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Daniel Puebla Neira,1 Mohammed Zaidan,2 Shawn Nishi,2 Alexander Duarte,2 Christopher Lau,1 Sairam Parthasarathy,3 Jiefei Wang,4 Yong-Fang Kuo,4 Gulshan Sharma2 1Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA; 2Division of Pulmonary Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA; 3Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA; 4Department of Biostatistics & Data Science, University of Texas Medical Branch, Galveston, TX, USACorrespondence: Daniel Puebla Neira, Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine-Phoenix, 1111 E McDowell Road, Phoenix, AZ, 85006, USA, Email dpueblaneira@arizona.eduRationale: There is concern that patients with chronic obstructive pulmonary disease (COPD) are at greater risk of increased healthcare utilization (HCU) following Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-COV-2) infection.Objective: To assess whether COPD is an independent risk factor for increased post-discharge HCU.Methods: We conducted a retrospective cohort study of patients with COPD discharged home from a hospitalization due to Coronavirus Disease 2019 (COVID-19) between April 1, 2020, and March 31, 2021, using Optum’s de-identified Clinformatics® Data Mart Database (CDM). COVID-19 was identified by an International Classification of Diseases, tenth revision, clinical modification (ICD-10-CM) diagnosis code of U07.1. The primary outcome was HCU (ie, emergency department (ED) visits, readmissions, rehabilitation/skilled nursing facility (SNF) visits, outpatient office visits, and telemedicine visits) nine months post-discharge after COVID-19 hospitalization (from here on “post-discharge”) in patients with COPD compared to HCU of patients without COPD. Poisson regression modeling was used to calculate relative risk (RR) and confidence interval (CI) for COPD, adjusted for the other covariates.Results: We identified a cohort of 160,913 patients hospitalized with COVID-19, with 57,756 discharged home and 14,622 (25.3%) diagnosed with COPD. Patients with COPD had a mean age of 75.48 years (± 9.49); 55.5% were female and 70.9% were White. Patients with COPD had an increased risk of HCU in the nine months post-discharge after adjusting for the other covariates. Risk of ED visits, readmissions, length of stay during readmission, rehabilitation/SNF visits, outpatient office visits, and telemedicine visits were increased by 57% (RR 1.57; 95% CI 1.53– 1.60), 50% (RR 1.50; 95% CI 1.46– 1.54), 55% (RR 1.55; 95% CI 1.53– 1.56), 18% (RR 1.18; 95% CI 1.14– 1.22), 16% (RR 1.16; 95% CI 1.16– 1.17), and 28% (RR 1.28; 95% CI 1.24– 1.31), respectively. Younger patients (ages 18 to 65 years), women, and Hispanic patients with COPD showed an increased risk for post-discharge HCU.Conclusion: Patients with COPD hospitalized with COVID-19 experienced increased HCU post-discharge compared to patients without COPD.Keywords: COPD, Healthcare Utilization disease, COVID-19

Abstract Background Dyskinesia is a movement disorder categorized by involuntary movement of muscle. Although dyskinesia can be brought on by taking medications, it can also be a symptom of a variety of diseases. Antiepileptic drug-induced involuntary movements have been well researched. Rare reports have been made for dyskinesia, a type of dystonia caused by phenytoin. The mechanism of its occurrence must be succinctly studied. Case presentation A 53-year-old Asian patient taking phenytoin (100 mg twice daily) experienced symptoms of perioral muscle involuntary movement, impaired speech, and generalized tremors and was admitted to the hospital. Brain magnetic resonance imaging showed significant development of encephalomalacia and porencephaly. The serum phenytoin levels were in the toxic range (33 g/ml). These were suggestive of phenytoin-induced dyskinesia. Levetiracetam and clonazepam were initiated, and the patient showed significant improvement in the symptoms. Conclusion This case presented a substantial reference value for the differential diagnosis and treatment prognosis of phenytoin-induced dyskinesia. The phenytoin-induced dyskinesia in this patient was successfully reversed with prompt identification and treatment. According to the case study’s findings, such people may benefit from periodic therapeutic drug monitoring.

Netherton syndrome (NS) is characterized by ichthyosis linearis circumflexa, trichorrhexis invaginata, and atopic diathesis. It is also considered a probable primary immunodeficiency as many patients have shown increased tendency for infections and abnormal levels of various immunoglobulins. Primary defect in NS is mutation in SPINK5 (serine protease inhibitor Kazal-type 5) gene which leads to the defective expression and function of lymphoepithelial Kazal-type-related inhibitor. We describe a case of a 7-year-old male born out of first-degree consanguineous marriage with findings of novel mutation, noninvolvement of the hair shaft, and unusual histopathology.

Hanako Kohama,1 Takeshi Ide,1 Kazuro Ikawa,2 Norifumi Morikawa,2 Shinichi Nishi1 1Division of Intensive Care Unit, Hyogo College of Medicine, Nishinomiya, 2Department of Clinical Pharmacotherapy, Hiroshima University, Hiroshima, Japan Background: Tazobactam/piperacillin (TAZ/PIPC), which is often combined with continuous renal replacement therapy (CRRT), induces renal excretion and is thought to have a high component removal rate for blood purification. CRRT procedures vary depending on the country, region, and institution. It is not clear whether the dose of TAZ/PIPC for use in Japan can be determined based on studies conducted in other countries. Therefore, in this study, we examined the suitability of recommended dose in Japan. Methods: The study subjects consisted of 10 patients who received TAZ/PIPC during CRRT in the intensive care unit of Hyogo College of Medicine, Nishinomiya, Japan. We used a one-compartment model to characterize and parameterize the pharmacokinetics of TAZ/PIPC because their blood levels were eliminated monoexponentially. Results: Compared with the data of healthy adults, the half-lives (t1/2) of both PIPC and TAZ were prolonged while their clearance rates decreased. Conclusion: For the continuous hemodiafiltration procedure adopted in Japan, we concluded that the dose and frequency were appropriate because the patients who received PIPC/TAZ 2.25 g twice a day during continuous hemodiafiltration maintained appropriate blood levels of both PIPC and TAZ. Keywords: hemodiafiltration, antibiotics, dosage regimen

Introduction: Fine Needle Aspiration Cytology (FNAC) plays a crucial role in the preoperative assessment of thyroid nodules. The Bethesda System of Reporting Thyroid Cytopathology (TBSRTC; 2023) is a standardised system for reporting thyroid FNAC. However, diagnostic challenges can occur in each category of TBSRTC. Aim: To categorise thyroid FNAC according to TBSRTC and revisit the challenges of cytological diagnosis in each category. Materials and Methods: A cross-sectional, observational study was conducted from November 2018 to April 2020 (18 months) in the Department of Pathology at ABVIMS and Dr. RML Hospital in New Delhi, India. The study included all 470 thyroid FNA cases received in the department from patients presenting with palpable thyroid nodules or ultrasonographically detected solid thyroid lesions, regardless of their age or sex. The cases were classified according to TBSRTC. Diagnostic tests were used to calculate sensitivity, specificity, Negative Predictive Value (NPV), Positive Predictive Value (PPV), and diagnostic accuracy of TBSRTC. Immunoexpression for Human Bone Marrow Endothelium marker-1 (HBME-1) and p63 was studied in Bethesda III to VI category cases, i.e., atypia of undetermined significance (AUS), Suspicious for Malignancy (SFM) and malignant cases only, and not in categories I and II. Results: The study included 470 thyroid FNA cases with a mean age of 39.72 years. Cytohistological follow-up was available for 50 cases, of which six cases were discordant and the remaining 44 cases were concordant. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of TBSRTC were calculated as 50%, 97.06%, 32%, 80.49%, and 82%, respectively. Three cases with diagnostic challenges were revisited and discussed. Immunohistochemistry was performed on a total of 33 FNAC cases. However, histological follow-up was available for only 18 cases, of which seven cases were diagnosed as Papillary Thyroid Carcinoma (PTC) on histological follow-up. HBME-1 and p63 were positive in 57.14% and 42.86% of these cases, respectively. Conclusion: The TBSRTC, 2023, is an excellent reporting system for thyroid FNA and serves as an initial investigative tool for thyroid lesions. Present study findings reveal that it has high specificity and diagnostic accuracy. The Risk of Malignancy (ROM) was comparable to other studies, except for the Bethesda II category. Immunoexpression of HBME-1 and p63 was useful in isolated cases; however, it is not sufficient for cytological diagnosis.

Abstract The objective of our study was to report real-world data on the safety and efficacy of standard-of-care teclistamab in patients with relapsed/refractory multiple myeloma (MM). This is a multi-institutional retrospective cohort study and included all consecutive patients that received at least one dose of teclistamab up until August 2023. One hundred and ten patients were included, of whom, 86% had triple-class refractory disease, 76% penta-refractory disease, and 35% had prior exposure to B-cell maturation antigen (BCMA)-targeting therapies. The overall response rate (ORR) in our cohort was 62%, with a ≥ very good partial remission (VGPR) rate of 51%. The ORR in patients with and without prior BCMA-targeted therapies was 54% vs 67%, respectively (p = 0.23). At a median follow-up of 3.5 months (range, 0.39–10.92), the estimated 3 month and 6 month progression free survival (PFS) was 57% (95% CI, 48%, 68%) and 52% (95% CI, 42%, 64%) respectively. The incidence of cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS) was 56% and 11% respectively, with grade ≥3 CRS and ICANS noted in 3.5% and 4.6% of patients respectively. 78 unique infections were diagnosed in 44 patients, with the incidence of all-grade and grade ≥3 infections being 40% vs 26% respectively. Primary prophylaxis with intravenous immunoglobulin (IVIG) was associated with a significantly lower infection risk on multivariate analysis (Hazard ratio [HR] 0.33; 95% CI 0.17, 0.64; p = 0.001).

Introduction: Remdesivir is currently approved for treating hospitalised patients with COVID-19. However, it is a priority to monitor its safety and effectiveness in various clinical settings. This study was undertaken to assess the impact of remdesivir on inflammatory and prognostic markers of COVID-19. Materials and Methods: A hospital-based prospective longitudinal study was conducted over two months comprising event monitoring of COVID-19 patients administered remdesivir as per standard guidelines. The demographic details, risk factors and all baseline parameters were collected. The patients were followed up for the appearance of any adverse drug reactions (ADRs) after the start of remdesivir therapy from Day 1 to discharge or death every day. Repeat Lab tests were done on days 2, 4, 6 and 10 days to assess the impact of remdesivir on inflammatory and prognostic markers of COVID-19 over time. Significant predictors of survival in the cohort were also assessed. Results: A total of 60 COVID-19 patients were administered remdesivir. The mean age of the patients was 59.2 (+13.7) years. There was a significant improvement in the serum creatinine (decreased from 0.9 to 0.7 mg/dL), lymphocyte count {decreased from 9.2 to 7.3 (109 cells/L)} and serum sodium (increased from 134.6 to 137.4) of the patients over six days after the administration of remdesivir. The significant survival predictors were multiple organ failure (P 0.046) and WBC count on Day 10 (P 0.001). Conclusion: Remdesivir administration improved the prognostic biomarker profile in COVID-19 patients.

Aim: To know attitudes, perceptions and barriers towards the use of Artificial Intelligence (AI) in dentistry in India among undergraduate and postgraduate students. Methodology: A questionnaire-based cross-sectional study was conducted among participants pursuing graduation and postgraduation. The questionnaire consisted of 23 close-ended and 2 open-ended questions divided into various sections of attitude, perception and barriers. The data was analysed using Statistical Package for Social Sciences (SPSS) version 24.0. Result: Out of 937 responses, 55.2% responded that they get information about AI from social media platforms. 51.3% of respondents have basic knowledge about the use of AI in dentistry. 59.6% agreed that AI can be used as a “definitive diagnostic tool” in the diagnosis of diseases. 66.5% agreed that AI can be used for radiographic diagnosis of tooth caries. 71.3% stated that AI can be used as a “treatment planning tool” in dentistry. 55.7% stated that AI should be part of undergraduate dental training. Conclusion: This study concluded that both dental students are aware of the concept of AI. Participants were positive when asked if AI can increase the efficiency of diagnosis, prognosis and treatment planning procedures as well as in managing patient data. Both participants believed that the barriers to the introduction of AI in dentistry are a lack of technical resources and a lack of training personnel in college.

Objective: This study aimed to evaluate the cyclic fatigue resistance (CFR) of three different heat-treated nickel-titanium (NiTi) files in rotary motion utilizing a cyclic fatigue testing device.Methods: Three NiTi rotary systems, Hero Gold, NeoEndo Flex, and T-Pro were used in this study. Ten files from each system (4% taper, #25 size, 21mm length) were tested for CFR. The test was conducted in an artificial canal in a customized cyclic fatigue device. The canal system is comprised of a 60° angle of curvature located 8 mm from the orifice. All files were rotated until fracture at the rotation per minute (RPM) and torque settings according to the manufacturer's recommendation. The time to fracture (TTF) was recorded in seconds for each instrument and then multiplied by (RPM/60) to obtain the number of cycles to fracture (NCF). The fracture length of each instrument fragment was recorded. Data were analyzed by one-way ANOVA and Tukey test and P-value

Not available.

Rifampicin-resistant (RR) tuberculosis (TB) in children is a major global health concern but is often neglected in economics research. Accurate cost estimations across the spectrum of paediatric RR-TB treatment regimens are critical inputs for prioritisation and budgeting decisions, and an existing knowledge gap at local and international levels. This normative cost analysis was nested in a Phase I/II pharmacokinetics, safety, tolerability, and acceptability trial of TB medications in children in South Africa, the Philippines and India. It assessed the pharmaceutical costs of 36 childhood RR-TB regimens using combinations from 16 different medicines in 34 oral formulations (adult and child-friendly) in 11 weight bands in children

Three new calculation methods for voltage-source problems with conductors, considering current distributions in conductors, have been developed using the finite element method and the ALPHA-phi formulation. The first is a dividing method for conductors. Equations for circuits including divided conductors are solved with Maxwell's equations. The division introduces the skin effect to conductors approximately. The second performs two sequential procedures: (1) current distributions are solved by putting electric potentials on boundaries of conductors using Poisson's equation; and (2) eddy currents are solved by Maxwell's equations with the solutions of (1). The sum of both currents are the real distributions in conductors. The third is a direct method to put electric potentials as the scalar potential on the boundaries. These methods are applied to two models. The inductances were also measured, and the experimental results have good agreement with the calculations.

Background Perhaps, as never before, we need innovators. With our growing population numbers, and with increasing pressures on our education systems, are we in danger of becoming more rigid and formulaic and increasingly inhibiting innovation? When young can we predict who will become the great innovators? For example, in medicine, who will change clinical practice? Aims We therefore determined to assess whether the current academic excellence approach to medical school entrance would have captured previous great innovators in medicine, assuming that they should all have well fulfilled current entrance requirements. Methods The authors assembled a list of 100 great medical innovators which was then approved, rejected or added to by a jury of 12 MD fellows of the Royal Society of Canada. Two reviewers, who had taken both the past and present Medical College Admission Test as part of North American medical school entrance requirements, independently assessed each innovator's early life educational history in order to predict the innovator's likely success at medical school entry, assuming excellence in all entrance requirements. Results Thirty-one percent of the great medical innovators possessed no medical degree and 24% would likely be denied entry to medical school by today's standards (e.g. had a history of poor performance, failure, dropout or expulsion) with only 24% being guaranteed entry. Even if excellence in only one topic was required, the figure would only rise to 41% certain of medical school entry. Conclusion These data show that today's medical school entry standards would have barred many great innovators and raise questions about whether we are losing medical innovators as a consequence. Our findings have important implications for promoting flexibility and innovation for medical education, and for promoting an environment for innovation in general. [ABSTRACT FROM AUTHOR]