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BACKGROUND: CLOVES (congenital lipomatous overgrowth, vascular malformations, epidermal nevi, scoliosis/skeletal/spinal) syndrome is a rare and progressive genetic disorder resulting from somatic mosaicism in activating mutations in the phosphatidylinositol-4,5- bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) gene. PIK3CA is a cell growth master regulator where gain of function mutations give rise to abnormal activation of the PI3K-AKT- mammalian target of rapamycin (mTOR) pathway. Treatment with sirolimus, an mTOR inhibitor, may therefore be of benefit in patients with CLOVES syndrome. OBJECTIVE: Here we describe the efficacy and toxicity of sirolimus in a pediatric patient with progressive CLOVES syndrome. RESULTS: The child presented with a large and painful abdominal malformation, massive overgrowth of his feet, limb length discrepancy and genu valgum. There was dramatic clinical and radiographic improvement in the size and comfort of his abdominal mass within several months of initiating medical therapy. This, combined with orthopaedic care of his genu valgum, leg length discrepancy, and overgrowth of his feet, has allowed for significant functional gains. CONCLUSIONS: Multidisciplinary care is essential for comfort and functional gains in patients with CLOVES syndrome, particularly those with severe symptoms. Close monitoring while on sirolimus medical therapy combined with frequent reassessment of orthopedic needs can dramatically improve patient quality of life and outcomes.

Rationale: Chronically critically ill patients admitted to a long-term acute care hospital (LTACH) setting are a vulnerable population of intensive care unit (ICU) survivors. Little is known of the goals and functional outcomes achieved by patients after rehabilitation in the LTACH setting. Objectives: We sought to examine patient goals and functional outcomes, including swallowing function, among ICU survivors admitted to an LTACH with a tracheostomy. Methods: This was a prospective observational cohort study of chronic critically ill LTACH patients. Results: Fifty older subjects with a median duration of intubation before tracheostomy of 13 days were enrolled. ICU-acquired weakness and cognitive impairment were present in 40 (80%) and 36 (72%) patients, as measured by the Medical Research Council scale and Montreal Cognitive Assessment, respectively. Mental health problems were also common, with 16 (32%) patients experiencing moderate to severe anxiety, 9 (18%) experiencing moderate to severe depression, and 11 (22%) reporting symptoms consistent with post-traumatic stress disorder, according to the Hospital Anxiety and Depression Scale and Post-Traumatic Stress Syndrome 10-Questions Inventory, respectively. Pharyngeal dysfunction, as measured by Fiberoptic Endoscopic Evaluation of Swallow examination, was present in 37 (74%) patients. Patient goals, in decreasing order of frequency, included eating and drinking, speaking, walking, returning home, and toileting. By LTACH discharge, goal attainment was variable, with 97% of those who ranked speaking as important being able to speak and 88% of those who ranked eating and drinking as important being able to eat and drink but with only 21% being able to walk and only 18% being able to self-toilet. Discharge to the home or acute rehabilitation setting, achieved in 52% of the population, was associated with greater strength, as measured by the total Medical Research Council score (P = 0.002) as well as by the European 5-dimension, 5-level health-related quality of life instrument domains of mobility (P = 0.008) and self-care (P = 0.04). Conclusions: Goal attainment during this period of recovery was variable. The ability to speak, eat, and drink, frequently identified as goals by these patients, were achieved, whereas functional goals such as walking were rarely achieved. These findings highlight the importance of identifying patient goals and setting realistic expectations informed by functional assessments when rehabilitating this vulnerable patient population in the LTACH and subsequent post–acute care settings.

Актуальность. 2020 год в истории человечества останется годом испытаний для населения более чем 180 стран мира, их правительств, экономик и систем здравоохранения в связи с пандемией острой респираторной болезни COVID-19, вызванной коронавирусом SARS-CoV-2. На конец мая в мире заболели коронавирусной инфекцией COVID-19 6 159 953 человек, 371 006 умерли, 2 738 179 выздоровели. Разработка вакцины против трех известных типов коронавируса может занять от одного до полутора лет и потребует дополнительно $2 млрд, считают во Всемирном банке. Цель исследования. Определить риски медицинской деятельности для учреждений первичной медицинской помощи в условиях эпидемии острой респираторной болезни COVID-19, вызванной коронавирусом SARS-CoV-2, и подходы к управлению ими. Материалы и методы. В качестве материалов исследования использованы научные источники (1 ед.), международные документы (7 ед.), законодательные и нормативно-правовые акты (10 ед.). Использованы методы системного подхода, системного и контент-анализа, концептуального моделирования. Результаты. Установлено, что в учреждениях первичной медицинской помощи Украины в период эпидемии острой респираторной болезни COVID-19, вызванной коронавирусом SARS-CoV-2, реализовались управленческо-организационные, нормативно-правовые, финансово-хозяйственные, операционно-технологические, кадровые риски за счет введения карантина на государственном уровне, утверждения нормативно-правовых документов по организации и оказанию медицинской помощи пациентам с COVID-19, в которые несколько раз вносились изменения за короткий период времени, начала второго этапа медицинской реформы с 01.04.2020 в учреждениях здравоохранения вторичной медицинской помощи. Предложено несколько направлений совершенствования подходов к управлению рисками в существующей системе риск-менеджмента учреждений первичной медицинской помощи: усиление руководства учреждением путем внедрения дополнительной специализированной функциональной структуры при руководителе – штаба управления учреждением в условиях эпидемии; разработка и реализация эффективной стратегии эпидемического мониторинга, профилактики и инфекционного контроля; обновления контента информации о рисках в целях обмена между всеми заинтересованными сторонами; пересмотр кадровой политики и кадрового обеспечения учреждения. Выводы. Существует необходимость оживления системы риск-менеджмента в учреждениях первичной медицинской помощи в связи со значительным усложнением эпидемической ситуации, которое может продолжаться длительный период времени. Необходимо пересмотреть подходы к управлению рисками в направлениях совершенствования управления учреждением, персоналом, эпидемической безопасностью, информационным обеспечением.

The word 'antibiotics' is an historical, but imprecise, term. Today, 'antibiotics' are also used for other indications and 'non-antibiotics' are repurposed for infectious diseases. This situation calls for a revision of antipathogenic drug terminology. The use of correct terms will facilitate rational antipathogenic treatment and understanding of drug repurposing.

The review presents the methodological recommendations of the Federation of Anesthesiologists and Resuscitators for the management of patients receiving long-term antithrombotic therapy, revised in 2021. The classification of complications and the degree of hemorrhagic risk, stratification of perioperative thromboembolic risk are presented. Taking into account modern concepts, the principles of interruption and resumption of antithrombotic, anticoagulant and antiplatelet therapy are described. Approaches to the emergency interruption of antithrombotic therapy during urgent surgical interventions, including emergency reversion of the effects of drugs received by the patient, are presented. The features of the appointment and changes in the tactics of antithrombotic therapy depending on the thromboembolic and hemorrhagic risk in such concomitant diseases and conditions as the presence of artificial heart valves, atrial fibrillation, ischemic stroke, myocardial infarction, coronary stenting are described. A separate section is devoted to thrombohemorrhagic safety when performing regional anesthesia against the background of antithrombotic therapy. Indications, contraindications and limitations for regional anesthesia in the context of antithrombotic therapy are given. Criteria for the quality of the provided medical care are given.

AIMS AND OBJECTIVES To offer a review of the differing terminologies used by clinicians and researchers to describe the long-term intensive care unit (ICU) patient and the underlying propositions that align with this terminology. BACKGROUND Ongoing medical and technological advances in emergency and intensive care have resulted in improved survival of critically ill patients in recent decades. In addition, these advancements have also resulted in improved survival of complex critically ill patients who progress to a trajectory of prolonged critical illness, having protracted stays in the ICU. There is great variability in terminology used to define the long-term ICU patient. This lack of a common definition for long-term ICU patients is problematic, increasing their vulnerability and risk of care not being centred about their unique needs. DESIGN In this discursive article, we explore the terminology used to define the long-term ICU patient. An initial broad search of the literature across four electronic databases was conducted to identify common terminology used to define the long-term ICU patient. From here, seven definitions were identified and chosen for inclusion in the review as they meet inclusion criteria and clearly described a group of patients who have an extended ICU stay. The seven selected terms are as follows: prolonged mechanical ventilation; failure to wean; insertion of tracheostomy; chronically critically ill; persistent critical illness; persistent inflammatory-immunosuppressive and catabolic syndrome; and frailty. Following this a focused review of the literature with the selected terms was conducted to explore in greater detail the terminology. DISCUSSION The lack of clear definition for this patient group can potentiate their care needs being unmet. Acknowledgement of the need to clearly define this patient group is the first step to improve outcomes. Nursing is well positioned to recognise the different terminologies use to describe this group of patients and implement care to suit their unique clinical characteristics. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE Recognition and standardisation of these terms are an important priority to pave the way to improve care pathways and outcomes for this group of patients and their family.

The term Long COVID (or Post COVID) describes a condition characterized by persistence of symptoms for at least 12 weeks after the onset of COVID-19. It may last several months but the duration is still matter of observation. The symptoms and the clinical manifestations are clinically heterogeneous and suggesting involvement of multi-organs/systems, including the cardiovascular system. The general recurrent symptoms include fatigue, breathlessness, myalgia, headache, loss of memory, and impaired concentration. Patients report loss of their previous psychophysical performance. Cardiovascular involvement manifests with common symptoms such as palpitations and chest pain, and, less commonly, with events such as late arterial and venous thromboembolisms, heart failure episodes, strokes or transient ischaemic attack, ‘myo-pericarditis’. The diagnostic criteria are mainly based on the narrative of the patients. Measurable biomarkers or instrumental findings or clinical events are not yet framed in a shared diagnostic framework. The open question for clinicians and researchers is whether biomarkers, electrocardiogram, non-invasive imaging, and clinical monitoring should be included in a shared diagnostic protocol aimed at defining the diagnostic path and protecting patients at risk of unexpected events.

ObjectiveThere is no widely used prognostic model for delirium in patients with advanced cancer. The present study aimed to develop a decision tree prediction model for a short-term outcome.MethodThis is a secondary analysis of a multicenter and prospective observational study conducted at 9 psycho-oncology consultation services and 14 inpatient palliative care units in Japan. We used records of patients with advanced cancer receiving pharmacological interventions with a baseline Delirium Rating Scale Revised-98 (DRS-R98) severity score of ≥10. A DRS-R98 severity score of ResultsAltogether, 668 records were included, of which 141 had a DRS-R98 severity score of Significance of resultsWe developed an easy-to-use prediction model for the short-term outcome of delirium in patients with advanced cancer receiving pharmacological interventions. The baseline severity of delirium and precipitating factors of delirium were important for prediction.

A new strain of coronavirus — SARS-CoV-2 (Severe Acute Respiratory Syndrome CorOnaVirus-2) has caused an increase in the number of cases and high mortality worldwide. In patients with coronavirus disease 2019 (COVID-19, Corona Virus Disease 19), in addition to lung damage, there is a high risk of developing multiple organ failure. Concomitant cardiovascular diseases are independent risk factors for the development of severe forms of COVID-19. Acute COVID-19 is manifested by polysegmental pneumonia, pulmonary edema, sepsis, atrial or ventricular fibrillation, acute myocardial injury, myocarditis, pericardial effusion, cardiac tamponade, and various thromboembolic disorders. COVID-19 can provoke chronic damage to the cardiovascular, nephro- and cerebrovascular systems, which worsen the patient's life prognosis. In persons who have undergone COVID-19, in the future, an increase in various cardiovascular complications, disorders of carbohydrate and purine metabolism, etc. can be expected. The article discusses the course and long-term consequences of Coronavirus Disease 2019 (COVID-19) based on the presented case series. The above observations of cases of coronavirus disease (COVID-19) demonstrate a variety of its clinical manifestations and outcomes, in which, along with damage to the lungs, there are also lesions of the cardiovascular, endocrine and urinary systems. Based on the accumulated experience in the management of patients, it is proposed to distinguish between acute (from 1 to 4 weeks), subacute (from 4 to 12 weeks) and chronic (from 12 weeks or more) forms. The use of this approach in real clinical practice facilitates the work of doctors in the outpatient-polyclinic stage of observation, reducing the social burden of the disease, routing patients, as well as stratification of persons suffering from COVID-19 for the development of pulmonary fibrosis.

The identification of children with traumatic brain injury (TBI) who are at risk of death or poor global neurological functional outcome remains a challenge. Magnetic resonance imaging (MRI) can detect several brain pathologies that are a result of TBI; however, the types and locations of pathology that are the most predictive remain to be determined. Forty-two critically ill children with TBI were recruited prospectively from pediatric intensive care units at five Canadian children's hospitals. Pathologies detected on subacute phase MRIs included cerebral hematoma, herniation, cerebral laceration, cerebral edema, midline shift, and the presence and location of cerebral contusion or diffuse axonal injury (DAI) in 28 regions of interest were assessed. Global functional outcome or death more than 12 months post-injury was assessed using the Pediatric Cerebral Performance Category score. Linear modeling was employed to evaluate the utility of an MRI composite score for predicting long-term global neurological function or death after injury, and nonlinear Random Forest modeling was used to identify which MRI features have the most predictive utility. A linear predictive model of favorable versus unfavorable long-term outcomes was significantly improved when an MRI composite score was added to clinical variables. Nonlinear Random Forest modeling identified five MRI variables as stable predictors of poor outcomes: presence of herniation, DAI in the parietal lobe, DAI in the subcortical white matter, DAI in the posterior corpus callosum, and cerebral contusion in the anterior temporal lobe. Clinical MRI has prognostic value to identify children with TBI at risk of long-term unfavorable outcomes.

Objectives This study aims at exploring the 3-month outcome predicting ability of delayed neurological improvement and the cause of delayed neurological improvement. Materials and methods Early neurological improvement and delayed neurological improvement were calculated to represent the neurological improvements. Good functional outcome was defined as a 90-day modified Rankin Scale score 0–2. We used multivariant logistic regression to explore the influential factors of good functional outcome as well as delayed neurological improvement. We applied net reclassification improvement and integrated discrimination improvement to assess the quantitative improvement of the predictive model. Results Early neurological improvement was observed in 50 (23%) patients and delayed neurological improvement exhibited in 67 (30%) patients. Early neurological improvement and delayed neurological improvement were both independent predictive factors to good functional outcome. In the basic model (adjusted for age, admission glucose level, baseline National Institute of Health Stroke Scale, and complications and number of retrieval attempts), early neurological improvement and delayed neurological improvement statistically improved the predictive ability (early neurological improvement: net reclassification improvement = 0.34, 95% confidence interval, 95% confidential interval (0.06, 0.69); integrated discrimination improvement = 0.05, p Conclusions Delayed neurological improvement could predict clinical outcomes more accurately than early neurological improvement. Hypertension, early neurological improvement, numbers of retrieval attempts, and complications were all predicting factors to delayed neurological improvement.

In RCTs with an interest in a long-term efficacy endpoint, the follow-up time necessary to observe the endpoint may be substantial. In order to reduce the expected duration of such trials, early-outcome data may be collected to enrich an interim analysis aimed at stopping the trial early for efficacy. We propose to extend such a design with an additional interim analysis using solely early-outcome data in order to expedite the evaluation of treatment's efficacy. We evaluate the potential gain in operating characteristics (power, expected trial duration, and expected sample size) when introducing such an early interim analysis, in function of the properties of the early outcome as a surrogate for the long-term endpoint. In the context of a longitudinal age-related macular degeneration (ARMD) ophthalmology trial, results show potentially substantial gains in both the expected trial duration and the expected sample size. A prerequisite, though, is that the treatment effect on the early outcome has to be strongly correlated with the treatment effect on the long-term endpoint, that is, that the early outcome is a validated surrogate for the long-term endpoint.

Objective: Adherence is a multifactorial phenomenon. Medication-related factors have long been the focus of attention. However, the results are inconsistent. Methods: In a cross-sectional questionnaire-based study of outpatients, we assessed 180 patients suffering from chronic conditions. The objective of this study is to determine the impact of medication regimen complexity on adherence to long-term drug therapies. Results: 91.66% of patients receiving more than four drugs had good or high adherence. 80.94% of patients on thrice a day (or more) drug administration had good or high adherence. 91.66% of patients receiving drug therapy for more than 5 years had good or high adherence. In all other groups, the adherence was low. The adherence was significantly (p

With the increasing use of HbA1c as a diagnostic marker, more values at the lower end of the reference range can be observed. As more emphasis has been on decreasing and controlling a rising value of glycated haemoglobin, it is currently uncertain how to interpret low HbA1c values. Various conditions not related to diabetes, but with a fairly common occurrence, influence HbA1c. Alternative indices may have to be used for assessing glycemic control in these cases. It is important that such influencing factors are looked into when evaluating an inappropriately or expectantly low HbA1c value. HbA1c is a biomarker that might have utility beyond just diabetes mellitus. Its role needs to be re-examined as it is a test which is widely available, less amenable to short term physiological variations, and can be easily studied. All that is required is a different perspective or approach to its utility.

DAIR (debridement, antibiotics, and implant retention), one-stage and two-stage revision surgery are the most common management strategies for prosthetic joint infection (PJI) management. Our knowledge concerning their efficacy is based on short to medium-term low-quality studies. Most studies report infection recurrence rates or infection-free time intervals. However, long-term survival rates of the infection-free joints, functional and quality of life outcome data are of paramount importance. DAIR, one-stage and two-stage revision strategies are not unique surgical techniques, presenting several variables. Infection control rates for the above strategies vary from 75% to 90%, but comparisons are difficult because different indications and patient selection criteria are used in each strategy. Recent outcome data show that DAIR and one-stage revision in selected patients (based on host, bacteriological, soft tissue and type of infection criteria) may present improved functional and quality of life outcomes and reduced costs for health systems as compared to those of two-stage revision. It is expected that health system administrators and providers will apply pressure on surgeons and departments towards the wider use of DAIR and one-stage revision strategies. It is the orthopaedic surgeon’s responsibility to conduct quality studies in order to fully clarify the indications and outcomes of the different revision strategies. Cite this article: EFORT Open Rev 2021;6:727-734. DOI: 10.1302/2058-5241.6.210008

Telemedicine is healing at a distance, and it was under-utilized ever since its reintroduction till this COVID-19 pandemic. COVID-19 has moved the field of telemedicine and almost every health specialty has embraced it to provide remote, timely, safe health-care services to their patients from the comfort of their home and prevent undesired exposure to COVID-19 infection. With the reach of smart phones and cheaper internet data, this has reached tier II/III cities and is also making inroads in the rural areas. Telemedicine in hematology is becoming increasingly popular because many of the hematology patients are immunocompromised and are more prone to various infections including COVID-19. It is very beneficial in follow-up visits for benign disorders such as anemia, immune thrombocytopenia as well as certain chronic leukemias such as Myeloproliferative neoplasms and for the patients on oral therapy. Astronaut getting treated on NASA mission from the earth is ultimate telemedicine. COVID-19 pandemic has reinvented telemedicine which is helping not only patients in getting medical advice but also physicians and medical students in attending medical conferences and keep them up to date with advances in their field. After this pandemic end, telemedicine is here to stay along with the age-old personal visit like a hand in gloves.

The changing epidemiology of early-onset neonatal sepsis among term infants has required reappraisal of approaches to management of newborn infants at potential risk. As this is now a rare disease, new strategies for reduction in diagnostic testing and empirical treatment have been developed. Adoption and refinement of these strategies should be a priority for all facilities where babies are born.

Introduction Pediatric cancer contributes Objective The aim of this study was to identify the risk factors responsible for poor outcome in critically ill children with malignancies admitted in PICU. Materials and Methods Sixty-four children with a primary diagnosis of malignancy admitted in PICU with disease or treatment related complications were enrolled retrospectively. The short-term outcome, that is, shifting from PICU to ward, was assessed in relation to the presence of febrile neutropenia, organ failure, hepatitis, acute renal failure as well as requirement of inotropes and mechanical ventilation. Death was considered as an adverse outcome in this study. Results The mean age of study population was 6.25 ± 3.91 and M:F ratio 2.4:1. The majority of children had hematological malignancies (81.25%), that is, pre-B acute lymphoblastic leukemia (ALL) (45.3%), non-Hodgkin lymphoma (21.3%), acute myeloid leukemia (12.5%), T ALL (10.9%), and Hodgkin lymphoma (3.1%). Few children also had retinoblastoma (4.7%) and Langerhans cell histiocytosis (1.6%). The mean duration of PICU stay was 3.16 ± 2.31 days. Sepsis (37.5%) was the most common indication for PICU admission, followed by metabolic disturbance (26.6%), respiratory failure (17.2%), neurological complaints (15.6%), and anaphylactic shock (3.1%). Children requiring mechanical ventilation (p < 0.001), inotrope support (p < 0.001), having acute renal failure (p = 0.001), and >1 organ failure (p < 0.001) were associated with adverse outcome. The overall survival at the time of discharge from PICU was 64%. Conclusion In the context of low- and middle-income countries, optimal resource utilization by early identification of risk factors for clinical deterioration is required to allow timely admission to PICU and delivery of life-saving therapy to salvageable patients.

Term newborn infants without significant medical problems usually transition from fetal to newborn life without medical assistance. Infants requiring therapy often need care in a neonatal intensive care unit as opposed to a well-baby unit. Infants with unclear physiologic status or disease that may require therapies in the immediate newborn period may benefit from a period of observation with close monitoring before admission to a well-baby unit. Whenever possible, providing care for a newborn infant in an area that provides care for the newborn and mother together in the same room facilitates adaptation to normal breastfeeding and family bonding.

The care of late preterm and term newborns delivered in hospital settings in the United States is largely standardized with many routine interventions and screenings that are evidence-based and serve to protect newborn's and the public's health. Refusals of various aspects of routine newborn care are uncommon but can be challenging for clinicians who care for newborns to navigate for many reasons. In this article, we describe the spectrum of refusal. We review suggested approaches that clinicians can take starting with increasing their own awareness of what specific components of newborn care are refused and why.

This article attempts to highlight contemporary issues relating to term neonatal hyperbilirubinemia and to focus attention on controversial issues and concepts with the potential to effect change in clinical approach. On the one hand, the focus is bilirubin neurotoxicity, which is now known to encompass a wide, diverse spectrum of features. The various aspects of this spectrum are outlined and defined. On the other hand, bilirubin also possesses antioxidant properties. As such, mild hyperbilirubinemia is suggested as actually offering the neonate some protective advantage.

PURPOSE: To understand how patients and providers weigh the risks and benefits of long-term opioid therapy (LTOT) for cancer pain. METHODS: Researchers used VA approved audio-recording devices to record interviews. ATLAS t.i., a qualitative analysis software, was used for analysis of transcribed interview data. Participants included 20 Veteran patients and 20 interdisciplinary providers from primary care– and oncology-based practice settings. We conducted semistructured interviews and analyzed transcripts used thematic qualitative methods. Interviews explored factors that affect decision making about appropriateness of LTOT for cancer related pain. We saturated themes for providers and patients separately. RESULTS: Factors affecting patient decision-making included influence from various information sources, persuasion from trusted providers, and sometimes deferral of the decision to their provider. Relative prioritization of pain management as the focal patient concern varied with some patients describing comparatively more fear of chemotherapy than opioid analgesics, comparatively more knowledge of opioids in relation to other drugs;patients expressed a preference to spend the limited time they have with their oncologist discussing cancer treatment rather than opioid use. Factors affecting provider decision making included prognosis, patient goals, patient characteristics, and provider experience and biases. Providers differed in how they weigh the relative importance of alleviating pain or avoiding opioids in the face of treating patients with cancer and histories of substance abuse. CONCLUSION: Divergent perspectives on factors need to be considered when weighing risks and benefits. Policies and interventions should be designed to reduce variation in practice to promote equal access to adequate pain management. Improved shared decision-making initiatives will take advantage of patient decision-making factors and priorities.

Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed classes of medications. The broad spectrum of side effects following long-term NSAID therapy includes mainly, but not only, gastrointestinal complications. Risk stratification of the gastrointestinal complications events is an important element of planning NSAIDs therapy, which allows to determine the indications for the use of proton pump inhibitors. This article presents the criteria for assessment and the method of adequate prevention of gastrointestinal side effects in patients receiving long-term NSAID therapy.

Background The Covid-19 pandemic has affected our lives for over a year and almost 500.000 people in Austria have been infected. Although many of them only had low or mild symptoms some had to be treated in the hospital. Even months after their infection some patients complain about fatigue, exercise intolerance and dyspnoea. The aim of this study was to perform a follow-up cardiopulmonary exercise test (CPET) on those patients, at 6 months after their hospitalization to find out if there are long-term cardio-pulmonary limitations (CPL) of Covid-19. We also wanted to check if there is any difference in outcome and CPL between patients who received oxygen therapy vs. without oxygen therapy. Methods 40 patients were included into this study (16 women = 40%; 24 men = 60%). All patients were hospitalized during their infection with Covid-19 (5 patients at ICU) and underwent CPET 6±2 month after discharge. 20 patients (50%) received oxygen therapy or ventilation during their hospitalization. CPET data were assessed at rest, during exercise and at recovery. Blood parameters including NT-pro BNP were collected and an interview and examination were performed. CPL was defined as VO2% of Predicted ≤84%, VE/CO2 Slope ≥34 and RER at peak of exercise ≥1.1. Results Median age of all patients was 46 years [interquartile range (IQR): 35.3–55.8], median BMI was 26.0 m2/kg [IQR: 23.0–29.0] and the median NTproBNP was 53.1 pg/mL [IQR: 24.0–95.6]. When comparing the two groups, we found higher percentage of CPL in patients who received oxygen therapy during their hospitalization (10% with oxygen vs. 5% without oxygen). Notably, the number of patients with a BMI ≥25 m2/kg was higher in the oxygen therapy group than in those without oxygen (80% vs. 45%). The median BMI without oxygen therapy was 24.0 [IQR: 20.3–26.8] vs. 29.0 [IQR: 25.0–31.0] with oxygen therapy (p=0.004). There were no significant differences in NT-proBNP levels (p=0.545). The median VO2% of predicted was 88.0% [72.5–98.0] without oxygen therapy vs. 84.5% [IQR: 70.8–91.8] with oxygen therapy (p=0.289), the median HR percentage of predicted was 92.5% [IQR: 85.5–97.8] without oxygen therapy vs. 94.5% [IQR: 88.3–103.5] with oxygen therapy (p=0.478), the median physical performance in watt in patients without oxygen therapy was 130.0 [IQR: 108.5–197.5] vs. 135.0 [IQR: 97.0–188.3] with oxygen therapy (p=0.820). Conclusion The findings of our study did not show any statistically significant difference in long-term CPL between patients who received oxygen therapy vs. those who didn't. Therefore, other causes of the exercise intolerance and dyspnoea have to be discussed multidisciplinary. Subclinical CPL in the absence of significant clinical symptoms represent a concern after a Covid-19 infection. Overall, 7.5% of our patients showed CPL although those patients didn't have any clinical symptoms. Therefore, CPET is a good method to discover asymptomatic patients with CPL. Funding Acknowledgement Type of funding sources: None.

Background Tremendous progress in acute stroke therapy has improved short-term outcome but part of this achievement may be lost in the long run. Concepts for a better long-term management of stroke survivors are needed to address their unmet needs and to reduce the burden of post-stroke complications, residual deficits, and recurrent vascular events. Aims This review summarizes current knowledge on post-hospital care and the scientific evidence supporting individual programs. Summary of review A systematic search of electronic databases according to PRISMA guidelines identified 10,374 articles, 77 of which met the inclusion criteria. One large randomised controlled trial on a multifaceted care program delivered by the multidisciplinary stroke team reduced recurrent vascular events and improved quality of life and functional outcome one year after the event, while a number of studies offer solutions for individual components of post-hospital disease management like patient education, counselling, and self-management or the management of post-stroke complications and residual deficits. A majority of studies, however, was small in size and limited by a short follow-up. Most initiatives with a narrow focus on risk factor control failed to lower the risk of recurrent events. The caregivers’ central role in post-stroke patient management is broadly neglected in research. Conclusions Over the past years, first knowledge on how to best organize post-hospital care of stroke patients has emerged. Comprehensive and pragmatic programs operated by the multidisciplinary stroke team hold promise to reduce the long-term health burden of stroke. There is a clear need for further high-quality studies with both clinical endpoints and patient-reported outcomes to establish sustainable solutions in different settings and regions to improve life after stroke, a key priority of the Stroke Action Plan for Europe 2018–2030.

Objective: The aim is to study the effect of various sociodemographic factors on patient compliance in long-term therapies. Methods: This is a questionnaire-based study of 195 adult outdoor patients suffering from chronic illnesses and receiving long-term drug therapy. Various sociodemographic factors were noted in a validated questionnaire. Questions about drugs being taken were asked. The compliance was measured by General Medication Adherence Scale. Results: The study population consists of 51.3% of males and 48.7% of females. About 39.0% of participants were literate and 61.0% were illiterate. About 72.3% belonged to the rural area, 13.3% urban, and 14.4% to the main city. About 33.3% were self-employed or unemployed, 17.4% government employees, and 49.3% were private employees. About 20.0% belonged to high-income group, and 40.0% to middle- and 40.0% to low-income group. Statistically significant correlation was found between compliance and age, gender, area of residence, education, and marital status (p

Background: The increasing prevalence of type 2 diabetes mellitus (T2D) and specialist shortage has caused a healthcare gap that can be bridged by a decision support system (DSS). We investigated whether a diabetes DSS can improve long- and/or short-term glycemic control. Methods: This is a retrospective observational cohort study of the Diabetiva program, which offered a patient-tailored DSS using Karlsburger Diabetes-Management System (KADIS) once a year. Glycemic control was analyzed at baseline and after 12 months in 452 individuals with T2D. Time in range (TIR; glucose 3.9-10 mmol/L) and Q-Score, a composite metric developed for analysis of continuous glucose profiles, were short-term and HbA1c long-term measures of glycemic control. Glucose variability (GV) was also measured. Results: At baseline, one-third of patients had good short- and long-term glycemic control. Q-Score identified insufficient short-term glycemic control in 17.9% of patients with HbA1c 7.5% and >8%, respectively. Application of DSS at baseline improved short- and long-term glycemic control, as shown by the reduced Q-Score, GV, and HbA1c after 12 months. Multiple regression demonstrated that the total effect on GV resulted from the single effects of all influential parameters. Conclusions: DSS can improve short- and long-term glycemic control in individuals with T2D without increasing hypoglycemia. The Q-Score allows identification of individuals with insufficient glycemic control. An effective strategy for therapy optimization could be the selection of individuals with T2D most at need using the Q-Score, followed by offering patient-tailored DSS.

Aim. To study the role and degree of influence of various clinical factors on osseointegration and the success of direct and delayed dental implantation using implant systems with different surface microstructure. Material and methods. Implant systems with different surface microstructures were used for the clinical study: Alfa Bio, Mis, Astra Tech, Dentium, Osstem, Antogher and Humana Dental. The study included 414 patients aged 20 to 70 years. All patients involved in the study were divided into two groups. The first group consisted of 109 patients who, after extraction, underwent direct implantation into the socket of the extracted tooth, followed by immediate loading. The second group, out of 305 patients, underwent delayed implantation. A total of 1302 implants were installed. Before the start of surgery, all patients underwent a thorough clinical and laboratory, X-ray and functional examination, as well as computed tomography. Dynamic observation was carried out on the basis of clinical, radiological and functional methods. In the course of treatment, starting from the moment of implantation at different times, the devices "Periotest" and "Osstel Mentor" were used to determine the stability of the implants and the dynamics of the quality of the osseointegration process. Results. The study found that implants placed in the lower jaw had higher success rates than implants placed in the upper jaw. There was no direct relationship between the length and diameter of implants and their survival rate. However, implants with a longer length and diameter are the best option for increasing primary stability. The analysis of implantation methods showed no statistically significant difference between the percentage of implant survival during immediate and delayed implantation. The highest percentage of implantation failures was noted with simultaneous implantation and sinus lifting, as well as with a horizontal increase in bone tissue volume. Conclusions. The findings of the study demonstrated that the long-term success of dental implantation depends on a combination of many factors, including bone volume and quality, shape, geometry, implant design, and surface microstructure.

not available Bangladesh Heart Journal 2020; 35(2) : 147-154

PURPOSE: Art therapy (AT) improves quality of life and symptoms in patients with cancer. However, previous studies that have demonstrated these effects focused on time-limited interventions. The benefits of longer-term AT interventions for patients with cancer remain unexplored. We aimed to delineate the benefits of one such intervention for patients with cancer. METHODS: The Art for Recovery open art studio (OAS) is a weekly experience that provides patients the opportunity to express themselves through art and discussion. In April 2019, we sent a cross-sectional survey with closed- and open-ended components to all patients attending the OAS. We analyzed the closed-ended results using descriptive statistics and the open-ended results using directed content analysis through the theoretical framework of community-based development (CBD). RESULTS: The response rate was 82% (18 of 22 patients). The median duration of OAS attendance was 2 years, and the median frequency of attendance was three times per month. All respondents found the OAS very helpful, and 17 (94%) of 18 believed that the friendships they had made were very valuable. Directed content analysis revealed three themes: togetherness, active engagement, and familiar surroundings. These themes and our closed-ended results aligned well with the CBD framework. CONCLUSION: Longer-term AT experiences may provide benefits, such as community development, that briefer interventions lack. Medical centers should consider providing longer-term AT experiences for patients with cancer to give them access to these benefits.

Background: Caregivers are essential for improved outcomes in patients living with left ventricular assist device (LVAD). There is a paucity of research on a long-term LVAD caregivers' experiences and burdens. Objectives: The aim of this study was to explore long-term challenges and needs of LVAD caregivers in the Asian health care setting. Design: We conducted semistructured interviews with caregivers of patients who were currently or previously living with the LVAD. Settings/Subjects: Caregivers were recruited from the National Heart Centre Singapore. Measurements: Interviews were conducted in English and Chinese. All interviews were transcribed verbatim and analyzed based on grounded theory. Chinese interviews were translated to English before transcription. Results: A multiethnic and multireligious sample of 11 caregivers participated. Median caregiving duration was 45 months. Caregivers described long-term challenges that were multifaceted. Misaligned patient expectations, stigmatization and limited social resources within the family and society affected caregivers' coping. Existing gender roles and spiritual and cultural influences shaped how caregivers appraised, made meaning of caregiving, and assessed support. Long-term caregivers' needs included learning from role models, shifting perspectives, enhancing communication between patient and caregivers, advocacy efforts, and holistic medical care. Conclusions: Gender roles as well as cultural and spiritual influences affected coping and access to support in long-term Asian LVAD caregivers. Future interventions should consider culturally relevant approaches to improve well-being and quality of life of caregivers.

Introduction: According to the literature, Central Retinal Arteriolar Equivalent (CRAE), Central Retinal Venular Equivalent (CRVE), and Artemio Venule Ratio (AVR) are three important markers in determining the changes of retinal artery. These markers are employed as an indicator of cardiovascular effects in workers. This study aimed to evaluate the changes in retinal micro vascular responses in workers exposed to short-term exposure to particulate matters caused by occupational processes using CRAE, CRVE, and AVR markers. Materials and Methods: In this study, 96 workers exposed to job-related pollution in a tile and ceramic company were investigated. Fundus photos of these people were analyzed via ARIA software using the related protocols. The data were investigated employing Kolmogorov–Smirnov and Mann-Whitney tests as well as the correlation and regression tests. Results: No significant difference was observed in the ocular parameters of smokers and non-smokers. Cardiovascular parameters had no significant correlation with CRAE and CRVE as well as breathable and inhalable dust; however, these parameters had a direct and significant correlation with AVR, PM10, and PM2.5 particles. Conclusion: The results did not show any changes in the retinal artery in workers who were exposed to job-related pollution. Moreover, no significant relationship was found between retinal artery changes and cardiovascular parameters. However, more large-scale studies are needed to clarify the relationship of particulate air pollutants with CRAE, CRVE, and AVR changes.

Life after recovery from SARS, influenza, and Middle East respiratory syndrome: An insight into possible long-term consequences of COVID-19

Background/Aim. The evaluation of blood levels of cardiac troponin I (cTnI), D-dimer, B-type natriuretic peptide (BNP), and C-reactive protein (CRP) on admission and during the treatment of pulmonary embolism (PE) are the part of routine diagnostic process and estimation of mortality risk. The aim of this study was to evaluate the predictive value of these biomarkers on admission for all-cause 30-day mortality in consecutive PE patients regarding whether they classified as spontaneous, transiently provoked, or permanently provoked PE. Methods. This retrospective analysis was gained from the data of 590 PE patients from the Serbian University Multicenter Pulmonary Embolism Registry (SUPER). Patients had at least one of these biomarkers (BNP, CRP, cTnI, and D-dimer) measured during the first 24 hours upon admission. Results. Receiver operating characteristic (ROC) curve analyses demonstrated that BNP had the highest prognostic accuracy for 30-day mortality in patients (n = 219) who had data for all examined biomarkers. BNP provided an AUC of 0.785 (p < 0.001). Separately, BNP had the highest c-statistic for all three groups of patients. CRP had a modest predictive value for the 30-day all-cause mortality in the group with transient provoked PE. Troponin I had a very modest predictive value for the 30-day all-cause mortality only in patients with spontaneous PE, and D-dimer was a very weak predictor of this end-point only in patients with persistent provoked PE. Conclusion. Patients with spontaneous, transient provoked, and persistent provoked PE have a significantly different pro-file of blood biomarkers level with different prognostic significance for early all-cause mortality.

The aim of the study is to investigate the influence exerted by short-term outpatient pulmonary rehabilitation on functional indices and the course of the perioperative period for patients with lung cancer against the background of COPD Material and methods. According to the study design, lung cancer patients with planned surgical treatment were distributed between groups according to the COPD severity (stages II-IV). At the outpatient stage, evaluation of the pulmonary function and 6-minute walk test were performed. The results of the test and the functional indices were registered with further establishment of the pulmonary rehabilitation procedure complex for the patient. The exercises were performed at home and designed for the duration of two weeks. The complex included cycles of breathing, strength and aerobic exercises with individually adjusted intensity depending on the severity of clinical COPD manifestations and the baseline physical status. Upon completion of the training course, the patients underwent repeated spirometry and the 6-minute walk test. The results obtained were registered and analysed with subsequent surgical treatment of the patients. Results. Minimal changes in functional indices upon completion of the course were registered in patients with COPD stage II, which prevented achievement of statistical significance. Therewith, patients with COPD stages III and IV who had undergone the course of exercises were noted to show statistically reliable improvement of pulmonary function (FEV1) and improvement of the overall physical status, which is testified to by enhanced tolerance to externally imposed physical loads (p