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PURPOSE OF REVIEW: To evaluate the current evidence and literature on treatment options for proximal hamstring injuries. RECENT FINDINGS: Patients with 3-tendon complete tears with greater than 2 cm of retraction have worse outcomes and higher complication rates compared to those with less severe injuries. Endoscopic and open proximal hamstring repair both have favorable patient reported outcomes at 5-year follow up. Proximal hamstring repair in patients who are male, with isolated semimembranosus injury, and have proximal hamstring free tendon rupture are more likely to have earlier return to sports. The Parisian Hamstring Avulsion Score (PHAS) is a validated patient-reported outcome measure to predict return to sports. Proximal hamstring injuries may occur in both elite and recreational athletes and may present with varying degrees of chronicity and severity. Injuries occur most commonly during forceful eccentric contraction of the hamstrings and often present with ischial tuberosity tenderness, ecchymosis, and hamstring weakness. Treatment decision-making is dictated by the tendons involved and chronicity. Many proximal hamstring injuries can be successfully treated with non-surgical measures. However, operative treatment of appropriately indicated proximal hamstring tendon injuries can result in significantly better functional outcomes and faster and more reliable return to sports compared to nonoperative treatment. Both endoscopic and open surgical repair techniques show high satisfaction levels and excellent patient-reported outcomes at short- and mid-term follow-up. Postoperative rehabilitation protocols vary across the literature and ongoing study is needed to clarify the optimal program, though emphasis on eccentric hamstring strengthening may be beneficial.

Aim: Androgen receptor pathway inhibitors (ARPIs) prolong metastasis-free survival and overall survival in patients with nonmetastatic castration-resistant prostate cancer (nmCRPC). This study aimed to evaluate real-world treatment patterns, utilization and survival outcomes in patients with nmCRPC. Patients & methods: This retrospective cohort study used Optum database electronic health records of patients with nmCRPC from 1 January 2007 to 31 December 2020 in the US. Results: Of 1955 patients, >80% received androgen-deprivation therapy (ADT) alone or ADT + first-generation nonsteroidal antiandrogen (NSAA) as first-line treatment, while only 8.24% received ADT + ARPI. ADT + ARPI remained underutilized even among those with high-risk nmCRPC. Further, ADT + NSAA had no survival benefit compared with ADT alone. Conclusion: Practice-improvement strategies are needed for treatment intensification with ARPIs for patients with nmCRPC. Plain Language Summary Prostate cancer cells often use hormones called androgens to grow and survive. Hormone therapy is a treatment that lowers the amount of these hormones in the body to slow down the cancer's growth. It includes androgen-deprivation therapy (ADT), which can either be used alone or along with nonsteroidal antiandrogens (NSAAs) or with androgen receptor pathway inhibitors (ARPIs). Nonmetastatic castration-resistant prostate cancer (nmCRPC) is defined as prostate cancer that has not spread to other parts of the body but exhibits rising levels of serum prostate-specific antigen despite surgery or ADT to reduce androgens. Research shows that ARPIs can improve survival in patients with nmCRPC, but more data on its use are needed. This study looked at the electronic health records of patients with nmCRPC to review the treatment they had received and their survival. Between 2008 and 2020, most patients received ADT alone or with NSAA. Even though the number of patients receiving ADT with ARPI increased during this period, it remained underused, even in patients with a high risk of cancer spreading to other body parts. Post-2018, even after 2 years of these drugs being available, only about one in five patients received ADT with ARPI. Also, people who received ADT with NSAA did not have a longer survival than patients treated with ADT alone. The study indicates that ARPIs, which could improve survival of patients with nmCRPC, are not being utilized optimally. Strategies that promote early use of ARPIs are needed to improve survival of patients with nmCRPC. In this retrospective observational cohort study, treatment patterns and survival outcomes of patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) were investigated using electronic health records from the Optum clinical database. During the study period between 1 January 2007 and 31 December 2020, patients with nmCRPC defined on the basis of recorded prostate-specific antigen (PSA) values after surgical or medical castration were identified as per the inclusion and exclusion criteria. First-line (1L) regimens included ADT alone, ADT + NSAA ± glucocorticoids (ADT + NSAA), ADT + ARPI ± glucocorticoids ± NSAA (ADT + ARPI) and "other," which included all remaining regimens. Between 2008 and 2020, most patients (>80%) were treated with ADT alone or ADT + NSAA as 1L treatment, and only 8% received ADT + ARPIs, suggesting that despite ARPIs having been approved and included in treatment guidelines, they remain underutilized, even in patients at a high risk of metastasis (PSADT ≤10 months or Gleason score ≥8). Approximately, 55% of patients with nmCRPC developed metastasis during follow-up, and 70% received a new regimen (metastatic 1L treatment); ADT + ARPI was the common metastatic 1L treatment (42%), 2L (44%) and 3L (36.5%) mCRPC regimen. Time to death was shorter in the ADT + NSAA cohort (median OS: 30.87 months, 95% CI: 28.2–35.73) than the ADT-alone cohort (median OS: 41.70, 95% CI: 37.63–45.60) with statistical significance (HR: 1.33, 95% CI: 1.16–1.52), suggesting that despite ADT + NSAA appearing to be associated with worse clinical outcomes than ADT alone, it still had higher utilization than ADT + ARPI. Healthcare professionals should recognize the limited efficacy of NSAA and consider using ARPIs to treat patients with severe disease. Practice-improvement strategies are needed to ensure early treatment with ARPIs in patients with nmCRPC. [ABSTRACT FROM AUTHOR]

Aim: This real-world study aimed to describe patient and clinical characteristics, treatment patterns and outcomes for patients with HR+/HER2- metastatic breast cancer receiving abemaciclib in France, Italy and Spain. Materials & methods: A multicenter chart review was conducted for adult females with HR+/HER2- advanced/metastatic breast cancer who received abemaciclib in routine care. Real-world progression-free survival (rwPFS) was estimated via Kaplan-Meier curves. Results: This study included 151, 173 and 175 patients from France, Italy and Spain, respectively. Abemaciclib was mostly prescribed as first-line therapy concomitantly with hormone therapy. Median rwPFS was >20 months and the 1-year rwPFS rate was >70%. Conclusion: Effectiveness was similar across the three countries and aligns with pivotal studies. Plain Language Summary Abemaciclib use in the clinic in France, Italy & Spain This study describes patients, the treatments they have received and the results of those treatments for patients with the most common type of advanced breast cancer. These patients were taking abemaciclib plus hormonal therapy in routine breast cancer care in France, Italy and Spain. The information used to conduct this study was taken from patients' medical charts. In this real-world study, abemaciclib was mostly used as the initial treatment for advanced breast cancer. Abemaciclib effectiveness was similar across the three countries confirming findings from previous studies. Our study supports the use of abemaciclib for patients with HR+/HER2- advanced breast cancer. Article highlights Patient & clinical characteristics Patients receiving abemaciclib in routine care in France, Italy and Spain were predominantly postmenopausal with a mean age of approximately 60 years. Breast cancer histological type at first diagnosis was predominantly nonspecific invasive carcinoma. Treatment patterns Abemaciclib was mostly prescribed in the first-line setting in combination with aromatase inhibitors or fulverstrant. Dosage Overall, most patients who initiated abemaciclib received a starting dose of 150 mg twice a day. Treatment discontinuation Range of discontinuation was between 45 and 55% across the three countries. Real world best tumor response & real-world progression free survival Real-world tumor response and rwPFS support the real-world use of abemaciclib for the treatment of HR+/HER2- advanced/metastatic breast cancer. Median rwPFS was ≥20 months for patients who received abemaciclib as first and second therapy lines across the three countries. Median rwPFS was highest for patients who received abemaciclib in the first-line setting. Healthcare resource utilization Levels of hospitalization remained low, and relatively constant, in the period immediately before treatment initiation and in the period after. Conclusion Our findings corroborate the effectiveness of real-world abemaciclib treatment for patients with advanced/metastatic breast cancer. [ABSTRACT FROM AUTHOR]

No evidence-based treatments exist for atypical anorexia nervosa (AAN) and little is known about differences in response to treatment between anorexia nervosa (AN) and AAN. The purpose of this paper is to explore treatment outcomes in two pilot trials for those with AN and AAN. Study 1 (N = 127) examined treatment outcomes in a digital imaginal exposure trial and Study 2 (N = 34) examined outcomes in a personalized treatment trial. Participants with an active eating disorder (ED) were eligible and those with AN or AAN were included in these analyses. ED symptoms and ED-related fears were assessed at pre-treatment, post-treatment, and one and six-month follow-up. Linear mixed effects models explored treatment outcomes by diagnosis. There were no significant differences in treatment response between diagnoses for most outcome measures. In Study 2, participants with AAN had a significant decrease in global ED symptoms across time, while AN did not. The samples were primarily white and female, limiting the generalizability of the studies. Additionally, due to limited consensus on "significant weight loss," a less conservative definition was used to diagnose AAN which may impact the results. In general, those with AN and AAN may respond to treatment similarly, with some small differences. Digital exposure therapy may be effective treatments for both AN and AAN, especially for ED-related fears. Personalized treatment may be more effective for those with AAN than those with AN. • Treatment response was similar between anorexia nervosa and atypical anorexia nervosa. • Online imaginal exposure therapy reduced global eating disorder symptoms and fears. • Larger reductions in eating disorder symptoms for atypical anorexia nervosa in personalized treatment [ABSTRACT FROM AUTHOR]

Ossification of the posterior longitudinal ligament of the cervical spine (C-OPLL) is a degenerative disorder that leads to the narrowing of the spinal canal and compression of both the spinal cord and nerve roots. This condition is more prevalent in East Asian populations, with marked regional variations in incidence. Symptoms include neck pain, restricted movement, limb numbness, and motor impairment. In severe cases, surgery may be required. Surgical strategies for C-OPLL can be divided into anterior and posterior approaches, each offering distinct advantages and limitations. Anterior approaches, such as anterior cervical corpectomy and fusion (ACCF), anterior cervical discectomy and fusion (ACDF), anterior floating method and vertebral body sliding osteotomy (VBSO), provide the benefit of direct decompression but are technically demanding and carry a higher risk of complications. In contrast, posterior approaches, including laminectomy (with or without instrumented fusion) and laminoplasty (LAMP), offer indirect decompression but may increase the risk of cervical kyphosis. In recent years, innovative techniques like anterior cervical ossified posterior longitudinal ligament en bloc resection (ACOE), anterior controllable antedisplacement and fusion (ACAF), and minimally invasive endoscopic spine surgery have been developed to reduce complications and enhance surgical outcomes. Selecting the appropriate surgical technique requires a thorough assessment of factors such as the severity of the lesion, cervical alignment, and the surgeon's experience. This narrative review examines the differences between these surgical options, discusses their respective advantages and disadvantages, and provides updated insights and recommendations. [ABSTRACT FROM AUTHOR]

Introduction: Pediatric Relapsing Polychondritis (RP) is a rare autoimmune disorder that causes inflammation and damage to cartilage in children. Common symptoms include pain, swelling and deformities in the ears, nose, trachea, joints, and eyes. The lack of research on the pediatric population necessitates further evaluation of the literature on pediatric RP to summarize existing patterns in presentation, management, and treatment. Methods: A systematic review was conducted on PubMed and Embase from 1947 to April 2023 on RP in patients under 21 years old abiding by the 2020 PRISMA checklist. Only patient presentations meeting McAdam criteria for RP and including information on management were included. Results: From the 304 initial studies, 54 studies were included for final analysis with a total of 68 patients, who were predominantly female (65%). With a median diagnostic delay of 1 year, the mean age of onset was 12 years old. The most common symptoms on presentation included bilateral auricular chondritis (69%), nasal cartilage inflammation (62%), and respiratory tract chondritis (63%). The most commonly reported information in the literature for the initial workup usually included CT/MRI (72%), bronchoscopy (57%), biopsy (51%), and labs (88%), which most commonly displayed elevated ESR (59%). The most common medications were corticosteroids (91%) and methotrexate (35%) and the most common procedural treatment was tracheostomy (38%). The most efficacious treatment options were monoclonal antibodies (87%, n = 15) and corticosteroids (66%, n = 62) used in 22% and 91% of patients, respectively. The most commonly used monoclonal antibody therapy was infliximab (13%, n = 9). Conclusion: The most common presentation for pediatric RP includes chondritis of the ear, nose, and respiratory tract. The most effective treatment options include corticosteroids and monoclonal antibody therapy, such as infliximab. Our findings highlight increasing remission achieved with anti-rheumatic drugs and monoclonal antibody treatment, especially alongside corticosteroids. [ABSTRACT FROM AUTHOR]

Background: Obstetrical fistula is an abnormal opening between the reproductive tract and lower urinary and/or gastrointestinal tract resulting from obstetrical complications, affecting nearly two million women worldwide. It imposes physical, economic, social, and mental consequences on the affected women. Treatment outcomes vary and, mostly, surgical treatment results in improved quality of life and successful subsequent pregnancy for survivors. Objectives: The review aimed to chart and examine the treatment outcomes of obstetrical fistula surgical repair in low‐ and middle‐income countries. Search Strategy: This is a scoping review study to identify treatment outcomes of obstetrical fistula surgical repair in low‐ and middle‐income countries. The search was conducted from databases (PUBMED, Embase, CINAHL, Scopus, and Web of Science), and gray literature (Google Scholar, Google, and conference proceedings). Selection Criteria: The eligibility criteria were constructed using a participant, concept, and context framework and included study types of primary research, reviews, and reports. Studies without full text and in languages other than English were excluded. Data Collection and Analysis: The relevant characteristics of the included studies were extracted on an Excel spreadsheet and analyzed to chart treatment outcomes. Main Findings: The review examined the full text of 57 studies on the treatment outcomes of obstetrical fistula. The findings were grouped into two themes: early and late outcomes. The early outcomes included incontinence, surgical‐site infection, urine retention, hemorrhage, and retained catheter. The late outcomes included fistula recurrence, residual incontinence, quality of life, reproductive issues, mental health, family and social support, and financial status. Conclusion: The treatment outcomes of obstetrical fistula can be grouped into short‐term and long‐term outcomes. Although this review found adequate studies for the analysis, most study designs were poor. Stronger studies are recommended in the future to guide policy and decision‐making. We would like to suggest that researchers conduct systematic reviews and meta‐analyses independently for short‐term and long‐term outcomes. Synopsis: Scoping review that charts and categorizes obstetrical fistula surgical repair outcomes in low‐ and middle‐income countries; presenting two main categories: early and late outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This study systematically reviews and meta-analyses the extent of ethnic minority representation in neuro-oncology Phase III and IV clinical trials, explores the effect of ethnicity on outcomes, and identifies predictors for the inclusion of ethnicity data in publications. Methods: Adhering to PRISMA guidelines, we conducted a comprehensive literature search across multiple databases, on Phase III and IV trials in neuro-oncology that reported on adult and/or paediatric subjects. Through meta-analysis, we synthesized information on overall survival, event-free survival, and the incidence of adverse outcomes across ethnicities. Results: From 448 identified articles, a fraction reported ethnicity data, with an even smaller number providing outcome data stratified by ethnicity. Most study participants were identified as White, underscoring a significant underrepresentation of minorities. Our meta-analysis did not reveal significant outcome differences by ethnicity, which may be attributed to the limited and inadequate reporting of data. Predictors for including ethnicity data were identified, including trials in North America(OR2.39, 95%CI 1.18–5.12, p < 0.02),trials of drugs or biologic agents(OR 5.28, 95%CI 1.43–3.42, p < 0.05),and trials funded by charities(OR 2.28, 95% CI 1.04–5.27, p < 0.05) or pharmaceutical companies(OR 3.98, 95% CI 1.60–10.0, p < 0.005). Conclusion: The underrepresentation of minorities in neuro-oncology clinical trials and the inadequately characterized impact of ethnicity on treatment outcomes highlight a critical need for more inclusive recruitment strategies and improved reporting standards. Change is necessary to ensure trials reflect the diversity of the patient population, which is essential for developing tailored strategies and improving outcomes. Future research should prioritize understanding the role of ethnicity in neuro-oncology to facilitate personalized treatment approaches. [ABSTRACT FROM AUTHOR]

Background: Seventy percent of epileptic patients may not experience seizures if they receive proper treatment with antiepileptic drugs (AEDs). However, many children and adolescents face poor seizure control (PSC). Therefore, the purpose of this review is to systematically and quantitatively summarize the pooled prevalence of PSC and its predictors among children with epilepsy in Ethiopia. Methods: The following databases were used to conduct a thorough literature search: Africa Journal of the Online Library, Hinari, Google Scholar, PubMed, Science Direct, EMBASE, Cochrane Database, Sci-Hub, and Scopus. To evaluate the quality of the studies, Newcastle‒Ottawa Scale (NOS) checklists were utilized. The data on study characteristics and prevalence estimates were then combined via random effects meta-analysis, followed by subgroup and sensitivity analyses. Both visual and statistical analyses were employed to assess for any potential publication bias. Results: This review analyzed a total of 12 main studies and reported that the overall prevalence of PSC was 42.42% (95% CI: 33.42–51.42). However, there was significant heterogeneity in the results based on the study region, design, and seizure-free period. The subgroup analysis revealed that the highest prevalence of PSC was found in Southern Nations, Nationalities, and Peoples' (SNNPs) studies (61.88%; 95% CI: 35.91–87.85), studies with a cross-sectional design (46.73%; 95% CI: 36.83–56.62), and studies with a seizure-free period < 6 months (44.69%; 95% CI: 34.51–54.86). However, the lowest prevalence was observed in the Amhara region (35.54%; 95% CI: 27.40–43.67), cohort studies (29.53%; 95% CI: 21.26–38.21), and studies with a seizure-free duration of six months or more (41.64%; 95% CI: 29.94–53.35). The results also revealed a significant correlation between PSC and medication nonadherence (4.64, 95% CI: 2.84–7.58), comorbidities (2.08, 95% CI: 1.01–4.26), and seizure type (3.59, 95% CI: 1.18–10.8). Conclusion: Based on this review, the findings suggest a notable prevalence of poorly controlled seizures (PSC) among children with epilepsy who are receiving antiepileptic drugs (AEDs) in Ethiopian outpatient epilepsy clinics. Seizures of tonic‒clonic status, comorbidities, and medication nonadherence were associated with poor seizure control. [ABSTRACT FROM AUTHOR]

AbstractMultiple myeloma is a hematologic malignancy that predominantly affects older individuals, in whom frailty is prevalent. Frailty is a clinical syndrome characterized by decreased reserve and increased vulnerability to stressors, leading to decreased functional capacity. Frailty is prevalent in older individuals and negatively impacts treatment outcomes. In this review, we summarize the tools and strategies used to assess frailty in patients with multiple myeloma, review data describing treatment outcomes in frail adults with multiple myeloma using clinical trial and real-world evidence and evaluate the potential relationship of frailty with quality of life and patient-reported outcomes during therapy for multiple myeloma. Frailty-adapted therapy for MM has the potential to improve treatment outcomes for older adults with myeloma. [ABSTRACT FROM AUTHOR]

ObjectiveMethodResultsConclusion\nKEY POINTSSome research suggests treatment outcome can be improved through more frequent therapy session scheduling. It is unknown how frequently Australian psychologists see their clients in routine practice. The present study investigated psychologists’ self-reported session-scheduling, attitudes, and perceived barriers towards more frequent scheduling.Using mixed methods, 246 psychologists completed an online survey, and 16 psychologists participated in qualitative interviews.Most psychologists had positive attitudes towards greater session frequency and perceived increased frequency to be associated with better outcomes, but a significant proportion scheduled sessions at suboptimal frequencies. Various barriers found confirmed previous literature findings, and enablers such as flexible scheduling and funding solutions were identified.Psychologists were willing to schedule sessions more frequently if sessions were more affordable to clients, and if they had a schedule able to accommodate more frequent sessions.What is already known about this topic: The prevalence of mental health in Australia has remained high over time.Weekly and greater frequency of therapy sessions is associated with better treatment outcomes for many clients and presentations.Some barriers may limit the capacity of psychologists to offer more frequent sessions.The prevalence of mental health in Australia has remained high over time.Weekly and greater frequency of therapy sessions is associated with better treatment outcomes for many clients and presentations.Some barriers may limit the capacity of psychologists to offer more frequent sessions.What this topic adds: Results indicated that session frequency is typically lower than ideal in routine psychology practice.In addition to barriers, various enablers conducive to more frequent scheduling were identified such as scheduling flexibility, strategic booking, funding solutions and reducing caseload.Strategies such as advocacy campaigns and increased education were identified as possible means to subvert these barriers.Results indicated that session frequency is typically lower than ideal in routine psychology practice.In addition to barriers, various enablers conducive to more frequent scheduling were identified such as scheduling flexibility, strategic booking, funding solutions and reducing caseload.Strategies such as advocacy campaigns and increased education were identified as possible means to subvert these barriers. [ABSTRACT FROM AUTHOR]

Purpose: Existing literature lacks an analysis of factors predicting the achievement of minimum clinically important differences (MCID) after water vapor thermal therapy (WVTT) for prostatic hyperplasia. This study aims to identify these predictors over a 36-month post-WVTT period. Methods: This prospective single surgeon case series assessed male patients receiving WVTT. Eligibility criteria included being at least 45 years old, having an estimated prostate volume (EPV) of 30–80 cc, an International Prostate Symptom Score (IPSS) of 12 points or more, and a maximum urinary flow rate (Qmax) under 16 mL/sec. MCID, representing the smallest symptomatic improvement perceived by patients, was calculated using the distribution-based method, considering half a standard deviation of baseline IPSS scores. Correlation and linear regression analyses assessed MCID attainment. Multivariable logistic regression evaluated MCID achievement, considering multicollinearity, heteroskedasticity, and normality. Results: Of 206 men with a median 29.1-month follow-up (Range: 24–36), 13.6% didn't achieve MCID for IPSS, and 7.2% for QoL scores. Significant hindrances to MCID attainment for IPSS were a large median lobe (> 10 mm protrusion) (OR = 3.01, 95% CI: 2.3–3.72), increased median lobe treatments (OR = 1.73, 95% CI: 1.23–2.35), and high preoperative irritative IPSS scores (OR = 1.25, 95% CI: 1.13–1.38). Factors for QoL MCID non-achievement included age over 75 (OR = 1.25, 95% CI: 1.13–1.38), a large median lobe (OR = 1.87, 95% CI: 1.62–2.01), and EPV over 60 cc (OR = 1.55, 95% CI: 1.16–1.97). A 6.3% surgical re-intervention rate was noted. Conclusions: The characteristics of the median lobe as well as the severity of lower urinary tract symptoms are crucial for treatment success. These should be integral to preoperative assessments and patient discussions on treatment options. [ABSTRACT FROM AUTHOR]

Background: This study investigates the clinical efficacy and safety of percutaneous endoscopic nucleotomy combined with platelet-rich plasma (PRP) injection in treating lumbar disc herniation (LDH) in young and middle-aged adults. Methods: From April 2022 to September 2023, 60 patients diagnosed with LDH were randomly divided into two groups (n = 30/group). The observation group underwent percutaneous endoscopic nucleotomy combined with autologous PRP gel injection into the disc, while the control group underwent percutaneous endoscopic nucleotomy alone. Visual Analogue Scale (VAS) scores and Oswestry Disability Index (ODI) scores were recorded preoperatively and at three time points postoperatively: three days, three months, and six months. The modified Macnab criteria were employed to evaluate efficacy at the final follow-up. Additionally, MRI Pfirrmann grading of the operated disc segment and potential complications were assessed both preoperatively and at the final follow-up. Results: All patients were followed for a minimum of six months. VAS and ODI scores at all postoperative time points (three days, three months, and six months) exhibited significant differences compared to preoperative scores in both groups (P < 0.05). Notably, a significant difference was observed in VAS and ODI scores between the two groups at three days postoperatively (P < 0.05). Preoperative MRI Pfirrmann grading indicated no significant difference between groups (P = 0.669). However, at the final follow-up, the observation group demonstrated superior recovery compared to the control group (P = 0.013). The modified Macnab criteria revealed no significant difference in the rates of excellent and good outcomes between the observation group (96.67%) and the control group (93.33%) (P > 0.05). Furthermore, no patients experienced complications such as dural tears, nerve root injury, infection, or hematoma. Conclusion: The combination of percutaneous endoscopic nucleotomy and PRP injection could be a safe and effective treatment for LDH in young and middle-aged adults to promote disc repair following endoscopic procedures. [ABSTRACT FROM AUTHOR]

Background: Headache disorders, including migraine, pose a significant burden globally, with varying prevalence rates across different regions. However, research on migraine in Nigeria and other low-income countries is limited. Understanding the prevalence, characteristics, and treatment outcomes of migraine in Nigeria is essential for informing healthcare policies and improving patient care. Methods: This systematic review and meta-analysis aimed to synthesize existing literature on migraine prevalence, characteristics, and treatment outcomes in Nigeria. Eligible studies were identified through comprehensive searches of multiple electronic databases and grey literature sources. Studies reporting migraine prevalence, diagnostic criteria, treatment modalities, and outcomes were included. Data extraction and quality assessment were performed following established guidelines. Results: Ten studies involving 7,768 participants met the inclusion criteria and were included in the meta-analysis. The pooled prevalence of migraine headache in Nigeria was calculated to be 16% (95% CI = 7–28), with significant heterogeneity observed among studies (I² = 99.35%, P < 0.001). Subgroup analysis revealed a higher prevalence of migraine among women compared to men. Common triggers for migraine included physical activity, sleep deprivation, mental and physical fatigue, and emotional stress. Treatment modalities varied, with simple analgesics, NSAIDs, ergotamine derivatives, and amitriptyline being commonly used. However, many participants reported inadequate pain relief or significant side effects, highlighting the need for improved management strategies. Conclusion: The findings of this systematic review and meta-analysis underscore the significant burden of migraine in Nigeria and the need for improved healthcare policies and interventions. Addressing gaps in access to specialized care and implementing more effective treatment regimens could help alleviate the burden of migraine on individuals and healthcare systems in Nigeria. Further research is needed to standardize diagnostic criteria and methodologies and provide more reliable prevalence estimates. [ABSTRACT FROM AUTHOR]

Purpose: Immune checkpoint inhibitors (ICIs) have improved lung cancer treatment but are associated with immune-related adverse events (irAEs). This study analyzes the relationship between irAEs and treatment effectiveness in advanced non-small cell lung cancer (NSCLC) patients. Methods: We conducted a retrospective study of NSCLC patients treated with ICIs from March 2019 to October 2022 at Zhongshan Hospital (Xiamen). Patients were divided into irAE and non-irAE groups, and treatment outcomes were compared. Results: A total of 154 patients were included, with 36.4% in the irAE group and 63.6% in the non-irAE group. Most irAEs were Grade 1–2 (86.4%), with 13.6% being Grade 3 or higher. The irAE group had higher disease control rates (DCR: 94.6% vs. 76.5%, P = 0.004) and objective response rates (ORR: 42.9% vs. 26.5%, P = 0.037). Median progression-free survival (PFS) was longer in the irAE group (18 vs. 9 months, HR: 0.53, P = 0.001), as was overall survival (OS: 39.5 vs. 16 months, HR: 0.46, P = 0.001). Landmark analysis at 6 and 12 weeks confirmed that irAEs were associated with improved outcomes. Moreover, patients who experienced two or more adverse events during treatment had significantly longer OS compared to those who had only one or no adverse events (41.6 months vs. 34.0 vs. 23.6, P = 0.003). Conclusion: Patients with irAEs demonstrated better outcomes, including ORR, DCR, PFS, and OS. Further studies on biomarkers and irAE incidence are warranted to improve lung cancer management. [ABSTRACT FROM AUTHOR]

Endovascular embolization procedures are typically the primary treatment modality for arteriovenous fistula (AVF). The objective of this subset analysis was to evaluate the prospective long-term clinical outcomes of AVF patients treated with the SMART COIL System. Patients who had AVFs and underwent endovascular coiling using the Penumbra SMART COIL system were part of a subset analysis within the SMART registry. The SMART registry is a postmarket registry that is prospective, multicenter, and single-arm in design. After the treatment, these patients were monitored for a period of 12 ± 6 months. A total of 41 patients were included. No patients (0/41) had a procedural device-related serious adverse event (SAE). Reaccess involving a guidewire due to catheter kickout was unnecessary for 85.4% (35/41) of the patients. Complete occlusion after the procedure was achieved in 87.8% (36/41) of patients. The periprocedural SAE rate was 2.4% (1/41), and no periprocedural deaths occurred (0/41). During the follow-up period, there were instances of retreatment in 3.4% (1/29) of patients. At 1 year, the lesion occlusion was better or stable in 93.3% (28/30) of patients. The rate of SAE from 24 hours to 1 year (±6 months) following the procedure was 26.8% (11/41). The 1-year all-cause mortality rate stood at 2.4% (1/41), and at the 1-year follow-up, 90.9% (20/22) of patients had a modified Rankin Scale score within the range of 0 to 2. The coiling procedure for AVFs using the SMART COIL System proved to be safe and effective at the 1-year follow-up. [ABSTRACT FROM AUTHOR]

Aim: Despite increasingly refined tools for identifying individuals at clinical high‐risk for psychosis (CHR‐P), less is known about the effectiveness of CHR‐P interventions. The significant clinical heterogeneity among CHR‐P individuals suggests that interventions may need to be personalized during this emerging illness phase. We examined longitudinal trajectories within‐persons during treatment to investigate whether baseline factors predict symptomatic and functional outcomes. Method: A total of 36 CHR‐P individuals were rated on attenuated positive symptoms and functioning at baseline and each week during CHR‐P step‐based treatment. Results: Linear mixed‐effects models revealed that attenuated positive symptoms decreased during the study period, while functioning did not significantly change. When examining baseline predictors, a significant group‐by‐time interaction emerged whereby CHR‐P individuals with more psychiatric comorbidities at baseline (indicating greater clinical complexity) improved in functioning during the study period relative to CHR‐P individuals with fewer comorbidities. Conclusion: Individual differences in clinical complexity may predict functional response during the early phases of CHR‐P treatment. [ABSTRACT FROM AUTHOR]

Objective: The role of hypoalbuminemia throughout the course of chronic periprosthetic joint infection (PJI) remains poorly understood. This study aimed to determine the prevalence and risk factors of hypoalbuminemia in periprosthetic joint infection (PJI) patients and to explore the association between hypoalbuminemia and treatment outcomes. Methods: This retrospective cohort study included 387 PJI cases who underwent two‐stage exchange arthroplasty between January 2007 and August 2020, of which 342 were reimplanted. The mean follow‐up period was 7.9 years. Multivariate logistic regression analyses were performed to identify risk factors for hypoalbuminemia and to assess the effect of hypoalbuminemia at 1st‐ and 2nd‐stage exchange on the treatment outcome. Furthermore, the impact of dynamic changes in hypoalbuminemia was investigated. Results: The prevalence of hypoalbuminemia at 1st‐ and 2nd‐stage exchange was 22.2% and 4.7%, respectively. Patients with age ≥ 68 years and those with isolation of Staphylococcus aureus, Streptococcus, or Gram‐negative bacteria exhibited a higher risk of hypoalbuminemia. Hypoalbuminemia at 1st‐stage was significantly related to treatment failure (OR = 3.3), while hypoalbuminemia at 2nd‐stage raised the OR to 10.0. Patients with persistent hypoalbuminemia at both the 1st‐ and 2nd‐stage exchanges had a significantly higher rate of treatment failure than patients with hypoalbuminemia at the 1st‐stage but normal albumin levels at the 2nd‐stage exchange (55.6% vs 20.0%, p = 0.036). Conclusion: One in five patients with chronic PJI exhibits hypoalbuminemia. Hypoalbuminemia is more likely to develop in patients of advanced age and those infected by specific highly virulent organisms. Also, our results highlight the close association between hypoalbuminemia and treatment outcomes. [ABSTRACT FROM AUTHOR]

Aim Methodology Results Conclusions The aim of this study is to compare the outcomes of restricted partial pulpotomy (R‐PP) versus extended partial pulpotomy (E‐PP) for managing cariously exposed mature permanent molars with symptomatic irreversible pulpitis (SIP).This double‐arm, parallel designed randomized clinical trial was registered at clinicaltrials.gov (registration number: NCT05406557). Following random allocation, 43 participants of each group received the designated intervention. In the R‐PP group, 2–3 mm of superficial pulp tissue was removed only from the exposure site, while chamber was completely de‐roofed and 2–3 mm of superficial pulp tissue from entire chamber was removed in the E‐PP group. Haemostasis was achieved using 3% sodium hypochlorite‐soaked cotton pellets. Upon haemostasis, ProRoot mineral trioxide aggregate (ProRoot MTA) was placed over the pulpal wound, overlaid with a resin‐modified glass ionomer liner, and restored with composite resin in the same visit. Outcome measures included clinical and radiographic success evaluation at 6 and 12 months, and pain assessment using the visual analogue scale pre‐operatively and daily for 7 post‐operative days. Nonparametric tests were used for variables including patient's age, pain intensities, mean analgesic consumption, and haemostasis time. Categorical variables including gender, caries type, analgesic intake, hard tissue barrier formation, clinical and radiographic success, and pulp sensibility responses were assessed using Chi‐square or Fisher's exact test. Tooth survival was analysed using Kaplan–Meier analysis.A total of 81 cases were analysed at 12 months follow‐up. Comparable success was observed in both groups (97.6% in E‐PP & 97.5% in R‐PP; p > .05). The R‐PP group reported significantly lower pain scores on the 1st and 2nd post‐operative days than E‐PP (p < .05) and required significantly less analgesic intake (p < .05). Hard tissue barrier formation was significantly lower in the R‐PP group (p < .05). No significant differences were observed between groups regarding haemostasis time, pulp sensibility responses, and tooth survival (p > .05).Both the PP approaches exhibited comparable success for managing cariously exposed mature permanent molars with SIP. Given the conservative nature of R‐PP, it may be used as preferred PP approach for managing such cases. Being the first study of this kind, further work is necessary to draw definitive conclusions. [ABSTRACT FROM AUTHOR]

Purpose: Identifying outcome measurements instruments (OMIs) to evaluate treatment efficacy in patients with vocal fold atrophy and/or sulcus. Methods: Systematic review of records published before March 2021 by searching Pubmed and EMBASE. Included studies reported on adults (> 18 year) with dysphonia caused by glottic insufficiency due to vocal fold atrophy with or without sulcus, who were enrolled into a randomized controlled trial, a non-randomized controlled trial, a case-controlled study or a cohort study. All included studies described an intervention with at least one outcome measurement. Results: A total of 5456 studies were identified. After removing duplicates, screening title and abstract and full text screening of selected records, 34 publications were included in final analysis. From these 50 separate OMIs were recorded and categorized according to the ELS protocol by DeJonckere et al. (Eur Arch Otorhinolaryngol 258: 77–82, 2001). With most OMIs being used in multiple studies the total number of OMIs reported was 265. Nineteen (19) individual OMIs accounted for 80% of reports. The most frequently used OMIs according to category were: VHI and VHI-10 (subjective evaluation); G of GRBAS (perceptual evaluation); F0, Jitter and Shimmer (acoustic evaluation); MPT and MFR (aerodynamic evaluation) and glottic closure and mucosal wave (endoscopic evaluation). Of these OMIs VHI had a high percentage of significance of 90%. Conclusion: This systematic review identifies the most used OMIs in patients with glottic incompetency due to vocal fold atrophy and/or sulcus as a step toward defining a Core Outcome Set (COS) for this population. PROSPERO registration: 238274. [ABSTRACT FROM AUTHOR]

Objective: This longitudinal study aimed to quantitatively document and evaluate the implementation and outcomes of the Open Dialogue (OD) approach within Italian Mental Health Departments (MHDs), focusing on the ratings of OD-network meetings by patients and their families and assessing the clinical outcomes over a span of 12 months. Results: Over the course of the study, 58 patients participated in 517 OD-network meetings, demonstrating a high level of satisfaction with the care received, as evidenced by the Session Rating Scale (SRS) and Outcome Rating Scale (ORS). Clinically, significant improvements were observed in the Global Assessment of Functioning (GAF), Clinical Outcomes in Routine Evaluation (CORE-OM), and the Lubben Social Network Scale (LSNS), indicating enhanced psychological and social functioning. The SRS scores showed that satisfaction with the meetings increased over time, while the ORS indicated that both patients and their social networks perceived gradual improvements throughout the therapy. Conclusion: The OD approach within Italian MHDs was successfully implemented and well-received by patients and their social networks, yielding significant clinical improvements. These findings suggest the feasibility and effectiveness of integrating the OD model into the Italian public mental health system, supporting its potential for broader application in diverse healthcare settings. The study highlights the importance of continuous engagement and evaluation to maintain high standards of practice and suggests that OD can be a valuable addition to existing mental health care practices, promoting recovery through inclusive, dialogue-based interventions. [ABSTRACT FROM AUTHOR]

Background: Endoscopic submucosal dissection (ESD) is a widely utilized treatment for early esophageal cancer. However, the rising incidence of postoperative esophageal stricture poses a significant challenge, adversely affecting patients' quality of life and treatment outcomes. Developing precise predictive models is urgently required to enhance treatment outcomes. Materials and Methods: This study retrospectively analyzed clinical data from 124 patients with early esophageal cancer who underwent ESD at Ningbo Medical Center Lihuili Hospital. Patients were followed up to assess esophageal stricture incidence. Binary logistic regression analysis was used to identify factors associated with post‐ESD esophageal stricture. A novel nomogram prediction model based on Systemic Immune‐inflammation Index (SII) was constructed and evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Results: ROC curve analysis showed that the optimal value of SII for predicting esophageal stricture was 312.67. Both univariate and multivariate analyses identified lesion infiltration depth (< M2 vs. ≥ M2, p = 0.002), lesion longitudinal length (< 4 cm vs. ≥ 4 cm, p = 0.008), circumferential resection range (< 0.5, 0.5–0.75, ≥ 0.75, p = 0.014), and SII (< 312.67 vs. ≥ 312.67, p = 0.040) as independent risk factors for post‐ESD esophageal stricture. A novel nomogram prediction model incorporating these four risk factors was developed. Validation using ROC curve analysis demonstrated satisfactory model performance, while calibration curves indicated good agreement between model‐predicted risk and observed outcomes. Conclusion: We successfully constructed a novel nomogram prediction model based on SII, which can accurately and intuitively predict the occurrence of esophageal stricture after ESD, providing guidance for clinicians and improving treatment outcomes. [ABSTRACT FROM AUTHOR]

Simple Summary: Although some of the novel systemic treatments, especially the group of tyrosine kinase inhibitors, have shown a durable central nervous system response, ionizing radiation remains the mainstay in the management of brain metastases (BM). Recent technological advancements have enabled the replacement of whole-brain radiotherapy with localized stereotactic radiotherapy (SRT) for treating up to 10 BM, either as a primary or combined treatment, reducing neurotoxicity and improving local control (LC). The delivered target dose and patient selection play a crucial role in enhancing treatment efficacy. However, there is still limited evidence supporting which factors most affect LC and which patients derive the greatest benefit from SRT. This retrospective single-institutional study evaluated treatment outcomes in a heterogeneous patient population treated with Linac-based SRT, with the aim of identifying potential dosimetric and clinical prognostic factors to better inform the decision-making process. Background/Objectives: To report on predictive factors in Linac-based SRT for single and multiple BM. Methods: Consecutive patients receiving either one or three fractions of single-isocenter coplanar VMAT SRT were retrospectively included. The GTV-PTV margin was 1–2 mm. The delivered target dose was estimated by recalculating the original plans on roto-translated CT according to errors recorded by post-treatment CBCT. The Kaplan–Meier method estimated local progression-free survival (LPFS), intracranial progression-free survival (IPFS), and overall survival (OS). Log-rank and Wilcoxon–Mann–Whitney tests evaluated inter-group differences, whereas Cox regression analysis assessed prognostic factors. Results: Fifty females and fifty males, with a median age of 69 years, received 107 SRTs. A total of 213 BM (range, 1–10 per treatment) with a median volume of 0.22 cc were irradiated with a median minimum BED of 59.5 Gy. The median delivered GTV D95 reduction was −0.3%. The median follow-up was 11 months. Nineteen LP events and a 1-year LC rate of 90.1% were observed. The GTV coverage did not correlate with LC, while the GTV volume was a risk factor for LP, with the 1-year rate dropping to 73% for volumes ≥ 0.88 cc. The median LPFS, IPFS, and OS were 6, 5, and 7 months, respectively. Multivariate analysis showed that patients with melanoma histology and those receiving a second or subsequent systemic therapy line had the worst outcomes, whereas patients with adenocarcinoma histology and mutations showed better results. Conclusions: The accuracy and efficacy of the Linac-based SRT approach for BM were confirmed, but the dose distribution alone failed to predict the treatment response, suggesting that other factors must be considered to maximize SRT outcomes. [ABSTRACT FROM AUTHOR]

Prostate cancer (PC) is one of the most commonly diagnosed tumours among men. Second-generation androgen receptor axis-targeted (ARAT) agents, namely abiraterone acetate (AbA) and enzalutamide (ENZ), are currently used in the management of metastatic castration-resistant PC (mCRPC). However, the treatment is challenging due to the lack of prognostic biomarkers. Meanwhile, single-nucleotide polymorphisms (SNPs) have emerged as potential prognostic indicators of mCRPC. Thus, this study evaluated the impact of relevant SNPs on the treatment outcomes of 123 mCRPC patients enrolled in a hospital-based cohort study. The CYP17A1 rs2486758 C allele was associated with a 50% reduction in the risk of developing castration resistance (hazard ratio (HR) = 0.55; p = 0.003). Among patients without metastasis at tumour diagnosis and under AbA, a marginal association between YBX1 rs10493112 and progression-free survival was detected (log-rank test, p = 0.056). In the same subgroup, significant associations of HSD3B1 rs1047303 (CC/CA vs. AA; HR = 3.41; p = 0.025), YBX1 rs12030724 (AT vs. AA; HR = 3.54; p = 0.039) and YBX1 rs10493112 (log-rank test, p = 0.041; CC vs. AA/AC; HR = 3.22; p = 0.053) with overall survival were also observed, which were confirmed by multivariate Cox analyses. Although validation with larger cohorts is required, these findings suggest that SNPs could enhance the prognosis assessment of mCRPC patients, leading to a more personalised treatment. [ABSTRACT FROM AUTHOR]

Study Design: A technical note and retrospective case series. Objective: Highly upward-migrated lumbar disc herniation (LDH) is challenging due to its problematic access and incomplete removal. The most used interlaminar approach may cause extensive bony destruction. We developed a novel translaminar approach using the unilateral portal endoscopic (UBE) technique, emphasizing effective neural decompression, and preserving the facet joint's integrity. Methods: This retrospective study included six patients receiving UBE translaminar discectomy for highly upward-migrated LDHs from May 2019 to June 2021. The migrated disc was removed through a small keyhole on the lamina of the cranial vertebra. The treatment results were evaluated by operation time, hospital stays, complications, visual analog scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score, and modified MacNab criteria. Results: The mean pre-operative VAS for back pain (5.0 ± 4.9), VAS for leg pain (9.2 ± 1.0), JOA score (10.7 ± 6.6), and ODI (75.7 ± 25.3) were significantly improved to 0.3 ± 0.5, 1.2 ± 1.5, 27.3 ± 1.8, 5.0 ± 11.3 respectively at the final follow-up. Five patients had excellent, and one patient had good outcomes according to the Modified MacNab criteria. The hospital stay was 2.7 ± 0.5 days. No complication was recorded. The MRI follow-up showed complete disc removal, except for one patient with an asymptomatic residual disc. Conclusions: UBE translaminar discectomy is a safe and effective minimally invasive procedure for highly upward-migrated LDH with satisfactory treatment outcomes and nearly 100% facet joint preservation. [ABSTRACT FROM AUTHOR]

Discharge from psychiatric treatment has been established as an emotionally intense and vulnerable time for patients; however, to date no studies have investigated symptoms directly preceding discharge and the impact on post-discharge outcomes. Our primary aim was to assess the prevalence of elevations in depression and anxiety symptoms prior to discharge from a partial hospitalization program (PHP). Our secondary aim was to assess whether these pre-discharge elevations predict post-discharge outcomes. We analyzed daily depression and anxiety symptom severity from 4211 patients attending a PHP. Two subsamples (n = 113 and n = 70) completed post-discharge outcome measures of symptom severity, well-being, and/or functional impairment at two-weeks, one-month, and three-months post-discharge. Approximately two-thirds of patients demonstrated a significant increase in depression (p < .001) and anxiety (p < .001) symptom severity prior to discharge. These pre-discharge elevations did not significantly predict post-discharge measures when controlling for symptom severity at discharge. Our results suggest patients experience an increase in symptom severity preceding discharge, even after improvement; however, these elevations do not provide additional prognostic information. Clinicians may consider sharing these results with patients to normalize the experience of symptom elevation prior to discharge and highlight that it is not a prognostic indicator. [ABSTRACT FROM AUTHOR]

Background: In Nigeria, since 2002, Imatinib mesylate (glivec®) has been available freely to chronic myeloid leukaemia (CML) patients but only at a tertiary health care centre in the southwestern part of the country. Despite this, it is not readily accessible to many patients due to the distance and other challenges including low socioeconomic status and political problems, preventing timely access to specialist care. This study evaluated the effect of the baseline characteristics on the prognostic implication and treatment outcome of CML patients in Nigeria. Method: This study retrospectively evaluated the baseline characteristics, clinical presentations and treatment outcomes of 889 CML patients over 18 years (2002–2020). Of these, 576 (65%) patients had complete information with up-to-date BCR::ABL1 records. These 576 patients were categorized based on their responses to Imatinib therapy into three groups viz.; Optimal response (OR) defined as BCR::ABL1 ratio of < 0.1% or major molecular remission (≥ 3-log reduction of BCR::ABL1 mRNA or BCR::ABL1 ratio of < 0.1% on the International Scale), Suboptimal response (SR) with BCR::ABL ratio of 0.1–1%, and Treatment failure (TF) when MMR has not been achieved at 12 months. The variables were analyzed using descriptive and inferential statistics and a p-value < 0.05 was considered statistically significant. Results: The result revealed a median age of 37 years at diagnosis with a male-to-female ratio of 1.5:1. The majority (96.8%) of the patients presented with one or more symptoms at diagnosis with a mean symptom duration of 12 ± 10.6 months. The mean Sokal and EUTOS scores were 1.3 ± 0.8 and 73.90 ± 49.09 respectively. About half of the patients presented with high-risk Sokal (49%) and EUTOS (47%) scores. Interestingly, both the Sokal (r = 0.733, p = 0.011) and EUTOS (r = 0.102, p = 0.003) scores correlated positively and significantly with the duration of symptoms at presentation. Based on response categorization, 40.3% had OR while 27.1% and 32.6% had SR and TF respectively. Conclusion: This study observed a low optimal response rate of 40.3% and treatment failure rate of 32.6% in our CML cohort while on first-line Imatinib therapy. This treatment response is strongly attributable to the long duration of symptoms of 12 months or more and high Sokal and EUTOS scores at presentation. We advocate prompt and improved access to specialist care with optimization of tyrosine kinase inhibitor therapy in Nigeria. [ABSTRACT FROM AUTHOR]

Background Aims Participants/Methods Results Conclusions Injectable fillers for soft tissue augmentation stand out as one of the most favored procedures in the field of aesthetic medicine, especially in addressing the clinical signs of skin aging. Among soft tissue fillers, non‐permanent fillers have been safely used in numerous medical applications for several decades.The aim of this post‐market observational, open‐label, uncontrolled, multicentered, prospective study (PMS) was to evaluate the effects of an injectable poly‐L‐lactic acid‐based collagen stimulator (Lanluma®, the study product).This analysis is based on the clinical outcomes data (safety and effectiveness) collected from investigators and participants between the first injection (T0, September 2022) and 9 months thereafter (T3, June 2023) in the treatment of five body‐contouring areas.Overall, 70 participants had 99 treatment sessions of the neck (31%), upper arm (20%), hand (17%), thigh (16%) and décolleté (15%). Lumps (neck, upper arm, hand) and nodules (neck, hand, thigh) were the most frequent adverse events (AEs) reported by investigators. All were treatment related. None were serious, severe or fatal. No AEs were reported following treatment of the décolleté. Both investigators and participants reported high levels of satisfaction during the nine‐month follow‐up period with the treatments in five body areas.These positive clinical outcomes can be attributed to a proper implementation of best practices and recommendations, and the rheological properties of the study product. This 9‐month follow‐up analysis should be reconsidered in light of the study's objectives for the final analysis at the 25‐month follow‐up. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the safety and effectiveness of high‐dose oral medroxyprogesterone acetate (MPA) therapy as a fertility‐sparing treatment for patients diagnosed with atypical endometrial hyperplasia (AEH) and endometrioid carcinoma G1 without myometrial invasion (G1EC). Particular attention was given to the extended administration and readministration of MPA for patients with persistent disease following initial treatment and those with recurrence. Methods: We conducted a retrospective analysis of data from 79 patients who underwent daily oral MPA treatment between 2005 and 2024 at Nagoya University Hospital. Patient characteristics, treatment outcomes, factors contributing to recurrence, and post‐MPA therapy pregnancies were examined. Results: MPA therapy achieved a remarkable complete response (CR) rate of 91.1%. The median time to achieve CR was 26.0 and 40.0 weeks for AEH and G1EC patients, respectively. Importantly, 27 patients (39.7%) attained CR after more than 6 months of treatment, including 8 patients (11.8%) who achieved CR after more than a year of treatment. The recurrence rates were 52.9% for AEH and 64.7% for G1EC. Twenty eight patients resumed MPA treatment, and 23 achieved second CR. Notably, recurrence was not associated with clinical factors such as age, body mass index, or post‐CR pregnancy. Among patients who attempted pregnancy after achieving CR, 22 live births were successfully achieved. Conclusions: High‐dose oral MPA therapy demonstrated both safety and efficacy for preserving fertility in patients with AEH and G1EC, resulting in a high CR rate. MPA extension and readministration proved to be beneficial strategies for managing patients with recurrence and persistent disease following initial treatment. [ABSTRACT FROM AUTHOR]

Purpose: Distant metastases (DM) are the primary cause of treatment failure and death of patients with salivary gland carcinomas (SGC). The purpose of present study was to evaluate factors predictive on DM development in a cohort of patients with high-grade salivary gland carcinomas. Methods: This was a retrospective cohort study of consecutive patients surgically treated with curative intention at the authors' institution from January 1993 to December 2018. Outcomes evaluated were overall survival (OS), disease specific survival (DSS), recurrence free survival (RFS), locoregional recurrence free survival (LRFS) and distant metastasis free survival (DMFS). Results: A total of 213 patients, 117 males (55%) and 96 females (45%), were included in the study. Parotid gland malignancies accounted for 56% of all cases. Adenoid cystic carcinoma (119 cases; 56%) was the most common tumor type. Cumulative OS for the 5-and 10-year follow-up period was 80% and 58% respectively. DM occurred with 75 patients (35%). The most common locations for DM were lung (55 cases; 73%) and liver (12 cases; 16%). Pathological nodal status, particularly the number of metastatic nodes, was the independent prognostic factor for OS, DSS, RFS and DMFS. Conclusion: Number of metastatic lymph nodes, instead of extranodal extension and largest nodal diameter, was the contributing factor related to DMFS. Since the main function of staging system is to predict outcomes, the significance of extranodal extension and nodal dimension in salivary gland cancer staging system requires further clarification. The elective neck dissection could be considered therapeutic approach for high-grade SGC since occult metastases were detected in 33% of cases. [ABSTRACT FROM AUTHOR]

Previous studies have shown that therapists' performance varies, known as therapist effects, and have indicated that therapists who excel in one treatment outcome may not necessarily be effective in other outcomes. This observational naturalistic study aimed to enhance our understanding of therapist effects and the assessment of therapists' performance in different areas. The study included 68 therapists and 5,582 clients from a large mental health facility. Information about their learning activities was available for a subsample of 49 therapists. Separate multilevel analyses were conducted for treatment outcomes, including case mix-corrected OQ-45 change scores, dropout rates, referrals to other facilities, treatment duration, and client satisfaction ratings. A hierarchical cluster analysis was performed to identify groups of therapists based on their performance across various treatment outcomes. Additionally, differences in therapist characteristics among the clusters identified were examined. Therapist effects varied across different outcomes, ranging from small (2.6% for OQ-45 change) to moderate (6.5% for number of sessions). The cluster analysis revealed four distinct clusters of therapists with specific profiles. They had performance differences in certain areas but not in others. This exploratory study supports the notion that therapists exhibit diverse profiles regarding treatment outcomes. These findings are significant for future investigations of therapist effects that aim to identify the characteristics of effective therapists and in the context of personalizing treatment for clients. [ABSTRACT FROM AUTHOR]

Background: Post‐dural puncture headache (PDPH) is a frequent complication following lumbar puncture, epidural analgesia, or neuraxial anesthesia. The International Classification of Headache Disorders, third edition categorizes PDPH as a self‐limiting condition; however, emerging evidence, including our findings, suggests that PDPH can have a prolonged course, challenging this traditional view. Objectives: To elucidate the diagnostic characteristics and treatment outcomes of persistent PDPH (pPDPH), offering insights into its demographic profiles and diagnostic features. Methods: We executed an anonymous, web‐based survey targeting individuals aged ≥18 years diagnosed with or suspected of having pPDPH. Recruitment occurred through self‐help groups on Facebook. The survey comprised questions regarding diagnostic procedures, treatment regimens, outcomes, and healthcare consultation. Results: The survey achieved a response rate of 179/347 (51.6%) individuals completing the questionnaire. Cerebrospinal fluid (CSF) leaks were confirmed in nine of 179 (5.0%) cases. Signs of intracranial hypotension without a CSF leak were observed in 70/179 (39.1%) individuals. All participants underwent magnetic resonance imaging scans of the brain and spine, with computed tomography myelography performed in 113/179 (63.1%) cases. Medications, including analgesics, theophylline, and gabapentin, provided minimal short‐term relief. Epidural blood patch treatments resulted in slight‐to‐moderate short‐term improvement in 136/179 (76.0%), significant improvement in 22/179 (12.3%), and complete effectiveness in eight of 179 (4.5%) individuals. For long‐term outcomes, slight‐to‐moderate improvement was reported by 118/179 (66.0%) individuals. Surgical interventions were carried out in 42/179 (23.5%) patients, revealing pseudomeningoceles intraoperatively in 20/42 (47.6%) individuals. After surgery, 21/42 (50.0%) of the participants experienced slight‐to‐moderate improvement, 12/42 (28.6%) showed more pronounced improvement, and five of the 42 (11.9%) achieved complete effectiveness. Conclusion: This study underscores the complexities of managing pPDPH. The delay in diagnosis can impact the effectiveness of treatments, including epidural blood patch and surgical interventions, resulting in ongoing symptoms. This underscores the importance of tailored and adaptable treatment strategies. The findings advocate for additional research to deepen the understanding of pPDPH and improve long‐term patient outcomes. Plain Language Summary: Headaches after procedures like spinal taps or epidural anesthesia are common. They are usually short‐lived, but our research shows they can last longer and become ongoing problems for some people. We found that standard treatments do not always work, highlighting the need for tailored treatments and better ways to diagnose these headaches to improve patients' lives. [ABSTRACT FROM AUTHOR]

BACKGROUND: The PARAGON-HF study (Prospective Comparison of ARNI With ARB Global Outcomes in Heart Failure With Preserved Ejection Fraction) investigated the effect of sacubitril-valsartan in heart failure (HF) with preserved ejection fraction. The results, which were analyzed using conventional statistical methods, did not find a significant reduction in the primary composite end point of cardiovascular death and total hospitalization for HF. Recent clinical trials used win ratio statistics that enable the incorporation of multiple outcome aspects into the primary end point and can detect positive outcomes with fewer patients. In this study, we assessed the effect of sacubitril-valsartan on outcomes using the win ratio to analyze results from patients included in the PARAGON-HF study. METHODS: In the PARAGON-HF study, 4822 patients with HF with preserved ejection fraction were randomized either to sacubitril-valsartan or valsartan groups. In the present study, the primary outcome was a hierarchical composite of time to cardiovascular death, total number of hospitalization for HF, time to first hospitalization for HF, time to renal composite outcome, and change in the Kansas City Cardiomyopathy Questionnaire total symptom score at 8 months analyzed using a win ratio statistical model. RESULTS: Using this approach, we found that a greater number of patients who received sacubitril-valsartan experienced clinical benefits compared with those who received valsartan (win ratio, 1.13 [95% CI, 1.04–1.23]; P=0.005). This clinical advantage was evident in patients regardless of whether the left ventricular ejection fraction was above or below the median, that is, the left ventricular ejection fraction of 57%, and regardless of sex (Pinteraction=0.76 for the left ventricular ejection fraction and 0.73 for sex). CONCLUSIONS: Employing the innovative win ratio approach, sacubitril-valsartan demonstrated significant clinical benefits among patients with HF with preserved ejection fraction. Notably, this benefit was observed irrespective of left ventricular ejection fraction and sex. [ABSTRACT FROM AUTHOR]

Background: Rheumatoid arthritis (RA) patients are at heightened risk of Coronavirus Disease—19 (COVID-19) complications due to immune dysregulation, chronic inflammation, and treatment with immunosuppressive therapies. This study aims to characterize the clinical and laboratory parameters of RA patients diagnosed with COVID-19, identify predictive risk factors for severe forms of this infection for RA patients, and determine if any RA immunosuppressive therapy is associated with worse COVID-19 outcomes. Methods: A retrospective observational case-control study included 86 cases (43 diagnosed with RA and 43 cases without any inflammatory or autoimmune disease) that suffered from SARS-CoV-2 in two Romanian hospitals between March 2020 and February 2024. Data on demographics, RA disease characteristics, COVID-19 severity, treatment regimens, and outcomes were analyzed. Results: RA patients exhibited a distinct symptom profile compared to non-RA controls, with higher incidences of neurological, musculoskeletal, and gastrointestinal symptoms, while the control group showed more respiratory and systemic manifestations. Severe COVID-19 is correlated with age and laboratory markers like erythrocyte sedimentation rate (ESR), leucocytes, neutrophils, neutrophil-to-lymphocyte ratio (NLR), aspartate aminotransferase (AST), serum creatinine, and urea. Additionally, RA treatments, particularly rituximab (RTX), were associated with more severe COVID-19 outcomes (but with no statistical significance), potentially due to the advanced disease stage and comorbidities in these patients. Post-infection, a significant number of RA patients experienced disease flares, necessitating adjustments in their treatment regimens. Conclusions: This study underscores the complex interplay between RA and COVID-19, highlighting significant clinical heterogeneity and the need for tailored management strategies. Limitations include sample size constraints, possible selection, and information bias, as well as the lack of adjustments for potential confounding variables that hinder the ability to formulate definitive conclusions. Future research plans to expand the research group size and further elucidate these relationships. [ABSTRACT FROM AUTHOR]

This retrospective study evaluated the effectiveness of different types of general anesthesia (GA) and sedation in pediatric dental procedures, focusing on treatment outcomes and follow-up compliance with an emphasis on gender differences. Clinical records of 1582 pediatric patients, aged 0–18 years, were analyzed to examine the distribution, duration and impact of anesthesia types on dental procedure complexity. The study population was divided into three age groups: 0–6, 7–12 and 13–18 years. We assessed follow-up attendance rates by gender and anesthesia type, calculated the decayed, missing and filled (DMF) index and evaluated the need for further treatment and reasons for retreatment. Our findings indicated that general anesthesia with inhalational agents and muscle relaxants was the most frequently used method (1260 instances), followed by nitrous oxide sedation (163 instances) and sevoflurane GA with a laryngeal mask airway (158 instances). Inhalational GA with muscle relaxants had the longest average duration (2.78 h) and the highest DMF index (7.43), reflecting its use in more severe dental conditions. Gender analysis revealed a slight male predominance in using inhalational GA with muscle relaxants (55.87% male vs. 44.13% female). Female patients demonstrated higher follow-up compliance across all periods. Overall, our results highlight the importance of tailored anesthesia and sedation plans, as well as follow-up protocols, in pediatric dentistry. This study provides valuable insights for practitioners in selecting appropriate anesthesia and sedation types and developing strategies to improve follow-up compliance and treatment success. [ABSTRACT FROM AUTHOR]

Abstract Ossification of the posterior longitudinal ligament of the cervical spine (C-OPLL) is a degenerative disorder that leads to the narrowing of the spinal canal and compression of both the spinal cord and nerve roots. This condition is more prevalent in East Asian populations, with marked regional variations in incidence. Symptoms include neck pain, restricted movement, limb numbness, and motor impairment. In severe cases, surgery may be required. Surgical strategies for C-OPLL can be divided into anterior and posterior approaches, each offering distinct advantages and limitations. Anterior approaches, such as anterior cervical corpectomy and fusion (ACCF), anterior cervical discectomy and fusion (ACDF), anterior floating method and vertebral body sliding osteotomy (VBSO), provide the benefit of direct decompression but are technically demanding and carry a higher risk of complications. In contrast, posterior approaches, including laminectomy (with or without instrumented fusion) and laminoplasty (LAMP), offer indirect decompression but may increase the risk of cervical kyphosis. In recent years, innovative techniques like anterior cervical ossified posterior longitudinal ligament en bloc resection (ACOE), anterior controllable antedisplacement and fusion (ACAF), and minimally invasive endoscopic spine surgery have been developed to reduce complications and enhance surgical outcomes. Selecting the appropriate surgical technique requires a thorough assessment of factors such as the severity of the lesion, cervical alignment, and the surgeon’s experience. This narrative review examines the differences between these surgical options, discusses their respective advantages and disadvantages, and provides updated insights and recommendations.

Abstract Background Seventy percent of epileptic patients may not experience seizures if they receive proper treatment with antiepileptic drugs (AEDs). However, many children and adolescents face poor seizure control (PSC). Therefore, the purpose of this review is to systematically and quantitatively summarize the pooled prevalence of PSC and its predictors among children with epilepsy in Ethiopia. Methods The following databases were used to conduct a thorough literature search: Africa Journal of the Online Library, Hinari, Google Scholar, PubMed, Science Direct, EMBASE, Cochrane Database, Sci-Hub, and Scopus. To evaluate the quality of the studies, Newcastle‒Ottawa Scale (NOS) checklists were utilized. The data on study characteristics and prevalence estimates were then combined via random effects meta-analysis, followed by subgroup and sensitivity analyses. Both visual and statistical analyses were employed to assess for any potential publication bias. Results This review analyzed a total of 12 main studies and reported that the overall prevalence of PSC was 42.42% (95% CI: 33.42–51.42). However, there was significant heterogeneity in the results based on the study region, design, and seizure-free period. The subgroup analysis revealed that the highest prevalence of PSC was found in Southern Nations, Nationalities, and Peoples’ (SNNPs) studies (61.88%; 95% CI: 35.91–87.85), studies with a cross-sectional design (46.73%; 95% CI: 36.83–56.62), and studies with a seizure-free period

Abstract Purpose Immune checkpoint inhibitors (ICIs) have improved lung cancer treatment but are associated with immune-related adverse events (irAEs). This study analyzes the relationship between irAEs and treatment effectiveness in advanced non-small cell lung cancer (NSCLC) patients. Methods We conducted a retrospective study of NSCLC patients treated with ICIs from March 2019 to October 2022 at Zhongshan Hospital (Xiamen). Patients were divided into irAE and non-irAE groups, and treatment outcomes were compared. Results A total of 154 patients were included, with 36.4% in the irAE group and 63.6% in the non-irAE group. Most irAEs were Grade 1–2 (86.4%), with 13.6% being Grade 3 or higher. The irAE group had higher disease control rates (DCR: 94.6% vs. 76.5%, P = 0.004) and objective response rates (ORR: 42.9% vs. 26.5%, P = 0.037). Median progression-free survival (PFS) was longer in the irAE group (18 vs. 9 months, HR: 0.53, P = 0.001), as was overall survival (OS: 39.5 vs. 16 months, HR: 0.46, P = 0.001). Landmark analysis at 6 and 12 weeks confirmed that irAEs were associated with improved outcomes. Moreover, patients who experienced two or more adverse events during treatment had significantly longer OS compared to those who had only one or no adverse events (41.6 months vs. 34.0 vs. 23.6, P = 0.003). Conclusion Patients with irAEs demonstrated better outcomes, including ORR, DCR, PFS, and OS. Further studies on biomarkers and irAE incidence are warranted to improve lung cancer management.

Abstract Background Headache disorders, including migraine, pose a significant burden globally, with varying prevalence rates across different regions. However, research on migraine in Nigeria and other low-income countries is limited. Understanding the prevalence, characteristics, and treatment outcomes of migraine in Nigeria is essential for informing healthcare policies and improving patient care. Methods This systematic review and meta-analysis aimed to synthesize existing literature on migraine prevalence, characteristics, and treatment outcomes in Nigeria. Eligible studies were identified through comprehensive searches of multiple electronic databases and grey literature sources. Studies reporting migraine prevalence, diagnostic criteria, treatment modalities, and outcomes were included. Data extraction and quality assessment were performed following established guidelines. Results Ten studies involving 7,768 participants met the inclusion criteria and were included in the meta-analysis. The pooled prevalence of migraine headache in Nigeria was calculated to be 16% (95% CI = 7–28), with significant heterogeneity observed among studies (I² = 99.35%, P

Objective The role of hypoalbuminemia throughout the course of chronic periprosthetic joint infection (PJI) remains poorly understood. This study aimed to determine the prevalence and risk factors of hypoalbuminemia in periprosthetic joint infection (PJI) patients and to explore the association between hypoalbuminemia and treatment outcomes. Methods This retrospective cohort study included 387 PJI cases who underwent two‐stage exchange arthroplasty between January 2007 and August 2020, of which 342 were reimplanted. The mean follow‐up period was 7.9 years. Multivariate logistic regression analyses were performed to identify risk factors for hypoalbuminemia and to assess the effect of hypoalbuminemia at 1st‐ and 2nd‐stage exchange on the treatment outcome. Furthermore, the impact of dynamic changes in hypoalbuminemia was investigated. Results The prevalence of hypoalbuminemia at 1st‐ and 2nd‐stage exchange was 22.2% and 4.7%, respectively. Patients with age ≥ 68 years and those with isolation of Staphylococcus aureus, Streptococcus, or Gram‐negative bacteria exhibited a higher risk of hypoalbuminemia. Hypoalbuminemia at 1st‐stage was significantly related to treatment failure (OR = 3.3), while hypoalbuminemia at 2nd‐stage raised the OR to 10.0. Patients with persistent hypoalbuminemia at both the 1st‐ and 2nd‐stage exchanges had a significantly higher rate of treatment failure than patients with hypoalbuminemia at the 1st‐stage but normal albumin levels at the 2nd‐stage exchange (55.6% vs 20.0%, p = 0.036). Conclusion One in five patients with chronic PJI exhibits hypoalbuminemia. Hypoalbuminemia is more likely to develop in patients of advanced age and those infected by specific highly virulent organisms. Also, our results highlight the close association between hypoalbuminemia and treatment outcomes.

Purpose: Dupuytren contracture is characterized by the formation of cords and nodules in the palm. Surgical release has historically been the definitive treatment. Collagenase clostridium histolyticum (CCH) has been used successfully as an alternative to surgery. The treatment of proximal interphalangeal (PIP) contractures is the most challenging. The purpose of this study was to evaluate CCH treatment for Dupuytren contracture of the PIP joint. Methods: A retrospective chart review was performed for CCH treatment of Dupuytren contracture at a single institution from January 2010 to April 2023. Data collected included pretreatment/posttreatment total flexion contracture and adverse events. Contractures were analyzed both by severity (high >40° and low 50% correction of contracture) were associated with low severity contractures at postmanipulation. There were 256 adverse events recorded (54.5%), including 187 skin tears (39.8%), 68 cases of lymphadenopathy (14.5%), and one injection site infection (0.2%). High severity and combined contractures were independently associated with an increased incidence of skin tears upon manipulation. Conclusions: Collagenase clostridium histolyticum treatment is effective for isolated or combined PIP joint contractures. Adverse events were associated with more severe contractures. Given the degree of improvement based on contracture severity, earlier intervention may provide better correction of contracture. Type of study/level of evidence: Therapeutic III.

Abstract Study Design A technical note and retrospective case series. Objective Highly upward-migrated lumbar disc herniation (LDH) is challenging due to its problematic access and incomplete removal. The most used interlaminar approach may cause extensive bony destruction. We developed a novel translaminar approach using the unilateral portal endoscopic (UBE) technique, emphasizing effective neural decompression, and preserving the facet joint’s integrity. Methods This retrospective study included six patients receiving UBE translaminar discectomy for highly upward-migrated LDHs from May 2019 to June 2021. The migrated disc was removed through a small keyhole on the lamina of the cranial vertebra. The treatment results were evaluated by operation time, hospital stays, complications, visual analog scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score, and modified MacNab criteria. Results The mean pre-operative VAS for back pain (5.0 ± 4.9), VAS for leg pain (9.2 ± 1.0), JOA score (10.7 ± 6.6), and ODI (75.7 ± 25.3) were significantly improved to 0.3 ± 0.5, 1.2 ± 1.5, 27.3 ± 1.8, 5.0 ± 11.3 respectively at the final follow-up. Five patients had excellent, and one patient had good outcomes according to the Modified MacNab criteria. The hospital stay was 2.7 ± 0.5 days. No complication was recorded. The MRI follow-up showed complete disc removal, except for one patient with an asymptomatic residual disc. Conclusions UBE translaminar discectomy is a safe and effective minimally invasive procedure for highly upward-migrated LDH with satisfactory treatment outcomes and nearly 100% facet joint preservation.

Abstract Background In Nigeria, since 2002, Imatinib mesylate (glivec®) has been available freely to chronic myeloid leukaemia (CML) patients but only at a tertiary health care centre in the southwestern part of the country. Despite this, it is not readily accessible to many patients due to the distance and other challenges including low socioeconomic status and political problems, preventing timely access to specialist care. This study evaluated the effect of the baseline characteristics on the prognostic implication and treatment outcome of CML patients in Nigeria. Method This study retrospectively evaluated the baseline characteristics, clinical presentations and treatment outcomes of 889 CML patients over 18 years (2002–2020). Of these, 576 (65%) patients had complete information with up-to-date BCR::ABL1 records. These 576 patients were categorized based on their responses to Imatinib therapy into three groups viz.; Optimal response (OR) defined as BCR::ABL1 ratio of

SETTING: Multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB) is now endemic in the National Capital District (NCD), Papua New Guinea. Loss to follow-up (LTFU) is a challenge. OBJECTIVE: To evaluate and identify risk factors for LTFU, including pre-treatment LTFU, in adults with MDR/RR-TB at Port Moresby General Hospital (PMGH). DESIGN: A retrospective analysis of treatment initiation in adults diagnosed with MDR/RR-TB (2018–2022) and outcomes for a cohort treated for MDR/RR-TB (2014-2019). We assessed the factors associated with LTFU using multivariate logistic regression. RESULTS: Of 95 patients diagnosed with MDR/RR-TB at PMGH from 2018 to 2022, 21 (22%) were lost to follow-up before treatment. Of the 658 adults who initiated treatment for MDR/RR-TB at PMGH from 2014 to 2019, 161 (24%) were lost to follow-up during treatment. A higher proportion of patients on injectable-containing long regimens (110/404, 27%) were lost to follow-up than those on the all-oral regimen containing bedaquiline (13/66, 12%). Treatment loss to follow-up was associated with age (35–54 years age group: aOR 0.49, 95% CI 0.32–0.77; 55–75 years age group: aOR 0.42, 95% CI 0.19–0.90; compared to the 15–34 years age group), residence outside of NCD (aOR 1.79, 95% CI 1.04–3.06), and year of treatment initiation. CONCLUSION: Pre-treatment LTFU requires programmatic focus. Shorter oral regimens and decentralised services may address the reasons for higher LTFU in younger people and people living outside NCD.

Abstract Background Enthesitis-related arthritis (ERA) is a subtype of juvenile idiopathic arthritis with high disease burden. The objectives of this study were to explore the prevalence of HLA-B27, clinical characteristics, and treatment outcomes in children with ERA and compare the differences between HLA-B27 positive and negative patients. Methods A retrospective cohort study at a pediatric rheumatology clinic in a tertiary referral hospital in Bangkok, Thailand, including ERA patients with at least 6 months of follow-up (July 2011-April 2022) was performed. Data were collected from medical records from diagnosis to recent follow-up, assessing disease activity and treatment outcomes, with an analysis comparing HLA-B27 positive and negative patients. Descriptive statistics were used for data analysis. Results There were 59 ERA patients with mean age ± SD at diagnosis 11.2 ± 2.5 years, 53 males (89.8%), and positive HLA-B27 in 38 patients (64.4%). The HLA-B27 positive group had significantly higher levels of inflammatory markers at initial diagnosis (p = 0.001), lower baseline hemoglobin (p = 0.001) and hematocrit (p = 0.002), higher disease activity assessed by the Juvenile Spondyloarthritis Disease Activity score at 6 and 12 months of follow-up (p = 0.028 and 0.040, respectively), increased utilization of bridging systemic corticosteroids (60.5% vs. 14.3%, p = 0.001) and anti-TNF (39.5% vs. 9.5%, p = 0.018), and longer duration of methotrexate (median[IQR] 1.7[1.1–3.1] vs. 1.3[0.6–1.9] years, p = 0.040). The HLA-B27 negative group had more prevalent hip arthritis than the positive group at initial diagnosis (66.7% vs. 28.9%, p = 0.005) and during the course of the disease (71.4% vs. 36.8%, p = 0.011). Conclusion Most of the ERA patients tested positive for HLA-B27. Throughout the follow-up period, these patients demonstrated greater disease activity, greater use of corticosteroids and anti-TNF, and longer duration of methotrexate to control the disease.

Liping Zou,1,&ast; Wanli Kang,2,&ast; Chunhui Guo,3,&ast; Juan Du,4,&ast; Qing Chen,1 Zhengyu Shi,1 Xianzhen Tang,1 Li Liang,1 Peijun Tang,5 Qing Pan,6 Qingdong Zhu,7 Song Yang,8 Zhanlin Chang,9 Zhouli Guo,1 Guihui Wu,1 Shenjie Tang2 1Department of Tuberculosis, Public Health Clinical Center of Chengdu, Chengdu, People’s Republic of China; 2Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, People’s Republic of China; 3Department of Tuberculosis, Harbin Chest Hospital, Harbin, People’s Republic of China; 4Department of Tuberculosis, Wuhan Pulmonary Hotel, Wuhan, People’s Republic of China; 5Department of Tuberculosis, the Fifth People’s Hospital of Suzhou, Suzhou, People’s Republic of China; 6Department of Respiratory and Critical Care Medicine, Anqing Municipal Hospital, Anqing, People’s Republic of China; 7Department of Tuberculosis, the Fourth People’s Hospital of Nanning, Nanning, People’s Republic of China; 8General Internal Medicine Department, Chongqing Public Health Medical Center, Chongqing, People’s Republic of China; 9Department of Surgery, the Third People’s Hospital of Tibet Autonomous Region, Lasa, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Guihui Wu, Department of Tuberculosis, Public Health Clinical Center of Chengdu, Jingjusi 18 Street, Jingjiang District, Chengdu, Sichuan, People’s Republic of China, Tel +86-28-8455-0573, Email wghwgh2584@sina.com Shenjie Tang, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, 101149, People’s Republic of China, Tel +86-13621028338, Email tangsj1106@vip.sina.comObjective: Rifampin-resistant tuberculosis (RR-TB) remains a serious global public health concern. We assessed treatment outcomes and associated influencing factors among RR-TB patients in China.Methods: This research enrolled 1339 patients who started RR-TB treatment between May 2018 and April 2020 in China retrospectively. Data were collected from the electronic medical records. Multivariable logistic regression analysis was used to identify the influencing factors related to unfavorable outcomes.Results: Of the 1339 RR-TB patients, 78.8% (1055/1339) achieved treatment success (cured or treatment completed), 5.1% (68/1339) experienced treatment failure, 1.1% (15/1339) died during treatment, 10.1% (135/1339) were lost to follow-up, and 4.9% (66/1339) were not evaluated. About 67.7% (907/1339) of patients experienced at least one adverse event (AE). The most common AE was hypohepatia (507/1339, 37.9%), followed by hyperuricemia (429/1339, 32.0%), anemia (368/1339, 27.5%), electrolyte disturbance (318/1339, 23.7%), peripheral neuritis (245/1339, 18.3%), and gastrointestinal reactions (203/1339, 15.2%). Multivariate analysis showed that age ≥ 60 years [adjusted odds ratio (aOR): 1.96, 95% confidence interval (CI): 1.39– 2.77], national minority (aOR: 2.36, 95% CI: 1.42– 3.93), smoking (aOR: 1.50, 95% CI: 1.10– 2.04), cardiopathy (aOR: 2.90, 95% CI: 1.33– 6.31), tumors (aOR: 9.84, 95% CI: 2.27– 42.67), immunocompromise (aOR: 2.17, 95% CI: 1.21– 3.91), re-treated TB (aOR: 1.46, 95% CI: 1.08– 1.97), and experienced gastrointestinal reactions (aOR: 2.27, 95% CI: 1.52– 3.40) were associated with unfavorable outcomes. Body mass index (BMI) ≥ 18.5 kg/m2, regimens containing bedaquiline and experienced adverse events (AEs) such as hypohepatia, leukopenia, peripheral neuritis, and optic neuritis were associated with favorable outcomes.Conclusion: High rates of treatment success were achieved for RR-TB patients at tertiary tuberculosis hospitals in China. Age ≥ 60 years, national minority, smoking status, comorbidities, re-treated TB, and experienced gastrointestinal reactions were independent prognostic factors for unfavorable treatment outcomes.Keywords: RR-TB, treatment outcomes, influencing factors, China

Aim: The aim of this study was to assess the patterns and treatment outcomes of permanent teeth requiring emergency endodontic care in children and to highlight the challenges encountered in obtaining this care at the Child Dental Health Unit, School of Dentistry, University of the West Indies, St. Augustine, Trinidad. Methods: This study was conducted through a retrospective analysis of pediatric patients requiring emergency endodontic treatment of permanent teeth at the Child Dental Health Unit clinic from January 2016 to December 2019. Data were collected via file record reviews and telephone interviews with the patients’ parents or caregivers, using standardized questions. The collected data included the patient’s age, sex, tooth involved, reasons for endodontic treatment, type of treatment provided, stage of endodontic treatment attained, and completion time. The data were then formatted and analyzed using descriptive statistical methods. Results: A total of 6887 patients attended the Child Dental Health Unit for emergency care, of which 5% required endodontic treatment in permanent teeth. Among these, 60.5% of cases were female and 39.5% were male, with a mean age of 12.1 years. The majority of cases (77.3%) were due to caries, while 22.7% were due to trauma. Molar teeth were the most commonly treated, but only 42.9% of all emergency endodontic treatments on permanent teeth were completed. The primary reason for the non-completion of endodontic treatment was lengthy patient wait times for follow-up appointments. Conclusions: The majority of emergency endodontic cases were not completed, primarily due to delays or lack of recall by dental students and vocational trainees. Lengthy waiting times resulted in an increased need for tooth extractions. Existing services require evaluation to ensure prompt treatment, preventing delayed care, recurrent pain, infection, and tooth loss.

Abstract Background The injectable shorter multi-drug resistant tuberculosis (MDR-TB) regimen, has been reported to be less costly and more effective in the treatment of MDR-TB compared to the longer regimen. Ethiopia introduced the injectable shorter regimen (SR) in April 2018 following official recommendation by the World Health Organization (WHO) in 2016. While the WHO recommendation was based on evidence coming from extensive programmatic studies in some Asian and African countries, there is paucity of information on patient outcomes in the Ethiopian context. Thus, we aimed to assess the treatment outcomes and identify factors associated with the outcomes of MDR-TB patients on injectable SR. Methods A multi-center facility-based retrospective cohort study was conducted in Ethiopia on 245 MDR-TB patients who were treated between April 2018 and March 2020. Data were collected from patients’ medical records and analyzed using SPSS version 25. Descriptive statistics was used to summarize the results while inferential analysis was employed to investigate predictors of treatment outcomes and survival status. Results A total of 245 patients were included in the study, with 129 (52.7%) of them being female. Median age of the patients was 27 (IQR: 21–33). The overall treatment success rate was 87.8%, with 156 (63.7%) cured and 59 (24.1%) patients who completed treatment. The unfavorable outcomes accounted for 12.2%, with 16 (6.5%) treatment failure, 8 (3.3%) death and 6 (2.4%) lost to follow up. Majority of the unfavorable outcomes occurred during the early phase of therapy, with median time to event of 1.8 months (95% CI: 0.99—2.69). The use of khat (a green leafy shrub abused for its stimulant like effect) and being diagnosed with MDR-TB than rifampicin resistant only, were identified as independent factors associated with unfavorable outcomes. Conclusion The injectable SR for MDR-TB was found to have positive treatment outcomes in the context of programmatic management in Ethiopia.