Nontypical presentation of a common disease: a case report

Background Kawasaki disease is an idiopathic medium-sized vasculitis that occurs primarily in infants and children younger than 5 years of age. Atypical Kawasaki disease applies to patients who do not fulfill the complete criteria of fever of 5 days or more with at least four of five features: bilateral conjunctival injection, changes in the lips and oral cavity, cervical lymphadenopathy, extremity changes, and polymorphous rash. Acute kidney injury is defined as a sudden decline in kidney function within hours, including structural injuries and loss of function. Acute kidney injury is extremely common in hospitalized pediatric patients. However, it is rarely documented in Kawasaki disease. Acute kidney injury is underestimated in Kawasaki disease due to the lack of a clear definition of age-specific normal serum creatinine levels and routine renal functions. This report describes a case who presented with clinical features suggestive of atypical Kawasaki disease and developed acute kidney injury. Case presentation A 2-year-old Saudi girl had a history of high-grade fever for 5 days, moderate dehydration, dry cracked lips, poor appetite, and generalized erythematous rash; therefore, she was diagnosed to have incomplete Kawasaki disease. Laboratory investigations revealed normochromic normocytic anemia, leukocytosis, thrombocytosis, high inflammatory markers, and acute kidney injury stage III. An echocardiogram showed a 4-mm dilatation on the left main coronary artery and a 3-mm dilatation on the right. A renal biopsy was not performed to identify the cause of the injury as it showed improvements after the start of the specific therapy for Kawasaki disease; intravenous immune globulin at a dose of 2 g/kg, aspirin at a high dosage of 80 mg/kg/day, and prednisolone at 2 mg/kg. In addition to the acute kidney injury management, normal saline boluses were followed by furosemide at a 2 mg/kg dose. Her urine output increased, and her renal functions normalized. She was discharged in good condition after 10 days. Conclusions It is valuable to check renal function tests in a confirmed case of Kawasaki disease to reduce the negative consequences of late acute kidney injury discovery. Early detection and intervention make a substantial difference in acute kidney injury management.

Outcomes of the management of corrosive injuries of the upper digestive tract in a tertiary care center

Summary Esophageal stricture is the most common delayed sequelae of aerodigestive tract corrosive injuries. Early endoscopic dilatation is an integral part of corrosive injury management. Self-dilatation of the esophagus is effective in preventing stricture recurrence. In this prospective study, we included patients with corrosive aerodigestive tract injury from January 2009 to December 2020. We analyzed the outcome of the endoscopic dilatation and self-dilatation treatments administered to patients with a corrosive esophageal stricture. Among 295 patients, 164 had an esophageal injury, 73 had esophago-gastric injury, 55 had a gastric injury, and 3 had the pharyngeal injury. Of the 295 patients, 194 (81.85%) underwent dilatation, and 13 patients with diffuse esophageal injury underwent upfront surgery. Successful dilatation was performed in 169 (87.11%) patients. Of the 68 patients undergoing self-dilatation, 63 patients achieved nutritional autonomy by 28 days. Early endoscopic dilatation effectively prevents surgery, and self-dilatation appears promising to prevent recurrent esophageal stricture.

Establishment and Application of Pressure Injury Assessment Module in Operating Room Based on Information Management System

A pressure injury is a common and painful health condition, particularly among people who are elderly or surgical patients. In order to explore how to use the information management system to optimize the pressure injury management process of surgical patients, this work establishes an integrated pressure injury management information platform for surgical patients, which can effectively control the key links in the process and realize the multistep full-process monitoring of surgical patients from admission to discharge. A total of 578 patients before the operation of the information platform were selected as the control group (CG), and after the operation of the information platform, 662 cases became the observation group (OG). Various evaluation metrics are employed to evaluate pressure injury in terms of single-pass rate, high-risk pressure injury, transfer skin condition description matching rate, hospital pressure injury incidence, and incidence of pressure injury in surgical patients at various stages. The results showed that the qualified rate of the pressure injury assessment in the OG was 99.2%, the accuracy rate of high-risk pressure injury screening and reporting was 100.0%, and the matching rate of the transfer skin description was 100.0%, which was higher than that of the CG. The integrated pressure injury management information platform for surgical patients based on the information management system realizes the full, continuous, accurate, and dynamic evaluation and monitoring of patients’ skin. Furthermore, it can effectively improve the quality of pressure injury care and facilitate care management.

Efek terapi oksigen hiperbarik terhadap nilai Montreal Cognitive Assesment Indonesia (MoCA-INA) pada pasien cedera otak traumatik ringan

Hyperbaric oxygen therapy (HBOT) uses 100% oxygen at a pressure of more than 1 ATM in a chamber, therefore, it can improve the state of tissue hypoxia. This study was aimed to prove that TOHB could increase the MoCA-INA score in mild traumatic brain injury (mTBI). This study was carried out at the Surgery Department of Prof. Dr. R. D. Kandou Hospital, Manado using the pre and post trial design. Subjects were 20 patients with mTBI divided into two groups: treated with HBOT and control group (without HBOT). Each patient involved would be examined for MoCA-INA before and after treatment or with HBOT added. The results showed that before treatment, the MoCA-INA scores tended to be evenly distributed around 36 (SD 5). The score increased to 71 (SD 10) at post-injury management or a mean increase of 35 points (p<0.001 in the paired two-sample t-test). However, there was no significat difference in MoCA-INA scores between the first and the second measurements. The density of the two groups clearly overlapped even though the variation of MoCA-INA scores of the HBOT group was much wider than that of the control group (p=0.302 and 0.297 in the first and second measurements, respectively). There was no cognitive disturbance either mild, moderate, or severe in all patients. In conclusion, there was an increase of the MoCA-INA value in mTBI patients after treatment. The patients treated with HBOT showed wider variation of MoCA-INA score of pre and post HBOT than those without HBOT Keywords: HBOT; mTBI; MoCA-INA; cognitive function Abstrak: Terapi oksigen hiperbarik (TOHB) menggunakan oksigen 100% pada tekanan lebih dari 1 ATM dalam sebuah chamber sehingga dapat memperbaiki keadaan hipoksia jaringan. Penelitian ini bertujuan untuk membuktikan bahwa TOHB dapat meningkatkan nilai MoCA-INA pada pasien cedera otak traumatik ringan (COTr). Penelitian dilaksanakan di Bagian Bedah RSUP Prof. Dr. R. D. Kandou, Manado dengan menggunakan pre and posttrial design. Subyek penelitian ialah 20 pasien COTr dibagi dalam dua kelompok: dengan dan tanpa TOHB (kelompok kontrol). Setiap subyek diperiksa MoCA-INA sebelum dan sesudah penatalaksanaan cedera/disertai TOHB. Sebelum penatalaksanaan cedera, rerata skor MoCA-INA sekitar 36 (SD 5) dan nilai tersebut meningkat menjadi 71 (SD 10) pasca penatalaksanaan cedera atau kenaikan rerata 35 poin (p<0,001 pada uji t dua sampel berpasangan). Tidak tampak perbedaan skor MoCA-INA baik pada pengukuran pertama maupun kedua. Densitas kedua kelompok terlihat jelas tumpang tindih sekalipun variasi skor MoCA-INA group TOHB jauh lebih lebar daripada group kontrol (p=0,302 dan 0,297 masing-masing pada pengukuran pertama dan kedua). Tidak terlihat adanya gangguan kognitif ringan sedang maupun berat pada semua pasien. Simpulan penelitian ini ialah terdapat peningkatan nilai MoCA-INA pada pasien COTr. Pasien dengan TOHB memperlihatkan variasi skor MoCA-INA yang lebih besar pada pre dan pasca TOHB.Kata kunci: TOHB; COT; MoCA-INA; gangguan kognitif

Rates of Operative Management of Midshaft Clavicle Fracture in Adolescents Have Increased in Florida between 2005 and 2014

Background: It is not known if the adult literature on midshaft clavicle fracture treatment with open reduction internal fixation (ORIF) has influenced injury management in adolescents. Purpose: We sought to longitudinally evaluate the rates of operative management of adolescent midshaft clavicle fractures in the state of Florida. Methods: We conducted a retrospective review of data from the following Healthcare Cost and Utilization Project databases: the State Inpatient Database, the State Ambulatory Surgery and Services Database, and the State Emergency Department Database. Patients in Florida ages 10 to 18 years with midshaft clavicle fractures between 2005 and 2014 were identified along with data on age, sex, race/ethnicity, insurance type, treatment, and income percentile. We reviewed the data to identify trends in the rates of operative management of midshaft clavicle fractures. We then compared the rates of operative management between the first 3 years and the most recent 3 years (2005–2007 vs 2012–2014). Various demographic and socioeconomic factors were compared between patients treated with and without surgery. Descriptive statistics as well as univariate and multivariate analyses were performed. Results: There were 4297 midshaft clavicle fractures in adolescents identified between 2005 and 2014, and 338 (7.8%) of these fractures underwent operative management. There was a significant increase in the rate of operative management; it increased from 4.3% (n = 59) of the 1373 clavicle fractures that occurred between 2005 and 2007 to 11.2% (n = 130) of the 1164 clavicle fractures that occurred between 2012 and 2014. Patients with commercial insurance and patients who were older were more likely to undergo ORIF. Patients with Medicaid were more likely to undergo ORIF between 2012 and 2014 compared with patients with Medicaid between 2005 and 2007. Conclusions: Operative management rates of adolescent midshaft clavicle fractures have significantly increased in Florida over a decade; additional research is needed to understand these findings.

Injury characteristics of Indonesian para-athletes prior to Tokyo Olympics 2020: a cross-sectional study

BACKGROUND: Sports for people with disabilities and injuries have been the subject of discourse in the professional literature in the fields of traumatology and sports medicine. OBJECTIVE: This research aims to elucidate the injury characteristics of athletes in the Indonesian national team. The subject of this study were nine athletes (male=5, female=4) with males around the age of 28±9.13 and females 28±5.66 years. METHOD: The method approach is descriptive with a cross-sectional study technique using a questionnaire about injury history, types of injury, injury factors, and injury management for Indonesian Para Athletics Athletes who have competed in the 2020 Tokyo Olympics. Data analysis is depicted in numbers and percentages and Fisher's exact test to determine the relationship between variables. RESULTS: The study results reported that Indonesian athletes suffered injuries of the lower limbs (70%), part of the body that is frequently injured was the thigh (28%) and the type of injury that was often experienced sprain/twist. CONCLUSION: The injury characteristics in the sprint (track) category form a pattern of injuries to the thigh, Achilles tendon, ankle, and knee. There appears to be no correlation between gender, training frequency, injury share, match number, and warm-up type. The implication is that injury management is necessary before and during competition by considering biomechanics, pathophysiology, and psychosocial problems. Injury prevention strategies by coaches and medical teams should lead to more significant injury reduction and optimize athletes' health, safety, and well-being.

Paediatrics vascular injury management in resource limited setting: anaesthesia challenges

Vascular injuries with significant blood loss causing ischemia and revascularization for limb salvage are rarely done in developing countries. Hence, most hospitals and surgeons lack the experience to deal with vascular injuries. We report successful management of a 9 years child with left subclavian artery transection and massive blood transfusions.

Discussion on the Identification of Work-related Injuries of “Shared Employees”

With the start of the special era in 2020, the employment model of businesses has been confronted with new issues. As a kind of flexible employment, the “shared employee” has gotten a lot of attention, and the injuries that come with it have also gotten a lot of attention. Comparative analysis of the general mode of industrial injury of employment and casualties of “shared employee” of industrial injury and “share employees” cause person casualties of industrial injury related concerns based on the analysis on the basis of “shared employee” labor properties. Such as the model of “shared employee” recruiting, industrial injury management systems perfectly provide theoretical perspective, and appropriate thinking about industrial injury, risk prevention, and control is put forward from the perspectives of the country, enterprise, and employees.

Cryotherapy and compression in sports injury management: a scoping review

Background/Aims For the management of sports injury, cryotherapy is commonly applied, yet modalities differ extensively in application including levels of compression. The aim of this study was to provide a comprehensive review of the current position in the literature on contemporary cryo-compression applications for musculoskeletal sports injury management. Methods A total of eight databases were searched: Sport Discus, Science Direct, CINHAL, Scopus, PubMed, Cochrane, ProQuest and MEDLINE. Publications were restricted to 30 years and had to be in the English language. Medical subject headings, free-text words, and limiting descriptors for concepts related to cryotherapy and compression for sports injury were applied. Inclusion criteria determined at least one modality of cryotherapy treatment applied simultaneous to compression or as a comparison, relevant to sports injury management. Modalities included cryo-compressive devices and gel/ice packs, in association with concomitant compression. Male, female, healthy and injured participants were included. Two reviewers independently selected eligible articles, resulting in 22 studies meeting the inclusion criteria following full-text appraisal. Results Inconsistent methodologies, low sample sizes and variability in outcome measures provided uncertainty over optimum protocols. A lack of previous understanding in the protocols in the available literature for isolated cryotherapy/compression applications prevents understanding of the therapeutic benefits of combined cryo-compression. No definitive agreement behind optimal cryo-compression applications were identified collectively from studies other than the consensus that compression aids the magnitude of cooling. Conclusions Although compression appears a useful adjunct to cooling modalities for the management of sports injury, no definitive agreement on optimum compression concurrent with cooling protocols were drawn from the studies. This was because of several methodological gaps in reporting throughout studies, highlighting a lack of studies that represent applications of compression and cryotherapy within a sporting context or applied nature within the available research.