Thromboembolic Events in Critically Ill Children with Multiple Risk Factors for Venous Thrombosis

The risk for venous thromboembolism (VTE) is considered to be low in the general paediatric intensive care unit (PICU) population, and pharmacological thromboprophylaxis is not routinely used. PICU patients considered at high-risk of VTE could possibly benefit from pharmacological thromboprophylaxis, but the incidence of VTE in this group of patients is unclear. This was an observational, prospective study at a tertiary multi-disciplinary paediatric hospital. We used comprehensive ultrasonography screening for VTE in critically ill children with multiple risk factors for VTE. Patients admitted to PICU ≥72 hours and with ≥two risk factors for VTE were included. Patients receiving pharmacological thromboprophylaxis during their entire PICU stay were excluded. Since pharmacological thromboprophylaxis has not been proven effective for central venous catheter(CVC)-related VTE, the primary outcome was VTEs not related to the use of a CVC. Ultrasonography screening of the great veins was performed at PICU discharge. Seventy patients with median (interquartile range) 3 (2-4) risk factors for VTE were evaluated. Median age was 0.34 years (0.03-4.3) and median PICU length of stay 9 days (5-17). Regarding the primary outcome, no symptomatic VTEs occurred and no asymptomatic VTEs were found on ultrasonography screening. The observed proportion of VTE, 0 in 70 patients, corresponds to a VTE incidence of 0-5.1%. Conclusion: No VTEs where pharmacological thromboprophylaxis could potentially have been an effective prophylactic measure were found. This indicates that VTE is an uncommon event even in a selected group of severely ill small children considered to be at high risk of VTE.

Prevention of Work-Related Musculoskeletal Disorders in Physiotherapist - A Review

Introduction: Healthcare professionals, especially those with in direct contact of patient are at the highest risk of work-related musculoskeletal disorders (WMSDs), physical therapists being one of them. Aim: Our aim was to review current knowledge relating to the prevalence, risk factors and prevention of WMSDs among physiotherapists. Method: Google Scholar and PubMed were searched for terms relating to WMSDs in Physiotherapists from inception to 2021. Result: The prevalence of WMSDs among Physiotherapist was high, with the lower back as the most frequently affected followed most often by the neck, upper back and shoulders. Knee joint was commonly affected joint in lower extremity. Multiple risk factors have been found responsible for WMSDs in physiotherapist and some of them are modifiable. Conclusion: Implementing preventive strategies for WMSDs in early stage of a physiotherapist’s career may help to prevent WMSDs and maintain good quality of treatment for patients. Keywords: Pain, Musculoskeletal disorders, Ergonomics, Prevention.

Clinical outcomes and complications of patients undergoing surgery during the COVID-19 incubation period

Conducting surgery might be challenging during the pandemic, especially for COVID-19 patients. This is because of the high transmissibility rate of the infection, which might lead to spreading the infection. Moreover, surgery might be associated with further risk over affected patients, a significant contributor to the operated patients' impaired immunity and generalized inflammatory state. Surgery is usually associated with an increased risk of high-stress levels and a generalized inflammatory state flare-up. The present literature review discusses the mortality rates and associated factors for COVID-19 patients during the incubation period. Our findings show that these patients have higher mortality rates as surgery influences the release of high levels of proinflammatory cytokines. Besides, surgery might impair the immune functions leading to progressive deterioration of COVID-19. On the other hand, it has been reported that COVID-19 can also worsen the outcomes and increase the risk of morbidities and mortality among patients undergoing surgery. Different factors have been identified to contribute to this risk, including old age, being male, and the presence of comorbidities. Therefore, avoiding surgery during infection is suggested to reduce the risk of mortality, especially among patients with multiple risk factors. However, it should be noted that this evidence needs further validation.

L’affidamento familiare: le strategie educative elaborate dagli affidatari

Foster care is a condition of welcoming children with families in serious difficulty, legally regulated, aimed at guaranteeing to minors a suitable space for growth, and to families of origin the possibility of overcoming the problems so as to consent the return of the children. It is a challenging educational condition, to be deepened with research. The complexity of the backgrounds of origin and the co-presence of multiple risk factors in fact generate in children and young people in foster care, important difficulties in development, which foster families have to cope with, also with the support of specialists, services and associations. However, the skills that caregivers come to build over the years are valuable, deserving of pedagogical insights, so that good practices of positive parenting can be valued and shared. In this paper we will report the results of a survey, carried out with a national sample of 323 foster families. The study makes it possible to investigate the reasons for the custody prevision, the relationships with families of origin, the difficult life trajectories of the children in foster care (transitions, placements, discontinuities, years of foster care, continuation of relationships after foster care). In this way it is possible to identify the needs highlighted by the minors, the relevant problems that emerge and the promising strategies adopted by the foster families.

Early insulin-resistance, T2D and treatment options in childhood

Background T2D (Type 2 Diabetes) represents just the tip of the iceberg of the complex metabolic alterations associated with obesity and other clinical conditions associated to impaired adipose tissue storage. Summary Available data have suggested the presence of a continuous spectrum of metabolic alterations developed in the progression from IR to T2D, most of which are likely preventable through the early characterization of all the multiple risk factors involved. Therefore, the complete characterization of the natural history of the disease and the major modifiable factors represents a milestone in the daily care of young subject at risk for the development of impaired glucose metabolism early in life. This review will focus on the main components defining the risk of IR and T2D in childhood with a specific focus on the main aspects of treatment options available in children and adolescents. Key messages Impaired adipose tissue storage documented in obesity results in a continuous spectrum of metabolic alterations ranging from IR to T2DM. These metabolic alterations are mostly likely preventable through the early characterization of all the multiple risk factors involved. The complete characterization of the disease and of the major modifiable factors represent a milestone in the daily care of young subject at risk for the development of impaired glucose metabolism early in life.

Pulmonary fibrosis as an outcome of COVID-19 pneumonia

In this study, we report three cases of persistent severe respiratory failure and radiological signs of diffuse pulmonary fibrosis in patients after COVID-19 related pneumonia. Chest CT criteria for a diagnosis of pulmonary fibrosis include the presence of traction bronchiectasis and parenchymal bands (linear opacities), as well as numerous small subpleural cystic air spaces (honeycombing). The study found that all cases of fibrosis were associated with such risk factors as male gender, old age, and multicomorbidity. Chest CT of one patient with acute respiratory distress syndrome showed radiographic characteristics of pulmonary fibrosis together with the presence of ground glass opacities (GGO) – the main CT feature of COVID-19 pneumonia. In two other patients, CT features of pulmonary fibrosis appeared in about 2 months after the hospital stay.Thus, pulmonary fibrosis is severe and rapidly progressive complication of COVID-19 pneumonia with a poor prognosis, especially in patients with multiple risk factors.

Role and Perspectives of Inflammation and C-Reactive Protein (CRP) in Psychosis: An Economic and Widespread Tool for Assessing the Disease

Schizophrenia is a major psychotic disorder affecting nearly 23.6 million people globally and greatly impacting the cognitive and social functioning of individuals. Multiple risk factors, including genetic, environmental, and epigenetic factors have been identified. However, the exact mechanism by which some factors aid in the development of schizophrenia is still uncertain. Acute and/or long-standing inflammation has been implicated as both a cause and effect of schizophrenia. Heightened immune responses have been documented in large cohorts of individuals with schizophrenia. While not completely known, multiple hypotheses, such as disruption of the blood–brain barrier, alterations in the kynurenine/tryptophan pathway, and increased microglial activation, have been presented to correlate inflammation with schizophrenic symptoms. Measurement of C-reactive protein (CRP) is a commonly performed and inexpensive test on patients’ serum to determine levels of systemic inflammation in the body. Multiple studies have reported an elevated CRP level in different stages of schizophrenia, indicating its potential to be used as a viable biomarker in the diagnosis and monitoring of schizophrenia along with assessing treatment response to conventional and non-conventional treatment regimens. This review aims to evaluate the role of inflammation, in general, and CRP, in particular, in the pathogenesis of schizophrenia and its potential significance in diagnostic, therapeutic, and preventative approaches towards schizophrenia and psychosis.

Scottish Index of Multiple Deprivation (SIMD) Indicators as Predictors of Mortality Among Patients Hospitalised with COVID-19 Disease in the Lothian Region, Scotland During the First Wave: A Cohort Study

Background: Sars-CoV-2, the causative agent of COVID-19, has led to more than 100,000 deaths in the UK and multiple risk factors for mortality including age, sex and deprivation have been identified. This study aimed to identify which indicators of Scottish Index of Multiple Deprivation (SIMD), an area-based deprivation index, were predictive of mortality. Methods: This was a prospective cohort study of anonymised electronic health records of 710 consecutive patients hospitalised with Covid-19 disease between March and June 2020 in the Lothian Region of Southeast Scotland. Data sources included automatically extracted data from national electronic platforms and manually extracted data from individual admission records. Exposure variables of interest were SIMD quintiles and more specifically 12 indicators of deprivation deemed clinically relevant selected from the SIMD. Our primary outcome was mortality. Univariable and multivariable logistic regression analyses adjusted for age and sex were used to determine measures of association between exposures of interest and the primary outcome. Results: After adjusting for age and sex, we found an increased risk of mortality in the more deprived SIMD quintiles 1 and 3 (OR 1.75, CI 0.99-3.08, p=0.053 and OR 2.17, CI 1.22-3.86, p=0.009, respectively), but this association was not significant in our multivariable model adjusted for co-morbidities and clinical parameters of severity at admission. Of the 12 pre-selected indicators of deprivation, two were associated with greater mortality in our multivariable analysis: income deprivation rate categorised by quartile (Q4 (most deprived): 2.11 (1.20-3.77) p=0.011)) and greater than expected hospitalisations due to alcohol per SIMD data zone (1.96 (1.28-3.00) p=0.002)). Conclusions: In contrast to other studies, deprivation quintile distribution was not predictive of mortality in our cohort. This possibly reflects the greater affluence and ethnic homogeneity of the Lothian Region compared to the rest of Scotland. We identified an increased risk of mortality in patients residing in areas with greater income-deprivation and/or number of hospitalisations due to alcohol. In areas where aggregate measures fail to capture pockets of deprivation, specific indicators may be helpful in targeting resources to residents at risk of poorer outcomes from Covid-19.

Peripheral polyneuropathy from electrodiagnostic tests: a 10-year etiology and neurophysiology overview

ABSTRACT Background: Polyneuropathies are characterized by a symmetrical impairment of the peripheral nervous system, resulting in sensory, motor and/or autonomic deficits. Due to the heterogeneity of causes, an etiological diagnosis for polyneuropathy is challenging. Objective: The aim of this study was to determine the main causes of polyneuropathy confirmed by electrodiagnostic (EDX) tests in a tertiary service and its neurophysiological aspects. Methods: This observational cross-sectional study from a neuromuscular disorders center included individuals whose electrodiagnostic tests performed between 2008 and 2017 confirmed a diagnosis of polyneuropathy. Through analysis of medical records, polyneuropathies were classified according to etiology and neurophysiological aspect. Results: Of the 380 included patients, 59.5% were male, with a median age of 43 years. The main etiologies were: inflammatory (23.7%), hereditary (18.9%), idiopathic (13.7%), multifactorial (11.1%), and diabetes (10.8%). The main electrophysiological patterns were axonal sensorimotor polyneuropathy (36.1%) and “demyelinating and axonal” sensorimotor polyneuropathy (27.9%). Axonal patterns showed greater etiological heterogeneity, with a predominance of idiopathic and multifactorial polyneuropathy, while demyelinating and “demyelinating and axonal” polyneuropathies had a significantly fewer etiologies, with a predominance of hereditary and inflammatory polyneuropathies. Conclusion: The main causes of polyneuropathy confirmed by EDX test in this study were those that presented a severe, atypical and/or rapidly progressing pattern. Other causes were hereditary and those that defy clinical reasoning, such as multiple risk factors; some polyneuropathies did not have a specific etiology. EDX tests are useful for etiological diagnosis of rare polyneuropathies, because neurophysiological patterns are correlated with specific etiologies.