Incidence Of Syndrome Research Articles

A study of incidence of respiratory distress syndrome in newborns born to mothers with gestational diabetes

Background: Hyaline membrane disease/RDS is an important cause for newborn morbidity and mortality. Many studies have established an association of infants of diabetic mothers (IDMs) with respiratory distress syndrome (RDS) since decades. Modern lifestyle changes have increased the prevalence of obesity in women and thus diabetes in pregnancy. Maintaining strict euglycemia is a double-edged sword in pregnancy which has been affecting the neonatal health and respiratory maturity in particular which has been associated with increased mortality and morbidity. Methods: It was a prospective case control study done over a span of one year. Results: Hyaline membrane disease (RDS) is significantly associated with gestational diabetes mellitus (GDM). Conclusions: Even our study emphasized the ill effects of gestational diabetes on the respiratory development of baby. Most of the babies are manageable and outcome can be drastically improved by early diagnosis and efficient treatment. Education and anticipation of the complications and prompt referral are the need of the hour in peripheries and advancement of neonatal intensive cares in the referral hospitals is needed.

Redefining postoperative hypertension management in carotid surgery: a comprehensive analysis of blood pressure homeostasis and hyperperfusion syndrome in unilateral vs. bilateral carotid surgeries and implications for clinical practice.

This study evaluates the implications of blood pressure homeostasis in bilateral vs. unilateral carotid surgeries, focusing on the incidence of postoperative hypertension, hyperperfusion syndrome, and stroke as primary outcomes. It further delves into the secondary outcomes encompassing major adverse cardiovascular events and all-cause mortality. Spanning two decades (2002-2023), this comprehensive retrospective research encompasses 15,369 carotid referrals, out of which 1,230 underwent carotid interventions. A subset of 690 patients received open carotid procedures, with a 10-year follow-up, comprising 599 unilateral and 91 bilateral surgeries. The Society for Vascular Surgery Carotid Reporting Standards underpin our methodological approach for data collection. Both univariate and multivariate analyses were utilized to identify factors associated with postoperative hypertension using the Statistical Package for the Social Sciences (SPSS) Version 22 (SPSS®, IBM® Corp., Armonk, N.Y., USA). A marked acute elevation in blood pressure was observed in patients undergoing both unilateral and bilateral carotid surgeries (p < 0.001). Smoking (OR: 1.183, p = 0.007), hyperfibrinogenemia (OR: 0.834, p = 0.004), emergency admission (OR: 1.192, p = 0.005), severe ipsilateral carotid stenosis (OR: 1.501, p = 0.022), and prior ipsilateral interventions (OR: 1.722, p = 0.003) emerged as significant factors that correlates with postoperative hypertension in unilateral surgeries. Conversely, in bilateral procedures, gender, emergency admissions (p = 0.012), and plaque morphology (p = 0.035) significantly influenced postoperative hypertension. Notably, 2.2% of bilateral surgery patients developed hyperperfusion syndrome, culminating in hemorrhagic stroke within 30 days. Intriguingly, postoperative stage II hypertension was identified as an independent predictor of neurological deficits post-secondary procedure in bilateral CEA cases (p = 0.004), attributable to hyperperfusion syndrome. However, it did not independently predict myocardial infarction or mortality outcomes. The overall 30-day stroke rate stood at 0.90%. Lowest incidence of post operative hypertension or any complications were observed in eversion carotid endartrertomy. The study identifies postoperative hypertension as a crucial independent predictor of perioperative stroke following bilateral carotid surgery. Moreover, the study elucidates the significant impact of bilateral CEA on the development of post-operative hyperperfusion syndrome or stroke, as compared to unilateral CEA. Currently almost 90% of our carotid practice is eversion carotid endartrerectomy.

Modulation of microRNA-133B in Post Mastectomy Pain Syndrome Following Yoga Intervention

Objectives: This study aimed to compare the efficacy of yoga combined with an integrated multimodal approach on the incidence and severity of post-mastectomy pain syndrome (PMPS) and the role of miR-133B expressions in patients undergoing breast cancer surgery. Methods: With approval from the institutional ethics committee and informed consent obtained from each participant, forty patients of ASA grade I - II, aged 20 - 65 years, undergoing breast cancer surgery were included. Patients received a thoracic paravertebral block for up to 72 hours and pregabalin until the end of the fourth postoperative week. Patients were randomly allocated into two groups: “Control” and “yoga.” Patients in the Yoga group practiced the yogic exercise “Anulom-vilom" from the third day until the 90th day postoperatively. The delta-CT of miRNA-133B expression of genes on the 90th postoperative day was compared to the baseline, along with various pain intensity and quality of life parameters. Results: In the Yoga group, a significant up-regulation in miR-133B expression was observed on days 30 and 90 postoperatively. Patients with PMPS in the Yoga group showed a decreased ΔCT of miR-133B, indicating an up-regulation of gene expression, compared to the control group. A lower incidence of PMPS (10% vs. 30%) was observed in the experimental group, along with a significant enhancement of quality of life in post-mastectomy patients and decreased mean Visual Analogue Scale )VAS( pain scores, Pain Detect Questionnaire )PDQ( ، and Neuropathic Pain Symptom Inventory )NPSI( scores in the Yoga group; however, these were not statistically significant. Conclusions: The study demonstrated the feasibility of integrating yoga with a multimodal pain management approach and highlighted the role of miR-133B in the pathogenesis of PMPS.

Identification Of Dry Eye Syndrome Risk Factors In Workers Who Use Visual Display Terminals (VDT)

Dry eye syndrome is a multifactorial disease of the eye air and eye surface which causes symptoms of discomfort, visual disturbances, and instability of the eye air layer which has the potential to damage the eye surface. This condition has an impact on productivity, activities in the work environment, apart from that it also has an impact on lower employment opportunities, decreased working hours and increases a person's inability to work. Using visual display terminals for 5-7 hours/day can significantly increase the incidence of dry eye syndrome. Therefore, paying attention to the risk factors of visual display terminal workers is very important in preventing the occurrence of dry eye syndrome. The research method uses literature studies from several national and international journals obtained from 18 reference sources through searches on PubMed and Google Scholar published in the last 5 years. There were 18 articles with full text that met the inclusion criteria and contained several risk factors associated with the incidence of dry eye syndrome. Risk factors for dry eye syndrome in workers who use visual display terminals include age, gender, screen exposure time, psychological stress, work environment, use of contact lenses, use of drugs and history of surgery, refractive disorders, and length of work. Identification of risk factors for dry eye syndrome in workers who use visual display terminals can reduce the incidence and morbidity associated with this disease. So it can improve the quality of life of workers

Incidence of hypercholesterolaemia and hyperglycaemia in schizophrenic patients: Atypical antipsychotic medication and clinical variables

Background: Atypical or second-generation antipsychotic drugs commonly used in the management of schizophrenia include risperidone. Risperidone is linked to the incidence of metabolic syndrome-related adverse effects. Objective: This study aims to investigate the correlation between the administration of risperidone therapy and the incidence of metabolic syndrome in outpatients diagnosed with schizophrenia. This inquiry involves an examination of relevant laboratory parameters, specifically cholesterol, blood glucose, and haemoglobin A1c (HbA1C) levels, alongside an evaluation of pertinent clinical variables that may exert an influence. Methods: This study adopted a cross-sectional approach to receiving risperidone therapy for a minimum of three months at Grhasia Mental Hospital in Yogyakarta, Indonesia. Sampling was executed using an accidental sampling technique, targeting patients who met the predefined inclusion criteria. Results: The study enrolled a total of 97 participants, comprising 58 males and 39 females. Subsequent statistical analyses failed to demonstrate any statistically significant associations between hyperglycemia and various factors, including the risperidone regimen (p = 0.574), risperidone dosage (p = 0.619), and the duration of risperidone therapy (p = 1.000). Conclusion: Risperidone has a long-term risk of causing hyperglycemia in people with schizophrenia; consequently, blood glucose and HbA1C levels must be monitored on a regular basis.

Evaluating the Impact of Eat, Sleep, Console in Neonatal Abstinence Syndrome Treatment for Infants Exposed to Substance Use In Utero

OBJECTIVE An increase in maternal use of licit or illicit substances, alcohol, and tobacco has resulted in an increased incidence of neonatal abstinence syndrome (NAS). In recent years, NAS management has shifted to initiating an Eat, Sleep, Console (ESC) approach prior to pharmacologic treatment. The objective of this study was to evaluate the impact of ESC in combination with pharmacologic treatment in the management of NAS for infants exposed to substance use in utero. METHODS This single system, multisite, retrospective cohort study evaluated infants with known exposure to substance or polysubstance use in utero or those who had signs and symptoms of withdrawal with a positive toxicology screen. The primary outcome of rate of pharmacologic therapy initiated was evaluated pre and post implementation of ESC. Secondary outcomes included hospital length of stay, day of life that pharmacologic therapy was initiated, and an evaluation of the ESC guideline. A subgroup analysis with similar outcomes was also performed for patients with maternal polysubstance use. RESULTS A total of 2843 patients were screened, and 50 patients were randomly selected for ­inclusion in both pre- and post-groups. The rate of pharmacologic therapy initiated post implementation of ESC decreased from 58% to 30% (p &amp;lt; 0.01). In the post-group, there was a decrease in the number of ­patients requiring scheduled morphine (33%, p &amp;lt; 0.01) and duration of pharmacologic therapy (14.6 days vs 6.47 days, p &amp;lt; 0.01). CONCLUSIONS Implementing an ESC guideline decreased the length of stay and rate of pharmacologic intervention needed for infants with NAS at our institution.

Incidence of Metabolic Syndrome among Adults on First-Line Highly Active Antiretroviral Therapy Regimens in Malaysia

Incidence of Metabolic Syndrome among Adults on First-Line Highly Active Antiretroviral Therapy Regimens in Malaysia

Evaluation of obesity and age as a predictive factor of lower extremity compartment syndrome: A national trauma data bank analysis

BackgroundRisk factors of acute compartment syndrome (ACS) of the leg include tibial fractures followed by soft tissue injuries. MethodsData collected from the National Trauma Data Bank (NTDB) between 2017 and 2019 were analyzed for adult patients with lower extremity fractures, including proximal tibia, tibial shaft, and distal tibia. The primary outcome was a diagnosis of ACS. ResultsThere were 1052/220,868 patients with lower extremity fractures with a concomitant diagnosis of compartment syndrome. Our study has shown that patients with a BMI of ≥30 had a lower incidence of compartment syndrome when compared with patients with a BMI of 25–29 and controlled for fracture type. Increased age ≥55 in males, and females between 65 and 84, also demonstrated a decreased risk. Proximal tibial fractures (n ​= ​54,696) were significantly associated with ACS compared to midshaft (n ​= ​42,153) and distal (n ​= ​100,432), p ​< ​0.0001. ConclusionWe found that being overweight decreases risk for development of compartment syndrome in patients with lower extremity fractures. This big data study aids in establishing risk factors for development of ACS in adult trauma patients.

Prognostic influence of weight loss on overweight/obese young heart failure patients.

To explore the prognostic influence of weight loss (WL) on young overweight/obesity (OW/OB) individuals with heart failure (HF). Heart failure enrollees (younger than 45 years, body mass index [BMI] of ≥25kg/m2) who received medical treatment at Beijing Chaoyang Hospital, Beijing, China, were classified into 2 groups according to whether they experienced significant WL (≥5% from baseline one year after discharge). One-year occurrence rate of major adverse cardiac events (MACEs) comprising cardiac death and rehospitalization for HF was determined. Of the 191 individuals recruited for this study, 47 had significant WL. The incidence of ischemic heart disease and obstructive sleep apnea syndrome, as well as BMI and blood pressure, were higher in those with significant WL compared to the control group. Although there was no noteworthy discrepancy in the occurrence of cardiac death between the 2 groups, significant WL correlated independently with a lower incidence of HF re-hospitalization (hazard ratio [HR]=0.32, 95% confidence interval [CI]: [0.11-0.91], p=0.032) and overall MACEs (HR=0.37, 95% CI: [0.14-0.94], p=0.036) in young OW/OB individuals with HF. Significant WL may correlate with favorable prognosis in OW/OB young HF patients.

Pancoast Syndrome Due to Metastatic Hepatocellular Carcinoma

Pancoast tumors are aggressive and locally invasive apical lung cancers that often compress and infiltrate adjacent structures including the brachial plexus, stellate ganglion, ribs, and vertebral bodies. Symptoms of Pancoast tumors include Pancoast Syndrome, characterized by Horner Syndrome and pain and weakness of the ipsilateral upper extremity. Pancoast tumors by definition are primary lung cancer and are nearly always non-small cell lung cancer (NSCLC). There are rare case reports of metastatic non-pulmonary malignancies forming apical lung tumors mimicking Pancoast tumors and causing Pancoast Syndrome. Here, we present a case of a 66-year-old male with a history of unresectable hepatocellular carcinoma (HCC) who presented with one year of progressive left wrist and forearm pain and hand weakness and was found on cross-sectional imaging to have a left upper lobe lung mass invading the T1 and T2 vertebral bodies. Pathology showed very poorly differentiated carcinoma that required specialized testing to achieve diagnostic clarity. The tumor was positive for albumin mRNA, which aided in confirming the lung mass as metastatic HCC. This case highlights a rare incidence of Pancoast Syndrome due to metastatic HCC and emphasizes the importance of considering this diagnosis as an etiology of left upper extremity pain in a patient with previously diagnosed malignancy. This case also demonstrates the utility of albumin mRNA in-situ hybridization as an additional tool in identifying metastatic HCC and reviews general principles of symptomatic management of Pancoast Syndrome.

Unusual Presentation of Acute Coronary Syndrome in a 22-Year-Old Male with Juvenile Idiopathic Arthritis: A Case Report

This case report documents the clinical journey of a 22-year-old male who was initially diagnosed with Rheumatoid Arthritis (RA) and later, at the age of 11, with Juvenile Idiopathic Arthritis (JIA). The patient manifested atypical symptoms, primarily marked by sudden and intense chest pain accompanied by sweating, leading to a collapse during his emergency room visit. Medical evaluation revealed an extensive myocardial infarction affecting the anterior wall. The patient underwent a successful percutaneous coronary intervention targeting the left anterior descending artery. This case underscores the rare incidence of acute coronary syndrome in young patients with a history of JIA.

Safety and efficacy of proactive versus reactive administration of desmopressin in severe symptomatic hyponatremia: a randomized controlled trial

This randomized controlled trial aimed to evaluate the safety and efficacy of proactive versus reactive desmopressin (DDAVP) strategies in treating severe symptomatic hyponatremia. Conducted from June 20, 2022, to February 20, 2023, it involved 49 patients with serum sodium levels below 125 mmol/L. Patients were assigned to either the proactive group, receiving DDAVP immediately upon diagnosis, or the reactive group, receiving DDAVP only if the serum sodium level tended to be overcorrected. The primary outcome was the incidence of overcorrection. The study revealed no significant difference in the overcorrection incidence between the proactive (16.7%) and reactive (28%) groups (p = 0.54). The change in serum sodium levels at 1, 6, 12, and 24 h were not different, however, at 48 h, the proactive group exhibited a higher but still safe change in serum sodium levels compared to the reactive group (10.3 ± 3.6 mmol/L vs. 7.7 ± 3.6 mmol/L, p = 0.013). Other parameters including time to symptom improvement, total intravenous fluid administered, DDAVP dose, urine volume, hospital stay duration, osmotic demyelination syndrome incidence, and 28-day mortality did not significantly differ between the groups. In conclusion, our findings suggest that there was no significant disparity in overcorrection rates between proactive and reactive DDAVP strategies for treating severe symptomatic hyponatremia. However, further large-scale studies are warranted to validate these results.

Acute coronary syndrome in a patient with gastric cancer treated by immune checkpoint inhibitor: A case report

AbstractObjectiveTo highlight the incidence and management of acute coronary syndrome (ACS) in patients with gastric cancer undergoing immune checkpoint inhibitor (ICI) therapy, emphasizing the need for early detection and intervention in this high‐risk population.Patients and methodsWe presented a case of a 71‐year‐old male patient with poorly differentiated adenocarcinoma of the gastric antrum, clinical stage cT4N2M0, phase III, with no prior history of chronic diseases or cardiovascular risk factors. The patient was treated with a combination of ICI therapy (sintilimab) and chemotherapy using the albumin‐bound paclitaxel combined with S1 regimen. Following therapy, he developed symptoms and diagnostic findings consistent with ACS, which was managed with percutaneous coronary stenting.ResultsThe patient's presentation with ACS during ICI therapy underscored the potential cardiovascular risks associated with cancer treatments, particularly in patients without traditional cardiovascular risk factors. Management involved collaboration between oncologists and cardiologists, leading to successful coronary stenting and continuation of antitumor therapy.ConclusionACS is a significant risk in patients with malignancies undergoing ICI therapy, even in those without prior cardiovascular disease. Early recognition and management of ACS in this context are crucial to enable the continuation of cancer treatment and improve patient outcomes. This case underscores the importance of interdisciplinary collaboration in managing complex patients with concurrent cancer and cardiovascular disease.

Exploring a New Pathophysiological Association in Acne Vulgaris and Metabolic Syndrome: The Role of Biogenic Amines and Glutathione Peroxidase.

Background and Objectives: Metabolic disorders cause many skin issues, including acne vulgaris. This research investigated the function of glutathione peroxidase (GTPx) and biogenic amines as a potential novel pathophysiological link between metabolic syndrome (MetS) and acne vulgaris. Materials and Methods: The patients were distributed into two groups: metabolic precondition (MPG, n = 78) and control (CG, n = 81). To determine the extent of acne and metabolic preconditioning, patients were subjected to extensive clinical/paraclinical investigations. Additionally, catecholamine levels in urine and GTPx levels in blood were measured. Results: Mild acne was more common in the CG (32.1 vs. 6.4, p < 0.001), and severe acne was more common in the MPG (61.54 vs. 25.9, p < 0.001), with the average age being substantially higher in the MPG (23.81 vs. 21.05, p = 0.002). Significant variations were observed in the paraclinical levels for catecholamines (p < 0.05). In the MPG, most severe acne patients were overweight (52.1%), insulin-resistant (48.8%), or obese (47.9%). Moderate acne was most often linked to obesity (56%), overweight (44%), and insulin resistance (20%). Patients with severe acne (48.83%) had a considerably greater incidence of insulin resistance syndrome (p = 0.039) than those with moderate or severe acne (20%). The presence of two or three metabolic disorders considerably raised the risk of severe acne. Significant differences between groups were observed only in the subgroup of patients with severe acne, with lower values in the MPG (p = 0.015). Significant differences between groups were observed regarding the subgroup of patients with severe acne, with lower DTPx values in the MPG. At the group level, only CG patients with severe acne had reduced GTPx levels. Significant differences in catecholamine values were seen between groups (p < 0.05), independent of acne severity, except for adrenaline in mild acne patients (p = 0.059). Conclusions: The complex connection between GTPx and catecholamines in MetS suggests a significant role of these factors in the pathogenesis of acne associated with this condition, opening new perspectives in the research and treatment of acne in the context of MetS.

Prevention of dialysis disequilibrium syndrome in children with advanced uremia with a structured hemodialysis protocol: A quality improvement initiative study.

Dialysis disequilibrium syndrome (DDS) is a rare but significant concern in adult and pediatric patients undergoing dialysis initiation with advanced uremia or if done after an interval. It is imperative to gain insights into the epidemiological patterns, pathophysiological mechanisms, and preventive strategies aimed at averting the onset of this ailment. Prospective observational quality improvement initiative cohort study. A prospective single-center study involving 50 pediatric patients under 18 years recently diagnosed with chronic kidney disease stage V with blood urea ≥200 mg/dL, admitted to our tertiary care center for dialysis initiation from January 2017 to October 2023. A standardized protocol was developed and followed for hemodialysis in pediatric patients with advanced uremia. This protocol included measures such as lower urea reduction ratios (targeted at 20%-30%) with shorter dialysis sessions and linear dialysate sodium profiling. Prophylactic administration of mannitol and 25% dextrose was also done to prevent the incidence of dialysis disequilibrium syndrome. Incidence of dialysis disequilibrium syndrome and severe dialysis disequilibrium syndrome, mortality, urea reduction ratios (URRs), neurological outcome at discharge, and development of complications such as infection and hypotension. Long-term outcomes were assessed at the 1-year follow-up including adherence to dialysis, renal transplantation, death, and loss to follow-up. The median serum creatinine and urea levels at presentation were 7.93 and 224 mg/dL, respectively. A total of 20% of patients had neurological symptoms attributable to advanced uremia at the time of presentation. The incidence of dialysis disequilibrium syndrome was 4% (n = 2) with severe dialysis disequilibrium syndrome only 2% (n = 1). Overall mortality was 8% (n = 4) but none of the deaths were attributed to dialysis disequilibrium syndrome. The mean urea reduction ratios for the first, second, and third dialysis sessions were 23.45%, 34.56%, and 33.50%, respectively. The patients with dialysis disequilibrium syndrome were discharged with normal neurological status. Long-term outcomes showed 88% adherence to dialysis and 38% renal transplantation. This study is characterized by a single-center design, nonrandomized approach, and limited sample size. Our structured protocol served as a framework for standardizing procedures contributing to low incidence rates of dialysis disequilibrium syndrome.

O250: Blood Pressure Homeostasis and Hyper-perfusion Syndrome Following Carotid Surgeries

Abstract Objectives We aim to compare blood pressure homeostasis in patients undergoing bilateral versus unilateral carotid surgeries. Our primary endpoints are the incidence of postoperative hypertension and hyperperfusion syndrome (HPS). Secondary endpoints are major adverse cardiovascular events and all-cause mortality. Methods All patients undergoing carotid endarterectomy (CEA) from 2003 to 2022 were reviewed. We performed 1230 carotid interventions, of which 690 procedures had ten years of follow-up. Results Both the unilateral (512) and bilateral (91) carotid interventions caused a significant acute elevation in blood pressure (p&amp;lt;0.001). In unilateral carotid interventions, the mean SBP was 137 ± 19.90 mmHg preoperatively and 152 ± 25.80 postoperatively (p&amp;lt;0.001). Smoking (p=0.007), hyperfibrinogenemia (p=0.004), emergency admission (p=0.005), ipsilateral carotid stenosis &amp;gt;90% (p=0.022), and previous ipsilateral carotid intervention (p=0.003) were significantly associated with the development of postoperative hypertension. No incidence of HPS occurred in the unilateral group. In bilateral carotid interventions, the mean SBP was 138 ± 20.50 mmHg preoperatively and 159 ± 24.60 mmHg postoperatively (p&amp;lt;0.001). Emergency admission (p=0.012) and plaque morphology (p=0.035) were significantly associated with postoperative hypertension. Three patients with bilateral carotid interventions had HPS (3.3%) and developed hemorrhagic stroke within 30 days. Multivariate analysis found postoperative stage II hypertension following bilateral carotid procedures to be an independent predictor of stroke (p=0.004). However, postoperative hypertension was not an independent predictor of myocardial infarction (p=0.475) and mortality (p=0.608). Conclusion Significant acute elevation in blood pressure occurred following carotid surgeries. We observed HPS post bilateral carotid interventions, with postoperative hypertension being an independent predictor of peri-operative stroke.

Case-tailored indicated extracapsular dissection versus “one-size-fits-all” nerve dissection: Has the bet been won?

ObjectiveThe aim of the study was to trace the development of surgical therapy in a large cohort, examine its changes at one single institution that has been specializing in salivary gland pathologies over the last 22 years, and to determine the extent to which a possible shift in the surgical therapy of parotid benign tumors towards less radical methods was correlated with a change in the incidence of facial palsy and Frey's syndrome. Study designRetrospective clinical study. MethodsA retrospective evaluation of the records of all patients treated for benign parotid tumors at a tertiary referral center between 2000 and 2022 was carried out. Surgical methods were classified into four groups: extracapsular dissection, partial superficial parotidectomy, superficial parotidectomy and complete parotidectomy. ResultsA total of 4037 patients were included in the study. Our analysis demonstrated an increase in the total number of parotidectomies for benign lesions from 71 (2000) to 298 (2022), mostly due to the increase in extracapsular dissections (from 9 to 212). The increased performance of less radical surgery was associated with a significantly decreased incidence of perioperative complications. ConclusionsOur study showed that the increased performance of less radical surgery was associated with better functional outcomes over the years.

The Correlation Between Crawford Wedge and 15 ° Table Left Tilt on Hemodynamic Changes in Caesarean Section a Prospective Observational Study

The supine hypotensive syndrome occurs due to the gravid uterus compressing the inferior vena cava when a pregnant woman lies in a supine position, resulting in reduced central venous return also known as inferior vena cava compression. syndrome Supine hypotension syndrome results in signs of shock and by a decrease in maternal blood pressure. This may result in life-threatening complications in the mother and fetus. To reduce the incidence of supine hypotension syndrome, a few practices were recommended by authors in maternal positioning during Lower abdominal cesarean section (LSCS) surgeries'. Here in this study, we are comparing hemodynamic stability between Table left tilt and wedge under the right hip

Effectiveness of Online Learning to Improve Knowledge About Metabolic Syndrome in Pregnancy

Background: Metabolic syndrome is a persistent global health problem and a risk factor for diabetes and heart disease. A metabolic syndrome that occurs during pregnancy will pose a threat to maternal and fetal health. The incidence of metabolic syndrome during pregnancy, especially in developing countries, will become a serious public health problem in the future. This study aims to assess the effectiveness of online learning in improving the knowledge of online learning participants on metabolic syndrome cases in pregnancy. Subjects and Method: This was a cross-sectional study conducted in July through Zoom online learning on Metabolic Syndrome in Pregnancy attended by 125 participants. The dependent variable was knowledge about metabolic syndrome in pregnancy. The independent variable was online learning. The data obtained from this study were in the form of pretest and post-test scores. The data were analyzed by t-test. Results: The mean score of knowledge about metabolic syndrome in pregnancy after online learning was higher (Mean= 90.8; SD= 14.05) than before (Mean= 60.08; SD= 6.94), and this was statistically significant (p= &lt;0.001). Conclusion: Online learning is effective to improve knowledge about metabolic syndrome in pregnancy among Indonesian Obstetrics and Gynecology Association (POGI) members and young POGI members. Keywords: metabolic syndrome, pregnancy, online learning. Correspondence: Nutria Widya Purna Anggraini. Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sebelas Maret/Dr. Moewardi General Hospital, Surakarta, Central Java, Indonesia. Mobile: +62 812-2651-819. E-mail: nutria_dr@staff.uns.ac.id

The incidence and mortality of refeeding syndrome in older hospitalized patients, based on three different diagnostic criteria: A longitudinal study

Background & AimsRefeeding syndrome (RFS) lacks both a global definition and diagnostic criteria. Different diagnostic criteria are used; serum phosphate (traditional criterion (TC)), the Friedli consensus recommendations, and the ASPEN. We investigated the incidence of RFS in older hospitalized patients and the mortality rates in patients with or without RFS using these three different diagnostic criteria. MethodsThis is a longitudinal study with data originating from a randomized controlled trial conducted between March 2017 and August 2019. A total of 85 malnourished hospitalized patients at risk of RFS according to the National Institute for Health and Clinical Excellence tool for detecting patients at risk of RFS, were included. All patients were provided with enteral tube feeding, and electrolytes were measured daily during the intervention period. Friedli and ASPEN included phosphate, magnesium, and potassium in their definitions, but used different cut-off values. Incidences were recorded, and Kaplan–Meier estimates were used to determine whether mortality was more prevalent in patients with RFS. Regression analysis was used to test for confounders regarding the association between RFS and death, and Kappa was used to test for agreement between the three diagnostic criteria. ResultsThe mean (SD) age of the patients was 79.8 (7.4) years, and the mean (SD) BMI was 18.5 (3.4) kg/m2. The mean (SD) kcal/kg/day was 19 (11) on day one and 26 (15) on day seven. The incidences of RFS differed with the criteria used; 12.9% (TC), 31.8% (Friedli), and 65.9% (ASPEN). Mortality was high, with 36.5% (n = 31) and 56.5% (n = 48) of patients dead at three-month and one-year follow-up, respectively. In the TC, 8/11 (72.7%) with RFS vs. 40/74 (54.1%) without RFS died within one-year, in Friedli 15/27 (55.5%) with RFS vs. 33/58 (56.9%) without RFS died, and in ASPEN 32/56 (65.9%) with RFS, vs. 16/29 (55.2%) without RFS died within one-year. There was no statistically significant difference in mortality between patients with or without RFS regardless of which criteria were used. Age was the only variable associated with death at one-year. The Kappa analysis showed very low agreement between the categories. ConclusionOur results show that using different diagnostic criteria significantly impacts incidence rates. However, regardless of criteria used, the mortality was not significantly higher in the group of patients with RFS compared to the patients without RFS. Furthermore, none of the criteria showed a significant association with death at one-year. This supports the need for a global unified diagnostic criterion for RFS.This study was registered in ClinicalTrials.gov (identifier NCT03141489).