University Hospital Center Research Articles

Does an instructional video as a stand-alone tool promote the acquisition of practical clinical skills? A randomised simulation research trial of skills acquisition and short-term retention

BackgroundThe effectiveness of instructional videos as a stand-alone tool for the acquisition of practical skills is yet unknown because instructional videos are usually didactically embedded. Therefore, we evaluated the acquisition of the skill of a humeral intraosseous access via video in comparison to that of a self-study with an additional retention test.MethodsAfter ethical approval, we conducted two consecutive studies. Both were designed as randomised controlled two-armed trials with last-year medical students as independent samples at our institutional simulation centre of a tertiary university hospital centre. In Study 1, we randomly assigned 78 participants to two groups: Vid-Self participants watched an instructional video as an intervention, followed by a test, and after seven days did a self-study as a control, followed by a test. Self-Vid ran through the trial in reverse order.In Study 2, we investigated the influence of the sequence of the two teaching methods on learning success in a new sample of 60 participants: Vid-Self watched an instructional video and directly afterward did the self-study followed by a test, whereas Self-Vid ran through that trial in reverse order.In Studies 1 and 2, the primary outcome was the score (worst score = 0, best score = 20) of the test after intervention and control. The secondary outcome in Study 1 was the change in score after seven days.ResultsStudy 1: The Vid-Self (Participants n = 42) was superior to the Self-Vid (n = 36) (mean score 14.8 vs. 7.7, p < 0.001). After seven days, Self-vid outperformed Vid-Self (mean score 15.9 vs. 12.5, p < 0.001).Study 2: The Vid-Self (n = 30) and Self-Vid (n = 30) scores did not significantly differ (mean 16.5 vs. mean 16.5, p = 0.97).ConclusionAn instructional video as a stand-alone tool effectively promotes the acquisition of practical skills. The best results are yielded by a combination of an instructional video and self-study right after each other, irrespective of sequence.Trial registrationsClinicalTrials.gov: NCT05066204 (13/04/2021) (Study 1) and NCT04842357 (04/10/2021) (Study 2).

Antinuclear antibody staining patterns by indirect immunofluorescence assay observed in patients from a tertiary health center in Latin America

Introduction/ObjectiveThis study aimed to describe the frequency of antinuclear antibody (ANA) staining patterns by indirect immunofluorescence assay observed in patients from a tertiary health center in Latin America. Materials and methodsThis retrospective, descriptive, and observational study evaluated data from all patients undergoing antinuclear antibody indirect immunofluorescence assay from a single-tertiary center (University Hospital Fundación Valle del Lili, Cali-Colombia) in 2020. ResultsOne thousand and eight patients met the inclusion criteria. The median patient age was 47 (34–59.2) years, and most were female (769, 75.3%). A positive ANA immunofluorescence assay was observed in approximately two-thirds of patients (664, 65.8%). ANA test results were primarily used to exclude a suspected diagnosis in approximately half of the patients (466, 46.2%). Thirty-seven percent (250/664) of the cohort with ANA-positive titers had a systemic autoimmune rheumatic disease (SARD). The most prevalent SARDs included rheumatoid arthritis (RA) (55, 8.2%) followed by systemic lupus erythematosus (SLE) (37, 5.5%). The vast majority of ANA-positive patients had a reported speckled pattern (anti-cell [AC]-2,4,5; 269; 40.5%) followed by homogenous (AC-1; 266; 40%), nucleolar (AC-8,9,10; 46; 6.9%), and centromere (AC-3; 16; 2.4%). The most frequent patterns observed among SLE patients included homogenous (AC-1) patterns in 17 (45.9%) patients, speckled (AC-2,4,5) nuclear patterns in 11 (29.7%) patients, mixed patterns in 7 (18.9%) patients, and reticular/anti-mitochondrial antibody (AMA, AC-21) cytoplasmic patterns in 2 (5.4%) patients. ConclusionThis study is the first to describe ANA patterns in a Colombian population. Speckled and homogenous patterns were predominant in patients with SARDs.

The Performance of GeneXpert in the Diagnosis of Lymph Node Tuberculosis: A Prospective Study Comparing GeneXpert and Culture Findings.

Background and objective Lymph node tuberculosis (LNTB) is a common manifestation of extrapulmonary tuberculosis (EPTB). GeneXpert is a rapid diagnostic molecular test that simultaneously detects tuberculosis and rifampicin (RIF) resistance. In this study, we aimed to assess the epidemiology of LNTB and diagnostic performance parameters of the GeneXpert in routineENT practice. Methods We conducted a cross-sectional prospective study from January to July 2019,in the Department of Otorhinolaryngology and Head Neck Surgery at the Hassan II University Hospital Center of Fez, Morocco. The samples were collected using lymph node biopsy and subjected to GeneXpert assay, culture, and histopathology. Diagnostic performance parameters of the GeneXpert were calculated and compared with culture. Results All patients with cervical adenopathy were included. Lymph node biopsies were performed for all patients. The performance of the GeneXpert was assessed according to culture findings. Among the 75 cases, the mean age was 21.6 ± 12.7 years with a female predominance (60%). GeneXpert was positive in 66.7% of specimens. The sensitivity and specificity of the GeneXpert assay were 78.6% and 40.4% respectively. GeneXpert accuracy was 54.6%. The positive predictive value (PPV) and negative predictive value (NPV) were found to be 44% (95% CI: 30.2-57.8) and 76% (95% CI: 59.3-92.7) respectively. Mycobacterium bovis was isolated in all samples, with no case of resistance to RIF found. Conclusions The performance of GeneXpert was found to be superior in terms of establishing the diagnosis of LNTB. It offers speedy and prompt results and clinicians should adopt it in routine clinical practice.

Safety of propranolol in neonates with severe infantile hemangiomas: A fourteen-year experience

Background: Infantile hemangiomas (IH) are the most common vascular tumors of infancy. Nearly 4–10% of infants require systemic treatment due to uncontrolled endothelial cell proliferation. Oral propranolol has been approved for the treatment of IH. Herein, we present our experience about the safety and tolerance of this treatment. Materials and Methods: This was a fourteen-year, prospective study conducted between 2008 and 2022 by the dermatology and pediatrics departments of the Hassan II University Hospital Center, located in Fez, Morocco, involving 215 children with infantile hemangioma with an indication for treatment by oral propranolol. Results: After a median follow-up period of fourteen years, the mean age of onset was six months. We encountered a 19% rate of side effects. Therapy was interrupted due to the occurrence of bronchospasm in two cases. Four patients (2.5%) had episodes of bronchiolitis. Other side effects were digestive disorders in 3%, sleep disorders in 6 cases, and coldness of the extremities in 7 cases. Four patients (8.6%) had a volumetric rebound. However, we noted sequelae, such as residual telangiectasias (39% cases), anetodermal skin in 15%, and unsightly scars in 24%. Conclusion: Our data shows that propranolol was generally well tolerated by young infants. We found side effects to be mostly minor, transient, and manageable, except for two cases of bronchospasm, whose treatment was permanently discontinued. This may be explained by the late age of treatment onset, yet we noted sequelae, such as telangiectasias and anetodermal skin. Key words: Propranolol, Infantile hemangioma, Safety

Management of chronic obstructive pulmonary disease in Algeria and implementation of international recommendations

Introduction Chronic obstructive pulmonary disease (COPD) is a common disease, yet it is often overlooked by the general public, patients themselves, and doctors due to its slow and insidious progression. Changing the natural history of COPD requires first of all the diagnosis of the disease, so its early detection seems an important element. It then becomes possible to set the objectives and criteria for the assessment of management and to choose the most appropriate treatments for each individual according to his characteristics. Patients and methods A prospective observational study in COPD patients who were hospitalized in the Department of Pneumology, University Hospital Center of Setif from January 2017 to March 2020 to analyze the quality of outpatient management of these patients. Results In all, 349 patients were included in the study of which 82.2% were men with an average age of 62 years. On admission, only 28.6% or 100 patients were diagnosed and confirmed to have COPD. The general practitioner received COPD patients first in more than 1/3 of cases (37.5%). Pneumologists received 34.6% of patients and diagnosed 99 cases out of 121 consultations, so the diagnosis was made in 81.8% of cases. Spirometry is essential for the diagnosis of COPD. It is simple, inexpensive, and safe; however, it was only performed for 100 patients or 28.6% of cases, confirming the sub-diagnosis of COPD in outpatients. In terms of therapeutic management, the differences between international recommendations and current practice are significant, particularly those concerning the prescription of inhaled or systemic corticosteroid therapy, as well as antibiotic therapy, without forgetting the underestimated therapies in these COPD patients, such as vaccinations (influenza vaccination rate at 27.2% of cases, pneumococcal at 8.26%), Long-term oxygen therapy, and the initiation of smoking cessation (4.1% of cases). Conclusion The publication of recommendations reviewed by experts enables updating the diagnostic management of COPD. We can hope that the recommendations will be followed up and that practices will be harmonized. However, differences between international recommendations and current practice are significant for COPD patients. Early diagnosis and effective therapeutic management of COPD remain, particularly current issues; they would reduce disability and improve the quality of life of the patient.

Epidemiological and Etiological Aspects of Acute Renal Failure in the Nephrology and Haemodialysis Department of the Point G University Hospital

Introduction: Acute renal failure (ARF) represents a major public health problem associated with high mortality. The incidence is increasing with the emergence of multiple risk factors. In Mali, there are currently no data on the extent and severity of this condition in either hospital or community settings. The aim of our study was to describe the epidemiological, therapeutic and prognostic aspects of ARF in adults treated at the University Hospital Centre (CHU) of Bamako. Patients and Methods: This was a retrospective and descriptive study that took place from 1 July 2021 to 30 June 2022 at the CHU du Point G in Bamako. It focused on patients hospitalised and/or followed up on an outpatient basis in the nephrology department during the study period. Results: The prevalence of acute renal failure was 11.55% with a sex ratio of 1.49. The mean age was 42.37±20.7 (range 6-88 years). Elevated plasma creatinine was the main reason for consultation. Creatinine levels were above 500µmol/l in 65.21% of cases. High blood pressure was the main presenting condition in 33.7% of cases. Acute renal failure was organic, obstructive and functional in 72.8%, 15.2% and 12% respectively. Rehydratation was used in 97.8% of cases. Dialysis was indicated in 40% of cases. Age over 60 years was a major risk factor for ARF. The outcome was favourable in 81.5% of cases. Conclusion: Mortality in dialysis patients with ARF remains high. Several factors influence the prognosis of these patients, including the severity of ARF and pre-existing comorbidity.

The Impact of Stress and Burnout on the Quality of Life of Healthcare Workers within the Covid-19 Pandemic

Background: The quality of an individual's life consists of the harmony of physical and mental health, which is influenced by working and material conditions and the social environment. Healthcare professionals face a lot of pressure caused by workload. Psychological pressure, lack of health personnel, and shift and overtime work lead to stress and burnout syndrome. Aim: This paper examines the impact of stress and burnout on the quality of life of healthcare workers during the COVID-19 pandemic. Methods: This cross-sectional study was conducted with 105 subjects who worked at the COVID wards at the COVID-19 Respiratory Centre of the University Hospital Centre Rijeka. Results: This research shows that healthcare workers developed symptoms of stress and experienced a high degree of burnout during the COVID-19 pandemic. A small number of healthcare professionals also experienced a worse quality of life. Conclusion: The COVID-19 pandemic put health workers under tremendous psychological pressure. In addition to numerous challenges such as work overload, long working hours, and impacts to work organization; health professionals had to deal with fear, uncertainty, high mortality rates, and the increased use of protective equipment. This impacted the quality of life for at least a small number of health workers.

PROFILE OF ISCHEMIC STROKE IN CHILDREN: EXPERIENCE OF THE UNIVERSITY HOSPITAL CENTER OF OUJDA

Ischemic strokes (IS) in children are rare but critical, presenting unique challenges due to age-specific factors. Defined by the American Heart Association as episodes of neurological dysfunction caused by focal infarctions, IS can lead to severe outcomes if not promptly addressed. Despite their rarity, pediatric IS requires careful management, complicated by the lack of validated treatment data for children. This study from the University Hospital Center of Oujda examines the management of acute IS in children, analyzing epidemiological aspects, clinical presentations, and therapeutic approaches. Results : 1. Population: 29 children, average age 3.5 years, slight male predominance (sex ratio: 1.2). 2. Consultation Delay: 14% were seen within 24 hours 50% after 7 days. 3. Symptoms: Motor deficit was the most common (82.7%). 4. Diagnostics: CT confirmed IS in 85% of cases MRI established etiological diagnosis in 51.8%, showing sylvian artery involvement in all patients. 5. Etiologies: Embolic cardiopathies (31.03%), vasculopathies (20.06%), and others such as hypertension and neurofibromatosis. 6. Treatments: Symptomatic management, motor physiotherapy, aspirin, and heparin. 7. Outcomes: 74% had complete regression of motor deficits, 20.6% had partial regression, and there were two deaths due to cardiogenic shock. The study underscores the need for a multidisciplinary approach to effectively manage IS in children and improve clinical outcomes.

Establishing and clinically validating a machine learning model for predicting unplanned reoperation risk in colorectal cancer.

Colorectal cancer significantly impacts global health, with unplanned reoperations post-surgery being key determinants of patient outcomes. Existing predictive models for these reoperations lack precision in integrating complex clinical data. To develop and validate a machine learning model for predicting unplanned reoperation risk in colorectal cancer patients. Data of patients treated for colorectal cancer (n = 2044) at the First Affiliated Hospital of Wenzhou Medical University and Wenzhou Central Hospital from March 2020 to March 2022 were retrospectively collected. Patients were divided into an experimental group (n = 60) and a control group (n = 1984) according to unplanned reoperation occurrence. Patients were also divided into a training group and a validation group (7:3 ratio). We used three different machine learning methods to screen characteristic variables. A nomogram was created based on multifactor logistic regression, and the model performance was assessed using receiver operating characteristic curve, calibration curve, Hosmer-Lemeshow test, and decision curve analysis. The risk scores of the two groups were calculated and compared to validate the model. More patients in the experimental group were ≥ 60 years old, male, and had a history of hypertension, laparotomy, and hypoproteinemia, compared to the control group. Multiple logistic regression analysis confirmed the following as independent risk factors for unplanned reoperation (P < 0.05): Prognostic Nutritional Index value, history of laparotomy, hypertension, or stroke, hypoproteinemia, age, tumor-node-metastasis staging, surgical time, gender, and American Society of Anesthesiologists classification. Receiver operating characteristic curve analysis showed that the model had good discrimination and clinical utility. This study used a machine learning approach to build a model that accurately predicts the risk of postoperative unplanned reoperation in patients with colorectal cancer, which can improve treatment decisions and prognosis.

Increased number of ruptured aortic aneurysms during SARS-CoV-2 pandemic

Background and purpose: The aim of the study was to verify whether ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic or Coronavirus disease (COVID-19) vaccination has any influence on established increased number of ruptured aortic aneurysms (RAA) during SARS-CoV-2 pandemic (years 2020-2021) regarding two-year of pre-pandemic period (2018-2019). Materials and methods: Medical records of patients treated for the ruptured abdominal aortic aneurysm (RAAA) by surgical or endovascular reconstruction at the Department of Surgery, University Hospital Center Zagreb, between 2018 and 2021, were retrospectively analyzed. Categorical variables were analyzed using Fisher’s exact test, while numerical variables were analyzed using Student’s t-test or Mann-Whitney U test, depending on the normality of the distribution. Results: The analysis revealed an increase in number of RAAAs by 55.56% in pandemic time (28 versus 18 in pre-pandemic years), decrease in their 30-day mortality by 18.65 % (53.57% vs. 72.22% respectively) and decrease in outpatient examinations during pandemic by 13.82%, but the differences were not statistically significant. Conclusion: No statistically significant relation between SARS-CoV-2 pandemic or the COVID-19 vaccination and the number of treated RAAAs could be established. History of COVID-19 positivity or vaccination were not associated with RAAA outcome. The increase of RAAAs in pandemic along with decrease of its 30-day mortality compared to pre-pandemic time suggests patients’ hesitance to go to elective surgery and avoidance of regular check-ups in the hospitals, where lots of patients with SARS-CoV-2 are presumed to be concentrated, since hospital service policy and protocols remained the same. The patients were never directly asked to answer this question, so even if the fear of getting SARS-CoV-2 infection remains the most plausible answer, it should be verified by an independent survey.

Real-world Outcomes of Dual HER2 Blockade Therapy in Metastatic HER2-Positive Breast Cancer: from Induction to Maintenance.

Dual human epidermal growth factor receptor 2 (HER2) blockade with trastuzumab and pertuzumab combined with taxane-based chemotherapy (Cht) has been the standard first-line treatment for HER2-positive metastatic breast cancer (mBC) for years, due to the impressive results of the CLEOPATRA study. Real-world (RW) studies have become critical for assessing treatment effectiveness and safety in real-life circumstances. The aim of this study was to analyze the treatment outcomes of first-line therapy for HER2-positive mBC in RW clinical practice, specifically focusing on the use of maintenance endocrine therapy (ET) in hormone receptor positive (HR-positive) patients. This retrospective analysis included 106 HER2-positive mBC patients treated with trastuzumab and pertuzumab combined with taxane-based Cht from October 2015 to December 2020 at the University Hospital Centre Zagreb. At a median follow-up of 30 months, median progression-free survival (PFS) was 25 months for the total population (95% confidence interval [CI] 16- not analyzed). Patients with de novo mBC had longer median PFS than patients with recurrent disease (not reached vs. 18 months; hazard ratio 1.99; 95% CI 0.69-3.64, p<0.022). Age, hormone receptor positivity, visceral involvement, number of Cht cycles and previous adjuvant trastuzumab did not impact PFS. Most HR-positive patients (N=55, 88.7%) received maintenance ET after induction Cht. This retrospective study provides additional data on patient characteristics, treatment and outcomes of RW HER2-positive mBC patients treated with pertuzumab and trastuzumab as first-line therapy. In our institution, maintenance ET after induction Cht has become standard clinical practice.

Linguistic Validation and Reliability of the Croatian Version of the TOPICOP Questionnaire.

Background and Objectives: This study demonstrates the factor structure and reliability of the Croatian version of the TOPICOP (Topical Corticosteroid Phobia) questionnaire, thereby contributing to further validation and standardization of the measurement of topical corticophobia with dermatological patients or their parents, which directly affects patient or parent compliance, as well as the final therapeutic effect. Materials and Methods: The cross-sectional, observational study was conducted at the University Hospital Centre Split, Department of Dermatovenerology. The research involved inviting 120 participants (age 12-68) who attended the University Hospital Centre Split's Atopy School, patients examined in the Dermatology Outpatient Clinic of the University Hospital Centre Split and diagnosed with atopic dermatitis (AD) or allergic contact dermatitis (ACD), and parents or legal representatives of patients younger than 12 years old. The TOPICOP questionnaire consists of 12 items assessing the three different components of topical corticophobia (worries, beliefs, and behaviour). Respondents evaluated their perception of the correctness of each statement within 10 min of filling out the questionnaire on a four-point Likert scale. Results: The response rate was 94%, resulting in a sample of 113 respondents (109 adults and 4 children). Factor analysis yielded one common factor of relatively high reliability (Cronbach α = 0.85, 95% CI 0.81 to 0.89). No differences were found in questionnaire scores between male and female participants, nor between the parents/legal representatives of dermatological patients and other patients. Conclusions: This research contributes to further development of the appropriate measuring instrument, its practical application, and thus, the better recognition, resolution, and prevention of topical corticophobia as part of the better overall healthcare and treatment of chronic dermatological patients.

Minimally invasive approach for retrorectal tumors above and below S3: a multicentric tertiary center retrospective study (MiaRT study)

BackgroundRetrorectal tumors are uncommon lesions developed in the retrorectal space. Data on their minimally invasive resection are scarce and the optimal surgical approach for tumors below S3 remains debated.MethodsWe performed a retrospective review of consecutive patients who underwent minimally invasive resection of retrorectal tumors between 2005 and 2022 at two tertiary university hospital centers, by comparing the results obtained for lesions located above or below S3.ResultsOf over 41 patients identified with retrorectal tumors, surgical approach was minimally invasive for 23 patients, with laparoscopy alone in 19, with transanal excision in 2, and with combined approach in 2. Retrorectal tumor was above S3 in 11 patients (> S3 group) and below S3 in 12 patients (< S3 group). Patient characteristics and median tumor size were not significantly different between the two groups (60 vs 67 mm; p = 0.975). Overall median operative time was 131.5 min and conversion rate was 13% without significant difference between the two groups (126 vs 197 min and 18% vs 8%, respectively; p > 0.05). Final pathology was tailgut cyst (48%), schwannoma (22%), neural origin tumor (17%), gastrointestinal stromal tumor (4%), and other (19%). The 90-day complication rates were 27% and 58% in the > S3 and < S3 groups, respectively, without severe morbidity or mortality. After a median follow-up of 3.3 years, no recurrence was observed in both groups. Three patients presented chronic pain, three anal dysfunction, and three urinary dysfunction. All were successfully managed without reintervention.ConclusionsMinimally invasive surgery for retrorectal tumors can be performed safely and effectively with low morbidity and no mortality. Laparoscopic and transanal techniques alone or in combination may be recommended as the treatment of choice of benign retrorectal tumors, even for lesions below S3, in centers experienced with minimally invasive surgery.

Evaluation of a training program using the SBAR communication tool for caregivers managing acute respiratory distress in lung cancer patients: A pilot randomized controlled trial protocol

BackgroundFamily-based caregivers are increasingly important in the management of non-hospitalized lung cancer patients. However, lack of training can negatively impact care including diagnostic errors that can lead to delays in providing appropriate medical treatment. Acute respiratory failure (ARF) is common symptom of lung cancer and requires urgent intervention as well as adequate communication with healthcare professionals (HCPs) to enable appropriate decision-making and improve patient outcomes. Standardized tools such as the Situation, Background, Assessment, Recommendation (SBAR) tool and its French adaptation SAED, standing for Situation, Antécédent, Évaluation et Demande, are designed to facilitate communication among (HCPs).Additionally, digital interventions, such as serious games, are increasingly used to train HCPs though its use for caregivers has not been studied. This pilot study aims to assess an innovative serious game training using the SAED tool combined with standard instructions on self-efficacy for family-based caregivers of lung cancer patients when facing a simulated situation of ARF. The study also aims to examine caregivers' emotional state, quality of life, satisfaction and knowledge about the SBAR tool. MethodsA monocentric, randomized, controlled, open-label, superiority, parallel-arm trial will be conducted for 18 months with 3 mid-study assessments (NCT05839353). Family caregivers of lung cancer patients will be recruited at the University Hospital Center of Saint Pierre, Reunion Island, France. Participants will be randomized (1:1) into two groups: the experimental group receiving training using the SBAR/SAED tool and standard instructions for managing respiratory distress/dyspnea, and the control group, receiving standard instructions only. The primary outcome will be to determine perceived self-efficacy as measured by the Generalized Self-Efficacy Scale. DiscussionThis study will present a preliminary assessment of training family caregivers in using the SBAR/SAED tool in simulated episodes of ARF in lung cancer patients. Our findings may provide valuable insights into effective training methods for caregivers in critical home care situations and could be widely used for lung cancer management.

The Impact of Silent Liver Disease on Hospital Length of Stay Following Isolated Coronary Artery Bypass Grafting Surgery.

Objectives: Risk assessment models for cardiac surgery do not distinguish between degrees of liver dysfunction. We have previously shown that preoperative liver stiffness is associated with hospital length of stay following cardiac surgery. The authors hypothesized that a liver stiffness measurement (LSM) ≥ 9.5 kPa would rule out a short hospital length of stay (LOS < 6 days) following isolated coronary artery bypass grafting (CABG) surgery. Methods: A prospective observational study of one hundred sixty-four adult patients undergoing non-emergent isolated CABG surgery at a single university hospital center. Preoperative liver stiffness measured by ultrasound elastography was obtained for each participant. Multivariate logistic regression models were used to assess the adjusted relationship between LSM and a short hospital stay. Results: We performed multivariate logistic regression models using short hospital LOS (<6 days) as the dependent variable. Independent variables included LSM (< 9.5 kPa, ≥ 9.5 kPa), age, sex, STS predicted morbidity and mortality, and baseline hemoglobin. After adjusting for included variables, LSM ≥ 9.5 kPa was associated with lower odds of early discharge as compared to LSM < 9.5 kPa (OR: 0.22, 95% CI: 0.06-0.84, p = 0.03). The ROC curve and resulting AUC of 0.76 (95% CI: 0.68-0.83) suggest the final multivariate model provides good discriminatory performance when predicting early discharge. Conclusions: A preoperative LSM ≥ 9.5 kPa ruled out a short length of stay in nearly 80% of patients when compared to patients with a LSM < 9.5 kPa. Preoperative liver stiffness may be a useful metric to incorporate into preoperative risk stratification.

Results of Turner Syndrome Treatment with Recombinant Human Growth Hormone in Albania

Background: There is no doubt that the use of rhGH in patients with TS brings satisfactory results regarding the improvement of height growth, realizing the improvement of the final adult height. This study aimed to evaluate the influence of the type/characteristic of the genetic anomaly on sex chromosome X on the outcome of treatment with rhGH among Albanian children diagnosed with TS. Methods and Results: This analytical-observational study was conducted at the Pediatric Endocrine Unit at University Hospital Centre Mother Teresa in Tirana, the only one of its kind treating TS pediatrics in Albania. Only TS patients who had attained near-adult height (NAH) by December 2023 were included in the analysis of this study. Near-adult height was obtained for 44(72.1%) patients. The mean age of starting treatment was 12.68±3.03 years. After a treatment duration of 3.60±2.26 years, the patients recovered 0.88±0.56 in height-for-age Z-score (HAZ), resulting in HAZ at the end of treatment of -2.73±0.87. They achieved their NAH of 144.56±6.53cm. Conclusion: Despite starting treatment late, our patients managed to gain 17.70±12.53cm in length. The progression of height improvement under rhGH treatment showed differences between chromosomal groups. The non-monosomy group had better results regarding NAH and HAZ at the treatment's end than the monosomy group.

Incidence of post-dural lumbar puncture headache (PDLPH) in comparison between emergency and elective lower segment cesarean section (LSCS) with 26G Quincke-Babcock cutting-beveled spinal needle.

C-section is usually performed under spinal anesthesia also known as a subarachnoid block (SAB) over general anesthesia. Because of the lesser amount of dose used, there is a lower risk of local anesthetic toxicity and minimal transfer of drugs to the fetus. Obstetric patients have a higher risk of having post-dural puncture headache (PDPH). PDPH occurs due to leakage of the cerebrospinal fluid (CSF) through the hole created by a spinal needle. There are many elements affecting the frequency of PDPH, these elements can also consist of age, female sex, needle size, and types, pregnancy, preceding records of PDPH, median-paramedian distinction in approach, a puncture level. PDPH is commonly in the form of a frontal, occipital, or retro-orbital headache that starts in 12-72 h after the dural puncture and will increase when standing and decrease when lying down or resting. We aimed to learn about headache frequency between elective and emergency lower segment cesarean section using 26-G Quincke spinal needle in full-term pregnant patients. To study the incidence of PDPH using the 26G Quincke spinal needle. To analyze the causal factors/determinants such as adequate preloading of fluids, size of spinal needle, number of pricks, and technique of lumbar puncture effects on the incidence of PDPH. This study is a prospective questionnaire-based comparative observational study using the convenience sampling method. The patients were interviewed with a structured questionnaire at the Symbiosis University Hospital and Research Centre, Lavale, Pune. The patients observed for the study were between 20 and 40 of age group, posted for emergency or elective lower segment cesarean section, with body mass index (BMI) less than 14.5 to 24.9 and with ASA I and II grades. Patients with any comorbidities, recurrent headaches, obesity, and spine deformity were excluded. According to the review of the literature and with the help of a formula, the sample size was calculated as 20; 10 patients for elective LSCS, and 10 patients for emergency LSCS. Out of 20 patients, 10 patients were posted for elective LSCS, and the rest 10 patients were for emergency LSCS under spinal anesthesia. The incidence of PDPH was found only in 2 out of 10 emergency LSCS patients, and no patients from elective LSCS cases showed up with the incidence of PDPH.

The Spectrum and Frequency of Cystic Fibrosis Mutations in Albanian Patients

Abstract BACKGROUND Cystic fibrosis (CF) is a genetic disease characterized by a wide spectrum of severity, resulting from the inheritance of a mutant allele of the gene for cystic fibrosis transmembrane conductance regulator (CFTR). The aim of the study was to present a CFTR mutation analysis among the Albanian population and to identify rare variants. METHODS We identified CFTR mutations in a representative cohort of CF patients comprising of Albanian patients and some Kosovo patients followed up by the Department of Pediatrics at the University Hospital Center “Mother Theresa” (UHCMT). Compiled clinical and genotypic data include 133 previously analyzed patients, of whom 116 have two identified mutations, 6 have only one known mutation, and 11 are unexamined. RESULTS The most frequent mutation is F508del (83.19%), followed by 621+1G&gt;T (2.45%). Other mutations identified in decrease order are E822X, G85E, G542X, R1066C, R1070Q, R1158X, G1349D, N1303K, S466X, 1811+1G-&gt;C, E831X, CFTRdele2,3(21kb). CONCLUSIONS The data suggest that most of these patients can benefit from new modulatory therapies targeting CFTR mutations, translating to very hopeful prospects for these patients. The Albanian population would benefit from Cystic Fibrosis neonatal screening, since outcomes can be improved through early diagnosis.

Loop diuretic discontinuation in chronic heart failure patients: A retrospective study

Introduction and ObjectivesThe use of loop diuretics is central in managing congestion in heart failure (HF), but their impact on prognosis remains unclear. In euvolemic patients, dose reduction is recommended, but there is no recommendation on their discontinuation. This study aims to assess the impact of loop diuretic discontinuation on the prognosis of outpatients with HF with reduced ejection fraction. MethodsThis retrospective cohort study collected data from medical records of patients followed in an outpatient HF clinic at a university hospital center. Patients were included if they had been on loop diuretics and these were discontinued. Demographic, clinical and laboratory data were collected, and number and type of congestive events during the one-year period after discontinuation were recorded. ResultsAmong 265 patients on loop diuretics, almost half (129) discontinued them at some point. Patients had optimized medical therapy, low median age, low New York Heart Association class, low B-type natriuretic peptide values, normal blood pressure, controlled heart rate and kidney function within normal limits. Among 122 patients with one year of follow-up, 18 (14.8%) had a congestive event. Fifteen events (83.3%) were low-dose diuretic reinitiation at a scheduled visit. There were only three worsening heart failure events (2.5%) during the one-year period. A significant improvement in kidney function from discontinuation to the one-year follow-up appointment was also observed. ConclusionsIn our cohort, loop diuretic discontinuation was possible and safe in a large proportion of patients. The results should be interpreted with caution and cannot be extrapolated to a broader population of HF patients.

Prognosis of Newborns of Parturient Who Have Suffered Female Genital Mutilation/Excision (FGM) in the Obstetrics Department of University Hospital Center (UHC) POINT G. BAMAKO/Mali

Prognosis of Newborns of Parturient Who Have Suffered Female Genital Mutilation/Excision (FGM) in the Obstetrics Department of University Hospital Center (UHC) POINT G. BAMAKO/Mali