Using machine learning to examine drivers of inappropriate outpatient antibiotic prescribing in acute respiratory illnesses

Using a machine-learning model, we examined drivers of antibiotic prescribing for antibiotic-inappropriate acute respiratory illnesses in a large US claims data set. Antibiotics were prescribed in 11% of the 42 million visits in our sample. The model identified outpatient setting type, patient age mix, and state as top drivers of prescribing.

Detection of Circulating VZV-Glycoprotein E-Specific Antibodies by Chemiluminescent Immunoassay (CLIA) for Varicella–Zoster Diagnosis

Varicella and herpes zoster are mild symptoms-associated diseases caused by varicella–zoster virus (VZV). They often cause severe complications (disseminated zoster), leading to death when diagnoses and treatment are delayed. However, most commercial VZV diagnostic tests have low sensitivity, and the most sensitive tests are unevenly available worldwide. Here, we developed and validated a highly sensitive VZV diagnostic kit based on the chemiluminescent immunoassay (CLIA) approach. VZV-glycoprotein E (gE) was used to develop a CLIA diagnostic approach for detecting VZV-specific IgA, IgG, and IgM. The kit was tested with 62 blood samples from 29 VZV-patients classified by standard ELISA into true-positive and equivocal groups and 453 blood samples from VZV-negative individuals. The diagnostic accuracy of the CLIA kit was evaluated by receiver-operating characteristic (ROC) analysis. The relationships of immunoglobulin-isotype levels between the two groups and with patient age ranges were analyzed. Overall, the developed CLIA-based diagnostic kit demonstrated the detection of VZV-specific immunoglobulin titers depending on sample dilution. From the ELISA-based true-positive patient samples, the diagnostic approach showed sensitivities of 95.2%, 95.2%, and 97.6% and specificities of 98.0%, 100%, and 98.9% for the detection of VZV-gE-specific IgA, IgG, and IgM, respectively. Combining IgM to IgG and IgA detection improved diagnostic accuracy. Comparative analyses on diagnosing patients with equivocal results displaying very low immunoglobulin titers revealed that the CLIA-based diagnostic approach is overall more sensitive than ELISA. In the presence of typical VZV symptoms, CLIA-based detection of high titer of IgM and low titer of IgA/IgG suggested the equivocal patients experienced primary VZV infection. Furthermore, while no difference in IgA/IgG level was found regarding patient age, IgM level was significantly higher in young adults. The CLIA approach-based detection kit for diagnosing VZV-gE-specific IgA, IgG, and IgM is simple, suitable for high-throughput routine analysis situations, and provides enhanced specificity compared to ELISA.

Mucosal Bridge Reconstruction: A Novel Approach for the Vocal Fold Mucosal Bridge

Introduction: Mucosal Bridges (MBs) are defined as benign connective tissue abnormalities of unclear etiology that extend over the free surface of the vocal fold, are attached to the front and back of the vocal fold but are not attached to its free surface, and are histologically covered by stratified squamous epithelium. In order to overcome these drawbacks, we aimed to retrospectively evaluate and present the preoperative and postoperative results of patients with MB, who were applied the method we call “Mucosal Bridge Reconstruction” (MBR), which we apply as suturing rather than resection of the MB. Methods: Between January 2016 and February 2020, 5 patients who applied to the voice clinic due to dysphonia and were diagnosed with MB via laryngostroboscopic examination and direct laryngoscopy under general anesthesia were included in the study. Dr Speech software was used for acoustic analysis; mean fundamental frequency (fo), jitter %, shimmer %, and noise to harmonic ratio (NHR) were objectively measured and recorded. Voice Handicap Index-10 (VHI-10) was used for positive self-reporting of the severity of vocal symptoms. GRBAS scale (G: Grade, R: Roughness, B: Breathiness, A: Asthenia, and S: Strain) was also used (by the same clinician) for clinic subjective evaluation. Results: Patient age ranged from 33 to 55 years and mean patient age was 42 years. Mean duration of symptoms was 22 months (range 16-30). Mean postoperative follow-up time was 14 months (range 6-24). Unilateral MB was observed in all patients (2 left, 3 right). There was a significant improvement in objective and subjective assessment methods in all our patients after surgery. Conclusions: According to the results of our few patients, MBR offers a physiological and anatomical approach to the treatment of patients with MB. The outcomes of delicate microlaryngeal surgery are promising.

Cas D’une Fausse Fracture De La Verge Par Rupture De La Veine Dorsale Profonde Au Centre Hospitalo-Universitaire Departemental -Oueme Plateau De Porto Novo, Benin

Introduction : Les traumatismes du pénis intéressant le réseau vasculaire sont rarement rapportés dans la littérature. La rupture de la veine profonde du pénis est une urgence urologique dont la clinique peut simuler une fracture de la verge.Nous rapportons un cas de rupture de la veine profonde du pénis survenue lors d’un faux pas de coït.Patient et Méthodes : Il s’est agi d’un patient âgé de 26 ans présentant une tuméfaction de tout le pénis précédée d’une douleur minime et d’une détumescence progressive survenue au décours d’un coït. L’exploration chirurgicale a mis en évidence une lésion incomplète de la veine dorsale profonde et qui a été réparée.Conclusion : La rupture de la veine dorsale profonde est rare et peut simuler une fracture des corps érectiles. . L’exploration chirurgicale reste un moyen diagnostique et thérapeutique accessible. Introduction: Penile trauma involving the vascular network is rarely reported in this paper. The rupture of the deep vein of the penis is a urological emergency which can simulate a fracture of the penis. A case of rupture of the deep vein of the penis is reported, which occurred during a false coitus.Patient and Methods: The case study was a 26-year-old patient with swelling of the entire penis. This was preceded by minimal pain and progressive detumescence during coitus. Surgical exploration revealed an incomplete lesion of the deep dorsal vein, which was repaired.Conclusion: Rupture of the deep dorsal vein is rare and may simulate a fracture of the erectile bodies. Surgical exploration remains an accessible diagnostic and therapeutic means.

Analysis of Consumer Exposure Cases for Alcohol-Based Disinfectant and Hand Sanitizer Use against Coronavirus Disease 2019 (COVID-19)

The development and distribution of vaccines and treatments as well as the use of disinfectants and hand sanitizers to cope with coronavirus disease 2019 (COVID-19) infection has increased rapidly. As the use of disinfectants and hand sanitizers increased, the number of unintended exposures to these substances also increased. A total of 8016 cases of toxic exposure to disinfectants and hand sanitizers were reported to the American Association of Poison Control Centers (AAPCC) from 1 January 2017 to 30 May 2021. The cases have been characterized by substance, sex, patient age, exposure reason and site, treatments received, and outcomes. The number of exposures correlates closely to the rise of COVID-19 cases, rising significantly in March 2020. About half of the total cases involved children less than 10 years old and 97% of those exposures per year were unintentional. In addition, the most common exposure site was the patient’s own residence. Over-exposure to disinfectants and hand sanitizers can cause symptoms such as burning and irritation of the eyes, nose, and throat, coughing, chest tightness, headache, choking, and, in severe cases, death.

Patient Age Is Significantly Related to Distant Metastasis of Papillary Thyroid Microcarcinoma

ObjectiveDistant metastasis in papillary thyroid microcarcinoma (PTMC) is rare but fatal, and its relationship with patient age remains unclear. The objective of this study was to examine the association between age at diagnosis and metachronous distant metastasis in PTMC.MethodsConsecutive patients who underwent thyroidectomy for PTC measuring 10 mm or less at a tertiary hospital from January 2000 to December 2016 were enrolled. Patients who had evidence of distant metastasis at diagnosis or underwent postoperative radioiodine (RAI) ablation were excluded. A Cox proportional hazards model with restricted cubic splines (RCS) was applied to examine the association between age at diagnosis and distant metastasis.ResultsA total of 4,749 patients were evaluated. The median age was 44 years (range, 8–78 years), and 3,700 (78%) were female. After a median follow-up of 65 months, 21 distant metastases (20 lung, 1 liver) were recognized. A univariate Cox proportional model using a 5-knot RCS revealed a significant overall (p = 0.01) and a potential nonlinear association (p = 0.08) between distant metastasis and age at diagnosis. In multivariate analysis, age at diagnosis, extrathyroidal extension (ETE), and lymph node metastasis (pN+) were independent risk factors for distant metastasis. Compared with the middle-aged group (30–45 years old), younger and older patients had a higher risk of distant metastasis [HR, 95% CI, p-value, age ≤ 30, 4.54 (0.91–22.60), 0.06, age > 45, 6.36 (1.83–22.13), <0.01].ConclusionAge at diagnosis is associated with metachronous distant metastasis of PTMC, and patients with younger or older age have a higher risk of distant metastasis than middle-aged patients.

Clinical Impact of the Patient Age Following Endoscopic Third Ventriculostomy: A Review

Background: Clinically erratic cerebrospinal fluid (CSF) outflow within brain ventricles was described as non-communicating and communicating hydrocephalous. Neurosurgical patients are commonly seen with increased intracranial pressure due to increased CSF accumulation. (1) Initially scientists followed ventriculoperitoneal shunt an inexpensive and available technique to treat hydrocephalous disorders. Due to least successful outcomes, Scientists used other alternative endoscopic techniques. These endoscopic techniques include aqueductal endoscopic stenting, aqueductoplasty and third ventriculostomy (2). Defining success rate of Endoscopic third ventriculostomy clinical and radiographic analysis are considered gold standard. Objectives: Our review aims to assess comparative role of patient age, patient selection, hydrocephalus etiology, surgical advancement and epigenetic treatment strategies following endoscopic third ventriculostomy focusing hydrocephalous. The main objectives of current study, to critically analyze available literature till to date and a step forward for the development of standard surgical protocols. Methodology: Clinical studies from Level I-IV published in English language focusing human subject only were only considered by retrieving NCBI/PubMed, Medline databases. Studies purely focusing third ventriculostomy in subject of patient age, hydrocephalus etiology and age associated complications were processed further. Objective based data inspection approach was followed. From each included study focusing third ventriculostomy detailed information demographic information was collected. Further data analysis was done by using SAS and multiple tools of Microsoft Excel Version 2010. Outcomes: From total 11 included studies specifically focusing hydrocephaly treatment via endoscopic third ventriculostomy, 757 patients with equal 1:1 male and female gender ratio and 125 cases of unknown gender were considered. Current study highlighting efficacy of Endoscopic third ventriculostomy at the rate of 77% effective treating obstructive hydrocephalus. On basis of etiological concerns about 36.32 % cases hydrocephalous cases were linked with encephalitis, underweight birth and nonspecific etiology. However, 24 % cases of hydrocephalus were led by group of tumors including, Ependymoma, Medulloblastoma, Meningioma, Cerebella pontine angle Tumors and Pineal gland carcinomas as well. 154 (20%) cases of obstructive hydrocephalus were associated with aqueduct stenosis, 16% cases reporting hemorrhage and only 23 cyst cases. Conclusion and future recommendations: Endoscopic third ventriculostomy (ETV) is a safe and effective (77%) treatment option for the treatment of obstructive hydrocephalus among all age groups. However, specifically highest efficacy was noted among patients of 15-30-year age group. Understanding disease etiology and patient selection criteria both are considered potential components following successful endoscopic third ventriculostomy. We highly recommend further research following a universal age criteria and reporting results in distinct age category to standardize ETV treating hydrocephaly efficiently. Key words: Endoscopic third ventriculostomy, ETV, hydrocephalous, aqueductal endoscopic stenting, aqueductoplasty.