A risk score to predict 30-day hospital readmission rate in cirrhotic patients with spontaneous bacterial peritonitis.

BACKGROUND AND AIM: There is lack of 30-day hospital readmission prediction score in patients with liver cirrhosis and SBP. The aim of this study is to recognize factors capable of predicting 30-day readmission and to develop a readmission risk score in patients with SBP. METHODS: This study prospectively examined the 30-day hospital readmission for patients previously discharged with a diagnosis of SBP. Based on index hospitalization variables, a multivariable logistic regression model was implemented to recognize predictors of patient hospital readmission within 30 days. Consequently, Mousa readmission risk score was established to predict 30-day hospital readmission. RESULTS: Of 475 patients hospitalized with SBP, 400 patients were included in this study. The 30-day readmission rate was 26.5%, with 16.03% of patients readmitted with SBP. Age ≥ 60, MELD > 15, serum bilirubin > 1.5 mg/dL, creatinine > 1.2 mg/dL, INR > 1.4, albumin < 2.5 g/dL, platelets count ≤ 74 (103/dL) were found to be independent predictors of 30-day readmission. Incorporating these predictors, Mousa readmission score was established to predict 30-day patient readmissions. ROC curve analysis demonstrated that at a cutoff value ≥ 4, Mousa score had optimum discriminative power for predicting the readmission in SBP with sensitivity 90.6% and specificity 92.9%. However, at cutoff value ≥ 6 the sensitivity and specificity were 77.4% and 99.7%, respectively, while a cutoff value ≥ 2 had sensitivity of 99.1% and specificity of 31.6%. CONCLUSIONS: The 30-day readmission rate of SBP was 25.6%. With the suggested simple risk assessment Mousa score, patients at high risk for early readmission can be easily identified so as to possibly prevent poorer outcomes.

Health care workers' perceptions of their hospitals' preparedness during the COVID-19 virus pandemic in three different world regions.

Introduction: Pandemics are extraordinary circumstances that necessitate a multifaceted approach to getting the most out of healthcare systems. Health authorities should be aware of the beliefs and attitudes of healthcare professionals before adopting control measures and communication campaigns. We aimed to find out how hospital staff members in three economically diverse regions perceive their facility's preparedness for pandemics. Methodology: A hospital-based cross sectional study was done in three separate world regions, classified according to the World Bank's economics, using a web-based questionnaire. A convenience sample of 450 healthcare workers was collected and analyzed using SPSS version 20. Results: Physicians made up 94.4% of the 450 participants, with 50.3% from High-Income Foreign Countries (HIFC), 20.4% from High-Income Arab Countries (HIAC), and 29.3% from Lower Middle-Income Countries (LMIC). 81.5% of participants from HIAC had formal PPE training, compared to 22.7% and 64.4% of participants from LMIC and HIFC, respectively. Evidently, 39.4% of the HIFC's participants stated that the level of their hospital precautions during the pandemic was above average, as compared to 50% and 14.4% of participants from HIAC and LMIC, respectively. Compared to 42.4% of HIAC participants and 36.4% of LMIC participants, 44.6% of HIFC participants reported feeling at risk because of their clinical role. Conclusion: In all three regions, hospital readiness was well viewed by healthcare professionals; nevertheless, more needs to be done to provide them with psychological and social support. This research may help health authorities put up a suitable preparedness plan to face emerging pandemics. Further research is needed to determine the best course of action to combat comparable pandemics at various economic levels.

Diagnosing Paget-Schroetter Syndrome Using Point of Care Ultrasound (POCUS).

Paget-Schroetter Syndrome, or effort thrombosis, is a relatively rare disorder. It refers to axillary-subclavian vein thrombosis (ASVT) that is associated with strenuous and repetitive activity of the upper extremities 1. Anatomical abnormalities at the thoracic outlet and repetitive trauma to the endothelium of the subclavian vein are key factors in its initiation and progression. Doppler ultrasonography is the preferred initial test, but contrast venography is the gold standard for diagnosis 1, 2. Early diagnosis coupled with a multimodal treatment strategy is crucial for optimal outcomes. We present a case of a 21-year-old male in which point of care ultrasound (POCUS) expedited the diagnosis and subsequent early treatment of right subclavian vein thrombosis. He presented to our Emergency Department with acute swelling, pain and erythema of his right upper limb. He was promptly diagnosed to have thrombotic occlusion of the right subclavian vein using POCUS in our Emergency Department.

Profile of sexuality and symptoms of lower urinary tract in non-institutionalized elderly

ABSTRACT Introduction: Urinary or sexual dysfunction in the elderly are underreported. However, they are highly prevalent. This study aims to identify the prevalence of these conditions. Objective: The aim is to carry out an investigation in non-institutionalized individuals over 60 years of age, to obtain data on its sexual and urinary health in São Paulo, Campinas, Santo André and Londrina. Results: 6.000 questionnaires were distributed, and 3425 were included in the study, for the analysis of the questionnaires separately. In relation to ADAM, 92% of the 1385 evaluated were suspicious of androgen deficiency (ADAM). As for the male sexual function, it was observed 37% of premature ejaculation. As for the female sexual function, 1300 (74%) did not practice sexual intercourse and the main reasons were: lack of partner and lack of sexual desire. In addition, 988 (78%) of women who had no sexual intercourse responded that they didn't want sex and, more importantly, about 22% of them would like to have sexual intercourse. International prostate symptom score (IPSS) showed gradual worsening of urinary symptoms with increasing age, being the most prevalent: nocturia and urinary urgency. As for the female IPSS, we noted that even after 80 years, the majority have mild symptoms related to voiding dysfunction; with increasing age there is a gradual increase in the result of the IPSS. Conclusion: Due to the large number of sexual and urinary disorders found, we recommend the improvement in health conditions, promoting a better quality of life in the elderly.

Profile of sexuality and symptoms of lower urinary tract in non-institutionalized elderly.

INTRODUCTION: Urinary or sexual dysfunction in the elderly are underreported. However, they are highly prevalent. This study aims to identify the prevalence of these conditions. OBJECTIVE: The aim is to carry out an investigation in non-institutionalized individuals over 60 years of age, to obtain data on its sexual and urinary health in São Paulo, Campinas, Santo André and Londrina. RESULTS: 6.000 questionnaires were distributed, and 3425 were included in the study, for the analysis of the questionnaires separately. In relation to ADAM, 92% of the 1385 evaluated were suspicious of androgen deficiency (ADAM). As for the male sexual function, it was observed 37% of premature ejaculation. As for the female sexual function, 1300 (74%) did not practice sexual intercourse and the main reasons were: lack of partner and lack of sexual desire. In addition, 988 (78%) of women who had no sexual intercourse responded that they didn't want sex and, more importantly, about 22% of them would like to have sexual intercourse. International prostate symptom score (IPSS) showed gradual worsening of urinary symptoms with increasing age, being the most prevalent: nocturia and urinary urgency. As for the female IPSS, we noted that even after 80 years, the majority have mild symptoms related to voiding dysfunction; with increasing age there is a gradual increase in the result of the IPSS. CONCLUSION: Due to the large number of sexual and urinary disorders found, we recommend the improve-ment in health conditions, promoting a better quality of life in the elderly.

Effects of mechanical vibrations on maxillary canine retraction and perceived pain: a pilot, single-center, randomized-controlled clinical trial.

The aim of this study was to investigate the effect of mechanical vibratory stimulation on maxillary canine retraction and pain perception in adolescents undergoing full-fixed orthodontic treatment with extraction. A pilot randomized-controlled clinical trial was conducted in one university orthodontic clinic. Twenty-one healthy adolescents who underwent full-fixed orthodontic treatment with maxillary first-premolar extraction were recruited. Subjects were randomly assigned to the experimental group (N = 10) that used a mechanical vibration device (AcceleDent Aura, OrthoAccel Technologies, Inc.) or the control group (N = 11) that did not receive a vibration device. The evaluation timepoints were T0 = day of initial canine retraction; T1 = 4 weeks post-initiation; T2 = 8 weeks post-initiation; and T3 = 12 weeks post-initiation. Three-dimensional palatal landmark superimpositions were made to assess amount of tooth movement (mm) at each visit, monthly rate of tooth movement (mm), and perceived pain levels (VAS scores). The total amount of tooth movement was observed in the control versus experimental groups, respectively, as 1.12 ± 0.22 mm versus 1.39 ± 0.36 mm at 4 weeks (p = 0.058), 2.59 ± 0.37 mm versus 2.49 ± 0.76 mm at 8 weeks (p = 0.702), and 3.54 ± 0.23 mm versus 3.37 ± 1.37 mm at 12 weeks (p = 0.716). The rate of tooth movement was 1.21 ± 0.32 mm/month in the control and 1.12 ± 0.20 mm/month in the experimental groups, which was not statistically significant at any of the timepoints and neither was the level of pain. This study found no statistically significant differences in canine retraction and pain perception between the experimental and control groups. We propose that further optimization of accelerated tooth movement with mechanical vibration devices is necessary.

Giant bladder stone in association with severe kidney injury.

Minimal data exist on the causes, incidence and management of giant bladder stones considering their rare occurrence. Only a handful of case reports have reported stones larger than 10 cm, and most of these cases are managed surgically. We present a case of a 56-year-old female who presented with vague, lower urinary tract symptoms who was later found to have severe post-renal acute kidney injury due to a giant bladder stone measuring 11 × 11 × 10.4 cm.

Ethnicity of Symptomatic Coronary Artery Disease Referred for Coronary Angiography in the Galilee: Prevalence, Risk Factors, and a Case for Screening and Modification.

BACKGROUND: Coronary artery disease (CAD) has known risk factors. Individual risks related to specific ethnicities are complex and depend on genetic predisposition and lifestyle. OBJECTIVES: To compare the nature and prevalence of risk factors in Arab and non-Arab ethnic patients with symptomatic obstructive CAD referred for coronary angiography. METHODS: CAD, defined as coronary angiography with a ≥ 50% narrowing in ≥ 1 vessel, was diagnosed in 1029 patients admitted to a medical center between April 2014 and October 2015. Patients were divided into two groups according to ethnic origin: Arab vs. non-Arab. Demographics, clinical presentation, and coronary risk profiles were compared. RESULTS: The diagnosis of CAD was made during ST-elevation myocardial infarction (STEMI) in 198 patients (19%) who arrived at the clinic, 620 (60%) with unstable angina/non-STEMI, and 211 (21%) with stable angina. Patients with symptomatic CAD and Arab ethnicity were 47% more prevalent than non-Arab patients presenting with CAD. The Arab patients were appoximately 5 years younger, 50% more likely to be active smokers, 25% more likely to be obese, and more likely to have a family history of CAD. Other coronary risk factors were similar between the two groups. CONCLUSIONS: Smoking and obesity, which are potentially modifiable CAD risk factors, stood out as major risk factors, in addition to genetic disposition, among Arab and non-Arab patients with symptomatic CAD. Screening and educational interventions for smoking cessation, obesity control, and compliance to treatment of co-morbidities should be attempted in order to decrease CAD in the Arab population.

Left Circumflex Coronary Artery as the Culprit Vessel in ST-Segment-Elevation Myocardial Infarction.

The prevalence of the left circumflex coronary artery (LCx) as the culprit vessel in ST-segment-elevation myocardial infarction (STEMI) is reportedly lowest among that of the 3 main epicardial arteries, and has not been described for non-STEMI (NSTEMI) and stable angina pectoris. We sought to define the distribution of culprit arteries in these clinical presentations and suggest mechanisms for the differences. We reviewed 189 coronary angiograms of patients with STEMI, 203 with NSTEMI, and 548 with stable angina (n=940), and compared distributions of stenotic and culprit coronary arteries (lesions prompting intervention). Obstructive coronary lesions (≥50% narrowing) were more prevalent in the left anterior descending coronary artery (LAD) (36%-38%) and similar in the LCx and right coronary artery (RCA) (27%-29%), regardless of clinical presentation (P <0.01). In NSTEMI and stable angina, culprit vessels and total obstructive disease had the same distribution. In STEMI, however, a culprit LCx was significantly less prevalent (17%) than was total obstructive disease (27%; P <0.01), or a culprit LAD (47%) or RCA (34%) (both P <0.001). In our computed tomographic angiographic model of coronary longitudinal strain (percentage of shortening), LCx strain was only 1.5% ± 2.4%, versus 9.5% ± 2.9% for LAD strain and 10.1% ± 3.9% for RCA strain. In STEMI, LCx plaques seem less prone to rupturing. Culprit and total disease distributions are similar in NSTEMI and angina, suggesting a different ischemic pathophysiology in these presentations. Lower LCx longitudinal strain might contribute to reduced plaque rupture in STEMI.

No clear evidence on the clinical performance of different removable prosthetic options in partially edentulous patients.

Data sourcesMedline/PubMed, Embase, BIOSIS/Ovid, SciSearch/DIMDI, Cochrane library, FIZ Technik Web and hand searches of the journals; Clinical Oral Investigations, International Journal of Prosthodontics, Journal of Prosthetic Dentistry, Deutsche Zahnärztliche Zeitschrift, Swiss Dental Journal, Journal of Dentistry and the Journal of Dental Research.Study selectionRandomised controlled trials, prospective and retrospective studies on survival rates of removable dental prostheses in the moderately reduced dentition with at least 15 participants having an observation period of at least two years, and a dropout rate of less than 25% were considered.Data extraction and synthesisTwo reviewers abstracted data. A qualitative summary of the included studies was carried out. Studies providing data that permitted a Kaplan-Meier analysis were included in meta-analysis.ResultsThe review included 19 studies, six of which were in multiple publications. Cast-metal framework dentures showed failure rates of 33% and 50% after five years. One study with a 25-year observation period reported failure rates of 50%. Proper pretreatment and a good recall scheme improve the results. Bilateral attachment prostheses showed failure rates of 11% and 30% after five years. Unilateral attachment prostheses showed failure rates of 75% after five years. Double-crown prostheses dentures show failure rates of 0% to 21.7% after three to six years.ConclusionsWithin the limitations of this study, it seems that removable partial dentures, (RPD), given suitable pretreatment and follow-up regimes, can provide a satisfactory treatment option. Based on only one paper, they revealed acceptable results even over a very long observation period (25 years).

Analysis of the effect of renal excretory system cooling during thermal radiofrequency ablation in an animal model.

OBJECTIVE: Analysis of renal excretory system integrity and efficacy of radiofrequency ablation with and without irrigation with saline at 2°C (SF2). MATERIALS AND METHODS: The median third of sixteen kidneys were submitted to radiofrequency (exposition of 1 cm) controlled by intra-surgical ultrasound, with eight minutes cycles and median temperature of 90°C in eight female pigs. One excretory renal system was cooled with SF2, at a 30mL/min rate, and the other kidney was not. After 14 days of post-operatory, the biggest diameters of the lesions and the radiological aspects of the excretory system were compared by bilateral ascending pyelogram and the animals were sacrificed in order to perform histological analysis. RESULTS: There were no significant differences between the diameters of the kidney lesions whether or not exposed to cooling of the excretory system. Median diameter of the cooled kidneys and not cooled kidneys were respectively (in mm): anteroposterior: 11.46 vs. 12.5 (p = 0.23); longitudinal: 17.94 vs. 18.84 (p = 0.62); depth: 11.38 vs. 12.25 (p = 0.47). There was no lesion of the excretory system or signs of leakage of contrast media or hydronephrosis at ascending pyelogram. CONCLUSION: Cooling of excretory system during radiofrequency ablation does not sig¬nificantly alter generated coagulation necrosis or affect the integrity of the excretory system in the studied model.