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Background: The global prevalence of diabetes has been rising rapidly in recent years, leading to an increase in patients experiencing hyperglycemic crises like diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). Patients with impaired renal function experience a delay in insulin clearance, complicating the adjustment of insulin dosing and elevating hypoglycemia risk. Accordingly, this study aims to evaluate the impact of renal function on the safety and efficacy of insulin use in patients with isolated DKA or combined DKA/HHS. Methods: A retrospective observational study was conducted at King Abdulaziz Medical City, Saudi Arabia, from January 2016 to December 2021. Eligible patients were ≥18 years, had a confirmed diagnosis of isolated DKA or combined DKA/HHS, presented with an anion gap (AG) of ≥ 16 mmol/L, and received insulin either via continuous infusion or as bolus doses. Patients were categorized into normal kidney function and patients with chronic kidney disease (CKD). The primary outcome was to determine the difference in time to close the AG between the two groups. Statistical analyses were performed using SAS® software. Results: Out of 319 screened patients, 183 patients met the inclusion criteria. The patients were divided into normal kidney function (43.2%) and CKD (56.8%) groups. The average eGFR for patients with normal kidney function was 93.7 ± 32.5 mL/min/1.73m2 compared to 33.4 ± 14.3 mL/min/1.73m2 for patients with CKD. The time to close AG was similar between patients in the normal kidney function and CKD groups (22.6 ± 16.0 hours vs. 24.5 ± 17.5 hours, p =0.4475). However, the patients' length of stay in hospital (3.4 ± 2.5 days vs. 5.2 ± 4.0 days; p =0.0004) and ICU (2.5 ± 1.8 days vs. 4.0 ± 2.8 days; p =0.0453) were both significantly longer for patients with CKD. Hypoglycemic events were low in our study with only four documented cases among patients with CKD. Conclusion: This study provides insights into DKA management and outcomes in patients with normal and impaired renal function. The time required to close AG was comparable between the two groups. Larger, multi-center studies are needed to validate these findings and explore additional factors that may impact the management of DKA in patients with CKD. [ABSTRACT FROM AUTHOR]

Introduction and Purpose Hyperosmolar Hyperglycemic State (HHS), a severe type 2 diabetes complication, presents with profound hyperglycemia, hyperosmolality, and dehydration sans ketosis, posing distinct challenges in diagnosis and treatment compared to diabetic ketoacidosis (DKA). This article aims to enhance medical community awareness by examining HHS features, prevalence, and associated risk factors, contributing to improved clinical management. Emphasizing tailored treatment strategies for dehydration, coexisting illnesses, and metabolic decompensation, it ultimately seeks to enhance outcomes for type 2 diabetes individuals. Material and methods Conducting a systematic review of medical articles from 1972 to 2023 using PubMed, this study analyzed keywords such as hyperglycemic hyperosmolar state, HHS, diabetes mellitus, hyperglycemia, and dehydration. Inclusion of pertinent articles ensured a comprehensive exploration of Hyperosmolar Hyperglycemic State (HHS) literature during the specified timeframe. Brief description of the state of knowledge. Hyperosmolar Hyperglycemic Syndrome (HHS) predominantly affects elderly type 2 diabetes individuals, often triggered by infections like pneumonia or urinary tract infections. Clinical presentation includes fatigue, weakness, polydipsia, polyuria, nausea, and altered consciousness. Diagnosis relies on criteria such as elevated blood glucose levels and increased osmolality. HHS management involves a multidisciplinary approach, addressing fluid depletion, compromised cerebral perfusion, and achieving gradual normalization of osmolality and blood glucose levels to prevent complications. Summary Hyperosmolar Hyperglycemic Syndrome (HHS), a severe metabolic disorder linked to diabetes, extends beyond hyperglycemia, necessitating a comprehensive understanding. This review sheds light on HHS etiology, clinical manifestations, diagnostic criteria, and treatment modalities, emphasizing its critical nature in diabetes care. [ABSTRACT FROM AUTHOR]

Abstract Objective Avascular necrosis of the femoral head is a disease usually seen in middle-aged individuals. Although many aetiological factors have been blamed, there are still aetiological factors that have not been fully elucidated. Although treatment options show a wide range, early and appropriate treatment is of great importance to preserve the hip joint. In our study, we compared the results of core decompression and core decompression combined with bone marrow mesenchymal stem cell implantation in patients with avascular necrosis of the femoral head. Material method In this retrospective study, Steinberg stage 1–2 patients operated on for avascular necrosis of the femoral head between 2018 and 2023 were analysed. Separate groups were formed from patients who underwent isolated core decompression and core decompression + bone marrow mesenchymal stem cell implantation. Age, gender, Steinberg staging, aetiology of the disease, follow-up period, progression to hip arthroplasty, Vas scores, Harris hip scores (HHS), and complications were evaluated. Harris hip scores at preoperative and 2-year follow-up periods; VAS scores at preoperative, 3-month, 6-month, 1-year, and 2-year follow-up periods were analysed. Results In the study, 44 patients were analysed. While 25 patients underwent core decompression only (group 1), 19 patients underwent core decompression and bone marrow mesenchymal stem cell implantation (group 2). The mean age of the patients in group 1 was 39.3 ± 6.5 years, and the mean age of the patients in group 2 was 38.4 ± 6.7 years. The mean follow-up was 31.85 ± 4.4 months in group 1 and 32.2 ± 4.1 months in group 2. Total hip arthroplasty was performed in 2 of the patients in group 1 (one of the patients underwent total hip arthroplasty at month 28 and the other at month 33). Conclusion The treatment of avascular necrosis of the femoral head varies according to various staging methods. Early diagnosis of the disease and correct treatment are very important for the patient's quality of life in the future. In our research, we found that patients who received both core decompression and stem cell implantation for early-stage avascular necrosis of the femoral head exhibited decreased pain at the 6-month, 1-year, and 2-year follow-up examinations. Additionally, their hip function improved at the 24-month mark according to the HHS evaluation.

Background: The aim of this study is to evaluate comparative biomechanical fixation provided with the BDSF method with the conventional CC screw fixation for treatment of femoral neck fractures with three parallel cannulated screws. Methods: This is a prospective cohort study. There were two teams of surgeons out of which one team operated the patients with BDSF technique and second with conventional CC screw fixation technique; thus, the patients were randomly distributed into two groups. Patients were included in the study as per the following inclusion and exclusion criteria. Results: Union was achieved in 15 (83.33%) patients managed by conventional CC screw technique, while union was achieved in 11 (91.67%) patients managed by BDSF technique in the present study. The average Harris hip score in present study was 90 score in patients managed by BDSF technique, while the average Harris hip score in present study was 80 score in patients managed by BDSF technique. Conclusion: Both BDSF and conventional CC screw fixation are good fixation methods for fracture neck of femur. But functional outcome and fracture union rates are better with BDSF Technique. Although, there are some minor problems noted in BDSF technique such as outer cortical fracture at the entry point of beam screw and opening up of anterior cortex of oblique fracture patterns. Thus, BDSF method provides reliable fixation in which early mobilization and partial weight bearing of the patient may be allowed. [ABSTRACT FROM AUTHOR]

Introduction and Purpose Hyperosmolar Hyperglycemic State (HHS), a severe type 2 diabetes complication, presents with profound hyperglycemia, hyperosmolality, and dehydration sans ketosis, posing distinct challenges in diagnosis and treatment compared to diabetic ketoacidosis (DKA). This article aims to enhance medical community awareness by examining HHS features, prevalence, and associated risk factors, contributing to improved clinical management. Emphasizing tailored treatment strategies for dehydration, coexisting illnesses, and metabolic decompensation, it ultimately seeks to enhance outcomes for type 2 diabetes individuals. Material and methods Conducting a systematic review of medical articles from 1972 to 2023 using PubMed, this study analyzed keywords such as hyperglycemic hyperosmolar state, HHS, diabetes mellitus, hyperglycemia, and dehydration. Inclusion of pertinent articles ensured a comprehensive exploration of Hyperosmolar Hyperglycemic State (HHS) literature during the specified timeframe. Brief description of the state of knowledge. Hyperosmolar Hyperglycemic Syndrome (HHS) predominantly affects elderly type 2 diabetes individuals, often triggered by infections like pneumonia or urinary tract infections. Clinical presentation includes fatigue, weakness, polydipsia, polyuria, nausea, and altered consciousness. Diagnosis relies on criteria such as elevated blood glucose levels and increased osmolality. HHS management involves a multidisciplinary approach, addressing fluid depletion, compromised cerebral perfusion, and achieving gradual normalization of osmolality and blood glucose levels to prevent complications. Summary Hyperosmolar Hyperglycemic Syndrome (HHS), a severe metabolic disorder linked to diabetes, extends beyond hyperglycemia, necessitating a comprehensive understanding. This review sheds light on HHS etiology, clinical manifestations, diagnostic criteria, and treatment modalities, emphasizing its critical nature in diabetes care.

Objective: Avascular necrosis of the femoral head is a disease usually seen in middle-aged individuals. Although many aetiological factors have been blamed, there are still aetiological factors that have not been fully elucidated. Although treatment options show a wide range, early and appropriate treatment is of great importance to preserve the hip joint. In our study, we compared the results of core decompression and core decompression combined with bone marrow mesenchymal stem cell implantation in patients with avascular necrosis of the femoral head. Material method: In this retrospective study, Steinberg stage 1–2 patients operated on for avascular necrosis of the femoral head between 2018 and 2023 were analysed. Separate groups were formed from patients who underwent isolated core decompression and core decompression + bone marrow mesenchymal stem cell implantation. Age, gender, Steinberg staging, aetiology of the disease, follow-up period, progression to hip arthroplasty, Vas scores, Harris hip scores (HHS), and complications were evaluated. Harris hip scores at preoperative and 2-year follow-up periods; VAS scores at preoperative, 3-month, 6-month, 1-year, and 2-year follow-up periods were analysed. Results: In the study, 44 patients were analysed. While 25 patients underwent core decompression only (group 1), 19 patients underwent core decompression and bone marrow mesenchymal stem cell implantation (group 2). The mean age of the patients in group 1 was 39.3 ± 6.5 years, and the mean age of the patients in group 2 was 38.4 ± 6.7 years. The mean follow-up was 31.85 ± 4.4 months in group 1 and 32.2 ± 4.1 months in group 2. Total hip arthroplasty was performed in 2 of the patients in group 1 (one of the patients underwent total hip arthroplasty at month 28 and the other at month 33). Conclusion: The treatment of avascular necrosis of the femoral head varies according to various staging methods. Early diagnosis of the disease and correct treatment are very important for the patient's quality of life in the future. In our research, we found that patients who received both core decompression and stem cell implantation for early-stage avascular necrosis of the femoral head exhibited decreased pain at the 6-month, 1-year, and 2-year follow-up examinations. Additionally, their hip function improved at the 24-month mark according to the HHS evaluation. [ABSTRACT FROM AUTHOR]

Low physical function is associated with poor outcomes in the elderly population suffering from hip fractures. The present study aims to evaluate the prognostic tools for predicting patient recovery after hip fractures and investigate the correlation between the pre-fracture motor and functional statuses. A prospective study was performed, including 80 patients suffering from hip fractures. Patient history, previous falls, the type of fracture and overall survival were evaluated. Patient-reported outcome measures (SF-36, EQ-5D/VAS, Charlson Comorbidity Index (CCI), Short Physical Performance Battery (SPPB), Timed Up and Go (TUG) and Harris Hip Score (HHS)) were monitored before hospital discharge at 6 weeks, and 3, 6 and 12 months postoperatively. Overall, 55% of patients experienced at least one fall, and 46% of them used crutches before the fracture. The average CCI score was 6.9. The SPPB score improved from 1.4 ± 1.3 (1 week) to 4.4 ± 2.1 (48 weeks). A one-year age increase, female sex, and prior history of falls lead to 0.1-, 0.92-, 0.56-fold lower SPPB scores, respectively, at 12 months. The HHS recorded the greatest improvement between 6 and 12 weeks (52.1 ± 14.6), whereas the TUG score continued to improve significantly from 139.1 ± 52.6 s (6 weeks) to 66.4 ± 54 s (48 weeks). The SPPB and performance test can be routinely used as a prognostic tool. [ABSTRACT FROM AUTHOR]

Introduction: This unique critical case, illustrates severe hyperglycemic dehydration, profound electrolyte derangements, and multiple organ failure complicating mixed HHS and DKA. Statement: Historically HHS was differentiated from DKA as a distinct entity, mostly encountered in adult type 2 diabetes. Occasionally diabetic children present in HHS, carry their own risks and require different treatment approaches. In practice, challenging pediatric diabetic patients concomitantly displaying mixed HHS and DKA features can be encountered, mandating higher risk awareness, complications prevention, and corresponding treatment addressing both states.

Hyperosmolar Hyperglycaemic State (HHS) is a medical emergency associated with high mortality. It occurs less frequently than diabetic ketoacidosis (DKA), affects those with pre‐existing/new type 2 diabetes mellitus and increasingly affecting children/younger adults. Mixed DKA/HHS may occur. The JBDS HHS care pathway consists of 3 themes (clinical assessment and monitoring, interventions, assessments and prevention of harm) and 5 phases of therapy (0–60 min, 1–6, 6–12, 12–24 and 24–72 h). Clinical features of HHS include marked hypovolaemia, osmolality ≥320 mOsm/kg using [(2×Na+) + glucose+urea], marked hyperglycaemia ≥30 mmol/L, without significant ketonaemia (≤3.0 mmol/L), without significant acidosis (pH >7.3) and bicarbonate ≥15 mmol/L. Aims of the therapy are to improve clinical status/replace fluid losses by 24 h, gradual decline in osmolality (3.0–8.0 mOsm/kg/h to minimise the risk of neurological complications), blood glucose 10–15 mmol/L in the first 24 h, prevent hypoglycaemia/hypokalaemia and prevent harm (VTE, osmotic demyelination, fluid overload, foot ulceration). Underlying precipitants must be identified and treated. Interventions include: (1) intravenous (IV) 0.9% sodium chloride to restore circulating volume (fluid losses 100–220 ml/kg, caution in elderly), (2) fixed rate intravenous insulin infusion (FRIII) should be commenced once osmolality stops falling with fluid replacement unless there is ketonaemia (FRIII should be commenced at the same time as IV fluids). (3) glucose infusion (5% or 10%) should be started once glucose <14 mmol/L and (4) potassium replacement according to potassium levels. HHS resolution criteria are: osmolality <300 mOsm/kg, hypovolaemia corrected (urine output ≥0.5 ml/kg/h), cognitive status returned to pre‐morbid state and blood glucose <15 mmol/L. [ABSTRACT FROM AUTHOR]

Abstract Background We report the clinical evaluation, quality of life and pain assessment in patients who had a femoral neck SPIRON endoprosthesis. Methods The study group consisted of 27 men in whom 35 femoral neck endoprosthesis were implanted (8 on the left side, 12 on the right side and 7 bilateral) due to idiopathic osteoarthritis of the hip (20 patients) or avascular femoral osteonecrosis (7 patients) in a mean 7-year follow-up. Results The median pre-operative Harris Hip score (HHS) was 35.5 and post-operative 98.5 (p 30) is associated with worse operation outcomes.

Hemiarthroplasty and total hip arthroplasty are routinely performed procedures. A comparison of these procedures in tumor patients can be performed based on complications and functional outcomes. To weigh the advantages and disadvantages of both procedures, a comparative study is indeed required to decide which procedure is more beneficial for primary bone tumor patients. The outcomes of proximal femur tumor-resected patients were collected from research reports from PubMed, MEDLINE, EMBASE, Cochrane, and Google Scholar until 30 December 2022. Differences between these two operative procedures in primary bone tumors patients were analyzed based on dislocation, infection, local recurrence, MSTS, and HHS. Six articles were included according to the selection criteria with a total of 360 patients. Our results showed that there was a significant difference in our primary outcome as hemiarthroplasty participants encountered less dislocation than those with total hip arthroplasty. Moreover, the secondary outcomes of our study were similar. Proximal femur bone tumors, when resected, tend to produce more complications and decrease functional ability due to extensive tumor extension and soft tissue involvement. The lower dislocation rate in hemiarthroplasty participants emphasizes the importance of preserving the acetabular head in hemiarthroplasty as a key to preventing dislocation. [ABSTRACT FROM AUTHOR]

Background: Hyperglycemic emergencies (HGEs) are the major deadliest acute complications of diabetes. HGEs have reached an alarming stage and increased year-to-year leading to increased morbidity, hospitalization, and mortality. Despite HGEs causing this increased healthcare, psychological, social, and economic burden, studies conducted to address this burden and its predictive factors remain limited. Thus, this study aimed to investigate the incidence and predictors of HGEs among adult diabetic patients., Methods: An institution-based retrospective follow-up study was employed on 538 systematically selected adult diabetic patients who had diabetic follow-up in Sidama region and Gedeo zone public hospitals from September 1, 2018, to September 1, 2022. The sample size was determined using STATA V-14. Data were collected using an extraction checklist, entered into EPI data version 4.4.2.2, and analyzed using STATA version 14. The Kaplan-Meier curve and log-rank test were used to determine the survival probabilities and to compare the survival status. The Cox proportional hazard regression model was used to determine the association and identify the predictor variables. A statistical significance was declared at a p -value of <0.05 in line with a 95% confidence interval (CI) and hazard ratios., Results: The study was conducted on 538 diabetic adult patients with a response rate of 100%. The mean age of study participants was 44.5 years, and more than 66.7% were males. The incidence rate of HGEs was found to be 29 (95% CI: 25.3-33.2) per 1000 person-months with a total of 7176.5 person-month observations. Being farmer (adjusted hazard ratio (AHR) = 6.47; 95% CI: 2.61-16.04), poor glycemic control (AHR = 6.84; 95% CI: 3.47-13.49), less frequent diabetic follow-up (AHR = 4.00; 95% CI: 1.02-15.57), and having hypertension (HTN) (AHR = 2.94; 95% CI: 1.62-5.34) were significantly associated with increased hazard of acquiring HGEs among adult diabetic patients. Conversely, the hazard of experiencing HGE was 63% lower among patients who had diabetic nephropathy relative to those without diabetic nephropathy (AHR = 0.35; 95% CI: 0.15-0.83). Hence, setting and strengthening specific diabetic management strategies focused on the identified predictors could be paramount to reducing HGEs and their unwanted effects. Moreover, it's better to consider more frequent diabetic follow-up visits for all patients regardless of other complications., (© The Author(s), 2024.)

Abstract A 4‐year‐old English setter presented with a 1‐week history of anorexia, lethargy and occasional vomiting. Blood analysis revealed moderate regenerative anaemia, mild monocytosis, thrombocytopaenia, hypoproteinaemia, hypoglobulinaemia, hypocholesterolaemia and increased C‐reactive protein. On ultrasonography, the spleen had multifocal hypoechoic lesions. Fine needle aspirates from the spleen and liver showed marked extramedullary haematopoiesis, an increased number of histiocytes, haemosiderin deposits and erythrophagocytosis. A tentative diagnosis of haemophagocytic histiocytic sarcoma (HHS) was made, and the owners elected euthanasia. On autopsy, the liver and spleen were enlarged. The spleen had an uneven surface and a yellow‐tan spotted appearance. Histologically, the red pulp was highly cellular and dominated by erythroid cells, as well as a population of larger polygonal cells and aggregates of histiocytes. HHS was confirmed by CD11d immunolabelling. This represents the first documented case of HHS in an English setter.

Background: We report the clinical evaluation, quality of life and pain assessment in patients who had a femoral neck SPIRON endoprosthesis.Methods: The study group consisted of 27 men in whom 35 femoral neck endoprosthesis were implanted (8 on the left side, 12 on the right side and 7 bilateral) due to idiopathic osteoarthritis of the hip (20 patients) or avascular femoral osteonecrosis (7 patients) in a mean 7-year follow-up.Results: The median pre-operative Harris Hip score (HHS) was 35.5 and post-operative 98.5 (p < 0.001). The median WOMAC HIP score was pre-operatively 57 and post-operatively 0 (p < 0.001). The median SF-12 score was pre-operatively 4 and post-operatively 33 (p < 0.001). The median pain assessment in VAS scale was 7 pre-operatively and 0 post-operatively (p < 0.001).Conclusions: The results of all examined patients have changed significantly in every category showing that SPIRON endoprosthesis improved their quality of life and statistically reduced pain ailments. Moreover we have proved that higher BMI (> 30) is associated with worse operation outcomes. [ABSTRACT FROM AUTHOR]

Fowl adenovirus (FAdV) was first reported in Angara Goth, Pakistan, in 1987. For this reason, it is also known as "Angara disease." It was later reported in China, Japan, South Korea, India, the United States, Canada, and other countries and regions, causing huge economic losses in the poultry industry worldwide. Notably, since June 2015, a natural outbreak of severe hydropericardium hepatitis syndrome (HHS), associated with a hypervirulent novel genotype FAdV-4 infection, has emerged in most provinces of China. The novel virus FAdV-4 spread rapidly and induced a 30-100% mortality rate, causing huge economic losses and threatening the green and healthy poultry breeding industry. Vaccines against FAdV-4, especially the emerging novel genotype, play a critical role and will be the most efficient tool for preventing and controlling HHS. Various types of FAdV-4 vaccines have been developed and evaluated, such as inactivated, live-attenuated, subunit, and combined vaccines. They have made great contributions to the control of HHS, but the details of cross-protection within FAdVs and the immunogenicity of different vaccines require further investigation. This review highlights the recent advances in developing the FAdV-4 vaccine and promising new vaccines for future research. [ABSTRACT FROM AUTHOR]

Abstract Background The lifetime implants is a key parameter that the surgeon should take into account at the time of the primary total hip arthroplasty (THA). The aim of this study was a clinical and radiographical evaluation of the Delta PF-FIT (LimaCorporate, Italy) THA system with ceramic-on-ceramic articulations. We have not found a clinical or radiographical assessment of this implant in available published literature. Methods A total of 197 (F = 94, M = 103) primary THAs were evaluated in 163 patients with a mean follow-up of 7.7 years (range 5.1–11.2 years (SD ± 1.5)) Harris hip Score (HHS) and the Western Ontario and McMaster Universities Arthritis index (WOMAC) were used for the clinical evaluation. The statistical evaluation was processed by standard statistical methods. The study was approved by Ethic Committee of the University Hospital Motol (Reference No. EK-73/19). Results The mean HHS score was found to be 97.59 points (61–100 range with a ± 5.13 SD, preoperative HSS was 51.21, range 28–73 with a ± 4,77 SD). 186 THAs were evaluated as excellent (90–100 points), 9 THAs rated as good (80–89 points), 1 THA was rated as fair (70–79) points and 1 THA rated as poor (less than 70 points). The mean WOMAC score was 97.38 points (65–100 range with a ± 5.18 SD, preoperative was 50,12, range 27–69 with a ± 4.85 SD). We documented an overall 99.49% Kaplan-Meier survival with a mean follow-up of 7.7 years with the FIT (LimaCorporate) stem revision and any component revision as the endpoint. With the Delta PF (LimaCorporate) cup revision as the endpoint, the survival was 100%. We have not found a previously published clinical or radiographical review of this THA system, the study shows a comparison with other THA implants. Conclusion Evaluation of the Delta-PF-FIT (LimaCorporate, Italy) THA system with the use of ceramic-on-ceramic BIOLOX®Delta articulation surfaces shows very good outcomes.

Fowl adenovirus (FAdV) was first reported in Angara Goth, Pakistan, in 1987. For this reason, it is also known as “Angara disease.” It was later reported in China, Japan, South Korea, India, the United States, Canada, and other countries and regions, causing huge economic losses in the poultry industry worldwide. Notably, since June 2015, a natural outbreak of severe hydropericardium hepatitis syndrome (HHS), associated with a hypervirulent novel genotype FAdV-4 infection, has emerged in most provinces of China. The novel virus FAdV-4 spread rapidly and induced a 30-100% mortality rate, causing huge economic losses and threatening the green and healthy poultry breeding industry. Vaccines against FAdV-4, especially the emerging novel genotype, play a critical role and will be the most efficient tool for preventing and controlling HHS. Various types of FAdV-4 vaccines have been developed and evaluated, such as inactivated, live-attenuated, subunit, and combined vaccines. They have made great contributions to the control of HHS, but the details of cross-protection within FAdVs and the immunogenicity of different vaccines require further investigation. This review highlights the recent advances in developing the FAdV-4 vaccine and promising new vaccines for future research.

Background and Objective: Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are life-threatening conditions that send nearly 180,000 patients to the intensive care unit each year, with mortality rates up to 5-10%. Little is known about the impact of concurrent psychiatric disorders on specific DKA/HHS outcomes. Identifying these relationships offers opportunities to improve clinical management, treatment planning, and mitigate associated morbidity and mortality., Methods: We conducted a retrospective review including adult DKA/HHS admissions within a large Massachusetts hospital system from 2010 to 2019. We identified patients admitted inpatient for DKA or HHS, then filtered by International Classification of Disease-9-CM and International Classification of Disease-10-CM codes for psychiatric diagnoses that were present in patients electronic medical record at any point in this observational period. Outcomes included the number of inpatient admissions for DKA/HHS, age of death, rates of discharging against medical advice (AMA) from any inpatient admission, and end-stage renal disease/dialysis status. Multivariate regression was conducted using R software to control for variables across patients and evaluate relationships between outcomes and concurrent psychiatric disorders. Significance was set at P < 0.05., Results: Seven thousand seven hundred fifty-six patients were admitted for DKA or HHS, 66.9% of whom had a concurrent psychiatric disorder. Of these patients, 54.5% were male, 70.4% were White, and they had an average age of 61.6 years. This compares with 26.1% with concurrent psychiatric condition within the general diabetes population, 52.1% of whom were male, 72.1% were White, and an average age of 68.2 years. A concurrent psychiatric disorder was associated with increased odds of rehospitalization (adjusted odds ratio [aOR] = 1.62 95% confidence interval [CI] 1.35-1.95, P < 0.001), of being diagnosed with end-stage renal disease and on dialysis (aOR = 1.02 95% CI 1.002-1.035, P = 0.02), and of leaving AMA (aOR = 6.44 95% CI 4.46-9.63, P < 0.001). The average age of death for those with a concurrent psychiatric disorder had an adjusted mean difference in years of -7.5 years (95% CI -9.3 to 5.8) compared to those without a psychiatric disorder., Conclusions: Of patients with DKA/HHS, 66.9% have a concurrent psychiatric disorder. Patients with a concurrent psychiatric disorder admitted for DKA/HHS were more likely to have multiple admissions, to leave AMA, to be on renal dialysis, and to have a lower age of mortality., (Copyright © 2024 Academy of Consultation-Liaison Psychiatry. Published by Elsevier Inc. All rights reserved.)

Introduction: With increasing life expectancy of people, the incidence of peritrochanteric fractures has increased significantly. In the management of unstable peritrochanteric fractures intramedullary devices have proven advantage over extra-medullary ones. Proximal femoral nail antirotation (PFNA) is believed to be better in term of stability, rotational stability and lower cut out rate than proximal femoral nail (PFN), but is still controversial. This study was undertaken to compare the duration of surgery, intraoperative blood loss and duration of C arm fluoroscopy exposure, position of implant, varus collapse and screw cutout, and functional outcome via Harris Hip Score (HHS) between the intramedullary devices. Method: This was a prospective observational study conducted in patients with diagnosis peritrochanteric fractures treated either with PFN and PFNA in National Trauma Center and Civil Services Hospital from 1st May 2018 to 30th November 2019. Out of 48 patients, 24 in each group were included who met the inclusion criteria. Both the groups were followed at 1 month, 3 month and 6 month and were compared in term demographic variables, postoperative complication, and functional outcome via HHS. Result: PFNA has better outcome than PFN in term of mean operative time (48.33±17.2 vs 74.16±21.9 minutes), mean blood loss (80.41±32.19 vs 138.75±45.90 millilitre) and duration of fluoroscopy exposure (48.33±17.29 vs 74.16±21.95 second) respectively. The postoperative varus collapse and screw cut out were higher in PFN than PFNA. The HHS at 6 month follow up of PFNA group had better result than PFN with P < 0.001 (86.12±5.16 vs 75.16±10.11 respectively). Conclusion: PFNA is better in reducing operative time, blood loss and duration of fluoroscopy exposure. Post-operative complication is comparable but the functional outcome at 6 month follow up of PFNA is better than PFN.

Severe hepatitis-hydropericardium syndrome (HHS) associated with a novel viral genotype, fowl adenovirus 4 (FAdV-4), has emerged and widely spread in China since 2015, causing severe economic losses to the poultry industry. We previously reported that the hexon gene is responsible for pathogenicity and obtained a non-pathogenic hexon-replacement rHN20 strain; however, the lack of information about the non-essential regions for virus replication limits the development of a FAdV-4 vector. This study first established an enhanced green fluorescent protein (EGFP)-indicator virus based on the FAdV-4 reverse genetic technique, effective for batch operations in the virus genome. Based on this, 10 open reading frames (ORFs) at the left end and 13 ORFs at the right end of the novel FAdV-4 genome were deleted separately and identified as non-essential genes for viral replication, providing preliminary insertion sites for foreign genes. To further improve its feasibility as a vaccine vector, seven combinations of ORFs were successfully replaced with EGFP without affecting the immunogenicity of the vector backbone. Finally, a recombinant rHN20-vvIBDV-VP2 strain, expressing the VP2 protein of very virulent infectious bursa disease virus (vvIBDV), was rescued and showed complete protection against FAdV-4 and vvIBDV. Thus, the novel FAdV-4 vector could provide sufficient protection for HHS and efficient exogenous gene delivery. Overall, our findings systemically identified 23 non-essential ORFs for FAdV-4 replication and seven foreign gene insertion regions, providing valuable information for an in-depth understanding of the novel FAdV-4 pathogenesis and development of multivalent vaccines. [ABSTRACT FROM AUTHOR]

Severe hepatitis-hydropericardium syndrome (HHS) associated with a novel viral genotype, fowl adenovirus 4 (FAdV-4), has emerged and widely spread in China since 2015, causing severe economic losses to the poultry industry. We previously reported that the hexon gene is responsible for pathogenicity and obtained a non-pathogenic hexon-replacement rHN20 strain; however, the lack of information about the non-essential regions for virus replication limits the development of a FAdV-4 vector. This study first established an enhanced green fluorescent protein (EGFP)-indicator virus based on the FAdV-4 reverse genetic technique, effective for batch operations in the virus genome. Based on this, 10 open reading frames (ORFs) at the left end and 13 ORFs at the right end of the novel FAdV-4 genome were deleted separately and identified as non-essential genes for viral replication, providing preliminary insertion sites for foreign genes. To further improve its feasibility as a vaccine vector, seven combinations of ORFs were successfully replaced with EGFP without affecting the immunogenicity of the vector backbone. Finally, a recombinant rHN20-vvIBDV-VP2 strain, expressing the VP2 protein of very virulent infectious bursa disease virus (vvIBDV), was rescued and showed complete protection against FAdV-4 and vvIBDV. Thus, the novel FAdV-4 vector could provide sufficient protection for HHS and efficient exogenous gene delivery. Overall, our findings systemically identified 23 non-essential ORFs for FAdV-4 replication and seven foreign gene insertion regions, providing valuable information for an in-depth understanding of the novel FAdV-4 pathogenesis and development of multivalent vaccines.

Background/Objective: Teprotumumab, a novel treatment for thyroid eye disease (TED), which blocks the insulin-like growth factor 1 receptor, has been associated with improvement in proptosis and inflammatory ocular symptoms. In the original trials, hyperglycemia was reported in 5% to 12% of patients; however, none required hospitalization. We report a case of hyperglycemic hyperosmolar state after the first infusion of teprotumumab. Case Report: A 56-year-old woman with Graves’ disease, severe thyroid eye disease, and prediabetes presented with polyuria, polydipsia, nausea, abdominal pain, headache, dizziness, and a fall to the emergency department 3 weeks after her first teprotumumab infusion. She was noted to have serum glucose levels of 939 mg/dL, serum bicarbonate levels of 28 meq/dL, serum osmolality of 324 mOsm/kg, and trace ketones in urine. She was treated with intravenous fluids and insulin with subsequent improvement in clinical status and biochemical profile. She was then discharged on multiple daily injections of insulin. Discussion: Hyperglycemia is a known adverse effect of insulin-like growth factor 1 receptor inhibitors like teprotumumab. The incidence of hyperglycemia in the original trials was 5% to 12%. Most cases were mild and resolved with titration of current diabetes medications. No cases of hospitalization due to severe hyperglycemia or hyperglycemic hyperosmolar state have been reported until now. Conclusion: We intend to highlight the severity of hyperglycemia that could occur with the use of teprotumumab and the need for research to evaluate the true incidence of this condition.

Results from a single-institution study support the need of a dose constraint for patients who have previously undergone hip replacement surgery. Our study provides evidence that a dose above 30 Gy to the area of hip prosthesis is significantly correlated with later hip arthroplasty dysfunction as measured by the Harris Hip Score. As total hip arthroplasty becomes more and more common, it is urgent to further look into radiation therapy treatment parameters that can be modified to improve the quality of life of patients who receive pelvic irradiation after hip arthroplasty. Further prospective studies are needed to extract safe conclusions. [ABSTRACT FROM AUTHOR]

Abstract Background Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are life-threatening complications of diabetes mellitus which require prompt treatment with large volume crystalloid fluid administration. A variety of crystalloid fluids is currently available for use and differs in their composition and ion concentrations. While there are potential pros and cons for different crystalloid fluids, it remains unknown if any particular fluid confers a clinical outcome benefit over others in the treatment of hyperglycemic emergencies. Methods A systematic search of MEDLINE, Embase, and the Cochrane Library of Systematic Reviews will be conducted to identify eligible studies, which will include observational and interventional studies involving adult and pediatric patients admitted to the hospital with either DKA or HHS. The interventions will include intravenous treatment with 0.9% saline versus other buffered (Ringer’s lactate, Hartmann’s, etc.), and non-buffered (0.45% saline) crystalloid fluids. The primary outcome is mortality at the latest follow-up time point. Secondary outcomes will include mortality at specific time points, length of hospital stay, development of acute kidney injury, requirement for renal replacement therapy, altered level of consciousness, and the time to normalization of several serum biochemical parameters. Where appropriate, meta-analyses will be performed for the outcomes and conducted separately for adult and pediatric patient populations. Discussion DKA and HHS are dangerous complications of diabetes mellitus and account for significant morbidity and mortality. Given the importance of crystalloid fluid administration in the management of these conditions, a systematic synthesis of the existing evidence base will identify potential evidence gaps and may help guide future clinical practice.

Nivolumab is a monoclonal antibody directed against programmed cell death-1 receptor. It has an increasing application in the treatment of various advanced metastatic cancers. The incidence of autoimmune side effects associated with such agents is expected to increase. New-onset autoimmune diabetes mellitus associated with immune checkpoint inhibitor treatment is rare, occurring in less than 1% of patients. Nivolumab-induced diabetes often presents as diabetic ketoacidosis, which could be life-threatening if not recognized and treated promptly. We present the case of a patient who developed severe diabetic ketoacidosis concomitant with hyperosmolar hyperglycaemic state (HHS) after receiving nivolumab for metastatic testicular lymphoma. Pre-nivolumab blood glucose levels were normal, apart from transient hyperglycaemia related to steroids as part of the chemotherapy protocol. The diagnosis was confirmed with extremely low C-peptide in the clinic.

ABSTRACT: Hypervirulent fowl adenovirus serotype 4 (hvFAdV-4) has emerged as a major pathogen of hepatitis-hydropericardium syndrome (HHS) with increased mortality in chickens, resulting in economic losses to the Chinese poultry industry since June 2015. Here, we isolated a hypervirulent FAdV-4 (hvFAdV-4) strain (designated GD616) from 25-day-old meat-type chickens with severe HHS in Guangdong Province China in June 2017. The whole genome of the strain GD616 shares high homology with those in the recently-reported hvFAdV-4 isolates in China, with natural deletions of ORF19 and ORF27. A comparative analysis of Hexon and Fiber-2 proteins revealed that 2 unique amino acid residues at positions 378 and 453 of the Fiber-2 protein might be associated with virulence due to their occurrences in all the hvFAdV-4 isolates only. To systemically evaluate the effect of age on the susceptibility of chickens to hvFAdV-4, we used this hvFAdV-4 strain to intramuscularly inoculate 7- to 180-day-old specific-pathogen-free chickens for the evaluation of pathogenicity. These results showed that the pathogenicity of the hvFAdV-4 strain GD616 to chickens exhibited age-relatedness, with younger than 59-day-old chickens showing 100% morbidity and mortality, while 180-day-old chickens still exhibited a hydropericardium syndrome-like clinicopathology with 60% morbidity and 20% mortality. These findings enrich the current available knowledge regarding the pathogenicity of the hypervirulent FAdV-4 virus in chickens with a wide range of ages, which assists with the selection of suitable-aged chickens for the evaluation of hvFAdV-4 vaccines.

A 4‐year‐old English setter presented with a 1‐week history of anorexia, lethargy and occasional vomiting. Blood analysis revealed moderate regenerative anaemia, mild monocytosis, thrombocytopaenia, hypoproteinaemia, hypoglobulinaemia, hypocholesterolaemia and increased C‐reactive protein. On ultrasonography, the spleen had multifocal hypoechoic lesions. Fine needle aspirates from the spleen and liver showed marked extramedullary haematopoiesis, an increased number of histiocytes, haemosiderin deposits and erythrophagocytosis. A tentative diagnosis of haemophagocytic histiocytic sarcoma (HHS) was made, and the owners elected euthanasia. On autopsy, the liver and spleen were enlarged. The spleen had an uneven surface and a yellow‐tan spotted appearance. Histologically, the red pulp was highly cellular and dominated by erythroid cells, as well as a population of larger polygonal cells and aggregates of histiocytes. HHS was confirmed by CD11d immunolabelling. This represents the first documented case of HHS in an English setter. [ABSTRACT FROM AUTHOR]

Background: The lifetime implants is a key parameter that the surgeon should take into account at the time of the primary total hip arthroplasty (THA). The aim of this study was a clinical and radiographical evaluation of the Delta PF-FIT (LimaCorporate, Italy) THA system with ceramic-on-ceramic articulations. We have not found a clinical or radiographical assessment of this implant in available published literature.Methods: A total of 197 (F = 94, M = 103) primary THAs were evaluated in 163 patients with a mean follow-up of 7.7 years (range 5.1-11.2 years (SD ± 1.5)) Harris hip Score (HHS) and the Western Ontario and McMaster Universities Arthritis index (WOMAC) were used for the clinical evaluation. The statistical evaluation was processed by standard statistical methods. The study was approved by Ethic Committee of the University Hospital Motol (Reference No. EK-73/19).Results: The mean HHS score was found to be 97.59 points (61-100 range with a ± 5.13 SD, preoperative HSS was 51.21, range 28-73 with a ± 4,77 SD). 186 THAs were evaluated as excellent (90-100 points), 9 THAs rated as good (80-89 points), 1 THA was rated as fair (70-79) points and 1 THA rated as poor (less than 70 points). The mean WOMAC score was 97.38 points (65-100 range with a ± 5.18 SD, preoperative was 50,12, range 27-69 with a ± 4.85 SD). We documented an overall 99.49% Kaplan-Meier survival with a mean follow-up of 7.7 years with the FIT (LimaCorporate) stem revision and any component revision as the endpoint. With the Delta PF (LimaCorporate) cup revision as the endpoint, the survival was 100%. We have not found a previously published clinical or radiographical review of this THA system, the study shows a comparison with other THA implants.Conclusion: Evaluation of the Delta-PF-FIT (LimaCorporate, Italy) THA system with the use of ceramic-on-ceramic BIOLOX®Delta articulation surfaces shows very good outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Unstable intertrochanteric femoral fractures in the elderly require either fixation or joint sacrificing surgery; proximal femoral nail (PFN) and bipolar hemiarthroplasties (BPH) are the most common interventions. PFN is considered to be the ideal construct for these fractures; however, the usage of hemiarthroplasties to facilitate earlier mobilization has been on a rise. Currently there is no consensus on the superiority of one of these two techniques over the other and the present review was done to determine this.Research Question: Is PFN a better alternative to BPH for unstable intertrochanteric femur fractures in the elderly?Objective: The present systematic review and meta-analysis was conducted to determine the superiority of PFN over BPH by comparing the primary outcomes like mortality, Harris Hip scores (HHS), complications, and re-operations. Additionally, secondary outcomes like blood loss, duration of surgery, and period of hospital stays were also compared.Methodology: Three databases of PubMed, EMBASE, and SCOPUS were searched for relevant articles that directly compared PFN and BPH in unstable intertrochanteric femur fractures in the elderly.Results: We analyzed a total of seven studies published between the years 2005 to 2017. There were four retrospective and three prospective randomized controlled studies. The number of patients in these studies ranged from 53 to 303.Primary Outcomes: There was a significant difference in HHS between two groups with standard mean difference of - 0.51 (range - 0.67 to -0.36), favouring the PFN group. The rate of mortality was higher in the BPH group with odds ratio of 2.07 (range 1.40-3.08). Implant-related complications like fractures and subsidence were more in BPH group but this was not significant.Secondary Outcomes: Mean surgical time (standard mean difference 2.19) and blood loss (3.75) were significantly less in the PFN group. The duration of hospital stay was also found to be significantly less in the PFN group (2.66).Conclusion: Proximal femoral nails are superior to bipolar hemiarthroplasties for unstable intertrochanteric femoral fractures in the elderly. PFN imparts better functional outcomes and has lower rates of overall mortality. Additionally it is faster surgery, with lesser blood loss contributing to better results. [ABSTRACT FROM AUTHOR]

Emergency medicine providers commonly will encounter children with type 1 and type 2 diabetes. Unfortunately, the incidence of both is increasing, and the acute care provider must be able to recognize the subtle and dramatic presentations of both diseases. Early recognition and management of both the disease and its complications — diabetic ketoacidosis, hyperglycemic hyperosmolar state, and cerebral edema — are critical to ensure an optimal outcome. [ABSTRACT FROM AUTHOR]