Mean Duration Of Recovery Research Articles

A comparison of the outcomes of a novel technique of Mini-Incision and Self-Express (MISE) for breast abscess with the conventional techniques: a retrospective comparative cohort study.

Patients with a pathologically confirmed breast abscess were retrospectively identified. Patients with mastitis, granulomatous mastitis, breast fillers with infection, ruptured abscess prior to intervention, other interventions or bilateral breast infection were excluded. Data collected included patient demographics, radiological features such as size and number of abscess, treatment modality, microbiological results and clinical outcomes. These outcomes were then compared between the patients with MISE, I&D and needle aspiration. Twenty-one patients were included. The mean age was 31.5 years old (range: 18-48). Mean abscess size was 57.4mm (range: 24-126). 5 (23.8%), 11 (52.4%) and 5 (23.8%) had MISE, needle aspiration and I&D, respectively. Average duration of antibiotics was 1.8, 3.9 and 2.6 weeks for MISE, needle aspiration and I&D groups, respectively, which was statistically significant after adjusting for confounders (P=0.024). Mean duration of recovery was 2.8, 7.8 and 6.2 weeks for the MISE, needle aspiration and I&D groups, respectively (P=0.027), after adjusting for confounders. MISE, in suitable patients, results in shorter recovery time and lesser antibiotics usage, compared with the conventional techniques.

The Adverse Effects After COVID-19 Vaccination and Its Determinants among Adults in Kuala Terengganu

Background: Although Centre for Disease Control and Prevention (CDC) recommends people aged 12 and older obtain one dose of age-appropriate bivalent mRNA booster after completing the primary series, only 68.8% of the Malaysian adult population received their booster injection. The rate was even lower in Terengganu (43.5%). One of the main reasons for unwillingness to receive booster injections was due to the vaccination side effects as reported in a local study.
 Aim/objectives: This study aimed to determine the prevalence of adverse effects (AEs) after COVID-19 vaccination and its determinants among our local population.
 Methods: This cross-sectional study examined the prevalence of self-reported AEs after COVID-19 vaccination (BNT162b2 mRNA vaccine) and its determinants within 7 days following the second dose of vaccination among 379 adults in September 2021 at a public vaccination centre in Kuala Terengganu, Terengganu, Malaysia. The questionnaire consists of socio-demographic information, comorbidities, allergy history, history of COVID-19 infection, AEs post-vaccination, and duration of recovery. Descriptive statistics and logistic regression analyses were conducted using IBM SPSS ver. 26.0. 
 Results: Most participants were 18 to 39 years old (n=307; 81%) and male (n=224; 59.1%). 43 (11.3%) participants had at least one comorbidity, and 28 (7.4%) participants had a history of COVID-19 infection prior to vaccination. 213 (56.2%) participants had mild adverse effects, and 16 (4.2%) reported severe adverse effects. Local pain (n=139; 36.7%), fever (n=91; 24%), and headache (n=61; 16.1%) were the commonest reported AEs. The mean duration of recovery was 1.21 days (SD=1.41). The commonest severe AEs reported was dyspnoea (n=4; 1.1%). From logistic regression, femaleshad 2.06 times the odds of having side effects compared to males (adjusted OR=2.06; 95% CI (1.32,3.22), p = 0.001). Those who never had COVID-19 infection were more likely to have side effects, as compared to those with COVID-19 infection (adjusted OR=3.50; 95% CI (1.52,8.84), p = 0.005).
 Conclusion: Our study provides the real-life safety of the COVID-19 vaccination (BNT162b2 mRNA vaccine) in our community, even among those with previous COVID-19 infection. 
 Keywords: SARS-CoV-2; vaccines; vaccination; immunity; adverse effects
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Dietary phytochemicals against COVID‐19: A focus on thymoquinone

Dietary phytochemicals against COVID‐19: A focus on thymoquinone

The Efficacy of Combined Olive Leaf and Curcumin Extract on Healing Human Papillomavirus: A Randomized Clinical Trial

Background. Genital warts are sexually transmitted diseases for which there is no definitive cure. This study aimed to determine the effect of the combination of olive leaf extract and curcumin on the number of lesions and the duration of recovery in patients with external anogenital warts. Methods. This study is a three‐blind randomized controlled clinical trial conducted in 2020. In this study, women with external anogenital warts were enrolled by the consecutive nonprobability sampling method and then assigned by stratified block randomization to two groups: placebo (n = 28) and intervention (n = 26). In the intervention group, the combined olive leaf and curcumin extract was applied topically three times a day until recovery and up to 12 weeks. Routine treatment was administered to both groups in addition to the interventions. The number of warts, the duration of recovery, and the severity and duration of treatment side effects were assessed in all participants. Results. The results showed that the mean number of warts was significantly lower in the intervention group (5.65 ± 5.223) than in the placebo group (7.61 ± 5.245) from the fifth day of treatment onwards (p = 0.027). The mean duration of recovery in days in the intervention group (14.73 ± 9.735)) was significantly less than the placebo group (34.25 ± 18.863) (p = 0.001). In addition, there was no significant difference between the two groups in the frequency of drug side effects such as burning (p = 0.083), redness (p = 0.413), and itching (p = 0.706). The intervention group experienced side effects for a shorter duration of time (1.50 ± 1.924) compared to the placebo group (4.93 ± 8.366) (p = 0.043). Conclusion. The combined 10% olive leaf and curcumin extract can be effective in reducing the number of warts, duration of healing, and reducing the duration of complications in patients with external anogenital warts and is recommended as a complementary treatment for these patients. This trail is registered with IRCT20200509047350N1

Study on Hydroxychloroquinine Sulfate Being Given to the Admitted COVID -19 Positive Patients at Institute of JLNMCH, Bhagalpur, Bihar, India.

BackgroundAs the global death toll from new coronavirus illness (COVID-19) rises, the scientific community and healthcare systems are under massive pressure to manage the outbreak and develop effective medical remedies. Meanwhile, desperation has pushed practitioners, scientists, and authorities to recommend and attempt medicines with little or no proof. Despite the lack of clear and unequivocal facts supporting its efficacy and safety, hydroxychloroquine-sulfate (HCQS) has recently received substantial public and political interest in treating and prophylaxis new infectious diseases COVID-19.AimTo analyze the impact of HCQS in COVID-19-positive patients admitted at tertiary level government-owned Jawaharlal Nehru Medical College and Hospital (JLNMCH, Bhagalpur) Bihar.MethodsTwo hundred two RT-PCR-positive COVID-19 patients were included in this research. The study participants were randomly distributed into the intervention category and control category, each consisting of 101 study subjects. Study participants in the intervention category were administered hydroxychloroquine in 200 mg tablets. The control category was given placebo tablets that looked similar to tablets of hydroxychloroquine and were given in the same pattern. Chest X-ray PA view, 12 lead ECG, baseline hemogram including a concentration of CD4 cells, ratio between the concentration of CD8 cells and CD4 cells and concentration of CD8 cells, the concentration of C-reactive protein, RT PCR test of samples obtained from the oropharyngeal region and nasopharyngeal region nasopharyngeal for verification COVID-19 were done. These measurements were carried out in both the control and intervention categories at baseline and at the moment of obtaining a negative RT-PCR report.ResultsThe confirmed cases of COVID-19 was 52.9% in the intervention category and 53.4% in the control category at the end of the administration of drugs. Symptoms related to COVID-19 were observed in 11.6% of subjects in the intervention category and 13.5% in the control category. Other new symptoms were observed in 16.8% of subjects in the intervention category and 14.5% of study subjects in the control category. One death was reported in the control category. Emergency hospitalization was required for one subject in the intervention category, while two subjects in the control category required emergency hospitalization. 12.4 days was the mean duration of recovery in the intervention category, while 13.6 days were the mean duration of recovery in the control category. The recovery duration and COVID-related symptoms were lesser in the intervention category than in the control category; however, the variation between the two categories was statistically non-significant (p˃0.01).ConclusionAccording to this research, no statistically significant difference was noticed in COVID-19 incidence between the control category and intervention category, showing that hydroxychloroquine sulfate cannot be utilized as the main curative agent in the treatment of COVID-19. However, there was a reduction in recovery days and symptoms related to COVID-19 in study subjects administered with HCQS.

Clinical outcomes and etiology of acquired sixth cranial nerve palsy.

The objective of this study was to investigate the difference in clinical features according to age and factors affecting recovery of acquired sixth cranial nerve (CN6) palsy.A total of 156 patients with acute CN6 palsy between March 2016 and August 2021 who were followed up for at least 3 months were included in this study. Etiology, rate of recovery, and factors associated with recovery were retrospectively investigated.The average age of patients with CN6 palsy was about 60years and the mean duration of recovery was about 2.5 months. Of 156 patients, 72 (46.15%) had a microvascular etiology and 25 (16.03%) patients had a brain vascular lesions. Brain neoplasm, trauma, and "others" were found in 10 (6.41%), 11 (7.05%), and 15 (9.62%) patients, respectively. Among the total of 156 patients, 28 (17.95%) failed to completely recover. Non-isolated CN6 palsy with other cranial nerve palsies were recorded in 29 (18.59%) cases. Comparison of age (<50years vs ≥50years), between recovery and non-recovery groups showed that etiology was significantly different.The recovery rate of acquired CN6 palsy was about 82% and about 27% of patients had brain lesions. Also, varying rates and duration of recovery were found according to etiology, so we should be pay attention to diagnosis of causative disease in CN6 palsy patients.

The clinical features and outcomes of Tolosa-Hunt syndrome

BackgroundThe objective of this study was to investigate the clinical features and outcomes of Tolosa-Hunt syndrome (THS).MethodsA retrospective review of the medical records was performed on patients with THS between March 2016 and January 2020. A total of eleven patients fulfilling the International Classification of Headache Disorders (ICHD-3 beta) diagnostic criteria for THS were included in this study.ResultsThe average age of the patients with THS was 57.18 ± 15.32 years and the mean duration of recovery was 26.91 ± 24.35 days. All eleven patients had orbital or periorbital pain as the first symptom followed by diplopia. Ptosis was found in five patients (45.45 %) in the involved eye. Sixth cranial nerve (CN) palsy was most common (eight cases, 72.73 %), followed by third and fourth CN palsy (five cases, 45.45 %, respectively), optic neuritis (two cases, 18.18 %), and trigeminal nerve and facial nerve palsy (one case, 9.09 %, respectively). One patient with optic neuritis failed to recover visual acuity and the other ten patients completely recovered their ocular motor limitation. All patients were initially treated with steroids. One patient relapsed after five weeks and one patient had a history of THS five years earlier.ConclusionsTHS responded well to steroid treatment, but if it was accompanied by optic neuritis as optic nerve involvement, we suggest follow-up with high dose steroid treatment especially was important.

Cisatracurium Versus Atracurium for Abdominal Surgeries Regarding Condition of Intubation and Hemodynamic Effect

Abstract Background: Neuromuscular-blocking drugs block neuromuscular transmission, causing paralysis of the affected skeletal muscles. In clinical use, neuromuscular block is used adjunctively to anesthesia to produce paralysis, first to paralyze the vocal cords, and permit intubation of the trachea, and second to optimize the surgical field by inhibiting spontaneous ventilation, and causing relaxation of skeletal muscles. Patients and Methods: This was a prospective, randomized study registered in Clinical Trials Registry of India (CTRI/2019/04/018580). We included 100 patients divided into two groups of 50 each. Group A received atracurium (0.5 mg/kg), whereas Group B received cisatracurium (0.15 mg/kg). Efficacy of both the drugs was compared in terms of onset of action, duration of action, duration of recovery, hemodynamic conditions during and after intubation, and signs of histamine release in both the drugs. Results: Mean duration of 25% recovery from the reversal in the atracurium group was 32.4 ± 1.90 min which was significantly less as compared to 49.46 ± 1.86 min of cisatracurium group (P &lt; 0.001). The mean duration of recovery from the reversal in cisatracurium group was 2.18 ± 0.82 min which was significantly more as compared to 1.8 ± 0.75 min of atracurium group (P = 0.02). Conclusion: Cisatracurium in a dose of 0.15 mg/kg had a faster onset and duration of action than atracurium 0.5 mg/kg. At this dose, cisatracurium provides optimal intubating condition, rapid neuromuscular blocking with longer duration of action, stable hemodynamic status, no signs of histamine release clinically, and without any residual muscle paralysis compared to atracurium.

Comparison of effects of propofol and ketofol (Ketamine-Propofol mixture) on emergence agitation in children undergoing tonsillectomy.

The aim of this study was to compare the effect of propofol and ketofol (ketamine-propofol mixture) on EA in children undergoing tonsillectomy. In this randomized clinical trial, 87 ASA class I and II patients, aged 3-12 years, who underwent tonsillectomy, were divided into two groups to receive either propofol 100 µg/kg/min (group p, n=44) or ketofol : ketamine 25 µg/kg/min + propofol 75 µg/kg/min (group k, n= 43). Incidence and severity of EA was evaluated using the Pediatric Anesthesia Emergence Delirium (PAED) scales on arrival at the recovery room, and 10 and 30 min after that time. There was no statistically significant difference in demographic data between the two groups. In the ketofol group, the need for agitation treatment and also mean recovery duration were lower than in the propofol group (30 and 41%, and 29.9 and 32.7 min), without statistically significant difference (P value=0.143 and P value=0.187). Laryngospasm or bronchospasm occurred in 2 patients in each group and bleeding was observed in only one individual in the ketofol group. Infusion of ketofol in children undergoing tonsillectomy provides shorter recovery time and lower incidence of EA despite the non significant difference with propofol.

The Effect of Maturation on Performance During Repeated Sprints With Self-Selected Versus Standardized Recovery Intervals in Youth Footballers.

The purpose of this experiment was to assess performance during repeated sprints utilizing self-selected recovery intervals in youth football (soccer) players at different stages of maturation. Quota sampling method was used to recruit 14 prepeak height velocity (PHV) and 14 post-PHV participants for the study (N = 28; age = 13 [0.9]y, stature = 162.5 [10.8]cm, mass = 50.2 [12.7]kg). Players performed repeated sprints comprising 10 × 30m efforts under 2 experimental conditions: using 30-second and self-selected recovery intervals. Magnitude of effects for within- and between-group differences were reported using effect size (ES) statistics ± 90% confidence intervals and percentage differences. The decline in sprint performance was likely lower in the pre-PHV compared with the post-PHV group during the standardized recovery trial (between-group difference = 37%; ES = 0.41 ± 0.51), and likely lower in the post-PHV group during the self-selected recovery trial (between-group difference = 50%; ES = 0.45 ± 0.54). Mean recovery duration was likely shorter in the pre-PHV compared with the post-PHV group during the self-selected recovery trial (between-group difference = 26.1%; ES = 0.47 ± 0.45). This is the first study to show that during repeated sprints with self-selected recovery, pre-PHV children have an impaired ability to accurately interpret physical capabilities in the context of the task compared with post-PHV adolescents.

Interval running with self-selected recovery: Physiology, performance, and perception

This study (1) compared the physiological responses and performance during a high-intensity interval training (HIIT) session incorporating externally regulated (ER) and self-selected (SS) recovery periods and (2) examined the psychophysiological cues underpinning SS recovery durations. Following an incremental maximal exercise test to determine maximal aerobic speed (MAS), 14 recreationally active males completed 2 HIIT sessions on a non-motorised treadmill. Participants performed 12 × 30 s running intervals at a target intensity of 105% MAS interspersed with 30 s (ER) or SS recovery periods. During SS, participants were instructed to provide themselves with sufficient recovery to complete all 12 efforts at the required intensity. A semi-structured interview was undertaken following the completion of SS. Mean recovery duration was longer during SS (51 ± 15 s) compared to ER (30 ± 0 s; p < .001; d = 1.46 ± 0.46). Between-interval heart rate recovery was higher (SS: 19 ± 9 b min−1; ER: 8 ± 5 b min−1; p < .001; d = 1.43 ± 0.43) and absolute time ≥90% maximal heart rate (HRmax) was lower (SS: 335 ± 193 s; ER: 433 ± 147 s; p = .075; d = 0.52 ± 0.39) during SS compared to ER. Relative time ≥105% MAS was greater during SS (90 ± 6%) compared to ER (74 ± 20%; p < .01; d = 0.87 ± 0.40). Different sources of afferent information underpinned decision-making during SS. The extended durations of recovery during SS resulted in a reduced time ≥90% HRmax but enhanced time ≥105% MAS, compared with ER exercise. Differences in the afferent cue utilisation of participants likely explain the large levels of inter-individual variability observed.

The Prevalence and Risk Factors of Postoperative Complications between Open and Lab Cholecystectomy among Al-Madinah Citizens, Kingdom of Saudi Arabia, 2017

Background: Gallstone disease is common, and it is asymptomatic, patients may need an operative. Laparoscopic cholecystectomy becomes the choice for symptomatic gallstone disease intervention; open surgery was replaced by Laparoscopic cholecystectomy in the cholecystolithiasis treatment, open surgery has different complications. Laparoscopic cholecystectomy has several advantages over open surgery, but it has several complications also. Aim: To investigate the prevalence and risk factors of postoperative complications of open and lab cholecystectomy in AL-Madinahcitizen. Method: This retrospective cross-section study included 205 patients from king Fahad hospital in Al-Madinah AL-Munwwarah. A questionnaire was conducted on the participant by interview to investigate different variables. Results: The percent of a female was 73.7%, and percent of a male was 26.3%, the bleeding complication represented 19.5%, infection was 3.9%, biliary leakage was 3.9%, and wound infection was 1.5%. The mean duration of recovery was 3.56 days while the mean duration for returning back to work was 12.37 days. Lap operation had less duration for recovery than an open operation. Conclusion: Bleeding was the most common complication among patients, lap group patients experienced complications less than the open group. Male gender, age, obesity, the emergency of operation, diabetes mellitus, hypertension, thyroid and heart disease were not risked factors for complications.

New Variant of the Treatment of Acromion-Clavicular Dislocation With TightRope ® System in a Mini - Open Approach: A Preliminary Clinical Study

Background Many different surgical techniques have been described to stabilize the acromion-clavicular (AC) dislocations. So far many of these procedures are performed only in arthroscopy. Objectives In this study, we describe a new technique that utilizes the tightrope with a mini-invasive open approach for the acute stabilization of the acromion-clavicular joint (ACJ) dislocation. Patients and Methods We set an prospective study aimed to verify the efficacy of this new surgical technique. We treated 28 patients with acute ACJ dislocation with ACJ TightRope ® System with dual mini access. We retrospectively reviewed the data of 34 patients treated with arthroscopic technique. They were considered as the control group. Results At 6 month’s follow-up, all the 28 patients showed a stable joint during clinical examination and obtained an average Constant score of 98.62/100, with a complete recovery of ROM and strength in abduction. The mean operation time was of 33.7 minutes. The mean recovery duration was 102.8 days. No significant difference was found between the experimental and control groups (P > 0.05). Conclusions Results of this trial suggest the effectiveness of this new mini-invasive surgical technique in producing clinical and functional recovery in patients with ACJ dislocations.

Effect of Achillea millefolium Distillate on Recovery Time in Patients with Gastroenteritis

Background Some animal studies have reported that Achillea millefolium (A. millefolium) extract can affect intestinal movements in rats. However, no study is available on the effect of A. millefolium on recovery from gastroenteritis in human subjects. Objectives This study aimed to investigate the effect of A. millefolium on recovery from gastroenteritis in patients over 12 years old. Patients and Methods A randomized controlled trial was conducted on 44 patients with gastroenteritis. The patients were randomly assigned to two groups of 22 each. The control group received the usual treatments. In addition to the usual treatments, the intervention group received 0.5 mL/kg of A. millefolium distillate every 8 hours. The duration of recovery was recorded for both groups. Descriptive statistics, Chi-square, Fisher’s exact test, and the t-test were used to compare the two groups. Results The mean duration of recovery in the group receiving A. millefolium distillate was 1.31 ± 0.71 days, while it was 1.86 ± 0.71 days in the control group (P = 0.015). Conclusions Adding A. millefolium distillate to the usual treatment for simple gastroenteritis was effective in shortening the recovery time.

Altered food-cue processing in chronically ill and recovered women with anorexia nervosa.

Anorexia nervosa (AN) is a severe mental disorder characterized by food restriction and weight loss. This study aimed to test the model posed by Brooks et al. (2012a,b) that women suffering from chronic AN show decreased food-cue processing activity in brain regions associated with energy balance and food reward (bottom-up; BU) and increased activity in brain regions associated with cognitive control (top-down; TD) when compared with long-term recovered AN (REC) and healthy controls (HC). Three groups of women, 15 AN (mean illness duration 7.8 ± 4.1 years), 14 REC (mean duration of recovery 4.7 ± 2.7 years) and 15 HC viewed alternating blocks of food and non-food images preceded by a short instruction during functional magnetic resonance imaging (fMRI), after fasting overnight. Functional region of interests (fROIs) were defined in BU (e.g., striatum, hippocampus, amygdala, hypothalamus, and cerebellum), TD (e.g., medial and lateral prefrontal cortex, and anterior cingulate), the insula, and visual processing areas (VPA). Food-cue processing activation was extracted from all fROIs and compared between the groups. In addition, functional connectivity between the fROIs was examined by modular partitioning of the correlation matrix of all fROIs. We could not confirm the hypothesis that BU areas are activated to a lesser extent in AN upon visual processing of food images. Among the BU areas the caudate showed higher activation in both patient groups compared to HC. In accordance with Brooks et al.’s model, we did find evidence for increased TD control in AN and REC. The functional connectivity analysis yielded two clusters in HC and REC, but three clusters in AN. In HC, fROIs across BU, TD, and VPA areas clustered; in AN, one cluster span across BU, TD, and insula; one across BU, TD, and VPA areas; and one was confined to the VPA network. In REC, BU, TD, and VPA or VPA and insula clustered. In conclusion, despite weight recovery, neural processing of food cues is also altered in recovered AN patients.

Sensorineural hearing loss: a complication of acute otitis media in adults

We aim to evaluate the incidence and clinical manifestations of sensorineural hearing loss (SNHL) in adult patients with acute otitis media (AOM). Seventy-five patients (age > 18 years; 83 ears) diagnosed with AOM between January 2008 and March 2011 at our clinic were enroled and retrospectively reviewed. We detected audiometrically confirmed SNHL during the course of AOM in eight patients. The clinical course, treatment, and audiometric final outcome of each case were reviewed. SNHL was associated with AOM in 8 out of 83 ears (9.3%). The mean age of patients was 57.5 years, and the mean follow-up period was 21.1 months (range 0.6-46.3 months). The most common symptom was tinnitus. Mean bone conduction hearing threshold was 39.5 dB in pure tone audiometry. All patients showed high-frequency HL, and three showed pan-frequency HL. All patients were treated with oral antibiotics at the initial visit. Seven ears were treated with a combination of oral steroids. Myringotomy was also performed. Seven of eight patients showed improvement; however, 8 kHz thresholds were not improved. This suggested that the inflammation spread through the round window. The mean duration of recovery was 18.6 days. SNHL associated with AOM in adult patients occurs during the early phases of the disease course. High-frequency hearing was commonly affected and was well treated with oral antibiotics, myringotomy, and steroid therapy. Audiometry can be helpful for treating adult patients with AOM. Active treatment, including myringotomy, should be performed during the early phase, if SNHL is suspected.

Aseptic Meningitis in Pediatrics: Epidemiologic Evaluation and Cerebrospinal Fluid Changes

Objective This study aimed at investigating seasonal variation, clinical symptoms, and cerebrospinal fluid (CSF) changes in patients with aseptic meningitis admitted in Mofid hospital between 1995 and 1996. Materials & Methods A total of 63 children with aseptic meningitis were enrolled in the study. Their age, gender, season of the disease, etiology, clinical symptoms, CSF changes, and treatment were evaluated and documented. Data were analyzed using SPSS 11.5. Results The male to female ratio of the patients was 2.5 to 1, mean age being 6.5 years. The disease occurrence was most common in spring and summer, and the most common symptoms observed were fever (92.6%), followed by nausea and vomiting (88.88% and 68.25%), neck stiffness, neck stiffness (54%), seizure (19%), kernig sign (14.28%), Brudzinski's sign (11.11%), and 1.58% of the patients had history of head injury. Mean white blood cell count for CSF was 165/mm3 (range, 6 to 850/mm3), the common cells being mononuclear cells; mean red blood cell count was 538 (range, 0 to 8100/mm3); protein and glucose levels were within the normal ranges. Blood and CSF culture and CSF smear were negative. Prognosis was excellent and mean duration of recovery was 5 days (range, 2 to 18 days). Conclusion Although the clinical symptoms of aseptic meningitis are similar to those of bacterial meningitis, its prognosis is excellent. The CSF features can be used to diagnose the disease.

Acute renal failure in neonatal sepsis

To evaluate the occurrence of acute renal failure (ARF) and the factors associated with it in cases of neonatal sepsis. The case control study was conducted in the referral neonatal intensive care unit of a tertiary teaching hospital. 200 out born neonates with sepsis admitted to the nursery from January to July 2003 were evaluated for presence of ARF (cases) or not (controls). Sepsis was diagnosed on the basis of either a positive sepsis screen (immature: total (I:T) neutrophil ratio > 0.2, micro-ESR > age in days + 2 mm or> 15 mm, CRP> 6 mg/dl, TLC< 5000 cells/mm3; 2 or more positive) or a positive blood culture in symptomatic neonates. ARF was defined as blood urea nitrogen (BUN)> 20mg/dl on two separate occasions at least 24 hours apart. Oliguria was defined as urine output < 1 ml/Kg/hr. 52 out of 200 (26%) neonates with sepsis had ARF; only 15% of ARF was oliguric. The mean gestation of neonates with ARF was similar to those without ARF (36.1+/-4.1 wks vs. 36.6+/-3.5 wk; p = 0.41). A significantly higher number of babies with ARF weighed less than 2500 gm as compared to those without ARF (86.5% vs 67.6%; p = 0.008). The association of meningitis, disseminated intravascular coagulation (DIC) and shock was also significantly higher in neonates with ARF (46.8% vs 26.2%, p = 0.01; 65.4% vs 20.3%, p < 0.001; 71.2% vs 27.0%, p < 0.001 respectively). Mortality in neonates who developed ARF was significantly higher (70.2% vs 25%, p < 0.001). Factors including gestational age, weight, onset of sepsis, culture positivity, associated meningitis, asphyxia, shock, prior administration of nephrotoxic drugs were subjected to univariate analysis for prediction of fatality in neonates with sepsis and ARF; only shock was found to be a significant predictor of fatality (p< 0.001). ARF had recovered in 22 out of 49 neonates in whom data was available; three patients had left against medical advice. The mean duration of recovery in these 22 neonates was 5.5 days (range 1-14 days). Presence of co-existing morbidities (perinatal asphyxia/congestive heart failure (CHF)/ necrotising enterocolitis (NEC)) or nephrotoxic drugs did not alter the frequency of recovery of ARF in septic neonates (45.5% vs 44.4%,p = 0.944; 41% vs 52%, p = 0.308 respectively). Renal failure occurred in 26% neonates with sepsis. Although ARF in neonates has been reported to be predominantly oliguric, it was observed that ARF secondary to neonatal sepsis was predominantly non oliguric. Low birth weight was an important risk factor for the development of ARF. The mortality being three times higher in neonates with ARF demands a greater awareness of this entity among practitioners and better management of this condition.

Time-motion analysis of elite field hockey during several games in succession: A tournament scenario

International field hockey tournaments may require teams to play three games within a period of four days. Therefore, there is potential for residual fatigue to affect the movement patterns of players during subsequent games. The purpose of this study was to document changes in time-motion analysis of 14 elite male field hockey players during three games within a period of four days during an international tournament. In addition, the nature of and any changes in repeated-sprint activity were investigated using a criteria of a minimum of three sprints with a mean recovery duration between sprints of < 21 s. The percent of total game time spent standing significantly increased across all three games (7.4+/-.2, 11.2+/-2.7 and 15.6+/-5.6%, respectively, P<0.05). Conversely, the percent time spent jogging significantly decreased from game 1 to game 2 and from game 1 to game 3 (40.5+/-7.3, 34.8+/-7.4 and 29.4+/-5.7%, respectively, P<0.05). Furthermore, the percent time in striding significantly increased from game 1 to game 3 and from game 2 to game 3 (4.1+/-1.3, 5.1+/-0.9 and 5.8+/-1.4%, respectively. P<0.05). Changes in mean motion frequency and duration were recorded across games for the motions of standing, striding and sprinting. The frequency of exercise bouts that met the criteria for 'repeated-sprint' decreased across the three games (17, 11 and 8, respectively). In summary, the results suggest that when elite field hockey players play three games within four days there are significant changes in time-motion analysis.

Score-Celebration Injuries among Soccer Players

Background Professional and amateur soccer players often perform dramatic on-field feats of celebration after scoring a goal. Injuries may occur during these activities. Purpose With the aim of preventing such “score-celebration injuries” in the future, the authors examine these events in professional soccer players and discuss potential avenues for prevention. Study Design Case series; Level of evidence, 4. Methods Over the course of 2 seasons (1996-1998), 152 soccer players were evaluated at an orthopaedic clinic for injuries incurred during matches. Nine players (6%) had injured themselves while celebrating after scoring goals in a match. The type of celebration, injury type, treatment, and mean duration of recovery were noted. Results Seven of the 9 patients were male professional soccer players with ages ranging between 17 and 29 years (mean age, 24 years). The injuries occurred when the playing ground was natural turf in 8 cases; most injuries occurred in the second half of the game. The types of celebration maneuvers were sliding (prone or supine) and sliding while kneeling in 5 cases, piling up on jubilant teammates in 3 cases, and being tackled while racing away in 1 case. Injuries included ankle, clavicle, and rib fractures; medial collateral ligament sprain; low back strain; hamstring and adductor muscle strain; quadriceps muscle sprain; and coccyx contusion. The mean duration for recovery was 6.2 weeks. Rival team players were usually not responsible for such trauma. Conclusion Exaggerated celebrations after making a goal, such as sliding, piling up, and tackling a teammate when racing away, can result in serious injury. In addition to general measures for preventing soccer injuries, coaches and team physicians should teach self-control and behavior modification to minimize the risk of such injuries. More restrictive rules, which penalize such behavior, may assist in the prevention of score-celebration injuries.