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Introduction: Acute leukemias (ALs) are aggressive diseases that lead to death without medical attention. We evaluated the association between delays in diagnosis and poor outcomes in AL by evaluating the symptom onset to treatment intervals in adults with newly diagnosed AL and their effect on an early death (ED). Methods: We assessed adults diagnosed with AL between 2015 and 2020 and evaluated baseline characteristics, the patient interval (PI), diagnostic interval (DI), treatment interval (TI) and the total time interval (TTI) to determine ED-associated factors. Main results: We assessed 102 patients with acute lymphoblastic leukemia (ALL), 57 with acute myeloblastic leukemia (AML) and 29 with acute promyelocytic leukemia (APL). Median interval days were PI 14, DI 10, TI 4 and TTI 31.5. The TI and TTI intervals were lower in APL than in ALL and AML; TI 1 vs. 4 and 3 (p = 0.001) and TTI 21 vs. 31 and 35 (p = 0.016). The 30-day and 60-day EDs were 13.8% and 20.7%, mainly infections. ECOG > 2 (OR = 15.0) and PI < 7 days (OR = 4.06) were associated with 30-day ED; AML (OR = 2.69), high-risk (OR = 3.34), albumin < 3.5 g/dl (OR = 5) and platelets < 20 × 103/uL (OR = 2.71) with a 60-day ED. Conclusion: None of the interval-delays were associated with an ED. Intervals seemed to be longer in patients without an ED, except for the TI, probably because of “the waiting time paradox.” Aggressive manifestations of disease may lead to shorter diagnostic intervals, but increased mortality.

The Polysplenia Syndrome (PSS) is a form of heterotaxy, a rare congenital anomaly with an estimated incidence of 1 in 250,000 live births, first described by Helwig in 1929. Most patients with polysplenia syndrome die during the neonatal period due to severe associated cardiac and biliary anomalies. Nevertheless, some individuals present with moderate cardiovascular malformations or abdominal anomalies, often discovered incidentally in adulthood. PSS is categorized under ambiguous situs syndromes or heterotaxy, also known as left or bilateral isomerism. However, it remains a complex and controversial entity, lacking specific pathognomonic features but exhibiting a broad spectrum of anomalies. We report the case of a 29-year-old woman admitted for acute chest pain, associated with lightheadedness and syncope. Clinical examination revealed tachycardia and tachypnea. A thoraco-abdominal CT angiography identified 3 splenules, auricular and bronchopulmonary isomerism, along with cardiovascular and digestive anomalies, suggestive of polysplenia syndrome. Symptomatic treatment was initiated, with a favorable clinical outcome and no need for specific therapeutic intervention.

Objective: Midaortic syndrome is a rare clinical condition that has been mainly studied in juveniles through case reports and series. This study aims to report the anatomic characteristics and long-term outcomes of 41 adult patients with midaortic syndrome who received open surgical treatment or endovascular treatment over a 14-year period. Methods: A consecutive cohort of 41 adult patients diagnosed with midaortic syndrome at our center between January 2008 and November 2021 were enrolled in the study. Patients’ baseline and anatomic characteristics were collected and analyzed. Primary follow-up outcomes included death and reintervention. Other follow-up outcomes included hypertension and complications. Results: The study enrolled 41 adult patients with midaortic syndrome with a mean age of 37.5 ± 13.4 years. Twenty-five patients received open surgical treatment, and 16 patients received endovascular treatment. Isolated infrarenal lesions were more likely to be found in the endovascular treatment group (P = .005), whereas patients with multiple (P = .002) or intravisceral involvement (P = .001) were more likely to be found in the open surgical treatment group. The open surgical treatment group was more likely to have a lower postoperative peak systolic pressure gradient (P = .020). The 5- and 10-year reintervention-free survivals were 87.7% and 71.7% in the open surgical treatment group and 92.3% and 79.1% in the endovascular treatment group, respectively. Conclusions: Both open surgical treatment and endovascular treatment showed satisfactory long-term efficacy outcomes for adult patients with midaortic syndrome. Given the patients’ relatively young age and long life expectancy, strict and regular lifelong follow-up is necessary.

Objectives: As part of a group randomized trial of a school-based intervention promoting gardening and healthy eating, health behaviors of adult family members were evaluated. The COVID-19 pandemic hit the Navajo Nation in March 2020 and the ongoing Yéego! collaborative study allowed description of adult response to COVID as an ancillary objective. Methods: Six elementary schools on the Navajo Nation in Arizona or New Mexico had been randomized to intervention or comparison group. One adult family member for each 3rd and 4th grade student completed surveys at baseline, nine-month and 21-month follow-up. Adult outcomes were fruit and vegetable (F&V) intake, obesogenic dietary index and gardening frequency. COVID-related measures were collected at 21-month follow-up. Differential changes and interactions were examined using repeated measures linear mixed models. Results: Adult F&V intake increased significantly more in the intervention group than in the comparison group at nine months by 2.26 servings/day (95% CI: 0.45, 4.06). No other changes were associated with the intervention at nine or 21 months. At 21 months, in the subgroup with COVID concerns, the differential change in F&V intake was 2.02 (95% CI: 0.21, 3.84) servings/day. In cross-sectional analyses, only healthy eating measures varied by levels of COVID concerns, stress and resilience. Conclusions: The child focused school-based intervention had some impact on adult family members, particularly their F&V intake, suggesting the reach of the intervention extended to students’ families. The impact on adult F&V intake persisted among those reporting COVID concerns. Findings have important implications for augmenting healthy eating interventions.

Objective: To investigate the frequency of various weight loss strategies among adults in the United States and to explore which weight-loss strategies are associated with several demographic factors. Methods: The study utilized 2017–2020 data from the National Health and Nutrition Examination Survey. Adult participants (N = 3,130) who had tried to lose weight during the past year were included. Pregnant women and individuals under age 20y were excluded. Weight-loss strategies were categorized into 6 groups: consuming more healthy options (e.g., more fruits); consuming less un-healthy options (e.g., junk food); quality of diet changes (e.g., changed eating habits); assisted weight-loss method (e.g., special diet); exercising; and un-healthy strategies (e.g., vomiting). Adjusted odds ratios (aORs) and 95%CIs were calculated using weighted logistic regression models. Results: The most frequently employed strategies to achieve weight loss were exercising (60.6%), consuming less un-healthy options (60.4%), and drinking a lot of water (55.3%). Un-healthy strategies were less prevalent among older individuals (aOR:0.46 [95% CI:0.37–0.58]) and those with higher incomes (aOR:0.69 [95% CI:0.54–0.89]). Conversely, individuals with obesity class I (aOR:1.85 [95% CI:1.38–2.48]) and obesity class II/III (aOR:1.69 [95% CI:1.27–2.25) showed an increased likelihood of adopting unhealthy strategies. Similarly, widowed individuals (aOR:1.31 [95% CI:1.03–1.66]) and those who have never been married (aOR:1.36 [95% CI:1.09–1.69]) exhibited a higher tendency for such behaviors compared to married individuals. Conclusion: The likelihood of using various weight-loss methods differs based on demographic characteristics. Recognizing these tendencies can guide public health initiatives and customized strategies for weight control.

Objectives: As permanent telehealth policies are considered in the United States (U.S.), it is important to understand who uses telehealth most often following the pandemic. We described patients who used a national virtual care practice frequently, identified how they differed from patients who used it less often, and characterized the types of care frequent telehealth patients utilized. Methods: We used video visit data for commercially-insured patients, aged 18+, from a national virtual integrated medical and behavioral health practice in 2022 in the U.S. Patients were categorized into three groups: one visit (’minimal use’), two to four visits (’some use’), and five or more visits (’frequent use’). We compared patient and geographic characteristics between the three groups and estimated an ordinary least squares linear regression to identify predictors of ‘frequent’ use relative to ‘minimal’ or ‘some’ use. Results: The probability of being a frequent user declined with age (−0.4 percentage points (p.p.) per year; 95 % CI, −0.4 – −0.3), was higher for females (5.4 p.p.; 95 % CI, 4.1 – 6.7) and patients with greater clinical complexity (7.9 p.p. for highest relative to lowest quartile risk score; 95 % CI, 5.9 – 10.0), and lower for patients in the Northeast (−9.2 p.p.; 95 % CI, −15.5 – −2.9) or West (−3.2 p.p.; 95 % CI, −5.7 – −0.7) regions relative to the Southern region of the U.S. The five most common diagnoses were mental health conditions. Conclusions: Our results highlight the need for comprehensive telehealth policy that enables access, particularly for patients who rely on it as their primary source of care.

Embryonal rhabdomyosarcoma of the prostate in adults is rare and often diagnosed at an advanced stage, with metastases. We report the case of a 23-year-old young adult presenting with low back pain and dysuria, whose imaging revealed a voluminous metastatic prostate mass. Biopsy confirmed embryonal rhabdomyosarcoma. Treatment was initiated with chemotherapy, resulting in significant regression of the tumour mass and metastases after 3 courses. Pediatric advances suggest improved survival with a multimodal approach, but its efficacy in adults requires further investigation.

Chronic health conditions such as cancer, diabetes, and heart disease are highly prevalent in the older adult population. Engaging in health behaviors can help prevent the onset of or better manage these conditions. To better understand how to increase older adult engagement in health behaviors, this rapid evidence review evaluated the relationship between health literacy and health behaviors in adults over the age of 65. The databases utilized for this review were PubMed (Medline), EBSCO (APA PsycInfo, Academic Search, and CINAHL Plus.) All six studies included demonstrated significant and positive associations between adequate health literacy and certain health behaviors including pap-smears, mammograms, physical activity, dietary variety, participation in medical checkups, patient participation in health care, hand hygiene practices, and diabetes self-management behaviors. Adequate health literacy was, however, associated with alcohol consumption in two studies. Knowing this, health professionals can utilize health literacy screening and interventions to promote health behaviors in older adults.

Background: Adults with food-protein-induced enterocolitis syndrome (FPIES) often develop severe abdominal symptoms after eating seafood. However, no investigation of a food elimination strategy for adult FPIES patients has been performed to date. Methods: We conducted a retrospective cohort study of seafood–avoidant adults by telephone interview, based on the diagnostic criteria for adult FPIES reported by González et al. We compared the clinical profiles, abdominal symptoms, and causative seafoods between FPIES and immediate-type food allergy (IgE-mediated FA) patients. We also profiled the detailed intake-status of seafoods in adult FPIES patients. Results: Twenty-two (18.8 %) of 117 adults with seafood-allergy were diagnosed with FPIES. Compared with the IgE-mediated FA patients, FPIES patients had an older age of onset, more pre-existing gastrointestinal and atopic diseases, more episodes, longer latency and duration of symptoms, more nausea, abdominal distention, and severe abdominal pain, and more frequent vomiting and diarrhea. In particular, abdominal distention—reflecting intestinal edema and luminal fluid retention—may be the most distinctive characteristic symptom in adult FPIES (p

The COVID-19 pandemic has exacerbated the significance of burn injuries as a critical public health challenge, demanding the exploration of effective strategies for prevention and care, particularly for individuals with burns. This retrospective observational cohort study aimed to analyze the characteristics of adult burn patients admitted to three reference centers in Iran from October 2020 to October 2023. The study focused on patients and burn wound characteristics, complications and morbidities, and treatment plans. Among the 382 patients aged 20 to 84, our findings suggested that being male decreased the likelihood of COVID-19 infection by about 77 %. Thermal burns accounted for 50.2 % of COVID-19-positive patients and 49.8 % of COVID-19-negative patients. Notably, the risk of COVID-19 infection increased with higher degrees of burn (p = 0.006) in both groups. Among the complications, pneumonia (p = 0.003) and paralytic ileus (p = 0.015) were significantly more common in COVID-19-positive patients. Additionally, COVID-19-positive patients underwent more frequent interventions such as skin grafting (p = 0.035) and surgical debridement (p = 0.030). These findings emphasize the importance of a carefully planned and proactive multidisciplinary management strategy to ensure optimal care for burn patients.

COVID-19 commonly presents respiratory symptoms that can linger after the acute phase. Asthma onset or exacerbations have been documented after viral infections although rarely in adults.We report a case of adult-onset asthma triggered by mildly symptomatic COVID-19 in a 24-year-old female without previous respiratory issues.Fatigue, exercise dyspnea, and intermittent cough persisting a month after the infection, led to spirometry testing, revealing reduced lung function, with normal CT imaging. Budesonide/formoterol therapy improved symptom control and repeated spirometry testing showed improving but reduced lung function after five months. Methacholine testing was thus conducted and confirmed bronchial hyperreactivity and adult-onset asthma.Clinicians should be attentive to persistent respiratory symptoms and suggest appropriate testing. Further research should focus on underlying mechanisms of this phenomenon.

Purpose: To determine the distribution and characteristics of peripheral refraction in adults with myopia using the novel multispectral refraction topography. Method: A total of 187 adults with myopia were recruited for this study. This study was conducted in two stages. Part I: participants were divided into 6 groups based on the central refraction of the right eyes, Part II: according to the interocular differences in refractive error (IOD) of the central refraction, we divided the participants into isomyopia group (IOD

Objectives: The present study evaluates the clinical outcomes of children, adolescents and adults with Ewing sarcoma and identifies the prognostic factors. Methods: Included in the study were 222 pediatric and adult patients diagnosed with Ewing sarcoma (EwS) who were followed up between 1992 and 2019, and whose data were analyzed retrospectively. Results: The median age of 131 male and 91 female patients included in the study was 13 (1–64). The median follow-up duration of the survivors was 79 months (range, 11–182 months). The 3-year EFS rate of the 222 patients was 34 % (Confidence Interval (CI) (0.158–0.242 %) and the OS rate was 54 % (CI, 0.289–0.590 %). For the non-metastatic patients, the 3-year EFS rate was 47 % and the OS was 68 %, while for the metastatic patients the 3-year EFS rate was 13 % and the OS was 30 %. Of the patient sample, 81 (36, 5 %) survived, of whom 72 were continuously free of disease while the disease persisted in nine, and three developed a secondary neoplasm (2 of whom subsequently died while one survived disease-free). Of the 129 patients who relapsed with metastases and/or local recurrence, eight survived and are disease-free, nine are alive with uncontrolled disease; five were lost to follow-up and 107 died. Conclusion: The findings of the present study suggest metastatic disease at presentation and positive margins after surgery to be of prognostic significance in EwS. Disruptions in aggressive local treatments may reduce the chances of cure in EwS.

Rationale & Objective: Atypical hemolytic uremic syndrome (aHUS) is a rare form of thrombotic microangiopathy (TMA) caused by complement dysregulation. Ravulizumab is a C5i approved for the treatment of aHUS. This analysis assessed long-term outcomes of ravulizumab in adults and pediatric patients with aHUS. Study Design: This analysis reports 2-year data from 2 phase 3, single-arm studies. Setting & Participants: One study included C5i-naïve adults (NCT02949128), and the other included 2 cohorts of pediatric patients (C5i-naïve and those who switched to ravulizumab from eculizumab [pediatric switch patients]; NCT03131219). Exposure: Patients received intravenous ravulizumab every 4-8 weeks, with the dose depending on body weight. Outcomes: The primary endpoint in the studies of C5i-naïve patients was complete TMA response, which consisted of platelet count normalization, lactate dehydrogenase normalization, and ≥25% improvement in serum creatinine concentrations from baseline, at 2 consecutive assessments ≥4 weeks apart. Analytical Approach: All analyses used descriptive statistics. No formal statistical comparisons were performed. Results: In total, 86 and 92 patients were included in efficacy and safety analyses, respectively. Complete TMA response rates over 2 years were 61% and 90% in C5i-naïve adults and pediatric patients, respectively. The median increase in estimated glomerular filtration rate from baseline was maintained over 2 years in C5i-naïve adults (35 mL/min/1.73 m2) and pediatric patients (82.5 mL/min/1.73 m2). Most adverse events and serious adverse events occurred during the first 26 weeks. No meningococcal infections were reported. Improvement in the Functional Assessment of Chronic Illness Therapy – Fatigue score achieved by 26 weeks was maintained over 2 years. Limitations: Limitations were the small sample of pediatric switch patients and limited availability of genetic data. Conclusions: Long-term treatment with ravulizumab is well tolerated and associated with improved hematologic and renal parameters and quality of life in adults and pediatric patients with aHUS. Plain-Language Summary: This research tested a drug called ravulizumab for the treatment of atypical hemolytic uremic syndrome (aHUS). aHUS is a rare disease that causes clots in tiny blood vessels. This can damage the kidneys and other organs. We analyzed data from 2 clinical trials in which children and adults with aHUS received ravulizumab through a tube placed in a vein (intravenous line). They received ravulizumab every 4-8 weeks depending on their weight. We found that treating patients for 2 years with ravulizumab was associated with improved blood health, kidney function, and quality of life and was well tolerated. These results support ravulizumab as a long-term treatment for people with aHUS.

Objectives: (1) To determine the prevalence of malnutrition risk in hospitalized patients at the end of life (EOL), (2) to evaluate which nutritional interventions are administered in hospitalized end-of-life patients with malnutrition risk and (3) to assess the association of end-of-life care and the administration of medical nutrition therapy in patients with malnutrition risk. Design: Cross-sectional multi-center study Setting: Hospital Participants: Hospitalized adult patients Measurements: Based on the valid and reliable questionnaire of the Nursing Quality Measurement 2.0 (LPZ), the parameters of demographic data, medical diagnoses, end-of-life phase, care dependency, malnutrition risk according to the Malnutrition Universal Screening Tool (MUST) and nutritional interventions conducted in patients at risk of malnutrition were assessed. Descriptive statistics and statistical tests were conducted. Logistic regression models were established to identify odds ratios (OR) and confidence intervals (CI) for the association of end-of-life care and the provision of medical nutrition therapy. This was done separately for oral nutritional supplements (ONS), enteral nutrition and parenteral nutrition as the respective dependent variables. Results: Of all 12,947 participants, 706 (5.5%) were in an end-of-life phase. The prevalence of malnutrition risk in end-of-life patients was 41.1% compared to 24.7% in other patients (p < 0.001). End-of-life patients with malnutrition risk received more nutritional interventions than other patients with malnutrition risk. The regression models showed that being at the end of life (CI 1.30, 2.63; p < 0.001), being treated by a dietitian (OR 6.02; CI 4.86, 7.45; p < 0.001), suffering from dementia (OR 1.85; CI 1.10, 3.12; p = 0.02) or cancer (OR 1.56; CI 1.25, 1.96; p < 0.001) increased the chance of receiving oral nutritional supplements. For receiving parenteral nutrition, being at the end of life (OR 1.68; CI 1.04, 2.71; p = 0.04), being treated by a dietitian (OR 5.80; CI 4.07, 8.25; p < 0.001), surgery within the previous two weeks (OR 1.58; CI 1.09, 2.30; p = 0.02), younger age (OR 0.99; CI 0.98, 1.00; p = 0.04), care dependency (OR 0.97; CI 0.96, 0.98; p < 0.001), suffering from a disease of the digestive system (OR 2.92; CI 2.07, 4.11; p < 0.001) or cancer (OR 2.44; CI 1.71, 3.49; p < 0.001) were independent predictors. Being at the end of life did not influence the application of enteral nutrition. Conclusion: This study showed that nutritional interventions are often applied in end-of-life patients admitted to general hospitals. Being at the end of life was positively associated with the application of oral nutritional supplementation and parenteral nutrition. This data does not allow a conclusion about the appropriateness of using medical nutrition therapy in this study sample. Judging the appropriateness of medical nutrition therapy at the end of life is challenging because of the high variability of prognostication as well as the wishes and needs of the specific patients and their relatives that influences the appraisal of adequate interventions. Every decision about nutrition and hydration in end-of-life patients should be a shared decision and be based on advanced care planning principles.

Background: Cystic fibrosis (CF) is an autosomal recessive hereditary disease causes concentration of secretions and this affects the lungs and digestive system. These patients are exposed to zinc (zn) deficiency. In this review, we decided to investigate the status of zn in CF patients compared to control group. Also, the clinical trials that have so far performed zinc supplementation in these patients are examined. Method: ISI Web of Science, Scopus, PubMed/Medline, and Cochrane database were searched, up to December 2023, for studies that reported the association between zn levels of CF patients compared to a healthy control group. A random-effect model was used to compute the pooled weighted mean difference (WMD) with 95 % confidence intervals (CI). Subgroup analysis was done for region, sample and method of measurement, zinc supplementation and age. Result: Overall, meta-analysis of 9 studies (n = 383 participants) revealed that the zn levels were significantly lower in children and adolescents with CF compared with healthy subjects (WMD = −11.97 μg/dL, 95 % CI: −22.57 to −1.37; I2 = 92.83 %). Meta-analysis of 8 studies (n = 320 participants) revealed that the serum and plasma level of zn was significantly lower in CF patients compared with healthy subjects (WMD = −14.31 μg/dL, 95 % CI: −25.09 to −3.53; I2 = 88.14 %, P-heterogeneity

Bile acid homeostasis is critical to human health. Low-level exposure to antibiotics has been suggested to potentially disrupt bile acid homeostasis by affecting gut microbiota, but relevant data are still lacking in humans, especially for the level below human safety threshold. We conducted a cross-sectional study in 4247 Chinese adults by measuring 34 parent antibiotics and their metabolites from six common categories (i.e., tetracyclines, qinolones, macrolides, sulfonamides, phenicols, and lincosamides) and ten representative bile acids in fasting morning urine using liquid chromatography coupled to mass spectrometry. Daily exposure dose of antibiotics was estimated from urinary concentrations of parent antibiotics and their metabolites. Urinary bile acids and their ratios were used to reflect bile acid homeostasis. The estimated daily exposure doses (EDED) of five antibiotic categories with a high detection frequency (i.e., tetracyclines, qinolones, macrolides, sulfonamides, and phenicols) were significantly associated with urinary concentrations of bile acids and decreased bile acid ratios in all adults and the subset of 3898 adults with a cumulative ratio of antibiotic EDED to human safety threshold of less than one. Compared to a negative detection of antibiotics, the lowest EDED quartiles of five antibiotic categories and four individual antibiotics with a high detection frequency (i.e., ciprofloxacin, ofloxacin, trimethoprim, and florfenicol) in the adults with a positive detection of antibiotics had a decrease of bile acid ratio between 6.6% and 76.6%. Except for macrolides (1.2×102 ng/kg/day), the medians of the lowest EDED quartile of antibiotic categories and individual antibiotics ranged from 0.32 ng/kg/day to 10 ng/kg/day, which were well below human safety thresholds. These results suggested that low-level antibiotic exposure could disrupt bile acid homeostasis in adults and existing human safety thresholds may be inadequate in safeguarding against the potential adverse health effects of low-level exposure to antibiotics.

Background: General practitioners play a pivotal role in the diagnosis attention-deficit/hyperactivity disorder (ADHD) in adults. This systematic review aims to determine the effectivity and feasibility of screening tools for ADHD in adults in primary care. Method: A literature search was performed in PubMed, Cochrane Library, Ovid, ERIC, PsycInfo, PSYNDEX and Embase in November 2022. Sensitivity and specificity were considered as primary outcomes. Further psychometric properties, feasibility in general practice as well as digital practicability were evaluated as secondary outcomes. Risk of bias was assessed via QUADAS-2/C. A narrative data synthesis and meta-analysis was performed (PROSPERO: CRD42022374597). Results: A total of fifty-eight studies were included in data analysis. These studies referred to eighty-four various screening tools. ASRS-6 (DSM-V), WURS-25, CAARS-s:sV and TRAQ10 are suitable instruments for screening of ADHD in adults in primary care. The highest test accuracy was shown by ASRS 6 (DSM-V) (Sensitivity=0.83 [0.67–0.92], Specificity=0.87 [0.93–0.8], AUC=0.92, I2=8.6–12.3 %). Limitations: Included studies used rating scales as reference standard. Some studies compared study groups to control groups with an unknown ADHD status and there is a large degree of heterogeneity between the populations. Some studies referred to the best-balanced results of sensitivity and specificity under a certain cut-off, that has not been determined before. Conclusion: Feasibility studies are needed to provide more evidence for WURS-25 and CAARS-s:sV. The determination of sufficient cut-offs is important, to improve the identification of ADHD in adults by general physicians.

Importance: The effectiveness of different combinations of inhaled corticosteroid (ICS) therapies in reducing severe exacerbations of adult asthma remains unclear. Objective: This network meta-analysis (NMA) extensively evaluated the treatment effects of single ICS; dual ICS i.e., ICS/long-acting β2-adrenergic agonists (LABA); ICS/LABA as single maintenance and reliever therapy (SMART); and triple ICS, i.e., ICS/LABA/long-acting muscarinic antagonists (LAMA) in preventing severe asthma exacerbations. Data sources: A systematic search of English databases, including PubMed and Web of Science, was conducted until December 31, 2022, using PRISMA-NMA. Study selection: Using the PICOS criteria, the questions for this study were carefully selected so that the correct keywords could be identified. Data extraction and synthesis: A pairwise meta-analysis was used to select trials based on the criteria for minimizing heterogeneity (I2). Subsequently, the “BUGSnet” package of R software was used to perform a Bayesian network meta-analysis. Main outcome measures: The main outcome measures were risk rate and annualized rate ratio of severe asthma exacerbations. Results: This review included 56 randomized control trials (RCTs; n = 78,171 patients). As the pairwise meta-analysis demonstrated that the annualized rate ratio of severe asthma exacerbation had moderate heterogeneity, we analyzed the risk rate of severe asthma exacerbation using a network meta-analysis. In terms of direct/indirect comparisons with non-ICS, single ICS, dual ICS, SMART, and triple ICS reduced severe asthma exacerbations by 34 %, 47 %, 58 %, and 57 %, respectively. SMART and triple ICS showed high effectiveness in reducing severe exacerbations. Conclusion: AND RELEVANCE: SMART and triple ICS were ranked higher in effectiveness in reducing severe asthma exacerbations in comparison with other therapies, indicating that these are the most effective treatments for reducing the future risk of severe asthma exacerbations.

Introduction: Encysted intrapelvic hematoma is rare [2]. The etiological diagnosis is often difficult but guided by computed tomography and magnetic resonance imaging (MRI) and confirmed by histopathological examination. Case report: A 40-year-old man was admitted for a painless iliac fossa with mass evolving for 6 months. In his medical history, he had an exploratory laparotomy following a road accident 20 years ago. Radiological investigation shows a process centered on the lysed left iliac bone, multi-loculated in favor of encysted hematoma. Histopathology confirmed the diagnosis. The treatment was a simple resection and drainage of the mass. No local recurrence was noted, after 24 months of follow-up. Conclusion: Before an unexplained polycystic mass, the diagnosis of encysted hematoma should be considered, especially in any patient presenting pain next to a mass with risk factors as an old trauma. Currently there is no consensus in the treatment, but surgery still has a place in the management, also making it possible to eliminate other pathologies, namely tumors.

Background: There is evidence that the worldwide need for safe blood is not being met, particularly in poor nations like Bangladesh, where there is a scarcity of voluntary blood donors. This research intends to evaluate the public's knowledge, attitude, and practice of voluntary blood donation and the socio-demographic factors associated with blood donation in Khulna city, Bangladesh. Materials and methods: 720 interviews were taken using a structural questionnaire with Khulna city residents implementing the convenience sampling technique. After pre-processing and removing missing values, 697 records were left for further analysis. To investigate the association of sociodemographic factors such as age, gender, education, occupation, marital status, permanent address, and smoking status with knowledge, attitude, and practice of blood donation, the binary logistic regression model was used. Results: According to this research, 478 (68.58%), 654 (93.83%), and 451 (64.71%) respondents were knowledgeable, had a favorable attitude, and practiced VBD, respectively. The study level higher secondary (AOR = 2.2; CI: 1.16–4.18), honors or degree (AOR = 2.37; CI: 1.3–4.3), and masters or above (AOR = 3.27; CI: 1.69–6.35) were associated with the knowledge. The favorable attitude was connected with being male (AOR = 2.24; CI: 1.23–4.06), learning about VBD through online social media (AOR = 2.61; CI: 1.13–6.05), and having knowledge of VBD (AOR = 3.05; CI: 1.82–5.12). Age between 26 and 35 years (AOR = 2.83; CI: 1.43–5.57) and older than 45 years (AOR = 3.74; CI: 1.34–10.4), being a man (AOR = 3.6; CI: 2.25–5.78), being a smoker (AOR = 1.87; CI: 1.17–2.98), knowing about VBD (AOR = 2.31; CI: 1.55–3.42), and having a positive attitude (AOR = 3.78; CI: 2.11–6.77) were significant factors for practicing blood donation. Conclusion: This research demonstrates poor blood donation practices and limited knowledge of blood donation among Khulna city residents. The awareness of the residents should be prolonged for voluntary blood donation by the health bureau, the government, and non-governmental organizations.

Background: Retroclival hematomas and clival fractures are not common, and retroclival hematoma is one of the types of posterior fossa extra-axial hematomas. The exact incidence is not known. They can be categorized into epidural or subdural hematomas based on their relationship to the tectorial membrane. In the literature, most cases occur in the pediatric population, and a few cases have been reported in the adult population as well. The etiology is related to accidental trauma in most cases. Others occur generally spontaneously due to coagulopathy, pituitary apoplexy, and ruptured aneurysms. Still, some remain idiopathic without an identifiable cause. Case presentation: This is a 28-year-old male patient who presented after sustaining a motor vehicle accident. He was a pedestrian walking by the side of a road when he was suddenly hit by a minibus. He lost consciousness immediately and was non-communicating after the trauma with right ear bleeding. GCS is 9/15, right pupil has cataract, and left pupil is midsized and reactive. A brain CT scan demonstrated retroclival hematoma extending from midclivus to the lower level of C2, right mastoid fracture, multiple post-traumatic subarachnoid hemorrhage, pneumocephalus, and transverse upper third clival fracture. This patient's GCS on the second day improved to 14/15. All cranial nerves are intact. Discharged on the 7th day with GCS 15/15. Conclusion: Retroclival hematomas and clival fractures are very rare in adults, most often reported in pediatric age groups, and mostly occur due to accidental trauma. Associated cranial nerve palsy is common and the management is non-surgical in most of the cases.

Intussusception occurs when a part of the intestine enters another segment of the intestine causing bowel obstruction. It is common in children but not in adults with only

Background: Patient-reported outcomes measurement information system (PROMIS) measures can be used to measure patient-reported outcomes. PROMIS measures, including computer adaptive tests (CATs) and short forms, have demonstrated the ability to adequately assess outcomes in patients with hemophilia. It is, however, unclear if PROMIS measures are suitable for patients with von Willebrand disease (VWD), inherited platelet function disorders (IPFDs), and rare bleeding disorders (RBDs). Objectives: To evaluate the feasibility, measurement properties, and relevance of PROMIS measures in adults with VWD, IPFDs, and RBDs. Methods: In this cross-sectional multicenter study, adults with VWD, IPFDs, and RBDs completed 9 PROMIS measures and the Short Form-36 version 2 (SF-36v2) electronically. Feasibility was determined by the number of completed items and floor/ceiling effects. Measurement properties included construct validity based on a multitrait–multimethod analysis and reliability using the reliability coefficient and greatest lower bound. Relevance was evaluated based on comparison with the Dutch general population. Results: In total, 111 patients (median age, 57 years [IQR, 44-67]; 60% VWD, 16% IPFD, 24% RBD) participated. Mean number of items answered varied from 5.3 to 8.7 (range, 4-12) per PROMIS CAT in patients with VWD. Construct validity was supported for all CATs and all instruments had a good reliability (≥0.70). The PROMIS measures had less ceiling effects than the SF-36v2. Conclusion: The PROMIS measures are a feasible, valid, and reliable alternative for the SF-36v2 in patients with primarily nonsevere forms of VWD. The relevance of the selected measures was limited. Additional research is necessary to evaluate the PROMIS measures in adults with IPFDs and RBDs.

Background: The FTO gene polymorphisms rs9939609 have been linked to obesity. It’s essential to note that genetic variations exist between different populations. This study aims to assess the correlation between FTO gene polymorphisms rs9939609 and the risk of obesity in adult populations from both Western and Asian countries. Methods: This research employed meta-analysis, conducting a comprehensive search across articles available in ProQuest, EBSCO, and PubMed from January 2013 to January 2024. Pooled Odds Ratio (POR) with 95 % CI were computed based on the collected data. Review Manager (RevMan) 5.4.1 and Stata 16.0 were employed for data analysis. Results: In Western compared to Asian countries, the FTO rs9939609 variant was found to be significantly associated with obesity in various genetic models: dominant (POR = 1.45 vs 1.45), recessive (POR = 1.33 vs 1.51), co-dominant (first model, POR = 1.56 vs 1.70; second model, POR = 1.30 vs 1.37), and allelic (POR = 1.61 vs 1.56) models. Moreover, in Western countries, the FTO rs9939609 variant’s association with obesity was homogeneous in the recessive and first co-dominant genetic models. In Asian countries, the association between FTO rs9939609 and obesity was homogeneous in the dominant, recessive, and co-dominant genetic models (I2

Background: The sex-differential prevalence of attention-deficit/hyperactivity disorder (ADHD) varies across the lifespan, but little is known about sex differences in executive functions in adults with ADHD. Methods: We assessed 261 adults, aged 18–40 years, diagnosed with ADHD (170 males [assigned at birth], aged 25.81 ± 5.49; 91 females, aged 27.76 ± 5.42) and 308 neurotypical adults (176 males, aged 24.62 ± 5.14; 132 female, aged 25.37 ± 5.42) via psychiatric interviews to confirm ADHD and other psychiatric diagnoses. They were assessed by the Cambridge Neuropsychological Testing Automated Battery (CANTAB) on Reaction Time (arousal/processing speed), Rapid Visual Information Processing (sustained attention), Spatial Span (spatial memory), Spatial Working Memory, Intradimentional/Extradimensional Shift (set-shifting), and Stocking of Cambridge (spatial planning). The primary analyses were adjusted for age, full-scale IQ, and co-occurring psychiatric conditions. Results: Adults with ADHD had various co-occurring psychiatric conditions without sex differences in ADHD-neurotypical differences. Both adult males and females with ADHD performed poorer in all CANTAB tasks than same-sex neurotypical adults. Significant sex-moderating effects were observed in neuropsychological performance, including greater ADHD-neurotypical differences in arousal for females than males and in location memory for spatial tasks in males than females. Conclusion: There were no sex-moderating effects in the presence of co-occurring psychiatric conditions in adult ADHD. However, there were sex-moderating effects on how ADHD related to neuropsychological functioning in adulthood. ADHD was associated with more challenges in arousal/processing speed in females and more challenges in strategy use or inhibition in spatial memory in males.

Streptococcus pneumoniae is the leading cause of bacterial pneumonia, bacteremia, and meningitis. Indonesia introduced the pneumococcal conjugate vaccine (PCV) nationwide in 2022. In this study, we present whole genome sequence (WGS) data of 94 S. pneumoniae isolates that were obtained from hospitalized patients, healthy children, and adult groups from different regions prior to PCV program in Indonesia. DNA sequences of S. pneumoniae were obtained using the TruSeq Nano DNA kit (Illumina NovaSeq6000 Platform). The genome data of S. pneumoniae features a 1,969,562 bp to 2,741,371 bp circular chromosome with 39–40% G+Ccontent. The genome includes 1935–3319 coding sequences (CDS), 2 to 5 rRNA genes, 43 to 49 tRNA genes, and 56 to 71 ncRNA. These data will be useful for analyzing the serotype, sequence type, virulence genes, antimicrobial resistance genes, and the impact of pneumococcal vaccination in Indonesia. The FASTQ raw files of these sequences are available under BioProject accession number PRJNA995903 and Sequence Read Archive accession numbers SRR25316461-SRR25316554.

Autoimmune enterocolopathy (AIE) is an immune-mediated disease effecting the gastrointestinal tract that has been increasingly recognized in adults. Prior reports of adult-onset AIE, as well as published diagnostic criteria, emphasize the histopathologic findings in the small bowel to support the diagnosis. However, AIE is known to be a pan-enteric disease, and the initial histologic findings could be first encountered at non-small bowel sites. Here, we report a case of adult-onset AIE, where the initial histologic findings of AIE manifested in the colon as marked loss of goblet cells and prominent basal apoptoses. We review the differential diagnostic considerations, and discuss the subsequent clinical workup needed to evaluate for AIE if it is suspected on a colon biopsy. Additionally, a literature review was performed to determine the histopathologic characteristics of adult-onset AIE in the colon. Overall, the present case report, as well as findings from the literature review, suggest that AIE should enter the differential diagnosis in an adult patient with diarrhea when loss of goblet cells and prominent basal apoptoses are observed in a patient’s colon biopsy, especially when alternative etiologies are not supported by appropriate clinical context.

Aim:: To present the body of evidence behind the International Continence Society (ICS) educational module on “Practice of uroflowmetry in adults” which consists of a PowerPoint® presentation. Methods:: This evidence review has been prepared by a working group instituted by the ICS Urodynamics Committee. The method used included systematic literature review, consensus formation by the members of the Working Group, and review by members of the ICS Urodynamics Committee core panel. Results:: A total of 104 articles were included in this systematic review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Evidence analysis was conducted along the following themes: physiology of voiding, pathophysiology of lower urinary tract dysfunction, technique of uroflowmetry, quality check of the uroflowmetry test, interpretation and reporting of uroflowmetry findings. Conclusions:: Uroflowmetry is the most commonly utilized diagnostic test in the evaluation of adults presenting with lower urinary tract symptoms. The practice of uroflowmetry exhibits variations which might lead to inconclusive or inaccurate assessments. The ICS educational module on the Practice of Uroflowmetry in Adults provides up-to-date and evidence-based guidance in an effort to establish standards in the technique, interpretation, and reporting of uroflowmetry.

Schizencephaly, a rare congenital cerebral deformity that affects the cerebral mantle and is caused by both hereditary and acquired factors, is defined by a cleft that spans the entire cerebral hemisphere from the lateral ventricle to the cerebral cortex. Adult symptoms have only been described in a few cases in the literature. Hemiparesis, developmental delays, or seizures are manifestations of the clinical presentation, which is dependent on the size and location of the lesion. Neuroimaging investigations, particularly MRI, enable the diagnosis and rule out other causes. Usually discovered at birth, this entity begins to show up in the first several years. To prevent receiving the wrong treatment, the ailment must be correctly diagnosed. We report the observation of a 43-year-old patient with partial epileptic seizures but with an asymptomatic childhood, in relation to unilateral closed cleft schizencephaly associated with gray matter heterotopia. In this case, we highlight the importance of neuroimaging, in particular MRI on the diagnosis of this entity and to identify the associated anomalies.

Objectives: A noticeable increase in HIV-positive cases among women, particularly those of middle and old age, has been observed worldwide. This study aimed to describe women’s perceived HIV risk, HIV/Acquired Immunodeficiency Syndrome (AIDS) knowledge, attitude, and sexual behaviors to determine factors associated with condom use among these women in Hunan, China. Methods: A cross-sectional study was conducted from July 2019 to August 2020 among 958 women aged 40 and older in four regions of Hunan, China. We collected data on sociodemographic characteristics, perceived HIV risk, HIV/AIDS knowledge and attitude, condom use, and sexual behaviors. Univariate and multivariate logistic regression were performed to identify factors related to condom use. Results: Out of 958 participants, 60.6% perceived no risk of HIV infection, and 46.8% reported they had never used a condom during their past sexual life. Those who were older, had lower monthly household income for family, had not received HIV education in the past year, were unwilling to use condoms, could not determine condom use during sexual activity, and had more negative attitudes towards HIV/AIDS and HIV-positive people were less likely to use condoms in their past sexual behaviors. Conclusions: In Hunan Province, most women aged 40 and older perceived themselves as having a low or no risk of HIV infection; their rate of condom use was low, and six factors were associated with condom use. It is imperative to strengthen HIV prevention and control programs among women aged 40 and above, particularly focusing on those who may use condoms infrequently or not at all.

Background: Food allergies are becoming more prevalent globally. The purpose of this study was to investigate the epidemiology of food allergies in Taiwan. Methods: In 2017, a food allergy questionnaire was administered to 6–7-year-old children, 13–14-year-old adolescents, and their parents in Taipei. The results were compared to those from a previous survey conducted in 2004. Results: A total of 16,200 questionnaires were completed, revealing a rise in the prevalence of food allergies from 7.7% to 10.4% in the pediatric group and from 6.4% to 12.5% in the adult group. Peanut allergies also increased to 1.1%. Shrimp and crabs were the most common allergens, with urticaria being the most common symptom. Shortness of breath or wheezing occurred in 10% of individuals, while 2.1% experienced syncope or shock, and 0.1% were admitted to an intensive care unit. Personal history of allergic rhinitis and atopic dermatitis, as well as family histories of food allergies, were risk factors for food allergy in 6–7-year-old children. In the 13–14-year-old group, personal history of asthma, allergic rhinitis, or atopic dermatitis, recent use of acetaminophen, and living with dogs were risk factors. Females, personal histories of asthma, allergic rhinitis, atopic dermatitis, and moist and damp at home were risk factors in adults. Breastfeeding was a protective factor in 6–7-year-old children. Conclusion: The increasing prevalence of food allergies, including peanut allergies, in Taiwan warrants attention from physicians to provide appropriate care and education to patients with food allergies. The protective effect of breastfeeding against food allergies shall be emphasized.

Ureteroscopy is increasingly being used for urolithiasis. Technological innovations have been accompanied by wide variations in practice patterns. At the same time, a common finding in many studies, especially systematic reviews, is that the heterogeneity of outcome measurements and lack of standardisation can limit both the reproducibility and generalisability of study findings. While many checklists are available to improve study reporting, there are no ureteroscopy-specific ones. The Adult-Ureteroscopy (A-URS) checklist is a practical aid for both researchers and reviewers for studies in this field. It contains five main sections (study details, preoperative, operative, postoperative, and long term data) and a total of 20 items. Patient summary: We developed a checklist to improve how studies on ureteroscopy (insertion of a telescope through the urethra to inspect the urinary tract) in adults are reported. This could help in advancing the field and improving patient outcomes, as all the key information is captured.

Background: Allergic parotitis (AP), due to its non-specific symptoms, frequently poses a diagnostic challenge, leading to cases being overlooked or misdiagnosed by clinicians. Objective: This study aimed to elucidate detailed clinical characteristics and common diagnostic indicators of AP. Methods: A comprehensive review and analysis of medical records was conducted from patients diagnosed with AP, encompassing demographic, clinical, and laboratory data, at the Affiliated Stomatological Hospital of Nanjing Medical University between January 2019 and March 2022. Results: The study enrolled 17 patients, evidenced by an average age of 36.00 ± 12.95 years. Common presentations of AP among the patients included notable symptoms such as parotid gland swelling, associated pain, and xerostomia. Ten patients had other atopic diseases. Palpation revealed the affected parotid glands to be soft and nodular, with an elevated local skin temperature. The unstimulated whole saliva flow rate was decreased. Ultrasonography demonstrated increased volume, reduced echo heterogeneity, and lymph node enlargement in the affected parotid glands. All cases observed increased serum salivary amylase and total IgE levels. Investigation of food allergens and inhaled allergen-specific IgE showed that all patients had suspected food allergies. Food provocation tests (FPT) induced AP in 13 cases, confirming the role of food allergens. Conclusion: Food allergens are involved in the etiology of AP, underscoring the importance of comprehensive clinical evaluation, including symptoms, signs, and confirmatory auxiliary tests, such as FPT, for accurate diagnosis and differentiation from other salivary gland pathologies.

Non-adherence to medications has many deleterious effects including poor treatment outcomes, increased economic burden, increased morbidity, hospitalization rate, health care utilization, productivity loss, and mortality. Therefore, this review aimed to estimate the pooled prevalence of medication adherence among asthmatic adults in 4 African countries.Primary studies were extensively searched from databases such as PubMed, HINARI, Cochrane Library, CINHALand, Google Scholar, and Google search engines. After screening and assessing the quality of studies, data were extracted using a checklist. Heterogeneity was assessed using forest plot, Chocran's Q Test and I2. The random effects meta-analysis model was employed to pool the prevalence of medication adherence among adult asthmatic patients in Africa. Sub-group analysis and meta-regression were performed to identify the sources of heterogeneity. Publication bias was assessed using funnel plots with Egger's test. A sensitivity analysis was performed to assess the influence of individual studies on the overall estimate.The review was performed among 16 studies of which 14 were cross-sectional with a total of 4019 participants. The pooled random effects prevalence of adherence to medications among adult patients with asthma in Africa was 39% (95% CI: 32, 47; p

Regardless of their age, adult patients with Wiskott-Aldrich syndrome should be considered for hematopoietic stem cell transplantation if clinically indicated.

Introduction: Atypical teratoid/rhabdoid tumor (AT/RT) of Central Nervous System (CNS) is a rare malignancy, usually confronted in childhood. Although few cases were reported in adults, it seems that there is a preference in supratentorial areas and specifically at the sellar region in middle-aged females with this subgroup presenting distinct features. Research question: We share a case report of a rare intracranial ATRT in the sellar area with lung metastasis in an adult female. Material/methods: Patient's medical records (laboratory tests, radiology examinations, histopathology report) were reviewed after retrieving an informed consent. A literature search within Pubmed and further “snowballing” was performed with the use of keywords “sellar”, “adult”, “ATRT” to address the current literature. Results: We present the case of a 51-year-old woman with headaches and left ptosis, diagnosed with a sellar mass, infiltrating the cavernous sinus. She underwent endoscopic transsphenoidal debulking of the lesion. The pathology report showed an aggressive AT/RT and the patient received radio- and chemo-therapy. On follow up imaging studies, lung metastases were shown and the patient died 7 months after the initial diagnosis. Discussion & conclusion: Only a few cases of sellar/suprasellar ATRT with lung metastases have been described so far. ATRT should be in the differential diagnosis of fibrous sellar masses in adult women.

Purpose: ARID1B is one of the most frequently mutated genes in intellectual disability cohorts. Thus, far few adult-aged patients with ARID1B-related disorder have been described, which limits our understanding of the disease’s natural history and our ability to counsel patients and their families. Methods: Data on patients aged 18+ years with ARID1B-related disorder were collected through an online questionnaire completed by clinicians and parents. Results: Eighty-seven adult patients with ARID1B were included. Cognitive functioning ranged from borderline to severe intellectual disability. Patients identified through the genetic workup of their child were either mosaic or had a variant in exon 1. New clinical features identified in this population are loss of skill (16/64, 25%) and recurrent patella luxation (12/45, 32%). Self-sustainability data showed that 88% (45/51) could eat independently, and 16% (7/45) could travel alone by public transport. Facial photo analysis showed that patients’ photographs taken at different ages clustered consistently, separate from matched controls. Conclusion: The ARID1B spectrum is broad, and as patients age, there is a significant shift in the medical aspects requiring attention. To address the changing medical needs with increasing age, we have formulated recommendations to promote timely intervention in an attempt to mitigate disease progression.

Gomez-Lopez-Hernandez syndrome (GLHS), also known as cerebello-trigeminal-dermal dysplasia, is a neurocutaneous disorder typically presenting in childhood. GLHS is characterized by rhombencephalosynapsis (RES) and partial alopecia, with or without trigeminal anesthesia. We describe a rare case of GLHS in a paucisymptomatic adult who presented with new-onset seizure-like activity. Magnetic resonance imaging revealed partial midline fusion of the cerebellar hemispheres, incomplete development of vermis, and slight medialization of the dentate nuclei: all consistent with the diagnosis of RES. Radiographic evidence combined with partial alopecia, truncal ataxia, and muscular hypotonia are suggestive GLHS diagnosis. Our report not only highlights the importance of maintaining GLHS on the differential for new-onset seizure-like activity, but also demonstrates how patients with GLHS may be minimally symptomatic and diagnosed in adulthood. Lay Summary: The Gomez-Lopez-Hernandez syndrome (GLHS), or cerebellotrigeminal-dermal dysplasia, is a rare condition that affects both the nervous system and the skin. It involves abnormal development of the brain, partial alopecia [thinning of hair], and loss of sensation in the face. One specific brain malformation, called rhombencephalosynapsis (RES), results from abnormal formation of the cerebellum and is seen in GHLS.Both RES and GLHS present early in childhood, and cases presenting later in life are exceptionally rare. Here we describe a young adult with RES and GLHS whose normal development and mild clumsiness eluded recognition by doctors until early adulthood when she presented with a single seizure.

This study presents a rare case of plastic bronchitis (PB) in a 57-year-old adult post-lung lobectomy, a condition predominantly found in post-Fontan children. The patient exhibited progressive dyspnea and complete atelectasis on the surgical side, revealing a gray rubbery bronchial cast obstructing the right main bronchus. Treatment involved repeated bronchoscopies, glucocorticoids, acetylcysteine, physiotherapy, and a low-fat diet, leading to gradual improvement. No similar cases have been reported, highlighting PB's diagnostic challenge. This underscores the need to consider rare conditions like PB in post-lobectomy complications. Timely examinations and bronchoscopies are essential for accurate diagnosis, ensuring prompt treatment and improving patient outcomes.

Objectives: This study was aimed at assessing the magnitude of treatment-seeking delay in adult heart failure patients and identifying factors that contribute to it. Design: An institution-based cross-sectional study with a consecutive sampling technique was conducted at Debre Tabor Comprehensive Specialized Hospital from February 1 to November 1, 2021. Setting: The study was conducted in the medical ward of the hospital. Participants: A total of 187 patients aged 18 and above admitted with a diagnosis of heart failure, and able to provide information were included. Results: The median delay time of adult heart failure patients admitted to the hospital was 15 days. The mean length of delay was also calculated to be 25.02 days. Urban residents and those who live at a ten or less-kilometer distance from healthcare facilities were found to be less likely to delay seeking care. Presenting with shortness of breath or paroxysmal nocturnal dyspnea, perceiving the cause to be heart-related, and getting positive responses from significant others were also associated with a relatively short delay time. Conclusion: Treatment-seeking delay was found to be a major problematic issue in heart failure patients. Therefore, patients, patient families, and the community at large must be taught about the symptoms of heart failure and the need for timely care.

Objective: To describe limitations in range of motion (ROM) in middle-aged adults with cerebral palsy (CP), and identify associations with CP subtype, gross motor function, sex and age. Design: Population-based cohort study. Setting: Local and regional referral centers. Participants: Inclusion criteria: diagnosis of CP, born 1959 to 1978 and living in the county of Västra Götaland, Sweden. In the population-based register of CP in Western Sweden, 417 subjects were identified and 139 volunteered to participate. Adults with CP, born elsewhere, who had moved into the area were invited through patient organizations and habilitation units, and eleven chose to participate. In total 150 participants, age 37-58 years (mean 48) 65 women (43%) (N=150). All CP subtypes and Gross Motor Function Classification (GMFCS) levels were represented. Interventions: Not applicable Main Outcome Measures: Passive ROM was measured in the upper and lower extremity and was classified into 4 levels (inspired by The Spinal Alignment and Range of Motion Measure and adapted from the values of the American Academy of Orthopedic Surgeons); good=1, vs mild=2, moderate=3 or severe=4 limitation. The results were summarized to obtain a total score of the participants' ROM limitations. Results: Moderate to severe limitations were present in 98 % of the participants. There was a correlation to GMFCS level in both the upper and lower extremity (P

Background: The coexistence of persistent trigeminal artery (PTA) and Moyamoya disease (MMD) has been reported. If their pathogenesis is related and if PTA is protective or harmful in MMD remains unknown as these are rare cerebrovascular anomalies. Case presentation: A 35-year-old woman with sudden global aphasia whose CT head and CT angiography of head and neck showed a hypodensity in the left posterior middle cerebral artery (MCA), a possible left proximal internal carotid artery occlusion, and a left PTA with hypoplasia of vertebral and basilar arteries. Digital subtraction angiography showed chronic MMD in the left MCA with extensive pial collateralization from anterior cerebral artery (ACA). The patient was initiated on single antiplatelet therapy and later she underwent direct bypass surgical intervention and rehabilitation. Discussion: Our case report brings attention to the infrequent coexistence of ipsilateral MMD and PTA suggesting a potential congenital pathogenesis based on embryologic development and hemodynamics. Also, we propose a protective role of PTA in MMD in case of large anterior vessel occlusion. This case contributes to the scarce literature on the intriguing relationship between MMD and PTA.

Primary spinal infection (PSI) is a generic term covering a heterogeneous group of infections that can affect the vertebral body, intervertebral disks, the content of the medullary cavity, and adjacent paraspinal tissues. Patients’ characteristics can vary significantly, notably according to their age, and some of these characteristics undoubtedly play a primordial role in the occurrence of a PSI and in the type of offending pathogen. Before approaching the subject of laboratory diagnostics, it is essential to define the characteristics of the patient and their infection, which can then guide the physician toward specific diagnostic approaches. This review critically examined the roles and usefulness of traditional and modern laboratory diagnostics in supporting clinicians’ decision-making in cases of pediatric and adult primary spinal infection (PSI). It appears impossible to compare PSIs in children and adults, whether from an epidemiological, clinical, bacteriological, or biological perspective. The recipients are really too different, and the responsible germs are closely correlated to their age. Secondly, the interpretation of traditional laboratory blood tests appears to contribute little guidance for clinicians attempting to diagnose a PSI. Biopsy or needle aspiration for bacterial identification remains a controversial subject, as the success rates of these procedures for identifying causative organisms are relatively uncertain in pediatric populations.Using nucleic acid amplification assays (NAAAs) on biopsy samples has been demonstrated to be more sensitive than conventional cultures for diagnosing PSI. Recent advances in next-generation sequencing (NGS) are particularly interesting for establishing a microbiological diagnosis of a PSI when standard cultures and NAAAs have failed to detect the culprit. We can even imagine that plasma metagenomic NGS using plasma (known as “liquid biopsy”) is a diagnostic approach that can detect not only pathogens circulating in the bloodstream but also those causing focal infections, and thus eliminate the need for source sample collection using costly invasive surgical procedures.

Introduction: Seasonal influenza is a contagious viral respiratory condition typically occurring in the fall to early spring months of the year globally. The risk of infection from seasonal influenza can be greatly reduced with vaccination. Unfortunately, research has indicated that the seasonal influenza vaccination rate in Saudi Arabia is low. This study assessed the uptake of seasonal influenza vaccination among adults residing in Al-Jouf region, Saudi Arabia. Materials and Methods: A cross-sectional survey targeting adults (20–80 years) residing in Al-Jouf region, Saudi Arabia, was conducted to gather information about their sociodemographic characteristics, chronic conditions, knowledge about periodic health examinations (PHE), regular use of PHE, and uptake of seasonal influenza vaccination. Comparative statistics and a multivariate logistic regression analysis were conducted to determine characteristics associated with the uptake of seasonal influenza vaccination. Results: A total of 624 respondents completed the survey and participated in this study. Among the participants, 27.4% indicated they visited their primary healthcare centers or hospitals every year to get a seasonal influenza vaccination. The regression analysis showed that the odds of getting a seasonal influenza vaccination were higher among employed respondents (Odds Ratio [OR] = 1.73; P = 0.039), respondents who were employees of the healthcare sector (OR = 2.31; P = 0.001), and those with a higher PHE Knowledge Score (OR = 1.22; P = 0.008), compared to their counterparts. Conclusions: Seasonal influenza is a serious condition warranting appropriate prevention measures, including vaccination. However, this study confirmed low rates of seasonal influenza vaccination in Al-Jouf Region of Saudi Arabia. Interventions to boost vaccination uptake, in particular among unemployed individuals, those not working in the healthcare sector, and those with lower PHE knowledge Scores, are therefore recommended.

Background: Information on changes in asthma prevalence and the treatment status for asthma is used as basic information for taking medical and administrative measures against asthma. However, this information among adults is relatively limited. Methods: To elucidate changes in the prevalence of asthma and treatment status over time among Japanese adults, health insurance claim data from some health insurance societies covering salaried employees and their dependents were studied longitudinally. Claim data from FY1999 to 2007 were obtained from two health insurance societies, and data from FY 2011 to 2019 were obtained from three different health insurance societies, and changes in standardized asthma prevalence among subjects aged 20–59 years, proportion of asthma patients prescribed ICS, leukotriene receptor antagonist (LTRA), and LABA, and the mean number of acute asthma exacerbations per year were analyzed. Results: The prevalence of asthma increased from 1.6% in 1999 to 3.0% in 2007 and 2.9% in 2011 to 4.6% in 2019. Increased trends in asthma prevalence from 2011 to 2019 were more noticeable in subjects in their 50s than those in their 20s for both sexes. The number of emergency visits related to asthma was 1.5 per year in 1999, which decreased to 0.8 per year in 2019. The proportion of people prescribed all anti-asthma medications (ICS, LTRA, and LABA) increased over time. Conclusions: The prevalence of adult asthma among Japanese salaried employees and their dependents has increased over the last 20 years, suggesting more attention should be paid to the prevention of this disease in adults.

Objective: To evaluate the risk factors of osteoporosis and establish a risk prediction model based on routine clinical information and traditional Chinese medicine (TCM) syndromes. Methods: Adults aged 30–82 who lived in 12 grass-roots communities or rural towns in Shanghai, Jilin Province, and Jiangsu Province from December 2019 to January 2022 through a multi-stage sampling method were included in this study. The risk factors and risk prediction of osteoporosis in women and men were explored and established by univariate analysis and multivariate logistic regression model. ROC curve and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the prediction model. Results: A total of 3000 subjects including 2243 females (75 %) and 757 males (25 %) were included in this study. The logistic prediction model of osteoporosis in women was Logit (P) = −2.946 + 0.960 (age ≥50 years old) + 0.633 (BMI ≥24 kg/m2) - 0.545 (daily exposure to sunlight >30 min) + 0.519 (no intake of dairy products) + 0.827 (coronary heart disease) + 0.383 (lumbar disc herniation) + 0.654 (no intake of calcium tablets and vitamin D) - 0.509 (insomnia) + 0.580 (flushed face and congested eyes) + 1.194 (thready and rapid pulse) + 1.309 (sunken and slow pulse). The logistic prediction model of osteoporosis in men was Logit (P) = −1.152–0.644 (daily exposure to sunlight >30 min) + 0.975 (no intake of calcium tablets and vitamin D) - 0.488 (insomnia). The area under the ROC curve (AUC) of female and male osteoporosis prediction models was 0.743 and 0.679, respectively. The Hosmer-Lemeshow goodness-of-fit test was >0.5. Conclusions: There are some significant differences in risk factors between female and male patients with osteoporosis. The risk of osteoporosis are found to be associated with TCM syndromes, and osteoporosis risk prediction models based on routine clinical information and TCM syndrome is effective.