Care Center Research Articles

Response to functional restoration in non-specific chronic low back pain with Modic type 1 changes.

Little information exists on the potential differential response to functional restoration between non-specific chronic low back pain (NSCLBP) individuals with and those without Modic type 1 changes. Therefore, this case-control study investigated the response profile of NSCLBP patients with and without Modic type 1 changes undergoing functional restoration. The present study included patients participating in a functional restoration program (day-hospital program lasting five weeks) at a French tertiary care center from 2009 to 2019. Each case with Modic type 1 changes was matched to one to two controls without Modic type 1 changes by sex, working incapacity, and lumbar spine surgery history. The primary effectiveness outcome was the Quebec Back Pain Disability Scale (QBPDS) score (0-100, with higher scores indicating higher disability). There were multiple secondary outcomes, such as subjective improvement and return to work. The study included 83 patients (cases: median [IQR] age 47.8 [11.6] years, 77.4% women; controls: median [IQR] age 46.0 [16.2] years, 75.0% women). At three months, there were no statistically significant differences between cases and controls in the QBPDS score (34.0 versus 31.5), subjective improvement (67.7% versus 69.2%), return to work in those who were not working at the inclusion (72.7% versus 52.6%), and the consumption of different analgesics. The response profile of NSCLBP adults undergoing functional restoration did not statistically differ between the groups with and without Modic type 1 changes. These findings suggest that patients may benefit from such a program irrespective of their Modic type 1 status.

The Natural History of Inflammatory Bowel Disease in Adults with Common Variable Immunodeficiency: A case series from a single US tertiary care center

The Natural History of Inflammatory Bowel Disease in Adults with Common Variable Immunodeficiency: A case series from a single US tertiary care center

Predictors of failure of percutaneous endoscopic gastrostomy tube placement: a retrospective study in a tertiary care center in the USA.

Percutaneous endoscopic gastrostomy (PEG) tube placement is a common procedure used to initiate enteral feeding. To our knowledge, there are no previous studies that analyze predictors of PEG failure. This study aims to identify risk factors for failure of inpatient PEG placement. A retrospective chart review was conducted of inpatients in the Montefiore Health System who were scheduled to undergo PEG placement from 2016 to 2020 (n=1,138). Patient, endoscopist, and procedural characteristics were summarized using descriptive statistics, both overall and stratified by whether the PEG was successfully placed. The overall success rate of PEG placement was 89%. The most common indications included stroke (31%), dementia (27%), and ventilator use (24%). Patient characteristics, including body mass index (BMI) (p=0.16) and indication for PEG placement (p=0.06), were not significantly associated with PEG failure. Instead, endoscopist and procedural characteristics were found to be significant, including type of attending (p<0.001), location of case (p=0.02), and category of anesthesia (p<0.001). PEG placement remains a highly successful procedure. Endoscopist and procedural characteristics, not patient characteristics, were associated with PEG placement success. Notably, patient BMI and indication for PEG placement could not be used to risk stratify candidates for PEG placement.

Presentation and Surgical Outcomes of Primary Hyperparathyroidism After Radioactive Iodine Therapy.

Radioactive iodine (RAI) is a common treatment for various thyroid diseases. Previous studies have suggested susceptibility of parathyroid glands to the mutagenic effect of RAI and the development of primary hyperparathyroidism (PHPT). We tested the possible link between prior RAI treatment, disease presentation, and treatment outcomes. A retrospective analysis of 704 individuals who underwent parathyroidectomy for PHPT at a tertiary care center between the years 2015 and 2023 was performed. Preoperative and postoperative parameters, including demographic characteristics, biochemical markers, imaging data, and surgical and pathology findings were collected and analyzed to compare differences in patients who had previous RAI treatment and those who did not (non-RAI). Univariate statistical analyses were performed. Twenty-nine patients had a history of RAI treatment. Indications for RAI treatment included hyperthyroidism (n=18), papillary thyroid cancer (n=6), subacute thyroiditis (n=1), follicular cancer (n=1), and toxic goiter (n=1). Average latency time between RAI exposure and development of PHPT was 18.4ys. On comparison of the two groups, there was no difference in age, sex, race/ethnicity, day of surgery body mass index, preoperative parathyroid hormone, calcium, glomerular filtration rate, creatinine, vitamin D, or phosphate levels. There was also no difference in preoperative diagnosis of osteoporosis or nephrolithiasis. Postoperatively, there was no difference in parathyroid hormone, calcium, or creatinine levels, or in rate of cure. There was significantly higher chance of unilateral exploration in the operating room (75.9% RAI, 54.1% non-RAI, P=0.02) and increased rate of single-gland disease in the RAI group, although the latter finding was not statistically significant (79.3% RAI, 65.2% non-RAI, P=0.12). There was no difference in adenoma size as noted on the pathology report (greatest dimension 1.7cm RAI, 1.7cm non-RAI, P=0.28). Subgroup analysis of the RAI group based on reason for RAI treatment (cancer versus hyperthyroidism) showed no statistically significant differences in the examined demographic or clinical data. There does not seem to be a relationship between prior RAI treatment and the clinical presentation of PHPT. Additionally, differences in RAI dose do not appear to be associated with a change in clinical presentation. Our study revalidates that age and latency are inversely related, which is a previously shown finding. Clinicians may be reassured that patients with prior RAI history may not have differences in clinical characteristics, disease presentation, or treatment outcomes.

Opportunities to Improve Care Processes for Ventilator-Dependent Children: A Single-Center Study.

Children with chronic ventilator dependence are a complex and heterogeneous population with unique needs. We sought input from parents, clinicians, and hospital staff to identify opportunities for process improvement during hospitalization and discharge preparation. We conducted a qualitative study at a large referral center for children with chronic ventilator dependence. Participants included parents of children with chronic ventilator dependence, physicians, nurses, respiratory therapists, and support staff. Two group-level assessment (GLA) sessions occurred, followed by one-on-one semistructured interviews. Thematic analysis identified areas for process improvements in the care of children with chronic ventilator dependence. A total of 27 individuals participated in 2 GLA sessions followed by 9 interviews. Potential areas for process improvements included (1) acknowledging and addressing limited resources for children with long-term mechanical ventilation dependence; (2) advancing beyond a "one-size-fits-most" care model; (3) placing the patient and family at the center of care; and (4) improving support for families and staff. Families persistently noted a traumatic component of their experiences through hospitalizations and learning to care for a child with chronic ventilator dependence. There are multiple opportunities for process improvement during the hospitalization of children with chronic ventilator dependence. Protocols and practices that support efficient and safe care, such as education before discharge, may require modifications to better meet family needs, address system shortcomings, and mitigate trauma.

Assessing and Enhancing Nutrition and Physical Activity Environments in Early Childhood Education and Care Centers: Scoping Review of eHealth Tools.

Early childhood is a critical period for shaping lifelong health behaviors, making early childhood education and care (ECEC) environments ideal for implementing nutrition and physical activity interventions. eHealth tools are increasingly utilized in ECEC settings due to their accessibility, scalability, and cost-effectiveness, demonstrating promise in enhancing educators' practices. Despite the potential effectiveness of these eHealth approaches, a comprehensive collection of available evidence on eHealth tools designed to assess or support best practices for nutrition or physical activity in ECECs is currently lacking. The primary objective of this scoping review is to map the range of available eHealth tools designed to assess or deliver interventions aimed at improving nutrition or physical activity in ECEC settings, while evaluating their components, theoretical foundations, and effectiveness. This scoping review adhered to the Joanna Briggs Institute methodology, in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. The objectives, inclusion criteria, and methods for this review were predefined and specified. Eligibility criteria were (1) early childhood educators (population); (2) eHealth (digital) technologies, such as websites, smartphone apps, emails, and social media; and (3) tools designed to assess or deliver interventions aimed at improving best practices for nutrition, physical activity, or both within ECEC settings (context). A search was conducted across 5 electronic databases (PubMed, Scopus, CINAHL Plus, ERIC, and Embase) to identify white literature, and 3 electronic databases (ProQuest, Google Scholar, and targeted Google search), along with hand-searching of reference lists, were used to identify gray literature. All literature was reported in English or French, with the search extending until May 2024. Separate data charting tools were used for white and gray literature. The search strategy identified 3064 results for white literature, yielding 2653 unique citations after duplicates were removed. Full texts for 65 citations were retrieved and screened for inclusion, resulting in 30 studies eligible for data extraction and analysis. The most common study design was a randomized controlled trial, comprising 16 studies (53%). The largest proportion of studies were conducted in the United States (11 studies, 37%). In total, 19 eHealth tools were identified, targeting nutrition (8 tools, 42%), physical activity (5 tools, 26%), or both nutrition and physical activity (6 tools, 32%). All tools were web based (19 tools, 100%). The gray literature search yielded 1054 results, of which 17 were moved to full-text screening, and 7 met the eligibility criteria for data extraction and analysis. The tools identified in the gray literature originated in Canada (4 tools, 57%) and the United States (3 tools, 43%). The majority targeted nutrition (4 tools, 57%) and were primarily web based (6 tools, 86%), with 1 mobile app (1 tool, 14%). This scoping review mapped the available eHealth tools designed to improve nutrition or physical activity environments in ECEC settings, highlighting the growing emphasis on web-based tools and the need for psychometric testing. Future research should systematically evaluate the effectiveness of these tools, particularly those addressing both nutrition and physical activity, to identify the key factors that contribute to long-term behavior change. Open Science Framework XTRNZ; https://osf.io/xtrnz. RR2-10.2196/52252.

Horizontal extraocular muscle insertion locations in children undergoing extraocular muscle surgery.

The location of extraocular muscle (EOM) insertions is clinically relevant in ophthalmologic surgery. The spiral of Tillaux has been a reference for normal EOM insertion since the nineteenth century. Research on EOM insertions is limited and has focused on adult cadaveric eyes. In this study we investigated the location of EOM insertions in children undergoing EOM surgery. Children who underwent EOM surgery for strabismus or anomalous head position at a large tertiary care center were consecutively identified from October 2022 to December 2023. Intraoperative measurements of medial rectus (MR) and lateral rectus (LR) insertions were compared to the spiral of Tillaux and within patient groups using one-sample and independent-samples t tests, respectively. Associations of EOM insertions with age, refraction, and axial length were evaluated with Pearson correlation. In 292 children who underwent EOM surgery, 528 previously unoperated EOM insertions were recorded. Mean insertions were closer to the limbus than expected by the spiral of Tillaux (MR, 5.21 vs 5.5 mm [P < 0.001]; LR, 6.76 vs 6.9 mm [P = 0.001]). Esotropia was associated with closer EOM insertions than exotropia (MR, P = 0.021; LR, P = 0.045). Males had farther MR insertions than females (5.33 vs 5.03 mm [P < 0.001]). Age was weakly associated with farther EOM insertions (MR, r = 0.215, P < 0.001; LR, r = 0.232, P < 0.001). Myopia was very weakly associated with farther MR insertions (r = -0.145, P = 0.024). In children undergoing EOM surgery, MR and LR insertions were closer to the limbus than expected relative to the spiral of Tillaux. This finding may have implications for surgical planning and outcomes.

Endoscopic Strategies for UGIB: Comprehensive Findings from a Tertiary Care Centre

Endoscopic Strategies for UGIB: Comprehensive Findings from a Tertiary Care Centre

Factors Associated with the Patient Safety Activities among Home-Visit Caregiver: A Cross-Sectional Study.

Home-visit care should prioritize patient safety and promote positive safety awareness to maintain caregivers' commitment to providing safe care. This descriptive study aims to examine the relationship between home-visit caregivers' knowledge, attitudes, awareness of patient safety, and safety-related activities. The participants were 210 adult home-visit caregivers, aged 20 years or older, with more than six months of experience working at six long-term care centers in D Metropolitan City. Data were collected using a structured self-report questionnaire to measure participants' general characteristics and their patient safety knowledge, attitudes, awareness, and activities and analyzed using SPSS/WIN 28.0. This study demonstrated that patient safety activities were significantly positively correlated with patient safety knowledge (r=.63, p˂.001), patient safety attitude (r=.49, p ˂.001), and patient safety awareness (r=.69, p˂.001). The factors affecting patient safety activities were patient safety awareness and patient safety knowledge, with an explanatory power of 55%. To practice patient safety activities and maintain a desirable attitude, an educational strategy that promotes cognitive change, such as a systematic and continuous practice-oriented campaign, is needed. Furthermore, efforts to improve the working environment to extend the tenure of experienced caregivers are required.

Home Healthcare Medication Safety risks among older adults with chronic diseases: a qualitative study

BackgroundOlder adults receiving home care often face significant safety risks related to medication management due to their chronic diseases and complex health needs. Despite the increasing reliance on home healthcare services, the specific factors contributing to medication safety risks in this demographic remain inadequately explored.Objective/AimThis study aims to explore the key factors involved in medication safety risks among older adults with chronic diseases receiving home healthcare in Iran.MethodsQualitative research employing conventional content analysis was conducted using Graneheim and Lundman’s approach. was conducted in three home care centers in Tehran (Iran) from August 2020 to July 2022. Data were collected through semi-structured interviews with 7 nurses, 2 supervisors, 2 nursing assistants (experts in non-nursing careers), 1 home care inspector (expert of the Deputy of Treatment), and 3 family caregivers in home settings, along with four participatory observations and visual methods (narrative photography) focusing on medication safety challenges. The trustworthiness of the research was evaluated using Lincoln and Guba’s four criteria for qualitative studies.FindingsFactors associated with medication safety risks were found to rely on its major components Patients’ attribution, Families’ characteristics, Home care centers’ condition, Health caregivers’ characteristics, and the Homes’ situations, where these factors all account for various medication safety risks. Indeed, a medication safety risk can be attributed to more than one of the factors associated with medication safety risk by participants at home.ConclusionAs a result, the analysis of factors associated with medication safety risks highlights a complex interplay among various elements, including patients, families, home care centers, health caregivers, and the home environment. These interconnected factors are crucial for identifying the diverse medication safety challenges faced by participants in home settings. A comprehensive understanding of these dynamics is essential for improving medication safety protocols and enhancing health outcomes for this vulnerable population.

Medulloblastoma Molecular Subgrouping and Outcomes Data of a Single Center From a Low- and Middle-Income Country.

Medulloblastoma (MB) is the most common malignant childhood brain tumor. Molecular subgrouping of MB has become a major determinant of management in high-income countries. Subgrouping is still very limited in low- and middle-income countries (LMICs), and its relevance to management with the incorporation of risk stratification (low risk, standard risk, high risk, and very high risk) has yet to be evaluated in this setting. We describe molecular findings from a tertiary care center in Pakistan and their implications for outcome. Children aged between 3 and 18years diagnosed with MB from April 2014 to December 2020 at Aga Khan University Hospital (AKUH) were included. Subgrouping was performed by NanoString through a collaboration with The Hospital for Sick Children, Toronto. Thirty-seven patients (30 males) were included in this study; median age was 9years. Twenty patients (54.1%) were high-risk, including 12 with metastatic disease. In 30 children, there was a clear molecular subgroup: 4 wingless (WNT) (10.8%), 6 sonic hedgehog (SHH) (16.2%), 3 Group 3 (8.1%), and 17 Group 4 (45.9%) MBs. Molecular subgrouping was inconclusive for three patients (8.1%) and not done in four patients (10.8%). All patients underwent surgery; 26 patients received radiation therapy at AKUH, and 9 were referred outside for radiotherapy; 24 patients received chemotherapy at AKUH (10 outside AKUH). Overall survival (OS) at 5years was 100%, 66.7%, 66.7%, and 88.2% for WNT, SHH, Group 3, and Group 4 patients, respectively (p=0.668). Low- and standard-risk patients had a 5-year OS of 100%, whereas very high-risk patients exhibited a significantly lower OS of 0% (p<0.001). WNT and Group 4 patients had excellent results despite one WNT patient having metastatic disease and eight Group 4 patients being high risk. Our study depicts that molecular subgrouping aids in accurately predicting survival, suggesting the potential benefit of tailored testing and treatment in the LMIC setting.

Evaluating the Effect of Various Pure Tone Averages on Cochlear Implant Candidacy Screening.

To provide evidence to use an extended frequency pure tone average to screen for cochlear implant evaluation candidates as recommended by the American Cochlear Implant Alliance. Additionally, to determine whether traditional low frequency, high or low frequency, high frequency, or extended frequency pure tone average most accurately predicts cochlear implant candidates based on speech perception scores from aided AzBio sentence testing or aided consonant-nucleus-consonant (CNC) testing. Adults from a tertiary care center who completed aided sentence testing during cochlear implant evaluation between 2014 and 2024 were assessed. Pure tone averages at low, high, low or high, and extended frequency ranges were evaluated with individual ear's aided AzBio or aided CNC scores as an outcome. Sensitivity, specificity, negative predictive value, and positive predictive value were assessed and compared using a paired study design. There were 675 observations from 363 patients with AzBio as an outcome variable and 665 observations from 364 patients with CNC scores as an outcome variable. High or low frequency achieved the highest sensitivity at 96.3% AzBio as an outcome and 95.6% with CNC as an outcome, which was significantly better than low frequency (p < 0.001). Low frequency achieved the best specificity at 63.6% with AzBio as an outcome 76.9% with CNC as an outcome. Extended frequency pure tones resulted in greater sensitivity in predicting CI candidates compared with the traditionally used low frequency pure tone average. Screening with wider frequency values will lead to a greater number of patients being identified for a cochlear implant evaluation. Level 3 Laryngoscope, 2025.

Barriers to the Management of Classic Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency.

Classic congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is a rare genetic condition that requires lifelong management from birth. Individuals with CAH and their families often face structural barriers to obtaining comprehensive care and treatment, including limited access to appropriate newborn screening, comprehensive care centers, and medications. Social and cultural barriers to care may include stigmatization, discrimination, and adverse medical experiences. At the individual and family level, comprehensive care may be affected by education, finances, health-care coverage, geographic location, and lack of social supports. These barriers are often further magnified for individuals living in underresourced countries. Inadequate access to comprehensive care and medications increases the risk of life-threatening adrenal crisis and disease-related comorbidities. This review article examines the current structural, sociocultural, and individual barriers that individuals with CAH and their families may face when managing their condition throughout their lifetime.

Social prescribing for adults with chronic pain in the U.K.: a rapid review.

Social prescribing links patients to community groups and services to meet health needs; however, it is uncertain what the benefits and impacts of social prescribing are for people with chronic pain. The National Institute for Health and Care Excellence (NICE) undertook a systematic review to investigate the clinical and cost effectiveness of social interventions aimed at improving the quality of life of people with chronic pain; no relevant clinical studies comparing social interventions with standard care for chronic pain were found, though the inclusion criteria for studies was narrow. To undertake a rapid review of all types of research and policy on social prescribing for adults with chronic pain in the U.K. (i) to describe the characteristics of relevant research and (ii) to synthesise data on impact. A two-stage rapid review was planned. Stage (i) scoped and categorised knowledge from a comprehensive representation of the literature. In stage (ii), we undertook a descriptive synthesis of quantitative data along with a thematic analysis of qualitative data identified by stage (i). Of 40 full-text records assessed for inclusion, three met the inclusion criteria from academic databases. An additional five records were found in grey literature. Six records reported quantitative findings suggesting that social prescribing reduced pain severity and discomfort, pain medication and clinical appointments; and improved quality of life and ability to manage health. Five records captured qualitative data from interviews, case studies and anecdotal quotes that suggested positive impact on health and wellbeing; and increased self-efficacy in social prescribers undertaking training on pain. There is tentative evidence that social prescribing improves health and wellbeing outcomes in adults with chronic pain and that there is a need to upskill social prescribers in contemporary pain science education. Research on the routes to referral, outcomes and impacts is needed. Social prescribing is valued and may be of benefit for people with chronic pain. There is a need to further develop and evaluate social prescribing services for people with chronic pain to enhance holistic patient centered care.

Revisiting ascending aortic resection in the elective valve-sparing root replacement: assessing the benefits and necessity of hemiarch replacement at three centres.

The aim of this study was to determine the indication and optimal timing for performing a hemiarch procedure in patients undergoing valve-sparing root replacement (VSRR). We conducted a retrospective study on 986 patients undergoing VSRR at three tertiary care centres. Inclusion criteria were all patients undergoing elective VSRR. Exclusion criteria were age <18 years, Stanford type A dissection, dissection in the arch, total aortic arch replacement or previous aortic arch replacement. We performed propensity score matching in a 1:1 ratio. The primary endpoint is a composite outcome that includes mortality, aortic arch reintervention, new aortic dissection during follow-up, and cerebrovascular incidents within the first 30 days. A total of 401 patients (41%) had a hemiarch replacement, while 585 (59%) did not. Root phenotype was present in 565 (57%). The mean follow-up time was 4.7 years (SD ± 4.6).In the matched population, there was no significant difference in the 10-year freedom from the composite outcome between the non-hemiarch and hemiarch groups (87.3% vs. 85.0%, p > 0.999). Similarly, no difference was found for aortic reinterventions (p = 0.13) or survival (p = 0.5). This was also true for patients with heritable thoracic aortic disease. However, in patients with a bicuspid aortic valve, the intervention rate was significantly higher in the hemiarch group (10.8% vs. 0%, p = 0.016).There was no significant difference in the 30-day incidence of cerebrovascular accidents between the groups (5% vs. 2.7% in the hemiarch group, p = 0.117). Only the distal ascending diameter showed a tendency with better outcome over 45mm for the hemiarch procedure, otherwise we found no reliable cut-off values based on asecending length, diameter-to-height index, or ascending length-to-height index. Our findings conclusively demonstrate that concomitant hemiarch replacement does not increase the perioperative risk in young patients undergoing VSRR. However, concomitant replacement does not seem to protect from aortic reinterventions during medium term follow-up.

Amitraz Poisoning: An Observational Study from a Tertiary Care Center in North Karnataka

Amitraz Poisoning: An Observational Study from a Tertiary Care Center in North Karnataka

Challenges in Burns Management in a Tertiary Care Center in Albania

Introduction: Burn injuries represent a significant public health concern globally, with a substantial impact on morbidity and mortality rates, particularly in low- and middle-income countries. This study provides valuable insights into the epidemiology of burn injuries in Albania. It highlights the critical need for targeted interventions to reduce the incidence and severity of burns in the population. Materials and Methods: This retrospective cohort study examined burn patients at the Department of Burns and Plastic Surgery at Mother Teresa University Hospital Center in Tirana from January 2022 to January 2024. Data were collected from medical records in Tirana, Albania. Formal approval was obtained from the Ethics Committee of Mother Teresa Hospital. The data were recorded in Excel and analyzed using the SPSS statistics program. Results: This retrospective cohort study included 303 burn patients admitted between January 2022 and January 2024. Data on patient demographics, burn causes, total body surface area (TBSA), and burn severity were collected and analyzed using SPSS software. The mean patient age was 36.1 years, with children aged 0-10 most affected, especially 2-year-olds. The youngest patient was seven months old, and the oldest was 89. Male patients comprised 60.7% of the cohort. The leading cause of burns was scalding from hot liquids (39.9%), followed by flames (20.4%) and electrical burns (8.2%). The average TBSA affected was 23.06%. The mortality rate was 7.3%. Conclusion: Burn injuries present significant physical and psychological challenges. Despite advancements in burn care, the importance of preventive measures and public awareness campaigns must be addressed. These remain the most effective strategies to reduce burn incidence and severity. These findings underscore Albania's need for improved burn prevention and public safety initiatives.

The clinical observation of none-promyelocytic AML patients inducted with idarubicin or daunorubicin included standard regimens: a tertiary care center experience

BackgroundFew Chinese study compared the impacts of idarubicin and daunorubicin based “3+7” intensive chemotherapies on early and long-term outcomes of AML patients through exploring their real-world data.Patients and methodsOur none promyelocytic AML patients inducted with “3+7” regimens were studied to find out the factors relating with induction response and long term survival.ResultsIdarubicin induction was related with less chemotherapy refractory rate comparing with daunorubicin induction (10% vs 25%, P = 0.02). But cytogenetic molecular risk classification was the only independent factor relating with achieving CR after initial induction or chemotherapy refractory (P = 0.000 and 0.036). Both to overall survival (OS) and progress free survival (PFS), having transplantation and chemotherapy refractory were independent factors related, MLL rearrangement and DNA methylating related genes’ mutations as well. CR at time of transplantation and MLL rearrangement were independent factors relating both with OS after transplantation and relapse free survival after transplantation.ConclusionTraditional “3+7” chemotherapy regimen with idarubicin plays better in CR induction than that with daunorubicin. But the patient’s long-term survival related with clinical practice aspects, like having stem cell transplantation, as well as genetic alterations equally, like MLL rearrangement and DNA methylating related genes’ mutations.

Cutaneous Findings in Neonates: A Clinical Study from a Tertiary Care Center

Cutaneous Findings in Neonates: A Clinical Study from a Tertiary Care Center

Anesthesia for pregnant patients with symptomatic neurological disease: 13 years’ experience from a tertiary care center

BackgroundImprovements in diagnostics and clinical care have allowed more women of childbearing age, suffering from neurological diseases, to safely have pregnancy, reducing peripartum complications. However, these patients remain at risk and are a constant challenge for anesthesiologists in the delivery room.MethodsTo assess the type of anesthesiologic management performed for delivery in obstetric patients with preexisting neurological disease and who reported significant neurological symptoms during pregnancy, a retrospective observational study was carried out between 1 October 2008 and 30 September 2021.ResultsData from 49,202 pregnant women were assessed over 13 years; 239 pregnant women with a diagnosis of preexisting neurological disease and who reported significant neurological symptoms during pregnancy were identified (prevalence 0.49%). The main neurological disorders that affected pregnant women included vascular abnormalities and intracranial bleeding (N = 42, 17.6%), central nervous system tumors (N = 35, 14.6%), epilepsy and episodic and paroxysmal disorders of the central nervous system (N = 34, 14.2%), diseases of the neuromuscular junction and muscles (N = 26, 10.9%), demyelinating central nervous system diseases (N = 24, 10%). A total of 234 (97.9%) pregnant women with neurological disorders and significant neurological symptoms underwent cesarean section: 192 (80.3% of the total cesarean sections) were elective, 39 (16.3%) were urgent type 2 and 3; 3 (1.2%) were emergency cesarean sections. General anesthesia was administered to 73 patients (30.5%), while 166 patients (69.5%) were managed with neuraxial techniques. 2 patients who had had neuraxial block reported worsening neurological symptoms that required a change in medical therapy. Postoperative multiparameter monitoring was performed for less than 24 h in the recovery room for 226 patients (94.6%). 3 patients (1.2%) were observed with multiparameter monitoring in the post-anesthesia care unit (PACU) for more than 24 hours; 10 patients (4.2%) were moved to the postoperative intensive care unit (ICU). The median hospitalization duration was 4 days (with an interquartile difference of 3–6 days).ConclusionsIn our experience, when neuraxial anesthesia was feasible, it proved to be a safe option for pregnant patients with symptomatic neurological disease, resulting in uncommon maternal complications.