Wellens’ Syndrome: Incidence, Characteristics, and Long-Term Clinical Outcomes

Background: Sparse study of large sample size are available on patients with Wellens’ syndrome. We sought to assess the current incidence, risk factors, clinical presentation and long-term outcomes of this population. Methods: Among a total of 3528 patients with ACS underwent angioplasty from 2017 to 2019 in our center, 2127 NSTE-ACS patients with culprit vessel of LAD were enrolled in this study. According to electrocardiographic criteria, they were divided into Wellens’ group (n = 200) and non-Wellens’ group (n =1927). The primary endpoint was cardiac death; the secondary endpoint was MACCE, a composite of all-cause death, cardiac death, recurrent myocardial infarction, target lesion revascularization, heart failure and stroke. Results: The incidence of Wellens’ syndrome was 5.7% (200 of 3528) in all the ACS patients. Wellens’ syndrome was more often manifested as NSTEMI (69% vs 17.5%, P＜0.001). Percent of preexisting coronary heart disease (39.6% vs 23%) and previous PCI (19.5% vs 9%) were significantly higher in the non-Wellens’ group than in Wellens’ group (all P<0.001). More importantly, the proportion of early PCI was higher in Wellens’ group (68% vs 59.3%, P=0.017). At a median follow-up of 24 months, Wellens’ syndrome was not a factor that affects the prognosis of MACCE (P=0.05) and cardiac death (P=0.188). Conclusions: In patients with NSTE-ACS, Wellens’ syndrome does not affect the prognosis. The presence of age≥65years, diabetes, NSTEMI, eGFR< 60ml/min and left main disease were associated with an incidence of cardiac death. Early recognition and aggressive intervention are critical as they may help to attenuate adverse outcomes.

Access to healthcare as an important moderating variable for understanding geography of immunity levels for COVID-19 - preliminary insights from Poland

Background. Underascertainment of COVID-19 burden and uncertainty in estimation of immunity levels is a known and common phenomenon in infectious diseases. We tested to what extent healthcare access (HCA) related supply/demand interfered with registered data on COVID-19 from Poland. Material and methods. We have run a multiple linear regressions model with interactions to explain geographical variability in seroprevalence, hospitalization (on voivodeship: NUTS-2 level) and current (beginning of the 4th wave: 15.09-21.11.2021) case notifications/crude mortality (on poviats: old NUTS-4 level) taking vaccination coverage and cumulative case notifications till so called 3rd wave as predictor variables and supply/demand (HCA) as moderating variables. Results. HCA with interacting terms (mainly demand) explained to the great extent the variance of current incidence and most variance in case of current mortality. HCA (mainly supply) is significantly moderating cumulative case notifications till the 3rd wave explaining the variance across seroprevalence. Conclusions. Seeking causal relations between vaccination or infection gained immunity level and current infection dynamics could be misleading without understanding socio-epidemiological context such as the moderating role of HCA (sensu lato). After quantification, HCA could be incorporated into epidemiological models for better prediction of real disease burden.

Current Incidence and Risk Factors of Fecal Incontinence After Acute Stroke Affecting Functionally Independent People

Background: Previously published retrospective series show a high prevalence of fecal incontinence (FI) in stroke patients. We aimed to analyze in a prospective series the current incidence of FI in acute stroke in functionally independent patients and its evolution over time and the patient characteristics associated with the appearance of FI in acute stroke.Methods: We included consecutive patients with acute stroke admitted in our stroke unit who fulfilled the following inclusion criteria: a first episode of stroke, aged &gt;18 years, with no previous functional dependency [modified Rankin Scale (mRS) ≤ 2] and without previous known FI. FI was assessed by a multidisciplinary trained team using dedicated questionnaires at 72 ± 24 h (acute phase) and at 90 ± 15 days (chronic phase). Demographic, medical history, clinical and stroke features, mortality, and mRS at 7 days were collected.Results: Three hundred fifty-nine (48.3%) of 749 patients (mean age 65.9 ± 10, 64% male, 84.1% ischemic) fulfilled the inclusion criteria and were prospectively included during a 20-month period. FI was identified in 23 patients (6.4%) at 72 ± 24 h and in 7 (1.9%) at 90 days ± 15 days after stroke onset. FI was more frequent in hemorrhagic strokes (18 vs. 5%, p 0.007) and in more severe strokes [median National Institute of Health Stroke Scale (NIHSS) 18 (14–22) vs. 5 (3–13), p &lt; 0.0001]. No differences were found regarding age, sex, vascular risk factors, or other comorbidities, or affected hemisphere. Patients with NIHSS ≥12 (AUC 0.81, 95% CI 0.71 to 0.89) had a 17-fold increase for the risk of FI (OR 16.9, IC 95% 4.7–60.1) adjusted for covariates.Conclusions: At present, the incidence of FI in acute stroke patients without previous functional dependency is lower than expected, with an association of a more severe and hemorrhagic stroke. Due to its impact on the quality of life, it is necessary to deepen the knowledge of the underlying mechanisms to address therapeutic strategies.

Accelerated pubertal onset in short children with delayed bone age

Objectives Constitutional delay of growth (CDG) is usually associated with a delay in pubertal onset (CDGP) and a catch-up growth after puberty. Some individuals, however, have earlier-than-expected pubertal onset resulting in a shorter adult height. We investigated the current incidence of such individuals and that of 30 years ago. Methods The study subjects are 1,312 consecutive Japanese children referred to Osaka City General Hospital (OCGH) for short stature during 2010–2018, and a cohort of 11,256 individuals in the Ogi Growth Research (OGR, 1979–1992). Individuals with the height standard deviation score <−1.0, the bone age (BA)/chronological age (CA) ratio <0.8 at first visits, and without other identifiable causes of short stature were extracted from the record of OCGH. Similarly, individuals meeting the height and bone age criteria were extracted from the OGR record. The pubertal growth onset was auxologically determined as the upward shift from the prepubertal growth curve fitted to a quadratic function. Earlier-than-expected onset was defined as the onset earlier than the population average +1 year. Results From the OCGH cohort, 55 children (38 boys, 17 girls) met the criteria, and earlier-than-expected onset was observed in 34.2% of boys and 29.4% of girls. In the 73 short individuals with delayed bone age in the OGR cohort, earlier-than-expected onset was less common (13.0% for boys and 14.8% for girls). There was no significant association between the timing of pubertal growth onset and the BA/CA ratio, IGF-1, and midparental height. Conclusions Earlier-than-expected pubertal growth onset is common in CDG and possibly increasing.

STEAM Elementary School With The Concept of Creative Learning Space in Heidegger’s View

This research aims to find out that education significantly influences the way people live in the world; with today’s education, humans and robots have become blurred. Therefore, it is necessary to change the curriculum and education, architecture which are the main problems Heidegger’s views used as a reference in this study. The solution offered to apply the future curriculum, namely STEAM, to the education system and its architectural forms by creating creative spaces and creating architecture that exudes human existence in them with metaphorical architecture. In this study, the current incidence of COVID-19 is taken as the context of the times in which humans are in, so it is necessary to make a school design is responsive to Covid-19. The method applied: 1) Applying the concept of ‘being’ in Heidegger’s philosophy; 2) creating a creative space; 3) creating a strategy when the Covid-19 incident in Heidegger’s philosophy of ‘time’. Architects need to think about the people who feel the existence of buildings in terms of form and function. The findings; how to create creative spaces to help the learning process in schools so that children can be motivated by their creativity by referring to Heidegger’s views on ‘being and time’.

Two Urgency Categories, Same Outcome: No Difference After “Therapeutic” vs. “Prophylactic” Fasciotomy

Objectives Fasciotomy to treat or prevent compartment syndromes in patients with truncal or peripheral arterial injuries is a valuable adjunct. The objective of this study was to document the current incidence, indications, and outcomes of below knee fasciotomy in patients with femoropopliteal arterial injuries. Methods The PROspective Observational Vascular Injury Treatment registry of the American Association for the Surgery of Trauma was utilized to identify patients undergoing two-incision four-compartment fasciotomy of the leg after repair of a femoropopliteal arterial injury. Outcomes after therapeutic versus prophylactic (surgeon label) fasciotomy were compared as was the technique of closure, that is, primary skin closure or application of a split-thickness skin graft (STSG). Results From 2013 to 2018, fasciotomy was performed in 158 patients overall, including 95.6% (151/158) at the initial operation. In the group of 139 patients who survived to discharge, fasciotomies were labeled as therapeutic in 58.3% (81/139) and prophylactic in 41.7% (58/139). There were no significant differences between the therapeutic and prophylactic groups in amputation rates (14.8% vs. 8.6%, P = .919). Primary skin closure was achieved at a median of 5.0 days vs. 11.0 days for STSG ( P = .001). Conclusions Over 55% of patients undergoing repair of an injury to a femoral or popliteal artery have a fasciotomy performed at the same operation. A “therapeutic” indication for fasciotomy continues to be more common than “prophylactic,” while outcomes are identical in both groups.

Fingolimod-associated macular edema: A case report of late onset

Introduction: The authors present a case of a male with Multiple Sclerosis (MS) who developed unilateral Fingolimod-Associated Macular Edema (FAME) 10 years after initiating fingolimod therapy. By reporting this case study, the authors present a comprehensive review on FAME, its current incidence, and therapy options in MS patients. Case description: A 58-year-old Caucasian male patient was referred to the hospital with a history of MS. He was on fingolimod treatment for 10 years. The patient presented with a referring second episode of blurred vision in his left eye (OS). His best corrected visual acuity (BCVA) was 20/20 (right eye – OD) and 20/30 (OS). Dilated fundus examination of the OS revealed dull foveal reflex with retinal thickening. Spectral domain optical coherence tomography (SD-OCT) scan demonstrated increased central macular thickness of 459 μm, foveal cysts and subretinal fluid. Neurologists decided to discontinue fingolimod treatment based on the ophthalmological findings. Three months post fingolimod discontinuation, macular edema resolved and BCVA was 20/20 (OD) and 20/25 (OS). Conclusions: The authors report a case of late onset FAME. FAME may occur several years after starting fingolimod treatment and it should be part of differential diagnosis of blurred vision in patients receiving fingolimod. Both Microcystic Macular Edema secondary to MS and Macular Edema Associated with MS-induced Uveitis should always be excluded. Those two conditions, secondary to MS, might show the lack of drug effectiveness and the possible need for changing the existing therapy in order to prevent further disease progress.

Meniscal tears are more common than previously identified, however, less than a quarter of people with a tear undergo arthroscopy

Purpose The management of meniscal tears is a widely researched and evolving field. Previous studies reporting the incidence of meniscal tears are outdated and not representative of current practice. The aim of this study was to report the current incidence of MRI confirmed meniscal tears in patients with a symptomatic knee and the current intervention rate in a large NHS trust. Methods Radiology reports from 13,358 consecutive magnetic resonance imaging scans between 2015 and 2017, performed at a large UK hospital serving a population of 470,000, were assessed to identify patients with meniscal tears. The hospital database was interrogated to explore the subsequent treatment undertaken by the patient. A linear regression model was used to identify if any factors predicted subsequent arthroscopy. Results 1737 patients with isolated meniscal tears were identified in patients undergoing an MRI for knee pain, suggesting a rate of 222 MRI confirmed tears per 100,000 of the population aged 18 to 55 years old. 47% attended outpatient appointments and 22% underwent arthroscopy. Root tears [odds ratio (95% CI) 2.24 (1.0, 4.49); p = 0.049] and bucket handle tears were significantly associated with subsequent surgery, with no difference between the other types of tears. The presence of chondral changes did not significantly affect the rate of surgery [0.81 (0.60, 1.08); n.s]. Conclusion Meniscal tears were found to be more common than previously described. However, less than half present to secondary care and only 22% undergo arthroscopy. These findings should inform future study design and recruitment strategies. In agreement with previous literature, bucket handle tears and root tears were significant predictors of subsequent surgery. Level of evidence III.

Syncope and COVID-19 disease – a systematic review

ABSTRACTBackgroundSyncope is not a common manifestation of COVID-19, but it may occur in this context and it can be the presenting symptom in some cases. Although several mechanisms may explain the pathophysiology behind COVID-19 related syncope, a valid relationship has not been established yet. In this systematic review, we aimed to examine the current incidence of syncope in COVID-19 patients and to explore different patterns observed in this setting.MethodsA systematic review across PubMed, ISI Web of Knowledge and SCOPUS was performed, according to PRISMA guidelines, in order to identify all relevant articles regarding both COVID-19 and syncope.ResultsWe identified 81 publications, of which 62 were excluded. The cumulative incidence of syncope and pre-syncope across the selected studies was 7.1% (256/3584 patients). Unspecified syncope was the most common type (76.2% of the reported episodes), followed by reflex syncope (18.1% of the cases). Orthostatic hypotension was responsible for 3.6% of the cases and syncope of presumable cardiac cause accounted for 2.0%. Arterial hypertension was present in 64.7% of the patients and either angiotensin receptor blockers or angiotensin converting enzyme inhibitors were used by 39.5% of hypertensive patients with syncope.ConclusionSyncope, although not considered a typical symptom of the COVID-19 disease, can be associated with it, particularly in early stages. Different types of syncope were seen in this context, each with different implications requiring distinct approaches. A careful reevaluation of blood pressure whenever a patient develops COVID-19 is suggested, including reassessment of antihypertensive therapy.