Assessment, outcomes and implications of multiple anthropometric deficits in children

BackgroundMalnutrition in children is widely prevalent around the world. It has been observed that malnourished children with multiple anthropometric deficits have higher mortality. However, adequate studies are not available on the outcome and recovery of these children.Nandurbar, a tribal district from Maharashtra, India, shows high prevalence of all three forms of malnutrition, often occurring simultaneously. A project previously undertaken in Nandurbar from July 2014 to June 2016 studied the effect of various therapeutic feeds in treatment of children with uncomplicated severe acute malnutrition (SAM). In this study, we analyse secondary data from it to correlate effects of stunting, wasting and underweight on treatment recovery.MethodsAnalysis was done on 5979 children with SAM using linear and logistic regression on R software for recovery rates and weight gain in children with SAM with single versus multiple anthropometric deficits, their relation to age, sex, and recovery from severe stunting by gain in height.ResultsThe mean age of children was 35 months and 53.1% of the children were males. 2346 (39.2%) children recovered at the end of the 8-week treatment. 454 (7.6%) had single anthropometric deficit (SAM only), 3164 (52.9%) had two anthropometric deficits (SAM and severe underweight (SUW)) and 2355 (39.4%) children had three anthropometric deficits (SAM, SUW and severe stunting). Out of the 5979 children with SAM, only 52 (0.9%) of children were not underweight (severe or moderate).44.94% of children with SAM who were severely stunted recovered, compared with 35.52% of children who were not (p<0.001). After controlling for confounders, severe stunting was found to increase the odds of recovery by 1.49. Severely stunted children with SAM also showed faster recovery and weight gain by 1.93 days (p<0.012) and 0.29 g/kg/day (p<0.001), respectively. Recovery was higher in females and younger age group. Recovery was also found to depend on the therapeutic feed, with children receiving medical nutrition therapy showing better recovery for severely stunted children.ConclusionOur findings corroborate previous literature that stunting is a way for the body to deal with chronic stress of nutritional deprivation and provides a survival advantage to a child.

Management of young girls with labial adhesion in the clinical and diagnostic Center of N.V. Dmitrieva Regional Children’s Clinical Hospital

Aim. This study aimed to compare the effectiveness of conservative treatment methods, namely, estriol-containing cream and non-hormonal drug, in girls with labial adhesion (LA) in the clinical and diagnostic center of N.V. Dmitrieva Regional Childrens Clinical Hospital. Materials and Methods. A retrospective analysis of pediatric clinical cases of labial adhesion (n=300) was carried out in N.V. Dmitrieva Regional Childrens Clinical Hospital in the period from 2016 to 2018. The study included 150 girls diagnosed with labial adhesion who were treated with estriol-containing cream (study group) and 150 girls with the same diagnosis (control group) who were treated with a non-hormonal gel containing onion extract 10 g, heparin 5000 IU, and allantoin. The age of the participants ranged from 4 months to 2 years and 2 months. Informed consent was obtained from the girls parents for the examination of the child, use of estriol-containing drug or a drug of non-hormonal composition, and processing of personal data. Recovery was considered the absence of recurrent synechiae for 2 years, improvement as not more than one recurrence not earlier than 6 months after the previous treatment, and no effect as two or more recurrences earlier than 6 months. Results. In the main group, recovery, improvement, and no effect were achieved in 108 (72%), 39 (26%), and 3 (2%) girls, respectively. In the control group, recovery, improvement, and no effect was achieved in 30 (20%), 75 (50%), and 45 (30%) girls, respectively. Conclusion. The results revealed the effectiveness and safety of using estriol-containing drugs in young girls diagnosed with labial adhesion.

TO EVALUATE SAFETY AND EFFECTIVENESS OF KETAMINE-PROPOFOL COMBINATION AND PROPOFOL ALONE IN DIAGNOSTIC RADIOLOGICAL PROCEDURES (MRI) IN PEDIATRIC PATIENTS.

Introduction: There is a growing need for magnetic resonance imaging (MRI) in children for accurate diagnosis and appropriate medical treatment. In recent times, small doses of ketamine have been used along with propofol for pediatric MRI sedation. Aims and objectives: to evaluate safety and effectiveness of Ketamine-propofol combination and propofol alone in diagnostic radiological procedures (MRI) in pediatric patients. Materials and methods: The present prospective randomized double blinded study was undertaken at Government General Hospital, Tirupati. Pediatric patients aged between 2 to 12 years of both sex, belonging to ASA grade I & II and posted for elective MRI Brain scan were included in the study. Results: KP group had significantly more reactions than P group. Recovery time (time taken to achieve modified aldrete recovery score of 9-10) was 37.33±2.88 min and 19.6±2.67 min in Ketofol group and propofol group respectively. Conclusion: Ketofol is an attractive combination for procedural sedation.

Evaluation of a Continuously Active Disinfectant for Disinfection of Mobile Equipment

Background: One of the limitations of current cleaning and disinfection strategies is that cleaned surfaces rapidly become recontaminated. In laboratory testing, a novel quaternary ammonium disinfectant provided sustained antimicrobial activity against multiple pathogens on surfaces after 24 hours. We hypothesized that this continuously active disinfectant would be effective in reducing contamination of portable medical equipment in a real-world healthcare setting.Methods: In a hospital and affiliated long-term care facility, 114 portable devices were randomized to receive no treatment (N = 38) or a single spray application of a quaternary ammonium-alcohol disinfectant (N = 38) or of the continuously active disinfectant (N = 38). The devices were cultured at baseline and on days 1, 4, and 7 after treatment for total aerobic colony counts, methicillin-resistant Staphylococcus aureus (MRSA), and enterococci.Results: As shown in Fig. 1, both spray disinfectants significantly reduced total aerobic colony counts in comparison to the untreated controls. The continuously active disinfectant resulted in sustained significant reductions in aerobic colony counts in comparison to baseline levels (P < .05), whereas counts returned to baseline levels by day 4 in the quaternary ammonium-alcohol disinfectant group. Recovery of MRSA and enterococci was significantly reduced on days 1–7 in the continuously active disinfectant group versus untreated controls (3 of 93, 3% vs 20 of 97, 21% respectively; P = .002), but not in the quaternary ammonium-alcohol disinfectant (11 of 97, 11%; P = .12). Conclusions: A single spray application of a continuously active disinfectant resulted in sustained reductions in total aerobic colony counts over 7 days and reduced recovery of MRSA and enterococci. The continuously active disinfectant could potentially reduce the risk for transmission of pathogens by portable devices.Funding: NoneDisclosures: None

The therapeutic effectiveness of Convalescent plasma therapy on treating COVID-19 patients residing in respiratory care units in Baghdad, Iraq

ObjectivesThe current COVID-19 pandemic needs unconventional therapies to tackle the resulted high morbidity and mortality. Convalescent plasma is one of the therapeutic approaches that might be of benefit.MethodsForty nine early-stage critically-ill COVID-19 patients residing in RCU of three hospitals in Baghdad, Iraq were included, 21 received convalescent plasma while 28 did not receive, namely control group. Recovery or death, length of stay in hospital, and improvement in the clinical course of the disease were monitored clinically along with laboratory monitoring through SARS-CoV-2 RNA detection via PCR, and SARS-CoV-2 IgG and IgM serological monitoring.ResultsPatients received convalescent plasma showed reduced duration of infection in about 4 days, and showed less death rate, 1/21 versus 8/28 in control group. In, addition, all of the patients received convalescent plasma showed high levels of SARS-CoV-2 IgG and IgM 3 days after plasma transfusion. Plasma from donors with high levels of SARS-CoV-2 IgG and donors with positive SRAS-CoV-2 IgM showed better therapeutic results than other donors.ConclusionsConvalescent plasma therapy is an effective mode of therapy if donors with high level of SARS-Cov2 antibodies are selected and if recipients were at their early stage of critical illness, being no more than 3 days in RCU.

Znaczące pogorszenie sytuacji finansowej banku a podatek od niektórych instytucji finansowych

<p>The subject of this article was the analysis of the impact of a significant deterioration of the bank’s financial standing on the obligation to pay the tax on certain financial institutions. The assessment that a significant deterioration of the financial situation has occurred results in the creation of obligations and rights towards the bank not only under banking law but also tax law. On the one hand, the bank is obliged to implement a rehabilitation plan. On the other hand, the bank obtains the right to be exempted from the tax on certain financial institutions. In this respect, difficulties emerge for group recovery plans. The plans may be drawn up both for bank holdings and for cooperative banking mutual solidarity systems. The research problem discussed herein boils down to the assessment of whether a significant deterioration of the situation of one of the member banks of the aforementioned corporate structures results in the initiation of the group recovery plan. Adopting such a hypothesis means that all the banks covered by the group recovery plan, regardless of their financial situation, would be exempted from the tax on certain financial institutions. The purpose of this study was to prove the claim that the exemption from the tax on certain financial institutions applies only to banks that have implemented recovery plans due to a significant deterioration of their financial situation. In view of the directive to keep the legal order consistent and coherent, banks that have not experienced a significant deterioration of their financial situation will not be entitled to take advantage of the tax exemption. Therefore, the interpretation of the provisions of the Act on the tax on certain financial institutions must cover the objective of the exemption, namely counteracting the deteriorating situation of unprofitable operators.</p>

Study of tuberculosis in HIV positive children in a tertiary care hospital of Odisha

Background: Tuberculosis and HIV have been closely linked since the emergence of AIDS. Worldwide, TB is the most common opportunistic infection affecting HIV seropositive individuals and it remains the most common cause of death in patients with AIDS. HIV infection has contributed to a significant increase in the worldwide incidence of TB. So, an attempt was made in the present study to know the magnitude/extent of tuberculosis, associated clinical patterns, epidemiological factors and outcomes in HIV positive children attending the ART Centre of SCB medical college and hospital, Cuttack.Methods: A tertiary care hospital based prospective study was carried out in 50 children between 6 months to 14 years of age for a period of 2 years.Results: Most of the cases were less than 6 years old. TB was more common in male children than in females. Most cases were from rural areas. Majority belong to Class IV (Upper Lower) and Class V(Lower) socio-economic class. Most had Grade II and Grade III malnutrition as per IAP classification. Definite history of contact and recent infection was present in most. Majority (75%) had pulmonary tuberculosis. Pleural variant was predominant in extra-pulmonary form followed by TB lymphadenitis and disseminated forms. 5% had both PTB and EPTB. Most cases were un vaccinated. Common clinical features were fever, cough, FTT, chronic diarrhoea. Disseminated TB was common in unvaccinated group. Recovery pattern was almost similar in vaccinated and unvaccinated groups. Most of the PTB cases were cured of the disease with only 2 deaths in this group whereas the number of deaths, children going LAMA and development of MDR-TB was more in disseminated forms.Conclusions: Occurrence of TB is high in HIV positive cases. EPTB is common in unvaccinated cases. TB is common in rural and underprivileged children. Drug compliance is poor in disseminated forms. Mortality is high in disseminated forms. Sequele is more in disseminated forms of TB.

Comorbidities Might Condition the Recovery of Quality of Life in Survivors of Sepsis

Purpose: To assess how preexisting disabling comorbidities (DC) affect the recovery rate of quality of life (QOL) over time in sepsis survivors. Methods: A prospective study was conducted on sepsis survivors who answered the 36-Item Short Form Health Survey (SF-36) 7 days after discharge from the intensive care unit. Subsequent interviews were held at 3, 6, and 12 months. The results of the physical component score (PCS) and mental component score (MCS) of the SF-36 were evaluated. Patients were divided into 2 groups to compare patients with DC (DC group) and without DC (no-DC group). Quantile regression was used to model changes in PCS and MCS between different time points. Results: Seventy-nine sepsis survivors were enrolled. After controlling for baseline age and QOL, the QOL scores were lower among patients with DC than in no-DC patients. The QOL of DC group got worse when compared to no-DC group. Recovery rate of PCS and MCS was higher in the DC group than in the no-DC group (PCS: 20.51 vs 16.96, P < .01; MCS: 19.24 vs 9.66, P < .01). Their baseline QOL was recovered only by 6 months after the sepsis episode. Conclusion: Quality-of-life impairment and its recovery rhythm in patients with sepsis appear to be conditioned by coexisting DC.

Predicting Recovery Patterns After Sport-Related Concussion

Context: Clinicians sometimes treat concussed individuals who have amnesia, loss of consciousness (LOC), a concussion history, or certain symptom types more conservatively, but it is unclear whether recovery patterns differ in individuals with these characteristics. Objective: To determine whether (1) amnesia, LOC, and concussion history influence the acute recovery of symptoms, cognition, and balance; and (2) cognition and balance are influenced by acute symptom type. Design: Cohort study. Setting: Seven sports at 26 colleges and 210 high schools. Patients or Other Participants: A total of 8905 collegiate (n = 1392) and high school (n = 7513) athletes. Main Outcome Measure(s): The Graded Symptom Checklist, Standardized Assessment of Concussion, and Balance Error Scoring System were administered to all athletes during the preseason. To allow us to track recovery patterns, athletes diagnosed with a concussion (n = 375) repeated these assessments immediately after the injury, 3 hours postinjury, 1 day postinjury, and at 2, 3, 5, 7, and 90 days after injury. Results: Athletes who experienced amnesia had markedly greater deficits in and a slower recovery trajectory on measures of symptoms, cognition, and balance. Athletes with 2 or more prior concussions demonstrated poorer balance than those with no previous history. Otherwise, LOC and concussion history largely did not affect symptoms, cognition, or balance. Greater deficits in balance scores were observed in athletes with all symptom types. Regardless of these characteristics, most athletes recovered within 7 to 10 days. Conclusions: Athletes who experienced amnesia had more symptoms and greater deficits in cognition and balance. Symptoms and cognitive or balance deficits were not consistently associated with LOC or concussion history. Acute symptoms had a strong influence on balance scores and, to a lesser extent, on cognition. However, we found no evidence to support more cautious return-to-play decisions for athletes with these characteristics, as group recovery occurred within normal timelines. Our study supports current clinical practice: recommending that athletes be withheld from activity until they are asymptomatic, followed by a graduated return-to-play progression.