Main Cause Of Hospitalization Research Articles

Acute viral bronchiolitis in infants: A narrative literature review

Severe acute bronchiolitis is mostly caused by the respiratory syncytial virus (RSV) and is the main cause of hospitalization in children under one year old. Although it has a low mortality rate, it has a high morbidity rate, requiring early diagnosis through a detailed clinical history and physical examination. A narrative review of fourteen articles found in the PubMED/MEDLINE, SciELO and BVS electronic databases was therefore carried out, with the aim of reviewing the most up-to-date literature on the subject. Currently, the monoclonal antibody Palivizumab is the main agent used to prevent bronchiolitis and is available for patients at high risk of developing the serious disease. In addition, the Abryso vaccine was recently approved by the National Health Surveillance Agency (Anvisa) and will be administered to pregnant women in the last trimester of pregnancy, with the aim of preventing the disease in newborns. Finally, it was found that the appropriate management of acute viral bronchiolitis consists of supportive measures such as hydration, nutritional support and oxygenation when necessary, while the use of corticosteroids and bronchodilators has not been shown to reduce the length of hospital stay or the natural course of the disease.

COVID-19 admissions: Trying to define the real impact of infection in hospitalized patients

Introduction and objectiveSeveral studies have suggested that the hospitalization rate for COVID-19 in children and adolescents may reflect the prevalence of the infection rather than the severity of the disease. The aim of this study was to describe the clinical features of hospitalised paediatric patients with SARS-CoV-2 infection in order to understand if the infection was the reason for admission. MethodsRetrospective cohort study including patients aged 0–18 years with SARS-CoV-2 infection or multisystem inflammatory syndrome in children (MIS-C) admitted to a tertiary care children’s hospital in Spain between 01/01/2020 and 12/31/2021. Results228 patients were included, corresponding to 150 cases of COVID-related admission (SARS-CoV-2 infection as main cause of hospitalization) and 78 of non-COVID-related admission (SARS-CoV-2 infection unrelated to the hospitalization).In the group of COVID-related admissions, 58 patients had comorbidities. Forty-nine patients had acute respiratory disease (pneumonia, bronchospasm or bronchiolitis). Multisystem inflammatory syndrome in children was diagnosed in 27 and was significantly more frequent in the first year of the pandemic (wild type virus). Eighty percent of patients with acute respiratory disease needed respiratory support, mostly low-flow oxygen therapy. The severity of the disease was similar in all virus variants. Two patients (both with severe comorbidities) died from COVID-related conditions. ConclusionsIn our study, one third of the patients were admitted with SARS-CoV-2 infection but not because of it. Acute respiratory disease was less frequent and had a better prognosis compared to the adult population, while MIS-C was a major cause of morbidity and hospitalization. The fatality rate was extremely low.

Non-Donors of Organs and Tissues Due to Medical Refusal in a Transplant Referral Service

Obtaining organs for transplants through a deceased donor occurs exclusively through donation. However, some open protocols with potential donors do not become effective donors due to medical refusal. Our aim was to identify the profile of non-donors of organs and tissues due to medical refusal in a state reference service for transplants. This is a cross-sectional study with retrospective data collection from medical records of patients who died and had a protocol opened to evaluate brain death and procurement of organs and tissues in 2019. The sample consisted of 27 patients, the majority of whom were female, aged over 71 years, had primary education, and were married. The main causes of medical refusal were age above the recommended age and septicemia. Brain death was mostly confirmed within 12 hours, and the main cause of hospitalization was a vascular event. Identifying the profile of non-donors due to medical refusal is necessary for services to identify possible misattributed medical contraindications and thus contribute to reducing the disproportion between supply and demand for organs and tissues for transplants.

Ingresos COVID-19: intentando comprender el impacto real de la infección en pacientes hospitalizados

Introduction and objectiveSeveral studies have suggested that the hospitalization rate for COVID-19 in children and adolescents may reflect the prevalence of the infection rather than the severity of the disease. The aim of this study was to describe the clinical features of hospitalised paediatric patients with SARS-CoV-2 infection in order to understand if the infection was the reason for admission. MethodsRetrospective cohort study including patients aged 0 to 18 years with SARS-CoV-2 infection or multisystem inflammatory syndrome in children (MIS-C) admitted to a tertiary care children's hospital in Spain between 01/01/2020 and 12/31/2021. Results228 patients were included, corresponding to 150 cases of COVID-related admission (SARS-CoV-2 infection as main cause of hospitalization) and 78 of non-COVID-related admission (SARS-CoV-2 infection unrelated to the hospitalization).In the group of COVID-related admissions, 58 patients had comorbidities. Forty-nine patients had acute respiratory disease (pneumonia, bronchospasm or bronchiolitis). Multisystem inflammatory syndrome in children was diagnosed in 27 and was significantly more frequent in the first year of the pandemic (wild type virus). Eighty percent of patients with acute respiratory disease needed respiratory support, mostly low-flow oxygen therapy. The severity of the disease was similar in all virus variants. Two patients (both with severe comorbidities) died from COVID-related conditions. ConclusionsIn our study, one third of the patients were admitted with SARS-CoV-2 infection but not becauseof it. Acute respiratory disease was less frequent and had a better prognosis compared to the adult population, while MIS-C was a major cause of morbidity and hospitalization. The fatality rate was extremely low.

MAIN CAUSES OF HOSPITAL ADMISSIONS OF CHILDREN AND ADOLESCENTS AGED 0 TO 18 IN THE CITY OF CAMPINA GRANDE/PB, FROM 2020 TO 2022: A CROSS-SECTIONAL STUDY

Introduction: Pediatric diseases and their main causes of hospitalization are directly related to simple outpatient measures, sensitive to basic care. However, there were changes in the epidemiological and clinical scenario of hospitalizations for these diseases, with the advent of the covid-19 pandemic. Objective: To study the causes of hospital admissions for children and adolescents aged 0 to 18 years old and their evolution from 2020 to 2022, in the city of Campina Grande/PB. Methodology: This is a descriptive, cross-sectional and retrospective study, carried out with data obtained from the Hospital Information System (SIH), searching for the main causes of hospital admissions for children and adolescents admitted to pediatric reference services in Campina Grande. The variables used were biological characteristics (sex, age) and clinical characteristics (number of hospitalizations; length of stay; hospital discharge conditions; deaths). Results: The main cause of hospitalization in the group of pediatric diseases in the three years studied was pneumonia due to non-specific microorganisms (PNM), corresponding to 9.9% of hospitalization cases in 2020; 12.5% in 2021 and 15.8% in 2022. Another important highlight was lymphoid leukemia (ALL), which accounted for 2.6% of cases in 2020; 4.2% in 2021 and 4.3% in 2022. In the group of neonatal and infant diseases, the main causes of hospitalizations were disorders related to short-term pregnancy and low birth weight, represented by 10.3% of cases in 2020, 7.4% in 2021 and 6.4% in 2022. Discussion: The consequences of the pandemic were the progressive increase in the incidence of respiratory diseases, with the return of classes and exposure to viruses and bacteria, after isolation prolonged social. In addition to the progressive increase in the incidence of premature births, directly related to teenage pregnancy, considered a public health problem. And the incidence of ALL, which was underdiagnosed in 2020, as most resources were directed to the pandemic. Conclusion: the pandemic impacted pediatric epidemiology, increasing the number and profile of hospitalizations, mainly due to respiratory diseases and oncological diseases.

Minori in viaggio per farsi curare

Equitable access to healthcare is crucial to ensure the fundamental human right to health for all, also for children. However, the possibility to use in appropriate manner medical services (e.g. to access hospital) differs substantially across Italian regions. It is a situa- tion, source of inequality, that has been known for some time and has not found a solu- tion to date. In 2020, the pandemic year, 74.071 hospital admissions occurred for chil- dren and adolescents residing in regions other than that of hospitalization (14.3% of to- tal hospitalizations outside the region of residence). The national flight index was 8.7 ranging from 3.4 of Lazio to 43.4 of Molise. 54.8% of out-region hospitalizations are for patients traveling from one of the regions bordering their residence, in particular to be born. The starting regions with the highest mobility rate and long distance hospitalisation were Calabria, Sardinia, and Sicily with a flight index of 29.0, 11.8 and 11.5 for a to- tal of 11,745 hospitalizations. The main causes of hospitalization in a region far from their own are attributable to psychiatric disorders (43.3% of its Major Diagnostic Cate- gory), epilepsy and cephalalgy care (24.3%), and surgery for the replacement of major joints or reimplantation of the lower limbs with (18.5%). The phenomenon of medical mi- gration undermines the principles of universality, equality and fairness and it is therefore necessary to intervene to guarantee an unfulfilled right in its entirety. Centers of excellen- ce for pediatric care and clinical research are also needed in the southern regions.

Optimisation of conservative treatment of patients with severe heart failure by using hemosorption

Background. Heart failure (HF) is a complex cardiac pathology that is the main cause of hospitalisation among adults and is characterised by a high mortality. Dilated cardiomyopathy (DCM) is the most common cause of HF, and it can be fatal within a few years after the first symptoms appear. Many patients with HF remain refractory to medical therapy, despite its constant development and improvement. The study aims to compare the effectiveness of conservative treatment of patients with severe HF that occurred on the background of DCM using drug therapy and its combination with a course of hemosorption (HS). Materials and methods. We analysed treatment outcomes in 30 patients with severe HF against DCM (New York Heart Association class III–V, left ventricular ejection fraction (LV EF) < 30 %). Patients in group 1 (n = 13; N-terminal fragment of brain natriuretic peptide precursor (NT-pro BNP) 4,546.23 ± ± 3,265.01 pg/ml; LV EF 16.77 ± 2.92 %; LV end-diastolic volume (EDV) 261.31 ± 60.60 ml, LV end-systolic volume (ESV) 214.85 ± 49.44 ml) received drug therapy according to local protocols. In group 2 (n = 17; NT-pro BNP 3,974.49 ± 3,550.17 pg/ml; LV EF 18.18 ± 4.36 %; LV EDV 261.12 ± 79.96 ml, LV ESV 212.06 ± 71.67 ml), medical treatment was supplemented with a course of 3 HS procedures using granular deligandizing hemosorbent. Results. Patients in both study groups noted an improvement in well-being and a decrease in the severity of symptoms. The level of NT-pro BNP decreased to 2,609.92 ± 1,465.14 pg/ml (p < 0.01) in group 1 and to 975.35 ± 511.55 pg/ml (p < 0.05) in group 2. LV EF increased to 22.77 ± 4.69 % and 26.76 ± 5.02 %, respectively, in the groups (p < 0.01). In patients of group 1, LV EDV and LV ESV changed to 262.22 ± 40.92 ml and 211.33 ± 35.22 ml, respectively. In group 2, there was a significant decrease in LV EDV to 228.94 ± 73.16 ml and LV ESV to 170.88 ± 60.28 ml (p < 0.01). Conclusions. The use of HS in combination with drug therapy for severe HF on the background of DCM improves the clinical status of patients and LV systolic function.

АНАЛИЗ ДЕТСКОГО ТРАВМАТИЗМА С ГОСПИТАЛИЗАЦИЕЙ В АРХАНГЕЛЬСКОЙ ОБЛАСТИ ЗА 2020-2022 ГГ.

Relevance. At the moment, the problem of child injuries is being discussed all over the world. Childhood trauma is one of the main causes of hospitalization and mortality. In this regard, a detailed analysis of the causes of childhood injuries and their consequences is necessary for the development and implementation of preventive work. The aim is to estimate the situation related to child injuries in the Arkhangelsk region with the proposal of some organizational measures to reduce the frequency of injuries and their consequences. Materials and methods. The analysis was carried out on the basis of information statistical materials obtained from the Arkhangelsk Regional Children's Clinical Hospital named after P.G. Vyzhletsov. The annual changes in the number of injuries among children of the Arkhangelsk region from 2020 to 2022 were studied. The age characteristics, the nature/localization of injuries, as well as the type (place) where the injury was received were determined. The results of the study. Throughout the study period, the number of injuries among children of the Arkhangelsk region decreased by almost 20%. Annual changes in the number of injured children in different age ranges showed a decrease in the studied indicator in the infant and preschool, as well as high school groups. At the same time, in the categories of primary and secondary school age, this indicator has been constantly increasing for three years, eventually increasing by almost 10% . The conclusion was made about the need for further development of a program for prevention, injury prevention, and its implementation should be entrusted to the educational direction in the family and in educational organizations.

MAJOR REASONS FOR HOSPITALIZATION TO ICU OF CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA: A LITERATURE REVIEW

Relevance: Acute lymphoblastic leukemia (ALL) is a common malignancy in children. Approximately 85% of ALLs have B-cell origin, and 15% are T-cell ALLs. Many patients diagnosed with hematologic cancer will require hospitalization in the intensive care unit (ICU) at some point in their treatment.
 The aim was to study the available literature on clinical deterioration in patients with АLL admitted to the ICU, the clinical significance and prognostic value of causes of clinical deterioration, and adverse outcomes in patients with АLL staying in the ICU.
 Methods: A descriptive cross-sectional study approach was used. We reviewed published sources from 2016 to 2023 to collect data on major reasons for ALL patients’ hospitalization to ICU.
 Results: First, the patient’s age at the time of initial diagnosis of ALL is crucial. Cure rates for B-cell ALL are higher between 1 and 9 years of age than in other age groups. Second, the initial white blood cell count during diagnosis is a prognostic indicator. Third, the specific subtype of ALL also affects prognosis. The risk factors emphasize the importance of comorbidities and infectious diseases, as well as monitoring and managing pulmonary and cardiovascular function in patients to avoid hospitalization in the ICU. The main causes of hospitalization in the ICU are complications related to chemotherapy, infection, and unplanned hospitalizations. Compared to normal-risk patients, high-risk patients had a higher rate of OIT hospitalization in the ICU. It is important to control chemotherapy and infections to reduce the number of admissions to the ICU in this group.
 Conclusion: Chemotherapy, concomitant and infectious diseases, hypoxia, and hemodynamic instability are reasons for hospitalization of these patients to ICU. The condition of various organs and systems shall be monitored.

MAJOR REASONS FOR HOSPITALIZATION TO ICU OF CHILDREN
 WITH ACUTE LYMPHOBLASTIC LEUKEMIA:
 A LITERATURE REVIEW

Relevance: Acute lymphoblastic leukemia (ALL) is a common malignancy in children. Approximately 85% of ALLs have B-cell origin, and 15% are
 T-cell ALLs. Many patients diagnosed with hematologic cancer will require hospitalization in the intensive care unit (ICU) at some point in their treatment.
 The aim was to study the available literature on clinical deterioration in patients with АLL admitted to the ICU, the clinical significance
 and prognostic value of causes of clinical deterioration, and adverse outcomes in patients with АLL staying in the ICU.
 Methods: A descriptive cross-sectional study approach was used. We reviewed published sources from 2016 to 2023 to collect data on major
 reasons for ALL patients’ hospitalization to ICU.
 Results: First, the patient’s age at the time of initial diagnosis of ALL is crucial. Cure rates for B-cell ALL are higher between 1 and 9 years of
 age than in other age groups. Second, the initial white blood cell count during diagnosis is a prognostic indicator. Third, the specific subtype of ALL
 also affects prognosis. The risk factors emphasize the importance of comorbidities and infectious diseases, as well as monitoring and managing
 pulmonary and cardiovascular function in patients to avoid hospitalization in the ICU. The main causes of hospitalization in the ICU are complications related to chemotherapy, infection, and unplanned hospitalizations. Compared to normal-risk patients, high-risk patients had a higher rate of
 OIT hospitalization in the ICU. It is important to control chemotherapy and infections to reduce the number of admissions to the ICU in this group.
 Conclusion: Chemotherapy, concomitant and infectious diseases, hypoxia, and hemodynamic instability are reasons for hospitalization of
 these patients to ICU. The condition of various organs and systems shall be monitored.

Association of iron deficiency anemia with acute bronchiolitis in children below 2 years of age

Background: Bronchiolitis is the leading cause of respiratory distress in small children and one of the main causes of hospitalization in children <2 years of age. Anemia is also identified as a risk factor for lower respiratory tract infection. Iron deficiency is considered the most common cause of anemia in developing countries. As anemia is highly prevalent in children of our country, this study was undertaken to evaluate whether iron deficiency anemia is associated with acute bronchiolitis. Method: This Cross-Sectional Analytical study was carried out in the Department of Paediatrics, Sir Salimullah Medical College Mitford Hospital (SSMCMH), Dhaka, during the period of December 2021 to November 2022 after obtaining ethical approval to explore the association between iron deficiency anemia and bronchiolitis. Hemoglobin level, RBC indices, TWBC count, serum iron, TIBC level, Transferrin saturation, and PBF were investigated and compared in all children with bronchiolitis and control. For this purpose, a total number of 71 patients were enrolled in the study and among them, 35 children with bronchiolitis were considered as cases, and 36 healthy children without bronchiolitis were considered as control, who were matched with age. After taking written informed consent from parents/legal guardians, a detailed history and thorough clinical examination and laboratory investigations were carried out on each child. Data were recorded in separate case record form and analyzed by SPSS version 23.0. Results: The mean age was found 12.1±6.7 months in cases and 14.1±6.9 months in controls. Male participants (47, 66.2%) were the predominant group in the study and female participants were (24, 33.8%). Exclusive breastfeeding was found in 10 (28.6%) cases and 25 (71.4%) controls. There was a statistically significant difference in Hb (gm/dl), MCV (fl), S.Iron (µg/dl), Transferrin Saturation (%) and RDW-CV (%) between cases and controls (p<0.05). Among 35 cases, 25 (67.6%) had Iron Deficiency Anemia and statistical difference between the case and control was significant (p=0.001) with an odds ratio of 5.0. Conclusion: Iron deficiency anemia has a significant association with bronchiolitis. A larger and more extensive study was recommended.

Effect of In utero Exposure to Air Pollution on Adulthood Hospitalizations

Empirical analyses have demonstrated that individuals exposed to severe air pollution in utero have worse health outcomes during childhood. However, there is little evidence on the long-term health impacts of air pollution exposure. The objective of this paper is to estimate the effect of in utero exposure to the Great London Smog of 1952 (GLS) on five health outcomes identified through a scoping review to be those most likely affected: respiratory, circulatory, neoplasms, mental health, and nervous system conditions. We use the GLS, an extreme air pollution event in December 1952, as a quasi-natural experiment to estimate the effect of exposure to air pollution in utero on adulthood health. Data from the UK Biobank is analysed for a cohort of participants born from December 1952 to July 1956. Differences in health outcomes between adults exposed and not exposed to the GLS due to their birth dates, born inside and outside London, were explored. Our primary focus is hospitalization events between 1997 and 2020 (corresponding to ages 40 to 69), as recorded in linked administrative data from the National Health Service (NHS). Specifically, the five primary outcomes are binary variables indicating that the individual had at least one hospitalization where the main cause of hospitalization is related to respiratory, circulatory, neoplasms, mental health, or nervous system conditions. The analytical sample comprised 36,281 individuals. A positive effect on adulthood hospitalizations due to respiratory conditions was observed. If exposed to the GLS in utero, the probability of at least one respiratory health-related hospitalization between 1997 and 2020 increased by 2.58 percentage points (95% CI 0.08, 4.30, p = 0.03), a 23% increase relative to the sample mean. Small effects were found for all other outcomes, suggesting that these conditions were not affected by the GLS. We do not find heterogeneous effects by sex or childhood socioeconomic status. This study found that a 5-day pollution exposure event while in utero significantly increased respiratory-related hospitalizations at ages 40 to 69 but had no impact on hospitalizations due to circulatory, neoplasms, mental health, and nervous system conditions.

Safety and effects of a home-based Tai Chi exercise rehabilitation program in patients with chronic heart failure: study protocol for a randomized controlled trial

IntroductionChronic heart failure (CHF), as the final stage of the progression of many cardiovascular disorders, is one of the main causes of hospitalization and death in the elderly and has a substantial impact on patients' quality of life (QOL). Exercise-based cardiac rehabilitation (CR) has been shown to considerably enhance QOL and prognosis. Given the barriers to center-based CR faced by most developing countries in the form of expensive instruments, the development of home-based CR is necessary. Tai Chi, as an instrument-free exercise, has been shown to be successful in treating elderly CHF individuals. Fu Yang, as one of the academic concept of Traditional Chinese Medicine (TCM), believes that the fundamental pathogenesis of CHF is the gradual decline of Yang, and emphasizes the restoration of Yang physiological function in the treatment process. Therefore, we develope a home-based Tai Chi exercise rehabilitation program called Fu Yang Tai Chi (FYTC) for elderly CHF patients by combining the Fu Yang Theory of TCM with the CR theory. The objective of this study is to evaluate the effectiveness, acceptability, and safety of the program.Methods and analysisWe suggest conducting a parallel randomized controlled clinical trial with open label. Eighty CHF elderly participants will be randomly assigned in a 1:1 ratio to the FYTC rehabilitation program group or the moderate-intensity aerobic walking control group. Eligible participants will engage in either three sessions weekly of FYTC or walking exercise for 12 weeks. The primary outcome is the relative change in 6 min walk distance (6MWD). The secondary outcomes are the plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), QOL, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), self-rating anxiety scale (SAS) and depression scale (SDS), exercise skills, and noninvasive hemodynamic monitoring. Throughout the trial, adverse events will be recorded for safety evaluation. Researchers who are blinded to the treatment allocation will analyze the data.Ethics and disseminationThis research was authorized by the Guang'anmen Hospital Ethics Committee of the Chinese Academy of Medical Sciences (2022-141-KY). Our findings will be shared online and in academic conferences as well as in peer-reviewed journals. Trial registration numberChiCTR2200063511.

Lack of correlation between levels of surfactant B and NT-pro-NBP in acute heart failure: an admission to discharge study

Abstract Background Acute pulmonary edema (APE) is a main cause of hospitalization for heart failure (HF). Surfactant type B (Surf-B) is a sensitive biomarker of alveolar damage that has been partially studied in chronic HF unless acute HF. Aims To clarify the pattern of Surf-B changes compared to the gold standard NT-pro-BNP after decongestion therapy. Methods 36 patients with acute HF due to APE (average age 74,9 ± 8,94; LVEF 36,7 ± 12,6; 61,0% males) underwent a combined evaluation of Surf-B, NT-pro-BNP levels with quantification of B-lines at hospital admission (time 0) and discharge (time 1). Results At time 1, the average Surf-B and NT-pro-BNP and B- lines were significantly lower compared to time 0. Interestingly, no correlation between Surf B and NT-pro-BNP was observed either at time 0 and time 1. A correlation between B-lines and Surf-B was observed only at time 0 while the correlation between NT-pro-BNP and B lines was observed just at time 1 (Table). Despite the significant average changes in Surf-B from admission to discharge, 28% of cases behaved as non-responders exhibiting a lack of reduction in Surf-B compared to NT-pro-BNP at time 1. Conclusions These data suggest that an organ specific biomarker of lung organ damage such as Surf-B is sensitive to decongestion therapy at a different extent compared to NT-pro-BNP with the two biomarkers that do not correlate each other. The evidence of a 28% cases of Surf-B non-responder subjects suggests that reparative process of alveolar break damage may dissociate from hemodynamic and cardiac benefits in acute HF.Table

Application of a Machine Learning Predictive Model for Recurrent Acute Pancreatitis.

Acute pancreatitis is the main cause of hospitalization for pancreatic disease. Some patients tend to have recurrent episodes after experiencing an episode of acute pancreatitis. This study aimed to construct predictive models for recurrent acute pancreatitis (RAP). A total of 531 patients who were hospitalized for the first episode of acute pancreatitis at the Affiliated Hospital of Southwest Medical University from January 2018 to December 2019 were enrolled in the study. We confirmed whether the patients had a second episode until December 31, 2021, through an electronic medical record system and telephone or WeChat follow-up. Clinical and follow-up data of patients were collected and randomly allocated to the training and test sets at a ratio of 7:3. The training set was used to select the best model, and the selected model was tested with the test set. The area under the receiver operating characteristic curves, sensitivity, specificity, positive predictive value, negative predictive value, accuracy, decision curve, and calibration plots were used to assess the efficacy of the models. Shapley additive explanation values were used to explain the model. Considering multiple indices, XGBoost was the best model. The area under the receiver operating characteristic curves, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the XGBoost model in the test set were 0.779, 0.763, 0.883, 0.647, 0.341, and 0.922, respectively. According to the Shapley additive explanation values, drinking, smoking, higher levels of triglyceride, and the occurrence of ANC are associated with RAP. The XGBoost model shows good performance in predicting RAP, which may help identify high-risk patients.

Characterizing neurocognitive impairments in Parkinson's disease with mobile EEG when walking and stepping over obstacles.

The neural correlates that help us understand the challenges that Parkinson's patients face when negotiating their environment remain under-researched. This deficit in knowledge reflects the methodological constraints of traditional neuroimaging techniques, which include the need to remain still. As a result, much of our understanding of motor disorders is still based on animal models. Daily life challenges such as tripping and falling over obstacles represent one of the main causes of hospitalization for individuals with Parkinson's disease. Here, we report the neural correlates of naturalistic ambulatory obstacle avoidance in Parkinson's disease patients using mobile EEG. We examined 14 medicated patients with Parkinson's disease and 17 neurotypical control participants. Brain activity was recorded while participants walked freely, and while they walked and adjusted their gait to step over expected obstacles (preset adjustment) or unexpected obstacles (online adjustment) displayed on the floor. EEG analysis revealed attenuated cortical activity in Parkinson's patients compared to neurotypical participants in theta (4-7 Hz) and beta (13-35 Hz) frequency bands. The theta power increase when planning an online adjustment to step over unexpected obstacles was reduced in Parkinson's patients compared to neurotypical participants, indicating impaired proactive cognitive control of walking that updates the online action plan when unexpected changes occur in the environment. Impaired action planning processes were further evident in Parkinson's disease patients' diminished beta power suppression when preparing motor adaptation to step over obstacles, regardless of the expectation manipulation, compared to when walking freely. In addition, deficits in reactive control mechanisms in Parkinson's disease compared to neurotypical participants were evident from an attenuated beta rebound signal after crossing an obstacle. Reduced modulation in the theta frequency band in the resetting phase across conditions also suggests a deficit in the evaluation of action outcomes in Parkinson's disease. Taken together, the neural markers of cognitive control of walking observed in Parkinson's disease reveal a pervasive deficit of motor-cognitive control, involving impairments in the proactive and reactive strategies used to avoid obstacles while walking. As such, this study identified neural markers of the motor deficits in Parkinson's disease and revealed patients' difficulties in adapting movements both before and after avoiding obstacles in their path.

Surgical aspects of peritoneal dialysis

Modern replacement kidney therapy belongs to a life-saving type of medical aid and includes dialysis and kidney transplantation. In the worlds nephrological practice integrated approach is preferable: the treatment starts with peritoneal dialysis as the most physiological method and later kidney transplantation or hemodialysis. Well-functioning peritoneal access is a key factor of successful peritoneal dialysis. Studies have shown that peritoneal dialysis, compared with hemodialysis, especially when performed in a dialysis center (not at home), has some clinical advantages. In particular, this treatment better preserves residual kidney function, better corrects anemia, avoids the need for vascular access, which in turn reduces the risk of access-related infectious complications, which in turn are the main cause of hospitalization and mortality among patients with end-stage renal disease. This review is focused on catheters for peritoneal dialysis access and methods of their placement. Malpractice of implantation technique can lead to unwanted consequences ranging from cuff extrusion and catheter migration to total loss of the latter. Following implantation technique by surgeons helps to avoid malpractice and improve the results. Implantation of a peritoneal catheter is an important component of peritoneal dialysis, which determines the quality of treatment, the development of non-infectious and infectious complications of peritoneal dialysis, and the duration of peritoneal dialysis therapy. A number of methods for implanting peritoneal catheters have been proposed in the world. All of them have the right to exist, each has its own advantages and disadvantages. When choosing a method, the surgeon is guided by the objective data of the patient, the patients ability to endure more invasive interventions (duration, anesthesia, volume of surgery), the capabilities of the surgical department, experience and qualifications. Expansion of indications for the use of the peritoneal dialysis technique, its complications, as well as concomitant diseases should determine the optimal method for implanting a peritoneal dialysis catheter for a given patient. It should be noted that to date, sufficient data have not been obtained on the effect of the method of peritoneal catheter implantation on the expansion of indications for peritoneal dialysis, the incidence of complications, and the need for additional surgical interventions.

Gut microbiota dysbiosis alters chronic pain behaviors in a humanized transgenic mouse model of sickle cell disease.

Pain is the most common symptom experienced by patients with sickle cell disease (SCD) throughout their lives and is the main cause of hospitalization. Despite the progress that has been made towards understanding the disease pathophysiology, major gaps remain in the knowledge of SCD pain, the transition to chronic pain, and effective pain management. Recent evidence has demonstrated a vital role of gut microbiota in pathophysiological features of SCD. However, the role of gut microbiota in SCD pain is yet to be explored. We sought to evaluate the compositional differences in the gut microbiota of transgenic mice with SCD and nonsickle control mice and investigate the role of gut microbiota in SCD pain by using antibiotic-mediated gut microbiota depletion and fecal material transplantation (FMT). The antibiotic-mediated gut microbiota depletion did not affect evoked pain but significantly attenuated ongoing spontaneous pain in mice with SCD. Fecal material transplantation from mice with SCD to wild-type mice resulted in tactile allodynia (0.95 ± 0.17 g vs 0.08 ± 0.02 g, von Frey test, P < 0.001), heat hyperalgesia (15.10 ± 0.79 seconds vs 8.68 ± 1.17 seconds, radiant heat, P < 0.01), cold allodynia (2.75 ± 0.26 seconds vs 1.68 ± 0.08 seconds, dry ice test, P < 0.01), and anxiety-like behaviors (Elevated Plus Maze Test, Open Field Test). On the contrary, reshaping gut microbiota of mice with SCD with FMT from WT mice resulted in reduced tactile allodynia (0.05 ± 0.01 g vs 0.25 ± 0.03 g, P < 0.001), heat hyperalgesia (5.89 ± 0.67 seconds vs 12.25 ± 0.76 seconds, P < 0.001), and anxiety-like behaviors. These findings provide insights into the relationship between gut microbiota dysbiosis and pain in SCD, highlighting the importance of gut microbial communities that may serve as potential targets for novel pain interventions.

Evidence of non-invasive ventilation in Acute Pulmonary Edema: an integrative review

Introduction: Acute pulmonary edema is a multifactorial clinical syndrome in which there is accumulation of fluid in the pulmonary interstitium and alveolar spaces. It is considered a clinical emergency and one of the main causes of hospitalization, represents one of the main causes of hypoxemic acute respiratory failure, and its severity will depend on the amount of fluid accumulated in the lungs. Initially, when the individual has lower accumulations, he/she will present aquidyspnea, shorthand, and bilateral basal stumour in pulmonary auscultation. Objective: To verify in the literature the existence of evidence of the use of non-invasive mechanical ventilation in the reversibility of acute pulmonary edema. Metodhology: Through the 6 phases of the integrative review, we were able to organize the research in a way that is understandable and accessible so that the data are used as evidence in clinical practice. In order to answer the question presented for the review, bibliographic research of publications indexed in the following databases was performed: MEDLINE/PubMed, Web of Science and Scopus. Results: A total of 1,584 studies were found in the databases, with only 3 articles being included in the discussion because they better answered the research question. Conclusion: On the available literature, it is suggested that therapy may benefit patients with cardiogenic pulmonary edema, and that a greater number of studies may elucidate the best treatment of individuals affected by the disease using non-invasive ventilation as a more assertive resource.

Migrate to be equal.

Equitable access to healthcare is crucial to ensure the fundamental human right to health for all. However, the possibility to use in appropriate manner medical services (e.g., to access hospital) differs substantially across Italian regions. It is a situation, source of inequality, that has been known for some time and has not found a solution to date. In 2020, the pandemic year, 7.6% of hospital admissions occurred for patients residing in regions other than that of hospitalization. The starting regions with the highest mobility rate were Molise, Basilicata, Calabria and Abruzzo with a flight index of 28.1 (Molise)-16.1 (Abruzzo) for a total of 86,787 hospitalizations (16.8% of total national hospitalizations outside the region of residence). 58.7% of hospitalizations are for patients traveling from one of the regions bordering their residence, while 13.9% are for those who have crossed 2 regions and 27.4% at least 3 regions. The main cause of hospitalization is attributable to surgery for the replacement of major joints or reimplantation of the lower limbs with 124,860 discharges for hospitalized residents in their own region (16.1%), 16,996 hospitalized in a neighbouring region (20.4 %) and 8,019 hospitalized in a region far from their own (17.7%). The phenomenon of medical migration undermines the principles of universality, equality and fairness and it is therefore necessary to intervene to guarantee an unfulfilled right in its entirety.