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Since 2014, the VA-LCP Condylar Plate 4.5/5.0, Depuy Synthes, has been the preferred implant for these injuries at our institution, however, speculations have been made whether it is more prone to failure compared to other implants. Thus, the aim of the study was to describe the cohort treated with the VA-LCP Condylar Plate 4.5/5.0, Depuy Synthes, at our department from 2014 to 2020, including the number of failures. Secondary, whether specific outcome measures were significantly overrepresented in the failure group. Patients were identified through the hospital database, and demographic data was extracted from patient files. X-rays were evaluated for injury type, osteosynthesis characteristics, and whether the construct failed during follow-up. Thanks to the national patient record database a minimum of patients was lost to follow-up. After exclusion 159 patients (165 osteosyntheses, descriptive part) and 108 patients (112 osteosyntheses, subgroup analysis) were eligible for inclusion. The VA-LCP Condylar Plate 4.5/5.0, Depuy Synthes, was used for most AO-type fractures and inserted as both neutralization, buttress, and bridging plates. Overall failure was seen in 8 % of osteosyntheses. Significantly more failures were seen in patients with increased Body Mass Index (BMI) (24 vs. 32, p = 0,046) and those treated for a periprosthetic fractures (41 % vs. 89 %, p = 0,005). We did not see an association between failure and plate length, bridge span, screw density or the degree of medial support. The VA-LCP Condylar Plate 4.5/5.0, Depuy Synthes is a versatile plate with failure rates comparable to previously reported studies. This study confirmed that elevated BMI may be a risk factor for failure, while other previously reported risk factors were not associated with failure in this study. [ABSTRACT FROM AUTHOR]

The primary objective of this research was to meticulously evaluate the therapeutic potential of steroid nebulization, administered over a 2-week period post-tracheostomy, in attenuating postoperative complications with a concentrated emphasis on tracheal stenosis. The study spanned three years, commencing in 2019 and concluding in 2022, examining a patient cohort of 400 individuals. Utilizing a retrospective cohort methodology, the participants were systematically stratified into two cohorts: those subjected to steroid nebulization (n = 200) and a control group (n = 200). Adverse outcomes were bifurcated into minor complications, which encompass stomal infections and inflammations, and major complications, which include bleeding, tracheoesophageal fistula, and tracheal stenosis. These complications were evaluated at distinct post-operative junctures: 1 week, 1 month, 3 months, and 6 months. The primary outcome was deduced through a rigorous multivariate logistic regression model, incorporating variables such as age, sex, and the diagnosis of chronic obstructive pulmonary disease (COPD). Analytical data unveiled that the cohort administered with steroid nebulization manifested a statistically significant diminution in the incidence of complications when juxtaposed with the control group (25 vs. 38%). Predominantly, the incidence of tracheal stenosis was discernibly lower in the steroid nebulization group (10 vs. 22%). The multivariate analytical framework further corroborated the pivotal role of steroid nebulization in substantially reducing the propensity for tracheal stenosis. The therapeutic intervention of steroid nebulization in the aftermath of a tracheostomy procedure presents a commendable avenue in curtailing major complications, with an acute focus on tracheal stenosis. To fortify these preliminary findings, it is quintessential to undertake more exhaustive studies, such as randomized controlled trials, to ascertain the optimal regimen concerning nebulization's timing, dosage, and duration. [ABSTRACT FROM AUTHOR]

The objectives of the study were to compare the demographic characteristics, presenting complaints, timeliness of diagnosis, and treatments given to all patients diagnosed with obstructive hemivagina ipsilateral renal agenesis (OHVIRA) between the adolescent group (age 10-19) and the adult group (age 20 and above) and to propose a feasible screening test consisting of routine bedside ultrasound to detect renal anomalies in addition to pelvic ultrasound during the assessment of females with gynecologic complications in resource-limited settings. We conducted a retrospective cohort analysis of all patients with OHVIRA at our institution, Sabah Women and Children's Hospital, Malaysia, between the 2013 and 2022. Data were collected by reviewing patients' medical notes. There were a total of 18 patients diagnosed with OHVIRA from 2013 to 2022, aged 10-41 years old. Nine patients (50%) presented during adolescence. Most (88.9%) came with symptoms such as abdominal pain, urinary symptoms, abnormal uterine bleeding, foul-smelling vaginal discharge, and primary infertility, whereas only 2 patients (11.1%) were asymptomatic and diagnosed incidentally. Acute abdomen was more common in the adolescent group (P =.015). No significant difference was found on the side of the renal anomaly. Presenting symptoms vary and are often mimicked other gynecologic or surgical conditions, making the diagnosis difficult and delayed. Some patients were incidentally diagnosed while being managed for other problems, and it was not uncommon to have unnecessary surgery before the correct diagnosis was made. We suggest that all female patients with abdominal and pelvic complaints should be screened for renal anomaly during pelvic scan to improve diagnostic rates. [ABSTRACT FROM AUTHOR]

Aim: Elderly acute myeloid leukemia (AML) patients are often not treated with antileukemic therapy due to their poor overall health condition, leaving supportive care as the sole treatment option. Objective: To evaluate patient characteristics, treatment patterns and outcomes of elderly patients with AML who are treated with supportive care only. Methods: A retrospective analysis of elderly AML patients included in the Surveillance, Epidemiology and End Results-Medicare database from 2008 to 2015. Results: Of elderly patients with AML (n = 7665), 3209 (41.9%) received supportive care only. Their mean age was 79 years, 50.5% were males; 48.2% died during the first 3 months and 67.3% died during the first 6 months. 82.2% died within the first year; only 13.2% survived >12 months. 77.9% patients died due to leukemia. Conclusion: In elderly AML patients treated with supportive care only, older age, concurrent hypertension, chronic obstructive pulmonary disease, chronic kidney disease and acute myocardial infarction were identified as prognostic factors associated with decreased likelihood of survival. Ideally, these patients should be treated with antileukemic therapy in addition to supportive care, as most of them die from disease progression. This study analyzed data on elderly patients with acute myeloid leukemia (AML) who were only treated with supportive care. The source of this data was the Surveillance, Epidemiology and End Results (SEER)-Medicare database. Of the 7665 patients diagnosed with AML during 2008–2015, 3209 (41.9%) received supportive care only. Their mean age at index date was 79 years; slightly more than half of these were males (50.5%). Almost half of these patients (48.2%) died within the first 3 months and approximately two-thirds (67.3%) died within the first 6 months. Only a small proportion (13%) of these patients were alive after 1 year. These patients who were alive after one were likely to be in remission (there was decrease in the signs and symptoms of AML). The results of this study showed that elderly AML patients who only received supportive care were more likely to die early if they also had chronic kidney disease, chronic obstructive pulmonary disease, history of acute myocardial infarction or hypertension. As elderly AML patients may be in poor general health and have other diseases (comorbidities), this could be the reason why they may not be treated with antileukemic therapy. Instead of treatment with supportive care only, these patients should ideally receive antileukemic therapy in addition to supportive care. More research should be done to find alternate treatments for these elderly AML patients. [ABSTRACT FROM AUTHOR]

Background: Without treatment, acute myeloid leukemia (AML) is rapidly fatal. Nevertheless, a large proportion of elderly AML patients do not receive any treatment. Aim: To characterize the demographics, comorbidities, survival and prognostic factors of elderly AML patients who do not receive any AML treatment or supportive care (SC). Methods: A retrospective cohort analysis of the Surveillance, Epidemiology and End Results-Medicare database (2008–2015). Results: Of 7665 AML patients, 2373 (31%) did not receive any AML treatment or SC. The mean age was 80.4 years, 52.8% were males and 79.7% and 95.3% died within the first 60 and 180 days, respectively; 2.1% survived >12 months and only 5.5% of patients had remission or relapse codes populated. Conclusion: Older age, male gender, concurrent depression, ischemic heart disease, chronic kidney disease and benign prostatic hyperplasia were associated with a decreased likelihood of survival. Multiple factors contribute to the complex clinical status of these patients preventing intensive chemotherapy; they should still ideally be treated, at least with the best SC. An analysis of the data collected in the Surveillance, Epidemiology and End Results-Medicare database from 2008 to 2015 was performed. This database includes data collected by a national cancer registry on people diagnosed with cancer in the United States and those who enroll in Medicare. This study focused on acute myeloid leukemia (AML) patients who did not receive any AML treatment or supportive care (SC). Of 7665 patients with AML, 2373 (31%) did not receive any AML treatment or SC. At the time the data was indexed for each patient in the database, their mean age was 80.4 years and around 53% were males. Within the first 60 days, around 80% of these patients died; over 95% died within the first 180 days. Only 2% of patients survived more than a year without treatment; these patients were likely in remission. Without treatment, AML patients who were older, were male or who also had depression, ischemic heart disease, chronic kidney disease or benign prostatic hyperplasia had a higher chance of dying early. There could be many reasons why these patients are not treated. The main reasons are their poor health condition and the presence of two or more health conditions in a patient at the same time (comorbidities). However, they should still ideally be treated, at least with the best SC. Additional treatment options are urgently needed for elderly AML patients who have comorbidities and are in poor general health. [ABSTRACT FROM AUTHOR]

The incidence of in utero drug exposure (IUDE) and neonatal extracorporeal membrane oxygenation (ECMO) utilization have both increased over the past decade. However, there are no studies to date that examine the impact that IUDE has on neonates requiring ECMO. In this retrospective cohort study, we compared the clinic course and outcomes of neonates who were placed on ECMO with IUDE vs. neonates without IUDE. Analysis included data extracted from medical records from all neonatal ECMO runs between January 2014 and January 2021 at the University of Kentucky Children's Hospital. A total of 56 neonatal patients were placed on ECMO during this time period and there were a total of 57 ECMO runs. Nearly one-third of neonates (16) had documented IUDE. There were no differences in gestational age, length of ECMO run, survival to discharge, or number of major complications while on ECMO in the neonates with IUDE compared to those without. In contrast, greater use of sedative and analgesic adjuvant medications during ECMO was required for IUDE-ECMO cases (p

Minimally invasive glaucoma surgery (MIGS) is increasingly performed at the time of cataract extraction. Understanding the demographic and clinical characteristics of patients undergoing MIGS procedures may provide insight into patient selection. This study evaluates racial-ethnic and other differences in the use of MIGS in persons with cataract and open-angle glaucoma (OAG). Retrospective cohort study using Intelligent Research in Sight (IRIS) Registry data. Patients aged ≥ 40 years with a diagnosis of OAG and no history of MIGS or cataract surgery who were undergoing cataract extraction, with or without MIGS, during 2013 to 2017 in the United States. Multivariable logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Variables assessed include age, sex, race-ethnicity, disease severity, insurance type, census region, comorbidity, and cup-to-disc ratio (CDR). The odds of MIGS use was greater among patients who were aged ≥ 60 years (OR, 1.10 [95% CI, 1.05–1.16]); Black (OR, 1.11 [CI, 1.07–1.15]) compared with White; a Medicare recipient (OR, 1.12 [CI, 1.10–1.15]) versus privately insured; or in the Midwest (OR, 1.32 [CI, 1.28–1.36]) or Northeast (OR, 1.26 [CI, 1.22–1.30]) compared with the South. Having moderate rather than mild glaucoma (OR, 1.07 [CI, 1.04–1.11]) and a higher CDR (OR for 0.5 to 0.8 vs. <0.5, 1.24 [CI, 1.21–1.26]; OR for >0.8 to 1.0 vs. <0.5, 1.27 [CI, 1.23–1.32]) were also each associated with increased odds of MIGS use. Use of MIGS was less likely in women (OR, 0.96 [CI, 0.94–0.98]); patients taking 5 to 7 glaucoma medications (OR, 0.94 [CI, 0.90–0.99]) compared with 1 to 2 medications; and patients with severe, compared with mild, glaucoma (OR, 0.64 [CI, 0.61–0.67]). This analysis highlights the importance of capturing race-ethnicity data and other pertinent patient characteristics in electronic health records to provide insight into practice patterns. Such data can be used to assess the long-term performance of MIGS and other procedures in various patient populations. [ABSTRACT FROM AUTHOR]

Background: The use of living-donor kidney allografts with multiple vessels continues to rise in order to increase the donor pool. This requires surgeons to pursue vascular reconstructions more often, which has previously been associated with a higher risk of developing early post-transplant complications. We therefore wanted to investigate the prognostic role of using living-donor renal allografts with a single artery (SA) vs. multiple arteries (MA) at the time of transplant.Methods: We retrospectively analyzed a cohort of 210 consecutive living-donor kidney transplants performed between January, 2008 and March, 2019, and compared the incidence of developing postoperative complications and other clinical outcomes between SA vs. MA recipients.Results: No differences were observed between SA (N = 161) and MA (N = 49) kidneys in terms of the incidence of developing a postoperative (or surgical) complication, a urologic complication, hospital length of stay, delayed graft function, estimated glomerular filtration rate at 3 or 12 mo post-transplant, and graft survival.Conclusions: The use of live-kidney allografts with MA requiring vascular reconstruction shows excellent clinical outcomes and does not increase the risk of developing postoperative complications or other adverse outcomes when compared with SA renal allografts.

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a common psychiatric disorder in children/adolescents and occurs frequently with psychiatric/neurologic comorbidities. The objective of this study was to assess the impact of psychiatric/neurologic comorbidities on pharmacotherapy patterns among patients with ADHD in Sweden. Methods: A retrospective cohort analysis was conducted using medical records from a regional database in Sweden. Patients aged 6-17 years, with ≥1 prescription for ADHD medication between July 1, 2007 and June 30, 2009, and continuously active in the database for ≥12 months before and after their prescription index date were selected. Patients were categorized as ADHD alone (ADHD-only) or with comorbidities (ADHD-comorbid). Between-group differences were analyzed before and after adjusting for potentially confounding variables. Results: Data on 1794 patients (1083 ADHD-only; 711 ADHD-comorbid) were analyzed. Among newly treated patients, 21.7% augmented their index therapy (ADHD-only, 20.5%; ADHD-comorbid, 24.4%; p = 0.23). After adjustment, ADHD-only patients were less likely ( p = 0.002) to augment versus ADHD-comorbid patients [odds ratio = 0.44, 95% confidence interval (CI) 0.27, 0.73]. ADHD-comorbid patients received more prescriptions versus ADHD-only patients (mean 13.1 vs 10.0; p < 0.001), and had more outpatient visits (mean 11.9 vs. 8.1; p < 0.001) and hospitalizations (10.7% vs. 6.0%; p < 0.001). After adjustment, ADHD-only patients had fewer outpatient visits ( p < 0.001) and referrals ( p < 0.001) versus ADHD-comorbid patients (visits: β = −0.21, 95% CI −0.28, −0.13; referrals: β = −0.25, 95% CI −0.33, −0.18). Conclusion: Patients with ADHD with comorbidities had more hospitalizations, physician visits, and medication prescriptions during 12 months' follow-up than did those with ADHD alone. ADHD therapy augmentation was prevalent among children/adolescents with ADHD, even among those without psychiatric/neurologic comorbidities. [ABSTRACT FROM AUTHOR]

Background: Recent studies have suggested shared comorbidities between heart failure and osteoporosis. In addition, patients with osteoporosis are associated with increased risks of developing cardiovascular disease.Methods: A retrospective cohort analysis was conducted to determine the association between osteoporosis and heart failure. Data was from the Longitudinal Health Insurance Database 2000 (LHID 2000), Taiwan. Patients with newly diagnosed osteoporosis were identified, and osteoporosis-free controls were randomly selected from the general population and frequency matched according to age, sex, and index year using the LHID 2000. We analyzed the risks of heart failure using Cox proportional-hazards regression models.Results: During the mean follow-up of 7.1 ± 3.5 years, the cumulative incidence of heart failure was 2.24% higher in the osteoporosis cohort than in the comparison cohort (p < .001). The overall incidence of heart failure was 10.3 versus 7.62 per 1000 person-years in osteoporosis patients and controls, respectively, with an adjusted HR of 1.13 (95% CI = 1.06-1.21).Conclusion: We observed a higher incidence of developing heart failure in Taiwanese adults with osteoporosis, especially in those with chronic comorbidities. There might be linking pathophysiology and mechanisms from osteoporosis to heart failure. [ABSTRACT FROM AUTHOR]

The incidence of in utero drug exposure (IUDE) and neonatal extracorporeal membrane oxygenation (ECMO) utilization have both increased over the past decade. However, there are no studies to date that examine the impact that IUDE has on neonates requiring ECMO. In this retrospective cohort study, we compared the clinic course and outcomes of neonates who were placed on ECMO with IUDE vs. neonates without IUDE. Analysis included data extracted from medical records from all neonatal ECMO runs between January 2014 and January 2021 at the University of Kentucky Children's Hospital. A total of 56 neonatal patients were placed on ECMO during this time period and there were a total of 57 ECMO runs. Nearly one-third of neonates (16) had documented IUDE. There were no differences in gestational age, length of ECMO run, survival to discharge, or number of major complications while on ECMO in the neonates with IUDE compared to those without. In contrast, greater use of sedative and analgesic adjuvant medications during ECMO was required for IUDE-ECMO cases ( p  < 0.01). Trending results indicated that post-ECMO feeding complications and total hospitalization length were also greater in the IUDE-ECMO group. These findings illustrate the complex influence of prenatal drug exposures on neonatal patient care and warrant the development of clinical care strategies optimized for this unique patient group., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Walther, Schadler, Garlitz, Bauer, Kohler, Waldsmith and Ballard.)

Abstract: Background/Purpose: Preterm infants needing patent ductus arteriosus (PDA) ligation are transferred to a pediatric cardiac center (CC) unless the operation can be done locally by a pediatric surgeon at a non-cardiac center (NCC). We compared infant outcomes after PDA ligation at CC and NCC. Methods: We analyzed 990 preterm infants who had PDA ligation between 2005 and 2009 using the Canadian Neonatal Network database. In-hospital mortality and major morbidities were compared between CC (n =18) and NCC (n =9). Results: SNAP-II-adjusted mortality rates were similar (CC=8.7% vs NCC=10.7%, P =.32). Significant cranial ultrasound abnormalities (CC=24.1% vs NCC=32.1%, P <.01) and culture-proven sepsis (CC=39.7% vs NCC=54.8%, P <.01) were more frequent in infants treated at NCC. Infants transferred to CC had higher rates of cranial ultrasound abnormalities (transferred 31.6% vs non-transferred 20.4%, P <.01). NSAIDs prior to PDA ligation were used more often at NCC (CC 36.6% vs NCC 75.6%, P <.001). Conclusions: Mortality rates after PDA ligation were similar at CC and NCC, but cranial ultrasound abnormalities and sepsis rates were higher at NCC. Higher morbidity may be associated with different PDA management strategies, including NSAID use or infant transfer. Further studies are needed to investigate the reasons for these differences in morbidity. [Copyright &y& Elsevier]

Background: The use of living-donor kidney allografts with multiple vessels continues to rise in order to increase the donor pool. This requires surgeons to pursue vascular reconstructions more often, which has previously been associated with a higher risk of developing early post-transplant complications. We therefore wanted to investigate the prognostic role of using living-donor renal allografts with a single artery (SA) vs. multiple arteries (MA) at the time of transplant. Methods: We retrospectively analyzed a cohort of 210 consecutive living-donor kidney transplants performed between January, 2008 and March, 2019, and compared the incidence of developing postoperative complications and other clinical outcomes between SA vs. MA recipients. Results: No differences were observed between SA ( N = 161) and MA ( N = 49) kidneys in terms of the incidence of developing a postoperative (or surgical) complication, a urologic complication, hospital length of stay, delayed graft function, estimated glomerular filtration rate at 3 or 12 mo post-transplant, and graft survival. Conclusions: The use of live-kidney allografts with MA requiring vascular reconstruction shows excellent clinical outcomes and does not increase the risk of developing postoperative complications or other adverse outcomes when compared with SA renal allografts., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Garcia, Parra, Gaynor, Baker, Guerra and Ciancio.)

Objective: To assess the risk factors for shoulder dystocia in Jamaica.Methods: A retrospective cohort analysis of all cases of shoulder dystocia, and birth weight-matched controls identified from January 1, 2000 to December 31, 2004. Multiple factors were analyzed individually and in combination to identify risk factors.Results: The incidence of shoulder dystocia was 0.83%. Nulliparity, a first stage of labor greater than 7 hours, a second stage lasting more than 1 hour, and use of oxytocin augmentation were found to be statistically significant factors with unadjusted odds ratios (95% confidence interval) of 1.78 (0.86-3.34), 1.89 (0.91-3.94), 2.78 (0.24-31.47), and 1.56 (0.77-3.15), respectively. The incidence of shoulder dystocia decreased as parity increased when adjusted for age.Conclusion: Individual risk factors for shoulder dystocia remain obscure. The nulliparous pelvis, when controlled for neonatal weight, was associated with a statistically increased risk of shoulder dystocia; this risk decreased with increasing parity. [ABSTRACT FROM AUTHOR]

Background: Metronidazole (MTZ) is a synthetic derivative of nitroimidazole that has been widely used for the treatment of several bacterial and parasitic infections including trichomoniasis, amoebiasis, giardiasis, liver abscess, gingivitis, syphilis and phagedena. Scientists have evaluated its carcinogenicity in preclinical in vitro and in vivo studies., Method: Google scholar and Pubmed search engines were used to construct historic timeline after discovery of MTZ with a journey of ~3 decades of research. Similar search was conducted for its in vivo carcinogenic activities, further extended to elaborate its role in carcinogenicity in humans., Results: In addition to preclinical in vitro validation of DNA damage, MTZ has been reported to induce cancer in a variety of animal models including lung cancer, malignant lymphomas, breast cancer, hepatocellular carcinoma, pituitary tumors, testicular neoplasms and uterine cancer. Several retrospective cohort studies have reported MTZ as a potential risk factor for lung cancer (n = 771), cervical cancer (n = 2500), breast cancer (n = 2), cholangiocarcinoma (n = 1), and neuroblastoma (n = 28). So far, all the reported data have confirmed MTZ carcinogenicity in animals; however it is still controversial in humans. Based on previous observations, the oxidative metabolites from MTZ are shown to have more carcinogenic effects than the parent drug itself., Conclusion: Due to potent carcinogenic behaviour, use of MTZ for animals' treatment and its uses in animal food products is prohibited in USA and European countries; however its clinical use in human population is still increasing. Therefore, regular research studies are required to explicate its mechanism/s involved in carcinogenesis., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Background: Human immunodeficiency virus (HIV) associated tuberculosis (TB) remains a major global public health challenge, with an estimated 1.4 million patients worldwide. Co-infection with HIV leads to challenges in the diagnosis and treatment of patients., Objectives: The aim of this study was to assess treatment outcomes of a cohort of smear positive TB-HIV co-infected patients over a five-year study period., Methods: A retrospective cohort study of 600 smear-positive tuberculosis patients registered at the chest unit of the University of Nigeria Teaching Hospital, Enugu from January 2008 to December 2012 was done. The data was analyzed using SPSS Version 17., Results: One hundred and three (17.2%) of the patients were co-infected with TB/HIV, while 398 (66.3%) and 99 (16.5%) were HIV negative and unknown respectively. Among the co-infected patients, 45(43.7%) were cured as against 222(55.8%) in the TB-HIV negatives (Z=4.53, p=0.000, 95%CI= 0.12-0.34). Respectively in the TB-HIV co-infected and TB-HIV negative patients, treatment completed were 21(20.4%) and 71(17.8%) (Z=9.15, p=0.000, 95%= 0.4035-0.60); defaulted 19(18.5%) vs 70 (17.6%) (Z=9.29, p=0.000, 95%CI=0.42-0.60), died 10(9.7%) vs. 6(1.5%) (Z=1.22, p=0.224, 95%CI= -0.0286-0.1086), and failures were 1(0.9%) vs. 7(1.8%) (Z=2.48, p=0.013, 95%CI=0.04-0.10). Treatment success rate was lower in TB-HIV co-infected patients, 64.1% compared to TB-HIV negative patients with 73.6%. Also those that defaulted among the TB-HIV co-infected patients (18.5%) were higher than 17.6% among TB-HIV negative patients, a difference of 0.9%., Conclusion: Findings demonstrate that HIV co-infection affects TB treatment outcomes adversely. Treatment adherence, timely and sustained access to antiretroviral therapy for TB/HIV co-infected patients are important.