Notes

Currently Available Techniques for Focus on Recognition involving Bioactive Organic Products.
ow South Africa by Ralf Henkel was funded by LogixX Pharma Ltd. R.R.H. Selleck LF3 is also Editor in Chief of
and has been an employee of LogixX Pharma Ltd. since 2020. M.S.K. is an associate editor with
. K.Mc.E. received an honoraria for lectures from Bayer and Pharmasure in 2019 and payment for an ESHRE grant review in 2019. His attendance at ESHRE 2019 and AUA 2019 was sponsored by Pharmasure and Bayer, respectively. The remaining authors declare no competing interests.

Core Outcome Measures in Effectiveness Trials (COMET) initiative registration No 1586. Available at www.comet-initiative.org/Studies/Details/1586.

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Older patients living in rural areas face unique challenges after trauma that may hinder optimal recovery. This study aims to qualitatively assess postdischarge challenges in this vulnerable population.

We conducted remote interviews with older trauma survivors in Washington State previously hospitalized in 2019 and residing in rural areas as determined by rural-urban commuting area code. Participants were identified through our institution's trauma registry and linked with postdischarge data. All eligible participants were contacted. Interview questions focused on needs relating to discharge transition, medical needs, housing, and daily living. Transcribed interviews underwent content analysis to derive a code hierarchy and themes.

We conducted 18 interviews out of 83 survivors queried. Compared with non-participants, interviewees had a higher rate of secondary insurance (61% vs 34%), and fewer had an emergency department visit within 1 year (22% vs 34%). Content analysis yielded four major themes discharge transitions, loss of control, rural insights, and self-efficacy. Most patients felt prepared for discharge and had social support. Regardless of disposition type, most patients needed therapy sessions after discharge. Geography and transportation issues were among the biggest barriers. Most participants were never offered a telemedicine appointment but would have used it if offered. Subthemes of self-efficacy included financial security, leisure, personal outlook, physical and logistical resources, and participants' support systems.

Older trauma patients from rural areas face unique challenges after discharge. Key strategies to improve patient experience might include more telemedicine appointments and increased awareness of resources in rural communities.

III.
III.
The opioid crisis has forced an examination of opioid prescribing and usage patterns. Multimodal pain management and limited, procedure-specific prescribing guidelines have been proposed in general surgery but are less well studied in trauma, where multisystem injuries and multispecialty caregivers are the norm. We hypothesized that opioid requirements would differ by primary type of injury and by age, and we sought to identify factors affecting opioid prescribing at discharge (DC).

Retrospective analysis of pain management at a level II trauma center for January-November 2018. Consecutive patients with exploratory laparotomy (LAP); 3 or more rib fractures (fxs) (RIB); or pelvic (PEL), femoral (FEM), or tibial (TIB) fxs were included, and assigned to cohorts based on the predominant injury. Patients who died or had head Abbreviated Injury Scale >2 and Glasgow Coma Scale <15 were excluded. All pain medications were recorded daily; doses were converted to oral morphine equivalents (OMEs). The primary r injury severity. Patients were discharged almost exclusively by trauma service advanced practice clinicians (APCs). There was no difference among APCs in number of pills or OMEs prescribed. 81% of patients received opioids at DC, of whom 69% were prescribed an opioid/acetaminophen combination drug; and only 13% were prescribed non-steroidal anti-inflammatory drugs, 19% acetaminophen, and 31% gabapentin.

Opioid usage varied among patients with different injury types. Opioid DC prescribing appears rote and does not correlate with actual opioid usage during the 72 hours prior to DC. Paradoxically, OMEDC tends to be higher among females, patients with ISS <16, and those with rib fxs, despite a tendency toward lower OME72 usage among these groups. There was apparent underutilization of non-opioid agents. These findings highlight opportunities for improvement and further study.

IV.
IV.
Blunt aortic injury (BAI) is associated with a high rate of mortality. Thoracic endovascular aortic repair (TEVAR) has emerged as the preferred treatment option for patients with BAI. In this study, we compare the longer-term outcomes of patients receiving TEVAR with other treatment options for BAI.

We conducted a retrospective cohort study using administrative health data on patients with BAI in Ontario, Canada between 2009 and 2020. Patients with BAI and who survived at least 24 hours after hospital admission were identified using diagnostic codes. We classified patients as having received TEVAR, open surgical, hybrid repair, or medical management as their initial treatment approach based on procedure codes. The primary outcome was survival to maximum follow-up. Secondary outcomes included aorta-related mortality or aortic reintervention. Cox's proportional hazards models were used to estimate the effect of TEVAR on survival.

427 patients with BAI were followed for a median of 3 years (IQR 1-6 years), with 348 patients (81.5%) surviving. Survival to maximum follow-up did not differ between treatment groups TEVAR 79%, surgical repair 63.6%, hybrid repair 85.7%, medical management 83.3% (p=0.10). In adjusted analyses, TEVAR was not associated with improved survival compared with surgical repair (HR 0.6, 95% CI 0.3 to 1.6), hybrid repair (HR 1.4, 95% CI 0.5 to 3.6), or medical management (HR 1.5, 95% CI 0.8 to 2.6). Aortic reinterventions were required in only 2.6% of surviving patients but were significantly more common in the TEVAR group (p<0.01).

The longer-term survival from BAI appears highly favorable with low rates of reintervention and death in the years after injury, regardless of the initial treatment approach.

IV, Therapeutic study.
IV, Therapeutic study.As academic staff scrambled into emergency remote teaching during COVID-19 restrictions, we also had to move in-person exams online without compromising integrity. This disruption caused us to think carefully about how chemistry is assessed, because 'business as usual' was no longer possible - and at some institutions, there are no plans for in-person exams to return.
Orbito-ocular cancers are a common cause of morbidity and mortality in our population, yet these cancers have not been adequately described in Malawi. This study sought to describe the burden and histopathological profile of orbito-ocular cancers in Northern Malawi.

A retrospective review of pathology reports was done. Descriptive analyses were performed to summarise patients' demographic and clinical characteristics, and histopathological results. A binary logistic regression was used to explore the association between demographic variables, site of lesion and cancer.

210 pathology reports of orbito-ocular biopsies were reviewed. 60.0% of patients were female. The majority (39.5%) of patients were in the 31 to 40 age group but overall mean age (±SD) was 34.81±15.9 years. Cancer was diagnosed in 84 (40.0%) patients. Squamous cell carcinoma constituted the majority (82.1%) of cancers followed by retinoblastoma at 7.1%. Orbito-ocular cancers were associated with HIV infection (OR5.9, 95% CI 2.0 to 17.2) and intraocular tumours were 8.3 times (OR 8.3, 95% CI 2.0 to 33.8) more likely to be malignant. However, squamous cell carcinoma was the only type of cancer found in patients with HIV infection and mostly affected the conjunctiva, constituting 94.4% of cancers affecting this site. Retinoblastoma on the other hand only affected children less than 10 years of age.

Cancer constituted a substantial proportion of orbito-ocular lesions in our study population, with conjunctiva being the common site. This calls for improved capacity to prevent, diagnose and manage orbito-oracular cancers in Northern Malawi and similar settings.
Cancer constituted a substantial proportion of orbito-ocular lesions in our study population, with conjunctiva being the common site. This calls for improved capacity to prevent, diagnose and manage orbito-oracular cancers in Northern Malawi and similar settings.
To evaluate the diagnostic performance of manual grading of anterior segment optical coherence tomography (AS-OCT) in detection of plateau iris configuration (PIC) based on the presence of standardised ultrasound biomicroscopy (UBM) criteria in at least two quadrants; namely, clinical diagnosis of PIC (DxPIC).

In this cross-sectional study, paired AS-OCT and UBM images were evaluated by three glaucoma specialists. AS-OCT was classified into two mechanisms, PIC versus non-PIC, of primary angle closure disease (PACD) and AS-OCT-PIC diagnostic performance was tested with DxPIC.

One hundred and seventy-nine eyes of 142 patients were enrolled for analysis, and DxPIC was found in 85 eyes (47.49%). Intraobserver agreement rates of AS-OCT classification by the graders were 0.77, 0.701 and 0.742 (all p<0.001), and interobserver agreement rates, between a senior glaucoma specialist and the other two glaucoma specialists, were 0.68 and 0.702 (all p<0.001). Plateau iris was classified in AS-OCT images by the three graders, rated 32.96%-39.1% and 24.58%-34.08% in the horizontal and vertical axes, respectively. Diagnostic performance was analysed, yielding sensitivity ranging from 56.47% to 77.78%, and specificity of 48.94% to 64.29%. We applied disease prevalence of 30%, revealing positive predictive values varying from 32.16% to 44.44%, and negative predictive values of 72.4% to 85.71%. Accuracy ranged from 51.2% to 65%. Agreement between the two devices was fair, kappa range 0.31-0.351.

Performance of manual grading of AS-OCT in detection of DxPIC was relatively poor; therefore, unadjusted AS-OCT does not appear to be good for manual PIC screening in PACD patients and cannot serve as a substitute for UBM in PIC detection.
Performance of manual grading of AS-OCT in detection of DxPIC was relatively poor; therefore, unadjusted AS-OCT does not appear to be good for manual PIC screening in PACD patients and cannot serve as a substitute for UBM in PIC detection.
To determine the characteristics, including the use of various diagnostic criteria, outcomes and treatment strategies in septic patients treated outside of the critical care area with pre-existing liver disease (LD).

The study population included patients recruited into two annual 24-hour prospective point-prevalence studies on the general wards and emergency departments across all Welsh acute hospitals in 2016 and 2017. Data were collected on patient demographics, observations and SIRS, SOFA and qSOFA scores.

Out of 839 recruited patients, 24 (2.9%) had a past medical history of LD. 12/24 (50%) had a SIRS score ≥ 2, 21/24 (87.5%) a SOFA score ≥ 2 and 3/24 (12.5%) a qSOFA score ≥ 2. Patients with LD had 2.4 times higher odds (95% CI = 1.07-5.53,
= 0.03) of mortality after the sepsis episode. LD patients were younger than non-LD patients (
= 0.04) but not significantly different in frailty, do not attempt cardiopulmonary resuscitation (DNA-CPR) status or ceiling of care (
= 0.78,
= 0.54,
= 0.
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