is not a rare cause and is often overlooked. Increasing the awareness and experience of physicians on SCN‐E will prevent patients from being exposed to unnecessary surgical or non‐surgical treatments. [ABSTRACT FROM AUTHOR]

Cricotracheostomy is a useful surgical procedure for opening the airway in cases where conventional tracheotomy is difficult. This is a safe and easy technique involving removal of the anterior portion of the cricoid cartilage. Herein, we report the case of a patient with difficulty in neck extension due to severe kyphosis, who underwent cricotracheostomy. A 65-year-old woman developed dyspnea and was transported to our hospital. SpO2 was 60% (room air) and endotracheal intubation was performed. She was managed on ventilator. However, weaning off the ventilator was difficult, and endotracheal intubation was prolonged. Subsequently, the patient was referred to us for a tracheostomy. The patient was unable to maintain the supine position due to severe kyphosis, and computed tomography revealed that the brachiocephalic artery was running just below the thyroid gland. Therefore, conventional tracheostomy was difficult to perform, and we performed cricotracheostomy instead. After the cricotracheostomy, there were no tracheal problems, such as tracheal stenosis and stomal hemorrhage. Cricotracheostomy can be performed in cases where multiple anatomical difficulties may be faced in the tracheostomy site, as in this case. Furthermore, cricotracheostomy is beneficial for long-term airway management because it causes fewer complications compared to conventional tracheotomy. [ABSTRACT FROM AUTHOR]

Aim: This study aims to explore the association between declining lung function and depression in middle‐aged and older adults, with a special focus on the mediating role of cognitive function. Methods: This study utilizes self‐reported and physical examination data from 5345 individuals participating in the 2015 cycle of the China Health and Retirement Longitudinal Study (CHARLS) to explore the role of cognitive function changes in mediating the effects of diminished lung function on depression among middle‐aged and older adults. Results: Multivariate linear regression analysis revealed a positive correlation between pulmonary and cognitive functions (β = 0.003, 95% CI: 0.002∼0.003, P < 0.01) and a negative correlation between cognitive function and depression (β = −0.279, 95% CI: −0.330–0.228, P < 0.01). Cognitive function plays a mediating role in linking pulmonary function with depression, exhibiting a mediation effect of −0.0007 and a total effect of −0.0046, wherein the mediation effect contributes to 15.22% of the total effect. For females, the mediating effect of cognitive function was stronger (β = −0.0013, 95% CI: −0.0018∼–0.0008, P < 0.01) than it was for males (β = −0.0006, 95% CI: −0.0009∼–0.0003, P < 0.01). Conclusions: The study underscores the importance of monitoring lung and cognitive functions as interconnected factors contributing to the mental health of middle‐aged and older adults. It suggests that interventions aimed at improving pulmonary health and cognitive function may help mitigate depressive symptoms among middle‐aged and older adults. Further research is warranted to validate these findings across diverse cultural and demographic settings. Geriatr Gerontol Int 2024; 24: 1210–1217. [ABSTRACT FROM AUTHOR]

A 6-week-old boy is brought to the hospital for fussiness and abdominal distension. He was febrile on presentation and was admitted to the hospital for further evaluation. On subsequent examinations, he continued to demonstrate abdominal distension and tenderness to palpation. Ultrasonography of the abdomen was performed and revealed a heterogeneous liver mass. With further diagnostics, a diagnosis was made and treatment initiated, with the infant experiencing resolution of his symptoms. Our panel of experts first discuss the management of an infant with abdominal distension, then discuss the evaluation of a liver mass in an infant, including oncologic, vascular, and infectious etiologies. [ABSTRACT FROM AUTHOR]

Faecal incontinence is a hidden problem that is often under-reported, under-diagnosed, under-investigated and under-treated. Faecal incontinence is more common in women and older people. Its prevalence also increases with age. Faecal incontinence occurs because of a complex interplay of contributing factors, some of which can be reversed in primary care without the need for specialist investigations and treatment. This article explores the reasons why adults develop faecal incontinence and how to identify and treat reversible causes in primary care. It also provides information on specialist treatment and the management of intractable faecal incontinence. A structured approach to assessment and management is key in identifying problems and offering primary care for timely treatment. [ABSTRACT FROM AUTHOR]

The article focuses on a case involving a 38-year-old woman who presented with sudden-onset voiding dysfunction, vaginal pain, and a protruding vaginal mass after sneezing. Topics include the diagnostic process of identifying a thrombosed lesion and ureterocele, the treatment and management involving drainage and further imaging, and the patient's outcome after successful decompression and follow-up cystoscopy.

The article presents a case study of a 6-year-old girl experiencing recurrent Kawasaki disease (KD) accompanied by Kawasaki disease shock syndrome (KDSS). Topics discussed include the challenges in diagnosing KDSS, the elevated inflammatory markers indicating severity, and the management strategies implemented, including the use of intravenous immunoglobulin (IVIG) and antiplatelet therapy.

The article presents a case study of a 4-month-old infant who presented to the emergency department with diarrhea, irritability, and poor reactions. Topics discussed include the infant's clinical symptoms and examination findings, abnormal laboratory results indicating metabolic disturbances, and the implications of the patient's premature birth on her overall health status.

The article presents a case study of a healthy female newborn, born at 40 weeks and 3 days to a 33-year-old mother, who was diagnosed with a congenital hemangioma presenting as a right-sided lateral neck mass. Topics discussed include the differential diagnosis of congenital lateral neck masses, the characteristics and progression of congenital and infantile hemangiomas, and the importance of using ultrasound with Doppler for proper imaging and assessment of such lesions.

The article presents a case study of a 7-year-old pediatric patient with stercoral colitis and acute kidney injury resulting from chronic constipation. Topics discussed include the recognition of conditions like stercoral colitis in children, the widespread and often underdiagnosed nature of chronic constipation, and the potential long-term complications that can arise if this condition is not adequately managed.

Background/Objectives: The miswak, crafted from the Salvadora persica tree, is a traditional teeth-cleaning twig that has served as a natural substitute for toothbrushes and toothpaste across diverse regions for centuries. This study aimed to evaluate and compare the effectiveness of miswak and a conventional toothbrush in reducing dental plaque and gingivitis over a two-week period. Methods: This two-week randomized, single-blind (clinical investigator), two-parallel-arm clinical trial was conducted at Princess Nourah University College of Dentistry (PNUCD). Stratified random sampling identified sixty participants who were then randomly assigned to two study groups: the miswak group and the toothbrushing group. To facilitate data collection, a self-designed form was employed to document participants' initials, assigned group, the Silness and Loe plaque index, and the Loe and Silness gingival index. The clinical examination, conducted by two blinded and trained examiners using a mouth mirror and explorer under natural light, aimed to assess the specified indices. The collected data were analyzed using IBM SPSS Statistics, Version 22. Results: Following the intervention, the miswak group exhibited no significant change in the plaque scores (p = 0.58) compared to the toothbrush group (p = 0.007). A notable rise in gingival score was observed within the miswak group (p < 0.001), whereas no significant change was noted within the toothbrush group (p = 0.52). Conclusions: Over a two-week period, miswak was successful in controlling dental plaque; however, gingival scores were higher, which could be attributed to the aggressive use of miswak. With proper training, the use of miswak has the potential to contribute positively to gingival health, particularly in regions where it is readily accessible and affordable. [ABSTRACT FROM AUTHOR]

The article describes the case of an eight-year-old girl who complained of multiple carious lesions, causing pain upon eating and teeth brushing. Topics discussed including findings on radiographic examination, treatment given to the patient, and the introduction of prefabricated zirconia crowns (PZCs) for first permanent molars (FPMs) after the success and wide acceptance of the PZCs for primary teeth.

Introduction: Carpal tunnel syndrome is the most common compression neuropathy. Grading the severity of carpal tunnel syndrome is an important factor in deciding on the type of treatment. This study aims to determine the relationships between the findings of the electrodiagnosis and ultrasonography methods based on the severity of carpal tunnel syndrome. Methods: In this prospective clinical study, 50 patients (96 wrists) who were referred to the Physical Medicine and Rehabilitation Department of the Shohada Tajrish Hospital, Tehran, Iran (from March 2021 to November 2022) were studied. All patients with a history and clinical examination related to CTS underwent electrodiagnosis studies. Based on the results of electrodiagnosis, patients were divided into three groups: mild, moderate, and severe. All eligible patients underwent ultrasound at the cross-section of the wrist (at the level of the pisiform bone, the entrance of the canal) and the middle of the forearm. Results: In this study, the cross-sectional area of the median nerve was measured in 96 wrists of 50 patients with a mean age of 51.78 ± 9.80 years. The mean CSA of the median nerve in the mild, moderate, and severe groups was reported as 0.12 ± 0.03, 0.14 ± 0.02, and 0.21 ± 0.06, respectively. The mean WFR in different groups of CTS was reported as 1.85 ± 0.56, 1.93 ± 0.56, and 2.45 ± 0.49, respectively. A significant relationship between ultrasound findings, including CSA-inlet and WFR, and electrodiagnosis findings was presented (P value < 0.05). Conclusion: Based on our findings, there is a statistically significant relationship between the sonographic findings, including the mean CSA-inlet and WFR, and the severity of CTS based on the electrodiagnosis study. Our findings revealed that as disease severity increases, sonographic parameters also increase significantly. [ABSTRACT FROM AUTHOR]

Cytomegalovirus (CMV) commonly infects immunocompromised individuals, such as cancer patients. We present a case involving a 60‐year‐old male with Stage 3A lung adenocarcinoma and chronic obstructive pulmonary disease (COPD) diagnosed with CMV tracheobronchitis, initially suspected as cancer progression. Treatment with ganciclovir led to partial improvement in symptoms of shortness of breath and cough, as well as bronchoscopic findings. However, due to ganciclovir‐induced neutropenia, the therapy was switched to foscarnet. Distinguishing between cancer progression and infectious tracheobronchitis through physical examination and chest CT scans remains challenging. In lung cancer patients presenting with airway and bronchial narrowing along with ulcerative mucosal lesions, CMV infection should be considered. A bronchoscopic biopsy is crucial for accurate diagnosis and determining the appropriate treatment in these patients. [ABSTRACT FROM AUTHOR]

Carney Complex (CNC) is a rare syndrome characterized by spotty skin pigmentation and multiple neoplasms, notably cardiac myxomas, schwannomas, and endocrine tumours. It is often inherited in an autosomal dominant manner with PRKAR1A gene mutations found in the majority of cases. Male infertility is established as part of the CNC phenotype and is largely associated with Large cell calcifying Sertoli cell tumours (LCCSCT). We describe a case of a 30-year-old male patient with Carney Complex, presenting with severe oligoasthenozoospermia and primary pigmented nodular adrenocortical disease (PPNAD). During follow-up consults, the severe oligozoospermia and impaired semen motility persisted and the patient was also diagnosed with a recurring cardiac myxoma and LCCSCT. Molecular testing identified a novel PRKAR1A mutation involving a deletion of exons 4 to 7. Our findings suggest this mutation causes PRKAR1A haploinsufficiency, which may be directly linked to male infertility, irrespective of the presence of testicular tumours. Accordingly, in male patients with CNC, detection of a PRKAR1A gene mutation may serve as a predictive marker for infertility. This case report illustrates the importance of early consideration and management of infertility in male patients diagnosed with CNC. Plain Language Summary: Male infertility associated with a novel PRKAR1A mutation in carney complex Carney Complex (CNC) is a rare genetic disorder that leads to the development of various tumours, including in the heart and endocrine glands. Most cases are linked to mutations in a gene called PRKAR1A and are inherited in an autosomal dominant manner. This case report presents a detailed examination of a patient diagnosed with Carney Complex (CNC), followed over nearly 10 years. The patient initially consulted due to infertility, which led to extensive investigations and diagnosis of several type of tumours: Primary pigmented nodular adrenocortical disease (PPNAD) in the adrenal glands, a cardiac myxoma, and Large cell calcifying Sertoli cell tumours (LCCSCT) in the testes - all tumours are characteristic features of CNC. Notably, genetic testing revealed a novel mutation in the PRKAR1A gene. Through this case, we highlight how this genetic mutation might cause PRKAR1A haploinsufficiency and be solely responsible for infertility in CNC irrespective of testicular tumours, providing valuable insights into a condition where male infertility is rarely documented. This report contributes important new information to the limited existing research on the connection between CNC and male infertility. [ABSTRACT FROM AUTHOR]

Increasing interest in applying large language models (LLMs) to medicine is due in part to their impressive performance on medical exam questions. However, these exams do not capture the complexity of real patient–doctor interactions because of factors like patient compliance, experience, and cognitive bias. We hypothesized that LLMs would produce less accurate responses when faced with clinically biased questions as compared to unbiased ones. To test this, we developed the BiasMedQA dataset, which consists of 1273 USMLE questions modified to replicate common clinically relevant cognitive biases. We assessed six LLMs on BiasMedQA and found that GPT-4 stood out for its resilience to bias, in contrast to Llama 2 70B-chat and PMC Llama 13B, which showed large drops in performance. Additionally, we introduced three bias mitigation strategies, which improved but did not fully restore accuracy. Our findings highlight the need to improve LLMs' robustness to cognitive biases, in order to achieve more reliable applications of LLMs in healthcare. [ABSTRACT FROM AUTHOR]

Condyloma acuminata (CA) is a common manifestation of human papillomavirus (HPV) infection affecting the urogenital tract. While external genital lesions are frequently encountered, urethral involvement presents a therapeutic challenge due to the risk of recurrence and long-term complications such as urethral stricture. We present a case of urethral condyloma acuminata in a 43-year-old male patient who demonstrated favorable progression following electrocoagulation therapy. The patient presented with urethrorrhagia and lower urinary tract symptoms, with subsequent diagnosis confirmed via urological examination. Negative results from extensive microbiological testing supported the diagnosis. Treatment involved biopsy excision combined with electrocoagulation, resulting in complete resolution of symptoms without recurrence at 2-month follow-up. This case underscores the importance of individualized treatment strategies for intraurethral condyloma acuminata and highlights electrocoagulation therapy as a viable option with favorable outcomes. [ABSTRACT FROM AUTHOR]

Background: In Venezuela, the predominant vaccines administered are BBIBP-CorV and Gam-COVID-Vac. Despite robust evidence from randomized clinical trials validating the effectiveness of COVID-19 vaccines in mitigating hospitalization and mortality, there is still a lack of post-authorization safety studies conducted within this demographic population. Methods: A prospective observational study from October 5, 2021 to March 31, 2022 encompassed COVID-19 vaccinated and unvaccinated patients from four sentinel hospitals in Venezuela. Patient lethality was predicted using Charlson Comorbidity index. Clinical outcomes were assessed through WHO's COVID-19 Clinical Progression Scale. Results: Out of the 175 patients assessed, 85 (48.6%) were vaccinated. The median Charlson Comorbidity index was 3 points, with no statistically significant differences observed between the groups (p = 0.2). A total of 50 (28.6%) patients died during the study period, with higher proportion of deaths in unvaccinated patients (35.6% vs. 21.2%, p = 0.035). Advanced age (OR = 1.043, 95% CI = 1.015–1.071, p = 0.002) was associated with increased death risk, whereas vaccination against COVID-19 (OR = 0.428, 95% CI = 0.185–0.99, p = 0.047), high oxygen saturation (OR = 0.964, 95% CI = 0.934–0.995, p = 0.024), and enoxaparin administration (OR = 0.292, 95% CI = 0.093–0.917, p = 0.035) were associated with decreased death risk. Conclusion: During the third and fourth waves of the pandemic, COVID-19 vaccination was associated with a 57% reduction in lethality among patients in four public hospitals in Venezuela. Key summary points: Less than half (48.6%) of the patients were vaccinated against SARS-CoV-2. At least one out of four patients died during the study period, mainly in the unvaccinated group. Advanced age was associated with a higher risk of death. Vaccination against COVID-19, high oxygen, and enoxaparin administration were factors associated with a lower risk of death. [ABSTRACT FROM AUTHOR]

Background: Dentigerous cysts (DCs) are among the most frequently odontogenic cysts in young and middle-aged individuals. Marsupialization and enucleation are the main treatment options in clinical practice. However, there are few reports on preserving molars severely involved by the cyst. Case presentation: A 35-year-old male patient with a large odontogenic cyst that was successfully treated using a multidisciplinary approach. The patient's chief complaint was discomfort during mastication in the lower left molar region for a month. Clinical examination revealed that teeth 36 and 37 were intact without pain upon percussion, while tooth 38 was unerupted. The radiology examination illustrated a typical well-defined oval radiolucent lesion surrounding the crown of unerupted tooth 38, extending to the distal root of tooth 37. The treatment was divided into two parts: removal of the cyst and the impacted third molar, followed by filling with collagen bone particles; and preserving the tooth 37 via hemisection, root canal treatment and crown restoration. Pathological examination indicated a dentigerous cyst. After 18 months of treatment, the bone defect completely recovered and tooth 37 functioned well following the hemisection. Conclusions: Hemisection effectively preserves the cyst-associated molars and maintains oral function. This article underscores the significance of collaboration among various departments in the treatment of odontogenic cysts, ultimately aiming to achieve minimally invasive and functional surgery. [ABSTRACT FROM AUTHOR]

Advanced clinical practitioners (ACPs) are experienced health professionals educated to master's level. They are accountable for the assessment, diagnosis and treatment of individuals, and are responsible for making complex decisions. The case study presented in this article critically analyses the consultation involving a male patient in his sixties with a 2-day history of abdominal pain, who was referred by his GP to a surgical assessment unit. Analysis was carried out using the Calgary-Cambridge Model. The article discusses history-taking, abdominal examination and differential diagnoses, and presents the process of how the trainee ACP arrived at the diagnosis of appendicitis. [ABSTRACT FROM AUTHOR]

Background: Controversy exists regarding the origin of femoral torsion, and specific treatment rules regarding the optimal position of femoral osteotomy in patients with recurrent patellar subluxation and excessive femoral torsion are scarce. Purpose: To establish a novel classification system for such patients, and to compare clinical and radiological outcomes after distal derotational femoral osteotomy (DDFO) between femoral torsion at proximal (neck and shaft) and distal levels. Methods: Between January 2014 and June 2019, patients who underwent DDFO were retrospectively reviewed. The segmental torsion analysis was performed to establish a novel classification system, and classify included patients into two groups: 35 patients in proximal torsion group and 38 patients in distal torsion group. These patients were followed-up for at least 3 years. Clinical evaluations included functional outcomes, physical examinations, quality of life, activity level, satisfaction, and complications. Radiological outcomes included patellofemoral osteoarthritis, congruence, and alignment. Results: Type I was defined as the proximal torsion. Type II was defined as the distal torsion. Proximal torsion group had lower postoperative femoral torsion (12.6 ± 2.6° vs. 14.8 ± 3.6°; P =.004) and higher surgical correction angle (21.6 ± 5.0° vs. 19.1 ± 3.0°; P =.009). All clinical and radiological outcomes improved significantly in both groups, but proximal torsion group had significantly higher quality of life (EQ-5D-5L: 0.96 ± 0.06 vs. 0.91 ± 0.07; P =.003. EQ-VAS: 92.0 ± 6.0 vs. 88.7 ± 5.8; P =.021) and Tegner activity score (5.2 ± 1.5 vs. 4.5 ± 1.4; P =.040), and fewer patellofemoral osteoarthritis (8.6% vs. 26.3%; P =.048). Two patients in the distal torsion group had subjective patellar instability. The percentage of patients with anterior knee pain was higher in the distal torsion group. Conclusion: A novel classification system for patients with recurrent patellar subluxation and excessive femoral torsion based on segmental femoral torsion analysis was established. DDFO was more appropriate for patients with proximal torsion, yielding higher surgical correction angle, and better clinical and radiological outcomes. Study design: Cohort study; Level of evidence, 3. [ABSTRACT FROM AUTHOR]

Diquat poisoning is a fatal condition that is becoming increasingly common. The mortality risk of patients taking lethal doses of diquat is extremely high. It typically leads to rapid dysfunction of multiple organs, including the kidneys, heart, lungs, and brain. Acute kidney injury is usually the first manifestation of this poisoning. However, the optimal treatment strategy for diquat poisoning remains uncertain. Additionally, the mechanism of multiple organ dysfunction syndrome caused by diquat poisoning may resemble the progression of sepsis. In this report, we present 3 cases of diquat poisoning, all of which resulted in death. We emphasize that acute kidney injury is the primary cause of death, and suggest that some strategies used in the treatment of sepsis could be beneficial in managing diquat poisoning-induced acute kidney injury. [ABSTRACT FROM AUTHOR]

Hypercalcemia can result from either hyperparathyroidism or non-parathyroid conditions. When hypercalcemia is accompanied by undetectable parathyroid hormone (PTH) levels, hyperparathyroidism is rarely considered the diagnosis. Herein, we report the case of a 65-year-old Caucasian woman referred to our hospital for further evaluation of hypercalcemia. Her symptoms included fatigue and brain fog, with undetectable PTH levels. A comprehensive workup, including a series of laboratory and imaging tests, excluded common non-parathyroid causes such as malignancy and familial hypocalciuric hypercalcemia. Ultrasound identified a likely enlarged parathyroid gland, which was further confirmed by a sestamibi scan. After 2 weeks of cinacalcet treatment, the patient's calcium levels decreased, indicating the parathyroid gland as the likely source of hypercalcemia. Parathyroidectomy was subsequently performed, revealing a 1927 mg adenoma. Postoperatively, the patient's calcium levels normalized, PTH levels became detectable within the normal range, and her symptoms resolved, with a marked improvement in energy. This case demonstrates that primary hyperparathyroidism can present with hypercalcemia and undetectable PTH. A genetic mutation in the PTH gene within the adenoma may explain the undetectable PTH levels preoperatively. Plain Language Summary: This case report discusses a 65-year-old woman who was found to have high calcium levels in her blood, a condition known as hypercalcemia. Typically, hypercalcemia can result from either a condition where the parathyroid glands produce too much parathyroid hormone (PTH) or from other non-parathyroid-related issues like cancer. However, when hypercalcemia occurs with undetectable levels of PTH, it is unusual for hyperparathyroidism to be the cause. In this patient's case, she experienced symptoms like fatigue and brain fog, but her initial tests showed undetectable PTH levels. Further tests ruled out other common causes of high calcium, such as cancer or a genetic condition called familial hypocalciuric hypercalcemia. An ultrasound and a special scan called a sestamibi scan revealed an enlarged parathyroid gland, suggesting the presence of a parathyroid adenoma, a non-cancerous tumor. To confirm this, the doctors gave the patient a medication called cinacalcet, which is known to lower calcium levels if the parathyroid glands are involved. After two weeks of treatment, her calcium levels dropped, indicating that the parathyroid gland was indeed the source of the problem. The patient underwent surgery to remove the adenoma, which weighed nearly two grams. Following the surgery, her calcium levels returned to normal, and her PTH levels became detectable again within the normal range. Her symptoms, including fatigue, improved significantly, and she reported feeling more energetic. This case is unusual because it demonstrates that primary hyperparathyroidism can still be the cause of hypercalcemia even when PTH levels are initially undetectable. The doctors suspect that a genetic mutation in the adenoma might explain why PTH levels were undetectable before surgery. This case emphasizes the importance of thorough clinical evaluation, even when initial test results are not typical. [ABSTRACT FROM AUTHOR]

Background: Bone metastases are common in patients with progressive cancer and often present in long bones, leading to adverse events such as pathologic fractures. In the acute care setting, physical therapists (PTs) may be the initial providers who identify symptoms associated with fracture risk and communicate concerns to help prevent such adverse events. Case description: A 39-year-old female patient with metastatic breast cancer was admitted to the hospital due to uncontrolled pain. She had a history of bone metastases to the left femur; however, no restrictions or precautions were noted during the initial PT examination. During this initial PT examination, she reported worsening hip pain with weight-bearing activities. Outcomes: With the PT's recognition of red flag symptoms, an MRI was completed, which revealed extensive metastatic disease in her left femur with concern for an imminent fracture; as a result, prophylactic fixation was performed. Her functional abilities improved after surgery and consistent therapeutic intervention, allowing her to achieve a level of independence sufficient to return home safely. Discussion and conclusion: This case demonstrates the successful identification of imminent fracture risk by a PT in a patient with metastatic breast cancer, as well as the therapeutic management that accompanied this process in the acute care setting. [ABSTRACT FROM AUTHOR]

The article describes the case of a 37-year-old woman at 35 weeks of gestation who presented to the clinic for evaluation due to decreased perceived fetal movements. Her ultrasonography revealed findings of slightly hyperechoic fetal ascites associated with hyperechogenic intestinal loops and without peritoneal calcifications. She underwent an emergency caesarean section due to decreased fetal movements and abnormal fetal tracing. The detection of fetal isolated ascites is discussed.

The article presents a case study of a 58-year-old woman with treatment-resistant hypertension (HTN) despite lifestyle adjustments and multiple medications. Topics discussed include the definition and prevalence of resistant HTN, distinguishing true resistance from pseudo-resistance, and strategies to improve medication adherence and blood pressure management.

Objective: Oxaliplatin is a platinum-group chemotherapeutic agent commonly used in the treatment of colorectal cancer. In addition to hematological and gastrointestinal side effects, laryngopharyngeal dysesthesia associated with cold is reported as a rare side effect. In this article, seven cases with pharyngolaryngeal dysesthesia were presented and the diagnosis and treatment planning were reviewed in the light of literature findings. Material and Methods: Patient records of cancer patients with laryngopharyngeal dysesthesia were retrospectively analyzed between 2020 and 2023. Demographic characteristics, presenting complaints, vital signs, physical examination, and laboratory tests of the patients diagnosed with laryngopharyngeal dysesthesia were recorded. Results: Seven patients who had gastrointestinal malignancy and oxaliplatin chemotherapy were diagnosed with laryngopharyngeal dysesthesia. The symptoms most commonly developed due to cold weather. The symptoms of three patients had developed while receiving treatment, while four patients were admitted to emergency service after oxaliplatin infusion. The physical examinations revealed no pathological findings of the allergic reaction at presentation or during follow-up skin. Patients were monitored and nasal oxygen therapy was administered. A 5 mg intravenous infusion was given for anxiety symptoms in three patients. Patients were discharged after 4 hours of follow-up with resolution of all symptoms Conclusion: Laryngopharyngeal dysesthesia should be kept in mind in patients treated with oxaliplatin and presenting with shortness of breath and a feeling of suffocation after cold exposure. [ABSTRACT FROM AUTHOR]

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a significant global health burden without established curative therapies. Early detection and preventive strategies are crucial for effective MASLD management. This study aimed to develop and validate machine-learning (ML) algorithms for accurate MASLD screening in a geographically diverse, large-scale population. Methods: Data from the prospective Fasa Cohort Study, initiated in rural Fars province, Iran (March 2014), were employed for this purpose. The required data were collected using blood tests, questionnaires, liver ultrasonography, and physical examinations. A two-step approach identified key predictors from over 100 variables: (1) statistical selection using mean decrease Gini in random forest and (2) incorporation of clinical expertise for alignment with known MASLD risk factors. The hold-out validation approach (with a 70/30 train/validation split) was utilized, along with 5-fold cross-validation on the validation set. Logistic regression, Naïve Bayes, support vector machine, and light gradient-boosting machine (LightGBM) algorithms were compared for model construction with the same input variables based on area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Results: A total of 6,180 adults (52.7% female) were included in the study, categorized into 4816 non-MASLD and 1364 MASLD cases with a mean age (± standard deviation [SD]) of 48.12 (± 9.61) and 49.47 (± 9.15) years, respectively. Logistic regression outperformed other ML algorithms, achieving an accuracy of 0.88 (95% confidence interval [CI]: 0.86-0.89) and an AUC of 0.92 (95% CI: 0.90-0.93). Among more than 100 variables, the key predictors included waist circumference, body mass index (BMI), hip circumference, wrist circumference, alanine aminotransferase levels, cholesterol, glucose, high-density lipoprotein, and blood pressure. Conclusion: Integration of ML in MASLD management holds significant promise, particularly in resource-limited rural settings. Additionally, the relative importance assigned to each predictor, particularly prominent contributors such as waist circumference and BMI, offers valuable insights into MASLD prevention, diagnosis, and treatment strategies. [ABSTRACT FROM AUTHOR]

Background: There is wide variation in premature mortality rates in adults with severe mental illness (SMI) across London, with Tower Hamlets (a highly deprived and ethnically diverse area) scoring the highest. Objective: To identify examples of best practice and co‐design recommendations for improving physical health checks and follow‐up care amongst people with SMI in Tower Hamlets. Methods: Data were collected through online questionnaires (using SMI physical health best practice checklists), one‐on‐one interviews (n = 7) and focus groups (n = 3) with general practices, secondary mental health services, commissioners and leads of community services and public health programmes, experts by experience and community, voluntary and social enterprise organisations in Tower Hamlets. Data were analysed using deductive and inductive thematic analysis. Results: Twenty‐two participants representing 15 general practices (out of 32), secondary mental health services, commissioners and public health leads completed the online questionnaires. Twenty‐one participants took part in interviews and focus groups. Examples of best practice included cleaning and validating the SMI register regularly by general practices, knowing the number of patients who had been offered and/or received physical health checks, having clear pathways to community and specialist care services, using various communication methods and having a key performance indicator (KPI) for tailored smoking cessation services for people with SMI. Recommendations included adopting evidence‐informed frameworks for risk stratification and utilising the wider primary care workforce with specific training to follow up on results, offer interventions and support navigating pathways and taking up follow‐up care. Incentivising schemes were needed to deliver additional physical health check components such as oral health, cancer screening, Covid‐19 vaccination and sexual health checks. Including KPIs in other community services' specifications with reference to SMI people was warranted. Further engagement with experts by experience and staff training were needed. Conclusion: The present initiative identified best practice examples and co‐designed recommendations for improving physical health checks and follow‐up care in deprived and ethnically diverse people with SMI. Patient or Public Contribution: This initiative was supported by three experts with experience, and two community organisations, who were involved in data curation and interpretation, development of recommendations and/or dissemination activities including writing this manuscript. [ABSTRACT FROM AUTHOR]

Comparing research performance across distinct subject domains is not recommended unless proper treatments are applied to normalize the domain‐specific characteristics. Except for limited research aimed at exploring the field‐dependent behaviours of specific research performance indicators, it is difficult to find comprehensive research examining both conventional and altmetric indicators for their influence on journals, articles, and authors in distinct subject domains. This research used Scopus and PlumX as sources to collect conventional and altmetric data, respectively. In addition to descriptive statistics, the Mann–Whitney U test, cluster plots, and correlation analysis were employed for data analysis. The results reveal that all three levels of indicators behave in notably different ways in Medicine compared with that of the Physical and Social Sciences. Most indicators in all three levels attain higher maximum and average values in Medicine. For instance, the maximum values for most indicators, except for citations and documents, are significantly higher in Medicine than in the Physical and Social Sciences. However, the citations and productivity of Physical Sciences journals surpass the two in other domains. SNIP deviates lightly across subject domains compared with that of other journal‐level indicators. Further, citations do not have a large influence on SNIP and SJR as they do Journal Impact Factor and CiteScore. All article‐level indicators show significant differences between Medicine and the Physical Sciences. Between the Physical and Social Sciences, all indicators except page count show significant differences. Further, article‐level indicators in the Social Sciences behave in nearly the same way as in the Physical Sciences. Citation counts positively influence captures. In addition, Medicine authors are likely to make more impact and be more productive in their field than authors in other fields. Collaboration was also found to improve both the productivity of authors and the impact of their research, irrespective of the domain they work in. These findings are important to authors, research evaluators, and publishers from different viewpoints. Discouraging performance comparisons based on raw indicator values can protect researchers from inaccurate assessments, enabling them to fully realize their potential for conducting cutting‐edge research. Finally, this research indicates different directions along which this area of research can be extended. [ABSTRACT FROM AUTHOR]

Background: Robotic retro-muscular mesh repair of parastomal hernia (PH) is possible with transversus abdominis release. The aim of this study is to report mid-term results with this method. Methods: Patients who underwent surgery for PH were enrolled in a prospective study. Patients with concomitant midline hernia also underwent Rives repair. Polypropylene meshes with an absorbable buffer mesh were used in the retro-muscular pocket—except PTFE was chosen for inflammatory bowel disease patients. Follow-up was by telephone and physical examination and CT if suspicion of complication. Results: Of the 56 included ostomy patients, 44 had colostomies, 10 had ileostomies, and two had urostomies. Thirty-nine percent had a concomitant hernia, and 25% had recurrent PH. The mean operating time without accessory repair was 156 min (SD 37), and with accessory repairs 220 min (SD 62). One bowel lesion and one vascular injury to the stoma occurred, prompting intraoperative stoma revision without postoperative morbidity. Postoperative complications ensued in 12 patients (23%). One patient had stoma necrosis after 3 weeks and the stoma was relocated. One patient had a mesh infection, 3 patients temporary ileus, one patient hypovolemic renal failure, and two patients experienced a flare-up of their Crohn's Disease. One parastomal abscess was drained percutaneously. The median postoperative stay was 3 days (1–21; mean 3.7 days), and the readmission rate was 8.9%. The recurrence rate at mean and median 24 months follow-up is 5.4%, two in ileostomy patients and one colostomy patient with unaltered bulging where CT shows a relatively large prolapse and recorded as a failure. Conclusion: Robotic Pauli repair has shown promising results. However, repair fails of PH at small bowel ostomies with short mesentery. ePauli/TAR is now the preliminary choice for eligible patients at our site. Comparative studies with the intraperitoneal mesh standard are needed. [ABSTRACT FROM AUTHOR]

Acute liver failure is rare in the neonatal and infant population; however, when encountered, it requires timely diagnosis, management, and identification of the underlying etiology to provide the best clinical outcomes. Here, we present a case of new-onset liver failure in a 4-month-old infant. She had previously been diagnosed with neonatal mucocutaneous herpes simplex virus disease, but had been healthy in the interval, and was referred to our hospital for evaluation of possible need for liver transplantation because of a rapidly progressing pace of disease. In this diagnostic dilemma article, we review the case history and presentation and consider the differential diagnosis from the points of view of the primary and consultative teams. We then follow the clinical evolution of disease, identify a final diagnosis, and explore the short- and long-term management and health implications of the diagnosis. This case should be of interest to primary care providers, intensivists who care for neonates or infants, and specialists who encounter liver failure in their clinical practice. [ABSTRACT FROM AUTHOR]

Background: With the rapid increase of chest computed tomography (CT) images, the workload faced by radiologists has increased dramatically. It is undeniable that the use of artificial intelligence (AI) image‐assisted diagnosis system in clinical treatment is a major trend in medical development. Therefore, in order to explore the value and diagnostic accuracy of the current AI system in clinical application, we aim to compare the detection and differentiation of benign and malignant pulmonary nodules between AI system and physicians, so as to provide a theoretical basis for clinical application. Methods: Our study encompassed a cohort of 23 336 patients who underwent chest low‐dose spiral CT screening for lung cancer at the Health Management Center of West China Hospital. We conducted a comparative analysis between AI‐assisted reading and manual interpretation, focusing on the detection and differentiation of benign and malignant pulmonary nodules. Results: The AI‐assisted reading exhibited a significantly higher screening positive rate and probability of diagnosing malignant pulmonary nodules compared with manual interpretation (p < 0.001). Moreover, AI scanning demonstrated a markedly superior detection rate of malignant pulmonary nodules compared with manual scanning (97.2% vs. 86.4%, p < 0.001). Additionally, the lung cancer detection rate was substantially higher in the AI reading group compared with the manual reading group (98.9% vs. 90.3%, p < 0.001). Conclusions: Our findings underscore the superior screening positive rate and lung cancer detection rate achieved through AI‐assisted reading compared with manual interpretation. Thus, AI exhibits considerable potential as an adjunctive tool in lung cancer screening within clinical practice settings. [ABSTRACT FROM AUTHOR]

Purpose: This case report describes a patient with a pelvic kidney associated with an aortoiliac aneurysm amenable to open repair. Methods: We chose the selective cold renal perfusion to preserve renal function. Results: Other techniques such as transient or permanent extra-anatomic bypass, extracorporeal circulation and proximal aortic double clamping are also described in this report. Conclusions: Choosing the renal perfusion technique depended on the anatomical evaluations of the kidney and the renal artery location during the preoperative period. [ABSTRACT FROM AUTHOR]

Aim: This cross‐sectional multicentre study aimed to determine the effect of interventions during vaginal birth for fear of childbirth. Methods: In this cross‐sectional and analytical study, 852 women who had a vaginal birth between 2019 and 2020 were enrolled. Data were collected using the Descriptive Questionnaire and Wijma Birth Expectation/Experience Scale Version B. Results: The mean total Wijma Birth Expectation/Experience Scale Version B score of the women was 97.00 ± 24.24, indicating severe and clinical levels of fear of childbirth. Moreover, 69.4% of the women had clinical, 18.6% had severe and 12% had moderate levels of fear of childbirth. During birth, women who had close supporters, who were allowed to move and who did not undergo amniotomy, enema, perineal shaving and electronic foetal monitoring had a low level of fear of childbirth. As the number of pregnant women in the labour room, frequency of vaginal examinations, duration of delivery/hour, severity of labour pain and negative perception of the approach of health professionals increased, the women's fear of childbirth increased. Fear of childbirth decreased as the frequency of antenatal follow‐ups, number of births and satisfaction levels of the women increased (p < 0.05). Low income perception, irregular prenatal follow‐up, severe labour pain and a long duration of labour were strong predictors of increased fear of childbirth. Increasing number of births, high birth satisfaction level and positive perception of the approach of health professionals were strong predictors of reduced fear of childbirth. Conclusions: The reduction of interventions in vaginal delivery and support from health care providers during delivery can be effective in reducing fear of childbirth. Summary statement: What is already known about this topic? Fear of childbirth (FOC) is a problem experienced by most women.Sociodemographic characteristics and past experiences can increase FOC.Birth interventions are common as the majority of births in Turkey take place in health institutions. What does this paper add? Women who have vaginal births appear to have severe and clinical levels of fear of childbirth. Multiparity, mobilization, high birth satisfaction and positive approaches by health care providers are strong predictors of reduced FOC.Enema, amniotomy and fundal pressure application, high‐intensity labour pain and a long duration of labour are strong predictors of increased FOC. The implications of this study: Many current routine interventions during childbirth should be avoided.The reduction of interventions in vaginal birth and support from health professionals during labour can be effective in reducing fear of childbirth and negative consequences related to FOC, as well as helping to achieve non‐invasive vaginal deliveries.It is recommended that hospitals be organized in line with the criteria of mother‐friendly hospitals, health professionals be trained and the environments in which women give birth be improved. [ABSTRACT FROM AUTHOR]

The article reviews the evaluation of pediatric syncope in the emergency department, emphasizing that while most cases are benign, there are critical, potentially life-threatening causes that must not be overlooked. Topics discussed include common causes like vasovagal syncope, the differential diagnosis of loss of consciousness, and the importance of identifying cardiac-related etiologies in children.

The article focuses on the use of point-of-care ultrasound (POCUS) for diagnosing a supracondylar humeral fracture in a 6-year-old girl with elbow pain after a fall. Topics include the child's initial presentation with limited elbow movement and tenderness, the role of POCUS in detecting fractures through the posterior fat pad sign and lipohemarthrosis, and confirmation of the diagnosis with radiographic imaging revealing a nondisplaced fracture.

The article focuses on a 5-month-old infant with a rapidly expanding rash and fever, initially misdiagnosed as cellulitis, but later identified as a potential spider bite. Topics include her clinical presentation and progression of symptoms, the initial treatment with antibiotics, and the findings of the blackish skin lesion with expanding erythema and subsequent evaluation in the emergency department.