Adult Female Patients Research Articles

Investigation of the Frequency of Cryptosporidium spp. and Giardia intestinalis in Patients with Suppressed Immune System

Objective: Giardia intestinalis and Cryptosporidium spp. are important agents causing diarrhea in developing and developed countries. If untreated, these agents may cause severe life-threatening diarrhea, especially in immunocompromised people and children. This study aimed to investigate the frequency of Cryptosporidium spp. and G. intestinalis in the stool samples of immunocompromised patients who applied to Harran University Research and Application Hospital. Methods: This study was carried out with a total of 100 patients with immunosuppression and diarrhea who were admitted to our hospital between January 2017 and January 2019. Cryptosporidium spp. and G. intestinalis antigens were investigated in stool samples of the patients by immunochromatographic (IC) method and oocyst, and cyst-trophozoite were examined with Native-Lugol and Kinyoun acid-fast staining. Results: G. intestinalis was detected in eight (8%) patients. Seven of them (14%) were pediatric patients (n=50) and one (2%) was an adult female patient (n=50). Cryptosporidium spp. was detected in 3 (3%) patients. Of these, two (4%) were children patients and one (2%) was an adult female patient. Our results also demonstrated that both Cryptosporidium and Giardia were more found in immunocompromised patients, especially in pediatric ones (4% and 14% respectively). Conclusion: Although the cost of the IC method, which detects antigens in stool samples is high, it is easy to work with, provides early results and it also helps to overcome the difficulties in active diagnostic methods. Despite the limited number of investigated samples, our findings showed that the incidence of infections from these two parasites is higher than in other studies conducted in Turkey or European countries.

S1324 Gender Disparities in Nonalcoholic Steatohepatitis Patients: Comparison of Patient Characteristics and Inhospital Outcomes

Introduction: Nonalcoholic steatohepatitis (NASH) is the progressive form of Nonalcoholic Fatty Liver Disease (NAFLD). With the increasing trend in the prevalence of NASH in last decade, it has become important to study each and every aspect of the disease prevalence. Presence of gender disparities have been reported in NASH but there have not been enough studies about that, so we decided to evaluate gender disparities among patients with NASH. Methods: Adult male and female patients admitted with NASH, were analyzed from September 2015 to December 2020 using the National Inpatient Sample database. The primary outcome was to determine the burden of NASH in both subgroups. Secondary outcomes included all-cause in-hospital mortality, length of stay (LOS), and total hospital costs. SAS 9.4 software was used for statistical analysis. Results: Out of 435760 patients admitted with NASH, 2,69,980(62%) were female and 1,65,780(38%) were male. Median age in males is 61.3 ± 13 vs 62.2 ± 13.2 in females. Predominantly Caucasian Males and Females were reported compared to other ethnic groups. Comorbidities like hypertension, coronary artery disease, diabetes, peripheral vascular disease, A fib were higher in the male group compared to female. Only Obesity was reported slightly higher (37.2% vs 35.9%) in females. Higher in hospital mortality was observed (3.8% vs. 3.6%, P < 0.001) in male patients with NASH. Male subgroup demonstrated higher burden of A.fib (17.1% vs 12.6%) and VTE (1.8% vs 1.4%) compared to female subgroup. Inpatient hospital stay was found to be almost similar in both subgroups. We noted the cost of hospitalization is higher [18156$ ± 31336 vs. 15701$ ± 25255 p < 0.001] in males with NASH. Furthermore, our study showed increased need for acute/subacute rehab facility upon discharge (18.5% vs 15.1%) in female subgroup (Table). Conclusion: Our study suggests that incidence of NASH is much higher in Caucasian female despite less comorbidities. Higher in-hospital mortality and cost burden noted in males with NASH. Given the fact that NASH is currently second leading cause of liver transplantation overall and leading cause in female, aggressive risk reduction strategies and proactive screening approaches needs to be established. Table 1. - Gender Disparity in NASH patients hospitalized between September 2015 and December 2020 - Baseline characteristics, comorbidities and Outcomes Variables MaleN=165,780(38%) FemaleN=269,980(62%) P-Value Age, in years (Mean ± SD*) 61.3 ± 13 62.2 ± 13.2 0.001 Age groups, % < 0.001 18 - 40 years 7.5% 7.2% 41 – 60 years 35.2% 31.6% 61 – 80 years 52.6% 55.2% >80 years 4.8% 6% Race, % < 0.001 Caucasians 77.9% 72.7% African Americans 3.6% 4.6% Others 18.4% 22.7% Comorbidities, % Hypertension 63.5% 61.9% < 0.001 Diabetes mellitus 61.5% 61.2% 0.04 Congestive heart failure 22.9% 21.7% < 0.001 CAD* 29.9% 18.9% < 0.001 Peripheral vascular disease 5.5% 3.9% < 0.001 COPD* 18.2% 24.7% < 0.001 Renal failure 28.9% 26.3% < 0.001 Coagulopathy 34.3% 31.3% < 0.001 Obesity 35.9% 37.2% < 0.001 Drug abuse 2.4% 2.4% 0.39 Alcohol abuse 5.6% 2.5% < 0.001 Smoking 36.5% 29% < 0.001 Admission Type, % < 0.001 Emergent 87.8% 86.9% Elective 12.2% 13% Insurance type, % < 0.001 Medicare 53.7% 58.6% Medicaid 10% 13.1% Private 30.3% 23.7% Other 6% 4.6% Location/Teaching status of the hospital, % < 0.001 Rural 7% 8% Urban nonteaching 17.6% 18.7% Urban teaching 75.4% 73.3% Outcomes In-hospital mortality, % 3.8% 3.6% < 0.001 Mortality adjusted odds ratio 0.96(0.93 – 0.99) 0.01 Length of stay, in days (mean ± SD) 5.8 ± 7.2 5.7 ± 6.5 0.008 Total hospitalization cost, in US $ (mean ± SD) 18156 ± 31336 15701 ± 25255 < 0.001 Atrial fibrillation 17.1% 12.6% < 0.001 VTE* 1.8% 1.4% < 0.001 Disposition, % < 0.001 Discharge to home 58.9% 54.5% Transfer other: includes Skilled Nursing Facility, Intermediate Care Facility, or another type of facility 15.1% 18.5% Home health care 17.9% 19.9% Against medical advice 0.9% 0.6% *Abbreviations (NASH - Non-alcoholic steatohepatitis, SD - Standard deviation, CAD - Coronary artery disease, COPD - Chronic obstructive pulmonary disease, VTE - Venous Thromboembolism).

Conservative Physiotherapy Treatment of Femoroacetabular Impingement

Abstract The femoro-acetabular impingement (FAI) syndrome is a motion-related disorder of the hip joint with premature contact between the acetabulum and the proximal femur. It is a relatively new clinical entity and no strict treatment protocols and guidelines have been established yet. Furthermore, patients are often misdiagnosed and not properly treated. We report a clinical case of a young adult female patient presenting with a bilateral FAI-CAM type deformity during the last 2 years. An individual progressive global elastic resistant training program was established which involved stimulation to all affected muscle groups using Pilates concept. Hip-specific and functional lower limb strengthening targeted the deep hip external rotators, abductors and flexors in the transverse, frontal, and sagittal planes. Improving the dynamic stability and Core stability was the main aim of the challenging physiotherapy treatment in this case. A good functional result was registered at 6 months follow up. All therapeutic activities were performed in a pain free range of motion which was of paramount importance for achieving excellent patient compliance and successful outcome respectively. The applied treatment strategy demonstrated to be reliable and could be a helpful tool in the armamentarium of contemporary physiotherapy when dealing with the FAI group of patients.

Congenital Intrahepatic Portal Vein Aneurysm Associated with Left Kidney Hypoplasia as Incidental Imaging Findings in An Adult– A Case Study

Background: Intrahepatic portal vein aneurysm is a rare condition, considered in less than 3% of all venous aneurysms, and may have a congenital or acquired etiology; another congenital pathology, such as renal hypoplasia occurs in approximately 2.2% of the population, with prenatal or postnatal diagnosis. Case Presentation: We present a rare case to our knowledge, without a correspondent in the literature, which developed both malformations, incidentally diagnosed using Doppler ultrasound and multidetector computed tomography, in an adult female patient with nonspecific abdominal discomfort. The absence of any complications and the stable evolution during three years of follow-up were the arguments for congenital pathology. Conclusion: This case illustrates a couple of rarely associated malformations represented by portal vein aneurysm and renal hypoplasia, the usefulness and limitations of Doppler ultrasound as the first method recommended in the diagnosis and follow-up, and the superior results of multidetector computed tomography as a complementary tool.

Clear Cell Syringoma of the Eyelids, a Distinctive Histopathologic Variant Associated with Diabetes Mellitus.

The authors describe the clinical and histologic findings of the clear cell variant of syringoma. Three adult female patients (age range 39-76 years old) were found to have multiple, flesh-colored lower eyelid papules, clinically consistent with syringomas, but histologically displaying abundant clear cell change. Two patients had known diagnoses of uncontrolled diabetes.

Shifting the Focus: A Pilot Study on the Effects of Positive Body Exposure on Body Satisfaction, Body Attitude, Eating Pathology and Depressive Symptoms in Female Patients with Eating Disorders.

One of the most commonly used techniques for the treatment of body image problems in eating disorders (ED) is body exposure (BE). However, evidence of its effectiveness in clinical populations is scarce. In the Positive Body Experience (PBE) protocol, the focus of positive BE is on aesthetic, functional and tactile aspects of the body. The current study evaluates the outcomes of positive BE with regard to changes in attitudinal body image and eating pathology, as well as the factors that influence these changes, in a sample of 84 adult female patients with different EDs who did not receive any other treatment for their EDs during the period in which BE treatment occurred. The results show significant positive changes in attitudinal body image, ED behaviors and depressive symptoms, with depressive symptoms at baseline mediating the changes in attitudinal body image. This study indicates that the PBE protocol is a suitable intervention for reducing negative attitudinal body image in anorexia and bulimia nervosa patients, as well as those with binge eating disorder. Furthermore, the results suggest that positive non-weight-related and functional body satisfaction are strong catalysts for change and that depressive symptoms play an important role in the ability to change. Additional RCTs are needed to gain more insight into the effects of PBE.

Blindness Secondary to Odontogenic Infections: Case Series from a Tertiary Health Care Facility in Sokoto, Northwestern Nigeria

Blindness secondary to odontogenic orbital infection is not uncommon. We report five (5) cases of severe odontogenic orbital cellulitis causing blindness. These patients were seen and managed over a 3-year study period (from July 2019 to August 2022) at the Dental and Maxillofacial surgery clinic of Usmanu Danfodiyo University Teaching Hospital Sokoto. There were 2 male children and a female child in the age range of 6-10years with a mean±SD of 7.7±2.1, a 37-year-old male and a 24-year-old female. Cancrum oris/osteomyelitis was the primary diagnosis in one child, right maxillary osteomyelitis in two children, buccal +temporal space abscess and buccal space abscess in the two adult (male and female) patients respectively. All patients had a preceding history of toothache before the onset of other symptoms. All the patients had visual acuity of no light perception in the affected eye. Additionally, they had a varying degree of proptosis and restricted ocular motility while one child presented with purulent discharge and disorganized globe. Aggressive medical and surgical treatment was instituted in consultation with the ophthalmologists, which resulted in the resolution of the disease in all the patients.

Area Deprivation Index is Associated with Variation in Quality of Life and Psychosocial Well-being Following Breast Cancer Surgery.

Neighborhood-level factors have been shown to influence surgical outcomes through material deprivation, psychosocial mechanisms, health behaviors, and access to resources. To date, no study has examined the relationship between area-level deprivation (ADI) and post-mastectomy outcomes. A cross-sectional survey of adult female breast cancer patients who underwent lumpectomy or mastectomy between January 2018 to June 2019 was carried out. Patient-specific characteristics and ADI information were abstracted and correlated with postoperative global- (SF-12) and condition-specific (BREAST-Q) quality-of-life performance via multivariable regression. Patients were classified into three ADI terciles: 0-39 (low deprivation), 40-59 (moderate deprivation), and 60-100 (high deprivation). A total of 564 consecutive patients were identified, being mostly white (75%) with mean age of 60.2 ± 12.4 years, median body mass index of 27.8 [interquartile range (IQR) 24.3-32.2) kg/m2, median Charlson Comorbidity Index of 3 (IQR 2-5), and mean ADI of 42.3 ± 25.7. African American and Hispanic patients and those with high BMI were more likely to reside in highly deprived neighborhoods (p = 0.003 and p < 0.001). In adjusted models, patients in highly deprived neighborhoods had significantly lower mean SF-12 physical (44.9 [95% CI, 43.8-46.0] versus 44.9 [95% CI, 43.7-46.1] versus 46.3 [95% CI, 45.3-47.3], p = 0.03) and BREAST-Q psychosocial well-being scores (63.5 [95% CI, 59.32-67.8] versus 69.3 [95% CI, 65.1-73.6] versus 69.7 [95% CI, 66.4-73.1], p = 0.01) relative to moderate- and low-deprivation groups. Patients residing in the most deprived neighborhoods were identified to have worse psychological well-being and quality-of-life. The ADI should be incorporated into the shared decision-making process and perioperative counseling to engender value-based and personalized care, especially for vulnerable populations.

Sample size considerations for studies comparing intubating conditions using quantitative monitoring versus a fixed interval during onset of neuromuscular blockade

IntroductionData in the literature are still scarce to establish any recommendations on the use of quantitative monitoring during tracheal intubation. Patients and methodsIn this monocentric study, non-morbidly obese adult female patients without risk factors for difficult tracheal intubation were prospectively included. After 0.5 mg.kg−1 atracurium during propofol-sufentanil anaesthesia, intubation conditions were evaluated using the Copenhague and Cormack-Lehane classification at the complete twitch suppression at the TOF to the AP (monitor group) or after a fixed 3 min waiting time after atracurium injection (3-min group). We also examined sample size for future studies. ResultsWe included 102 (monitor group) and 97 (3-min group) adult non-obese female patients without different characteristics. Intubation conditions were acceptable in 96/102 (94%) in the monitor group vs. 84/97 (87%) in the 3-min group, p = 0.07. The presence of a Cormack and Lehane view of 1 was marginally better in the monitor group as compared to the 3-min group, p = 0.041. We propose two possibility of sample size based on a difference of observed events based on acceptable intubation conditions, n = 602, or on excellent intubation conditions, n = 550. DiscussionThis observational study shows that the use of a neuromuscular TOF monitoring of the ulnar nerve as compared to a fixed 3-min waiting time after atracurium injection could improve laryngoscopic view and show a tendency to better intubation conditions without conclusive statistical significance. We suggest that researchers consider our recommendations in terms of the sample size to include in their future research, keeping in mind the limitations of our study.

Oropharynx and hyoid bone changes in female extraction patients with distinct sagittal and vertical skeletal patterns: a retrospective study

BackgroundPrevious studies have reported inconsistent effects of premolar extraction on the oropharynx and hyoid bones. Currently, no strong evidence is available regarding the effect of extraction on upper airway size. Hence, the aim of this study was to analyse the effects of first premolar extraction on the oropharynx and hyoid bone positions in female adult patients, and further explored differences in oropharynx and hyoid bone changes among skeletal patterns.MethodsThe study population included 40 female adult patients who did not undergo extraction and 120 female adult patients who underwent extraction of four premolars; the including patients had four distinct sagittal and vertical skeletal patterns. Cone-beam computed tomography was performed before (T0) and after (T1) orthodontic treatment. Eight oropharynx variables and five hyoid bone variables were measured using Dolphin 3D Imaging software. Paired and independent t-tests were used to analyse measurements between timepoints and groups, respectively.ResultsThe oropharynx volume increased significantly in the extraction group; changes did not differ significantly between extraction and non-extraction groups. Oropharynx variables did not differ significantly at T0 among the four skeletal pattern groups. After orthodontic extraction treatment, the oropharynx volume increased significantly in the class I-norm and class I-hyper subgroups, but not in the class II-norm and class II-hyper subgroups. Significant increases were observed in the oropharynx volume and most constricted axial area from T0 to T1 in the moderate retraction group, but not in the maximum retraction group. Extraction patients exhibited significant posterior movement of the hyoid, particularly among maximum retraction patients.ConclusionsIn female adult patients, first premolar extraction tends to increase the oropharynx size and cause posterior movement of the hyoid bone, particularly in skeletal class I patients. For skeletal class II and hyperdivergent patients with a narrow oropharynx, first premolar extraction does not negatively influence oropharynx size or hyoid bone position. The differences of oropharyngeal changes between moderate retraction patients and maximum retraction patients were not significant.

Correlation between surgical patient supine positioning and the neurovascular injuries

Background: The surgical supine position is the most common position used in the operating room. Even though, there are many risks to patients under anesthesia that result from supine position on the operating table. The aim was to investigate the relationship between surgical supine positioning and the related neurovascular injuries among patients undergoing elective surgeries. Question: What was the relationship between surgical supine positioning and the related neurovascular injuries among patients undergoing elective surgeries? Descriptive correlational design was utilized. Tools: I- Preoperative Assessment Data Form. II- Risk Assessment Scale for the Development of Injuries Due to Surgical Positioning III- Postoperative Neurovascular Assessment Form and IV- Numerical Pain Rating Scale. A convenience sample of 50 male and female adult patients over a period of 6 months; who had undergone elective surgeries and were positioned on surgical supine position and not suffering from neuropathy and neuromuscular diseases at one of Cairo University Hospitals, Egypt constituted the study sample. Results: There was a positive correlation between supine surgical positioning and postoperative neurovascular injuries among the study sample in relation to tissue perfusion, sensory alteration and postoperative pain as r = .503, .551 &amp; .440 and p value = .000, .000 &amp; .001 respectively.

P9.45: Report of the First Cases of Hepatic SPLIT for Liver Transplantation in Peru

Introduction: Liver SPLIT is the surgical technique used in liver transplantation in which a liver graft from a cadaveric donor can be used for two recipients on the waiting list, these recipients being both adults and one adult and one pediatric. In Peru, a country with a poor donation rate, the implementation of this technique was very beneficial since through it we expand the donation pool and we can help our patients on the waiting list for liver transplantation. Materials and methods: In the first transplant operation with the SPLIT technique, it was from a 33-year-old donor Cause of death Ischemic stroke, ideal, who underwent complete right and complete left hepatic partitioning for a 48-year-old adult male diagnosed with autoimmune hepatitis and a 13-year-old female patient diagnosed with cystic fibrosis and hepatopulmonary syndrome. In the second transplant operation with the SPLIT technique, it was from a 37-year-old donor, cause of death due to severe ECT, ideal, who underwent complete right and complete left hepatic partitioning for a 52-year-old adult female patient with cirrhosis due to virus C and a 10-year-old male patient diagnosed with allagille syndrome. Results: □first operative: □Adult male right liver recipient □TIF: 417 min; ICT: 45 min. TOTAL: 462 min. Total bleeding 5000 cc □Girl left liver receptor □TIF: 660 min; ICT: 55 min. TOTAL: 715 min. Total bleeding 11000 cc □second operative: □Adult female right liver recipient □TIF:621min; ICT: 49 min. TOTAL: 710 min. Total bleeding 3800 cc □Recipient boy left liver □TIF: 744 min; ICT: 65 min. TOTAL: 809 min. Total bleeding 3000 cc Conclusion: Liver transplantation with the SPLIT technique is an option to expand the pool of donors and is a reality in our country, hoping to make further progress in order to continue helping our patients on the waiting list. The described procedure is effective and must be performed by experienced surgical teams and under high standards of quality and excellence.

Effect of structured educational intervention booklet regarding anticoagulation therapy on knowledge among patients undergoing mechanical valve replacement in Egypt

Background Valvular heart diseases are the principal causes of morbidity and mortality among patients with rheumatic heart diseases in Egypt. Management of these patients needs mechanical valve replacement. So, these patients require prolonged anticoagulation to prevent bleeding and thromboembolic emergencies unless international normalized ratio is maintained within the normal therapeutic range. Effectively, patient education can help in improving the patient outcomes. Aim The aim was to evaluate the effect of a structured educational intervention booklet regarding anticoagulation therapy on knowledge among patients undergoing mechanical valve replacement at a National Heart Institute in Egypt. Research design A pre/postquasiexperimental design was used in the current study. Research hypothesis The patients who were exposed to a structured educational intervention booklet regarding anticoagulation therapy among patients undergoing mechanical valve replacement would have greater knowledge than before exposure to an educational booklet. Sample: a purposive sample of 171 adult male and female patients who underwent mechanical valve replacement, received oral anticoagulation therapy, and were provided with an educational intervention booklet was included. Tools of data collection Two tools were used: a structured interview questionnaire sheet and a knowledge questionnaire. Baseline knowledge was evaluated preoperatively and immediately after exposure to an educational booklet. Results The age of 28.7% of patients ranged between 30 and 39 years, with a mean age of 37.895±10.472 years. Concerning patients’ sex and educational level, 53.2 and 39.3% were female and uneducated, respectively. Regarding comparison of patients’ knowledge before and after exposure to an educational intervention booklet regarding anticoagulation therapy, it revealed that majority of patients showed higher mean knowledge scores. So, the patients recorded higher correct answer responses after exposure to the educational booklet versus before exposure regarding benefit of anticoagulants (81.9 vs. 8.2%), normal rate of international normalized ratio ratio (93.6 vs. 3.5%), the factors that affect the effectiveness of anticoagulant drugs (94.2 vs. 4.1%), adverse effects of anticoagulants (52 vs. 2%), complications (59.6 vs. 3%), precautions (95.3 vs. 5.8%), foods that reduce the effect of anticoagulant (46.8 vs. 0%), and foods that increase the effect of anticoagulant (24 vs. 0%). Conclusion Significant improvements in patients’ knowledge scores were found after exposure to the structured educational intervention booklet regarding anticoagulation therapy. Recommendations Patient education interventions should be provided to improve patient outcomes. Furthermore, replication of the same study on a larger probability sample should be conducted at different geographical locations for data generalizability.

Dynamic Structural Brain Changes in Anorexia Nervosa: A Replication Study, Mega-analysis, and Virtual Histology Approach.

Several, but not all, previous studies of brain structure in anorexia nervosa (AN) have reported reductions in gray matter volume and cortical thickness (CT) in acutely underweight patients, which seem to reverse upon weight gain. The biological mechanisms underlying these dynamic alterations remain unclear. In this structural magnetic resonance imaging study, we first replicated and extended previous results in (1) a larger independent sample of 75 acutely underweight adolescent and young adult female patients with AN (acAN; n= 54 rescanned longitudinally after partial weight restoration), 34 weight-recovered individuals with a history of AN (recAN), and 139 healthy controls (HC); and 2) a greater combined sample compiled of both our previous samples and the present replication sample (120 acAN [90 rescanned longitudinally], 68 recAN, and 207 HC). Next, we applied a "virtual histology" approach to the combined data, investigating relations between interregional profiles of differences in CT and profiles of cell-specific gene expression. Finally, we used the ENIGMA toolbox to relate aforementioned CT profiles to normative structural and functional connectomics. We confirmed sizeable and widespread reductions of CT as well as volumes (and, to a lesser extent, surface area) in acAN and rapid increases related to partial weight restoration. No differences were detected between either short- or long-term weight-recovered patients and HC. The virtual histology analysis identified associations between gene expression profiles of S1 pyramidal cells and oligodendrocytes and brain regions with more marked differences in CT, whereas the remaining regions were those with a greater expression of genes specific to CA1 pyramidal, astrocytes, microglia, and ependymal cells. Furthermore, the most affected regions were also more functionally and structurally connected. The overall data pattern deviates from findings in other psychiatric disorders. Both virtual histology and connectomics analyses indicated that brain regions most affected in AN are also the most energetically demanding.

Polyarticular Septic Arthritis Secondary to Septic Thrombophlebitis of the Brachiocephalic Vein: A Rare Case Report

BackgroundPolyarticular septic arthritis (PASA) accounts for approximately 15% of all septic arthritides and is rare in immunocompetent adults. Even with appropriate therapy PASA's mortality rate is nearly 50%. Case ReportWe report a rare presentation of PASA caused by idiopathic septic thrombophlebitis of the brachiocephalic vein in an immunocompetent adult female patient who presented with symptoms of right clavicular, left wrist, and right hip pain associated with fevers. Methicillin-sensitive Staphylococcus aureus was isolated in blood cultures and joint aspiration of one of the affected hips. Transesophageal echocardiogram was negative for valvular vegetations and computed tomography chest with contrast revealed thrombi in the brachiocephalic and subclavian veins extending to the superior vena cava. It also showed bilateral pulmonary nodules consistent with septic pulmonary emboli. No clear precipitant for the underlying septic thrombophlebitis was identified. Management was conservative, with systemic anticoagulation and IV antibiotics. The patient's symptoms improved, and she was discharged to subacute rehabilitation. Why Should an Emergency Physician Be Aware of This?Early diagnosis and treatment of PASA in the emergency department is imperative to reducing overall morbidity and mortality associated with this condition. To the best of our knowledge, this is the only case report of idiopathic septic thrombophlebitis of the subclavian vein causing PASA in an immunocompetent adult.

Preoperative exercise induces endothelial progenitor cell mobilisation in patients undergoing major surgery – A prospective randomised controlled clinical proof-of-concept trial

IntroductionPrehabilitation is increasingly recognised as a therapeutic option to reduce postoperative complications. Investigating the beneficial effects of exercise on cellular mechanisms, we have previously shown that a single episode of exhaustive exercise effectively stimulates endothelial progenitor cells (a cell population associated with vascular maintenance, repair, angiogenesis, and neovascularization) in correlation with fewer postoperative complications, despite the ongoing debate about the appropriate cell surface marker profiles of these cells (common phenotypical definitions include CD45dim, CD133+, CD34+ and/or CD31+). In order to translate these findings into clinical application, a feasible prehabilitation programme achieving both functional and cellular benefits in a suitable timeframe to expedite surgery is necessary. ObjectiveThe objective of this study was to test the hypothesis that a four-week prehabilitation programme of vigorous-intensity interval exercise training is feasible, increases physical capacity (primary outcome) and the circulatory number of endothelial progenitor cells within peripheral blood. MethodsIn this unblinded, parallel-group, randomised controlled proof-of-concept clinical trial (German Clinical Trial Register number: DRKS00000527) conducted between 01st December 2014 and 30th November 2016, fifteen female adult patients scheduled for incontinence surgery with abdominal laparotomy at the University Hospital Cologne were allocated to either an exercise (n = 8, exclusion of 1 patient, analysed n = 7) or non-exercise group (n = 7, exclusion of 1 patient, analysed n = 6). The exercise group's intervention consisted of a vigorous-intensity interval training for four weeks preoperatively. Cardiopulmonary Exercise Testing accompanied by peripheral blood collection was performed before and after the (non-)training phase. Cellular investigations were conducted by flow cytometry and cluster-based analyses. ResultsVigorous-intensity interval training over four weeks was feasible in the exercise group (successful completion by 8 out of 8 patients without any harms), with significant improvements in patients' functional capacity (increased oxygen uptake at anaerobic threshold [intervention group mean + 1.71 ± 3.20 mL/min/kg vs. control group mean −1.83 ± 2.14 mL/min/kg; p = 0.042] and peak exercise [intervention group mean + 1.71 ± 1.60 mL/min/kg vs. control group mean −1.67 ± 1.37 mL/min/kg; p = 0.002]) and a significant increase in the circulatory number of endothelial progenitor cells (proportionate CD45dim/CD14dim/CD133+/CD309+/CD34+/CD31 + subpopulation within the circulating CD45-pool [p = 0.016]). ConclusionsWe introduce a novel prehabilitation concept that shows effective stimulation of an endothelial progenitor cell subpopulation within four weeks of preoperative exercise, serving as a clinical cell-mediated intervention with the aim to reduce surgical complications. FundingInstitutional funding. DFG (German Research Foundation, 491454339) support for the Article Processing Charge.

Nodular Sclerosing Hodgkin Lymphoma With Paraneoplastic Cerebellar Degeneration.

There are a variety of paraneoplastic syndromes associated with Hodgkin lymphoma including paraneoplastic cerebellar degeneration (PCD), which is associated with unique autoantibodies, such as anti-Tr antibody. Most of these autoimmune phenomena involve older adult patients with abrupt, acute presentations. We report an atypical case of a young adult female patient with slow progressive onset of PCD symptoms with subsequent detection and treatment of Hodgkin lymphoma. Early detection of PCD is critical, as treatment of the underlying malignancy decreases overall morbidity and disability.

NECROTIZING ULCERATED GINGIVITIS FROM MULTI-DRUG-RESISTANT PSEUDOMONAS INFECTION IN PATIENTS UNDER CHEMOTHERAPY

Acute myeloid leukemia (AML) is a type of cancer of the myeloid line blood cells. It starts in the bone marrow, but it can spread to other tissues, including the lymph nodes, liver, and central nervous system. Due to chemotherapy, patients can become more susceptible to neutropenic ulcerations and consequently are highly susceptible to multi-drug-resistant pathogen infection. Four female adult patients were under different chemotherapy protocols for AML when clinical examinations showed an initial ulceration and necrosis pattern in their inserted gingiva associated with pain and fever. Bacteriological profile exam and antibiogram for pyogenic bacteria in gingival crevicular fluid were performed. Analyses indicated multi-drug-resistant <i>Pseudomonas aeruginosa</i>. All patients were treated with broad-spectrum antibiotics, yet 2 cases evolved to disseminated intraoral necrotic tissue and sepsis. Both severe cases ended in death. The other 2 patients recovered from the infection and were able to complete the chemotherapy cycle.

Effects of family functioning on eating pathology and psychosocial quality of life: The mediating role of self-esteem.

Family dysfunction and self-esteem play an important role in the development of eating disorders (EDs), but this role has not been sufficiently examined regarding eating pathology and psychosocial quality of life (QoL), which often remains unchanged even after ED symptoms reduce. The purpose of this study was to therefore assess the mediating role of self-esteem between family dysfunction and both eating pathology and psychosocial QoL in ED patients and controls. One hundred and fifty four female adult ED patients and 154 female healthy adult controls were recruited from Athens, Greece, and self-reported measures were used to assess family dysfunction, eating pathology, self-esteem, and psychosocial QoL. Structural equation modelling (SEM) was employed to test the mediation hypotheses. For both the ED and control groups, family dysfunction levels did impact eating pathology, but only through self-esteem. Family dysfunction, self-esteem, and eating pathology had a direct effect on both groups' psychosocial QoL. Self-esteem's important role in EDs was confirmed in both groups, along with its sensitivity to family dysfunction. We propose a parsimonious yet comprehensive theoretical model of the role of family dysfunction and self-esteem in EDs which future studies should further investigate longitudinally and in other population groups.

A Dose Response Study Of Oral clonidine as premedication in patients undergoing abdominal gynaecological surgery

Background: The current study was designed to investigate the safe and effective dose of oral clonidine onpost-operative analgesia in patients undergoing gynaecological laparotomy. The objective of the study was to see theeffectiveness of oral Clonidine as a preanesthetic medication and to determine which dose of oral Clonidine givesbetter analgesic effect. Method: In this prospective, randomized, double-blind, controlled study sixty adult female patients of ASA physicalstatus I &amp; II aged 18-40 yrs, undergoing gynaecological laparotomy received low dose clonidine 2-2.5mcg/kg (n=30)and high dose clonidine 4-4.5mcg/kg (n=30).These drugs were administered 105 min before the estimated time ofinduction of anesthesia. Heart rate &amp; arterial pressure were recorded prior to induction, 5 min intervally upto 20 minin peroperative time and 2 hour intervally upto 6 hours in postoperative period. In the Group-A (clonidine2-2.5mcg/kg) mean heart rate ranged from73.80 ±8.69 to 71.45±5.80, in Group-B mean heart rate decreased morefrom 70.85±7.64 to 67.85±6.47. Systolic blood pressure in Group-A (low dose clonidine) was 113.00±7.32, inGroup-B (high dose clonidine) was 120.00±10.38 and where p=0.024. Diastolic blood pressure of Group-A (low doseclonidine) was 76.15±5.29, in Group-B(high dose clonidine) was 80.10±5.3. Postoperative pain was assessed by ablinded observer using a VAS scale. This study was done in the department of anesthesiology of Apollo HospitalsDhaka over a period of six months. Results: Patients in group A (low dose) and group B (high dose) showed no significant hemodynamic changesbetween groups. Five patients in group B showed marked hypotension and bradycardia and treatedaccordingly.Group B patients (high dose clonidine) showed more post operative analgesia compared to group A. Conclusion: These data suggest that low dose clonidine (100mcg/kg) premedication is safe and effective to facilitatepost-operative analgesia with stable haemodynamics &amp; without any side effects. On the other hand,.high doseclonidine showed more post op analgesia &amp;.marked hypotension and bradycardia. JBSA 2022; 35 (2) : 12-16