Effects of prolonged waiting time on visual outcomes of patients with pediatric cataract in a Tertiary Public Hospital

Background@#Pediatric cataract is one of the most common preventable cause of childhood blindness worldwide. Early and timely intervention of pediatric cataract is important to maximize the visual outcomes and start prompt visual rehabilitation.@*Objectives@#This study aimed to determine the average time from the day of initial consult at the outpatient clinic to the day of the cataract surgery and compare the effects of delayed surgery on visual outcomes of patients.@*Methods@#This is a retrospective chart review of medical records from January 2015 to June 2022. The dates of the different steps in the process up to the day of intervention were noted and the average interval duration and the total waiting time were determined. Patients operated on within 2 weeks from initial consult was defined as no delay while those operated >2 weeks had delayed surgery. Pre-operative and post-operative best corrected log MAR visual acuity were compared within each group to determine if delay in surgical intervention has a significant effect on the visual outcomes of patients.@*Results@#Median age at initial consult was 4.9 years while median age at surgery was 5.2 years. Ninety-nine (99) patients had developmental cataract and 123 patients had bilateral cataract. Leukocoria was the most common chief complaint (63.45%). Pre-operatively, 94 patients had strabismus, 49 had eye preference, 48 had nystagmus, and 43 had amblyopia in the diagnosis. There was significantly faster admission to cataract surgery during the pandemic compared to pre-pandemic period but there was no difference in the total waiting time. Patients with congenital cataract had the least total waiting time followed by developmental, and rubella cataract. There is no significant difference in visual outcomes between patients operated without delay and with delay.@*Conclusion@#There is delayed age at diagnosis and surgery of pediatric cataract patients in the Philippine General Hospital. Early surgery did not reflect better visual outcomes compared to delayed surgery probably due to delay in consultation of patients.

Variantes en la presentación clínica de la enfermedad por arañazo de gato en niños del hospital Garrahan / Variants in the clinical presentation of cat scratch disease in children at Garrahan Hospital

La infección por Bartonella henselae (BH) adopta diversas formas de presentación clínica en pediatría. Según la bibliografía la forma de presentación más frecuente en pacientes inmunocompetentes es la linfadenopatía única asociada a fiebre. En el 85 % de los casos se compromete un solo ganglio siendo los axilares y los epitrocleares los más frecuentemente involucrados. Existen otras formas de presentación menos frecuentes que debemos tener en consideración, para poder realizar un diagnóstico precoz e indicar un tratamiento adecuado si así lo requiere. El diagnóstico requiere de la sospecha clínica del equipo de salud tratante, junto al antecedente epidemiológico, los hallazgos clínicos del examen físico y la realización de serologías que incluyan el dosaje de inmunoglobulina M y G. Los objetivos del presente trabajo fueron reconocer las manifestaciones clínicas típicas y atípicas de la EAG por Bartonella henselae, describir la epidemiología, características clínicas y evolución de esta enfermedad que se presentaron en nuestro hospital. Se estudiaron un total de 187 pacientes. La media de edad fue de 7.6 años (rango 1-14); siendo 53.5% de género masculino. Las formas de presentación más frecuentes en nuestro trabajo fueron la adenitis y la fiebre. La mayoría recibió diversos esquemas de tratamiento antibiótico, secundario al retraso en el diagnóstico. La tasa de hospitalización fue muy baja, remitió con tratamiento ambulatorio con antibióticos o sin ellos (AU)

Bartonella henselae infection has different clinical presentations in pediatrics. According to the literature, the most common form of presentation in immunocompetent patients is single lymphadenopathy associated with fever. In 85 % of the cases a single lymph node is involved, with the axillary and epitrochlear nodes being the most commonly involved. There are other, less frequent, forms of presentation that should be taken into consideration in order to make an early diagnosis and indicate appropriate treatment if required. Diagnosis relies on clinical suspicion by the treating healthcare team, together with the epidemiological history, clinical findings on physical examination, and serology including immunoglobulin M and G dosage. The objectives of this study were to identify both the typical and atypical clinical manifestations of Bartonella henselae cat scratch disease, to describe the epidemiology, clinical characteristics, and outcomes of cases presenting at our hospital. A total of 187 patients were studied. The mean age was 7.6 years (range 1-14); 53.5% were male. The most frequent forms of presentation in our study were adenitis and fever. Most of them received different antibiotic treatment regimens due to delayed diagnosis. The hospitalization rate was very low and the disease typically resolved with outpatient treatment, with or without antibiotics (AU)

Fiebre prolongada, síndrome de Good y cáncer de colon: una asociación poco frecuente / Prolonged fever, Good syndrome and colon cancer: a rare association

Se define «síndrome febril prolongado¼ a todo cuadro de hipertermia que persiste al menos 10 días sin ser diagnosticado. El síndrome de Good es una inmunodeficiencia primaria del adulto que se caracteriza por presentar hipogammaglobulinemia, disminución de linfocitos B y anormalidades en los linfocitos T. Entre el 15 y el 20% de los casos de «fiebre de origen desconocido¼ ocurren debido a neoplasias, y el cáncer de colon representa menos del 1% de todos estos casos. Se presenta una paciente de 49 años admitida en el hospital por presentar síndrome febril con un mes de evolución, con antecedentes de síndrome de Good. Se le diagnostica cáncer de colon. (AU)

A prolonged febrile syndrome (PFS) is defined as any episode of hyperthermia that persists for at least 10 days without being diagnosed. Good's syndrome is a primary immunodeficiency in adults characterized by hypogammaglobulinemia, decreased B lymphocytes, and abnormalities in T lymphocytes. Between 15 to 20% of fever of unknown origin (FOD) cases are due to neoplasms, and colon cancer represents less than 1% of all these cases. A 49-year-old patient with a history of Good's syndrome was admitted to the hospital due to a febrile syndrome lasting for a month. She was diagnosed with colon cancer. (AU)

Efecto de los fármacos en la prolongación del QT y la aparición de muerte súbita en la COVID-19 / Effect of Drugs on QT Prolongation and Sudden Death in COVID-19

Introducción: Las evidencias científicas han demostrado que durante el período pandémico por la COVID-19 ha existido un incremento de la incidencia de muerte súbita cardiovascular, proporcional al incremento de los casos y a la letalidad por la enfermedad. Objetivos: Compilar información sobre los fármacos empleados en el tratamiento de la COVID-19 y sus posibles efectos en la prolongación del intervalo QT y la aparición de muerte súbita. Métodos: Se realizó una búsqueda de información a partir de las bases de datos PubMed, Medline y SciELO, en los idiomas español e inglés en el período de enero de 2020 a enero de 2023. Resultados: Los hallazgos más recientes sugieren que los factores relacionados con el tratamiento médico del paciente para sus enfermedades cardiovasculares previas, el empleo concomitante de drogas para otras comorbilidades, el ensayo de nuevas drogas que se investigan en la actualidad para el tratamiento de la enfermedad y el uso inadecuado de fármacos en complicaciones graves por la COVID-19, pueden ocasionar prolongación del intervalo QT y arritmias ventriculares tipo torsades de pointes, lo que puede conllevar a la aparición de muerte súbita. Conclusiones: Ha sido demostrado el efecto deletéreo de los fármacos en el tratamiento de la COVID-19 y sus posibles asociaciones a la terapéutica del paciente, en la prolongación del tiempo de repolarización ventricular cardíaca, cuya traducción eléctrica es un intervalo QT prolongado y su contribución a la génesis de arritmias malignas potencialmente fatales capaces de desencadenar un paro cardíaco y evolucionar a la muerte súbita(AU)

Scientific evidence has shown an increase in the incidence of sudden cardiovascular death during the COVID-19 pandemic period. This has been proportional to the increase in cases and mortality from the disease. Direct and indirect injury to the myocardium and vascular system allow to partially explain the statistics. Among the factors related to the medical treatment of the patient for previous cardiovascular diseases, it is the concomitant use of drugs for other comorbidities. The trial of new drugs for the treatment of this condition and the inappropriate use of drugs in serious complications from COVID-19 are currently being investigated. These can cause QT prolongation and torsades de pointes ventricular arrhythmias, which can lead to sudden death. Monitoring the QT interval is recommended, before and during treatment, in patients who come to the emergency room with a clinical condition suggestive of COVID-19. Additionally, modifiable factors favoring its prolongation should be evaluated. Decision-making in the application of therapeutic protocols in patients with COVID-19 with prolonged QTc at baseline, or with increased QTc after starting treatment, must go through the analysis of the risk/benefit ratio defined by a multi- and interdisciplinary team(AU)

Taquicardia ventricular polimórfica tipo Torsadess de Pointes secundaria a estimulación por marcapasos

La taquicardia ventricular polimórfica se origina en los ventrículos, cuyos complejos QRS son de morfología, amplitud y dirección variable, con frecuencias que oscilan entre 200 y 250 lpm, pudiendo ser autolimitadas o degenerar en una fibrilación ventricular. La TdP es un tipo de taquicardia ventricular polimórfica caracterizada por complejos con un eje eléctrico que gira alrededor de la línea isoeléctrica y que está asociada a QT largo. Se presenta el caso de una paciente portadora de marcapaso que presenta episodios de taquicardia ventricular polimórfica, con una morfología típica de TdP, sin documentación de QT prolongado previo ni actual, generada por la estimulación ventricular sobre onda T, de forma accidental por desplazamiento del electrodo auricular a Ventrículo Derecho (VD).

Polymorphic ventricular tachycardia is a tachycardia originating in the ventricles, where the QRS complexes have variable morphology, amplitude, and direction, with frequencies ranging between 200 and 250 bpm; it may be self-limited or degenerate into ventricular fibrillation. Torsades de Pointes (TdP) is a type of polymorphic ventricular tachycardia characterized by complexes with an electrical axis that rotates around the isoelectric line and that is associated with long QT interval. We present the case of a patient with a pacemaker who presents episodes of polymorphic ventricular tachycardia, with a typical morphology of TdP, without documentation of previous or current prolonged QT, generated by ventricular stimulation on the T wave, accidentally due to displacement of the atrial electrode to the Right Ventricle (RV).

Prolonged grief disorder treatment: An approach to COVID-19 grief / Tratamiento del trastorno de duelo prolongado: Una aproximación al duelo en tiempos de COVID-19

Abstract Background It has been estimated that COVID-19 grief will affect approximately sixteen million people worldwide, while the prevalence of prolonged grief disorder (PGD) could rise to 40%. Objective To review treatments that can be administered to patients with PGD due to COVID-19. Method PUBMED and Google Scholar were searched with the following keywords: prolonged grief disorder, complicated grief, grief and psychotherapy, and treatment of prolonged grief, complicated grief or persistent complex grief. Results Fifty articles were reviewed on the efficacy of interpersonal therapy, rational emotional-behavioral therapy, supportive therapy, humanistic therapy, systemic family therapy, group therapy, writing therapy, Internet-based intervention, and a modality of cognitive behavioral therapy used with prolonged grief, metacognitive therapy, and acceptance and commitment therapy. Discussion and conclusion There is no consensus on the psychotherapeutic treatment of choice for people with PGD due to the loss of a family member to COVID-19. Group therapy is effective in reducing the intensity of uncomplicated grief, cognitive-behavioral therapy is highly efficacious in reducing the severity of grief, metacognitive therapy specifically designed for PGD has a positive impact on depression, anxiety, stress, rumination, and quality of life while Acceptance and Commitment Therapy is helpful for restoring spirituality. Psychotherapy is most effective when combined with drug therapy. It is suggested that comparative studies be undertaken of psychotherapeutic techniques for managing patients with PGD associated with COVID-19 and the adaptation of these techniques to virtual settings.

Resumen Antecedentes Se estima que el duelo secundario a COVID-19 dejará cerca de 16 millones de personas afectadas mundialmente, y la prevalencia del Trastorno de Duelo Prolongado (TDP) pudiera incrementarse al 40%. Objetivo Revisar los tratamientos susceptibles de aplicar en pacientes con TDP por COVID-19. Método Se realizó la búsqueda en PUBMED y Scholar google con las palabras clave trastorno de duelo prolongado, duelo complicado, duelo y psicoterapia y tratamiento del duelo prolongado o complicado o complejo persistente. Resultados Se revisaron 50 artículos, se refirió la eficacia de la terapia interpersonal, la terapia racional emotiva del comportamiento, la terapia de apoyo, la terapia humanista, la terapia familiar sistémica, la terapia grupal, la terapia de escritura, la intervención basada en internet, y una modalidad de terapia cognitivo conductual aplicada al duelo prolongado, la terapia metacognitiva y la terapia de aceptación y compromiso. Discusión y conclusión No hay consenso sobre el uso preferencial de tratamientos psicoterapéuticos en personas con TDP por la pérdida de una familiar por COVID-19. La terapia grupal es efectiva en disminuir la intensidad del duelo no complicado, la terapia cognitivo conductual es altamente efectiva para disminuir la gravedad del duelo, la Terapia Metacognitiva diseñada específicamente para el TDP impacta positivamente en la depresión, ansiedad y calidad de vida; y la Terapia de Aceptación y Compromiso es útil en el restablecimiento de la espiritualidad. La psicoterapia es más eficaz cuando se combina con terapia farmacológica. Se sugiere la realización de estudios comparativos entre técnicas psicoterapéuticas para el manejo de pacientes con TDP asociado a COVID-19 y la adaptación de estas técnicas a ambientes virtuales.

Harvester’s palsy – bilateral common peroneal nerve palsy: A descriptive case report

Peroneal neuropathy is the common mononeuropathy of the lower extremities in adults. The documented etiologies for peroneal nerve injury include trauma, traction, and external compression. Fibular neck is the most common site of common peroneal nerve (CPN) injury as the nerve lies superficial and vulnerable for injury. A 50-year-old male presented with foot drop in his left leg after working in squatting position for prolonged hours along with sensory disturbance in dorsum of left foot. Clinical examination showed poor dorsiflexion in both side ankle with preserved plantar flexion. Electrophysiological findings locate the site of lesion to be CPN at the level of fibular neck. We conclude that CPN is injured due to knee flexion in farmers repeatedly squatting for long hours. Superficial peroneal nerve may be spared due to their interfascicular arrangement at the level of fibular neck placing deep peroneal nerve near the fibula making them more susceptible to compression type of injury. Peroneal nerve may be damaged at multiple sites including ankle. The condition can be reversed with conservative treatment, primarily by avoiding the precipitating position.

Tabagismo na pandemia de Covid-19: aspectos neurobiológicos do abuso de drogas em condições de estresse prolongado / Smoking on Covid-19 pandemic: neurobiological aspects of drug abuse in lasting stress conditions / Fumar en la pandemia de Covid-19: aspectos neurobiológicos del abuso de drogas en condiciones de estrés duradero

No fim de 2019 iniciou-se uma das maiores crises da saúde pública global em Wuhan, China. Essa emergência foi o aparecimento do SARS-CoV-2 e da doença COVID-19, uma síndrome respiratória aguda de alta transmissibilidade. A declaração da pandemia pela OMS em março de 2020 fez com que o mundo tomasse diversas medidas para o combate e contenção da doença. Inicialmente o isolamento social e lockdown foram as principais iniciativas, já que não havia formas de tratamento ou prevenção da doença. Essas medidas restritivas geraram uma mudança de hábito da população que deflagrou sérios comprometimentos físicos e psicológicos. Uma das consequências foi o aumento do uso de substâncias de abuso e, consequentemente, do transtornos por uso de substâncias, dentre elas o tabaco. Durante a pandemia o consumo de cigarro aumentou de 10 a 30% no mundo, o tabagismo é a principal causa de morte evitável e fator de risco para diversas doenças. Conjuntamente ao álcool, a nicotina têm um poder aditivo superior a muitas drogas ilícitas. A combinação dos transtornos por uso de substâncias e a COVID-19 acabam por ter um efeito sinérgico, dessa forma, buscamos integrar aspectos neuroquímicos, cognitivos e comportamentais que levaram ao aumento do consumo e/ou recaída nicotina e a terapêutica utilizada.

One of the biggest global public health crisis began in Wuhan, China at the end of 2019. That emergency was the emergence of SARS-CoV-2 and the disease COVID-19, a highly transmissible acute respiratory syndrome. The pandemic declaration by the WHO in March 2020 caused the world to take on several measures to combat and contain the virus. Initially, social isolation and lockdown were the main initiatives, as there were no forms of treatment or prevention of the disease. These restrictive measures generate a change in the habit of the population that triggered serious physical and psychological impairments. One of the consequences was the increase in the use of substances of abuse and, consequently, substance use disorder, including tobacco. During the pandemic, cigarette consumption increased from 10 to 30% worldwide, whereas smoking is the main cause of preventable death and a risk factor for several diseases. Along with alcohol, nicotine has a greater addictive power than illicit drugs. Substance use disorders and COVID-19 have a synergistic effect, in this way, we seek to integrate neurochemical, cognitive and behavioral aspects that led to increased consumption and/or relapse in nicotine consumption and the used therapy.

Una de las mayores crisis mundiales de salud pública comenzó en Wuhan (China) a finales de 2019. Esa emergencia fue la aparición del SARS-CoV-2 y la enfermedad COVID-19, un síndrome respiratorio agudo altamente transmisible. La declaración de pandemia por parte de la OMS en marzo de 2020 hizo que el mundo adoptara varias medidas para combatir y contener el virus. Inicialmente, el aislamiento social y el encierro fueron las principales iniciativas, ya que no existían formas de tratamiento o prevención de la enfermedad. Estas medidas restrictivas generaron un cambio en los hábitos de la población que desencadenó graves alteraciones físicas y psicológicas. Una de las consecuencias fue el aumento del consumo de sustancias de abuso y, en consecuencia, el trastorno por consumo de sustancias, incluido el tabaco. Durante la pandemia, el consumo de cigarrillos aumentó del 10 al 30% en todo el mundo, mientras que el tabaquismo es la principal causa de muerte evitable y un factor de riesgo de varias enfermedades. Junto con el alcohol, la nicotina tiene un mayor poder adictivo que las drogas ilícitas. Los trastornos por uso de sustancias y la COVID-19 tienen un efecto sinérgico, de esta manera, buscamos integrar los aspectos neuroquímicos, cognitivos y conductuales que llevaron al aumento del consumo y/o recaída en el consumo de nicotina y la terapia utilizada.

Effect of repetitive transcranial magnetic stimulation combined with median nerve electrical stimulation on patients with prolonged disorders of consciousness in different age / 中国康复理论与实践

ObjectiveTo investigate the effect of combination with repetitive transcranial magnetic stimulation (rTMS) and median nerve electrical stimulation (MNS) on patients with prolonged disorders of consciousness (pDOC) in different age. MethodsFrom January, 2021 to May, 2023, 93 patients with pDOC in the First Affiliated Hospital of Nanchang University were divided into young group (≤ 45 years old), middle-aged group (46 to 60 years old) and elderly group (> 60 years old). All the groups were treated with rTMS and MNS for four weeks. The Coma Recovery Scale-Revised (CRS-R), Glasgow Coma Scale (GCS), and Full Outline of Unresponsiveness Scale (FOUR) were used to evaluate the efficiency of awakening after treatment and the awakening ratios were compared among three groups weekly. Four weeks after treatment, regional cerebral blood flow (rCBF) was measured with CT perfusion imaging. The score of Glasgow Outcome Scale Extended (GOS-E) was compared six months after treatment. ResultsFrom three weeks after treatment, the scores of CRS-R, GCS and FOUR increased in all groups (P < 0.05). After weekly treatment, there was no significant difference in the composition ratio of consciousness level and the awakening ratio among three groups (χ2 < 11.057, P > 0.05). After four weeks of treatment, rCBF improved in three groups (|t| > 2.495, P < 0.05), however, there was no difference among three groups (F < 1.887, P > 0.05). There was no difference in the score of GOS-E at six months after treatment (F = 3.083, P = 0.055). ConclusionrTMS combined with MNS is effective on pDOC patients in different ages, and elderly patients could also benefit from it.

Treatments for prolonged disorder of consciousness in recent five years: a visualized analysis / 中国康复理论与实践

ObjectiveTo investigate the current landscape and hotspots on researches about treatment of prolonged disorder of consciousness (pDOC) in the recent five years, and forecast the trends. MethodsLiterature about treatment of pDOC was retrieved from the Web of Science Core Collection database, from January 1st, 2019, to June 7th, 2023. The data were analyzed with CiteSpace 5.8.R3 to create knowledge maps for authors, countries, institutions, keywords, references, co-cited authors and co-cited literature. ResultsA total of 411 articles were included. Aurore Thibaut was the most influential author, Belgium was the most influential country, and Harvard Medical School was the institution with the most publications. The researches focused on neuromodulation, prognostic assessment and care, and management of swallowing function. The neuromodulation techniques mainly included transcranial direct current stimulation, repetitive transcranial magnetic stimulation, deep brain stimulation and transcutaneous auricular vague nerve stimulation. In the coming years, the researches trended to explore neuromodulation and mechanisms of consciousness recovery, and the main neuromodulation techniques might be deep brain stimulation and transcutaneous auricular vague nerve stimulation. ConclusionThe researches about treatment of pDOC are increasing, mainly focusing on neuromodulation, prognostic evaluation, nursing care, and training for swallowing function. More researches would focus on neuromodulation and mechanisms for restoring consciousness.

Effects of delayed ureteral stents removal during the COVID-19 pandemic on the quality of life and psychological status of postoperative patients with urinary calculi / 北京大学学报(医学版)

OBJECTIVE@#To explore the impacts of delayed ureteral stent removal on the quality of life (QoL) and mental health of urinary calculi postoperative patients due to the corona virus disease 2019(COVID-19) pandemic.@*METHODS@#The demographic and clinical data of patients with ureteral stent placement after urinary endoscopic lithotripsy and returned to Peking University People's Hospital for stent removal from December 2019 to June 2020 were collected. Ureteral stent symptoms questionnaire (USSQ) score and the outcome 20-item self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were collected to estimate the QoL and mental status. The USSQ consisted of 44 questions in 6 domains (including urinary symptom, physical pain, general health, work performance, sexual function, and ureteral stent related infection). For most questions in each domain, its score was a five-point Likert-type scale from 1 to 5, and a small proportion of questions was quantified by 1 to 4 or 1 to 7 scale. SAS and SDS both contained 20 questions used to assess a patient's level of anxiety and depression. Its scoring for each item was on a four-point Likert-type scale from 1 to 4. A total score (ranging from 20 to 80) was the main statistical indicator. The level of clinical anxiety and depression was quantified by using standard scores (total score multiplied by 1.25 to produce integers). And the multi-group structural equation model was constructed by analysis of moment structure (AMOS) analysis.@*RESULTS@#Overall, 71 patients were enrolled for analysis. It was found that the median duration of ureteral stent time differed significantly between the control and delayed groups for 32 (30, 33) d and 94.5 (88, 103) d, respectively. The delayed group resulted in higher scores in the USSQ multidimensional, which included urinary symptoms, general health, work performance and ureteral stent related infections. Anxiety and depression were also significantly serious in the delayed group than in the control group. A longer indwelling time of a ureteral stent could exacerbate the effects of urinary symptoms and physical pain on work performance (P=0.029 < 0.05). Among them, the patients with severe urinary symptoms leading to poor work performance were most significantly affected by prolonged ureteral stent duration time (CR=2.619>1.96).@*CONCLUSION@#Patients with delayed ureteral stent removal due to the COVID-19 had resulted in worse QoL and mental status. Stents related symptoms are more severe in patients with higher anxiety and depression degree during COVID-19. To improve the QoL and mental health of patients after urinary calculi surgery during COVID-19, it is still not recommended to prolong the stent duration time or corresponding intervention measures should be taken.

Length of Hospital Stay and Its Associated Factors among Surgical Patients in Hospital Serdang

@#Introduction: Hospital length of stay (LOS) is one of the measurable indicators which can be used to evaluate hospital administration, operative performance, and quality of patient care. Prolonged LOS has been associated with poor outcomes in patients and inefficient use of hospital resources. Due to the scarcity of findings in this field in Malaysia, this study aims to identify the factors affecting LOS. Methods: A single health facility-based retrospective cross-sectional study was conducted in Hospital Serdang. Data of patients admitted to the surgical ward from 2017 to 2021 were retrieved. Result: A total of 114 surgical patients’ data were analysed, of which most were adults (72.8%), female (69.3%) and Malay (67.5%). The mean LOS was 5.90 ± 4.35 days. Pearson correlation revealed age (r = 0.309, p = 0.001) and preoperative albumin (r = -0.397, p <0.001) having a significant correlation with LOS. An independent samples T-test showed that males had significantly higher mean LOS than females (t = 2.653, p = 0.009). Surprisingly, having been seen by dietitians and being supplemented by oral nutrition supplements (ONS) had longer stay compared to groups who were not seen by dietitians and given ONS respectively (t = 4.278, p<0.001), (t = 3.111, p = 0.002). Furthermore, those with a moderate and high risk of malnutrition spent approximately 3.27 days longer hospitalized than low-risk patients (t = -2.868, p = 0.007). Conclusion: Factors that influence LOS are age, gender, preoperative albumin, seen by a dietitian, risk of malnutrition and oral nutrition supplementation.

A Rare Case of Cystic Biliary Atresia

@#Biliary atresia is one of the commonest causes of prolonged jaundice in neonate, whereas cystic biliary atresia is a rare form of biliary atresia with similar presentation, but a slightly different sonographic finding. Being able to differentiate them radiologically is important as the surgical management is different for these two diagnoses. An ultrasound examination was done for a 2-month-old baby girl with prolonged jaundice with the finding of a cyst along the portal triad, which raised the suspicion for cystic biliary atresia. The diagnosis was confirmed with intraoperative cholangiography (IOC) and Kasai procedure was done. The patient was well after the surgery with resolution of jaundice.

Second-generation laryngeal mask airway as an alternative to endotracheal tube in prolonged laparoscopic abdominal surgery: a comparative analysis of intraoperative gas exchanges

INTRODUCTION@#Laryngeal mask airway (LMA), which is used in difficult airway maintenance conditions during emergencies, is rarely used in prolonged surgery despite its advantages over endotracheal tube (ETT). In this study, we conducted a comparative analysis of intraoperative gas exchanges between second-generation LMA and ETT during prolonged laparoscopic abdominal surgery.@*METHODS@#Prolonged surgery was defined as a surgery lasting more than 2 h. In total, 394 patients who underwent laparoscopic liver resection via either second-generation LMA or ETT were retrospectively analysed. The following parameters were compared between the two groups of patients: end-tidal pressure of carbon dioxide (ETCO2), tidal volume (TV), respiratory rate (RR), peak inspiratory pressure (PIP), arterial partial pressure of carbon dioxide (PaCO2), pH and ratio of arterial partial pressure of oxygen to fractional inspired oxygen (PFR) during surgery. In addition, the incidence of postoperative pulmonary complications (PPCs), including pulmonary aspiration, was compared.@*RESULTS@#The values of ETCO2, TV, RR and PIP during pneumoperitoneum were comparable between the two groups. Although PaCO2 at 2 h after induction was higher in patients in the LMA group (40.5 vs. 38.5 mmHg, P < 0.001), the pH and PFR values of the two groups were comparable. The incidence of PPC was similar.@*CONCLUSION@#During prolonged laparoscopic abdominal surgery, second-generation LMA facilitates adequate intraoperative gas exchange and may serve as an alternative to ETT.

Sitmate: an android mobile application for the prevention of musculoskeletal discomfort among a business process outsourcing company workforce management personnel / The Health Sciences Journal

INTRODUCTION@#Due to COVID-19 pandemic, many have shifted into working at home which led to physical inactivity. This may cause musculoskeletal discomfort, chronic disease, muscle atrophy and spinal imbalance due to improper and prolonged sitting posture. Since mobile devices are relatively available for most of the office workers, there were still a lack of evidence-based mobile applications that can counteract the inactivity through exercises, which led to the researchers to create an application called SitMate that consists of evidence-based exercises which aimed to prevent musculoskeletal discomfort among a business process outsourcing company Workforce Management Personnel (BPO-WMP).@*METHODS@#Eleven participants (18-40 years old) full-time, work-from-home BPO-WMP were randomized into Treatment Group(TG)(n=6) and Control Group (CG)(n=5). The TG received one month intervention with the use of SitMate Application containing relaxation exercises, range of motion exercises and stretching exercises, and notifications for postural correction while the CG continued their usual working schedule.@*RESULTS@#There were no significant differences between two groups on all body parts that were measured using the Cornell Musculoskeletal Discomfort Questionnaire, and no significant differences in the intragroup pre-test and post-test scores on all body parts between TG and CG. For the intra-group post-test of the TG, there were noted improvements on the hip/buttock, right shoulder, upper back (median = 0) and right wrist (median = 1.5). There was also a noted increase in discomfort on the neck (median = 1.5) and lower back (median = 3). For the post-test of the CG, there were noted improvements on the right shoulder, right wrist (median = 0) and lower back (median = 1.5).@*CONCLUSION@#This study has shown that the SitMate application does not effectively reduce the prolonged sitting-related discomfort among the personnel after 1 month of intervention.

Outcomes of COVID-19 positive and COVID-19 negative adult patients who underwent tracheostomy for prolonged intubation in a COVID-19 referral center during the pandemic

Objective@#To compare outcomes of COVID-19 positive and COVID-19 negative patients who underwent tracheostomy for prolonged intubation in terms of weaning duration, length of ICU and hospital stay, overall and 30-day mortality, and explore risk factors for particular outcomes (mortality, 30-day mortality and weaning duration post tracheostomy). @*Methods@#Design: Retrospective Cohort Study Setting: Tertiary National University Hospital Participants: Of 122 adult patients that underwent tracheotomy between March 30, 2020 and March 30, 2021; 76 adult patients underwent tracheostomy for prolonged intubation were analyzed.@*Results@#Open tracheotomy was performed on 122 adult patients. Seventy six (62.3%) due to prolonged intubation and 46 (37.7%) for airway prophylaxis. Among the former, the mean age was 58.46±16.81 and 54 (71.05%) patients were female, 22 (28.95%) tested COVID-19 positive and 54 (71.05%) tested negative. Mean APACHE II score was 16.62±6.78. Average days of intubation prior to tracheostomy was 29.14±17.66 days. No statistically significant difference in outcomes (weaning days, length of stay, days discharge from ICU and hospital, 30-day mortality, days to death) were noted between COVID19 positive and negative patients who underwent tracheostomy for prolonged intubation. Mortality rates post tracheostomy in this institution appear to be higher than existing literature. On multiple linear regression analysis, days of intubation prior to tracheostomy was associated with increased weaning time post-tracheostomy (OR: 0.35 CI:0.18-0.51 95% p = <.001). This implies that for every additional day of intubation prior to tracheostomy, weaning days increase by 0.35 of a day. @*Conclusion@#Outcomes of COVID-19 compared to non-COVID-19 patients undergoing tracheostomy for prolonged intubation do not seem to be significantly different which is consistent with existing literature.

Research Progress on Risk Factors and Intervention Measures for Prolonged Thrombocytopenia after Allogeneic Hematopoietic Stem Cell Transplantation --Review / 中国实验血液学杂志

Prolonged thrombocytopenia (PT) is a common complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT), with an incidence of about 5%-37%, which is closely related to the poor prognosis of patients. Previous studies have shown that transplantation type, CD34+ cell number, pretreatment regimen, acute graft-versus-host disease, virus infection, pre-transplantation serum ferritin level and donor specific antibodies can affect platelet implantation after transplantation. Identifying the risk factors of PT is helpful to early identify high-risk patients and take targeted preventive measures according to different risk factors to reduce the incidence of PT, reduce the risk of bleeding and improve the prognosis of patients. This article reviews the latest research progress of risk factors and intervention measures related to PT after allo-HSCT, in order to provide reference for the prevention and treatment of PT after transplantation.

Facteurs associés à l'hospitalisation prolongée et à la mortalité au niveau du service de néphrologie de l'hôpital Aristide Le Dantec de Dakar / Factors associated with prolonged hospitalization and mortality in the nephrology department of the Aristide Le Dantec hospital in Dakar

Introduction : L'hospitalisation en néphrologie n'avait pas fait l'objet de plusieurs études au Sénégal et les données sont limitées. Notre travail avait pour but de déterminer les facteurs associés à l'hospitalisation prolongée et à la mortalité en néphrologie. Patients et méthodes : Il s'agissait d'une étude observationnelle prospective de 5 mois incluant tous les patients hospitalisés dans le service durant au moins 24H. La durée d'hospitalisation (la période allant du jour d'admission dans la chambre d'hospitalisation au jour de sortie du patient) était dite prolongée si > 12 jours. Résultats : Quatre-vingt-dix-neuf patients ont été analysés durant cette période avec une durée moyenne en hospitalisation de 11,14 ± 9,89 jours. L'âge moyen était de 45,22 ± 18,03 ans avec un sex-ratio (H/F) de 0,62. Les anomalies biologiques étaient : l'hyponatrémie (62,36%), l'hypokaliémie (23,91%), l'hypocalcémie (25%), l'hyperphosphatémie (51,21%), l'anémie (92,30%), la CRP élevée (90,90%) et l'hypoalbuminémie (80,76%). La protéinurie moyenne était de 3,38 ± 3,35 g/24h avec 34,61% de protéinurie néphrotique. La mortalité hospitalière était de 25,25%. En analyse univariée, l'hospitalisation prolongée était associée à l'âge ≤ 45 ans (p = 0,018), aux patients non dialysés chroniques (p=0,034), à la transfusion sanguine (p=0,008) tandis que la mortalité était liée à l'âge de plus de 45 ans (p=0,032), le diabète (p=0,014), l'hypokaliémie (p=0,045) et l'hospitalisation prolongé (p=0,007). En analyse multivariée, les patients présentant des œdèmes et ceux ayant été transfusés avaient respectivement 2,89 et 3,9 fois plus de risque d'avoir une hospitalisation prolongée. Les patients diabétiques avaient 4,63 fois plus de risque de décès et ceux ayant été hospitalisés de plus de 12 jours avaient 0,14 fois de risque de décès. Conclusion : La durée d'hospitalisation était relativement prolongée avec une mortalité élevée. Cependant l'impact de certains facteurs a été démontré permettant ainsi de réduire la durée d'hospitalisation et le nombre de décès.

Introduction: Hospitalization in nephrology had not been the subject of several studies in Senegal and the data are limited. Our work aimed to determine the factors associated with prolonged hospitalization and mortality in nephrology. Patients and methods: This was a 5-month prospective observational study including all patients hospitalized in the department for at least 24 hours. The duration of hospitalization (the period from the day of admission to the hospital room to the day of the patient's discharge) was said to be prolonged if > 12 days. Results: Ninety-nine patients were analyzed during this period with an average hospital stay of 11.14 ± 9.89 days. The mean age was 45.22 ± 18.03 years with a sex ratio (M/F) of 0.62. The biological abnormalities were: hyponatremia (62.36%), hypokalemia (23.91%), hypocalcemia (25%), hyperphosphatemia (51.21%), anemia (92.30 %), elevated CRP (90.90%) and hypoalbuminemia (80.76%). The mean proteinuria was 3.38 ± 3.35 g/24h with 34.61% nephrotic proteinuria. Hospital mortality was 25.25%. In univariate analysis, prolonged hospitalization was associated with age ≤ 45 years (p = 0.018), chronic non-dialysis patients (p = 0.034), blood transfusion (p = 0.008) while mortality was related to age over 45 (p=0.032), diabetes (p=0.014), hypokalaemia (p=0.045) and prolonged hospitalization (p=0.007). In multivariate analysis, patients with edema and those who had been transfused were respectively 2.89 and 3.9 times more likely to have prolonged hospitalization. Diabetic patients had a 4.63 times greater risk of death and those who had been hospitalized for more than 12 days had a 0.14 times greater risk of death. Conclusion: The duration of hospitalization was relatively prolonged with high mortality. However, the impact of certain factors has been demonstrated, thus making it possible to reduce the duration of hospitalization and the number of deaths

Post?Cardiopulmonary Bypass Longitudinal Strain provides Higher Prognostic Ability than Baseline Strain or Change in Strain

Context:Global longitudinal strain (GLS) measured by speckle?tracking echocardiography demonstrates excellent prognostic ability in predicting major adverse cardiac events after cardiac surgery. However, the optimal timing of intraoperative GLS measurement that provides the best prognostic value is unclear. Aim: Our goal was to evaluate whether GLS measured prior to cardiopulmonary bypass (pre?CPB GLS), following CPB (post?CPB GLS), or change in GLS provides the strongest association with postoperative complications. Setting and Design: Post hoc analysis of prospectively collected data from a clinical trial (NCT01187329). 72 patients with aortic stenosis undergoing elective AVR ± coronary artery bypass grafting between January 2011 and August 2013. Material and Methods: Myocardial deformation analysis from standardized transesophageal echocardiographic examinations were performed after anesthetic induction and chest closure. We evaluated the association between pre?CPB GLS, post?CPB GLS, and change in GLS (percent change from pre?CPB baseline) with postoperative atrial fibrillation and hospitalization >7 days. The association of post?CPB GLS with duration of mechanical ventilation, N?terminal pro?BNP (NT?proBNP) and troponin T were also assessed. Statistical Analysis: Multivariable logistic regression. Results: Risk?adjusted odds (OR[97.5%CI] of prolonged hospitalization increased an estimated 27% (1.27[1.01 to 1.59];Padj =0.035) per 1% decrease in absolute post?CPB GLS. Mean[98.3%CI] NT?proBNP increased 98.4[20 to 177]pg/mL; Padj =0.008), per 1% decrease in post?CPB GLS. Pre?CPB GLS or change in GLS were not associated with any outcomes. Conclusions: Post?CPB GLS provides the best prognostic value in predicting postoperative outcomes. Measuring post?CPB GLS may improve risk stratification and assist in future study design and patient outcome research.

Poor Respiratory Health Following Relapsing SARS-CoV-2 Infection in Children with Cystic Fibrosis

Children with cystic fbrosis (CF) constitute a high-risk group for COVID-19 with underlying chronic lung disease. COVID19 severity varying from mild infection to need of intensive care has been described in children with CF. Two children with signifcant underlying pulmonary morbidity are described here, who developed severe disease following SARS-CoV-2 infection. Case 1 (a 9-y-old boy) had pneumonia with respiratory failure requiring noninvasive ventilation support. He had delayed clearance of SARS-CoV-2, with recurrence of symptomatic disease with short asymptomatic period in between. He was also diagnosed with CF-related diabetes and allergic bronchopulmonary aspergillosis during the second episode. Case 2 (an 18-mo-old boy) had two episodes of SARS-CoV-2–related severe lower respiratory infection within a period of 2 mo, requiring high-fow nasal oxygen support. Both children had 3rd pulmonary exacerbation but SARS-CoV-2 was not detected in respiratory secretions. To conclude, children with CF with underlying pulmonary morbidity, can develop severe COVID-19 and prolonged SARS-CoV-2 shedding.