Risk factors for unexpected admission following arthroscopic and open treatment of shoulder instability: a national database study of 11,230 cases

Background@#Shoulder instability procedures have low morbidity; however, complications can arise that result in readmission to an inpatient healthcare facility. The purpose of this study is to identify the demographics and risk factors associated with unplanned 30-day readmission and reoperation following arthroscopic and open treatment for shoulder instability. @*Methods@#The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to find patients who underwent shoulder instability surgery from 2015 to 2019. Independent sample Student t-tests, chi-square, and (where appropriate) Fisher’s exact tests were used in univariate analyses to identify demographic, lifestyle, and peri-operative variables related to 30-day readmission and reoperation following repair for shoulder instability. Multivariate logistic regression modeling was subsequently performed. @*Results@#Of the 11,230 cases included in our sample, only 0.54% were readmitted, and 0.23% underwent reoperation within the 30-day postoperative period. Multivariate logistic regression modeling confirmed that the following patient variables were associated with statistically significantly increased odds of readmission and reoperation: open repair, congestive heart failure (CHF), and hospital length of stay. @*Conclusions@#Unplanned 30-day readmission and reoperation after shoulder instability surgery is infrequent. Patients with American Society of Anesthesiologists class II, CHF, longer than average hospital length of stay, or an open procedure have higher odds of readmission than patients without those factors. Patients who have CHF, longer than average hospital length of stay, and open surgery have higher odds of reoperation than others. Arthroscopic procedures should be used to manage shoulder instability, if possible. Surgeons should explain the risks and benefits of each intervention taking individual patient risk factors into account because comorbidities can also increase the risk of adverse outcomes. Level of evidence: III

Hiperkalemia crónica, diagnóstico y manejo. Consenso colombiano / Chronic hyperkalemia, diagnosis and management. Colombian consensus

Resumen Objetivo: Generar recomendaciones para el diagnóstico, el manejo y el seguimiento de la hiperkalemia crónica. Método: Este consenso fue realizado por nefrólogos y cardiólogos siguiendo la metodología GRADE. Resultados: La hiperkalemia crónica puede definirse como una condición bioquímica, con o sin manifestaciones clínicas, caracterizada por una elevación recurrente de las concentraciones séricas de potasio que puede requerir una intervención farmacológica, no farmacológica o ambas. Puede clasificarse en leve (K+ 5,0 a < 5,5 mEq/l), moderada (K+ 5,5 a 6,0 mEq/l) o grave (K+ > 6,0 mEq/l). Su incidencia y prevalencia no han sido claramente determinadas. Se consideran factores de riesgo la enfermedad renal crónica, la insuficiencia cardiaca crónica, la diabetes mellitus, la edad ≥ 65 años, la hipertensión arterial y el tratamiento con inhibidores del sistema renina-angiotensina-aldosterona (iSRAA), entre otros. No hay consenso sobre el manejo de la hiperkalemia crónica. Se sugiere identificar y eliminar o controlar los factores de riesgo, brindar asesoramiento sobre la ingesta de potasio y, para quien esté indicado, optimizar la terapia con iSRAA, administrar aglutinantes orales del potasio y corregir la acidosis metabólica. Conclusiones: Se recomienda prestar atención al diagnóstico, el manejo y el seguimiento de la hiperkalemia crónica, en especial en los pacientes con factores de riesgo.

Abstract Objective: Generate recommendations for the diagnosis, management, and follow-up of chronic hyperkalemia. Method: This consensus was made by nephrologists and cardiologists following the GRADE methodology. Results: Chronic hyperkalemia can be defined as a biochemical condition with or without clinical manifestations characterized by a recurrent elevation of serum potassium levels that may require pharmacological and or non-pharmacological intervention. It can be classified as mild (K+ 5.0 to < 5.5 mEq/L), moderate (K+ 5.5 to 6.0 mEq/L) or severe (K+ > 6.0 mEq/L). Its incidence and prevalence have yet to be determined. Risk factors: chronic kidney disease, chronic heart failure, diabetes mellitus, age ≥ 65 years, hypertension, and drugs that inhibit the renin angiotensin aldosterone system (RAASi), among others. There is no consensus for the management of chronic hyperkalemia. The suggested pattern for patients is to identify and eliminate or control risk factors, provide advice on potassium intake and, for whom it is indicated, optimize RAASi therapy, administer oral potassium binders and correct metabolic acidosis. Conclusions: The recommendation is to pay attention to the diagnosis, management, and follow-up of chronic hyperkalemia, especially in patients with risk factors.

After action review of the COVID-19 pandemic response in North West province, South Africa

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused coronavirus disease 2019 (COVID-19) pandemic with major disruptions globally. Northwest Province Department of Health (NWDoH) in South Africa set up comprehensive epidemiological emergency response plans for preventing, finding, containing and stopping the spread of COVID-19 in accordance with the National Disaster Management Act. Objectives: This After-Action Report (AAR) describes the provincial response to the pandemic from September 2020 to October 2022. Method: The AAR was conducted using the World Health Organization AAR methodology. Focus groups discussed five items: coordination, leadership and governance; epidemiology, surveillance and laboratory; case management and continuity of essential services; risk communication and community engagement and COVID-19 vaccination. Results: The timely establishment and activation of provincial intergovernmental and intersectoral coordinating structures led to effective coordination, resource mobilisation, leadership, decision-making and intervention. The effective communication in the department and other stakeholders resulted in improved surveillance data quality, timelier response and increased ownership of data. Dissemination, training and implementation of case management protocols ensured standardised case management. The multi-channel information dissemination targeting different audiences empowered people with real-time knowledge on the infection and encouraged health-seeking behaviours. Conclusion: The AAR demonstrated the importance of coordinated epidemiological, laboratory and communication response that requires significant public health reserve capacity in peacetime for rapid expansion in an emergency. Contribution: This review contributes to the body of knowledge emerging from the COVID-19 pandemic and provides guidance on enhanced public health response to future emergencies.

Pyloric Functional Lumen Imaging Probe Measurements Are Dependent on Balloon Position

Background/Aims@#The functional lumen imaging probe (FLIP) device has been used to assess pyloric dysfunction in patients with gastroparesis. We aim to investigate whether varying FLIP catheter positions affect pyloric FLIP measurements. @*Methods@#Patients undergoing endoscopy for chronic unexplained nausea and vomiting (CUNV) or gastroparesis were prospectively enrolled. FLIP balloon was adjusted for 3 positions within the pylorus: (1) proximal position, 75% of FLIP balloon in the duodenum and 25% in the antrum; (2) middle position, 50% in the duodenum and 50% in the antrum; and (3) distal position, 25% in the duodenum and 75% in the antrum. Pylorus cross-sectional area (CSA), intra-bag pressure (P), and distensibility indices (DI) were measured for 30, 40, and 50-mL balloon volumes. Fluoroscopic images were obtained to confirm FLIP balloon geometry. Data was analyzed separately using FLIP Analytic and customized MATLAB software. @*Results@#Twenty-two patients with CUNV (n = 4) and gastroparesis (n = 18) were enrolled. Pressures were significantly higher in the proximal position compared to the middle and distal positions. CSA measurements were significantly higher at the proximal and middle positions for 30-mL and 40-mL volume compared to the distal position values. DI values were significantly lower at the proximal positions for 40-mL and 50-mL distensions when compared to the middle and distal positions. Fluoroscopic images confirmed increased balloon bending when placed mostly in the duodenum. @*Conclusions@#FLIP balloon position within the pylorus directly affects balloon geometry which significantly affects P, CSA, and DI measurements. Standardized pyloric FLIP protocols and balloon design adjustments are needed for the continued application of this technology to the pylorus.

Ectopic teeth with disparate migration: A literature review and new case series

Purpose@#Ectopic eruption can be defined as the emergence of a tooth in an abnormal location, where the tooth does not follow its typical eruption pathway. While ectopic eruption within the dentate region is well-documented in the literature, ectopic eruption in non-dentate regions is relatively rare. This study aimed to report 6 cases of ectopic teeth and present a systematic review of the English-language literature on ectopic teeth, emphasizing demographic characteristics, radiographic features, potential complications, and treatment options. @*Materials and Methods@#A literature search was conducted using the PubMed, Medline, Web of Science, and Cochrane databases. The demographic data and radiographic findings of patients presenting with ectopic teeth were recorded. @*Results@#The literature review yielded 61 cases of ectopic teeth, with patients ranging in age from 3 to 74 years. The findings from these previously reported cases demonstrated that the most common location for ectopic teeth was the maxillary sinus, which is consistent with this case series. The Pearson chi-square test was performed to evaluate the correlation between age and location of ectopic teeth, and the results were found to be statistically significant (P<0.05). However, no statistically significant relationship was observed between sex and the location of ectopic teeth. @*Conclusion@#The distinct features of these cases warrant reporting. This study presents the first case of supernumerary teeth in the condyle without any associated pathosis. Another notable characteristic is the pre-eruptive resorption of 2 inverted supernumerary teeth ectopically located in the palate, which predisposes to sinus opacification.

Risk factors for unexpected readmission and reoperation following open procedures forshoulder instability: a national database study of 1,942 cases

Background@#The purpose of this study was to identify demographics and risk factors associated with unplanned 30-day readmission and reoperation following open procedures for shoulder instability and examine recent trends in open shoulder instability procedures. @*Methods@#The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried using current procedural terminology (CPT) codes 23455, 23460, and 23462 to find patients who underwent shoulder instability surgery from 2015 to 2019. Independent sample Student t-tests and chi-square tests were used in univariate analyses to identify demographic, lifestyle, and perioperative variables related to 30-day readmission following repair for shoulder instability. Multivariate logistic regression modeling was subsequently performed. @*Results@#In total, 1,942 cases of open surgical procedures for shoulder instability were identified. Within our study sample, 1.27% of patients were readmitted within 30 days of surgery, and 0.85% required reoperation. Multivariate logistic regression modeling confirmed that the following patient variables were associated with a statistically significant increase in the odds of readmission: open anterior bone block/Latarjet-Bristow procedure, being a current smoker, and a long hospital stay (all P<0.05). Multivariate logistic regression modeling confirmed statistically significant increased odds of reoperation with an open anterior bone block or Latarjet-Bristow procedure (P<0.05). @*Conclusions@#Unplanned 30-day readmission and reoperation after open shoulder instability surgery is infrequent. Patients who are current smokers, have an open anterior bone block or Latarjet-Bristow procedure, or a longer than average hospital stay have higher odds of readmission than others. Patients who undergo an open anterior bone block or Latarjet-Bristow procedure have higher odds of reoperation than those who undergo an open soft-tissue procedure.Level of evidence: III.

Physical Signs and Clinical Features of Cervical Myelopathy in Elderly Patients, Especially 80 Years or Older: Comparison of 100 Consecutive Operative Cases across Three Age Groups

Methods@#We evaluated 100 consecutive surgical patients with CM and divided them into the following groups: 80s (34 patients; mean age, 83.9 years), 70s (33 patients; mean age, 73.9 years), and 69 or younger (33 patients; mean age, 60.9 years). The clinical symptoms and physical signs were evaluated and recorded. @*Results@#Although the recovery rate decreased with increasing age, all groups demonstrated a significant improvement in clinical symptoms relative to preoperative values. The Hoffman sign and hyperreflexia of the triceps tendon were, respectively, present in 82% and 88% of patients in the 80s group, 74% and 64% of those in the 70s group, and 69% and 82% of those in the 69 or younger group, with no significant difference among the groups. In contrast, the rates of hyperreflexia of the patellar and Achilles tendons were, respectively, 59% and 32% in the 80s group, 85% and 48% in the 70s group, and 91% and 70% in the 69 or younger group, with significant differences. @*Conclusions@#The positivity rate of the lower extremity hyperreflexia decreased significantly with increasing age in patients with CM. The absence of hyperreflexia, particularly lower extremity, is not uncommon in elderly patients with suspected CM.

Sociodemographic and clinical profile of crack cocaine treatment-seeking individuals living in "Crackland", Brazil / Perfil sociodemográfico e clínico de indivíduos em busca de tratamento para o uso de crack que vivem na "Cracolândia"

OBJECTIVE: São Paulo's Crackland is the biggest and oldest open drug use scene in Brazil, yet little is known about the profile of crack cocaine treatment-seeking individuals living in this region. The aim of this crossectional study was to describe the demographics and clinical characteristics of treatment-seeking crack users living in the Crackland region. METHODS: A sample of nighty eight individuals were screened for DSM-V substance use disorders, including substance use, impulsiveness, and psychiatric symptoms. Recent crack cocaine use was also tested using biologic specimens. RESULTS: Results indicated severe social vulnerability, as participants experienced high rates of homelessness (46.9%), unstable housing (50%), unemployment (60.4%) and early school drop-out (27.5%). The average age of crack use onset was 20 years (SD = 6.9) and the mean duration of continuous crack use was 15 years (SD = 9.7). Most participants presented with concomitant mental health disorders, particularly alcohol use disorder (87.8%), as well high rates of psychiatric symptomatology and impulsiveness. More than half of the sample reported at least one previous inpatient (73.5%) and outpatient (65.3%) addiction treatment attempt. CONCLUSION: This population profile should inform mental healthcare services, promoting the provision of tailored assistance by targeting specific demands at all levels of treatment.

OBJETIVO: Localizada em São Paulo, a Cracolândia é o maior e mais antigo cenário aberto de uso de drogas do Brasil. Ainda assim, pouco se sabe sobre o perfil dos indivíduos que vivem nessa região e buscam tratamento para crack. O objetivo deste estudo transversal foi descrever características demográficas e clínicas de usuários de crack vivendo na região da Cracolândia que estão em busca de tratamento. MÉTODOS: Noventa e oito indivíduos foram avaliados para transtornos por uso de substâncias do DSM-V, padrão de uso de substâncias, impulsividade e sintomatologia psiquiátrica. O uso recente de crack também foi determinado por meio de coleta de amostras toxicológicas. RESULTADOS: Os resultados indicaram grave vulnerabilidade social, com significativas prevalências de falta de moradia (46,9%), moradia instável (50%), desemprego (60,4%) e abandono escolar precoce (27,5%). A idade média de início do uso de crack foi de 20 anos (DP = 6,9) e a duração média do uso contínuo do crack foi de 15 anos (DP = 9,7). A maioria dos participantes apresentou alguma comorbidade psiquiátrica, particularmente transtorno por uso de álcool (87,8%), bem como altas taxas de sintomatologia psiquiátrica e impulsividade. Mais da metade da amostra relatou pelo menos uma tentativa anterior de tratamento por internação (73,5%) e ambulatorial (65,3%). CONCLUSÃO: Os achados desse estudo permitem um maior entendimento do perfil e das necessidades de usuários de crack vivendo na região da Cracolândia e podem ajudar serviços de saúde especializados em dependência química a promoverem uma assistência mais direcionada às demandas específicas dessa população.

YouTube as a source of patient education information for elbow ulnar collateral ligament injuries: a quality control content analysis

Background@#While online orthopedic resources are becoming an increasingly popular avenue for patient education, videos on YouTube are not subject to peer review. The purpose of this cross-sectional study was to evaluate the quality of YouTube videos for patient education in ulnar collateral ligament (UCL) injuries of the elbow. @*Methods@#A search of keywords for UCL injury was conducted through the YouTube search engine. Each video was categorized by source and content. Video quality, reliability, and accuracy were assessed by two independent raters using five metrics: (1) Journal of American Medical Association (JAMA) benchmark criteria (range 0–4) for video reliability; (2) modified DISCERN score (range 1–5) for video reliability; (3) Global Quality Score (GQS; range 1–5) for video quality; (4) ulnar collateral ligament-specific score (UCL-SS; range 0–16), a novel score for comprehensiveness of health information presented; and (5) accuracy score (AS; range 1–3) for accuracy. @*Results@#Video content was comprised predominantly of disease-specific information (52%) and surgical technique (33%). The most common video sources were physician (42%) and commercial (23%). The mean JAMA score, modified DISCERN score, GQS, UCL-SS, and AS were 1.8, 2.4, 1.9, 5.3, and 2.7 respectively. @*Conclusions@#Overall, YouTube is not a reliable or high-quality source for patients seeking information regarding UCL injuries, especially with videos uploaded by non-physician sources. The multiplicity of low quality, low reliability, and irrelevant videos can create a cumbersome and even inaccurate learning experience for patients.

Is vitamin D status associated with non-communicable disease risk in children? A cohort study

Background: Studies in children and adults have reported variations in 25-hydroxyvitamin D (25(OH)D), body mass index (BMI) and blood pressure (BP) over time. Furthermore, there has been a reported association of 25(OH)D with BMI, BP and lipid levels in some cross-sectional and longitudinal studies. Methods: This is a longitudinal study of a group of adolescents with measurements of 25(OH)D, BP, anthropometry and lipids at the ages of 11, 12 13, 15 and 18­20 years. For age-related changes, year 12 participants (n = 261) were matched with year 18­20 participants (n = 368), resulting in 200 paired participants. Longitudinal analyses using the Generalized Estimating Equations (GEE) comprised the following groups of participants, Year 11 (n = 288), Year 12 (n = 253), Year 13 (n = 292), Year 15 (n =238) and Year 18­20 (n = 368). The relationship of 25(OH)D with BMI, BP and lipid levels over a period of 10 years was assessed. Results: There were significant increases in mean BMI and BP, and decreases in 25(OH)D levels with age (all p-values < 0.0001).In females, systolic BP was significantly higher in older participants (18­20) years than younger participants (12 years), but 25(OH)D was significantly higher in younger than older participants. In males, there was significant increase in BP in participants between age 12 years and 18­20 years. 25(OH)D, total cholesterol (TC) and low-density lipoprotein (LDL-C) were significantly lower in 18­20-year-old participants compared with 12-year-old participants. Longitudinally, 25(OH)D was inversely associated with LDL-C. Conclusion: There is evidence of changes in 25(OH)D, BMI and BP in adolescents over a period of 10 years. After adjusting for covariates, BMI and LDL-C were significantly negatively associated with 25(OH)D, which suggests that vitamin D status might be associated positively with favourable lipid profiles in children and adolescents.

Toxoplasmosis congénita: la importancia de la adherencia a las guías y las implicaciones clínicas en Colombia / Congenital toxoplasmosis: the importance of adherence to guidelines and clinical implications in Colombia

Resumen Introducción: La toxoplasmosis congénita continúa siendo un problema de salud pública. Aun cuando existen guías plenamente divulgadas y conocidas, se observa poca implementación de ellas en algunas instituciones de salud y una inadecuada interpretación de las pruebas serológicas en las gestantes. Esto puede generar falta de captación y tratamiento en embarazadas con primoinfección por Toxoplasma gondii. Casos clínicos: Se reportan dos casos de toxoplasmosis congénita, uno de ellos con desenlace fatal. En ambos no se siguieron las guías de práctica clínica, lo cual conllevó un diagnóstico tardío y, en consecuencia, un manejo en condiciones inapropiadas con daños graves. Conclusiones: La toxoplasmosis es una infección congénita aún prevalente en algunos países, con secuelas graves, discapacidad neurológica y riesgo de daño ocular, incluso tardío. Además, existen algunas variedades de cepas de T. gondii con un comportamiento más agresivo en Latinoamérica, lo cual empeora la presentación de los casos e incluye mayor riesgo de muerte.

Abstract Background: Congenital toxoplasmosis continues to be a public health problem. Although clinical guidelines have been divulgated and are well known, they are not implemented in some health institutions, in addition of an inappropriate interpretation of the serological tests in pregnant women. This situation can lead to lack of screening and treatment in pregnant women with primary Toxoplasma gondii infection. Case reports: We report two cases of congenital toxoplasmosis, one with a fatal outcome. In both cases, the clinical guidelines were not initially followed, leading to a delayed diagnosis and, consequently, an inappropriate management in conditions with severe damage. Conclusions: Toxoplasmosis is a congenital infection still prevalent in some countries, with severe sequelae, neurological disability, and even late risk of ocular damage. Additionally, some varieties of the T. gondii strains have a more aggressive pattern in Latin America, worsening the clinical presentation of cases and including a high risk of death.

Planes, políticas públicas y estrategias de salud bucal en Latinoamérica y el Caribe (1991-2018) / Plans, public policies and strategies of oral health in Latin America and Caribbean (1991-2018)

Introducción: La identificación de políticas públicas y estrategias en salud bucal, así como lo relacionado con sus propósitos, acciones y limitaciones, es un paso importante en la acción intersectorial en salud para alcanzar equidad. Objetivo: Describir las características principales de los documentos relacionados con planes, políticas y estrategias en salud bucal en Latinoamérica y el Caribe. Métodos: Estudio exploratorio mediante el análisis documental de fuentes secundarias de información disponibles en las páginas web de los ministerios de salud de 23 países, y rastreo sistemático en el buscador Google, sin restricción espacio-temporal. Se realizó análisis de contenido cuantitativo y cualitativo. Resultados: Se analizaron 85 documentos. Los países con mayor número de documentos relacionados con el tema propuesto fueron Colombia (n = 14), México (n = 8) y Panamá (n = 7). Una buena parte centran su atención en poblaciones específicas; por ejemplo: gestantes, comunidades vulnerables, escolares, maestros, entre otras. Tienen como propósito la disminución de factores de riesgo para las principales enfermedades bucales, desde enfoques relacionados con los determinantes sociales. El enfoque de género es más tímido y centra su atención en necesidades especiales de las mujeres en embarazo, parto y posparto. Los objetivos de la mayoría de los documentos analizados consistían en una atención integral sobre el estado de salud bucodental, mediante acciones de educación, promoción y actividades clínicas a la población, según sus necesidades. Conclusiones: Se encontró una representación importante de países que tienen documentos relacionados con programas y planes nacionales o locales y con indicadores que reflejan su cumplimiento. También existen guías prácticas de actuación. Aunque en el diseño y construcción de los documentos intervienen profesionales, sobre todo de la estomatología, falta la participación de otras áreas del conocimiento que ayudarían a lograr una visión más amplia hacia la determinación social de la salud(AU)

Introduction: The identification of public policies and strategies in oral health, as well as its purposes, actions and limitations is an important step in intersectoral action in health to achieve equity. Objective: To describe the main characteristics of the documents related to oral health plans, policies and strategies in Latin America en the Caribbean. Methods: An exploratory study was conducted by means of documentary analysis of secondary sources of information available on the websites of the ministries of health of 23 countries, and systematic search in the Google, without spatio-temporal restriction. Quantitative and qualitative content analysis was performed. Results: 85 documents were analyzed. The countries with the highest number of documents related to the research topic were Colombia (n = 14), Mexico (n = 8) and Panama (n = 7). A good part is focused on specific populations, such as pregnant women, socially vulnerable communities, school children, teachers, among others. Their purpose is to reduce risk factors for the main oral diseases, making important advances in approaches related to social determinants. However, the gender approach is more timid by focusing attention on the oral health special needs of women in pregnancy, childbirth and postpartum. The main objectives of most of the documents analyzed consisted of an integral attention on the state of oral health, applying education, promotion and clinical activities to the population, according to their needs. Conclusions: An important representation of countries with documents related to national or local programs and plans were found and they have indicators that reflect their compliance. Also practical action guides were described. Although many professionals, especially in dentistry, intervene in the design and construction of documents, the participation of other areas of knowledge is lacking, what will help to achieve a broader vision towards the social determination of health(AU)

Endoscopic Ultrasound-Guided Fine Needle Biopsy Needles Provide Higher Diagnostic Yield Compared to Endoscopic Ultrasound-Guided Fine Needle Aspiration Needles When Sampling Solid Pancreatic Lesions: A Meta-Analysis

Background/Aims@#Studies comparing the utility of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for solid pancreatic lesions have been inconclusive with no clear superiority. The aim of this meta-analysis was to compare the diagnostic accuracy and safety between the two sampling techniques. @*Methods@#We performed a systematic search of randomized controlled trials published between 2012 and 2019. The primary outcome was overall diagnostic accuracy. Secondary outcomes included adverse event rates, cytopathologic and histopathologic accuracy, and the mean number of passes required to obtain adequate tissue between FNA and FNB needles. Fixed and random effect models with pooled estimates of target outcomes were developed. @*Results@#Eleven studies involving 1,365 participants were included for analysis. When compared to FNB, FNA had a significant reduction in diagnostic accuracy (81% and 87%, p=0.005). In addition, FNA provided reduced cytopathologic accuracy (82% and 89%, p=0.04) and an increased number of mean passes required compared to FNB (2.3 and 1.6, respectively, p<0.0001). There was no difference in adverse event rate between FNA and FNB needles (1.8% and 2.3% respectively, p=0.64). @*Conclusions@#FNB provides superior diagnostic accuracy without compromising safety when compared to FNA. FNB should be readily considered by endosonographers when evaluating solid pancreatic masses.

Endoscopic Ultrasound-Guided Fine Needle Biopsy Needles Provide Higher Diagnostic Yield Compared to Endoscopic Ultrasound-Guided Fine Needle Aspiration Needles When Sampling Solid Pancreatic Lesions: A Meta-Analysis

Background/Aims@#Studies comparing the utility of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for solid pancreatic lesions have been inconclusive with no clear superiority. The aim of this meta-analysis was to compare the diagnostic accuracy and safety between the two sampling techniques. @*Methods@#We performed a systematic search of randomized controlled trials published between 2012 and 2019. The primary outcome was overall diagnostic accuracy. Secondary outcomes included adverse event rates, cytopathologic and histopathologic accuracy, and the mean number of passes required to obtain adequate tissue between FNA and FNB needles. Fixed and random effect models with pooled estimates of target outcomes were developed. @*Results@#Eleven studies involving 1,365 participants were included for analysis. When compared to FNB, FNA had a significant reduction in diagnostic accuracy (81% and 87%, p=0.005). In addition, FNA provided reduced cytopathologic accuracy (82% and 89%, p=0.04) and an increased number of mean passes required compared to FNB (2.3 and 1.6, respectively, p<0.0001). There was no difference in adverse event rate between FNA and FNB needles (1.8% and 2.3% respectively, p=0.64). @*Conclusions@#FNB provides superior diagnostic accuracy without compromising safety when compared to FNA. FNB should be readily considered by endosonographers when evaluating solid pancreatic masses.

The efficacy of low dose short-term prednisone therapy for remission induction in newly diagnosed rheumatoid arthritis patients

Abstract Background: The ACR/EULAR recommendations endorse the use of glucocorticoids (GCs) for rheumatoid arthritis (RA) patients' flares and as a bridge to a DMARD. However, the recommendation of low dose short-term monotherapy with (GCs) remains open to the discretion of the clinician. The aim of this study was to assess whether a short-term use of low dose prednisone monotherapy was effective in inducing remission in newly diagnosed RA patients. Methods: A retrospective analysis of patients newly diagnosed with RA at a Community Health Center in North Dakota was performed based on the ACR/EULAR RA classification criteria. Demographic and clinical data were abstracted from patients' medical charts. Patients treated with (≤ 10 mg/day) of prednisone up to 6 months were included. Response to prednisone was analyzed according to pre- and post-treatment DAS28-ESR score and EULAR response criteria. Results: Data on 201 patients were analyzed. The mean prednisone dose was 8 mg/day (range: 5-10; SD = 1.2) and the mean treatment duration was 42.2 days (12-177; 16.9). Disease severity significantly improved from baseline to follow-up for: tender joint count (8.6 ± 4.8 vs. 1.5 ± 3.3; P < 0.001), swollen joint count (6.2 ± 5.0 vs. 1.4 ± 3.0; P < 0.001), and visual analog pain score (4.8 ± 2.6 vs. 2.1 ± 2.5; P < 0.001). DAS28-ESR disease severity significantly improved from baseline to follow-up: (5.1 ± 1.2 vs. 2.7 ± 1.3; P < 0.001). Per EULAR response criteria, 69.7% of patients showed good response to treatment and 20.4% showed moderate response. 54.2% of patients reached remission. Conclusion: Short-term use of low dose prednisone monotherapy induced disease remission and improved clinical severity of RA in the majority of newly diagnosed patients.

Over-the-counter tooth whitening agents: a review of literature

Abstract There is an increased accessibility of over-the-counter (OTC) whitening agents with very little data in the literature regarding their effectiveness. This review was done to determine their effectiveness of the predominant OTC whitening agents from 2006 until 2018 where a comparison of each agent was made with a placebo, no treatment or with other OTC whitening agents. The major categories of OTC whitening agents such as dentifrices, whitening strips and paint on gels. Dentist prescribed bleaching applied at home and in-office bleaching studies and studies that demonstrated whitening products to participants were excluded. Articles were searched for in the databases of Medline (Ovid), PubMed, the Cochrane Library and Cochrane Central Register of Controlled Trials. Twenty-four articles were included in the systematic review and the quality of studies was determined by the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) ranking criteria. Compared to other OTC, strips are reported to be effective. Two studies determined whitening strips to be effective. Whitening strips have been shown to be effective when compared with placebos and other OTC whitening agents. Dentifrices are effective in changing the shade of the tooth "by removing extrinsic stains" when compared to a placebo and non-whitening dentifrices, but they are not as effective in comparison to whitening strips. There is a lack of evidence with regards to the effectiveness of paint-on gels. While there is some evidence that OTC can alter shade in the short term, there is a need for better-designed studies.

Resumo Há um aumento da acessibilidade dos agentes clareadores de venda livre com poucos dados na literatura sobre sua eficácia. Esta revisão foi feita para determinar a eficácia dos agentes clareadores de venda livre predominantes de 2006 a 2018, onde foi feita uma comparação de cada agente com um placebo, sem tratamento ou com outros agentes clareadores de venda livre. As principais categorias de agentes clareadores de venda livre, como dentifrícios, tiras branqueadoras e géis. Estudos em que o dentista prescreveu clareamento caseiro e em consultório, e estudos que demonstraram os agentes clareadores para os participantes. Os artigos foram pesquisados ​​nas bases de dados do Medline (Ovid), PubMed, Cochrane Library e Cochrane Central Register of Controlled Trials. Vinte e quatro artigos foram incluídos na revisão sistemática e a qualidade dos estudos foi determinada pelo critério de classificação GRADE (Classificação de Recomendações, Avaliação, Desenvolvimento e Avaliações). Em comparação com outros clareadores de venda livre, as tiras são relatadas como eficazes. Dois estudos determinaram que as tiras de clareamento são eficazes. As tiras de clareamento mostraram-se eficazes quando comparadas com placebos e outros agentes clareadores de venda livre. Os dentifrícios são eficazes na mudança da tonalidade do dente "removendo manchas extrínsecas" quando comparados a dentifrícios com placebo e sem clareamento, mas não são tão eficazes em comparação com as tiras de clareamento. Há uma falta de evidência com relação à eficácia dos géis de tinta. Embora exista alguma evidência de que os clareadores de venda livre possa alterar a tonalidade no curto prazo, há necessidade de estudos melhor projetados.

The Role of Endoscopic Ultrasound-Guided Ki67 in the Management of Non-Functioning Pancreatic Neuroendocrine Tumors

Background/Aims@#The management of small, incidentally discovered nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) has been a matter of debate. Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is a tool used to identify and risk-stratify PNETs. This study investigates the concordance rate of Ki67 grading between EUS-FNA and surgical pathology specimens in NFPNETs and whether certain NF-PNET characteristics are associated with disease recurrence and disease-related death. @*Methods@#We retrospectively reviewed the clinical history, imaging, endoscopic findings, and pathology records of 37 cases of NFPNETs that underwent pre-operative EUS-FNA and surgical resection at a single academic medical center. @*Results@#There was 73% concordance between Ki67 obtained from EUS-FNA cytology and surgical pathology specimens; concordance was the highest for low- and high-grade NF-PNETs. High-grade Ki67 NF-PNETs based on cytology (p=0.028) and histology (p=0.028) were associated with disease recurrence and disease-related death. Additionally, tumors with high-grade mitotic rate (p=0.005), tumor size >22.5 mm (p=0.104), and lymphovascular invasion (p=0.103) were more likely to have poor prognosis. @*Conclusions@#NF-PNETs with high-grade Ki67 on EUS-FNA have poor prognosis despite surgical resection. NF-PNETs with intermediate-grade Ki67 on EUS-FNA should be strongly considered for surgical resection. NF-PNETs with low-grade Ki67 on EUSFNA can be monitored without surgical intervention, up to tumor size 20 mm.

Determination of Biofilm-Forming Capacity of Otopathogens Isolated from Discharging Ears in Children with Chronic Otitis Media

Chronic otitis media is a common disease of the developing world with persistent ear discharge, leading to major complications. This study describes the microorganisms isolated from the middle ear and nasopharynx of children with chronically discharging ears. Middle ear and nasopharyngeal swabs from 89 children were studied, and the microorganisms isolated were assessed for biofilm-forming ability. Methicillin-susceptible Staphylococcus aureus was common in the nasopharynx, while the middle ear showed predominantly pseudomonas and Methicillin-resistant S. aureus. Pseudomonas aeruginosa showed strong biofilm formation, whereas Escherichia coli, Proteus sp. and Providentia sp. were weak biofilm producers. S. aureus isolates were negative for biofilm formation.