History Of Surgical Intervention Research Articles

Evaluation of transmission routes in patients with acute hepatitis B

Aims: In this study, we aimed to determine the possible transmission routes in patients diagnosed with acute hepatitis B virus (HBV) infection by anamnesis, physical examination and serologic tests. Methods: For this purpose, 44 patients hospitalized with acute hepatitis B in the Infectious Diseases and Clinical Microbiology Clinic of Ankara Numune Training and Research Hospital were included in the study. Patients were questioned about possible transmission routes. The diagnosis of acute hepatitis B was based on anamnesis, physical examination findings, anti-HBcIgM positivity by ELISA, absence of HBsAg positivity for more than 6 months and an increase in liver enzymes AST and ALT values 8-10 times above normal levels. HBsAg, HBeAg, AntiHBe serologic tests and Anti-HDV antibody against hepatitis delta virus (HDV) were also investigated in the sera of patients with acute hepatitis B. Possible transmission forms were questioned and recorded in the patient follow-up forms. All serologic markers were analyzed by ELISA (Organon, Netherlands). Results: Of the 44 patients included in the study, 29 (66%) were male and 19 (34%) were female. The mean ages of male and female patients were 36.6 (24-66 years) and 31.6 (23-60 years), respectively. When the patients with acute hepatitis B were evaluated in terms of possible transmission routes, 8 (18.2%) of the patients had HBsAg positive spouses, 3 patients had a history of surgical intervention in the last 6 months, 3 patients had a history of dental intervention, 2 patients had a history of blood transfusion in the last 6 months, and 2 patients had more than one possible transmission risk. Twenty-six (59.3%) patients had no possible route of transmission. Conclusion: Our findings revealed that possible transmission routes could not be identified in more than half of acute hepatitis B patients. In addition, we determined that 18.2% HBsAg positivity in the spouses of acute hepatitis B patients may be a possible route of transmission. In conclusion, we believe that patients with acute HBV infection should be evaluated for possible transmission routes, family members of acute hepatitis B patients should be screened for HBV infection, those with negative anti-HBs antibodies should be vaccinated, and relatives of HBsAg positive patients should be checked periodically.

Assessment of chronic pain syndrome after laparoscopic transabdominal preperitoneal plastic surgery in patients with inguinal hernia

Aim. To assess pain syndrome in patients with inguinal hernia after laparoscopic transabdominal preperitoneal (TAPP) plastic surgery. Materials and methods. The study involved 58 patients with unilateral Nyhus type 2 and 3 inguinal hernia. The patients underwent laparoscopic TAPP plastic surgery using a mesh implant that was not fixed independently. According to the method of graft fixation, the patients were divided into two groups. In the first patient group, staple fixation of the mesh was applied – 28 (48.3 %), the second group – 30 (51.7 %) patients without mesh fixation. Patients with a history of surgical interventions on the abdominal cavity and pelvis, complicated or recurrent inguinal hernia were excluded from the study. Pain syndrome was assessed using the visual analog scale and an independent survey during postoperative follow-ups of the patients every three months for two years. Results. In the assessment of postoperative pain in the first patient group, moderate pain intensity was noted, and it was minimal in the second group, p < 0.001. 9 (32.1 %) patients who underwent mesh implant fixation required opioid analgesics, compared with 4 (13.3 %) patients who did not undergo fixation, p = 0.043. At the first examination, chronic pain was detected in 6 (21.4 %) patients of the first group and in 3 (10.0 %) patients of the second group. During a year, pain syndrome gradually disappeared. After 9 months, pain was reported by 4 (14.3 %) patients in the group with mesh fixation and by 1 (3.3 %) patient without fixation. At the 6th examination in the first group, 2 (7.1 %) patients reported pain; 1 (3.6 %) patient underwent Lichtenstein hernioplasty due to recurrent, increasing acute pain. Conclusions. Laparoscopic TAPP plastic surgery without graft fixation shows a lower possibility of pain syndrome development than with mesh implant fixation. In the case of chronic pain syndrome development following the TAPP technique without mesh fixation, the general condition of patients improves more quickly.

Age related progression of lower limb coordination during gait in children with cerebral palsy without a history of surgical intervention

Walking requires precise movement between body segments, referred to as intersegmental coordination, which is an important factor in efficient motor performance. For children with cerebral palsy (CP), who often demonstrate an impaired neuromuscular system, intersegmental coordination has been shown to be different when compared to their typically developed (TD) peers. However, how intersegmental coordination changes over time in these children is unclear. The aim of this study was to quantify age-related changes in intersegmental coordination in children with bilateral CP without a history of surgical intervention and to compare to control groups of children with TD of similar age, weight, and height. A retrospective analysis of 162 children with bilateral CP who had a baseline and follow-up 3D gait assessment, and no history of surgical intervention, was conducted. Two age, weight, and height control groups of children with TD were included. A full 3-dimensional kinematic analysis was performed, and continuous relative phase analysis of the thigh-shank and shank-foot, while walking at a self-selected walking speed, was used to measure intersegmental coordination. Differences were present for children with CP compared to children with TD at baseline for thigh-shank intersegmental coordination. However, children with CP demonstrated a change over time with a move towards TD patterns at follow-up assessment. This study provides insights into the acquisition and stabilisation of intersegmental coordination between children with CP and TD.

ASSESSMENT OF THE LIFE QUALITY OF PERSONS WITH KNEE JOINT INJURIES AFTER SURGERY INTERVENTION

ASSESSMENT OF THE LIFE QUALITY OF PERSONS WITH KNEE JOINT INJURIES AFTER SURGERY INTERVENTION

Neurovascular Compression in Patients With Trigeminal Neuralgia May Be Associated With Worse Outcomes After Primary Percutaneous Rhizotomy

BACKGROUND AND OBJECTIVES: Percutaneous rhizotomy may be an effective primary intervention in patients with trigeminal neuralgia who are poor candidates for microvascular decompression or those who desire a less invasive approach. However, the influence of neurovascular compression on pain-free survival after primary percutaneous rhizotomy is not well understood. METHODS: We retrospectively reviewed all patients undergoing percutaneous rhizotomy at our institution from 1995 to 2022. Patients were included if they had no history of surgical intervention, available preoperative MRI imaging, and postoperative follow-up data. Barrow Neurological Institute pain scores were assigned at various time points. We collected baseline patient information, pain characteristics, and perioperative complications for each patient. In addition, we recorded evidence of pain recurrence. Patients were dichotomized into those with evidence of neurovascular compression on preoperative MRI vs those without. The effect of neurovascular compression on pain-free survival was assessed using Kaplan-Meier Cox proportional hazards analyses. RESULTS: Of the 2726 patients reviewed, 298 met our inclusion criteria. Our study comprised 261 patients with no evidence of neurovascular compression on preoperative MRI vs 37 patients with evidence of neurovascular compression on preoperative MRI. Patients in the compression group had a shorter median duration to recurrence compared with those in the no compression group, P = .01. Kaplan-Meier survival analysis revealed that patients with preoperative evidence of neurovascular compression on MRI imaging demonstrated shorter pain-free survival compared with those without such evidence [hazard ratio = 1.57 (1.03-2.4), P = .037]. Cox proportional hazards analysis demonstrated that evidence of neurovascular compression was associated with poor pain-free survival [hazard ratio = 1.64 (1.06-2.53), P = .03]. CONCLUSION: Patients with neurovascular compression on preoperative MRI may experience reduced time to recurrence compared with those without after percutaneous rhizotomy. These patients should be counseled on potential reduced efficacy of percutaneous rhizotomy as a primary intervention for their pain.

Translated article] Checklist for the pharmaceutical care of patients with interstitial lung disease (CheckEPID): A Delphi-based consensus

ObjectiveTo develop a checklist to facilitate pharmaceutical care for patients with interstitial lung disease who require or are undergoing treatment with antifibrotic drugs. MethodFive hospital pharmacists developed an initial list of 37 items divided into 4 blocks: (1) First visit, which included general patient data and data from the first treatment; (2) follow-up visits, assessing aspects of the follow-up of the treatment with nintedanib or pirfenidone; (3) telepharmacy, consisting of the evaluation of the inclusion of patients in a program of this type, course of the disease, and identification of the contact with the pharmacy service; (4) non-pharmacological treatment and patient information. To decide its potential inclusion in the checklist, 2 rounds of the Delphi were carried out in which the panelists had to assess the degree of agreement of each proposed item according to its “utility”, which was the determining criterion for its inclusion, and its “applicability”. ResultsForty-eight hospital pharmacists were contacted, 30 (63%) agreed in writing to participate, 28 (58%) completed the first round of the Delphi, and 27 (56%) completed the second round. After the first round of the Delphi, the questionnaire was amended and comprised 40 items. Of the 40 items evaluated after the 2 rounds of the Delphi, there were 2 that, based on utility, the participants did not reach consensus for inclusion in the checklist: the one referring to “History of surgical intervention, specifically abdominal surgery in the last 4 weeks” (finally kept on the checklist due to its involvement in the indication of nintedanib) and to make recommendations on “Relaxation”. No consensus was reached on their applicability for 2 of the items: “Patient stratification according to the Spanish Society of Hospital Pharmacy (SEFH) chronic patient model” and “Collection of Results Reported by the Patient”. ConclusionsThe management of patients with ILD and/or pulmonary fibrosis is complex and requires a multidisciplinary approach where the hospital pharmacist plays a key role, especially, although not only, in monitoring drug treatment. We believe that this checklist can contribute from pharmaceutical care to improving the integrated care of patients with ILD who require or are undergoing treatment with antifibrotic drugs.

Lista de comprobación para la atención farmacéutica del paciente con enfermedad pulmonar intersticial (CheckEPID): un consenso basado en el método Delphi

ObjectiveTo develop a checklist to facilitate pharmaceutical care for patients with interstitial lung disease who require or are undergoing treatment with antifibrotic drugs. MethodFive hospital pharmacists developed an initial list of 37 items divided into 4 blocks: 1) First visit, which included general patient data and data from the first treatment; 2) Follow-up visits, assessing aspects of the follow-up of the treatment with nintedanib or pirfenidone; 3) Telepharmacy, consisting of the evaluation of the inclusion of patients in a program of this type, course of the disease, and identification of the contact with the pharmacy service; 4) Non-pharmacological treatment and patient information. To decide its potential inclusion in the checklist, two rounds of the Delphi were carried out in which the panelists had to assess the degree of agreement of each proposed item according to its “utility”, which was the determining criterion for its inclusion, and its “applicability”. Results48 hospital pharmacists were contacted, 30 (63%) agreed in writing to participate, 28 (58%) completed the first round of the Delphi, and 27 (56%) completed the second round. After the first round of the Delphi the questionnaire was amended and comprised 40 items. Of the 40 items evaluated after the two rounds of the Delphi, there were two that, based on utility, the participants did not reach consensus for inclusion in the checklist: The one referring to “History of surgical intervention, specifically abdominal surgery in the last 4 weeks” (finally kept on the checklist due to its involvement in the indication of nintedanib) and to make recommendations on “Relaxation”. No consensus was reached on their applicability for two of the items: “Patient stratification according to the Spanish Society of Hospital Pharmacy (SEFH) chronic patient model” and “Collection of Results Reported by the Patient”. ConclusionsThe management of patients with ILD and/or pulmonary fibrosis is complex and requires a multidisciplinary approach where the hospital pharmacist plays a key role, especially, although not only, in monitoring drug treatment. We believe that this checklist can contribute from pharmaceutical care to improving the integrated care of patients with ILD who require or are undergoing treatment with antifibrotic drugs.

Prevalence of Obstructive Sleep Apnea in Patients with Difficult Intubation: Looking for Evidence?

BACKGROUND: The link between obstructive sleep apnea and difficult intubation needs to be fully investigated and made clear. If a compromised airway can be anticipated and managed; it can lessen the likelihood of adverse consequences. AIM: The aim of this study was to investigate the incidence, severity, and possible association of obstructive sleep apnea in individuals with unexpected difficult endotracheal intubation and their associated clinical and polysomnographic findings. METHODS: Thirty patients referred for examination after difficult endotracheal intubation were enrolled in the study group, while 30 cases from the sleep laboratory unit database with a history of surgical intervention without difficult intubation were randomly selected for the control group. Documentation was obtained for the office clinical examination and fiber-optic nasopharyngolaryngoscopy assessment by Muller maneuver. The inspected upper airway was graded clinically using the Modified Mallampati technique. A comprehensive polysomnographic assessment was done overnight. The available data from the anesthetic record, as well as those derived from clinical and polysomnographic examination, such as age, sex, Body mass index, M Mallampati score, clinical positive findings, Cormack and Lehane grade, Apnea-Hypopnea Index (AHI), desaturation index, and average O2%, were statistically analyzed. RESULTS: The mean ± SD of the AHI of the study group was (29.7 ± 16.1) while in the control group, it was (13.1 ± 9.9), and the difference was of statistical significance (p < 0.001). The grading of the severity of obstructive sleep apnea (OSA) was significantly different between both groups, with 53.3% of the studied cases having severe OSA and the rest having moderate (26.7%) or mild OSA (13.3%). The desaturation index was significantly higher in the study group (28.9 ± 17.4) than the control group (10.2 ± 7.4), while the average O2% saturation was significantly lower among cases (91.8 ± 6.2). The mean modified Mallampati score was significantly higher among cases with grade III-CL, and the significance was also noticed in class IV. CONCLUSION: OSA is a major risk factor for difficult airway management and OSA patients are more likely to have difficult intubations. Patients who underwent a difficult intubation had a higher incidence and severity of OSA compared to the control group. OSA severity and higher modified Mallampati scores were independently related.

Hourglass appearance in cystocele with an impacted vesical calculus.

A 62-year-old hypertensive female presented with a mass protruding from the vagina for the past 20 years. She complained of dysuria and urinary incontinence for the past 3 months. There was no history of surgical intervention in the past. The examination revealed a tender irreducible total uterine prolapse (procidentia) and cystocele with a decubitus ulcer. Computed tomography urogram showed a total uterine prolapse along with the prolapse of a part of urinary bladder, with a vesical calculus of size 2.8 cm × 2.7 cm in the prolapsed part of the bladder, below the level of the pubic symphysis, with minimal wall thickening. After optimization, vesical lithotripsy and bilateral ureteric stenting were performed, followed by hysterectomy after 2 days.

Comparative analysis of the intestinal microbiota in patients with exocrine pancreatic insufficiency of various severity

Exocrine pancreatic insufficiency (EPI) is a critical host factor in determining the composition of the gut microbiota. Diseases that cause exocrine insufficiency can affect the gut microbiome, which can potentiate disease progression and complications. To date, the relationship of exocrine insufficiency in various pancreatic (PA) pathologies, in chronic pancreatitis (CP), with dysbiotic changes in the intestinal microbiota (IM) has not been reliably studied. The available data are heterogeneous and contradictory, which determines the need for further research. To conduct a comparative analysis of the taxonomic composition of the intestinal microbiota in patients with CP of various etiologies, without or with the presence of EPI of varying severity, as well as patients with severe EPI with a history of surgical intervention (SI) on the pancreas. A total of 85 patients were included in the study. Patients were divided into groups according to the severity of EPI: Group 1 (n=16) - patients with CP without EPI; Group 2 (n=11) - patients with CP and mild EPI; Group 3 (n=17) - patients with severe CP and EPI; Group 4 (n=41) - severe EPI in persons with a history of SI on the pancreas. Verification of CP was carried out according to clinical, anamnestic and instrumental data. The degree of EPI was determined by the level of pancreatic elastase-1 (PE-1) feces. Informed consent for the study was obtained for each patient, an anamnesis was collected, physical and laboratory examinations were performed, and a stool sample was obtained. DNA was extracted from each stool sample, the taxonomic composition of BM was determined by sequencing the bacterial 16S rRNA genes, followed by bioinformatic analysis. We followed the changes in the gut microbiota from a group of patients with CP without EPI to a group with severe EPI, in those who underwent SI. At the level of the phylum, the IM of all groups showed the dominance of Firmicutes, with the lowest representation in the severe EPI group, both with SI and CP, and the growth of the Actinobacteria, Verrucomicrobiota and Fusobacteria types. The differential representation of childbirth varied: in patients with severe EPI and CP, compared with mild, statistically significant genera - Akkermansia, Ruminococcus gauvreauii group and Holdemanella; compared with CP without exocrine insufficiency, Prevotella, Ruminococcus gauvreauii group, Peptostreptococcus and Blautia dominated. The CP group with mild EPI was dominated by the following genera: Lachnospiraceae_ND 2004 group, Faecalitalea, Fusobacterium, Catenibacterium, Roseburia, Atopobium, Cloacibacillus, Clostridium innococum group, Ruminococcus torques group. All groups showed a low diversity of taxa with a predominance of opportunistic flora, including participants in oncogenesis. The results of the study show that patients with CP of various etiologies and patients with severe EPI who underwent specific intervention on the pancreas have intestinal microbiota dysbiosis, the severity of which is significantly influenced by the degree of EPI.

A98 ASSOCIATIONS BETWEEN DISTANCE TO CLINIC AND PATIENT CHARACTERISTICS FOR YOUNG ADULTS WITH IBD AT THE TIME OF PEDIATRIC TO ADULT TRANSFER OF CARE

Abstract Background Patients with inflammatory bowel disease (IBD) in childhood are a vulnerable population. Compared to patients diagnosed in adulthood, they may present more often with extensive disease, delayed growth, and more frequently have perianal disease. Eventually, these patients will transfer care from the pediatric to the adult system, which has been associated with medication nonadherence and increase in health care utilization. Within the literature, travel distance has been cited as a barrier to accessing health care; however, understanding its’ impact on this vulnerable patient population has not been well-established. Purpose The study objective was to characterize differences between patients transferring from pediatric to adult care based on distance from an IBD center. To achieve this, the study aims to measure associations between distance to clinic and smoking status, anxiety and depression, history of surgery, and biologics at the time of first appointment in adult care. Method A retrospective cross-sectional study is ongoing using electronic medical charts for patients who transferred from pediatric to adult care from January 1, 2014 – October 4, 2022. Transfer was defined as the patient’s first appointment in adult care at the University of Alberta’s IBD clinic. Distance was measured by driving distance from the patient’s postal code to the postal code of the IBD clinic. Distance was categorized as being <50km from IBD clinic and >50km. Binary outcome variables collected at time of transfer included reported biologic use, anxiety and depression, smoking status, and history of surgeries. Descriptive and inferential statistics were used to analyze data. Result(s) Of the 185 electronic medical charts were reviewed, 46 (24.9%) patients lived >50km from clinic. The median age at diagnosis for the >50km group was 14.5 (IQR: 15.9-13.6), 41% were female sex, 54% had Crohn disease, 41% had ulcerative colitis (UC), and 26% had completed a fecal calprotectin within the last 6 months. The median age at diagnosis of the 139 patients living <50km from clinic was 14.3 (IQR:15.9-12.5), 45% were female sex, 60% had Crohn disease, 32% had UC, and 59% had completed a fecal calprotectin. Of those who had a fecal calprotectin, in group 1, 26% had a result over >250 ug/g, compared to 60% in the reference group. Univariate analysis (Table 1) showed that those living further than 50 km were more likely than those closer to engage in daily smoking (OR~4.7). Weaker and lack of associations were seen with anxiety and depression (OR~1); being on biologics (OR~0.7); history of surgical intervention (OR~2.2). Image Conclusion(s) When smoking status was reported, patients > 50km away from clinic were 4.7 times more likely to engage in daily smoking at time of transfer compared to those patients within 50km from the clinic. By acknowledging and understanding potential differences and similarities between patients characterized by geographical location, we can use this research to inform personalized care plans. Disclosure of Interest None Declared

Frequency and Clinicopathologic Characteristics of Triple-Negative Breast Cancer Among Breast Cancer Patients Presenting to Medical Oncology Department, Hayatabad Medical Complex Peshawar, Pakistan.

Breast cancer is one of the most common cancers affecting females.The outcomes of this study will aid future research and policy suggestions by giving a rapid local burden and clinicopathologic profile of triple-negative breast cancer (TNBC) patients. This cross-sectional study was carried out at the Department of Oncology, Hayatabad Medical Complex Peshawar, Pakistan, from April 21, 2022, to October 21, 2022. The sample size was 120 using a 95% confidence level, 18.7% proportion of TNBC frequency in patients with breast cancer, and 7% absolute precision. All patients who presented with newly diagnosed breast cancer and were between the ages of 30-60 yearswere included in the study. The study excluded male patients and patients with a history of surgical intervention on the breast during the previous six months. A total of 120 patients were evaluated. Age ranged between 30-60 years with a mean age of 45 years. Thirty-four (28%) patients were in the age range of 30-45 years and 86 (72%) patients were in the age range of 46-60 years. Fifty-six (47%) patients had BMI ≤27 kg/m2 while 64 (53%) had BMI >27 kg/m2. The use of oral contraceptives was noted in 25 (21%) patients. A total of 62 (52%) patients had breast cancer on the right side while 58 (48%) had it on the left side. According to the results of our study, 14% of breast cancer patients had triple-negative disease.

What Do Patients Know About Peripheral Arterial Disease? A Knowledge Questionnaire.

The lack of knowledge about Peripheral Arterial Disease (PAD) is worryingly high as it triggers and main- tains behaviors of denial, indifference, and non-adherence to therapeutics. Therefore, the aim of this study was to build and assess the reliability and validity of a knowledge questionnaire about PAD (Peripheral Arterial Disease Knowledge Questionnaire - PADKQ). A longitudinal study was carried out with two evaluations that included a sample of patients with PAD and Intermittent Claudication, with no history of surgical interventions, in follow-up at the vascular surgery consulta- tion. The PADKQ was applied to 114 patients (85% men, with a mean age of 65 years, SD=7.2). Sociodemographic and clinical data were collected from clinical records, and physical activity level (International Physical Activity Questionnaire - IPAQ) and walking impairment (Walking Impairment Questionnaire - WIQ) were evaluated through questionnaires. A 2nd evaluation session took place two weeks after the 1st evaluation session where an educational intervention was performed. Internal consistency, temporal stability, content validity, and convergent validity were performed Results: The sample related results have reflected the good reliability (kr-20=0.775) and validity properties of the PADKQ. This sample showed a high level of knowledge about PAD (10.96 points, SD=3.28, from 0 to 16 possible points), which increased significantly from moment 1 to moment 2 (t= -7.457, p<.001). Only half of the sample considered the disease to be serious and identified smoking habits as one of the risk factors. Patients with higher education were the most physically active. The PADKQ proved to be a useful, brief, and easy-to-use instrument in health contexts to identify patients' level of knowledge about PAD. Education about PAD increases patients' knowledge about the disease and the greater the knowl- edge about PAD, the greater the practice of physical activity.

Age related progression of clinical measures and gait in children with bilateral Cerebral Palsy without a history of surgical intervention

Age related progression of clinical measures and gait in children with bilateral Cerebral Palsy without a history of surgical intervention

Reference values for MRI-derived psoas and paraspinal muscles and macroscopic fat infiltrations in paraspinal muscles in children.

BackgroundSarcopenia, defined as loss of skeletal muscle mass, is a novel term associated with adverse outcomes in children. Magnetic Resonance Imaging (MRI) is a safe and precise technique for measuring tissue compartments and is commonly used in most routine paediatric imaging protocols. Currently, there is a lack of MRI‐derived normative data which can help in determining the level of sarcopenia. This study aimed to introduce reference values of total psoas muscle area (tPMA), total paraspinal muscle area (tPSMA), and total macroscopic fat infiltrations of the PSMA (tMFI).MethodsIn this retrospective study, the local database was searched for abdominal and pelvic region MRI studies of children aged from 1 to 18 years (mean age (standard deviation (SD)) of 9.8 (5.5) years) performed in the years 2010–2021. Children with chronic diseases and a history of surgical interventions were excluded from the analysis. Finally, a total of 465 healthy children (n = 233 girls, n = 232 boys) were enrolled in the study. The values of the tPMA, tPMSA, and tMFI were measured in square centimetres (cm2) at the level of the L4/L5 intervertebral disc as the sum of the left and right regions. Age‐specific and sex‐specific muscle, fat, and body mass index percentile charts were constructed using the LMS method. Inter‐observer agreement and intra‐observer reproducibility were assessed using the Bland–Altman plots.ResultsBoth tPMA and tPSMA showed continuous increases in size (in cm2) throughout all age groups. At the age of 18, the median tPMA areas reached 26.37 cm2 in girls and 40.43 cm2 in boys. Corresponding tPSMA values were higher, reaching the level of 40.76 cm2 in girls and 56.66 cm2 in boys. The mean value of tMFI within the paraspinal muscles was 5.0% (SD 3.65%) of their total area in girls and 3.5% (SD 2.25%) in boys with the actual difference between sexes up to 0.96 cm2. Excellent intra‐observer reproducibility and inter‐observer agreement were noted. Actual mean differences for tPMA were at the level of 0.43 and 0.39 cm2, respectively. Mean bias for tPSMA was 0.1 cm2 for inter‐observer and 0.05 cm2 for intra‐observer measurements.ConclusionsOur findings demonstrate novel and highly reproducible sex‐specific MRI‐derived reference values of tPMS, tPSMA, and tMFI at the level of the L4/L5 intervertebral disc for children from 1 to 18 years old, which may guide a clinician in the assessment of sarcopenia, a prognostic outcome marker in children.

Risk Factors for Treatment Failure with Oral Antivirals in HCV

Introduction: Chronic hepatitis C virus (HCV) infection is one of the major cause of cirrhosis of liver and leads to significant morbidity and mortality. In past, HCV therapy was limited to subcutaneous peg interferon plus oral ribavirin, a regimen that was generally poorly tolerated and provided low efficacy, with cure rates below 40% for HCV genotypes 1 and 4, and below 75% for HCV genotypes 2 or 3. The availability of oral direct-acting antiviral (DAA) as treatment for chronic hepatitis C has revolutionized the field. Although current HCV therapies rarely fail to achieve viral eradication, a subset of patients experience treatment failure. Aim: To study the risk factors associated with treatment failure with oral antiviral drugs in patients of Chronic hepatitis C. Materials &amp; Methods: It was a retrorospective study done at Medical Gastroenterology Department, PGIMS, Rohtak in which six years data i.e.from 01.01.2015 to 31.12.2020, pertainining to Eighty Six (86) chronic hepatitis C patients who had treatment failure i.e. SVR failure on oral antiviral drugs was analyzed. Observations: Out of the total 86 patients, there was clear cut male predominance i.e. 54 (62.79 %) with rural background (villages) i.e.73 (84.88%). The age distribution in these 86 patients varied between 10-80 yrs of age and characterstically peak was seen in 31-40 yrs age group i.e.25 patients (29.06 %). The majority of patients had high baseline HCV viral load (&gt; 4 lakhs I.U. /ml) i.e. 52 patients (60.46%). Out of total 86 patients, , 50 patients (58.13%) were cirrhotic, 34 patients (39.53 %) were smokers, 33 patients (38.37%) were alcoholic, 26 patients (30.23 %) had past history of surgical intervention, 9 patients (10.46 %) were diabetic, 9 patients (10.46 %) had got tattoo, 8 patients (9.30%) had history of previous blood transfusion and 13 patients (15.11%) gave history of use of alternative medications. Results: The direct risk factors associated with development of failed SVR in HCV patients are high baseline HCV RNA viral load, cirrhosis, rural background and indirect risk factors are smoking, alcohol and Diabetes Mellitus but large scale studies in future are required to confirm the same.

Diagnóstico molecular de sepsis polimicrobiana en paciente pediátrico: reporte de un caso

El diagnóstico de sepsis polimicrobiana es controvertido, se ha considerado factible en pacientes con antecedentes de intervenciones quirúrgicas, sepsis abdominal, entre otros factores de riesgo. A continuación, se describe el caso de un paciente pediátrico con múltiples hospitalizaciones e intervenciones quirúrgicas por el diagnóstico de base de atresia yeyunal múltiple tipo IV, que produjo sepsis polimicrobiana confirmada por biología molecular y cultivos tradicionales. Es importante considerar la sepsis polimicrobiana en hemocultivos tomados con la técnica correcta, ya que la identificación de patógenos conduce al tratamiento dirigido, aumentando la probabilidad de supervivencia de estos pacientes.

Age related progression of clinical measures and gait in ambulant children and youth with bilateral cerebral palsy without a history of surgical intervention

BackgroundAge related progression needs to be considered when assessing current status and treatment outcomes in cerebral palsy (CP). Research questionWhat is the association between age, gait kinematics and clinical measures in children with bilateral CP? MethodA retrospective database review was conducted. Subjects with bilateral CP with baseline and follow-up 3D gait analyses, but no history of intervening surgery were identified. Clinical and summary kinematic measures were examined for age related change using repeat measures correlation. Interactions with GMFCS classification and whether surgery was recommended were examined using robust linear regression. Timeseries kinematic data for baseline and most recent follow-up analyses were analysed using statistical parametric mapping. Results180 subjects were included. 75% of participants were classified as GMFCS I or II at baseline. Mean time to follow-up was 4.89 (2.8) years (range 1–15.9 years) with a mean age of 6.4 (2.4) at baseline and 11.3 (3.4) at final follow-up. 15.5% of subjects demonstrated an improvement in GMFCS classification while GDI remained stable. Age related progression was noted across many clinical measures with moderate correlations (r ≥ 0.5) noted for reduced popliteal angle, long lever hip abduction and internal hip rotation range. In gait, there was reduced hip extension in late stance (p < 0.001), increased knee flexion in mid-stance (p < 0.001), reduced peak knee flexion in swing (p < 0.001) and increased ankle dorsiflexion in stance (p < 0.001). In the coronal plane, there was reduced hip abduction in swing (p < 0.001). In the transverse plane, increased external rotation of the knee (p < 0.001) and reduced external ankle rotation were noted in early stance and through swing (p < 0.001). There were no changes in foot progression or hip rotation. SignificanceIndividuals with CP show age related progression of clinical and kinematic variables. Treatment can only be deemed successful if outcomes exceed or match these age-related changes.

Recurrent respiratory papillomatosis: clinical presentation, treatment modalities, and outcomes in Khartoum state

BackgroundIn this hospital-based cohort study, a total number of 52 patients with recurrent respiratory papillomatosis were studied. The medical histories of all the patients were taken and physical examination was conducted thoroughly. Types of surgeries were also observed and the sites of papillomatous lesions were identified. The patients then followed up after surgeries to assess the outcomes and to evaluate the satisfaction levels of the patients.ResultThere was obvious gender predilection toward male patients. Ninety percent of the cases were younger than 20 years old, and 50% of the cases were found to be in the group of 5–10 years old. The most predominant symptom that had been noticed in all of the patients was the change of voice. The study also found that around 46% of the patients had a history of surgical interventions as trials to treat the disease. Acyclovir tabs were prescribed for only 4 patients. No other forms of adjuvant therapies were prescribed. It is also showed that around 65.4% of the cases underwent surgical removal of the papillomata by debulking using cold steel. 30.8% underwent laser and two patients underwent coblation surgeries. Forty-two percent of the patients reported good and satisfactory outcomes with obvious relief from presenting symptoms and no apparent papilloma after IDL examination.ConclusionRecurrent respiratory papillomatosis presents with a highly variable clinical course in both juvenile and adult patients, with a spectrum from indolent to aggressive disease. But the severity of the condition is more among the younger ages. Change of voice was the first symptom in all of the cases. The use of adjuvant medical treatment in Sudan to treat respiratory papillomatosis is not a routine practice.

Clinical and diagnostic aspects of deep infiltrative endometriosis (diagnosis, treatment, recurrence)

Aim. To analyze the recurrence of endometriosis after surgical treatment of patients with deep endometriosis.&#x0D; Materials and methods. The case histories of 90 patients aged 19 to 45 years were retrospectively analyzed. The study group consisted of 70 endometriosis patients: 20 with peritoneal endometriosis and 50 with deep infiltrative endometriosis (DIЕ). The comparison group included 20 women without endometriosis. There was an in-depth study of anamnestic data in the cohort of patients under study. The results of preoperative laboratory tests, including serum levels of the CA-125 and CA 19-9 oncomarkers, were processed.&#x0D; Results. Analysis of the obtained data showed that about half of the DIE patients (54%) in the main group had a history of surgical interventions for endometriosis. The number of operations was significantly higher in patients compared to the peritoneal endometriosis group (68% vs 20%, respectively; р=0.0012). Two subgroups were formed from the group of women with DIE: patients who had no history of previous surgical treatment for endometriosis and those hospitalized for repeated surgical treatment of endometriosis (patients with recurrent endometriosis). Patients with recurrent endometriosis had a significantly higher incidence of heavy menstruation, pregnancy terminations (abortions), and a high proportion of gastrointestinal diseases. Analysis of the hormonal therapy received in patients with DIE showed that every second patient with relapses (18/53%) after surgical treatment and every third patient without a prior history of surgery (5/31%) received hormonal therapy. Examination of the preoperative serum levels of CA-125 and CA 19-9 serum markers in patients with DIE showed an increase in their serum levels and a correlation with the frequency of endometriosis recurrence and the size of DIE foci.&#x0D; Conclusion. Despite the conservative and surgical treatment of DIE patients, the recurrence rate is still high. At present, there is no satisfactory therapy for all endometriosis patients. Therefore, the development of therapy for the conservative treatment of the disease remains an urgent task.