Retrospective analysis of pediatric patients with multiple rare-earth magnets ingestion: a single-center experience from China

Abstract Background The aim of this study was to characterize patients who ingested multiple rare-earth magnets, reveal the harm of rare-earth magnet foreign bodies in the digestive tract, and develop a clinical management algorithm. Methods This was a retrospective review of patients with rare-earth magnet foreign bodies in the digestive tract admitted to a university-affiliated pediatric medical center in China, between January 2016 and December 2019; the subset of medical data evaluated included clinical symptoms, signs, treatments and outcomes. Results A total of 51 cases were included in this study, including 36(70.6%) males and 15(29.4%) females. The magnets were passed naturally in 24(47.1%) patients and removed by intervention in 27(52.9%) patients, including 5(9.8%) cases by endoscopy and 22(43.1%) cases by surgery. Twenty-two (43.1%)cases had gastrointestinal obstruction, perforation, and fistula. Compared with the non-surgical group, the time of the surgical group from ingestion to arriving at the hospital was longer([80(5–336) vs 26(2–216)]hours, p < 0.001) while there was no significant difference in the mean age or the number of magnets swallowed. Conclusions Magnets are attractive to children, but lead to catastrophic consequences including gastrointestinal obstruction, perforation, and surgical interventions when ingested multiple magnets. Endoscopic resection should be urgently performed in the presence of multiple magnets as early as possible within 24 h, even in asymptomatic patients.

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Retrospective analysis of pediatric patients with multiple rare-earth magnets ingestion: a single-center experience from China.

10.21203/rs.3.rs-35857/v3 ◽

2020 ◽

Author(s):

Yucan Zheng ◽

Zhihua Zhang ◽

Kunlong Yan ◽

Hongmei Guo ◽

Mei Li ◽

...

Keyword(s):

Rare Earth ◽

Digestive Tract ◽

Foreign Bodies ◽

Clinical Symptoms ◽

Medical Center ◽

Rare Earth Magnet ◽

Gastrointestinal Obstruction ◽

Asymptomatic Patients ◽

Significant Difference ◽

Surgical Group

Abstract Background The aim of this study was to characterize patients who ingested multiple rare-earth magnets, reveal the harm of rare-earth magnet foreign bodies in the digestive tract, and develop a clinical management algorithm. Methods This was a retrospective review of patients with rare-earth magnet foreign bodies in the digestive tract admitted to a university-affiliated pediatric medical center in China, between January 2016 and December 2019; the subset of medical data evaluated included clinical symptoms, signs, treatments and outcomes. Results A total of 51 cases were included in this study, including 36（70.6%） males and 15（29.4%） females. The magnets were passed naturally in 24（47.1%） patients and removed by intervention in 27（52.9%） patients, including 5（9.8%） cases by endoscopy and 22（43.1%） cases by surgery. Twenty-two（43.1%）cases had gastrointestinal obstruction, perforation, and fistula. Compared with the non-surgical group, the time of the surgical group from ingestion to arriving at the hospital was longer（［80（5-336） vs 26（2-216）］hours, p<0.001）while there was no significant difference in the mean age or the number of magnets swallowed. Conclusions Magnets are attractive to children, but lead to catastrophic consequences including gastrointestinal obstruction, perforation, and surgical interventions when ingested multiple magnets. Endoscopic resection should be urgently performed in the presence of multiple magnets as early as possible within 24 hours, even in asymptomatic patients.

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Retrospective analysis of pediatric patients with multiple rare-earth magnets ingestion: a single-center experience from China.

10.21203/rs.3.rs-35857/v2 ◽

2020 ◽

Author(s):

Yucan Zheng ◽

Zhihua Zhang ◽

Kunlong Yan ◽

Hongmei Guo ◽

Mei Li ◽

...

Keyword(s):

Rare Earth ◽

Digestive Tract ◽

Foreign Bodies ◽

Clinical Symptoms ◽

Medical Center ◽

Surgical Interventions ◽

Rare Earth Magnet ◽

Gastrointestinal Obstruction ◽

Asymptomatic Patients ◽

Surgical Group

Abstract Background The aim of this study was to characterize patients who ingested multiple rare-earth magnets, reveal the harm of rare-earth magnet foreign bodies in the digestive tract, and develop a clinical management algorithm. Methods This was a retrospective review of patients with rare-earth magnet foreign bodies in the digestive tract admitted to a university-affiliated pediatric medical center in China, between January 2016 and December 2019; the subset of medical data evaluated included clinical symptoms, signs, treatments and outcomes. Results A total of 51 cases were included in this study, including 36(70.6%) males and 15(29.4%) females. The magnets were passed naturally in 24(47.1%) patients and removed by intervention in 27(52.9%) patients, including five (9.8%) cases by endoscopy and 22(43.1%) cases by surgery. Twenty-two (43.1%) patients cases had gastrointestinal obstruction, perforation, and fistula. Compared with the non-surgical group, the proportion of males in the surgical group was higher (21/23 vs 15/28, p=0.004), and the time from ingestion to arriving at the hospital was longer (80(72) vs 26(5), hours, p=0.008). Conclusions Magnets are attractive to children, but lead to catastrophic consequences including gastrointestinal obstruction, perforation, and surgical interventions when ingested multiple magnets. Endoscopic resection should be urgently performed in the presence of multiple magnets as early as possible within 24 hours, even in asymptomatic patients. Trial registration The study will be retrospectively registered.

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Retrospective Analysis of Pediatric Patients with Multiple Rare-Earth Magnet Ingestion: A Single-Center Experience from China.

10.21203/rs.3.rs-35857/v1 ◽

2020 ◽

Author(s):

Yucan Zheng ◽

Zhihua Zhang ◽

Kunlong Yan ◽

Hongmei Guo ◽

Mei Li ◽

...

Keyword(s):

Rare Earth ◽

Digestive Tract ◽

Foreign Bodies ◽

Clinical Symptoms ◽

Medical Center ◽

Rare Earth Magnet ◽

Single Center Experience ◽

Management Algorithm ◽

Magnet Ingestion ◽

Surgical Group

Abstract Background The aim of this study was to characterize patients with multiple rare-earth magnet ingestion in a single-pediatric medical center, reveal the harm of rare-earth magnets foreign bodies in digestive tract, and develop a clinical management algorithm. Methods This was a retrospective review of patients with rare-earth magnets foreign bodies in digestive tract admitted to a university-affiliated pediatric medical center in China, between January 2016 to December 2019, with a subset of medical data including clinical symptoms, signs, treatments and outcomes. Results A total of 51 cases were included in this study, including 36(70.6%) males and 15(29.4%) females. The magnets were passed naturally in 24(47.1%) patients and removed by intervention in 27(52.9%) patients, including five(9.8%) cases by endoscopy and 22(43.1%) cases by surgery. 22(43.1%) cases had gastrointestinal obstruction, perforation, and fistula. Compared with the non-surgical group, the proportion of males in the surgical group was higher (21/23 vs 15/28, p=0.004), and the visiting time to hospital was longer (80(72) vs 26(5), hours, p=0.008). Conclusions The rate of surgical intervention is high in multiple rare-earth digestion cases and the consequences are serious, and a more efficient management algorithm for these cases should be needed. A policy for strictly restricted or prohibited the sale of the toys with multiple rare-earth magnets needed to put into the agenda. Trial registration The study will be retrospectively registered.

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International practice variation in postoperative imaging of chronic subdural hematoma patients

Journal of Neurosurgery ◽

10.3171/2018.8.jns181767 ◽

2019 ◽

Vol 131 (6) ◽

pp. 1912-1919 ◽

Cited By ~ 3

Author(s):

Alexander F. C. Hulsbergen ◽

Sandra C. Yan ◽

Brittany M. Stopa ◽

Aislyn DiRisio ◽

Joeky T. Senders ◽

...

Keyword(s):

Clinical Outcomes ◽

Subdural Hematoma ◽

Medical Center ◽

Chronic Subdural Hematoma ◽

Ct Scanning ◽

Burr Hole ◽

Ct Scans ◽

Neurological Condition ◽

Asymptomatic Patients ◽

Significant Difference

OBJECTIVEThe value of CT scanning after burr hole surgery in chronic subdural hematoma (CSDH) patients is unclear, and practice differs between countries. At the Brigham and Women’s Hospital (BWH) in Boston, Massachusetts, neurosurgeons frequently order routine postoperative CT scans, while the University Medical Center Utrecht (UMCU) in the Netherlands does not have this policy. The aim of this study was to compare the use of postoperative CT scans in CSDH patients between these hospitals and to evaluate whether there are differences in clinical outcomes.METHODSThe authors collected data from both centers for 391 age- and sex-matched CSDH patients treated with burr hole surgery between January 1, 2002, and July 1, 2016, and compared the number of postoperative scans up to 6 weeks after surgery, the need for re-intervention, and postoperative neurological condition.RESULTSBWH patients were postoperatively scanned a median of 4 times (interquartile range [IQR] 2–5), whereas UMCU patients underwent a median of 0 scans (IQR 0–1, p < 0.001). There was no significant difference in the number of re-operations (20 in the BWH vs 27 in the UMCU, p = 0.34). All re-interventions were preceded by clinical decline and no recurrences were detected on scans performed on asymptomatic patients. Patients’ neurological condition was not worse in the UMCU than in the BWH (p = 0.43).CONCLUSIONSWhile BWH patients underwent more scans than UMCU patients, there were no differences in clinical outcomes. The results of this study suggest that there is little benefit to routine scanning in asymptomatic patients who have undergone surgical treatment of uncomplicated CSDH and highlight opportunities to make practice more efficient.

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Are there any long-term cardio-pulmonary limitations of hospitalized Covid-19 patients?

European Heart Journal ◽

10.1093/eurheartj/ehab724.2446 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

R Badr Eslam ◽

C Binder-Rodriguez ◽

A Iscel ◽

J Niebauer ◽

R A Mousavi ◽

...

Keyword(s):

Oxygen Therapy ◽

Clinical Symptoms ◽

Therapy Group ◽

Good Method ◽

Blood Parameters ◽

Exercise Intolerance ◽

Asymptomatic Patients ◽

Number Of Patients ◽

Significant Difference

Abstract Background The Covid-19 pandemic has affected our lives for over a year and almost 500.000 people in Austria have been infected. Although many of them only had low or mild symptoms some had to be treated in the hospital. Even months after their infection some patients complain about fatigue, exercise intolerance and dyspnoea. The aim of this study was to perform a follow-up cardiopulmonary exercise test (CPET) on those patients, at 6 months after their hospitalization to find out if there are long-term cardio-pulmonary limitations (CPL) of Covid-19. We also wanted to check if there is any difference in outcome and CPL between patients who received oxygen therapy vs. without oxygen therapy. Methods 40 patients were included into this study (16 women = 40%; 24 men = 60%). All patients were hospitalized during their infection with Covid-19 (5 patients at ICU) and underwent CPET 6±2 month after discharge. 20 patients (50%) received oxygen therapy or ventilation during their hospitalization. CPET data were assessed at rest, during exercise and at recovery. Blood parameters including NT-pro BNP were collected and an interview and examination were performed. CPL was defined as VO2% of Predicted ≤84%, VE/CO2 Slope ≥34 and RER at peak of exercise ≥1.1. Results Median age of all patients was 46 years [interquartile range (IQR): 35.3–55.8], median BMI was 26.0 m2/kg [IQR: 23.0–29.0] and the median NTproBNP was 53.1 pg/mL [IQR: 24.0–95.6]. When comparing the two groups, we found higher percentage of CPL in patients who received oxygen therapy during their hospitalization (10% with oxygen vs. 5% without oxygen). Notably, the number of patients with a BMI ≥25 m2/kg was higher in the oxygen therapy group than in those without oxygen (80% vs. 45%). The median BMI without oxygen therapy was 24.0 [IQR: 20.3–26.8] vs. 29.0 [IQR: 25.0–31.0] with oxygen therapy (p=0.004). There were no significant differences in NT-proBNP levels (p=0.545). The median VO2% of predicted was 88.0% [72.5–98.0] without oxygen therapy vs. 84.5% [IQR: 70.8–91.8] with oxygen therapy (p=0.289), the median HR percentage of predicted was 92.5% [IQR: 85.5–97.8] without oxygen therapy vs. 94.5% [IQR: 88.3–103.5] with oxygen therapy (p=0.478), the median physical performance in watt in patients without oxygen therapy was 130.0 [IQR: 108.5–197.5] vs. 135.0 [IQR: 97.0–188.3] with oxygen therapy (p=0.820). Conclusion The findings of our study did not show any statistically significant difference in long-term CPL between patients who received oxygen therapy vs. those who didn't. Therefore, other causes of the exercise intolerance and dyspnoea have to be discussed multidisciplinary. Subclinical CPL in the absence of significant clinical symptoms represent a concern after a Covid-19 infection. Overall, 7.5% of our patients showed CPL although those patients didn't have any clinical symptoms. Therefore, CPET is a good method to discover asymptomatic patients with CPL. FUNDunding Acknowledgement Type of funding sources: None.

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OBSERVATIONAL STUDY OF FOREIGN BODIES IN DIGESTIVE TRACT

10.36106/ijsr/5706333 ◽

2020 ◽

pp. 80-82

Author(s):

Alokendu Bose ◽

Indranil Khatua ◽

Nayana Sengupta ◽

Debarshi Jana

Keyword(s):

Digestive Tract ◽

Foreign Bodies ◽

West Bengal ◽

Dietary Habits ◽

Definitive Treatment ◽

P Value ◽

Significant Difference ◽

High Incidence ◽

Lower Status ◽

Very High

Background: Parent‘s laxness and lack of attention by leaving small objects at the reach of children contributes to this high incidence of foreign bodies. Ears, noses and throats are the most exposed orifices, hence the incidence of foreign bodies is also high in them. Problem of dealing with aspirated foreign body either swallowed or aspirated are since antiquity. In such cases, no definitive treatment was available and hence, the morbidity and mortality were very high. Aim: To determine the incidence of foreign bodies in the upper aerodigestive tracts according to the age and sex among patients attending ENT department at TMH. Material and methods: This Prospective study was carried out in the Department of Otorhinolaryngology, Department of Otorhinolaryngology, R. G. Kar Hospital, Kolkata, West Bengal. Results: Complications after FB ingestion or removal are higher in lower SES group. Lower SES – 19/72(26.7%) while high SES with 10/68(14%). There were statistically no significant difference among the patients according to their Complications when compared with their SES although the percentage of lower status group are more than higher, with p – value=0.5533 {p >0.05}. Conclusion: Adults have more predilections for digestive tract foreign bodies which is mainly because of dietary habits and hasty eating.

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Performance of a Rapid Diagnostic Test for Influenza in a Tertiary Military Hospital, Philippines

Military Medicine ◽

10.1093/milmed/usab006 ◽

2021 ◽

Cited By ~ 1

Author(s):

John Mark Velasco ◽

Maria Theresa Valderama ◽

Paula Corazon Diones ◽

Fatima Claire Navarro ◽

Maribel Develos ◽

...

Keyword(s):

Predictive Value ◽

Influenza A ◽

Clinical Symptoms ◽

Medical Center ◽

Age Groups ◽

Armed Forces ◽

The Philippines ◽

Military Hospital ◽

Ct Value ◽

Significant Difference

ABSTRACT Introduction It is important to evaluate the performance of existing rapid influenza diagnostic tests (RIDTs) and the factors that can affect performance especially when the circulation dynamics of influenza strains change such as the displacement and replacement of the circulating seasonal influenza strains. Materials and Methods Nasal swabs were collected from patients presenting at V Luna Medical Center, Armed Forces of the Philippines Health Service Command, with influenza-like illness (ILI) with one swab tested using Quickvue (QV) influenza A+B RIDT (Quidel) and the other swab tested using the ABI 7500 (Applied Biosystems) real-time reverse transcriptase-polymerase chain reaction. Sensitivity, specificity, positive predictive value, and negative predictive value were estimated. We identified clinical symptoms predictive of influenza subtype and evaluated the independence of QV sensitivity on (1) Cycle threshold (Ct) value, controlling for timing of collection; (2) timing of collection, controlling for Ct value; and (3) Ct value and timing of collection taken together. Results Between August 2011 and October 2016, patients presenting with ILI (n = 2333) underwent testing. Quickvue sensitivity across all subtypes was significantly correlated with lower Ct values (higher virus titers) (P <.001) and, except for flu A/H3 (P = .974), was also significantly associated with timing of specimen collection (P <.05). No statistically significant difference was noted in QV sensitivity for Flu A/H3 (P = .130), pandemic H1/N1 (P = .207), Flu A/H3 + pandemic H1/N1 (P = .341), and Flu B (P = .103) across different age groups but sensitivity of QV significantly differed (P <.001) across the different influenza subtypes. Conclusion Overall specificity of QV was high across all flu subtypes, but overall sensitivity was low (Flu A/pdm H1) to moderate (Flu A/H3 and Flu B). The findings highlight the need to develop more sensitive influenza RDTs to detect circulating influenza strains and the use of the quadrivalent flu vaccine during the annual influenza vaccination.

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Comparative Characterization and Risk Stratification of Asymptomatic and Presymptomatic Patients With COVID-19

Frontiers in Immunology ◽

10.3389/fimmu.2021.700449 ◽

2021 ◽

Vol 12 ◽

Author(s):

Lei Shi ◽

Rong Ding ◽

Tingting Zhang ◽

Wei Wu ◽

Ziyu Wang ◽

...

Keyword(s):

Risk Stratification ◽

Operating Characteristic ◽

Clinical Symptoms ◽

Characteristic Curve ◽

Case Series ◽

Asymptomatic Patients ◽

Risk Stratification Model ◽

Significant Difference ◽

The Mean ◽

Cell Data

The identification of asymptomatic, non-severe presymptomatic, and severe presymptomatic coronavirus disease 2019 (COVID-19) in patients may help optimize risk-stratified clinical management and improve prognosis. This single-center case series from Wuhan Huoshenshan Hospital, China, included 2,980 patients with COVID-19 who were hospitalized between February 4, 2020 and April 10, 2020. Patients were diagnosed as asymptomatic (n = 39), presymptomatic (n = 34), and symptomatic (n = 2,907) upon admission. This study provided an overview of asymptomatic, presymptomatic, and symptomatic COVID-19 patients, including detection, demographics, clinical characteristics, and outcomes. Upon admission, there was no significant difference in clinical symptoms and CT image between asymptomatic and presymptomatic patients for diagnosis reference. The mean area under the receiver operating characteristic curve (AUC) of the differential diagnosis model to discriminate presymptomatic patients from asymptomatic patients was 0.89 (95% CI, 0.81-0.98). Importantly, the severe and non-severe presymptomatic patients can be further stratified (AUC = 0.82). In conclusion, the two-step risk-stratification model based on 10 laboratory indicators can distinguish among asymptomatic, severe presymptomatic, and non-severe presymptomatic COVID-19 patients on admission. Moreover, single-cell data analyses revealed that the CD8+T cell exhaustion correlated to the progression of COVID-19.

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1685. Inappropriate Treatment of Asymptomatic Bacteriuria in Elderly Patients: A Quality Improvement Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1863 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S826-S826

Author(s):

Tuhina Cornelius ◽

Kiran K Patel ◽

Michael Rubinson ◽

Nadia Aslam ◽

Ashish Rana ◽

...

Keyword(s):

Elderly Patients ◽

Educational Opportunity ◽

Clinical Symptoms ◽

Medical Center ◽

Asymptomatic Bacteriuria ◽

Provider Education ◽

Diagnostic Challenge ◽

Asymptomatic Patients ◽

Inappropriate Treatment ◽

N 93

Abstract Background Asymptomatic bacteriuria is often misdiagnosed as Urinary Tract Infection (UTI) in elderly patients. Studies suggest that 15-30% of males and 25-50% of females have asymptomatic bacteriuria. We wanted to estimate the percentage of elderly patients who are treated for UTI at our facility and if treatment was appropriate. The goal was to provide the staff with an educational opportunity and help decide if more antibiotic restriction policies would be beneficial. Methods A retrospective study of patients > 65 years of age who were started on antibiotics for presumed UTI at a single medical center between 7/2018 and 12/2018. Reviewed data included demographics, admitting diagnosis, presence or absence of symptoms of UTI and urine culture results. The data was presented at educational conferences and at antimicrobial stewardship meetings in our facility. Results: 234 patients were started on antibiotics on the basis of pyuria on admission. Of these, only 47% (n=110/234) had symptoms suggestive of UTI. Positive urine cultures were more common in symptomatic patients (n=93/110) compared with asymptomatic patients (n=47/80). In addition, ninety patients had a change in mental status on presentation and were started on antibiotics for suspected UTI. Approximately one third of these patients had eventual negative urine cultures. Conclusion: Elderly patients with pyuria and asymptomatic bacteriuria represent a diagnostic challenge due to their inability to vocalize signs or symptoms of UTI. In addition, a percentage of patients who are asymptomatic and admitted for another reason were often started on antibiotics inappropriately on the basis of pyuria alone. Studies have shown that treating asymptomatic bacteriuria does not add a mortality benefit or lower risk of infection. The CDC emphasizes the importance of assessing for clinical symptoms of UTI before treatment is considered. Our study highlights the importance of provider education in the management of asymptomatic bacteriuria in elderly patients. We also feel that antibiotic restriction policies may limit use of antibiotics for asymptomatic bacteriuria. This would in turn improve patient outcomes and decrease incidence of clostridium difficile associated colitis. Disclosures All Authors: No reported disclosures

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Case Example: Adjacent Segment Disease: What Is It, and How Is It Rated?

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2011.marapr02 ◽

2011 ◽

Vol 16 (2) ◽

pp. 8-9

Author(s):

Marjorie Eskay-Auerbach

Keyword(s):

Clinical Symptoms ◽

Lumbar Fusion ◽

Adjacent Segment Degeneration ◽

Adjacent Segment Disease ◽

Adjacent Segment ◽

Disc Space Narrowing ◽

Disc Disease ◽

Disc Space ◽

Radiographic Findings ◽

Asymptomatic Patients

Abstract The incidence of cervical and lumbar fusion surgery has increased in the past twenty years, and during follow-up some of these patients develop changes at the adjacent segment. Recognizing that adjacent segment degeneration and disease may occur in the future does not alter the rating for a cervical or lumbar fusion at the time the patient's condition is determined to be at maximum medical improvement (MMI). The term adjacent segment degeneration refers to the presence of radiographic findings of degenerative disc disease, including disc space narrowing, instability, and so on at the motion segment above or below a cervical or lumbar fusion. Adjacent segment disease refers to the development of new clinical symptoms that correspond to these changes on imaging. The biomechanics of adjacent segment degeneration have been studied, and, although the exact mechanism is uncertain, genetics may play a role. Findings associated with adjacent segment degeneration include degeneration of the facet joints with hypertrophy and thickening of the ligamentum flavum, disc space collapse, and translation—but the clinical significance of these radiographic degenerative changes remains unclear, particularly in light of the known presence of abnormal findings in asymptomatic patients. Evaluators should not rate an individual in anticipation of the development of changes at the level above a fusion, although such a development is a recognized possibility.

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