Bone Age Determination of Epiphyseal Fusion at Knee Joint and Its Correlation with Chronological Age.

Background and Objectives: Bone age determination is a valuable method for forensic and disaster identifications of unknown human remains, as well as for medical and surgical procedural purposes. This retrospective research study aimed to determine the age based on epiphyseal fusion stages and investigate differences related to gender. Materials and Methods: X-rays of the knee were collected from medical imaging centers in hospitals in the south of Jordan and examined by two observers who determined the bone epiphyseal phase of closure for the femur, tibia, and fibula bone ends close to the knee based on a three-stage classification. Results: The main results revealed that females showed earlier epiphyseal union (Stage II) at the lower end of the femur and the upper ends of the tibia and fibula compared to males. In males, the start of complete union (Stage III) at knee bones was seen at the age of 17-18 years, while in females, it was seen at the age of 16-17 years. Additionally, knee bones showed complete union in 100% of males and females in the age groups 21-22 years and 20-21 years, respectively. Although females showed an earlier start and end of epiphyseal complete union than males, analysis of collected data showed no significant age differences between males and females at the three stages of epiphyseal union of the knee bones. Conclusions: Findings of the radiographic analysis of bone epiphyseal fusion at the knee joint are a helpful method for chronological age determination. This study supports the gender and ethnicity variation among different geographical locations. Studies with a high sample number would be needed to validate our findings.

Key Performance Indicators: A Framework for Allied Healthcare Educational Institutions.

Background: Performance evaluation in the allied healthcare education sector is complex, making it essential for policymakers and managers to approach it comprehensively and thoughtfully to understand their performance. Hence, the development and monitoring of Key Performance Indicators (KPIs) in this domain must be considered one of the key priorities for the policymakers in AHIs. Aim: This study aims to develop a framework for the AHIs to extract and profile the indicators, measure, and report the results appropriately. Methods: The authors adopted a general review of the literature approach to study the primary goals of the institutional KPI framework, emphasizing the need for benchmarking while implementing KPIs and how to track performance using a KPI dashboard. Results: The study provides the scope, relevant KPI categories, and a list of KPIs for evaluating the effectiveness of allied healthcare programs. The study findings also emphasized the need for benchmarking the KPIs and establishing a KPI dashboard while measuring and monitoring performance. Conclusion: KPIs are considered an invaluable tool that contributes immensely to the performance monitoring process of AHIs, irrespective of the specialties. This helps to identify and guide AHIs for developing KPIs and the associated minimum data set to measure organizational performance and monitor the quality of teaching and learning. In addition, the KPI framework reported in this study is a tool to assist performance monitoring that can subsequently contribute to the overall quality of AHIs.

Mandibular Incisive Canal Morphometry: A Cone-Beam Computed Tomography Study in Jordan

SUMMARY: Mandibular incisive canal (MIC) and related mental foramen (MF) and anterior loop (AL) morphometrics are important landmarks in medical and dental clinical applications. The main aim of this retrospective study to determine the morphometry of the mandibular incisive canal (MIC) in a Jordanian population and to propose a new shape-pattern classification of the MIC. In addition, MF and AL morphometrics were determined. Carestream 3D imaging software was used on 100 Cone-Beam Computed Tomography (CBCT) of a Jordanian population to determine the MF, AL and MIC morphometrics. The detection prevalence of the MIC was 96 %. The right and left MIC showed four distinct line patterns, proposed for the first time in this paper. The line-patterns were angular (L-line), straight (I-line), curved (V-line) and wavy (W-line), with a prevalence of 41 %, 19 %, 25.5 %, and 10.5 %, respectively. MF was detected in all mandibles with a round shape in 58 % of the images. The most common horizontal and vertical positions of the MF were H4 and H3 (73.5 %) and V3 and V2 (95 %), respectively. An accessory MF was detected in 14.5 % of the samples and was more prevalent in males and on the right side. AL was detected in 92.5 % of the samples and exhibited a pattern prevalence of 25.5 %, 40 % and 27 % for types I, II and III, respectively. Results revealed that asymmetry and gender differences between right and left MIC, MF, AL and AMF was seen in patient's mandibles. In conclusion, this is the first study to propose and show that Mandibular incisive canal exhibits four potential line patterns (L, I, V and W lines patterns). Gender and ethnic variations of the mandibular canal landmarks morphometrics of both right and left hemi-mandible are important to be acknowledged in learning anatomy and when planning or performing dental and medical procedures.

Las relaciones de la morfometría del canal incisivo mandibular (MCI), del foramen mentoniano (FM) y del asa anterior (AA) son hitos importantes en las aplicaciones clínicas médicas y dentales. El objetivo principal de este estudio retrospectivo fue determinar la morfometría del MCI en una población jordana y proponer una nueva clasificación de patrón de forma del MCI. Además, se determinaron la morfometría de FM y AA. Se utilizó el software de imágenes 3D Carestream en 100 tomografías computarizadas de haz cónico (CBCT) de una población jordana para determinar la morfometría de FM, MCI y AA. La prevalencia de detección de MCI fue del 96 %. El MCI derecho e izquierdo mostraron cuatro patrones de líneas distintas, propuestas por primera vez en este artículo. Los patrones de líneas fueron angulares (línea L), rectos (línea I), curvos (línea V) y ondulados (línea W), con una prevalencia del 41 %, 19 %, 25,5 % y 10,5 % respectivamente. Se detectó el FM en todas las mandíbulas y con forma redonda en el 58 % de las imágenes. Las posiciones horizontal y vertical más comunes del FM fueron H4 y H3 (73,5 %) y V3 y V2 (95 %), respectivamente. Se detectó FM accesorio en el 14,5 % de las muestras y fue más prevalente en el sexo masculino y en el lado derecho. AA se detectó en el 92,5 % de las muestras y exhibió un patrón de prevalencia del 25,5 %, 40 % y 27 % para los tipos I, II y III, respectivamente. Los resultados revelaron asimetría y diferencias en el sexo entre MCI, FM, AA derecha e izquierda en las mandíbulas de los pacientes. En conclusión, este es el primer estudio que propone y muestra que el canal incisivo mandibular exhibe cuatro patrones de líneas potenciales (patrones de líneas L, I, V y W). Es importante reconocer las variaciones étnicas y de sexo de la morfometría de los puntos de referencia del canal mandibular de la hemimandíbula derecha e izquierda al estudiar y aprender anatomía y al planificar o realizar procedimientos médicos y dentales.

DETOUR2 trial outcomes demonstrate clinical utility of percutaneous transmural bypass for the treatment of long segment, complex femoropopliteal disease.

OBJECTIVE: Percutaneous transmural arterial bypass (PTAB) using the DETOUR system aims to create a percutaneous, endovascular femoropopliteal bypass for the treatment of long segment, complex superficial femoral and proximal popliteal artery disease. The goal of the DETOUR2 study is to investigate the safety and effectiveness of the therapy in comparison with pre-established performance goals. METHODS: The DETOUR2 investigational device exemption study is a prospective, single-arm, multicenter, international trial of symptomatic peripheral arterial disease patients (Rutherford classes 3-5) undergoing the DETOUR procedure for long segment (>20 cm) superficial femoral artery disease. Prespecified end points included primary safety (composite of major adverse events) at 30 days, and effectiveness (primary patency defined as freedom from restenosis or clinically driven target lesion revascularization) at 1 year. RESULTS: We enrolled 202 patients at 32 sites with 200 treated with the DETOUR system. The mean lesion length was 32.7 cm, of which 96% were chronic total occlusions (CTO) and 70% were severely calcified. Technical success was achieved in 100% of treated patients. The primary safety end point was met with a 30-day freedom from major adverse event rate of 93.0%. The 1-year primary effectiveness end point was met with 72.1% primary patency at 12 months. Primary-assisted and secondary patency were 77.7% and 89.0%, respectively, at 12 months. The 12 month deep venous thrombosis incidence was 4.1% with no pulmonary emboli reported. Venous quality-of-life scores showed no significant changes from baseline. There was a Rutherford improvement of at least one class through 12 months in 97.2% of patients. The mean ankle-brachial index also improved from 0.61 to 0.95 during this period. There were marked improvements in quality-of-life and functional status measures. CONCLUSIONS: The DETOUR2 study met both the primary safety and effectiveness end points, demonstrating clinical usefulness of this novel therapeutic strategy in long femoropopliteal lesions.

Primary results of the SAVAL randomized trial of a paclitaxel-eluting nitinol stent versus percutaneous transluminal angioplasty in infrapopliteal arteries.

BACKGROUND: Effective and durable options for infrapopliteal artery revascularization for patients with chronic limb-threatening ischemia (CLTI) are limited. METHODS: The SAVAL trial is a prospective, multicenter, randomized trial of patients with CLTI and infrapopliteal artery lesions with total lesion length ⩽ 140 mm, stenosis ⩾ 70%, and Rutherford category 4-5 assigned 2:1 to treatment with the SAVAL self-expandable paclitaxel drug-eluting stent (DES) or percutaneous transluminal angioplasty (PTA) with an uncoated balloon. The primary effectiveness endpoint was primary vessel patency (i.e., core lab-adjudicated duplex ultrasound-based flow at 12 months in the absence of clinically driven target lesion revascularization or surgical bypass of the target lesion). The primary safety endpoint was the 12-month major adverse event (MAE)-free rate; MAEs were defined as a composite of above-ankle index limb amputation, major reintervention, and 30-day mortality. The endpoints were prespecified for superiority (effectiveness) and noninferiority (safety) at a one-sided significance level of 2.5%. RESULTS: A total of 201 patients were enrolled and randomly assigned to treatment (N = 130 DES, N = 71 PTA). Target lesion length was 68.1 ± 35.2 mm for the DES group and 68.7 ± 49.2 mm for the PTA group, and 31.0% and 27.6% of patients, respectively, had occlusions. The 12-month primary patency rates were 68.0% for the DES group and 76.0% for the PTA group (Psuperiority = 0.8552). The MAE-free rates were 91.6% and 95.3%, respectively (Pnoninferiority = 0.0433). CONCLUSION: The SAVAL trial did not show benefit related to effectiveness and safety with the nitinol DES compared with PTA in infrapopliteal artery lesions up to 140 mm in length. Continued innovation to provide optimal treatments for CLTI is needed. (ClinicalTrials.gov Identifier: NCT03551496).

Incidence of adverse cardiovascular events in patients with insomnia: A systematic review and meta-analysis of real-world data.

Insomnia is a prevalent sleeping disorder associated with increasing cardiovascular (CV) mortality and morbidity. However, data incorporating recent clinical studies evaluating these outcomes is scarce. Hence, we aimed to investigate the association of insomnia with CV mortality, myocardial infarction (MI), all-cause mortality, and incidence of CV disease by conducting the first-ever meta-analysis of real-world data evaluating these CV outcomes. MEDLINE and Scopus databases were queried till August 2022 to identify studies comparing prespecified outcomes in patients with and without insomnia. The primary outcomes were CV mortality and myocardial infarction, while secondary outcomes included all-cause mortality, and CV-disease incidence. All data were pooled using an inverse-variance weighted random-effects model, and results were reported as relative risks (RRs) and p-values. 21 studies were analyzed. Risks for CV mortality and MI were significantly higher in patients with insomnia (RR 1.53, p<0.01, and RR 1.48, p = 0.03, respectively). The risk for all-cause mortality and CV disease incidence was also significantly higher in insomnia patients (RR 1.14, p = 0.03, and RR 1.31, p<0.01, respectively). Individuals with insomnia experience a higher risk of long-term mortality, MI, and incidence of CV disease.

Attitudes and Practices Surrounding Opioid Prescriptions following Open Reduction Internal Fixation of Distal Radius and Ankle Fractures: A Survey of the Canadian Orthopaedic Association Membership.

Background: The past two decades have seen a significant increase in consequences associated with nonmedical misuse of prescription opioids, such as addiction and unintentional overdose deaths. This study aimed to use an electronic survey to assess attitudes and opioid-prescribing practices of Canadian orthopaedic surgeons and trainees following open reduction internal fixation (ORIF) of distal radius and ankle fractures. This study was the first to assess these factors following ORIF of distal radius and ankle fractures using a survey design. Methods: A 40-item survey was developed focusing on four themes: respondent demographics, opioid-prescribing practice, patients with substance use disorders, and drug diversion. The survey was distributed among members of the Canadian Orthopaedic Association. Descriptive statistics were used to summarize respondent demographics and outcomes of interest. A Chi-square test was used to determine if proportion of opioid prescriptions between attending surgeons and surgeons in training was equal. Results: 191 surveys were completed. Most respondents prescribed 10-40 tabs of immediate-release opioids, though this number varied considerably. While most respondents believed patients consumed only 40-80% of the prescribed opioids (73.6%), only 28.7% of respondents counselled patients on safe storage/disposal of leftover opioids. 30.5% of respondents felt confident in their knowledge of opioid use and mechanisms of addiction. Most respondents desired further education on topics such as procedure-based opioid-prescribing protocols (74.2%), alternative pain management strategies (69.7%), and mechanisms of opioid addiction (49.0%). Conclusions: The principle finding of this study is the lack of a standardized approach to postoperative prescribing in distal radius and ankle fractures, illustrated by the wide range in number of opioids prescribed by Canadian orthopaedic surgeons. Our data suggest a trend towards overprescription among respondents following distal radius and ankle ORIF. Future studies should aim to rationalize interventions targeted at reducing postoperative opioid prescribing for common orthopaedic trauma procedures.

An Evaluation of the Effect of Social Media Platforms on the General Population's Decision-Making About Cosmetic Procedures in Makkah City, Saudi Arabia.

Background and objective Aesthetic procedures are one of the most commonly performed medical procedures. Surgical and non-surgical cosmetic treatments that are routinely performed include breast augmentations, rhinoplasty, botulinum toxin, and fillers. Several factors contribute to the increase in the popularity of these procedures, including body image dissatisfaction, the opinion of peers, and surgeon-related factors such as the surgeon's reputation, board certification, or years of experience. In addition, recent evidence suggests that active and passive usage of highly visual social media that focus on appearance-centric content have been positively associated with the acceptance of, and desire for, cosmetic procedures. In this study, we aimed to investigate the influence of social media on individuals' decision-making in terms of cosmetic procedures. Method The setting for this population-based cross-sectional study was public places in Makkah City, Saudi Arabia, and it was conducted from September to November 2021. Our study included adults above the age of 18 years. The exclusion criteria were as follows: non-Arabic speakers and individuals with congenital anomalies or dysmorphic dermatological diseases. The final sample consisted of 364 participants. All analyses were carried out using IBM SPSS Statistics version 28 (IBM Corp., Armonk, NY). Continuous and categorical variables were compared using ANOVA and Pearson's Chi-squared test. Result A total of 364 participants were included in the study, and 80% of them used their phones on a daily basis for >4 hours per week. The mean age of the participants was 27.4 ± 8.3 years, and they had a mean BMI of 25.0 ± 6.4 kg/m2; 60% of the participants were female. Participants with a history of cosmetic procedures or a desire to undergo cosmetic procedures reported a similar pattern of daily phone use. There was no significant association between the reported history of cosmetic procedures and the daily duration of selected social media platform use. Conclusion We found no significant correlation between the hours spent on social media and the participants' history or desire for cosmetic procedures. Only 54 subjects compared themselves to social media celebrities. These findings could be attributed to the fact that the Makkah population is conservative in their religious attitudes and traditions, which makes them less susceptible to social media influences.

ALTERED LEVELS OF ANTI-MULLERIAN HORMONE AND HEPCIDIN AS POTENTIAL BIOMARKERS FOR POLYCYSTIC OVARY SYNDROME.

Polycystic Ovary Syndrome (PCOS) is one of the most common endocrinopathies in women of reproductive age group. Aim - to determine the relationship of Anti-Mullerian hormone (AMH) with hepcidin, ferritin, serum iron and interleukin-6 among PCOS women. A total of 60 PCOS women enrolled in the study, whose ages ranges were between 15-45 years old versus control group (30 healthy volunteer females with regular menstrual cycles aged between 15 to 45 years). All PCOS patients and healthy control underwent full physical examination and anthropometric measurements. Blood samples were collected from each woman for measurement of AMH, and hepcidin. The study showed that the Lowest mean of hepcidin was observed among PCOS women (13.27±1.46 ng/ml) as compared to the control group of non-PCOS women (98.76±2.88 ng/ml). The mean SD of AMH in PCOS women was (7.63±3.66 ng/ml), which was significantly higher than the control group with a mean SD of (2.09±1.11 ng/ml). Based on the study findings, women with PCOS had significantly higher average serum iron levels compared to the control group (223.5±57.3 and 129.1±44.9 g/dl), serum ferritin levels were significantly elevated in women with PCOS (279.9±44.9 and 129.1±44.9 ng/ml). The mean level of hepcidin was (14.77±1.31 ng/ml) in overweight PCOS women, which was elevated significantly than in PCOS women with normal BMI (12.18±1.58 /ml). The study found a negative correlation of serum hepcidin with each iron, ferritin and AMH among PCOS women.

The Role of Communication and Commitment in COVID-19 Knowledge, Attitudes, and Behaviors Among University Students in Jordan: Interaction and Analysis.

INTRODUCTION: Several fields, such as public health, economy, and science, have been adversely affected by the COVID-19 pandemic. The objectives of the present study were to investigate knowledge, attitudes, communication, commitment, and behavioral practices of Jordan university students; and using structural equation modelling (SEM) to investigate the relationship among COVID-19 knowledge, attitude, communication, commitment and behavioral practices of students. METHODS: In this cross-sectional study, the primary data were collected from 1,095 students comprising 298 males (27.21%) and 797 females (72.79%) from three major universities in Jordan using an online-based questionnaire. RESULTS: It was found that scores of knowledge, attitudes, communication, commitment, and behavioral practices of students about COVID-19 were 81.4, 79.3, 70.0, 72.6, and 67.4%, respectively. The results also showed that significant association the variables of knowledge and attitudes as well as the commitment and communication are partial mediators in this relationship. Further, a clear positive relationship was observed between the communication, commitment, and behavioral practices of students. CONCLUSIONS: This study confirms the importance of communication and commitment to generate proactive behavioral practices.

The Prevalence and Characteristics of Body Dysmorphic Disorder Among Adults in Makkah City, Saudi Arabia. A Cross-Sectional Study.

BACKGROUND: Body dysmorphic disorder (BDD) is a mental health condition where a person spends much time worrying about flaws in their appearance. The international prevalence of BDD had been reported, and it was about 1.9-2.2%. OBJECTIVES: The current study aims to explore the prevalence of BDD among the general population in Makkah, Saudi Arabia. METHODS: This is a descriptive cross-sectional study that used an electronic questionnaire. It was distributed to the general population using the convenience sample technique between September 2021 to November 2021. BDD was assessed among the participants using an Arabic-validated tool. The sample size was calculated to be 385 participants. RESULTS: The study included a total of 392 participants. Most of them were female (59.7%), 18-27 years old (62.8%), and had bachelor or post-graduate degrees (67.6%). Among all the included participants, only 28 met the criteria of BDD (7.1%). The BDD population had an equal gender ratio, and most included respondents between 18 and 27 years old (78.6%), college students (60.7%), those with the lowest income level (< 5,000 SR) (78.6%), and who had a normal body mass index (46.4%). CONCLUSION: The prevalence of BDD in Makkah, Saudi Arabia, was 7.1%. No significant differences were noticed between BDD and non-BDD groups in age, obesity, and gender.

Perceived responsibility for mechanical ventilation and weaning decisions in intensive care units in the Kingdom of Saudi Arabia.

Background: Optimizing patient outcomes and reducing complications require constant monitoring and effective collaboration among critical care professionals. The aim of the present study was to describe the perceptions of physician directors, respiratory therapist managers and nurse managers regarding the key roles, responsibilities and clinical decision-making related to mechanical ventilation and weaning in adult Intensive Care Units (ICUs) in the Kingdom of Saudi Arabia (KSA). Methods: A multi-centre, cross-sectional self-administered survey was sent to physician directors, respiratory therapist managers and nurse managers of 39 adult ICUs at governmental tertiary referral hospitals in 13 administrative regions of the KSA. The participants were advised to discuss the survey with the frontline bedside staff to gather feedback from the physicians, respiratory therapists and nurses themselves on key mechanical ventilation and weaning decisions in their units. We performed T-test and non-parametric Mann-Whitney U tests to test the physicians, respiratory therapists, and nurses' autonomy and influence scores, collaborative or single decisions among the professionals. Moreover, logistic regressions were performed to examine organizational variables associated with collaborative decision-making. Results: The response rate was 67% (14/21) from physician directors, 84% (22/26) from respiratory therapist managers and 37% (11/30) from nurse managers. Physician directors and respiratory therapist managers agreed to collaborate significantly in most of the key decisions with limited nurses' involvement (P<0.01). We also found that physician directors were perceived to have greater autonomy and influence in ventilation and waning decision-making with a mean of 8.29 (SD±1.49), and 8.50 (SD±1.40), respectively. Conclusion: The key decision-making was implemented mainly by physicians and respiratory therapists in collaboration. Nurses had limited involvement. Physician directors perceived higher autonomy and influence in ventilatory and weaning decision-making than respiratory therapist managers and nurse managers. A critical care unit's capacity to deliver effective and safe patient care may be improved by increasing nurses' participation and acknowledging the role of respiratory therapists in clinical decision-making regarding mechanical ventilation and weaning.

Photobiomodulation for Tendinopathy: A Review of Preclinical Studies.

The outcomes of clinical studies utilizing Photobiomodulation on tendon disorders are not homogeneous and since its design depends on preclinical studies utilizing animal models as a prerequisite, this review investigates the literature to help extrapolate preclinical evidence-based outcomes (safety and efficacy) into clinical treatment options. PubMed and Embase databases were searched for tendinopathy, Photobiomodulation and preclinical studies with inclusion criteria were restricted to in vivo animal studies using rat's models subjected to partially injured tendons. Data extracted were methodology quality and design, light parameters, study methods, and outcomes. Twenty two articles were included, half of them were partially transected, while the other half were partially traumatized. The most common wavelengths used were 660, 830, and 904 nm with energy density range between 1 and 17 J/cm2 and applied mostly daily. Fourteen studies (64%) relied merely on a single assessment. Histological measurements were the most common method of evaluation (75%) and 35% of studies used chemical measures. Mechanical outcomes were reported in four, and two studies demonstrate significant effects. Photobiomodulation has the potential to enhance tendon structure and function, however, inevitable embedded heterogeneity related to study design and quality of methods, light parameters delivered, and evaluations methods renders the ability to establish unified treatment parameters difficult. Adjustments for variability within preclinical studies might lead to better designing of clinical studies. It is recommended to embrace a protocol for designing and performing preclinical studies to improve its quality. Moreover, it is recommended to prove efficacy using at least two evaluation methods and apply Photobiomodulation as a combined varying energy/wavelength protocol (several energies with several wavelengths). Clinical relevance: Establishing a proof of concept for Photobiomodulation that may lead to further high-quality clinical studies, in which the applicable parameters can be determined.

The Prevalence and Impact of Coinfection and Superinfection on the Severity and Outcome of COVID-19 Infection: An Updated Literature Review.

Patients with viral illness are at higher risk of secondary infections-whether bacterial, viral, or parasitic-that usually lead to a worse prognosis. In the setting of Corona Virus Disease 2019 (COVID-19), the Severe Acute Respiratory Syndrome Coronavirus-type 2 (SARS-CoV-2) infection may be preceded by a prior microbial infection or has a concurrent or superinfection. Previous reports documented a significantly higher risk of microbial coinfection in SARS-CoV-2-positive patients. Initial results from the United States (U.S.) and Europe found a significantly higher risk of mortality and severe illness among hospitalized patients with SARS-CoV-2 and bacterial coinfection. However, later studies found contradictory results concerning the impact of coinfection on the outcomes of COVID-19. Thus, we conducted the present literature review to provide updated evidence regarding the prevalence of coinfection and superinfection amongst patients with SARS-CoV-2, possible mechanisms underlying the higher risk of coinfection and superinfection in SARS-CoV-2 patients, and the impact of coinfection and superinfection on the outcomes of patients with COVID-19.

PROMISE I: Early feasibility study of the LimFlow System for percutaneous deep vein arterialization in no-option chronic limb-threatening ischemia: 12-month results.

OBJECTIVE: We report the 6- and 12-month outcomes of the PROMISE I early feasibility study after treatment of no-option chronic limb-threatening ischemia (CLTI) with percutaneous deep vein arterialization (pDVA) using the LimFlow System. METHODS: Thirty-two patients with no-option CLTI, previously offered major amputation, were enrolled in this single-arm early feasibility study of the LimFlow pDVA System. No-option CLTI was defined as being ineligible for surgical or endovascular arterial revascularization. Patients were assessed for clinical status, pain, wound healing, and duplex ultrasound at 30 days, 6 months, and 12 months post-treatment. Primary endpoint analysis was amputation-free survival (AFS) at 30 days and 6 and 12 months. AFS was defined as freedom from above-ankle amputation of the index limb and freedom from all-cause mortality. Secondary endpoints evaluated included technical success of the procedure, and wound healing at 6 and 12 months. RESULTS: Of 32 enrolled patients, 31 (97%) were successfully treated with the LimFlow System at the time of the procedure, and two (6.3%) were lost to follow-up. The 30-day, 6-month, and 12-month AFS rates were 91%, 74%, and 70% respectively. The wound healing status of fully healed or healing was 67% at 6 months, and 75% at 12 months. Reintervention was performed in 16 patients (52%) with 14 (88%) of the maintenance reinterventions occurring within the first 3 months. The majority of reinterventions (n = 12; 75%), involved the arterial inflow tract proximal to the stented LimFlow circuit, and no in-stent stenoses were determined to have been the cause of reintervention. CONCLUSIONS: The LimFlow pDVA System was utilized in treating patients with no-option CLTI. A high technical success rate was observed, with a significant percentage of patients surviving free of major amputation at 12 months. These results suggest early safety and provide an initial assessment of the efficacy of the LimFlow pDVA System that supports the expansion of carefully executed studies to determine whether this is a viable option that can be used in this critically disadvantaged and growing patient population.

Prevalence and mortality of lung comorbidities among patients with COVID-19: A systematic review and meta-analysis.

COVID-19 infections are seen across all age groups, but they have shown to have a predisposition for the elderly and those with underlying comorbidities. Patients with severe COVID-19 infections and comorbidities are more prone to respiratory distress syndrome, mechanical ventilator use, and ultimately succumb to these complications. Little evidence exists of the prevalence of underlying lung comorbidities among COVID-19 patients and associated mortality. We performed a systematic review of the literature including PubMed (Medline), Embase (Ovid), Google Scholar, and Cochrane Library. The last date for our search was April 29, 2020. We included all original research articles on COVID-19 and calculated prevalence of chronic lung disease patients among COVID-19 patients using random effects model. Further, we assessed for mortality rates among COVID-19 patients associated with these lung comorbidities. The authors identified 29 articles that reported prevalence of chronic lung conditions among COVID-19 patients. Among those, 26 were from China and 3 from the United States. The pooled prevalence of lung comorbidities including asthma, chronic obstructive pulmonary disease (COPD), and lung cancer was 3% (95% confidence interval [CI] = 0%-14%), 2.2% (95% CI = 0.02%-0.03%), and 2.1% (95% CI = 0.00%-0.21%), respectively. Mortality rates associated with these comorbidities was 30% (41/137) for COPD and 19% (7/37) for lung cancer respectively. No mortality rates were reported for patients with asthma. This study offers latest evidence of prevalence of chronic lung conditions among patients with COVID-19. Asthma, followed by COPD and lung cancer, was the most common lung comorbidity associated with COVID-19, while the higher mortality rate was found in COPD. Future studies are needed to assess other lung comorbidities and associated mortality among patients diagnosed with COVID-19.

Modern multidisciplinary team approach is crucial in treatment for critical limb threatening ischemia.

The aim of this study was to provide a brief overview of the history the multidisciplinary team approach, highlighting the benefit to the patient with critical limb threatening ischemia in relation to health care economics. Furthermore, we provided a description of the requisites and key components, showing how to build a multidisciplinary team.

Characteristics and Outcomes of Patients With Diabetes Mellitus Undergoing Peripheral Vascular Intervention for Infrainguinal Symptomatic Peripheral Artery Disease.

PURPOSE: Patients with diabetes mellitus (DM) are known to be at higher risk for peripheral artery disease (PAD), amputations, and major adverse cardiovascular events, though it is unclear whether they are at any higher risk for repeat intervention. LIBERTY 360 offered an opportunity to study a real-world cohort of patients who underwent distal superficial femoral artery endovascular revascularizations. We aimed to describe patients with DM, their outcomes following peripheral vascular intervention, and the effect of DM on outcomes in the LIBERTY 360 cohort. METHODS: LIBERTY 360 is a prospective, multi-center, non-randomized, mono-industry funded observational study of patients undergoing endovascular revascularization. Outcomes included 30-day and 1-year all-cause mortality, major amputation, target vessel/lesion revascularization, and a composite of those events. A multivariable regression model including DM was constructed to examine the effect of DM on outcomes. Multivariable survival estimates were made using Cox proportional hazards models. RESULTS: A total of 1,204 patients were enrolled, of whom 727 had DM (60.4%). Patients with DM had significantly more comorbidities and a third required insulin for DM management. Patients with DM had more severe disease based on Rutherford classification at baseline. After adjusting for comorbidities and disease severity, DM patients had more frequent major amputations at 1 year (5.2% versus 1.2%; HR 2.71, 95%CI 1.05-6.98, p = 0.040). The 1-year rates of all-cause mortality and target vessel/lesion revascularization were not significantly higher for patients with DM. CONCLUSIONS: Diabetes mellitus was associated with increased major amputations at 1 year following endovascular revascularization after accounting for demographics, comorbidities, and PAD-related characteristics. Further research is needed to determine which aspects of PAD and DM are most strongly associated with poor outcomes following lower extremity revascularization.

The impact of chronic kidney disease on outcomes following peripheral vascular intervention.

BACKGROUND: Patients with chronic kidney disease (CKD) have worsened clinical outcomes following percutaneous coronary intervention; however, limited evidence exists in patients undergoing peripheral vascular intervention (PVI). PURPOSE: We aimed to assess the effect of CKD on outcomes following PVI for symptomatic peripheral artery disease. METHODS: Using patients from the LIBERTY 360 study, we compared the rates of 30 day and 1 year major adverse vascular events (MAVE), a composite of all-cause mortality, major amputation, and target vessel/lesion revascularization, between patients with and without CKD (estimated glomular filtration rate less than 60) following PVI. Multivariable adjustment was performed to assess for independent association between CKD and outcomes. RESULTS: Among 1189 patients enrolled, 378 patients (31.8%) had CKD. At 1 year, patients with CKD had higher rates of MAVE (34.6% vs 25.6%), all-cause mortality (11.9% vs 5.5%), and major amputation (5.9% vs 2.6%) when compared with patients without CKD (all P < .05). After adjustment, patients with CKD had higher risks of 1-year MAVE (HR 1.30, 95% CI 1.04-1.64; P = .023) and all-cause mortality (HR 1.88, 95% CI 1.22-2.91; P = .005) when compared with patients without CKD. There was no statistically significant difference in risk of major amputations (HR 1.70, 95% CI 0.91-3.17; P = .094). CONCLUSIONS: Despite high procedural success and low amputation rates, patients with CKD remain at greater risk for MAVE and all-cause mortality after PVI. Further research is needed to determine treatment strategies to mitigate substantial mortality risk in this vulnerable population.