Severity Of Clinical Condition Research Articles

Potentials for patients with severe arterial hypertension, by using antihypertensive pharmacotherapy combined with ozone therapy and nasal laser therapy.

Background: More people die each year from cardiovascular diseases than from any other cause. Arterial hypertension (AH) is a particularly important public health issue in Mongolia which has one of the highest mortality rates from hemorrhagic stroke in the world. Antihypertensive pharmacological therapy combined by other non-medication therapy is well-studied in patients with mild and moderate AH. However, studies that have investigated combination of low intensity laser irradiation and ozone therapy in patients with severe AH are lacking. The objective of the present work was to develop methods using low intensity laser irradiation therapy (LLLT) combined with major autohemotherapy (MAH) for the patients presenting with AH. 
 Studies have shown that LLLT is capable of inducing a photobiological response within the cells which modifies the micro and macrovascular response; this accompanies evidence showing the systemic effects even using in nasal laser irradiation (NLI). 
 Oxygen-ozone therapy exerts a positive effect on the platelet aggregation, cell remodeling, cytoskeletal elements organization and mitochondria structure. Due to O2-O3 therapy is an effective method in hypertension, and it diminishes the hypoxia state of various tissues. 
 In recent years, scientists have made great progress in the area of pharmacotherapy for patients with AH. Drugs help to achieve the target level of arterial blood pressure, particularly in patients with mild and moderate AH. With a higher degree of AH (severe arterial hypertension – the 3rd degree of arterial hypertension) the effectiveness of pharmacological therapy decreases and to achieve the target level of arterial blood pressure it is necessary to use a combination of all major groups of antihypertensive medicines.
 
 Method and Result: The study was held at Wellness Med Hospital Mongolia since the beginning of 2021 until the end of year. The study included a total of 60 patients of any age (63% of men and 37% of women) having AH associated with coronary heart disease and abnormal blood lipid spectrum. Initially, clinical-instrumental and laboratory examination, blood pressure registration and daily arterial blood pressure monitoring were carried out. Suitable drugs were selected for all the patients. 3 months after starting drug treatment the patients were divided in 2 groups each comprising 30 patients matched for age, sex, severity of clinical conditions, and character. The patients of the first group were prescribed combination with NLI and ozone therapy (MAH) in addition to drugs. For ozone therapy used Ozomed smartline ozone generator by Hansler Medical, Germany. The total dose of ozone to be given at each session will vary according to the general condition of the patient. Intervals from daily to weekly and twice a week. Ten to twelve treatments are considered as one course of treatment. Also, as cycles to be given once or more times per year. It may vary from less than 1000 µg to 3000 µg. This procedure is in line with the Madrid Declaration (ISCO3/QAU/01/03). The ozone concentration in the O2-O3 gas mixture were between 20 µg/ml to 35 µg/ml. The volume of blood to use varies between 50 mL and 100 ml. For NLI therapy we used Semiconductor laser Therapeutic apparatus Model W-001 by Fithope, China. The laser watch with nasal laser irradiation with 650nm (5mW) of lights. Used this equipment same day with Ozone therapy for about 30-40 minutes each time. If AH was higher used the laser therapy longer time. 
 The second group of patients continued receiving drugs alone. 3 months later, average daily blood pressure (BP), systolic BP and diastolic BP were compared in both groups. Three months after both groups demonstrated a significant decrease in SBP and DBP, but these indicators remained higher than normal and did not reach the target level. Three months after the inclusion of MAH+NLI in the comprehensive treatment, the first group demonstrated a significant decrease in BP (systolic and diastolic), not only in comparison with the initial data, but also with the data observed three months after PT. After 6 months SBP and DBP in the first group were significantly lower compared with those of patients in the second group. The inclusion of MAH+NLI in addition to multicomponent antihypertensive drugs is a promising treatment option for severe AH. 
 
 Discussion: Drug therapy is not sufficient for the elimination of cellular-tissue and microcirculatory disorders in case of severe AH, it should be advisable to include MAH+NLI into the multicomponent treatment, and positive changes in the indicators of the 1st group of patients after the inclusion of MAH+NLI are suggestive of it. 
 The oxygen-ozone therapy and LLLT seem to have no adverse events or side effects. Moreover, it is very cost-effective, as standard treatment costs can be reduced by 25% also.

JAK-STAT signaling pathway-related gene single nucleotide polymorphisms and susceptibility to ankylosing spondylitis in eastern Chinese Han population.

A case-control study was utilized to investigate the relationship between genetic variation of JAK-STAT signaling pathway-related genes and the susceptibility to ankylosing spondylitis (AS). Fifteen SNPs in the JAK-STAT signaling pathway-related genes from 660 AS patients and 646 healthy controls were genotyped using iMLDR technology (JAK1: rs2230587, rs2230588, rs2780815, rs310241; JAK2: rs2274472, rs2230722, rs2230724, rs10758669; STAT1: rs10199181, rs1547550, rs2066802, rs45463799, rs6718902; STAT3: rs3744483; STAT5A: rs1135669). Allele analysis revealed that the T allele of STAT1 rs6718902 was a protective agent for male AS patients (OR = 0.765, 95% CI = 0.644-0.909). Inheritance models showed that GG + CG as well as GG genotypes of STAT1 rs1547550 had a significant risk of developing AS in males (OR = 5.374, 95%CI = 2.505-11.526; OR = 5.186, 95%CI = 2.412-11.153). The TT + CT and TT genotypes at STAT1 rs6718902 were observed to be associated with a significantly decreased risk of AS compared to CC genotypes among male patients and male controls (OR = 0.637, 95%CI = 0.485-0.837; OR = 0.597, 95%CI = 0.422-0.845). Furthermore, the genotypes of JAK1 gene rs2230588, rs2780815, and rs310241 were correlated with the severity of clinical conditions in female AS patients, while the JAK2 rs2230724 genotypes may affect disease ability in male AS patients. These findings indicated that JAK-STAT signaling pathway-related gene single nucleotide polymorphisms may be associated with AS susceptibility in eastern Chinese Han population. Key Points • The T allele of rs6718902 on the STAT1 gene may be a protective agent for male AS patients. • STAT1 rs1547550 GG + CG and GG genotypes were observed to be connected with a risk of male AS patients. However, STAT1 rs6718902 TT + CT and TT genotypes reduced the susceptibility risk of male AS patients compared to wild-type CC. • The JAK1 genes rs2230588, rs2780815, and rs310241 may affect disease functional status in female AS patients, while the JAK2 rs2230724 genotype was related to disease activity in male AS patients.

The Association of New-Onset Acute Kidney Injury and Mortality in Critically Ill Patients With COVID-19 With Less Severe Clinical Conditions at Admission: A Moderation Analysis.

Acute kidney injury (AKI), electrolyte, and acid–base disorders complicate the clinical course of critically ill patients with coronavirus-associated disease (COVID-19) and are associated with poor outcomes. It is not known whether the severity of clinical conditions at admission in the intensive care unit (ICU) changes the clinical significance of AKI and/or electrolyte or acid–base disorders developing during ICU stay. We conducted a retrospective study in critically ill patients with COVID-19 to evaluate whether the severity of clinical conditions at admission in the ICU affects the impact of AKI and of serum electrolytes or acid–base status on mortality. We carried out a 28-day retrospective follow-up study on 115 critically ill patients consecutively admitted to ICU for severe COVID-19 at a tertiary care university hospital and surviving longer than 24 h. We collected baseline demographic and clinical characteristics, and longitudinal data on kidney function, kidney replacement therapy, serum electrolytes, and acid–base status. We used Cox proportional hazards multiple regression models to test the interaction between the time-varying variates new-onset AKI or electrolyte or acid–base disorders and Sequential Organ Failure Assessment (SOFA) or Acute Physiology and Chronic Health Evaluation II (APACHE II) score at admission. After adjusting for age, sex, Charlson’s comorbidity index, and AKI present at ICU admission, new-onset AKI was significantly associated with 28-day mortality only in the patients in the lowest and middle SOFA score tertiles [lowest SOFA tertile, hazard ratio (HR) 4.27 (95% CI: 1.27–14.44; P = 0.019), middle SOFA tertile, HR 3.17 (95% CI: 1.11–9.04, P = 0.031), highest SOFA tertile, HR 0.77 (95% CI: 0.24–2.50; P = 0.66); P = 0.026 for interaction with SOFA as a continuous variable]. After stratifying for APACHE II tertile, results were similar [adjusted HR (aHR) in the lowest tertile 6.24 (95% CI: 1.85–21.03, P = 0.003)]. SOFA or APACHE II at admission did not affect the relationship of serum electrolytes and acid–base status with mortality, except for new-onset acidosis which was associated with increased mortality, with the HR of death increasing with SOFA or APACHE II score (P < 0.001 and P = 0.013, respectively). Thus, unlike in the most severe critically ill patients admitted to the ICU for COVID-19, in patients with the less severe conditions at admission the development of AKI during the stay is a strong indicator of increased hazard of death.

Burdens and predictors of the Burden experienced by Family Caregivers of Patients with Oral and Maxillofacial Tumours.

Aim:There is a dearth of knowledge on the burden of family caregivers of patients with maxillofacial tumours in Nigeria. This burden may be influenced by racial peculiarities and the disease entity of the patient. The aim of this study is to assess and document the burdens and predictors of burdens experienced by family caregivers of patients with oral maxillofacial tumours presenting at a tertiary health facility in South Western Nigeria.Materials and Methods:A descriptive cross-sectional study that included 110 consenting family caregivers of patients diagnosed with oral and maxillofacial tumours. A semi-structured questionnaire was used to collect information on their sociodemographic characteristics and caregiving burden using the Zarit burden interview tool. Data were analysed using descriptive and inferential statistics with Statistical Package for Social Sciences version 21.0.Result:The most frequent group of caregivers was patients’ children (32.0%), aged 30–39 years (28.2%), females (54.5%), with secondary education (41.8%), and traders (38.2%), who earned less than national minimum wage (55.5%). Majority (42.7%) experienced mild-to-moderate burden; coping strategy was mainly prayers (76.4%), while the greatest need expressed was financial assistance (93.6%). The significant predictors of caregiver burden were the presence of pain (adjusted odds ratio [AOR] = 2.961; 95% confidence interval [CI] = 1.165–7.526; P = 0.023) and severe clinical condition (AOR = 3.342; 95% CI = 1.133–9.853; P = 0.029).Conclusion:The most common category of the burden of family caregivers of patients with maxillofacial tumours was the mild-to-moderate category, and the most significant predictors were the presence of pain and severity of clinical condition. The greatest need expressed was financial assistance. Therefore, an emphasis on adequate pain control and alternate sources of funding may appreciably relieve the burden of family caregivers of patients with maxillofacial tumours.

Innovative Cell-Based Therapies and Conditioning to Cure RAG Deficiency.

Genetic defects in recombination activating genes (RAG) 1 and 2 cause a broad spectrum of severe immune defects ranging from early severe and repeated infections to inflammation and autoimmune manifestations. A correlation between in vitro recombination activity and immune phenotype has been described. Hematopoietic cell transplantation is the treatment of care; however, the availability of next generation sequencing and whole genome sequencing has allowed the identification of novel genetic RAG variants in immunodeficient patients at various ages, raising therapeutic questions. This review addresses the recent advances of novel therapeutic approaches for RAG deficiency. As conventional myeloablative conditioning regimens are associated with acute toxicities and transplanted-related mortality, innovative minimal conditioning regimens based on the use of monoclonal antibodies are now emerging and show promising results. To overcome shortage of compatible donors, gene therapy has been developed in various RAG preclinical models. Overall, the transplantation of autologous gene corrected hematopoietic precursors and the use of non-genotoxic conditioning will open a new era, offering a cure to an increasing number of RAG patients regardless of donor availability and severity of clinical conditions.

Designing a Minimum Data Set of Triage Section in the Hospital Information System

Background: The triage process prioritizes emergency care patients as a first step, and distributes them to different levels of triage based on the severity of clinical conditions. Since this method depends on the memory of the triage performer, it may be affected by lack of time, complexity of triage, and bias, causing nurse confusion and ultimately affecting patient safety. One of the interventions that can improve the efficiency and quality of patientcare in this unit is the use of electronic medical records, so the present study aimed to design a minimum data set to collect data in a uniform and standard way in the triage unit. Methods: This is a descriptive-analytic study that was performed in hospitals affiliated to Qazvin University of Medical Sciences that had emergency medicine specialty in 2018. The study population consisted of 15 emergency medicine specialty and triage nursepractitioners who were selected by convenience sampling. To collect data from was used a researcher-made questionnaire designed that Validity and reliability of checklists were assessed by emergency medicine specialty and triage nurse in pre-hospital emergency with Cronbach's alpha of 0.89. The results were analyzed using SPSS 21 and statistical indices. Results: The survey results indicate that 6 data elements should be considered asmandatory components of MDS for the triage department. These elements include basic triage information, timing, evacuation, accidents, life-threatening conditions and counseling. Conclusion: The findings of the study indicated that minimal data design can lead to standardization and effective management of data by providing comprehensive data elements for triage, thus improving the quality of care, speed of emergency services andreducing costs. And most importantly increase patient satisfaction. It will also allow comparisons of information at different levels of effective decision-making and policy-making and prevention of future injuries.

A Study on 696 COVID-19 Cases in Basrah-Southern Iraq: Severity and Outcome Indicators

Background: COVID-19 epidemic is escalating in Basrah regardless of the efforts to abate the wave of new cases. Objectives: To present a profile on the demographic and selected clinical characteristics of COVID-19 cases reported in Basrah from March 9 to May 19, 2020. Patients and Method: A record-based observational study was conducted in Basrah. Data were compiled from all available sources on the cases reported between March 9 and May 19, 2020. Data included age, sex, residence, occupation, date of onset of detection of infection, severity of clinical condition, and fate in terms of cure, continuing treatment, or death. Excel and Statistical Package for Social Sciences programs were used for data-base generation and for statistical analysis. Results: A total of 696 cases were identified, with ages ranging from &lt; one year to 99 years. Males accounted for 42.5% and females for 57.5%. Most of the cases were from Basrah city and the district of Hartha. Housewives and self-employed people represented a majority of cases (28.4 and 21.6% respectively). Most of the cases were either asymptomatic (51.3%) or with mild condition (30.3%). Critical cases represented a small proportion (3.2%) and case fatality was relatively low (2.6%). The presence of co-morbidity, older age and travel history were significant predictors of both severe cases and higher case fatality. Conclusions: COVID-19 cases in Basrah was found among young people, predominantly females, and the fatal outcomes are predicted by severity, older age, and presence of co-morbidity Keywords: COVID-19, Basrah, Case fatality, COVID severity.

A Hospital Protocol for Decision Making in Emergency Admission for Acute Diverticulitis: Initial Results from Small Cohort Series.

Background and objectives: We present initial results from a small cohort series for a hospital protocol related to the emergency hospitalization decision-making process for acute diverticulitis. We performed a retrospective analysis of 53 patients with acute diverticulitis admitted to the Department of Emergency and Trauma Surgery of the “Azienda Ospedaliero Universiaria-Ospedali Riuniti” in Ancona and to the Department of General and Emergency Surgery of the “Azienda Ospedaliera-Universitaria” in Perugia. Materials and Methods: All patients were evaluated according to hemodynamic status: stable or unstable. Secondly, it was distinguished whether patients were suffering from complicated or uncomplicated forms of diverticulitis. Finally, each patient was assigned to a risk class. In this way, we established a therapeutic/diagnostic process for each group of patients. Results: Non-operative treatment (NonOP) was performed in 16 patients, and it was successful in 69% of cases. This protocol primarily considers the patient’s clinical condition and the severity of the disease. It is based on a multidisciplinary approach, in order to implement the most suitable treatment for each patient. In stable patients with uncomplicated diverticulitis or complicated Hinchey grade 1 or 2 diverticulitis, the management is conservative. In all grade 3 and grade 4 forms, patients should undergo urgent surgery. Conclusions: This protocol, which is based on both anatomical damage and the severity of clinical conditions, aims to standardize the choice of the best diagnostic and therapeutic strategy for the patient in order to reduce mortality and morbidity related to this pathology.

Quality improvement of triage accuracy in the Emergency Department

Introduction: Triage is the sorting of patients into priority groups according to their need and severity of clinical condition. The study aims to present outcome of complete audit cycle of triage by the triage nurse for quality improvement of triaging in Emergency.&#x0D; Method: 150 patients were randomly selected over 2 weeks who were triaged by the Emergency triage nurse into Emergency (Red), Priority (Yellow) and Queue (Green) in the Emergency Department at Patan Hospital.We followed the WHO quick check triage and assessed those who were accurately triaged, over triaged and those who were under triaged.The necessary changes were done after analysis of data from first cycle and same process was repeated for second cycle. In the second cycle, 150 patients were selected randomly over 2 weeks who were triaged by the Emergency triage nurse. Plan-Do-Study-Act (PDSA) cycle was used for quality improvement cycle.&#x0D; Result: Data were collected from 150 patients in the first cycle and 150 patients in the second cycle. In the first cycle, 48.7 % of patients were correctly triaged, 48.7% were over triaged and 2.7% were under triaged. After the second PDSA cycle, it was found that 65.3% of patients were correctly triaged, 33.3 % were over triaged and 1.3% were under triaged.&#x0D; Conclusion: Accuracy of triage can be improved by continuous quality improvement audit and necessary interventions. Plan-Do-Study-Act (PDSA) cycle is a useful tool for quick detection of problems and acting on necessary interventions for improvement&#x0D;

Espiritualidade e resiliência na atenção domiciliar

Introdução: A atenção domiciliar (AD) caracteriza-se por práticas de cuidado que realizam abordagem integral do paciente em seu contexto familiar, socioeconômico e cultural. Religiosidade e espiritualidade atuam como mecanismos de fortalecimento da resiliência. Objetivo: Avaliar a relação entre religiosidade e espiritualidade com resiliência em pacientes em AD de Unidades de Saúde de Atenção Primária à Saúde (US-APS) de Porto Alegre (RS), Brasil. Métodos: estudo quantitativo transversal e descritivo, incluindo 44 adultos de quatro US-APS em AD por condições crônicas e problemas de saúde controlados/compensados com alguma dependência para atividades da vida diária. Foram utilizadas escalas de religiosidade (DUREL), espiritualidade (ARES), resiliência (RS-14), funcionalidade (Katz), sintomas depressivos (PHQ-2), suporte social (mMOS-SS), classificação econômica (ABEP 2016) e grau de severidade das condições clínicas (CIRS-G). Resultados: Pacientes avaliados são majoritariamente de sexo feminino (72,7 %), idosas (média 74 anos), viúvas, brancas, de baixo estrato socioeconômico, baixa escolaridade, aposentadas, com tempo médio de 7,5 anos de restrição domiciliar e grau moderado de resiliência. Os entrevistados apresentam altos índices de religiosidade e espiritualidade, sendo que 90,9% apresentam alta religiosidade intrínseca e 79,6% realizam práticas religiosas privadas uma ou mais vezes ao dia. A maioria (88,6%) considera importante que sua religiosidade e espiritualidade seja abordada em seus atendimentos de saúde, mas somente 20,5% já foram questionados sobre tal temática. Resiliência associou-se à maior espiritualidade (B=0,44; p=0,02), controlando-se este efeito para suporte social e sintomas depressivos; e à maior idade (B=0,18; p=0,02). Conclusão: O estudo corrobora a relevância da dimensão de religiosidade e espiritualidade e indica seu papel na promoção de resiliência nesta população em AD. Recomenda-se a abordagem da religiosidade e espiritualidade com esses indivíduos, fortalecendo o cuidado integral preconizado pela APS.

Gut microbiota and systemic inflammation in patients with chronic heart failure

Aim To study the interrelationship between intensity of chronic systemic inflammation (CSI) with severity of the condition and intestinal microbiocenosis parameters in patients with chronic heart failure (CHF).Material and methods 47 hospitalized patients with symptomatic CHF were evaluated. The following parameters were determined: clinical condition; N-terminal pro-B-type natriuretic peptide (NT-proBNP). C-reactive protein (CRP); serum interleukins (IL) 6 and 10; and intestinal microbiocenosis composition by mass-spectrometry of microbial markers in whole blood. Microbiocenosis indexes were compared in the main group and in 38 outpatient patients with arterial hypertension and ischemic heart disease without CHF.Results Direct, medium-power correlations were found between CRP and IL-6 concentrations and severity of clinical condition (NT-proBNP, ХСН stage, and edema severity) in patients with CHF. Most patients with CHF had lower numbers of bifido-, lacto-, propionic-, and eubacteria, and Clostridium (С.) ramosum and higher numbers of aspergillus. Among CHF patients, the highest indexes of endotoxemia, gram (-) bacteria, cocci, actinomycetes, and microfungi were observed in the group with NT-proBNP from 400 to 2000 pg/ml. Direct correlations were observed for amounts of C. hystolyticum, Pseudonocardia spp., and Aspergillus spp. with IL-6 and IL-10 and unidirectional inverse correlation were observed for these cytokines with Propionibacterium acnes and jensenii, Streptomyces spp., and Nocardia asteroides. In addition, IL-6 concentration was negatively correlated with contents of Staphylococcus aureus, C. difficile, C. ramosum, Eggerthella lenta, and Corynebacterium spp. and was positively correlated with C. propionicum, Moraxella spp. and Flavobacterium spp. Concentration of IL-6 directly correlated with the number of Eubacterium spp. and inversely correlated with numbers of Ruminicoccus spp. and Streptomyces farmamarensis. The amount of Streptomyces farmamarensis negatively correlated with CRP concentrations.Conclusion The study results evidence the significance of intestinal microbial-tissue complex in the pathogenesis of CSI in CHF and allow suggesting this complex as a promising target for therapy.

Ayurveda Practitioners Consensus to Develop Strategies for Prevention and Treatment of Corona Virus Disease (COVID-19)

Background: The outbreak of Coronavirus disease (COVID-19) has been recently declared as Public Health Emergency of International Concern (PHEIC) by World Health Organization and the virus has now spread beyond the boundaries of countries and continents. At present, no specific antiviral treatment or vaccine is available or recommended to counter the COVID-19, and the potential therapy is still symptomatic. Objective: The primary aim of the study is to review ancient classical literatures and past human treatment protocols of Ayurveda for prevention and treatment of infectious diseases and flu like illnesses, so as to provide guidance for the prevention of COVID-19. Methods: Classical Ayurveda and recent modern literature with treatment protocols of Ayurveda for prevention and treatment of flu and infectious diseases were reviewed and COVID-19 has been categorized in four specific situations based on the severity of clinical condition. Total 110 Ayurveda practitioners of different parts of India were participated in the survey. These specific situations were conveyed and described to these participants and their opinions and options were collected through social media platform i.e. WhatsApp or SMS. Results: Recommendation and suggestions received from more than 50% participants were taken into accounts to draft the recommendation for probable preventive and therapeutic regimen for the disease. Conclusion: The results obtained in the study may provide a preventive strategy to the Ayurveda practitioners as well as common people across the globe by increasing the innate immunity of the body to combat COVID-19. However, till today, social distancing is considered as most effective way to stop the spread of COVID-19. Further, pilot study for different group is recommended.

Severity of Retrognathia and Glossoptosis Does Not Predict Respiratory and Feeding Disorders in Pierre Robin Sequence.

Pierre Robin sequence (PRS) may lead to life-threatening respiratory and feeding disorders. With the aim to analyse the association of the severities of retrognathia and glossoptosis with those of respiratory and feeding disorders, we retrospectively studied a series of 50 infants with retrognathia, glossoptosis, cleft palate, and airway obstruction. The patients were managed from birth to at least 6 years of age by a single pediatric team at the Armand Trousseau Hospital in Paris within a 12 years period (2000–2012). Retrognathia and glossoptosis were graded in the neonatal period according to a specific clinical examination. Ventilation assistance was required for 32/50 (64%) patients, and enteral feeding for 41/50 (82%). The grades of retrognathia and glossoptosis and the severity of respiratory disorders did not differ between patients with isolated PRS and syndromic PRS. Severe respiratory disorders were more common and long-lasting feeding (>12 months) was more frequently required in patients with syndromic PRS compared with isolated PRS (42 vs. 13%, p = 0.04 and 42 vs. 4%, p < 0.01 respectively). Using univariate analysis, neurological impairments and laryngomalacia were associated with severe respiratory disorders [Odds ratio (OR) 5.0, 95% CI 1.3–19.6; and OR 14.6, 95% CI 1.3–161.4; p < 0.05] as well as with long-lasting feeding (>12 months) disorders (OR 18.6, 95% CI 3.9–89.2 and OR 20.4, 95% CI 3,4–122.8; p < 10−2). Syndromic SPR status was also associated with severe respiratory disorders (OR 4.9, 95% CI 1–32.5; p < 0.05). Using multivariate analysis, only syndromic PRS status was predictive for severe respiratory disorders (adjusted OR 8, 95% CI 1.47–44.57; p < 0.05); and only neurological impairments remained a significant risk for long lasting feeding disorders (>12 months) (adjusted OR 21.72, 95% CI 3.4–138.63; p < 10−2). The grades of retrognathia and glossoptosis were not predictive factors for the severity of respiratory and feeding disorders.Conclusion: In children with PRS, the severity of clinical conditions may not correlate with anatomic variables but rather with laryngeal abnormalities, neurological impairement and syndromic PRS status.

Cerebrospinal fluid lactate and neurological outcome after subarachnoid haemorrhage

BackgroundIncreased lactate in cerebrospinal fluid (CSF) has been regarded as a marker for cerebral ischemia and damage in the central nervous system. The aim of this study was to evaluate if CSF-lactate was associated with; impaired cerebral circulation, outcome, sex, age, clinical condition or treatment after subarachnoid haemorrhage (SAH). MethodsThis study consists of 33 patients (22 females, 11 males) with aneurysmal SAH treated at Umeå university hospital 2008–2009. Samples were obtained from external ventricular catheters 0–240 h after SAH. Normal CFS-lactate was defined as 1.2–2–1 mmol/L. Hunt & Hess scale assessed clinical condition. Impaired cerebral circulation was evaluated by clinical examination, transcranial doppler, CT-scan, and cerebral angiography. Glasgow outcome scale (GOS) evaluated outcome. ResultsSeventy-nine CSF-lactate samples were analysed. CSF-lactate >2.1 mmol/L was found in 25/33 (76%) patients and in 50/79 (63%) samples. No difference in CSF-lactate levels was found over time. No association was found between patients with CSF-lactate >2.1 mmol/L and; sex, severity of clinical condition, impaired cerebral circulation or outcome. CSF-lactate >2.1 mmol/L was more common in patients ≥61 years of age (p = 0.04) and in patients treated with endovascular coiling compared to surgical clipping (p = 0.0001). ConclusionIn patients with SAH, no association was found between increased CSF-lactate (>2.1 mmol/L) and severe clinical condition, impaired cerebral circulation or unfavourable outcome. Endovascular coiling and age ≥61 years was associated with CSF-lactate above >2.1 mmol/L.

Evaluation of mycobacterium cell wall fraction (MCWF) immune stimulant as antimicrobial alternative following administration to veal calves

High levels of mortality in dairy calves is a significant welfare issue and a major source of economic losses. A preventative measure used to reduce mortality is antimicrobial incorporation into the milk or milk replacers. As a result of the abundant use of antimicrobials, high levels of antimicrobial resistant bacteria have been detected. With antimicrobial resistance becoming of greater concern worldwide, it is imperative to seek alternative treatment options. Mycobacterium cell wall fraction (MCWF), Amplimune™ (NovaVive Inc, Canada), is an immunostimulant licensed for treatment of infection caused by enterotoxigenic E. coli in young calves. In a recent study, application of MCWF on arrival in conjunction with metaphylactic treatment significantly reduced incidence and severity of respiratory and gastrointestinal clinical signs in veal calves. The main objective of the current study was to determine if MCWF could be used as a stand-alone preventive therapeutic administered on arrival. We hypothesized that, MCWF could be used as an antimicrobial alternative not only reducing mortality but also significantly reducing the incidence and severity of clinical conditions and consequently the number of antimicrobials used in the veal operations.

Фузиформні аневризми основної артерії — клінічні прояви та лікування

Objective — to study the prevalence and clinical manifestations of fusiform aneurysms (FA) of the basic artery (MA), methods of their treatment.Materials and methods. The analysis of 2049 histories of diseases of patients with arterial aneurysms of the vessels of the brain for the period from January 2007 to December 2018. It was revealed that in 87 (4.25 %) patients there were FA, of which 30 (34.5 %) — FA MA. Aneurysms were initially detected according to neuroimaging techniques (spiral computer and magnetic resonance imaging). All patients were given a selective cerebral angiography. Depending on clinical manifestations of patients, it was divided into four groups: the 1st group — patients with hemorrhagic manifestations; the 2nd group — patients with ischemic manifestations; the 3rd group — patients with compressive and ischemic manifestations (pseudo-fumarous action or «mass effect»); the 4th group — patients with asymptomatic course. Groups were compared by age and sex composition, severity of clinical condition of patients, data of neuroimaging methods and angiographic characteristics of aneurysms.Results. 12 (40 %) patients with FA MA had an asymptomatic course, 10 (33 %) — ischemic manifestations, 6 (20 %) compressive-ischemic manifestations, 2 (7 %) — hemorrhagic manifestations. Operated 18 (60 %) patients. 20 operations were performed, including 16 single-session endovascular operations on FA and 2 repeated (in patients with MA, after coiling). According to the study, among operated patients in 4 (22.2 %) cases — the reduction of clinical manifestations of the disease within 5–7 days after the operation (2 — in the 2nd group, 2 — in the 3rd group). In 5(27.8 %) cases — the emergence or increase of a neurological deficit associated with the implantation of an intracranial stent in the form of an increase/appearance of stem-symmetry (1 — in the 2nd group, 1 — in the 3rd group, 3 — in the 4th group). Surgical mortality among operated patients was 16.7 % (3 cases (all in the 2nd group)) and is related to the presence of concomitant cardiovascular disease. Clinical outcomes of endovascular treatment of patients with fuziform aneurysms of the main artery on the Glasgow Outcomes Scale at the time of discharge from the hospital are good (≥ 5 points) in 12 (80 %) patients and satisfactory (4 points) — in 3 (20 %) patients.Conclusions. FA MA often occur asymptomatic — in 40 % of patients. The most frequent and clinically significant manifestation of the disease is ischemic (in 33 % of patients), compression-ischemic (in 20 %), while hemorrhagic was observed in 7 % of patients. Clinical manifestations of the disease are closely related to the sex and age of the patients. Results of treatment depend on the period of the disease, the structure of the aneurysm, the gender of the patient and the presence of concomitant pathology.

Evaluation of APOE Genotype and Ability to Perform Activities of Daily Living Following Aneurysmal Subarachnoid Hemorrhage.

Survivors of aneurysmal subarachnoid hemorrhage (aSAH) often experience unfavorable functional outcomes that result in a reduced ability to independently perform activities of daily living. The apolipoprotein E gene ( APOE) encodes for a protein known to facilitate lipid transport and aid in neuronal repair within the central nervous system and to moderate the inflammatory response, making functional variations in this gene likely candidate biomarkers to predict outcomes following aSAH. In the present work, we examined the relationship between APOE genotype and the ability to perform activities of daily living as measured by the Barthel Index (BI) score at 3 months ( n = 298) and 12 months ( n = 288) following aSAH. APOE genotypes were determined using polymerase chain reaction followed by restriction digestion and gel electrophoresis and treated as binary variables depending on the presence or absence of alleles E4 and E2. Multiple logistic regression was used to determine whether APOE genotype accounted for variability in BI score after controlling for age, sex, and severity of clinical condition as measured by the Hunt and Hess classification. No significant association was found between the presence of allele E4 and BI score at 3 ( p = .20) or 12 months ( p = .29) or between the presence of allele E2 and BI score at 3 ( p = .23) or 12 months ( p = .86) after controlling for covariates. The results of this study do not support a relationship between APOE genotype and the ability to perform activities of daily living after aSAH.

Influence of non-drug bundle of care on incidence rate of ventilator associated pneumonia

Objective To explore the influence of non-drug bundle of care on incidence rate of VAP. Methods Prospective analysis was performed on patients with mechanical ventilation in ICU from January 2015 to December 2016. The patients were assessed daily, monitored for target, and divided into infected group and non-infected group according to incidence of VAP. Relationship between incidence of VAP and measures taken in non-drug bundle of care, with all data statistically analyzed by SPSS 19.0 for windows. Results A total of 1 326 cases were collected in this study, with 109 infected cases and 1 217 non-infected cases. It was shown in related single factor analysis that factors influencing incidence of VAP included mode of tracheal intubation (whether with subglottic secretion drainage or not) , severity of clinical conditions of the patients (APACHEⅡ score >18 points) , time of mechanical ventilation (>7 days) , hand sanitation, the patients' compliance to operations like elevation of bed head (>30°) , oral care, assessment of tracheotomy cuff pressure, monitoring of gastric residual volume, timely dumping of condensed water, and unobstructed subglottic secretion drainage (P<0.05) . It was shown in Logistic regression analysis that mechanical ventilation time was an independent factor affecting incidence of VAP (OR=30.536, P<0.01) . Conclusions According to non-drug bundle of care strategies, daily evaluation should be conducted. Early off-machine and early extubation can reduce incidence of VAP. Key words: Pneumonia, ventilator associated; Non-drug bundle of care strategies; Influencing factors

International Study Group of Pancreatic Surgery Definitions for Postpancreatectomy Complications: Applicability at a High-Volume Center.

The perioperative morbidity following pancreas surgery remains high due to various specific complications: postoperative pancreatic fistula, postpancreatectomy hemorrhage, and delayed gastric emptying. The International Study Group of Pancreatic Surgery has defined these complications. The aim of this study is to evaluate the clinical applicability, to validate the International Study Group of Pancreatic Surgery definition, and to evaluate the postoperative morbidity. Between 2004 and 2014, 769 patients underwent resection. Data were collected in a prospective database. Univariate examination was performed using the χ2-test. Continuous data were tested with the Mann-Whitney U-test. Student's t-tests and Fisher's exact tests were performed. A total of 542 patients were included in this study. In all, 91 (16.8%) patients developed postoperative pancreatic fistula, 69 of them clinically relevant grades B and C postoperative pancreatic fistula. Grades B and C postoperative pancreatic fistulas were significantly associated with a longer hospital stay. The postoperative pancreatic fistula grade significantly correlated with re-operation. Totally, 32 (5.9%) patients developed postpancreatectomy hemorrhage. Postpancreatectomy hemorrhage grade was significantly associated with re-operation and 30-day mortality. In all, 14 of 19 patients with grade C postpancreatectomy hemorrhage (73.7%) were re-operated; 3 had a simultaneous postoperative pancreatic fistula C. Grade B postpancreatectomy hemorrhage significantly prolonged hospital stay. Grade C postpancreatectomy hemorrhage significantly prolonged intensive care unit stay. Grade C postpancreatectomy hemorrhage led to longer intensive care unit stay but a shorter hospital stay. Delayed gastric emptying occurred in 131 (24.2%) patients. The delayed gastric emptying grade was significantly associated with re-operation. Nine of the re-operated patients had a simultaneous postoperative pancreatic fistula C. Grades A, B, and C delayed gastric emptying were associated with prolonged hospital- and intensive care unit stay. Delayed gastric emptying is the most common specific complication after pancreas resection, followed by postoperative pancreatic fistula and postpancreatectomy hemorrhage. The International Study Group of Pancreatic Surgery definitions are well applicable in clinical routine and the different grades correlate well with severity of clinical condition, length of hospital or intensive care unit stay, and mortality. Their widespread use can contribute to a more reproducible and reliable comparison of surgical outcomes in pancreas surgery.

Persistent Ductus Arteriosus in Critically Ill Preterm Infants.

Persistent ductus arteriosus (PDA) is found with increased incidence in preterm infants, significantly affecting neonatal morbidity and mortality rates. To evaluate the association between the presence of PDA and the severity of clinical condition at birth in critically ill preterm infants, with gestational ages (GA) ≤ 32 weeks and severe respiratory distress. All preterm infants with GA ≤ 32 weeks admitted to the neonatal intensive care unit (NICU) of the Clinical County Emergency Hospital, Sibiu between 1 January 2010 and 31 December 2015 were included in the study. These were categorized as Group 1 [Preterm infants with PDA; n=154] and Group 2 [Preterm infants without PDA; n=186]. Epidemiological and clinical data were collected in the National Registry for Respiratory Distress Syndrome for all children, and data related to prenatal period, clinical characteristics at birth i.e GA, weight, gender, Apgar scores, and clinical features such as resuscitation at birth, surfactant administration, need and duration of respiratory support, neonatal sepsis, complications associated with prematurity, and death, were analyzed. Group 1 infants had significantly lower GA and birth weights, were more often out born (p=0.049, HR 1.69), and had significantly lower Apgar scores at 1 and 10 minutes (p=0.022, p=0.000). They presented a significantly higher need for surfactant administration (42.9% vs 24.7%, p<0.0001) and respiratory support (96.8% vs 90.3%, HR 3.19, p=0.019 for need of CPAP and 22.1% vs 10.8%, HR 2.35, p=0.004 for mechanical ventilation). Duration of respiratory support was also significantly higher in the Group 1 (7.6%±7.5 vs. 5.1±3.8 days, p<0.0001 for CPAP and 20.1±22.5 vs. 12.0±15.7 days, p<0.0001 for mechanical ventilation). In very preterm infants, PDA may be associated with a critical clinical condition leading to serious complications. The presence of PDA after the seventh day of life was associated with an increased need for respiratory support, both CPAP and mechanical ventilation, increased severity of the respiratory distress syndrome, requiring a longer duration of respiratory support, and increased the hospitalization length. In very preterm infants, PDA presence was also associated with a higher rate of severe complications and death, indicating the need for a careful and proper management of these critical cases in neonatal intensive care units.