Syndrome Categories Research Articles

P-1642. The Devil's in the details: Developing metrics for discharge antibiotic stewardship

Abstract Background International Classification of Diseases, Tenth Revision codes (ICD-10s) are commonly used to identify antibiotic indications but may not reflect clinician intent. We investigated concordance of different antibiotic indication sources in the electronic health record (EHR) with clinician intent upon discharge.Figure 1:Indication choices for inpatient antibiotic orders Methods In this quality improvement project, we included prescriptions for patients discharged on oral antibacterials from January 2022-March 2023, including patients with > 1 admission. We excluded those with >90 days duration and those for dapsone or rifaximin. We randomly selected 100 prescriptions and performed manual chart review to obtain the discharge summary antibiotic indications which we categorized into syndromes (Table 1.) We compared discharge indication with other EHR indication sources: last inpatient antibiotic order indication (is required, Figure 1), ICD-10s from separate fields ( “principle”, “encounter”, “billing”) and “composite ICD-10” which included all ICD-10s from any field. We compared each indication source with the associated discharge indication (considered most accurate) and report concordance.Table 1:Syndrome Categories and associated ICD-10 codes Results We included 3,088 prescriptions and excluded 364. Of the 100 encounters reviewed, 62% patients were discharged from medicine services and 46% had a trainee involved in discharge. These encounters were associated with 184 unique ICD-10s and 132 (72%) representing non-infectious diagnoses; the most common infectious diagnosis was skin and soft tissue infections (12 (7%)) (Table 2.) Overall, 37% (30/100) of prescriptions had ICD-10s that were categorized only as non-infectious. Clinicians most commonly intended discharge antibiotics for genitourinary indications (32/108, 30%) (Table 2). Last inpatient antibiotic order indication matched clinician intent in 91% of cases, while composite ICD-10 matched clinician intent in 47% of cases. Any single ICD-10 field (principle, billing, encounter) matched clinician intent in only 1/3 of cases (Table 3.)Table 2:ICD-10 codes and Clinician Intent by Syndrome Data from 100 chart reviews. A total of 184 unique ICD-10 were collected from 100 prescriptions. 8 discharge summaries included two indications. Conclusion Compared to ICD-10s, last inpatient antibiotic order indication more accurately matched clinician intent for antibacterial discharge prescriptions. This may be a useful and simple way to facilitate discharge prescription stewardship.Table 3:Agreement of different indication sources from EHR with ICD-10 code “Composite ICD-10” includes all ICD-10s from “principle”, “encounter”, “billing” fields. And was considered to match clinical intent if any ICD-10 category was concordant with clinical intent. Disclosures All Authors: No reported disclosures

The Placement of Auer Rods as a Single Diagnostic Criterion for the Highest-Risk Category of Myelodysplastic Syndromes: A Single-Institution Study and Critical Analysis

The Placement of Auer Rods as a Single Diagnostic Criterion for the Highest-Risk Category of Myelodysplastic Syndromes: A Single-Institution Study and Critical Analysis

The Effect of Adjuvant Therapy on Metabolic Syndrome in Schizophrenia Patients at Madani Hospital

Background: Schizophrenia is a mental disorder that impacts behavior, emotions, and communication. In recent years, atypical antipsychotics have been increasingly prescribed because they significantly reduce both positive and negative symptoms. However, the long-term effects of atypical can cause metabolic syndrome. Additional therapy is provided to maximize the primary therapy and reduce the side effects. Method: This study used a quasi-experimental design with a single-blind, pretest-posttest approach. Patients who had been using atypical antipsychotics, either monotherapy or combination therapy, for more than 3 were examined pretest to determine metabolic syndrome levels. Group A received adjuvant therapy, while Group B did not receive adjuvant therapy. Based on this data, an analysis of the reduction in metabolic syndrome categories was conducted. Result: The percentage of schizophrenia patients by gender was dominated by males (60%). By age, the majority were adults (87%). In Group A, the incidence of metabolic syndrome decreased from 53% in the pretest to 40% in the posttest after being given vitamin A, B, and folic acid therapy. The most commonly used other medication was THP (38%). Conclusion: The administration of adjuvant therapy with vitamins A, B, E, and folic acid can reduce the value of one or two of the five metabolic syndrome criteria for schizophrenia patients (p = 0.052) compared to the group of patients who did not receive vitamins A, B, E, and folic acid adjuvant therapy. Future research should use a longer duration to observe the effects of vitamins A, B, E, and folic acid and evaluate their therapeutic doses. Additionally, it should narrow down the criteria for medication use, focusing solely on the atypical antipsychotic’s clozapine or olanzapine.

Sleep disorder syndromes of post-acute sequelae of SARS-CoV-2 (PASC) / Long Covid

IntroductionCOVID-19 infection has resulted in a high prevalence of a post-infectious syndrome, known as post-acute sequelae of SARS-CoV-2 (PASC) or “Long COVID”. PASC is a heterogeneous disease with a high prevalence of sleep disturbances, varying from an insomnia disorder to excessive daytime sleepiness. MethodsPatients seen in the Covid Survivorship Program at the Beth Israel Deaconess Medical Center Boston, USA, were screened for sleep disorders as part of a comprehensive multi-system evaluation. Those who screened positive were referred for a comprehensive sleep evaluation in a dedicated COVID-19-Sleep clinic, followed by diagnostic sleep testing and treatment. This report summarizes patients who completed an American Academy of Sleep Medicine (AASM) accredited facility-based diagnostic evaluation. International Classification of Sleep Disorders 3rd Edition-Revised criteria were met for all diagnoses. ResultsIn 42 patients with PASC, five categories of sleep disorder syndromes were observed following a sleep clinic evaluation, including obstructive sleep apnea, chronic insomnia disorder, primary hypersomnia, REM behavior disorder (RBD), and new onset circadian phase delay. Seven patients met criteria for idiopathic hypersomnia, and two had narcolepsy type 2. RBD patients were infected in three different waves; circadian disturbance patients were all infected in the winter wave of 2020/21, and the primary hypersomnolence group occurred during all waves, predominantly the initial wave of 2020. A peculiar form of insomnia was a persistent loss of sleep regularity. ConclusionsSpecific sleep symptoms/syndromes are reported in this select group of patients with PASC/Long Covid. As new onset sleep complaints are prevalent in PASC, we recommend a complete clinical and investigative sleep evaluation for persistent severe sleep symptoms following COVID-19 infection.

Evaluating the Influence of Acute and Chronic Orofacial Pains on the Overall Comprehensive Quality of Life.

Background Orofacial discomfort refers to various disorders that affect the mouth, jaws, and face. These conditions may substantially influence a person's quality of life (QoL). This kind of pain may be categorised into two primary classifications: acute and chronic. Acute orofacial pain (OFP) usually occurs suddenly and lasts for a short period. It is commonly caused by specific factors such as dental treatments, traumas, or infections. Hence, this study aimed to assess the influence of acute and chronic orofacial discomfort on the overall QoL. Methodology This research used a convenience sample to gather data from the five groups. It was conducted as a cross-sectional study. Four categories of OFP syndromes were utilised: temporomandibular disorders (TMDs), atypical dental pain (ADP), trigeminal neuralgia (TN), and persistent dentoalveolar pain disorder (PDAP). In addition, a control group consisting of individuals who did not experience any discomfort was also included in the study. Participants received a standardised explanation of the questionnaires utilised, and in most instances, they completed them at the clinic under the supervision of one of the investigators. Results The correlations between each version of the Oral Health Impact Profile (OHIP) were statistically significant (p < 0.001), with correlation values ranging from 0.92 to 0.97. When comparing the occurrence of OHIP items across the four pain types, we identified 18 variations that exceeded the 35% prevalence threshold we established for identifying important items that frequently occur out of the 315 comparisons. The question "Have you had a painful aching in your mouth?" showed a low frequency in patients with TN, TMD, and ADP but a significant prevalence in patients with PDAP (90%). This difference in prevalence across pain types was the biggest seen. The question that seemed to distinguish between the pain categories most effectively was "Have you experienced a toothache?" This question had a high occurrence in PDAP (65%) and ADP (60%), perhaps allowing for differentiating these two diseases from TN and TMD. The highest prevalence differences, over 30%, were most often seen when PDAP was included as one of the disorders being compared. ADP had the fewest variances, over 30%, occurring just seven times. Conclusion Both acute and chronic OFPs have a major negative influence on QoL, but they affect it differently and to differing extents. Injury-related acute pain obviously poses rapid and severe restrictions on physical function and causes temporary psychological distress and temporary social exclusion. On the other hand, chronic pain for the patient always implies being locked in a physical world that does not allow him or her to bypass physical limitations, psychological disorders remain constant, and isolation from other people persists for life.

Digital treatments for affective disorders: an integrated overview

AbstractAffective disorders represent a category of psychiatric syndromes with high prevalence and associated disability. While effective, both pharmacological and psychosocial, treatments are available for depression and bipolar disorder, the many therapeutic needs of affected patients are far from being properly addressed under routine conditions. Along the past decade, several digital treatments, tools and approaches have been developed and tested in clinical settings, showing an highly promising potential to fill the treatment gap of affective psychopathology. In more detail, reviewed here will be telepsychiatry solutions for affective disorders, also encompassing the available officially approved digital therapies for major depression and bipolar disorder. Furthermore, the impact of artificial intelligence, serious gaming, social media and virtual/augmented reality in the treatment of mood disorders will be also discussed, in the light of the most recent research evidence on these topics.Disclosure of InterestNone Declared

Applicability of the International League Against Epilepsy (ILAE) 2022 diagnostic criteria for epilepsy syndromes in children: A retrospective review of 1550 children with epilepsy

ObjectiveRecently, the ILAE Nosology and Definitions Task Force defined diagnostic criteria for epilepsy syndromes. There is paucity of data on the use of these new diagnostic criteria in children with epilepsy, and how these criteria may lead to changes from previous practice. MethodsThis was a retrospective chart review of data of children attending the epilepsy clinic in a tertiary care children's hospital from January 2011 to January 2023. The clinical details such as age at onset, types of seizures, co-morbidities, and results of EEG, MRI and genetic testing were reviewed. Epilepsy syndrome diagnosis was made as per the ILAE 2022 criteria, and compared with the previous syndrome diagnosis as per records. ResultsData from 1550 children (63 % boys) with epilepsy were analysed, and 55.4 % children were classified to have epilepsy syndromes as per the new ILAE 2022 diagnostic criteria. Application of the new 2022 ILAE diagnostic criteria was associated with a change in name alone in 676 (77.8 %) children. Hundred (11.5 %) children were newly classified under an epilepsy syndrome who had previously remained unclassified. Eleven (1.3 %) children who were previously classified into an epilepsy syndrome could not be classified using the new diagnostic criteria. Eight (0.9 %) were shifted to a new syndromic category. Overall, change in diagnosis occurred in 13.7 (11.5 + 1.3 + 0.9)%. No change in epilepsy syndrome classification/nomenclature occurred in 74 (8.5 %) children. SignificanceThe new diagnostic criteria led to an overall change in diagnosis in 13.7 % of children with epilepsy. These criteria will hopefully lead to uniformity in diagnosis of epilepsy syndromes across diverse settings.

MILLER FISHER SYNDROME: A RARE BENIGN VARIANT OF GUILLAIN- BARRE SYNDROME

Abstract&#x0D; Introduction : Guillain-Barré Syndrome (GBS) is a broad category of syndromes that includes several types of acute immune-mediated polyneuropathy. Miller Fisher Syndrome (MFS) is a scarce variant of GBS (1-2:1,000,000) that presents at least 2 of ataxia, areflexia, and ophthalmoplegia.&#x0D; Case Illustration : A 32 years-old-man came to JEC-Candi with ophthalmic discomfort and exhibited a week onset of total ophthalmoplegia, ptosis, diplopia, and lagophthalmos. Two weeks backward, the patient had a respiratory infection then emerged symmetrical sensory abnormalities (glove-and-stocking-type pinprick sensations in distal extremities). Neurological examinations were performed, and the patient got multiple cranial nerve weaknesses (oculomotor, trochlear, abducens, trigeminal, and facial) both in motoric and sensory, ataxia (positive Romberg sign, stepping test, gait, shallow-knee- bend), and negative pathologic reflexes. Hematology showed leukocytosis, MRI and CT-Scan were normal. Pulse therapy was given (Methylprednisolone 1g/day) for three days, neuroprotector and artificial tears added. Ataxia and diplopia improved, then the patient was referred to Kariadi Hospital for five-times plasmapheresis that involved neurologist and internist. Ophthalmoplegia improved slowly, and lagophthalmos disappeared one month after hospital admission.&#x0D; Discussion : GBS subvariant could overlap; this case presents bifacial weakness with paresthesia and MFS. Viral infection precedes neurological symptoms in most cases, with an average of 10 days of the incubation period. Ataxia, diplopia, and ophthalmoplegia may confuse the physician and presume an upper motor neuron sign or central cause. Steroid and plasmapheresis evince meaningful upturn.&#x0D; Conclusion : This rare disease requires a multidisciplinary approach to cure and diagnose. Nonetheless, MFS has a good prognosis. Appropriate treatment selection will enhance patients' quality of life.

Essential thrombocythemia: nutritional management in weight loss and malnutrition.

Essential thrombocythemia is the category of myeloproliferative syndromes, generally characterized by a group of clonal stem cell diseases that present a disturbance in the growth of one or more sets of hematopoietic cells. All long clinical treatment, patients may experience gastrointestinal disorders and other metabolic processes that can lead to weight loss and malnutrition. Cytokine is involved in the control of appetite, digestive, and metabolic processes in the body, it can be assumed that increased stimulation could impair the control of these processes leading to loss of body mass. Effective and systematic nutritional intervention is required to ensure patient compliance with treatment and improved nutritional status.

COVID Pneumonia, Non-ST Elevation Myocardial Infarction, QRS Fragmentation, and Electrocardiographic Wavy Triple or Yasser's Sign in Hodgkin Lymphoma-Prognostic Influence and Serious Outcome

Rationale: The COVID-19 virus with severe acute respiratory syndrome (SARS) has a remarkable effect on morbidity and mortality. Non-ST elevation myocardial infarction (NSTEMI) is a category of acute coronary syndrome (ACS) that may represent a primary cardiac manifestation of COVID-19 disease. The QRS-complex fragmentation had been considered a hallmark of structural heart disease. Wavy triple, an electrocardiographic sign (Yasser’s sign) is a new specific diagnostic sign and therapeutic guide for hypocalcemia. Immunosuppression is a shared criterion for both cancers such as lymphomas and COVID-19 virus infection. Objectives: This case study aimed to clarify the role of COVID-19 viral pneumonia, chemotherapy, and Hodgkin lymphoma in the probability of the current case deterioration. Patient concerns: A 70-year-old, housewife, widow female, Egyptian patient was presented to the emergency department with COVID-19 pneumonia with Non-ST elevation myocardial infarction recently diagnosed as Hodgkin lymphoma. Methods: This is a retrospective-observational case study. Diagnosis: COVID pneumonia with Non-ST elevation myocardial infarction, QRS-complex fragmentation, and Wavy triple electrocardiographic sign (Yasser’s sign) in Hodgkin lymphoma disease. Interventions: CT pulmonary angiography, electrocardiography, and oxygenation. Outcomes: Bad response and poor outcomes in the presence of numerous remarkable serious risk factors were the results. Lessons: Hypocalcemia with Wavy triple electrocardiographic sign (Yasser’s sign) and not hypercalcemia is a new description association that may be present in a malignancy. The association of COVID pneumonia with the recent use of chemotherapy in Hodgkin lymphoma is highly interesting in case of deterioration and away to death. An elderly age, female sex, COVID-19 pneumonia, Non-ST elevation myocardial infarction, sinus tachycardia, QRS-complex fragmentation, Wavy triple electrocardiographic signs (Yasser’s sign), and Hodgkin lymphoma disease are constellation serious risk factors.

Choline-acetyltransferase (ChAT) and acetylcholinesterase (AChE) in the human infant dorsal motor nucleus of the Vagus (DMNV), and alterations according to sudden infant death syndrome (SIDS) category

Amongst other molecules, the cholinergic system consists of choline-acetyltransferase (ChAT, − synthesis enzyme), acetylcholinesterase (AChE – primary hydrolysis enzyme), and butyrylcholinesterase (BuChE – secondary hydrolysis enzyme). In the brainstem, the Dorsal Motor Nucleus of The Vagus (DMNV) has high cholinergic expression and is a region of interest in the neuropathology of sudden infant death syndrome (SIDS). SIDS is the unexpected death of a seemingly healthy infant, but postmortem brainstem abnormalities suggesting altered cholinergic regulation have been found.This study aimed to determine the percentage of positive ChAT and AChE neurons within the infant DMNV through immunohistochemistry at the three levels of the brainstem medulla (caudal, intermediate, and rostral), to investigate whether the proportion of neurons positive for these enzymes differs amongst the diagnostic subgroups of SIDS compared to those with an explained cause of Sudden unexpected death in infancy (eSUDI), and whether there were any associations with SIDS risk factors (male gender, cigarette smoke exposure, co-sleeping/bed sharing, and prone sleeping). Results showed that ChAT-positive neurons were lower in the rostral DMNV in the SIDS II cohort, and within the caudal and intermediate DMNV of infants who were exposed to cigarette smoke. These findings suggest altered cholinergic regulation in the brainstem of SIDS infants, with potential contribution of cigarette smoke exposure, presumably via the nicotinic acetylcholinergic receptor system.

Mechanism difference of ginseng medicines with different natures on hyperthyroidism

Ethnopharmacological relevanceMedicinal nature is a unique index in traditional Chinese medicine (TCM) to measure the efficacy of Chinese medicines. Hyperthyroidism, qi-Yin deficiency syndrome in TCM was regarded as the classic heat syndrome category in Chinese medicine. Moreover, it is extensively employed to evaluate the medicinal nature of herbs within the framework of the ‘hot/cold’ nature theory. Ginseng, red and black ginseng (GS, RG, and BG, respectively), and ginseng leaves (GL) are qi-tonifying herbs with different medicinal natures and were just right used to examine the underlying mechanisms between the nature of ginseng medicines and their tonifying effect. Aim of the studyTo examine the different mechanisms between different natures of ginseng medicines and their qi-tonifying action by comparison of their effects on hyperthyroidism and elucidate the nature of BG. Materials and methodsThe hyperthyroidism model was induced through the oral administration of Euthyrox. Steroids belonging to hypothalamus pituitary adrenal (HPA) and hypothalamic pituitary gonadal (HPG) axes were determined with an ultra-performance liquid chromatography-triple quadrupole tandem mass spectrometry (UPLC-QqQ-MS/MS) method. Furthermore, the biochemical indexes associated with energy metabolism, including the serum cyclic nucleotide system and phosphatidylinositol-3-kinase (PI3K)/protein kinase B (Akt) signaling pathways were examined. Additionally, the gut microbiota was subjected to 16 S rDNA sequencing, followed by gas chromatography-mass spectrometry (GC-MS) analysis of short-chain fatty acids (SCFAs). ResultsGS, RG, and BG could treat hyperthyroidism rats by regulating the hypothalamus pituitary thyroid (HPT) axis. The RG also had a strong regulatory effect on the HPA and HPG axis. The BG has a regulatory effect on the HPG axis. GL had a strong regulatory effect on HPA, HPG, and HPT axes. GS had the ability to regulate Firmicutes/Bacteroides of the intestinal flora, and GS, RG, and BG ameliorated the decrease of SCFAs induced by hyperthyroidism. According to PCA, BG is similar to GS, indicating a mild-warm nature. ConclusionThe nature of BG was attributable to mild-warm and the GL with cold nature is best for the treatment of hyperthyroidism based on PCA analysis with all the bio-indices. In addition, the mechanism study indicated that the qi-tonifying effects of ginseng medicines are involved in HPT, HPA, and HPG axes to alleviate hyperthyroidism. In addition, the primary indexes reflected different natures of ginseng medicines are cyclic adenosine monophosphate (cAMP)/cyclic guanosine monophosphate (cGMP), AchE, and substance metabolism associated with Na+-K+-ATPase and PI3K/AKT signaling pathways, which are potential biomarkers for evaluation on the natures of qi-tonifying medicines.

Implication of inflammatory markers in post COVID syndrome

Post-COVID syndrome was described in the context of a survey of prolonged COVID-19 symptoms for the first time in 2020, run by the Patient-Led Research Collaborative, citizen’s scientist group. Symptoms persisting for more than three weeks after the diagnosis of COVID-19 fall into the category of post-COVID syndrome. The most common post-COVID symptoms include fatigue, dyspnea, olfactory and gustatory dysfunction, chest pain, myalgia, and sleep and mental disorders. The pathogenesis of post-COVID syndrome is multi-factorial. Underlying chronic, low grade inflammation has been theorized for pathogenesis. Available data shows conflicting results regarding the implication of inflammatory markers in full clinical spectrum and its long-term outcome.

Spatio-temporal variation of seed rain between urban and rural fragments of humid tropical forests

Introduction: The type of land use surrounding the remnants of tropical forest may generate changes in the characteristics of plant populations and communities. Consequently, there may be a significant reduction in processes of pollination and diasporas dispersion. Therefore, causing changes in some parameters of seed rain. Objective: To characterize and compare seed density, species richness, floristic composition, habit, dispersal syndrome, and successional category of seed rain between urban and rural fragments of Atlantic Forest, in the 2015 and 2016 weather seasons. Methods: The study areas were defined after mapping and quantification of urban and rural occupations around the remnants, based on satellite images. In each fragment, were installed 36 collectors of 0.25 m2. The material was collected monthly during two consecutive years. Results: Seed rain richness was higher in the urban fragment during the rainy season in the two years, whereas it was similar between the fragments in the dry season. The seed density in the rural fragment was higher than in the urban during the rainy season; did not vary in urban between years or between seasons; and it was higher in the rural fragment in the rainy season of one year. There was a difference in the floristic composition of the seed rain between the fragments along time. The variations in the functional attributes of habit, dispersal syndrome, and successional category, were explained by the variables fragment, season, and year. Conclusions: Differences in the characteristics of the seed rain between the fragments might reflect the spatial and temporal heterogeneity, due to the diverse uses of the soil and external pressures (anthropogenic actions) present in the surroundings of the forest fragments and temporal variation in precipitation.

Epidemiology of Congenital Upper-Limb Anomalies in Southern Taiwan Based on the Updated Oberg, Manske, and Tonkin Classification: A Series of 1,335 Anomalies in 1,188 Patients

This study aimed to investigate the relative frequency of congenital upper-limb anomalies (CULAs) in southern Taiwan using the 2020-updated the Oberg, Manske, and Tonkin (OMT) classification system and evaluate the practicality of the new classification system. We retrospectively reviewed patients with CULAs from 1987 to 2021 at a referral center in southern Taiwan. All patients were analyzed based on medical records, photographs, and radiographs, and the anomalies were classified according to the 2020 OMT classification system. A total of 1,188 patients with 1,335 CULAs were retrospectively reviewed. The results demonstrated that the most common type of CULA was malformations (1,092 cases), followed by dysplasias (144 cases), syndromes (51 cases), and deformations (48 cases). Among the malformations, radial polydactyly was the most common anomaly (732 cases), followed by simple syndactyly (66 cases). Among the dysplasias, camptodactyly was the most common anomaly (52 cases), followed by thumb-in-palm deformity (45 cases) and vascular tumors (17 cases). In the deformations, constriction ring sequence accounted for all cases. Poland syndrome (21 cases) occurred most often in the category of syndromes. The results of this study show that radial polydactyly (732 cases, 55%) is the most common CULA in southern Taiwan, followed by simple syndactyly (66 cases, 5%) and then camptodactyly (52 cases, 4%). The OMT classification system is reasonably practical for precise classification of CULAs and enables easy comparison of studies over different time periods. However, continually updating the OMT classification system is required to better categorize the highly variable presentations of CULAs.

THE PROFILE OF DIAGNOSTIC OF UNCATEGORIZED SYNDROME TREATED BY ISLAMIC SPECIFIC PRAYER IN NUR HIDAYAH HOSPITAL

In daily practice, there are many patients that medically are not sick but suffer from illness. Those syndrome categories to be psychosomatic disorder (ICD 10). Islam believes about the power of an evil spirit. It can invade and attack a person caused illness. Physical exam and laboratory finding can be normal. They need islamic specific praying to relieve their suffering. The research design is a cross sectional study. Subjects in this study are patients at Nur Hidayah Hospital in 2014 - 2019 to whom receiving Islamic specific praying (ruqyah syar’iyyah). There are 369 patients treated by Islamic specific praying, but in the beginning, there is no standardized recording. The complete data of 22 patient are collected and statistically analyzed. The medical diagnosis of the subjects is: gastrointestinal disorders (10; 45%); cephalgia-epilepsy (5; 22%) anxiety disorders (4; 18%), sexual disorders (3; 13%). The reaction of treatment is vomiting, headache, heat sensation, and delirium. After those kinds of reaction, the patient relief from suffering and cure their illness. It is studied the diagnostic profile of Islamic specific praying in Nur Hidayah Hospital. Ruqyah Syar’iyyah can be used as complementary treatment

Being devastated by critical illness journey in the family: A grounded theory approach of post-intensive care syndrome-family

ObjectivesThis study aimed to explore the meaning and structure of postintensive care syndrome experienced by families of critically ill patients. MethodsThis qualitative study applied the constructivist grounded theory approach and conducted one or two interviews with eight participants with postintensive care syndrome-family for a total of 12 interviews. The contents of the interviews were analysed through line-by-line coding, focused coding, and categorisation. Data collection and analysis were iterative, to enable continuous comparative analysis. FindingsThe core category of postintensive care syndrome experienced by families was ‘being devastated by the critical illness journey in the family’ and comprised the interactions of four categories: ‘overwhelming intensive care experience’, ‘taking responsibility for the recovery trajectory of critical illness’, ‘life devastated by the trauma of intensive care and family caregiving’, and ‘balancing and compromising’. ConclusionBased on this grounded theory approach, postintensive care syndrome experienced by families is a complex and ongoing phenomenon that arises from the recovery trajectory of a critical illness. It involves mental, physical, social and familial aspects, particularly the impact on the patient’s family. Implications for Clinical PracticeThe findings can guide critical care nurses to understand postintensive care syndrome experienced by families in providing patient or family-centred care. To improve the long-term outcomes and quality of life for families, it is necessary to assess their unique needs within the continuum of post-intensive care syndrome experienced by the family and to propose interventions to satisfy those needs.

Abstract #1405303: Common Adverse Events During Levoketoconazole Titration: An Integrated Analysis of Data from Two Prospective Cushing’s Syndrome (CS) Clinical Trials

Illustrate common AEs reported during titration phases of the Phase 3 SONICS and LOGICS studies in adult patients with CS to inform the clinical use of levoketoconazole and enhance patient counseling. Treatment-emergent AE data with levoketoconazole were pooled from two prospective relatively similarly designed dose-titration phases from SONICS and LOGICS for integrated analysis. Titrations of up to 7 dose levels (from 150 mg BID to 600 mg BID) occurred no more frequently than once every 2 weeks as needed to normalize mean 24-hour urine free cortisol. AE preferred terms describing similar events were combined to form 24 mutually exclusive AE syndromic categories. Categories with a reported-patient frequency of ≥10% (n=14) were analyzed descriptively as to frequency, severity, action taken, times to onset and resolution, and recurrences during titration. Patient frequency of common AEs ranged between 10% (myalgia) and 30% (nausea/vomiting), with no apparent dose relationship among 13 of 14 AE categories (exception of upper respiratory infection). Drug-exposure duration differed by dose. Investigator-assessed AE severity was most often Grade 1 (mild, median patient frequency for 14 categories combined: 69%, range 41% to 90%). Overall, Grade 3 (severe) events were reported for 25% of patients with liver abnormality/injury, 15% with hypertension, and less than 10% for all other categories. Levoketoconazole dose reductions or interruptions were used for management of AEs most often for arrhythmia (typically asymptomatic QT interval prolongation; in 37% of arrhythmia events) and nausea/vomiting (19%), whereas withdrawal of levoketoconazole was most often used for management of liver abnormality/injury (29%). Median time to first onset for common AEs combined was 49.5 d, with fatigue the earliest onset (median 27 d) and arrhythmia (median 77 d) the latest. Median time to event resolution was 17 d, with headache (median 3d) the quickest to resolve and hypokalemia (median 64 d) the slowest. Among patients with a common AE, recurrence averaged 18% of patients across categories: nausea/vomiting (36%) recurring most often and hypertension (3.7%) least often. Median time to first recurrence following initial event resolution for combined categories was 25 d. Mean number of recurrences per patient was highest for hypokalemia (1.8±0.5). Detailed characterization of common AEs from an integrated dataset of 2 clinical studies populations during titration with levoketoconazole provides new knowledge relevant to levoketoconazole clinical use as chronic medical treatment in adult patients with CS.

TCM understanding and treatment strategy of hypertension complicated with sexual dysfunction

Hypertension and its target organ damage have become a major public health problem. Sexual dysfunction is a new problem in the treatment of modern hypertension. Modern pathophysiological studies have shown that hypertension can lead to sexual dysfunction. In addition, three major hypotensive drugs represented by diuretics can also lead to sexual dysfunction. In traditional Chinese medicine(TCM), hypertension belongs to &quot;vertigo&quot; &quot;headache&quot; &quot;head wind&quot;, etc. In the past, the understanding of the TCM pathogenesis of hypertension was mainly from the perspectives of &quot;liver wind&quot; and &quot;Yang hyperactivity&quot;. However, based on the in-depth research on ancient and modern literature and medical records and many years of clinical practice, it has been identified that kidney deficiency was the key pathogenesis. Hypertension complicated with sexual dysfunction belongs to the category of kidney deficiency syndrome in TCM, especially the deficiency of kidney Yin. Previous studies by other research groups showed that Yin-enriching and kidney-tonifying method could effectively reduce blood pressure, improve sexual dysfunction, reverse risk factors, and protect target organs. This article systematically discussed the TCM understanding, modern pathophysiological mechanism, and the clinical treatment strategy of kidney-tonifying drugs(single drugs and compounds) in the treatment of hypertension complicated with sexual dysfunction in order to provide a scientific basis for kidney-tonifying method in the treatment of hypertension complicated with sexual dysfunction.

Syndromic forms of congenital hyperinsulinism.

Congenital hyperinsulinism (CHI), also called hyperinsulinemic hypoglycemia (HH), is a very heterogeneous condition and represents the most common cause of severe and persistent hypoglycemia in infancy and childhood. The majority of cases in which a genetic cause can be identified have monogenic defects affecting pancreatic β-cells and their glucose-sensing system that regulates insulin secretion. However, CHI/HH has also been observed in a variety of syndromic disorders. The major categories of syndromes that have been found to be associated with CHI include overgrowth syndromes (e.g. Beckwith-Wiedemann and Sotos syndromes), chromosomal and monogenic developmental syndromes with postnatal growth failure (e.g. Turner, Kabuki, and Costello syndromes), congenital disorders of glycosylation, and syndromic channelopathies (e.g. Timothy syndrome). This article reviews syndromic conditions that have been asserted by the literature to be associated with CHI. We assess the evidence of the association, as well as the prevalence of CHI, its possible pathophysiology and its natural course in the respective conditions. In many of the CHI-associated syndromic conditions, the mechanism of dysregulation of glucose-sensing and insulin secretion is not completely understood and not directly related to known CHI genes. Moreover, in most of those syndromes the association seems to be inconsistent and the metabolic disturbance is transient. However, since neonatal hypoglycemia is an early sign of possible compromise in the newborn, which requires immediate diagnostic efforts and intervention, this symptom may be the first to bring a patient to medical attention. As a consequence, HH in a newborn or infant with associated congenital anomalies or additional medical issues remains a differential diagnostic challenge and may require a broad genetic workup.