A review: Management of motor neuron diseases

Motor neuron diseases are a group of chronic sporadic and hereditary neurological disorders characterized by progressive degeneration of motor neurons. These might affect the upper motor neurons, lower motor neurons, or both. The prognosis of the motor neuron disease depends upon the age at onset and the area of the central nervous system affected. Amyotrophic lateral sclerosis (ALS) has been documented to be fatal within three years of onset. This activity focuses on amyotrophic lateral sclerosis as the prototype of MND, which affects both the upper and the lower motor neurons and discusses the role of inter-professional team in the differential diagnosis, evaluation, treatment, and prognostication. It also discusses various other phenotypes of MND with an emphasis on their distinguishing features in requisite detail.

“Better Not Let Me Know”: The Mediating Role of Regret on the Relation Between Social Comparison Discrepancy in Online Hotel Review and Revisit Intention

Online review is powerful in influencing tourists’ travel decision. However, understanding of how online reviews affect tourist emotion and decision at the post-trip stage is limited. The present study examines whether encountering travel experiences shared on social media by other users with disparity in the cost of same accommodation after a trip will cause regret and alter the intention to revisit from a retrospective point of view. Drawing from the experimental study, the result showed that regret mediates the negative effect of comparison discrepancy (in the case of differences in the paid room rate) on intention to stay in the hotel again. The current study of the effects of social comparison on revisit intention adds to the literature and establishes the groundwork for future scholarly work on post-trip online review management. Meaningful implications and strategies are recommended to online review platform and hotel marketing management.

Peer support for youth suicide prevention: a scoping review protocol

IntroductionYouth suicide is a significant public health priority, and is the second leading cause of death among young people between 15 and 29 years of age. An emerging intervention in suicide prevention programming with youth is peer support. Although increasingly used in other settings, the evidence for peer support interventions in youth suicide prevention remains nascent. This article presents a protocol for a scoping review aimed at systematically mapping the current evidence on peer support for youth suicide prevention.Methods and analysisArksey and O’Malley’s scoping review framework will guide the review methods. The search strategy will be developed with guidance from a health sciences librarian. Multiple databases (Medline, Embase, PsycINFO, Cumulative Index for Nursing and Allied Health Literature) and grey literature will be identified using terms related to peer support and youth suicide prevention. Publication date restrictions will not be applied. All identified records of published literature will be collated and uploaded to a systematic review management software, Covidence, for review and selection. Screening will be completed in duplicate by two reviewers using predefined inclusion and exclusion criteria. Conflicts during screening will be resolved by a third reviewer. The title and abstract screening and full-text review will be completed in Covidence. Two reviewers will complete data extraction from the selected records, using a tailored extraction form. Screening and data extraction will be completed between January and April 2021. A narrative summary will be completed to synthesise key findings as well as contextual information about the use of peer support interventions in youth suicide prevention programming.Ethics and disseminationThe results will be disseminated through a community research report, presentations of findings at relevant conferences and academic publications of the scoping review protocol and results. The data used for this scoping review will be derived from published resources; therefore, ethics approval is not required for this study.

Buccal mucosal graft urethroplasty for anterior urethral stricture, experience from a low-income country

Background/purpose This study was conducted to present our experience in urethral mucosal graft urethroplasty to repair urethral stricture, as the first experience in our context. Methods This is a prospective hospital-based study that had been designed to review management outcomes of buccal mucosal graft urethroplasty for anterior urethral stricture from January 2017 to January 2019. Results The total number of involved patients was 60. The success rate was found to be 90% (n = 54), while 6 (10%) had a recurrence of stricture. Pain and pain combined bleeding from internal suture lines were the only early complication encountered in 50 (83.3%) and 2 (3.3%) patients, respectively. late complications occurred as follows 14 (23.3%) patients had UTI, 12 (20%) had wound infections, 8 (13.3%) had changes in ejaculation, and decrease in intensity of orgasm, and 6 (10%) had erectile dysfunction. One of the long-term complications was graft diverticulum in one case and was treated conservatively (in ventral on lay BMG). Conclusion Improvement of the service in limited resources countries like Sudan and was reflected in the excellent outcome of BMG urethroplasty as treatment of anterior urethral stricture (success rate 90%).

PICO Portal (product review)

PICO Portal is a Web-based systematic review management tool launched in September 2020 to better facilitate collaborative knowledge synthesis in biomedical research. Most notably, it uses machine learning and Natural Language Processing algorithms to continuously refine the screening process by analyzing decisions as made by the review team. PICO Portal was evaluated by researchers with the Health Assessment Technology team at the University of Calgary, who routinely undertake PICO-based systematic reviews, currently using an in-house manual system. The team appreciated many aspects of PICO Portal and felt it held considerable promise to better support the review process. At the same time, they found it wasn’t as user-friendly as expected and would benefit from additional refinement if it is to appeal to a wider range of users, particularly those less familiar with the systematic review process.

COVID 19 vaccine in patients of hypercoagulable disorders: a clinical perspective

COVID 19 is an infectious disease caused by severe acute respiratory syndrome corona virus 2. Thromboembolism has been a characteristic manifestation in most of the severely ill COVID-19 patients. Thromboembolism in COVID 19 infection is attributed to injury to the vascular endothelial cell, hypercoagulability and blood stasis. The hypercoagulable state of blood and thrombophilic diseases leads to hypercoagulability. COVID 19 infected patients with pre-existing hypercoagulable disorders have higher risk of developing thrombosis and thromboembolism and such thrombotic episodes may prove to be severely morbid in these patients. As immune-prophylaxis COVID 19 vaccines are being administered to the public. The known side effects of the COVID 19 vaccine are mild to moderate and include fever, chills, nausea, vomiting, headache, fatigue, myalgia, malaise, pain and swelling at injection site and diarrhea. Thrombosis with thrombocytopenia has been noted as a rare side effect of COVID 19 vaccine. Such side effect of COVID 19 vaccine in patients of hypercoagulable disorder may prove to be fatal. The health care workers should be cautious and judicious in managing such patients. A detailed lab profile for coagulable state of blood should be carried out in all patients COVID 19 infected patients with pre-existing hypercoagulability diseases. The patients should also be health educated regarding side effects of vaccine especially with those indicating thrombosis and they should be warranted to receive immediate medical care in case of any side effects or complications. Paucity of literature gave us an impetus to review management profile in patients of hypercoagulable disorders.

Peer review declaration

All conference organisers/editors are required to declare details about their peer review. Therefore, please provide the following information: • Type of peer review: Single-blind / Double-blind / Triple-blind / Open / Other All papers have been reviewed by at least two reviewers and follow a double-blind peer review process. For the peer review, an editor has been assigned to the submitted paper as per the major theme of the conference, i.e., design engineering, thermal engineering and fluid science, material science and nanomaterials, production and industrial engineering. Four editors have been handling the review process by assigning two domain expert reviewers to each paper. The papers have been evaluated as per the quality criteria of IOP Publishing and the decisions were sent to the authors, such as: strong accept, accept, weak accept, borderline paper, and reject. The weakly accepted and borderline papers were sent back to authors for revision and resubmission was done through EasyChair. The resubmitted paper was again evaluated by the editor, and a final decision has been conveyed to the author. • Conference submission management system: Easychair Easychair was chosen as the conference paper submission and review management system for ICRAMEN 2021. All papers have been submitted and also reviewed by the Easychair account only. A revised submission was also accepted only by the easychair account. All email correspondence with the author was done through easychair email and also from [email protected]. • Number of submissions received: 52 We have received a total of 52 papers, out of which accepted and registered papers have been considered for presentation at the conference and publication in a journal. • Number of submissions sent for review: 50 Two papers were not considered for review due to late submission and was rejected by the editor. • Number of submissions accepted: 28 • Acceptance Rate (Number of Submissions Accepted / Number of Submissions Received X 100): 54% • Average number of reviews per paper: 2.2 • Total number of reviewers involved: 23 • Any additional info on review process: 1. The Plagiarism Checker X software has been used to check the similarity index of the papers. The similarity index of all the papers is not more than 20%. 2. ICRAMEN 2021 was a virtual conference, with all presentations delivered via the Zoom online platform. 3. All papers have been evaluated by the editor and reviewed by a minimum of two reviewers. Also, some papers are sent back to the author for further revision after the presentation at the conference to amend the corrections suggested by the session chair. • Contact person for queries: Dr. Manoj A. Kumbhalkar, Conference Chair, ICRAMEN 2021. President, Research Association of Masters of Engineering (RAME), India. [email protected], [email protected]

EP.TU.809Challenges in management of acute diverticulitis within a district general hospital

Aim Incidence of perforated sigmoid diverticular disease is estimated at 3.4 to 4.5 per 100,000. Perforation may be the first manifestation of complicated diverticulitis with a range of 50% to 70%. We aim to review management of systemically unwell patients with acute diverticulitis in a district general hospital against the 2019 NICE guidelines. Methods 29 patients presenting septic with acute diverticulitis, M:F ratio 12:17, median age 55 (range 24-82), median ASA 2 (range 0-3) were retrospectively reviewed over a 6-month period. Results Mean time to antibiotics was 3.96 hours (range 0-23.11). Of the 7 with perforated diverticulitis severity classification included: Hinchey I – n = 1, 3.4%; Hinchey IIa – 5 (17.2%), and; Hinchey IIb – 1 (3.4%). Time to CT abdomen pelvis was 3.38 hours (range 0-16.4 hours). Two pericolic abscesses met NICE drainage criteria at 3.7 cm and 3.9 cm respectively. The 3.7 cm abscess was drained radiologically at 7 days post-admission and was re-admitted 6 days later requiring further radiological drainage. The patient with a 3.9 cm abscess received a Hartmann’s procedure and had multiple re-admissions requiring a hospital stay of 34 days. There was 0% mortality at 30 days. Conclusion Management of acute diverticulitis continues to present a unique challenge. For systemically unwell patients, timely administration of antibiotics within an hour of sepsis recognition is encouraged to optimise outcomes. Timely cross-sectional imaging is pivotal in disease classification and decision-making regarding acute management. Interventional drainage and surgical resection remain important therapeutic strategies for unwell patients with Hinchey grade II diverticulitis.

EP.WE.802Are we over-zealous in our management of acute diverticulitis?

Aims Of the 25% of people with diverticula who develop symptomatic diverticular disease, approximately 75% will have at least one episode of diverticulitis. However according to the latest NICE guidance those with diverticulitis who are not systemically unwell may not require either admission or antibiotics. In the financially austere environment facing the NHS within the COVID 19 pandemic, prudence in such resource allocation is of vital importance. We aim to review management of patients with acute diverticulitis over a 6-month period in a district general hospital against the 2019 NICE guidelines. Methods 29 patients presenting with acute diverticulitis, M:F ratio 12:17, median age 55 (range 24-82), median ASA 2 (range 0-3) were retrospectively reviewed. Biochemical markers, lactate and vital signs were used to assess if attending patients were systemically unwell. Results 23 patients were admitted and 6 managed as outpatients via the surgical ambulatory unit. Of the 29 patient cohort, 9 (31%) were systemically unwell. All 9 unwell patients received antibiotics. Of the 20 patients not considered systemically unwell, 11 (55%) received antibiotics. 16 (80%) that were admitted did not require admission on retrospective review. Conclusion Prompt administration of intravenous antibiotics for septic patients with diverticulitis reduces associated morbidity and mortality and the observed adherence to this principle is encouraging. For systemically well patients, increased clinical discernment is required to consider managing patients in the surgical ambulatory setting, avoiding unnecessary admissions. Similar caution must be used in appropriate use of antimicrobials to avoid unnecessary adverse consequences.

Burns in pregnancy: Five-year experience in a tertiary hospital in southeastern Nigeria

BackgroundBurns in pregnancy is often associated with high maternal and fetal morbidity and mortality especially when the total burn surface area (TBSA) involved is high. This study aims to review management outcome of cases of burns in pregnancy at Alex Ekwueme Federal University Teaching Hospital Abakaliki (AE-FUTHA).MethodsA five year retrospective study of all pregnant women that presented at AE-FUTHA with burn injury between April 2014 and March 2019. Information was collected from the medical records using a proforma and analyzed with IBM SPSS Statistics version 20.0 (IBM Corp., Armonk, NY, USA) using descriptive statistics.ResultsA total of 222 cases of burns were managed but only 8 were pregnant, giving an incidence of 3.6%. The commonest causes were flame (62.5%), scald (25%) and friction (12.5%) occurring mostly during the harmattan season. The median age of participants was 25-34 years. The burns affected 12.5% of the patients in the first trimester and 62.5% and 25% in the 2nd and 3rd trimesters respectively. Most patients (62.5%) had superficial burns while 25% had other associated injuries in addition to burns. About 87.5% had term spontaneous vaginal delivery. There was no maternal death but, there was an early neonatal death.ConclusionThe good outcome observed in this study with a 100% survival, could be explained by inter-disciplinary management approach given, even as most cases were minor degrees of burns. Early involvement of obstetricians in all burns affecting pregnant women is advised especially in burn centres where obstetricians are hardly in the employ.