Previne brasil e financiamento da atenção primária: facilidades e dificuldades de gestores municipais de saúde / Previne Brasil and primary care financing: facilities and difficulties for municipal health managers / Previne Brasil y financiamiento de la atención primaria: facilidades y dificultades para los gestores municipales de salud

Objetivo: compreender as facilidades e dificuldades enfrentadas por gestores municipais de saúde com o novo modelo de financiamento da Atenção Primária à Saúde. Método: estudo qualitativo, tipo Pesquisa Convergente Assistencial, fundamentado na Política Nacional de Atenção Básica. Participaram 77 gestores ou seus representantes, de 47 municípios de uma Macrorregião de saúde de Santa Catarina, Brasil. Foram realizadas três oficinas nas Gerências Regionais de Saúde, em agosto e setembro de 2022. Os dados foram analisados pela análise de conteúdo. Resultados: apresentam-se como facilidades do Previne Brasil informatização, comprometimento dos profissionais, e qualificação do cuidado. Foram descritas como dificuldades falta de informações, sistema informatizado e denominador estimado e, equipe de trabalho. Conclusão: o programa apresenta facilidades que qualificam o processo de trabalho e cuidado à saúde da população. Contudo, persistem dificuldades que devem ser consideradas pela gestão municipal para avanços na atenção integral e no financiamento da Atenção Primária à Saúde.

Objective: understand the facilities and difficulties faced by municipal health managers with the new Primary Health Care financing model. Method: this is a qualitative study, of the Convergent Care Research type, based on the National Primary Care Policy. The participants were 77 managers or their representatives from 47 municipalities in a health Macroregion in Santa Catarina, Brazil. Three workshops were held in the Regional Health Departments in August and September 2022. The data was analyzed using content analysis. Results: Previne Brasil's facilities include computerization, commitment of professionals, and qualification of care. Difficulties were described as lack of information, computerized system and estimated denominator, and work team. Conclusion: the program offers facilities that improve the work process and health care for the population. However, there are still difficulties that must be considered by municipal management in order to make progress in comprehensive care and Primary Health Care financing.

Objetivo: comprender las facilidades y dificultades que enfrentan los gestores municipales de salud con el nuevo modelo de financiamiento de la Atención Primaria de Salud. Método: estudio cualitativo, tipo Investigación Convergente Asistencial, basado en la Política Nacional de Atención Primaria. Participaron 77 gestores o sus representantes, de 47 municipios de una Macrorregión de salud de Santa Catarina, Brasil. Se realizaron tres talleres en las Gerencias Regionales de Salud, en agosto y septiembre de 2022. Los datos fueron analizados mediante análisis de contenido. Resultados: las instalaciones de Previne Brasil incluyen informatización, compromiso de los profesionales y calificación de la atención. Las dificultades fueron descritas como falta de información, sistema informatizado y denominador estimado y equipo de trabajo. Conclusión: el programa presenta facilidades que cualifican el proceso de trabajo y la atención de la salud de la población. Sin embargo, aún hay dificultades que la gestión municipal debe considerar para lograr avances en la atención integral y el financiamiento de la Atención Primaria de Salud.

Evaluating the Safety of Retrograde Intrarenal Surgery (RIRS): Intra- and Early Postoperative Complications in Patients Enrolled in the Global Multicentre Flexible Ureteroscopy Outcome Registry (FLEXOR)

ABSTRACT Purpose To assess the incidence of the most common intra- and early postoperative complications following RIRS in a large series of patients with kidney stones. Methods We conducted a retrospective analysis of patients with kidney stones who underwent RIRS across 21 centers from January 2018 to August 2021, as part of the Global Multicenter Flexible Ureteroscopy Outcome (FLEXOR) Registry. Results Among 6669 patients undergoing RIRS, 4.5% experienced intraoperative pelvicalyceal system bleeding without necessitating blood transfusion. Only 0.1% of patients, required a blood transfusion. The second most frequent intraoperative complication was ureteric injury due to the ureteral access sheath requiring stenting (1.8% of patients). Postoperatively, the most prevalent early complications were fever/infections requiring antibiotics (6.3%), blood transfusions (5.5%), and sepsis necessitating intensive care unit admission (1.3%). In cases of ureteric injury, a notably higher percentage of patients exhibited multiple stones and stone(s) in the lower pole, and these cases were correlated with prolonged lasing and overall surgical time. Hematuria requiring a blood transfusion was associated with an increased prevalence of larger median maximum stone diameters, particularly among patients with stones exceeding 20 mm. Furthermore, these cases exhibited a significant prolongation in surgical time. Sepsis necessitating admission to the intensive care unit was more prevalent among the elderly, concomitant with a significantly larger median maximum stone diameter. Conclusions Our analysis showed that RIRS has a good safety profile but bleeding requiring transfusions, ureteric injury, fever, and sepsis are still the most common complications despite advancements in technology.

Knowledge, attitude and practice pattern among intensive care nursing staff on eyecare practices in ICU patients

Background: Eyecare forms a major part of the care provided to all patients in ICUs. Critical care nurses limited knowledge about anatomy and physiology of eyes and ocular manifestations in critically ill patients can delay the identification and delivery of proper eyecare. Methods: A hospital based descriptive study among 74 ICU nursing staff was conducted using a well-structured questionnaire. Basic demographic data including age, gender, education, experience in ICU, type of ICU and previous eye training were collected. Questionnaire had 3 parts-knowledge, attitude and practice with 7 MCQs in each. Knowledge assessment was on different ocular signs in patients, their risk factors and management with 2 or more correct responses and a score of 3, 2, 1 or 0 was given. Attitude assessment was regarding the importance of early detection, treatment and prevention of eye diseases. Positive response was given score1, negative response 0. Practice assessment was based on methods and techniques of eyecare followed in ICU. Results: 54% had 1-5 years experience in ICU. 20.3% were from NSICU. 78% had average knowledge. 86.8% answered the question on high risk for exposure keratopathy correctly. 50% showed good attitude, maximum positive attitude was for the question on the effect of eye care on preventing eye disorders. No correlation was found between attitude and knowledge score. Average practice pattern was shown by 54%. Practice patterns followed included assessment of lid closure in their last duty by 66.2%, eyelid closure assessed hourly by 59.5%, eyedrops instilled 3 hourly and 6 hourly by 36.5% and method of cleaning eyes using distilled water by 41.9%. 50% of nurses cleaned the eyes hourly. 60% staffs did taping for incomplete eyelid closure and 61% followed fixed eyecare protocol. Conclusions: ICU nurses level of knowledge concerning eye care of mechanically ventilated develop a fixed protocol for eyecare in ICU which will help in systematic management.

Caracterização dos pacientes internados por infecção odontogênica em unidade hospitalar / Characterization of patients hospitalized for odontogenic infection in a hospital unit / Caracterización de pacientes hospitalizados por infección odontogénica en una unidad hospitalaria

Introdução: As infecções orais e maxilofaciais de origem odontogênica representam uma área relevante do conhecimento médico, pois podem evoluir para quadros de alta morbidade e mortalidade. Objetivo: Avaliar o perfil dos pacientes atendidos com diagnostico de infecção de origem odontogênica em um hospital público de Mato Groso do Sul. Métodos: Trata-se de um estudo retrospectiva do tipo observacional e transversal que consistiu na análise de 68 prontuários de pacientes com diagnostico de infecção odontogênica, no período de março de 2019 a fevereiro de 2022. Resultados e Conclusão: Os resultados apontam para uma incidência de infecção odontogênica em 39,70% para a população jovem entre 16 a 28 anos, com sintomas como edema em 82,35% dos casos, seguidos de trismo 51,47% e disfagia 17,64%, uma média de internação de 6,1 dias e necessidade de traqueostomia em 10,29% dos casos. Deste modo, o cirurgião dentista em frente a processos agudos de infecção odontogênica exerce a função primordial do reconhecimento dos sintomas e intervenção precoce evitando seu agravamento... (AU)

Introduction: Oral and maxillofacial infections of odontogenic origin represent a relevant area of medical knowledge, as they can evolve into cases of high morbidity and mortality. Objective: To evaluate the profile of patients treated with a diagnosis of infection of odontogenic origin in a public hospital in Mato Groso do Sul. Methods: This is a retrospective observational and cross-sectional study that consisted of analyzing 68 medical records of patients diagnosed with odontogenic infection, from March 2019 to February 2022. Results and Conclusion: The results point to an incidence of odontogenic infection in 39.70% for the young population between 16 and 28 years old, with symptoms such as edema in 82.35% of cases, followed by trismus 51.47% and dysphagia 17.64%, an average hospital stay of 6 ,1 days and need for tracheostomy in 10.29% of cases. In this way, the dental surgeon, faced with acute pro[1]cesses of odontogenic infection, plays the primary role of recognizing the symptoms and early intervention, preventing their aggravation... (AU)

Introducción: Las infecciones orales y maxilofaciales de origen odontogénico representan un área relevante del conocimiento médico, ya que pueden evolucionar hacia casos de alta morbilidad y mortalidad. Objetivo: Evaluar el perfil de los pacientes atendidos con diagnóstico de infección de origen odontogénico en un hospital público de Mato Groso do Sul. Métodos: Se trata de un estudio observacional retrospectivo y transversal que consistió en analizar 68 historias clínicas de pacientes con diagnóstico de infección odontogénica, desde marzo de 2019 hasta febrero de 2022. Resultados y Conclusión: Los resultados apuntan a una incidencia de infección odontogénica del 39,70%. para la población joven entre 16 y 28 años, con síntomas como edema en el 82,35% de los casos, seguido de trismo 51,47% y disfagia 17,64%, estancia hospitalaria promedio de 6,1 días y necesidad de traqueotomía en el 10,29% de los casos . De esta forma, el cirujano dentista, ante procesos agudos de infección odontogénica, realiza la función primordial de reconocer los síntomas e intervenir precozmente, evitando su agravamiento... (AU)

Post-menopausal Sertoli-Leydig cell tumour: a report of two cases

Ovarian Sertoli-Leydig cell tumors (SLCTs) represent less than 0.2 percent of all ovarian cancers and are an uncommon type of sex cord–stromal malignancy. Since these tumors are discovered in young women at an early stage, the management challenge is in striking the correct balance between a treatment that is effective enough to stop recurrences but yet permits fertility preservation. We present 2 case report of patients, one presented with hirsuitism and on evaluation found to have elevated levels of serum total testosterone and suspicion of SLCTs in magnetic resonance imaging (MRI) pelvis. Total laparoscopic hysterectomy (TLH) was done with bilateral salpingo-oophorectomy (BSO) and histopathology report came as ovarian Leydig cell tumour. Second case with postmenopausal bleeding and on evaluation MRI report showed right ovarian solid tumour-fibroma/fibrothecoma. Tumour markers were normal. TLH was done with BSO, histopathology report came as ovarian SLCT.

Atopic dermatitis in children: a cross-sectional study of its impact on quality of life

Background: Atopic dermatitis, characterized by chronic inflammation of the skin, manifests with symptoms such as itching, skin discomfort, and sleep disturbances, significantly impacting the physical health and daily functioning of affected children. We embarked on this study to assess the Quality of Life of children with AD, identify factors that influence their QoL, and determine the specific domains of QoL most affected by the condition.Methods: Children up to 16 years of age, who met the Hanifin and Rajka抯 diagnostic criteria for AD, were identified. The severity of AD was assessed using the severity scoring of atopic dermatitis index, and QoL was assessed using validated questionnaires: the infants dermatitis quality of life index for children under 4 years and the children抯 dermatology life quality index for children 4 years and above.Results: A total of 70 children with AD were enrolled in the study. The mean QoL (IDQOL/CDLQI) score for children with AD was 6.7�05 and QoL was significantly impaired in children with more severe disease. The domains of QoL most affected by AD were related to pruritus, sleep disturbances, mood changes and treatment related issues. The duration of illness and the presence of other atopic comorbidities showed a significant correlation with QoL impairment, whereas age, gender and socioeconomic status demonstrated no such correlation.Conclusions: This study highlights the substantial impact of AD on the QoL of affected children, especially due to symptoms like itching and sleep disturbances.

In silico analysis of anti-inflammatory and anticancer properties of bioactive compounds from Pancratium triflorum (Roxb)

Herbal remedies with medicinal properties have been utilized in Asian countries for centuries. Recently, Pancratium triflorum Roxb., also known as the forest spider lily, has captured the attention of researchers due to its potential therapeutic benefits. This plant produces white flowers and contains several important phytochemicals, including Lycorine, citrate, Gallic acid, Ellagic acid, Quercetin, and Kaempferol. Molecular docking, a computer simulation technique, has been used to identify potential drug candidates that can bind effectively to the active site of a protein. This study explored the anti-inflammatory and anticancer properties of Pancratium triflorum Roxb.'s Phyto-constituents using molecular docking with Auto dock 4.2.6. The study focused on the Vioxx-bound human Cox2 receptor and the Tyrosine kinase receptor bound to Gliteritinib. Standard ligands were used for redocking, and the Swiss ADME software was employed for bioavailability prediction to validate the findings. The results showed that Lycorine and Crinine have excellent anti-inflammatory properties, while Kaempferol and Quercetin have promising anticancer properties. Further research is necessary, but these findings suggest that Pancratium triflorum Roxb. could be a valuable addition to the medical world. However, further research is required to validate these findings, and in vivo studies are needed to confirm the efficacy and safety of these phytochemicals as potential drug candidates.

IN SILICO SCREENING BY MOLECULAR DOCKING OF HETEROCYCLIC COMPOUNDS WITH FURAN OR INDOLE NUCLEUS FROM DATABASE FOR ANTICANCER ACTIVITY AND VALIDATION OF THE METHOD BY REDOCKING

Objective: This study aims to perform in silico screening of nine heterocyclic ligands containing furan or indole with oxygen in their structure selected from the compound database based on a literature review for predicting their anticancer activity on tyrosine kinase receptor receptors.Methods: The receptor is complex with the ligand Gliteritinib and was downloaded from the protein database. The ligands used for this study were 5-fluoro-1H-indole-2-carboxylic acid,2(5H)-Furanone Furfuryl pentanoate, Furan-2,5-dicarbaldehyde, 2,5-Furandicarboxylic acid, Furan-2-yl(1H-indol-3-yl) methanone, Tert-butyl 3-formyl-1H-indole-1-carboxylate,7-Amino-5-fluoroindolin-2-one,7H-Furo[3,2-g]chromen-7-one. Pyrex molecular docking software was used to perform the analysis. The study was validated using a re-docking technique using the ligand Gliteritinib.Results: A good docking score of (-7.8) was obtained for tert-butyl 3-formyl-1H-indole-1-carboxylate, leading to promising activity prediction. Furan-2-yl(1H-indol-3-yl) methadone and 7H-Furo[3,2-g]chromen-7-one also scored well with (-7.5) and (-7.3) respectively. The redocking process resulted in a score of (-9.2).Conclusion: Values are comparable to the root primary square value, showing the reproducibility of this method. The finding gives insight into Insilco docking for anticancer activity and further exploration of phytochemicals for Insilco screening.

"It's a bit exasperating to be locked up"- an exploration of Mexican adolescents' perceived barriers and facilitators for physical activity and healthy eating / "É um pouco irritante estar preso" - uma exploração das barreiras e facilitadores percebidos pelos adolescentes mexicanos para a prática de atividade física e alimentação saudável

Mexican adolescents' diet and physical activity levels fall short of recommendations for health. The aim of this study was to explore Mexican adolescents' perceived barriers and facilitators of physical activity and healthy eating. Twelve single-sex focus groups were conducted in six secondary schools in Mexico City during three months from October 2016. Data were analysed via inductive thematic analysis. Three themes were identified, namely: understanding the health-behaviour link, the impact of a restricted life, and social support. Participants understood how physical activity contributes to multiple dimensions of health, and how diet contributes to physical health. They also identified so-cialising, having fun, and stress relief as facilitators of PA, and knowledge and the desire for healthy food as facilitators for healthy eating. Barriers included inadequate facilities, insufficient time within current school structures, and inadequate social support from teachers. Context-specific physical activity barriers of neighbourhood safety concerns, and limited family support were also reported. Participants had a basic knowledge of healthy eating but showed little motivation to improve their diet. In conclusion, the findings of this study suggest that improvement of opportunities for safe outdoor time, social support, and availability of healthy food would be useful to explore to promote the health behaviours of Mexican adolescents.

A dieta e os níveis de atividade física dos adolescentes mexicanos estão aquém das recomendações para a saú-de. O objetivo deste estudo foi explorar as barreiras percebidas por adolescentes mexicanos e facilitadores da atividade física e da alimentação saudável. Doze grupos focais unissexuais foram realizados em seis escolas secundárias na Cidade do México durante três meses a partir de outubro de 2016. Os dados foram analisados por meio da Análise Temática Indutiva. Foram identificados três temas: compreensão do nexo saúde-comportamento, impacto da restrição de vida e apoio social. Os participantes compreenderam como a atividade física contribui para múltiplas dimensões da saúde e como a dieta contribui para a saúde física. Identificaram a socialização, a diversão e o alívio do estresse como facilitadores da atividade física, e o conhecimento e o desejo por alimentos saudáveis como facilitadores para uma alimentação saudável. As barreiras incluíram instalações inadequadas, tempo insuficiente dentro das estruturas escolares atuais e apoio social inadequado dos professores. Barreiras de atividade física específicas do contexto de preocupações com a segurança da vizinhança e suporte familiar limitado também foram relatados. Os participantes tinham um conhecimento básico sobre alimentação saudável, mas mostraram pouca motivação para melhorar sua dieta. Em conclusão, os resultados deste estudo sugerem que a melhoria das oportunidades de tempo seguro ao ar livre, apoio social e disponibilidade de alimentos saudáveis seria útil para explorar para promover os comportamentos de saúde de adolescentes mexicanos.

Síndrome de Rapunzel: atadura sicológica y simulación orgánica / Rapunzel syndrome: psychological bondage and organic simulation

Introducción. El síndrome de Rapunzel es una entidad infrecuente, que se presenta como un tricobezoar a causa de una aglomeración de cabello acumulado dentro del tracto gastrointestinal, por lo que simula otras patologías quirúrgicas. Caso clínico. Paciente femenina de 10 años de edad, con tricotilomanía y tricofagia, dolor abdominal y síntomas inespecíficos de obstrucción intestinal de ocho meses de evolución. Al examen físico se encontró abdomen con distensión y masa palpable en epigastrio y mesogastrio. La ecografía permitió hacer el diagnóstico de tricobezoar gástrico extendido hasta el intestino delgado, por lo que se llevó a cirugía para gastrotomía y se extrajo el tricobezoar, con evolución satisfactoria de la paciente. El abordaje integral permitió conocer la atadura sicológica por posible maltrato infantil. Resultado. La paciente tuvo una evolución satisfactoria y se dio egreso al quinto día de hospitalización. Actualmente se encuentra en seguimiento por sicología, siquiatría infantil y pediatría. Discusión. El caso clínico denota la importancia en reconocer situaciones de presentación infrecuente en pediatría, que puedan estar asociadas a alteraciones sicológicas o presunción de maltrato infantil y que se presenten como una condición orgánica recurrente que simule otras patologías abdominales frecuentes en la infancia. El retraso diagnóstico puede conducir a un desenlace no deseado con complicaciones. Conclusión. Se hace mandatorio el manejo integral del paciente pediátrico y aumentar la sensibilidad para reconocer situaciones de presunción de maltrato infantil, sobre todo en pacientes con una condición orgánica quirúrgica recurrente.

Introduction. Rapunzel syndrome is an uncommon condition that manifests as trichobezoars, which are hair bundles in the stomach or small intestine that can mimics other surgical illnesses. Multiple complications can arise from delayed diagnosis and treatment. Clinical case. A 10-year-old female patient with trichotillomania and trichophagia, with abdominal pain and nonspecific symptoms of intestinal obstruction of eight months of evolution. Physical examination revealed epigastric tenderness and a solid mass was palpable in the mesogastric and epigastric region. An abdominal ultrasound showed gastric trichobezoar that extended into the small intestine. A gastrotomy was performed and the trichobezoar was extracted with satisfactory evolution of the patient. The comprehensive approach allowed knowing the psychological bond due to possible child abuse. Results. The patient had a satisfactory evolution and was discharged on the fifth day of hospitalization. He is currently being monitored by psychology, child psychiatry and pediatrics. Discussion. This clinical case highlights the importance of recognizing situations that seldom present in pediatrics, which may have a psychological aspect due to the presumption of child abuse, and which present as a recurrent organic condition simulating other frequent abdominal pathologies in childhood; all of which may lead to an unwanted outcome due to diagnostic delay. Conclusion. The comprehensive management of the pediatric patient is mandatory to recognize situations of presumed child abuse, in the face of a recurrent surgical conditions.

Identify risk factors for perioperative outcomes in Intracorporeal Urinary Diversion and Extracorporeal Urinary Diversion with Robotic Cystectomy

ABSTRACT Introduction: The increasing adoption of robotic-assisted cystectomy with intracorporeal urinary diversion (ICUD), despite its complexity, prompts a detailed comparison with extracorporeal urinary diversion (ECUD). Our study at a single institution investigates perioperative outcomes and identifies risk factors impacting the success of these surgical approaches. Methods: In this retrospective analysis, 174 patients who underwent robotic-assisted cystectomy at the University of Louisville from June 2016 to August 2021 were reviewed. The cohort was divided into two groups based on the urinary diversion method: 30 patients underwent ECUD and 144 underwent ICUD. Data on demographics, complication rates, length of hospital stay, and readmission rates were meticulously collected and analyzed. Results: Operative times were comparable between the ICUD and ECUD groups. However, the ICUD group had a significantly lower intraoperative transfusion rate (0.5 vs. 1.0, p=0.02) and shorter hospital stay (7.8 vs. 12.3 days, p<0.001). Factors such as male sex, smoking history, diabetes mellitus, intravesical therapy, higher ASA, and ACCI scores were associated with increased Clavien-Dindo Grade 3 or higher complications. Age over 70 was the sole factor linked to a higher 90-day readmission rate, with no specific characteristics influencing the 30-day rate. Conclusion: Robotic cystectomy with ICUD results in shorter hospitalizations and lower intraoperative transfusion rates compared to ECUD, without differences in operative time, high-grade postoperative complications, or readmission rates. These findings can inform clinical decision-making, highlighting ICUD as a potentially more favorable option in appropriate settings.

A case report of severe hypertriglyceridemia induced acute pancreatitis managed with continuous insulin infusion

31-year-old male, chronic alcoholic presented to the emergency room with epigastric pain, nausea and vomiting. On examination he was febrile, had abdominal distention with tenderness in the epigastric region. His lipase was elevated and computed tomography of abdomen showed evidence of acute pancreatitis. His past history was significant for chronic myeloid leukemia on imatinib and poorly controlled type 2 diabetes mellitus. Laboratory studies revealed elevated triglyceride levels (5254 mg/dl) and uncontrolled blood sugars (HbA1c-10.77%). Due to the severity of his pancreatitis presentation, he was admitted to the intensive care unit. He received aggressive intravenous fluid hydration and was started on continuous insulin infusion. He improved significantly with insulin therapy. His triglyceride levels decreased from 5254 mg/dl to 1891 mg/dl after 48 hours of initiating insulin therapy, by fifth day of admission triglycerides were below 500 mg/dl and was clinically better. He was discharged with a basal dose of insulin and fenofibrates. Intravenous insulin infusion is an effective, affordable, and accessible therapy for acute pancreatitis due to severe hypertriglyceridemia.

Cesarean scar ectopic pregnancy management with simultaneous isthmocele repair

Caesarean scar ectopic pregnancy (CSEP) is a very rare form of ectopic pregnancy. If not diagnosed and treated accordingly it can lead to life-threatening complications. Hitherto there is no standardised treatment established because of the rarity and diversity of the disease. We present the case of a 35-year-old third gravida primi para with caesarean scar pregnancy in 7th week of gestation. Since the patient declined a Methotrexate treatment, we performed hysteroscopic and laparoscopic resection of the ectopic pregnancy in combination with repair of the isthmocele. Because human chorionic gonadotrophin (hCG)-level showed no proper decline three weeks after the initial surgery a second look hysteroscopy and laparoscopy were performed with laparoscopic injection of MTX around the uterine suture, resulting in a full decline of hCG-level. The ultrasound performed before discharge shows a well-adapted uterine scar. A pregnancy can be aspired six-month post-surgery.

Global incidence of adverse clinical events in non-alcoholic fatty liver disease: A systematic review and meta-analysis

Background/Aims@#Nonalcoholic fatty liver disease (NAFLD) is associated with a multitude of adverse outcomes. We aimed to estimate the pooled incidence of NAFLD-related adverse events. @*Methods@#We performed a systematic review and meta-analysis of cohort studies of adults with NAFLD to evaluate the pooled incidence of adverse events. @*Results@#19,406 articles were screened, 409 full-text articles reviewed, and 79 eligible studies (1,377,466 persons) were included. Mean age was 51.47 years and body mass index 28.90 kg/m2. Baseline comorbidities included metabolic syndrome (41.73%), cardiovascular disease (CVD) (16.83%), cirrhosis (21.97%), and nonalcoholic steatohepatitis (NASH) (58.85%). Incidence rate per 1,000 person-years for mortality included: all-cause (14.6), CVD-related (4.53), non-liver cancer-related (4.53), and liver-related (3.10). Incidence for liver-related events included overall (24.3), fibrosis progression (49.0), cirrhosis (10.9), liver transplant (12.0), and hepatocellular carcinoma (HCC) (3.39). Incidence for non-liver events included metabolic syndrome (25.4), hypertension (25.8), dyslipidemia (26.4), diabetes (19.0), CVD (24.77), renal impairment (30.3), depression/anxiety (29.1), and non-liver cancer (10.5). Biopsy-proven NASH had higher incidence of HCC (P=0.043) compared to non-NASH. Higher rates of CVD and mortality were observed in North America and Europe, hypertension and non-liver cancer in North America, and HCC in Western Pacific/Southeast Asia (P<0.05). No significant differences were observed by sex. Time-period analyses showed decreasing rates of cardiovascular and non-liver cancer mortality and increasing rates of decompensated cirrhosis (P<0.05). @*Conclusions@#People with NAFLD have high incidence of liver and non-liver adverse clinical events, varying by NASH, geographic region, and time-period, but not sex.

Impact of a simple non-invasive nasal mask device on intraprocedural hypoxemia in overweight individuals undergoing upper gastrointestinal endoscopy with sedation provided by a non-anesthesiologist provider

Background/Aims@#Hypoxemia is a common side effect of propofol sedation during endoscopy. Applying mild positive airway pressure (PAP) using a nasal mask may offer a simple way to reduce such events and optimize the conditions for diagnostic and therapeutic upper gastrointestinal endoscopies. @*Methods@#We compared overweight patients (body mass index >25 kg/m2) with a nasal PAP mask or standard nasal cannula undergoing upper gastrointestinal endoscopies by non-anesthesiologists who provided propofol sedation. Outcome parameters included the frequency and severity of hypoxemic episodes. @*Results@#We analyzed 102 procedures in 51 patients with nasal PAP masks and 51 controls. Episodes of hypoxemia (oxygen saturation [SpO2] <90% at any time during sedation) occurred in 25 (49.0%) controls compared to 8 (15.7%) patients with nasal PAP masks (p<0.001). Severe hypoxemia (SpO2 <80%) occurred in three individuals (5.9%) in both groups. The mean delta between baseline SpO2 and the lowest SpO2 recorded was significantly decreased among patients with nasal PAP mask compared to controls (3.7 and 8.2 percentage points difference, respectively). There were significantly fewer airway interventions performed in the nasal PAP mask group (15.7% vs. 41.2%, p=0.008). @*Conclusions@#Using a nasal PAP mask may be a simple means of increasing patient safety and ease of examination.

Comparing Outcomes of Bicruciate-Stabilized and Cruciate-Retaining Total Knee Arthroplasty

Background@#Bicruciate-stabilized (BCS) total knee arthroplasty (TKA) aims to restore normal kinematics by replicating the function of both cruciate ligaments. Conventional cruciate-retaining (CR) design in TKA has shown previous clinical success with lower complication rates. This study compared the patient-reported outcomes between the BCS and CR TKA designs. @*Methods@#This retrospective study examined patients who underwent primary TKA using a CR or a BCS implant. Patient demographics, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR), and Forgotten Joint Score (FJS) were compared between two cohorts. Patient-reported outcome measures were analyzed using independent samples t-tests. @*Results@#There were no significant preoperative demographic differences between groups. The CR cohort (n = 756) had significantly higher average KOOS, JR Scores compared to the BCS cohort (n = 652) at 3 months (59.7 ± 3.8 vs. 53.0 ± 3.9, p < 0.001) and 2 years (62.6 ± 8.0 vs. 53.8 ± 6.7, p = 0.001) after TKA. Within the cohort, KOOS, JR delta differences were not significant for CR when comparing patient scores 3 months to 1 year after surgery. Meanwhile, the BCS patients did show significant delta improvement (4.1 ± 1.9, p = 0.030) when compared 3 months to 1 year after surgery. One year postoperatively, the BCS cohort (n = 134) showed a significantly higher average FJS score (49.5 ± 31.4, vs. 36.8 ± 28.5, p = 0.028) than the CR cohort (n = 203). Both cohorts displayed a significant difference in delta improvements within their respective cohort when measuring FJS from 3 months to 1 year, 2 years, and 3 years after surgery. @*Conclusions@#The CR cohort performed better on average, compared to the BCS cohort in measures of KOOS, JR scores at the 2-year follow-up. The BCS cohort performed marginally better regarding FJS only at 1-year follow-up.

Management of gunshot wounds near the elbow: experiences at a high-volume level I trauma center

Gunshot-related fractures near the elbow are challenging, and available data to guide the practitioner are lacking. This report analyzes injury patterns and treatment strategies in a case series from a high-volume urban trauma center. Methods: All periarticular gunshot fractures near the elbow treated at a level 1 trauma center from 2014 to 2018 were retrospectively reviewed. Fracture location, patient demographics, concomitant injuries, treatment modalities, and complications were analyzed. Results: Twenty-four patients were identified. All patients received prophylactic antibiotics upon admission and underwent urgent surgical debridement. Open reduction and internal fixation (ORIF) was performed with initial debridement in 22 of 24 patients. Seven patients sustained distal humerus fractures, 10 patients sustained isolated proximal ulna or proximal radius fractures, and seven had combined fracture patterns. Eleven patients presented with nerve palsy, and two had transected nerves. Two patients had vascular injury requiring repair. One patient required a temporary elbow-spanning external fixator and underwent staged debridement followed by ORIF. One patient with a grade IIIC fracture developed a deep infection that precluded ORIF. One patient required revision ORIF due to fracture displacement. Conclusions: This investigation reports on management of ballistic fractures near the elbow at a busy urban level I trauma center. Our management centered on rapid debridement, early definitive fixation, and intravenous antibiotic administration. We report on associated neurovascular injury, bone loss, and other challenges in this patient population. Level of evidence: IV.

Influence of lateralized versus medialized reverse shoulder arthroplasty design on external and internal rotation: a systematic review and meta-analysis

Restoration of external (ER) and internal rotation (IR) after Grammont-style reverse shoulder arthroplasty (RSA) is often unreliable. The purpose of this systematic review was to evaluate the influence of RSA medio-lateral offset and subscapularis repair on axial rotation after RSA. Methods: We conducted a systematic review of studies evaluating axial rotation (ER, IR, or both) after RSA with a defined implant design. Medio-lateral implant classification was adopted from Werthel et al. Meta-analysis was conducted using a random-effects model. Results: Thirty-two studies reporting 2,233 RSAs were included (mean patient age, 72.5 years; follow-up, 43 months; 64% female). The subscapularis was repaired in 91% (n=2,032) of shoulders and did not differ based on global implant lateralization (91% for both, P=0.602). On meta-analysis, globally lateralized implants achieved greater postoperative ER (40° [36°–44°] vs. 27° [22°–32°], P<0.001) and postoperative improvement in ER (20° [15°–26°] vs. 10° [5°–15°], P<0.001). Lateralized implants with subscapularis repair or medialized implants without subscapularis repair had significantly greater postoperative ER and postoperative improvement in ER compared to globally medialized implants with subscapularis repair (P<0.001 for both). Mean postoperative IR was reported in 56% (n=18) of studies and achieved the minimum necessary IR in 51% of lateralized (n=325, 5 cohorts) versus 36% (n=177, 5 cohorts) of medialized implants. Conclusions: Lateralized RSA produces superior axial rotation compared to medialized RSA. Lateralized RSA with subscapularis repair and medialized RSA without subscapularis repair provide greater axial rotation compared to medialized RSA with subscapularis repair. Level of evidence: 2A.