Nephropleural fistula (NPF) is an exceptionally rare yet clinically significant complication that typically arises in the context of severe urinary tract infections or following percutaneous nephrolithotomy. We describe a case of NPF secondary to a complicated urinary tract infection, outlining its clinical course, diagnostic challenges, and therapeutic management. This report highlights the importance of early recognition and appropriate interventions to prevent the morbidity associated with this unusual entity.
PURPOSE:This study aimed to evaluate the retinal and ocular findings and identify factors associated with the timing of the first ophthalmology visit among diabetic patients in Hafar Al Batin, Saudi Arabia, where there is concern that patients are not having prompt ophthalmic evaluation after diabetes mellitus (DM) diagnosis. METHODS:This retrospective cohort study analyzed data from 357 diabetic patients who had no prior ocular examination after their DM diagnosis at King Khaled General Hospital during the second semester of 2021-2022. Data on demographics, clinical characteristics, and the duration between DM diagnosis and the first ophthalmology visit were collected from medical records and analyzed using multiple regression. RESULTS:A significant delay was found between initial DM diagnosis and the first ophthalmology visit. The prevalence of diabetic retinopathy (DR) and macular edema was approximately 42% and 30%, respectively. Longer delays were significantly associated with older age ( P < 0.001), elevated HbA1C levels ( P = 0.022), coexisting hypertension ( P = 0.012), Type I DM ( P < 0.001), and lower education level ( P < 0.001). Patients ultimately diagnosed with DR had a significantly longer delay compared to those within normal limits ( P < 0.001). CONCLUSION:A substantial delay exists between diabetes diagnosis and initial eye examination among patients in Hafar Al Batin, leading to a high prevalence of preventable, vision-threatening complications. These findings underscore the urgent need for proactive public health strategies focused on improving patient education and implementing timely screening protocols to mitigate the risk of vision loss from diabetes.
BACKGROUND:Adequate bowel preparation is essential for colonoscopy, directly influencing diagnostic accuracy, therapeutic safety, and procedural efficiency. Different cleansing agents, including polyethylene glycol (PEG), sodium phosphate, and sennosides, are commonly used in clinical practice, but their comparative effectiveness remains debated. AIM:The primary aim of this study was to compare the bowel cleansing efficacy of senna, sodium phosphate, and PEG using the Aronchick Bowel Preparation Scale. Additionally, we sought to evaluate secondary objectives, including the impact of these agents on cecal intubation time, lesion detection rates, and patient tolerability. METHODS:Patients were categorized into three groups based on bowel preparation regimen: PEG, sodium phosphate, and sennosides. Data collected included demographic characteristics, preparation quality assessed by the Aronchick Bowel Preparation Scale, procedure time, cecal intubation success, and detection of polyps or diverticula. RESULTS:A total of 200 patients were included. The overall mean Aronchick score was 2.09±1.07, with no statistically significant difference among groups ( P =0.325). Polyp detection ( P =0.084), diverticula presence ( P =0.059), and maneuver requirement ( P =0.060) were also comparable. However, cecal intubation time differed significantly ( P <0.001). CONCLUSION:In conclusion, all three bowel preparation agents were comparable in terms of cleansing quality and tolerability. However, sodium phosphate was associated with a shorter cecal intubation time. These findings suggest that bowel preparation should be individualized based on patient characteristics and institutional practices. Further prospective studies with larger sample sizes are recommended to validate these results.
BACKGROUND:Acquired gynatresia is an exhausting condition that affects sexual and reproductive health. Vaginoplasty using a bilateral pudendal thigh flap provides a good functional outcome. AIM:To evaluate the demographic data, clinical characteristics, and surgical outcomes of vaginoplasty using pudendal thigh flaps in patients with acquired gynatresia managed in Enugu, Nigeria. METHODS:The study was a retrospective study of patients with acquired gynatresia who underwent vaginoplasty in Enugu from January 2 nd , 1999, to December 31 st , 2024. Data retrieved included patient demographics, etiology, degree of stenosis, perioperative details, and functional outcome. Descriptive statistics were used in data analysis, and the functional outcome was assessed. The vaginal assessment was based on the ease of penetration and coital pain/discomfort despite the use of lubricant. RESULTS:A total of 19 patients were seen and treated. The mean age was 38.74 ± 4.62. Herbal pessary (17, 89.5%) was the predominant cause of gynatresia. Vaginal assessment scores increased from 0 during preoperative assessment to a mean score of 69.2 ± 7.9, with a range from 55 to 80 in the postoperative stage. Patients were followed up for at least 6 months. CONCLUSION:Vaginoplasty using pudendal thigh flaps is a reliable procedure for the effective management of acquired gynatresia, producing a functional outcome, that is, painless coitus and resumption of menstrual flow.
BACKGROUND:Systemic vascular injuries during elective thoracic surgery are rare, but potentially life-threatening complications. Their occurrence is closely related to tumor-vessel proximity and intraoperative technical challenges. AIMS:To determine the incidence proportion, mechanisms, and clinical outcomes of systemic vascular injuries during elective thoracic surgery, and to assess the impact of multidisciplinary preoperative planning. METHODS:This retrospective descriptive study reviewed patients with intraoperative systemic vascular injuries during elective thoracic surgery at a tertiary center between January 2015 and December 2024. Demographic, surgical, and perioperative data-including injured vessel, blood loss, transfusion, complications, and need for cardiovascular surgery (CVS) support-were analyzed. Pulmonary artery injuries and emergency surgeries were excluded. RESULTS:Of 7,597 elective thoracic surgeries, 11 patients (0.15%) sustained systemic vascular injuries. The most injured vessels were the superior vena cava (SVC), brachiocephalic vein, and subclavian artery. Preoperative imaging failed to detect vascular invasion in 45.5% of patients. CVS consultation was obtained in 5 cases (45.5%), but cardiopulmonary bypass (CPB) was not required. Median blood loss and transfusion requirements were higher in the CVS group, though differences were not statistically significant. Three patients (27.3%) died during the postoperative period, with pulmonary complications such as pneumonia identified as the primary cause of death. One neoadjuvant-treated patient experienced a subclavian artery injury requiring graft interposition. CONCLUSIONS:Although uncommon, systemic vascular injuries in elective thoracic surgery are associated with significant morbidity and mortality. Preoperative imaging may underestimate vascular risk. Multidisciplinary planning and intraoperative preparedness are essential to mitigate complications. Larger multicenter prospective studies are warranted to develop standardized preventive strategies.
BACKGROUND:Teledentistry is a new field of dentistry that delivers remote dental care services using various technologies. It employs digital imaging and the Internet to improve access for underserved patients in rural or remote areas. To support its integration into future dental practice, it is essential to assess current students' knowledge, awareness, and attitudes toward teledentistry. MATERIALS AND METHODS:A cross-sectional survey was administered online via Google Forms to third-, fourth-, and fifth-year undergraduate students. The questionnaire collected sociodemographic information as well as items assessing knowledge of, awareness of, and attitudes toward teledentistry. Data were analyzed using IBM Statistical Package for the Social Sciences Statistics version 22. RESULTS:The study included 302 dental students (48% female, 52% male; mean age: 22.99 ± 2.09 years). Overall, 29% had heard of teledentistry, while only 2% had used it. Among those aware, prior use was higher than among those unaware (5.8% vs. 0.5%, P = 0.001). Significant differences were observed by academic year. Fourth-year students were more likely than third- and fifth-year students to report that teledentistry could be used for educational purposes (50.5% vs. 35.2% and 36.8%, P = 0.045). They also showed higher agreement regarding its use in interdisciplinary virtual consultations (64.4% vs. 46.4% and 56.6%, P = 0.044), Medication-Related Osteonecrosis of the Jaw (MRONJ) follow-up (38.6% vs. 8.8% and 32.9%, P = 0.001), and clinical cost reduction (49.5% vs. 40% and 27.6%, P = 0.025). CONCLUSION:Most dental students were unfamiliar with teledentistry, its advantages and limitations, and practical applications. Given that teledentistry remains a novel technology, its principles and applications should be incorporated into the undergraduate dental curriculum.
BACKGROUND:Intrauterine pathologies are common among women with infertility and may negatively impact fertility treatment outcomes if undetected. AIM:To determine the patterns and associated clinical factors of intrauterine pathologies at hysteroscopy in women evaluated for infertility. METHODS:A retrospective cross-sectional study of 282 women with infertility was carried out at Blessed Specialist Hospital, Npor, Anambra state a private endoscopy center in Southeast Nigeria over 10 years. Clinical data and hysteroscopic findings were extracted. Statistical associations were analyzed using Chi-square tests with a significance level of P < 0.05. RESULTS:The mean age of the participants was 34.8 ± 5.2 years. Uterine pathologies were confirmed hysteroscopically in 50.35% (n = 142/282) of the patients. The most frequent intrauterine pathologies identified were intrauterine adhesions (24.47%, n = 69), endometrial polyps (14.18%, n = 40), submucous myomas (12.06%, n = 34), and uterine septa (5.32%, n = 15). Regarding procedures, 22.80% (n = 57/250) of patients with complete surgical logs underwent therapeutic hysteroscopy, while 77.20% (n = 193/282) had diagnostic interventions. Bivariate analysis revealed significant statistical associations between the presence of intrauterine pathologies and both maternal age ≥35 years ( P = 0.012) and uterine enlargement ( P < 0.001). CONCLUSION:Intrauterine pathologies affect half of the women evaluated for infertility in this cohort, with intrauterine adhesions being the most prevalent entity. Advanced maternal age and uterine enlargement are strongly associated with these anomalies. Hysteroscopy remains crucial for accurate diagnosis during fertility work-ups.
BACKGROUND:In Türkiye and moderate-income developing countries, skin-to-skin contact (SSC) is not a routine practice and is often neglected, especially after a cesarean. AIM:The aim of this research was to evaluate the effect of immediate and early SSC after cesarean on maternal and neonatal parameters in the first 24 hours. METHODS:This quasi-experimental clinical study involved 92 mother-neonate pairs. Uninterrupted 40-minute SSC was implemented within the first 5 minutes in the immediate SSC (ISSC) group and within the first hour after cesarean in the early SSC (ESSC) group. Routine care was given to the control group. Data collected with the Infant Breastfeeding Assessment Tool, State Anxiety Inventory and maternal-neonatal monitoring timeline. RESULTS:The maternal anxiety scores and hemorrhage amounts were similar between the groups ( P > 0.05). Breastfeeding initiation in the ISSC group was significantly earlier than in other groups ( P = 0.006). The 24 th -hour breastfeeding scores and body temperature of neonates in the ISSC group were found to be significantly higher than those of the control group ( P = 0.032; P = 0.038, respectively). There were no differences between the neonates in terms of pulse, respiratory rate and peripheral oxygen saturation values, crying, postnatal 2 nd hour blood glucose, weight loss, urine and stool outputs ( P > 0.05). However, those in the ESSC group were determined to sleep significantly longer compared to the control group ( P = 0.014). CONCLUSION:Immediate and uninterrupted 40-minute SSC significantly promoted earlier breastfeeding initiation, improved 24-hour breastfeeding success and neonatal thermoregulation. ESSC has been associated with prolonged sleep duration in newborns. Consequently, SSC is a feasible, low-cost intervention that can be incorporated into routine postnatal care.
BACKGROUND/AIM:Recurrent corneal erosion (RCE) syndrome is characterized by recurrent corneal epithelium detachment, and patients with RCE usually experience sudden onset unilateral ocular pain upon awakening from sleep. The aim of this study was to investigate the association of risk factors and clinical course of RCE syndrome. METHODS:A retrospective chart review was performed at King Abdul-Aziz University Hospital in Jeddah, Saudi Arabia, focusing on RCE patients. The study included 28 individuals who met the inclusion criteria, ensuring a comprehensive examination of RCE cases. Data collection was meticulous using the Phoenix system and Microsoft Excel data sheets, and the obtained data were analyzed using SPSS version 27. RESULTS:Twenty-eight patients with RCE were included in the study. The causes of RCE varied and included trauma, map dot fingerprint dystrophy (MDF), fingernail-related issues, and other unknown factors. The number of RCE recurrences ranged from 1 to 4 times, and the duration of recurrence ranged from 1 to 48 months. Treatment modalities included superficial keratectomy, photorefractive keratectomy, phototherapeutic keratectomy, antibiotic eye drops and ointments, and hyaluronic acid eye drop substitutes. There was no significant difference ( P > 0.05) in patients' clinical profiles between trauma-related and MDF-related cases. Furthermore, no significant ( P > 0.05) correlation was observed between RCE recurrence duration and other factors, including gender, position of RCE, past ocular history, past medical history, initiating causative factors, and treatment approaches. CONCLUSION:Trauma, including fingernail injuries and MDF, was the most important and prevalent causative/risk factor. However, a nonsignificant correlation was observed between recurrence duration and risk factors.
Peripheral ulcerative keratitis (PUK) is an acute, destructive peripheral keratitis usually associated with an underlying systemic autoimmune disease. However, its association with hidradenitis suppurativa (HS) has been scarcely documented. We report a 35-year-old male with HS who presented with a 1-month history of a whitish spot in the left eye, associated with redness and pain. Visual acuity was 20/20 in the right eye and 20/30 in the left eye, with intraocular pressure of 14 mmHg and 13 mmHg, respectively. Slit-lamp examination revealed a crescent-shaped whitish peripheral corneal lesion at the 5 to 6 o'clock position near the limbus. Laboratory investigations were unremarkable except for elevated C-reactive protein, and the patient denied rheumatologic or autoimmune symptoms. He was treated with topical and systemic steroids, immunosuppressive therapy, biologic agents, and multiple conjunctival recession and resection procedures. PUK is a potentially serious but treatable condition; although the association with HS is rare, it should be considered in patients with HS presenting with ocular involvement.
BACKGROUND:Gender variation exists in the clustering of cardiovascular (CV) risk factors. Hypertension (HTN), diabetes mellitus (DM), lipid abnormalities, obesity, cigarette smoking, and significant alcohol use are risk factors that typically influence one another and predispose to cardiovascular disease (CVD). AIM:This study assessed gender-based variation in the prevalence of CV risk factors among young individuals with HTN. METHODS:This was a cross-sectional study involving 157 participants aged between 18 and 45 years with systemic HTN. Participants were recruited consecutively and categorized by gender. Sociodemographic and clinical information were collected using a pro forma. Lipoprotein (a), lipid profile, fasting blood glucose, uric acid, and creatinine were obtained from a fasting venous blood sample. Data were analyzed using STATA 17. RESULTS:The median age of the study participants was 30 years (24-37). Females accounted for 48% of the participants. A higher prevalence rate of significant alcohol use (34.2% vs 5.3%, P < 0.001), and cigarette smoking (14.6% vs 1.3%, P < 0.001) was found in males. A higher prevalence of LP (a) (2.2% vs 13.3%, P = 0.036) was found in the females. Moderate and severe obesity were more common among females ( P = 0.036). There was no significant difference in the prevalence of hyperuricemia, DM, dyslipidemia, reduced estimated glomerular filtration rate, and blood pressure control rate between the male and female participants. CONCLUSION:The study demonstrated some gender-based differences in the prevalence of some CV risk factors among young hypertensives. These findings are valuable for developing gender-specific strategies to reduce CV risk in this population.
BACKGROUND:Acute postpartum hypertension is common among women with preeclampsia, particularly after cesarean delivery, and is traditionally managed with intravenous (IV) antihypertensive agents. However, evidence directly comparing IV nitroglycerin-based regimens with oral-only strategies is limited. AIM:To compare the efficacy of oral-only antihypertensive therapy versus IV nitroglycerin-based regimens in achieving 24-hour blood pressure control among women with preeclampsia after cesarean delivery. METHODS:In this two-center retrospective cohort study, we included women with preeclampsia who developed acute hypertension within 24 hours after cesarean delivery. Patients were categorized into three groups: oral-only therapy, IV nitroglycerin plus oral therapy, and IV nitroglycerin-only regimens. The primary outcome was 24-hour blood pressure control (systolic <160 mmHg and diastolic <110 mmHg). Secondary outcomes included 30-day healthcare utilization and in-hospital complications. Multivariable regression models adjusted for baseline characteristics. RESULTS:All strategies achieved substantial blood pressure reduction. Rates of 24-hour control were high and comparable across groups ( P = 0.941), with no significant advantage of IV nitroglycerin over oral-only therapy after adjustment. Short-term clinical outcomes, including 30-day emergency visits ( P = 0.930) and in-hospital complications ( P = 0.810), were similar across groups. In subgroup analyses, IV nitroglycerin and oral nifedipine yielded similar hemodynamic responses. CONCLUSION:Oral-only therapy provides 24-hour blood pressure control and short-term outcomes comparable with resource-intensive IV nitroglycerin regimens. In stable postpartum patients, oral therapy can be used as first-line management.
BACKGROUND:Post-term pregnancy increases maternal and perinatal morbidity. Methods that promote spontaneous labor before 42 weeks may reduce the need for formal induction. Membrane sweeping (MS) is recommended by World Health Organization, whereas castor oil is commonly used in some settings but is not routinely guideline-endorsed. This study compared MS, castor oil, and expectant management for prevention of post-term pregnancy in Enugu. AIM:This study compared MS, castor oil, and expectant management for prevention of post term pregnancy in Enugu. METHODS:This randomized controlled trial enrolled women at 40 + 0 to 41 + 0 weeks' gestation in two hospitals in Enugu, who were allocated in a 1:1:1 ratio to MS, castor oil, or control using a computer-generated random sequence with sealed opaque envelopes. The primary outcome was labor within 48 hours. Secondary outcomes included subsequent formal induction, mode of delivery, and maternal/neonatal outcomes. RESULTS:Labor within 48 hours occurred more frequently after MS (44/70, 62.9%) and castor oil (37/70, 52.9%) than control (17/70, 24.3%). Compared with control, MS increased the odds of labor within 48 hours (OR 5.28, 95% CI 2.54-10.95; P < 0.001), as did castor oil (OR 3.50, 95% CI 1.70-7.18; P = 0.001). There was no significant difference between membrane sweeping and castor oil (OR 1.51, 95% CI 0.77-2.96; P = 0.232). Subsequent formal induction was more common in the control group. CONCLUSION:Compared with expectant management, both membrane sweeping and castor oil were associated with higher rates of labor within 48 hours and lower need for formal induction. Neither intervention was superior for the primary outcome. Larger studies are needed to confirm maternal and neonatal safety outcomes.
BACKGROUND:Preeclampsia may be complicated by cerebral edema and elevated intracranial pressure (ICP), yet magnetic resonance imaging is not always feasible for urgent or serial assessment. Ultrasonographic optic nerve sheath diameter (ONSD) measurement is a bedside surrogate that may reflect ICP-related changes. AIM:To compare ONSD values among nonpregnant healthy women, normotensive pregnant women, and women with preeclampsia (with and without severe features), and to evaluate the discriminative performance of ONSD for hypertensive disorders of pregnancy. METHODS:This single-center retrospective cohort study (January 2021-January 2025) included 79 participants: nonpregnant healthy women ( n = 19), normotensive pregnant women ( n = 20), preeclampsia ( n = 20), and severe preeclampsia ( n = 20). Preeclampsia diagnosis/severity followed the American College of Obstetricians and Gynecologists criteria. ONSD was measured by ocular ultrasonography (Voluson S8) 3 mm posterior to the globe in both eyes; the mean of both eyes was analyzed. Measurements were performed contemporaneously by four radiologists and recorded by consensus. RESULTS:Groups were comparable regarding age, gravidity, parity, and gestational week at measurement (mean gestational age 34.20 ± 0.70 weeks; P > 0.05). Mean ONSD increased stepwise across groups: 4.11 ± 0.21 mm (nonpregnant controls), 4.62 ± 0.19 mm (pregnant controls), 5.71 ± 0.18 mm (preeclampsia), and 5.99 ± 0.20 mm (severe preeclampsia) ( P < 0.001). An ONSD cutoff of 5.15 mm distinguished preeclampsia/severe preeclampsia from the control groups with excellent diagnostic performance (AUC = 1.000; P < 0.001). CONCLUSION:ONSD is higher in preeclampsia, especially in severe cases. Ocular ultrasound may help with quick screening and follow-up, but confirmation in larger studies using imaging or invasive ICP standards is needed.
BACKGROUND:The investigation aimed to determine whether there has been an increase in the amount of stem cells discarded due to patient mortality resulting from COVID-19 infection in our apheresis unit. Records were reviewed to investigate whether there were any differences in stem cell discards before and after the COVID-19 pandemic period following 2015. RESULTS:In both periods, products retrieved from patients with myeloma and non-Hodgkin lymphoma constituted the majority of discarded stem cells. The process of discarding 230 hematopoietic stem cell products that were discarded after 2015 involved a period of five years prior to the COVID-19 pandemic, during which half of the products were discarded, and the other half were discarded in the last 2.5 years of the pandemic. Over 90% of the discarded products were autologous stem cell products. Additionally, 43 patients had their products discarded due to mortality associated with COVID-19 infection. This number does not include those who passed away at home for unknown reasons or in cases where COVID-19 infection could not be confirmed. The disposal of a single hematopoietic stem cell product, including the cost of the collection bag and DMSO freezing, was approximately 5,000 Turkish Lira during that period. In our country, which has around 50 hematopoietic stem cell transplantation centers, if we assume an average of about 40 stem cell disposals per center, this would result in a total loss of approximately 10 million Turkish Lira (calculated as 5,000 TL x 40 x 50 centers = 10,000,000 TL). This figure does not account for personnel labor costs. CONCLUSION:Furthermore, this review suggests that, similar to previous observations, preserving stem cells for second transplants in patients with non-Hodgkin lymphoma and certain elderly myeloma patients may be unnecessary.
BACKGROUND:The widespread use of CAD/CAM technologies in dentistry has enabled the application of various restorative materials with differing mechanical and aesthetic characteristics. While lithium disilicate ceramics are known for their strength and translucency, resin-matrix ceramics are preferred for their ease of processing and intraoral repairability. However, their long-term color stability and surface behavior under staining conditions remain insufficiently understood. AIM:This study aimed to evaluate and compare the effects of different staining solutions on the color stability, surface roughness, microhardness, and contact angle of selected CAD/CAM restorative materials. METHODS:An in vitro study was conducted using three resin-matrix ceramics and one fully crystallized lithium disilicate ceramic. Specimens were immersed in three different staining solutions (distilled water, coffee, and red wine). Measurements of color change (ΔE00), surface roughness (Ra), microhardness, and contact angle were performed at baseline and after 30 days. RESULTS:All materials showed varying levels of discoloration, with the highest ΔE00 value observed in the Shofu Block HC group stored in red wine (ΔE00 = 5.48 ± 0.43). Lithium disilicate ceramic exhibited the least discoloration among all tested materials. In coffee and red wine, all materials, including lithium disilicate, exceeded the clinically acceptable threshold (ΔE00 = 1.8) after 30 days, although lithium disilicate consistently exhibited lower discoloration compared to resin-matrix ceramics. Surface roughness increased in all groups but remained within clinically acceptable limits. Contact angle values varied according to material type, reflecting differences in surface wettability. CONCLUSION:Resin-matrix ceramics demonstrated greater susceptibility to discoloration and surface changes than lithium disilicate ceramic. Although lithium disilicate exhibited the lowest discoloration among the tested materials, its ΔE00 values also exceeded the clinical acceptability threshold (ΔE00 = 1.8) after 30 days of immersion in coffee and red wine. These findings indicate that material composition and environmental exposure conditions play a critical role in determining the long-term aesthetic and surface performance of CAD/CAM restorations.
BACKGROUND:Invasive meningococcal disease (IMD) remains a critical threat during Hajj. Following a 2024 resurgence of travel-related IMD cases, assessing domestic adherence to mandatory quadrivalent (MenACWY) meningococcal vaccination has become a public health priority. While international compliance is high, data on domestic pilgrims who constitute 25-40% of the population remain limited. AIM:To assess Meningococcal vaccine coverage and identify the sociodemographic determinants, motivators, and barriers among domestic pilgrims. METHODS:We analyzed data from a large-scale cross-sectional assessment of 4,678 domestic pilgrims (aged ≥16 years) conducted in Mina during the 2019 Hajj. As the final full-scale pilgrimage prior to the coronavirus disease 2019 pandemic, this cohort provides the definitive baseline for understanding domestic vaccination realities. Using multi-stage cluster sampling, participants were surveyed on several domains; this study specifically analyzed MenACWY uptake (within the required validity period), sociodemographics, and motivators. RESULTS:Overall uptake was 87.3%, but policy-compliant adherence was 86.2%. Multivariate analysis showed nonadherence was significantly associated with residency in Makkah Province (adjusted odds ratio [aOR] = 0.51, 95% confidence interval [CI]: 0.35-0.75, P < 0.001) and prior Hajj experience (aOR = 0.48, 95% CI: 0.33-0.70, P = <0.001). Conversely, female sex (aOR = 1.86, 95% CI: 1.01-3.42, P = 0.045), healthcare employment (aOR = 2.13, 95% CI: 1.20-3.75, P = 0.009), and the receipt of pre-Hajj health advice (aOR = 2.60, 95% CI: 1.79-3.77, P < 0.001) were linked with increased adherence. While policy mandate was the primary motivator (47.6%), 6.2% reported out-of-pocket costs, with non-citizens 4.14 times more likely to incur expenses ( P < 0.001). CONCLUSION:Domestic pilgrims exhibit suboptimal adherence, suggesting that geographic proximity and prior pilgrimage experience foster a familiarity-driven complacency that diminishes perceived risk. These findings from the 2019 baseline are vital for tailoring current strategies. Linking permit issuance to timely vaccination is essential to achieve the coverage required for Hajj health security.
Background: Acute appendicitis (AA) is an emergency surgical condition with diagnostic difficulty and a high complication rate in geriatric patients due to atypical presentations. Aim: This study evaluated the diagnostic and prognostic value of the systemic immune-inflammation index (SII), delta neutrophil index (DNI), and neutrophil-to-lymphocyte ratio (NLR) in patients aged ≥65 years. Methods: This retrospective study included 120 participants: 60 geriatric patients who underwent appendectomy for AA between January 2021 and October 2025 and 60 age-matched healthy controls. Demographic data, hematological parameters, and histopathological findings were analyzed. AA patients were classified as complicated or uncomplicated. Receiver operating characteristic (ROC) curve analysis was performed to assess diagnostic performance. Results: White blood cell count (WBC), absolute neutrophil count, NLR, DNI, and SII were significantly higher in the AA group compared with controls (P < 0.05). Patients with complicated AA had higher absolute neutrophil count, NLR, platelet-to-lymphocyte ratio (PLR), DNI, C-reactive protein, and symptom duration than uncomplicated cases. ROC analysis showed 85% sensitivity for SII (cutoff 0.84) and NLR (cutoff 3.79) in diagnosing AA. For predicting complications, SII (cutoff 1.71) showed 77.3% sensitivity and 68.4% specificity, while DNI (cutoff 0.055) had the highest specificity (71.1%). Conclusion: Hematological-based indices such as SII, NLR, and DNI are inexpensive and easily accessible markers for diagnosing AA and predicting complications in geriatric patients, although their diagnostic performance differs between outcomes.
Background: Sarcopenia and coxarthrosis frequently coexist in older adults and may contribute to functional decline. Computed tomography (CT)-based muscle measurements are commonly used for the assessment of sarcopenia. Aim: To quantitatively evaluate the relationship between the presence and severity of coxarthrosis and sarcopenia using computed tomography (CT) and to investigate the usability of the upper thigh skeletal muscle as an alternative to the psoas muscle in the evaluation of sarcopenia in coxarthrosis. Methods: Patients who underwent a hip CT examination between June 2019 and May 2023 were evaluated retrospectively. Patients with coxarthrosis were included in the study. Coxarthrosis staging was performed according to the Tönnis classification. Muscle area and density values were measured at the L4 level for bilateral psoas muscles and skeletal muscle in the upper thigh level at the inferior tip of the ischial tuberosity. Results: Increasing Tönnis grade remained independently associated with lower psoas and upper thigh muscle area and density (all Holm-adjusted P < 0.001). Muscle areas were lower in women than in men ( P = 0.001). There was no significant difference between the genders in terms of the psoas muscle density ( P > 0.05), while the upper thigh muscle density was significantly lower in women than in men ( P < 0.05). A positive correlation was detected between the areas and densities of the psoas and upper thigh muscles in every grade of coxarthrosis. Conclusion: The presence and severity of coxarthrosis are associated with the area and density of the psoas and upper thigh skeletal muscles. Upper thigh skeletal muscles may serve as an alternative muscle group for the imaging-based evaluation of sarcopenia.
Background: Double valve replacement (DVR) of both the aortic and mitral valves is a technically demanding cardiac procedure associated with significant risks, including extended cardiopulmonary bypass times and a pronounced systemic inflammatory response. The De Ritis ratio (aspartate aminotransferase/alanine aminotransferase), a biomarker of cellular injury, has emerged as a prognostic indicator in various clinical scenarios. Aim: The primary objective of this investigation is to elucidate the association between the postoperative De Ritis ratio and the incidence of complications among patients undergoing DVR. Methods: A retrospective cohort study was conducted, encompassing 120 consecutive patients who underwent DVR at our institution between October 2017 and October 2023. The De Ritis ratio was calculated from laboratory values obtained preoperatively and within the first 24 hours postoperatively. Patients were stratified into two groups (postoperative De Ritis ratio ≤1.5 vs. >1.5) to assess its association with adverse outcomes. Results: The mean age of the cohort was 58.2 ± 12.4 years. Patients with a postoperative De Ritis ratio >1.5 experienced a statistically significant prolongation of both their intensive care unit stay (4.8 ± 1.6 days vs. 3.2 ± 1.4 days, P = 0.01) and their overall hospital stay (14.3 ± 4.2 days vs. 9.5 ± 3.1 days, P = 0.008). The 30-day mortality rate was also significantly higher in the elevated De Ritis group (12% vs. 5%, P = 0.04). Conclusion: The postoperative De Ritis ratio independently predicts unfavorable outcomes after DVR. Its integration into routine postoperative risk stratification may enhance surveillance and optimize perioperative management.
