Community Medical Center

<title>Abstract</title> Purpose Although image-enhanced endoscopy (IEE) is useful, its benefit over white light imaging (WLI) for the detection of superficial non-ampullary duodenal epithelial tumors (SNADETs) remains unclear. We evaluated whether narrow-band imaging (NBI) and texture and color enhancement imaging (TXI) could improve SNADET visibility compared to WLI under CO ₂ insufflation and underwater conditions. Methods We conducted a post-hoc analysis using a prospectively collected image database from patients with SNADET enrolled in a multicenter observational study. We used the EVIS X1 system with a GIF-H290Z or GIF-EZ1500 endoscope to compare the visibility scores for the recognition of SNADETs. We also measured the color difference (ΔE*), saturation difference (ΔC*), and lightness difference(ΔL*) between the tumor and background mucosa. Results We analyzed 50 lesions, comprising 46 intramucosal adenocarcinomas and 4 adenomas. Under CO ₂ insufflation, TXI provided a significantly higher visibility score than the WLI (2.7 ± 0.8 vs 2.5 ± 0.9, <italic>P</italic> = 0.002); however, no significant differences were observed between TXI and NBI (2.7 ± 0.8 vs 2.6 ± 0.7, <italic>P</italic> = 0.072). Underwater conditions yielded significantly higher visibility scores than CO ₂ insufflation across the three modes (WLI, 3.1 ± 0.6 vs. 2.5 ± 0.9, <italic>P</italic> &lt; 0.001; NBI, 2.9 ± 0.7 vs. 2.6 ± 0.7, <italic>P</italic> &lt; 0.001; TXI, 3.2 ± 0.5 vs. 2.7 ± 0.8, <italic>P</italic> &lt; 0.001). The ΔC* in TXI was significantly higher than that in WLI under CO ₂ insufflation (8.5 ± 6.0 vs 5.9 ± 3.9, <italic>P</italic> &lt; 0.001) and underwater condition (9.2 ± 5.6 vs 6.6 ± 3.5, <italic>P</italic> &lt; 0.001). Conclusion TXI significantly improved SNADET visibility compared to WLI under CO ₂ insufflation and underwater conditions, likely due to the increased saturation difference.

This retrospective study aimed to verify the efficacy of endoscopic submucosal dissection (ESD) using a scissor-type knife for early gastric cancer (EGC). The patients who underwent ESD for EGC between April 2014 and March 2022 were enrolled. The primary endpoint of this study was to assess the efficacy of a scissor-type knife by comparing the self-completion rate of trainees between gastric ESD performed using a scissor-type knife (ESD-SC) and nonscissor devices (ESD-NS). Of the 903 lesions, 485 and 418 underwent ESD-SC and ESD-NS, respectively. The self-completion rate of trainees was significantly higher for ESD-SC than for ESD-NS (50.3 and 33.0%, respectively; p < 0.001). The procedure time was also significantly shorter for ESD-SC (50.0 vs. 66.5 min, respectively; p < 0.001). Intraoperative perforation rate was not significantly different (0.6% for ESD-SC and 1.4% for ESD-NS, respectively). In multivariate analyses, tumor located in the lower third of the stomach (odds ratio [OR] 1.93, 95% confidence interval [CI] 1.46-2.55, p < 0.001), tumor size ≤ 20 mm (OR 3.32, 95% CI 2.20-5.00, p < 0.001), and a scissor-type knife (OR 2.22, 95% CI 1.67-2.94, p < 0.001) were factors related to the self-completion rate of trainees for gastric ESD. A scissor-type knife was associated with higher self-completion rates and shorter procedure times among trainees. Further prospective studies are needed to validate its clinical utility in ESD training.

Background: Substance abuse is a critical public health concern worldwide, causing significant social, economic, and health burdens. In Iran this issue is driven by diverse socioeconomic conditions and its position along regional drug trafficking routes. This study aims to explore spatial variations and identify factors contributing to substance-related mortality across provinces and counties. Methods: An ecological study was conducted using a 5-year data from the Iran Legal Medicine Organization (ILMO) in 31 provinces and 424 counties. Descriptive statistics and univariate regression analysis determined the key variables. Geographically Weighted Poisson Regression (GWPR) was employed to assess local impacts and spatial clustering methods were developed to visualize influential variables. Results: A total of 12,632 substance-related deaths were recorded during the study period, with over 90% of cases among men and 36% aged 30–39 years. Mortality rates ranged from 24.6 per million population in Kohgiluyeh and Boyer-Ahmad to 302.13 per million in Hamedan. Spatial clustering of mortality was significant (Moran's I = 0.015, p = 0.014). The GWPR demonstrated superior model performance than ordinary least squares (AIC: 3351 vs. 6764), revealing substantial spatial heterogeneity in risk factors. Percentages of tenant families, older adults, and substance abuse arrests had the strongest positive association. Conversely, substance smuggling arrests, provincial gross income, and distance from key points demonstrated negative associations (p &lt; 0.05). Conclusion: Substance-related mortality in Iran shows significant spatial clustering with geographically varying socioeconomic determinants, indicating need for region-specific prevention and treatment public health strategies rather than uniform national interventions.

Treating chronic hepatitis C virus infection with direct-acting antivirals (DAAs) results in a sustained virological response (SVR) in most cases, but hepatocellular carcinoma (HCC) can occur in some patients after achieving SVR. Thus, this study comprehensively assessed the risk factors associated with the development of HCC during long-term follow-up in patients who achieved SVR. Furthermore, we aimed to identify a group of patients without prior HCC treatment who are at extremely low risk for HCC long after achieving SVR. This retrospective cohort study included patients who achieved SVR after DAA therapy, and predictors contributing to the incidence of HCC were determined via Cox regression analysis. Specifically, we evaluated the factors contributing to the incidence of HCC among patients without previous HCC treatment later than 5 years after achieving SVR, and these were used to construct a predictive scoring system for HCC. Overall, 267 cases of HCC were observed during follow-up. Male sex, older age, previous HCC treatment before starting DAA therapy, excessive alcohol use, diabetes mellitus, elevated γ-GTP, low albumin, and low platelet count were independent predictors of HCC. Since previous HCC treatment strongly influenced the incidence of HCC after SVR, we further analyzed the risk factors for HCC among patients without previous HCC treatment. In that cohort, parameters at 5 years after achieving SVR that contributed to the incidence of HCC later than 5 years after SVR were an age of ≥ 70 years, diabetes mellitus (DM), and fibrosis-4 index(Fib-4) of ≥ 2.67. These three factors were used to create a scoring system, with scores of 0 to 3 predicting a 0.8%, 2.7%, 11.9%, and 28.8%, respectively, cumulative incidence rate of HCC later than 5 years after SVR. Using long-term follow-up data, we investigated the risk factors for HCC among patients who achieved SVR after DAA therapy. Previous HCC treatment strongly predicted HCC after SVR. Although this was a retrospective cohort study, among patients without previous HCC treatment, those younger than 70 years, without DM and with a Fib-4 index of < 2.67 had a very low risk of developing HCC later than 5 years after SVR.

This paper provides a guideline for establishing medical skills training clinics aimed at better preparing future physicians with essential clinical and surgical skills, particularly in underdeveloped regions where high mortality rates are often linked to insufficient hands-on training. In some areas, physicians are forced to perform procedures on live patients without prior practical experience. This study examines simulation kits developed by a student-run surgical organization at a Caribbean medical school and discusses the outcomes of their clinical skills clinics. Results show that systematic learning, deliberate practice, and the use of simulation centers contribute to producing better-trained physicians by offering safe environments for practicing clinical techniques without compromising patient care. Rather than replacing bedside teaching, simulation centers serve as valuable adjuncts that reinforce clinical competence. By highlighting the structure and content of these training clinics, this paper advocates for their adoption, particularly in resource-limited settings, to enhance physician preparedness and support global medical standards while encouraging further research into optimizing such programs.

Surgical drains remain a common adjunct in general surgery to prevent fluid collections and detect early postoperative complications. However, their routine use and timing of removal continue to generate debate. This review analyzes evidence-based criteria for drain removal, identifies complications related to prolonged use, and evaluates evolving trends in drain management across gastrointestinal, hepatobiliary, pancreatic, and abdominal wall procedures. The evidence consistently supports early drain removal typically once drainage output is <50 mL/24 h and non-bilious or non-hemorrhagic being associated with lower rates of surgical site infection, fistula formation, and hospital stay duration. Conversely, delayed removal beyond postoperative day five to seven increases the risk of infection, prolonged inflammation, and wound complications. Biochemical monitoring, particularly amylase and bilirubin levels in pancreatic and biliary drains, enables safer, individualized removal decisions. Early, criteria-based, and selective drain management integrated within Enhanced Recovery After Surgery (ERAS) frameworks improves postoperative outcomes and reduces morbidity in general surgery. These findings emphasize the importance of tailored protocols and continued refinement of evidence-driven drain removal practices.

Abstract Background The FRAIL questionnaire is a validated screening tool for frailty in geriatric trauma patients that has been associated with functional outcomes and mortality. It includes five components: Fatigue, Resistance, Aerobic, Illness, and Weight Loss. This study aims to determine whether a single component is a better predictor than others of in predicting frailty. Methods A retrospective chart review was conducted on 613 geriatric trauma patients admitted between June and November 2023. Patient demographics, injury severity scores (ISS), and FRAIL questionnaire responses were obtained from electronic health records. Spearman’s rank correlation coefficient (ρ) was used to assess the relationship between each FRAIL component and total FRAIL score. A bootstrap 95% confidence interval (CI) was calculated using 10,000 replicates to evaluate statistical significance. Results All FRAIL components showed significant positive correlations with FRAIL score. Resistance (ability to climb a flight of stairs) had the strongest correlation (ρ = 0.69, 95% CI: 0.65–0.73), followed by Fatigue (ρ = 0.65, 95% CI: 0.61–0.69), Aerobic (ρ = 0.55, 95% CI: 0.50–0.60), Illness (ρ = 0.40, 95% CI: 0.35–0.45), and Weight Loss (ρ = 0.29, 95% CI: 0.24–0.34). Conclusions Resistance, specifically the ability to climb a flight of stairs, is the strongest correlate of frailty in geriatric trauma patients. Its strong correlation with frailty-related outcomes suggests its potential as a simple, rapid, and reliable bedside screening tool to improve risk

BackgroundOpioid use disorder (OUD) is a persistent public health crisis, with medication for opioid use disorder (MOUD) significantly reducing overdose risk and improving outcomes. However, treatment adherence and retention remain critical challenges. Digital health tools offer promising solutions, yet their integration into MOUD programs has been limited. This study evaluates the implementation of Recovery Connect, a mobile application designed to enhance engagement, communication, and adherence in MOUD treatment.MethodsThis observational study assessed the adoption and impact of Recovery Connect across 53 opioid treatment clinics over 12 months. A total of 11,495 patients and 302 mental health professionals (MHPs) engaged with the app, which facilitated real-time patient-clinician communication, self-monitoring, and access to evidence-based resources. Patient acceptance, engagement patterns, and clinical outcomes, particularly 30-day retention, were analyzed using survey responses, app usage metrics, and historical retention data.ResultsPatient and clinician acceptance of the app was high, with 83.7% of patients who completed baseline acceptance survey expressing intent to use it. Early engagement—particularly self-monitoring and clinician-initiated messaging—was significantly associated with increased retention. Compared to historical data, 30-day retention improved by 12.2% across all clinics and by 13.2% in Arizona-based clinics. Patients with higher app engagement and more frequent clinician interactions had significantly greater odds of remaining in treatment.ConclusionDigital tools such as Recovery Connect show promise in addressing key barriers to MOUD retention by enhancing patient accountability, self-monitoring, and clinician-patient communication. These findings support the integration of digital interventions into standard MOUD care, with future research needed to assess long-term retention and scalability.

BACKGROUNDSepsis and septic shock pose critical public health challenges with high mortality, particularly in critical care. While racial differences in sepsis incidence are documented, the impact of race on sepsis outcomes remains inconsistent.AIMTo evaluate racial disparities in clinical outcomes among patients hospitalized with septic shock, focusing on in-hospital mortality, length of stay (LOS), and hospitalization costs.METHODSWe conducted a retrospective cohort study using the National Inpatient Sample database from 2016 to 2021. Patients diagnosed with septic shock were identified using ICD-10 code R65.21. The primary outcome was in-hospital mortality; secondary outcomes included trends in septic shock hospitalizations, mortality, length of stay, and cost of hospitalizations.RESULTSAmong 3581504 hospitalizations for septic shock, the racial distribution was 67% Non-Hispanic White (NHW), 15% Non-Hispanic Black (NHB), 11% Hispanic, and 7% other groups, with a mean age of 66.3 years. In-hospital mortality was 33.6%, highest among other racial groups (36.7%). Mortality was stable across racial groups from 2016–2019 but rose sharply in 2020–2021, especially among Hispanic patients. Adjusted in-hospital mortality were higher for NHB and Hispanic compared to NHW patients. NHB patients had the longest LOS, while other racial groups incurred the highest cost of hospitalizations.CONCLUSIONWe found higher mortality among NHB, Hispanic, and other racial groups in septic shock patients, likely driven by higher risk of in-hospital complications among these racial groups. This highlights the need for future research to identify the factors contributing to the adverse outcomes in these populations.