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Creighton, Breen, Catrina Denvir, Richard Johnstone, Shae McCrystal, and Alice Orchiston. "Pre-Strike Ballots and Collective Bargaining: The Impact of Quorum and Ballot Mode Requirements on Access to Lawful Industrial Action." Industrial Law Journal 48, no. 3 (September 12, 2018): 343–76. http://dx.doi.org/10.1093/indlaw/dwy022.
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Abstract In 2016, the UK Parliament passed the Trade Union Act 2016 (TU Act 2016), which introduced new quorum and approval requirements for pre-strike ballots. In Australia, mandatory pre-strike ballots, including a quorum requirement, were first introduced in 2006. This article explains the key features of the Australian pre-strike ballot system and reports on quantitative and qualitative empirical research findings on the operation of the ballots process to analyse the majority and quorum requirements, mode of ballot (postal, attendance or electronic) and choice of ballot agent. Quorum is the biggest obstacle to Australian unions authorising strike action under the pre-strike ballot rules, and postal ballots fail to reach quorum at significantly higher rates than do attendance ballots. By introducing quorums and retaining the requirement that all pre-strike ballots must be conducted by post, the TU Act 2016 endorsed the two factors under the Australian regime most likely to impede the authorisation of strike action in a pre-strike ballot.
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Sutherland, Keith. "The Two Sides of the Representative Coin." Studies in Social Justice 5, no. 2 (December 24, 2011): 197–211. http://dx.doi.org/10.26522/ssj.v5i2.987.
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In Federalist 10 James Madison drew a functional distinction between “parties” (advocates for factional interests) and “judgment” (decision-making for the public good) and warned of the corrupting effect of combining both functions in a “single body of men.” This paper argues that one way of overcoming “Madisonian corruption” would be by restricting political parties to an advocacy role, reserving the judgment function to an allotted (randomly-selected) microcosm of the whole citizenry, who would determine the outcome of parliamentary debates by secret ballot—a division of labour suggested by James Fishkin’s experiments in deliberative polling. The paper then defends this radical constitutional proposal against Bernard Manin’s (1997) claim that an allotted microcosm could not possibly fulfil the “consent” requirement of Natural Right theory. Not only does the proposal challenge Manin’s thesis, but a 28th Amendment implementing it would finally reconcile the competing visions that have bedevilled representative democracy since the Constitutional Convention of 1787.
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Alam, Shahzad, Akunuri Shalini, Rajesh Hegde, and Rufaida Mazahir. "Acute kidney injury as a predictor of poor outcome post cardiopulmonary bypass in children." International Journal of Contemporary Pediatrics 4, no. 1 (December 21, 2016): 234. http://dx.doi.org/10.18203/2349-3291.ijcp20164611.
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Background: We objective of the current study was to identify the prevalence of AKI and classify them based on Acute Kidney Injury Network (AKIN) staging system. We also evaluated the outcome of patients developing AKI and identified the associated risk factors.Methods: This retrospective study was conducted in pediatric cardiac ICU of a tertiary care hospital. Patient < 18 years who underwent cardiac surgery on cardiopulmonary bypass (CPB) for congenital heart disease were enrolled in the study. AKI was defined as increase in serum creatinine ≥ 0.3 mg/dl within 48 hours or 1.5 times or more from baseline within the first 7 days post-surgery. Results: Nine hundred and twenty children were enrolled in the study. Three hundred and twelve (34%) children developed AKI with 202 (20%) developing stage I, 92 (10%) stage II and 18 (2%) stage III. Resolution was achieved in all the patients and none developed chronic kidney disease. Risk factors for AKI were higher CPB time, higher aortic cross clamp time, significant arrhythmias and higher inotropic requirement at admission. Children with stage 2 and 3 disease had higher odds for requirement of mechanical ventilation > 24 hours and > 72 hours, length of ICU stay > 5 days and in hospital mortality. Conclusions: AKI following cardiac surgery is common. Although majority of the cases are mild disease and self-limiting it can significantly affect the outcome of these patients.
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Singer, Matthew M. "Was Duverger Correct? Single-Member District Election Outcomes in Fifty-three Countries." British Journal of Political Science 43, no. 1 (August 20, 2012): 201–20. http://dx.doi.org/10.1017/s0007123412000233.
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In districts where only one seat is contested, the electoral formula (plurality or majority) should be a major determinant of the number of parties that receive votes. Specifically, plurality rule should generate two-party competition while other institutional arrangements should generate electoral fragmentation. Yet tests of these propositions using district-level data have focused on a limited number of cases; they rarely contrast different electoral systems and have reached mixed conclusions. This study analyses district-level data from 6,745 single-member district election contests from 53 democratic countries to test the evidence for Duverger's Law and Hypothesis. Double-ballot majoritarian systems have large numbers of candidates, as predicted, but while the average outcome under plurality rule is generally consistent with two-party competition, it is not perfectly so. The two largest parties typically dominate the districts (generally receiving more than 90 per cent of the vote), and there is very little support for parties finishing fourth or worse. Yet third-place parties do not completely disappear, and ethnic divisions shape party fragmentation levels, even under plurality rule. Finally, institutional rules that generate multiparty systems elsewhere in the country increase electoral fragmentation in single-member plurality districts.
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Oppelland, Torsten. "Die thüringische Landtagswahl vom 27. Oktober 2019: Das nächste Experiment – eine rot-rot-grüne Minderheitsregierung mit Verfallsdatum." Zeitschrift für Parlamentsfragen 51, no. 2 (2020): 325–48. http://dx.doi.org/10.5771/0340-1758-2020-2-325.
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After a campaign, which was both polarized and poor in content, the state election failed to produce a clear majority in the Landtag . The winners of the election were The Left and the AfD, while the parties of the right and left center suffered losses; only the FDP gained a little and managed to pass the five percent threshold . The election outcome deemed it unlikely that a government could be formed since neither the previous red-red-green coalition nor a CDU-FDP coalition had a majority . As coalitions transcending the traditional coalition blocks or any agreements for the toleration of a minority government could not be reached either, the consequence was that in February 2020, the Thuringian FDP leader Thomas Kemmerich was elected state premier in the third ballot with votes from the FDP, CDU, and AfD . Of the latter party not a single member voted for their own candidate . The outrage in the general public led to FDP’s federal party leader Patrick Lindner to force Kemmerich to resign on the day after his election . Only then, during the „interregnum“ that followed, were CDU and the former coalition parties The Left, SPD, and Greens able to agree on a „stability mechanism“ which allowed Bodo Ramelow to be reelected as a state premier of a minority government, which is meant to stay in office for only a little more than one year .
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Sharma, Ravi, and Swapnil Baheti. "Outcome of neonatal ventilation: a prospective and cross-sectional study in tertiary care centre." International Journal of Contemporary Pediatrics 4, no. 5 (August 23, 2017): 1820. http://dx.doi.org/10.18203/2349-3291.ijcp20173793.
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Background: Neonatal mortality accounts for nearly two thirds of infant mortality and half of under 5 mortalities in India. It is possible to increase neonatal survival and improve the quality of life only through prompt and adequate management of critically ill newborn. Mechanical ventilation has become a must to enhance neonatal survival and is an essential component of neonatal intensive care.Methods: Hospital based prospective, cross-sectional study from 1st July 2012 to 30th June 2013. All NICU admitted neonate requiring mechanical ventilation were included. It was a descriptive, cross-sectional study of a prospective data.Results: Indication of mechanical ventilation: Out of 72 neonates studied, majority of preterm were ventilated for RDS - 34 (89.5%) and majority of Full term were ventilated for MAS - 16 (100%) followed by HIE - 8 (88.89%). Out of 38 RDS cases, 30 (79%) were ventilated till 4-7 days duration and 3 (7.9%) required ventilation for >10 days. Out of 16 MAS cases, 10 (62.5%) were ventilated for 4-7 days duration and none required prolonged ventilation. Duration of ventilation is not statistically associated with indication of mechanical ventilation with p=0.301.Conclusions: Mechanical and Pulmonary complications of mechanical ventilation are not statistically significant for outcome of mechanical ventilation but it increases length of NICU stay. Hypotension on ventilator, requirement of more than 3 ionotropes were associated with high mortality.
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Ranagattimath, Anand, and Ramesh R. Naik. "Capacity Building for Library Professionals: A Study." International Journal of Emerging Research in Management and Technology 6, no. 8 (June 25, 2018): 146. http://dx.doi.org/10.23956/ijermt.v6i8.131.
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The present study aims to find out need for capacity building which includes requirement of skills, support of electronic infrastructure (hardware/software related content) and relevant training programmes in the university setup. The study also concentrates on the attitudes of library professionals towards ICT applications and capacity building. The outcome of the study shows that capacity building programme is very much needed in the university libraries as the existing skills of the library professionals is deprived. The libraries have got minimum basic infrastructure, majority of the training programmes are undergone by the professionals or after the completion of the education and got the jobbut having positive attitude towards ICT applications.
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Arias-Morales, Carlos E., Nicoleta Stoicea, Alicia A. Gonzalez-Zacarias, Diana Slawski, Sujatha P. Bhandary, Theodosios Saranteas, Eva Kaminiotis, and Thomas J. Papadimos. "Revisiting blood transfusion and predictors of outcome in cardiac surgery patients: a concise perspective." F1000Research 6 (February 20, 2017): 168. http://dx.doi.org/10.12688/f1000research.10085.1.
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In the United States, cardiac surgery-related blood transfusion rates reached new highs in 2010, with 34% of patients receiving blood products. Patients undergoing both complex (coronary artery bypass grafting [CABG] plus valve repair or replacement) and non-complex (isolated CABG) cardiac surgeries are likely to have comorbidities such as anemia. Furthermore, the majority of patients undergoing isolated CABG have a history of myocardial infarction. These characteristics may increase the risk of complications and blood transfusion requirement. It becomes difficult to demonstrate the association between transfusions and mortality because of the fact that most patients undergoing cardiac surgery are also critically ill. Transfusion rates remain high despite the advances in perioperative blood conservation, such as the intraoperative use of cell saver in cardiac surgery. Some recent prospective studies have suggested that the use of blood products, even in low-risk patients, may adversely affect clinical outcomes. In light of this information, we reviewed the literature to assess the clinical outcomes in terms of 30-day and 1-year morbidity and mortality in transfused patients who underwent uncomplicated CABG surgery.
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B.B, Supriyaa, Manoj Kumar A.S, and N. Bhakthavatchalam. "CLINICAL PROFILE AND OUTCOME OF COVID-19 PATIENTS WITH REQUIREMENT OF OXYGEN THERAPY FOR GREATER THAN ONE WEEK." International Journal of Advanced Research 9, no. 06 (June 30, 2021): 638–40. http://dx.doi.org/10.21474/ijar01/13056.
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The novel coronavirus disease (COVID-19) pandemic, caused by the highly contagious severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), is still at its height causing thousands of deaths each week.Although several large randomized drug trials are underway, current survival from severe COVID-19 de- pends entirely on providing the best possible supportive care.1 Data from China suggests that although the majority of people with COVID-19 have mild illness (40%) or moderate illness (40%) about 15 % of them have se- vere illness requiring oxygen therapy, and 5% will be critically ill requiring inten- sive care unit treatment.2,3 Oxygen therapy is recommended for all moderate, severe and critical COVID-19 patients, with low doses ranging from 1-2 L/min in children and starting at 5 L/min in adults with nasal cannula, moderate flow rates for use with venturi mask (6-10 L/min) or higher flow rates (10-15 L/min) using a mask with reservoir bag. In addition, oxygen can be delivered at higher flow rates and in higher concentrations, using high-flow nasal cannula (HFNC) devices, non-invasive ventilation (NIV) and invasive ventilation devices.4 In this study we would like to identify the risk factors leading to prolonged oxygen requirement in COVID-19 patients.This information will help us in managing our resources effectively in a resource-limited setting by preparing the mindset of the patients early on in the admission for home oxygenation. The aim of the study is to assess the clinical profile and outcome of COVID-19 patients requiring oxygen therapy for more than one week duration.
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Perera, Marlon, Joseph Ischia, Damien Bolton, Arthur Shulkes, Graham S. Baldwin, and Oneel Patel. "Experimental rat models for contrast-induced nephropathy; a comprehensive review." Journal of Nephropathology 9, no. 2 (February 7, 2020): e12-e12. http://dx.doi.org/10.34172/jnp.2020.12.
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Contrast-induced nephropathy (CIN) is an iatrogenic disease caused by the parenteral administration of iodinated contrast media (CM). A number of agents are currently being assessed to minimise or prevent CIN. Such agents are typically assessed using rat models. The aim of this study was to provide a comprehensive review of the rat models of CIN used in pre-clinical research. The MEDLINE, EMBASE, Web of Science and Cochrane databases were systematically searched. Articles reporting rat models of CIN were included for assessment. Study designs, contrast agents and outcome measures were assessed. Of the assessed studies, a majority report a requirement for pre-existing renal impairment prior to the administration of CM. Outcome measures are heterogenous between studies, but typically include assessment and quantification of serum biochemical markers, cellular oxidative stress and histopathological changes. The significant variation in methodology reported in the current literature highlights the lack of consensus. The use of a reliable pre-contrast insult appears critical to result in the development of contrast nephropathy. The use of acceptable outcome measures appears to include serum laboratory markers, quantification of reactive oxygen species (ROS) and objective histopathological outcomes.
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Siwatch, Sujata, and Goter Doke. "Sublingual vs Oral Misoprostol for Labor Induction." Journal of Postgraduate Medicine, Education and Research 48, no. 1 (2014): 33–36. http://dx.doi.org/10.5005/jp-journals-10028-1097.
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ABSTRACT Background This study compares the eficacy and safety of sublingual vs oral misoprostol for induction of labor. Materials and methods 160 women admitted for induction of labor at the Postgraduate Institute of Medical Education and Research, Chandigarh were randomized to receive 25 µg misoprostol orally 3 hourly or 25 µg sublingual misoprostol 4 hourly for labor induction. Outcome The two groups were compared for number of women not delivered in 24 hours, misoprostol dose required, induction delivery interval, incidence of uterine contraction abnormalities, mode of delivery, side effects and neonatal outcomes. Results Low dose of misoprostol is eficacious with both routes of administration. Majority women delivered vaginally and of them, comparable numbers in both vaginal and sublingual misoprostol groups delivered within 24 hours of induction (93.1 and 83.7%). The sublingual route is associated with a statistically signiicant lesser induction to delivery interval (14.8 ± 6.2 hours vs 17.67 ± 7.32 hours) and lesser requirement of oxytocin augmentation (62.5 vs 35%). The occurrence of uterine contraction abnormalities and neonatal outcome was similar in both groups. Conclusion The low dose of 25 µg is eficacious and safe by both sublingual and oral routes. Sublingual route has lesser induction to delivery interval and lesser requirement for oxytocin augmentation. How to cite this article Siwatch S, Doke G, Kalra J Bagga R. Sublingual vs Oral Misoprostol for Labor Induction. J Postgrad Med Edu Res 2014;48(1):33-36.
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Patnaik, Manasi, Tejaswini M, Sudhanshu Kumar Rath, and Shaik Afrah Naaz. "Role of admission cardiotocography and amniotic fluid index on perinatal outcome in low risk pregnancy at term." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 10, no. 4 (March 24, 2021): 1591. http://dx.doi.org/10.18203/2320-1770.ijrcog20211142.
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Background: Fetal surveillance even in normal or low risk pregnancy is essential to ensure safe parturition with minimum intervention. Cardiotocography (CTG) and clinical estimation of amniotic fluid volume (AFV) measured as amniotic fluid index (AFI) are two tests that are easily available in the labor room and can be used to identify fetal well-being. Our study aimed to evaluate role of admission cardiotocography (CTG) and amniotic fluid index (AFI) on perinatal outcome in low risk pregnancy at term.Methods: The study was conducted as a prospective observational study. All low risk pregnant women at term admitted to the labor ward in early or established labour between September 2018 and August 2020 were included in the study. They underwent admission CTG and AFI assessment using ultrasonography. All parameters including CTG changes, mode of delivery, AFI, presence of meconium, APGAR score at 1 and 5 mins, need for admission in neonatal ICU and perinatal mortality were recorded. Quantitative data was compared using chi square test.Results: A total of 180 patients were included in the study. Majority of the women belonged to the age group of 30-35 years. Abnormal CTG showing fetal distress was seen in 105 (58.33%) cases. Non-reactive CTG was significantly associated with meconium stained liqour, requirement for LSCS, still birth, fetal distress, APGAR <7 at 1 and 5min and NICU admission (p<0.001). The association of low AFI with non-reactive CTG had statistically significant impact on perinatal outcomes like low birth weight, requirement for LSCS, fetal distress, APGAR <7 at 1 and 5 mins and NICU admissions.Conclusions: Admission CTG is a simple non-invasive test that can serve as a screening tool in low risk obstetric population to detect fetal distress already present or likely to develop and prevent unnecessary delay in intervention. Thus, it may help in preventing fetal morbidity and mortality.
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Gupta, Bhaskar, James E. Neffendorf, Roger Wong, David A. H. Laidlaw, and Tom H. Williamson. "Ethnic Variation in Vitreoretinal Surgery: Differences in Clinical Presentation and Outcome." European Journal of Ophthalmology 27, no. 3 (October 22, 2016): 367–71. http://dx.doi.org/10.5301/ejo.5000894.
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Purpose The true prevalence of retinal detachment and other vitreoretinal disorders in different ethnic groups is not well-established. Understanding differences in vitreoretinal disease prevalence is important to appropriately allocate resources to meet demand where ethnic variation in the community exists. The aim of this study is to provide hospital-based data on the proportion of people with vitreoretinal disorders in the 3 main ethnic groups in the United Kingdom: Caucasian, Afro-Caribbean, and South Asian. Methods A retrospective study was performed on 3,262 patients undergoing vitreoretinal procedures for various indications between 2001 and 2014 from a single center in London, UK. Results The majority of patients with known ethnicity were Caucasian (80.19%) followed by Afro-Caribbean (12.31%) and Asian (5.20%). The mean age of the study population was 59.64 ± 15.75 years, with 57.28% males. Rhegmatogenous retinal detachment (RRD) was the common indication for surgery across all ethnic groups (54.83%). Caucasians were older, on average, compared to other ethnic groups at the time of surgery for RRD (p<0.05) and achieved higher success rates after primary surgery and were less likely to require silicone oil as primary tamponade. Macular hole was more common in the ethnic minorities with similar closure rates. Surgery for complications of diabetic retinopathy was more common in Afro-Caribbeans and Asians compared to Caucasians (28.07%, 24.02%, and 9.40%, p<0.05). Conclusions This study presents a large population-based data analysis on ethnic variation in vitreoretinal disorders. This may assist in predicting the requirement of vitreoretinal service provision depending on local ethnic variation.
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Phillips, Christian. "Wanting, and Weighting: White Women and Descriptive Representation in the 2016 Presidential Election." Journal of Race, Ethnicity, and Politics 3, no. 1 (January 30, 2018): 29–51. http://dx.doi.org/10.1017/rep.2017.39.
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AbstractThis paper demonstrates that the relationship between wanting a descriptive representative based on gender, and giving that attitude weight in voting decisions, is weakest among White women voters. Among under-represented groups of voters, White women were uniquely positioned going into the 2016 presidential election—they had the option to choose “one of their own” in terms of race and gender. Yet, the majority did not vote for the White woman on the ballot, Hillary Rodham Clinton. This outcome is an opportunity to interrogate how descriptive representation functions in different ways across groups with distinct socio-political positions in American politics. I argue that the relationship between desiring descriptive representation, and giving it weight when deciding for whom to vote for, is different across groups. Using American National Election Survey (ANES) data, I show that this is the case in the 2016 election. Nearly two-thirds of White women who said that electing more women is important, voted for Trump. Moreover, White women's espoused belief in the necessity of electing more women had no significant effect on their ultimate vote choice. In contrast, the same desire for increased descriptive representation based on gender had large, positive, and significant effects on women of color's vote choice. This study bears on extant research considering descriptive representation's importance to voters based only on race, or gender, and on the broader literature linking group identities and voter behavior.
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Zuke, William A., Timothy S. Leroux, Bonnie P. Gregory, Austin Black, Brian Forsythe, Anthony A. Romeo, and Nikhil N. Verma. "Establishing Maximal Medical Improvement After Arthroscopic Rotator Cuff Repair." American Journal of Sports Medicine 46, no. 4 (June 26, 2017): 1000–1007. http://dx.doi.org/10.1177/0363546517707963.
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Background: As health care transitions from a pay-for-service to a pay-for-performance infrastructure, the value of orthopaedic care must be defined accurately. Significant efforts have been made in defining quality and cost in arthroplasty; however, there remains a lag in ambulatory orthopaedic care. Purpose: Two-year follow-up has been a general requirement for reporting outcomes after rotator cuff repair. However, this time requirement has not been established scientifically and is of increasing importance in the era of value-based health care. Given that arthroscopic rotator cuff repair is a common ambulatory orthopaedic procedure, the purpose of this study was to establish a time frame for maximal medical improvement (the state when improvement has stabilized) after arthroscopic rotator cuff repair. Study Design: Systematic review. Methods: A systematic review of the literature was conducted, identifying studies reporting sequential patient-reported outcomes up to a minimum of 2 years after arthroscopic rotator cuff repair. The primary clinical outcome was patient-reported outcomes at 3-month, 6-month, 1-year, and 2-year follow-up. Secondary clinical outcomes included range of motion, strength, retears, and complications. Clinically significant improvement was determined between various time intervals by use of the minimal clinically important difference. Results: The review included 19 studies including 1370 patients who underwent rotator cuff repair. Clinically significant improvement in patient-reported outcomes was seen up to 1 year after rotator cuff repair, but no clinical significance was noted from 1 year to 2 years. The majority of improvement in strength and range of motion was seen up to 6 months, but no clinically meaningful improvement was seen thereafter. All reported complications and the majority of retears occurred within 6 months after rotator cuff repair. Conclusion: After rotator cuff repair, a clinically significant improvement in patient-reported outcomes, range of motion, and strength was seen up to 1 year after surgery, but not beyond this. This information is important not only to establish appropriate patient expectations but also to determine a time frame for outcome collection after surgery to better define value in orthopaedic care.
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Saraswathy, Anusree, Ajitha Ravindran, Jayshree V. Vaman, and C. Nirmala. "A study on the obstetric outcome in preterm pre-labour rupture of membranes." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 10, no. 1 (December 26, 2020): 78. http://dx.doi.org/10.18203/2320-1770.ijrcog20205411.
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Background: The major risks to the baby following preterm pre-labour rupture of membranes (PPROM) are related to the complications of prematurity. Since the goal of management in PPROM is prolongation of pregnancy, the most commonly accepted management scheme for the patient less than 34 weeks is expectant management in the hospital which consists of careful observation for signs of infection, labour or fetal distress in an effort to gain time for fetal growth and maturation.Methods: Patients admitted in Obstetrics and Gynaecology Department SAT Hospital, Medical College Trivandrum, Kerala with PPROM meeting the inclusion and exclusion criteria were recruited for the study. They were followed in the antenatal, intrapartum and postnatal period and the babies were also followed in the postnatal ward. The maternal and neonatal outcome were analysed and studied.Results: Maternal chorioamnionitis developed in 12.1% of cases, abruption 1.7%, puerperal pyrexia 8.8%, early onset neonatal sepsis in 22.9% of cases, congenital pneumonia in 17% cases and neonatal deaths in 6.3% of cases. The mean gestational age at delivery in this study was 33.42 weeks with majority of cases delivering between 32-34 weeks.Conclusions: The study suggests that maternal chorioamnionitis, puerperal pyrexia, congenital pneumonia, early onset neonatal sepsis, neonatal death, and requirement for ICU care occur with increased frequency in cohorts with PPROM. The present study concluded that most common maternal morbidity associated with PPROM was chorioamnionitis, that of neonatal morbidity was prematurity and its complications. A team effort by the obstetrician and neonatologist in a tertiary care setting can ensure healthy and fruitful life for the mother and her baby.
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Bhaskar Gorla and Vishwas Rao. "Role of PSOFA-E Score in Predicting the Clinical Outcome of Critically Ill Children." Asian Journal of Clinical Pediatrics and Neonatology 8, no. 1 (April 12, 2020): 27–31. http://dx.doi.org/10.47009/ajcpn.2020.8.1.7.
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Background: Recently pediatric sequential organ failure assessment (pSOFA) score was adapted and validated in critically ill children. This study was aimed to evaluate the feasibility of addition of echocardiographic parameters to paediatric version of SOFA score (pSOFA-E score) and to adapt and validate with reference to pSOFA score in predicting the mortality of critically ill children.Subjects and Methods:This hospital based prospective, observational, analytical study was conducted in the Department of Paediatrics, A. J Hospital, Mangalore, Karnataka, from November 2017 to November 2019. A total of 74 cases were studied. Result:Most of the children were aged <1 year (41.89%). Majority of the patients (62.16%) improved and 37.84% of the patients expired. The mean and median pSOFA-E scores were 10.53±4.06 and 10 respectively and pSOFA-E score of 5-8 was noted in most of the children (32.43%). Mortality was significantly high in children with pSOFA-E score between 9-12 (39.13%), 13-16 (77.78%), 17-20 (83.33%) (p<0.001). Receiver operating characteristic curve (ROC) yielded area under curve (AUC) of 0.920 and 0.791 with a cut-off value of 11.5 in predicting mortality. Significantly higher number of children with pSOFA-E score of ≥ 11.5 had positive blood culture (30%). Conclusion:The findings of the present study validate and emphasize that, addition of score devised by requirement of ionotropes to maintain adequate ejection fraction defy simple bedside echocardiography to pSOFA score is highly useful and accurate in discrimination of PICU mortality, morbidity and cardiovascular status/ compromise of body.
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Madhavan, Giri. "Telepsychiatry in intellectual disability psychiatry: literature review." BJPsych Bulletin 43, no. 4 (March 7, 2019): 167–73. http://dx.doi.org/10.1192/bjb.2019.5.
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Aims and MethodThe aims of this review were to explore the effectiveness and patient and provider acceptability of telepsychiatry consultations in intellectual disability, contrasting this with direct face-to-face consultations and proposing avenues for further research and innovation. Computerised searches of databases including AMED and EMBASE were conducted.ResultsFour USA studies of intellectual disability telepsychiatry services have been reported. The majority (75%) focused on children with intellectual disability. Sample sizes ranged from 38 to 900 participants, with follow-up from 1 to 6 years. Outcome measures varied considerably and included cost savings to patients and healthcare providers, patient and carer satisfaction and new diagnoses.Clinical implicationsThe innovations summarised suggest a requirement to further explore telepsychiatry models. Despite some promising outcomes, there is a relative dearth in the existing literature. Further studies in other healthcare systems are required before concluding that telepsychiatry in intellectual disability is the best approach for providing psychiatric services to this population.Declaration of interestNone.
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Singh, Prachi, Namrata Saxena, Vineeta Gupta, Neeta Bansal, and Yashika Pehal. "Obstetrics outcome in pregnant women with cardiac disease in tertiary care center, Dehradun - India." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, no. 1 (December 26, 2019): 313. http://dx.doi.org/10.18203/2320-1770.ijrcog20196040.
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Background: Incidence of heart disease in pregnancy is about 1%. Pregnant patient with cardiac disease can present with lot of challenges for the obstetrician, paediatrician and the cardiologist. With improvement in diagnostic, medical, surgical management, more patient with cardiac diseases especially congenital are able to reach reproductive age. Therefore, still a cardiac disease remains a significant cause of maternal death. Maternal and fetal prognosis both is affected by the care given and the skills used in the treatment of the individual patient. Hospital has resulted in majority of cardiac disease patient being managed in a tertiary care center and this provide an opportunity to report on clinical experiences of pregnancy with cardiac disease, their management and obstetrical outcomes.Methods: This was a retrospective study, with all the patients detailed demographic information, diagnosis, course in the hospital, management, maternal and fetal outcome was obtained from the medical records and files.Results: Incidence of cardiac disease was found to be 0.7%, 47% of pregnant women fell in age group of 26-30 years, 38.2% were primigravida, only 23.53% were booked, and half of them belonged to NYHA II class. 73.5% had Rheumatic heart disease and the most common obstetrics complications were preterm labor and anemia. LSCS was done in 29.4% cases and 38.2% of the newborns were premature.Conclusions: Prematurity anaemia, IUGR, are the common obstetrical complication in pregnant patient with cardiac disease which can be taken care with increased awareness and pre-conceptional counselling especially in patient with congenital heart disease. For optimization of maternal and neonatal outcomes in these patients, dedicated team of obstetrician, fetal medicine specialist, pediatricians, cardiologist and anesthesiologist is the prime requirement.
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Samaratunga, Hemamali, Troy Gianduzzo, and Brett Delahunt. "The ISUP system of staging, grading and classification of renal cell neoplasia." Journal of Kidney Cancer and VHL 1, no. 3 (July 20, 2014): 26–39. http://dx.doi.org/10.15586/jkcvhl.2014.11.
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There have been significant changes in the staging, classification and grading of renal cell neoplasia in recent times. Major changes have occurred in our understanding of extra-renal extension by renal cell cancer and how gross specimens must be handled to optimally display extra-renal spread. Since the 1981 World Health Organization (WHO) classification of renal tumors, in which only a handful of different entities were reported, many new morphological types have been described in the literature, resulting in 50 different entities reported in the 2004 WHO classification. Since 2004, further new entities have been recognized and reported necessitating an update of the renal tumor classification. There have also been numerous grading systems for renal cell carcinoma with Fuhrman grading, the most widely used system. In recent times, the prognostic value and the applicability of the Fuhrman grading system in practice has been shown to be, at best, suboptimal. To address these issues and to recommend reporting guidelines, the International Society of Urological Pathology (ISUP) undertook a review of adult renal neoplasia through an international consensus conference in Vancouver in 2012. The conduct of the conference was based upon evidence from the literature and the current practice amongst recognized experts in the field. Working groups selected to deal with key topics evaluated current data and identified points of controversy. A pre-meeting survey of the ISUP membership was followed by the consensus conference at which a formal ballot was taken on each key issue. A 65% majority vote was taken as consensus. This review summarizes the outcome and recommendations of this conference with regards to staging, classification and grading of renal cell neoplasia.
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Bagale, Bishow Bandhu, and Anita Bhandari. "Neonatal Thrombocytopenia: Its associated risk factors and outcome in NICU in a tertiary hospital in Nepal." Journal of College of Medical Sciences-Nepal 14, no. 2 (July 30, 2018): 65–68. http://dx.doi.org/10.3126/jcmsn.v14i2.19322.
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ABSTRACTBackground: Thrombocytopenia is a frequently encountered hematological abnormality in Neonatal Intensive Care Unit (NICU). There are various maternal and neonatal risk factors associated and the incidence varies greatly depending upon the population studies. This study was performed on neonates admitted in Bharatpur Hospital NICU.Materials & Methods: In this retrospective study, 412 neonates who were admitted in NICU from November 2016 to October 2017 were included in the study. Frequency of thrombocytopenia was determined along with associated maternal and neonatal risk factors. Maternal risk factors like Pregnancy induced hypertension (PIH), Diabetes, Eclampsia, drug use and neonatal risk factors like sepsis, asphyxia, intrauterine growth retardation (IUGR), prematurity were analyzed. Requirement of platelet transfusion and the outcome were also evaluated. Results: Of the 412 neonates included, 74 had thrombocytopenia which comprised approximately 18% neonates admitted in NICU. Early onset thrombocytopenia occurring within 72 hrs comprised 91.8% while late onset thrombocytopenia occurring after 72 hrs comprised 8.2% of total thrombocytopenia. 58.1% (43) were mild , 29.7% (22) moderate and 12.2% (9) severe thrombocytopenia. The major neonatal risk factors were sepsis, asphyxia, IUGR and prematurity while gestational diabetes and PIH were maternal risk factors contributing to neonatal thrombocytopenia. Only 4.05% received platelet transfusion. 77.03% of the neonates recovered and were discharged while 12.16% neonates were referred to other centres and 5.40% neonates died.Conclusion: Neonatal thrombocytopenia accounted for 18% of neonates which were admitted in the NICU. Significant neonatal risk factors were asphyxia and sepsis and maternal risk factors were PIH and diabetes. Majority did not require platelet transfusion and outcome was also good.
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Sinha, S., SVV Raja, and MH Lewis. "Recent Changes in the Management of Blunt Splenic Injury: Effect on Splenic Trauma Patients and Hospital Implications." Annals of The Royal College of Surgeons of England 90, no. 2 (March 2008): 109–12. http://dx.doi.org/10.1308/003588408x242033.
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INTRODUCTION Management of blunt splenic injury has been controversial with an increasing trend towards splenic conservation. A retrospective study was performed to identify the effect of this changed policy on splenic trauma patients and its implications. PATIENTS AND METHODS Data regarding patient demography, mode of splenic injury, CT grading, blood transfusion requirement, operative findings hospital stay and follow-up were collected. Statistical analysis of the data was performed using non-parametric Mann–Whitney tests RESULTS Over an 8-year period, only 21 patients were admitted with blunt splenic injury. Ten patients were managed operatively and 11 non-operatively. Non-operative management failed in one patient due to continued bleeding. Using Buntain's CT grading, the majority of grades I and II splenic injuries were managed non-operatively and grades III and IV were managed operatively (P = 0.008). Blood transfusion requirement was significantly higher among the operative group (P = 0.004) but the non-operative group had a significantly longer hospital stay (P = 0.029). Among those managed non-operatively (median age, 24.5 years), a number of patients were followed up with CT scans with significant radiation exposure and unknown long-term consequences. CONCLUSIONS Non-operative management of blunt splenic trauma in adults can be performed with an acceptable outcome. Although CT is classed as the ‘gold standard’, initial imaging for detection and evaluation of blunt splenic injury, ultrasound can play a major role in follow-up imaging and potentially avoids major radiation exposure.
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Albertson, Ann M., A. Christine Wold, and Nandan Joshi. "Ready-to-Eat Cereal Consumption Patterns: The Relationship to Nutrient Intake, Whole Grain Intake, and Body Mass Index in an Older American Population." Journal of Aging Research 2012 (2012): 1–8. http://dx.doi.org/10.1155/2012/631310.
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Objective. To investigate the relationship between ready-to-eat (RTE) breakfast cereal consumption patterns and body mass index (BMI), nutrient intake, and whole grain intake in an older American population.Design. A cross-sectional survey of US households, collected by the NPD Group via the National Eating Trends (NET) survey. Main outcome measures include BMI, nutrient intake, and whole grain intake.Subjects/Setting. The sample included 1759 participants age 55 and older, which was divided into approximate quartiles based on intake of RTE breakfast cereal for the 2-week period (0 servings, 1–3 servings, 4–7 servings, and ≥8 servings).Results. In the multivariate linear regression analysis adjusted for energy and age; intake of dietary fiber, whole grains, and the majority of micronutrients examined were found to be positively associated with frequent RTE cereal consumption. The proportion of participants consuming less than the Estimated Average Requirement (EAR) was lower for the highest quartile of RTE cereal consumers compared to nonconsumers, for the majority of vitamins and minerals examined. Significant differences in BMI between RTE breakfast cereal intake groups were found for men.Conclusion. Results suggest that ready-to-eat breakfast cereals may contribute to the nutritional quality of the diets of older Americans. Prospective studies and experimental trials are needed to better evaluate the role of RTE cereal consumption in energy balance.
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Himelhoch, Seth, Sarah Edwards, Mark Ehrenreich, and M. Philip Luber. "Teaching Lifelong Research Skills in Residency: Implementation and Outcome of a Systematic Review and Meta-Analysis Course." Journal of Graduate Medical Education 7, no. 3 (September 1, 2015): 445–50. http://dx.doi.org/10.4300/jgme-d-14-00505.1.
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ABSTRACT Background There is rising concern that fundamental scientific principles critical to lifelong learning and scientific literacy are not sufficiently addressed during residency. Objective We describe the development, implementation, and evaluation of a systematic review and meta-analysis course designed to improve residents' research literacy. Intervention We developed and implemented a novel, interactive, web-enhanced course for third-year psychiatry residents to provide the theoretical and methodological tools for conducting and reporting systematic reviews and meta-analyses. The course is based on Bloom's learning model, and established criteria for reporting systematic reviews and meta-analyses. Eight sequential learning objectives were linked to 8 well-specified assignments, with the objectives designed to build on one another and lead to the creation of a scientific manuscript. Results From 2010–2014, 54 third-year psychiatry residents (19 unique groups) successfully completed the course as part of a graduation requirement. The majority rated the course as being good or very good, and participants reported a statistically significant increase in their confidence to conduct systematic reviews (χ2 = 23.3, P < .05) and meta-analyses (Fisher exact test, P < .05). Estimated total dedicated resident and faculty time over a period of 36 weeks was 36 to 72 hours and 60 hours, respectively. Residents' academic productivity included 11 conference presentations and 4 peer-reviewed published manuscripts, with 2 residents who were awarded honors for their projects. Conclusions A formal training course in systematic reviews and meta-analyses offers a valuable learning experience, which enhances residents' research skills and academic productivity in a feasible and sustainable approach.
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Petronijevic, Zvezdana, Gjulsen Selim, Lidija Petkovska, Ljubica Georgievska-Ismail, Goce Spasovski, and Liljana Tozija. "The Effect of Treatment on Short-Term Outcomes in Elderly Patients with Acute Kidney Injury." Open Access Macedonian Journal of Medical Sciences 5, no. 5 (August 9, 2017): 635–40. http://dx.doi.org/10.3889/oamjms.2017.148.
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BACKGROUND: Elderly population (≥ 65) are more prone to develop acute kidney injury (AKI) compared to younger, also elderly with AKI have an increased requirement for dialysis treatment and an elevated risk of short-term and long-term mortality.AIM: The objectives of this study were to examine the effect of treatment of short-term outcomes and mortality in elderly patients with AKI.MATERIAL AND METHODS: Seventy elderly AKI patients, that filled one of the criteria of AKI definition and had hospitalization over 24 hours, were enrolled in the study.RESULTS: The median age of patients was 74.28 ± 6.64, with mean CCI (Charlson Comorbidity Index) score of 6.94 ± 1.94. The majority of patients (70%) were classified at stage 3 of AKIN, 20% of patients were classified at stage 2 and 10% at stage 1. In the groups of patients with death outcome, the chronic cardiomyopathy was more frequently present (p = 0.034). Regarding treatment, 58.6% of the AKI patients underwent hemodialysis while 41.4% received conservative treatment. Mortality rate was 52.8%, out of which 28.6% was in-hospital mortality, while in 24.3% of patients death occurred in the follow-up period of 90 days.CONCLUSION: In our study, short- term survival is not related to different treatment options. Applied treatment in elderly patients with AKI should be assessed by measuring the long term outcome.
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Dalwani, Abdul Ghafoor, Ahsan Ali Laghari, and Syed Asad Ali. "LAPAROSCOPIC CHOLECYSTECTOMY." Professional Medical Journal 23, no. 04 (April 10, 2016): 383–88. http://dx.doi.org/10.29309/tpmj/2016.23.04.1493.
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With surgeon’s growing experience and advancement of technology laparoscopiccholecystectomy has gone thru many modifications including reduction in number and size ofports. Midline three port laparoscopic cholecystectomy is not performed extensively and istechnically possible. Aim of our study is to see outcome of midline three port laparoscopiccholecystectomy. Study Design: Descriptive study. Period: January 2013 to December 2013.Setting: Surgical unit I, Liaquat University Hospital Jamshoro. Materials and Methods: Midlinethree port laparoscopic cholecystectomy was performed in 75 patients. Outcome of procedureincluded patient’s safety, procedure’s duration, quantitative analgesic requirement, postoperativepain assessed on 10cm visual analog scale after 24 hours, post-operative hospitalstay and post-operative complications. Results: Total of 75 patients underwent midline threeport LC with majority of females 84%. Mean age being43.62±6.85 years. Mean operative timewas 41.30±6.38 minutes. Mean post-operative pain assessed on visual analog scale after24 hours was 2.5±0.45. Maximum site of tenderness was at 10mm subxiphisternal port. 47patients (62.66%) tolerated post-operative pain on NSAID (injection diclofenac), while remaining28 patients (37.33%) required additional opiate (injection Nalbuphine). Mean post-operativehospital stay was 1.186 ±0.60 days. 1patient (1.33%) had port site infection. Conclusion:Midline three port laparoscopic cholecystectomy prevents one extra scar of traditional 4portlaparoscopic cholecystectomy. This technique is safe, efficient and feasible. This techniquecan be used as an alternative approach to traditional 4 port laparoscopic cholecystectomy inuncomplicated cases.
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Khalid, Zaigham Rasool, Abdul Razzaq Mughal, Muhamamd Mujtaba Ali Siddiqui, and Riaz ul Haq. "Early outcome of total correction in adult tetralogy of fallot patients." Professional Medical Journal 27, no. 06 (June 10, 2020): 1304–10. http://dx.doi.org/10.29309/tpmj/2020.27.06.4702.
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Objectives: To detect the early outcome of total correction of Tetralogy of Fallot (TOF) in adult patients of age 16 years or above. Study Design: Retrospective descriptive case series. Setting: Paediatric Cardiac Surgery Department of Faisalabad Institute of Cardiology, Faisalabad. Period: October 2016 to June 2019. Material & Methods: All consecutive patients of age 16 years or above who underwent total correction for TOF during study period were included. Surgical procedure and early outcome measures were recorded and analyzed. Results: Sixty nine patients underwent total correction for TOF during the study period. Majority of patients (n=55, 79.7%) were between16 to 25years of age. Male dominated the study population (56.5%, n=39) with male to female ratio 1.3: 1. Nine patients (13%) had coiling of MAPCA before surgery while prior palliation with Blalock Taussig shunt (BT Shunt) was seen in 5.8 % patients (n=4). All patients were operated with trans-atrial trans-pulmonary approach (n=69, 100%). Pulmonary artery was augmented with pericardial patch in 22 cases (32%) while left pulmonary artery (LPA) augmentation was done in two patients. Pulmonary valve annulus divided in 22 % of patients (n=15), RVOT was reconstructed with trans-annular pericardial patch in 10.1% patients (n=7) while Pulmonary valve was replaced with tissue valve in 7 patients (10.1%). In one patient RV to PA continuity was established with contegra. Post operatively Inotropic support was given for initial 39 ±45 hours, mean ICU stay was 39±75 hours, mean chest drainage 1086±741 ml and mean requirement for blood transfusion was 2.2 ±2.4 units. As regard early complications, six patients had tiny to small residual VSD (8.7%) while no patient developed complete heart block. Two patients had neurological damage (2.9%), one patient developed renal failure (1.45%) while chest reopening was done in two patients due to postoperative bleeding and/ or tamponade (2.9%). There was death of two patients (2.9%), one had renal failure due to low cardiac output (LCOS) and the other had stroke. Conclusion: The early outcome of complete repair of TOF in patients 16 years and above is good with a negligible mortality and limited number of complications.
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Cole, Alistair. "A Strange Affair: The 2002 Presidential and Parliamentary Elections in France." Government and Opposition 37, no. 3 (July 2002): 317–42. http://dx.doi.org/10.1111/1477-7053.00103.
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The 2002 Elections In France Were A Gripping Drama Unfolding in four acts. Each act has to be understood as part of a whole, as each election was ultimately dependent upon the results of the first round of the presidential election on 21 April. However untypical in the context of Fifth Republican history, the first round of the presidential election strongly inf luenced the peculiar course of the subsequent contests. The outcome of the first election on the 21 April – at which the far-right leader Jean-Marie Le Pen won through to the second ballot against Jacques Chirac, narrowly distancing the outgoing premier Lionel Jospin – created an electric shock which reverberated around the streets of Paris and other French cities and sparked a civic mobilization without parallel since May '68. The end-result of this exceptional republican mobilization was to secure the easy (initially rather unexpected) re-election of Chirac as president at the second round two weeks later. The election of 5 May was unlike a typical second-round election. Rather than a bipolar contest pitting left and right over a choice of future governmental orientations, it was a plebiscite in favour of democracy (hence Chirac) against the far-right (Le Pen). Chirac was re-elected overwhelmingly as president, supported by at least as many leftwing as right-wing voters. This enforced plebiscite against the extreme right allowed a resurgent Jacques Chirac to claim a renewed presidential authority. At the parliamentary election of 9 and 16 June, the Fifth Republic reverted to a more traditional mode of operation, as a new ‘presidential party’, informally launched just weeks before the elections, obtained a large overall majority of seats to ‘support the President’ in time-honoured Fifth Republican tradition.
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PL, Bordoloi, Barooah MS, and M. Gogoi. "Demography and Feeding Practices of ICU Patient of Government and Private Hospitals of Jorhat District, Assam." International Journal of Public Health Science (IJPHS) 6, no. 4 (December 1, 2017): 288. http://dx.doi.org/10.11591/ijphs.v6i4.8065.
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The aim of the present study was to analyze the characteristics and feeding practices of patient admitted to medicine ICUs. All relevant clinical and dietary information were collected for patients admitted to ICUs of selected Government and private hospitals of Jorhat district, Assam. This information was abstracted with the help of pre-structured schedule from the Medical Record Department and Intensive Care Unit team and analysed. A total of 1034 patients were admitted during the study period. Majority of the patients (49.61%) were from the age group of 60years and above. Majority incidence of diseases is a reason of admission in ICUs of both the hospitals was non-communicable diseases and patients were admitted via emergency OPD. Highest length of stay of 10-15 days was observed among the majority of patient from government hospital while it was shorter (6-10 days) for private hospital. The daily feeding pattern of each of the patients was recorded. Patients dependent on homemade blenderized foods for nutritional support were more in Government hospital while compare to the patient using both the commercial formulae as well as homemade food till the last day of stay in private hospitals. Increased cost of hospitalization and better outcome of patient in terms of short stay at hospitals and better nutritional status of the patient admitted to private hospitals were not feasible for low income groups patients admitted in Government hospital. The results of the present study will help the need of formulation and development of patient specific homemade foods with its ingredients used and nutritional requirement in it are taken account for both oral and enteral feedings in the hospitals with higher standard values with all demonstration on the development of protocols for clean techniques in the preparation, safe handling and storage of handmade enteral feeds.
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Rossi, Davide, Chiara Lobetti Bodoni, Elisa Genuardi, Luigia Monitillo, Daniela Drandi, Clara Deambrogi, Michaela Cerri, et al. "Telomere Length Is An Independent Predictor of Survival, Treatment Requirement and Richter’s Syndrome Transformation in Chronic Lymphocytic Leukemia." Blood 112, no. 11 (November 16, 2008): 1052. http://dx.doi.org/10.1182/blood.v112.11.1052.1052.
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Abstract Background and aims. In CLL, TL has been associated to outcome. However a larger patient sample and an analysis on a blinded validation series are required to fully establish the independent prognostic value of TL and to define its impact on prognostic subgroups defined according to established predictors. These issues have been addressed on a CLL learning cohort and validated on an independent blinded cohort, overall accounting for 401 CLL patients. Also, we have tested TL as a risk factor of Richter’s Syndrome (RS), an extremely severe event that most of the currently available biomarkers fail to predict. Methods. The learning series (LS) included 191 patients from the university of Torino (UT), while the blinded validation series (BVS) included 210 patients from University of Eastern Piedmont (UEP). TL was assessed on PBMC collected at diagnosis by Southern blotting and no biological or clinical feature of BVS patients was available to the laboratory performing the analysis. Detailed clinical history, clinical parameters at diagnosis as well as VH-mutational status, cytogenetics, CD38 expression and Zap-70 were available for the vast majority of patients and employed together with TL as covariates for multivariate survival analysis. Results. The two series showed no differences for any clinical and biological features except age that was slightly higher in the BVS series. Also TL distribution was similar in the two series (median TL 6024 and 5959 bp respectively). By applying ROC analysis and Youden’s index to the LS we identified a cut-off point of 5000bp segregating 26% (104/401) of patients in the high-risk subgroup. TL was a powerful and independent outcome predictor for both TFS (24.6 vs 73 months p<.001, Fig.1A) and OS (105.5 vs 281 months p<0.001, Fig. 1B). The same cut-off was then applied to the BVS and again TL emerged as strong predictor for TFS (15.2 vs 130.8 months; p<.001) and OS (79.8 vs not reached; p<.001). Multivariate analysis in the BVS selected TL as an independent predictor for both TFS (p=.002) along with peripheral blood lymphocytes (p<.001), CD38 expression (p<.001), beta-2-microglobulin levels (p=.001), and unfavorable FISH karyotype (p=.046), and OS (p.035) (along with age >65 years, p<.001 and advanced Binet stage p=.015). The strict biopsy policy adopted at UEP in case of suspected RS allowed to demonstrate that TL≤5000 acts as an independent predictor also for this event (five-year risk: 18.9% vs 6.4%; p=.016 HR 2,70) (Fig 1C). Finally we analyzed how TL performed in conjunction to established prognostic indicators: TL segregated a CLL group displaying short TFS and OS despite being characterized by Binet A (p<.001), IGHV-homology< 98% (p<.001), CD38<30% (p<.001) and ZAP70<20% (p<.001) and favorable FISH (p<.001). Also, among CLL carrying unfavorable prognosticators, TL<5000 bp identified a CLL subgroup with longer OS despite being characterized by age >65 years (p=.004), Binet stage B-C (p<.001), or unfavorable cytogenetics (p=.001). Conclusions. These results demonstrate that TL is a powerful independent predictor of multiple outcome events in CLL and contributes to refine the prognostic assessment of CLL when utilized in combination with other prognostic markers. We thus recommend a more widespread use of this biomarker in CLL. Figure Figure
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D. K., Siva Kumar, and Karthikeyan M. "Study of clinical profile and outcome of acute kidney injury in acute poisoning and envenomation." International Journal of Advances in Medicine 5, no. 2 (March 21, 2018): 249. http://dx.doi.org/10.18203/2349-3933.ijam20180404.
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Background: Envenomation and poisonings can cause renal damage by number of mechanisms. Some of them may cause rhabdomyolysis or hemolysis, thereby leading pigment induced renal injury. Other contributory factors like shock, sepsis can also cause acute kidney injury (AKI). The study was done with the aim to evaluate the clinical profile and outcome of acute kidney injury in acute poisoning and envenomation and to find the relationship between early anti serum venom (ASV) administration and early presentation to tertiary care and outcome.Methods: This prospective observational study carried out on 50 patients with history of envenomation and poisoning after meeting the requirements of inclusion criteria. History, examination findings and investigations results were collected and analysed.Results: The incidence of AKI in envenomation and poisoning patients was 5.62%. Majority of the toxin induced AKI were due to the poisoning constitutes about 62%. Among them, paraquat (n=15) was the most common poison. snake bites were the commonest to cause AKI in the envenomation group (n=17). The average time between the event and arrival to hospital was 31 hours. Whereas in case of died patients, the average time between the event and arrival to hospital was about 59 hours. The mean time interval between poison consumption to ASV administration in recovered cases was 6.6 hours and in death cases it was 15 hours. Dialysis requirement was in about 43 (86%) patients. Of them 37 patients underwent hemodialysis (HD). 6 patients underwent peritoneal dialysis (PD). Total number of deaths in the study was 26 and the most common cause was respiratory failure (38.5%).Conclusion: The present study suggests the most common cause of AKI in case of envenomation was snake bite and in case of toxin it was paraquat poisoning. Hence it is necessary to take initiative by the government to increase the facilities in primary health care centers to save the lives of the affected people and to impose restrictions on the availability of poisonous substances in the market.
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Gangadharaiah, Jayaprakasha, Imdad Ali N, and Paresh Sankhe. "A Retrospective Analysis of Effect of Hounsfield Unit of Ureteric Calculus on Outcome of Ureteroscopic Lithotripsy." Journal of Evidence Based Medicine and Healthcare 8, no. 12 (March 22, 2021): 662–66. http://dx.doi.org/10.18410/jebmh/2021/130.
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BACKGROUND This study was conducted to check whether computer tomography (CT) parameter Hounsfield Unit has any bearing on outcome of ureteroscopic pneumatic lithotripsy and as to whether it can predict success rate of ureteroscopic lithotripsy in the management of ureteric calculus. CT Hounsfield Unit tells us about hardness of stone, and it is primarily important in non-invasive management of ureteric and renal calculus such as extracorporeal shock wave lithotripsy (ESWL). METHODS We retrospectively reviewed records of 420 patients who underwent URSL from January 2016 to January 2020. A total of 186 patients of ureteric calculus did undergo CT in pre-operative evaluation for stone. Data of those patients was taken for study. Intra op clearance of calculus was decided by ureteroscopy finding on the table. All complications and difficulties of the procedure were documented. RESULTS We analysed the correlation between the outcome of the URSL and Hounsfield unit in finding the position of the stone and size of the stone. Out of 186 study participants, 111 (59.6 %) patients needed a single procedure for stone clearance whereas 75 (40.4 %) needed multiple procedures for clearance. Out of 186, 22 had HU < 500, 112 had HU 501 - 1000, 52 had HU > 1000. The majority of patients had HU between 501 - 1000HU. Complete clearance was seen in 63.6 % of < 500 HU patients, 62.5 % of 501 - 1000 HU patients and 55.7 % of > 1000 HU patients. This difference in clearance was statistically not significant. Similarly, the rate of complication when compared among the three groups doesn’t show a statistically significant difference (P value 0.293). The requirement of repeat procedure was maximum in > 1000 HU patients but the difference between the three groups was not statistically significant. Stone migration rate was found to be more in > 1000 HU stones (80.76 %) and this was statistically significant. CONCLUSIONS To conclude CT Hounsfield Unit’s utility in predicting the stone-free rate and complication rate doesn’t show significant bearing in patient undergoing URSL procedure. KEYWORDS CT, Hounsfield Unit, URSL, Stone Free Rate, Stone Density, Complication
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Assing Hvidt, Elisabeth, Thomas Ploug, and Søren Holm. "The impact of telephone crisis services on suicidal users: a systematic review of the past 45 years." Mental Health Review Journal 21, no. 2 (June 13, 2016): 141–60. http://dx.doi.org/10.1108/mhrj-07-2015-0019.
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Purpose – Telephone crisis services are increasingly subject to a requirement to “prove their worth” as a suicide prevention strategy. The purpose of this paper is to: first, provide a detailed overview of the evidence on the impact of telephone crisis services on suicidal users; second, determine the limitations of the outcome measures used in this evidence; and third, suggest directions for future research. Design/methodology/approach – MEDLINE via Pubmed (from 1966), PsycINFO APA (from 1967) and ProQuest Dissertation and Theses (all to 4 June 2015) were searched. Papers were systematically extracted by title then abstract according to predefined inclusion and exclusion criteria. Findings – In total, 18 articles met inclusion criteria representing a range of outcome measures: changes during calls, reutilization of service, compliance with advice, caller satisfaction and counsellor satisfaction. The majority of studies showed beneficial impact on an immediate and intermediate degree of suicidal urgency, depressive mental states as well as positive feedback from users and counsellors. Research limitations/implications – A major limitation pertains to differences in the use of the term “suicidal”. Other limitations include the lack of long-term follow-up and of controlled research designs. Future research should include a focus on long-term follow-up designs, involving strict data protection. Furthermore, more qualitative research is needed in order to capture the essential nature of the intervention. Originality/value – This paper attempts to broaden the study and the concept of “effectiveness” as hitherto used in the literature about telephone crisis services and offers suggestions for future research.
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Newaz, Md Mehedi, Avijit Kumar Sikder, and Faruquzzaman. "Comparison of the outcome of management of congenital idiopathic clubfoot treated by ponseti method with modified technique." Bangladesh Medical Journal Khulna 52, no. 1-2 (March 26, 2020): 7–11. http://dx.doi.org/10.3329/bmjk.v52i1-2.46141.
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Background: Ponseti's technique has become the standard and most effective treatment modality for correction of Congenital Talipes Equinovarus (CTEV) in newborn. With time, little modification has been done in the classic technique.
Objective: Our objective in this study was to compare the outcome in the recent years (modified Ponseti technique) with the results of our previous study (classic Ponseti technique).
Methods: A total number of 976 patients (1553 feet) of Congenital Talipes Equino Varus were treated from October 2009 to February 2019 in Khulna Medical College Hospital and in private hospitals. In this retrospective study (based on convenient sampling), there were two groups. In group A, a total 621 patients (with a total 1033 feet) were treated from October 2009 to August, 2015. In group B, 355 patients (520 feet) were treated from November 2015 to February 2019.
Results: In this study, in group A, approximately 88.6% was in 0-6 months age group. 64.9% was male patients. 3.7% patients had positive family history. In group B, majority of the patients (301, 84.8%) was in 0-6 months age group. 211 patients (59.4%) was male child. In approximately 3.1% (11) patients family history was positive. Approximately in 95.9% (991 out of total 1033) and 96.5% (502 out of total 520) feet respectively in group A and B, tenotomy was required. Dropout rates were 7.6% and 4.1% in respective groups. Minor bleeding was observed in approximately 1.5% (15) and 1.4% (7) feet in respective groups, followed by plaster related complications in approximately 2.2% (23) and 1.0% (5) feet in group A and B. Patients' compliance was found significantly higher in group B in contrast to group A. In group B, it was over 90%, whereas in group A, it was approximately 64.1 %.
Conclusion: The ultimate outcome of Ponseti repair is improving by less requirement of total number of plaster, resistant cases and reduction in overall dropout rate by the newer modification.
Bang Med J (Khulna) 2019; 52 : 7-11
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McInnis, Micheal C., David Wang, Laura Donahoe, John Granton, John Thenganatt, Kongteng Tan, John Kavanagh, and Marc de Perrot. "Importance of computed tomography in defining segmental disease in chronic thromboembolic pulmonary hypertension." ERJ Open Research 6, no. 4 (October 2020): 00461–2020. http://dx.doi.org/10.1183/23120541.00461-2020.
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BackgroundRadiological assessment of patients with chronic thromboembolic pulmonary hypertension (CTEPH) is critical to decide whether patients should be treated with pulmonary endarterectomy (PEA). Although computed tomography pulmonary angiography (CTPA) is increasingly used for decision making in CTEPH, the value of CTPA to predict surgical findings and outcome has never been explored.MethodsWe retrospectively reviewed 100 consecutive patients with high-quality CTPA undergoing PEA for CTEPH between May 2015 and December 2017. The most proximal level of disease in the pulmonary artery on CTPA was classified by two blinded radiologists as level 1 (main pulmonary artery), 2a (lobar pulmonary artery), 2b (origin of basal segmental pulmonary artery), 3 (segmental pulmonary artery) or 4 (predominantly subsegmental pulmonary artery).ResultsCTPA demonstrated level 1 in 20%, level 2a in 43%, level 2b in 11%, level 3 in 23% and level 4 in 3%. A majority of males presented with level 1 (55%) and level 2 (57%), and a majority of females (83%) with level 3 (p=0.01). Levels 3 and 4 were associated with longer duration of circulatory arrest (p=0.03) and higher frequency of Jamieson type III disease at surgery (p<0.0001). Requirement for targeted pulmonary hypertension therapy after PEA was 28% at 3 years in level 2b/3/4 compared with 6% in level 2a and 13% in level 1 (p=0.002). Level 2b/3/4 was an independent predictor for targeted pulmonary hypertension therapy after PEA (hazard ratio 4.23, 95% CI 1.24–14.39; p=0.02).ConclusionsHigh-quality CTPA provides accurate evaluation of CTEPH patients. The level of disease on CTPA can help guide peri-operative planning and post-operative monitoring.
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Ozturk, Mehmet, Martin L. Harris, and Hemal Mehta. "An Evidence-based Approach to Using Intravitreal Steroids in the Management of Diabetic Macular Oedema." European Ophthalmic Review 11, no. 01 (2017): 44. http://dx.doi.org/10.17925/eor.2017.11.01.44.
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Diabetic macular oedema (DMO) is the leading cause of acquired visual loss in the working age population. The landscape for DMO treatment has changed significantly over the past decade. Macular laser has been reported to reduce the risk of moderate visual loss in seminal clinical trials from the 1980s, but relatively few patients achieved visual gain. With the advent of intravitreal pharmacotherapy it is now possible to achieve visual gains in the majority of patients. Intravitreal anti-vascular endothelial growth factor (VEGF) agents are now a first-line treatment option in centre-involving DMO. This review assesses clinical trial and more recent real-world evidence to guide clinicians as to when intravitreal steroids should be considered in the management of DMO. In particular, intravitreal steroids can be considered in pseudophakic patients, or those due to undergo cataract surgery, in patients unable to attend for regular intravitreal procedures, and non-responders to intravitreal anti-VEGF therapy. Assessing clinical trial data, the dexamethasone implant appears to have a more predictable intraocular rise profile than triamcinolone or fluocinolone with a lower requirement for incisional glaucoma surgery. There is a need for consensus regarding real-world outcome measures for intravitreal steroids in the management of DMO to allow easier comparison across studies.
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Chen, Shuang-Kun, Zhi-Huang Qiu, Guan-Hua Fang, Xi-Jie Wu, and Liang-Wan Chen. "Reported outcomes after aortic valve resuspension for acute type A aortic dissection: a systematic review and meta-analysis." Interactive CardioVascular and Thoracic Surgery 29, no. 3 (April 10, 2019): 331–38. http://dx.doi.org/10.1093/icvts/ivz080.
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AbstractIn the majority of patients presenting with acute type A aortic dissection (AAD) complicated by aortic valve insufficiency, the aortic valve (AV) can be preserved by AV resuspension. A meta-analysis was performed to investigate the outcomes following AV resuspension for AAD. A systematic literature search for publications reporting outcomes after AV resuspension in AAD published between January 1998 and June 2018 was conducted. Early outcome events and linearized occurrence rates for late outcome events were derived. The retrieval process yielded 18 unique studies involving 3295 patients with a total of 17 532 patient-years (pt-yrs). Pooled early mortality was 15.5% [95% confidence interval (95% CI) 11.5–19.4%, I2 = 91.9%], and the linearized late mortality rate was 3.21%/pt-yrs (95% CI 2.49–3.77, I2 = 29%). The linearized occurrence rates for aortic root reintervention was 1.4%/pt-yrs (95% CI 0.88–1.79, I2 = 48%); for recurrent significant aortic valve insufficiency (>2+), it was 1.12%/pt-yrs (95% CI 0.79–1.45, I2 = 68%); and for endocarditis, it was 0.01%/pt-yrs (95% CI 0–0.04, I2 = 7%). The composite rate of thromboembolism and bleeding was 1.41%/pt-yrs (95% CI 0.18–2.63, I2 = 82%). A more recent surgical period was associated with a decreased hazard of reoperation on the aortic root (P < 0.001). Requirement of AV resuspension alone in AAD is a risk factor for mortality. The long-term durability of AV resuspension is excellent, with low rates of endocarditis and thromboembolism and bleeding. Root reoperation hazard has become acceptable in recent years. Preoperative aortic valve insufficiency grade exceeding 2+ is a predictor for root reoperation.
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Ashraf, Fatema, Sania Sultana, Tasdik Hasan, Hamida Pervin, Fahima Mustanzid, Taslim Sazzad Mallick, Jinnat Ara Islam, et al. "Patient Empowerment: An Effective Strategy to Improve Management of GDM." Journal of Shaheed Suhrawardy Medical College 10, no. 2 (April 25, 2019): 91–94. http://dx.doi.org/10.3329/jssmc.v10i2.41167.
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Background: GDM is a public health issue, affecting mostly the South East Asian region, as well in Bangladesh (prevalence 9.7% - 12.9%). It has a significant adverse impact on maternal and foetal outcome. So it needs to be addressed energetically to avoid maternal and foetal morbidity and mortality. Also it will contribute a lot to the pool of Type II Diabetes as substantial number of GDM mother and their offspring may develop type II DM in near future. Self-management of GDM is well-known globally but there is still lacking in adequate handling of diabetes by the patients themselves. Nevertheless the lacking can be minimized through ‘Patient Empowerment’ by clear understanding of the disease and its consequences along with intense learning, training, monitoring and evaluation of the clients involved. Also it will help in emotional stability of the client which is an essential component of diabetes management during pregnancy. The innovative strategy may contribute significantly in GDM management at low cost in a resource constraint setting.
Objective: To find the effectiveness of ‘patient empowerment’ promoting better self-management of GDM.
Methodology: This quasi experimental study was done on 96 cases (48 in each group) by purposive sampling technique at Shaheed Suhrawardy Medical College Hospital (ShSMC) as study group & Rajshahi Medical College Hospital (RMCH) as control group, from August 2012 – August 2015. Both group were matched of age, parity, education and income. Ethical clearance was taken from ethical committee of both ShSMC and RMCH
Result: In the study group good glycemic control achieved with diet & exercise (75%) and Insulin required in only 25% cases, while in control group Insulin given in 75% cases. In the study group NVD (67%) were more than control group (33.3%). There were no obstructed labour in study group but control group (12.50%). Majority of the study group (74.6%) had no or minimum antenatal complication, in comparison to control group (74.66%). Regarding Neonatal outcome, neonatal resuscitation required none in study group but 12 (25%) in control group. So, overall adverse outcome observed less in study group than control group
Conclusion: Patient empowerment can be an effective tool to manage GDM cases with an outcome of good control of blood sugar; less antenatal, intrapartum and post natal complications, good foetal and neonatal outcome and low requirement of insulin.
J Shaheed Suhrawardy Med Coll, December 2018, Vol.10(2); 91-94
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Malik, Abida, Hafsah Qureshi, Humayra Abdul-Razakq, Zahra Yaqoob, Fatima Zahra Javaid, Faatima Esmail, Emma Wiley, and Asam Latif. "‘I decided not to go into surgery due to dress code’: a cross-sectional study within the UK investigating experiences of female Muslim medical health professionals on bare below the elbows (BBE) policy and wearing headscarves (hijabs) in theatre." BMJ Open 9, no. 3 (March 2019): e019954. http://dx.doi.org/10.1136/bmjopen-2017-019954.
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ObjectivesThe objective of this study is to explore the impact of workplace dress code policies and guidance that may influence inclusivity and opportunities in the workplace.DesignQuantitative, self-completion cross-sectional survey.SettingBritish Islamic Medical Association conference.ParticipantsEighty-four female medical healthcare professionals with a range of ethnicities and wide geographical coverage.Primary and secondary outcome measuresThe study reports on the experiences of female Muslim healthcare professions wearing the headscarf in theatre and their views of the bare below the elbows (BBE) policy. Percentage of positive answers and their respective 95% CIs are calculated.ResultsThe majority of participants agreed that wearing the headscarf was important for themselves and their religious beliefs (94.1%), yet over half (51.5%) experienced problems trying to wear a headscarf in theatre; some women felt embarrassed (23.4%), anxious (37.1%) and bullied (36.5%). A variety of different methods in head covering in operating theatres were identified. The majority of respondents (56.3%) felt their religious requirement to cover their arms was not respected by their trust, with nearly three-quarters (74.1%) of respondents not happy with their trust’s BBE uniform policy alternative. Dissatisfaction with the current practice of headscarves in theatre and BBE policy was highlighted, with some respondents preferring to specialise as GPs rather than in hospital medicine because of dress code matters. The hijab prototype proposed by the research team also received a positive response (98.7%).ConclusionsOur study suggests that female Muslims working in the National Health Service (NHS) reported experiencing challenges when wearing the headscarf in theatre and with BBE policy. The NHS needs to make its position clear to avoid variations in individual trust interpretation of dress code policies. This illustrates a wider issue of how policies can be at odds with personal beliefs which may contribute to a reduction in workforce diversity.
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Sheth, Paresh N., and Prema Ram Choudhary. "Prospective study to compare abdominal hysterectomy versus non- descent vaginal hysterectomy at a tertiary care hospital." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 10, no. 3 (February 24, 2021): 885. http://dx.doi.org/10.18203/2320-1770.ijrcog20210529.
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Background: Hysterectomy can be performed by vaginal, abdominal and via laparoscopic route. In the current scenario of importance of non-invasive surgery there has been increase in interest and requirement of vaginal hysterectomy for non-prolapsed uterus i.e. Non-descent vaginal hysterectomy (NDVH) due to scarless surgery. Gynecologist across the world continue to use the abdominal approach for a large majority of hysterectomies that may be performed vaginally despite well documented evidence which says that vaginal hysterectomy do have better outcome. This study aimed to find out to compare outcomes of NDVH and Abdominal hysterectomy (AH).Methods: The study is conducted at department of Obstetrics and Gynecology, at a tertiary care hospital Gujarat, India, between the periods of May 2018 to December 2019 of 100 patients. 50 Patients who underwent hysterectomy by abdominal route are taken as study group A and 50 Patients who underwent hysterectomy by vaginal routes are taken as group B.Results: Out of 100 women we have studied, duration of surgery, intra operative blood loss, intra operative complications, postoperative morbidity and duration of hospital stay, time required to resume normal work are less in group B (NDVH).Conclusions: It can be concluded that NDVH is feasible, safe and better alternative to abdominal hysterectomy for benign gynecological conditions. It also provides greater efficacy and safety with minimal invasiveness.
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Weaver, Greta, Raffaela Schiavon, Maria Elena Collado, Stephanie Küng, and Blair G. Darney. "Misoprostol knowledge and distribution in Mexico City after the change in abortion law: a survey of pharmacy staff." BMJ Sexual & Reproductive Health 46, no. 1 (November 5, 2019): 46–50. http://dx.doi.org/10.1136/bmjsrh-2019-200394.
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ObjectiveFirst-trimester abortion is widely available in Mexico City since legalisation in 2007, but few data exist surrounding pharmacy staff knowledge and sales practices. We describe misoprostol availability, whether a prescription is required, and knowledge of the legal status of abortion and uses for misoprostol among pharmacy staff in Mexico City.MethodsData were collected from 174 pharmacies in Mexico City. One employee at each pharmacy was asked about availability, need for prescription, indications for misoprostol, and sociodemographic information. Our primary outcome was availability of misoprostol. We used descriptive and bivariate statistics to compare knowledge and practices by type of pharmacy and staff gender.Patients and public involvementNo patients were involved in this study.ResultsOf the 174 pharmacies, 65 were chain and 109 small independent. Misoprostol was available at 61% of sites. Only 49% of independent pharmacies sold misoprostol, compared with 81.5% of chain pharmacies (p<0.05). Knowledge of indications for misoprostol use was similar. The majority (80%) of respondents knew that abortion was legal in Mexico City, and 44% reported requiring a prescription for sale of misoprostol, with no significant difference between male and female staff or by pharmacy type.ConclusionsAvailability, requirement of a prescription, and knowledge of indications for use of misoprostol varies among pharmacies, resulting in differential access to medical abortion. Pharmacies may be a good place to target education for pharmacy staff and women about safe and effective use of misoprostol for abortion.
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Rajbanshi, Lalit Kumar, Batsalya Arjyal, Akriti Bajracharya, and Kanak Khanal. "Comparison of Ultrasound Guided Interscalene and Supraclavicular Brachial Plexus Block for Clavicle Fracture Surgery." Journal of College of Medical Sciences-Nepal 14, no. 4 (December 30, 2018): 189–95. http://dx.doi.org/10.3126/jcmsn.v14i4.20635.
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Introduction:The clavicle has dual nerve supply from the brachial plexus and cervical plexus. The interscalene brachial plexus block combined with superior cervical plexus block is frequently used for the clavicle surgery. This study was conducted to compare ineterscalene approach with the supraclavicular approach for brachial plexus block used for clavicle surgery Methodology:This was prospective comparative study conducted for two years in tertiary care hospital. Sixty patients with clavicle fracture with ASA I and II were randomly divided into two equal groups; ISBPB (interscalene approach) and SCBPB (supraclavicular approach). Both of these blocks were combined with superior cervical plexus block. Ultrasound was used to perform all the blocks. Primary outcome for the comparison was block characteristics, which included sensory and motor block onset, duration, and block satisfaction. The secondary variables used for comparison were analgesic properties and complications. Results: Supraclavicular brachial plexus had rapid onset of sensory and motor block and was statistically significant (P<0.05) as compared to interscalene approach. Similarly, SCBPB had significantly longer duration of sensory block (P=0.003). The duration of motor block was comparable between the blocks. The intraoperative pain score (VAS), requirement of rescue analgesia with in 24 hours of surgery and complications related with the procedures were comparable between the two groups. Majority of the patients were satisfied with either of the approach for brachial plexus block. Conclusion: Supraclavicular brachial plexus block combined with superior cervical plexus block provided equally effective and adequate anesthesia and analgesia for clavicle surgery with comparable complications as compared to interscalene approach.
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Sacco, Vanessa, Barbara Rauch, Christina Gar, Stefanie Haschka, Anne L. Potzel, Stefanie Kern-Matschilles, Friederike Banning, et al. "Overweight/obesity as the potentially most important lifestyle factor associated with signs of pneumonia in COVID-19." PLOS ONE 15, no. 11 (November 18, 2020): e0237799. http://dx.doi.org/10.1371/journal.pone.0237799.
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Objective The occurrence of pneumonia separates severe cases of COVID-19 from the majority of cases with mild disease. However, the factors determining whether or not pneumonia develops remain to be fully uncovered. We therefore explored the associations of several lifestyle factors with signs of pneumonia in COVID-19. Methods Between May and July 2020, we conducted an online survey of 201 adults in Germany who had recently gone through COVID-19, predominantly as outpatients. Of these, 165 had a PCR-based diagnosis and 36 had a retrospective diagnosis by antibody testing. The survey covered demographic information, eight lifestyle factors, comorbidities and medication use. We defined the main outcome as the presence vs. the absence of signs of pneumonia, represented by dyspnea, the requirement for oxygen therapy or intubation. Results Signs of pneumonia occurred in 39 of the 165 individuals with a PCR-based diagnosis of COVID-19 (23.6%). Among the lifestyle factors examined, only overweight/obesity was associated with signs of pneumonia (odds ratio 2.68 (1.29–5.59) p = 0.008). The observed association remained significant after multivariate adjustment, with BMI as a metric variable, and also after including the antibody-positive individuals into the analysis. Conclusions This exploratory study finds an association of overweight/obesity with signs of pneumonia in COVID-19. This finding suggests that a signal proportional to body fat mass, such as the hormone leptin, impairs the body’s ability to clear SARS-CoV-2 before pneumonia develops. This hypothesis concurs with previous work and should be investigated further to possibly reduce the proportion of severe cases of COVID-19.
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Holm, Lars, Rasmus Bechshoeft, Soren Reitelseder, Kenneth Mertz, Jacob Bulow, and Grith Hojfeldt. "PROTEIN SUPPLEMENTATION DOES NOT RESCUE MUSCLE MASS AND FUNCTION–HEAVY RESISTANCE TRAINING IS REQUIRED." Innovation in Aging 3, Supplement_1 (November 2019): S86—S87. http://dx.doi.org/10.1093/geroni/igz038.332.
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Abstract The requirement of an enhanced dietary protein intake to counteract the age-related loss of muscle mass is still debated. Further, the dinner meal generally contains the majority of protein and energy and since, the muscle of older adults responds less to protein intake than that of younger adults it is hypothesized that older adults would benefit from taking more protein in at other meals. The aim of this study was to investigate whether the provision of protein supplements for breakfast and lunch meals over the course of a year would make healthy, older, home-dwelling adults (N=136) take in more protein and whether that then would affect their muscle mass (primary outcome) and a number of metabolic health parameters, muscle strength parameters and functional capabilities. More than 77% ingested more than 75% of the provided supplements, irrespective of supplementation type (isocaloric carbohydrate; collagen hydrolysate low quality protein: whey hydrolysate high quality protein). Providing supplementation for a year among older adults makes them comply very well. However, provision of extra protein has no impact on the muscle mass or strength or on the functional parameters. Further, we studied the impact of adding resistance training on top of WHEY protein supplementation and found that heavy more than light-load resistance training affects fat-free mass and maximal-voluntary contraction. Daily protein intake can be enhanced by supplementation but do not impact muscle mass and function over the course of a year, where heavy resistance training on top benefits, but to a lesser than expected degree.
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Pokhrel Ghimire, Sita, Ashima Ghimire, Gauri Shankar Jha, Manisha Chhetry, and Mahanand Kumar. "Feto-Maternal outcomes in Intrahepatic Cholestasis in Pregnancy in a Tertiary Care Centre in Eastern Nepal." Journal of Nobel Medical College 5, no. 1 (September 23, 2016): 20–25. http://dx.doi.org/10.3126/jonmc.v5i1.15749.
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Background Intrahepatic cholestasis of pregnancy has poor feto-maternal outcomes. To date there has been sparse publications regarding impact of intrahepatic cholestasis in feto-maternal outcomes in our setting. Therefore, we aimed to study the feto-maternal outcome in patients with intrahepatic cholestasis of pregnancy.Material and Methods A hospital based prospective cross-sectional study carried out in department of Obstetrics and Gynecology of Nobel Medical College, Biratnagar, Nepal from 1st January 2014 to 30th December 2015 in women who presented with pruritus in third trimester of pregnancy and having deranged liver function tests. All the cases were followed from admission to discharge. Socio-demographic, clinico-laboratory profile and feto-maternal outcomes were recorded in a preformed structured proforma. Descriptive statistics was used to present the data.Results Among 6,780 women admitted for delivery, 80 had cholestasis of pregnancy with incidence of 1.15%. 83% were of 18-35 years and 65% were primigravida. Most distressing symptom was generalized pruritus (75.0 %). The cesarean delivery rate was 46.25% and labor induction rate was (47.5%). Fetal complications were seen in majority of cases that included meconium aspiration syndrome 26 (32.5%), intrapartum fetal distress 21 (26.25%) and requirement of: intensive care 38 (48.75%). There were 7 perinatal and 3 neonatal deaths.Conclusion Intrahepatic cholestasis of pregnancy seems fairly common among pregnant women. It may be responsible for a large number of perinatal and neonatal deaths especially after 36 weeks of gestation. A large prospective study is needed to address the problems in time.Journal of Nobel Medical College Volume 5, Number 1, Issue 8, January-July 2016, 20-25
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Bhargava, Amita, Basavaraj F. Banakar, Guruprasad S. Pujar, and Shubhakaran Khichar. "A study of Guillain–Barré syndrome with reference to cranial neuropathy and its prognostic implication." Journal of Neurosciences in Rural Practice 05, S 01 (December 2014): S043—S047. http://dx.doi.org/10.4103/0976-3147.145200.
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ABSTRACT Background: Focused studies on cranial neuropathy in Guillain–Barrι syndrome (GBS) and its prognostic implication are not done previously. Aim: To study the clinical profile of GBS patients with special reference to cranial neuropathy and its prognostic implication. Materials and Methods: The study included 61 patients with GB syndrome, fulfilling Asbury Cornblath’s criteria for GB syndrome. A pre-designed semi-structured questionnaire was used to obtain data regarding demographic profile and clinical profile. All patients underwent detailed neurological examination, investigations including nerve conduction studies and CSF examination and treated according to the severity of the illness. Patients were followed up for 6 months. During analysis two groups were made depending on cranial nerve involvement, and compared with respect to various parameters. Results: Out of 61 patients 38 (62.3%) patients had cranial nerve palsies, in that 25 had multiple cranial nerve palsies, and 13 had single isolated nerve palsy. A majority of 30 (49.2%) had bulbar palsy, 28 (46%) had facial nerve palsy, and all had bilateral involvement except 3 patients who had unilateral palsy. Hypoglossal nerve involvement was seen in six (10%) patients and four (6.5%) patients had ophthalmoplegia. Only one had bilateral vestibulocochlear nerve palsy. On comparing various clinico-electrophysiological parameters among patients of GB syndrome with and without cranial nerve involvement, the presence of respiratory paralysis, IVIg and ventilatory support requirement had significant association with cranial nerve involvement in GBS. Conclusion: Our study found a correlation between cranial nerve palsies and severity of the illness. Cranial nerve innervated muscles recover earlier as compared to distal limb muscles. No association was found between outcome at 6 months and cranial nerve involvement.
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Tang, K. K. W., M. R. Mahmud, A. Hussaini, and A. G. Abubakar. "EVALUATING IMAGERY-DERIVED BATHYMETRY OF SEABED TOPOGRAPHY TO SUPPORT MARINE CADASTRE." ISPRS - International Archives of the Photogrammetry, Remote Sensing and Spatial Information Sciences XLII-4/W16 (October 1, 2019): 633–39. http://dx.doi.org/10.5194/isprs-archives-xlii-4-w16-633-2019.
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Abstract. The Department of Survey and Mapping Malaysia has introduced marine cadastre system to register the rights, other valid interests therein and ownership of spatially determined parcels in the context of the marine environment yet the implementation of the system is still at the rudimentary stage. One of the big issues here is gathering land-to-seabed data to create a seamless topographic base map to support its marine cadastre project. Seabed bathymetric mapping in coastal zone is one of the major components to support marine cadastre. In the past, accurate bathymetric measurements can be a very laborious task in hydrographic surveying. Traditional vessel-based acoustic soundings require a lot of time, operation cost and others. Today, human’s ingenuity to yield bathymetric depths from multispectral images as an alternative source to chart the seabed topography has brought in new revolution to hydrography. The paper is initiated for evaluating water depth determination by using imagery-derived bathymetry technique and check its correlation with in-situ bathymetry depths. In the course of experiment, it demonstrates a good correlation between the imagery-derived bathymetric depths and the in-situ bathymetric depths, and majority of the derived depths have passed the minimum requirement of the IHO S-44 survey standard. The result also shows that these empirical models deliver promising outcome which can be use over the turbid environment setting. Hence, imagery-derived bathymetry approach can be an efficient and repeatable way to derive the seabed topography over a huge segment of coastal region. This study also suggests that imagery-derived bathymetry approach can be recognised as an aid in seabed topographic mapping to support marine cadastre initiative.
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Dudareva, Maria, Jamie Ferguson, Nicholas Riley, David Stubbs, Bridget Atkins, and Martin McNally. "Osteomyelitis of the Pelvic Bones: A Multidisciplinary Approach to Treatment." Journal of Bone and Joint Infection 2, no. 4 (October 9, 2017): 184–93. http://dx.doi.org/10.7150/jbji.21692.
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Abstract. Background and Purpose: A case series review of chronic pelvic osteomyelitis treated with combined medical and surgical treatment by a multidisciplinary team.Methods: All patients treated with surgical excision of pelvic osteomyelitis at our tertiary referral centre between 2002 and 2014 were included. All received combined care from a clinical microbiologist, an orthopaedic surgeon and a plastic surgeon. The rate of recurrent infection, wound healing problems and post-operative mortality was determined in all. Treatment failure was defined as reoperation involving further bone debridement, a requirement for the use of long-term suppressive antibiotics or sinus recurrence.Results: Sixty-one adults (mean age 50.2 years, range 16.8-80.6) underwent surgery. According to the Cierny-Mader classification of osteomyelitis there were 19 type II, 35 type III and 7 type IV cases. The ischium was the most common site of infection. Osteomyelitis was usually the result of contiguous focus infection associated with decubitus ulcers, predominantly in patients with spinal or cerebral disorders. Most patients with positive microbiology had polymicrobial infection (52.5%). Thirty patients required soft tissue reconstruction with muscle or myocutaneous flaps.Twelve deaths occurred a mean of 2.8 years following surgery (range 7 days-7.4 years). Excluding these deaths the mean follow-up was 4.6 years (range 1.5-12.2 years). Recurrent infection occurred in seven (11.5%) a mean of 1.5 years post-operatively (92 days - 5.3 years). After further treatment 58 cases (95.1%) were infection free at final follow-up.Interpretation: Patients in this series have many comorbidities and risk factors for poor surgical outcome. Nevertheless, the multidisciplinary approach allows successful treatment in the majority of cases.
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Gupta, Karishma, Arthika Shetty, Madhva Prasad, and Alka S. Gupta. "Clinical outcomes among pregnant patients with cardiac disease only and those with co-existing pregnancy-associated hypertension." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 8 (July 26, 2018): 3288. http://dx.doi.org/10.18203/2320-1770.ijrcog20183332.
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Background: Impact of cardiac disease on pregnancy is significant. Impact of hypertension on pregnancy is also significant. “Does occurrence of hypertension along with cardiac disease worsen the outcomes?” forms the crux of this study. The aim of the present study was to determine the impact of pregnancy-associated hypertension on the clinical outcomes of pregnant patients with cardiac disease.Methods: Retrospective, observational, comparative, case control study of one and half year duration conducted in a tertiary care referral hospital. The various medical and obstetric parameters were studied and compared.Results: Among 143 patients studied, 36 were hypertensive and 107 were non-hypertensive. Non-severe hypertension was seen in 17%, severe hypertension in 4% and eclampsia in 4%. Average age was 26 years and majority were first or second gravida. Valvular heart disease was the most common cardiac disease encountered. Gestational age at delivery, perinatal outcome and occurrence of pulmonary hypertension were all similar in both the hypertensive and non-hypertensive groups. The most common mode of delivery was vaginal delivery. The cesarean section rate was 29% and was similar among both hypertensive and non-hypertensive groups. Requirement for induction of labor, occurrence of small-for- gestational age among the newborns, intensive care unit admission due to heart failure and maternal death was higher (statistically significant (p<0.05) among the hypertensive group.Conclusions: Presence of hypertension worsens outcomes among pregnant patients with cardiac disease. The coexistence of hypertension and cardiac disease should alert the obstetrician and specialist physician towards a more vigilant management. The findings of this study may help risk stratification (development of pregnancy associated hypertension) while counseling patients with heart disease.
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Raval, Bina M., Nainesh S. Zalavadiya, Pushpa A. Yadava, and Shital T. Mehta. "Comparative study of intra vaginal misoprostol (PGE1) with intracervical dinoprostone (PGE2) gel for induction of labour." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 9 (August 27, 2018): 3769. http://dx.doi.org/10.18203/2320-1770.ijrcog20183792.
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Background: Labour is a final consequence of Pregnancy and is inevitable. The timing of labour may vary widely but it will happen sooner or later. The aim of the present research was to study the safety, efficacy and effect of intra vaginal Misoprostol and intra cervical Dinoprostone gel for induction of labour.Methods: 100 patients who required labour of induction were included in this prospective cross-sectional study from September 2017- March 2018. 50 patients of them received 25mcg tablet misoprostol intravaginal and 50 patients of them required 0.5mg intracervical dinoprostone gel and doses were repeated every 6 hourly for up to maximum 6 doses for Misoprostol and 3 doses for Dinoprostone gel.Results: The majority of patients had gestational age above 40 weeks and between 37-40 weeks in PGE2 and PGE1 group respectively. The mean time taken for the onset of labour was less in Misoprostol than in Dinoprostone group (43.22min v/s 1 hr40 min). The mean time taken for induction to active phase of labour (1hr 42min v/s 4hr 10min) and active phase to delivery (3hr 6min v/s 4hr54min) was less in Misoprostol than Dinoprostone group. The mean time required for induction to delivery was less in Misoprostol group (5hr 2min v/s 11hrs). Requirement of oxytocin for augmentation of labour was almost equal in both groups. Caesarean section rate was less in Misoprostol group (10% v/s 22%). Maternal side effects were minimal in either groups and neonatal outcome was good in both the groups.Conclusions: Both Misoprostol and Dinoprostone gel are safe, effective for cervical ripening and induction but Misoprostol is more cost effective and stable at room temperature.