Therapy Unit Research Articles

Can Intravenous Caffeine Citrate Be Used for Severe Asthma Exacerbation in Children? A Retrospective Comparative Study.

To assess the effectiveness of intravenous caffeine citrate in paediatric asthma exacerbation unresponsive to beta2-agonists and steroids. A 10-year retrospective cohort study was conducted on asthmatic children unresponsive to beta2-agonists and steroids, who were treated with either intravenous caffeine citrate or magnesium sulphate. The study outcomes were changes in the Paediatric Respiratory Assessment Measure (PRAM) score, duration of oxygen therapy and paediatric intensive care unit (PICU) length-of-stay. Overall, 296 children were treated in the PICU between January 1, 2011, and December 31, 2020. Fifteen and 26 children unresponsive to beta2-agonists and steroids (median ages 2.3 [0.7-11] and 3.0 [1.2-8.5] years), respectively, received caffeine citrate and magnesium sulphate. The two groups showed similar demographic characteristics and baseline parameters. At 24 and 48 h, the median (IQR) PRAM scores for the caffeine and magnesium groups were 4 (2-6) and 5 (4-6), respectively (p = 0.27), and 7 (6-8) and 8 (5-9), respectively (p = 0.57). The median (IQR) durations of PICU stay for the caffeine and magnesium groups were 36 (19-46) and 32 (23-45) h, respectively (p = 0.77). The median (IQR) durations of oxygen therapy for the caffeine and magnesium groups were 25 (10-30) and 20 (15-30) h, respectively (p = 0.29). No serious adverse events occurred in the caffeine group. One occurred in the magnesium group. Caffeine citrate and magnesium sulphate demonstrated comparable effectiveness in treating steroid- and beta2-agonist-resistant asthma. A multicentre prospective study is needed to validate these results.

End-of-life issues in the ITU - 10 important points to remember.

End-of-life (EOL) issues have become increasingly common in intensive therapy units (ITUs), largely due to advances in critical care that enable patients to be kept alive for extended periods. Death in the ITU now generally follows an EOL decision, which can pose ethical, emotional, and practical challenges. Our approach to such issues should be based on adherence to the four bioethical principles -autonomy, beneficence, nonmaleficence, and distributive justice- as well as the concept of proportionate care, and requires careful and effective communication with the whole ITU team, including the patient and their family. In this article, we discuss 10 key considerations related to EOL care in the ITU, in an attempt to highlight some critical aspects of EOL decision-making for intensivists navigating this sensitive and multifaceted area of practice.

Assessing quality of health care in the context of patient satisfaction from patients’ perspective among a physical therapy and rehabilitation unit

Health service policies are evolving into qualified health care providing best possible outcomes as well as focused on patient satisfaction. Hence the qualification valued health care includes patient satisfaction measurements, it is suggested to get feedbacks during the assessment of outcomes from the patient’s perspective. Aging of the world population accelerates demand on rehabilitation medicine which means recovering impairments so is directly related with quality of life. This study measures the patient satisfaction among 286 patients referring to outpatient clinics and receiving therapy within Physical Medicine and Rehabilitation Unit of City Hospital in Balikesir, Turkey. Results showed 63.4 ± 2.6 years mean of age and female majority (63.6%). Region of therapy included 9.8% for total body, plegic syndromes, 19.6% for neck, 25.2% for shoulder, 21.6% for knee and 23.8% for lumbar regions. Patients are grouped in two according to ‘yes’ or ‘no’ answer of the question ‘Do you agree with you have benefit from applied treatment, does the treatment met your expectations?’. 274 patients (95.8%) were agree with therapy met their expectations. Article discusses one of the valid patient satisfaction questionnaire as evidence based outcome measures. In divisions the means of query scores were 3.9 for technical quality, 4.2 for communication with therapist, 3.6 for physical comfort, 3.9 for communication with secretary, 4.1 for communication with doctor, 3.5 for accessibility and 3.5 for cleanliness. Comparison of means among groups did not seem statistically significant as result of Mann–Whitney U test, p > 0.05. In conclusion in the context of qualified health service providing, it is essential to get feedback from health care receivers to measure satisfaction and this needs improvement of generally valid questionnairres. Improved communication and greater provider sensitivity towards patients can enhance patient satisfaction resulting as meeting the expectation.

Morphofunctional Characteristics of the Mouse Small Intestine Mucosa After a sIngle Irradiation with Various Absorbed Doses

Radiation-induced intestinal damage is a typical complication of radiation exposure, it can be caused by various sources of radiation. Clinical treatment today consists of symptomatic supportive therapy, as there are no specific treatment strategies. The main target of radiation damage is the epithelial cells of the mucous membrane of the small intestine. The study of morphological changes and mechanisms of damage to epithelial cells is necessary when developing the model of radiation damage to the intestine for further assessment of the severity of pharmacological correction. The purpose of the work is to provide a morphological assessment to the state of the epithelial tissue in the mouse small intestine mucosa on the 9th day after a single exposure to X-ray radiation at various absorbed doses (6.5, 7 and 7.8 Gy). Materials and methods. The study was performed on sexually mature white outbred male mice weighing 18-22 g (n = 50). Acute radiation sickness was simulated using the RUM-17 X-ray therapy unit. The animals of the three experimental groups (n = 15 each) received a single X-ray irradiation with different absorbed doses of 6.5, 7 and 7.8 Gy, respectively. On the 9th day after irradiation, the material was fixed according to a routine technique for transmission electron microscopy. The analysis of semifine sections was carried out using a Scope A1c light microscope with an Axiocam ERc 5s camera and using the ZEN 2.3 morphometric program with further processing using Microsoft Office Excel 2013. Results. When exposed to radiation with different absorbed doses on the mucous membrane of the jejunum in mice, common morphological features were revealed: a decrease in the height and deformation of the mucous membrane villi; a decrease in the height of enterocytes from 32.03±2.21 µm in intact animals to 22.86±0.51 µm (at 7 Gy); in crypts, the height of epithelial cells had no significant changes; single dividing cells were located along the entire depth of the crypts; an increase in the length of the microvilli in the brush border on the apical surface of enterocytes from 0.89±0.01 µm to 1.46±0.03 µm (at 7.8 Gy) was revealed. Sublethal and lethal doses are characterized by a slight expansion of the basal parts of crypts with profiles of actively synthesizing goblet cells, in the absorbed dose of 6.5 Gy, similar changes are more pronounced. In all animals of the experimental groups, the loose connective tissue of the proper mucous plate is abundantly infiltrated by leukocytes. Epithelial cell extrusion zones are weakly expressed on the apical surfaces of the villi. A sharp decrease in the number of Paneth cells was revealed. Conclusions. On the 9th day after a single exposure to X-ray radiation at absorbed doses of 6.5, 7 and 7.8 Gy, reactive changes in the epithelial tissue of the mucous membrane of the small intestine have a non-specific character. The most pronounced of them were noted at an absorbed dose of 6.5 Gy. A decrease in the absorbing surface of the mucous membrane results in disturbances of its basic function.

The Effect of Foot Reflexology and Knee Massage With Black Cumin Seed Oil on Knee Osteoarthritis Symptoms.

This study aimed to examine the effect of foot reflexology and knee massage with black cumin seed oil on pain and fatigue symptoms in elderly individuals with knee osteoarthritis and assess which of these 2 applications is more effective. Our randomized controlled trial was conducted with 150 participants. Study data were collected from participants over 65years who received outpatient treatment in a university hospital's physical therapy and rehabilitation unit and were determined to have no perception problems based on the Mini-Mental Test. After randomization, the study sample was classified into 5 groups, each including 30 participants: (1) foot reflexology with black cumin seed oil, (2) foot reflexology with a placebo, (3) knee massage with black cumin oil, (4) knee massage with a placebo, and (5) control. Participants were administered a Patient Descriptive Information Form, the Lequesne Knee Osteoarthritis Index, the Pain-Visual Analog Scale, the Fatigue Severity Scale, and the Western Ontario and McMaster Universities Osteoarthritis Index. Control group participants received standard of care, while participants in treatment groups received the studied interventions for 6weeks. Data were collected by administering questionnaires to the participants in the first and sixth weeks and analyzed using IBM Statistical Package for Social Sciences 22.0 software. The study showed that foot reflexology and knee massage administered using black cumin oil effectively reduced pain and fatigue severity in Osteoarthritis (OA) patients, and overall, foot reflexology administered using black cumin oil was the most effective treatment to reduce pain and fatigue.

Use of two general-purpose scales to assess clinical pharmacy activities in a cell transplantation unit.

The general-purpose rating scales used by clinical pharmacists to rate their activities have not been extensively studied in specialist care units. This study aims to describe drug-related problems (DRPs) and pharmacist interventions (PIs) in a French hematopoietic cell therapy (HCT) unit and to evaluate the PIs' likely clinical, economic, and organizational impacts. We retrospectively assessed all DRPs reported and all PIs issued between December 2018 and December 2021. The Act-IP scale was used to rate DRPs and PIs, and the ClEO scale was used to rate each PI's clinical, economic and organizational impacts. Fisher's exact test was used to assess the relationships between PIs and DRPs and between the three dimensions of the ClEO scale. The DRPs were most frequently related to drug-drug interactions (16.5%), physicochemical incompatibilities (15.5%), and drug monitoring problems (14.9%). 62.8% of the PIs had at least a moderate clinical impact. PIs that recommended drug monitoring were most frequent (26.8%), and most of these (75%) were likely to have prevented incidents that would have required patient monitoring or treatment. The results of this study showed that after a slight adaptation, the Act-IP scale can be used to map clinical pharmacy activity in an HCT unit. More than 60% of the DRPs/PIs were likely to have had a positive impact on the patient's clinical outcome. All the PIs were rated with a positive organizational impact and PIs likely to lead to cost savings were balanced by those likely to increase costs.

Incidence of diabetes mellitus following hospitalisation for COVID-19 in the United Kingdom: A prospective observational study.

People hospitalised for coronavirus disease 2019 (COVID-19) have elevated incidence of diabetes. However, it is unclear whether this is due to shared risk factors, confounding or stress hyperglycaemia in response to acute illness. We analysed a multicentre prospective cohort study (PHOSP-COVID) of people ≥18 years discharged from NHS hospitals across the United Kingdom following COVID-19. Individuals were included if they attended at least one research visit with a HbA1c measurement within 14 months of discharge and had no history of diabetes at baseline. The primary outcome was new onset diabetes (any type), as defined by a first glycated haemoglobin (HbA1c) measurement ≥6.5% (≥48 mmol/mol). Follow-up was censored at the last HbA1c measurement. Age-standardised incidence rates and incidence rate ratios (adjusted for age, sex, ethnicity, length of hospital stay, body mass index, smoking, physical activity, deprivation, hypertension, hyperlipidaemia/hypercholesterolaemia, intensive therapy unit admission, invasive mechanical ventilation, corticosteroid use and C-reactive protein score) were calculated using Poisson regression. Incidence rates were compared with the control groups of published clinical trials in the United Kingdom by applying the same inclusion and exclusion criteria, where possible. Incidence of diabetes was 91.4 per 1000 person-years and was higher in South Asian (incidence rate ratios [IRR] = 3.60; 1.77, 7.32; p < 0.001) and Black ethnic groups (IRR = 2.36; 1.07, 5.21; p = 0.03) compared with White ethnic groups. When restricted to similar characteristics, the incidence rates were similar to those in UK clinical trials data. Diabetes incidence following hospitalisation for COVID-19 is high, but it remains uncertain whether it is disproportionately higher than pre-pandemic levels.

Virtual surgical planning in microsurgical head and neck reconstruction: The Newcastle experience

Head and neck microvascular reconstruction is a complex but powerful tool following immediate cancer ablation or delayed sequalae after cancer treatment. Virtual surgical planning (VSP), using computer-aided design or computer-aided manufacturing has emerged as a potentially beneficial adjunct to head and neck reconstruction. The aim of this study was to assess the outcomes of VSP technology using the KLS Martin custom-made cutting guides and low-profile plates in head and neck microvascular reconstruction in our centre. A retrospective study was conducted at the regional head and neck centre in the UK from March 2017 until June 2023. A total of 127 patients were included. Among them, 77.8% of the patients underwent immediate reconstruction following cancer ablative procedure, with 22.2% being treated for osteoradionecrosis. Median flap ischaemia time was 130min (45-360min). Median number of osteotomies was 1 (0-3). Median operative time was 622min (302-962min). Procedural complications occurred in 16.2% of the patients. Total flap failure rate was 6.35%. This study found that patients who were operated on with palliative intent had significantly worse flap survival rates (p<0.033). The length of hospital stay was significantly impacted by longer operative time (p<0.002) and overall length of intensive therapy unit stay was significantly increased in diabetic and palliative patients. Three-dimensional planning software has become a standard of care within our centre, leading to shorter operative time, reliable and accurate reconstruction and a short learning curve for skill acquisition. Extensive surgery in palliative patients requires a robust consenting process in the context of a multi-disciplinary team discussion.

Utilisation of the National Early Warning Score (NEWS) and Assessment of Patient Outcomes Following Cardiac Surgery.

Objectives: The national early warning score (NEWS) was introduced to improve the detection of, and standardise the assessment of, the severity of acute illness in the National Health Service (NHS). We assessed whether the recommended threshold trigger score of 5 or more in a Critical Care Outreach Team (CCOT) review could accurately predict patients at risk of deterioration following cardiac surgery and patient outcomes. Methods: We investigated adult cardiac surgery patients between October 2019 and December 2021. NEWS 2 parameters triggering CCOT referrals and NEWS 2 parameters < 5 versus ≥5 were compared, and the resulting patient outcomes were evaluated. Results: Over this period, 3710 patients underwent surgery, of whom 162 (4.4%) initiated 193 calls to the CCOT. The mean number of NEWS 2 parameters on CCOT activation was 6.14 ± 2.43 (NEWS 0-16); 34 (20.98%) activations were from patients with NEWS 2 < 5. Low oxygen saturation (SpO2) (59.3%) and oxygen therapy (83.3%) were the most common physiological parameters raising the score. CCOT activations led to 38 transfers from the ward to the high-dependency unit (HDU) and 18 transfers to the intensive therapy unit (ITU). Cardiac arrest calls were initiated in 12 (7.40%) patients and two culminated in death. Fourteen (8.64%) had emergency resternotomy. The in-hospital mortality rate was 10.5% (17/162) in patients referred to CCOT versus 3.9% (139/3548) in patients who were not (p < 0.001). The in-hospital mortality in patients with NEWS 2 < 5 vs. NEWS ≥ 5 was 17.6% (6/34) versus 8.6% (11/128) (p = 0.126). Conclusions: There was no difference in in-hospital mortality in patients below or above a NEWS 2 of 5, but there was a significant difference in in-hospital mortality in patients reviewed by the CCOT (p < 0.001). Tailoring the threshold score specifically for the cardiac surgical cohort, in conjunction with clinician involvement, may improve outcomes.

EGS SO22 - When What Is Left Is Not Right

Abstract Background Aims We present a case of small bowel obstruction in a massive inguinoscrotal hernia, with loss of abdominal domain, treated successfully by emergency surgery. The chronicity of the condition resulted in a large pendulous pelvic stomach, with the Duodeno jejunal flexure within the hernia and constricted by the hernial ring. Method The first contact with surgical team was as emergency, since initial referral to surgical outpatients was deferred by the patient, due to his embarrassment. After initial attempts to decompress the stomach through nasogastric tube and with nutritional support with parenteral nutrition, the patient was counselled for surgery. Informed consent was taken for right orchidectomy, possibility of open abdomen with delayed reconstruction, stoma, respiratory compromise, multiorgan failure and death.Prior to intervention, Intensive Therapy unit was consulted for admission following surgery, with plans to use Botox in the abdominal wall, to improve compliance, in case of abdominal compartment syndrome or respiratory failure. Results Through an inguinoscrotal incision, the inguinal canal was opened and the cord structures were transfixed and divided. The internal ring was divided laterally to allow gradual compression and replacement of the hernia intraabdominally. Over 8 litres of fluid was removed from Nasogastric aspirate. Lymphoedema in the scrotum made the laterality of the testis seen in the operative field ambiguous. The hernia was repaired with Bassini repair of the muscles, followed by polypropelene mesh. Following surgery, patient was discharged home with no immediate complications. Histology of the sac and Tunica Vaginalis revealed an atrophic right testis. Conclusion Distorted anatomy from chronicity of common surgical pathology may present challenge to even experienced surgeons. Unusual presentation of common pathology requires thinking outside the box. Since the lymphoedema in the scrotal hernial sac made the laterality of the testis unclear, an informed decision was taken not to remove the single testis seen in the operative field. The histology confirmed that this was the right decision, since the atrophic right testis was included in the operative specimen. Post operative imaging confirmed what was left, was the left testis.

Closed-incision negative pressure wound therapy (NPWT) in elderly patients following sacral pressure sore reconstruction

BackgroundPressure sores significantly affect elderly patients, with the sacrum being especially vulnerable, often due to its proximity to the anus and potential for fecal contamination. Despite preventive measures such as frequent repositioning and specialized cushions, some sores still necessitate surgical intervention. Postoperative care focuses on monitoring, hygiene, and pressure alleviation. This study assessed the efficacy of Closed-Incision Negative Pressure Wound Therapy (CI-NPWT) for postoperative wound management in patients with sacral pressure sores treated with local flaps.MethodsA retrospective analysis was performed on sacral sore patients who underwent reconstructive surgery from March 2019 through April 2023. Surgical procedures involved debridement and wound coverage using gluteal artery perforator-based fasciocutaneous flaps, followed by postoperative monitoring. Patients were grouped into conventional monitoring or NPWT management, with the latter utilizing the INFOV.A.C. The therapy unit was calibrated to 125 mmHg. Data on patient demographics, flap metrics, fluid drainage amounts, and six-month postoperative outcomes were collected, and then analyzed with SPSS Statistics.ResultsIn this study of 52 patients with sacral pressure sores, the NPWT group (n = 25) showed significantly fewer flap complications and a lower drainage volume on the seventh postoperative day (mean 17.2 cc) compared to the conventional dressing group (mean 27.8 cc, P < 0.05). No postoperative complications were observed in the NPWT group, whereas the conventional group (n = 27) experienced one infection and three cases of dehiscence. Both groups achieved a 100% flap survival rate.ConclusionClosed-incision negative pressure wound therapy (CI-NPWT) shows promise in reducing wound dehiscence and infection rates in elderly patients undergoing sacral pressure sore reconstruction with local flaps. However, further research with larger, randomized studies is needed to confirm its effectiveness as an alternative to conventional postoperative care.Trial registration.The study was retrospectively registered by the Institutional Review Board of Seoul Metropolitan Government-Seoul National University Boramae Medical Center (No. 20–2023–25, Date: Mar. 24 2023).

Wrist Stabilising Exercise Versus Hand Orthotic Intervention for Persons with Hypermobility – A Randomised Clinical Trial

Objective To investigate the effectiveness of wrist stabilisation exercises compared to conventional intervention, whether it reduces pain and/or paraesthesia in the hand, as well as how the interventions affected activity ability, health-related quality of life and effects on hand function and grip strength in people with Hypermobility Diagnosis. Design A randomised controlled trial. Setting: Units of Occupational therapy in Primary Care, Kalmar County Council, Sweden Participants: The study included 169 participants’ data randomised to the Exercise group (n = 83) or the Control group (n = 86). The samples consisted of adults in diagnosed Hypermobility Spectrum Disorders or hypermobility Ehlers Danlos Syndrome with symptoms of pain and/or paraesthesia in the hands in the last three years. Interventions: The Exercise group trained according to structured progressive exercises and weights programme. The Control group used the hand orthosis during selected activities. Both groups performed randomised intervention for 12 weeks. Main measures: The primary outcome was the Disabilities of Arm, Shoulder, and Hand questionnaire. Secondary outcomes were the Grip Ability Test, the Jamar dynamometer and the EuroQol EQ-5D. Results There were 116 subjects who completed the intervention. There were no statistically significant difference between the wrist stabilisation exercise and the conventional intervention in terms of activity ability, health-related quality of life, hand function, grip strength, pain or paraesthesia in people with Hypermobility Spectrum Disorders or hypermobility Ehlers Danlos Syndrome. Conclusion There is no statistically significant difference between the Exercise group and the Control group regarding activity ability after 12 weeks intervention period.

Effect of Early Intervention on Developmental Domains and Parent-Child Interaction Among Children With Developmental Delay: A Randomized Controlled Study.

The scope of early intervention (EI) programs, which mostly focus on motor skills, needs to be expanded. To examine the effects of an EI on developmental domains and parent-child interactions. Randomized controlled study. Children ages 24-36 mo with developmental delay (DD; intervention group, n = 30; control group, n = 40). Pediatric occupational therapy unit of Hacettepe University. The intervention group received an intervention that used the Goal Activity and Motor Enrichment (GAME) approach and a home program, whereas the control group received a home program only. Both groups received the same intervention dosage. Developmental domains were assessed using the Bayley Scales of Infant and Toddler Development Third Edition (Bayley III) and the Ages and Stages Questionnaires (ASQ). Sensory processing was assessed with the Infant/Toddler Sensory Profile 2 (ITSP-2), social-emotional development with the ASQ:Social-Emotional (ASQ:SE), and parent-child interaction with the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO™). A compliance checklist was used to determine compliance with the home program. A significant between-groups difference was found on all Bayley III and PICCOLO subscales and on the Gross Motor, Fine Motor, Problem-Solving, and Social-Emotional domains of the ASQ and ASQ:SE in favor of the intervention group (p < .05). The intervention group showed more typification (normal sensory processing) in sensory quadrants and general processing. Both groups were 100% compliant with the home program. The GAME-based intervention for children with DD, including sensory and cognitive activities, is effective in improving developmental domains and parent-child interactions. Plain-Language Summary: The scope of early intervention programs mostly focuses on motor skills and needs to be expanded to include the essential roles of children's sensory and cognitive abilities. This study provides important insights into early interventions by occupational therapists and the impact on children with developmental delay and parent-child interactions. We found that the Goal Activity and Motor Enrichment (GAME) intervention for children with developmental delay, which includes sensory and cognitive activities, is effective in improving developmental domains and parent-child interactions.

The effect of different essential oils used in stoma bags of individuals with colostomy remooval of odor, life satisfaction and effect on stoma fit: Randomized controlled study

ObjectiveThe aim of the research was conducted as a randomized controlled interventional study to determine the effect of lavender/mint essential oils placed in stoma bags on odor removal, life satisfaction and stoma compliance in individuals with colostomy. MethodThe research population is patients with permanent colostomy registered in a university hospital's stoma therapy unit. The sample consisted of 60 (20 lavender oil, 20 peppermint oil, 20 control group) patients who met the sampling criteria and voluntarily agreed to participate in the study. In the evaluation of the data the 'Numerical Evaluation Scale' (NES), the 'Satisfaction with Life Scale (SLS), and the 'Ostomy Adjustment Scale' (OAS-23) were used. ResultsThe lavender oil and peppermint oil groups had lower mean odor intensity, mean scores, higher life satisfaction, and stoma compliance scores than the control group. A statistically significant difference was found between the groups (p<0.05). In comparisons made within the groups, statistically, significant differences were found in the mean scores of odor intensity level, life satisfaction, and stoma compliance after the process (p<0.05). ConclusionIt was determined that lavender/peppermint oil placed in the stoma bag in patients with colostomy decreased the level of odor intensity, and increased life satisfaction, and stoma compliance. The trial was registered in the Clinical Trial (ClinicalTrials.gov ID: NCT05716711

8144 Hypertension in Sheehan Syndrome: A Diagnostic Challenge

Abstract Disclosure: E. Ahsan: None. F.F. Foo: None. C. Lesniak: None. M. Akula: None. K. Hu: None. R. Ong: None. K. Chalasani: None. J. Cheng: None. S. Holland: None. Introduction: Postpartum pituitary necrosis, commonly known as Sheehan syndrome (SS), is the term used to describe the necrosis of anterior pituitary gland cells that occurs after significant postpartum bleeding, hypovolemia, and shock. This typically occurs after delivery, during which the mother suffers significant blood loss. The pituitary gland fails to produce hormones due to this blood loss. Depending on the degree of tissue damage, SS can have an acute or chronic course, and patients may present with a wide range of clinical symptoms at diagnosis. Acute SS is associated with postpartum pituitary infarction, which can result in hypotension, shock, hypoglycemia, hyponatremia, headache, vision disturbances, unconsciousness, and an inability to lactate. We present a rare case of SS where the patient experienced hypertension instead of classic hypotension due to postpartum preeclampsia. Clinical Case: A 40-year-old female with no significant medical history presented to the hospital for scheduled induction of labor for polyhydramnios and underwent vacuum-assisted vaginal delivery and postpartum hysterectomy due to severe postpartum hemorrhage secondary to DIC. The postpartum course was also complicated by preeclampsia with severe features. Patients developed features like excessive fatigue, hypoglycemia, hyponatremia, hypothyroidism, polyuria, and failure of lactation, which were consistent with panhypopituitarism secondary to Sheehan syndrome. However, the patient was hypertensive to 145/91 before steroids were given. Labs were significant for serum sodium 116 mmol/L (135-145 mmol/L), FSH &amp;lt;0.7 mIU/mL (Follicular Phase: 2.5-10.2, Mid-cycle Peak: 3.1-17.7, Luteal Phase: 1.5-9.1, Postmenopausal: 23.0-116.3), LH &amp;lt;0.2 mIU/m (Follicular Phase: 1.9-12.5, Mid-Cycle Peak: 8.7-76.3, Luteal Phase: 0.5-16.9, Postmenopausal: 10.0-54.7), Prolactin: 2.4 ng/mL (Non-pregnant: 3.0-30.0, Pregnant: 10.0-209.0, Postmenopausal: 2.0-20.0), PM Cortisol on admission: 1.10 ug/dL (3.44-16.76 ug/dL), plasma ACTH 7 pg/mL( 6 - 50 pg/mL), TSH 0.430 uIU/mL (0.550 - 4.780 uIU/mL), FT4 0.59 ng/dL - 1.76 ng/dL). MRI of the brain pituitary showed- A 1.5 cm region of hypoenhancement and an additional 2 mm focus of hypoenhancement in the sella, findings represent evolving pituitary necrosis. The patient received 24 units of blood transfusion and hormone replacement therapy, followed by outpatient endocrinology follow-up. Clinical lessons: Although considerable blood loss causes hypotension in patients with SS, additional postpartum medical issues can sometimes result in atypical presentations. In our patient, postpartum preeclampsia caused hypertension. Identifying the atypical symptoms of SS is just as vital as identifying its typical features to prevent potentially fatal consequences. Presentation: 6/2/2024

Smart analysis of sandwich foldable cylinders as gymnastic accessories

A novel smart analysis of sandwich composite cylindrical shell is presented in this article. It is assumed that the sandwich shell is manufactured from the graphene origami reinforced copper core between two intelligent layers. The proposed structure in this article can be used as an idealized model for cylinder shapes in gymnastic sport and physical therapy units. The virtual work principle in the piezo elasticity framework and the cylindrical coordinate system is extended to derive governing equations. To arrive at more accurate results, a third order shear deformable model is extended for kinematic relations. The electro elastic responses are explored using the analytical method to seek impact of main parameters of the composite structure such as foldability parameter, graphene content percent, and applied electric potential on the electro elastic strain, deformation and stress results.

Oculomic stratification of COVID-19 patients' intensive therapy unit admission status and mortality by retinal morphological findings.

To investigate if retinal thickness has predictive utility in COVID-19 outcomes by evaluating the statistical association between retinal thickness using OCT and of COVID-19-related mortality. Secondary outcomes included associations between retinal thickness and length of stay (LoS) in hospital. In this retrospective cohort study, OCT scans from 230 COVID-19 patients admitted to the Intensive Care Unit (ITU) were compared with age and gender-matched patients with pneumonia from before March 2020. Total retinal, GCL + IPL, and RNFL thicknesses were recorded, and analysed with systemic measures collected at the time of admission and mortality outcomes, using linear regression models, Pearson's R correlation, and Principal Component Analysis. Retinal thickness was significantly associated with all-time mortality on follow up in the COVID-19 group (p = 0.015), but not 28-day mortality (p = 0.151). Retinal and GCL + IPL layer thicknesses were both significantly associated with LoS in hospital for COVID-19 patients (p = 0.006 for both), but not for patients with pneumonia (p = 0.706 and 0.989 respectively). RNFL thickness was not associated with LoS in either group (COVID-19 p = 0.097, pneumonia p = 0.692). Retinal thickness associated with LoS in hospital and long-term mortality in COVID-19 patients, suggesting that retinal structure could be a surrogate marker for frailty and predictor of disease severity in this group of patients, but not in patients with pneumonia from other causes.

Association of Rate of Functional Recovery With Therapy Time and Content Among Adults With Acquired Brain Injuries in Inpatient Rehabilitation

ObjectiveTo examine associations among the time and content of rehabilitation treatment with self-care and mobility functional gain rate for adults with acquired brain injury. DesignRetrospective cohort study using electronic health record and administrative billing data. SettingInpatient rehabilitation unit at a large, academic medical center. ParticipantsAdults with primary diagnosis of stroke, traumatic brain injury, or nontraumatic brain injury admitted to the inpatient rehabilitation unit between 2012 and 2017 (N=799). InterventionsNot applicable. Main Outcome MeasuresGain rate in self-care and mobility function, using the Functional Independence Measure. Hierarchical regression models were used to identify the contributions of baseline characteristics, units, and content of occupational therapy, physical therapy, and speech-language pathology treatment to functional gain rates. ResultsMedian length of rehabilitation stay was 10 days (interquartile range, 8-13d). Patients received an mean of 10.62 units of therapy (SD, 2.05) daily. For self-care care gain rate, the best-fitting model accounted for 32% of the variance. Occupational therapy activities of daily living units were positively associated with gain rate. For mobility gain rate, the best-fitting model accounted for 37% of the variance. Higher amounts of physical therapy bed mobility training were inversely associated with mobility gain rate. ConclusionsMore activities of daily living in occupational therapy is associated with faster improvement on self-care function for adults with acquired brain injury, whereas more bed mobility in physical therapy was associated with slower improvement. A potential challenge with value-based payments is the alignment between clinically appropriate therapy activities and the metrics by which patient improvement are evaluated. There is a risk that therapists and facilities will prioritize activities that drive improvement on metrics and deemphasize other patient-centered goals.

Observational Study of the Clinical Impact of E-scooter Injuries at a Major Trauma Centre.

Background Due to the increased use of e-scooters in the UK, associated injuries have increased, and its cost has increased as well. Worldwide data on injuries related to e-scooter use are relatively limited, owing to the short duration since their first introduction to the public. Aim There has been an increase in using e-scooters as a method of transport recently. It was noticed that the severity and frequency of its injuries are increasing as well. This study focuses on the frequency of e-scooter-associated injuries, especially open fractures, and to evaluate its burden on the health system. Methods Data on e-scooter injuries were extracted from our trauma database from November 2017 to July 2022. Patients' notes and images were reviewed. Outcome measures were the type of injuries: site of bony fractures, closed vs. open fracture (using Anderson and Gustilo classification), number of operations, complications, and length of hospital stay. Results The number of patients enrolled was 104. The mean age was 34.3 years, and 78.8% (n = 82) were male. The main mechanism of injury was riding (91%, n = 95) vs. hitting by an e-scooter (9%, n = 9). Injured patients were more likely not to wear helmets (82% of total injured patients). Patients with bony injuries were 65.4% (n = 68), with 22.1% (n = 15) of them being open fractures. The most common bony injuries were lower limb-only fractures at 45.6% (n = 31), then upper limb-only injuries at 39.7% (n = 27). Combined upper and lower limb cases were 8.8% (n = 6), and pelvic injuries were 5.9% (n = 4). Head and neck injuries composed 23.1% (n = 24) of the reported injuries, including intracranial haemorrhages (9.6%, n = 10), extensive traumatic brain injury (3.8%, n = 4), haematoma/lacerations (3.8%, n = 4), cervical spine fractures (1.9%, n = 2), and skull fractures (1.9%, n = 2). The mean duration of hospital stay was 8.6 days, and 9.6% (n = 10) of patients needed intensive therapy unit(ITU) admission. The number of patients presented as trauma calls was 55.8% (n = 58). Patients who needed surgical intervention either under orthopaedics or other specialties were 52.9% (n = 55) and 21.2% (n = 22) of total patients had complications either due to surgical intervention or a long hospital stay. Conclusion E-scooter riding can lead to serious injuries that can end with limb- or life-threatening conditions. The most common demographic characteristics were adults in their early 30s. There should be more emphasis on wearing protective gear like wrist and elbow guards in addition to helmets. Future prospective studies with larger cohorts across multiple regions and hospitals are necessary to truly characterize the nature and cost of e-scooter injuries.

The Assessment of Parental Acceptance- Rejection Perception in Adults Who Stutters

Objectives: This study aims to evaluate parental acceptance/rejection perception in adult who stutterers. Specifically, it highlights the significance of the attitudes of parents of individuals who stutter in terms of the lifelong effects of stuttering. Materials and Methods: This study was conducted with a total of 40 individuals, 20 females and 20 males, who stutter, and 20 females and 20 males who not stutter. These participants were recruited from the Speech and Language Therapy Unit at Hacettepe University. Digital video recordings of individuals with stuttering were made to assess their stuttering, and a Visual Analog Scale (VAS) was administered to the participants with stuttering to evaluate how they perceived the severity of their stuttering. All participants were administered the Parental Acceptance-Rejection Questionare Adult Form (PARQ) to assess their perception of parental attitudes. Results: The parental acceptance-rejection perceptions of mothers of individuals who stutter are significantly different from those of individuals who do not stutter (t=5.584, p &amp;lt; .05). The parental acceptance-rejection perceptions of fathers of individuals who stutter significantly differ from those of individuals who do not stutter (t=5.533, p &amp;lt; .05). The total parental acceptance-rejection scores and sub-dimensions of scores perceived by participants from their parents did not differ by gender. Conclusion: It was concluded that there are negative effects of parental acceptance-rejection perception in individuals who stutter