Nevin Manimala

Orv Hetil. 2025 Jan 26;166(4):146-153. doi: 10.1556/650.2025.33211. Print 2025 Jan 26.

ABSTRACT

Bevezetés: A szuicid viselkedés megelőzése szempontjából kiemelt jelentőséggel bír az akut szuicid veszély felismerése. Ugyanakkor kevés olyan adattal rendelkezünk, amelynek segítségével megbízhatóan felismerhető lenne a preszuicidális lelkiállapot. Célkitűzés: A Galynker és munkacsoportja által kidolgozott szuicid krízis szindróma alapján kifejlesztett szűrőteszt és kérdőív magyar adaptálása. Módszer: Az általános pszichiátriai vizsgálat mellett a szuicid krízis szindróma szűrésére alkalmas rövid Akut Szuicid Rizikó Teszt és a Rihmer-féle rizikóbecslő Rövid Szuicid Kérdőív felvételére került sor konszekutív módon minden olyan pácienssel, aki a vizsgálati időszakban klinikánk ambuláns vagy osztályos ellátásában részesült. A rövid szűrőtesztek pozitivitása esetén a szuicid krízis szindróma tüneteit felmérő részletes skála is kitöltésre került. Eredmények: 99 páciens 150 kérdőívének kitöltésére került sor, egyharmaduk (n = 35) ambuláns, kétharmaduk (n = 64) osztályos ellátásban részesült. A klinikai diagnózisok között a leggyakoribbak a depressziós (44,7%), az alkalmazkodási (34%), a pszichotikus (33,3%) és a szerhasználati (33,3%) zavarok voltak, és nagy volt a komorbiditás aránya. Az ambuláns ellátásban részesülők felében (n = 19; 54,3%), míg az osztályos felvételre kerülők háromnegyedében (n = 49; 76,6%) igazoltak a szűrőtesztek szuicid rizikót. Az osztályos kezelést követően ez az arány egyharmadra csökkent (n = 17; 33,3%). A szuicid krízis szindróma teljes diagnosztikai kritériumai azoknál teljesültek a leggyakrabban, akiknél az Akut Szuicid Rizikó Teszt pozitív volt, akár önmagában (74,2%), akár a Rövid Szuicid Kérdőívvel együtt (87,1%). E két kérdőív együttes pozitivitása esetén fordult elő a leggyakrabban súlyos szuicid krízis szindróma (29%). Megbeszélés: A szuicid krízis szindrómán alapuló rövid szűrőteszt jelentős arányban azonosítja az aktuális szuicid rizikót. A szuicid krízis szindróma koncepció és a módszer előnye, hogy akkor is lehetővé teszi az öngyilkossági veszély felismerését, amikor direkt szuicid szándékok nem kerülnek felszínre. Az akut szűrőteszt értékét tovább növeli az elsősorban az élettartamra vonatkozó szuicid rizikót felmérő Rihmer-féle Rövid Szuicid Kérdőív. Következtetés: Ezeknek a teszteknek az együttes alkalmazása támogatja az akut pszichiátriai osztályos felvételt megalapozó klinikai döntéshozatalt, és megelőzi a páciensek kezelésének korai lezárását, így szűrőmódszerünk fontos szuicidprevenciós jelentőséggel bír. Orv Hetil. 2025; 166(4): 146–153.

PMID:39864028 | DOI:10.1556/650.2025.33211

Orv Hetil. 2025 Jan 26;166(4):139-145. doi: 10.1556/650.2025.33221. Print 2025 Jan 26.

ABSTRACT

Bevezetés: A minimálinvazív műtéteknek és a hatékony perioperatív protokolloknak köszönhetően a colorectalis műtétek utáni morbiditás és kórházi tartózkodás csökkenthető, elektív colorectalis műtétek után a betegek egy része 72 órán belül elbocsátható. A korai emisszió nem rutingyakorlat, kritériumai nem egyértelműek. Módszer: Retrospektív kohorszvizsgálatot végeztünk 2022. 03. 01. és 2024. 05. 01. között anastomosissal járó elektív colorectalis műtéten átesett páciensek körében. Elemeztük a korai elbocsátás (<72 óra) összefüggését a 30 napos morbiditással és nem tervezett kórházi újrafelvétellel. A sikeres korai emissziót befolyásoló tényezők azonosítására demográfiai, anamnesztikus, intraoperatív és posztoperatív adatokat elemeztünk. Eredmények: Összesen 109 betegen végeztünk elektív colorectalis műtétet. A beavatkozások közül 85 laparoszkópos, 8 robotasszisztált és 4 nyitott műtét volt, 12 stomazárás történt. A 30 napos morbiditás 8,25% (n = 9), ebből súlyos (Clavien–Dindo 3b) morbiditás 4,6% (n = 5) volt. A 72 órán belül komplikációval járó eseteket (n = 9) kizártuk. Eseménytelen posztoperatív szak mellett korai elbocsátás 30, ennél hosszabb tartózkodás 70 betegnél történt (ápolási idő: 67,5 ± 4,13 vs. 99,8 ± 2,06 óra; p = 0,0001). A csoportok homogének voltak az életkor (57,17 ± 5,27 vs. 61,94 ± 2,75 év; p = 0,09), a nem (p = 0,83), a testtömegindex (p = 0,13) és a kísérő betegség (p = 0,85) tekintetében. A bélműködés helyreállása sem különbözött a csoportok között (31,0 ± 3,84 vs. 34,5 ± 3,49 óra; p = 0,26). A korai és a normál csoportban azonos arányban voltak jobb és bal oldali resectiók (p = 0,28), több stomazárás történt a korai csoportban (11 vs. 1; p<0,00001). Egyik csoportban sem volt 30 napon belül újrafelvétel, morbiditás vagy mortalitás. Következtetés: Nem szövődményes elektív colorectalis resectio és stomazárás után a korai (72 órán belüli) elbocsátás biztonságos. Orv Hetil 2025; 166(4): 139–145.

PMID:39864024 | DOI:10.1556/650.2025.33221

EJNMMI Phys. 2025 Jan 26;12(1):8. doi: 10.1186/s40658-025-00718-7.

ABSTRACT

BACKGROUND: System calibration is essential for accurate SPECT/CT dosimetry. However, count losses due to dead time and pulse pileup may cause calibration errors, in particular for ¹³¹I, where high count rates may be encountered. Calibration at low count rates should also be avoided to minimise detrimental effects from e.g. background counts and statistical fluctuations. This paper aims to present experimental data illustrating count-rate dependencies and to propose practical routines to mitigate errors in the ¹³¹I calibration procedure without needing advanced analysis tools.

RESULTS: The sensitivities of two General Electric (GE) Discovery 670 Pro systems were assessed using two Jaszczak phantom geometries. SPECT/CT data were collected over two months, starting with an initial ¹³¹I content of > 2 GBq, decaying to approximately 20 MBq. This allowed for a detailed analysis of count losses due to dead time and pulse pileup. From the sensitivity analysis, it was shown that robust calibration was obtained for ¹³¹I phantom activities ranging between 250 and 1500 MBq.

CONCLUSIONS: The results show that adequate corrections for dead-time and pulse-pileup counting losses are essential for accurate calibration. It is argued that loss corrections should be based on total spectrum count rates in projections and not only on the 364.5 keV energy window data. The measurement campaigns presented in this paper, using basic tools and equipment, may serve as a model for establishing routines for count-loss corrections as well as for system calibration and regular control of system sensitivity. The data suggest that analysis of source and count concentration in a homogeneous Jaszczak phantom offers robust calibration, whereas analysis of source strength and counts in a delineated phantom insert offers a practical and robust method for regular quality control.

PMID:39864022 | DOI:10.1186/s40658-025-00718-7

Int J Radiat Oncol Biol Phys. 2025 Jan 24:S0360-3016(24)03705-2. doi: 10.1016/j.ijrobp.2024.11.098. Online ahead of print.

ABSTRACT

PURPOSE: Standard therapy for breast cancer after breast-conserving surgery is radiation therapy (RT) plus hormone therapy (HT). For patients with a low-risk of recurrence, there is an interest in deescalating therapy.

METHODS AND MATERIALS: A retrospective study was carried out for patients treated at the Swedish Cancer Institute from 2000 to 2015, aged 70 years or older, with pT1N0 or pT1NX estrogen receptor-positive and ERBB2-negative unifocal breast cancer without positive surgical margins, high nuclear grade, or lymphovascular invasion.

RESULTS: Patient numbers were sufficient to carry out analyses for RT + HT (n = 307) and RT alone (n = 148). The median follow-up was 9.6 years. There were no statistically significant differences in adjusted overall survival (OS), disease-specific death, progression-free survival (PFS), distant recurrence, and second primary cancers with RT monotherapy compared with RT + HT. Cumulative rates of all of these outcomes were <5%, even at 15 years of follow-up, regardless of treatment, greatly outweighed by the incidence of death from other causes in this elderly population. In matched analysis, we calculated a hazard ratio of 1.12 (95% CI, 0.82-1.53) for RT versus RT + HT for OS and a hazard ratio of 1.12 (95% CI, 0.82-1.53) for RT versus RT + HT for PFS.

CONCLUSIONS: Our data suggest that elderly, low-risk breast cancer patients have similarly high OS and PFS with low rates of local recurrence, distant recurrence, and death from breast cancer with much higher rates of death from competing causes, whether treated with RT or HT + RT. These patients are likely to die of other causes without disease recurrence, regardless of which of these treatments is used. Thus, they may benefit from the administration of more modern forms of breast irradiation without the need for adjuvant systemic hormone therapy. A detailed analysis of which clinical, pathologic, genomic, and comorbidity variables are needed to select these patients.

PMID:39864014 | DOI:10.1016/j.ijrobp.2024.11.098

J Hand Surg Am. 2025 Jan 24:S0363-5023(24)00608-7. doi: 10.1016/j.jhsa.2024.11.022. Online ahead of print.

ABSTRACT

PURPOSE: We compared the radiographic union and magnitude of humpback deformity correction when using different vascularized bone grafts (VBGs) and nonvascularized bone grafts (NVBGs) in the treatment of unstable scaphoid nonunions (USNUs).

METHODS: This was a retrospective radiographic review of 93 patients with an USNU treated between 2013 and 2022 at a single center by a single surgeon. Inclusion criteria included skeletally mature patients with radiographic evidence of an USNU resulting from failure of either nonsurgical or operative treatment. There were three treatment groups. Two groups were treated with either a palmar radiocarpal artery (PRCA) VBG or a 1,2 intercompartmental supraretinacular (1,2 IC-SRA) VBG. The third group comprised patients who were treated with a heterogeneous mix of NVBGs. Patients were followed radiographically at regular intervals until they were deemed healed or underwent a salvage procedure because of treatment failure. Measurements of carpal and scaphoid alignment were then repeated on the final imaging series and compared to preoperative measurements.

RESULTS: Ninety patients were included in the final analysis. PRCA VBG had the highest radiographic union rate, followed by 1,2 IC-SRA VBG and finally NVBGs. PRCA VBG had a significantly higher rate of union than NVBGs. Scapholunate angle change and scaphoid length change were greatest with PRCA VBG. These differences were statistically significant for the former when compared with 1,2 IC-SRA VBG and NVBGs and for the latter when compared with the 1,2 IC-SRA VBG in both univariate and multivariable analyses.

CONCLUSIONS: PRCA VBG had the highest radiographic union rate compared with alternative grafts as well as providing the greatest degree of humpback deformity correction in the treatment of USNUs.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

PMID:39864012 | DOI:10.1016/j.jhsa.2024.11.022

J Adolesc Health. 2025 Jan 23:S1054-139X(24)00447-6. doi: 10.1016/j.jadohealth.2024.09.017. Online ahead of print.

NO ABSTRACT

PMID:39864002 | DOI:10.1016/j.jadohealth.2024.09.017

J Adolesc Health. 2025 Jan 24:S1054-139X(24)00563-9. doi: 10.1016/j.jadohealth.2024.11.011. Online ahead of print.

ABSTRACT

PURPOSE: There is a paucity of evidence examining clinician experiences with structured health-care transition (HCT) programs. Among HCT Learning Collaborative participants, this study describes clinician experiences with implementation of a structured HCT process: Got Transition’s 6 Core Elements.

METHODS: Representative members from 6 health systems designed a survey to collect clinician feedback regarding HCT and demographic and practice information. The survey included adapted Got Transition Current Assessment of HCT Activities Level 4 and Clinician Feedback surveys as well as the following factors: clinical role, care setting, status, time involved in HCT process implementation, presence of champion, and partnership between pediatric and adult systems. Surveys were distributed across pediatric and adult clinical settings to 855 clinicians involved in HCT process implementation efforts during August and September 2022. Statistical analysis was performed to identify relationships between key clinician demographic data and responses on the survey.

RESULTS: A total of 272 clinicians provided feedback (31% response rate) on implementing a structured HCT process. About two-thirds reported that fidelity to a structured HCT process was present. The 6 Core Elements most implemented processes included transition policy, tracking, and transition planning. The majority of clinicians agreed that a structured HCT process improves safety and quality of care, as well as both patient and clinician experiences. Time invested in HCT processes was significantly associated with securing senior leadership buy-in. Presence of an identifiable institutional HCT process improvement champion was significantly associated with positive clinician experiences.

DISCUSSION: Clinicians found positive benefits in providing a structured HCT process using the 6 Core Elements and having a champion in their health system. They acknowledge that added time and continued investment in practice-wide HCT processes are needed.

PMID:39864000 | DOI:10.1016/j.jadohealth.2024.11.011

J Perianesth Nurs. 2025 Jan 23:S1089-9472(24)00518-5. doi: 10.1016/j.jopan.2024.10.010. Online ahead of print.

ABSTRACT

PURPOSE: The aim in the present study was to evaluate the effects of chewing postoperative xylitol gum on gastrointestinal functional recovery after laparoscopic cholecystectomy.

DESIGN: A three-arm randomized controlled trial.

METHODS: After a baseline assessment, participants were randomly assigned in three groups. The random assignment was performed by using a computer program (Microsoft Excel 2016). Afterward, participants were categorized into three subgroups. Group 3 was the control group that consisted of participants who had no intervention for chewing gum (n = 25). Group 2 was xylitol-free gum chewing group (n = 25), whereas Group 1 was xylitol gum chewing group (n = 24). In later phases, the time to first postsurgical flatus, time to first bowel sound after surgery, time to first postsurgical defecation, time to first mobilization after surgery, and discharge time from hospital were recorded. Nausea and vomiting, which are among the postoperative symptoms, were also evaluated.

FINDINGS: The duration of the control group from the end of surgery to the flatulence and bowel sounds was statistically higher than the xylitol group and xylitol-free group (all P < .05). Also, first postoperative flatulence time of xylitol-free group was higher than the xylitol group (P < .05). The duration from the end of surgery to defecation was longer in the control group compared with the xylitol group and the xylitol-free group, with a statistically significant difference between the groups (P < .05). In this study, a statistically significant difference was observed in terms of the time to first postsurgical flatus, time to first bowel sound after surgery, and time to first postsurgical defecation (all P < .000). No significant difference was found between the xylitol group, xylitol-free group, and control group when discharge from hospital and mobilization times were analyzed (all of them are P > .05).

CONCLUSIONS: Chewing xylitol gum facilitates postoperative gastrointestinal recovery after laparoscopic cholecystectomy. Further studies are recommended to confirm these findings and investigate the underlying mechanisms.

PMID:39863997 | DOI:10.1016/j.jopan.2024.10.010

Psychiatr Pol. 2024 Oct 31;58(5):747-759. doi: 10.12740/PP/186721. Epub 2024 Oct 31.

ABSTRACT

In 2024, we observe the fortieth anniversary of the publication, where, for the first time, the term of Seasonal Affective Disorder (SAD) was used. Presently, SAD is regarded as a special category of mood disorder. In the American Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V), the seasonality makes a specifier, “with seasonal pattern”, both for recurrent depression or Major Depressive Disorder (MDD), and for Bipolar Disorder (BD). The most spectacular phenomenon among SAD is winter depression. Its symptomatology is mostly similar to atypical depression, characterized by excessive sleepiness and carbohydrate craving. SAD can pertain up to one fifth of persons with MDD or BD and is more frequent in women. SAD can be considered as an extreme expression of the central nervous system (CNS) changes related to circannual rhythm of lighting. The seasonal changes of the CNS function apply to the secretion of melatonin, the neurotransmitters dopamine and serotonin and the hypothalamic-pituitary-adrenal axis. In the circadian and circannual processes, a significant role is played by so-called “clock genes”. SAD may be a legacy of Homo neanderthalensis. In winter depression, the therapeutic effect is obtained by an exposition to bright light (bright light therapy – BLT) as well as to blue light or using the method of dawn simulation. The therapeutic effect of phototherapy has also been ascertained in non-seasonal depression. As a counterpoint to this mechanism, promising trials have been undertaken in manic states by light restriction using blue light blocking glasses.

PMID:39863986 | DOI:10.12740/PP/186721

West Afr J Med. 2024 Sep 30;41(9):972-975.

ABSTRACT

BACKGROUND: The vital statistics in the third world countries are poor and have witnessed minimal improvement over the years with childhood mortality in Nigeria remaining one of the highest among the developing countries despite various child survival programmes. Child survival strategies can only be efficient if the major reasons for morbidity are known. The objective of this retrospective study was to review the patterns of childhood mortality at the emergency room of the Federal Teaching Hospital, Ido-Ekiti (FETHI).

MATERIALS AND METHODS: This study was conducted at the Children Emergency room of FETHI. Admission, discharge records and the case notes of the patients who died from September 2017 to October 2022 at the emergency units were retrospectively reviewed to extract the data on the age, sex, diagnosis, and duration of stay on admission before demise. A p-value of <0.05 was accepted as statistically significant.

RESULTS: There was a total of 2503 admissions with a M: F ratio of 1.25:1. The mortality rate was 3.9%. Age at demise was independent of the sex of the patients with a p-value of 0.33. More deaths occurred within six to 72 hours on admission and 68% of deaths in the EPU were U-5. Sepsis and malaria were the leading causes of death.

CONCLUSIONS: The high incidence of mortality among under-5 largely from preventable causes of death stresses the need to strengthen the existing childhood preventive measures.

PMID:39863983