Hospital Institute Research Articles

Co-occurring Autism Spectrum Disorder and Gender Dysphoria in Adolescents.

Autism spectrum disorder (ASD) and gender dysphoria (GD) frequently cooccur. However, existing research has primarily used smaller samples, limiting generalizability and the ability to assess further demographic variation. The purpose of this study was to (1) examine the prevalence of cooccurring ASD and GD diagnoses among US adolescents aged 9 to 18 and (2) identify demographic differences in the prevalence of cooccurring ASD and GD diagnoses. This secondary analysis used data from the PEDSnet learning health system network of 8 pediatric hospital institutions. Analyses included descriptive statistics and adjusted mixed logistic regression testing for associations between ASD and GD diagnoses and interactions between ASD diagnosis and demographic characteristics in the association with GD diagnosis. Among 919 898 patients, GD diagnosis was more prevalent among youth with an ASD diagnosis compared with youth without an ASD diagnosis (1.1% vs 0.6%), and adjusted regression revealed significantly greater odds of GD diagnosis among youth with an ASD diagnosis (adjusted odds ratio = 3.00, 95% confidence interval: 2.72-3.31). Cooccurring ASD/GD diagnoses were more prevalent among youth whose electronic medical record-reported sex was female and those using private insurance, and less prevalent among youth of color, particularly Black and Asian youth. Results indicate that youth whose electronic medical record-reported sex was female and those using private insurance are more likely, and youth of color are less likely, to have cooccurring ASD/GD diagnoses. This represents an important step toward building services and supports that reduce disparities in access to care and improve outcomes for youth with cooccurring ASD/GD and their families.

Role of TaqMan array card in determining causative organisms of acute febrile illness in hospitalized patients.

Acute febrile illness (AFI) is a prevalent disease in developing countries that is difficult to diagnose due to the diversity of infectious organisms and the poor quality of clinical diagnosis. TaqMan array card (TAC) can detect up to 35 AFI-associated organisms in 1.5 h, addressing diagnostic demands. In this study, we aimed to evaluate the role of TAC in determining the causative organisms in hospitalized AFI patients. The study had a cross-sectional design and enrolled 120 admitted patients with persistent fever for three or more days from the medicine ward of Chittagong Medical College Hospital (CMCH) and Bangladesh Institute of Tropical and Infectious Diseases Hospital (BITID). Blood samples were collected and then subjected to automated BacT/Alert blood culture, microbial culture, TAC assay, and typhoid/paratyphoid test. The total number of study participants was 120, among them 48 (40%) samples showed a positive result in TAC card, 29 (24.16%) were TP positive and nine (7.51%) were culture positive. The number of organisms detected by the TAC card was 13 bacteria, three viruses, one protozoan, and one fungus. The sensitivity and specificity of the TAC assay for different bacterial pathogen compared to blood culture was 44.44%, and 90.99%, respectively. In contrast, the TP test had a sensitivity and specificity of 100% and 80%, respectively, compared to the blood culture test. TAC can be a handful tool for detecting multiple organisms in AFI with high specificity which can facilitate early diagnosis of different pathogens contributing to AFI.

Virtual versus In-Person Ophthalmology Interviews: Perceptions of U.S. Ophthalmology Fellowship Applicants in 2022-2023.

Purpose Despite easing restrictions on social distancing and travel since the beginning of coronavirus disease 2019 pandemic, virtual interviews remain a widely used format for ophthalmology fellowship interviews. This study aims to evaluate the relative benefits and drawbacks of in-person versus virtual interviews during a cycle where both formats were prevalent. Methods A prospective cross-sectional study surveyed all fellowship applicants ( N = 311) who applied to Wills Eye Hospital and Bascom Palmer Eye Institute during the 2022 to 2023 application cycle. Results A total of 59 (19%) applicants responded to the survey, with the majority being male (53.0%) and between the ages of 20 and 35 (91.3%). There was no statistically significant difference between the number of virtual and in-person interviews attended or the total number of interviews attended. The highest ranked limitations of the virtual interview process were limited exposure to details of the program structure, limited opportunity to exhibit applicants' strengths to the program, and limited exposure to the fellows. The highest ranked strengths were less pressure during interviews, greater scheduling flexibility, and ability to interview at more fellowship programs. The highest ranked limitations of the in-person interview process were more pressure during interviews, inability to interview at all desired fellowship programs, and decreased scheduling flexibility. The highest ranked strengths based on median rankings were greater exposure to details of the program structure, greater ability to exhibit an applicant's strengths to the program, and greater exposure to the geographic location/city. Conclusion While both in-person and virtual interviews have their own benefits and limitations, virtual interviews appear to be more cost-effective and time-efficient while in-person interviews provide better opportunities to assess program fit and culture. A hybrid format that combines the ideal aspects of both formats may be an optimal solution.

The short-term and long-term adverse effects of melatonin treatment in children and adolescents: a systematic review and GRADE assessment.

Currently, melatonin is used to treat children and adolescents with insomnia without knowing the full extent of the short-term and long-term consequences. Our aim was to provide clinicians and guideline panels with a systematic assessment of serious-and non-serious adverse events seen in continuation of melatonin treatment and the impact on pubertal development and bone health following long-term administration in children and adolescents with chronic insomnia. We searched PubMed, Embase, Cinahl and PsycINFO via Ovid, up to March 17, 2023, for studies on melatonin treatment among children and adolescents (aged 5-20 years) with chronic insomnia. The language was restricted to English, Danish, Norwegian, and Swedish. Outcomes were non-serious adverse events and serious adverse events assessed 2-4 weeks after initiating treatment and pubertal development and bone health, with no restriction on definition or time of measurement. Observational studies were included for the assessment of long-term outcomes, and serious and non-serious adverse events were assessed via randomised studies. The certainty of the evidence was assessed using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). The protocol is registered with the Danish Health Authority. We identified 22 randomised studies with 1350 patients reporting on serious-and non-serious adverse events and four observational studies with a total of 105 patients reporting on pubertal development. Melatonin was not associated with serious adverse events, yet the number of patients experiencing non-serious adverse events was increased (Relative risk 1.56, 95% CI 1.01-2.43, 17 studies, I2=47%). Three studies reported little or no influence on pubertal development following 2-4 years of treatment, whereas one study registered a potential delay following longer treatment durations (>7 years). These findings need further evaluation due to several methodological limitations. Children who use melatonin are likely to experience non-serious adverse events, yet the actual extent to which melatonin leads to non-serious adverse events and the long-term consequences remain uncertain. This major gap of knowledge on safety calls for caution against complacent use of melatonin in children and adolescents with chronic insomnia and for more research to inform clinicians and guideline panels on this key issue. The Danish Health Authority. The Parker Institute, Bispebjerg and Frederiksberg Hospital, supported by the Oak Foundation.

Use of melatonin in children and adolescents with idiopathic chronic insomnia: a systematic review, meta-analysis, and clinical recommendation.

Melatonin prescriptions for children and adolescents have increased substantially during the last decade. Existing clinical recommendations focus on melatonin as a treatment for insomnia related to neurodevelopmental disorders. To help guide clinical decision-making, we aimed to construct a recommendation on the use of melatonin in children and adolescents aged 5-20 years with idiopathic chronic insomnia. A systematic search for guidelines, systematic reviews and randomised controlled trials (RCT) were performed in Medline, Embase, Cochrane Library, PsycInfo, Cinahl, Guidelines International Network, Trip Database, Canadian Agency for Drugs and Technologies in Health, American Academy of Sleep Medicine, European Sleep Research Society and Scandinavian Health Authorities databases. A search for adverse events in otherwise healthy children and adolescents was also performed. The latest search for guidelines, systematic reviews, and adverse events was performed on March 18, 2023. The latest search for RCTs was performed on to February 6, 2023. The language was restricted to English, Danish, Norwegian, and Swedish. Eligible participants were children and adolescents (5-20 years of age) with idiopathic chronic insomnia, in whom sleep hygiene practices have been inadequate and melatonin was tested. There were no restrictions on dosage, duration of treatment, time of consumption, or release formula. Primary outcomes were quality of sleep, daytime functioning and serious adverse events. Secondary outcomes included total sleep time, sleep latency, awakenings, drowsiness, quality of life, all-cause dropouts, and non-serious adverse events. Outcomes were assessed at different time points to assess short-term and long-term effects. Meta-analysis was performed using inverse variance random-effects model and risk of bias was assessed using Cochrane risk of bias tool. If possible, funnel plots would be constructed to investigate publication bias. Heterogeneity was calculated via I2 statistics. A multidisciplinary guideline panel formulated the recommendation according to Grading of Recommendations Assessment, Development and Evaluation (GRADE). The certainty of evidence was considered either high, moderate, low or very low depending on the extent of risk of bias, inconsistency, imprecision, indirectness, or publication bias. The evidence-to-decision framework was subsequently used to discuss the feasibility and acceptance of the constructed recommendation alongside the impact on resources and equity. The protocol is registered with the Danish Health Authority. We included eight RCTs with 419 children and adolescents with idiopathic chronic insomnia. Melatonin led to a moderate increase in total sleep time by 30.33min (95% confidence interval (CI) 18.96-41.70, 4 studies, I2=0%) and a moderate reduction in sleep latency by 18.03min (95% CI-26.61 to-9.44, 3 studies, I2=0%), both as assessed by sleep diary. No other beneficial effects were found. None of the studies provided information on serious adverse events, yet the number of participants experiencing non-serious adverse events was increased (Relative risk 3.44, 95% CI 1.25-9.42, 4 studies, I2=0%). Funnel plots were not constructed due to the low number of studies. The certainty of evidence was very low on the quality of sleep and low for daytime functioning. Evidence of very low certainty shows that benefits are limited and unwanted events are likely when melatonin is used to treat otherwise healthy children and adolescents with chronic insomnia. Melatonin should never be the first choice of treatment for this particular population, yet carefully monitored short-term use may be considered if sleep hygiene practices and non-pharmacological interventions have proven inadequate, and only if daytime function is compromised. The Danish Health Authority and the Parker Institute, Bispebjerg and Frederiksberg Hospital supported by the Oak Foundation.

PARIST study protocol: a phase I/II randomised, controlled clinical trial to assess the feasibility, safety and effectiveness of paracetamol in resolving acute kidney injury in children with severe malaria

BackgroundAcute kidney injury (AKI) has in the past been considered a rare complication of malaria in children living in high-transmission settings. More recently, however, a growing number of paediatric case...

Comparison Between Maternal Blood Glucose and Fetal Cord Insulin Level Among Gestational Diabetes Mellitus Women

Introduction: Offspring of gestational diabetes mellitus (GDM) mothers are at high risk of developing insulin resistance, type 2 diabetes mellitus (T2 DM), and cardiovascular complications later in life. So, screening maternal blood glucose during pregnancy and identifying high-risk infants immediately after birth is necessary to prevent the potential long-term implications. Aim: To correlate the maternal fasting and post-prandial blood glucose withfetal insulin level. Materials and methods:A case-control study, was conducted at Chettinad Hospital and Research Institute, India, between May 2019 to May 2020. A 75-gram OGTT was performed among pregnant women between 24 to 28 weeks of pregnancy for diagnosing GDM according to American Diabetes Association (ADA) guidelines. 94 GDM mothers and Non-GDM mothers and theirnew-bornswere taken up for this study. 2.5ml of maternal venous blood was collected in a vacutainer containing sodium fluoride and EDTA as an anticoagulant for FBS and PPBS estimation. Some mothers on induction of labor were posted for emergency LSCS (for failed induction and non - progression of labor) and some had normal vaginal deliveries. Plasma FBS and PPBS estimation in the mother’s blood sample was assayed by the Hexokinase method in Siemen'sDimension RxLMachine immediately after centrifugation. 2.5ml of umbilical cord blood was collected in a vacutainer without an anticoagulant after the 2nd stage of labor. 0.5 ml of cord blood serum was separated and stored at -80°C in an eppendorf for later estimation of insulin by CLIA method in Beckman Coulter – Access 2 Immunoassay System. Independent students’ t-tests and Pearson’s correlation were used as statistical methods. p-value <0.05 is considered significant. Results: There is a positive correlation and significant difference between maternal FBS, PPBS, and fetal insulin levels in the GDM group (p-value 0.008, r-value 0.272 and p-value 0.005, r-value 0.286) compared to the Non-GDM group (p-value -0.087, r-value 0.243 and p-value 0.018, r-value 0.212). Conclusion: Significant hyperinsulinemia was noted in the offspring of the GDM group compared to the NON-GDM group.Those hyper-insulinemic babies are at very high risk of developing obesity, metabolic syndrome, and type 2 DM in the future and possess a threat to society.

Благотворительная деятельность женщин в Нижегородской губерниии в 1870-1890-е гг.

The article considers women's charitable activities in the Nizhny Novgorod region in the 1870-1890s. In the XIX century women were especially social active in the field of charity. The involvement of women in the social life of the province affected mainly upper and wealthy groups of the urban population (in the peasant group the features of traditional society were preserved for a long time). The article presents new facts (found both in archival and published sources) about the philanthropy of Nizhny Novgorod merchantry and nobility. The facts demonstrate that charitable initiatives of charity activists manifested themselves mainly in their social and cultural projects. In article all donations of women are systematized by type of assistance (assistance to the poor and the church, maintenance of almshouses, donations for the construction of hospitals and maternity hospitals, charity in the field of education, donations to orphanages, registration of wills for the needs of philanthropy). It is concluded that the largest amount of donations in monetary terms in the last third of the XIX century was ordered for the construction of new hospitals. For the first time, the article presents a detailed history of the hospital institution, created with a large donation from the merchant G.N. Ryabinina for a building of surgical department of the Nizhny Novgorod Provincial Zemstvo Hospital in 1899.

Perioperative anesthetic management of premature neonates weighing less than 1500 grams undergoing transcatheter PDA (TC-PDA) closure: An institutional anesthetic experience

ObjectivesThe aim of our study is to describe the various anesthetic techniques and intraoperative management used during transcatheter closure of hemodynamically significant PDAs in VLBW premature infants weighing less than 1.5 kg and their potential impact on postoperative outcomes using a retrospective chart review. DesignA retrospective electronic medical chart review was performed in infants who underwent Transcatheter Patent Ductus Arteriosus (TC-PDA) closure at an academic institution between January 1, 2008 and October 4th 2019. Only premature patients with isolated PDA weighing less than 1500 g at the time of the procedure were included in the study. SettingSingle Institutional Hospital. ParticipantsPremature patients with isolated PDA weighing less than 1500 g at the time of the procedure. InterventionsNone. Measurements and main resultsInterprocedurally, there was no evidence of device embolization or clinically significant vascular obstruction on follow-up echocardiography, and inotropic or vasoactive infusions were not required. All patients survived and were discharged from the hospital after a mean of 86.4 ± 48.49 days (median 74, range 40–180) following initial admission to the NICU. At 7 post-operative days, freedom from ventilatory support reached 70% in all patients. Incidences of device embolization or clinically significant vascular obstruction were not noted on follow-up echocardiography. ConclusionsThough our preliminary findings show promising outcomes following TC-PDA closure relative to traditional surgical approaches, further investigations with higher patient volume are needed to validate these promising observations.

Assessment of Visual Perception in Children with Autism Spectrum Disorder

Autism spectrum disease (ASD) is a nervous disorder. In this disease children have sensory processing dysfunction and they unable to communicate, interact, and showed repetition in behaviours. The present study was designed to determine visual impairment frequency in children with autism spectrum disorder (ASD). A descriptive study was performed in Paediatrics Department of Children's Hospital and The Institute of Child Health, Lahore. Data was collected in six months and 52 patients of both gender were considered. A total of 40 boys and 12 girls of 3-8 years old children were included. A structured Questionnaire based on visual perception was designed to determine the visual sensory processing issues in children with an autism spectrum disorder. The findings showed a strong difficulties in the visual sense particularly in differentiation among the colours and eye tracking in autism children. It was concluded that sense of sight highly affected in the patients of autism spectrum disorder.

Prognostic Impact of Tumor Markers (CEA and CA19-9) on Patients with Resectable Colorectal Liver Metastases Stratified by Tumor Number and Size: Potentially Valuable Biologic Markers for Preoperative Treatment.

Although patients with resectable colorectal liver metastasis (CLM), a population with good prognosis, have been treated with upfront surgery, some patients have had a poor prognosis. This study aimed to investigate biologic prognostic factors in patients with resectable CLMs. This single-center retrospective study enrolled consecutive patients who underwent liver resection for initial CLMs at the Cancer Institute Hospital between 2010 and 2020. The study defined CLMs as resectable (tumor size < 5cm; < 4 tumors; no extrahepatic metastasis) or borderline resectable (BR). Preoperative chemotherapy was administered to patients with BR CLMs. During the study period, 309 CLMs were classified as resectable without preoperative chemotherapy and 345 as BR with preoperative chemotherapy. For the 309 patients with resectable CLMs, the independent poor prognostic factors associated with overall survival in the multivariable analysis were high tumor marker levels (CEA ≥ 25ng/mL and/or CA19-9 ≥ 50U/mL; (hazard ratio [HR], 2.45; p = 0.0007), no adjuvant chemotherapy (HR, 1.69; p = 0.043), and age of 75 years or older (HR, 2.09; p = 0.012). The 5-year survival rates for the patients with high tumor marker (TM) levels (CEA ≥25 ng/mL and/or CA19-9 ≥50U/mL) were significantly worse than for those with low TM levels (CEA < 25 ng/mL and CA19-9 < 50U/mL) (55.3% vs. 81.1%; p <0.0001) and similar to the rate for those with BR CLMs (52.1%; p = 0.864). Postoperative adjuvant chemotherapy had an impact on prognosis only in the high-TM group (HR, 2.65; p = 0.007). High TM levels have a prognostic impact on patients with resectable CLMs stratified by tumor number and size. Perioperative chemotherapy improves long-term outcomes for patients with CLM and high TM levels.

CONTRIBUTING FACTORS AND PREVALENCE OF TURNOVER INTENTION AMONG EMERGENCY DEPARTMENT NURSES

This prospective study was conducted in three hospitals of Multan: Nishtar Hospital, Children Hospital, and Institute of Child Health and Institute of Cardiology from July 2022 to July 2023 to analyze the prevalence of turnover intention and factors contributing to it among emergency nurses working in a government hospital. Three hundred twenty-two nurses were taken as sampling subjects using a simple random sampling technique. Participants were given questionnaires that included details about demographics, work-related factors, and turnover intention. Results show that higher education, long work tenure, working in shifts, and workplace violence were associated with a higher likelihood of leaving among emergency nurses who were female and aged &gt; 19 and 25 years. According to analysis, nearly half of emergency nurses intend to leave their jobs at some point in the future. To avoid staff shortages that would restrict the availability of emergency medical services, targeted interventions are needed.

Evaluation of Children with Autism Spectrum Disorder by using Common Brief Core Sets of International Classification of Functioning, Disability, and Health for Children and Youth (ICF-CY)

Objective: To evaluate children with Autism Spectrum Disorder (ASD) by using Common Brief Core Sets of International Classification of Functioning, Disability, and Health for Children and Youth (ICF-CY)&#x0D; Study Design: Cross-sectional study&#x0D; Place and Duration of Study: Department of Developmental-Behavioural Paediatrics, The Children’s Hospital and The Institute of Child Health, Lahore Pakistan, from Nov 2020 to Jan 2021.&#x0D; Methodology: This study included 48 children with Autism Spectrum Disorder aged 3-18 years. Common Brief, a Core Set of the international classification of functioning, disability, and health in children and youth (ICF-CY), was administered to assess their functional status. Strengths and weaknesses in body structure, body function, activity and participation and environmental factors were evaluated.&#x0D; Results: The functioning profile in all categories of body function, activities and participation showed severe impairment other than sleep, involuntary and voluntary functions, while complete impairment in complex interpersonal, recreational and leisure categories. Environmental factors were substantial facilitators 4(10%), moderate facilitators 6(15%), mild facilitators 3(7.5%), mild barriers 5(12.5%), moderate barriers 7(17.5%), severe barrier 1(2.5%) and complete barrier 5(12.5%) among children with Autism Spectrum Disorder (ASD).&#x0D; Conclusion: Common Brief, Core Set of ICF-CY, is a comprehensive and flexible tool which provides functional information about ASD children beyond the diagnosed criteria used for ASD.Keywords: Autism spectrum disorder (ASD), Common brief core set of the international classification of functioning, disability, and health in children and youth (ICF-CY), International classification of functioning, disability, and health in children and youth (ICF-CY).

Morphological response and tumor shrinkage as predictive factors in metastatic colorectal cancer treated with first-line capecitabine, oxaliplatin, and bevacizumab.

Morphologic response (MR) is a novel chemotherapeutic efficacy predictor of solid tumors, especially those treated with anti-vascular endothelial growth factor antibodies. Nevertheless, the importance of systemic chemotherapy MR for colorectal liver metastases (CLM) remains unclear. We aimed to evaluate the usefulness of MR as a factor associated with the therapeutic effects of chemotherapy plus bevacizumab for initially unresectable CLM cases. We retrospectively evaluated the associations between MR and/or Response Evaluation Criteria in Solid Tumors (RECIST), progression-free survival (PFS), and overall survival (OS) in patients who received first-line capecitabine, oxaliplatin, and bevacizumab treatment for initially unresectable CLM using multivariate analysis. Patients who showed a complete or partial response based on the RECIST, or an optimal response based on MR, were defined as "responders." Ninety-two patients were examined, including 31 (33%) patients who responded optimally. PFS and OS estimates were comparable in MR responders and non-responders (13.6 vs. 11.6months, p = 0.47; 26.6 vs. 24.6months, p = 0.21, respectively). RECIST responders showed better PFS and OS than non-responders (14.8 vs. 8.6months, p < 0.01; 30.7 vs. 17.8months, p < 0.01, respectively). The median PFS and OS estimates of MR and RECIST responders were better than those of single responders or non-responders (p < 0.01). Histological type and RECIST response were independently associated with PFS and OS. MR predicts neither PFS nor OS; nevertheless, it may be useful when combined with the RECIST. The Ethics Committee of The Cancer Institute Hospital of JFCR approved this study in 2017 (No. 2017-GA-1123): retrospectively registered.

Optimizing Weekend Schedules in Home Health Care: The Essential Care on Weekends for Personal Support Quality Improvement Project

The availability of personal support workers (PSWs) is a limiting factor for home care system capacity, as this workforce provides 70% to 80% paid care in this sector. Without sufficient support to live at home, many seniors and people with disabilities experience poorer outcomes and require care in more expensive and less preferred institutional long-term care or hospital settings. Insufficient PSW availability is limiting access to necessary care in the community. Capacity challenges are particularly pronounced on weekends. The Essential Care on Weekends (ECoW) program was co-developed as one solution to adapt current PSW scheduling practices to increase the number of clients with high-intensity care needs who can be served within the constraints of PSW availability. ECoW focused on increasing weekend capacity and care consistency, particularly for clients with the highest care needs, through prioritizing essential care and moving less time sensitive tasks to weekdays. ECoW was operationalized through 4 activities: communication and engagement, clinical care plan review, geographic review of PSW schedules and the creation of the ECoW schedule. Implementation of ECoW demonstrated success in increasing access to and consistency of care for clients with the highest care needs: weekend capacity increased, access to care improved for clients requiring daily or near-daily care and missed care rates decreased both on weekends and weekdays. This strategy represents a change in scheduling practices that organizations can use to provide consistent service to a growing number of clients with high-intensity care needs in the context of increasingly limited health human resource capacity.

Implications of methods for calculating the left ventricular outflow tract area in aortic stenosis severity grading

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): - Spanish Ministry of Economy and Competitiveness through the Carlos III Institute of Health-Fondo de Investigación Sanitaria. - Post-residency research contract. Medical Research Institute Hospital La Fe (IIS La Fe), Valencia, Spain. Introduction Aortic valve area (AVA) calculation by continuity equation is a fundamental aspect to estimate aortic stenosis (AS) severity. The estimation of the left ventricular outflow tract (LVOT) area is a source of technical variability in the calculation of AVA that can lead to errors in severity grading. Formulas for calculating LVOT diameter (LVOTd) based on body surface area (BSA) and patient height have been proposed, but their impact on reclassifying patients based on severity has not been described. Purpose To evaluate the differences in AS grading according to the LVOT area used in the calculation of the AVA. Methods We retrospectively analyzed (2019–2022) 1722 echocardiograms with a diagnosis of AS and with the following variables reported: AVA calculated using the continuity equation, height and weight of the patient. Predicted LVOTd by BSA was calculated by the formula: (5.7*BSA + 12). Predicted LVOTd by height was calculated as: (5.78 * height + 12.1). Results LVOT area and AVA from predicted LVOTd based on BSA and height showed slightly higher values. The AVA based on the LVOTd predicted by BSA was associated with a lower prevalence of severe AS, as well as a lower prevalence of discordant cases (mean gradient &amp;lt;40 mmHg and AVA &amp;lt;1 cm2) (Table). The AVA based on both methods of predicted LVOTd led to a reclassification from severe (by the standard method) to non-severe in a significant percentage of patients (13.6% for the BSA-predicted method, and 8.7% for the height-predicted method). For the AVA predicted by BSA, the "downgrade" of AS severity was more frequent (23.3%) in patients in the quartile with the highest BMI (&amp;gt;30 kg/m2), while the degree of obesity did not affect the method predicted by height. Conclusion Despite suppressing the potential errors derived from the LVOTd measurement, the AVA based on predicted LVOTd methods using BSA or height lead to a significant percentage of reclassification in terms of severity and prevalence of discordant severe AS due to low gradient. In obese patients, the method predicted by BSA is highly discordant and the method predicted by the patient's height is preferable.

Aortic stenosis progression by different echocardiographic parameters: which one should we use?

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): - Spanish Ministry of Economy and Competitiveness through the Carlos III Institute of Health (Fondo de Investigación Sanitaria). - Post-residency research contract. Medical Research Institute Hospital La Fe (IIS La Fe), Valencia, Spain. Introduction Aortic stenosis (AS) is a significant health problem, particularly in older individuals, and is the most common valve disease necessitating surgical or percutaneous intervention. Echocardiography is central in the diagnosis, management and assessment of disease progression of AS patients. AS severity grading is based on 3 parameters: aortic valve area by continuity equation (AVA), mean gradient (MG), and peak aortic valve velocity (Vmax). Although the AVA is relevant in low gradient situations, its calculation is more complex and therefore may show greater technical variability. Knowing the differences between the 3 parameters to assess progression may be useful in clinical practice. Purpose Assess the differences between the 3 main quantitative parameters to detect the progression of disease in patients with AS. Methods We retrospectively analyzed a cohort of 130 patients with a diagnosis of isolated AS (without other valve disease) and 2 echocardiograms performed at an interval of more than 1 year, in which the AVA calculated using the continuity equation was measured. The annual rate of change of AVA, MG, and Vmax, and the proportion of patients with progression based on predefined criteria (AVA decrease &amp;gt;0.2 cm2, MG increase &amp;gt; 10 mmHg, and Vmax &amp;gt; 30 cm/s) were analyzed. Results The mean interval between the 2 echocardiograms was 26 (9) months. Globally, the annual rate of change was small for the 3 parameters, with a higher proportion of relevant progression considering Vmax (49.2%), and lower for MG (28.5%), being intermediate for AVA (36.1%) (Table). Of the 47 patients with AS progression by AVA criteria, progression by Vmax criteria was observed in 32 patients (68%), and only in 19 patients (40%) by MG criteria. Conclusions Although the criterion for progression of AS based on Vmax is considered in the clinical practice guidelines, in many patients it is not associated with relevant changes in AVA or MG. Discrepancies on AS progression across different parameters is frequent and may lead to inconsistent decision making.

The experiences of psychiatric patients, their caregiversand companions in upholding patient dignity during hospitalization: A qualitative study.

The quality of care and patient satisfaction is closely linked with dignity, which is a crucial component of therapy and care. However, there is very little study on dignity in the context of mental health care. Planning for ongoing patient care might benefit from an understanding of the notion of dignity by exploring the experiences of patients, caregiversand companions of patients who have a history of hospitalization in mental health institutions. To retain patients'dignity while they were being treated in mental wards, this study sought to understand the experiences of patients, caregiversand companions of patients. This investigation was qualitative. Semistructured interviews and focus groups were utilized to collect the data. The purposeful sampling method was employed for participant recruitment, which continued until data saturation. Two focus group discussions and 27 interviews were conducted. Participants included 8 patients, 2 patients'family members (companions), 3 psychologists, 4 nursesand 11 psychiatrists. Two focus group discussions were held with seven family members or companions of patients. Thematic analysis was used for data analysis. The primary theme that emerged was the infringement of patients'dignity, through negative guardianship, dehumanizationand violations of their rights. Subthemes included dehumanization, worthlessness and namelessness, patient rights violationsand stripping patients of authority. Our results suggest that, regardless of the severity of the illness, the nature of psychiatric illness significantly compromises patients'dignity. Mental health practitioners, due to their sense of guardianship, may unintentionally treat patients with mental health disorders, thus compromising the patient's dignity. The research team's experiences as a psychiatrist, doctorand nurse informed the study's objectives. Nurses and psychiatrists who work in the healthcare industry designed and conducted the study. The primary authors, who are healthcare providers, collected and analysed the required data. Furthermore, the entire study team contributed to the writing of the manuscript. Study participants were involved in the data collection and analysis.

Perinatal Outcome in Twin Pregnancy According to Chorionicity

Background: Multiple pregnancy is defined as pregnancy with 2 or more fetuses. It is termed as twins for 2 fetuses, triplets for 3 fetuses, Quadruplets for 4 fetuses, Quintuplets for 5 fetuses, Sextuplets for 6 fetuses and Septuplets for 7 fetuses and so on. The incidence of multiple pregnancies varies significantly. In several overview studies (since the early 1970) it was found that natural twinning rates were less than 8 twin births per 1000 births in East Asia and Oceania, 9-16 per 1000 births in Europe, USA and India and 17 and more per 1000 births in African countries. Methods: This prospective observational study was conducted by the department of OBG at Sri muthukumaran medical college hospital and research institute, Shikkarayapuram, Chennai from December 2019 to May 2020. Results: Primigravidas constituted for 43% of pregnancies and multigravidas constituted for 57% of pregnancies. The maximum cases 42 (42%) were in the age of 25-29 yrs followed by 31(31%) in the age group 21-24 years. The mean age of the patients was 26.87 (SD 9.67) years. The discordant growth constituted for 12% of pregnancies in both monochorionic and dichorionic twins where as it was absent in 88% of cases.

Maternal and Fetal Outcome in Early Onset Severe Pre-eclampsia

Background: Hypertensive disorders of pregnancy are among the most common medical problems in pregnancy with an incidence of between 5-10%.1 The incidence varies amongst different hospitals, regions and countries. Hypertensive disorders in pregnancy are a major cause of maternal and perinatal morbidity and mortality worldwide. Methods: This prospective observational study was conducted by the department of OBG at Sri Muthu Kumaran medical college hospital and research institute, Shikkaraya puram Chennai from December 2019 to May 2020. Results: Out of 100 subjects enrolled into the study, Primigravidas constituted for 66% of pregnancies and multigravidas constituted for 34% of pregnancies. Maximum cases 60 (60%) were in the age of 25-30 yrs followed by 22 (22%) in the age group &lt;20 years. The mean age of the patients was 24.57(SD 6.54) years. Caesarean was the most common mode of delivery constituting for 70% of deliveries where as vaginal delivery constituted for 30% of cases.