Retrospective Descriptive Observational Study Research Articles

Surgical Etiology of Respiratory Distress in Infant and Short Term Outcome at Benghazi Children Hospital (2017-2018)

Background: Respiratory distress (RD) is a common problem in newborns immediately following birth. It is often seen during the transition from fetal to neonatal life. Aims: This study was conducted to demonstrate the surgical causes of respiratory distress in infants admitted to paediatric surgical department of Benghazi Children Hospital and to describe the short term outcome of the sample. Methodology: A retrospective observational descriptive cross section study was done to achieve the aims of this study. Results: A sample of (50) children admitted with respiratory distress due to congenital anomalies, the age range of the sample was from one day to one year, male were (70%) and females and (30%). Residency (20%) from Benghazi and (80%) from outside Benghazi. Normal delivery was reported in52% of the cases and (48%) C/S, (86%) were born at term and (14%) preterm. The mean weight of the cases was (3.38) (±1.91) kg with minimum of (2) kg and maximum (10) kg. TOF in (52%), diaphragmatic hernia in (40%) and lung emphysema in (8%). Clinical presentation of the cases was mainly with respiratory distress in (84%), while (16%) presented with frothy secretion, ultrasound scan was done to (88%) and was normal. Echocardiogram was normal, atrial septal defect in (16%), ventricular septal defect in (14%), patent ductus arteriosus in (8%). (80%) were operated. Death was recorded in half of the cases. Cases with TOF were in total (26) cases of them (17) died and (9) survived, diaphragmatic hernia cases were (20), of them (12) discharged and (8) died, all cases of congenital lobar emphysema discharged. This association was highly significant Fisher`s (exact=6.9 P=0.005). all preterm neonate died (seven cases) and those who were term were in total (43) of them (25) survived and (18) died, Fisher`s (exact=10.85 P=0.005). Cases who were presented with respiratory distress were in total (42) of them (18) died and (25) discharged, while cases who presented with frothy secretions ....

Evaluation of Drug Interactions in Hospitalized Patients with Respiratory Disorders in Greece

Background: Patients with respiratory disorders often have additional diseases and are usually treated with more than one medication to manage their respiratory conditions as well as additional comorbidities. Thus, they are frequently exposed to polypharmacy (≥5 drugs), which raises the risk for drug-drug interactions (DDIs) and adverse drug reactions (ADRs). In this work, we present the results regarding the prevalence of DDIs in hospitalized patients with respiratory disorders in Greece. Methods: A 6-month descriptive single-center retrospective observational study enrolled 102 patients with acute or chronic respiratory disorders. Clinical characteristics and medication regimens were recorded upon admission, hospitalization, and discharge. The prevalence of DDIs and their clinical significance was recorded and analyzed. Results: Unspecified acute lower respiratory tract infection (25%), exacerbations of chronic obstructive pulmonary disease (12%) and pneumonia (8%) were the most frequent reasons for admission. Cardiovascular disorders (46%), co-existing respiratory disorders (32%), and diabetes (25%) were the most prevalent comorbidities. Polypharmacy was noted in 61% of patients upon admission, 98% during hospitalization, and 63% upon discharge. Associated DDIs were estimated to be 55% upon admission, 96% throughout hospitalization, and 63% on discharge. Pharmacodynamic (PD) DDIs were the most prevalent cases (81%) and referred mostly to potential risk for QT-prolongation (31.4% of PD-DDIs) or modulation of coagulation process as expressed through the international normalized ratio (INR) (29.0% of DDIs). Pharmacokinetic (PK) DDIs (19% of DDIs) were due to inhibition of Cytochrome P450 mediated metabolism that could lead to elevated systemic drug concentrations. Clinically significant DDIs characterized as "serious-use alternative" related to 7% of cases while 59% of DDIs referred to combinations that could be characterized as "use with caution-monitor". Clinically significant DDIs mostly referred to medication regimens upon admission and discharge and were associated with outpatient prescriptions. Conclusions: Hospitalized patients with respiratory disorders often experience multimorbidity and polypharmacy that raise the risk of DDIs. Clinicians should be conscious especially if any occurring arrhythmias, INR modulations, and prolonged or increased drug action is associated with DDIs.

Conjunctivitis Patients in the Ophthalmology Outpatient Clinic Dr. Soetomo General Academic Hospital, Surabaya, in 2017

Highlights:1. Ginger (Zingiber officinale) has antimicrobial activity against UPEC which commonly causes UTI in women.2. The MIC and MBC of ginger against UPEC in this study was 1000 mg/ml. AbstractIntroduction: Conjunctivitis is a self-limiting disease. It can be diagnosed through clinical signs found in the eye examination. The purpose of this study was to define the characteristics of conjunctivitis patients in the ophthalmology outpatient clinic Dr. Soetomo General Academic Hospital, Surabaya, in 2017.Methods: This was a retrospective descriptive observational study of all conjunctivitis patients from the medical history in the ophthalmology outpatient clinic Dr. Soetomo General Academic Hospital, Surabaya, in 2017.Results: There were 497 patients included in this study. Most patients with conjunctivitis were 0-9 years old (19.32%). The most common sign of conjunctivitis was conjunctival hyperemia (80.89%), followed by eye discharge (24.14%), eyelid edema (8.05%), blepharospasm (5.63%), and papillary hypertrophy (5.03%). Most cases of conjunctivitis were bilateral (58.75%). Conclusion: The majority of conjunctivitis was bilateral conjunctivitis. It commonly affects children under ten years old. The most typical finding was conjunctival hyperemia.

Study of The Use of Antibiotics in Meningoencephalitis Patients at Dr. Soetomo Hospital in 2019—2020

Background: Encephalitic meningitis became the 17th ranked disease in Indonesia in 2007, with a mortality proportion of 0.8%. Every patient with suspected encephalitic meningitis needs to be given antibiotics as empiric therapy while waiting for the results of the culture from the lumbar puncture. In fact, the administration of these antibiotics cannot be separated from the risk of resistance, so monitoring and evaluation is needed in administering antibiotics to patients to prevent resistance. This study aims to determine patient profiles, patterns, and appropriateness of antibiotic use in meningitis and/or encephalitis patients at RSUD DR. SOETOMO in 2019— 2020. This is a retrospective observational descriptive study with a total of 82 medical records in patients diagnosed with meningitis and/or encephalitis who were given antibiotics as empiric therapy at RSUD DR. SOETOMO in 2019— 2020. The age of the patients from the 82 data obtained varies quite a bit, but the final elderly aged 56-65 years had the highest number, namely 16 of 82 patients (20%). Then, the sex of the most patients was found in male sex with a total of 49 of 82 with a ratio of men and women was 3:2. Most of the patients final conditions were found in the final condition of death with a total of 42 of 82 patients (51%). All of the antibiotics used were Ceftriaxone by injection route in 12-hour intervals. The most frequently used dose was 2 grams (89%), and the most frequently used duration was 7 days (21%). The results of the Gyssen method analysis showed that there were 78 (95%) I category, 1 (1%) IIIa, and 3 (4%) IIIb. DDD per 100 days of hospitalization in this study was 66.2 DDD/100 days of hospitalization. The majority of meningitis and/or encephalitis patients had a final elderly age of 56-65 years, were male, and died in the final condition. Empiric antibiotics were used entirely with Ceftriaxone intravenously at 12 hourly intervals. Most of the antibiotics are given within 7 days and the dose is 2 grams. The results of the analysis found that 95% of the use of antibiotics was already appropriate.

Clinical Profile of Peripheral Arterial Disease Inpatients at Dr. Soetomo General Hospital Surabaya from 2019-2021

Background:</strong> As one of the leading causes of vascular morbidity and mortality, peripheral arterial disease (PAD) remains one of the most underdiagnosed and undertreated atherosclerotic diseases. The relatively high prevalence of PAD combined with an aging population, increasing burden of chronic diseases, and poor control of risk factors will contribute to poorer clinical outcomes in the coming decades. <strong>Objective:</strong> This study aims to identify the clinical profile of PAD inpatients at Dr. Soetomo General Hospital Surabaya in 2019 – 2021. <strong>Material and methods:</strong> This study is a retrospective observational descriptive study using the total sampling technique to acquire data from patients medical records and arteriography reports diagnosed as PAD, which confirmed by arteriography examination at Dr. Soetomo General Hospital Surabaya during January 2019 - July 2021. <strong>Results:</strong> Among 74 PAD inpatients included, PAD was more prevalent in men (52.7%) than in women. The most commonly affected age group above the age of 45. Duplex ultrasonography examination reported triphasic waveform was the most commonly found waveform on the left (33.8%) and right (39.2%) lower extremities with the left common femoral artery (55.4%) and right common femoral artery (52.7%) lower as the disease location. Arteriography examination reported complete total occlusion on the left (44.6%) and right (41.9%) lower extremities with femoral artery (51.4%) as the disease location. Critical limb ischemia (70.3%) was the most found clinical presentation among the patients. Antiplatelet agents (93.2%) were the most prescribed pharmacological agent among the patients with PAD. Patients with PAD on average were hospitalized for 6.76 days. <strong>Conclusion:</strong> This study discovered that the vast majority PAD inpatients were men over the age of 45, with the femoral artery being the most common location for PAD lesion.

Mapping the Spatiotemporal Distribution of Bovine Rabies in Colombia, 2005-2019.

Introduction: Rabies is caused by a virus belonging to the genus Lyssavirus and family Rhabdoviridae, which can infect any mammal including humans. Hematophagous, fructivorous, and insectivorous bats have become the main reservoir of sylvatic rabies in Latin America. In the sylvatic cycle, hematophagous bats are usually the main reservoir. In contrast, dogs and cats fulfil this critical role in the urban cycle. However, in rural areas, the most affected animals are bovines. They show clinical signs such as behavioural changes, hypersalivation, muscle tremors, spasms caused by extensive damage to the central nervous system, and death from respiratory paralysis. Objective: To describe the spatiotemporal distribution of bovine rabies in Colombia from 2005 to 2019. Methods: Retrospective cross-sectional descriptive observational study, based on the monthly reports of the Colombian Agricultural Institute (ICA) on the surveillance of bovine rabies in Colombia from 2005 to 2019, retrieved from its official website. The data were converted to databases in Microsoft Access 365®. Multiple epidemiological maps were developed with the GIS software Kosmo RC1® 3.0 coupled to the shape files (.shp) of all the country’s municipalities. Results: During the study period, 4888 cases of rabies were confirmed in cattle, ranging from a peak of 542 cases (11.1%) in 2014 to 43 in 2019 (0.88%). From 2014 to 2019, there has been a significant reduction in the annual national number of cases (r2 = 0.9509, p < 0.05). In 2019, 32.6% of the cases occurred in January, and 48.8% occurred in the department of Sucre. In 2009, the maximum number of spatial clusters (13) occurred in the Orinoquia region, where other clusters were also identified in 2005, 2006 and 2008. In 2018, 98 outbreaks were identified that led to the death of cattle and other animals, 28.6% of them in the department of Sucre. In the first half of 2019, of 38 outbreaks, 55.2% were identified in Sucre. Conclusions: It is necessary to review the current national program for the prevention and control of rabies in cattle, incorporating concepts from the ecology of bats, as well as the prediction of contagion waves of geographical and temporal spread in the context of the OneHealth Approach. Sylvatic rabies remains a threat in Colombia that requires further study.

Impacto clínico en el hombro luego del uso de clavos endomedulares para tratamiento de fracturas diafisarias de húmero

BackgroundIntramedullary fixation is a frequently used option for the management of proximal and diaphyseal humeral fractures. The biomechanical advantages of this fixation method are known, in addition to the preservation of soft tissues and periosteal irrigation. However, in clinical practice, the postoperative follow-up reveals that some patients develop symptoms associated with shoulder pathology, such as subacromial pain, decreased flexion and abduction strength. MethodsA retrospective descriptive observational study was conducted, evaluating 25 adult patients with humeral shaft fractures treated with antegrade intramedullary nailing. Follow-up was performed 12 months after the procedure, assessing functional range of motion and DASH score, pain by visual analog scale (VAS) and subacromial impingement tests (Yocum, Neer, and Hawkins–Kennedy). ResultsAll patients achieved adequate antegrade flexion with a mean arc of 145° (±31), a DASH score with a mean of 6.1 (±8.5), and a VAS score of 2 (±2.6). 64% of the patients did not present any clinical sign of subacromial impingement. ConclusionWe conclude that in this group of patients, osteosynthesis with humeral intramedullary nails did not have a significant clinical impact on the shoulder in terms of range of motion and symptoms of impingement.

The incidence of self-harm ingestions in adolescents and young adults at a tertiary care center

BackgroundThere has been an increasing incidence of self-harm attempts in recent years in the United States. Particularly concerning, there has been a growing trend of self-harm in the adolescent and young adult population. In order to inform initiatives to address this trend, risk factors and substances used for self-harm need to be clarified. MethodsThis is a descriptive retrospective observational study on all cases of self-harm poisoning in patients between the ages of 12 and 25 years reported at the state's only tertiary care center from January 2019 through March 2022. ResultsThere was an increased incidence of 69% for self-harm poisonings for all ages and a 90% increase in ages 12–17 years between the years 2019 and 2021. Fifty percent of all cases occurred in patients aged 14–17 years, 69% were female, and 22% required an intensive care unit. The top three most common substances used are available without a prescription. DiscussionThere was a persistent increase in self-harm attempts via poisoning throughout the study period with a particularly vulnerable period in the adolescent age group.

Differences in Prevalence of Haematological Abnormalities on Presentation to Hospital in COVID-19-Infected Adult and Paediatric Patients: A Retrospective Multicentre Descriptive Study

Background: It is well known that COVID-19 infection affects multiple systems in the body. Reports have documented many changes in the hematopoietic system in the pathophysiology of the disease, and many haematological markers like lymphopenia and high d dimer have been linked to worse outcomes after COVID-19 infection in adult patients. Aim: The aim of the study was to find out the prevalence and any significant difference in routine haematological parameters on presentation in paediatric and adult patients with COVID-19 infection. Methodology: We conducted a multicentre retrospective descriptive observational study and investigated the prevalence of haematological abnormalities at the presentation of 1,000 PCR swab-confirmed COVID-19-infected randomly selected adult and paediatric patients admitted to 3 tertiary hospitals in Dubai from 15 March–30 May 2020. Data were gathered through their electronic medical records, and all analysis was done using the Statistical Package for the Social Sciences software (SPSS). Results: The prevalence of at least one abnormal haematological parameter was 95.1% (794/835) on the first presentation to the hospital. After adjusting of age and gender, the prevalence of any white cell abnormality was 34.7% (290/835) (5.7% leukopenia, 9.6% leucocytosis, 25.4% lymphopenia, 5.5% neutropenia, 16.4% neutrophilia, 7.3% monocytosis, and 1.2% eosinopenia). A prevalence of 15.3% (128/835) anaemia, 9.5% (79/835) thrombocytopenia, and 4.3% (36/835) thrombocytosis was also observed. The prevalence of other abnormal blood parameters was C-reactive protein 69.5% (573/835), D dimer 57.5% (280/835), high lactate dehydrogenase 52% (383/835), high ferritin 72.1% (452/835), high international normalized ratio 5.1% (38/835), prolonged prothrombin time 32.2% (240/835), and prolonged activated partial thromboplastin time 35.6% (264/835). A significant difference in the prevalence of these abnormalities was evident between adult and paediatric populations, and these abnormalities were much more prevalent in adults but interestingly paediatric population tended to have a higher incidence of neutropenia, eosinophilia, and monocytosis (p < 0.001). Conclusion: COVID-19 infection tends to be milder and has better outcomes in the paediatric population. The immune system responds differently to the infection in these populations. The response is exaggerated in adults reflected by the increased prevalence of haematological abnormalities like raised inflammatory markers and other white cell abnormalities and has been linked with increased severity of infection and mortality.

"Proportional Condylectomy" for Vertical Condylar Hyperplasia Without Intermaxillary Elastics: Clinical Results and Patient Satisfaction.

First, to investigate the clinical outcome of 'proportional condylectomy' for patients with active unilateral condylar hyperplasia without complementary treatment by intermaxillary elastics and, second, to examine their level of satisfaction regarding function and esthetics. A retrospective observational descriptive study was conducted. All patients included in the study suffered from active unilateral condylar hyperplasia with a vertical component. The length of the condylar-ramus unit was measured on both sides by an multidetector computed tomography scan. The difference was calculated and resected from the hyperplastic condyle during the operation. Facial, occlusal, and skeletal changes were evaluated using photographic and radiologic records, and a satisfaction questionnaire regarding function and esthetics was completed. P <0.05 was considered significant. Fifteen patients were included in the study. The mean participants' age was 27.93±13.06 years, and the mean follow-up duration was 12.40±6.55 months. The mean chin deviation improved by 58.47% ( P =0.001). Mean lip commissure plane tilt was improved by 61.31% ( P =0.001). Six months postoperatively, all patients exhibited centered dental midlines ( P =0.001). Occlusal plane tilt was significantly improved by 70.02% ( P =0.001), and high patient satisfaction was recorded. Twenty-six percent (4/15) of patients did not require the complementary orthodontic treatment, and none of them required complementary orthognathic surgery. 'Proportional condylectomy' for patients with active unilateral vertical condylar hyperplasia without complementary treatment by intermaxillary elastics is a predictable procedure in terms of function and esthetics.

20 years of experience with the Fontan procedure: characteristics and clinical outcomes of children in a tertiary referral hospital.

Without participating in a contractile chamber, the Fontan procedure seeks to create a separation of oxygenated and deoxygenated blood in patients with univentricular heart, reducing the risks of long-term hypoxemia and improving their survival. This study describes the clinical outcomes of children undergoing the Fontan procedure between 2000 and 2020 in a tertiary referral hospital care centre in southwestern Colombia. A retrospective observational descriptive study. The 81 patients who underwent the Fontan procedure were included. Categorical variables were presented with percentages and continuous variables with measures of central tendency according to the distribution of the data evaluated through the Shapiro-Wilk test. Sociodemographic, clinical, surgical variables, complications, and mortality were described. Between 2000 and 2020, 81 patients underwent the Fontan procedure: 43 (53.1%) males and a median age of 5.3years (interquartile range 4.3-6.6). The most common diagnosis was tricuspid atresia (49.4%). The median mean pulmonary arterial pressure was 12mmHg (interquartile range 10-15), the Nakata index 272mm2/m2 (interquartile range 204-327), and the McGoon index (interquartile range 1.86-2.3). Seventy-two (88.9%) patients underwent extracardiac Fontan and 44 (54.3%) patients underwent fenestration. The median hospitalisation days were 19days. The main complication was coagulopathy (19.8%), mortality in the first month between 2000 and 2010 was 8.6%, and after 2010 was 1.2%. The Fontan procedure is a palliative surgery for children with complex heart disease. According to anatomical and physiological variables, the proper choice of patients determines the short- and long-term results.

Brain Waves Reflect Cognition-Emotion State as a Diagnostic Tool for Intervention in Dysfunctional States: A Real-World Evidence

Objective: This study aims to characterize electrical signals to establish a diagnosis of cognitive-emotional dysfunction and guide a successful therapeutic intervention. Therefore, the present study aimed to observe these frequency bands in a sample of dysfunctional neurological behaviors to establish a neural marker of neural dysfunction that helps diagnose and monitor treatment. &#x0D; Methods: A descriptive retrospective (extracted from the database) observational study design based on real-world historical data from routine clinical practice. According to DSM-5, low academic achievement (n =70), disruptive behavior (externalizing behavior problems) (n=70), and somatic syndrome disorder (n=70) were the subjects. The mean age of the sample was 14.13 (SD = 1.46; range 12-18), 31.5% women. The measuring instrument was the NeXus-10, which is suitable for acquiring a wide range of physiological signals. Brain electrical activity was recorded by using the quantitative electroencephalograph (qEEG) in accordance with the 10-20 International Electrode Placement System. In particular, the specific form of miniQ (mini-qEEG) was used.&#x0D; Results: A pattern record present in all cases were identified. The record refers to (a) activity along the midline, namely, Fz-Cz-Pz, (b) activity from the center (Cz) to back, namely, Pz-O1 and O2, (c) activity from the center (Cz) forward (Fz), and (d) comparison between hemispheres. The characteristics of theta, alpha, and beta waves define the characteristic pattern of neurological dysfunction. The reversal of the dysfunctional pattern coincided with the remission of the clinical symptoms after treatment, which occurred in 87,6% of the subjects. We define remission as not meeting DSM-5 criteria.&#x0D; Conclusion: This study suggests that miniQ register could be considered a simple and objective tool for studying neurological dysfunction. This dysfunction is explained according to current neurological knowledge of interactive cognition-emotion processing. MiniQ may be a cheap and reliable method and a promising tool for the investigation in the field.

Postoperative water and electrolyte disturbances after extended endoscopic endonasal transsphenoidal surgery.

IntroductionWater and electrolyte disturbances are common after pituitary surgery and can generally be classified into transient hypotonic polyuria and transient or permanent diabetes insipidus (DI). The prevalence varies in the literature between 31-51% for transient hypotonic polyuria, 5.1-25.2% for transient DI, and 1-8.8% for permanent DI.ObjectiveThe aim of this study was to identify the prevalence of water and electrolyte disturbances with polyuria and the preoperative and postoperative predictive factors in patients undergoing surgery with an extended endoscopic endonasal approach.Material and methodsThis retrospective observational descriptive study included 203 patients with a diagnosis of pituitary adenoma who underwent their first transsphenoidal surgery via the extended endoscopic endonasal approach between April 2013 and February 2020. The diagnosis of water and electrolyte disturbances was based on the criterion for polyuria (>4 ml/kg/h). Postoperative polyuria was defined as those cases diagnosed during the immediate postsurgical period that resolved prior to discharge. Transient DI included all cases with a duration of less than 6 months but still present at hospital discharge, and permanent DI included cases lasting more than 6 months.ResultsThe overall prevalence of water and electrolyte disorders was 30.5% (62), and the prevalence of postoperative polyuria was 23.6% (48). The median number of desmopressin doses administered to patients with postoperative polyuria was one dose (interquartile range [IQR] 1-2), and thus the median duration of treatment was 0 days. The median initiation of desmopressin was the second day after surgery (IQR 1-2). The overall prevalence of DI was 6.89%. Among the patients with transient DI, the duration was less than 3 months in three patients (1.47%), and between 3 and 6 months in two (0.98%). Nine patients had permanent DI (4.43%). (4.43%).ConclusionsThe prevalence of electrolyte disturbances in our study was high, although similar to that found in the literature. Most of the cases were transient hypotonic polyuria that resolved within one day. The prevalence of transient DI in our cohort was lower than that described in the literature, while permanent DI was similar.

Teleorientation in the ophthalmology service in a public hospital from May to August 2020 during the COVID-19 pandemic in Peru

Objectives:&#x0D; To identify presumptive diagnoses of patients treated by synchronous teleorientation in the Ophthalmology Service of Cayetano Heredia Hospital (CHH) during the COVID-19 pandemic, describing their demographic characteristics and the percentage of patients referred for a face-to-face evaluation.&#x0D; Methods:&#x0D; A retrospective observational descriptive study with secondary analysis of a database collected from May to August 2020 consisting of patients treated with teleorientation in the Ophthalmology service at CHH.&#x0D; Results:&#x0D; Three hundred and eight patients were included in the analysis. The main presumptive diagnoses were dry eye syndrome (24,68%), glaucoma (18.51%), cataract (17,85%), post-operated (5,84%) and viral/bacterial conjunctivitis (5,52%). Most patients were female (64,29%) and they came from Metropolitan Lima (91,88%). The number of older adults was higher than that of non-older adults (51,29% vs 48,70%). Finally, the patients sent to the Ophthalmology service for a face-to-face appointment were 4,55%. &#x0D; Discussion:&#x0D; During the period of this study, the main presumptive diagnosis was dry eye syndrome. This result obtained is similar to other hospitals. The main presumptive diagnoses that required a face-to-face appointment were acute posterior vitreous detachment, glaucoma, age-related macular degeneration because they needed especial examination, like measuring the intraocular pressure and fundoscopy. Older adults required assistance more frequently compared to the non-older adult group (84.41% vs 59.57%, p&lt; 0,001).&#x0D;

Mental Health Presentations Across Health Care Settings During the First 9 Months of the COVID-19 Pandemic in England: Retrospective Observational Study.

BackgroundThe COVID-19 pandemic has resulted in an unprecedented impact on the day-to-day lives of people, with several features potentially adversely affecting mental health. There is growing evidence of the size of the impact of COVID-19 on mental health, but much of this is from ongoing population surveys using validated mental health scores.ObjectiveThis study investigated the impact of the pandemic and control measures on mental health conditions presenting to a spectrum of national health care services monitored using real-time syndromic surveillance in England.MethodsWe conducted a retrospective observational descriptive study of mental health presentations (those calling the national medical helpline, National Health Service [NHS] 111; consulting general practitioners [GPs] in and out-of-hours; calling ambulance services; and attending emergency departments) from January 1, 2019, to September 30, 2020. Estimates for the impact of lockdown measures were provided using an interrupted time series analysis.ResultsMental health presentations showed a marked decrease during the early stages of the pandemic. Postlockdown, attendances for mental health conditions reached higher than prepandemic levels across most systems—a rise of 10% compared to that expected for NHS 111 and 21% for GP out-of-hours service—while the number of consultations to GP in-hours service was 13% lower compared to the same time previous year. Increases were observed in calls to NHS 111 for sleep problems.ConclusionsThese analyses showed marked changes in the health care attendances and prescribing for common mental health conditions across a spectrum of health care provision, with some of these changes persisting. The reasons for such changes are likely to be complex and multifactorial. The impact of the pandemic on mental health may not be fully understood for some time, and therefore, these syndromic indicators should continue to be monitored.

Narrowband Ultraviolet B (NB-UVB) Phototherapy in Psoriasis: A Retrospective Study

Background: Psoriasis with higher Psoriasis Area and Severity Index (PASI) scores correlate with impaired quality of life. Assessing narrowband ultraviolet B (NB-UVB) phototherapy as a new therapy option in Indonesia is necessary to find the most effective treatment for psoriasis patients. Purpose: To determine the usage of NB-UVB phototherapy and the therapy response in psoriasis patients. Methods: This retrospective descriptive observational study was conducted at Dr. Soetomo General Academic Hospital Surabaya in March 2019-November 2020. The variables were collected through medical records. Result: A total of 28 patients were obtained at this study. Psoriasis type plaque/vulgaris were found in 92.9% of the patients. The patients mostly started with PASI score &gt;10 with the initial dose of NB-UVB phototherapy is 260 mJ/cm2. The most common initial phototherapy frequency is 3 times per week (53.6%). The latest dose and frequency distribution was varied in each subject. The mean total number of sessions was 31.54 ± 20.549. Patients were also administered various combination therapy. The majority of patients had missed NB-UVB phototherapy sessions and the phototherapy dose needed to be reduced (57.1%). The achievement of PASI-75 (treatment success) was mostly achieved by subjects that went through 40-60 sessions of phototherapy and subjects with psoriasis type plaque/vulgaris. Conclusion: The achievement of PASI-75 was found to be low (17.5%), influenced by multiple factors such as the total number of NB-UVB phototherapy sessions, combination therapy, dose of NB-UVB phototherapy, frequency of NB-UVB phototherapy, and the level of patient compliance to therapy.

CT-Scan Images of The Posterior Orbital, Orbital Apex, Extraocular Muscles Positions and Axes in Craniosynostosis

Craniosynostosis is the premature and pathological fusion, either partial or complete, of one or more cranial sutures. One of the ophthalmological complications is strabismus (in 39–76% of cases), with more severe manifestations in syndromic craniosynostosis. Head-CT with 3D-reconstruction can be used to evaluate the anatomical abnormalities of the orbital aspects to assist clinicians in planning surgery. Materials and Methods: A retrospective descriptive–observational study was conducted for 43 patients in the period from January 2017 to March 2022. The patients had syndromic or non-syndromic craniosynostosis and underwent head CT-scans at Dr. Soetomo General Hospital, Surabaya. The posterior orbital bones, orbital apexes, positions and axes of the extraocular muscles were evaluated by an neuroimaging radiology consultant. Results: 26 male subjects (60.5%) and 17 female subjects (39.5%) were evaluated. 18 patients (41.9%) had normal posterior orbital configurations and extraocular muscles, 4 (9.3%) showed mild abnormalities, 13 (30.2%) had moderate abnormalities, 2 (4.7%) showed moderate–severe abnormalities, and 6 (11.6%) had seesaw pattern abnormalities. 33 patients (76.7%) had normal orbital apex configurations, 3 (7%) showed ballooning ethmoidal sinuses, 2 (4.7%) had protrusions of the lateral orbital wall (greater sphenoid wing), and 5 (11.6%) showed combined ethmoidal sinus ballooning and protrusion of the lateral orbital wall. Conclusion: The smallest excyclorotation was observed for the mild abnormalities of the posterior orbital configuration and extraocular muscles in the right eye (4.5–11.3°) and left eye (3.6–7°). The greatest was noted for the seesaw pattern in the right eye (7.6–21.4°) and left eye (7.4–30°). 3 patients (7%) had an incyclorotated axis and 26 (60.5%) had an excyclorotated axis, with a greater degree of excyclorotation in the seesaw pattern.

Clinical Presentation and Outcome of Fibrous Dysplasia in Patients attending Sahiwal Teaching Hospital, Punjab.

Objective: To study the clinical presentation, management and outcome of Fibrous Dysplasia in patients admitted in Neurosurgery Department of Sahiwal Teaching Hospital, Punjab.&#x0D; Methods: This retrospective descriptive observational study was conducted in the months of January-June, 2021 on 20 patients with histologically confirmed Fibrous Dysplasia whose records were obtained from the hospital laboratory data base admitted between January 2017 to January 2021. The age of the patients, gender, socioeconomic status and length of stay of patients was also recorded. Clinical presentation and exact location on x-rays of the lesion, surgical intervention and clinical outcome were tabulated.&#x0D; Results: This condition was common in the age range of 25-50 years, affected both genders equally, was more prevalent in low socioeconomic group and prolonged the length of stay of patients to 3-4 weeks. It was observed from the radiographs of the patients that ethmoid bone was most commonly eroded (75%) followed by sphenoid (60%) and frontal bone (25%), 2 cases involved the maxillary bone (10%) and in one case it infiltrated the zygomatic bone (5%). The most common presenting features included visual deterioration and proptosis. Surgical intervention ranged from biopsy and conservative treatment to craniotomy and resection. There was no mortality recorded.&#x0D; Conclusion: Patients with fibrous dysplasia most commonly present with visual deterioration. Although it is a benign disease, but surgical intervention is required for cosmetic purposes.&#x0D; Keywords: Fibrous dysplasia, computed tomography (CT), magnetic resonance imaging (MRI).

Out-of-Season Epidemic of Respiratory Syncytial Virus during the COVID-19 Pandemic: The High Burden of Child Hospitalization in an Academic Hospital in Southern Italy in 2021.

Respiratory syncytial virus (RSV) infection is the most common cause of hospitalization in young children. In the last 2 years, public health measures aimed at controlling the spread of SARS-CoV-2 have affected the epidemiology and seasonality of RSV worldwide. The aim of this descriptive retrospective observational study was to describe the characteristics of children hospitalized with RSV in an academic tertiary care hospital in Southern Italy in 2021. We also investigate the seasonal trends of RSV from 2017 to 2021. The demographic characteristics, comorbidities, clinical data, and coinfections were retrospectively evaluated. Compared with previous seasons, the 2021 outbreak of RSV was characterized by an increased number of patients, with a delayed peak observed in November. Overall, 179 children, including 128 (71.5%) aged <12 months, were hospitalized for RSV infection between August and December 2021. Ten children (5.6%) were admitted to the intensive care unit (ICU), all aged <5 months. One patient (0.5%) aged <1 month with severe comorbidities died. The severity of symptoms was significantly associated with younger age, underlying chronic disease, and the length of hospital stay (p < 0.05 each). History of prematurity was not significantly associated with the presence of coinfections. Because of the high burden of RSV infection and the expected larger RSV epidemics resulting from a greater number of RSV-naïve children, systematic epidemiological and virological surveillance is needed. Appropriate pathways for access to RSV prevention in all infants should also be introduced.

Severe traumatic brain injuries secondary to motor vehicle crashes in two Namibian regions: A retrospective review.

IntroductionTraumatic Brain Injuries (TBIs) are a leading cause of morbidity and mortality among trauma patients globally, with motor vehicle crashes (MVCs) being a major contributor. Namibia had a World Health Organization (WHO) estimated MVC-related fatality rate of 30.4 per 100 000 population in 2016, higher than that of the African continent, while no epidemiological studies describing the distribution and determinants of TBIs exist in the country. The study aimed to describe the characteristics of adult patients (≥18 years) with severe TBI secondary to MVCs which occurred in two regions of Namibia between the years 2014–2018.MethodsA retrospective descriptive observational study was conducted in adult patients who sustained severe TBIs secondary to MVCs in two Namibian regions. The inclusion criteria were patients ≥18 years with a severe (as described on the Motor Vehicle Accident Fund system) MVC-related TBI who sustained an injury in the Otjozondjupa or Khomas regions between the years 2014–2018.ResultsA total of 87 patients met the inclusion criteria, 65 (74.7%) from the Khomas region, and 22 (25.3%) from the Otjozondjupa region. The overall mean age of patients was 34 years (SD 11.79), most were male (n = 78. 89.7%) and 55.2% (n = 48) of all patients sustained an isolated TBI. The majority of the patients were admitted to a state healthcare facility (n = 52, 59.8%). Pedestrians were the most injured (n = 34, 52.3%) in the Khomas region while vehicle drivers were the most injured (n = 11, 50%) in the Otjozondjupa Region. A total of 34 (39.1%) patients died and 53 (60.9%) were discharged from hospital. Overall, there were no statistically significant relationships between patient outcomes and independent variables.ConclusionsThe study was to our knowledge the first to describe the epidemiology of TBIs in Namibia. Young individuals are the main people who sustained TBIs, which may subsequently place a socio-economic burden on the country. There is however limited research in Namibia to guide healthcare planning.