Admission Period Research Articles

Cerebrospinal Fluid Shunting in Children with Hydrocephalus and Increased Intracranial Pressure Secondary to Human Immunodeficiency Virus–Related Cryptococcal Meningitis

Hydrocephalus and increased intracranial pressure secondary to human immunodeficiency virus-related cryptococcal meningitis are rare in children. The role and outcomes of cerebrospinal fluid (CSF) shunting in children are not well reported. We report our experience with CSF shunting in the management of this condition in children over a 14-year period. This was a retrospective review of data collected from a single neurosurgery unit. Data collected included demographics, clinical characteristics, Glasgow Coma Scale score, lumbar puncture opening pressure, antiretroviral therapy, laboratory results, neuroimaging findings, shunting procedures, complications, and mortality. Seventeen children underwent CSF shunting. Median age was 10 years (range, 6-13), most being male (76%). All children were on antiretroviral therapy. Median Glasgow Coma Scale score was 15 (interquartile range [IQR], 14-15). Clinical characteristics included headaches (100%), visual impairment (82%), and seizures (47%). Lumbar puncture opening pressure was >30 cm H2O in 88% of children. Median CD4 count was 45 cells/μL (IQR, 17-56). Computed tomography brain scans showed hydrocephalus in 14 children (82%). Surgical procedures included ventriculoperitoneal shunts (82%) and lumboperitoneal shunts (18%). Shunt complications included infection (18%) and obstruction (18%). Staphylococcus aureus was cultured in all infections. Median follow-up was 45 months (IQR, 7.5-74). Three children (18%) died during the admission period. Ten children (59%) were alive at 1 year follow-up. This study is the largest series reporting on CSF shunting of hydrocephalus and increased intracranial pressure in children with human immunodeficiency virus-related cryptococcal meningitis. Treatment with ventriculoperitoneal shunt and lumboperitoneal shunt regardless of the CD4 count is an important option in suitable children to reduce mortality.

Sudden cardiac death in heart failure. A 20 years perspective from a Mediterranean cohort

Abstract Background Although sudden cardiac death (SCD) has progressively decreased in the last decade, it remains an important cause of death in patients with heart failure (HF). Differences based on clinical management and regional characteristics might be important. Purpose To assess the prevalence of SCD along 20 years of study in HF outpatients of different aetiologies managed in a multidisciplinary HF Clinic, and compare this prevalence with the expected proportional occurrence according to the acknowledged Seattle Proportional Risk Model (SPRM) score. Methods In a prospective observational registry of real-life HF outpatients, modes of death were classified as SCD (any unexpected death, witnessed or not, of a previously stable patient with no evidence of worsening HF or any other known cause of death) and non-SCD (progression of HF, acute myocardial infarction, stroke, procedural, other cardiovascular causes and non-cardiovascular). Results From August 2001 to May 2021, 2772 outpatients with known cause of death and with SPRM score available were included. Out of them, 1351 (48.7%) died during a median follow-up of 3.8 years [IQR 1.6–7.8], up to 20 years. Observed prevalence of SCD in the 1351 dead patients was 13.6% while predicted SPRM prevalence was 39.6%. Annual SPRM predicted SCD mortality rate was 3.0% while observed SCD annual mortality rate was 1.3%. Figure 1 depicts cumulative incidence of causes of death through the study period. A lower prevalence of SCD was observed in every quintile of SPRM risk (Figure 2). This lower prevalence of SCD was observed independently of left ventricular ejection fraction group, ischemic or non-ischaemic aetiology and implantable cardiac defibrillator (ICD). Although the baseline SPRM predicted risk of SCD showed a significant decreasing trend (p=0.005) along the periods of admission at the Unit, the lower observed prevalence of SCD was seen in all periods of admission. Conclusions The prevalence of SCD through a perspective of 20 years in a Mediterranean HF outpatient cohort managed in a multidisciplinary HF Clinic was significantly lower than that expected according to the SPRM independently of degree of predicted risk, ischaemic aetiology, period of admission and implanted ICD. Regional lifestyle and dietary habits may have an impact on the lower rate of SCD in this Mediterranean cohort, and deserve further in-depth analyses. Funding Acknowledgement Type of funding sources: None.

Clinical significance of R-TEG in severe burn patients with coagulation dysfunction

IntroductionThe aim of this study was to retrospectively analyze Thrombelastography (TEG) data of severe burn patients to provide a clinical basis for timely diagnosis and treatment of coagulation dysfunction. MethodsThe present study comprised burn patients with full thickness TBSA ≥ 60%. The patients included in the study were admitted to the Third Affiliated Hospital of Inner Mongolia Medical University between March 2019 and March 2022 and died within 10 days. Patient demographic and clinical data, including abbreviated burn severity index (ABSI) score, full thickness and overall total surface burn area (TBSA), injury cause, International Society on Thrombosis and Hemostasis (ISTH) score, were retrieved from the electronic medical record system. TEG data (including ACT, K, α, MA and LY30), platelet count (PLT), mean platelet volume (MPV) and platelet distribution width (PDW) data were obtained from the records of included patients for analysis. ResultsA total of 9 patients were enrolled. The average burn area was 90.0% TBSA and the full-thickness TBSA was 72.0%. The results showed that α, MA and PLT count values were significantly lower relative to those at obtained throughout admission period (all p < 0.05). PDW and MPV were significantly higher compared with the values at admission (all p < 0.05). ACT time was significantly longer from day 2 after severe burn compared with the ACT time at admission (all p < 0.05). LY30 value from day 3 after severe burn was significantly higher compared with the value at admission (p < 0.05). One patient was diagnosed with diffuse intravascular coagulation (DIC) on admission, whereas eight patients were diagnosed with DIC on the day of death. ConclusionCoagulation dysfunction after severe burn is mainly characterized by procoagulant disorders and hyperfibrinolysis, which can be timely detected by TEG. Coagulation after severe burn exhibits a gradual aggravation, and can lead to death of patients.

Mortality over time among COVID-19 patients hospitalized during the first surge of the pandemic: A large cohort study.

Capacity strain negatively impacts patient outcome, and the effects of patient surge are a continuous threat during the COVID-19 pandemic. Evaluating changes in mortality over time enables evidence-based resource planning, thus improving patient outcome. Our aim was to describe baseline risk factors associated with mortality among COVID-19 hospitalized patients and to compare mortality rates over time. We conducted a retrospective cohort study in the largest referral hospital for COVID-19 patients in Sao Paulo, Brazil. We investigated risk factors associated with mortality during hospitalization. Independent variables included age group, sex, the Charlson Comorbidity Index, admission period according to the stage of the first wave of the epidemic (early, peak, and late), and intubation. We included 2949 consecutive COVID-19 patients. 1895 of them were admitted to the ICU, and 1473 required mechanical ventilation. Median length of stay in the ICU was 10 (IQR 5-17) days. Overall mortality rate was 35%, and the adjusted odds ratios for mortality increased with age, male sex, higher Charlson Comorbidity index, need for mechanical ventilation, and being admitted to the hospital during the wave peak of the epidemic. Being admitted to the hospital during the wave peak was associated with a 33% higher risk of mortality. In-hospital mortality was independently affected by the epidemic period. The recognition of modifiable operational variables associated with patient outcome highlights the importance of a preparedness plan and institutional protocols that include evidence-based practices and allocation of resources.

Prognosis of patients with cardiogenic shock following acute myocardial infarction: The difference between ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction.

Acute myocardial infarction (AMI) complicated by cardiogenic shock has high mortality and remains challenging even in the revascularization era. We conducted this study to understand patients' outcomes. We retrospectively analyzed electronic medical records data from 1175 patients with AMI complicated by cardiogenic shock that developed within 3 days of admission to a multicenter medical care system between January 1, 2000, and July 31, 2018. Patients with AMI were classified into the ST-segment elevation MI (STEMI) group or the non-ST-segment elevation MI (NSTEMI) group. The short-term and 1-year mortality and adverse events after index admission were analyzed via logistic regression and a Cox proportional hazards model. When compared with NSTEMI, patients with STEMI tended to be younger (65.68 ± 14.05 years vs 70.70 ± 12.99 years, P < .001), men (73.29% vs 60.87%, P < .001), and have fewer underlying chronic diseases. Short-term mortality at index hospitalization was 14.83% in the STEMI group and 21.30% in the NSTEMI group; long-term mortality was 17.06% for the STEMI group and 24.13% for the NSTEMI group. No difference was observed between the 2 groups for patients who developed a cerebral vascular accident during the admission period. However, the major and gastrointestinal bleeding rates were higher in the STEMI group (2.66% vs 0.22%, P = .014; 3.36% vs 0.22%, P = .007, respectively). Age and respiratory failure were the most significant risk factors for short-term mortality. Revascularization may be beneficial for the short-term outcome but did not reach significance in multivariable analysis. In patients with AMI with cardiogenic shock, NSTEMI was associated with a significantly higher mortality rate in short-term results.

Sampled‐data‐based H∞ load frequency control for power systems with wind power

AbstractLoad disturbances, the intermittent generation of wind power, and the uncertainty of sampling period will significantly affect the frequency stability of power system. This paper presents a sampled‐data‐based load frequency control (LFC) scheme for power systems with wind power (PSWPs), which aims to guarantee the stable operation of the systems under a sampling period as large as possible while retaining the desired robust performance. First, by considering the feature that power system plant operates in continuous‐time domain and LFC controller operates in discrete‐time domain, the closed‐loop PSWPs installed with a PI‐type LFC controller is modeled as sampled‐data control system with aperiodic samplings. Second, by utilizing an augmented two‐side looped Lyapunov functional and the linear matrix inequality (LMI), two sampling‐interval‐dependent stability criteria with less conservatism are derived for the studied systems, which guarantee that the presented LFC scheme operates in a large sampling period. Then, based on proposed stability condition, a sampled‐data‐based PI‐type LFC controller with the consideration of sampling period and performance index is obtained. Following this, an algorithm is given to obtain the gain of sampled‐data‐based PI‐type LFC controller and the admissible maximum sampling period while preserving the desired robust performance. Finally, case studies are carried out on the one‐area power system and three‐area PSWPs. The simulation results demonstrate the effectiveness of the presented LFC scheme, and robustness against load disturbances, wind power fluctuations and sampling period. It also shows that the designed LFC scheme can tolerate a larger sampling period while preserving the desired performance.

Protection of Prisoners with Mental Health Disorders in Italy: Lights and Shadows after the Abolition of Judicial Psychiatric Hospitals.

In Italy, a person suffering from a mental disorder who commits a crime will be given a custodial security order and serve the period of admission at a Residenza per la esecuzione delle misure di sicurezza (REMS) (Residence for the Execution of Security Measures, hereinafter “REMS”). These institutions have been established recently and though equipped with the necessary safety measures, the focus is on psychiatric therapy. Despite being present on a national scale, access is very limited in terms of capacity. Immediate remedial measures are needed, so much so that the European Court of Human Rights recently condemned Italy for this very reason. This article, through a review of the constitutive principles of these institutions, shows how they have very positive aspects such as the attention to necessary psychotherapy in order to protect the right to health and the real taking charge of the fragility of the subjects; however, it is seen how there are many negative aspects linked above all to the scarce availability of places in these structures. The article provides suggestions on a more comprehensive strategy for facilities for detainees with mental disorders.

Optimizing Time Management for Drip-and-Ship Stroke Patients Qualifying for Endovascular Therapy-A Single-Network Study.

BACKGROUND: We sought to identify factors for delayed drip-and-ship (DS) management in stroke patients transferred from primary hospitals to our comprehensive stroke center (CSC) for endovascular therapy (EVT). METHODS: We conducted a retrospective study of all patients transferred to our CSC for EVT between 2016 and 2020. We analyzed emergency and hospital records to assess DS process times and factors predictive of delays. We dichotomized the admission period to 2016–2017 and 2018–2020 according to the main process optimization, including the introduction of a prenotification call. RESULTS: We included 869 DS patients (median age 76 years (IQR 65–82), NIHSS 16 (IQR 11–21), 278 min (IQR 243–335) from onset to EVT); 566 were transferred in 2018–2020. Admission in 2016–2017, during on-call, longer tranfer distance, and general anesthesia were factors independently associated with delayed onset to EVT time (F(5, 352) = 14.76, p < 0.000). Other factors associated with delayed DS management were: transfer mode, primary hospital type, site of large-vessel occlusion, and intravenous thrombolysis. Total transfer time was faster for distances <50 km by ambulance and for distances >71 km by helicopter. CONCLUSION: Assessment of DS processes and times throughout the patient pathway allows identification of potentially modifiable factors for improvement of the very time-critical workflow for stroke patients.

Cell free DNA as a biomarker in medicolegal assessment in burn patients

Background: Burn victims have higher levels of cell free DNA (cfDNA), which allows its use as a direct indicator of cellular damage and burn vitality. Aim: Determination of cfDNA levels in burn patients and their correlation with total body surface area burned percent (TBSA%). Subjects and methods: Burn cases were evaluated to determine the prevalence of age and sex variations, period of admission, TBSA%, and the etiology and manner of burns. The plasma cfDNA concentration was measured within 24 hours of the burn injury in 40 burn cases and 20 control subjects. Results: The mean age of the cases was 34.38 years (median 33 years). Most patients were males (62.5%). Burning by flame or scalding represented 50% of the cases. Accidental burns were the most predominant. The mean of admission periods was 36.55 days while the mean value of TBSA% of the cases was 16.68%. There was a statistically significant difference in cfDNA values between cases and control subjects (p = 0.001). A positive correlation was found between cfDNA levels and TBSA% (r = 0.7; p &lt; 0.001). Conclusion and recommendations: Levels of cfDNA were significantly different between burn cases and controls.

Retrospective Review of ART Regimens in HIV-Positive to HIV-Positive Kidney Transplant Recipients

IntroductionThe management of complex interactions between antiretroviral therapy (ART) and calcineurin inhibitor (CNI) immunosuppression regimens in HIV-positive to HIV-positive renal transplant recipients can be challenging. Literature describing ART regimens and indications for regimen switching in these patients is limited.MethodsThis retrospective review included 53 HIV-positive to HIV-positive renal transplant recipients. Data on ART regimens, reasons for ART switching, and timing of switches were described from day of transplant to study endpoint (end of study date, death, or graft failure). The association between rejection and ART regimen (protease inhibitor [PI] -based vs. non-PI-based regimen) was analyzed using negative binomial regression.ResultsThere were a total of 46 switches in 31 of 53 patients (58%). Protocol switches (n = 17 of 46, 37%) accounted for most switches, of which the majority were from non-nucleoside reverse transcriptase inhibitors (NNRTIs) to PIs. Other common reasons for switching include cytochrome P450 enzyme induction from efavirenz (EFV) (9 of 46, 20%), tenofovir disoproxil fumarate (TDF) nephrotoxicity (8 of 46, 17%) or side effects (6 of 46, 13%). Of the 46 switches, nearly half (n = 21, 46%) occurred during the transplant admission period, and approximately two-thirds (n = 28, 62%) were during the first year post-transplantation. There was an association between rejection and being maintained on a PI-based regimen (incidence rate ratio 2.77 (95% confidence interval 1.03–7.48), P = 0.044).ConclusionDespite frequent switching of ART regimens, HIV viral loads remained supressed and graft function remained stable in most HIV-positive kidney transplant recipients in our cohort. There was however a concerning signal for increased rejection rates in those on a PI-based regimen.

Fall predictors in hospitalized patients living with cancer: a case-control study.

To identify fall predictors and develop an assessment tool to be used for screening hospitalized cancer patients at risk for fall. A retrospective case-control study was conducted in 2018 at a cancer center in Northern Italy. The study participants were 448 adult cancer patients admitted to the oncology ward from 2009 to 2013. The case group consisted of 112 patients presenting at least one fall, while controls were randomly chosen by matching each case for age, sex, and admission period with three patients who did not fall. Data for the fall predictors were extracted from the electronic medical records. Conditional logistic regression was used to evaluate the association between patient's characteristics and fall risk. The overall prevalence of patients having at least one candidate fall predictor was high (98%). Seven of the studied variables showed an independent association with fall risk at multivariate analysis. These were tumor site, the presence of neurologic diseases, gait imbalance disorders, fatigue, and the assumption of certain medications such as diuretics, hypnotics, and opioids (odds ratios and 95% confidence intervals in brackets were 3.78 (1.78-8.13), 2.26 (1.08-4.77), 4.22 (1.87-9.52), 2.76 (1.45-5.26), 2.66 (1.52-4.66), 2.41 (1.20-4.85), and 3.03 (1.68-5.45), respectively). In this study, we identified falling risk factors in an Italian population of hospitalized cancer patients and developed a new risk assessment tool. An external validation is necessary before implementing our screening tool in clinical practice.

Antibiotic prescription pattern of cardiovascular thoracic surgery department in a tertiary care hospital of North Mumbai- A retrospective study

Cardiovascular diseases are the most common cause of morbidity and mortality. Prevention of surgical site infection is the major concern in cardiac surgery because deep sternal infection leads to prolonged hospital stay, increased cost of treatment and even death. The cardiac surgeons have used many different therapeutic protocols for antimicrobial prophylaxis. The aim of this study is to evaluate the prescribing pattern of antibiotics in patients undergoing cardiovascular thoracic surgery (CVTS). A single centre retrospective study was conducted in the CVTS department from January 2017 to October 2018. The hospital has centralised electronic medical and laboratory record database that uses unique identification numbers. The data was obtained from medical record department of the hospital. All records including patient’s age, gender, admission period, investigations performed, antibiotics advised during indoor stay and at discharge along with their administration routes, dosages and duration were noted. The pre-existing comorbidities and surgical intervention were also recorded. Among the total 86 patients reviewed, 88.84% were males with the mean age of 58.7 years. 87.21% of the patients received parenteral antibiotics, 98.83% received more than one antibiotic, either in oral or parenteral formulations. The most commonly used generic antibiotics were cefoperazone – sulbactam (69.77%), levofloxacin (59.30%), cefuroxime (25.58%), cefoperazone (11.63%) and amoxicillin – clavulanic acid (43.02%). While in admitted patients, beta lactam / beta lactamase inhibitors combination (98.83%), fluoroquinolones (69.77%), cephalosporins (34.88%), glycopeptides (3.49%) and carbapenem (2.33%) were used and on the other hand at the time of discharge, fluoroquinolones (43.02%), cephalosporins (32.56%) and beta lactam / beta lactamase inhibitors combination (39.53%) were prescribed. The indications for admission were Coronary artery bypass grafting (90.7%), Aortic valve replacement (5.81%), Mitral valve replacement (2.33%) and Dual valve replacement (1.16%). The most common associated comorbidities were ischemic heart disease (73.26%), diabetes mellitus (47.67%), hypertension (56.98), chronic kidney disease (5.81%) and chronic obstructive pulmonary disease (3.49%). The mean duration of usage of parenteral drugs was 5.20 days whereas it was 5.14 days for the oral drugs. There was an irrational usage of antibiotics in patients undergoing surgery in the CVTS department. The prescription pattern varied according to the surgeon’s preference or experience. This study strongly recommends the implementation of antimicrobial stewardship programme and written protocol driven antibiotics prescription.

Post-recovery Stress, Anxiety, Depression and Stigma in Early COVID-19 Pandemic Patients

COVID-19, the first pandemic experienced in the current generation, results various physical and mental stress and stigma. Stress (Korean version of the stress perception scale), anxiety and depression (hospital anxiety depression scale) and stigma was evaluated from the 20 patients recovered from the initial pandemic period, during February to March 2020. The average age was 51.3 (± 8.26) years old. The average hospital and therapeutic living center admission period was 26.8 (± 5.24) days, and the average period after discharge was 19.4 (± 4.33) days. The severity of the symptoms was 3 (15%) asymptomatic, 13 (65%) mild, and 4 (20%) severe (pneumonia). The average score on the perceive stress scale was 19.6 (± 6.52) and 65% (13/20) perceived moderate or severe stress status. The average score for hospital anxiety depression was 15.0 (± 5.45) points, the average score for anxiety was 6.6 ± 3.25 points, and the average score for depression was 8.4 (± 3.86). The average stigma score was 79.6 (± 16.16) points. Post-recovery patients from COVID-19 was perceived significant stress, experiencing anxiety, depression, and stigma in early pandemic period. Keywords: Anxiety, COVID-19, Depression, Stigma, Stress

Hospitality in dementia-friendly environments is significant to caregivers during hospitalisation of their loved ones. Aqualitative study.

To explore what is meaningful to caregivers in relation to a dementia-friendly environment during hospitalisation of their loved ones with dementia or cognitive impairment. Implementation of dementia-friendly initiatives and person-centred care approach have shaped the political agenda within Danish society. Patients with dementia or cognitive impairment and their accompanying caregivers are challenged when admitted to hospital. During hospitalisation, caregivers find themselves in a vulnerable state of mind. Thus, the implementation of a dementia-friendly environment and adherence to person-centred care in hospital settings leaves room for improvement. This study was guided by a qualitative and explorative approach. Data were collected through 17 semi-structured interviews with caregivers at a subacute neurological ward. Thematic analysis was employed to interpret data. The study reports according to the COREQ checklist. The following three themes were identified: 1) Being a watchful bystander. 2) Visiting an undefined and foreign environment. 3) Longing for kindness. Hospitality expressed by staff towards caregivers is significant in allowing caregivers to experience hospital environments as "friendly." Dementia-friendly environments embrace existential aspects that go far beyond physical spaces; hence, experiences of kind acts shape caregivers' sense of safety and comfort during hospitalisation. Hospitality is an essential part of nursing in dementia care because caregivers are contextually vulnerable. Our study sheds new light on the provision of person-centred care to people with dementia and their families in healthcare. Nurses need to be aware that caregivers experience vulnerability and to involve caregivers in the care provided for patients with dementia. We recommend that a permanent contact person be appointed to follow patients throughout their admission period. Furthermore, systematic interventions focusing on phenomena such as hospitality and kindness may serve to form a person-centred clinical culture; an issue that warrants further investigation.

Changes of Acute Kidney Injury Epidemiology during the COVID-19 Pandemic: A Retrospective Cohort Study.

To evaluate the impact of the Coronavirus Disease-19 (COVID-19) pandemic on the epidemiology of acute kidney injury (AKI) in hospitalized patients, we performed a retrospective cohort study comparing data of patients hospitalized from January 2016 to December 2019 (pre-COVID-19 period) and from January to December 2020 (COVID-19 period, including both severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-negative and positive patients). AKI was classified by evaluating the kinetics of creatinine levels. A total of 51,681 patients during the pre-COVID-19 period and 10,062 during the COVID-19 period (9026 SARS-CoV-2-negative and 1036 SARS-CoV-2-positive) were analyzed. Patients admitted in the COVID-19 period were significantly older, with a higher prevalence of males. In-hospital AKI incidence was 31.7% during the COVID-19 period (30.5% in SARS-CoV-2-negative patients and 42.2% in SARS-CoV-2-positive ones) as compared to 25.9% during the pre-COVID-19 period (p < 0.0001). In the multivariate analysis, AKI development was independently associated with both SARS-CoV-2 infection and admission period. Moreover, evaluating the pre-admission estimated glomerular filtration rate (eGFR) we found that during the COVID-19 period, there was an increase in AKI stage 2–3 incidence both in patients with pre-admission eGFR < 60 mL/min/1.73 m2 and in those with eGFR ≥ 60 mL/min/1.73 m2 (“de novo” AKI). Similarly, clinical outcomes evaluated as intensive care unit admission, length of hospital stay, and mortality were significantly worse in patients admitted in the COVID-19 period. Additionally, in this case, the mortality was independently correlated with the admission during the COVID-19 period and SARS-CoV-2 infection. In conclusion, we found that during the COVID-19 pandemic, in-hospital AKI epidemiology has changed, not only for patients affected by COVID-19. These modifications underline the necessity to rethink AKI management during health emergencies.

Whole genome sequencing reveals hidden transmission of carbapenemase-producing Enterobacterales

Carbapenemase-producing Enterobacterales (CPE) infection control practices are based on the paradigm that detected carriers in the hospital transmit to other patients who stay in the same ward. The role of plasmid-mediated transmission at population level remains largely unknown. In this retrospective cohort study over 4.7 years involving all multi-disciplinary public hospitals in Singapore, we analysed 779 patients who acquired CPE (1215 CPE isolates) detected by clinical or surveillance cultures. 42.0% met putative clonal transmission criteria, 44.8% met putative plasmid-mediated transmission criteria and 13.2% were unlinked. Only putative clonal transmissions associated with direct ward contact decreased in the second half of the study. Both putative clonal and plasmid-mediated transmission associated with indirect (no temporal overlap in patients’ admission period) ward and hospital contact did not decrease during the study period. Indirect ward and hospital contact were identified as independent risk factors associated with clonal transmission. In conclusion, undetected CPE reservoirs continue to evade hospital infection prevention measures. New measures are needed to address plasmid-mediated transmission, which accounted for 50% of CPE dissemination.

Role of C-reactive protein, lactate dehydrogenase, Vitamin D, and interleukin-6 in the prognosis of COVID-19 – A retrospective study in a tertiary care hospital in Tamil Nadu

Background: SARS-COV-2 is also known as coronavirus causes an infectious disease has caused a global concern due to its pandemic nature. In India, nearly 36 million cases and 5.1 lakh deaths have been recorded so far. Laboratory biomarkers play an important role in improving the clinical situational awareness by predicting risk stratification and by discriminating between severe and non-severe cases. There is no sufficient information available regarding the role of C-reactive protein (CRP), lactate dehydrogenase (LDH), Vitamin D, and interleukin-6 (IL-6) in the prognosis of COVID-19 patients in Southern part of India. Aims and Objectives: We aim to retrospectively analyze CRP, LDH, Vitamin D, and IL-6 in COVID-19 patients. Materials and Methods: The observational and retrospective study was carried out from the case records of 103 patients from November 2021 to February 2022 in which CRP, LDH, Vitamin D, IL-6, COVID-19 Reporting and Data System (CO-RADS), and CT sore were analyzed during admission and follow-up period in the hospital. Mean, mean difference, standard deviation, standard error difference, and P value were calculated. P&lt;0.05 was considered to be significant. Results: CRP, LDH, IL-6, Vitamin D, CO-RADS, and CT score were decreased during the follow-up period when these levels were compared at the time of admission in the hospital, while there is an increase in Vitamin D levels during the follow-up period. Conclusion: The use of reliable and easy to use assays such as CRP, LDH, Vitamin D, and IL-6 plays an important role in the diagnosis and prognosis of COVID-19.

Korean Medicine Treatment for Anterior Inferior Cerebellar Artery Infarction: A Case Report

Objective: The aim of this study is to report the effectiveness of Korean medicine for a patient with dizziness following anterior inferior cerebellar artery infarction.Methods: The patient was treated with traditional Korean methods including acupuncture, herbal therapy, moxibustion, and vestibular rehabilitation exercise during an admission period of seven days. The patient’s dizziness was assessed using a numeric rating scale (NRS) and the Korean Dizziness Handicap Inventory (K-DHI), Korean Activities-specific Balance Confidence (K-ABC), Korean Vestibular Disorders Activities of Daily Living (K-VADL), the modified Rankin scale (mRS), and the Korean version of the Modified Barthel Index (K-MBI).Results: After seven days of combined treatment with traditional methods and vestibular rehabilitation, the patient’s dizziness was reduced from NRS 6-7 to NRS 2. In addition, K-DHI decreased from 84 to 22; K-ABC improved from 52% to 78.125%; K-VADL reduced from 175 to 37; the mRS score changed from 4 to 1; and the K-MBI score increased from 86 to 98. No adverse events were observed during treatment.Conclusion: This study suggests that combined therapy of Korean medicine and vestibular rehabilitation can be effective treatment for anterior inferior cerebellar artery infarction patients.

Presentations of Routine Dental Interventions in Children over a Six-Year Period.

Aim To evaluate over a six-year period, the prevalence of the dental procedures in primary and mixed dentitions, in males and females. Materials and Methods A retrospective descriptive study on dental treatments in primary and mixed dentitions was conducted in the Department of Pediatric Dentistry at the Faculty of Dental Medicine, Lebanese University, from 2015 to 2020. The total number of children was 1291. Data were classified and reviewed according to the dentition type, gender, and type of dental treatment. Results The number of children decreased from 741 for the period 2015–2017 to 550 during the period 2018–2020 (279 males and 271 females). No significant association was found between the admission periods and the genders. A significant relationship was found between the number of treatments performed in both genders and the dentition types (p value = 0,015). Males were slightly more likely than females to present for the treatment in mixed dentition (54.58% versus 45.2%, respectively). Results portrayed a significant relationship between surgical treatment and gender (p value = 0.049). However, no significant relationship between gender and other treatment types was noted. The comparison between the 2 time frames and the types of treatments showed a significant association in composite fillings (p value = 0.043), extractions (p value < 0.0001), sealants (p value = 0.039), preventive resin restoration (p=0.011), pulp therapies (p value < 0.0001), pediatric crowns (p value < 0.0001), and surgical interventions (p value = 0.013). A nonsignificant relationship was recorded for the appliances and composite crowns (p value = 0.45 and 0.14, respectively). Conclusion The present study points out the implications of the COVID-19 outbreak and Lebanon's economic collapse on children's dental status, with the number of children receiving dental care dropping remarkably. A decrease in all types of dental procedures was noted in mixed dentition, whereas an increase in dental treatments related to aggravated carious lesions was reported in primary dentition. More medical and financial aids are required to encourage and support parents' attitude towards children dental care during unprecedented crises.

High-flow nasal cannula versus standard low-flow nasal cannula during deep sedation in patients undergoing radiofrequency atrial fibrillation catheter ablation: a single-centre randomised controlled trial

BackgroundTo our knowledge, there are few trials studying the effect of high-flow nasal cannula (HFNC) during deep sedation. Our hypothesis is that high-flow nasal cannula (HFNC) will prevent hypoxemia and desaturation as compared to low-flow nasal cannula (LFNC) during prolonged deep sedation in patients with atrial fibrillation undergoing radiofrequency catheter ablation (RFCA).MethodsA single-centre, randomised controlled trial with HFNC as the intervention and LFNC as the control group. A total of 94 adult patients per group undergoing elective radiofrequency atrial fibrillation catheter ablation under deep sedation. will be included. The primary outcome is the lowest oxygen saturation (SpO2). Secondary outcomes are as follows: the duration of lowest SpO2, cross over from oxygen therapy in both directions, incidence of SpO2 below 90% > 60 seconds, adverse sedation events, adverse effects of HFNC, mean CO2, peak CO2 and patients experience with oxygen therapy. The study will take place during the 2-day admission period for RFCA. Patients can fill out their questionnaires in the first week after treatment.DiscussionHFNC is increasingly used as a technique for oxygen delivery in procedural sedation and analgesia. We hypothesise that HFNC is superior to the standard treatment LFNC in patients under deep sedation with respect to the incidence of desaturation. To our knowledge, there are no adequately powered clinical trial studies on the effects of HFNC in prolonged deep sedation.Trial registrationClinicalTrials.gov NCT04842253. Registered on 04 April 2021