Search Results (129)

CAPOX and FOLFOX are widely used chemotherapy regimens for colorectal cancer (CRC). The superiority of one regimen over the other in a real-world setting (RWE) could have significant clinical implications given their common use, but such RWE is limited. This study analyzed provincial database records of 13,461 Canadian patients treated from 2005 to 2017. The primary outcomes were rates of Emergency Department visits and/or hospitalizations (ED/H) and overall survival (OS). CAPOX was used less frequently (8.4%) than FOLFOX (91.6%), often in older patients (p < 0.003 for Stage I–III; p < 0.001 for Stage IV). CAPOX recipients had shorter treatment durations (median 15 vs. 20 weeks, p = 0.002) and higher unadjusted ED/H rates (60.8% vs. 50.9%, p < 0.001), though this difference was nonsignificant on multivariate analysis (MVA) (HR 1.05 (0.92, 1.20), p = 0.466). Patients receiving CAPOX had worse OS than those on FOLFOX, (5-year OS 70.1% vs. 77.2% (p < 0.001) non-metastatic; 16.6% vs. 33.2% (p < 0.001) metastatic). MVA confirmed inferior OS with CAPOX (HR 1.42, p < 0.001). Other predictors of shorter OS included older age, male sex, comorbidities, rural residence, and lower income. This administrative data is at risk of bias but highlights the need for careful patient selection and informed treatment decision making. Full article

Background: Penile prosthesis implantation (PPI) is an established treatment for erectile dysfunction (ED). Nevertheless, the effectiveness of and satisfaction with PPI in mainly psychogenic ED compared to mainly organic ED patients remain underexplored. Aim: To evaluate patient satisfaction outcomes following PPI in individuals diagnosed as mainly psychogenic ED vs. mainly organic ED. Methods: Twenty-five patients with psychogenic ED who underwent PPI were included. Data were collected from medical records and a follow-up assessment was done using the Quality of Life and Sexuality with Penile Prosthesis (QolSPP) questionnaire. Additionally, the patients filled out an ad hoc questionnaire including self-reported satisfaction rated on a 1-to-10 scale, the Global Assessment Questionnaire-Questions 1 and 2 (GAQ-1, 2), and the Sexual Encounter Profile Questions 2 and 5 (SEP-2, 5). Results were compared with those of 36 patients with mainly organic ED (control) for comparative analysis. Results: In the psychogenic ED group, 96% reported improved erections, 92% felt more confident initiating sex, 92% achieved penetration and 95% had satisfactory sexual encounters. The overall satisfaction score was 8.71 on a 10-point scale. Comparative analysis using the QolSPP questionnaire revealed statistically significant differences favouring the psychogenic group in 8 of 16 questions, regarding prosthesis satisfaction and overall well-being. Surgical complications were noted in 16% of the psychogenic group, compared to a 2.8% complication rate in the organic ED control group. Conclusions: The findings indicate high levels of satisfaction with PPI among patients with psychogenic ED, comparable to those with organic ED. However, an increase in complications in the psychogenic cohort highlights the need for careful consideration of surgical risks in this population. Full article

Background/objectives: Falls are a leading cause of traumatic injury and hospitalization for adults over the age of 65. While common, bed-related falls are relatively understudied when compared to ambulatory falls. The aim of this study is to characterize the risk factors for the hospitalization of older adults presenting to U.S. emergency departments (EDs) after a fall from bed. Methods: This was a cross-sectional study using publicly available data from the U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS) from 2014 to 2023, including all adults over the age of 65 presenting to the NEISS’s participating EDs with bed-related fall injuries. We identified fall injuries using a keyword search of the NEISS narratives and determined how the fall occurred by manually reviewing a randomized 3% sample of the narratives. We summarized demographics and injury patterns with descriptive statistics. We constructed a multivariable logistic regression model to identify risk factors for hospitalization and used Poisson regression to assess temporal trends in fall incidence and hospital admissions. Results: An estimated average of 320,751 bed-related fall injuries presented to EDs annually from 2014 to 2023. ED visits increased by 2.85% per year, while hospital admissions rose by 5.67% per year (p < 0.001). The most common injury patterns were superficial injuries (contusions, abrasions, lacerations, avulsions, and punctures) (28.6%), fractures (21.7%), and internal injuries (including concussions) (21.6%). Most of the falls occurred while transitioning into or out of bed (34.4%) or falling out of bed (56.8%). Hospitalization was required in 34.1% of cases and was associated with male sex, medication use at time of injury, and fracture injuries. Conclusions: Bed-related falls and associated hospitalizations are increasing among older adults. ED providers should understand risk factors for hospitalization in these common injuries such as male sex, medication use at time of injury, and high-risk injury patterns. Additionally, prevention efforts should focus on helping older adults remain safely in bed and then assisting with transitions into or out of bed. Full article

Emerging evidence highlights the critical role of the gut microbiota in the development and progression of eating disorders (EDs), particularly in women, who are more frequently affected by these conditions. Women with anorexia nervosa, bulimia nervosa, and binge eating disorder exhibit distinct alterations in gut microbiota composition compared to healthy controls. These alterations, collectively termed dysbiosis, involve reduced microbial diversity and shifts in key bacterial populations responsible for regulating metabolism, inflammation, and gut–brain signaling. The gut microbiota is known to influence appetite regulation, mood, and stress responses—factors closely implicated in the pathogenesis of EDs. In women, hormonal fluctuations related to menstruation, pregnancy, and menopause may further modulate gut microbial profiles, potentially compounding vulnerabilities to disordered eating. Moreover, the restrictive eating patterns, purging behaviors, and altered dietary intake often observed in women with EDs exacerbate microbial imbalances, contributing to intestinal permeability, low-grade inflammation, and disturbances in neurotransmitter production. This evolving understanding suggests that microbiota-targeted therapies, such as probiotics, prebiotics, dietary modulation, and fecal microbiota transplantation (FMT), could complement conventional psychological and pharmacological treatments in women with EDs. Furthermore, precision nutrition and personalized microbiome-based interventions tailored to an individual’s microbial and metabolic profile offer promising avenues for improving treatment efficacy, even though these approaches remain exploratory and their clinical applicability has yet to be fully validated. Future research should focus on sex-specific microbial signatures, causal mechanisms, and microbiota-based interventions to enhance personalized treatment for women struggling with eating disorders. Full article

Background/Objectives: Children with sickle cell disease (SCD) often experience limited access to care, contributing to poor health outcomes. Patient-level predictors and outcomes associated with telehealth use among Medicaid-enrolled children with SCD remain unknown. This study aims to (1) analyze telehealth trends before and during the pandemic (March 2020–March 2022), (2) identify patient-level predictors of telehealth use, (3) assess its association with care continuity and health outcomes, and (4) identify physician specialties involved in telehealth visits. Methods: Using Texas Medicaid claims (March 2017–March 2022), we conducted a retrospective analysis of children aged 1–18 with ≥3 SCD-related claims. Monthly trends in outpatient visits (in-person and telehealth) were visualized from March 2019 to March 2022. Multivariable regression models examined predictors of telehealth use and associations with ≥10 hydroxyurea fills, emergency department (ED) visits, and hospitalizations, adjusting for age, sex, regions with SCD clinics, and prior healthcare utilization. Results: Among 903 included patients (mean [SD] age = 10.4 [4.1], 52.6% male), 59.4% had ≥1 telehealth visits between March 2019 and March 2022. Telehealth use peaked between March 2020 and May 2020, then gradually declined. Children with ≥10 SCD-related outpatient visits 1 year before the lockdown (March 2019–February 2020) had 77.4% higher odds of using telehealth compared to those with 0–4 visits (OR = 1.774, 95% CI = 1.281–2.457, p = 0.0006), while controlling for sociodemographic characteristics. However, SCD-related telehealth use during the pandemic was not associated with either ≥10 hydroxyurea fills or reduced ED visits. Prior healthcare utilization remained a strong predictor of both outcomes. The majority of telehealth visits were conducted at multispecialty clinics (74%). Conclusions: Telehealth use surged early in the pandemic but later declined among Texas Medicaid-enrolled children with SCD. Children with high healthcare needs adopted telehealth, but this did not impact care continuity or extensive healthcare utilization. While maintaining telehealth access, other measures should be implemented to improve access and outcomes for this vulnerable population. Full article

Background/Objectives: Missed outpatient appointments contribute to care discontinuity and emergency department (ED) overcrowding. This study investigated the association between missed appointments and ED visits, identifying predictors such as patient characteristics, distance from the hospital, and waiting time. Methods: A retrospective analysis was conducted using a dataset of 749,450 scheduled outpatient appointments from adult patients (aged ≥ 18 years). Patients under 18 were excluded. We identified missed appointments and assessed their association with ED visits occurring in the same period. Descriptive statistics, non-parametric tests, and logistic and linear regression models were applied to examine predictors such as age, sex, distance from the hospital, waiting time, the type of service, and medical specialty. Results: The overall no-show rate was 3.85%. Among patients with missed appointments, 37.3% also visited the ED. An older age (OR = 1.007; p = 0.006) and the male gender (OR = 1.498; p < 0.001) were significant predictors of having a scheduled appointment before an ED visit. No significant associations were found for distance or specialty branch. Conclusions: Missed appointments are associated with ED utilization. Predictive factors can inform targeted interventions, such as via improved scheduling systems and personalized reminders. Distance alone may not be a barrier, but system-level solutions are needed to address no-show rates and optimize healthcare resource use. Full article

Background/Objectives: Excessive daytime sleepiness (EDS) has been suggested to negatively affect academic performance and behavior. Malocclusion is reportedly a risk factor for sleep-disordered breathing and may be associated with daytime sleepiness. This study investigated the age and sex of patients with malocclusion who are at increased risk of EDS and collected data for future EDS screening. Methods: We analyzed 556 patients with malocclusion aged 6–29 years to identify age- and sex-specific differences in the risk of EDS. Adults were surveyed using the Epworth Sleepiness Scale (ESS), and non-adults were surveyed using the Epworth Sleepiness Scale for Children and Adolescents. Results: The mean ESS score was 4.1 ± 4.1, and the median score was 3. The mean score tended to increase significantly with age. In adolescents, ESS scores increased gradually. In adolescents and young adults, ESS scores were significantly higher in females than in males, and the prevalence of EDS in young adults was 16.7% in men and 32.1% in women, with a marked sex-related difference. Conclusions: In patients with malocclusion, daytime sleepiness may gradually increase from adolescence to young adulthood and be more pronounced in females. The prevalence of EDS in young adults seems higher in women than in men. Our findings could aid in the early identification of EDS and facilitate multidisciplinary cooperation between dentists and sleep specialists. Early identification of sleep problems and prompt intervention during the high-risk period for developing EDS could improve the quality of life for many adolescents and contribute to improved public health. Full article

Myopathic Ehlers-Danlos syndrome (RmEDS) is an emerging hybrid phenotype that combines connective and muscle tissue abnormalities. It has been associated with variants of the COL12A1 gene, which are known as Ullrich congenital muscular dystrophy-2 (UCMD2; 616470) and Bethlem myopathy-2 (BTHLM2; 616471). Here, we report two splicing mutations of COL12A1 identified in three patients from two unrelated families who present a combination of joint hypermobility and axial, distal, and proximal weakness. The muscular strength of their neck and limb muscles was assessed at 4/5 (MRC); however, when measured with a myometer, the expected percentage by age and sex ranged from 35% to 40% for elbow flexion, 37% to 75% for knee extension, and was 50% for neck flexion. In addition to confirming the characteristic atrophy of the rectus femoris, we presented evidence of involvement of the neck and lumbar muscles through MRI and CT imaging. In vitro studies revealed filamentous disorganization and an altered pattern of collagen XII alpha 1 chain migration due to the skipping of exons 55 and 56 of collagen XII. Additionally, we review the myopathic involvement of COL12-RM in 30 patients across 18 families with dominant mutations and 15 patients from 13 families with recessive mutations. Full article

Background/Introduction: Undernutrition’s impact on healthcare utilisation across age groups and care settings remains underexplored, particularly in Asian contexts. This study investigated the dynamic association between nutritional status and healthcare utilisation among community-dwelling adults in Singapore and assessed whether age modified this relationship. Methods: The study sampled 1703 adults enrolled in the Population Health Index study. Nutritional status was assessed annually using the Mini Nutritional Assessment, and healthcare utilisation data—across primary care, specialist outpatient clinics (SOCs), emergency departments (EDs), day surgeries, and inpatient admissions—were extracted from administrative databases. Negative binomial regressions with interaction terms using longitudinal panel data were conducted to examine age-modified effects. Results: At baseline, 9.7% of participants were classified as undernourished, with a higher prevalence in older adults (15.0%). Key risk factors for undernutrition included female sex, unemployment, financial inadequacy, currently smoking, lack of formal education, and multimorbidity. Undernutrition was associated with increased ED visits (IRR 1.41, AME: 0.35) and inpatient admissions (IRR 1.52, AME: 0.42). Among older adults, undernutrition was associated with less primary and specialist care (IRR: 0.72 and 0.57), while younger undernourished adults had more SOC visits (AME: 0.46). Older undernourished adults had 0.46 more ED visits and 0.47 more inpatient admissions on average in one year, though these increases did not differ from younger adults (interaction p > 0.05). Conclusions: Undernutrition is associated with increased ED visits and inpatient admissions, especially in older adults. Integrating nutritional screening and targeted interventions into community and primary care may help reduce preventable hospitalisations in high-risk populations. Full article

Background/Objectives: Research on eating disorders (EDs) in individuals with multiple sclerosis (MS) is limited. In ED populations, neuroticism has been linked to ED symptoms through lower self-esteem and greater body dissatisfaction, but these relationships remain unexplored in MS. This study aimed to examine whether self-esteem and body dissatisfaction mediate the link between neuroticism and ED symptoms in individuals with MS. Methods: The current sample consisted of 275 participants who reported a neurologist-confirmed diagnosis of MS (Mage = 43.0, SD = 12.9) with the majority being female (218/275; 79.3%). Participants completed an online questionnaire measuring neuroticism (Big Five Inventory), self-esteem (Rosenberg Self-esteem Scale), body dissatisfaction (Body Shape Questionnaire), and ED symptoms (Eating Attitudes Test-26). Results: A serial mediation analysis controlling for age, sex, and level of ambulation revealed that the association between neuroticism and ED symptoms is respectively and serially explained by self-esteem and body dissatisfaction in individuals with MS. The total model accounted for 43% of the variance in ED symptoms. Conclusions: Findings suggest that self-esteem and body dissatisfaction are important in understanding the relationship between neuroticism and ED symptoms. Neuroticism, self-esteem, and body dissatisfaction may be important targets for assessing and treating EDs in individuals with MS. Future longitudinal research is needed to examine causal relationships. Full article

Sleep is essential for maintaining both mental and physical well-being. It plays a critical role in the health and development of children. This study investigates sleep patterns and habits of First Nations children, the prevalence of sleep disturbances, and excessive daytime sleepiness (EDS), along with the factors associated with EDS. Our 2024 First Nations Children Sleep Health Study assessed the sleep health of children aged 6 to 17 years living in a First Nation in Canada. Statistical analyses were performed using comparison tests and logistic regression models. A total of 78 children participated; 57.7% were boys. The average age of the participants was 10.49 years (SD = 3.53 years). On school days, children aged 6 to 9 years slept an average of one additional hour, while on weekends, they slept an extra 40 min compared to adolescents aged 10 to 17 years. Only 39.7% of the children (ages 6 to 17) slept alone in a room, with more than 80% of the children sharing a bed every night. Only 30.6% of the children aged 6 to 9 years and 7.2% of the adolescents aged 10 to 17 years adhered to the recommended maximum screen time of 2 h on school days. More than two-thirds of the children reported experiencing sleep disturbances. The prevalence of EDS was 19.7%. After adjusting for age and sex, it was determined that the children who snored loudly and those who did not sleep in their own beds were more likely to experience abnormally high levels of daytime sleepiness. A high proportion of children exceeded the recommended screen time, an important public health issue. Further, identifying sleep patterns among children will facilitate the diagnosis and treatment of disordered sleep. Full article

Background: The purpose of this study is to assess how the socio–family demographic status of patients is related to the onset of delirium in a large cohort of older adults aged ≥65 years evaluated in the emergency department (ED) using a comprehensive geriatric assessment (CGA). Methods: This is a cross-sectional, observational, retrospective study conducted in the ED of a teaching hospital. We enrolled 2770 geriatric patients admitted to the ED from January 2019 to December 2023 and evaluated them using CGA. Clinical variables assessed in the ED were evaluated for associations with delirium onset and in-hospital mortality. Results: Delirium was statistically related to frailty statuses as measured via the Clinical Frailty Scale (CFS) (OR 1.47 [1.39–1.56]; p < 0.001). The occurrence of delirium was also associated with living arrangements: “living with other relatives” condition (OR 1.43 [1.12–1.83]; p = 0.004) and residence in a nursing home (OR 1.72 [1.30–2.31]; p < 0.001). In addition, compared to patients in emergency conditions (NEWS > 5), it emerges that patients with better clinical stability have a lower risk of developing delirium (NEWS 3–5 OR 0.604 [0.48–0.75]; p < 0.001—NEWS < 3 OR 0.42 [0.34–0.53]; p < 0.001). In-hospital mortality was associated with age, male sex, frailty status, clinical instability, and the onset of delirium in the ED. Conclusions: Delirium is a multifactorial and acute syndrome representing a negative prognostic factor of in-hospital mortality, especially in elderly patients. Independent of the clinical condition, the patient’s living arrangement could be of relevance to the onset of delirium in the ED. Early comprehensive geriatric assessments in the ED could allow the early detection of all predisposing risk factors, resulting in the timely implementation of supportive strategies to prevent the onset of delirium in EDs. Full article

Background/Objectives: Approximately 1% of people worldwide suffer from epilepsy. The development of safer and more effective antiepileptic medications (AEDs) is still urgently needed because all AEDs have some unwanted side effects and roughly 30% of epileptic patients cannot stop having seizures when taking current AEDs. It should be noted that the derivatives of pyrazolo[3,4-b]pyridine are important core structures in many drug substances. The aim of this study is to synthesize new derivatives of piperazino-substituted pyrazolo[3,4-c]-2,7-naphthyridines and 9,11-dimethylpyrimido[1′,2′:1,5]pyrazolo[3,4-c]-2,7-naphthyridines for the evaluation of their neurotropic activity. Methods: The synthesis of the target compounds was performed starting from 1-amino-3-chloro-2,7-naphthyridines and using well-known methods. The structures of all the synthesized compounds were confirmed by spectroscopic data. Compounds were studied for their potential neurotropic activities (anticonvulsant, sedative, anti-anxiety, and antidepressive), as well as side effects, in 450 white mice of both sexes and 50 male Wistar rats. The anticonvulsant effect of the newly synthesized compounds was investigated by using the following tests: pentylenetetrazole, thiosemicarbazide-induced convulsions, and maximal electroshock. The psychotropic properties of the selected compounds were evaluated by using the following tests: the Open Field test, the Elevated Plus Maze (EPM), the Forced Swimming test, and Rotating Rod Test to study muscle relaxation. For the docking studies, AutoDock 4 (version 4.2.6) was used, as well as the structures of the GABA_A receptor (PDB ID: 4COF), the SERT transporter (PDB ID: 3F3A), and the 5-HT_1A receptor (PDB ID: 3NYA) obtained from the Protein Data Bank. Results: A series of piperazino-substituted pyrazolo[3,4-c]-2,7-naphthyridines (3a–j) and 9,11-dimethylpyrimido[1′,2′:1,5]pyrazolo[3,4-c]-2,7-naphthyridines (4a–j), as well as new heterocyclic systems, i.e., isoxazolo[5,4-c]-2,7-naphthyridines 6a–d, were synthesized and evaluated for their neurotropic activity. The investigation showed that some of these compounds (3a,b,d,f–i and 4a,d,f,i) display high anticonvulsant activity, especially in the test of antagonism with pentylenetetrazol, surpassing the well-known antiepileptic drug ethosuximide. Thus, the most active compounds in the pentylenpotetrazole test are 3h, 3i, and 4i; the ED50 of compound 4i is 23.8, and the therapeutic index is more than 33.6, which is the highest among these three active compounds. On the other hand, they simultaneously exhibit psychotropic (anxiolytic, antidepressant, or sedative) or behavioral depressant) effects. The effective compounds do not cause myorelaxation at the tested doses and have high therapeutic indices. Docking on the most active compounds, i.e., 3h, 3i, and 4i, is in agreement with the experimental results. Conclusions: The studies reveled that some of these compounds (3i, 4a, and 4i) display high anticonvulsant and psychotropic activities. The most active compounds contained methyl and diphenylmethyl groups in the piperazine ring. The docking studies identified compounds 3i, 4i, and 4a as the most potent anticonvulsants, showing strong affinity for GABA_A, 5-HT_1A receptors, and the SERT transporter. Notably, compound 4i formed two hydrogen bonds with Thr176 and Arg180 on GABA_A and exhibited a binding energy (−8.81 kcal/mol) comparable to that of diazepam (−8.90 kcal/mol). It also showed the strongest binding to SERT (−7.28 kcal/mol), stabilized by interactions with Gly439, Ile441, and Arg11. Furthermore, 4i displayed the best docking score with 5-HT_1A (−9.10 kcal/mol) due to multiple hydrogen bonds and hydrophobic interactions, supporting its potential as a dual-acting agent targeting both SERT and 5-HT_1A. Full article

Background/Objectives: Sparse data exist identifying racial/ethnic outcome disparities among patients with lung cancer, specifically regarding healthcare utilization patterns, such as emergency department visits and outpatient follow-ups. We aimed to utilize our large, multicenter, and ethnically diverse integrated health system to assess for such disparities among patients undergoing pulmonary resections for lung cancer. Methods: The cohort comprised all patients undergoing pulmonary resections for lung cancer at our integrated health system from 1 January 2016 to 31 December 2020. Outcomes including the length of stay (LOS), 30-day return to the emergency department (30d-ED), 30-day readmission, 30- and 90-day outpatient appointments, and 30- and 90-day overall mortality were compared by race/ethnicity. Multivariable logistic and linear models adjusted for age, sex, body mass index (BMI), Charlson Comorbidity Index scores, procedure approach, neighborhood deprivation index (NDI), cancer stage, receipt of adjuvant chemotherapy, and insurance. Results: Of the 645 included patients, non-Hispanic White patients tended to be older and live in the least deprived neighborhoods. Among each race/ethnicity, the percentage of patients insured by Medicaid was highest among Asian patients. On bivariate analysis, only the outcome of surgical outpatient appointments within 30 days had differing distributions by race/ethnicity with no other significant associations between race/ethnicity and other outcomes; however, multivariable analysis showed Asian patients having lower odds of 30d-ED (adjusted odds ratio 0.51; 95% CI 0.27–0.98) while those with Medicaid insurance had higher odds of 30d-ED (adjusted odds ratio 3.29; 95% CI 1.26–8.59). Conclusions: Despite parity across clinical outcomes, some patient encounter-related differences still exist within our system. To better understand racial/ethnic disparities in care, systems must track such disparities in addition to clinical outcomes. Full article

Background: Burns represent one of the most severe injuries encountered in the pre-hospital and ED environment, with essential features and an often negatively powerful impact on patients’ quality of life. Preventive measures can significantly reduce the number of cases presenting to medical facilities; knowledge and the correct application of first aid measures in the pre-hospital stage have a significant role in reducing the risk of complications and in obtaining optimal outcomes. Methods: This retrospective one-year single-center study analyzed 399 adult burn patients treated at the Clinical Emergency Hospital of Bucharest (CEHB) in 2023. Information concerning the main characteristics of the patients (age, sex, and residence), etiology and severity of burns, and pre-hospital management of patients was analyzed. Results: Most patients (63.41%) resided in urban areas, with a higher prevalence of males (55.89%). Thermal burns accounted for 77.69% of cases, primarily caused by water, food, oil, or flames. Burns covered ≤10% TBSA in 77.19% of cases, while 6.52% extended beyond 50% TBSA. First aid was provided to 52.63% of patients at the accident site, often by non-specialized individuals. The mean time to presentation was 34.90 h, with significant correlations between time, age, burned body surface area, and burn depth. Conclusions: There is a real need for improvements in first-aid training and health initiatives to enhance pre-hospital burn care. Better documentation of the care provided to patients before being admitted to specialized centers, as well as further studies in this field, are absolutely necessary for improving prevention programs and burn management in the acute stage. Full article