Purpose: Splenic flexure mobilization (SFM) is occasionally utilized during sigmoidectomy to facilitate a tension-free colorectal anastomosis. Present literature regarding its use, safety, and efficacy predominantly evaluates traditional laparoscopic vs. open techniques, thus not adequately representing the current minimally invasive surgical landscape. Methods: This retrospective cohort analysis evaluated SFM during sigmoidectomy for diverticular disease via traditional laparoscopic, single-incision laparoscopic, and robotic techniques at a United States academic institution from 2019 to 2022. Primary outcomes were the rate of SFM, independent predictors, and short-term outcomes. Results: A total of 117 patients underwent sigmoidectomy for diverticulitis by six colorectal surgeons, of whom 27 underwent SFM. SFM was associated with higher rates of complicated diverticulitis (85.2% vs. 46.7%, p < 0.001), including abscess (55.6% vs. 33.3%, p = 0.037) and fistulae (59.3% vs. 17.8%, p < 0.001). Presence of a fistula was an independent predictor of SFM by logistic regression (odds ratio [OR], 5.886; p < 0.001). Mobilization was associated with more concomitant surgical procedures (66.7% vs. 28.9%, p < 0.001). There was a significant association between SFM and conversion to open approach (14.8% vs. 3.3%, p = 0.049), longer length of stay (4.2 ± 2.8 days vs. 3.6 ± 4.3 days, p = 0.041), and increased operative time (241.7 ± 76.4 minutes vs. 199.2 ± 75.7 minutes). There was no difference in 30-day morbidity/mortality. Conclusion Routine SFM can be considered in minimally invasive sigmoidectomy for complicated diverticulitis without significant impact on 30-day morbidity/mortality regardless of surgical approach and may be anticipated preoperatively, particularly when a fistula is present.

Background: and Purpose In patients with ischemic stroke and isolated cervical internal carotid artery occlusion (c-ICA-O), endovascular therapy (EVT) can improve cerebral perfusion. To maintain vessel patency, EVT is frequently combined with carotid artery stenting (CAS). We assessed the efficacy and safety of emergent CAS during EVT for isolated c-ICA-O. Methods: This retrospective multinational cohort study (42 centers) included consecutive patients who underwent EVT for isolated c-ICA-O within 24 hours from the time last seen well. Patients who underwent emergent CAS were compared with those who did not. Co-primary outcomes were c-ICA vessel patency and symptomatic intracerebral hemorrhage (sICH) 24 hours post-EVT. Secondary outcomes included any intracerebral hemorrhage (ICH) at 24 hours and disability at 3 months (modified Rankin Scale [mRS] shift). Outcomes were adjusted using inverse probability of treatment weighting. Results: Of 317 patients (mean age, 68.6 years [standard deviation, 12.9]; median National Institutes of Health Stroke Scale 11 [interquartile range, 6–17]; 26.8% female), 219 (69.1%) underwent CAS, whereas 98 (30.9%) did not. At 24 hours, vessel patency was more common after CAS (83.5% vs. 40.7%; adjusted odds ratio [aOR], 9.45; 95% confidence interval [CI], 4.91–18.17); sICH rates did not differ (2.3% vs. 3.1%; aOR, 0.92; 95% CI, 0.18–4.73). Any ICH was more common after CAS (19.3% vs. 9.3%; aOR, 2.50; 95% CI, 1.12–5.60). CAS was not associated with mRS at 3 months (adjusted common odds ratio, 0.98; 95% CI, 0.62–1.56). Conclusions In patients undergoing EVT for isolated c-ICA-O, emergent CAS was technically effective and reasonably safe. More frequent vessel patency in patients who underwent CAS did not translate into improved functional outcome at 3 months.

BACKGROUND

Artificial Intelligence (AI) is increasingly transforming various fields, including healthcare. In occupational therapy (OT), Generative AI (GenAI) holds promise for enhancing clinical practice and patient outcomes. However, its successful integration depends not only on technological advancements but also on the perceptions, acceptance, and experiences of clinicians. Despite global interest, limited research exists on the perspectives of OT practitioners in the Philippines.

OBJECTIVE

A qualitative study will be conducted with a theoretical sample of 15 OT clinicians actively working across Metro Manila who are familiar with AI, excluding those in academic roles. The Technology Acceptance Model (TAM) will be used as a guiding framework to understand OT clinicians' attitudes towards the usage of GenAI. After a successful pilot test, one-on-one semi-structured interviews will be
conducted online. Data will be thematically analyzed using NVivo 15, following a coding framework

METHODS

A qualitative study will be conducted with a theoretical sample of 15 OT clinicians actively working across Metro Manila who are familiar with AI, excluding those in academic roles. The Technology Acceptance Model (TAM) will be used as a guiding framework to understand OT clinicians' attitudes towards the usage of GenAI. After a successful pilot test, one-on-one semi-structured interviews will be
conducted online. Data will be thematically analyzed using NVivo 15, following a coding framework

EXPECTED RESULTS

The study is expected to provide insights into the familiarity, experiences, attitudes, and intentions of OT clinicians in Metro Manila regarding AI use in clinical practice. Findings may identify perceived benefits, concerns, ethical and practical considerations, and factors influencing the adoption of AI, highlighting opportunities and barriers for its responsible integration into OT practice.

Human ; Artificial Intelligence ; Occupational Therapy

Aortic stenosis (AS) is one of the most common types of valvular heart disease in older adults, with age being significantly associated with the development of AS. The transcatheter aortic valve replacement (TAVR) procedure, since it was first performed in 2002, has emerged as a preferred treatment option for patients who are at intermediate to high surgical risk due to advanced age or medical comorbidities. Older adults with severe AS may present with acute decompensated heart failure leading to cardiogenic shock (CS). Among patients 65 years and older with AS presenting for TAVR, 4.1% were reportedly in acute CS. Regardless of etiology, mortality from CS itself is high (30%-50%) and increases with advancing age. TAVR for these patients could provide a definite treatment for both AS and CS. There is still limited evidence regarding the safety and efficacy of TAVR in this population, but recent studies are promising, with successful procedural results and a good recovery rate after the procedure. However, particularly for older adults, there are other factors that clinicians should consider during pre- and post-procedural status, such as patient's goals, frailty, polypharmacy, dementia, or delirium. In this article, we reviewed current studies regarding TAVR for older adults with AS and CS, the reason for comprehensive geriatric assessment, and the introduction of appropriate geriatric assessment tools based on the Age-Friendly 4Ms framework that cardiologists can adopt in real-world practice.

This study was to survey the relationship between semen values and demographics, comorbidities, and recreational substance use in a large cohort of adult men at the University of Chicago Medical Center Department of Urology (Chicago, IL, USA). We performed an analysis from January 2013 to December 2023 of semen samples obtained from adult patients at our institution and collected their demographics, comorbid medical conditions, and recreational substance use information. Patients were divided into categories of normozoospermia, oligozoospermia, and azoospermia on the basis of the 5 th version of the World Health Organization (WHO) guidelines. Data were analyzed by univariate linear and logistic regression models, after which statistically significant variables were placed into multivariable models. Azoospermia and oligozoospermia were both associated with Caucasian or Black, Indigenous, and People of Color (BIPOC) race (both P < 0.001), increasing age ( P = 0.005 and P < 0.001, respectively), anemia ( P < 0.001 and P = 0.02, respectively), lifetime tobacco use (both P < 0.001), lifetime alcohol use ( P = 0.02 and P < 0.001, respectively), and lifetime use of at least two recreational substances ( P < 0.001 and P = 0.003, respectively) in multivariable models. Oligospermia was additionally associated with benign prostatic hyperplasia (BPH; P = 0.003) in multivariable models. This study suggests that at-risk populations may benefit from additional early screening and workup for infertility.
Humans ; Male ; Adult ; Longitudinal Studies ; Middle Aged ; Semen Analysis ; Life Style ; Oligospermia/epidemiology* ; Azoospermia/epidemiology* ; Comorbidity ; Midwestern United States/epidemiology* ; Young Adult

CONTEXT

Accurate diagnosis of onychomycosis is important since misdiagnosis can lead to inappropriate therapy, delayed diagnosis of other nail conditions, and antifungal resistance. Dermoscopy is an emerging diagnostic tool, particularly valuable in the resource-poor settings.

AIMS

The study aimed to evaluate the accuracy of dermoscopy as a point-of-care tool in diagnosing distal subungual onychomycosis (DSO) at a tertiary hospital.

SETTINGS AND DESIGN

An observational, prospective, and cross-sectional study was conducted among 22 clinically diagnosed DSO patients using convenience sampling at a tertiary hospital from November 2019 to September 2021.

SUBJECTS AND METHODS

Participants underwent gross nail examination, dermoscopy, potassium hydroxide (KOH), and periodic acid-Schiff (PAS) examinations.

STATISTICAL ANALYSIS USED

Sensitivity, specificity, predictive value, and likelihood ratios (LRs) of the dermoscopic patterns were obtained using KOH and PAS results as the reference standard.

RESULTS

Fifty-one nails were submitted but 2 were lost during the processing, leaving 49 nails for analysis. The most common pattern was jagged edge with spikes (65.3%). Individual patterns yielded only low-to-moderate sensitivity (32.4%–73.5%). However, combining all patterns increased sensitivity to 91.2% (95% confidence interval: 76.3–98.1). Ruin appearance showed the highest specificity (100%) and positive predictive value (100%). LRs were not significant enough to draw the conclusions.

CONCLUSIONS

Dermoscopy may serve as an on-site, adjunct tool in the diagnosis of DSO, especially when the combination of patterns is considered. Ruin appearance maybe particularly useful in ruling in DSO. However, confirmation using mycological and histopathological tests remains essential.

Human ; Dermoscopy ; Onychomycosis

Human ; Optic Nerve Diseases ; Optic Neuropathy, Ischemic ; Ophthalmologists

Low back pain is one of the most common reasons for consultation encountered in the primary care setting. The majority of cases are due to mechanical low back pain; however, proper evaluation is needed to identify patients who have secondary causes. This can be done through a focused history and physical examination using the Look-Move-Feel Approach as a guide. Identification of red flags suggests underlying pathology. The mnemonic BACK PAINS (Bladder/bowel incontinence, Age extremes, Chronic infection, Known Malignancy, Pain worse at night, Acute trauma, IV drug/Immunosuppression, Neurologic findings, and Systemic symptoms) can be used to remember red flags of low back pain. In general, patients with non-specific low back pain often require no imaging or work-up, while those with red flags warrant diagnostic investigation and possible referral.

Human ; Low Back Pain

BACKGROUND

Hypertension is a major contributor to cognitive decline, and dementia is an increasing public health concern in the Philippines. Despite evidence linking these conditions, the awareness of dementia risk remains limited. Broader modifiable factors—such as nutrition, physical activity, smoking, alcohol use and sleep—also influence dementia risk but are not consistently emphasized in health education for hypertensive adults.

OBJECTIVE

To comprehensively assess the dementia risk awareness of hypertensive Filipino adults residing in the Philippines.

METHODS

An adapted questionnaire will gather data on dementia risk awareness among hypertensive Filipino adults. Phase I involves distributing the questionnaire via Google Forms on social media and collecting informed consent, the Personal Data Sheet (PDS), Dementia Knowledge Assessment Scale (DKAS) responses and self-reported modifiable risk factors from the McCance Brain Care Score (BCS). Phase II consists of quantitative analysis using descriptive statistics, including sub-analyses assessing correlations between dementia risk awareness and secondary measures.

EXPECTED RESULTS

At least 384 responses from hypertensive Filipino adults are anticipated, allowing classification into dementia risk–aware or dementia risk–unaware groups using DKAS thresholds. Exploratory analyses will describe potential associations between dementia risk awareness and selected modifiable risk factors

Human ; Male ; Female ; Adolescent: 13-18 Yrs Old ; Young Adult: 19-24 Yrs Old ; Adult: 25-44 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Adult ; Awareness ; Dementia ; Learning ; Philippines ; Risk