Affected Body Systems Research Articles

Integumentary and musculoskeletal indications for surgery predominate in a 15-year study of search-and-rescue dogs.

Analyze data from a 15-year longitudinal study of search-and-rescue (SAR) dogs to determine the indications for surgery and evaluate whether the risk varied by breed, sex, neutering, or deployment status during 9/11. 150 SAR dogs: 95 dogs deployed to sites from the September 11, 2001, terrorist attacks and 55 SAR dogs not deployed to these sites. Search-and-rescue dog handlers completed an annual health survey until the dog's death, or the handler withdrew from the study. The reported surgical events were categorized by body system and etiology. Incidence risk rates, with 95% CIs, were calculated for the most common surgical indications. Incidence rate ratios were calculated stratified by deployment status, sex, and breed, and significance was assessed. Over the study period, 103 surgical events were recorded in 67 of the 150 dogs (45%; 95% CI, 37% to 53%); 41 dogs had 1 event, 18 had 2 events, 6 had 3 events, and 2 had 4 events. Deployment status during 9/11, breed, sex, and neuter status were not significantly associated with the affected body system. The most affected body systems were the integumentary and musculoskeletal systems. The most common etiologies were trauma, neoplasia, inflammatory, and degenerative conditions. Search-and-rescue dogs experienced relatively routine or minor conditions despite the occupational hazards of their careers. Surgery will impact working dog health and performance. Preventive efforts to reduce and interventions to treat surgical conditions in SAR dogs should focus on the integumentary and musculoskeletal systems.

Monitoring and integrated care coordination of patients with alpha-mannosidosis: A global Delphi consensus study

IntroductionCurrent literature lacks consensus on initial assessments and routine follow-up care of patients with alpha-mannosidosis (AM). A Delphi panel was conducted to generate and validate recommendations on best practices for initial assessment, routine follow-up care, and integrated care coordination of patients with AM. MethodsA modified Delphi method involving 3 rounds of online surveys was used. An independent administrator and 2 nonvoting physician co-chairs managed survey development, anonymous data collection, and analysis. A multidisciplinary panel comprising 20 physicians from 12 countries responded to 57 open-ended questions in the first survey. Round 2 consisted of 11 ranking questions and 44 voting statements. In round 3, panelists voted to validate 60 consensus statements. The panel response rate was ≥95% in all 3 rounds. Panelists used 5-point Likert scales to indicate importance (score of ≥3) or agreement (score of ≥4). Consensus was defined a priori as ≥75% agreement with ≥75% of panelists voting. ResultsConsensus was reached on 60 statements, encompassing 3 key areas: initial assessments, routine follow-up care, and treatment-related follow-up. The panel agreed on the type and frequency of assessments related to genetic testing, baseline evaluations, quality of life, biochemical measures, affected body systems, treatment received, and integrated care coordination in patients with AM. Forty-nine statements reached 90% to 100% consensus, 8 statements reached 80% to 85% consensus, and 1 statement reached 75% consensus. Two statements each reached consensus on 15 baseline assessments to be conducted at the initial follow-up visit after diagnosis in pediatric and adult patients. ConclusionThis is the first Delphi study providing internationally applicable, best-practice recommendations for monitoring patients with AM that may improve their care and well-being.

Characterizing the blood microbiota in healthy and febrile domestic cats via 16s rRNA sequencing

This study aimed to evaluate the blood bacterial microbiota in healthy and febrile cats. High-quality sequencing reads from the 16S rRNA gene variable region V3-V4 were obtained from genomic blood DNA belonging to 145 healthy cats, and 140 febrile cats. Comparisons between the blood microbiota of healthy and febrile cats revealed dominant presence of Actinobacteria, followed by Firmicutes and Proteobacteria, and a lower relative abundance of Bacteroidetes. Upon lower taxonomic levels, the bacterial composition was significantly different between healthy and febrile cats. The families Faecalibacterium and Kineothrix (Firmicutes), and Phyllobacterium (Proteobacteria) experienced increased abundance in febrile samples. Whereas Thioprofundum (Proteobacteria) demonstrated a significant decrease in abundance in febrile. The bacterial composition and beta diversity within febrile cats was different according to the affected body system (Oral/GI, systemic, skin, and respiratory) at both family and genus levels. Sex and age were not significant factors affecting the blood microbiota of febrile cats nor healthy ones. Age was different between young adult and mature adult healthy cats. Alpha diversity was unaffected by any factors. Overall, the findings suggest that age, health status and nature of disease are significant factors affecting blood microbiota diversity and composition in cats, but sex is not.

Association of Depression With the Progression of Multimorbidity in Older Adults: A Population-Based Cohort Study

The relationship between depression and the risk of multimorbidity progression has rarely been studied in older adults. This study was aimed to determine whether depression is associated with progression in the severity and complexity of multimorbidity, considering the influence of depression's severity and subtype. As a part of the Korean Longitudinal Study on Cognitive Aging and Dementia, this population-based cohort study followed a random sample of community-dwelling Koreans aged 60 and older for 8 years at 2-year intervals starting in 2010. Participants included those who completed mood and multimorbidity assessments and did not exhibit complex multimorbidity at the study's outset. Depression was assessed using the Geriatric Depression Scale, while multimorbidity was evaluated using the Cumulative Illness Rating Scale. The study quantified multimorbidity complexity by counting affected body systems and measured multimorbidity severity by averaging scores across 14 body systems. The 2,486 participants (age = 69.1 ± 6.5 years, 57.6% women) were followed for 5.9 ± 2.4 years. Linear mixed models revealed that participants with depression had a faster increase in multimorbidity complexity score (β = .065, SE = 0.019, p = 0.001) than those without depression, but a comparable increase in multimorbidity severity score (β = .001, SE = .009, p = 0.870) to those without depression. Cox proportional hazard models revealed that depression was associated with the risk of developing highly complex multimorbidity affecting five or more body systems, particularly in severe or anhedonic depression. Depression was associated with the worsening of multimorbidity in Korean older adults, particularly when severe or anhedonic. Early screening and management of depression may help to reduce the burden of multimorbidity in older adults.

Treatment of hypophosphatasia

ypophosphatasia is a systemic metabolic disorder due to genetically determined deficient activity of the tissue non-specific alkaline phosphatase (TNAP). The phenotypic presentation is characterized by a wide spectrum of clinical manifestations regarding both, affected body systems and organs as well as the severity of associated deficits. Appropriate treatment strategies thus have to be multimodal in order to cover individual disease manifestation. For patients with disease onset before adulthood, enzyme replacement therapy with asfotase alfa is approved in Europe to treat the bone manifestations of the disease. Available data from clinical trials as well as real-word evidence confirm encouraging results of this treatment in severely affected children with substantial improvement regarding radiographic and functional outcome parameters as well as overall survival. In adult patients with disease manifestation pursuant to the label, published results also report substantial amelioration of disease-specific deficits along with functional improvements. Meanwhile, there is are also data supporting the safety and efficacy of long-term treatment with asfotase alfa over several years. While inflammatory muskuloskeletal pain - seemingly the most prevalent clinical manifestation along with exhaustion - can transiently be mitigated with on-demand NSARs, essential treatment options to causatively overcome that issue are still lacking. Accordingly, maintenance of musculoskeletal health and functionality requires sustained supportive treatment including physiotherapy and individually adjusted technical orthopedic support. The use and potential clinical impact of phosphate and vitamin B6 on the course of the disease requires further investigation. Current data regarding the use of bone-targeted compounds established for osteoporosis is critical in terms of antiresorptive, while osteoanabolic treatment strategies appear feasible. Considering further organ manifestation including orodental, gastrointestinal and neurological symptoms etc., the entirety of therapeutic measures should be coordinated among a multidisciplinary team and overlooked at an experienced center, while individual tasks can preferably be accomplished at local facilities near the patient’s home.

ОПЫТ ИСПОЛЬЗОВАНИЯ ЭКСТРАКОРПОРАЛЬНОЙ МЕМБРАННОЙ ОКСИГЕНАЦИИ У ПАЦИЕНТА С ИНГАЛЯЦИОННЫМ ОТРАВЛЕНИЕМ СОЕДИНЕНИЯМИ ФТОРА

Throughout the history of mankind, technological progress has not stood still, but, unfortunately, the production and discoveries that the age of progress brings to us always go hand in hand with an industrial injury. Despite the fact that over the past decades, the requirements and control of compliance with safety regulations have significantly increased, yet sometimes accidents occur that can take more than one human life. Work involving the risk of inhalation poisoning with particularly dangerous chemical compounds, which can lead to severe systemic and respiratory damage, is particularly dangerous for humans. According to the Federation of Independent Trade Unions of Russia, chemical poisoning accounts for 21.93% of all industrial injuries. Depending on the damaging agent, duration and area of exposure, all victims need a certain amount and specifics of assistance, which often requires prosthetics of several affected body systems, including using extracorporeal technologies. We present a clinical case of the successful application of extracorporeal membrane oxygenation (ECMO) methods in the complex therapy of inhalation poisoning with hydrofluoric acid vapors received by a patient as a result of an industrial accident. Based on the lack of clear clinical recommendations for the treatment of inhalation poisoning of this etiology, the method of extracorporeal membrane oxygenation and respiratory protection for volumetric lung tissue damage in complex therapy has shown its effectiveness and prospects that require further study.

Trend and co-occurrence network of COVID-19 symptoms through large-scale social media: Infoveillance Study.

For an emergent pandemic, such as COVID-19, the statistics of symptoms based on hospital data may be biased or delayed due to the high proportion of asymptomatic or mild-symptom infections who were not recorded in hospitals. Meanwhile, the difficulty of accessing large-scale clinical data also limits many researchers to conduct timely research. Given the wide coverage and promptness of social media, this study aimed to present an efficient workflow to track and visualize the dynamic characteristics and co-occurrences of symptoms for the pandemic from large-scale and long-term social media data. This retrospective study included 471,553,966 COVID-19-related tweets from February 1, 2020, to April 30, 2022. We curated a hierarchical symptom lexicon for social media containing 10 affected organs/systems, 257 symptoms, and 1808 synonyms. The dynamic characteristic of COVID-19 symptoms over time were analyzed from the perspectives of weekly new cases, overall distribution, and temporal prevalence of reported symptoms. The symptom evolutions between virus strains (Delta and Omicron) were investigated by comparing the symptom prevalence during their dominant periods. A co-occurrence symptom network was developed and visualized to investigate inner relationships among symptoms and affected body systems. This study identified 201 COVID-19 symptoms and grouped them into 10 affected body systems. The weekly quantity of self-reported symptoms has a high consistency (0.8528, P<.001) and one-week leading trend (0.8802, P<.001) with new COVID-19 infections. The frequency of symptoms showed dynamic changes as the pandemic progressed, from typical respiratory symptoms in the early stage to more musculoskeletal and nervous symptoms at later stages. We found the prevalence difference of symptoms between Delta period and Omicron period: less severe symptoms (coma and dyspnea), more flu-like symptoms (throat pain and nasal congestion), and less typical COVID symptoms (anosmia and taste altered) (All P<.001). Network analysis reveals the co-occurrences among symptoms and systems corresponding to specific disease progressions, including palpitation (cardiovascular) and dyspnea (respiratory), alopecia (musculoskeletal) and impotence (reproductive). This study identified more and milder COVID-19 symptoms than clinical research and characterize the dynamic symptom evolution based on 400 million tweets over 27 months. The symptom network reveals potential comorbidity risk and prognostic disease progressions. These demonstrate that the cooperation of social media and a well-designed workflow can depict a holistic picture of pandemic symptoms to complement clinical studies.

Extrahepatic Replication Sites of Hepatitis E Virus (HEV)

Hepatitis E virus (HEV) is an emerging viral disease known to cause acute viral hepatitis globally. Various genotypes of HEV have been identified that produce genotype specific lesions depending on the HEV targeted population. Pregnant or immunosuppressed individuals develop significantly more severe hepatitis E in comparison to the general population. In the last 40 years, we discovered that the tropism of HEV is not restricted to the liver, and virus replication was demonstrated in multiple organs. Out of the 10 body systems described in humans, HEV produces lesions causing a broad range of extrahepatic clinical manifestations in each of them. Affected body systems include nervous and musculoskeletal, cardiovascular, digestive, endocrine, integumentary, renal, respiratory, immune, and reproductive systems producing systemic lesions. All extrahepatic signs are caused by either direct HEV replication in these tissues, or indirectly by various immune mediated mechanisms. Extrahepatic replication features of HEV allowed it to cross the placental barrier, blood–brain barrier (BBB), and blood–testis barrier (BTB) that do not typically grant entry to viruses in general. Thus, in this review, we summarized the extrahepatic replication sites of HEV, listed the body systems where HEV invaded, and described multiple animal models including immunocompetent and immunosuppressed that were used to study the extrahepatic replication sites of HEV.

Correlations of whole blood heavy metals with serum immunological and oxidative markers during the early dry period and transition period of dairy cattle.

Immunological and oxidative alterations have been reported around calving in dairy cattle. In addition, the levels of heavy metals rise in the blood around parturition, which might affect body systems. Therefore, in this Research Communication we evaluate the changes in whole blood lead (Pb), arsenic (As), and cadmium (Cd) around calving, in comparison with the beginning of the dry period, and assess the correlations of these elements with immunological factors and oxidative markers. Samples were collected from 30 clinically healthy dairy cows in the early dry period (-6 w), one week before expected calving (-1 w), and one week postpartum (+1 w). The highest concentrations of Pb, As, and Cd were observed at -1 w and all the three elements decreased after parturition leading to significantly lower As and Cd, compared to -1 w (P < 0.05). The lowest levels of tumor necrosis factor-alpha, immunoglobulin G, interleukin 4, interleukin 10 and haptoglobin were found at -1 w simultaneous with the highest measures of the heavy metals, with tumor necrosis factor-alpha being significantly lower at this time (P < 0.05). At -6 w, As concentration was significantly (P < 0.05) correlated negatively (r = -0.366) and positively (r = 0.417) with total antioxidant capacity and malondialdehyde, respectively. Furthermore, at -1 w Pb and As had significant (P < 0.05) negative correlations with interferon gamma (r = -0.502) and interleukin 4 (r = -0.483), respectively. After parturition, Pb was observed to be negatively correlated with total antioxidant capacity (r = -0.538, P < 0.05). The observed results revealed that the alterations in immunological factors and antioxidant capacity around parturition were correlated with Pb and As levels.

Multimorbidity patterns and the relation to self-rated health among older Japanese people: a nationwide cross-sectional study

ObjectivesClassifying individuals into multimorbidity patterns can be useful to identify the target population with poorer clinical outcomes. Self-rated health (SRH) is one of the core outcomes in multimorbidity patients. Although...

RETROSPECTIVE ANALYSIS OF MORTALITY CAUSES IN MANAGED KIRK'S DIK-DIKS (MADOQUA KIRKII) IN NORTH AMERICA FROM 1988 to 2019.

Kirk's dik-diks (Madoqua kirkii) are the most common dik-dik species managed in North American zoological institutions, but their numbers are declining at a concerning rate, with less than 40 individuals currently housed in accredited institutions. This retrospective study reports the causes of mortality in Kirk's dik-diks in North American zoological institutions from 1988 to 2019. Out of 15 institutions accredited by the Association of Zoos and Aquariums (AZA) currently housing Kirk's dik-diks, nine contributed to this study (60% participation). Eighty-four necropsy records were reviewed to determine the primary affected body system and etiological cause of death across and within age categories. Neonatal death (prior to 1 mon of age) was most common (38.1%), followed by death in adults (29.8%), geriatric animals (19.0%), and juveniles (13.1%). As a whole population, causes of death by body system were multisystemic (47.6%), musculoskeletal (15.5%), respiratory (8.3%), and digestive (8.3%). Neonatal complications accounted for 50.0% of all deaths in animals prior to 1 mon of age. In juveniles, a nutritional cause of death was most common (27.3%) and significantly higher compared to measures of this cause within other age categories. In adults, metabolic etiologies and trauma each accounted for 28.0% of deaths. Degenerative etiologies were most common in geriatric individuals, representing 31.3% of the deaths. Death from infectious disease was found across all ages, representing 11.9% of all mortalities. Results from this study provide a baseline reference for this species and may aid clinicians in decision-making as it relates to the medical care and management of this species during different life stages.

Histological Origin and Anaplastic Behavior of Neoplasms Diagnosed in Canines in Guatemala (2015-2019)

The present study sought to statistically relate the histological origin and anaplastic behavior of neoplasms diagnosed in the Pathology Unit of the Faculty of Veterinary Medicine and Zootechnics of the University of San Carlos of Guatemala in the years 2015 to 2019, as well as associate race, age, sex and affected body system. A total of 1,162 canine samples were diagnosed, and a subsample of 289 cases was determined by systematic stratified random sampling of proportional allocation of each year. Regarding histological origin, 44% were epithelial neoplasms, 29% connective and derivatives, 12% other types, 4% endothelial, and 1% nervous. Concerning the anaplastic behavior, 51% of neoplasms were benign and 49% malignant. Likewise, it was determined that the neoplasms affected mostly females, pure breeds, canines of 7-10 years, and affected the integumentary system and soft tissues.

Pregnancy and the Singing Voice: A Survey of What Singers Report

Pregnancy has profound effects on a variety of body systems by way of hormonal and physical changes. Many of these changes directly affect body systems involved in singing. Assumptions exist about what can happen to a person's voice during pregnancy, but these assumptions are based on theoretical predictions leaving little knowledge of the lived experiences of voice changes during pregnancy. An anonymous mixed-method survey was given to 321 professional singers to gain insights on the lived experiences of pregnant singers. This investigation explored what people were told about the effects of pregnancy on the voice in comparison to what they actually experienced. Results show that about half of the respondents' experience matched what they were told for respiration. For phonation and vocal quality less than 25% respondent's experience matched what they were told. In addition, most of the information respondents received came from friends, colleagues, and teachers compared to medical professionals suggesting a need for more interdisciplinary education to best prepare vocalists who are contemplating becoming pregnant.

Prevalence and pattern of acute and chronic multimorbidity across all body systems and age groups in primary health care

Multimorbidity is more than just the addition of individual illnesses, and its diagnosis and treatment poses special problems. General practitioners play an important role in looking after multimorbid patients. The aim of this study is to assess the prevalence and pattern of acute and chronic multimorbidity in primary care patients, regardless of body system and age group. A convenience sample of 2099 patients treated by 40 general practitioners was assessed using the Burvill scale. This measure of multimorbidity differentiates according to organ system and covers both acute and chronic illnesses. It also allows severity ratings to be assessed for both acute and chronic conditions, and thus patients’ actual need for general practice care. Patients reported an average of 3.5 (SD = 2.0) acute and/or chronically affected body systems. Overall, 12.7% of patients reported only one health problem, 83.0% at least two, 65.8% at least three, 46.1% at least four, and 29.7% five or more. The most frequent problems were musculoskeletal (62.5%) and psychological (56.6%). Some morbidities were interrelated, while others co-occurred despite being medically independent. In primary care, multimorbidity is the rule rather than the exception. Acute and chronic morbidity both contribute to the burden of illness. Body systems reflect treatment needs. Instead of specialist treatment for individual illnesses, an integrative treatment approach is needed. This is the specialty of general practitioners.

Appropriateness of hospital admissions in a university hospital in Egypt: Analyzing a preintervention phase.

Identifying the magnitude of this improper use and applying interventions to eliminate unnecessary hospitalization will reduce health-care expenditure, improve the quality of care for patients, and increase the accessibility to care for actual patients in need on waiting lists. Aim of Work To measures the rate of inappropriate admissions at the Ain Shams University Hospital. This research is the preintervention phase of a study conducted to improve the appropriateness of patient admission at this hospital. The appropriateness evaluation protocol (AEP) was used to review the appropriateness of 576 hospital admissions over 100 days. The patients' medical records were stratified according to the admission route into two groups, namely emergency and outpatient admission. Next, the systematic random samples were taken from each stratum based on the admission list of the previous day. The results showed that 20.5% of the sampled cases were inappropriately admitted. Furthermore, a statistically significant difference was observed between appropriately and inappropriately admitted cases regarding gender and shifts during which admission occurred in addition to body systems affected; inappropriate admissions were more among females, and admissions occurred most frequently during the morning shifts (8:00 am-2:00 pm). The remaining other factors that were studied also proved insignificant. It can be concluded that a considerable proportion of hospital admissions is inappropriate, especially in the elective surgery department, and these admissions vary according to patient's gender, shifts during which admission occurred, and the affected body systems. Adopting hospital admission policies based on the AEP criteria in addition to training of physicians on these criteria would help prevent inappropriate admission and ensure optimization during use of hospital facilities.

Antimicrobial prescribing patterns in equine ambulatory practice

Antimicrobial resistance is one of the most important public health risks facing our world today. Antimicrobials are commonly prescribed in equine veterinary medicine, but limited information exists documenting their use in practice. The goal of this study was to investigate antimicrobial prescription patterns in regards to prescription frequency, duration, drug class, clinician and affected body system in an equine ambulatory setting via retrospective analysis of billing and electronic medical records. Risk factors associated with antimicrobial prescription including the nature of the visit, submission of a culture, body system affected and clinician were assessed using multivariable regression. We found that antimicrobials were prescribed in 8.5 % of visits with a median number of 3.5 (IQR 0.8−12.2) animal-defined daily doses (ADD), defined as the number of daily doses of all antimicrobials prescribed to a patient at a single visit. Aminoglycosides were the most common class of antimicrobials prescribed and trimethoprim sulfamethoxazole was the most common drug prescribed overall. Amikacin was primarily used for patients presenting with musculoskeletal signs, and the median number of ADDs for visits where amikacin was prescribed was 1 (IQR 0.9–1.9), while the median number of antimicrobial ADDs for all other visits was 4.4 (IQR 0–14.1). Statistically significant differences in antimicrobial use patterns existed across clinicians, months, years and affected body systems. Horses presenting with ocular (OR 1199; 95 % CI 204-7,037; p < 0.001) and integumentary (OR 365; 95 % CI 87.2−1532; p < 0.001) signs were most likely to be prescribed an antimicrobial. Emergency visits (OR 5.61; 95 % CI 3.19−9.89; p < 0.001) and submission of a bacterial culture (OR 3.58; 95 % CI 2.11−6.09; p < 0.001) were associated with an increased likelihood of an antimicrobial prescription. This observational study was the first to quantitatively characterize antimicrobial use patterns in equine ambulatory practice in the United States, which is an important step needed to determine appropriateness of use and develop and evaluate antimicrobial stewardship guidelines.

Study Protocol - Impact of Lactobacillus rhamnosus GG on Allergic Reactions and Gut Microbiota Composition in Children with Cow’s Milk Allergy A Single-Center, Randomized, Double-Blinded, Placebo-Controlled, Phase II – MILK ALLERGY Trial

Background: IgE-mediated reactions constitute 70% of cow's milk-induced allergic reactions (AR). There is no established treatment. Recent evidence suggests that immunomodulation with probiotics represents a safe novel strategy, influencing immunity and inducing tolerance to milk protein antigens by action on human gut microbiota. Current evidence focuses most on the infant population. Objective: We will study the impact of Lactobacillus rhamnosus GG (LGG), compared to placebo, as an effective agent to improve ARs upon exposure to cow's milk in children from 5 to 10 years of age. Methods: This will be a phase II, single-center, randomized, double-blinded, placebo-controlled study, where a total of 200 participants will be treated for 12 months, with either; LGG or placebo, randomly allocated at 1:1. A double-blinded placebo-controlled food challenge (DBPCFC) with cow's milk will be used before and after the intervention. Results will be graded using the PRACTALL scoring system. The primary outcome will be binary – 'passing' by the absence of any AR, or a decrease from the baseline results or 'not passing' the DBPCFC after treatment. Secondary outcomes will include covariate adjustment and subgroup analysis by affected body systems and severity of ARs. Secondary analyses will include a comparison of the proportions of the taxonomic composition of gut microbiota, and quality of life, with baseline measurements. Conclusion: This trial will contribute to filling knowledge gaps about cow's milk allergy management using LGG in this specific population as an affordable and accessible non-pharmacological agent with few recorded side effects. If proven to be efficacious, it has the potential to decrease the worldwide prevalence of CMA and the resulting systemic, familial, and personal burdens.

Frequency and Implications of Concurrent Complications Following Adult Spinal Deformity Corrective Surgery

Retrospective review. Identify co-occurring perioperative complications and associated predictors in a population of patients undergoing surgery for adult spinal deformity (ASD). Few studies have investigated the development of multiple, co-occurring complications following ASD-corrective surgery. Preoperative risk stratification may benefit from identification of factors associated with multiple, co-occurring complications. Elective ASD patients in National Surgical Quality Improvement Program (NSQIP) 2005 to 2016 were isolated; rates of co-occurring complications and affected body systems were assessed via cross tabulation. Random forest analysis identified top patient and surgical factors associated with complication co-occurrence, using conditional inference trees to identify significant cutoff points. Binary logistic regression indicated effect size of top influential factors associated with complication co-occurrence at each factor's respective cutoff point. Included: 6486 ASD patients. The overall perioperative complication rate was 34.8%; 28.5% of patients experienced one complication, 4.5% experienced two, and 1.8% experienced 3+. Overall, 11% of complication co-occurrences were pulmonary/cardiovascular, 9% pulmonary/renal, and 4% integumentary/renal. By complication type, the most common co-occurrences were transfusion/urinary tract infection (UTI) (24.3%) and transfusion/pneumonia (17.7%). Surgical factors of operative time ≥400 minutes and fusion ≥9 levels were the strongest factors associated with the incidence of co-occurring complications, followed by patient-specific variables like American Society of Anesthesiologists (ASA) physical status classification grade ≥2 and age ≥65 years. Regression analysis further showed associations between increasing complication number and longer length of stay (LOS), (R2 = 0.202, P < 0.001), non-home discharge (R2 = 0.111, P = 0.001), and readmission (R2 = 0.010, P < 0.001). For surgical ASD patients, the overall rate of co-occurring perioperative complications was 6.3%. Body systems most commonly affected by complication co-occurrences were pulmonary and cardiovascular, and common co-occurrences included transfusion/UTI (24.3%) and transfusion/pneumonia (17.7%). Increasing number of perioperative complications was associated with greater LOS, non-home discharge, and readmission, highlighting the importance of identifying risk factors for complication co-occurrences.Level of Evidence: 3.

COVID-19 and nutritional deficiency: a review of existing knowledge.

COVID-19 has resulted in an ongoing global pandemic, which spread largely among people who have had close contact with the infected person. The immunopathology of the SARS-CoV-2 virus includes the production of an excess amount of pro-inflammatory cytokines "a cytokine-storm". The respiratory system (main), cardiovascular system and the gastrointestinal tract are the most affected body systems during viral infection. It has been found that most of the patients who require admission to hospital are elderly or have chronic underlying diseases. Higher cases of malnutrition and co-morbidities like diabetes mellitus and cardiovascular diseases are reported in elderly patients due to which, the immune system weakens and hence, the response to the virus is diminished in magnitude. A deficiency of micronutrients results in impaired immune responses leading to improper secretion of cytokines, alterations in secretory antibody response and antibody affinity which increases susceptibility to viral infection. The deficiency of various micronutrients in COVID-19 patient can be treated by appropriate nutritional supplements, prescribed after evaluating the patients' nutritional status. Here we aim to highlight the role of a few particular nutrients namely Vitamin D, Vitamin C, Omega-3 fatty acids, Zinc and Magnesium along with the synergistic roles they play in enhancing immunity and thus, maintaining homeostasis.

Prevalence and Trends of Congenital Anomalies Among Neonates at Jimma Medical Center, Jimma, Ethiopia: A Three-Year Retrospective Study.

IntroductionCongenital anomalies are a major public health problem which is defined as structural or functional anomalies that occur during intrauterine life which can be detected prenatally, at birth, or sometimes may only be detected later in infancy. The impact of congenital anomalies is severe in middle- and low-income countries than in other developed and developing countries.ObjectiveTo assess the prevalence and trends of congenital anomalies among neonates admitted at Jimma Medical Center from 2017 to 2019.MethodsA facility-based retrospective, descriptive crossectional study was conducted among neonates admitted at Jimma Medical Center from 2017–2019. Descriptive analysis (frequency and percentage) was calculated for the variables. The result was present in the table, text, and figure.ResultsFrom a total of 3346 admitted neonates, 199 (5.95%) neonates were diagnosed with congenital anomalies; of which 120 (60.3%), 146 (73.4%), 144 (72.4%) and 30 (15.1%) of neonates were males, urban dwellers, delivered with normal birth weight and had multiple congenital anomalies, respectively. Central nervous system was the most commonly affected body system 56 (28.1%), followed by the gastrointestinal tract 41 (20.1%) and musculoskeletal system 32 (16.1%). The proportion of congenital anomalies was significantly increasing over time.ConclusionThe overall prevalence of congenital anomalies was high and increased from year to year. The proportions observed in the study indicated that a significant number of neonates were affected and suffered from the impacts of congenital anomalies which need immediate preventive actions such as iron folate supplementation during preconception and early pregnancy. Therefore, design strategies to create community awareness and prevention mechanism of congenital anomalies, and strengthening the care and rehabilitation services for affected patients are crucial.