Platelets and Immature Neutrophils in Preterm Infants with Feeding Intolerance

Objective Feeding intolerance (FI) is a common presentation of necrotizing enterocolitis (NEC) and sepsis. NEC and sepsis are associated with hematological changes, but these changes alone are not reliable biomarkers for early diagnosis. This study examined whether the combination of hematological indices and FI can be used as an early diagnostic tool for NEC or sepsis. Study Design This retrospective cohort study included infants born at <1,500 g or <30 weeks who had symptoms of FI. The exclusion criteria were congenital or chromosomal disorders, thrombocytopenia or platelet transfusion before the onset of FI, and history of bowel resection. We compared the hematological indices from infants with pathologic FI (due to NEC or sepsis) to infants with benign FI. Results During the study period, 211 infants developed FI; 185 met the inclusion criteria. Infants with pathologic FI (n = 90, 37 cases with NEC and 53 with sepsis) had lower birth gestational age and weight compared with 95 infants with benign FI (n = 95). Pathologic FI was associated with lower platelet count (median 152 × 103/μL vs. 285 × 103/μL, p < 0.001) and higher immature-to-total neutrophil (I/T) ratio (median 0.23 vs. 0.04, p < 0.001) at the onset of FI. Pathologic FI was also associated with a decrease in baseline platelets compared with an increase in benign FI. For diagnosis of pathologic FI, a decrease ≥10% in platelets from baseline had a sensitivity and specificity of 0.64 and 0.73, respectively, I/T ratio ≥0.1 had a sensitivity and specificity of 0.71 and 0.78, respectively, and the combination of both parameters had a sensitivity and specificity of 0.50 and 0.97, respectively. Conclusion FI caused by NEC or sepsis was associated with a decrease in platelets from baseline, and a lower platelet level and higher I/T ratio at the onset of FI. These findings can help clinicians in the management of preterm infants with FI. Key Points

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The association of triglyceride levels with the incidence of initial and recurrent acute pancreatitis

Lipids in Health and Disease ◽

10.1186/s12944-021-01488-8 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Robert J. Sanchez ◽

Wenzhen Ge ◽

Wenhui Wei ◽

Manish P. Ponda ◽

Robert S. Rosenson

Keyword(s):

Acute Pancreatitis ◽

Medical Records ◽

Adult Population ◽

Baseline Period ◽

Prior History ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Recurrent Acute Pancreatitis ◽

History Of ◽

Nationally Representative

Abstract Background This retrospective cohort study assessed the annualized incidence rate (IR) of acute pancreatitis (AP) in a nationally representative US adult population, as well as the variation in the risk of AP events across strata of triglyceride (TG) levels. Methods Data were obtained from IQVIA’s US Ambulatory Electronic Medical Records (EMR) database linked with its LRxDx Open Claims database. Inclusion criteria included ≥1 serum TG value during the overlapping study period of the EMR and claims databases, ≥1 claim in the 12-month baseline period, and ≥ 1 claim in the 12 months post index. All TG measurements were assigned to the highest category reached: < 2.26, ≥2.26 to ≤5.65, > 5.65 to ≤9.94, > 9.94, and > 11.29 mmol/L (< 200, ≥200 to ≤500, > 500 to ≤880, > 880, and > 1000 mg/dL, respectively). The outcome of interest was AP, defined as a hospitalization event with AP as the principal diagnosis. Results In total, 7,119,195 patients met the inclusion/exclusion criteria, of whom 4158 (0.058%) had ≥1 AP events in the prior 12 months. Most patients (83%) had TGs < 2.26 mmol/L (< 200 mg/dL), while < 1% had TGs > 9.94 mmol/L (> 880 mg/dL). Overall, the IR of AP was low (0.08%; 95% confidence internal [CI], 0.08–0.08%), but increased with increasing TGs (0.08% in TGs < 2.26 mmol/L [< 200 mg/dL] to 1.21% in TGs > 11.29 mmol/L [> 1000 mg/dL]). In patients with a prior history of AP, the IR of AP increased dramatically; patients with ≥2 AP events at baseline had an IR of 29.98% (95% CI, 25.1–34.9%). Conclusion The risk of AP increases with increasing TG strata; however, the risk increases dramatically among patients with a recent history of AP.

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Clinical features of spongy urethral strictures requiring multi-stage urethroplasty or permanent urethrostomy

Experimental and Сlinical Urology ◽

10.29188/2222-8543-2021-14-3-156-163 ◽

2021 ◽

Vol 14 (3) ◽

pp. 156-163

Author(s):

V.P. Glukhov ◽

◽

A.V. Ilyash ◽

V.V. Mitusov ◽

D.V. Sizyakin ◽

...

Keyword(s):

Clinical Features ◽

Urethral Stricture ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Urethral Stricture Disease ◽

One Stage ◽

Urethral Strictures ◽

Multi Stage ◽

History Of ◽

Urethral Surgery

Introduction. Extended spongy urethral strictures require the use of plastic surgery techniques. In most cases, a one-stage urethral repair can be performed. However, staged urethroplasty and permanent urethrostomy are important in patients with extremely complex urethral strictures. Purpose of the study. To determine the clinical features of spongy urethral strictures, which cannot be cured by one-stage urethroplasty, but are subject to multistage plastic or permanent urethrostomy. Materials and methods. The study included 158 patients who underwent surgery for urethral strictures in 2010 − 2019. Inclusion criteria: spongy urethral strictures requiring staged urethroplasty or permanent urethrostomy. Exclusion criteria: age<18 years, proximal urethral strictures, urethra-vesical anastomosis and bladder neck stenosis, previously untreated congenital anomalies (hypospadias and epispadias), and history of any other urethral surgery not meeting the inclusion criteria. Results. The age of the patients ranged from 18 to 88 years. Iatrogenic (34.8%) and inflammatory (32.3%) urethral lesions predominate in the structure of etiological factors with the most common penile localization of narrowing (43.7%). The length of strictures in half of the patients exceeds 6 cm; a quarter of the sample has subtotal and total spongy urethral lesions. The proportion of recurrent urethral strictures is 56.3%. The average duration of the urethral stricture disease reaches 8 years. In 61.3% of cases, the disease is accompanied by complications from both local tissues and organs of the urinary and reproductive systems. Conclusion. Clinical evaluation of patients with spongy urethral strictures requiring multi-stage urethroplasty or permanent urethrostomy reveals a particular severity of urethral stricture disease. This category of patients has a high risk of unsuccessful outcomes with one-stage surgery. In these cases, patients require a multi-staged urethroplasty or a permanent urethrostomy.

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AN UPDATE ON THE ASSOCIATION BETWEEN TYPE 2 DIABETES AND ALZHEIMER- A SYSTEMATIC REVIEW

10.5327/1980-5764.rpda076 ◽

2021 ◽

Author(s):

Juliana Almeida ◽

Fernanda Almeida

Keyword(s):

Type 2 Diabetes ◽

Mexican Americans ◽

Amyloid Β ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Memory And Attention ◽

Randomized Controlled ◽

Attention Skills ◽

History Of

Background: The association of Type 2 Diabetes (T2D) and Alzheimer’s Disease (AD), that is 6th cause of death in United States, have been long noted. The history of T2D increases the risk for AD by 50-200% and the 10 years risk in 10-30%, which is 25-35 times the general. Objective: To investigate findings of the last 5 years that directly correlate T2D with AD. Methods: Use of the PICO strategy, conducted on September 17, on PubMed using “Alzheimer disease” and “diabetes mellitus” as descriptors, identifying 14 articles, selecting 4 after screening. Inclusion criteria: clinical and randomized controlled trials with diabetic and Alzheimer patients, published on the last 5 years. Exclusion criteria: articles focused on medications. Results: Mexican Americans are more likely to evolve T2D, to have an earlier onset and severer forms of AD. Furthermore, cell-free mitochondrial DNA, common in diabetics, is related to cognitive impairment. Besides, metformin improves learning, memory and attention skills, and BG control is linked to longer survival time and an apparent delay of the dementia. Moreover, lower levels of plasma amyloid-β (Aβ) 40 and 42 were found when T2D and higher levels of Aβ42 have been found in people treated with insulin, but the Aβ levels meaning needs to be clarified. Conclusion: T2D is often related to lifestyle and AD to a genetic component. Anyhow, more studies are needed to clarify the meaning of these findings. Study limitations: few trials performed.

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DOZ047.42: The value of rigid tracheobronchoscopy for the diagnosis of tracheomalacia in esophageal atresia patients

Diseases of the Esophagus ◽

10.1093/dote/doz047.42 ◽

2019 ◽

Vol 32 (Supplement_1) ◽

Author(s):

I P Aanen ◽

B Pullens ◽

J van Rosmalen ◽

R M H Wijnen

Keyword(s):

Sensitivity And Specificity ◽

Esophageal Atresia ◽

Surgical Intervention ◽

Medical Center ◽

Primary Repair ◽

Demographic Data ◽

P Value ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Low Sensitivity

Abstract Aim of the Study The aim of this study is to evaluate routine airway endoscopy prior to the closure of the trachea-esophageal fistula (TOF) and esophageal atresia (EA) repair in a tertiary medical center concerning pre- and postoperative tracheomalacia. Methods We evaluated all patients with EA born between 2013 and 2016 who underwent routine rigid tracheobronchoscopy (TBS) before primary repair of the EA at our center. Inclusion criteria included peroperative rigid TBS performed by an otolaryngologist. Exclusion criteria included impossibility to determine pre- and or postoperative TM (because of logistic or medical reasons). Demographic data, comorbidities, surgical intervention, TBS findings, and subsequent surgical management were analyzed. Main Results Twenty-four patients with EA were included in this study. Eight of the 24 patients developed postoperative TM. Of these 8 patients with TM, 5 were diagnosed at the preoperative TBS (62.5%). Of the 16 patients without postoperative TM, there were 6 patients (37.5%) with peroperative diagnosed TM. So the sensitivity and specificity of routine airway endoscopy prior to EA-repair are, respectively, 62.5% (CI 30.4%–86.5%) and 62.5% (CI 38.5%–81.6%). Concerning postoperative TM, there is a significant higher appearance in females versus males (P-value 0.021). There was no significant causality between mean gestational age, birth weight, type of EA, type of surgery (open or thoracoscopic), presence of gastroesophageal reflux disease, and the appearance of postoperative TM. Conclusions Preoperative TBS can be useful for the evaluation of tracheoesophageal fistula but has a low sensitivity and specificity to detect postoperative TM.

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Antenatal Steroids and Acute Kidney Injury in Preterm Infants

American Journal of Perinatology ◽

10.1055/s-0040-1722330 ◽

2021 ◽

Author(s):

Nuran Üstün ◽

Sertac Arslanoglu ◽

Fahri Ovali

Keyword(s):

Acute Kidney Injury ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Very Low Birth Weight ◽

Tertiary Care ◽

Kidney Injury ◽

Inclusion Criteria ◽

Vlbw Infants ◽

Antenatal Steroids ◽

Key Points

Objective The aim of this study was to identify the effects of antenatal steroids (ANS) on acute kidney injury (AKI) in very low birth weight (VLBW) preterm infants. Study Design We performed a retrospective cohort study of VLBW infants admitted to a tertiary-care neonatal intensive care unit between January 2016 and June 2019. Infants were divided into no ANS, partial ANS, and complete ANS groups. Serum creatinine (SCr) levels and rates of AKI during the first 2 weeks of life were compared. Results During the study period, 335 infants met our inclusion criteria. Among no, partial, and complete ANS groups, there were significant differences in rates of stages 2 and 3 AKI (17, 11, and 6%, respectively). Logistic regression analysis revealed that complete ANS course was associated with lower rates of AKI (odds ratio [OR] = 0.41 95% confidence interval [CI]: 0.20–0.83) and stages 2 and 3 AKI (OR = 0.205 95% CI: 0.075–0.563) compared with no ANS. Infants in complete ANS group had significantly lower SCr at 72 hours of life and at discharge, SCr peak was compared with infants in no ANS group. Conclusion In VLBW infants, complete ANS exposure may be associated with improved renal function and decreased risk for AKI compared with no ANS. Key Points

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A study of second to fourth digit ratio in relation to verbal and numerical intelligence among medical students

Biomedicine ◽

10.51248/.v41i3.1206 ◽

2021 ◽

Vol 41 (3) ◽

pp. 678-681

Author(s):

G .Yuvarani ◽

Jibi Paul ◽

M. Manoj Abraham ◽

N. Harikrishnan

Keyword(s):

Shoulder Pain ◽

Prospective Observational Study ◽

External Rotation ◽

Dominant Hand ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Female Population ◽

Female Age ◽

History Of ◽

Severity Of The Disease

Introduction and Aim:Periarthritis shoulder is generally defined as a self - limiting disorder that affects mostly the diabetic persons. Periarthritis shoulder affects the older population with females at its peak.This study was intended to find out whether all the shoulder pain subjects were victims of periarthritis shoulder and to analyse the prevalence of periarthritis among subjects who were suffering from shoulder. Materials and Methods:This study was a prospective, observational study conducted on the patients who visited the outpatient Physiotherapy Departments. Nearly 300 patients who came with shoulder pain were taken as samples. A detailed explanation about the purpose of the study was given to the subjects. The subjects included were based on the inclusion criteria pain more than 1 month, both male and female, age group of 40-60 years, both dominant and non-dominant hand, history of shoulder pain at night, progressive limitation of shoulder movement, particularly a reduction of at least half the normal range of abduction and external rotation. Results:Based on the inclusion and exclusion criteria nearly 300 participants were selected and they were asked to fill the SPADI questionnaire. Out of 300 participants nearly 127 subjects were concluded with positive signs of periarthritis shoulder. Conclusion: The result obtained from our study states that the severity of the disease is more among the female population. The subjects who are suffering from shoulder pain must be taken into anticipation that in future they may develop shoulder periarthritis.

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The Rationality of Using Diclofenac in Outpatient Cases of Osteoarthritis of RSUP MH Palembang Period January-March 2018

Archives of The Medicine and Case Reports ◽

10.37275/amcr.v2i1.12 ◽

2021 ◽

Vol 2 (1) ◽

pp. 67-74

Author(s):

Dara Prameswari ◽

M. Totong Kamaluddin ◽

Nita Parisa

Keyword(s):

Medical Records ◽

Sampling Technique ◽

Outpatient Setting ◽

Common Disease ◽

Low Back ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Cross Sectional ◽

Drug Of Choice ◽

History Of

Rationality of Diclofenac Use in Osteoarthritis Outpatient Case at RSUP MH Palembang in January-March 2018. Osteoarthritis (OA) is the most common disease in joints that affects people in their middle until late years. In Indonesia the prevalence of OA is relatively high and disturbs their daily activity. Diclofenac is one of the drug of choice in treating OA. To avoid multiple side effects from Diclofenac use, the usage must be in accordance to rationality indicators which are correct dose, correct frequency, and correct length of use. This study is aimed to know the rationality of Diclofenac use in Osteoarthritis outpatient cases at RSUP Mohammad Hoesin Palembang. This study is a descriptive observational with a cross-sectional approach to know the rationality of Diclofenac use in outpatient cases of osteoarthritis at RSUP Mohammad Hoesin Palembang. Samples were medical records of OA patients in outpatient setting from January to March 2018 which fulfilled the inclusion and exclusion criteria. Sampling technique used was total sampling. The amount of samples fulfilling the inclusion criteria were 201 patients, with the most were aged 46-65 years (60.2%), female (55.7%), and has a history of comorbidity which includes low back pain (22.8%). The result of this study shows pattern of Diclofenac use with dosage of 2 x 25mg (73.6%), length of use about <7 days (57.2%). In combination with other drugs there were no interaction to be found (84.4%), or synergistic interaction (8.5%) and antagonistic interaction (7.1%). The use of diclofenac in osteoarthritis cases at outpatient setting in RSUP Dr Mohammad Hoesin Palembang is rational and needs to be maintained.

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THE ANTIDIPHTHERIA ANTIBODIES OF SEROEPIDEMIOLOGY SURVEY AMONG ADOLESCENTS IN BANGKALAN AND KEDIRI DISTRICTS

Jurnal Berkala Epidemiologi ◽

10.20473/jbe.v7i22019.94-102 ◽

2019 ◽

Vol 7 (2) ◽

pp. 94

Author(s):

Dominicus Husada ◽

Kristina Marbun ◽

Desy Primayani ◽

Leny Kartina ◽

Dwiyanti Puspitasari ◽

...

Keyword(s):

High Schools ◽

Immunization Coverage ◽

Cross Sectional Study ◽

Sectional Study ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Resistance Level ◽

Cross Sectional ◽

History Of

Background: An increase in diphtheria cases has occurred in East Java Province since 2011. The resistance level to diphtheria is considered as the most important cause. Purpose: The study aims analyzed the immunity level immunity to diphtheria in adolescents aged 16-18 years old in Bangkalan and Kediri Districts. Methods: This study was a cross-sectional study, conducted on students in eleven grade of senior high schools (SMAN) from both districts. The inclusion criteria included being 16-18 years old and students in eleven grades of senior high schools in Bangkalan and Kediri. This study was approved by their parents/guardians. The exclusion criteria included immunocompromised students and those who have a history of diphtheria infection. The data were obtained from 204 samples, 89 samples in Bangkalan, and 115 samples in Kediri. The antidiphtheria antibodies examination was carried out by the Vero cell method. The antibodies levels were grouped according to WHO standard, consist of vulnerable, basic, full, and long-term. Further analysis was done with 2 tiers of immunity, consist of immune and vulnerable. Results: The immunization coverage for basic and booster diphtheria vaccine is better in Kediri than in Bangkalan. In contrast, levels of antibodies samples in Bangkalan District is better. The participants who were immune in Bangkalan were higher than those in Kediri (91% vs. 44.3%). Conclusion: The immunity adolescents of Bangkalan is higher than in adolescent Kediri District. The adolescents in Kediri have a greater risk to get infected by the disease

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Appropriate use of echocardiography for palpitations in paediatric cardiology clinics

Cardiology in the Young ◽

10.1017/s104795112000325x ◽

2020 ◽

pp. 1-3

Author(s):

Saloni Sheth ◽

Munes Fares ◽

Sandra Kikano ◽

Christopher Snyder ◽

Andrew Dodgen ◽

...

Keyword(s):

Diagnostic Yield ◽

Appropriate Use Criteria ◽

Inclusion Criteria ◽

Appropriate Use ◽

Single Centre ◽

Exclusion Criteria ◽

Paediatric Cardiology ◽

History Of ◽

Echocardiographic Findings ◽

Or History

Abstract Objectives: Identify diagnostic yield and frequency of echocardiograms for palpitation-related indications at outpatient paediatric cardiology clinics in relation to the 2014 ACC/AAP/AHA/ASE/HRS/SCAI/SCCT/SCMR/SOPE appropriate use criteria for Initial Transthoracic Echocardiography in Outpatient Paediatric Cardiology. Study design: A single-centre, retrospective study of children presenting for evaluation of a chief complaint of palpitations to outpatient paediatric cardiology clinics from 2015 to 2017. Palpitations were defined as an unpleasant sensation of rapid, irregular, and/or forceful beating of the heart. Indications for echocardiogram in patients were retrospectively classified based on the appropriate use criteria as “appropriate,” “may be appropriate,” or “rarely appropriate.” The incidence of abnormal and incidental echocardiographic findings for each category was determined. Results: A total of 286 patients presented with palpitations, with 128 (52% female) meeting inclusion criteria. Exclusion criteria included patients with additional cardiac complaints, prior echocardiogram, or history of congenital heart disease. Echocardiograms were performed on 36 (28%) patients. The appropriate use criteria were retrospectively applied, and indications for their performance were classified as “appropriate” (n = 4), “may be appropriate” (n = 17), or “rarely appropriate” (n = 15). Minor echocardiographic abnormalities were present in 22% (n = 8) of echocardiograms obtained for all appropriate use criteria classifications. No moderate or severe echocardiographic abnormalities were found. Incidental findings were noted in eight echocardiograms. Conclusion: Echocardiography in the evaluation of “rarely appropriate” and “may be appropriate” palpitation-related indications is of low diagnostic yield.

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Comparison between primary repair and exteriorization in cases of Typhoid perforation

Annals of King Edward Medical University ◽

10.21649/akemu.v11i3.1004 ◽

2016 ◽

Vol 11 (3) ◽

Cited By ~ 1

Author(s):

Asaad Akbar Khan ◽

Intesarur Rashid Khan ◽

Umer Najeeb ◽

Asim Jameel Sheikh

Keyword(s):

Abdominal Pain ◽

Comparative Study ◽

Clinical Finding ◽

Primary Repair ◽

Inclusion Criteria ◽

Widal Test ◽

Exclusion Criteria ◽

Bowel Sounds ◽

X Ray ◽

History Of

Objectives: This comparative study was conducted at Mayo Hospital, Lahore from April 2004 to May 2005 to compare the results of primary repair and exteriorization in cases of typhoid perforation Materials and methods: :80 patients were selected out of which 48 were males and 32 were females. Inclusion criteria: Consisted of a history of fever abdominal pain, constipation, sharp shooting pain superimposed over the colicky abdominal pain clinical finding included tense tender abdomen and absent bowel sounds, investigations including gas under diaphragm in abdominal x-ray and positive widal test. Exclusion criteria: Consisted of negative Widal test even if there was gas under diaphragm, per op findings suggestive of tuberculosis or histopathology reports suggestive of tuberculosis or any pathology other than typhoid. Primary repair was done in patients who presented within 36 hrs of experiencing sharp shooting pain and per op findings of minimal contamination. Exteriorization in the form of loop or double barrel ileostomy was done in other cases.

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