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BackgroundThe first month of life is the most critical in a child’s heath because it is associated with the highest risk of adverse health outcomes. In Tanzania the risk of adverse health outcomes in preterm infants is five times higher compared to term infants.The objective of this study was to assess common adverse health outcomes and compare the risk of such outcomes between preterm and term infants, in Tanzania, within the first 28 days of life.MethodsThis was a case-control study involving preterm (cases) and term (controls) infants delivered at the Muhimbili National Hospital between August and October 2019 . About 222 pairs of cases and controls were reviewed for their medical records. Logistic regression was used to compare the risk of neonatal outcomes between the study groups. Statistical significance was achieved at P-value < 0.05 and 95% confidence interval.ResultsPreterm infants have an increased risk of mortality (OR = 7.2, 95% CI: 3.4-15.1), apnea (OR = 4.7, 95% CI: 3.4-15.1), respiratory distress syndrome (OR = 4.8, 95% CI: 3.2-7.3), necrotizing enterocolitis (OR = 5.5, 95% CI: 1.2-25.3), anemia (OR = 4.3 , 95% CI: 2.8-6.6), pneumonia (OR = 2.7, 95% CI: 1.6-4.6) and sepsis (OR = 2.6, 95% CI: 1.7-3.9) in the first month of life compared to term infants. No differences in the risk of intraventricular hemorrhage, bronchopulmonary dysplasia, patent ductus arteriosus and jaundice were observed between preterm and term infants. ConclusionThe findings of this study informs the Tanzanian health sector about the most common and high risk neonatal outcomes in preterm infants. Additionaly, for promoting neonates' health, the health sector needs to consider preventing and treating the most common and high risk adverse neonatal outcomes in preterm infants.

Purpose: To evaluate the long-term effects of uncomplicated traumatic hyphema on endothelial morphology, anterior segment structure, and corneal and lenticular densitometryMethods: In this retrospective comparative study, eyes with a history of uncomplicated traumatic hyphema were compared with the healthy contralateral unaffected eyes. The corneal endothelial cell properties were captured using specular microscopy. Anterior segment analysis, corneal densitometry (12-mm corneal diameter), and lens densitometry measurements were performed using the Pentacam imaging system.Results: Measurements were obtained at a mean follow-up of 49.5 ± 15.8 months after injury. The average endothelial cell density was significantly lower in the study group than in the control group (2,506.6 ± 294.0 cells/mm² vs. 2,665.7 ± 195.0 cells/mm², p = 0.020). There was no difference between the groups in respect of polymegathism and pleomorphism (p = 0.061 and p = 0.558, respectively). All the investigated corneal tomographic and angle parameters were similar in both groups (all p > 0.05). The corneal densitometry values in all concentric zones and layers showed no statistically significant difference between the groups (p > 0.05 for all). The lens zone 1 densitometry value was significantly higher in the study group than in the control group (9.6% ± 1.1% vs. 8.9% ± 1.2%, p = 0.031). No difference was observed in zone 2 and 3 (p = 0.170 and p = 0.322, respectively). The degree of hyphema was not correlated with endothelial cell and lenticular clarity loss (p = 0.087 and p = 0.294, respectively).Conclusions: Even if traumatic hyphema is not complicated, long-term outcomes indicate endothelial cell loss and increased lenticular density.

Diyetlerdeki karbonhidrat çeşitleri hakkında bilimsel tartışmalar devam etmektedir. Fruktoz, gıda ürünlerinde yaygın olarak kullanılmaktadır. Çalışmada, ratlarda düşük ve yüksek fruktoz solüsyonlarının lipogenik ve inflamatuar etkileri araştırılmıştır. Hayvanlar, 10 hafta süreyle fruktoz solüsyonları ile beslenmiştir. Gruplar: Con (Kontrol), F15 (Fruktoz %15), F30 (Fruktoz %30), F60 (Fruktoz %60) şeklinde olmuştur. F60 en hafif grupken, F30 en ağır grup olarak belirlenmiştir. Trigliserit seviyeleri tüm deneme gruplarında Con'dan önemli ölçüde daha yüksek olmuştur (P, The aim of this study was to investigate the lipogenic and inflammatory effects of low and high percentage fructose solutions in rats. Wistar albino rats were fed with fructose solutions for 10 weeks. The groups were as follows: Cont (Control), F15 (Fructose 15%), F30 (Fructose 30%), and F60 (Fructose 60%). Rats' body weights were measured weekly. Also, lipogenic and inflammatory gene expression levels, biochemical parameters, and histopathological changes in the liver were investigated. After 10 weeks, it was observed that the animals in the F60 were the heaviest, while the animals in the F30 were the lightest. In all experimental groups, triglycerides were significantly higher than those of controls (P

Background: Early childhood caries remains a public health challenge and many interventions to manage this disease have focused on prevention during early infancy. Promoting oral health during pregnancy may also improve the oral health of children, however, there is limited evidence in Australia. The Midwifery Initiated Oral Health-Dental Service (MIOH-DS) was developed to train midwives to promote maternal oral health and a large trial showed the program substantially improved the oral health status, knowledge and behaviours of pregnant women. This study evaluated the long-term effectiveness of the program (post trial) on maternal oral health knowledge, preventative dental behaviours, and early childhood caries in offspring.Methods: A prospective cohort study was conducted in three large metropolitan health services in Sydney, Australia. The study followed 204 women and their children three to four years after participating in the original MIOH-DS trial (intervention and control groups). The outcome measures included child dental decay (cariogenic bacteria), and a maternal oral health knowledge and behaviours questionnaire. Descriptive statistics were used to analyse the main outcomes and a regression model was constructed to explore predictors of dental decay among children.Results: There were no significant differences across the outcome measures between the MIOH-DS participants (mother/child) and control groups except for a small difference in maternal oral health knowledge. Most mothers across both groups demonstrated high oral health knowledge and positive oral health practices, and the regression model found that these outcomes provided a protective effect (low levels of bacteria and dental caries) among children. Some aspects of oral health remained poorly understood by mothers across both groups―the oral health impact of sugary foods and drinks, at-risk feeding practices, and the recommended age for first dental visits.Conclusions: The long-term impact of the program demonstrates the effectiveness of improving maternal oral health knowledge and preventative behaviours to reduce the risk of early childhood caries, although the specific effect of the MIOH-DS program was not found. Although oral health knowledge was high across participants the findings suggest the need for reinforced education around feeding, diet and dental visiting through postnatal early childhood services to show sustained improvements.

Purpose: The purpose of this study was to correlate fetal weight estimation by ultrasound and clinical methods with actual birth weight in KNH.Methodology: This is a prospective comparative study. The design was suitable because it enabled comparison of the predictive value, sensitivity and specificity in estimating fetal weight which is known after birth. Study area was KNH Obstetric wards. The study population was all pregnant women admitted to obstetric wards for elective caesarean delivery and study period was February -March 2016. Data was analysed using SPSS version 20. Categorical variables were presented as proportions in tables and graphs, bars or pie charts). Continuous variable were summarized as means or medians and presented in table form.Results: The findings show that the correlation between actual weight and Ultra Sound estimated weight was significant (r=0.65, p

BACKGROUND: CLOVES (congenital lipomatous overgrowth, vascular malformations, epidermal nevi, scoliosis/skeletal/spinal) syndrome is a rare and progressive genetic disorder resulting from somatic mosaicism in activating mutations in the phosphatidylinositol-4,5- bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) gene. PIK3CA is a cell growth master regulator where gain of function mutations give rise to abnormal activation of the PI3K-AKT- mammalian target of rapamycin (mTOR) pathway. Treatment with sirolimus, an mTOR inhibitor, may therefore be of benefit in patients with CLOVES syndrome. OBJECTIVE: Here we describe the efficacy and toxicity of sirolimus in a pediatric patient with progressive CLOVES syndrome. RESULTS: The child presented with a large and painful abdominal malformation, massive overgrowth of his feet, limb length discrepancy and genu valgum. There was dramatic clinical and radiographic improvement in the size and comfort of his abdominal mass within several months of initiating medical therapy. This, combined with orthopaedic care of his genu valgum, leg length discrepancy, and overgrowth of his feet, has allowed for significant functional gains. CONCLUSIONS: Multidisciplinary care is essential for comfort and functional gains in patients with CLOVES syndrome, particularly those with severe symptoms. Close monitoring while on sirolimus medical therapy combined with frequent reassessment of orthopedic needs can dramatically improve patient quality of life and outcomes.

The purpose of this systematic review is to evaluate for evidence of the association of acupuncture with relieving the symptoms of adenomyosis. We searched ten electronic databases and included randomized controlled trials (RCTs) in women with adenomyosis. The methodological quality was moderate evidence level by Cochrane risk-of-bias criteria. The results were analyzed by Review Manager 5.3 and expressed as standardized mean differences (SMD) or mean differences (MD). Eleven RCTs (942 subjects) were included in this meta-analysis. Analysis with no heterogeneity showed that acupuncture group obtained a significant better effect (95% CI, -0.48 to -0.10; I2 = 0%) on reducing the size of the uterus and was superior in the shrink of carbohydrate antigen 125 (CA125) level (95% CI, -1.13 to -0.44; I2 = 0%) than that in pharmacological medicine alone group. Moreover, acupuncturewas significantly associated with improving patients' dysmenorrheal symptoms after 3-month menstrual cycles treatment (95% CI, -1.25 to -0.13). The adverse events, especially the incidence of hot flashes, -1.25 to -0.13). The adverse events, especially the incidence of hot flashes, were less reported in acupuncture group compared to pharmacological medicine alone group (Odds Ratio, OR, 0.17; 95% CI, 0.08 to 0.35; I2 = 0%). Acupuncture therapy is a promising avenue for the development of alternatives to surgery and medicine in the treatment of adenomyosis. However, further rigorous trials are needed to confirm the claims of our results.

Background: Macrodactyly is a rare congenital disorder of overgrowth affecting the digits of the upper or lower extremity. Mostly, patients are surgically treated during childhood to reduce the digit or to stop growth. There are no standardized guidelines for the treatment and follow-up of macrodactyly. Consequently, follow-up may not be regularly scheduled into adulthood. Methods: A retrospective, descriptive analysis of patients with the long-term progression of macrodactyly who presented at our tertiary referral hospital between July 2018 and March 2020 was performed. All patients from our local macrodactyly database were screened for progression of macrodactyly since adulthood; this resulted in four patients. The aim of these case series is to highlight the clinical features and disease course at long-term follow-up. Results: All patients were surgically treated during childhood and showed progression of tissue overgrowth during adult life. All patients developed severe secondary degenerative bone changes in macrodactyly affected digits, such as ankyloses of joints, new bone formation, and bony spurs. Subsequently, tissue overgrowth and degenerative bone changes led to functional problems. Conclusion: Patients with macrodactyly may experience growth during adult life, which may progress to deforming changes. Consequently, patients should be informed about the possible growth, and the progressive growth should be monitored.

The aim of this study was to determine the short-term compliance with regular home monitoring of macular retinal sensitivity (RS) in intermediate age-related macular degeneration (iAMD). Home-based outcomes were compared with in-clinic outcomes determined using (1) the same tablet device under supervision, and (2) the Macular Integrity Assessment (MaIA) microperimeter.Single-center longitudinal compliance and reliability study.A total of 73 participants with iAMD were trained to perform macular field testing with the Melbourne Rapid Fields-macular (MRF-m) iPad application. Volunteers were asked to return 6 weekly tests from home, guided by audio instructions. We determined compliance with weekly testing and surveyed for factors that limited compliance. Test reliability (false positive, false negative) and RS were compared to in-clinic assays (MaIA). Data are given as mean ± SD or as median [quartile 1-3 range]. Group comparisons were achieved with bootstrap to define the 95% confidence limits.A total of 59 participants submitted 6 home examinations with a median intertest interval of 8.0 [7.0-17] days. Compliance with weekly testing (7 days ±24 hours) was 55%. The main barrier to compliance was information technology (IT) logistic reasons. Of 694 home examinations submitted, 96% were reliable (false-positive results25%). The mean RS returned by the tablet was significantly higher (+3.2 dB, P.05) compared to the MaIA.Home monitoring produces reliable results that differ from in-clinic tests because of test design. This should not affect self-monitoring once an at-home baseline is established, but these differences will affect comparisons with in-clinic outcomes. Reasonable compliance with weekly testing was achieved. Improved IT support might lead to better compliance.

Acute renal failure requiring dialysis after heart transplantation remains a significant clinical issue because of its increasing incidence. We aimed to investigate its time trends, clinical predictors, and long-term outcomes.Adult heart transplantation recipients registered in the United Network for Organ Sharing registry between 2009 and 2020 were identified. The patients were grouped according to the requirement for dialysis in the postoperative heart transplantation period. The independent risk predictors were identified, and the association between post-heart transplantation renal failure requiring dialysis and long-term mortality accounting for re-transplantation was investigated.A total of 28,170 patients were included in the study, of which 3,371 (12%) required dialysis immediately post-heart transplantation. The incidence increased from 7.9% to 13.9% during the study period. Longer ischemic time, serum creatinine at transplantation1.2 mg/dL, prior cardiac surgery, higher recipient body mass index, support of mechanical ventilation or extracorporeal membrane oxygenation, and history of congenital heart disease or restrictive/hypertrophic cardiomyopathy were its predictors (all p0.05). Patients on posttransplant dialysis had a higher risk of all-cause mortality (adjusted hazard ratio [aHR]: 5.2, 95% CI: 4.7-5.7, p0.001), 30 day mortality (aHR: 7.7, 95% CI: 6.3-9.6, p0.001) and 1 year mortality (aHR: 7.5, 95% CI: 6.6-8.6, p0.001). Post-transplant dialysis was associated with a risk of treated rejection at 1 year.Acute renal failure requiring dialysis after heart transplantation is associated with significantly worse 30 day and long-term mortalities, and thus, early identification of high-risk patients is crucial to prevent severe renal complications.

Objectives. The aim of this study was to compare the long-term oncologic outcomes of sentinel lymph node biopsy (SLNB) versus elective neck dissection (END) in clinically node-negative (cN0) tongue cancer.Methods. This was a retrospective cohort study of patients with cN0 tongue cancer from a single institution, including 91 patients in the SLNB group and 120 patients in the END group.Results. The overall recurrence rate showed no significant difference between the two groups. The regional control rate was also comparable between the two groups (P=0.490). The 5-year recurrence-free survival (RFS) was slightly better in the SLNB group than in the END group (P=0.427). The 5-year overall survival (OS) rate was 89.9% in the SLNB group versus 91.9% in the END group (P=0.737). In a propensity-matched subgroup analysis, the type of neck management did not affect RFS or OS.Conclusion. SLNB showed non-inferior oncologic outcomes compared to END in patients with cN0 tongue squamous cell carcinoma.

Background: Epidemiological data on anticoagulation for venous thromboembolism (VTE) in prostate cancer are sparse. We aimed to investigate associations between anticoagulation duration and risks of VTE recurrence after treatment cessation and major on-treatment bleeding in men with prostate cancer in Sweden. Methods: Using nationwide prostate cancer registry and prescribing data, we followed 1413 men with VTE and an outpatient anticoagulant prescription following prostate cancer diagnosis. Men were followed to identify cases of recurrent VTE, and hospitalized major bleeding. We calculated adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) to quantify the association between anticoagulation duration (reference ≤3 months) and recurrent VTE using Cox regression. We estimated 1-year cumulative incidences of major bleedings from anticoagulation initiation.Results: The outpatient anticoagulation prescribed was parenteral (64%), direct oral anticoagulant (31%), and vitamin K antagonist (20%). Median duration of anticoagulation was 7 months. Adjusted HRs (95% CI) for off-treatment recurrent pulmonary embolism (PE) were 0.32 (0.09–1.15) for >3–6 months’ duration, 0.21 (0.06–0.69) for >6–9 months and 0.16 (0.05–0.55) for >9 months; corresponding HRs for deep vein thrombosis (DVT) were 0.67 (0.27–1.66), 0.80 (0.31–2.07), and 1.19 (0.47–3.02). One-year cumulative incidences of intracranial, gastrointestinal and urogenital bleeding were 0.9%, 1.7%, 3.0% during treatment, and 1.2%, 0.9%, 1.6% after treatment cessation.Conclusion: The greatest benefit in reducing recurrent VTE risk was with >9 months anticoagulation for PE and >3–6 months for DVT. Risks of major bleeding were low not being substantially different to the risks after treatment cessation.

Background overview and rationale We co-developed a multi-component virtual care solution (TtLIVE) for the home mechanical ventilation (HMV) population using the aTouchAway™ platform (Aetonix). The TtLIVE intervention includes (1) virtual home visits; (2) customizable care plans; (3) clinical workflows that incorporate reminders, completion of symptom profiles, and tele-monitoring; and (4) digitally secure communication via messaging, audio, and video calls; (5) Resource library including print and audiovisual material. Objectives and brief methods Our primary objective is to evaluate the TtLIVE intervention compared to a usual care control group using an eight-center, pragmatic, parallel-group single-blind (outcome assessors) randomized controlled trial. Eligible patients are children and adults newly transitioning to HMV in Ontario, Canada. Our target sample size is 440 participants (220 each arm). Our co-primary outcomes are a number of emergency department (ED) visits in the 12 months after randomization and change in family caregiver (FC) reported Pearlin Mastery Scale score from baseline to 12 months. Secondary outcomes also measured in the 12 months post randomization include healthcare utilization measured using a hybrid Ambulatory Home Care Record (AHCR-hybrid), FC burden using the Zarit Burden Interview, and health-related quality of life using the EQ-5D. In addition, we will conduct a cost-utility analysis over a 1-year time horizon and measure process outcomes including healthcare provider time using the Care Coordination Measurement Tool. We will use qualitative interviews in a subset of study participants to understand acceptability, barriers, and facilitators to the TtLIVE intervention. We will administer the Family Experiences with Care Coordination (FECC) to interview participants. We will use Poisson regression for a number of ED visits at 12 months. We will use linear regression for the Pearlin Mastery scale score at 12 months. We will adjust for the baseline score to estimate the effect of the intervention on the primary outcomes. Analysis of secondary outcomes will employ regression, causal, and linear mixed modeling. Primary analysis will follow intention-to-treat principles. We have Research Ethics Board approval from SickKids, Children’s Hospital Eastern Ontario, McMaster Children’s Hospital, Children’s Hospital-London Health Sciences, Sunnybrook Hospital, London Health Sciences, West Park Healthcare Centre, and Ottawa Hospital. Discussion This pragmatic randomized controlled single-blind trial will determine the effectiveness and cost-effectiveness of the TtLIVE virtual care solution compared to usual care while providing important data on patient and family experience, as well as process measures such as healthcare provider time to deliver the intervention. Trial registration ClinicalTrials.gov NCT04180722. Registered on November 27, 2019.

Children born very preterm ( 32 weeks' gestation) are at greater risk of motor impairment and executive/attentional dysfunctions than term-born children; however, little is known about how functional tasks, including walking, may be affected by very preterm birth.How does the gait pattern of preschool-age children born 30 weeks compare with term-born controls under a variety of walking conditions?In this prospective cohort study, children born 30 weeks and at term were assessed at 4.5-5 years' corrected age, blinded to birth group. Four walking conditions were assessed using the GAITRite® system: preferred speed, cognitive dual-task, motor dual-task, and tandem walking. Gait variables analysed included speed, cadence, step length, step time, base of support (BOS), and single and double support time. Spatiotemporal variables were compared between groups using linear regression, adjusting for lower-limb length, corrected age at assessment, and number of trials.224 children (112 30 weeks and 112 term-born) were assessed. Gait variables of children born 30 weeks did not differ from their term-born peers when walking at their preferred speed, except for higher BOS variability (mean difference [MD] = 0.19 cm, 95% confidence interval [CI] 0.10, 0.27, p 0.001). Under the motor dual-task condition, children born 30 weeks walked faster (MD= 3.06 cm/s, 95% CI 0.14, 5.97, p = 0.040), with a longer step length (MD= 1.10 cm, 95%CI 0.19, 2.01, p = 0.018), and a wider BOS (MD= 0.37 cm, 95%CI 0.06, 0.67, p = 0.019). In cognitive dual-task and tandem conditions, children born 30 weeks walked with a wider BOS compared with term-born peers (MD= 0.43 cm, 95%CI 0.05, 0.81, p = 0.028; and MD= 0.30 cm, 95%CI 0.09, 0.51, p = 0.005, respectively).This research highlights the need to consider the walking performance of preschool-age children born 30 weeks under challenging conditions, such as dual-task or tandem walking, when assessing gait patterns and planning interventions.

Preoperative variables can predict short term left ventricular assist device (LVAD) survival, but predictors of extended survival remain insufficiently characterized.Patients undergoing LVAD implant (2012-2018) in the Intermacs registry were grouped according to time on support: short-term (1 year, n = 7,483), mid-term (MT, 1-3 years, n = 5,976) and long-term (LT, ≥3 years, n = 3,015). Landmarked hazard analyses (adjusted hazard ratio, HR) were performed to identify correlates of survival after 1 and 3 years of support.After surviving 1 year of support, additional LVAD survival was less likely in older (HR 1.15 per decade), Caucasian (HR 1.22) and unmarried (HR 1.16) patients (p0.05). After 3 years of support, only 3 preoperative characteristics (age, race, and history of bypass surgery, p0.05) correlated with extended survival. Postoperative events most negatively influenced achieving LT survival. In those alive at 1 year or 3 years, the occurrence of postoperative renal (creatinine HR MT = 1.09; LT HR = 1.10 per mg/dl) and hepatic dysfunction (AST HR MT = 1.29; LT HR = 1.34 per 100 IU), stroke (MT HR = 1.24; LT HR = 1.42), infection (MT HR = 1.13; LT HR = 1.10), and/or device malfunction (MT HR = 1.22; LT HR = 1.46) reduced extended survival (all p ≤ 0.03).Success with LVAD therapy hinges on achieving long term survival in more recipients. After 1 year, extended survival is heavily constrained by the occurrence of adverse events and postoperative end-organ dysfunction. The growth of destination therapy intent mandates that future LVAD studies be designed with follow up sufficient for capturing outcomes beyond 24 months.

Objective : To provide an overview of the literature on the mid-term outcomes of chimney EVAR (ChEVAR) for the treatment of juxtarenal abdominal aortic aneurysms (JAAA). Methods : Different electronic databases were searched for published articles up to January 2020. The eligibility criteria were studies describing mid- or long-term outcomes of chimney EVAR (mean follow-up at least 1 year) for treatment of JAAA, including more than 10 cases, published in English, and with full text available. The outcomes measure were overall survival rate, target vessel patency, and freedom from reintervention at 3 years. Quality of the included studies was analysed using the MINORS criteria. Pooled effect estimates were analysed using random-effect models and heterogeneity was tested using I2 statistics. Results : Thirteen articles met the inclusion criteria. The included studies described 1,019 patients. According to the quality assessment, methodological quality was moderate to poor. The pooled overall survival, freedom from reintervention, and target vessel patency at 3 year was 81.4 % (95%CI 73.8 to 87.9), 85.7% (95%CI 75.6 to 93.5), and 95.1% (95%CI 89.3 to 98.7) respectively. Conclusion : The results of this review show good to acceptable short and mid-term survival and good mid-term durability, which supports that ChEVAR as a suitable alternative in high-risk JAAA. However, proper patient selection for ChEVAR seems essential to attain good mid-term outcomes, and further large prospective and good quality studies are required to demonstrate its long-term results and enable conclusions on specific determinants for outcome.

This study investigated the effects of a ballistic training programme using an arm/shoulder specific strength device (ASSSD) on the upper body peak power (PP), muscle volume (MV) of the dominant arm and throwing velocity in junior handball players. Twenty-six players were randomly assigned to an experimental (EG = 15, age 17.6 ± 0.51 years) and control (CG = 11, age 17.36 ± 0.50 years) group. Over an 8-week in-season period, the EG performed a ballistic training programme (2 sessions/week) immediately before their normal team handball training. Both groups underwent tests on the ASSSD, which operates in consecutive accelerative and decelerative actions, for throwing characteristics determination. Peak power (PP), peak force (PF), peak velocity (PV), peak rate of power development (PRPD), muscle volume (MV), throwing velocity with runup, standing throw, and jump throw were also assessed before/after the training programme. The EG group showed significant post-training improvements in PP (52.50% - p0.001), PF (26.45% - p0.01) and PRPD (78.47% - p0.001) better than the CG (1.81, 0.67 and 1.64%, p0.05, respectively). There was also a post-training improvement in the velocity at PP (22.82% - p0.001) and PF (42.45% - p0.001) in the EG compared to the CG (4.18 and 8.53%, p0.05 respectively). There was a significant increase in acceleration at PP (51.50% - p0.01) and PF (69.67% - p0.001). MV increased (19.11% - p0.001) in the EG, with no significant change (3.34% - p = 0.84) in the CG. Finally, significant increases were obtained in the three throw types (3.1-6.21%, p0.05-0.001) in the EG compared to the CG. The additional ASSSD training protocol was able to improve muscle strength/volume and ball throwing velocity in junior handball players.

In this article, members of the American College of Radiology Committee on Drugs and Contrast Media propose a new term for symptoms reported after intravascular exposure to gadolinium-based contrast agents-Symptoms Associated with Gadolinium Exposure, or SAGE. This term is advocated in lieu of other proposed nomenclature that presumes a causal relationship that has not yet been scientifically verified. The purpose of this new term, SAGE, is to assist researchers and clinical providers in describing such symptoms without prematurely causally attributing them to a disease and to standardize reporting of these symptoms to allow for coherent interpretation of related studies.

Rationale Infants born prematurely have impaired capacity to deal with oxidative stress shortly after birth. Objectives We hypothesize that the relative impact of exposure to air pollution on lung function is higher in preterm than in term infants. Methods In the prospective BILD-birth-cohort of 254 preterm and 517 term infants, we investigated associations of particulate matter (PM10) and nitrogen dioxide with lung function at 44 weeks postconceptional age and exhaled markers of inflammation and oxidative stress response (fraction of exhaled nitric oxide (FeNO)) in an explorative hypothesis-driven study design. Multilevel mixed-effects models were used and adjusted for known confounders. Measurements and Main Results Significant associations of PM10 during the second trimester of pregnancy with lung function and FeNO were found in term and preterm infants. Importantly, we observed stronger positive associations in preterm infants (born 32 - 36 weeks), with an increase of [184.9 (79.1, 290.7) mL/min] minute ventilation per 10 ��g/m3 increase in PM10 than in term infants [75.3 (19.7, 130.8) mL/min] (pprematurity �� PM10 interaction = 0.04, after multiple comparison adjustment padj = 0.09). Associations of PM10 and FeNO differed between moderate to late preterm [3.4 (-0.1, 6.8) ppb] and term [-0.3 (-1.5, 0.9) ppb] infants, the interaction with prematurity was significant (pprematurity �� PM10 interaction = 0.006, padj = 0.036). Conclusion Preterm infants showed significant higher susceptibility even to low-to-moderate prenatal air pollution exposure than term infants, leading to increased impairment of postnatal lung function. FeNO results further elucidate differences in inflammatory/oxidative stress response comparing preterms to terms.

The growing number of COVID-19 cases puts pressure on healthcare services and public institutions worldwide. The pandemic has brought much uncertainty to the global economy and the situation in general. Forecasting methods and modeling techniques are important tools for governments to manage critical situations caused by pandemics, which have negative impact on public health. The main purpose of this study is to obtain short-term forecasts of disease epidemiology that could be useful for policymakers and public institutions to make necessary short-term decisions. To evaluate the effectiveness of the proposed attention-based method combining certain data mining algorithms and the classical ARIMA model for short-term forecasts, data on the spread of the COVID-19 virus in Lithuania is used, the forecasts of epidemic dynamics were examined, and the results were presented in the study. Nevertheless, the approach presented might be applied to any country and other pandemic situations. The COVID-19 outbreak started at different times in different countries, hence some countries have a longer history of the disease with more historical data than others. The paper proposes a novel approach to data registration and machine learning-based analysis using data from attention-based countries for forecast validation to predict trends of the spread of COVID-19 and assess risks. © 2021 Tech Science Press. All rights reserved.

Acute Kidney Injury (AKI) is a common problem in hospitalized patients and is associated with poor clinical outcome. We studied the incidence, severity, and short-term outcome of AKI amongst patients admitted to a general hospital in Hong Kong.

Purpose: The purpose of this study was to inform school-based services for children with acquired brain injury (ABI) by describing and analyzing functional student-outcome data from a state-wide, school-based, school re-entry consultation program, BrainSTEPS (Strategies Teaching Educators, Parents, and Students), in Pennsylvania. Method: A nonexperimental, retrospective analysis was conducted with data collected during a pilot follow-up survey for BrainSTEPS. Caregivers reported on 337 students with ABI participating in BrainSTEPS. Results: Most students post-ABI who were participating in BrainSTEPS were enrolled in regular education and reported no ongoing symptoms, as well as no parent perception of need for additional BrainSTEPS consultation during the time period of the follow-up survey. Current receipt of therapy was significantly associated with injury type, χ 2 (1, n = 329) = 16.72, p < .001. A multiple logistic regression was significant ( p < .001) in predicting the need for additional BrainSTEPS consultation. More severe injuries, educational placement postinjury of regular education with a 504 plan (compared to regular education), and current receipt of therapy significantly increased the odds of need for consultation. Conclusions: Due to the wide range of experiences of students in this sample, hospital-to-school transition services, educational supports and services, and long-term follow-up must be individualized for children with ABI. Speech-language pathologists are critical members of the school-based academic team for students with ABI to decrease long-term unmet needs.

Purpose: In this work, we have determined the long-term average speech spectra (LTASS) and dynamic ranges (DR) of 17 Indian languages. This work is important because LTASS and DR are language-dependent functions used to fit hearing aids, calculate the Speech Intelligibility Index, and recognize speech automatically. Currently, LTASS and DR functions for English are used to fit hearing aids in India. Our work may help improve the performance of hearing aids in the Indian context. Method: Speech samples from native talkers were used as stimuli in this study. Each speech sample was initially cleaned for extraneous sounds and excessively long pauses. Next, LTASS and DR functions for each language were calculated for different frequency bands. Similar analysis was also performed for English for reference purposes. Two-way analysis of variance was also conducted to understand the effects of important parameters on LTASS and DR. Finally, a one-sample t test was conducted to assess the significance of important statistical attributes of our data. Results: We showed that LTASS and DR for Indian languages are 5–10 dB and 11 dB less than those for English. These differences may be due to lesser use rate of high-frequency dominant phonemes and preponderance of vowel-ending words in Indian languages. We also showed that LTASS and DR do not differ significantly across Indian languages. Hence, we propose a common LTASS and DR for Indian languages. Conclusions: We showed that differences in LTASS and DR for Indian languages vis-à-vis English are large and significant. Such differences may be attributed to phonetic and linguistic characteristics of Indian languages.

Objective. To evaluate the clinical effects and survival prognosis of radical gastrectomy assisted by external vision in gastric cancer. Methods. A total of 60 hospitalized gastric cancer patients from June 2016 to December 2018 were selected and divided into the observation group and control group according to different surgical procedures. The control group was treated with traditional open radical gastrectomy, while the observation group was treated with radical gastrectomy assisted by an external vision microscope. Relevant surgical indicators, visual analogue scale (VAS), postoperative complications, and life quality assessment were analyzed and compared between the two groups. Results. The incision length and intraoperative blood loss in the observation group were smaller than those in the control group, and the difference was statistically significant ( P < 0.05 ); compared with the control group, the observation group had significantly shorter hospital stay, earlier postoperative first exhaust time, and lower gastric fluid volume at the 3rd day after surgery ( P < 0.05 ). The pain scores of the observation group at 1, 4, and 12 weeks after surgery were lower than those of the control group ( P < 0.05 ), and the difference was significant. The quality of life scores at the 1st week and 12th week after surgery showed that the dysphagia symptom scores of the observation group and the control group were significantly reduced but the two groups had significant differences in fatigue, physical function, pain score, postoperative pain, and overall quality of life. The observation group was significantly better than the control group ( P < 0.05 ). Follow-up studies showed no significant difference between mortality and cancer recurrence ( P > 0.05 ); the patients recovered well at postoperation, and the diet of the observation group was better than that of the control group ( P < 0.05 ); gastric reflux and knife pain were less than those of the control group ( P < 0.05 ). Conclusion. Radical gastrectomy assisted by external vision for gastric cancer yields clinical benefits for gastric cancer patients, which not only dramatically shortened the length of hospital stay but also effectively ameliorated the quality of life of patients, all indicating that external vision-assisted surgery was significantly better than traditional gastrectomy in improving the postoperative quality of life of gastric cancer patients in the absence of increasing the risk of adverse events.

To determine the association of anti-obesity medications (AOMs) with weight loss maintenance over 2 years.This is a retrospective observational cohort study of adults treated for obesity between 1 April 2014 and 1 April 2016 at a tertiary academic weight management center and who completed 2 years of follow-up. Main outcome measures were mean percent weight loss, percent of individuals who achieved clinically significant long-term weight loss (≥5% weight loss over 2 years), and long-term weight loss maintenance (achievement of ≥5% weight loss at 1 year and maintenance of the ≥5% reduction for the second year).Of the 1566 new patients, 421 completed 1- and 2-year follow-up appointments. Patients were mostly female and on average 51 years old; they weighed 100.1 kg and had a BMI of 35.8 kg/mLong-term weight loss maintenance was observed among adults with medically managed obesity who completed 2 years of follow-up.

PURPOSE This real-life cohort of patients describes the treatment patterns and compares the overall survival (OS) and hazard risk of utilization of multiple therapies. MATERIALS AND METHODS Electronic medical registries of patients with stage III non–small-cell lung cancer (NSCLC) regularly attended in 72 hospitals were included. Univariate and multivariate analyses were conducted to evaluate the primary patients' characteristics leading to better OS and cancer-specific survival. RESULTS A total of 3,363 patients with stage III NSCLC followed over 19 years were included in this study. The median age was 66.00 (58.00-72.00) years, 65% male, and 41.2% with squamous cell carcinoma followed by adenocarcinoma (34.6%) and undifferentiated carcinoma (13.1%) in clinical stage T3 (50.3%), T2 (29.3%), and T4 (12.3%). The median survival (in months) was 18.4 (95% CI, 16.9 to 19.5) in patients submitted to radiotherapy plus chemotherapy, 11.2 (95% CI, 10.5 to 12.1) to chemotherapy, 31.5 (95% CI, 25.9 to 37.7) to surgery plus chemotherapy, and 33.8 (95% CI, 28.3 to 47.8) to chemotherapy plus radiotherapy plus surgery. The median cancer-specific survival (in months) was 19.3 (95% CI, 17.9 to 20.9) in patients submitted to radiotherapy plus chemotherapy, 12.1 (95% CI, 11.1 to 12.9) to chemotherapy, 36.9 (95% CI, 29.6 to 43.2) to surgery plus chemotherapy, and 41.3 (95% CI, 32.1 to 61.3) to chemotherapy plus radiotherapy plus surgery. The patients treated with multiple chemotherapy plus radiotherapy followed by surgery had significantly better OS and lower mortality rates than those treated with other treatments (adjusted hazard ratio, 0.55; 95% CI, 0.45 to 0.66; P < .001). At the end of the study, 11.2% and 10.7% of the patients were living with and without cancer, respectively. CONCLUSION Our real-life 19-year cohort study has shown that only 30.3% of the total patients with stage III NSCLC have been submitted to standard chemotherapy and radiotherapy treatment. This may show a substantial difference between the recruited clinical trials' patients and the real-life patients' characteristics in daily routine treatment.

Background There is currently no existing consensus regarding timing of knee arthroplasty. This study aimed to develop a weighted scoring system from patient-reported outcome measures (PROMs) to guide timing of knee arthroplasty based on preoperative severity and long-term effectiveness. Methods Prospectively collected data of 766 total knee arthroplasties (TKAs) and 382 unicompartmental knee arthroplasties (UKAs) at a single institution were analyzed. PROMs were assessed preoperatively and at 10 years using the Knee Society Score (KSS), Oxford Knee Score (OKS), and Short Form-36 physical component score (SF-36 PCS). Receiver operating characteristic analysis identified thresholds where preoperative PROMs predicted 10-year clinically meaningful improvements (minimal clinically important difference [MCID]). Threshold weights were assigned to PROMs based on their ability to predict MCID in isolation or in combination. Results Poorer baseline PROMs predicted 10-year MCID attainments. The threshold of 49.5 points for the KSS, 30.5 points for the OKS, and 40.7 points for the SF-36 PCS and 55.5 points for the KSS, 33.5 points for the OKS, and 40.5 points for the SF-36 PCS was weighted 1 point for predicting MCID in 1 PROM for TKA and UKA, respectively. The threshold of 33.4 and 33.9 points for the SF-36 PCS was weighted 2 points for predicting MCID in 2 PROMs, whereas 29.3 and 31.3 points for the SF-36 PCS were weighted 3 points for predicting MCID in 3 PROMs for TKA and UKA, respectively. The sum of weighted components from 0 (lowest) to 5 (highest) represented likelihood for long-term benefits at 10 years. Conclusion This scoring system is a useful clinical adjunct for deciding timing of knee arthroplasty and prioritizing patients in institutions with long waitlists. Level of Evidence II.

Violent injury is known to be a chronic, recurrent issue, with high rates of recidivism in the 5 years following initial injury. Much of the strategy behind violence intervention programs, who are ...

We aimed (1) to estimate the short-term effect (postintervention period) of neurodynamic techniques on pain, symptom severity, functional status, electrophysiological status, grip strength, and pinch strength in people with carpal tunnel syndrome (CTS); and (2) to estimate the effect of neurodynamic techniques compared to other physical therapy modalities and surgical interventions.Intervention systematic review with meta-analysis.We searched the MEDLINE, Cochrane Database of Systematic Reviews, Web of Science, Physiotherapy Evidence Database, and Scopus databases from their inception to September 2020.We included randomized controlled trials reporting the effect of neurodynamic techniques on pain, symptom severity, function, distal motor latency, grip strength, and pinch strength in people with CTS.Using the DerSimonian-Laird method, we estimated pooled standardized mean differences (SMDs) and 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development and Evaluation approach to judge the certainty of the evidence of each pairwise comparison.There were 22 trials included (n = 1203 people with CTS; mean age, 26.0 to 57.9 years; mean symptom duration, 4.1 to 62.8 months). There was very low-certainty evidence of neurodynamic techniques improving pain (SMD, -0.54; 95% CI: -0.95, -0.13) and function (SMD, -0.35; 95% CI: -0.61, -0.09). There was no significant effect on symptom severity (very low certainty), distal motor latency (very low certainty), and grip and pinch strength (low certainty).Neurodynamic techniques were effective for improving pain and function in people with CTS, albeit with very low-certainty evidence.

Objective:Few studies have evaluated patients with spontaneous subarachnoid haemorrhage (sSAH) from an intensivist perspective. This study aimed to report the results of patients with sSAH in a high-volume centre monitored by a team experienced in the fields of brain surgery, interventional radiology and intensive care.Materials and Methods:Data of patients with sSAH followed up between January 2014 and July 2018 in the intensive care unit (ICU) were retrieved from ICU patient observation charts, file records and hospital automated information system.Results:This study enrolled 150 patients, of which 61 (40.7%) patients died despite receiving intensive care. Mortality rates between patients with (42.8%) and without (40%) vasospasm were comparable (p=0.917). Vasospasm developed in 37.8% of the 45 patients who underwent endovascular coiling and in 19.2% of those who underwent neurosurgical clipping (p=0.044). The median times that elapsed before endovascular or surgical procedures were 2.5 [interquartile range (IQR): 2-5] days in the surviving group and 2 (IQR: 1-5) days in the deceased group (p=0.164). Blood sodium and blood chloride levels were significantly higher in the deceased group from the third day onward. The median blood sodium level exceeded 142 mEq/L in the deceased group, but was lower than 142 mEq/L on the same day in the surviving group.Conclusion:The results of this study suggest that Glasgow coma scale (GCS) at admission to the ICU is one of the important factors that affect treatment success. GCS is an important independent factor in selecting the timing or type of treatment (surgical clipping/endovascular coiling) and medical treatments such as nimodipine in patients with sSAH requiring intensive care. In addition, the incidence of vasospasm was higher in patients who underwent endovascular coiling. Increased sodium and chloride values during follow-up are the only parameters significantly associated with mortality.

Urban noise is a common environmental exposure that may increase the burden of hypertension in communities, yet it is largely unstudied in the United States, and it has not been studied in relation to blood pressure (BP) control. We investigated associations of urban noise with BP levels and control in the United States. We used repeated BP and medication data from Chicago-based participants of the Chicago Health and Aging Project (≥65 years) and MESA (Multi-Ethnic Study of Atherosclerosis; ≥45 years). Using a spatial prediction model with project-specific measurements, we estimated noise at participant homes. We imputed BP levels for those on medication and used mixed-effects models to evaluate associations with noise. Logistic regression was used for uncontrolled and apparent treatment-resistant hypertension. Models were run separately by cohort and altogether, all with adjustment for age, sex, sociodemographic factors, and other plausible sources of confounding. We evaluated 16 462 BP measurements from 6764 participants (6073 Chicago Health and Aging Project and 691 MESA) over an average of 4 years. For both cohorts, we found that greater levels of noise were associated with higher BP levels and greater risk of apparent treatment-resistant hypertension. In our pooled models, 10-dBA higher residential noise levels corresponded to 1.2 (95% CI, 0.1–2.2) and 1.1 mm Hg greater (95% CI, 0.6–1.7) systolic and diastolic BPs as well as a 20% increased odds of apparent treatment-resistant hypertension (odds ratio per 10 dBA: 1.2 [95% CI, 1.0–1.4], P =0.04). Urban noise may increase BP levels and complicate hypertension treatment in the United States.

Didik Librianto,1 Ismail Hadisoebroto Dilogo,2 Achmad Fauzi Kamal,2 Ifran Saleh,2 Fachrisal Ipang,1 Dina Aprilya2 1Orthopedic Spine Surgeon, Fatmawati General Hospital, Jakarta, Indonesia; 2Department of Orthopedic and Traumatology, Faculty of Medicine Universitas Indonesia, Jakarta, IndonesiaCorrespondence: Dina AprilyaDepartment of Orthopedic and Traumatology, Faculty of Medicine Universitas Indonesia, Prof. Soelarto building, 1st floor, RS Fatmawati Street, Jakarta, 12430, IndonesiaTel +6289655106136Fax +6221-7660616Email dina.cia.aprilya@gmail.comBackground: Kyphosis in spondylitis tuberculosis (STb) is more than just a cosmetic issue. It has a potentially detrimental effect on both spine-associated structures and cardiopulmonary function. It can be corrected in any stage of STb; however, the corrective surgery is challenging, especially in the late case, in which the additional stiffness of the spine can come into consideration. To date, the cantilever technique is still a gold standard for sagittal plane deformity correction. However, no study to date has explored its effectiveness for thoracolumbar kyphotic deformity, especially that caused by spondylitis tuberculosis.Methods: This is a retrospective study of 16 consecutive cases of spondylitis tuberculosis with thoracolumbar kyphosis that underwent corrective surgery in our center in the period of 2020– 2021. We aim to evaluate the effectiveness of the cantilever technique that we use for kyphotic correction in thoracolumbar STb patients.Results: At the 3-months follow-up, the mean Cobb angle was 14.6°± 10.27°, with the mean gain of 20.90°± 12.00° and positively correlate with the thoracolumbar kyphosis (TLK) correction (68.69%, r = 0.654, p = 0.001). The mean thoracic kyphosis, lumbar lordosis, and sagittal vertebral axis were 30.6°± 13.08°, 39.4°± 16.02°, and 1.4± 4.09 cm, respectively, with sagittal Cobb difference of 12.70± 9.85.Conclusion: The kyphotic Cobb angle reduction by cantilever technique in the thoracolumbar area significantly improved the thoracolumbar kyphosis and realign the spinal sagittal axis. Thus, the cantilever technique remains the gold standard for sagittal plane deformity correction which can be applied for kyphotic deformity correction in thoracolumbar STb cases.Keywords: thoracolumbar spine, kyphotic deformity, spondylitis tuberculosis, deformity correction, cantilever technique

Introduction: Laparoscopic one-anastomosis gastric bypass (OAGB) is a bariatric surgery that can be used to treat obesity. It is considered a new procedure in the Gulf Region. The purpose of this s...

Background Ovarian cancer (OC) is a common malignancy in the gynecological tumor. Standard treatment for ovarian cancer is surgery and chemotherapy based on paclitaxel and platinum. However, traditional chemotherapy for ovarian cancer is limited by drug resistance and systemic side effects. It is imperative to explore effective treatment options for refractory ovarian cancer. Case Presentation A 52-year-old female initially presented with lower abdominal distension and migratory pain. After the laparoscopic exploration and biopsy, immunohistochemistry showed poorly differentiated adenocarcinoma originated from ovarian (cT3NxM1, stage IV, peritoneal and abdominal wall metastasis). The next generation sequence detected ERRFI1 (T187A, exon4) mutation. Results The patient received first-line chemotherapy (paclitaxel, nedaplatin plus avastin), followed by maintenance therapy with gefitinib, achieving a 15-month progression-free survival (PFS). After disease progression and second-line treatment failure, endostar plus apatinib was administered for 14 cycles and she obtained a PFS of 14 months without long-term adverse events. Conclusion We believe that the ERRFI1 gene may be a potential target of gefitinib. Importantly, endostar combined with apatinib is worth recommending for maintenance treatment in refractory ovarian cancer.

BACKGROUND AND OBJECTIVES Australian information on the physical health of general practice patients with a mental illness is limited. The aim of this study was to explore the physical health of patients with a severe and/or long-term mental illness (SMI). METHOD Analysis was performed of routinely collected data from patients visiting one of 452 general practice sites participating in the national MedicineInsight program during 2017-18. RESULTS Of the 173,861 participants, 9.1% had recorded SMI. Almost three-quarters had a record of the selected long-term physical health conditions, compared with half of patients without recorded SMI (adjusted odds ratio: 2.2, 95% confidence interval: 2.1, 2.3). Patients with SMI were also more likely to have a history of smoking or moderate-to-heavy drinking. DISCUSSION More patients with SMI had records of the investigated health conditions than those without SMI. They also had higher rates of modifiable risk factors. As patients with SMI are likely to visit their general practitioners often, this presents an opportunity for intervention that may improve patient outcomes.

Rationale: Chronically critically ill patients admitted to a long-term acute care hospital (LTACH) setting are a vulnerable population of intensive care unit (ICU) survivors. Little is known of the goals and functional outcomes achieved by patients after rehabilitation in the LTACH setting. Objectives: We sought to examine patient goals and functional outcomes, including swallowing function, among ICU survivors admitted to an LTACH with a tracheostomy. Methods: This was a prospective observational cohort study of chronic critically ill LTACH patients. Results: Fifty older subjects with a median duration of intubation before tracheostomy of 13 days were enrolled. ICU-acquired weakness and cognitive impairment were present in 40 (80%) and 36 (72%) patients, as measured by the Medical Research Council scale and Montreal Cognitive Assessment, respectively. Mental health problems were also common, with 16 (32%) patients experiencing moderate to severe anxiety, 9 (18%) experiencing moderate to severe depression, and 11 (22%) reporting symptoms consistent with post-traumatic stress disorder, according to the Hospital Anxiety and Depression Scale and Post-Traumatic Stress Syndrome 10-Questions Inventory, respectively. Pharyngeal dysfunction, as measured by Fiberoptic Endoscopic Evaluation of Swallow examination, was present in 37 (74%) patients. Patient goals, in decreasing order of frequency, included eating and drinking, speaking, walking, returning home, and toileting. By LTACH discharge, goal attainment was variable, with 97% of those who ranked speaking as important being able to speak and 88% of those who ranked eating and drinking as important being able to eat and drink but with only 21% being able to walk and only 18% being able to self-toilet. Discharge to the home or acute rehabilitation setting, achieved in 52% of the population, was associated with greater strength, as measured by the total Medical Research Council score (P = 0.002) as well as by the European 5-dimension, 5-level health-related quality of life instrument domains of mobility (P = 0.008) and self-care (P = 0.04). Conclusions: Goal attainment during this period of recovery was variable. The ability to speak, eat, and drink, frequently identified as goals by these patients, were achieved, whereas functional goals such as walking were rarely achieved. These findings highlight the importance of identifying patient goals and setting realistic expectations informed by functional assessments when rehabilitating this vulnerable patient population in the LTACH and subsequent post–acute care settings.

Objectives: This study explores the effects of the Active Plus intervention aiming to decrease loneliness among older adults (>65 years) with chronic diseases. Methods: A randomized controlled trial (RCT) was performed (N = 585; age: M = 74.5 years, SD = 6.4), assessing loneliness at baseline, 6 months and 12 months. Outcome measures in the multilevel linear regression analyses were total, social and emotional loneliness. Results: At 12 months, significant decreases in total ( B = −.37, p = .01) and social loneliness ( B = −.24, p = .02) were found. Age was a significant moderator for total and social loneliness; however, the intervention was effective only for participants aged 80 years and older. Discussion: The Active Plus intervention showed a significant decrease in total and social loneliness and was especially beneficial for the vulnerable age group of 80 years and older. A more comprehensive tool for measuring social activity and mobility impairments, and using a longer time frame to detect loneliness changes, may form interesting future research.

Background and Aim Following an index episode of acute pancreatitis, sometimes the inflammation subsides completely, but sometimes inflammation persists and progresses to chronic pancreatitis, which may be or may not be preceded by recurrent acute pancreatitis. Some patients may also develop diabetes mellitus. There is only limited information on the longer‐term outcome of patients with acute pancreatitis. The aim of this study was to evaluate the longer‐term consequences of acute pancreatitis in the form of the development of recurrent attacks of acute pancreatitis, chronic pancreatitis, diabetes, or pancreatic carcinoma. Methods The index study included 122 patients who presented with their first episode of acute pancreatitis. This retrospective, cross‐sectional survey was performed 5 years after the index episode. Results Of the 122 patients, 96 were available for follow‐up while 4 were known to have died (one from pancreatic cancer). On reassessment after 5 years, 28 of 96 patients had further episodes of pancreatitis. Fifteen patients were diagnosed as having recurrent acute pancreatitis, 13 patients were diagnosed as having chronic pancreatitis, while 17 developed new‐onset diabetes. Recurrent acute pancreatitis was more common in younger patients, while chronic pancreatitis was associated with alcohol abuse and a more severe index episode. The development of diabetes was more common with advanced age. Conclusions In this study, a good proportion of patients progressed to chronic pancreatitis and diabetes within 5 years after surviving acute pancreatitis., Cross‐sectional review was done after 5 years of follow‐up of acute pancreatitis. Out of 100 patients, 15% patients developed recurrent acute pancreatitis, 13% patients developed chronic pancreatitis, and 17% patients developed diabetes.