Lakes Region General Hospital

Abstract Neurological stroke is the second leading cause of mortality in Brazil, where approximately 46% of patients never receive appropriate intervention. Telesurgery has the potential to expand access to treatment by enabling remotely assisted surgical procedures; however, its economic feasibility within Brazil’s public health system (SUS) remains unclear. We developed a socio-economic cost model to estimate the national burden of stroke in Brazil and to evaluate the impact of introducing remote treatment access. The model incorporated direct medical costs, productivity losses, disability severity using the modified Rankin Scale (mRS) as well as different implementation scenarios. The current stroke burden is approximately $191 billion. With telesurgery implemented, the burden was reduced by $170 million under the lowest adoption scenario and by $11.7 billion under the highest adoption scenario. Telesurgery could improve access to stroke care and reduce long-term disability while being economically advantageous, suggesting an economically sustainable strategy for Brazil's public healthcare system.

Neonates born at 37-38 weeks of gestation have been shown to face a relatively higher risk of mortality and various morbidities compared to those born at full term (39-41 weeks). The aim of this study was to conduct a comprehensive analysis of early term birth rate (ETBR) trends in Greece from 1980 to 2023. Data on live births in Greece from 1980 to 2023 were obtained from the Hellenic Statistical Authority (ELSTAT), based on birth certificate records. A total of 4,595,020 live births were categorized by gestational age. The annual ETBR was calculated as the number of live births occurring at 37-38 completed gestational weeks (from 37+0 to 38+6 weeks) per 100 total live births. Additionally, ETBR was calculated separately for 37 and 38 gestational weeks, as well as the overall birth rate < 39 weeks of gestation. Time trends were evaluated using joinpoint regression analysis. The ETBR decreased with an annual percent change (APC) of -1.4 (95% confidence interval (CI): -1.8 to -0.9, p = 0.004) between 1980 and 1994, followed by a sharper decline with an APC of -12.8 (95% CI: -14.4 to -8.5, p = 0.005) during 1994-1997. Subsequently, the ETBR increased with an APC of 3.2 (95% CI: 2.0 to 5.6, p = 0.016) from 1997 to 2004. This trend reversed again from 2004 to 2010, with an APC of -2.6 (95% CI: -5.9 to -1.1, p = 0.016), while in the most recent period (2010-2023), the ETBR stabilized (p = 0.630), fluctuating between 41.9% in 2010 and 44.3% in 2012 and 2013. During the study period (1980-2023), the ETBR at 37 weeks increased by an average of 7.1% per year, whereas the ETBR at 38 weeks decreased by an average of -2.1% annually. The overall birth rate < 39 weeks of gestation has remained consistently above 50% over the past two decades (2004-2023). In 2023, the ETBR was 43.7%, while a total of 56.0% of neonates were born < 39 gestational weeks. This study provides a comprehensive analysis of ETBR in Greece, revealing persistently high levels that exceed those of all developed countries. The elevated rate is likely driven by factors such as maternal demographics and obstetrical practices. The alarmingly high levels of ETBR, combined with the country's extremely high preterm birth rates, result in a substantial burden of neonatal morbidity and an increased risk of potential chronic diseases. These findings underscore an enormous public health challenge.

IntroductionNon-steroidal anti-inflammatory drugs (NSAIDs) and tumor necrosis factor inhibitors (TNFi) are the most common therapies used in AS, however, the associated long-term cardiovascular risk is unclear. We performed a systematic review and meta-analysis on the association of therapies used for ankylosing spondylitis (AS) such as NSAIDs and TNFi on cardiovascular events (CVE) in AS.MethodsA comprehensive search was performed from database inception to May 29, 2020 to include controlled studies of AS treated with NSAIDs, oral small molecules, or biologics reporting CVE. Study-specific risk ratios (RR) were pooled using a random effects model.ResultsNine non-randomized studies from 1570 studies screened fulfilled inclusion criteria. Among NSAID users as a whole versus no NSAIDs, no increased risk of CVE (composite outcome) was observed; however, the risk of cerebrovascular accident was significantly lower (RR 0.58, 95% CI 0.37–0.93, I2 = 66%). Cox-2 inhibitor use was associated with reduced risk of all CVE (RR 0.48, 95% CI 0.33–0.70, I2 = 0%). Non-selective NSAIDs were not associated with any increased/decreased risk of any CVE. Meta-analysis of three studies of MI did not show a significant association with TNFi (RR 0.88, 95% CI 0.57–1.35, I2 = 76%).ConclusionsIn this meta-analysis of non-randomized studies, NSAID users as a whole and users of non-selective NSAIDs did not seem to have a higher risk of any CVE. Limited data suggest a lower risk of composite CVE outcome with Cox-2 inhibitors, unlike the increased risk reported in the general population. No significant association between TNFi and MI was observed. The certainty in evidence was very low due to all studies being observational. More studies are needed to study the association between TNFi use and CVE in general to evaluate a possible protective role in AS.Electronic Supplementary MaterialThe online version of this article (10.1007/s40744-020-00248-x) contains supplementary material, which is available to authorized users.

To investigate the effect of therapies on radiographic progression in patients with axial spondyloarthritis (SpA). A comprehensive database search for studies assessing radiographic progression in axial SpA (particular treatment versus no treatment of interest) was performed. Study-specific standardized mean differences in treatment outcomes at 2 and ≥4 years were estimated and combined using random-effects models. Twenty-four studies in patients with axial SpA were identified, of which 18 involved tumor necrosis factor inhibitors (TNFi), 8 involved nonsteroidal antiinflammatory drugs (NSAIDs), and 1 involved secukinumab. Spinal radiographic progression, as measured by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), was not significantly different between TNFi-treated and biologics-naive patients at 2 years (mSASSS difference -0.73 [95% confidence interval (95% CI) -1.52, 0.12], I2 = 28%) and ≥4 years (mSASSS difference -2.03 [95% CI -4.63, 0.72], I2 = 63%). Sensitivity analyses restricted to studies with a low risk of bias showed a significant difference in spinal radiographic progression between TNFi-treated and biologics-naive patients at ≥4 years (mSASSS difference -2.17 [95% CI -4.19, -0.15]). No significant difference in spinal radiographic progression was observed between NSAID-treated and control patients (mSASSS difference -0.30 [95% CI -2.62, 1.31], I2 = 71%) or between secukinumab-treated and biologics-naive patients (mSASSS difference -0.34 [95% CI -0.85, 0.17]). With regard to treatment differences in patients with nonradiographic axial SpA or in patients with radiographic progression measured using the sacroiliac joint score, an insufficient number of studies were available for analysis. Although no significant protective effect of TNFi treatment on spinal radiographic progression was seen over the course of 2 years or ≥4 years in patients with axial SpA, our analysis restricted to studies with a low risk of bias showed a protective effect of TNFi after ≥4 years. Therefore, long-term TNFi exposure might confer beneficial effects on spinal radiographic progression in axial SpA. No difference in radiographic progression at 2 years was seen in either the NSAID or secukinumab treatment groups compared to their controls. Future studies should explore the effects of biologic treatment on radiographic progression, as well as the effects of long-term biologics exposure, in patients with early axial SpA or those with nonradiographic axial SpA.

Tuberous sclerosis complex (TSC) is an autosomal dominant condition characterised by the presence of multiple hamartomas in various organ systems in the body. The kidneys are affected in 80% of patients, usually in the form of renal angiomyolipomas, renal cysts or renal cell carcinoma. Although extremely rare, TSC and autosomal dominant polycystic kidney disease (ADPKD) can co-exist in the same patient as a result of concurrent deletion of both polycystic kidney disease (PKD) 1 and TSC2 genes present on the chromosome 16p13.3. These patients develop end-stage renal disease at an earlier age and have an increased risk of malignancy. We present a case of a 30-year-old man with a history of tuberous sclerosis, presenting with loin pain and subsequently diagnosed to have ADPKD.

Lee FT, Sproat IA, Rappe AH, Violante MR, Bronson JP. Liver enhancement techniques in computed tomography: a comparison of intravenous bolus, computed tomographic portography and iodipamide ethyl ester particle injections in a canine model. Invest Radiol 1994;29:S289–S292.

Back to table of contents Next article ArticleNo AccessPsychiatrists and Community Mental Health CentersGordon H. Clark Jr.Gordon H. Clark Jr.Search for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ps.38.2.113AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Psychiatrists and Community Mental Health Centers." Psychiatric Services, 38(2), p. 113 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byLetter to the EditorGordon H. Clark, Jr.1 April 2006 | Psychiatric Services, Vol. 38, No. 11 Volume 38Issue 2 February 1987Pages 113-113 Metrics PDF download History Published online 1 April 2006 Published in print 1 February 1987