Incidence Of Crises Research Articles

A 63-year-old Chinese female with mixed connective tissue disease who suffered from renal crisis

Mixed connective tissue disease (MCTD) is a rare autoimmune disorder. We present a case of a Chinese female who has been admitted to our hospital on eight separate occasions. Her initial symptoms involved internal organs including the lung and heart. Due to the presence of anti-U1RNP antibodies and other clinical features, a diagnosis of MCTD was considered. Throughout her first to seventh admissions, her serum creatinine levels remained normal. During her eighth hospitalization, her renal function deteriorated rapidly, culminating in renal crisis. Chest computed tomography (CT) confirmed pulmonary edema, necessitating hemodialysis. Her interleukin (IL)-6 level increased significantly during throughout hospitalizations. The patient responded well to treatment with an IL-6 receptor antagonist (IL-6RA). This case raises the question of whether IL-6 could serve as a potential biomarker for predicting renal crisis incidence in MCTD patients, a topic warranting further investigation in the future.

Impact of Srs-CoV2 Infection on Pain Crises and Acute Chest Syndome in Patients with Sickle Cell Anemia: A Retrospective Multi-Cohort Study Based on USA Data from 2020-2022

Objective: To determine the impact of SARS-CoV-2 infection on vaso-occlusive pain crisis (VOC) and acute chest syndrome (ACS), incidence, and outcomes in sickle cell anemia (SCA) patients. Method: This retrospective study used the TriNetX USA health research network database to identify SCA patients (Hb-SS, Sβ0-thal) ages 1-50 with and without concomitant SARS-CoV-2 infection from May 2020 to May 2022. A total of 6 cohorts were created: pain crisis with/without SARS-CoV-2, ACS with/without SARS-CoV-2, and SARS-CoV-2 without pain crisis/ACS. Patients with SARS-CoV-2 and pain crisis/ACS were compared to 2 cohorts (SARS-CoV-2 without pain crisis/ACS) for demographic characteristics, baseline laboratory parameters, disease-modifying drug use, and influenza/COVID-19 vaccination status by t-tests. Pain crisis/ACS patients with SARS-CoV-2 were then compared to 2 cohorts (pain crisis/ACS without concomitant infection) for demographic characteristics, and relative risk for acute settings of care, pain control, laboratory parameters/outcomes (including hemolytic and inflammatory markers), procedures (blood transfusion) and mortality. Results : The incidence of pain crises and ACS in SCA patients following SARS-CoV-2 infection was 34 and 27 per 100 patients, respectively. The risk of developing ACS was significantly increased by SARS-CoV-2 infection (2.57% vs. 1.17%, RR 2.2), but not the risk of developing a pain crisis (RR 1.04). Pain crisis and ACS patients with concomitant SARS-CoV-2 infection had a greater risk for inpatient services, subsequent hospital visits, opioid and non-opioid analgesia, blood transfusions, and concerning hemolytic and inflammatory markers compared to those without the infection. Patients with SARS-CoV-2 who did not develop pain crises/ACS had higher baseline hemoglobin levels prior to infection compared to patients who developed pain crisis/ACS. There was a higher rate of COVID-19 and influenza vaccination in the cohorts who did not develop pain crisis/ACS and might have improved pain crisis rates (but not ACS) following SARS-CoV-2 infection. Conclusions: COVID-19 illness had an impact on the incidence of both pain crises and ACS, significantly increased the risk of developing ACS, and influenced morbidity outcomes for both pain crises and ACS. Prior vaccination against influenza and COVID-19 may represent a protective factor for developing pain crises.

A medical impact of war: the hypertension crises dynamic in an adjacent population

Abstract Background The current military conflagration in Ukraine impacted also boundaring countries by fear military conflict extension in the region, often augmented by mass-media, as well as by real horror stories told by refugees. Goal. The aim of our research was evolutive assessment of the hypertension (HTN) crises in our emergency units during last twenty months. Method In this observational study, we analysed 45.293 patient (pts) files during five distinct intervals: 24.06.2021-23.10.2021, as four months of peace (P), 24.10.2021-23.02.2022, as four months of pre-war army manœvres (PW), 24.02.2022-23.06.2022, as the first four months of war – Russian invasion (RI), 24.06.2022-23.10.2022, as next four months of war – Ukrainean counteroffensive (UC), and 24.10.2022 – 23.02.2023, as other four months of war – Russian destructive attacks (RD), statistically matched 1:1:1:1:1. The acquisition of arterial pressure values was performed by professional digital tensiometers. Results From a quite steady number of 150 +/- 14 pts daily, the distribution of HTN pts was: 29,17 (P); 38,21 (PW); 67,49 (RI); 43,58 (UC); 56,14 (RD). Concerning the HTN crises, the data are as follows: 12,43 (P); 14,97 (PW); 27,65 (RI); 16,28 (UC); 24,93 (RD). Demographically, the male predominance oscillated as follows: 68,32% (P); 65,89% (PW); 59,58% (RI); 62,37% (UC); 56,94% (RD). The medium age for HTN crises pts balanced as follows: 65,32 yrs (P); 64,97 yrs (PW); 62,18 yrs (RI); 63,74 yrs (UC); 62,85 (RD). Conclusion According to our outcomes, the stress and high anxiety caused by fear of war in the neighbourhood significantly influenced the incidence of HTN crises along the five abovementioned periods. The most dramatic data were registered during RI period. Taking into consideration that this war is irrepeatable, this research is unique.

Value of certification in collective reputation crises: Evidence from Chinese dairy firms

Collective reputation crisis incidents imply considerable negative within-sector spillovers. Understanding how to reduce such negative spillovers is crucial for industry development, especially in the food industry where information is asymmetric. As certification is an important tool to reduce information asymmetry in product quality, it’s role in reducing such spillovers needs to be discussed systematically. First, we use an analytical model to reveal the effects and mechanisms by which certification helps dairy firms resist the negative spillovers of collective reputation crises. Next, we study the effects of certification in the context of a large-scale dairy scandal in China. Using firm-level microdata, we empirically analyze the effects of adopting certification on improving innocent firms’ return on capital. The results show that in the year of the scandal, the return on capital of firms without certification was significantly negatively affected while that of firms with certification was not affected. In the wake of the scandal, adopting certification helped dairy firms effectively improve their return on capital, but these effects diminished over time. In addition, the effects are larger for firms with lower established reputations, such as new and non-state-owned dairy firms.

Practical study on the application of full-cycle fast track surgical nursing model in patients with replantation of severed fingers: A retrospective analysis.

To explore the effect of full-cycle fast track surgical (FTS) nursing in patients with replantation of severed fingers, and observe its effect on functional recovery of replanted fingers and quality of life of patients. From January 2021 to December 2022, 86 patients with replantation of severed fingers were selected from Rizhao People's Hospital, 41 patients were given routine perioperative care, 45 patients were given full-cycle rapid rehabilitation surgical care. Compare the relevant indexes of the 2 groups of patients during hospitalization. Three months after discharge, the finger function recovery of the 2 groups were compared, and the quality of life of the patients was scored with the QL-Index scale, and the satisfaction was evaluated at the same time. The first time of getting out of bed and the time of hospitalization in the full-cycle FTS nursing group were significantly shorter than those in the conventional nursing group, and the incidence of postoperative nausea, vomiting, constipation and venous thromboembolism were significantly lower than those in the conventional nursing group. The anxiety score was significantly lower than that in the conventional nursing group, the difference was statistically significant (P < .05). There was no significant difference in the incidence of arteriovenous crisis between the 2 groups (P > .05). Three months after discharge, the scores of finger sensation and movement, quality of life and satisfaction of patients in the FTS nursing group were higher than those in the conventional nursing group, and the difference was statistically significant (P < .05). Full-cycle fast track surgical nursing model can improve the in-patient experience, reduce the incidence of complications, promote rapid rehabilitation, improve the quality of life of patients, and improve satisfaction.

The Effect of Modified Postoperative Treatment on Finger Replantation Survival Rate

Objective: To explore the clinical effect of modified treatment after finger replantation and its impact on the survival rate of replantation. Methods: The research was conducted from March 2022 to March 2023. A total of 58 patients who underwent finger replantation at our hospital were selected. These patients were divided into two groups using the digital table grouping method: the research group (n = 29) and the control group (n = 29). Patients in the control group received standard treatment following finger replantation, while patients in the study group received modified treatment after the procedure. The incidence of vascular crisis and the survival rate of replantation were compared between the two groups. Results: The incidence of vascular crisis in the study group was lower than that in the control group (P &lt; 0.05); the replantation survival rate in the study group was higher than that in the control group (P &lt; 0.05). Conclusion: Modified treatment after replantation of severed fingers can reduce the incidence of vascular crisis replantation and improve the survival rate of replantation, so it should be popularized and applied in medical institutions.

Adverse outcomes for chronic myeloid leukemia patients with splenomegaly and low in vivo kinase inhibition on imatinib

Variability in the molecular response to frontline tyrosine kinase inhibitor (TKI) therapy in chronic myeloid leukemia may be partially driven by differences in the level of kinase inhibition induced. We measured in vivo BCR::ABL1 kinase inhibition (IVKI) in circulating mononuclear cells after 7 days of therapy. In 173 patients on imatinib 600 mg/day, 23% had low IVKI (<11% reduction in kinase activity from baseline); this was associated with higher rates of early molecular response (EMR) failure; lower rates of major molecular response (MMR), and MR4.5 by 36 months, compared to high IVKI patients. Low IVKI was more common (39%) in patients with large spleens (≥10 cm by palpation). Notably 55% of patients with large spleens and low IVKI experienced EMR failure whereas the EMR failure rate in patients with large spleens and high IVKI was only 12% (p = 0.014). Furthermore, patients with large spleen and low IVKI had a higher incidence of blast crisis, inferior MMR, MR4.5, and event-free survival compared to patients with large spleen and high IVKI and remaining patients. In nilotinib-treated patients (n = 73), only 4% had low IVKI. The combination of low IVKI and large spleen is associated with markedly inferior outcomes and interventions in this setting warrant further studies.

Surgical repair of neonatal total anomalous pulmonary venous connection: A single institutional experience with 241 cases

ObjectiveChallenges persist in surgery for neonatal total anomalous pulmonary venous connection (neoTAPVC), with the high mortality risk not mitigated over time. MethodsA prospectively collected single-center database containing all neonates with TAPVC undergoing biventricular repair in 2012 to 2020 was retrospectively reviewed. The primary outcome was death or postoperative pulmonary venous obstruction (PPVO). Based on the preoperative admission location in our hospital, patients were classified into those being admitted to cardiac intensive care unit versus neonatal intensive care unit or general pediatric intensive care unit. Access to dedicated presurgical care (DPC) was defined as patients who were preoperatively admitted to the cardiac intensive care unit. ResultsOverall, 241 patients with a median age at surgery of 14 days (interquartile range [IQR], 9-21 days) were included. Anomalous return was supracardiac in 38.6%, cardiac in 26.1%, infracardiac in 28.6%, and mixed in 6.6%. Patients receiving DPC had better survival (96.3% vs 84.3%; P = .0028) and lower incidence of PPVO (15.2% vs 28.6%; P = .011) compared with those without DPC. Patients in the DPC group were less likely to undergo operation within 24 hours on presentation (27.1% vs 40.3%; P = .041), had improved lactate clearance (1.5 [IQR, 1.0-2.2] vs 2.8 [IQR, 1.8-4.1]; P < .001), and had lower incidence of postoperative pulmonary hypertension crisis (2.8% vs 18.7%; P < .001) compared with those in no-DPC group. After matching, no difference in PPVO could be observed in patients undergoing conventional versus sutureless repair (22.6% vs 12.9%; P = .29). ConclusionsAccess to DPC potentially improves outcomes in the neoTAPVC setting; freedom from PPVO were similar using conventional versus sutureless repair.

Primary adrenal insufficiency among Sri Lankan adults: A cross-sectional study in National Hospital Colombo, Sri Lanka

Background: Clinical, biochemical &amp; radiological characteristics and aetiologies of primary adrenal insufficiency (PAI) among Sri Lankan adults are not known.Aims: To describe the clinical features, aetiology, diagnostic and treatment outcomes of patients with PAI in Sri Lanka.Methods: A cross-sectional study was conducted in Endocrine clinics of National Hospital of Sri Lanka. We screened prescription records to identify patients with PAI. Data was collected using a structured interviewer administered questionnaire and by reviewing clinic records, during their scheduled clinic visit.Results: Forty patients were recruited (median age 38 (IQR 27-52), men 35%, 361 patient-years follow up). Adrenal tuberculosis was the aetiology in 10 / 40. Cause was unknown in 29 / 40, among whom 16 had an associated other organ autoimmune dysfunction. Delay in presentation, diagnosis and presentations with Addisonian crisis were less in patients who presented after 2010 compared to those before (9 vs 18 months, 6 vs 12 months and 5/12 vs 3/28 respectively). Hyperpigmentation (39 / 40), weight loss (32/ 40) and postural lightheadedness (27 / 40) were the common manifestations. Adrenal atrophy and adrenal calcification were seen in 20/30 and 6/30 respectively. All patients were on hydro cortisone, 31 / 40 were on fludrocortisone and none were on androgen replacement. Incidence of Addisonian crisis was 7.5 per 100 patient-years: commonest cause was lapses in medication adherence (14 of 24 events).Conclusion: Tuberculosis was the cause of PAI in 25% of adult patients. Aetiology in others is presently unknown. Delay in presentation and diagnosis has shortened over time. Addisonian crisis after diagnosis is commonly due to non-adherence.

The Role of Non-genetic Therapies to Reduce the Incidence of Sickle Cell Crisis: A Systematic Review.

Sickle cell anemia is a hemoglobinopathy that causes complications such as Vaso-Occlusive Crisis (VOC), stroke, priapism, Acute Chest Syndromes (ACS), and bone infarcts due to blood vessel occlusion, resulting in hypoxia, ischemia, and inflammation. Preventing these incidents improves the quality of life and lowers mortality rates in Sickle Cell Disease (SCD) patients. This systematic review aims to describe the drugs, their mechanisms of action, dosages, changes in hemoglobin parameters, decrease in VOCs, delay the time for the next VOC, decrease in the length of hospital stay, and side effects associated with these drugs. This review adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines. For this review, we searched the PubMed, Google Scholar, and Cochrane databases and screened them for full free texts published in English and studied in humans in the last five years beginning in 2018. Randomized clinical trials (RCT), observational studies, meta-analyses, systemic reviews, and traditional reviews were all included in the search. According to the type of study, quality assessment tools are used, and eight papers are chosen. Full-text articles from these papers are studied, analyzed, and tabulated. We discussed seven interventions that are used to treat sickle cell disease. Voxelotor, crizanlizumab, L-glutamate, long-term blood transfusions, Zinc (Zn), Niprisan®, and Ciklavit* were found to reduce the number and severity of VOC. We discovered that VOCs containing L -glutamate reduced the length of hospitalization. Magnesium (Mg) did not affect the number and severity of VOCs. This review includes a few articles for the study. Future papers on this subject should include a large sample size and many papers. More clinical trials are required to evaluate the dosages and outcomes of using these drugs in combination to prevent VOCs.

Analysis of Legal Risks in Psychological Crisis Events among University Students

The psychological crises of university students are an important factor affecting the security and stability of colleges and universities. Against the background of school governance, the definition and characteristics of college students&amp;#39; psychological crisis events should be correctly understood and the legal risks clearly classified to help prevent crisis incidents. Legal risks have important practical significance. The author starts with the definition of college students&amp;#39; psychological crisis events and divides the characteristics into two parts: cause diversity and result sensitivity. The legal risks associated with the process are clearly divided into civil, administrative and procedural legal risks, which are specifically manifested in the duty of care in the prevention and response stages of the safety responsibility of colleges and universities. In the process, is there any infringement of privacy violations, and when an incident occurs, does the university take timely and positive measures and pay attention to protecting citizens&amp;rsquo; legitimate rights and interests during the emergency response process? Are statutory after-care obligations such as diversion and guidance covered in the aftermath phase? Are students provided with reasonable and legitimate complaint channels?

Is Hydroxyurea Treatment Changing the Life of Children with Sickle Cell Disease?

Background: Sickle cell disease (SCD) is a prevalent hemoglobinopathy involving sickled hemoglobin that causes multiorgan disease due to chronic recurrent vaso-occlusion and hemolysis. Fetal hemoglobin (HbF) being present showed reduction in disease severity, owing to which hydroxyurea has gained significant recognition. The latter’s exact mechanism of action is yet unknown, but it has been demonstrated that the resulting rise in HbF raises hemoglobin levels and lessens the incidence of acute chest syndrome and vaso-occlusive crises. In the United Arab Emirates, our study is the first to assess the effects of hydroxyurea therapy in pediatric SCD patients. Methods: We conducted a retrospective cross-sectional study on 100 patients aged 2–13 years who were diagnosed with SCD, under regular outpatient follow-up with pediatric hematology clinic and receiving hydroxyurea therapy for at least 2 years. Basic hematologic parameters, frequency of SCD complications, and need for blood transfusions were studied. Results: Our analysis has shown a statistically significant (p < 0.05) correlation between hydroxyurea therapy and improved baseline hemoglobin and HbF levels; it decreased the incidence of painful crises and acute chest syndrome episodes; reduced the demand for blood transfusions; and recorded no side effects (pancytopenia or liver function disturbance). Conclusions: This study is the first of its kind in the UAE, and our findings support those of international data. The use of hydroxyurea therapy in SCD significantly improved hematologic and clinical parameters, thus markedly improving the patient’s quality of life. The side-effect profile is also limited, which further supports the fact that hydroxyurea is a relatively safe drug.

A dual perspective of organizational resilience (OR) and information technology systems resilience (ITSR): an analysis of interdependencies and tensions

Contemporary organizations face a rising incidence of disasters, extreme events and crises (Boin and Lodge 2021). In parallel, the socioeconomic landscape is increasingly complex which intensifies inter-organizational dependencies and the risk of cascading failures (Ansell et al. 2021). To survive and perhaps thrive, organizations must cultivate organizational resilience (OR). However, their capacity to do so is currently curtailed. Although it is widely recognized that the performance of organizational processes, functions and capabilities is closely aligned to the effectiveness of associated information technology systems (ITS) (Schultze and Orlikowski 2004); models of OR have yet to elucidate mechanisms by which ITS contribute to resilience capabilities (Annarelli and Nonino 2016). In this conceptual paper, which is a work in progress, we reflect upon the nature of interdependencies and tensions between ITS resilience (ITSR) and OR. We adopt a deductive, qualitative approach to systematically compare OR &amp; ITSR. Our comparative analysis is informed by OR models described by Duchek (2020), Sheffi and Rice Jr (2005) and Weick and Sutcliffe (2011), while for ITSR, we employ the Reactive Manifesto as interpreted by Bonér et al. (2014) and Debski et al. (2017). Figs 1, 2 illustrate our interpretation of each resilience construct. As may be seen on Fig. 1 we interpret OR as a three-phase process including preemptive, proactive &amp; recovery phases each possessing associated resilience capabilities. The process may occasion three operational outcomes (or levels of resilience maturity). 1st , 2nd and 3rd order resilience denote organizations that when a disruption occurs, merely maintain key operations, rapidly achieve a return to normal operations or that capitalize on a disruption to achieve an improved post-shock trajectory respectively. merely maintain key operations, rapidly achieve a return to normal operations or that capitalize on a disruption to achieve an improved post-shock trajectory respectively. ITSR is interpreted via the notion, reactive scalability which describes an organizational system that is both responsive and scalable (Debski et al. 2017) i.e., which is able to rapidly achieve (responsive) appropriately dimensioned (scalable) adaptations to intra and extra-organizational changes. Our analysis employs a multi-level approach. The preliminary results of the analysis are presented in Table 1. Upon completion of the analysis, we will elaborate theoretical propositions pertaining to the relationship between the OR and ITSR constructs to guide subsequent empirical research to bridge the theoretical divide between these in reality, indissociable resilience constructs. This comprises the main anticipated contribution.

Gains from the transition from face-to-face to digital/online modality to improve education in emergency

Education during emergencies demands attention from both institutions and governments, as the incidence of disasters and crises continues to increase worldwide due to various challenges that threaten humanity, including climate change, terrorism, food and water scarcity, energy crises, poverty, and inequality. Emergency remote teaching (ERT) is a critical factor in providing academic opportunities, building resilience, and promoting recovery for affected individuals. This research examines the challenges associated with transitioning from face-to-face to online/digital lessons, according to the perceptions of 105 professors in a Mexican private university, 2 months after mandatory online/digital teaching was implemented. By analyzing data collected through a survey using statistical and data mining techniques, we identified factors that should be considered when designing future education in emergency situations. The study found that while most professors positively evaluated their performance in ERT, they still preferred face-to-face teaching due to the lack of personal interaction and distractions. Professors adapted to ERT with technological training provided by the institution, but reported an increase in workload and the importance of the balance between job responsibilities and family issues. The study also revealed that professors’ performance in ERT depended on the conditions of their teaching space at home. Furthermore, the study suggested the need for the development of an improved assessment framework for online evaluation methods, and integration of the most effective online and face-to-face teaching strategies for everyday academic contexts. The sudden change in education modality represented a fantastic opportunity to introduce teaching-learning-evaluating strategies and technologies while forcing institutions to evolve into the digital environment. Therefore, every education stakeholder should identify and implement best practices of the online and face-to-face modalities to improve future education in emergencies.

Pattern of anaemic crises in Paediatric Sickle Cell Anaemic Patients seen at the University of Maiduguri Teaching Hospital, North-eastern Nigeria

Background: Sickle cell anaemia (SCA) is the commonest haemoglobinopathy worldwide. The main presentation is chronic anaemia often exacerbated during periods of rapid destruction of red blood cells, marrow failure, or acute sequestration. Blood transfusion is often needed to save lives; unfortunately, this is often not available. Objectives: This study aimed at identifying the pattern of anaemic crises, the age group with the highest frequency and associated morbidities. Methodology: This was an analytical observational study that examined patterns of anaemic crises in children with SCA. Patients who that fulfil the inclusion criteria were recruited consecutively. Standard laboratory methods as described by Dacie and Lewis were employed in the evaluation of specimens. Results: One hundred patients in anaemic crisis, comprised 53 males and 47 females, given an M: F ratio of 1.1:1, and 100 SCA patients age and sex-matched in steady state. The mean ± SD age of cases was 7.2 ± 3.5 while that of controls was 6.82 ± 3.98, there was no difference between the ages p = 0.53. The highest incidence of anaemic crisis was seen among those aged 10 to 16 years. Malaria was the commonest morbidity among all types of anaemic crises. There was no association between types of morbidity and anaemic crisis p = 0.42. Conclusions: Haemolytic crisis was the most common anaemic crisis; acute splenic sequestration was commoner in the under-fives. Children older than 10 years were at greatest risk of anaemic crisis. Malaria was the commonest associated morbidity.

Clinical Profiles of Children With Sickle Cell Anaemia Presenting With Acute Clinical Events: A Single-Center Study.

Sickle cell disease is a common genetic disorder characterised by chronic haemolytic anaemia and vaso-occlusive crisis. Sickle cell anaemia (SCA) has both short-term effects in the form of acute clinical events and long-term repercussions seen with chronic multiorgan involvement. It is associated with significant morbidity and mortality. In India, the disease is largely undocumented. Thus, there is an urgent need to highlight the features of the disease so that locally appropriate models of care may be implemented. This study aims to evaluate acute clinical events in SCA and to provide data that may help to reduce the rate of morbidity and mortality associated with this disease by early interventions. A cross-sectional observational study was conducted between November 2020 and May 2022 at Indira Gandhi Government Medical College and Hospital, Nagpur, Central India. The inclusion criteria included previously diagnosed patients of SCA (homozygous sickle cell disease) on high-performance liquid chromatography (HPLC) between the age groups of six months and 12 years, presenting with acute clinical events. The exclusion criteria included patients younger than six months and older than 12 years of age, and all patients with other haemoglobinopathies and sickle cell trait. The study was approved by the Institutional Ethical Committee. All the data was entered into a well-designed Microsoft Office Excel spreadsheet (v 2019, Microsoft, Washington, USA). All the clinical, biochemical, and haematological data were tabulated and analysed. A total of 100 children with sickle cell disease diagnosed by HPLC were enrolled during the study period. About 215 acute clinical events among the 100 cases were recorded, for which they were admitted to the paediatric ward or PICU. The majority (35%, n=35) were seen in the age group of six to nine years (school-going age). About 52% were male and 48% were female (male-to-female ratio= 1.08:1). Pain was the most common symptom. The highest incidence of 36.75% (n=79) was seen with acute painful crises and was the most common indication of hospitalisation, followed by acute febrile illness (AFI) (34.42%, n=74), aplastic crisis (10.23%, n=22), splenic sequestration crisis (9.77%, n=21), hepatobiliary involvement (3.72%, n=8), acute chest syndrome and haemolytic crisis (each 1.86%, n=4), and stroke (1.40%, n=3). In cases of having foetal haemoglobin (HbF) ≥20%, the incidence of acute painful crisis (p=0.0001), hand-foot syndrome (p=0.047), aplastic crisis (p=0.033), splenic sequestration crisis (p=0.039), and AFI (p=0.035) was low as compared to cases having HbF ≤20% which was statistically significant. The incidence of acute painful crisis, hand-foot syndrome, and an aplastic crisis was significantly low in patients receiving hydroxyurea therapy as compared to patients who were not on hydroxyurea. Out of 100 cases, four died during the study period, three died because of splenic sequestration crisis with septic shock, and one died due to hepatic encephalopathy due to haemolytic crisis with septic shock. Acute clinical events in sickle cell disease can have significant morbidity and mortality in the paediatric age group. The nutritional status of sickle cell disease children must be given due importance. Early initiation of hydroxyurea must be encouraged to maintain higher HbF levels, which plays a significant role in reducing morbidity.

The Relationship Between Medication Compliance And The Incidence Of Hypertension Crisis In RSUD. Haji Makassar

A hypertension crisis is an acute complication characterized by a severe increase in blood pressure, generally occurring ≥ 180/120 mmHg. Risk factors for hypertension generally occur due to a history of disease in the family, and age factors as factors that cannot be modified. An unhealthy lifestyle, including consuming alcohol, uncontrolled hypertension, or compliance to taking antihypertension drugs, is a modifiable factor but is often the cause of chronic hypertension to lead to a hypertension crisis. The purpose of this study is to determine the relationship between medication compliance to the incidence of hypertension crisis in hospitals. Makassar Hajj. This study used a cross-sectional research design with a total sampling technique of 34 respondents. This research was carried out in the treatment room of RSUD Haji Makassar. From the results of the study, it can be concluded that compliance to taking medication is associated with the incidence of emergency hypertension with a value of p = 0.008, OR = 112; the more obedient to taking antihypertension drugs, the less likely people with hypertension are to experience hypertension emergencies.

Adherence to hydroxyurea and clinical outcomes among children with sickle cell anemia.

Hydroxyurea lowers the incidence of vaso-occlusive pain crises (VOC) and acute chest syndrome (ACS) among children with sickle cell anemia (SCA). Our objective was to assess the relationship between levels of adherence to hydroxyurea and clinical outcomes among children and adolescents with SCA. This retrospective cohort study included Medicaid data (2005-2012) from Florida, Illinois, Louisiana, Michigan, South Carolina, and Texas. The study population consisted of children 1-17 years old with SCA enrolled in Medicaid for 3 years. Among children that initiated hydroxyurea, the medication possession ratio (MPR) was calculated as the proportion of days covered by hydroxyurea. Six months after initiation of hydroxyurea, clinical outcomes were assessed through the end of the study period: numbers of VOC-related inpatient admissions and emergency department visits, and encounters for ACS. Multivariable Poisson models were used to predict outcomes by MPR quartile adjusting for previous healthcare utilization, state, and age. Hydroxyurea was initiated by 515 children. The median MPR was 0.53 (interquartile range=0.3-0.8). The annual median number of visits was 0.0 for ACS, 1.3 for VOC-related emergency department, and 1.4 for VOC-related inpatient admissions. For each outcome, the highest quartile of MPR had the lowest predicted count; this difference was significant for ACS visits when compared with the lowest quartile of MPR. This study demonstrated a high level of adherence (>75%) was essential to achieve a lower incidence of common negative clinical outcomes. Further, moderate and severe hydroxyurea nonadherence may be more common than previously appreciated among children, emphasizing the importance of developing and testing innovative strategies to increase adherence.

Psychological distress in community-dwelling individuals living with severe and persistent mental illness.

To explore psychological distress levels, using the validated Kessler 6 (K6), as well as the relationship between demographics and K6 scores, and incidence of mental health crises in a cohort of community-dwelling people living with severe and persistent mental illness (SPMI). People living with SPMI taking antipsychotic or mood stabiliser medications were recruited from Australian community pharmacies between September 2020 and Februrary 2021 and completed an electronic survey, including the K6 scale. Pharmacists were interviewed and supplied written reports with details of the consultation when participants obtained 'very high' (⩾19/30) K6 scores. Records were reviewed and coded by an independent coder. Multivariate linear regression was used to determine predictors of K6 scores. The median K6 score was 16/30 (IQR = 11,21; range = 6-30). Younger age, unemployment and multimorbid mental health diagnoses were significant predictors of higher K6 scores (p < .01; R2 = .24). Fifty-nine (39.3%) consumers scored ⩾19, of which 25/59 (42.4%) were reported to be exhibiting signs of psychological distress and none were experiencing mental health crises. People living with SPMI have high levels of psychological distress as measured by the K6. Further work is needed to understand the prevalence, extent, precipitating factors and impact of psychological distress in people living with SPMI.

PAI-BEL: a Belgian multicentre survey of primary adrenal insufficiency.

Primary adrenal insufficiency (PAI) is a rare disease with an increasing prevalence, which may be complicated by life-threatening adrenal crisis (AC). Good quality epidemiological data remain scarce. We performed a Belgian survey to describe the aetiology, clinical characteristics, treatment regimens, comorbidities and frequency of AC in PAI. A nationwide multicentre study involving 10 major university hospitals in Belgium collected data from adult patients with known PAI. Two hundred patients were included in this survey. The median age at diagnosis was 38 years (IQR 25-48) with a higher female prevalence (F/M sex ratio = 1.53). The median disease duration was 13 years (IQR 7-25). Autoimmune disease was the most common aetiology (62.5%) followed by bilateral adrenalectomy (23.5%) and genetic variations (8.5%). The majority (96%) of patients were treated with hydrocortisone at a mean daily dose of 24.5 ± 7.0 mg, whereas 87.5% of patients also received fludrocortisone. About one-third of patients experienced one or more AC over the follow-up period, giving an incidence of 3.2 crises per 100 patient-years. There was no association between the incidence of AC and the maintenance dose of hydrocortisone. As high as 27.5% of patients were hypertensive, 17.5% had diabetes and 17.5% had a diagnosis of osteoporosis. This study provides the first information on the management of PAI in large clinical centres in Belgium, showing an increased frequency of postsurgical PAI, a nearly normal prevalence of several comorbidities and an overall good quality of care with a low incidence of adrenal crises, compared with data from other registries.