Background: Fatigue significantly affects health-related quality of life (HRQoL) in patients with immune thrombocytopenia (ITP). However, the interplay between fatigue and cytokines in ITP remains poorly understood. Methods: This study included 100 patients with persistent or chronic ITP who had not received ITP-directed therapy in the previous 8 weeks and 50 age-matched healthy controls. Fatigue and HRQoL were assessed using the Functional Assessment of the Chronic Illness Therapy (FACIT) scale. Concurrently, plasma levels of interleukin (IL)-2, IL-4, IL-6, IL-10, IL-12, IL-17, and interferon-gamma (IFN-γ) were measured via enzyme-linked immunosorbent assay (ELISA). Results: ITP patients had significantly lower total FACIT scores [median 146 (range 59–160]) and fatigue subscale scores [median 45 (range 9–52]) than controls [155 (149–159) and 49 (44–52), respectively; both p < 0.001]. IL-12 levels were significantly elevated in patients (313.2 vs. 95.5 pg/mL; p < 0.001) and showed a significant negative correlation with FACIT scores (Spearman’s ρ = –0.272, p = 0.007). Multivariate analysis revealed that female sex, longer disease duration among patients with chronic ITP (> 24 months), and elevated IL-12 levels were independently associated with greater fatigue and poorer HRQoL. Conclusions ITP is associated with significant fatigue and HRQoL impairment, with IL-12 emerging as a potential immunological marker linked to this symptom burden.

Background: The standard dose (SD) of horse anti-thymocyte globulin (hATG) ATGAM (Pfizer, USA) or its biosimilar thymogam (Bharat Serum, India) for the treatment of Aplastic Anemia (AA) is 40 mg/kg/day for 4 days in combination with cyclosporine. Data on the impact of hATG dose on long-term outcomes are limited. Here, we describe our comparative experience using 25 mg/kg/day (low-dose [LD]) hATG for 4 days with SD for the treatment of AA. Methods: We retrospectively studied patients with AA (age > 12 years) who received two doses of hATG combined with cyclosporine. Among 93 AA patients who received hATG, 62 (66.7%) and 31 (33.3%) patients received LD and SD hATG with cyclosporine, respectively. Among these,seventeen(18.2%) patients also received eltrombopag with hATG and cyclosporine. Overall response rates [complete response (CR) and partial response (PR)] of LD and SD hATG groups at 3 months (50% vs. 48.4%; p = 0.88), 6 months (63.8% vs. 71.4%; p = 0.67), and 12 months (69.6% vs.79.2%; p = 0.167) were comparable. The mean (Standard Deviation) 5-year Kaplan–Meier estimate of overall survival and event-free survival was 82.1 (4.6)% and 70.9 (5.5)% for the study population. The mean (standard deviation) 5-year Kaplan–Meier estimate of overall survival and event-free survival of those who received LD hATG versus SD hATG dose was 82.9 (5·3)% versus 74.8 (10·3)% (p = 0·439), and 75.2 (6.2)% versus 61.4(11.2)% (p = 0·441). Conclusion Our study revealed that the response rates of patients with AA and LD were similar to those of patients with SD to hATG combined with cyclosporine in a real-world setting.

Background: The standard dose (SD) of horse anti-thymocyte globulin (hATG) ATGAM (Pfizer, USA) or its biosimilar thymogam (Bharat Serum, India) for the treatment of Aplastic Anemia (AA) is 40 mg/kg/day for 4 days in combination with cyclosporine. Data on the impact of hATG dose on long-term outcomes are limited. Here, we describe our comparative experience using 25 mg/kg/day (low-dose [LD]) hATG for 4 days with SD for the treatment of AA. Methods: We retrospectively studied patients with AA (age > 12 years) who received two doses of hATG combined with cyclosporine. Among 93 AA patients who received hATG, 62 (66.7%) and 31 (33.3%) patients received LD and SD hATG with cyclosporine, respectively. Among these,seventeen(18.2%) patients also received eltrombopag with hATG and cyclosporine. Overall response rates [complete response (CR) and partial response (PR)] of LD and SD hATG groups at 3 months (50% vs. 48.4%; p = 0.88), 6 months (63.8% vs. 71.4%; p = 0.67), and 12 months (69.6% vs.79.2%; p = 0.167) were comparable. The mean (Standard Deviation) 5-year Kaplan–Meier estimate of overall survival and event-free survival was 82.1 (4.6)% and 70.9 (5.5)% for the study population. The mean (standard deviation) 5-year Kaplan–Meier estimate of overall survival and event-free survival of those who received LD hATG versus SD hATG dose was 82.9 (5·3)% versus 74.8 (10·3)% (p = 0·439), and 75.2 (6.2)% versus 61.4(11.2)% (p = 0·441). Conclusion Our study revealed that the response rates of patients with AA and LD were similar to those of patients with SD to hATG combined with cyclosporine in a real-world setting.

Background: The standard dose (SD) of horse anti-thymocyte globulin (hATG) ATGAM (Pfizer, USA) or its biosimilar thymogam (Bharat Serum, India) for the treatment of Aplastic Anemia (AA) is 40 mg/kg/day for 4 days in combination with cyclosporine. Data on the impact of hATG dose on long-term outcomes are limited. Here, we describe our comparative experience using 25 mg/kg/day (low-dose [LD]) hATG for 4 days with SD for the treatment of AA. Methods: We retrospectively studied patients with AA (age > 12 years) who received two doses of hATG combined with cyclosporine. Among 93 AA patients who received hATG, 62 (66.7%) and 31 (33.3%) patients received LD and SD hATG with cyclosporine, respectively. Among these,seventeen(18.2%) patients also received eltrombopag with hATG and cyclosporine. Overall response rates [complete response (CR) and partial response (PR)] of LD and SD hATG groups at 3 months (50% vs. 48.4%; p = 0.88), 6 months (63.8% vs. 71.4%; p = 0.67), and 12 months (69.6% vs.79.2%; p = 0.167) were comparable. The mean (Standard Deviation) 5-year Kaplan–Meier estimate of overall survival and event-free survival was 82.1 (4.6)% and 70.9 (5.5)% for the study population. The mean (standard deviation) 5-year Kaplan–Meier estimate of overall survival and event-free survival of those who received LD hATG versus SD hATG dose was 82.9 (5·3)% versus 74.8 (10·3)% (p = 0·439), and 75.2 (6.2)% versus 61.4(11.2)% (p = 0·441). Conclusion Our study revealed that the response rates of patients with AA and LD were similar to those of patients with SD to hATG combined with cyclosporine in a real-world setting.

Background: Maxillary molars are commonly anesthetized via buccal infiltration. A patient’s mouth opening during maxillary buccal infiltration can influence dental treatment. Hence, this study aimed to evaluate and compare the influence of palatal root length on the efficacy of 2% lidocaine in 1:80000 adrenaline for maxillary buccal infiltration (MBI) between the open- and closed-mouth techniques. Methods: Sixty patients were selected based on inclusion and exclusion criteria. The intensity of pre-operative pain was measured using a visual analog scale (VAS). Samples were randomly divided using the chit method, with odd numbers in group 1 and multiples of two in group 2. In group 1 (n = 30), MBI was performed using the open-mouth technique, and in group 2 (n = 30), MBI was performed using the closed-mouth technique.Five minutes after injection, electric pulp testing was performed. For a negative response, patients were asked to rate their level of discomfort using the VAS. The palatal root length was measured after opening the access point using an apex locator. The groups were evaluated for patient discomfort using VAS. Results: Results were analyzed using the Wilcoxon signed-rank test and Mann–Whitney test. A comparison of MBI between the open- and closed-mouth techniques showed that the closed-mouth technique had significantly better efficacy than the open-mouth technique when the palatal root length was greater than 19 mm (P < 0.05). Conclusion Within the limitations of the study, when the palatal root length was greater than 19 mm, the closed-mouth technique resulted in less patient discomfort, improved visibility, and better needle penetration.

Background: Maxillary molars are commonly anesthetized via buccal infiltration. A patient’s mouth opening during maxillary buccal infiltration can influence dental treatment. Hence, this study aimed to evaluate and compare the influence of palatal root length on the efficacy of 2% lidocaine in 1:80000 adrenaline for maxillary buccal infiltration (MBI) between the open- and closed-mouth techniques. Methods: Sixty patients were selected based on inclusion and exclusion criteria. The intensity of pre-operative pain was measured using a visual analog scale (VAS). Samples were randomly divided using the chit method, with odd numbers in group 1 and multiples of two in group 2. In group 1 (n = 30), MBI was performed using the open-mouth technique, and in group 2 (n = 30), MBI was performed using the closed-mouth technique.Five minutes after injection, electric pulp testing was performed. For a negative response, patients were asked to rate their level of discomfort using the VAS. The palatal root length was measured after opening the access point using an apex locator. The groups were evaluated for patient discomfort using VAS. Results: Results were analyzed using the Wilcoxon signed-rank test and Mann–Whitney test. A comparison of MBI between the open- and closed-mouth techniques showed that the closed-mouth technique had significantly better efficacy than the open-mouth technique when the palatal root length was greater than 19 mm (P < 0.05). Conclusion Within the limitations of the study, when the palatal root length was greater than 19 mm, the closed-mouth technique resulted in less patient discomfort, improved visibility, and better needle penetration.

Background: Maxillary molars are commonly anesthetized via buccal infiltration. A patient’s mouth opening during maxillary buccal infiltration can influence dental treatment. Hence, this study aimed to evaluate and compare the influence of palatal root length on the efficacy of 2% lidocaine in 1:80000 adrenaline for maxillary buccal infiltration (MBI) between the open- and closed-mouth techniques. Methods: Sixty patients were selected based on inclusion and exclusion criteria. The intensity of pre-operative pain was measured using a visual analog scale (VAS). Samples were randomly divided using the chit method, with odd numbers in group 1 and multiples of two in group 2. In group 1 (n = 30), MBI was performed using the open-mouth technique, and in group 2 (n = 30), MBI was performed using the closed-mouth technique.Five minutes after injection, electric pulp testing was performed. For a negative response, patients were asked to rate their level of discomfort using the VAS. The palatal root length was measured after opening the access point using an apex locator. The groups were evaluated for patient discomfort using VAS. Results: Results were analyzed using the Wilcoxon signed-rank test and Mann–Whitney test. A comparison of MBI between the open- and closed-mouth techniques showed that the closed-mouth technique had significantly better efficacy than the open-mouth technique when the palatal root length was greater than 19 mm (P < 0.05). Conclusion Within the limitations of the study, when the palatal root length was greater than 19 mm, the closed-mouth technique resulted in less patient discomfort, improved visibility, and better needle penetration.

Background: It is acknowledged that legislation acts as a motivator for organizational action on psychosocial risks. Our study aims to provide evidence on the relationship between key occupational safety and health (OSH) policy principles and organizational action on work-related stress, and, in turn, with reported employee job demands and resources and their experience of work-related stress. We focus on Italy where specific legislation and practices on work-related stress were introduced in 2008 which are underpinned by these key OSH policy principles. Methods: Secondary analysis of the Italian samples from the employer ESENER-2 and employee 6th EWCS surveys was conducted, using path analysis in structural equation modeling (SEM) linking the two datasets. Results: We found a strong statistically significant relationship between OSH policy principles and organizational action on work-related stress (C.I. = .62-.78 p < .001). The existence of an organizational action plan on work-related stress was found to be significantly associated with more reported job resources (C.I. = .02-.24, p < .05) but these were not found to be significantly associated with less work-related stress. No significant association was found between having an organizational action plan for work-related stress and reported job demands. However, job demands were significantly related to reported work-related stress (C.I. = .27-.47, p < .001). Conclusions Findings add support to the call for specific legislation on work-related psychosocial risks and highlight how an organizational OSH culture underpinned by key OSH principles, and awareness/competence development on psychosocial risk management can have a positive effect on organizational action. However, further support needs to be provided to organizations around developing primary prevention interventions at the organizational level with the aim of reducing job demands.

Intracapsular fractures of the proximal femur are one of the most common fractures of the lower limbs. Most cases require osteosynthesis with suitable implants, and intraoperative positioning of the patient on the fracture table is a prerequisite to facilitate fracture manipulation, traction, reduction and fluoroscopy assessment. However, positioning the limbs of bilateral above-knee amputees for internal fixation of related proximal femoral fractures is a difficult task, which requires customized inventory for effective limb positioning and fracture manipulation. This study reported a rare case following a crush injury of bilateral lower limb in a road traffic accident, and described some technical tips of acute femoral neck fractures in bilateral above-knee amputation. The patient was managed with immediate guillotine amputation and later secondary wound closure followed by internal fixation of the right-sided femoral neck fracture with multiple cancellous cannulated screws.
Amputees ; Femoral Neck Fractures/surgery* ; Femur ; Fracture Fixation, Internal ; Humans ; Lower Extremity

Bipolar clavicular dislocation is rare, and therefore its management is contentious. With an increase of patient’s physical demand and a near-normal shoulder function, there has been a shift in the paradigm of its management from a conservative one to a stabilized one of anatomical open reduction. Proposed methods of fixation have also evolved with the advent of more biological fixation devices, which elude implant or fixation related complications. This case report highlights the salient features of this rare case and details the management options along with the benefits of biological anatomical repair and reconstruction.