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Background: Robotic-assisted surgery has attained widespread acceptance within clinical practice, emerging as the definitive standard for various medical indications. Within the realm of Gynae surgery, there has been a notable upsurge in the utilization of robotic and laparoscopic techniques. The Versius robotic system, developed by CMR Surgical, has demonstrated its efficacy on a global scale since its introduction in 2018, marking a significant stride in the landscape of robotic-assisted surgery. This review article was dedicated to providing an impartial assessment of robotic technology, elucidating our insights gleaned from 53 gynaecological surgeries conducted with the Versius robotic system.Methods: A meticulous examination of 53 cases was undertaken, wherein average operative time, estimated blood loss, postoperative hospital stay, Intraoperative and postoperative complications, and conversion rates were subjected to retrospective scrutiny.Results: The study conducted at a Tertiary care hospital involved the analysis of 53 gynecological cases using the Versius system. Results indicate the feasibility, efficiency, and patient-friendly nature of the Versius system, with notable advantages such as reduced hospital stay and smoother manipulation of tissues.Conclusions: We acknowledge the ongoing evolutionary trajectory of robotic surgery and it is evident that its merit has already been substantiated by the endorsement of numerous medical practitioners and patients worldwide. The Versius robotic system stands as a revolutionary force within the healthcare paradigm, distinguished not only by its favorability among medical professionals but also by its patient-friendly attributes. In the realm of minimally invasive gynecologic surgery, robot-assisted surgery emerges as a compelling alternative.
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Objectives@#Education in biomedical and health informatics is essential for managing complex healthcare systems, bridging the gap between healthcare and information technology, and adapting to the digital requirements of the healthcare industry. This review presents the current status of biomedical and health informatics education domestically and internationally and proposes recommendations for future development. @*Methods@#We analyzed evidence from reports and papers to explore global trends and international and domestic examples of education. The challenges and future strategies in Korea were also discussed based on the experts’ opinions. @*Results@#This review presents international recommendations for establishing education in biomedical and health informatics, as well as global examples at the undergraduate and graduate levels in medical and nursing education. It provides a thorough examination of the best practices, strategies, and competencies in informatics education. The review also assesses the current state of medical informatics and nursing informatics education in Korea. We highlight the challenges faced by academic institutions and conclude with a call to action for educators to enhance the preparation of professionals to effectively utilize technology in any healthcare setting. @*Conclusions@#To adapt to the digitalization of healthcare, systematic and continuous workforce development is essential. Future education should prioritize curriculum innovations and the establishment of integrated education programs, focusing not only on students but also on educators and all healthcare personnel in the field. Addressing these challenges requires collaboration among educational institutions, academic societies, government agencies, and international bodies dedicated to systematic and continuous workforce development.
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ABSTRACT Rotavirus, a dsRNA virus in the Reoviridae family, shows a segmented genome. The VP1 gene encodes the RNA-dependent RNA polymerase (RdRp). This study aims to develop a multiepitope-based vaccine targeting RdRp using immunoinformatic approaches. In this study, 100 available nucleotide sequences of VP1-Rotavirus belonging to different strains across the world were retrieved from NCBI database. The selected sequences were aligned, and a global consensus sequence was developed by using CLC work bench. The study involved immunoinformatic approaches and molecular docking studies to reveal the promiscuous epitopes that can be eventually used as active vaccine candidates for Rotavirus. In total, 27 highly immunogenic, antigenic, and non-allergenic T-cell and B-cell epitopes were predicted for the Multiepitope vaccine (MEV) against rotavirus. It was also observed that MEV can prove to be effective worldwide due to its high population coverage, demonstrating the consistency of this vaccine. Moreover, there is a high docking interaction and immunological response with a binding score of −50.2 kcal/mol, suggesting the vaccine's efficacy. Toll-like receptors (TLRs) also suggest that the vaccine is physiologically and immunologically effective. Collectively, our data point to an effective MEV against rotavirus that can effectively reduce viral infections and improve the health status worldwide.
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Abstract ER:YAG laser and experimental resin-based dental adhesive loaded with functionalized carbonated apatite filler were used in this study to evaluate the dentin interaction in terms of penetration and occlusion of the dentinal tubules aiding in the control of dentin hypersensitivity (DH). Spheroidal Carbonated apatite nanoparticles (N-CAP), with an average size of 20±5 nm diameter, were synthesized, characterized, and incorporated in a universal adhesive "All Bond Universal, Bisco, USA", in (2% weight) concentration. Er:YAG laser "Lightwalker, FOTONA, EU" was adjusted to an energy output of 40mJ/ pulse and pulse repetition of 10 Hz for 10 seconds. Dentin specimens were prepared from the buccal surface of 75 extracted sound human molars. The specimens were randomly divided into five groups (n=15) according to the surface treatment: Group (L): Laser only; Group (LB): Laser in combination with adhesive; Group (LBN): Laser in combination with adhesive loaded with N-CAP; Group (B): adhesive only; and Group (BN): adhesive loaded with N-CAP. Depth of penetration and occlusion of the dentinal tubules were assessed using Environmental Scanning Electron Microscope Examination (ESEM). One-way ANOVA was used to compare groups, followed by a pairwise test for multiple comparisons (α=0.05). Groups (LB), and (LBN) showed the highest mean of dentinal tubules' penetration, with a non-significant difference between them. In contrast, the specimens treated with laser only (L) showed the most minor penetration. The employment of ER-YAG laser irradiation with the adhesive loaded with N-CAP was evaluated to be effective in penetrating and occluding the opened dentinal tubules.
Resumo O laser ER-YAG e o adesivo dentário experimental à base de resina carregado com carga de apatita carbonatada funcionalizada foram usados neste estudo para avaliar a interação com a dentina em termos de penetração e oclusão dos túbulos dentinários, auxiliando no controle da hipersensibilidade dentinária (HD). Nanopartículas de apatita carbonatada esferoidal (N-CAP), com tamanho médio de 20±5 nm de diâmetro, foram sintetizadas, caracterizadas e incorporadas em um adesivo universal "All Bond Universal, Bisco, EUA", na concentração de 2% em peso. O laser Er:YAG "Lightwalker, FOTONA, EU" foi ajustado para uma saída de energia de 40mJ/pulso e repetição de pulso de 10 Hz por 10 segundos. Os espécimes de dentina foram preparados a partir da superfície vestibular de 75 molares humanos sadios extraídos. Os espécimes foram divididos aleatoriamente em cinco grupos (n=15) de acordo com o tratamento da superfície: Grupo (L): Somente laser; Grupo (LB): Laser em combinação com adesivo; Grupo (LBN): Laser em combinação com adesivo carregado com N-CAP; Grupo (B): somente adesivo; e Grupo (BN): adesivo carregado com N-CAP. A profundidade de penetração e a oclusão dos túbulos dentinários foram avaliadas por meio do Exame de Microscópio Eletrônico de Varredura Ambiental (ESEM). ANOVA de um fator foi usada para comparar os grupos, seguida pelo teste de pares para comparações múltiplas (α=0,05). Os grupos (LB) e (LBN) apresentaram a maior média de penetração dos túbulos dentinários, com uma diferença não significativa entre eles. Em contraste, os espécimes tratados apenas com laser (L) apresentaram menor penetração. O emprego da irradiação do laser ER-YAG com o adesivo carregado com N-CAP foi avaliado como eficaz na penetração e oclusão dos túbulos dentinários abertos.
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Resumo O objetivo deste estudo é avaliar as taxas de homicídios contra mulheres residentes no Brasil, segundo unidades da federação e raça/cor, no período de 2016 a 2020. Trata-se de um estudo ecológico de tendência temporal. Foi realizada análise múltipla adotando-se modelo de regressão para dados longitudinais. No período, ocorreram no Brasil 20.405 homicídios de mulheres e as taxas padronizadas mostraram que as mulheres negras (6,1/100.000) apresentaram as maiores taxas, em comparação às brancas (3,4/100.000). O Brasil apresentou queda de 25,2% de 2016 a 2020. A taxa de homicídio variou de 4,7 mortes por 100 mil mulheres em 2016 para 3,5 em 2020, mas a tendência decrescente e estatisticamente significante foi observada nas taxas de mulheres negras e brancas. As variáveis IDH, taxa de analfabetismo e proporção de causas mal definidas apresentaram uma relação inversa e estatisticamente significante com as taxas de homicídio de mulheres. Nos anos de 2019 e 2020 houve uma diminuição da taxa média de homicídio em relação ao ano de 2016. Apesar do decrescimento na evolução temporal das taxas para negras e brancas, houve diferenças raciais importantes nos homicídios de mulheres, com piores resultados para as mulheres negras.
Abstract This ecological, time-trend study examined rates of homicide against women residing in Brazil, by state and race/colour, from 2016 to 2020, by performing. Multiple analysis by regression model on longitudinal data. During the study period, 20,405 homicides of women were recorded in Brazil. Standardised homicides rates were higher among black women (6.1/100,000) than among white women (3.4/100,000). From 2016 to 2020, rates decreased 25.2%, from 4.7 deaths per 100,000 women in 2016 to 3.5 in 2020, with a statistically significant downward trend among both black and white women. Statistically significant inverse relationships were found between female homicide rates and HDI, illiteracy rate and proportion of ill-defined causes. The average homicide rate decreased in 2019 and 2020, as compared with 2016. Despite the decreasing time trend in homicide rates for both black and white women, they differed substantially by race, with worse outcomes for black women.
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Abstract Objective: To validate the 10-item Cervantes Scale (CS-10) among Brazilian women. Methods: This is a cross-sectional observational study involving women in the community aged 40-55 years in the Southern region of Brazil. They completed a general health, habits and socio-demographic questionnaire, the CS-10 and the Women's Health Questionnaire (WHQ). Women unable to understand the survey, not consenting to participate, or having incapacity imposing difficulties during the completion of the questionnaire were excluded. A Confirmatory Factor Analysis (CFA) was conducted with the AMOS 16.0 software. Chi-square of degrees of freedom (χ2/df), the Comparative Fit Index (CFI), the Tucker-Lewis Index (TLI) and the Root-Mean-Square Error of Approximation (RMSEA) were used as indices of goodness of fit. Cronbach's alpha coefficient was used for internal consistency. Results: A total of 422 women were included (premenopausal n=35, perimenopausal n=172, postmenopausal n=215). The CFA for the CS-10 showed a good fit (χ²/df=1.454, CFI=0.989; TLI=0.985; RMSEA=0.033; CI 90%=0.002-0.052; PCLOSE=0.921; Model p=0.049). Good reliability was established in CS-10 and WHQ (Cronbach's alpha=0.724). Postmenopausal women had higher total CS-10 scores (p≤0.0001), reflecting worse quality of life (QoL) related to menopause symptoms and confirming the greater symptomatology evaluated by high total scores for WHQ found in this population when compared to those in the premenopausal period (p=0.041). Conclusion: The CS-10 is a consistent tool for health-related QoL in Brazilian mid-aged women.
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Humanos , Femenino , Calidad de Vida , Climaterio , Encuestas y Cuestionarios , Estudio de ValidaciónRESUMEN
Objectives: To explore the activities and performances of a virtual pediatrics medication counseling clinic in Riyadh City, Saudi Arabia. Methods: it was a retrospective analysis of activities and performances of a virtual pediatric medicine counseling clinic operated by the pharmacist at a public pediatric and maternity hospital. The pharmacist documented all the activities, including demographic information of patients visiting the clinic, the reason for the counseling, medication requirements to be counseled, and patient counseling items based on international guidelines. The data analysis was done through SPSS version 20 and Microsoft Excel version 2021; descriptive analysis and logistic regression of factors associated with the reason for counseling. Results: The total number of patients who visited the virtual pediatric medicine clinic through 20 months was 1955, with (97.75) per month. The majority of patients were female in the year 2021, 204 (63.55%) vs. female 900 (61.19%) in 2021, compared to male 117 (36.46%) vs. males in year 2022 628 (38.81%) with non-significant differences (p=0.149). The majority of patients were diagnosed as Diabetic Miletus in both years, 145 (45.17%) vs 884 (54.47%), with statistical significance differences between two 2021 and 2022 (p=0.000). The majority of patients counseled due to high alert medication was 230 (71.65%) in 2021 vs. 1198 (73.32%) in 2022, with non-statistically significant difference between them (p=0.539), and chronic diseases such as diabetes and asthma 224 (69.78%) vs. 901 (55.14%) in the year 2021 and 2022 respectively with statistical significance differences between both years (p=0.000). Most medication counseled was Insulin Aspart in both years, 121 (21.72%) vs. 909 (31.92%), insulin Glargine 104 (18.67%) in 2021 vs. 555 (19.49%) in 2022, and Enoxaparin in both years 40 (7.18%) vs. 205 (7.20%). Conclusion: The virtual pediatric medicine counseling clinic served many patients, emphasizing pediatric chronic diseases such as Diabetes and Asthma. Future studies are highly recommended to measure the clinical and economic outcomes and patient satisfaction.
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Objetivo: analisar práticas de enfermeiros da Estratégia Saúde da Família no pré-natal durante o terceiro trimestre gestacional. Método: trata-se de um estudo descritivo com abordagem qualitativa com 24 enfermeiros da Estratégia Saúde da Família em Iguatu, Ceará, entre agosto e dezembro de 2021. A coleta incluiu levantamento territorial e entrevistas, interpretadas por análise de conteúdo. Resultados: evidenciaram-se temas relacionados àatuação do enfermeiro nesta etapa da gestação: orientações no acompanhamento clínico no terceiro trimestre gestacional e desafios na assistência pré-natal enfrentados pelos enfermeiros. Conclusão: entre osavanços, desvelaram-se as orientações prestadas às gestantes no final da gestação relacionadas ao aleitamento materno e tipos de parto; e, entre os desafios, a sobrecarga administrativa, pois dificulta àassistência.
Objective:to analyze the practices of nurses from the Family Health Strategy in prenatal care during the third trimester of pregnancy. Method:this is a descriptive study with a qualitative approach with 24 nurses from the Family Health Strategy in Iguatu, Ceará, between August and December 2021. Collection included a territorial survey and interviews, interpreted using content analysis. Results:themes related to the role of nurses at this stage of pregnancy were highlighted: guidelines for clinical monitoring in the third trimester of pregnancy and challenges in prenatal care faced by nurses. Conclusion:among the advances, guidance provided to pregnant women at the end of pregnancy related to breastfeeding and types of birth were revealed; and, among the challenges, administrative overload, as it makes assistance difficult.
Objetivo:analizar las prácticas de los enfermeros de la Estrategia Salud de la Familia en la atención prenatal durante el tercer trimestre del embarazo. Método:se trata de un estudio descriptivo, con enfoque cualitativo, con 24 enfermeros de la Estrategia de Salud de la Familia en Iguatu, Ceará, entre agosto y diciembre de 2021. La recolección incluyó encuesta territorial y entrevistas, interpretadas mediante análisis de contenido. Resultados:se destacaron temas relacionados al papel del enfermero en esta etapa del embarazo: directrices para el seguimiento clínico en el tercer trimestre del embarazo y desafíos en el cuidado prenatal que enfrentan los enfermeros. Conclusión: entre los avances, se revelaron orientaciones brindadas a las gestantes al final del embarazo relacionadas con la lactancia materna y tipos de parto; y, entre los desafíos, la sobrecarga administrativa, ya que dificulta la asistencia.
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Atención Prenatal , Tercer Trimestre del Embarazo , Atención de EnfermeríaRESUMEN
ABSTRACT Introduction: Immune dysfunction and thrombocytopenia are common features in liver cirrhosis. Platelet transfusion is the most widely used therapeutic approach for thrombocytopenia when indicated. The transfused platelets are prone to lesions during their storage that empower their interaction with the recipient leucocyte. These interactions modulate the host immune response. The impact of platelet transfusion on the immune system in cirrhotic patients is little understood. Therefore, this study aims to investigate the impact of platelet transfusion on neutrophil function in cirrhotic patients. Methods: This prospective cohort study was implemented on 30 cirrhotic patients receiving platelet transfusion and 30 healthy individuals as a control group. EDTA blood samples were collected from cirrhotic patients before and after an elective platelet transfusion. Flowcytometric analysis of neutrophil functions (CD11b expression and PCN formation) was performed. Results: There was a significant increase in expression of CD11b on neutrophils and Frequency of platelet-complexed neutrophils (PCN) in patients with cirrhosis compared with controls. Platelet transfusion increased level of CD11b and the frequency of PCN even more. There was a significant positive correlation between change in PCN Frequency pefore and after transfusion and the change in expression of CDllb among cirrhotic patients. Conclusions: Elective platelet transfusion appears to increase level of PCN in cirrhotic patients, moreover, exacerbate the expression of activation marker CDllb on both neutrophils and PCN. More research and studies are needed to corroborate our preliminary findings.
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Background: This cone beam computed tomography (CBCT) examination aimed to determine the inter-radicular bone dimensions inside exceptional increase patterns and decide a safe region for the placement of miniscrew implants. Methods: The inter-radicular bone dimensions have been measured at particular websites within the maxillary and mandibular arches. The measurements were taken on the coastal stage, middle of the root, and apical stage of the selected teeth. Statistical evaluation was completed to compare the bone dimensions among distinctive boom styles. Results: The effects discovered giant variations in inter-radicular bone dimensions and the various increase styles. Class II and class III disorder exhibited narrower inter-radicular spaces as compared to class I disorder, especially in the maxillary arch. The crystal degree and middle of the root confirmed narrower dimensions than the apical level in all increase patterns. These findings provide valuable insights into the ability to secure zones for miniscrew implant placement primarily based on the patient's increased sample. Conclusions: This study highlights the importance of considering growth styles whilst planning miniscrew implant placement. Clinicians have to be cautious and select suitable websites for miniscrew insertion, particularly in sufferers with class II or class III disorder, to ensure the most excellent balance and avoid headaches related to inter-radicular bone dimensions. Tailoring implant placement to individual boom patterns can enhance the fulfilment and protection of orthodontic treatments utilizing miniscrew implants.
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For the concurrent measurement of Dapagliflozin Propanediol Monohydrate (DAPA) and Metformin Hydrochloride (MET) in combined dosage form, a quick, accurate, specific and easy Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS) approach was created. The method was performed on a column C8 RRHD Eclipse (150 × 4.60 mm, 5 µm). 5 mM Ammonium Acetate Buffer pH-4.0, Methanol and Acetonitrile were the components of the mobile phase in the ratios of 30:65:05, respectively. The effluent was detected at 227 nm at a flow rate of 0.4 mL/min. The observed retention times for DAPA and MET were 7.297 and 3.230 min, respectively. The drug was stressed by being exposed to acid and alkali hydrolysis. From the mass spectra, it was found that two degradant peaks were observed in the standard mixture and the sample during alkali stress condition and probable degradants formed. The developed approach was validated in accordance with ICH guidelines. With correlation coefficients of 0.9969 for DAPA and 0.9975 for MET, it was discovered that the standard curve was linear over the range of 60-140 µg/mL and 300-700 µg/mL for DAPA and MET, respectively. The limit of detection (LOD) was 2.959 µg/mL and 8.893 µg/mL for DAPA and MET, respectively. The limit of quantification (LOQ) was 8.967 µg/mL and 26.949 µg/mL for DAPA and MET, respectively. The % recovery was determined in between 98 to 102%. The precision was within the limit (Relative Standard Deviation (RSD) <2%). The proposed stability indicating LC-MS/MS method can be successfully utilized for simultaneous estimation of DAPA and MET in combined dosage form without any prior separation of individual drugs and no interference was found due to degradant formed during stress condition.
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This is a retrospective study conducted on Sudanese patients from January 2021 to May 2021 at the radiation and isotope center in Khartoum. In this study we aimed to determine the expression of P63 marker in malignant and benign breast tumors. One hundred paraffin-embedded blocks previously diagnosed as breast tumors were collected. The study included 65 (65%) samples of malignant and 35 (35%) benign samples. All these samples were Immunohistochemically stained by using monoclonal antibodies (by indirect streptavidin-biotin technique) for p63. All immune-stained slides were scored as either positive or negative. Data collected from patient file and results were analyzed using social science statistic web SPSS computer program.
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Polyembolokoilamania is a rare but serious medical condition that involves the presence of multiple foreign bodies in the patient's body. This condition can be challenging to diagnose and manage in the emergency department. In this chapter, we will discuss the presentation, diagnosis, and management of polyembolokoilamania in the emergency department.
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Background: Guillain-Barré syndrome (GBS) is a group of clinical syndromes involving acute polyneuropathy secondary to an immune-mediated process. The aim of the research is to study clinical profile and outcome in children aged 1-12 years presenting with GBS.Methods: It is a prospective plus retrospective observational study (5-year retrospective + 18 months prospective). All cases of GBS admitted from January 2020-july 2021 were enrolled for the study and retrospective cases were taken from case record from January 2015 onwards in a tertiary care centre.Results: Total 45 children were enrolled. The male: female ratio was 1.64:1. Mean age at presentation was 6.3 years, in a range of 1.5 -11.5 years of age. History of antecedent illness prior to the occurrence of GBS was present in 93.3% patients with upper respiratory tract infection being most common seen in 53.3% patients. Following variants of GBS were seen on NCV study performed in 34 patients, the most common was AIDP in 46.7% patients, followed by AMAN in 22.2% subjects and AMSAN in 6.7% patients. All children presented with lower limb weakness which progressed to involve upper limbs. Other associated features like bulbar cranial nerve involvement, respiratory muscle weakness, sensory symptoms and autonomic disturbance (arrythmia, hypotension, tachycardia, bradycardia) was observed in 30,12,7,16 patients respectively. Out of the total 45 patients, 12 patients required mechanical ventilation.Conclusions: Male predominance seen in GBS. AIDP the most common subtype of GBS. Respiratory distress and autonomic instability were associated with greater severity of Hughes disability score. Factors associated with poor outcome were sensory symptoms, autonomic instability, respiratory distress and bulbar cranial nerve involvement.
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Background & objectives: To examine ?-D-mannuronic acid (M2000) effects on L-selectin shedding and leucocyte function-associated antigen-1 (LFA-1) expression as mechanisms of action of this drug in patients with ankylosing spondylitis (AS). Methods: To investigate the molecular consequences of ?-D-mannuronic acid on L-selectin shedding, flow cytometry method was used. Furthermore, the effect of it on LFA-1 gene expression was analyzed by using quantitative real time (qRT)-PCR technique. Results: The LFA-1 expression in patients with AS was higher than controls (P=0.046). The LFA-1 expression after 12 wk therapy with ?-D-mannuronic acid was meaningfully decreased (P=0.01). After 12 wk treatment with ?-D-mannuronic acid, the frequency of CD62L-expressing CD4+ T cells in patients with AS, was not considerably altered, compared to the patients before therapy (P=0.5). Furthermore, after 12 wk therapy with ?-D-mannuronic acid, L-selectin expression levels on CD4+ T-cells in patients with AS, were not remarkably changed, compared to the expression levels of these in patients before treatment (P=0.2). Interpretation & conclusions: The results of this study for the first time showed that ?-D-mannuronic acid can affect events of adhesion cascade in patients with AS. Moreover, ?-D-mannuronic acid presented as an acceptable benefit to AS patients and could aid in the process of disease management
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Abstract Objective: Female genital mutilation/cutting (FGM/C) can affect women's lives through various physical, psychological, social and even sexual mechanisms. According to the World Health Organization guidelines for managing the health effects of FGM/C, further research into its psychological effects and preventative measures is required. In this study, a comprehensive review of the mental health consequences of circumcised women of reproductive age has been conducted with a special focus on providing preventive solutions. Methods: A comprehensive search of the Web of Science, PubMed(MEDLINE), Proquest ,Scopus and Google scholar was carried outfrom 2000 to 2022. The second stage of search was conducted in grey literature. To facilitate a systematic approach to search the literature, the PECO framework, was adopted. Results: The result of this narrative review study showed that, the most common mental health disorder in reproductive age circumcised women were depression, anxiety and post-traumatic stress disorder. Some studies found a significant relationship between parents' education level and circumcised girls, so that parents of the circumcised women had a low level of education. Two studies considered religious beliefs, tradition, cleanness, sexual desire control and virginity as the reasons for FGM/C. Conclusion: All forms of FGM/C may be harmful to one's health. Women, who have undergone widespread forms of circumcision, are more likely to develop mental disorders. As the psychosocial effects of circumcision can affect the sexual experience of circumcised women, addressing this issue, emphasizing its legal aspects, and providing preventative solutions can improve physical, mental, social, and even sexual health in circumcised women.
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Humanos , Femenino , Circuncisión Femenina , Síntomas Afectivos , DepresiónRESUMEN
Background: Mesenteric cysts are rare, benign, fluid-filled tumors that occur in the mesentery, a thin layer of tissue that supports the intestines. The management of mesenteric cysts in children typically involves surgical intervention. The aim of this study was to evaluate the prevalence, the clinical presentation and management of mesenteric cysts in children. Material & Methods: This retrospective study was conducted in the Division of Pediatric Surgery, Bangladesh Shishu Hospital & Institute, Dhaka from July 2016 to June 2022. A total of 18,326 patients admitted in the Division of Pediatric Surgery, hospital records of 55 patients diagnosed with mesenteric cysts were evaluated and included in this study. Results: The prevalence of mesenteric cyst in our study was almost 1 per 333 pediatric surgical admissions. In our study, the mean (± SD) age of the patients was 36.5±13.5 months ranged between 2 days to 12 years. Majority of the patients were male (58.2%). Of the total of 55 patients, 18 patients required emergency surgery and 37 underwent elective surgery. Abdominal pain was the main presenting symptom, present in 52.7% of the patients. Fifteen of the emergency surgery were done on preoperative diagnosis of appendicitis or perforated appendicitis with peritonitis. Majority of patients (76.4%) had multiple numbers of cysts. The cysts were located in the small bowel mesentery in 23 cases, the base of the mesentery having retroperitoneal extension in 18 cases, the transverse mesocolon in 14 cases. Complete cyst excision was done in majority of the patients (65.5%) and complete excision with intestinal resection was required in 19 (34.5%) patients. With a mean follow-up of 9 months, we encountered no recurrences. Some patients are still under follow-up. Conclusion: Mesenteric cysts are usually symptomatic and CT scan is the investigation of choice. Complete surgical excision is the optimal treatment. Prognosis is excellent after complete surgical excision; long-term follow-up is needed due to the possibility of recurrence, even in adulthood. Though mesenteric cysts are a rarity in children in the literature, but it is not so uncommon in our experience.
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Adverse cardiac remodeling refers to progressive structural and functional modifications in the heart because of increased wall stress in the myocardium, loss of viable myocardium, and neurohormonal stimulation. The guideline-directed medical therapy for Heart failure (HF) includes Angiotensin receptor-neprilysin inhibitor (ARNI) (sacubitril/valsartan), ?-blockers, sodium-glucose co-transporter 2 (SGLT2) inhibitors, and mineralocorticoid receptor antagonists (MRA). ARNI is under-prescribed in India despite its attractive safety and efficacy profile. Therefore, the consensus discusses objectives and topics related to ARNI in the management of cardiac remodeling, and experts shared their views on the early timely intervention of effective dosage of ARNI to improve the diagnosis and enhance mortality and morbidity benefits in cardiac reverse remodeling (CRR).
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Background: Acquired demyelinating diseases (ADS) ??nstitute ? heterogeneous gr?u? of central nervous system disorders of autoimmune origin that causes significant physical and cognitive disabilities. Early recognition and prompt management causes significant improvement in acute episodes of demyelinating disorders.Methods: 33 children diagnosed with demyelinating disorders at Lokmanya Tilal municipal medical college and hospital in Mumbai were enrolled. The study was conducted between January 2013 and November 2022. Demographic data, clinical profile, CSF study, serum antibody, radiological findings were collected and results were analyzed. Statistical Data was analysed using statistical software GraphPad in Stat.V3.0. Data were presented in tables and figures whenever needed. P value <0.05 considered as significant.Results: Of 33 patients, 21 (63%) were cases of acute disseminated encephalomyelitis (ADEM), 6 (18.1%) of transverse myelitis (TM), 1 case of ADEM + TM (3%), 3 (9%) of neuromyelitis optica, 1 (3%) of Optic neuritis and 1 (3%) of multiple sclerosis. ADEM patients presented with encephalopathy and multifocal neurological deficits, 40% were MOG positive. Two patients were of multiphasic ADEM. Patients of transverse myelitis had paraparesis or quadriparesis and sensory + bladder involvement. Patients with NMO presented with bilateral visual impairment with limb weakness and bladder involvement. Steroids were the primary treatment, 3 patients (9%) required intravenous immunoglobulin (IVIG) and 1 (3%) patient received plasma exchange therapy.Conclusions: ADEM is the most common ADS. Early diagnosis and management with steroids therapy improves outcome in most of the patients. Non response to steroids warrants second line treatment options like IV Immunoglobulin (IVIG) or Therapeutic plasma exchange.
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Background: Neurocysticercosis is one of the common cause of acquired epilepsy in childhood. The objective of this study was to study the clinic-demographic profile of children having Neurocysticercosis and to evaluate the potential risk factors for persistent seizures.Methods: A prospective observational study was conducted after recruiting 30 children with neurocysticercosis. After detailed history and clinical examination, the neuroimaging findings were studied. Patients were started on standard anti-helmenthic and antiepileptic therapy. A regular follow up was taken with regard seizure recurrence. A neuroimaging was repeated at 6 moths follow up.Results: Among 30 children with neurocysticercosis who presented with first seizure due to neurocysticercosis, focal seizure was the commonest (63.3%) presentation and 23.3% of these presented with status epilepticus. Out of 30 cases, 7 (23.3%) patients had seizure recurrence on follow up. Patients presenting with status epilepticus, neuroimaging showing larger lesions (size more than 10 mm), multiple number of lesions and persistent presence of lesion on the CT scan at a follow up of 6 months were the factors found to have significant positive association with recurrence of seizures on follow up.Conclusions: There are potential clinical and radiological risk factors which are associated with the recurrence or persistence of seizures in patients with neurocysticercosis.