Non-recovery Rate Research Articles

Permanent unilateral visual loss and orbital compartment syndrome following unilateral frontal craniotomy: illustrative case.

Vision loss following supine craniotomy is an unexpected and devastating complication for the patient and the operating team. Postoperative vision loss (POVL) is commonly associated with cardiac, spinal, neck, and prone head surgeries, as they share common risk factors, such as a prone position, intraoperative hypotension, a longer anesthesia duration, and the use of vasopressors. Herein, the authors report a case of irreversible vision loss following a frontal craniotomy in the supine position together with a review of the literature. All published cases in the literature since the first reported case in 1970 are summarized. Possible etiologies and proposed preventive measures are discussed. Different pathologies, such as vascular, intra-axial, and extra-axial lesions, are associated with POVL and have similar clinical courses and nonrecovery rates, which raises the question of whether POVL begins during the exposure part of these surgeries. Preventive measures could include avoiding direct ocular pressure during flap reflection, the use of elastic bands or fishhooks to avoid stretching the orbital contents and impairing venous outflow, and a careful review of the venous drainage of frontal tumors, which could help avoid unnecessary large venous thrombi or waxing. The role of intraoperative visual neurophysiological monitoring in predicting POVL requires further exploration. https://thejns.org/doi/10.3171/CASE2434.

Serum bicarbonate levels and kidney outcomes in critically ill patients: a prospective cohort study.

The interplay between serum bicarbonate levels and kidney outcomesis not fully understood. We conducted a prospective cohort study in three intensive care units (ICUs) to evaluate the association of serum bicarbonate levels with acute kidney injury (AKI) and kidney function recovery in critically ill patients. A prospective cohort study in three intensive care units (ICUs) was performed. The serum bicarbonate level in the first 24h after ICU admission was categorized as low (< 22mEq/L), normal (22-26mEq/L), or high (> 26mEq/L). Serum creatinine (SCr) levels according to theKDIGOAKI guideline were used for defining AKIwithin the first 7 days of ICU stay. At ICU admission, SCr≥ 1.1for women and ≥ 1.3 mg/dL for men were indicative of impaired kidney function.Mortality outcome was tracked up to 28days, and kidney function recovery was assessed at hospital discharge. A total of 2732 patients (66 ± 19years and 55% men) were analyzed, with 32% having impaired kidney functionat ICU admission. Overall, 26% of patients had low bicarbonate levels, while 32% had high bicarbonate levels. Notably, patients with preserved kidney function showed a lower prevalence of low bicarbonate levels compared to those with impaired kidney function (20% vs. 39%, p < 0.001), while higher rates were observed for high bicarbonate (35% vs. 24%, p < 0.001). Compared with patients with normal serum bicarbonate levels, those with low bicarbonate were 81% more likely to develop AKI (OR = 1.81; 95% CI 1.10-2.99), whereas those with high bicarbonate were 44% less likely (OR = 0.56; 95% CI 0.32-0.98) in the adjusted model for confounders. Neither those with high nor low serum bicarbonate levels were associated with an increased risk of mortality (HR = 1.03; 95% CI 0.68-1.56 and 0.99; 95% CI 0.68-1.42, respectively). In subgroup analysis, regardless of the kidney functionat ICU admission, serum bicarbonate levels were not associated with the development of AKI and all-cause mortality. Regarding kidney function recovery, higher non-recovery rates were found for those with low bicarbonate. In critically ill ICU patients, low bicarbonate levels were associated with the more likely development of AKIand subsequentnon-recovery ofkidney function, while high bicarbonatelevels showed no such association. Therefore, low bicarbonate levels may be considered a risk factor for adverse kidney outcomes in critically ill patients.

Long-term renal outcomes of patients with COVID-19: a meta-analysis of observational studies.

Kidney involvement is common in hospitalized coronavirus disease 2019 (COVID-19) patients during the acute phase, little is known about the long-term impact of COVID-19 on the kidney. This is a systematic review and meta-analysis on long-term renal outcomes among COVID-19 patients. We carried out a systematic literature search in PUBMED, EMBASE, SCOPUS, and Cochrane COVID-19 study register and performed the random-effects meta-analysis of rates. The search was last updated on November 23, 2022. The study included 12 moderate to high-quality cohort studies involving 6976 patients with COVID-19-associated acute kidney injury and 5223 COVID-19 patients without acute kidney injury. The summarized long-term renal non-recovery rate, dialysis-dependent rate, and complete recovery rate among patients with COVID-19-associated AKI was 22% (12-33%), 6% (2-12%), and 63% (44-81%) during a follow-up of 90-326.5days. Heterogeneity could be explained by differences in the prevalence of chronic kidney disease and proportion of acute kidney injury requiring renal replacement therapy using meta-regression; patients with more comorbidities or higher renal replacement therapy rate had higher non-recovery rates. The summarized long-term kidney function decrease rate among patients without acute kidney injury was 22% (3-51%) in 90-199days, with heterogeneity partially explained by severity of infection. Patients with more comorbidities tend to have a higher renal non recovery rate after COVID-19-associated acute kidney injury; for COVID-19 patients without acute kidney injury, decrease in kidney function may occur during long-term follow-up. Regular evaluation of kidney function during the post-COVID-19 follow-up among high-risk patients may be necessary.

Clinical Profile of Sixth Nerve Palsy

Aim: This study aimed to assess various causative factors of sixth nerve palsy, the recovery rate of sixth nerve palsy, and to develop the diagnostic algorithm for sixth nerve palsy. Methods: This was a hospital-based retrospective observational study. For this study, electronic case records of all patients with sixth cranial nerve palsy who were followed up for 6 months were collected. The study duration was between June 2017 and May 2022. Characteristics such as the age of onset, gender, presence of any systemic conditions, and laterality were analysed. Results: Total number of patients was 82. 63% were males and rest were 37% females. 62% had systemic involvement, and 38% had no systemic involvement. Among systemic illnesses, diabetes was the most common cause of isolated sixth nerve palsy (61%). The most common cause of sixth nerve palsy was due to vasculopathy (49%). Trauma (11%) was the second leading cause of sixth nerve palsy; the tumour was very rare in our study about 1%. Sixth nerve palsy in idiopathic intracranial hypertension amounting to about 5%. We were unable to identify the cause in certain patients (16%); post-viral aetiology consists of about 1%, cortical vein thrombosis to about 1%, cavernous vein thrombosis to about 2%, aneurysm consists about 3%, congenital cause amounting to about 5%, inflammatory accounts about 6%. Recovery rate among sixth nerve palsy: 87% had complete recovery in our study; vasculopathy had a 100% recovery rate. In contrast, trauma had 50% recovery and 50% non-recovery rate. In contrast, tumour and congenital had no recovery rate. Conclusion: Ischaemia followed by trauma is the common aetiology raising concerns about the health issues of young Indians and road safety.

Carcass non-recovery rate of franciscana dolphin (Pontoporia blainvillei), calibrated with a drift mark-recapture study at FMA Ia, Brazil

The franciscana dolphin (Pontoporia blainvillei) is one of the smallest dolphins globally and the most threatened in the Southwest Atlantic Ocean. Beach monitoring helps to investigate cetacean strandings within their distributions and assess impacts that cause mortality. Using drifters in mark-recapture studies helps to estimate recovery rates when carcasses are unavailable. The study aims to estimate the non-recovery rate of franciscana carcasses from FMA Ia by comparing the spatial distribution between carcasses and drifters along the coast; correlating the influence of cold fronts with the recovery rate of drifters; estimating the non-recovery rate of carcasses according to the drifters’ results and the meteorological profile in the pre-stranding period; characterizing the death diagnostic with temporal distribution of franciscanas by considering the stranding index and the carcass non-recovery rates. We repeated the release of 54 drifters in two campaigns close to the coast within the range of franciscana dolphins, where beaches are monitored daily, in the north region of Espírito Santo state, Brazil. The carcass stranding hotspots (21%) and drifters (18%) were 10 km apart. Cold fronts significantly increase the number of strandings. Considering the incidence of cold fronts in the pre-stranding period and linear regression from drifters, the median carcass recovery rate is 0.26, 95% IC [0.22 - 0.29], which means that for each stranding, the carcass non-recovery rate varies from 0.78 to 0.71. The range between 265 to 350 estimates the total of carcasses from 77 strandings observed from 2003 to 2021. The record year of strandings was 2014 (n = 14). About 52% of records occurred in summer, and January is the month with the highest occurrence of strandings. Of the conclusive diagnoses (n = 43), around 77% (n = 33) were attributed to incidental capture in gillnets. Estimating the number of carcasses based on stranding records is essential for population viability analyses and conservation purposes, especially considering small and isolated populations as in the present study. To prevent local extinction, a solution to avoid incidental capture, especially along summers, must be addressed quickly.

Association of magnesium abnormalities at intensive care unit admission with kidney outcomes and mortality: a prospective cohort study

Magnesium abnormalities have been associated with adverse kidney outcomes and mortality in critically ill patients, however, this association remains inconsistent. This study aimed to investigate the association of magnesium abnormalities at intensive care unit (ICU) admission with kidney outcomes (i.e., acute kidney injury (AKI) and kidney function recovery) and mortality risk in a large cohort of critically ill patients. A prospective cohort study was conducted by collecting data from three ICUs in Brazil. The ICU admission serum magnesium level was used to define hypomagnesemia (< 1.60mg/dL) and hypermagnesemia (> 2.40mg/dL). The Kidney Disease Improving Global Outcomes AKI Guideline was used to define AKI based on serum creatinine levels. Kidney function recovery was defined as full recovery, partial recovery, and non-recovery at ICU discharge. Mortality was screened up to 28days during ICU stay. A total of 7,042 patients was analyzed, hypomagnesemia was found in 18.4% (n = 1,299) and hypermagnesemia in 4.4% (n = 311). Patients with hypomagnesemia were 25% more likely to develop AKI after adjustment for confounding variables (OR = 1.25; 95% CI 1.08-1.46). No significant association was found for hypermagnesemia and AKI (OR = 1.18; 95% CI 0.89-1.57). Kidney function recovery was similar among groups but hypermagnesemia had lower non-recovery rates. Both hypomagnesemia and hypermagnesemia were associated with 65 and 52% higher mortality risk after adjustments for confounders, respectively (HR = 1.65; 95% CI 1.32-2.06 and 1.52; 95% CI 1.01-2.29). Hypomagnesemia, but not hypermagnesemia, at ICU admission was associated with AKI development. On the other hand, both hypomagnesemia and hypermagnesemia were associated with higher mortality risks.

Cumulative Application of Creatinine and Urine Output Staging Optimizes the Kidney Disease: Improving Global Outcomes Definition and Identifies Increased Mortality Risk in Hospitalized Patients With Acute Kidney Injury.

Acute kidney injury is diagnosed according to creatinine and urine output criteria. Traditionally, both are applied, and a severity stage (1-3) is conferred based upon the more severe of the two; information from the other criteria is discarded. Physiologically, however, rising creatinine and oliguria represent two distinct types of renal dysfunction. We hypothesized that using the information from both criteria would more accurately characterize acute kidney injury severity and outcomes. Prospective cohort study. Multicenter, international collaborative of ICUs. Three thousand four hundred twenty-nine children and young adults admitted consecutively to ICUs as part of the Assessment of the Worldwide Acute Kidney Injury, Renal Angina and Epidemiology Study. The Kidney Disease: Improving Global Outcomes creatinine and urine output acute kidney injury criteria were applied sequentially, and the two stages were summed, generating an Acute Kidney Injury (AKI) Score ranging from 1 to 6. The primary outcome was 28-day mortality; secondary outcomes were time until ICU discharge and nonrecovery from acute kidney injury. Models considered associations with AKI Score, assessing the relationship unadjusted and adjusted for covariates. Twenty-eight-day mortality and nonrecovery from acute kidney injury were modeled using logistic regression. For 28-day ICU discharge, competing risks analysis was performed. Although AKI Scores 1-3 had similar mortality to no Acute Kidney Injury, AKI Scores 4-6 were associated with increased mortality. Relative to No Acute Kidney Injury, AKI Scores 1-6 were less likely to be discharged from the ICU within 28 days. Relative to AKI Score 1, AKI Scores 2-6 were associated with higher risk of nonrecovery. Within the traditional Kidney Disease: Improving Global Outcomes Stage 3 acute kidney injury cohort, when compared with AKI Score 3, AKI Scores 4-6 had increased mortality, AKI Scores 5-6 had prolonged time to ICU discharge, and AKI Score 6 experienced higher nonrecovery rates. Cumulative application of the creatinine and urine output criteria characterizes renal excretory and fluid homeostatic dysfunction simultaneously. This Acute Kidney Injury score more comprehensively describes the outcome implications of severe acute kidney injury than traditional staging methods.

Post Cyclone Idai Evaluation of the Integrated Management of Acute Malnutrition (IMAM) Programme for Children under Five in Chimanimani, Zimbabwe

Background: Natural disasters like cyclones have been shown to cause food insecurity and infectious diseases leading to malnutrition. Objective: To evaluate the point prevalence of severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) and post cyclone Idai Integrated Management of Acute Malnutrition (IMAM) response in Chimanimani district. Methods: A stratified random sampling method was used to select mother/child pairs who were IMAM beneficiaries. Clinic level records and reports on admissions and treatment outcome statistics were collected. Stories of most significant change (MSC), Focus Group Discussions (FDG) and Key Informants interviews were conducted. Results: At baseline, 74 children were admitted as malnourished, 25 had SAM and 49 had MAM, the number reduced to 45 with 13 SAM and 32 MAM four months post cyclone. The impact of the intervention was measured by the quality of treatment outcomes. The average cure rate from April to December for MAM was 79%, defaulter rate 19%, non-recovery 0%, died 2% and for SAM, cure rate 82%, defaulter rate 13%, died 0% and non-recovery 5%. The cure rate, non-recovery rate and death rate were in line with the SPHERE minimum standards Conclusion: The prevalence of SAM and MAM were highest two months after the cyclone with a marked reduction of cases 4 months post cyclone. The cure, death and non-recovery rate outcome indicators were desirable; however, defaulter rate compromised the effectiveness of the IMAM programme. These findings warrant the strengthening and establishment of effective defaulter follow up systems in displaced and hard to reach areas.

Hydrometallurgical metal recovery from waste printed circuit boards pretreated by microwave pyrolysis

Waste printed circuit boards (PCBs) were pretreated by either microwave or conventional pyrolysis prior to acid leaching processes. Microwave pyrolysis can provide higher weight loss of waste PCBs and better metal recycling than conventional pyrolysis. After microwave and conventional pyrolysis of waste PCBs, the overall copper recovery rates of two-stage acid leaching can be up to approximately 96 and 75%, respectively. The gold recovery rates of thiourea leaching from microwave- and conventional-pyrolyzed PCBs were approximately 80 and 69%, respectively. Therefore, size-reduction processes for the pretreatment of waste PCBs would not be necessary, as long as microwave pyrolysis is applied prior to hydrometallurgical processes. The gold recovery rates of this study should be credible, since the sum of recovery and non-recovery rates was close to 100%. The initial acid leaching of copper may be governed by the copper content in the PCBs as well as the concentration of oxidizing agent in the leaching solution. Besides, the reaction rate of thiourea leaching of microwave-pyrolyzed PCBs may be largely influenced by the thickness of product layer. Both acid and thiourea leaching experimental results were better fitted by the pseudo-second-order reaction model. However, the maximum recovery rate determined by using the pseudo-first-order reaction model should be more reasonable.

Treatment outcomes of severe acute malnutrition and predictors of recovery in under-five children treated within outpatient therapeutic programs in Ethiopia: a systematic review and meta-analysis

BackgroundSevere acute malnutrition affects around 17 million under-five children in the world, of which the highest burden is accounted by Sub-Saharan Africa where Ethiopia is found. Though there are few individual, inconsistent and inconclusive studies, there is no nationally representative study on treatment outcomes of SAM in outpatient therapeutic feeding programs of Ethiopia. This study aimed at estimating the pooled treatment outcomes and predictors of recovery rate among under- five children with SAM in Ethiopia.MethodsElectronic databases (PubMed, Medline (EBSCOhost), EMBASE (Elsevier), CINAHL (EBSCOhost), web of science, Scopus, Science Direct and Food Science and Technology s (FSTA)), and grey literature sources (Google scholar, Mednar, World Cat and google) were used to retrieve articles. The random effect model was used to estimate the pooled treatment outcomes. Hazard ratios were used to determine the predictors of recovery rate. Cochran’s Q, I2, and univariate Meta regression were done for heterogeneity. Begg’s & Egger’s tests were used for publication bias.ResultsNineteen articles with a total number of 23,395 under-five children with SAM were used for this meta-analysis. The pooled recovery, death, defaulter and non-recovery rates were 70% (95% CI: 64, 76), 2% (95% CI: 1, 2), 10% (95%CI: 7, 12), 15% (95% CI: 10, 20), respectively. Diarrhea (HR = 0.8, 95% CI: 0.75, 0.94), no edema (HR = 0.41, 95% CI: 0.33, 0.50) and amoxicillin (HR = 1.81, 95% CI: 1.18, 2.44) were independent predictors of recovery rate of children with SAM in Ethiopia. Publication year was found to be the potential source of heterogeneity between included studies.ConclusionThe treatment outcomes of children with SAM from outpatient therapeutic feeding programs of Ethiopia are lower than the sphere guidelines, WHO and national recommendations. Diarrhea and no edema antagonized the recovery rate of children, while amoxicillin enhanced the recovery rate of children from SAM. Community health workers need to be trained. Especial attention should be given while treating children with diarrhea and severe wasting. Community mobilization is also recommended to improve community awareness about the therapeutic foods.

The significance of cervical sagittal alignment for nonrecovery after whiplash injury

BACKGROUND CONTEXTWhiplash-associated disorder is a common cause of chronic neck pain. Several radiological cervical angular variables are suggested to have constitutional characteristics, that is, them being minimally influenced by body positioning. However, the association between these variables and pain conditions remains poorly understood. To our knowledge, no previous studies have investigated the association between constitutional angular variables and the outcome after whiplash trauma. PURPOSEOur objectives were (1) to study the inter-rater agreement of sagittal radiologic variables between 2 raters and (2) to investigate any association between these variables and self-perceived nonrecovery after whiplash injury. STUDY DESIGNProspective cohort study. PATIENT SAMPLEForty-six patients aged 16 to 70 years, attending an emergency department after a motor vehicle accident resulting in neck pain were recruited. OUTCOME MEASURESSelf-perceived nonrecovery (yes/no) was the primary outcome measure. The secondary outcome measure was pain level on a numeric rating scale. METHODSThe participants underwent computed tomography scans in a supine position. Sagittal alignment variables (T1 slope, neck tilt, thoracic inlet angle [TIA], and C2–C7 angle) on the computed tomography scans were measured by 2 independent raters. Inter-rater agreement was tested with a paired sample t test and Bland-Altman plots for each variable. The patients were followed up after 6 months. RESULTSNo systematic differences for the assessed variables were found between the 2 raters. The overall nonrecovery rate was 28%. For the group with low neck tilt, the nonrecovery rate was 50% (95% CI: 36%–78%) and for the group with high neck tilt, 8% (95% CI: 3%–25%). The nonrecovery rate for the group low TIA was 50% (95% CI 29%–72%) and for those with high TIA 14% (95% CI 4%–26%). The associations remained significant after adjustments for possible confounders. The inter-rater analysis shows satisfactory agreement without proportional bias. CONCLUSIONSThis study indicates the existence of an association between the constitutional sagittal alignment of the cervical spine and the outcome after whiplash injuries.

Intervention with an educational video after a whiplash trauma - a randomised controlled clinical trial.

Background and aims Previous systematic reviews have considered that providing patient information is ineffective for patients with whiplash-associated disorders (WAD), with the exception of interventional educational videos. The aim of this randomised controlled clinical trial was to determine if use of an educational video as an intervention in the acute stage after a whiplash injury might improve self-reported recovery at 6 months after the injury. Methods In total, 289 consecutive patients with a whiplash injury following a motor vehicle collision were randomised to an intervention group (educational video) or to a control group (written information sheet). The video focused on information about pain mechanisms, deep flexor physiotherapy and reassurance. Emailed questionnaires were used to collect baseline data within 2 weeks after the accident and then to collect outcome data at 6 months post-injury. Non-responders were followed up with a brief telephone interview regarding the outcome. The primary outcome measure was self-reported recovery (yes/no) at 6 months post-injury. The secondary outcomes measures were pain level according to a numeric rating scale (NRS) and the whiplash disability questionnaire (WDQ) score at the same time point. Results The response rate for the baseline questionnaire was 70% (203/289). The follow-up rate was 97% (196/203). The non-recovery rates were similar between the intervention group, at 37.9% (39/103), and the control group, at 33.3% (31/93) (p = 0.55). No differences between the groups were noted in pain levels, NRS scores (1.9 vs. 2.2, p = 0.35) or the mean WDQ scores (17.5 vs. 21.2, p = 0.42). Conclusions The intervention with the educational video used in this study had no effect on the non-recovery rate when compared to a basic written information sheet. Implications The results of this trial add knowledge to the area of patient education for patients with acute WAD. Further studies are needed before the current recommendations for patient information are modified.

Predictive factors of a non-recovery from sepsis-3: comparison with sepsis-2

Introduction: After living donor liver transplantation (LDLT), the rate of complications of sepsis is one of the causes of poor short-term results. On the other hand, the definition of sepsis was revised from Sepsis-2 using SIRS to Sepsis-3 using SOFA score in 2016. However, there is no report on sepsis onset based on Sepsis-3 in the field of liver transplantation. The aim of this study was to evaluate the non-recovery predictors based on Sepsis-3 after LDLT and to compare the prediction rate with the non-recovery rate of severe sepsis in Sepsis-2. Method: LDLT was performed in 64 patients at our institute. Based on the definition of Sepsis-3, cases with sepsis within 14 days after LDLT were extracted, and the predictors of non-recovery from sepsis were examined. This prediction rate was compared with the non-recovery rate in severe sepsis extracted from the definition of Sepsis-2. Result: Fourteen patients (21.9%) developed sepsis after LDLT. Out of them 5 patients were included in non-recovery. In the non-recovery, the SOFA score at the sepsis onset was significantly higher than recovery(10.8 ± 0.83 vs. 7.3 ± 2.44; p = 0.01) .The number of lymphocytes also tended to be low in the non-recovery. When the high SOFA score (≧ 10) and low lymphocytes (<583.7 /μL) at the sepsis onset were set as the non-recovery predictor from Sepsis-3, the prediction rate was 100%. On the other hand, 15 patients (23.4%) were included in severe sepsis patients defined by Sepsis-2. Out of them 5 cases (33.3%) were non-recovery. The non-recovery predictive rate at the onset of Sepsis-3 was significantly higher than severe sepsis in Sepsis-2 (p = 0.01). Conclusion: The SOFA score (≥10 points) and lymphocyte count (<583.7/μ L) at sepsis onset can predict non-recovery. The non-recovery patients could be predicted more accurately than severe sepsis in Sepsis-2.

Long-term follow-up of whiplash injuries reported to insurance companies: a cohort study on patient-reported outcomes and impact of financial compensation

PurposeThe long-term outcome of Whiplash-associated disorder (WADs) has been reported to be poor in populations from medical settings. However, no trials have investigated the long-term prognosis of patients from medico-legal environment. For this group, the “compensation hypothesis” suggests financial compensation being associated with worsened outcome. The aims of this study were to describe long-term (2–4 years) non-recovery rates in participants with WAD recruited from insurance companies and to investigate the association between self-reported non-recovery and financial compensation.Methods144 participants, reporting neck pain after a motor vehicle accident, were recruited from two major insurance companies in Sweden. Self-reported recovery was measured at 6 months and 2–4 years. Those who received financial compensation from an insurance company were compared with those who received no compensation.ResultsThe overall non-recovery rate after 2–4 years was 55.9% (66/118). In the non-compensated group, the non-recovery rate was 51.0% (25/49) and in the compensated group 73% (27/37) (p = 0.039). Adjusted OR was 4.33 (1.37–13.66). High level of pain at baseline was a strong predictor of non-recovery [OR 46 (4.7–446.0)]. However, no association was found between pain level at baseline and financial compensation.ConclusionsThe non-recovery rate among patients making insurance claims is high, especially among those receiving financial compensation even if causal relationship cannot be determined based on this study. However, lack of association between baseline level of pain and compensation supports the compensation hypothesis.

Assessment of Performance on Community Management of Acute Malnutrition in Wagini OTP Center, Batsari Local Government Area of Katsina State

Community Management of Acute Malnutrition (CMAM) is a community-based integrated approach for management of acute malnutrition. Retrospective and on the spot (present) assessment performance of community management of acute malnutrition program was carried out at Outpatient Therapeutic Programme (OTP) centers in Wagini of Batsari Local Government Area of Katsina State with the aim of assessing the performance of the programme in the locality. Assess coverage and other performance indicators of CMAM programme, biochemical and hematological parameters of children with severe acute malnutrition (SAM) and relapse rate were indices assessed using standard procedures. Point (95.66%), treatment (87.70%) and period (96.26%) were significantly (p&lt;0.05) higher than the 50% (rural coverage) and 70% urban coverage stipulated by the SPHERE standard and there was no significant difference (p&gt;0.05) in the coverage data between the retrospective study and present study. The performance indices: cure rate (93.19%), death rate (5.65%), default rate (13.27%) and non-recovery rate (3%) are classified as good performance when compared with SPHERE standard. There were also no significant differences (p&gt; 0.05) among the performance indices in the retrospective and present study. There was also a notable steady improvement in the growth performance and recovery indices (Mid Upper Arm Circumference Weight for height and Oedema) among the SAM children admitted to the OTP Centers for the 8 week period. Similarly, significant (p&lt;0.05) improvements were recorded in the biochemical and haematological indices determined (Packed cell volume, Haemoglobin concentrations, Serum albumin and glucose concentrations) in both study groups at the point of discharge and the average relapse rates determined for SAM children at wagini OTP center was 10%. From these results, the CMAM programme in Wagini, Batsari LGA of Katsina State is running well in alleviating the SAM burden in the coverage area. There is the need to work with other partners especially World Food Program (WFP) Action against hunger (AAH) for the harmonization and integration of Supplementary Feeding Program (SFP).&#x0D;

COMT genotype and non-recovery after a whiplash injury in a Northern European population

BackgroundThe COMT (Catechol-O-Methyl Transferase) gene may influence a person’s vulnerability to develop long-term pain and some COMT single nucleotide polymorphisms (SNPs) may associate with patterns of acute or chronic pain. Many patients with whiplash-associated disorders (WADs) suffer from long-term pain and other related symptoms, but it is less known if genetic factors play a role in the recovery process. The primary aim of this study was to evaluate whether self-reported non-recovery, including pain, was related to COMT genotype in patients with WAD. The secondary aim was to investigate whether or not background factors, including mental health, were related to genotype and non-recovery.MethodsA total of 133 patients with neck pain after a whiplash trauma were included. Background factors were collected and blood samples were taken during the acute phase after the accident. DNA was isolated from blood and used to genotype the SNPs rs6269, rs4633, rs4818 and rs4680 in the COMT gene; additionally haplotypes were estimated and haplogenotypes inferred. The patients were followed up after 12 months and asked to rate their recovery including pain, mental health and quality of life.ResultsThe overall reported non-recovery rate at 12 months was 44% with no significant differences in distribution of the COMT haplotypes. High levels of self-reported pain (OR 7.2) and anxiety (OR 4.4) after the accident were associated with non-recovery, but not related to the haplotypes. None of the other background factors were related to the haplotypes or non-recovery.ConclusionNo association between self-reported non-recovery or pain levels and COMT haplotypes in patients with acute whiplash injuries could be detected. Independent replications are necessary to discard the hypothesis that COMT haplotypes do not influence non-recovery or pain levels in patients with acute whiplash injuries. High levels of initial pain and anxiety were associated with non-recovery, thereby confirming previously published reports.

The liver recipient with acute renal dysfunction: A single institution evaluation of the simultaneous liver-kidney transplant candidate.

The Organ Procurement Transplant Network (OPTN) listing criteria for simultaneous liver-kidney transplant (SLK) are not well defined. Concerns remain about rising numbers of SLKs, which divert quality kidneys from candidates awaiting kidney transplants (KT). We performed a retrospective review of liver transplants (LTs) at our center from 2004 to 2014; 127 recipients (liver transplant alone; 102 LTA, 25 SLK) were identified with short-term preoperative kidney dysfunction (creatinine >4mg/dL or preoperative hemodialysis [HD] for <6weeks). Both cohorts had comparable baseline demographic characteristics with the exception of higher model for end-stage liver disease (MELD) score in the LTA group (41.4 vs 32.9, P<.0001) and higher incidence of pre-LT diabetes in the SLK cohort (52% vs 26.5%, P=.0176). Duration of pre-LT HD was higher in SLK recipients, but the difference was not statistically significant (P=.39). Renal nonrecovery (RNR) rate in LTA cohort was low (<5%). No significant difference was noted in 1-year mortality, liver graft rejection/failure, or length of stay (LOS) between the cohorts. Thus, it appears that liver recipients with short-term (<6weeks) HD or AKI without HD have comparable outcomes between LTA and SLK. With provisions for a KT safety net, as proposed by OPTN, LTA may be the most adequate option for these patients.

High-dose corticosteroids improve the prognosis of Bell’s palsy compared with low-dose corticosteroids: A propensity score analysis

ObjectiveThe aim of this study was to evaluate the effectiveness of high-dose corticosteroid (120mg prednisolone equivalent daily) in Bell’s palsy compared with low-dose corticosteroid (60mg PSL equivalent). MethodsA single-center retrospective observational study was performed. We included adult Bell’s palsy patients who were treated within 7days after disease onset. We compared high- and low-dose corticosteroid for the non-recovery rate at 6 months after disease onset using inverse probability-weighted propensity score analysis (IPW-PS). ResultsA total of 368 Bell’s palsy patients (281 in the high-dose and 87 in the low-dose group) were included. The non-recovery rate without IPW-PS was 13.8% in the low-dose and 8.2% in the high-dose group. After IPW-PS adjustment, the non-recovery rate was 13.1% in the low-dose and 7.8% in the high-dose group (difference=−5.28%, 95% confidence interval [CI] −12.7% to −2.1%, p=0.040). High-dose corticosteroid decreased the non-recovery rate in severe Bell’s palsy patients with a Yanagihara score of 0–10 (difference=−16.1%, 95% CI −38.5% to −6.2%, p=0.012), but did not decrease in moderate Bell’s palsy patients with a Yanagihara score of 12–18 (difference=−2.0%, 95% CI −11.0% to 7.0%, p=0.591). Subgroup analysis revealed that the efficacy of high-dose corticosteroids was higher when patients were treated within 3days after disease onset, but not when patients were treated at 4days or later after disease onset. ConclusionsPhysicians would be better to treat severe Bell’s palsy patients with high-dose corticosteroids when the patients are treated within 3days after disease onset.

Characteristics of cardio-Cerebrovascular modulation in patients with generalized anxiety disorder: an observational study

BackgroundGeneralized anxiety disorder (GAD) has been shown in previous studies to display abnormal cerebral blood flow velocity (CBFV); however, the characteristics of cardio-cerebrovascular modulation are unknown. We aimed to analyze cardio-cerebrovascular modulation using parameters from a supine-to-standing test.MethodsThere are 2 parts to this study; in Part 1, 125 participants with Hamilton Anxiety scale scores ≥14 were enrolled, and 33 age- and sex-matched medically and psychiatrically healthy volunteers were recruited as control participants. Patients were divided by score into mild, moderate, and severe anxiety groups. The cardio-cerebrovascular modulation using the parameters of dynamic changes of CBFV and heart rate in response to an orthostatic challenge were investigated. In Part 2, we followed up the severe GAD patients for 6 months and repeated the supine-to-standing test, and severe GAD patients were divided into recovery and non-recovery groups.ResultsIn part 1, the GAD group displayed more marked CBFV and heart rate changes than the healthy group, but there was no difference in the CBFV and heart rate changes from the supine to upright position in mild, moderate, and severe anxiety groups. In part 2, The recovery group demonstrated significant improvement in changes in the CBFV and heart rate values from the supine to the upright position after treatment compared with before treatment. In the non-recovery group, the CBFV and heart rate changes were significantly higher than the healthy group regardless of treatment.ConclusionsCardio-cerebrovascular modulation is compromised in patients with GAD, however, this impairment can be restored to normal after the disappearance of anxiety.

Management of acute whiplash: A randomized controlled trial of multidisciplinary stratified treatments

Acute whiplash is a heterogeneous disorder that becomes persistent in 40% to 60% of cases. Estimates of recovery have not changed in recent decades. This randomized, single-blind, controlled trial tested whether multidisciplinary individualized treatments for patients with acute whiplash (<4weeks postinjury) could reduce the incidence of chronicity at 6mo by 50% compared to usual care. Participants (n=101) were recruited from accident and emergency centres and the community. It was hypothesized that better recovery rates were achievable if the heterogeneity was recognised and patients received individualised interventions. Patients randomized to pragmatic intervention (n=49) could receive pharmaceutical management (ranging from simple medications to opioid analgesia), multimodal physiotherapy and psychology for post-traumatic stress according to their presentations. The treatment period was 10wks with follow-up at 11weeks and 6 and 12-months. The primary outcome was neck pain and disability (Neck Disability Index (NDI)). Analysis revealed no significant differences in frequency of recovery (NDI ⩽8%) between pragmatic and usual care groups at 6months (OR 95%, CI=0.55, 0.23–1.29), P=0.163) or 12mo (OR 95%, CI=0.65, 0.28–1.47, P=0.297). There was no improvement in current nonrecovery rates at 6mo (63.6%, pragmatic care; 48.8%, usual care), indicating no advantage of the early multiprofessional intervention. Baseline levels of pain and disability had a significant bearing on recovery both at 6 and 12mo in both groups, suggesting that future research focus on finding early effective pain management, particularly for the subgroup of patients with initial high levels of pain and disability, towards improving recovery rates.