Frequency Of Need Research Articles

Effect of Intraoperative Loading Dose of Amiodarone for Prophylaxis Against Atrial Fibrillation in Patients with Rheumatic Valvular Heart Disease Undergoing Valve Replacement Surgery

Background: Atrial Fibrillation (AF) is the most common arrhythmia occurring after cardiac surgery and its peak incidence is between second or third postoperative day. It occurs in 40% to 50% of patients after valve surgery alone or combined valve and CABG surgery respectively. Among all the anti-arrhythmic drugs evaluated for AF, amiodarone has shown the most promising results with successful conversion and maintenance of normal sinus rhythm achieved in 50%–70% of patients.
 Methods: Sixty diabetic patients purposively selected who underwent isolated off pump coronary artery bypass procedure in NICVD. Group A – 30 patients receiving loading dose of amiodarone intra-operatively before establishment of CPB during valve replacement surgery and Group B- 30 patients without receiving loading dose of amiodarone intra-operatively during valve replacement surgery. Incidence of atrial fibrillation in postoperative period was evaluated.
 Results: Atrial fibrillation was observed in 8 (26.7%) patients in group A and 18 (60%) patients in group B (p=0.009). Ventricular tachycardia developed in 6.7% patients in group B and none in group A (p=0.47). Mean duration of ICU stay was 2.04±0.30 days in Group A and Group B was 2.98±0.77 days (p=0.03). Mean duration of post-operative stay was 7.20±0.66 days in Group A and Group B was 7.85±0.60 days (p=0.10).
 Conclusion: A single intra operative dose of intravenous amiodarone increases the incidence of conversion of AF to normal sinus rhythm. When AF persisted, use of amiodarone reduces the frequency of need for cardioversion and the energy required for it.
 Cardiovasc. j. 2020; 12(2): 102-108

Peritoneal Flap in Robot-Assisted Radical Prostatectomy.

Lymphocele is the most common complication arising after pelvic lymph node dissection (PLND) in the setting of robot-assisted radical prostatectomy (RARP). The only data available until now on the utility of a peritoneal flap to prevent lymphocele were retrospectively acquired. A randomized, controlled, multi-center trial with blinded assessment of endpoints was carried out on 232 patients with prostate cancer who underwent RARP with PLND. The patients in the intervention group were given a peritoneal flap; in the control group, surgery was performed without this modification. The two joint primary endpoints were the rates of symptomatic lymphocele during the same hospitalization as the operative procedure (iT1) and within 90 days of surgery (iT2). The secondary endpoints were lymphocele volume, the need for treatment of lymphocele, complications requiring an intervention, and the degree of postoperative stress incontinence. German Clinical Trials Register number: DRKS00011115. The data were evaluated in an intention-to-treat analysis, which, in this trial, was identical to an as-treated analysis. 108 patients (46.6%) were allotted to the intervention group. There were no statistically significant intergroup differences with respect to any clinical or histopathological criteria. A median of 16 lymph nodes were removed (interquartile range, 11-21). A symptomatic lymphocele arose in 1.3% (iT1) and 9.1% (iT2) of the patients, without any statistically significant difference between the two trial groups (p = 0.599 and p = 0.820, respectively). Nor did the groups differ significantly with respect to lymphocele volume (p = 0.670 on hospital discharge [T1], p = 0.650 90 days after surgery [T2]) or the type and frequency of need for subsequent surgical intervention (p = 0.535; iT2). 81.5% of all patients (n = 189) had no complications at all in the first three months after surgery. Nor were there any intergroup differences at 90 days with respect to the degree of stress urinary incontinence (p = 0.306) or complications (p = 0.486). A peritoneal flap after RARP was not found to influence the rate of postoperative lymphocele, whether asymptomatic or requiring treatment.

Frequency of need for mechanical ventilation and dialysis in children with septic shock

To determine the frequency of need for mechanical ventilation and dialysis in children admitted with septic shock to the Paediatric Intensive Care Unit (PICU), this descriptive case series was conducted from August 2015 to February 2016. A total of 100 children from 1 month to 15 years of age of both sexes having septic shock diagnosed within 24 hours of admission were enrolled from the PICU of Children's Hospital Lahore after informed consent from parents of the patients. The standard guideline for the treatment of septic shock was followed. Patients were followed throughout the stay in the hospital to assess the need for mechanical ventilation or the need for dialysis. Arterial blood gases and urea, creatinine were assessed daily or more frequently (if needed) till discharge or death. Of the 100 patients recruited in the study, with a mean age of 2.16±3.26 years, 63 (63 %) were male while 37 (37%) were females. The frequency of need for mechanical ventilation was recorded in 75 (75%) while 22 (22%) required dialysis. We concluded that the frequency of dialysis in children admitted to PICU with septic shock is significantly lower as compared to frequency of mechanical ventilation.

Comparative outcomes of right versus left congenital diaphragmatic hernia: A multicenter analysis

BackgroundCongenital diaphragmatic hernia (CDH) occurs in 1 out of 2500–3000 live births. Right-sided CDHs (R-CDHs) comprise 25% of all CDH cases, and data are conflicting on outcomes of these patients. The aim of our study was to compare outcomes in patients with right versus left CDH (L-CDH). MethodsWe analyzed a multicenter prospectively enrolled database to compare baseline characteristics and outcomes of neonates enrolled from January 2005 to January 2019 with R-CDH vs. L-CDH. ResultsA total of 588, 495 L-CDH, and 93 R-CDH patients with CDH were analyzed. L-CDHs were more frequently diagnosed prenatally (p=0.011). Lung-to-head ratio was similar in both cohorts. R-CDHs had a lower frequency of primary repair (p=0.022) and a higher frequency of need for oxygen at discharge (p=0.013). However, in a multivariate analysis, need for oxygen at discharge was no longer significantly different. There were no differences in long-term neurodevelopmental outcomes assessed at two year follow up. There was no difference in mortality, need for ECMO, pulmonary hypertension, or hernia recurrence. ConclusionIn this large series comparing R to L-CDH patients, we found no significant difference in mortality, use of ECMO, or pulmonary complications. Our study supports prior studies that R-CDHs are relatively larger and more often require a patch or muscle flap for repair. Type of studyPrognosis study Level of evidenceLevel II

Comparison of rectal misoprostol's effect when used before and after a cesarean section on post-cesarean bleeding

ObjectiveCesarean section is a common surgery in women. Different drugs are used to control its bleeding. This study compared the effect of using rectal misoprostol before and after surgery on the amount of post-cesarean bleeding. Materials and MethodsA number of 120 women who were admitted to our hospital because of elective cesarean section entered this clinical trial. They were divided into two groups. The first (before surgery) group received 400μg of rectal misoprostol before the cesarean section and the second (after surgery) group after the surgery. The amount of bleeding was measured in both groups. The data were recorded and analyzed. ResultsTheir mean of age was 29.1±6.1 years old. The mean of blood loss volume was 283±147mL in the before-surgery group and 294±108mL in the after-surgery group (P=0.6). There was no significant difference in the level of post-operation hemoglobin between the two groups. However, the frequency of need for additional uterotonics was 47% in the first group and 85% in the second group (P<0.001). ConclusionThere seems to be no significant difference in administering rectal misoprostol before or after the surgery, but the need for additional uterotonics is reduced if it is used before the surgery.

A relational perspective on care coordination.

Care coordination occurs largely through care coordinators' interactions with patients and community partners to identify and address patients' individual needs. More frequent and higher-quality communication with each may enhance care coordination effectiveness. The purpose of this study was to understand (a) how care coordinator perceptions of interactions with patients and community partners, respectively, compared to each other group's perceptions of their interactions with care coordinators and (2) whether these dynamics between care coordinators and community partners changed over time. The research context was a comparative case study of provider-based care coordination projects funded through the Texas 1115(a) Medicaid waiver. The Relational Coordination instrument was administered through (a) two waves of in-person interviews with care coordinators (2014-2015 and 2015-2016) at a total of 10 sites across the state, (b) a single 2016 phone survey with 159 patients at nine of those sites, and (c) phone surveys with representatives of the community resources that care coordinators had identified as key partners in 2014-2015 and again in 2015-2016. Care coordinators reported more frequently needing both patients and community partners than either other group reported relative to care coordinators. Frequency of need and mutual influence with community partners increased in the first 2 years of the care coordination programs' implementation. The perceived quality of interactions between care coordinators and both patients and community partners was positive, but with room for improvement. Care coordination may entail limited interactions with patients and community partners, especially at program inception. As care coordination programs mature, interactions may become more frequent and influence with partners may expand. Decision makers should support care coordinators in improving the quality of their communication with both patients and community partners, as well as allow time for these relationships to develop.

Venous access in neonates: our experience

Background: The aim of this work was to study various tools for intravenous access in neonates, both short- and long-term, and their feasibility and associated complications.Methods: Records of 366 neonates who required three or more days of hospital admission were retrieved and included in the study. Their requirements of intravenous fluids, and medications and parenteral nutrition were recorded. The type of intravenous (IV) device, its in-situ duration, any complications and the frequency of need to change it were recorded.Results: 42 patients needed long-term (more than 7 days) indwelling cannula and central line insertion. The indications were prolonged stay with the need for IV fluids, need for prolonged antibiotics, and parenteral nutrition. Commonest complication was local thrombophlebitis. Other complications noted were fever and local skin necrosis.Conclusions: Neonatal care has come a long way in last few decades and involves high-end NICUs, advanced ventilators, and other similar gadgets and methodologies. This applies to both, medical as well as surgical neonates. This mandates prolonged admission and various invasive procedures, including surgical operations. Obtaining a secure and long-term venous access automatically becomes an important part of this kind of neonatal care. There are now available a plethora of intravenous cannulas and devices for various indications of intravenous access in neonates. The present article discusses the experience of various options available for intravenous access in neonates including their complications and prevention of the latter.

ÍNDICE DE CPOD Y NECESIDAD DE TRATAMIENTO PROTÉSICO EN ADULTOS MAYORES DE LA PARROQUIA CHIQUINTAD

OBJETIVO: Determinar la frecuencia de la necesidad de tratamiento protésico y la frecuencia del índice CPOD en lospacientes adultos mayores de la parroquia de Chiquintad, Cuenca-Ecuador 2016. MATERIALES Y MÉTODOS: Se realizóun estudio descriptivo retrospectivo, la muestra estuvo formada por 400 adultos mayores de los cuales quedaron excluidos23 personas que no aceptaron el estudio teniendo una población de 377 personas adultas mayores con un rango de edadde 65 años a 106 años, quienes fueron evaluados clínicamente, mediante un cuestionario de la Organización Mundial de laSalud. RESULTADOS: Se determinó que la población evaluada es edéntula total, con un total de 302 pacientes (80,10 %) yedéntula parcial con un total de 75 pacientes (19,89 %). La frecuencia de la necesidad de tratamiento protésico, es alta en elsexo femenino con un 75 %, al igual que el sexo masculino con un 65% representando una necesidad de prótesis total. Lafrecuencia del índice CPOD es de 13,87 en personas edéntulas parciales. CONCLUSIONES: La población evaluada fue de377 adultos mayores, los cuales presentan edentulismo total en un 80,10%y parcial en un 19,89 %, la necesidad de tratamientoprotésico es necesaria en 302 personas de la población adulta mayor, las 75 personas restantes no lo requieren. Mediante elíndice de diagnóstico de piezas cariadas, perdidas y obturadas (CPOD), se encontró una mayor frecuencia de piezas pérdidascon 10,69 tanto en hombres como en mujeres.

NECESIDAD DE TRATAMIENTO ENDODÓNCICO Y PREVALENCIA DE CARIES EN ESCOLARES DE 12 AÑOS EN LA PARROQUIA YANUNCAY CUENCA-ECUADOR 2016

OBJETIVO: Determinar la frecuencia de necesidad de tratamiento endodóncico y la prevalencia de caries en escolares de 12 años en la Parroquia Yanuncay de la ciudad de Cuenca – Ecuador 2016. MATERIALES Y MÉTODOS: Estudio transversal de evaluación clínica bucal en 130 escolares de 12 años en la Parroquia Yanuncay de la ciudad de Cuenca – Ecuador 2016, esta muestra se calculó mediante fórmula en base a una población de 1398 escolares, se incluyeron pacientes con dentición permanente, fueron excluidos los que presentaron enfermedades sistémicas y malformaciones bucales, se utilizaron los criterios del índice de Pulpitis, Ulceras, Fístulas y Abscesos (P.U.F.A) para la necesidad de tratamiento endodóncico y los criterios epidemiológicos de la Organización Mundial de la Salud (OMS) para la prevalencia de caries.Los observadores fueron calibrados por un especialista, los padres firmaron el consentimiento y los escolares dieron el asentimiento informado. Todos los exámenes bucales fueron desarrollados con luz natural y espejo bucal, previo a la hora de su refrigerio. RESULTADOS: La muestra presentó 50% de escolares de cada sexo; 7% del total de la muestra presentaron necesidad de tratamientoendodóncico,principalmenteporpulpitis;asímismodeltotaldeescolaresel5%requieretratamientoenunasola pieza dental y el 95% en 2 o más piezas dentales. El 39% de la muestra presentó caries. No existe diferencia significativa en la frecuencia de necesidad de tratamiento endodóncico ni en la prevalencia de caries entre ambos sexos (X2 p&gt;0.05)

Outcome of Blunt Abdominal Traumas with Stable Hemodynamic and Positive FAST Findings.

Focused assessment with sonography for trauma (FAST) is a highly effective first screening tool for initial classification of abdominal trauma patients. The present study was designed to evaluate the outcome of patients with blunt abdominal trauma and positive FAST findings. The present prospective cross-sectional study was done on patients over 7 years old with normal abdominal examination, positive FAST findings, and available abdominopelvic computed tomography (CT) scan findings. The frequency of need for laparotomy as well as its probable risk factors were calculated. 180 patients were enrolled (mean age: 28.0 ± 11.5 years; 76.7% male). FAST findings were confirmed by abdominopelvic CT scan in only 124 (68.9%) cases. Finally, 12 (6.6%) patients needed laparotomy. Mean age of those in need of laparotomy was significantly higher than others (36.75 ± 11.37 versus 27.34 ± 11.37, p = 0.006). Higher grading of spleen (p = 0.001) and hepatic (p = 0.038) ruptures increased the probability of need for laparotomy. 68.9% of the positive FAST findings in patients with blunt abdominal trauma and stable hemodynamics was confirmed by abdominopelvic CT scan and only 6.6% needed laparotomy. Simultaneous presence of free fluid and air in the abdominal area, old age, and higher grading o solid organ injuries were factors that had a significant correlation with need for laparotomy.

The Need for Orthognathic Surgery in Nonsyndromic Patients with Repaired Isolated Cleft Palate

To determine the frequency of need for orthognathic surgery among nonsyndromic patients with isolated cleft palate repaired during infancy at The Hospital for Sick Children in Toronto, Canada. Retrospective cohort study. PATIENTS with nonsyndromic isolated cleft palate born between 1970 and 1997 with available records including a lateral cephalometric radiograph taken at ≥15 years of age. PATIENTS who had undergone or were being prepared for orthognathic surgery were automatically counted as requiring surgery. For the remaining patients, lateral cephalometric radiographs were traced and analyzed. Arbitrarily set cephalometric criteria were used to identify the "objective" need for orthognathic surgery. Of the 189 patients identified with nonsyndromic isolated cleft palate and for whom records were available, 25 (13.2%) were deemed to require orthognathic surgery. Of the surgical cohort, 92% required surgical correction for a Class III malocclusion. Similar percentages of males and females required orthognathic surgery. An apparently greater proportion of patients of Asian background (18.5%) than of white background (10.6%) required surgery, but this difference was not significant (P = .205). The current results suggest that approximately one in eight patients at our institution with nonsyndromic isolated cleft palate requires orthognathic surgery. There is a tendency for this to be higher in patients of Asian descent and lower in patients of white descent. Variability in extent, severity, and phenotype of the cleft, which may be attributed largely to genetics, may play an important role in dictating the need for orthognathic surgery.

Alcohol Fat Clearing Increases Lymph Node Yield after Surgery for Colorectal Cancer

Lymph node (LN) yield is associated with oncologic outcome in patients who undergo surgery for colorectal adenocarcinoma (CRC). Standards to maximize LN yield have been initiated to enhance treatment of patients with CRC. This study evaluates the impact of a simple alcohol-based preparation protocol on LN yield. Surgical specimens from patients with CRC were prepared using either the alcohol protocol or standard formalin fixation and LN yield was compared. In total, 80 consecutive patients (n = 40 formalin, n = 40 alcohol) were examined. Overall, median LN yield increased from 17 to 29 (P < 0.01) with the alcohol fat clearance protocol. For patients with rectal adenocarcinoma who underwent proctectomy after neoadjuvant chemoradiotherapy, LN yield increased from 15 to 23 (P = 0.02). The frequency of need for additional sampling to achieve a minimum 12 LN count was also reduced. Initiation of a standardized alcohol fat-clearing protocol increased LN yield after surgery for CRC. This simple, cost-effective measure may improve the efficiency of LN assessment and accurate staging, which may impact oncologic outcomes.

Service evaluation of the on-call experience of OMFS SHOs providing ENT cross-cover over a 6-week period in a District General Hospital

In certain units in the UK, OMFS SHOs are required to provide cross-cover support for ENT. The purpose of this service evaluation was to determine the range and complexity of on-call requests that an SHO in OMFS may have to manage for ENT in a district general hospital. The workload this generated and the frequency of need for 2nd on-call contact was explored, together with a comparison with OMFS duties. Data was collected prospectively over a 6-week period in Chesterfield Royal Hospital for all on-call cases by the OMFS SHOs working in the unit. It was found that that ENT workload was approximately equal to the OMFS workload, but the 2nd on-call for ENT was contacted almost three times more compared to OMFS 2nd on-call. ENT cross-cover presented a wide range of referrals, with throat conditions most common and forming 36% of all referrals. Throat problems also generate the greatest number of 2nd on-call requests from OMFS SHOs (62.5%), compared to the need to call for ear (42%) and nose (43%) problems. This service evaluation suggests that OMFS SHOs require senior support more often when dealing with ENT duties compared to OMFS duties. The majority of OMFS SHOs are not medically qualified and may perceive a need for more standardised training before embarking on providing ENT cross-cover. A questionnaire has also been completed by past and present OMFS SHOs in order to evaluate their experience of providing ENT cover, the results of which will be presented.

Early intervention with high-dose inhaled corticosteroids for control of acute asthma exacerbations at home and improved outcomes: A randomized controlled trial

Various studies have examined the efficacy of a temporary increase in the dose of inhaled corticosteroids (ICSs) during acute asthma exacerbations with conflicting results. This study was designed to investigate the efficacy of high-dose ICSs in controlling asthma exacerbations in children. Data were collected on asthmatic children, aged 2-17 years, who were maintained on ICSs. Participants were randomly assigned to a 12-day treatment protocol for acute asthma exacerbation at doses of ICS that were two, four, or eight times their maintenance ICS dose. The primary outcome was the frequency of need to progress to systemic steroid therapy. The secondary outcome was difference in symptom scores among the three treatment groups to determine if one dosing protocol was superior to another. Eighty-two of 197 enrolled patients experienced acute asthma exacerbation and completed the increased dosing protocol. No significant difference in systemic corticosteroid use was detected between patients treated with two, four, or eight times their maintenance dose of ICS, but we observed a trend toward a larger reduction in mean total symptom score with increasing ICS dose at the end of the study. We did not observe a significant difference in need for systemic corticosteroids between doubling the maintenance dose and increasing to four or eight times the dose, but we observed a trend suggesting that higher doses may improve symptoms better than doubling the dose. A more specific design may be needed to provide a more reliable answer to this question.

A statistical approach to estimating acceptance of electric vehicles and electrification of personal transportation

The environmental and economic impact of electric vehicles (EVs) will depend on the fraction of users that can accept an EV of a given capability, and then in turn on how those EVs are actually used. Historically, estimates of the fraction of total travel that could be electrified as a function of EV range are based on vehicle usage data for large populations of vehicles, most often the National Household Travel Survey (NHTS). Two assumptions implicit in such estimates are subject to question: (1) that any user could accept an EV as a primary vehicle and would use it for all trips within its range, and (2) that the usage patterns of any individual EV user are the same as that exhibited by entire population. The first assumption is clearly unrealistic; willingness to accept an EV is dependent on the transportation needs and alternatives readily available to each individual user. As a surrogate for a priori knowledge of individual preferences, we use a crude metric of acceptance defined as a threshold frequency of need for alternative transportation above which all users would not accept the inconvenience. To test the validity of the second assumption and better estimate market and electrification potential, we analyze roughly 1year of usage data for each of 133 instrumented vehicles in Minneapolis–St. Paul. We find a characteristic individual usage pattern that does not resemble the average over a large number of vehicles. Using the surrogate metric of EV acceptance and a simple payback model, we show that although the market acceptance and electrification potential of EVs are severely limited by battery cost, it is possible to determine an optimal EV range. Using the same usage data and payback model, we show that plug-in hybrid electric vehicles (PHEVs) can be much more effective than all-electric vehicles in electrifying personal transportation.

Lack of an Effect of Lactobacillus reuteri DSM 17938 in Preventing Nosocomial Diarrhea in Children: A Randomized, Double-Blind, Placebo-Controlled Trial

To evaluate the efficacy of administering Lactobacillus reuteri DSM 17938 for the prevention of nosocomial diarrhea. Children (n = 106; aged 1-48 months) admitted to the hospital for reasons other than diarrhea were enrolled in a randomized, double-blind, placebo-controlled trial. They received L reuteri DSM 17938 at a dose of 10(8) colony-forming units (n = 54) or a placebo (n = 52) orally, once daily, for the duration of the hospital stay. Data from all children were included in the final analysis. L reuteri DSM 17938 did not significantly affect the risk of developing nosocomial diarrhea, defined as 3 loose or watery stools per day in a 24-hour period that occurred >72 hours after admission (risk ratio 1.06, 95% CI 0.7-1.5) or rotavirus infection (1.04, 0.6-1.6). There was also no difference between the probiotic and placebo groups for any of the other secondary outcomes (ie, incidence of rotavirus infection, incidence of diarrhea, duration of diarrhea, incidence of recurrent diarrhea, incidence of chronic diarrhea, length of hospital stay in days, and frequency of need for rehydration). No adverse events were reported. In hospitalized children, the administration of L reuteri DSM 17938 compared with placebo had no effect on the overall incidence of nosocomial diarrhea, including rotavirus infection.

Obesity as a risk factor for sedation-related complications during propofol-mediated sedation for advanced endoscopic procedures

There are limited data on the safety of anesthesia-assisted endoscopy by using propofol-mediated sedation in obese individuals undergoing advanced endoscopic procedures (AEPs). To study the association between obesity (as measured by body mass index [BMI]) and the frequency of sedation-related complications (SRCs) in patients undergoing AEPs. Prospective cohort study. Tertiary referral center. A total of 1016 consecutive patients undergoing AEPs (BMI <30, 730 [72%]; 30-35, 159 [16%]; >35, 127 [12%]). Monitored anesthesia sedation with propofol alone or in combination with benzodiazepines and/or opioids. SRCs, airway maneuvers (AMs), hypoxemia, hypotension requiring vasopressors, and early procedure termination were compared across 3 groups. There were 203 AMs in 13.9% of patients, hypoxemia in 7.3%, need for vasopressors in 0.8%, and premature termination in 0.6% of patients. Increasing BMI was associated with an increased frequency of AMs (BMI <30, 10.5%; 30-35, 18.9%; >35-26.8%; P < .001) and hypoxemia (BMI <30, 5.3%; 30-35, 9.4%; >35, 13.4%; P = .001); there was no difference in the frequency of need for vasopressors (P = .254) and premature termination of procedures (P = .401). On multivariable analysis, BMI (odds ratio [OR] 2.0; 95% CI, 1.3-3.1), age (OR 1.1; 95% CI, 1.0-1.1), and American Society of Anesthesiologists class 3 or higher (OR 2.4; 95% CI, 1.1-5.0) were independent predictors of SRCs. In obese individuals (n = 286), there was no difference in the frequency of SRCs in patients receiving propofol alone or in combination (P = .48). Single tertiary center study. Although obesity was associated with an increased frequency of SRCs, propofol sedation can be used safely in obese patients undergoing AEPs when administered by trained professionals.

Comparison of interval duration between single course antenatal corticosteroid administration and delivery on neonatal outcomes.

This study was performed to determine the effect of antenatal corticosteroid the interval between administration and delivery affect on neonatal outcomes. An observational study was performed on all deliveries between 28-34 weeks gestation where delivery occurred vaginally after completing a single course of antenatal corticosteroid (dexamethasone). Women were divided into 3 groups on the basis of the interval from first corticosteroid dose to delivery (<2 days, 2-7 and >7 days). The primary outcome was the need for neonatal resuscitation and the secondary outcome was respiratory distress syndrome (RDS), which was described as "need for ventilation with positive pressure O2 during the first 24 hrs of life". P value <0.05 was significant. Of 104 neonates whose mothers received a full course of antenatal corticosteroid, 29 delivered <2 days, 41 delivered 2-7 days, and 34 delivered more than 7 days after the initial dose. Overall, those delivering within 2 days after the first injection of corticosteroid had more need for resuscitation and ventilation than those infants delivering between 2-7 days and after 7 days. Infants delivering between 2-7 days had a lower incidence of need for resuscitation and receiving respiratory support for more than 24 hours. We found that the interval between corticosteroid administration and delivery influences the incidence of need for resuscitation and ventilation. Infants delivering less than 2 days of corticosteroid exposure have a higher frequency of need for resuscitation and ventilation than delivering between 2-7 days and after 7 days.

Practical Aspects and Efficacy of Intraoperative Adjustment in Concomitant Horizontal Strabismus Surgery

To analyze the practical aspects and advantages of one-stage adjustable surgery under topical anesthesia in concomitant horizontal strabismus. A retrospective review of 363 patients was completed to assess (1) the frequency of need to perform adjustment, (2) the amount and pattern of adjustment, and (3) the final alignment at least 6 months after surgery. Intraoperative adjustment was performed strictly toward the aim of orthophoria or slight overcorrection (heterophoria < 6 prism diopters [PD]) while avoiding diplopia. Of the 363 patients, 261 (72%) required intraoperative adjustment. Of these, 85% of exotropes underwent a decreased amount of surgery compared with the standard amount, whereas 58% of esotropes underwent an increased amount of surgery. Forty-two patients underwent a one-muscle surgery instead of the scheduled two-muscle surgery, and all had less than 35 PD preoperative angle of deviation. Success rates were 83% in all patients with one-stage adjustable sutures and 87% in patients who underwent adjustment. In 42 patients with one-muscle surgery instead of two-muscle surgery, 32 (76%) obtained successful results. Intraoperative adjustment was effective in concomitant horizontal strabismus surgery and can provide the opportunity to avoid a large overcorrection, especially in cases with moderate angle horizontal muscle surgery.

Early Intervention with High-Dose Inhaled Corticosteroids for Control of Acute Asthma Exacerbations and Improved Outcomes; A Randomized Controlled Trial

This study investigates the efficacy of high-dose inhaled corticosteroids (ICS) in controlling asthma exacerbations in children with a previous diagnosis of asthma. Data were collected on asthmatic children, ages 2 to 17 years, who have been maintained on ICS for at least 3 months. Upon enrollment, participants were randomly assigned to twice (2×), 4 times (4×) or 8 times (8×) their maintenance ICS dose 12-day exacerbation treatment protocols. Prior to starting the protocol, participants spoke with a physician to determine that it was appropriate to begin. Physicians assessed their clinical status with symptoms scores via telephone calls following the start of therapy. The primary outcome was the frequency of need to progress to systemic steroid therapy. Of 166 enrolled patients, 67 patients have completed the increased dosing protocol. Only two of these patients required treatment with systemic corticosteroids and one had the ICS dose further increased by the primary care physician. One patient withdrew from the study due to concern about side effects on the increased medication. No significant difference between the patients treated with 2×, 4× or 8× their maintenance dose could be detected. Treating asthmatic patients with increased doses of inhaled corticosteroids early in the course of an exacerbation prevents worsening of symptoms that require treatment with systemic corticosteroids. This regimen may be helpful in decreasing the adverse effects known to occur with frequent courses of systemic corticosteroids. This type of treatment may also decrease visits to emergency departments and urgent care visits to the primary care physician.