Infraorbital Hyaluronic Acid Filler: Common Aesthetic Side Effects with Treatment and Prevention Options

Background Infraorbital hollows can give a fatigued or aged appearance which can be treated by volumizing the segmented transition from the tear trough to the cheek with hyaluronic acid filler. Due to thin skin and the complex anatomy of the infraorbital area, both short- and long-term side effects from this treatment are very common. While some patients are clear surgical candidates vs. filler candidates, in real-world practice, many, if not most patients are on a continuum where either procedure is appropriate, and the treatment decision is individualized based on each person’s risk vs. benefit profile. Objectives Common aesthetic side effects from hyaluronic acid filler treatment in the infraorbital area will be reviewed, including their etiology, prevention, detection, and treatment. Method The authors’ experience from injecting the infraorbital areas of more than 800 patients in private clinical practice and observations from both short and long-term follow ups over eight years is leveraged to provide detailed guidance. Results Recommendations on injection techniques, patient selection, and patient education are presented along with algorithms for the prevention and management of bruising, short- and long-term swelling, bumps, and blue discoloration (which is usually secondary to swelling from the filler rather than just the filler alone placed or migrating too superficially). Conclusion For nearly all patients, complete dissolution of filler with hyaluronidase is not required to address the issue, and the guidelines provided here will assist clinicians in management of side effects to increase patient satisfaction with their treatment and aesthetic outcome.

Diminished capacities to make treatment decision for COVID-19 vaccination in schizophrenia

Recent evidence suggests that schizophrenia patients are at high risk for severe COVID-19 and should be prioritized for vaccination. However, impaired decision-making capacities could negatively affect the uptake of COVID-19 vaccination in this population. Competence to consent to COVID-19 vaccination was assessed in 80 outpatients with schizophrenia. Using the MacArthur Competence Assessment Tool for Treatment, 56.3% of the sample were classified as having diminished mental capacity. Poor performance was associated with lower vaccination rates, poorer cognition and higher level of psychotic symptoms. Developing interventions for enhancing informed consent for vaccination is urgent within this population.

Unraveling a rare cause of spinal stenosis: Coexistent AL and ATTR amyloidosis involving the ligamentum flavum

Background: Amyloidosis is a protein misfolding disorder that leads to the deposition of beta-pleated sheets of a fibrillar derivative of various protein precursors. Identification of the type of precursor protein is integral in treatment decision-making. The presence of two different types of amyloid in the same patient is unusually rare, and there are no previous reports of two different types of amyloid deposition in the ligamentum flavum (LF) in the same patient. Case Description: Here, we describe two patients with spinal stenosis who underwent laminectomies and were found to have AL and ATTR amyloid deposits in the LF. Conclusion: As the spine is becoming recognized as a site for ATTRwt amyloid deposition, patients undergoing spinal decompression surgery may potentially benefit from evaluation for amyloidosis in the LF.

The Significance of Patient-Reported Outcomes for Metastatic Breast Cancer Patients

Background: Breast cancer is still the most common malignancy in women worldwide. Once metastasized, breast cancer treatment primarily aims at reducing symptom burden, thereby trying to maintain and improve a patient´s quality of life (QoL), delaying disease progression, and prolonging survival. Curing the disease is not possible in the palliative setting. To better understand metastatic breast cancer patients, their symptoms and wishes, which are important for treatment-decision making and outcome, patient-reported outcomes (PROs) are of great importance, giving an impression of what really matters to and concerns a patient. Summary: Many advances have been made to implicate PROs in clinical trials, non-interventional studies, registries, and clinical routine care of metastatic breast cancer. For example, large phase III trials like PALOMA-3 (NCT01942135), MONALEESA-7 (NCT02278120), HER2CLIMB (NCT02614794), and KEYNOTE-119 (NCT02555657) trials implemented PROs in their trial design to assess the QoL of their trial patients. Also, non-interventional studies on metastatic breast cancer, like e.g., the NABUCCO study (IOM-02240), and prospective non-interventional, multicenter registries e.g., the tumor registry breast cancer (NCT01351584) or the breast cancer registry platform OPAL (NCT03417115), have implemented PROs to assess QoL during the anti-cancer treatment periods of the patients. Key Message: Using PROs in metastatic breast cancer can support shared treatment-decision making and management of symptoms, eventually leading to an improvement in QoL. Progressively, regulatory authorities take PROs into consideration for the approval of new drugs. Hence, the implication of PROs in cancer treatment, and especially in MBC, is of significant value.

Ventriculostomy-Related Intracranial Hemorrhage Following Surgical and Endovascular Treatment of Ruptured Aneurysms

Introduction : Endovascular therapy of ruptured aneurysms is regularly accompanied by periprocedural heparinization and requires the use of periprocedural antiplatelets in more complex cases. This raises concerns regarding increased bleeding risks in the case of frequently required ventriculostomy. The aim of this study was to analyze risk factors for ventriculostomy-related intracranial hemorrhages (VS-ICH) in endovascular or surgical treatment of ruptured aneurysms with a focus on antithrombotic therapy. Materials and Methods In this retrospective analysis we included patients admitted to our institution over a 12-year period who had received at least one ventriculostomy due to subarachnoid hemorrhage-related hydrocephalus. Patients were dichotomized into an endovascular and surgical group and rates of VS-ICH were compared. Risk factors for VS-ICH were assessed in uni- and multivariate analyses. Results A total of 606 ventriculostomies were performed in 328 patients. Within the endovascular group, antiplatelet therapy was used in 44.8% of cases. The overall rate of ventriculostomy-related intracranial hemorrhage was 13.1%. Endovascular treatment was associated with a higher rate of VS-ICH compared to surgical treatment (p=0.011), but not in cases without antiplatelet therapy (p=0.166). Application of any antiplatelet therapy (odds ratio, 2.647 [95% confidence interval, 1.141-6.143]) and number of ventriculostomies (odds ratio, 2.513 [95% confidence interval, 1.859-3.395]) were independent predictors of ventriculostomy-related hemorrhages. Discussion Our findings indicate an increased risk of VS-ICH in the endovascular group if administration of antiplatelets was required. While this aspect has to be included into treatment decision making, it must be weighed against the benefits of endovascular techniques.

The Use of PCR for Respiratory Virus Detection on the Diagnosis and Treatment Decision of Respiratory Tract Infections in Iraq

Diseases of the respiratory system are a common cause of antibiotic prescription in Iraq and worldwide. Technology has been recently used for its diagnosis, such as the Film Array Respiratory Panel. This study aims to identify the correlation between the diagnosis and treatment of respiratory tract infections with the result of polymerase chain reaction (PCR) for respiratory viruses. A descriptive, cross-sectional, retrospective study included 134 patients treated at Alkharama Hospital and the Private Hospital in Baghdad, Iraq, in the period from January 2020 to March 2020 For all cases, the results of the panel and the treatment received by the patients were analysed. 58% received antibiotic treatment upon admission, 13% combined treatment (antibiotic + antiviral), 27% received symptomatic treatment, and 2% were treated with the first-instance antiviral. After the result, 38% continued with antibiotics, 30% with antibiotics and antivirals, 13.8% with antivirals and 18.2% with symptomatic treatment. Despite the worldwide alarm over antimicrobial resistance, patients continue to be treated with antibiotics due to a situation that is influenced by several factors.

Identification of Multi-omics Biomarkers and Construction of the Novel Prognostic Model for Hepatocellular Carcinoma

Genome changes play a crucial role in carcinogenesis, and many biomarkers can be used as effective prognostic indicators in various tumours. Although previous studies have constructed many predictive models for hepatocellular carcinoma (HCC) based on molecular signatures, the performance is unsatisfactory. To fill this shortcoming, we hope to build a more accurate predictive model to guide prognostic assessments of HCC. We use the TCGA to identify crucial biomarkers and construct single-omic prognostic models through difference analysis, univariate Cox, and LASSO/stepwise Cox analysis. The performances of single-omic models were evaluated and validated through survival analysis, Harrell’s concordance index (C-index), and receiver operating characteristic (ROC) curve. A multi-omics model was built and evaluated by decision curve analysis (DCA), C-index, and ROC analysis. Multiple mRNAs, lncRNAs, miRNAs, CNV genes, and SNPs were significantly associated with the prognosis of HCC. Five single-omic models were constructed, and the mRNA and lncRNA models showed good performance with c-indexes over 0.70. The multi-omics model presented a quite predictive solid ability with a c-index over 0.80. In this study, we identified many biomarkers that may help study underlying carcinogenesis mechanisms in HCC. In addition, we constructed multiple single-omic models and an integrated multi-omics model that may provide practical and reliable guides for prognosis assessment and treatment decision-making.