Early Outcomes of Third-Generation Minimally Invasive Chevron-Akin (MICA) Osteotomy for Symptomatic Hallux Valgus Deformity.

Hallux valgus is a common progressive forefoot deformity. Although open techniques have shown good outcomes, no technique has been shown to be superior to other techniques. The current third generation of minimally invasive Chevron-Akin (MICA) technique features a percutaneous procedure with a stable internal fixation. The technique used in this study resulted in stable internal fixation; however, 1 screw was used in intramedullary fashion in the majority of cases. The purpose of this study is to review the early outcomes of MICA. Electronic Health Records (EHR) were queried for patients who underwent MICA to treat hallux valgus (HV) deformity, by a single surgeon. The primary clinical outcomes assessed were visual analog pain score (VAS), rate of revision surgery, and recurrence. Radiographic outcomes were assessed including pre and postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), and bony foot width. The secondary outcomes included postoperative complications. A total of 91 feet underwent MICA to correct symptomatic HV deformity. The mean age of this cohort was 53.63 ± 15.42 years, mean body mass index (BMI) of 26.81 ± 6.21 kg/m2, mean follow-up of 6.33 ± 6.39 months and 87 feet belonged to female patients. Patients showed significant improvement in VAS and radiographic outcomes at final follow-up, with a mean improvement of 10.70° ± 6.42°, 2.39° ± 3.55°, and 5.30 mm ± 4.23 mm for the HVA, IMA, and bony foot width, respectively. Two patients (2.2%) required revision surgery for nonunion and removal of symptomatic hardware. One patient had a second metatarsal fracture treated nonoperatively. No feet had recurrence, hardware loosening, infection, or scar hypersensitivity. The current study reported on early outcomes for MICA. This technique appears to be effective and safe with no failure of fixation in our patients. We showed in our short-term follow-up, MICA led to significant improvement in pain and radiographic scores.Levels of Evidence: III, retrospective study.

The effect of polypharmacy on healthcare services utilization in older adults with comorbidities: a retrospective cohort study.

BACKGROUND: Older adults are more prone to increasing comorbidities and polypharmacy. Polypharmacy is associated with inappropriate prescribing and an increased risk of adverse effects. This study examined the effect of polypharmacy in older adults on healthcare services utilization (HSU). It also explored the impact of different drug classes of polypharmacy including psychotropic, antihypertensive, and antidiabetic polypharmacy on HSU. METHODS: This is a retrospective cohort study. Community-dwelling older adults aged ≥ 65 years were selected from the primary care patient cohort database of the ambulatory clinics of the Department of Family Medicine at the American University of Beirut Medical Center. Concomitant use of 5 or more prescription medications was considered polypharmacy. Demographics, Charlson Comorbidity index (CCI), and HSU outcomes, including the rate of all-cause emergency department (ED) visits, rate of all-cause hospitalization, rate of ED visits for pneumonia, rate of hospitalization for pneumonia, and mortality were collected. Binomial logistic regression models were used to predict the rates of HSU outcomes. RESULTS: A total of 496 patients were analyzed. Comorbidities were present in all patients, with 22.8% (113) of patients having mild to moderate comorbidity and 77.2% (383) of patients having severe comorbidity. Patients with polypharmacy were more likely to have severe comorbidity compared to patients with no polypharmacy (72.3% vs. 27.7%, p = 0.001). Patients with polypharmacy were more likely to visit the ED for all causes as compared to patients without polypharmacy (40.6% vs. 31.4%, p = 0.05), and had a significantly higher rate of all-cause hospitalization (adjusted odds ratio aOR 1.66, 95 CI = 1.08-2.56, p = 0.022). Patients with psychotropic polypharmacy were more likely to be hospitalized due to pneumonia (crude odds ratio cOR 2.37, 95 CI = 1.03-5.46, p = 0.043), and to visit ED for Pneumonia (cOR 2.31, 95 CI = 1.00-5.31, p = 0.049). The association lost significance after adjustment. CONCLUSIONS: The increasing prevalence of polypharmacy amongst the geriatric population with comorbidity is associated with an increase in HSU outcomes. As such, frequent medication revisions in a holistic, multi-disciplinary approach are needed.

Clinical predictors of mortality in patients with pseudomonas aeruginosa infection.

BACKGROUND: Infections caused by Pseudomonas aeruginosa are difficult to treat with a significant cost and burden. In Lebanon, P. aeruginosa is one of the most common organisms in ventilator-associated pneumonia (VAP). P. aeruginosa has developed widespread resistance to multiple antimicrobial agents such as fluoroquinolones and carbapenems. We aimed at identifying risk factors associated for P. aeruginosa infections as well as identifying independent risk factors for developing septic shock and in-hospital mortality. METHODS: We used a cross-sectional study design where we included patients with documented P. aeruginosa cultures who developed an infection after obtaining written consent. Two multivariable regression models were used to determine independent predictors of septic shock and mortality. RESULTS: During the observed period of 30 months 196 patients were recruited. The most common predisposing factor was antibiotic use for more than 48 hours within 30 days (55%). The prevalence of multi-drug resistant (MDR) P. aeruginosa was 10%. The strongest predictors of mortality were steroid use (aOR = 3.4), respiratory failure (aOR = 7.3), identified respiratory cultures (aOR = 6.0), malignancy (aOR = 9.8), septic shock (aOR = 18.6), and hemodialysis (aOR = 30.9). CONCLUSION: Understanding resistance patterns and risk factors associated with mortality is crucial to personalize treatment based on risk level and to decrease the emerging threat of antimicrobial resistance.

Drug Repurposing in Non-Small Cell Lung Carcinoma: Old Solutions for New Problems.

Lung cancer is the second most common cancer and the leading cause of cancer-related deaths in 2022. The majority (80%) of lung cancer cases belong to the non-small cell lung carcinoma (NSCLC) subtype. Despite the increased screening efforts, the median five-year survival of metastatic NSCLC remains low at approximately 3%. Common treatment approaches for NSCLC include surgery, multimodal chemotherapy, and concurrent radio and chemotherapy. NSCLC exhibits high rates of resistance to treatment, driven by its heterogeneity and the plasticity of cancer stem cells (CSCs). Drug repurposing offers a faster and cheaper way to develop new antineoplastic purposes for existing drugs, to help overcome therapy resistance. The decrease in time and funds needed stems from the availability of the pharmacokinetic and pharmacodynamic profiles of the Food and Drug Administration (FDA)-approved drugs to be repurposed. This review provides a synopsis of the drug-repurposing approaches and mechanisms of action of potential candidate drugs used in treating NSCLC, including but not limited to antihypertensives, anti-hyperlipidemics, anti-inflammatory drugs, anti-diabetics, and anti-microbials.