Capacidad de los Centros de Atención Psicosocial de Alcohol y Drogas para manejar situaciones de crisis / The ability of Psychosocial Care Centers specialized in Alcohol and Drugs to handle crises / Capacidade de manejo de situações de crise por Centros de Atenção Psicossocial Álcool e Drogas

Objetivo: evaluar la capacidad de los Centros de Atención Psicosocial de Alcohol y Otras Drogas 24 horas para manejar situaciones de crisis de las personas que consumen AOD en la atención integral. Método: estudio cuantitativo, evaluativo y longitudinal, realizado de febrero a noviembre de 2019. La muestra inicial estuvo compuesta por 121 personas que consumen AOD, que recibieron atención integral en situaciones de crisis en dos Centros de Atención Psicosocial para Alcohol y Otras Drogas 24 horas en el centro de São Paulo. Los mismos fueron reevaluados después de 14 días de atención. La capacidad para manejar la crisis se evaluó mediante un indicador validado. Los datos se analizaron utilizando estadísticas descriptivas y modelos de regresión de efectos mixtos. Resultados: sesenta y siete personas que consumen AOD completaron el follow-up (54,9%). Durante la atención de las situaciones de crisis, nueve personas que consumen AOD (13,4%; p=0,470) fueron derivadas a otros servicios de la red de salud: siete por complicaciones clínicas, una por intento de suicidio y una por hospitalización psiquiátrica. La capacidad de los servicios para manejar situaciones de crisis fue del 86,6%, fue considerada positiva. Conclusión: los dos servicios evaluados fueron capaces de manejar situaciones de crisis en su área de influencia, evitando internaciones y contando con el apoyo de la red cuando fue necesario, logrando así los objetivos de desinstitucionalización.

Objective: to assess the ability of 24-hour Psychosocial Care Centers specialized in Alcohol and Other Drugs to handle the users' crises in comprehensive care. Method: a quantitative, evaluative, and longitudinal study was conducted from February to November 2019. The initial sample consisted of 121 users, who were part of the comprehensibly care in crises by two 24-hour Psychosocial Care Centers specialized in Alcohol and other Drugs in downtown São Paulo. These users were re-evaluated 14 days after admission. The ability to handle the crisis was assessed using a validated indicator. The data were analyzed using descriptive statistics and regression of mixed-effects models. Results: 67 users (54.9%) finished the follow-up period. During crises, nine users (13.4%; p=0.470) were referred to other services from the health network: seven due to clinical complications, one due to a suicide attempt, and another for psychiatric hospitalization. The ability to handle the crisis in the services was 86.6%, which was evaluated as positive. Conclusion: both of the services analyzed were able to handle crises in their territory, avoiding hospitalizations and enjoying network support when necessary, thus achieving the de-institutionalization objectives.

Objetivo: avaliar a capacidade dos Centros de Atenção Psicossocial Álcool e outras Drogas 24 horas em manejar situações de crise dos usuários no acolhimento integral. Método: estudo quantitativo, avaliativo e longitudinal, realizado de fevereiro a novembro de 2019. A amostra inicial foi composta por 121 usuários, acolhidos integralmente em situações de crise por dois Centros de Atenção Psicossocial Álcool e outras Drogas 24 horas do centro de São Paulo. Estes foram reavaliados após 14 dias de acolhimento. A capacidade de manejar a crise foi avaliada por um indicador validado. Os dados foram analisados por estatística descritiva e por regressão de modelos de efeitos mistos. Resultados: sessenta e sete usuários concluíram o follow-up (54,9%). Durante o acolhimento às situações de crise, nove usuários (13,4%; p=0,470) foram encaminhados para outros serviços da rede de saúde: sete por complicações clínicas, um por tentativa de suicídio e um para internação psiquiátrica. A capacidade de manejo das situações de crise pelos serviços foi de 86,6%, avaliada como positiva. Conclusão: os dois serviços avaliados foram capazes de manejar situações de crise no próprio território, evitando internações e tendo apoio da rede quando necessário, atingindo assim, os objetivos da desinstitucionalização.

Kasai Portoenterostomy at a Slightly Delayed Age and Native Liver Survival in Children With Biliary Atresia: Single Center Experience

Objectives: We studied the modifiable prognostic factors that extend native liver survival at 2 years after Kasai portoenterostomy (KPE). Methods: We reviewed hospital records of patients with neonatal cholestasis, with focus on infants diagnosed with biliary atresia in a tertiary care hospital between January, 2014 and May, 2021. We determined the association of outcome with clinical and laboratory variables. Results: Infants who underwent KPE at a median (IQR) age of 76 (72-79) days had best outcomes, with minimal severe post-KPE complications and 2- year survival rate of 84.6%, compared to other infants (younger and older age at KPE). The median (IQR) weight at KPE in this group was 4.66 (4.2, 5.0) kg. Conclusions: In contrast to traditional recommendations, babies with median age at KPE of 76 days had superior native liver survival (84.6%) and reduced post-KPE complications, as compared to earlier KPE age. Nutritional status and weight of infant at KPE could be associated with this survival difference. This observation needs confirmation through multicentric prospective studies in different settings.

Modified Pediatric Penile Perception Scale to Evaluate Cosmetic Outcome in Children With Hypospadias Repair

Objectives: To compare the interpretation for cosmesis post-hypospadias repair by child, parents and surgeons using modified Pediatric Penile Perception Scale (PPPS). Methods: This cross-sectional study involving 50 children (aged 2 to 17 years) with hypospadias was conducted at the pediatric surgery department of our public sector tertiary care hospital. Subjects were assessed 6 months after completion of all stages of hypospadias repair. Cosmetic assessment was done using modified PPPS. We clubbed together the variables ‘meatus’ and ‘glans’ as MG (meatus-glans) complex due to their extreme proximity (embedding), while cosmesis of phallus was considered independently. The modified PPPS scoring parameters included phallus, MG complex, shaft skin, and general appearance. Independent assessment by surgeon, patients and parents was compared, and analyzed using SAS 9.2 statistical software. Cosmetic results of single vs staged repair, and different repair types was compared. Results: Assessment using modified PPPS showed that MG complex cosmesis and skin scarring were the most heeded parameters by all three categories of observers. PPPS by surgeons remained least affected by phallic cosmesis and that of the patient by the overall phallic appearance. Tubularized incised plate urethroplasty (TIPU) scored better on cosmesis. Conclusion: Phallic cosmesis should be considered an independent variable for assessing cosmetic outcome of hypospadias, apart from MG cosmesis.

MTHFR C677T Polymorphism, Plasma Homocysteine, and PDGF-AA Levels and Transcranial Doppler Velocity in Children With Sickle Cell Disease

Objective: To evaluate the effect of methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism on plasma homocysteine (tHcy) and platelet-derived growth factor (PDGF-AA) levels in children with sickle cell disease (SCD), and ascertain their role in predicting high transcranial doppler velocity (TCD). Methods: We estimated MTHFRC677T gene polymorphism, plasma tHyc and PDGF-AA in 44 SCD patients and 44 healthy children. Results: The prevalence of mutant homozygous MTHFR (C677TT) in SCD was 13.6%. Significantly higher plasma tHcy was observed in mutant homozygous MTHFRC677TT patients. Significantly higher plasma tHcy and PDGF-AA levels were observed in SCD patients than in controls. Median (IQR) PDGF-AA levels were significantly higher in conditional and high-risk TCD patients as compared to low-riskTCD patients [325 (93.1-368) and 368 (111-480) vs 111 (56-201) pg/mL, respectively; P<0.001]. Mean (SD) tHcy levels were significantly higher in high-risk TCD children than low-risk TCD children (12.9 (2.7) vs 9.9 (2.5) µmol/L; P=0.006). The receiver operating characteristic revealed that the area under the curve (AUC) of PDGF-AA for high TCD velocity was 0.934 (95% CI 0.845-1.00; P<0.001) and tHcy had an AUC of 0.675 (95% CI 0.517-0.833; P=0.04). Conclusion: PDGF-AA and tHcy levels could be used as predictive markers for stroke in SCD children. MTHFR Polymorphism contributes to elevated tHcy levels.

Clinical profile and visual outcome in patients with traumatic optic neuropathy

Purpose: To analyze the visual outcome in patients with traumatic optic neuropathy (TON) with respect to different treatment modalities, to study the correlation of initial visual loss with the final visual outcome, and to find out the predictor of final visual outcome in patients with indirect TON. Methods: A retrospective analysis of 36 eyes with TON was done. Data on clinical profile, including demographics, mode of trauma, best corrected visual acuity (BCVA), pupillary reflex examination, and anterior and posterior segment examination, was collected. Presence and location of orbital and cranial fractures were identified from computed tomography scan. Visual outcomes following steroid therapy, optic nerve (ON) decompression, and in untreated patients were analyzed. Pre? and post?treatment BCVA were divided into three groups based on logarithm of the minimum angle of resolution (logMAR) as follows: group A: 3, group B: 2.9–1.3, and group C<1.3. BCVA values at follow?up visits were taken as the primary outcome measure. Association between various risk factors and final visual outcome in patients with indirect TON was also analyzed. Results: Out of 34 patients whose 36 eyes were studied, three (8.8%) patients were females and 31 (91.2%) patients were males. Most common mode of trauma was road traffic accident (RTA; 91.2%), which was followed by fall (8.8%) and assault (2.9%). Pre? and post?treatment BCVA values of 36 eyes were compared, and improvement in BCVA after treatment was found to be statistically significant. Also, 28.6% of patients with presenting BCVA of no light perception showed improvement compared to 94.1% and 100% in groups B and C, respectively. Orbital wall fractures were seen in 80.5% (n = 29) of the patients, with lateral wall fracture being the most common (58.3%) followed by medial wall (33.3%), roof (27.7%), floor (27.7%), and optic strut (5%). Conclusion: Baseline BCVA had significant association with final vision improvement. Lateral wall fracture was the most common fracture associated with indirect TON. Patients treated with high?dose corticosteroids, irrespective of the time of presentation, had a better visual outcome

Debilidad neuromuscular del paciente crítico post covid-19: resultados de recuperación funcional en dos centros de tercer nivel / Neuromuscular weakness in the critically post COVID-19 patient: functional recovery results in two third-level Centers

Resumen Introducción : La efectividad de las terapias de reha bilitación física sobre los pacientes que requirieron ven tilación mecánica prolongada y egresaron de Unidad de Cuidados Intensivos (UCI) con debilidad neuromuscular post COVID-19 se conoce principalmente en el perio do agudo. El objetivo de este estudio fue caracterizar la recuperación funcional en personas con debilidad neuromuscular post UCI por COVID-19 admitidas a rehabilitación. Métodos : Estudio retrospectivo que incluyó a 42 pa cientes con debilidad neuromuscular post COVID-19, de dos centros de rehabilitación de tercer nivel, desde abril de 2020 hasta abril de 2022. Resultados : Encontramos diferencias estadísticamen te significativas entre las valoraciones funcionales de ingreso y alta. La Medida de Independencia Funcional (FIM) mejoró de 49 [41-57] a 107 [94-119] (p < 0.001). La escala de Berg de 4 [1-6] a 47 [36-54] (p < 0.001), el test de 6 minutos de 0 [0-0] a 254 [167-400] (p < 0.001), y el test de 10 metros de 0 [0-0] a 0.83 [0.4-1.2] (p < 0.001). No hubo diferencias estadísticamente significativas entre la puntuación total al ingreso y al alta de las evaluaciones funcionales con la edad y la complejidad respiratoria. Discusión : El tratamiento para la recuperación fun cional en un centro de tercer nivel y larga duración, sería beneficioso para personas con grave debilidad neuromuscular post UCI a causa del COVID-19, a pesar que el 43% no alcanzó el nivel de movilidad previo. La edad y la complejidad respiratoria son variables que no impactaron en la recuperación final.

Abstract Introduction : The effectiveness of physical rehabi litation therapies on patients who required prolonged mechanical ventilation and were discharged from the Intensive Care Unit (ICU) with post-COVID-19 neuro muscular weakness is known in the acute period. The objective of this study was to characterize the functional recovery in people hospitalized with post-ICU neuro muscular weakness due to COVID-19 admitted to rehab. Methods : Retrospective study which included 42 patients with post-COVID-19 neuromuscular weakness, who were admitted to two tertiary care rehabilitation centers, from April 2020 to April 2022. Results : We found statistically significant differen ces between the functional evaluations of admission and discharge. The Functional Independence Measure improved from 49 [41-57] a 107 [94-119] (p < 0.001). The Berg scale from 4 [1-6] a 47 [36-54] (p < 0.001), the 6-mi nute test from 0 [0-0] a 254 [167-400] (p < 0.001), and 421 the 10-meter test from 0 [0-0] a 0.83 [0.4-1.2] (p < 0.001). There were no statistically significant differences bet ween the admission and discharge total score of the functional assessments with age and respiratory com plexity. Discussion : Treatment for functional recovery in a tertiary and long-term center is beneficial for people with severe post-ICU neuromuscular weakness due to COVID-19, even though 43% did not reach the previous level of mobility. Age and respiratory complexity are variables that did not impact the final recovery.

Pain and Physiological Stress During Minimally Invasive Surfactant Therapy (MIST) in Very Preterm Infants

Objectives: To evaluate the pain or physiological stress caused during minimally invasive surfactant therapy (MIST) to very preterm neonates. Methods: In this prospective observational study conducted in a tertiary NICU, very preterm neonates were assessed for pain using Premature Infant Pain Profile-Revised (PIPP-R) score before, during and after MIST. Changes in the heart rate and oxygen saturation were also recorded during the procedure. Results: 23 neonates who received MIST were assessed for pain using PIPP-R. Mean (SD) PIPP-R score during MIST was 3.87(1.3), before; 12.83 (1.9), during; and 6.26 (1.0), after the procedure, respectively (all P<0.001). Heart rate and oxygen saturation were also significantly reduced during MIST (P<0.001). Conclusion: The high PIPP-R scores during surfactant administration suggest that MIST can cause moderate to severe pain/discomfort and significant physiological stress in very preterm infants.

Assessment of QT Interval Abnormalities on Electrocardiogram in Children With Breath-Holding Spells

Objective: To assess QT interval abnormalities among children with breath-holding spells. Methods: This case control study included 204 children (104 cases of breath-holding spells and 100 healthy children) younger than 3 years. Breath-holding spells were evaluated for age of onset, type (pallid/cyanotic), triggering factors, frequency and presence of family history. Twelve- lead surface electrocardiogram (ECG) was analyzed for QT interval (QT), corrected QT interval (QTc), QT dispersion (QTD) and QTc dispersion (QTcD) in milliseconds. Results: The mean (SD) QT, QTc, QTD and QTcD interval in milliseconds were 320 (0.05), 420 (0.07), 61.15 (16.20), 102.3 (17.24), respectively for breath-holding spells as compared to control group [300 (0.02), 370 (0.03), 38.6(14.28), 78.6 (14.28), respectively] (P<0.001). Similarly, pallid breathholding spells had prolonged mean (SD) QT, QTc, QTD and QTcD interval in milliseconds [380 (0.04), 520 (0.08), 78.88 (10.78), 123.33 (10.28), respectively] as compared to cyanotic spells [310 (0.04), 400 (0.04), 57.44 (14.64), 97.90 (15.03), respectively] (P<0.001). The mean QTc interval was 590 (0.03) and 400 (0.04) milliseconds in prolonged and non-prolonged QTc group, respectively (P<0.001). Conclusion: Abnormal QT, QTc, QTD and QTcD were observed among children with breath-holding spells. ECG should be strongly considered, especially in pallid, frequent spells occurring at younger age and having positive family history, to identify long QT syndrome.

Overall and Event Free Survival of Childhood Cancer - Report From a Hospital-based Cancer Registry in Northern India, 2013-21

Objectives: Using data from a hospital-based cancer registry (HBCR) in the private sector in Northern India, we provide overall survival (OS) and event-free survival (EFS) for childhood cancer patients. Methods: All newly diagnosed childhood (age <18 years) cancer patients in our HBCR registered between March 1, 2013 till July 31, 2021 were eligible. 3-year and 5-year OS (death was an event), EFSc (death, progression/relapse was an event), and EFSa (death, progression/relapse, abandonment of treatment was an event) were calculated using the Kaplan-Meier method. Regression analysis was done to see their association with demographic, diagnostic and treatment variables. Results: 705 newly diagnosed children (36.2% female) with cancer were registered. Common cancers were leukemias (26%), CNS tumors (20%) and bone tumors (16%). 202 (28.6%) had experienced an event at median follow up of 1.95 years (range 0-8.14 years), which included 23 (3.3%) who abandoned treatment. The 3- year OS, EFSc, EFSa were 70.8%, 64.4% and 63.6%, respectively. Correspondingly, 5-year OS, EFSc, EFSa were 66%, 58.6% and 57.5%, respectively. There was no significant difference by age group, gender, nationality, and if cancer directed treatment initiated elsewhere. The OS, EFSa and EFSc by the main and the extended International Childhood Cancer Classification categories varied significantly (P<0.001). Conclusion: We add more recent registry-based OS data on childhood cancer in India and present the first estimates on EFS.

AN OUTCOME ANALYSIS OF SUSTAINABLE ENERGY AND ITS ROLE IN ELECTRICAL VEHICLE

The future of sustainable energy is bright, with continued advancements in technology and growing global awareness of the need to transition to renewable energy sources to combat future challenges. The electrical vehicle is new hope for the automobile industry where the deduction of carbon emission is the priority. The increasing level of carbon emission may be harmful to the environment and society. A qualitative exploration of sustainable energy and its role in electrical vehicles are other aspects of the study where green energy is another variable. The research design used in the study is exploratory in nature and covers the different dimensions of sustainable energy. Production of the batteries is also following certain protocols of natural sustainability and emission. This study will enunciate the role of sustainable energy sources under the aspects of green energy. Economic benets are also associated with the dened issue. Resultants are qualitative in nature where the crux of the previous study had been discussed. This study has concluded

Sinonasal Outcomes Using Oral Corticosteroids in Patients with Chronic Rhinosinusitis with Nasal Polyps and Positive Sinonasal Cultures

Abstract Introduction Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and positive sinonasal bacterial cultures may be recalcitrant to topical therapy alone due to the additional local inflammatory burden associated with bacterial infection/colonization. Objectives To evaluate sinonasal outcomes in CRSwNP patients with a positive perioperative bacterial culture, who were treated with postoperative intranasal corticosteroids (INCS) alone versus INCS in combination with a short-term course of oral corticosteroids (OCS). Methods This is a retrospective chart review of CRSwNP patients. A total of 59 patients met inclusion criteria, including positive perioperative bacterial culture and treatment with INCS with or without concomitant use of OCS. Two cohorts were formed based on the chosen postoperative medical treatment; 32 patients underwent postoperative INCS alone, while 27 underwent INCS plus a ≤ 2-week course of OCS. The 22-item sinonasal outcome test (SNOT-22) scores and Lund-Kennedy scores (LKS) were assessed preoperatively, and at 2-week, 4-week, and 4 to 6 months after endoscopic sinus surgery (ESS). Results There were no statistically significant differences in postoperative sinonasal symptoms or endoscopic scores between the cohorts treated with INCS plus OCS versus those prescribed INCS alone (p > 0.05). Our regression model failed to demonstrate a relationship between the use of OCS and better sinonasal outcomes at 2-week, 4-week, and 4 to 6 months after ESS (p > 0.05). Conclusions Our study suggests that in a cohort of CRSwNP patients with recent bacterial infections, the postoperative use of combined OCS and INCS did not result in a statistical improvement of endoscopic and symptomatic outcomes over INCS irrigation alone. However, both treatment groups had a clinically significant improvement based on the Minimal Clinically Important Difference.

Etiology and Outcome of Community-Acquired Acute Kidney Injury in Pediatric Inpatients

Objective: To estimate the etiology, outcome, and risk factors for mortality in children with community-acquired acute kidney injury (CA-AKI). Methods: Between October, 2020 and December, 2021, consecutive hospitalized children aged 2 mo-12 years with a minimum 24 hours of stay, and at least one serum creatinine level measured at or within 24 hours of hospitalization were prospectively enrolled. CA-AKI was labelled in children with an elevated serum creatinine level at admission and subsequent fall during hospitalization. Results: Of 2780 children, 215 were diagnosed as CA-AKI (7.7%, 95% CI 6.7-8.6). Diarrhea with dehydration (39%) and sepsis (28%) were the most common causes of CA-AKI. 24 children (11%) died during hospitalization. Requirement of inotropes was an independent predictor of mortality. Out of 191 children discharged, 168 (88%) had complete renal recovery. At 3 months, out of 22 children without complete renal recovery, 10 progressed to chronic kidney disease (CKD), with 3 becoming dialysis dependent. Conclusions: CA-AKI is common in hospitalized children, and is associated with increased risk of progression to CKD, especially in those with incomplete renal recovery.

Desmopressin Plus Tolterodine vs Desmopressin Plus Indomethacin for Refractory Pediatric Enuresis: An Open-label Randomized Controlled Trial

Objective: To compare the efficacy of desmopressin plus tolterodine (D+T) with desmopressin plus indomethacin (D+I) for treating enuresis in children. Design: Open-label randomized controlled trial. Setting: Bandar Abbas Children’s Hospital, a tertiary care children’s hospital in Iran, from March 21, 2018, to March 21, 2019. Participants: 40 children older than five years with monosymptomatic and non-monosymptomatic primary enuresis resistant to desmopressin monotherapy. Intervention: Patients were randomized to receive either D+T (60 µg sublingual desmopressin and 2 mg tolterodine) or D+I (60 µg sublingual desmopressin and 50 mg indomethacin) every night before bedtime for five months. Outcome: Reduction in the frequency of enuresis was evaluated at one, three, and five months, and response to treatment at five months. Drug reactions and complications were also noted. Results: After adjustment for age, consistent incontinence from toilet training, and non-monosymptomatic enuresis, D+T was significantly more efficacious than D+I; mean (SD) percent in nocturnal enuresis reduction at 1 [58.86 (7.27)% vs 31.18 (3.85) %; P<0.001], 3 [69.78 (5.99)% vs 38.56 (3.31)%; P<0.000], and 5 [84.84(6.21)% vs 39.14 (3.63)%; P<0.001] months showing a large effect. At 5 months, complete response to treatment was only observed with D+T, while treatment failure was significantly higher with D+I (50% vs 20%; P=0.047). None of the patients in either group developed cutaneous drug reactions or central nervous system symptoms. Conclusion: Desmopressin plus tolterodine appears to be superior to desmopressin plus indomethacin for treating pediatric enuresis resistant to desmopressin.

Active Bleeding Control - Can Pediatricians Stem the Tide of Lives Lost From Trauma Through ‘Stop the Bleed’ Training?

Trauma is a global challenge and India has one of the highest trauma deaths in the world. Despite the United Nations’ target to halve the global number of deaths and injuries from road traffic crashes by 2030, death tolls from road traffic injuries (RTI) are rising in India. In the pediatric age group, falls from height add to the burden of trauma. Uncontrolled bleeding from exsanguination on scene is estimated to account for nearly 40% of RTI trauma related mortality. Stopping the bleeding in the first few minutes is crucial for meaningful survival and hence the role of training lay public who can reach the scene in minutes. Active bleeding control (ABC) pilot research project to simulation train the bystanders to stop the bleed showed promising outcomes in Hyderabad, India. This paper describes the ABC project and discusses the role of pediatricians in training the public to reduce morbidity and mortality from uncontrolled bleeding at the trauma scene.

CLINICAL PROFILE IN PATIENTS WITH CEREBRAL VENOUS SINUS THROMBOSIS IN TERTIARY CARE HOSPITAL: A CROSS SECTIONAL STUDY

CVST often creates challenges regarding diagnosis among physicians, due to the nonspeci?c symptoms and countless presentation and absence of uniform symptoms. This study aims to understand current knowledge about CSVT including its pathogenesis, etiogenesis, clinical profile, diagnosis, and treatment. A Methods: descriptive cross-sectional study was conducted in the department of neurology at tertiary care hospital, Mumbai between January, 2021 and June 2022. This study was approved by institutional ethics committee. All patients who were more than 18 years with diagnosis of cerebral venous sinus thrombosis, admitted to critical care unit of neurology department were included in this study and those with bleeding disorder and prior anticoagulation therapy, already diagnosed with CVST were excluded. CVST was 3 times more common in females than in m Results: ales and the age group of 21 to 30 years was more common affected. Headache was the most common symptom seen and papilledema was the most common sign. In females puerperium was the main cause of CVST. Superior sagittal sinus and right transverse sinus were the most common sinuses involved as seen on Computed tomography(CT)venography/Magnetic resonance venography(MRV)and common finding was venous infarct. The mortality rate was 16%. Patients with Isolated intracranial hypertension syndrome(ICH) had good outcome. Variables like age ?35 years, GCS score of <8 and coma at presentation were associated with poor prognosis. CVST has a wide range of cli Conclusion nical presentation. The prognosis is good in CVST but early diagnosis with treatment and care is required in patients with poor prognostic factors.

The Clinical Outcome of Brolucizumab in the Treatment of Neovascular Age-Related Macular Degeneration – A Prospective Observational Study

Background: Neovascular age-related macular degeneration (nAMD), also known as wet AMD, is a chronic eye disease that affects the macula, which is the central part of the retina responsible for sharp, central vision. Brolucizumab is a type of anti-vascular endothelial growth factor (VEGF) drug, which works by blocking the activity of a protein called VEGF that promotes the growth of abnormal blood vessels under the macula in neovascular AMD. The aim of this study was to evaluate the clinical outcome of brolucizumab in the treatment of neovascular age-related macular degeneration. Material & Methods: This prospective observational study was conducted in Department of Ophthalmology, Bangladesh Eye Hospital & Institute Ltd, Dhaka, Bangladesh, during the period from February 2022 to February 2023. Total 60 patients with neovascular AMD were included in this study who were treated with brolucizumab. Results: The mean age of the patients was 74.3 (SD±9.8) years. Majority of the study subjects were (51.7%) female patients in the study. In our study, majority (38.3%) of the patients had only their right eye affected. In optical coherence tomography (OCT) findings, we found that a high percentage of patients had subretinal fluid (85%), intraretinal fluid (61.7%), and sub-RPE fluid (83.3%). The BCVA showed a significant change after 12 weeks of treatment, as indicated by the P-value of 0.0007. Here improvement of vision was seen in patients with AMD with active Choroidal neovascularization (CNV). But in case of AMD with macular scar, no improvement of vision was seen. In addition, the SRT, FCP, and CMT parameters also showed a statistically significant (P<0.001) improvement after brolucizumab treatment. In our study, 4 patients (6.7%) experienced intraocular inflammation, which is inflammation within the eye, 2 patients (3.3%) reported cloudy vision, and 3 patients (5%) experienced eye redness as a complication of the treatment. The majority of the patients, 51 (85%) did not experience any complications from the treatment. After treatment, improved vision was seen in most of the study patients (70%) and 30% had no improvement. Conclusion: From the findings of our study, it can be concluded that brolucizumab may be an effective treatment for neovascular AMD, as it can improve the best-corrected visual acuity and structural outcomes of the retina such as subfoveal retinal thickness, foveal center point, and central macular thickness. There was also a tolerable complication rate after treatment.

Efficacy of Neoadjuvant Chemotherapy on Locally Advanced Gastric Adenocarcinoma in Terms of Downstaging and Resectability in a Tertiary Cancer Hospital

Background: Neoadjuvant chemotherapy (NACT) in carcinoma stomach was introduced in an effort to eliminate micro-metastasis and to improve resectablity before surgery which improves R0 resection rates. The aim of the current study was to evaluate the effect of neoadjuvant chemotherapy on downstaging and resectability rate in locally advanced gastric cancer. Material & Methods: This was a single-center quasi-experimental study conducted in the Department of Surgical Oncology in collaboration with the Departments of Medical Oncology, Radiation oncology, and Pathology at the National Institute of Cancer Research and hospital, Dhaka, which is a tertiary care cancer hospital in Bangladesh, between January 2021 and June 2022.Patients with locally advanced adenocarcinoma stomach staged by contrast-enhanced computed tomography (CECT) were randomly included in this study by purposive sampling. Patients in Group I underwent upfront surgery Patients in Group II were started on neoadjuvant chemotherapy, either XELOX or FLOT regimen. Surgery was done following the response assessment CECT. We assessed R0 resection rate, age, sex, comorbidities, tumour size, TNM stage and complications were compared between the two groups. Response to NACT was assessed in Group II. Results: The mean age of patients in groups 1 & 2 was 56 ± 11.06 and 55.70 ± 10.46 years of age respectively (p > 0.05). Majority of the respondents (55/74) were male and 19 patients (26%) were female. Male to female ratio was (24/37 &31/37) in group 1 and (31/37 & 6/37) groups respectively (p > 0.05). Out of 37 patients who received NACT, in 9 patients (24.32%) complete response was noted. Partial response was found in 20 cases (54.05%), p-value (<.0001) while a stable disease was reported in three (8.1%) cases. 5 patients (13.51%) had progressive disease. In the upfront surgery group, R0 resection was feasible in 16 (43.2%) cases, and in the NACT plus surgery group, R0 resection was done in 29 (78.4%) cases. In group 1, R1 resection was done in considerable numbers (19/37) compared to group 2 (5/37), P=0.001. Three patients (8.1%) in group 2 and one (2.7) in group 1 had irresectable lesions. Conclusion: In this study it can be concluded that neoadjuvant chemotherapy could downstage tumour and increase tumor resectability rate in patients with locally-advanced gastric adenocarcinoma. However, further studies are necessary to confirm the effect of this modality on patients’ overall survival. We await survival analysis to further validate the role of NACT.

An Exploratory Study to Assess the Knowledge & Attitude of Parents Regarding Play Needs of Children (under 5 years of age) in Selected Hospital of Durg (C.G.)

Background-The human life has a distinct sphere– the world of play makes childhood more meaningful, happy & motivate the child to learn, develop & mature. Parents, teachers, nurses, psychologists are becoming increasingly aware of the importance of play and its influence upon bringing of children. The study was designed to assess the knowledge and attitude of parents regarding play needs of children. Materials & Methods- 100 couples were selected using purposive sampling technique. A structured questionnaire was prepared for assessing the knowledge & attitude of parents regarding play needs of children (under 5 years of age). Results- 20% of them had moderately adequate knowledge whereas 22% had moderately adequate attitude with. Knowledge & attitude of parents correlated. There is no significant association between socio demographic variables and knowledge except gender, religion, and mass media exposure, type of family, and monthly income and number of children as demographic variables. There is no significant association between socio demographic variables and attitude except gender, religion, qualification, type of family, and number of children as demographic variables. Conclusion-This study was conducted in Govt. Hospital of Durg (Chattisgarh) with the parents having children under 5 years of age. The findings of the study recommended the further interventional approaches regarding play needs of children. Parents need to be educated about meaning and importance of play for child. It creates awareness play know, attitudes, play needs, under five.

Clinical Outcomes of Surgery for Age-related Cataract with Intraocular Lens Implantation in Two Hospitals in North-Central Nigeria

Aims: The study aimed to assess the post-operative presenting visual acuity (PVA) and best-corrected visual acuity (BCVA) from six weeks and above post-surgery, of patients operated for age-related cataract with biometry-calculated IOL power and available IOL power implantation, in two hospitals in Jos, Nigeria.Study Design: Retrospective cross-sectional survey.Place and Duration of Study: Eye units of two mission Hospitals in Jos namely; Bingham University Teaching Hospital and the Faith Alive foundation Hospital, between June and August 2021.Methodology: Patients aged 40 years and above, who had undergone surgery for age-related cataract in the preceding 18 months in two hospitals in Jos and were six weeks or more post-surgery were consecutively enrolled into the study, after obtaining informed consent. Socio-demographic data and surgical history were obtained from patients and their surgical records. The PVA and BCVA were assessed and categorized based on World Health Organization guidelines. Results: A total of 87 patients were examined within the study period. Post-operative PVA was good (?6/18) in 32 (36.8%), borderline (<6/18-6/60) in 41 (47.1%) and poor (<6/60) in 14 (16.1%) participants. After refraction, the proportion of good outcomes increased to 78.2% with only 8.1% of outcomes remaining poor. Biometry-calculated IOL power and available IOL power use did not significantly influence visual outcome (P=.645 and P=.146 for PVA and BCVA respectively).Conclusion: Majority of participants had post-operative PVA in the borderline category with residual uncorrected refractive error as the principal cause. Regardless of the IOL power implanted, surgery for age-related cataract enhanced patients’ vision. This study has shown that the presence of biometry is a guarantee of refractive success. Hence, refractive outcome audits are essential.

Cirugía en horario extendido: una visión de los actores involucrados / Extended hours surgery: a vision of the actors involved

Introducción. Las listas de espera para cirugía de alta prevalencia son producto de una limitada oferta ante una elevada demanda de jornadas quirúrgicas. Tienen un impacto sobre las condiciones médicas de los pacientes y la consulta por urgencias. Como respuesta, se han incorporado los espacios quirúrgicos adicionales en horarios no convencionales. Su creciente implementación, aunque controversial, se reconoce cada vez más como una nueva normalidad en cirugía. Hay una limitada documentación de la efectividad de la medida, debido a la complejidad e intereses de los participantes. Métodos. Se analizó desde una posición crítica y reflexiva la perspectiva de los actores involucrados en un programa de cirugía en horario extendido, estableciendo las posibles barreras y los elementos facilitadores de una política enfocada a procedimientos en horario no convencional. Asimismo, se describen posibles oportunidades de investigación en el tema. Discusión. Los programas quirúrgicos en horarios no convencionales implican un análisis de los determinantes de su factibilidad y éxito para establecer la pertinencia de su implementación. La disponibilidad de las salas de cirugía, una estandarización de los procedimientos y una cultura de seguridad institucional implementada por la normativa vigente, favorecen estas acciones operacionales. Los aspectos económicos del prestador y del asegurador inciden en la planeación y ejecución de esta modalidad de trabajo. Conclusión. La realización segura y el éxito de un programa de cirugía en horario no convencional dependen de la posibilidad de alinear los intereses de los actores participantes en el proceso

Introduction. Waiting lists for high-prevalence surgeries are the product of limited supply due to a high demand for surgical days. They have an impact on patients' medical conditions and emergency consultation. In response, additional surgical spaces have been incorporated at unconventional times. Its growing implementation, although controversial, is increasingly recognized as a new normal in surgery. There is limited documentation of the effectiveness of the measure due to the complexity and interests of the participants. Methods. The perspective of the actors involved in an extended hours surgery program was analyzed from a critical and reflective position, establishing the possible barriers, and facilitating elements of a policy focused on procedures during unconventional hours. Possible research opportunities on the topic are also described. Discussion. Surgical programs at unconventional times involve an analysis of the determinants of their feasibility and success to establish the relevance of implementation. The availability of operating rooms, a standardization of procedures and a culture of institutional security implemented by current regulations, favor these operational actions. The economic aspects of the provider and the insurer affect the planning and execution of this type of work. Conclusion. The safe realization and success of a surgical program in unconventional hours depend on the possibility of aligning the interests of the actors involved in the process