Medical Files Of Patients Research Articles

Pneumatic dilation for the treatment of persistent post-laparoscopic fundoplication dysphagia: long-term efficacy and safety

ABSTRACT Background Post-laparoscopic fundoplication (LF) dysphagia occurs in 5%–17% of patients and optimal management remains a topic of expert discussion. We assessed the efficacy and safety of pneumatic dilation (PD) in patients with persistent post-lLF dysphagia. Methods Medical files of patients treated with PD for persistent post-fundoplication-associated dysphagia were reviewed. The primary outcome was long-term clinical success. Secondary endpoints were initial clinical success, dysphagia recurrence rate, and PD-related complication incidence. Results Overall, 46 patients (74% women, 57.9±11.9 years) underwent 74 PD (mean: 1.6±0.8). A 30 mm, 35 mm, and 40 mm balloon was used in 45.9%, 43.2%, and 10.8%, respectively, of dilations. Among 45 patients with available follow-up, the overall long-term success rate of PD was 31/45 (68.9% [55.4–82.4]). Initial clinical success was 36/45 (80% [68.3–91.7]). Dysphagia recurred in 9 patients (25%; 95%CI 10.9–39.1) and 4 of these were effectively treated with a new dilation. Among 14 non-responders to PD, 11 underwent surgery. Four complications (2 perforations, 1 muscularis dilaceration, and 1 peri-procedural bleeding) occurred in 4 patients (incidence: 5.4% [95%CI; 0.3–10.6]) and were treated with partially covered self-expandable esophageal stents andhemostatic clips. Conclusions Pneumatic balloon dilation for post-fundoplication-associated symptoms is associated with a satisfactory long-term success rate and acceptable safety profile.

Effect of Initial Antibiotic Therapy in Patients with Blunt Abdominal Trauma

Background: Practising the use of antibiotics in emergency surgeries drastically reduces the incidence of post-operative systemic and surgical site infections. There are very few articles about the details of use of antibiotics in abdominal trauma. We studied the effect of preliminary drugs therapy against bacteria in patients with abdominal trauma.
 Methods: From Ma y 2020 to May 2021, we looked back and surveyed the medical files of patients with abdominal trauma in our institution, Krishna institute of medical sciences deemed to be university, Karad. Blunt and piercing abdominal injuries were included in our study
 Results: Data of the 432 patients were accumulated. Antibiotic was initiated in 96.4% of penetrating injury and 79.7% with blunt injury. Initial antibiotics therapy was provided to 78.2% of patients with solid organ injury and 97.5% with hollow viscus injury. On an average of 6 days, antibiotics were given in solid organ injuries, 6.2 days in hollow viscus. Infection within 2 weeks of admission occurred in 50 cases. Infection linked severity of injury, surgery performed and blood transfused. Time for which the antibiotic was given did not affect the rate of infection.
 Conclusion: It was inferred that the antibiotics were used in massive numbers (84.2%) and for prolonged time (6.2 days) in these patients in Karad.

Tinjauan Penolakan Pada Klaim Pasien BPJS Kesehatan di RSUD Tanjung Pura

Rejection of claims is one of the obstacles in the BPJS Kesehatan claim collection process. The purpose of this study was to determine the description of administrative verification on the rejection of BPJS Kesehatan patient claims at Tanjung Pura Hospital. This type of research is descriptive qualitative. The population is all BPJS patient medical record files that were rejected in June 2021 counted 135 files and BPJS Kesehatan claiming officers at Tanjung Pura Hospital, totaling 2 people. The samples of this study were the medical record files of BPJS patients who were rejected in June 2021 and the BPJS claiming officers who were taken by saturated sampling. The instruments used are check list sheets and interview guidelines. Data was collected by using documentation, observation and interview methods. Data analysis was done descriptively. The results showed that there were 123 claim files (2.9%) which were rejected by BPJS Kesehatan from 4,253 claim files submitted. The reason for the rejection of the claim file was because all of them did not pass the verification of the service administration which consisted of the absence of a DPJP signature on the resume and proof of service, no referral letter attached, no inpatient indication/order sheet, and no indication of anesthesia attached to the operation report. This incompleteness is due to the lack of thorough examination of the completeness of the medical record file by the data analysis section and the absence of SOPs in the implementation of the claim process. It is recommended to the hospital director to make an SOP for claiming BPJS Kesehatan and to the claims officer and data analysis to be more thorough in checking the completeness of the BPJS Kesehatan claim file.

In-hospital delay of surgery increases the rate of complicated appendicitis in patients presenting with short duration of symptoms: a retrospective cohort study

Current practice allows for surgery for acute appendicitis to be delayed up to 24h in the belief that there will be no increase in complicated appendicitis rates. We evaluated the combined effect of Patient Time (between symptom onset and hospital admission) and Hospital Time (between hospital admission and surgery) on the surgical outcome. We hypothesized that in patients with a short Patient Time, increased Hospital Times will be associated with a higher rate of complicated appendicitis, even in patients operated within 24h. Retrospective evaluation of medical files of patients operated for acute appendicitis between 12/2006 and 12/2016. Of 2749 patients with acute appendicitis included in this analysis, 818 (29.8%) were admitted with symptom onset the same day as admission, 577 (21.0%) reported symptom onset had started the previous day but less than 24h before admission, and 1354 (49.3%) had over 24h of symptoms. In patients with symptom onset the same day, a gradual increase in the rate of complicated appendicitis was noted with increasing Hospital Times (≤ 6h-6.3%; 6-12h-9.9%; 12-18h-14.7%; and 18-24h-12.7%; p = 0.017). In all other patients no differences in the rate of complicated appendicitis were noted as long as the patients were operated within 24h of admission. In patients with a short Patient Time, delaying operation is associated with an increased rate of complicated appendicitis and this group of patients should be prioritized for early surgery. Study registered as ClinicalTrials.gov Identifier: NCT04689906 ( https://clinicaltrials.gov/ct2/show/NCT04689906?term=ashkenazi+itamar&draw=2&rank=2 ).

Sexual function in adult females after feminizing genitoplasty for congenital adrenal hyperplasia

To investigate sexual function and subjective attitudes towards surgery in adult women after feminizing genitoplasty (FG) for congenital adrenal hyperplasia (CAH). We retrospectively reviewed the medical files of patients who underwent FG from 1996 to 2018. Of those, patients older than 16 years of age were asked to answer non-standardized questions aiming at the awareness of genital surgery and standardized questionnaire evaluating sexual function (GRISS). The anonymized answers were compared to a control group of 50 healthy females. Student's t-test, Pearson's χ2 test, Fisher's exact test and Spearman's rank correlation coefficient were performed. A P-value less than 0.05 was considered significant. Out of 106 patients who underwent FG, 64 were included, 55 successfully contacted and 32, aged 17-40 years (median 25.5), answered the questionnaires (58% response rate). In all, 11 patients underwent historical clitorectomy in early childhood by a pediatric gynecologist before 1996 and pull-through vaginoplasty at puberty. A total of 21 patients underwent modern one- or two-staged FG. There were statistically significant differences between the CAH group and controls as to the proportion living in committed partnerships (28% and 84%, respectively; p=0.0000), having sexual intercourse (41% and 92%, respectively; p=0.0000) and having their own children (13% and 36%, respectively; p=0.0369). The median overall GRISS score was 4 (range 1-7) in the CAH group compared to 1 (range 1-9) in the control group, with infrequency and vaginismus representing the least favorable subscales (median 5). In all, 81% of the women operated on for CAH would recommend such an operation to any other individual with CAH and 66% of them suggested the surgery should be performed in early childhood. By this study we have contributed to the debate over suggestions that FG may cause adverse effects on sexual life of the patients in adulthood, beside already published effects on their mental well-being and LUTS. Despite possible selection bias due to only 58% response rate the comparison with control group shows only a moderate sexual dysfunction and more significant impact on long-term partnership that might be caused by other factors related to CAH beside FG itself. Partnership, offspring, sexual frequency and function were impaired in adult females with CAH after FG. However, the median GRISS score was below the pathological level of 5.

POS-844 Prevalence and associated factors for renal dysfunction in hospitalized patients with COVID-19 pneumonia

A significant link has been reported between COVID-19 disease and renal dysfunction. This study investigated the prevalence and correlated factors for renal impairment in hospitalized patients with COVID-19 pneumonia This retrospective study examined medical files of patients with confirmed severe COVID-19 pneumonia that had available serum creatinine results. The outcome variable was renal dysfunction that was defined as increased serum creatinine above the upper limit of normal range (ULNR). Factors significant at 10% level in bivariate analyses were considered in a multivariate logistic regression analysis to produce adjusted odds ratios and their 95% confidence intervals. In total, 179 patients were included in the study and the mean age was 58 years (SD 16.5) and 49% were female. The main admission comorbidities were hypertension (50.0%), diabetes mellitus (28.6%), HIV/AIDs (21.9%) and chronic kidney disease (7.6%). The prevalence of renal impairment was 51.9%. Renal impairment was significantly higher in males vs. females (59.3% vs. 44.3%, p=0.044) and in patients with underlying hypertension (60.5% vs. 39.9%, p=0.039). After adjusting for age, male gender, underlying CKD, diastolic blood pressure, and raised white cell count, hypertension was an independent predictor of renal impairment with a 1.53 (95% CI [1.03-2.26], p=0.033) odds ratio. The study shows that renal dysfunction is common in hospitalized patients with severe COVID-19 pneumonia and hypertension is a positive independent predictor of renal impairment.

No common peroneal nerve palsies found after a peroneal nerve release prior to TKA in fixed valgus deformities (a retrospective cohort study).

The main purpose of this study was to analyse the incidence of Common Peroneal Nerve Palsy (CPNP) after Total Knee Arthroplasty (TKA) for all alignments. Secondarily, the efficiency and safety of a Peroneal Nerve Release (PNR) prior to TKA in preoperative severe fixed valgus deformities were evaluated to prevent a CPNP. Overall, 7612 TKAs were performed in the institution from 2009 to 2021. 1913 TKAs were performed by three surgeons, who consistently performed a PNR in case of a fixed valgus deformity of (1) more than 15°, or (2) more than 10° but in combination with a flexion contracture of more than 15°. Patients with fixed valgus deformities of more than 10° were identified (81 knees) and a comparison was made between the patients who received a PNR (26 knees) and those who did not receive a PNR (55 knees). Data for the analysis were collected from patient medical files and were compared with the Chi2-test or Fisher Exact test. A CPNP incidence of 0.2% (16/7612) was found after TKA for all alignments together. No CPNP cases (0%) were developed in the PNR-group, compared to five (9%) in the non-PNR group (p = NS). A larger preoperative valgus angle (17° vs 13°, p < 0.001) and flexion contracture (10° vs 3°, p < 0.001) was present in the PNR group compared with the non-PNR group. No PNR-related complications were reported. The CPNP incidence in this study is consistent with the previous literature. Furthermore, although not significant, the group that received a PNR procedure developed fewer CPNPs compared to the group without PNR. Retrospective cohort study, III.

Optimalisasi Pengelolaan Berkas Rekam Medis Pasien pada Puskesmas Dasan Agung

Dasan Agung Public Health Center is one of the health service agencies in the city of Mataram. The Dasan Agung Health Center has 5 polyclinics, namely General Poly, Dental Poly, Children's Poly, and Maternal and Child Health Poly. Currently, the data processing of patient medical record files at the Dasan Agung Public Health Center is still done manually. This condition makes the patient's medical record file management system not practical and efficient, because the patient's medical record file is still possible to be tucked or scattered. To overcome the problems faced, the Dasan Agung Public Health Center needs an effective and efficient information system to optimize the management of patient medical record files at the Dasang Agung Public Health Center.

Epidemiological and Clinical Aspects of Acute Intoxications in Children Between 1 Month and 15 Years in the Paediatric Emergency of the UHC Gabriel Toure

<i>Introduction:</i> Defined by the WHO as all the pathological manifestations following ingestion of food or the administration of products or drugs behaving like a poison in the body, acute intoxication is a growing problem. serious in pediatrics, in developing countries because of their frequency and the difficulties of care. In Mali, poisoning in children is very poorly assessed, in part due to the lack of popularization of poison control and pharmacovigilance centers. The objective of our study is to study the epidemiological and clinical aspects of acute poisoning in children in the emergency department of the pediatric department of the Gabriel Touré University Hospital. <i>Material and methods:</i> We carried out a retrospective, cross-sectional and descriptive study from January 2016 to December 2018, or a period of 3 years. It concerned children from 1 month to 15 years old hospitalized in the pediatric emergency room of the Gabriel Touré University Hospital for proven acute poisoning. The data were collected by: a pre-established individual survey form, information contained in the medical files of patients after the approval of the Head of the Department. <i>Results:</i> During our study period, 80 children were hospitalized for acute poisoning out of a total of 5,437, a frequency of 1.47%. The sex ratio was 1.3. The 13-48-month age group accounted for 65% of cases. The patients themselves were responsible for their poisoning in 74.2% of cases. Poisoning by unspecified drugs accounted for 25% of cases. The oral route represented 92.4% of the poisoning routes. Ingestion of milk (29.9%) and oil (6.3%) were the most common actions for parents. Vomiting with 35% and respiratory distress with 35% were the most frequent manifestations. The mean hospital stay was 3.5 days (50%). In 50% of cases, death occurred within the first 24 hours. <i>Conclusion:</i> Poisoning remains a common occurrence in our department, mainly linked to several medicines and household products.

Siğil Tedavisinde Kriyoterapinin Başarısını Etkileyebilecek Faktörlerin Değerlendirilmesi: Retrospektif Kesitsel Bir Çalışma

Objective: Success of the treatment of warts with cryotherapy differs from patient to patient. We aimed to evaluate how the age and gender of the patient, the type, number, duration, localization of warts and cryotherapy session intervals affect the success of treatment. Material and Methods: After ethics committee approval had been received, the medical files of patients with diagnosis of wart, between June 2016 and June 2019, were analysed retrospectively. Demographic and clinical features of patients were recorded. Patients who did not improve clinically after 6 sessions were considered resistant to treatment. Demographic and clinical features were compared between treatment resistant and non-resitant groups by using SPSS 17 (Chicago, IL, USA), twosided p value 10 mm were compared and resistance rates were found respectively 14.7%, 31.5%, 60%. Difference between subgroups was statistically significant (p=0.01). The mean age, lesion localization, lesion number, verruca subtype, duration of the disease and the session intervals for both groups were found similar (p>0.05). Conclusion: Treatment success was found to be lower in women and in patients with larger warts.

A graph based recommender system for managing Covid-19 Crisis

The paper aims to present a graph based recommender system for managing the Covid-19 crisis by considering patient and medical staff data. Working with limited number of medical staff, require optimization when creating the appropriate medical staff to assist patient. Patient medical files usually contain more information about the patient diseases and symptoms. In this paper the recommender system at first analyses the patient medical files to find and decide which profile of medical staff could assist efficiency this patient in a crisis situation. Second the recommender system by taking into account the availability of the medical staff will try to propose others doctors with the same profile and the nearest competencies.

Post-emergency teleconsultations during COVID crisis: TELE-SCOPE tool's feedback and epidemiological analysis.

IntroductionThe severe acute respiratory syndrome-coronavirus 2 pandemic spread quickly. Health professionals are facing new challenges and looking for new ways to provide care in the context of lockdown and physical distancing. The Saint Vincent de Paul Hospital has leveraged its recent post-emergency teleconsultation solution (TELE-SCOPE), to address some COVID situations. Thanks to the usual follow-up teleconsultation within 24 h after their emergency discharge and the introduction of an additional one six days after, the eligible patients are able to return home earlier. This article provides feedback on how teleconsultation helps manage such a crisis. We also present an analysis of the treated population.Materials and methodsThe study includes the cases of 239 patients presenting symptoms of COVID-19 infection with a COVID score <4 over a period from 16 March to 11 May 2020. These were patients from the emergency department (ED) or COVID units. We based our analysis on the patient's medical files and an individual survey.ResultsOne hundred and eighty-four teleconsultations (with video) and 143 phone calls were carried out. By the end of the teleconsultations, 92.9% were getting better and did not need further follow-up, 5.9% were reconvened to the ED, and 2.5% were hospitalized. No patient died, nor did get hospitalized in intensive care. In total, 95.6% are strongly or rather satisfied with the care provided by teleconsultation and 87.7% of patients are ready to reuse TELE-SCOPE as a means of monitoring in the context of the epidemic.ConclusionThe teleconsultations are efficient and safe to follow patients with confirmed or suspected non-severe COVID infection (COVID score <4) after discharge from the emergency room or hospitalisation. It protects the patients and practitioners. The patient's satisfaction is high.

Olecranon Fractures in Children: About 21 Cases Treated at the Owendo University Hospital Center at Libreville (Gabon)

Background: The olecranon fractures in children are relatively rare articular fractures. The aim of this work is to study the epidemiological, clinical and therapeutic particularities of this fracture in children at Owendo University Teaching Hospital. Patients and Methods: This was a retrospective analytical, monocentric study over 2 years from January 1, 2018 to January 1, 2020 at the Owendo University Hospital in Libreville and relating to the medical files of patients treated for a fracture of the olecranon in children in the service and regularly followed in outpatient consultation. Results: We collected 21 patients with an average age of 8.7 years. Falls dominated the etiologies. The Bracq classification was the one used in our series with the predominance of type D. The treatment was orthopedic in 33.3% of cases and surgical in 66.7% of cases. With an average follow-up of 12 months, the results were good in 71.5%, average in 19.0% and poor in 9.5%. Conclusion: The analysis of our results compared to those of the authors of the literature according to the precise parameters seems satisfactory.

Renal Risk among Diabetic Patients in Togo

Background: Diabetic patients have risk of kidney disease. The aim of this study was to assess the level of renal risk in our study population and to identify the associated predictive factors. Methods: It was a descriptive and analytical cross-sectional study carried out over 5 years (January 1, 2016 to December 31, 2020). All patients were included regardless of the duration of diabetes and having achieved at least one serum creatinine and at least two (2) proteinuria in the 24 hours over a period of at least three months. The level of renal risk was assessed using the KDIGO 2012 classification. Results: A total of 320 patient medical files were retained. The sex ratio M/F was 1.2. The average age was 57.2 ± 11.8 years. Hypertension was the most common comorbidity (84.4%). Diabetic nephropathy was found in 177 patients, a frequency of 42.8%. The very significant renal risk was found in 174 patients (54.4%). In multivariate logistic regression, the risk factors significantly associated with renal risk were: Male sex (OR = 2.50; 95% CI = 1.29 - 4.84, p-value = 0.006); microangiopathy (OR = 5.54; 95% CI = 1.82 - 16.85 p = 0.002) and beta-blockers (OR = 5.64; 95% CI = 1.04 - 30.53 p = 0.004). The Oral Antidiabetes (OR = 0.23; 95% CI = 0.10 - 0.55, p = 0.001), the blockers of Renin-Angiotensin system (OR = 0.58; 95% CI = 0.41 - 0.90, p = 0.040) and the average socioeconomic level (OR = 0.50; 95% CI = 0.25 - 0.98, p = 0.044) were rather the protective factors.

Incidence and risk factors associated with development of oxalipatin-induced acute peripheral neuropathy in colorectal cancer patients.

Oxaliplatin utilized in colorectal neoplasms treatment could induce acute peripheral neuropathy (APN) which is a dreadful and frequent adverse event. The objective of this study is to estimate incidence of APN induced by oxaliplatin cumulative incidence in cancer patients colorectal and to describe the distribution of the APN incidence according to demographic and clinical characteristics, as well as according to oxaliplatin cumulative dose. This is a prospective descriptive study which took place from June to December 2018 at the Salah Azaiz Institute, Tunis. Demographic data, clinical data and data on oxaliplatin administration were collected from patient interview, medical files and pharmaceutical databases. The APN (grade 1, grade 2 and grade 3) cumulative incidence during the period of six months of follow up was 86% (95% CI [0.7815-0.9132]). While 38.3% (95% CI [0.29-0.48]) of the patients had grade 2 or 3 neuropathy. The search for factors associated with the risk of grade 2 and 3 NAP revealed trend significant association with diabetes (adjusted RR = 5.7 (IC95% [0.9- 37.3]; p = 0.07). Moreover, there was significant association with oxaliplatin cumulative dose (≥421 mg/m2) to increase the risk of APN grade 2 and 3 (adjusted RR = 7.8; [2.7-22.7]; p = 0.0001). Furthermore, significant association with obesity to increase the risk of APN grade 2 and 3 (adjusted RR = 5.3 [1.1- 25.4]; p = 0.04) was found. Among the patients included, 31.1% experienced oxaliplatin dose reduction and in the majority of cases this reduction is due to neurotoxicity (90.9%). The high incidence of oxaliplatin-induced APN remains an embarrassing and handicapping side effect. Our study has shown that oxaliplatin cumulative dose (≥421 mg/m2), diabetes and obesity are risk factor for the development of grade 2 and 3 APN.

Pigmented demodicidosis - an under-recognized cause of facial hyperpigmentation.

There is a paucity of data regarding demodicidosis-associated facial hyperpigmentation. To delineate the clinical, dermoscopic, and histopathologic features of demodicidosis-associated facial hyperpigmentation. Clinical and diagnostic data were collected from the medical files of patients who were referred to our outpatient dermatology clinic in 2006-2019 for evaluation of facial hyperpigmentation and were diagnosed with demodicidosis. The cohort included 19 patients (13 male) aged 42-76 years, all with Fitzpatrick skin type 3-4. All presented with mostly asymptomatic dusky, brown-gray, facial pigmentation, localized or diffuse with background erythema in 36.8% of cases, and skin roughness in 26.3%. Dermoscopy yielded characteristic findings of white gelatinous or opaque protrusions from hair follicles or infiltration of follicular openings with an amorphic material. A specific finding was perifollicular and reticulated pigmentation of the affected areas. Findings were confirmed on microscopic (n = 7) and histopathologic (n = 5) studies. Anti-demodectic treatment led to complete (73.6%) or partial (23.4%) resolution of pigmentation within 2 years. We describe unique clinicopathological and dermoscopic findings associated with an under-recognized type of facial hyperpigmentation caused by demodex for which we propose the term "pigmented demodicidosis." Demodicidosis should be added to the list of causes of facial hyperpigmentation.

Vancomycin-resistant enterococcus bacteraemia in an endemic region: clinical features and genomic analysis: a 12-year cohort

Vancomycin-resistant enterococci (VRE) are important nosocomial pathogens with increasing prevalence worldwide. Hospitals in Jerusalem, Israel are known to have high rates of VRE carriage. However, the clonicity of this pathogen in endemic areas remains unclear. The medical files of patients with VRE bacteraemia (N=182) hospitalized in the three major hospitals in Jerusalem between 2009 and 2020 were reviewed. These were compared with 100 patients with vancomycin-susceptible enterococcus (VSE) bacteraemia during the same period, and their clinical and demographic characters were analysed. Whole-genome sequencing (WGS) of the VRE isolates was performed, and the results were analysed considering the demographic, epidemiologic and clinical outcome data. Patients with VRE bacteraemia had higher rates of central line use, haematologic malignancy and immunosuppression compared with patients with VSE bacteraemia (63% vs 27%, P<0.001; 25% vs 13%, P=0.02; 24% vs 13%, P=0.04, respectively). Patients with VRE bacteraemia had significantly higher 7- and 30-day in-hospital mortality rates (31% vs 18%, P= 0.02; 57% vs 34%, P<0.001, respectively) and a longer mean hospital stay (39 vs 24 days, P=0.005) than patients with VSE bacteraemia. The WGS results of VRE isolates showed diversity rather than endemicity of a single clone. No clones were associated with specific ethnicity, geographical distribution or worse prognosis. WGS revealed the occurrence of small unrelated outbreaks rather than the expansion of large clusters in Jerusalem. VRE bacteraemia was found in sicker patients, and was associated with higher mortality and longer hospitalization compared with VSE bacteraemia.

Higher need for removal of osteosynthesis material after multi-piece versus one-piece Le Fort I osteotomy: A retrospective study of 339 patients

The aim of the present study was to identify the risk factors for removal of osteosynthesis material after multi-piece Le Fort I osteotomy compared to standard one-piece Le Fort I osteotomy (LF1).Medical files of patients treated with multi-piece or one-piece LF1 were retrospectively reviewed, including the indication for removal and time between insertion and removal. A total of 339 patients were included: 290 patients with LF1 and 49 patients with multi-piece LF1.Patients undergoing multi-piece LF1 had 2.7-times significantly higher (p < 0.001) relative risk of osteosynthesis removal in the upper jaw (42.9%) than patients undergoing LF1 (15.9%). Significant independent predictors of removal of osteosynthesis material after multi-piece LF1 were older age (odds ratio [OR] 1.1, 95% confidence interval [CI] 1.0–1.2; p = 0.028), simultaneous bilateral sagittal split osteotomy (OR 7.8, 95% CI 1.2–50.3; p = 0.031), and no previous surgically assisted rapid palatal expansion (OR 0.14, 95% CI 0.03–0.69; p = 0.15).Significantly higher removal rates of osteosynthesis material were found after multi-piece LF1. Therefore, all patients must be informed of the higher risk for removal of osteosynthesis material when undergoing a multi-piece LF1.

Management of Intraocular Inflammatory Disease

Background: Intra ocular inflammatory disease is a broad-spectrum eye inflammatory condition. Objective: To evaluate various management protocols for Intra ocular inflammatory disease. Study Design: Retrospective study Place and Duration of Study: Department of Ophthalmology, Lorallai Medical College, Loralai from 1st January 2020 to 31st March 2021. Methodology: One hundred and twenty medical files of patients with various intra ocular inflammatory diseases were recruited. Patients were managed by various pharmacological drugs including corticosteroids, second line agents, anti-metabolites as well as biologics (anti-TNF-alpha) therapy. Results: There were 45% females while 55% were males. The mean age of the patients was 45±4.4 years. Majority of the patients were within 41-50 years with 37.5% followed by those &gt;50 years of age. Corticosteroids were efficient in 50% of patients with intra ocular inflammatory disease as a secondary condition while azathioprine in 75% patient and tacrolimus 93.4% patients. Conclusion: Second line agents and antimetabolites have higher prevalence of acceptance and efficacy in managing intra ocular inflammatory disease. Keywords: Management, Intraocular inflammatory disease, Broad spectrum

High prevalence of malaria in a non-endemic setting among febrile episodes in travellers and migrants coming from endemic areas: a retrospective analysis of a 2013\u20132018 cohort

BackgroundThe study aimed to analyse the likelihood of imported malaria in people with a suggestive clinical picture and its distinctive characteristics in a hospital in the south of Madrid, Spain.MethodsObservational retrospective study that consisted of a review of all medical files of patients with any malaria test registered at Móstoles University Hospital between April 2013 and April 2018. All suspected malaria cases were confirmed by Plasmodium spp. polymerase chain reaction (PCR).ResultsOf the 328 patients with suspected malaria (53.7% migrant-travellers; 38.7% visitors; 7.6% travellers), 108 cases were confirmed (101 by Plasmodium falciparum), accounting for a 33% positive sample rate. Sixteen cases were diagnosed only by PCR. Patients with malaria, compared to those without, presented predominantly with fever (84% vs. 65%), were older (34 vs. 24 years), sought medical attention earlier (17d vs. 32d), had a greater number of previous malaria episodes (74% vs. 60%), lower levels of platelets (110,500µL vs. 250,000µL), and higher of bilirubin (0.6 mg/dL vs. 0.5 mg/dL). Severe malaria was present in 13 cases; no deaths were recorded. Malaria diagnosis showed a bimodal distribution with two peaks: June to September and November to January.ConclusionsMalaria is still a common diagnosis among febrile patients coming from the tropics specially among migrant travellers. Fever, thrombocytopenia, and/or high bilirubin levels should raise suspicion for this parasitic infection. Prompt diagnosis is crucial to avoid severe cases and deaths.