Impact of Povidone-iodine Versus Chlorhexidine for Periurethral Cleaning Before Catheterization on Pyuria and Bacteriuria Among Emergency Department Patients

Background: We aimed to determine the effect of periurethral cleaning before catheterization using chlorhexidine and povidone-iodine on bacteriuria and pyuria. Methods: This study was a single-blind clinical trial on a sample selected by convenience sampling. Demographic and clinical questionnaires were completed, and patients were randomly divided into two groups) 36 patients each of povidone-iodine and chlorhexidine using Minimization Software based on confounding variables including age, consciousness level, triage level, nutritional status, and underlying disease. The periurethral areas were cleaned with the given antiseptics and catheterized using standard and sterile procedures. Then, specimens were taken for urinalysis and urine culture immediately, 72 hours, and five days after catheterization. Then, bacteriuria rate, pyuria rate, and the number of microorganisms were determined through examinations. Data analysis was conducted using SPSS version 19. Results: There was no statistically significant difference in the bacteriuria rate between the two groups immediately (P = 0.76), 72 hours (P = 0.22), and five days (P = 0.50) after catheterization. The positive pyuria rate was not significantly different between the two groups immediately after catheterization. However, it was significantly higher in the povidone-iodine group 72 hours (P = 0.03) and five days (P = 0.004) after catheterization. The Mann-Whitney test compared the mean number of microorganisms between the two groups at different times. This test showed no significant difference in the number of microorganisms immediately (P = 0.93), 72 hours (P = 0.43), and five days (P = 0.61) after catheterization. Conclusions: Due to the lower side effects of chlorhexidine than povidone-iodine, it is suggested that similar studies be performed in other hospital wards with more stable patients to obtain more statistically significant results.

Characteristics and pharmacological treatment options of delirium patients treated at Sanglah Central General Hospital

Delirium is a syndrome characterized by disturbances of consciousness and cognition that occur acutely and fluctuate. Delirium can be caused by general medical conditions, drug users, sensory disturbances, polypharmacy, etc. The etiology of delirium is diverse and non-specific. The preference of pharmacological therapy in delirium is still a debate. Descriptive research with the retrospective cross-sectional method, using secondary data in medical records at the Sanglah Central General Hospital Denpasar for the period January 1, 2020, to December 31, 2020. Patients who were consulted were 166 people, with sex 57 people (34.3%) and 109 women (65.7%). The incidence of delirium in adults (20-59 years old) and elderly (age 60 years) is the highest with 51.2% and 45.1% respectively. One-third of 45 people (37.2%) had overlapping dementia. Most of the 142 people (85.5%) were experiencing significant life stress. The most common type of delirium was hyperactive delirium (74%). The underlying disease of delirium varies such as the cause of infection (24.1%), intracranial process (19%), malignancy 18.1%, cardiovascular (10.1%), endocrine disorders,(7.8%), kidney disorders (6%), and others in small percentages.

Immunologic Response, Efficacy, and Safety of Vaccines Against COVID-19 in Children and Adolescents Aged 2 - 21 Years Old: A Systematic Review

Backgrounds: Children and adolescnets form a large proportion of societies and play an important role in the transmission of Covid-19. On the other hand, their education, mental and physical wellness, and safety are compromised which makes vaccination a crucial step to return to normal life. Aim and Objectives: To collect and summarize all data about the immune response, effectiveness, and safety of available Covid-19 vaccines for people aged 2 - 21 years old. Methods: A thorough systematic review was performed on available publications in English language regarding immunogenicity, efficacy, and safety of Covid-19 vaccines in individuals aged 2 - 21 years old. Types of selected studies were clinical trials, observational studies, and cohort. Searched databases comprised Ovid Medline, Cochrane Library, Embase, Scopus, Web of Sciences, Google Scholar, and ClinicalTrials.gov website. Data extraction and analysis were performed in Microsoft Word software, version 16.56. Results: the Covid-19 vaccination was evaluated in a total of 50,148 children and adolescents in 22 published studies and 5,279 participants in two ongoing clinical trials. Data was collected about multiple vaccines including BNT162b2 (Pfizer), mRNA-1273 (Moderna), JNJ-78436735 (Johnson and Johnson), CoronaVac (Sinovac), BBIBP-CorV (Sinopharm), adenovirus type-5-vectored vaccine, ZyCov-D, and BBV152 (Covaxin). The immune response and efficacy of such vaccines were 96% - 100% in healthy children and adolescents and were also acceptable in those with underlying disease and suppressed immune system. The current systematic review revealed favourable safety profiles of employed vaccines in children and adolescents; however, adverse reactions such as myocarditis and myopericarditis were reported which were transient and resolved entirely. Conclusion: Vaccinating children and adolescents aged 2 - 21 years old is beneficial to abort the Covid-19 pandemic. Moreover, the risk-benefit assessments revealed favourable results for vaccinating children and adolescents, especially those with underlying disease, alongside adults to prevent transmission, severe infection, negative outcomes, and new variants formation. Keywords: Covid-19; Vaccination; Immunization; Children; Adolescents; Systematic Review

Follow-up Strategies in Focal Liver Lesions and Treatment Methods

Today, advances in cross-sectional imaging have led to the detection and early recognition of incidental/focal liver lesions (FCL). In approximately 17,000 cases of chest CT, incidental liver lesions were found in 6% [1]. In general, FCL consists of hepatocytes, biliary epithelium, mesenchymal tissue, connective tissue, or metastasized cells from distant sites. Most incidental lesions are benign, some may require careful management and treatment. In evaluating the lesion, the patient's clinical history, underlying disease and age factor should be considered. FCL can be detected at a rate of 10-30% in normal healthy and chronic liver disease patients, and even in oncology patients with malignancy, FCLs can be highly benign (50-80%)

Iatrogenic Tracheal Rupture Related to Prehospital Emergency Intubation in Adults: A 15-Year Single Center Experience

Objective: Iatrogenic tracheal rupture is an unusual and severe complication that can be caused by tracheal intubation. The frequency, management, and outcome of iatrogenic tracheal rupture due to prehospital emergency intubation in adults by emergency response physicians has not yet been sufficiently explored. Methods: Adult patients with iatrogenic tracheal ruptures due to prehospital emergency intubation admitted to an academic referral center over a 15-year period (2004-2018) with consideration of individual risk factors were analyzed. Results: Thirteen patients (eight female) with a mean age of 67 years met the inclusion criteria and were analyzed. Of these, eight tracheal ruptures (62%) were caused during the airway management of cardiopulmonary resuscitation (CPR). Stylet use and difficult laryngoscopy requiring multiple attempts were documented in eight cases (62%) and four cases (30%), respectively. Seven patients (54%) underwent surgery, while six patients (46%) were treated conservatively. The overall 30-day mortality was 46%; five patients died due to their underlying emergencies and one patient died of tracheal rupture. Three survivors (23%) recovered with severe neurological sequelae and four (30%) were discharged in good neurological condition. Survivors had significantly smaller mean rupture sizes (2.7cm versus 6.3cm; P <.001) and less cutaneous emphysema (n = 2 versus n = 6; P = .021) than nonsurvivors. Conclusions: Iatrogenic tracheal rupture due to prehospital emergency intubation is a rare complication. Published risk factors are not consistently present and may not be applicable to identify patients at high risk, especially not in rescue situations. Treatment options depend on individual patient condition, whereas outcome largely depends on the underlying disease and rupture extension.

Molecular Characterization of Fungal Colonization on the Provox™ Tracheoesophageal Voice Prosthesis in Post Laryngec-tomy Patients

Background: Tracheoesophageal voice prostheses (TVPs) have been the gold standard in rehabilitation, after laryngectomy, producing faster and premier voicing towards esophageal speech. Fungal colonization shortens the device’s lifetime and leads to prosthesis dysfunction, leakage, and subsequent respiratory infection. Therefore, in the current study, we aimed to investigate the fungal colonization patterns and to propose prophylactic measures that shall increase the longevity of voice prosthesis. Methods: Failed TVPs were removed - due to leakage and/or aspiration - from 66 post laryngectomy patients and examined. They were referred to Amiralam and Rasoul Hospital, the main centers of Ear, Nose, and Throat in Tehran, Iran from April 2018 to January 2020. Fungal colonization patterns were assessed using DNA sequencing techniques. Furthermore, the susceptibility to fluconazole, amphotericin B, nystatin, and white vinegar was evaluated according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Resident fungal species from the upper airways colonized all the 66 TVPs (100%). Diabetes (31%) and smoking (98%) were the predominant underlying disease and predisposing factors, respectively. Among the 79 fungal agents isolated from the 66 TVPs, Candida glabrata (n=25, 31.7%) was the most common. A significant reduction in minimum inhibitory concentration (MIC) values were observed for white vinegar when used alone (P<0.05). Conclusion: White vinegar at a very low concentration could decrease the amount of fungal colonization on TVPs without any adverse effects; its wide accessibility and affordability ensure a decrease in the overall health cost.

Functional outcomes in children related to self-care, mobility, and social function after stroke in early childhood: a cohort study

ABSTRACT Background: Stroke has been increasingly recognized as an important morbidity and mortality factor in neonates and children. Children have different and more diverse risk factors than adults, commonly related to an underlying disease. Stroke may compromise functional capacity in children. Few studies have focused on functional outcomes related to activities and participation. Objectives: To investigate post-stroke functionality of children related to self-care, mobility, and social function. Methods: We assessed the functional outcome of 14 children younger than 7.5 years who suffered a stroke in early childhood through the use of the Pediatric Evaluation of Disability Inventory (PEDI). Results: The average age of the sample at assessment was 3.6 ± 1.4 years (2 - 6 years). The average scores in the PEDI functional domains of self-care, mobility, and social function were, respectively, 37.6 ± 15.4, 36.2 ± 15.4, and 48.7 ± 11.1. Children showed age-appropriate functional outcomes in the PEDI functional domains: 71.4% of them in self-care and mobility and 92.9% in social function. Children with bilateral injuries (p = 0.05) and longer hospital stays (r = -0.79, p = 0.001) showed the worst scores in PEDI's social function domains. Conclusions: Overall, our sample of preschool children showed age-appropriate functional outcomes on self-care, mobility, and social function domains after stroke. However, children with bilateral injuries and longer hospital stays showed the worst scores in social function domains. We recommend focusing on functional rehabilitation to promote activities and participation and to monitor the development of children's social skills after stroke.

Clinical and laboratory findings of COVID-19 in children younger than six months old; Neutropenia is more common not lymphopenia

Background: Studies on age-related differences in clinical and laboratory features on coronavirus disease 2019 (COVID-19) are limited. We aimed to evaluate the demographic, clinical, and laboratory findings of COVID-19 in children younger than six months old and compare them with older children. Methods: A single-center retrospective study, including 209 confirmed COVID-19 cases, was conducted between March 11, 2020, and September 1, 2021. The case group consisted of 47 patients younger than six months old, and the control group consisted of 162 patients older than six months old. Results: The mean age of the case group was 2.77±1.52 months, and the control group was 101.89±65.77 months. Cough was statistically higher in the control group, poor feeding was higher in the case group (P=.043, .010). The underlying disease ratio was statistically higher in the case group; however, the hospitalization rate was higher in the case group (P=.001, .036). The case group had significantly lower median values of the absolute neutrophil count, hemoglobin, and higher median values of white blood cell, absolute lymphocyte count, platelet than the control group (P<.05). C-reactive protein, fibrinogen values were significantly lower, and procalcitonin, D-dimer, troponin T, N‑terminal pro-B-type natriuretic peptide significantly higher in the case group (P<.05). Lymphopenia was more common in the control group, whereas neutropenia was more common in the case group (P= .001, .011). Conclusions: We showed that most children younger than six months old had mild and asymptomatic COVID-19; however, the hospitalization rate was higher, and neutropenia was more common than older children.

Clinical features of invasive fungal disease in children with no underlying disease

There is limited research into Invasive fungal disease (IFD) in children with no underlying disease. We undertook a retrospective study of children with IFD who did not suffer from another underlying disease, from June 2010 to March 2018 in Changsha, China. Nine children were identified. Eosinophil counts were elevated in six cases. The level of procalcitonin (PCT) was elevated in six cases. Fungal culture was positive in all patients, including eight cases of Cryptococcus neoformans and one case of Candida parapsilosis. 8.33 days following antifungal treatment, the body temperature of the eight patients affected by cryptococcal disease had returned to normal. Our study indicates that the primary pathogen in IFD was Cryptococcus neoformans in children who had no other underlying disease. Eosinophils can be considered to be indicators of cryptococcal infection. IFD in children with no other underlying disease has a satisfactory prognosis.

Santulli Procedure Revisited in Congenital Intestinal Malformations and Postnatal Intestinal Injuries: Preliminary Report of Experience

In our experience, the Santulli procedure (SP) can improve bowel recovery in congenital intestinal malformations, necrotizing enterocolitis (NEC), and bowel perforation. All cases managed at our institution using SP between 2012 and 2017 were included in this study. Forty-one patients underwent SP (median age: 39 (0–335) days, median weight: 2987 (1400–8100) g) for intestinal atresia (51%, two gastroschisis), NEC (29%), midgut volvulus (10%), Hirschsprung’s disease (5%), or bowel perforation (5%), with at least one intestinal suture below the Santulli in 10% of cases. The SP was performed as a primary procedure (57%) or as a double-ileostomy reversal. Anal-stool passing occurred within a median of 9 (2–36) days for 95% of patients, regardless of the diversion level or the underlying disease. All three patients requiring repeated surgery for Santulli dysfunction had presented with stoma prolapse (p < 0.01). Stoma closure was performed after a median of 45 (14–270) days allowing efficient transit after a median of 2 (1–6) days. After a median follow-up of 2.9 (0.7–7.2) years, two patients died (cardiopathy and brain hemorrhage), full oral intake had been achieved in 90% of patients, and all survivors had normal bowel movement. Whether used as primary or secondary surgery, the SP allows rapid recovery of intestinal motility and function.