Study of patients undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) at Tishreen University Hospital in Lattakia – Syria: دراسة مرضى التنظير الراجع للطرق الصفراوية والبنكرياسية في مستشفى تشرين الجامعي في اللاذقية - سوريا

Objective: The aim of this study is to evaluate the indications, findings, and complications of performing Endoscopic Retrograde Cholangiopancreatography (ERCP). Patients and Methods: A Prospective Observational Descriptive study conducted for the period from January 2020 to January 2021, 167 consecutive ERCP were performed at Tishreen University Hospital in Lattakia-Syria. Results: The median age was 58 years, 59.30% of patients were female. The most common indications for ERCP were common bile duct stones (44.9%) and obstructive jaundice (44.3%). The median number of attempts for cannulation was 2 counts, and 74.3% of the procedures were graded as with difficulty grade 1. The most common abnormal findings were common bile duct dilation (50.3%) and bile duct stones (43.7%). The most therapeutic endoscopic interventions were sphincterotomy (64.7%) and stone extraction balloons (68.9%). The therapeutic success rate was 93.5% with repeated the procedure and complications occurred in (10.8%) of patients. The most frequent complication was mild pancreatitis (6%). Death was reported in five cases (3%), one of them (0.6%) was due to ERCP. Conclusion: ERCP is a potential risk for complications, so physicians should be adept at recognizing and treating any complications as soon as they arise.

Anatomical Variations of Uncinate Process in a Tertiary Care Hospital of a Coastal city in Karnataka

Introduction: Superior attachment of uncinate process is the most important anatomical landmark in frontal recess surgery. The uncinate process is an integral struc­ture of osteomeatal complex and prevents the direct contact of the inspired air with the maxillary sinus. It acts as a shield and also plays a role in muco-ciliary activity. Anatomic variations of the uncinate process have surgical implications. Aim: This study was done to know the different variations of superior attachment of uncinate process. Materials and Methods: In this retrospective observational descriptive study, Computed Tomography (CT) scans of Para Nasal Sinuses (PNS) of 256 patients from Sept 2018 to May 2020 were studied. The results were expressed in percentages and proportions. Results: Among 256 CT images, 139 belonged to males and 117 females. In the CT films examined, on the right side, the most common attachment of uncinate was to lamina papyracea which was (64.8%) followed by skull base (19.5%) and to the middle turbinate(15.6%). Similar findings were seen on left side. Conclusion: Uncinate process shows different variations in its superior attachment. Superior attachment to lamina papyracea was the most common attachment of uncinate in our study.

A STUDY TO EVALUATE THE THYROID FUNCTION IN SERO POSITIVE RHEUMATOID ARTHRITIS

Background: The thyroid dysfunction in rheumatoid arthritis is well-known but unfortunately there are only few studies available in our country to assess the thyroid function in RA patients. Methods: It was a Hospital based observational, descriptive study . Upgraded department of General Medicine, SMS Medical College and AttachedHospitals, (Jaipur). Results: Maximum patients 208(80.00%) are euthyroid followed by 28(10.77%) are overt - hypothyroidism, 22(8.46%) subclinical hypothyroidism and 2 patients (0.77%) are subclinical hyperthyroidism patients Conclusion: Prevalence of thyroid dysfunctions in rheumatoid arthritis is high and associated with thyroid autoimmunity and suggested that allrheumatoid arthritis patients should go for thyroid functions. Hence, it is advisable to screen the patients of rheumatoid arthritis for thyroid dysfunction so that early identification and treatment can provide a healthier life ahead. Keywords: NAFLD, TSH, T3, T4.

The effect of COVID-19 on maternal and neonatal outcome - A retrospective study

The pandemic of coronavirus disease (COVID-19) has caused serious adverse effects on the human race. There are limited data on maternal and neonatal outcomes of pregnant women with COVID-19.An observational descriptive study was conducted in the department of obstetrics & gynaecology at SMSR and Sharda hospital located in Greater Noida, Uttar Pradesh. This medical college drains patients from entire Greater Noida and as well as from far-away places as referrals. All pregnant patients were included that came to this hospital from 1 April to 31 May 2021. These were the two dreadful months for the entire country in which so many lives were lost. All pregnant patients were labelled COVID-19 positive after undergoing either Rapid antigen test/RTPCR test taken from nasopharyngeal and oral swab.: This included assessment of the maternal morbidity and mortality, comorbidities & worsening of outcome due to COVID-19 infection in pregnant patients as well assessment of the effect of COVID-19 infection on fetus and newborn.

A Retrospective Observational Descriptive Study on the Effectiveness and Usage of Emicizumab and Antihemophilic Factor (recombinant), Fc Fusion Protein in Patients with Hemophilia A in the US

Introduction Hemophilia A is a rare bleeding disorder characterized by coagulation Factor VIII (FVIII) deficiency. Symptoms are primarily bleeding episodes that occur spontaneously or following injury, trauma, or surgical procedure. The treatment for hemophilia A involves replacement of FVIII for on-demand or prophylactic care. The aim of this analysis was to describe treatment outcomes and patterns between patients with hemophilia A who switch to emicizumab (Hemlibra®), Fc fusion protein (rFVIIIFc; Eloctate®), or other factor therapy using specialty pharmacy data from the US. Methods This was a retrospective observational descriptive study conducted between November 2014 and January 2021 using specialty pharmacy data including over 5,000 total patients with hemophilia A in the US. Patients included in the analysis were male, had a diagnosis of hemophilia A without a history of inhibitors, and had a minimum of 6 months baseline pre-index data and 6 months follow-up data post-index. Index date was defined as the first dispense of emicizumab after October 2018 or rFVIIIFc after May 2015. Patient reported and claims-based treatment outcomes assessed pre- and post-treatment included: annualized bleeding rate (ABR, calculated from patient bleed logs), any factor usage including on-demand FVIII use, prescribed and dispensed dosage of treatment, and frequency. Wastage as a percentage was a calculated as: (prophylaxis logged - prophylaxis prescribed)/prophylaxis dispensed. Results 118 patients treated with emicizumab and 55 patients treated with rFVIIIFc were included in the analysis. Additionally, 26 patients switched from rFVIIIFc to emicizumab, and therefore met inclusion criteria for both treatment groups (these patients are described separately). Baseline characteristics are reported in Table 1; the majority of patients in all cohorts had severe hemophilia and prior prophylaxis therapy. The most frequently prescribed dosing patterns for patients in the emicizumab cohort was once every 2 weeks (Q2W) for 56 patients (47.5%) and once weekly (Q1W) for 51 patients (43.2%). Whereas the most frequently prescribed dosing patterns for the rFVIIIFc only cohort was twice per week (BIW) in 27 patients (49.1%), every 4 days (Q4D) in 15 patients (27.3%), and Q1W in 2 patients (3.6%). Total mean (95% confidence intervals [CI]) weekly prophylaxis consumption was 1.68 (1.65; 1.72) mg/kg in the emicizumab cohort and 83.17 (72.06; 94.29) IU/kg in the rFVIIIFc cohort post index. Mean (95% CI) weekly dispensed dosage for prophylaxis was 1.81 (1.76; 1.86) mg/kg emicizumab and 83.83 (72.55; 95.11) IU/kg rFVIIIFc post index. Mean (95% CI) total supplied FVIII for on-demand factor on hand was 5.14 (2.92; 7.35) IU/kg in the emicizumab cohort and 11.76 (9.06; 14.46) IU/kg in the rFVIIIFc cohort post index. Weekly percentage of supplied dosage wasted was 6.03% (4.50; 7.57; p<0.01) emicizumab for the overall cohort, with a mean (standard deviation [SD]) of 10.46% (12.21) wasted per patient within the emicizumab age <12 years cohort. Weekly percentage of supplied dosage wasted was 0.70 (-0.10; 1.50; p=0.09) rFVIIIFc for the overall cohort, with a mean (SD) of 2.63% (3.53) wasted per patient within the rFVIIIFc age <12 years cohort. Mean (95% CI) change in overall ABR pre- and post-treatment was -1.14 (-2.16; -0.18) in the rFVIIIFc cohort and -0.91 (-1.36; -0.50) in the emicizumab cohort (Table 2). Mean (95% CI) changes in spontaneous ABR and spontaneous joint ABR pre- and post-treatment were -0.36 (-1.12; 0.27) and -0.16 (-0.70; 0.31), respectively, in patients treated with rFVIIIFc, whereas within the emicizumab group they were -0.40 (-0.71; -0.13) and -0.37 (-0.66; -0.12). Conclusion Patients were prescribed emicizumab labeled dosing primarily on a Q1W or Q2W pattern, whereas patients prescribed rFVIIIFc had more individualized dosing primarily being prescribed Q4D or BIW. FVIII for on-demand treatment use was found post index in both the factor and non-factor treated cohorts. Overall product wastage with emicizumab is higher than previously reported. Product wastage was highest among emicizumab patients under 12 years, but wastage was still considerable in patients 12 or older. This descriptive analysis indicated that both treatments remained effective with lower bleed rates than prior FVIII therapies. Figure 1 Figure 1. Disclosures Cockerham: Sanofi: Current Employment, Current equity holder in publicly-traded company. Wilson: Sanofi: Current Employment, Current equity holder in publicly-traded company; Alexion: Current equity holder in publicly-traded company. Frick: Trio Health, Inc.: Current Employment; Sanofi S.A.: Research Funding. Dasmahapatra: Sanofi: Current Employment, Current equity holder in publicly-traded company.

Efecto del curso avanzado de combate sobre cualidades físicas condicionantes y características antropométricas en alumnos de la Escuela Militar de Cadetes General José María Córdova de Bogotá D.C. (Effect of the advanced combat course on conditioning phy

El Ejército Nacional de Colombia garantiza la formación de sus alumnos a partir del curso avanzado de combate, que simulan operaciones militares reales. Este artículo busca determinar el efecto del curso avanzado de combate sobre cualidades físicas y antropométricas en alumnos de la Escuela Militar. Para ello se realizó un estudio observacional, descriptivo con componente analítico, cuyos sujetos fueron medidos antes y después del Curso de Combate. La muestra incluyó 113 participantes, 26 mujeres y 87 hombres con edades promedio de 22 ± 1,3 años, pertenecientes a la Escuela Militar de Cadetes de Colombia. Las variables que se midieron fueron peso, talla, perímetro de cintura e Índice de masa corporal, el VO2 máximo indirecto con el test de Leger, la fuerza máxima del cuadrante superior con el press banca acoplado al sistema T-Force®, fuerza prensil y de espalda con dinamometría y la flexibilidad con el test Sit and Reach. Se evidenciaron cambio significativo: controladas por género: perímetro de cintura p <.001, IMC p = .000847, flexibilidad p =.0147, dinamometría de espalda p = 5.12e-05 y la variable RM p = 9.26e-06; controlando por género y lateralidad: fuerza prensil izquierda p <.001. Se logró evidenciar una reducción del IMC y perímetro de cintura. Existe un incremento de la fuerza isométrica extensora de tronco con disminución de la flexibilidad lumbar e isquiotibial, generando rigidez, estabilidad del tronco permitiendo soportar posturas y cargas. Se presentaron mejoras de fuerza máxima en miembros superiores y fuerza prensil izquierda, mejorando la capacidad de mantener cargas. Abstract. The National Army of Colombia guarantees the education of their students from advanced combat courses, which simulate real military operations. This article seeks to determines the effect of the advanced combat course on physical qualities and anthropometric characteristics in students of the Military School. For this, an observational, descriptive study with an analytical component was carried out, whose subjects were measured before and after the Combat Course. The sample included 113 participants, 26 women and 87 men with an average age of 22 ± 1.3 years, belonging to the Colombian Military Cadet School. The variables that were measured were weight, height, waist circumference and body mass index, the maximum indirect VO2 with the Leger test, the maximum force of the upper quadrant with the bench press coupled to the T-Force® system, prehensile and back strength with dynamometry and flexibility with the Sit and Reach test. Results: The following variables showed change: controlled by gender: waist circumference p <.001, BMI p = .000847, flexibility p = .0147, back dynamometry p = 5.12e 05 and the variable RM p = 9.26e-06; controlling for gender and laterality: left grip strength p <.001. There was a reduction of BMI and waist circumference and significant increase in isometric trunk extensor force with decreased lumbar and hamstring flexibility, which generates rigidity, stability of the trunk allowing to support postures and loads. Students developed superior levels of maximum strength in upper limbs and left prehensile strength, improving the ability to hold loads.

COVEVOL: Natural Evolution at 6 Months of COVID-19

Many studies have investigated post-COVID symptoms, but the predictors of symptom persistence remain unknown. The objective was to describe the natural course of the disease at 6 months and to identify possible factors favoring the resurgence or persistence of these symptoms. COVEVOL is a retrospective observational descriptive study of 74 patients. All patients with positive SARS-CoV-2 PCR from March 2020 were included. We compared a group with symptom persistence (PS group) with another group without symptom persistence (no-PS group). Fifty-three out of seventy-four patients (71.62%) described at least one persistent symptom at 6 months of SARS-CoV-2 infection. In the PS group, 56.6% were women and the average age was 54.7 years old [21-89.2] ±16.9. The main symptoms were asthenia (56.6%, n = 30), dyspnea (34%, n = 18), anxiety (32.1% n = 17), anosmia (24.5%, n = 13) and agueusia (15.1% n = 8). Ten patients (13.51%) presented a resurgence in symptoms. Patients in the PS group were older (p = 0.0048), had a higher BMI (p = 0.0071), and were more frequently hospitalized (p = 0.0359) compared to the no-PS group. Odynophagia and nasal obstruction were less present in the inaugural symptoms of COVID-19 in the PS group (p = 0.0202 and p = 0.0332). Persistent post-COVID syndromes are common and identification of contributing factors is necessary for understanding this phenomenon and appropriate management.

The elusive retromolar foramen and retromolar canal: A CBCT study

This study aims to evaluate the presence of retromolar foramen (RMF) and retromolar canal (RMC) in the mandible using cone beam computed tomography (CBCT) in Chhattishgarh population and to correlate its possible clinical impact. 175 CBCT images were collected from which 100 bilateral CBCT images of patients were retrospectively selected from the Department of Oral Medicine and Radiology of the Chhattishgarh Dental College and Research Institute and evaluated bilaterally which were taken for diagnostic purposes from maxillofacial radiology clinic and data were statistically analyzed. This was an observational descriptive study and all the images were processed and analyzed on CS3D imaging software. The data was analyzed using chi square test. The prevalence of RMF and RMC was observed in 8.5%, of which 10 were in females and 7 in males. The RMCs traversed in different directions – horizontal, vertical and angular. Based on the subjective assessment, each of these canals was further subclassified into straight and curved canal. In the present study in 12 of the cases angular curved type was found and in 3 cases, vertical straight was noticed. The bifurcation of the inferior alveolar nerve (IAN) canal was observed in 15% of the scans and remaining 85% had single mandibular canal. The proximity of RMF from buccal and lingual cortical plates was found buccally in 16 cases and in single case was found to be lingually. Position of RMF might change with the presence and absence of third molar. The absence of third molar results in anteriorly located RMF. In majority of cases it was found that RMF was located more buccal than lingual. The parameters considered in the current study will guide the oral and maxillofacial surgeons while giving incisions in 3molar impacted cases, other pathologies and ease to preserve the retromolar foramen.

EARLY MANAGEMENT OF SEVERE PRE-ECLAMPTIC AND ECLAMPTIC REFFERAL PATIENT AT KOTABARU REGENCY

ABSTRACTBackground: The maternal mortality rate is 305 per 100,000 live births in Indonesia. The most common cause of maternal death is preeclampsia / eclampsia. The maternal mortality rate is 247 per 100,000 live births in 2017 in Kotabaru Regency. Most preeclamptic referral patients are in critical condition when they arrive at the hospital. Method: This type of research is an observational descriptive study. The population is all patients with severe preeclampsia and eclampsia in the delivery room of RS Pangeran Jaya Sumitra Kabupaten Kotabaru from January - December 2018. The sample is total sampling.Results: PEB referral patients was 57 cases. Most of those are in the group age of 20 - 35 years which are 35 people (61.4%), not nullipara is 31 people (54,4%), 34-40 weeks of gestation is 43 people (75,4%), as many as 44 people (77,2%) with previous severe preeclampsia/ hypertension, 41 people (71,9%) brought referral letters, referred by Puskesmas are 47 people (82.5%), most of the locations of referral is from Pulau Laut as many as 35 referrals (61,4%). The initial management of PEB and eclampsia: IV Pathway in 11 patients (19.3%) of severe preeclamptic and eclamptic patients, 50 patients (87.7%) were not given MgSO4, 51 people (89.5% ) did not get anti-hypertension, 52 patients (91.2%) were not installed catheters. Conclusion: Early management of severe preeclamptic and eclamptic patients is not optimal and does not fulfil the standard yet. Proper and appropriate early management can reduce morbidity and maternal mortality from complications of severe preeclampsia and eclampsia that can be prevented by providing right initial management.