Impact of Clinical, Laboratory and Fluid Therapy Variables on Hospital Length of Stay for Children with Acute Pancreatitis / 대한소아소화기영양학회지

Purpose@#There have been many efforts to develop generalizable severity markers in children with acute pancreatitis (AP). Expert opinion panels have developed consensus guidelines on management but it is unclear if these are sufficient or valid. Our study aims to assess the effect of clinical and laboratory variables, in addition to treatment modality on hospital length of stay (LOS) as a proxy variable for severity in pediatric patients admitted with AP. @*Methods@#We conducted a retrospective chart review of patients between ages of 0–18 years, who were admitted with AP at 2 institutions between 2013–2018, John R. Oishei Children's Hospital (Buffalo, NY, USA) and Medical University of South Carolina Children's Hospital (Charleston, SC, USA). We constructed three linear regression models to analyze the effect of clinical signs of organ dysfunction, laboratory markers and fluid intake on hospital LOS. @*Results@#Ninety-two patients were included in the study. The mean age was 12 years (range, 7.6–17.4 years), 55% were females, and median LOS was 3 days. The most frequent cause of AP was idiopathic. Our study showed that elevated blood urea nitrogen (BUN) on admission (p<0.005), tachycardia that lasted for ≥48 hours (p<0.001) and need for fluid resuscitation were associated with increase LOS. Total daily fluid intake above maintenance did not have a significant effect on the primary outcome (p=0.49). @*Conclusion@#Elevated serum BUN on admission, persistent tachycardia and need for fluid resuscitation were associated with increase LOS in pediatric AP. Daily total fluid intake above recommended maintenance did not reduce LOS.

The foramen transversarium of typical and atypical cervical vertebrae: morphology and morphometry / El foramen transverso de vértebras cervicales típicas y atípicas: morfología y morfometría

The seven cervical vertebrae found in the human body are classified into typical and atypical vertebrae. Their transverse processes contain foramen transversarium (FT) and traditionally there is one foramen present on each side, of similar size. However, variations of this foramen regarding its shape, size, number, laterality, location and osteometric characteristics have been documented in the literature. This morphological and morphometric study was conducted on 126 cervical vertebrae (82 typical and 44 atypical) obtained from the osteological bank at the University of Kwa-Zulu Natal to produce a database which may serve as a useful guideline to medical personnel. There were variations observed regarding shape, number of FT, laterality and position, which have not previously been reported. The most types of variations were evident in the typical cervical vertebrae, then secondly, the seventh cervical vertebrae. The axis vertebrae did not display any accessory FT or variations.

Las siete vértebras cervicales que se encuentran en el cuerpo humano se clasifican como vértebras típicas y atípicas. Sus procesos transversos presentan un foramen transverso (FT) y normalmente este foramen es de tamaño similar en cada lado. Sin embargo, se han reportado en la literatura variaciones de este foramen, con respecto a su forma, tamaño, número, lateralidad, ubicación y características osteométricas. Este estudio morfológico y morfométrico se realizó en 126 vértebras cervicales (82 típicas y 44 atípicas) obtenidas del banco de Osteología de la Universidad de Kwa-Zulu Natal, para producir una base de datos que pueda servir como una guía útil para el personal médico. Se observaron variaciones con respecto a la forma, el número de FT, la lateralidad y la posición, que no se habían reportado anteriormente. La mayoría de los tipos de variaciones eran evidentes en las vértebras cervicales típicas y en segundo lugar en las séptimas vértebras cervicales. Los axis no mostraron ningún FT accesorio o variaciones.

Hexon and fiber gene changes in an attenuated fowl adenovirus isolate from Malaysia in embryonated chicken eggs and its infectivity in chickens

Fowl adenovirus (FAdV) is distributed worldwide and causes economic losses in the poultry industry. The objectives of this study were to determine the hexon and fiber gene changes in an attenuated FAdV isolate from Malaysia in specific pathogen-free chicken embryonated eggs (SPF CEE) and its infectivity in commercial broiler chickens. SPF CEE were inoculated with 0.1 mL FAdV inoculum via the chorioallantoic membrane (CAM) for 20 consecutive passages. The isolate at passage 20 (E20), with a virus titer of 10(8.7)TCID₅₀/mL (TCID₅₀, 50% tissue culture infective dose), was inoculated (0.5 mL) into one-day-old commercial broiler chicks either via oral or intraperitoneal routes. The study demonstrated that 100% embryonic mortality was recorded from E2 to E20 with a delayed pattern at E17 onwards. The lesions were confined to the liver and CAM. Substitutions of amino acids in the L1 loop of hexon at positions 49 and 66, and in the knob of fiber at positions 318 and 322 were recorded in the E20 isolate. The isolate belongs to serotype 8b and is non-pathogenic to broiler chickens, but it is able to induce a FAdV antibody titer. It appears that molecular changes in the L1 loop of hexon and the knob of fiber are markers for FAdV infectivity.

Determining if Positive Predictive Value using Laboratory Risk Indicator for Necrotising Fasciitis is Applicable in Malaysian Patients with Necrotising Fasciitis

Introduction: Necrotising fasciitis (NF) is a rapidly progressive infection of the subcutaneous tissue and fascia which spreads rapidly. The scoring system of Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) developed by Wong et al has been proposed as a tool for distinguishing NF and other soft tissue infections (STI) in Singapore. We set out to establish whether the LRINEC score is applicable in our Malaysian setting. Materials and Methods: A cross sectional study of all patients admitted to our hospital diagnosed with NF or To Rule Out NF (TRO NF) between January 1st 2016 to 30th June 2016. The sensitivity, specificity, positive and negative predictive values were then calculated for LRINEC score of ≥ 6 and ≥ 8. Results: Fourty-four patients were identified with the diagnosis of NF or TRO NF in the study. Twenty-seven patients (61.4%) were deemed post-operatively as having NF and 17 patients (38.6%) not having NF. A sensitivity of 59.3% and specificity of 47.1% when a LRINEC score of ≥ 6 was taken with positive predictive value (PPV) of 64.0% and the negative predictive value (NPV) of 42.1%. When score ≥ 8 was taken, the sensitivity was 48.1% and specificity of 58.8% with PPV of 65% and NPV of 41.7%. Conclusion: The low sensitivity and low PPV achieved in this study as well as other studies makes the LRINEC score unsuitable to be used solely to distinguish NF with other soft tissue infections.

Social media in healthcare: uses, risks, and barriers

Establishing a social media presence has never been more important for the healthcare industry. With patients going online to discuss their health and research their conditions, it is essential for healthcare professionals and organizations to maintain a social web presence and have a voice in these conversations. Though there are many potential benefits for social media in healthcare, there are also risks to be taken into consideration when planning to engage in these relatively new forms of media. Privacy and security are top consumer concerns on sharing health information. Social media is about dialogue, interactivity, spontaneity, people, and technology. One of the goals of social media is to help patients become better informed, equipped to participate in their care, and be able to partner with their healthcare providers to develop plans of care that meet their individual needs. This review will present important social media elements and discuss their barriers and risks

Idiopathic adult ileoileal and ileocolic intussusception in situs inversus totalis: a rare coincidence

Situs inversus totalis is a rare autosomal recessive congenital anomaly that is characterized by mirror image anatomy of the abdominal and thoracic organs. We report a case of a 28-year-old male with situs inversus totalis, who developed an idiopathic ileoileal and ileocolic intussusception, which was diagnosed on computed tomography scan. Patient underwent successfully ileal resection and side-to-side functional anastomosis of ileum 12 cms from ileocecal junction. Postoperative course was uneventful. To the best of our knowledge, this is the first case of idiopathic adult intussusception with situs inversus totalis in the literature

Development and validation of an Arabic version of the visual functioning index VF-14 for cataract patients

To develop and validate an Arabic version of the Visual Functioning Index [VF-14] for patients with cataracts. The VF-14 was translated into Arabic by an epidemiologist and an ophthalmologist, both fluent in Arabic and English. The VF-14 was administered to patients diagnosed with cataract at two hospitals in Egypt and two hospitals in Saudi Arabia. Patients were also administered three other forms; the cataract symptoms score [CSS]; global measure of vision; and cataract medical form. Internal reliability and external validity were measured. Index sensitivity to visual acuity was detected and potential effective factors were investigated. Correlation analyses were performed. A p value less than 0.05 was considered statistically significant. The translated VF-14 was consistent and reliable [sigma = 0.763, p < 0.0001]. It was also statistically significantly sensitive to vision [p < 0.0001]. The mean calculated index was 62.18 +/- 19.34, and was highly correlated with; CSS and other scores [p < 0.0001, all cases]. Factors that may affect the index are; age, sex, vision, wearing glasses, type, position, and severity of cataract. The Arabic VF 14 is a reliable and valid tool for evaluation of both visual functioning and quality of visual life among cataract patients. It is also sensitive to changes in visual acuity, demographic, and clinical characteristics

Hearing health practices and beliefs among over 20 year-olds in the Omani population

The objective of this study was to investigate hearing health practices and beliefs among people over 20 years old in the Omani population. This descriptive study was conducted in Oman during 2007-2008. Arabic speaking health staff interviewed a total of 598 selected people from urban and rural Oman and also industrial workers using a closed ended questionnaire with 15 questions. Participants' responses to the hearing practice related questions were graded into excellent [>/= 20 points], average [10 to 19] and poor [<10 points]. The responses to the questions about hearing beliefs were grouped into excellent [>/= 25 points], good [5 to 24], average [-4 to 4], poor [-24 to -5] and very poor [<-25] grades. We calculated the frequencies, percentage proportions and 95% confidence intervals of the different grades of beliefs and hearing practice. The rates were also compared among different subgroups. We performed regression analysis to identify predictors of good hearing practice and scientific beliefs. Among the 598 participants, an 'excellent' grade of hearing practice and belief was noted in 386 [64.5% [95% CI 60.7-68.4]] and average in 205 [34.3% [95% CI 29.5 - 37.1]]. Being in the 20 to 39 years age group [OR=1.67] and an urban resident [OR=0.53] were both predictors of an excellent grade of hearing practice, while male gender [OR=1.71] and illiteracy [OR=1.80] were predictors of scientific beliefs. We noted high levels of good hearing practice and low levels of modern scientific beliefs among Omani participants. The Ear Health Care program of Oman should focus on improving the knowledge about healthy hearing so that attitudes and hearing practices are improved and noise-induced hearing loss can be prevented or delayed

Meckel's diverticulum-revisited

Meckel's diverticulum is a true intestinal diverticulum that results from the failure of the vitelline duct to obliterate during the fifth week of fetal development. In about 50% cases, it contains ectopic or heterotopic tissue which can be the cause of complications. A systematic review of literature was undertaken to study the history, incidence, embryoanatomy, clinical presentation, complication and management of Meckel's diverticulum. Although Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, it is often difficult to diagnose. It may remain asymptomatic or it may mimic disorders such as Crohn's disease, appendicitis and pepticulcr disease

Leiomyomatosis peritonealis disseminata with features of carcinomatosis on laparoscopy: a case report

Leiomyomatosis peritonealis disseminata [LPD], also known as diffuse peritoneal leiomyomatosis, is a rare disease characterised by subperitoneal proliferation of benign nodules mainly composed of benign smooth muscle cells, macroscopically mimicking peritoneal carcinomatosis. We report a 43 year-old woman who presented with menorrhagia, pelvic pressure and pain. Ultrasound of the pelvis showed uterine fibroids and an ovarian cyst. She was scheduled to have a laparoscopic hysterectomy and left salpingo-oophorectomy for symptomatic relief. A picture of carcinomatosis was seen on laparoscopy so multiple biopsies were taken and the patient was referred to the gynaecological oncology team. Definitive surgery was performed and final pathology was consistent with LPD with no evidence of malignancy. No hormone replacement therapy was offered after surgery. Macroscopically, LPD has features of malignancy; it usually pursues a benign course. To review current management of LPD and the risk of malignant transformation, we conducted a search in Medline, EMBASE, and the Cochrane Database of systematic reviews using the keywords: leiomyomatosis peritonealis disseminata, management and malignant transformation. LPD is a diagnostic challenge. Although rare, malignant transformation can occur since hormones play an important role in the pathogenesis of LPD, following surgery, patients should be followed carefully if they are on hormone replacement as these tumours could re-grow and cause symptoms or transform to malignancy

Evaluation of patients' adherence to chemotherapy for breast cancer

The study aimed to establish the common reasons for non-adherence to drug treatment among breast cancer patients at the Obafemi Awolowo University Teaching Hospitals Complex; Ile-Ife; Nigeria over a ten-year period (Jan 1993 - Dec 2002). Patients' adherence and reasons for non-adherence to chemotherapy were evaluated using descriptive statistics. Two hundred and twenty-five breast cancer patients including 199 females and 6 males with breast cancer were recruited. 12(5.3) patients had Stage I disease while 126 (56) were in stage IV. The non-adherence rate was 80.9and 111(73) of the non-adherent patients were eventually not seen again. Of the one hundred and one patients who gave reasons for non-adherence; 45complained of financial difficulties; 18thought they were well enough; 15were fearful of subsequent operation and 11were unable to further bear the drug side effects. In conclusion; the study demonstrated poor economic status of the patients as one of the major reasons for non-adherence to cancer chemotherapy in Nigeria. Government subsidy of breast cancer treatment; improved health education and advocacy complemented by home visiting to encourage hospital attendance would be required for better adherence to chemotherapy

Cardiac metastasis in malignant fibrous histiocytoma

Malignant fibrous histiocytoma [MFH] is an aggressive spindle cell cancer and is the most common soft tissue tumor in the elderly, primarily affecting the extremities. It has high metastatic potential and can spread to various viscera including liver, lung, bone, and brain; however, cardiac metastasis is an extreme rarity. Here, we present a 50-year-old male, diagnosed as pleiomorhphic storiform MFH a of right arm who developed parenchymal pulmonary metastases and a mass lesion in left atrium. Patient had a downhill course and eventually succumbed

Von Recklinghausen's neurofibromatosis associated with membranous glomerulonephritis

A 70-year old woman, known case of von Recklinghausen's neurofibromatosis presented with nephrotic syndrome and mild azotemia. Renal biopsy revealed membranous nephropathy. After ruling out secondary causes of membranous nephropathy, a possible coexistence of von Recklinghausen's neurofibromatosis and membranous nephropathy were thought of. This association has rarely been reported

Accidental dapsone induced methemoglobinemia in a young child

Acquired Methemoglobinemia is unusual. It should be suspected in a child presenting with acute or subacute onset of cyanosis when respiratory and cardiovascular reasons are unlikely. Here, the venepuncture reveals dark brown [chocolate] colored blood. In spite of free flow supplement of 100% oxygen, the pulse oximetry shows low oxygen saturation while blood gas analysis shows normal or elevated PaO[2].The measurement of methemoglobin level is diagnostic and history of exposure to the offending agent is contributory. Intravenous Methylene blue is highly effective to tide over the dangerous consequences. Overdose or accidental ingestion of dapsone tablets has been reported to cause symptomatic acquired methemoglobinemia in children and adults. This appears to be the first case reported in a young child from the Middle East Gulf region

Effects and a dose response relationship of physical activity to high density lipoprotein cholesterol and body mass index among Saudis

The objective of our study was to examine the effects and a dose response relationship of physical activity on plasma high density lipoprotein cholesterol [HDL-C] levels and body mass index [BMI] among Saudi men and women living in the metropolis of Riyadh, Kingdom of Saudi Arabia [KSA]. The sample population of 474 Saudi men and women visiting the health centers in and around Riyadh was studied from September 2003 to February 2004. The population was classified in 4 physical activity groups on the basis of frequency [F], intensity [I] and time [T] of exercise. The F, I and T value was calculated by multiplying the scores of 3 parameters. Plasma HDL-C and BMI were measured and the association of HDL-C and BMI with all 4 levels of physical activity, sedentary, light, moderate and heavy were calculated applying Pearsons correlation coefficient. We found that the sedentary Saudi men had mean HDL-C levels of 0.65 +/- 0.25 and BMI of 28.7 while women had 0.70 +/- 0.22 HDL-C levels and 31.06 BMI. The moderate and heavy physical activity showed an increase of 53-92% and 44.2-95% in the HDL-C levels in both men and women. The physical activity had a strong association to HDL-C and an inverse association to BMI. The substantial increase in the levels of plasma HDL-C and a moderate reduction in BMI is seen in men and women who are at moderate and heavy physical activity status, however the HDL-C level does not reach to the coronary heart disease protective level, if not combined with proper dieting. A health awareness program is urgently needed at the primary care level in KSA to educate people regarding the significance of physical activity and proper diet

Plasma fibrinogen and its correlates in adult Saudi population

To determine plasma fibrinogen and its correlates in the adult Saudi population and to investigate hyperfibrinogenemia as a possible risk factor for cardiovascular diseases [CVD]. A cross-sectional survey was designed and carried out through multi-stage stratified cluster random sampling of every third house in 6 heterogeneously populated districts of Riyadh, Kingdom of Saudi Arabia, during the period 1999 to 2002. Demographic and clinical data of 2263 adult Saudi subjects, consisting of 1934 [85.5%] men and 329 [14.5%] women, was collected through a standard questionnaire. Body mass index [BMI], blood pressure [BP] and history of smoking were recorded. Plasma fibrinogen, total serum cholesterol, triglycerides, high density lipoproteins [HDL] and blood sugar were determined in fasting blood samples. The majority [84.6%] of the subjects were between 20-50 years of age. The mean plasma fibrinogen was 336 +/- 115 mg/dl, and was increasing with age both in men and women. The mean +/- SD fibrinogen in women [357 +/- 118 mg/dl] was significantly higher [p value of 0.03] than men [332 +/- 114 mg/dl]. Hyperfibrinogenemia [>400 mg/dl] was indicated in 554 [24.6%] of the total subjects. Among hyperfibrinogenemic Saudi adults, the prevalence of hypercholesterolemia was 14.3%, hypertriglyceridemia 24%, obesity 26.3%, systolic/diastolic hypertension 11.5% and 11% and hyperglycemia 26% [in women only]. A reciprocal relation was observed between HDL and plasm fibrinogen. Significant positive correlation was seen between fibrinogen and BMI, systolic and diastolic BP and total cholesterol. There was no significant difference in the distribution of plasma fibrinogen between smokers and non-smokers [p value of 0.864]. The difference in the magnitude of metabolic as well as modifiable CVD risk factors between smokers and non-smokers was not significant, except serum triglyceride which was significantly higher in smokers than non-smokers [p value of 0.020]. A significant positive correlation was observed between hyperfibrinogenemia and obesity, systolic/diastolic hypertension and hypercholesterolemia. Our results thus support the earlier reports that hyperfibrinogenemia is a potential CVD risk factor. Unlike other reports, we could not find any correlation between smoking and plasma fibrinogen in our studied subjects. The value of hyperfibrinogenemia as a definite risk factor for CVD has to be quantified in future case-control studies comparing its significance between CVD subjects and normal controls