Procedural Outcomes of Double Vs. Single Fluoroscopy for Fixing Supracondylar Humerus Fractures in Children: A Case-Control Study

Background: Supracondylar humerus fractures (SHFs) are frequently seen in the pediatric population. The aim of this study was to compare single- and double-fluoroscopy methods for the closed reduction and percutaneous pinning (CRPP) of Gartland type 2 and type 3 SHFs. Materials and Methods: Forty patients who underwent surgery between March 2016 and April 2018 were evaluated retrospectively. Twenty-one patients (group 1) who received double fluoroscopy and 19 patients (group 2) who had single fluoroscopy were evaluated. The preparation period, surgical duration, radiation exposure time, fracture types, sex distributions, distribution of sides, radiologic results at the third month, cosmetic and functional results, and the incidence of complications were recorded. Results: The mean age of the patients in group 1 and group 2 was 4.76 and 4.68 years, respectively. The mean preparation time of group 1 was 11.3 min; whereas in group 2, it was 8.7 min (p < 0.01). The mean surgical duration was 31.76 min in group 1, and 40.47 min in group 2 (p < 0.01). The mean radiation exposure time in group 1 and group 2 was 41.19 and 47.36 s, respectively (p = 0.04). There were statistically significant differences between the two groups in terms of the preparation period, surgical duration, and radiation exposure time. Radiation exposure time and surgical duration were significantly shorter in group 1; the preparation period was shorter in group 2. Conclusions: The double-fluoroscopy technique can significantly reduce surgical duration and radiation exposure time during surgery while treating SHFs of children. © 2020, Indian Orthopaedics Association

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

Purpose: Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant professional society guideline recommendations, and provide expert recommendations. Materials and Methods: Clinicians managing male infertility were invited to take part in a global online survey on SDF clinical practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indications for SDF testing were then formulated, and the Delphi method was used to reach consensus. Results: The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recurrent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing. Conclusions: This article presents the largest global survey on the indications for SDF testing in infertile men, and demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians

Case-based MCQ generator: A custom ChatGPT based on published prompts in the literature for automatic item generation

A fundamental challenge in medical education is creating high-quality, clinically relevant multiple-choice questions (MCQs). ChatGPT-based automatic item generation (AIG) methods need well-designed prompts. However, the use of these prompts is hindered by the time-consuming process of copying and pasting, a lack of know-how among medical teachers, and the generalist nature of standard ChatGPT, which often lacks the medical context. The Case-based MCQ Generator, a custom GPT, addresses these challenges. It has been trained by using GPT Builder, which is a platform designed by OpenAI for customizing ChatGPT to meet specific needs, in order to allow users to generate case-based MCQs. By using this free tool for those who have ChatGPT Plus subscription, health professions educators can easily select a prompt, input a learning objective or item-specific test point, and generate clinically relevant questions. It enhances the efficiency of MCQ generation and ensures the generation of contextually relevant questions, surpassing the capabilities of standard ChatGPT. It streamlines the MCQ creation process by integrating prompts published in medical education literature, eliminating the need for manual prompt input. Future development aims at sustainability and addressing ethical and accessibility issues. It requires regular updates, integration of new prompts from emerging health professions education literature, and a supportive digital ecosystem around the tool. Accessibility, especially for educators in low-resource countries, is vital, demanding alternative access models to overcome financial barriers.</p

Integrated approaches in resilient hierarchical load forecasting via TCN and optimal valley filling based demand response application for clean energy adoption

regarding demand and supply-side policies. In this manner, predictive analysis of the demanded power accuracy is carried out to boost profits and increase the penetration of similar demand response (DR) programs across all levels of end-user categories. Residential loads experience stiff spikes and unpredictable variations due to occupancy activities and environmental factors. To address this, we first propose a robust short-term multivariate-multistep forecasting framework that is resilient to missing or erroneous data, employing temporal convolution networks (TCNs). We then incorporate two distinct valley-filling indices to optimize the charging of electric vehicle loads according to DR requirements, showcasing the efficacy of leveraging artificial intelligence to enhance the utilization of clean energy resources. Simulation studies are conducted using real-world nodal residential loads with hourly granularity. The results demonstrate that the forecasting method is reliable for residential locations, even when dealing with highly damaged data. The case studies effectively fill the load into the valleys and minimize fluctuations in residential locations. Through the integration of emission- aware forecasting and optimization strategies, our study lays the groundwork for a comprehensive approach that not only improves economic outcomes and grid stability but also advances the imperative of reducing carbon emissions

Polycythemia Vera: Diagnosis, Clinical Course, and Current Management

Very important developments related to polycythemia vera (PV) have occurred during the last two decades. The discovery of Janus kinase (JAK) 2 mutations has changed both the diagnosis and clinical management of PV. Currently JAK2 molecular testing is essential in the diagnostic work-up and JAK2 mutation positivity is a major diagnostic criterion. The discovery of JAK2 mutations suggested that abnormal JAK-STAT signaling was a pivotal feature in the pathogenesis of Philadelphia-negative myeloproliferative neoplasms. This idea led to the development of JAK inhibitors. Currently ruxolitinib, a JAK1/JAK2 inhibitor, is also approved for PV patients with hydroxyurea resistance or intolerance. International collaborations have made it possible to describe disease characteristics and evolution better. Presently it is possible to quantify the symptomatic burden of the disease and to estimate prognosis. In spite of these developments, management of PV still largely depends on estimation of thromboembolic risk and trying to decrease the risk with or without cytoreductive medications. Different approaches have been proposed by international disease experts for the diagnosis, thromboembolic risk estimation, and drug selection. This paper aims to review clinical aspects of PV and propose a management algorithm. The authors also point to still unresolved questions and unmet needs in diagnosis and management.WoSScopu

Serum levels of insulin-like growth factor-I and insulin-like growth factor binding protein-3 in children with insulin-dependent diabetes mellitus

Pubertal development has recently been evaluated from the standpoint of changes in insulinlike growth factor (IGF)-I and IGF-binding protein-3 (IGFBP-3) levels in healthy children, We studied puberty related changes in serum IGF-I and IGFBP-3 levels in 24 patients (11 prepubertal) with insulin dependent diabetes mellitus (IDDM) and 26 healthy subjects (14 prepubertal), Serum IGF-I and IGFBP-3 levels were assayed using immunoradiometric assays and radioimmunoassays, respectively, Serum IGF-I and IGFBP-3 levels in diabetics did not increase during puberty, as opposed to those in healthy children, Serum IGF-I and IGFBP-3 levels of diabetic patients were found to be lower than those of control subjects during puberty (p<0.0001 and p<0.05, respectively), Proteolysis is believed to be a general mechanism to increase IGF bioavailability in the presence of IGFBPs, Increased IGFBP-3 protease activity has been shown in sera of children with IDDM as well as a decrease in this activity in response to insulin therapy, Our data displaying low IGFBP-3 levels in diabetic children may be due to increased proteolysis, which also causes a shift in IGF-I to its lower molecular weight forms. Higher rate of clearance of the latter may be the reason for the low IGF-I levels we observed in children with IDDM. The moderate correlation between insulin dose and IGFBP-3 levels (r=0.5, p<0.01) may suggest insulin to be a contributing factor in the regulation of IGFBP-3 levels, We conclude that regulation of IGF-I and IGFBP-3 concentrations is disturbed in children with IDDM, in particular during adolescence

The Investigation of Bovine Viral Diarrhoea Virus Antigens with Immunofluorescence and Immunohistochemical Methods in Bovine Abortions

The investigation of bovine viral diarrhoea virus (BVDV) in bovine abortions in Erzurum, Turkey was undertaken with immunofluorescence, immunohistochemistry and histopathological methods. For this purpose, tissue sections from 56 aborted foetuses were examined. At the end of the study, histopathological lesions were observed in 17(30.36%) samples. Hyperaemia in sinusoids and central veins, degeneration and necrosis of some hepatocytes and cellular infiltration in portal areas were main histopathological changes in liver. In brain sections, hyperaemia, degeneration and necrosis of neurons, spongiosis and vasculitis, especially in BVDV positive sections, were prominent. In addition, there was interstitial or catarrhal pneumonia in lung sections. Positive immunofluorescence staining was detected in 8(14.28%) foetal tissues by direct immunofluorescence method. In immunohistochemical staining, 6(10.71%) samples were found positive. Antigenic localisations were observed in the cytoplasm of neuronal cells, neuroglia and leptomeninges in brain; hepatocytes cytoplasm of the liver; apical portion of bronchiolar epithelium and alveolar macrophages of lung sections. It is concluded that BVDV is an effective factor for the cattle abortion in Erzurum, Turkey. (C) 2015 PVJ. All rights reserve

The Clinical Impact of Low Doses of Dasatinib in Patients with Chronic Myeloid Leukemia

WOS: 000306389200002We report our experience in 41 patients with chronic phase (CF)-chronic myeloid leukemia (CML) who had discontinued imatinib switched to dasatinib, retrospectively. The CF-CML patients received dasatinib at starting dose of 100 once daily. Dose adjustment were observed in 11 patients, respectively. In case of other circumstances, treatment has been continued with a lower dose if needed. The median dose of dasatinib was 100 mg daily (range: 50 to 140 mg). We conclude that even low-dose dasatinib therapy is an effective and safe in second line treatment of CML patients patients