Search

Objective: To describe the restructuring if in-hospital systems of care at a Level -1 trauma center in India and to analyze volume and patterns of injury for future preparedness as well as to institute preventive measures for specific injuries during health emergencies like COVID-19.Methods: The data were extracted from a prospectively managed trauma registry at level-1 trauma center in India. We compared data of lockdown period with data of the same number of days from the pre-lockdown period. Patients were grouped according to age, gender, cause of injury, place of injury, injury severity, and injury outcome for comparative analysis between two periods.Results: Total emergency department (ED) footfall due to trauma decreased significantly by 73% during lockdown period. Injuries resulting due to blunt forces, increased significantly. There was a significant decrease in the percentage of patients having major injury. The road traffic injuries (RTIs) cases were less, but number of falls reported increased significantly during lockdown. Significantly less number of patients presented without receiving primary care. Majority of the patients were transported using private cars, police vehicle, and two wheelers during lockdown, however, as expected significantly less number of patients were transported by three wheelers. The comparative analysis between quantitative data points shows significant difference in median ISS and length of stay during lockdown. Conclusion: This study highlighted that the preparedness during health emergencies should not focus solely on the response to treatment of infectious disease but also on ensuring access and provision of reasonable quality of care for non-infectious illnesses, especially acute conditions like trauma.

Background. About 35% of the global child deaths and 11% of the total disease burden are due to inadequate nutrition. While in India, 1 in 3 children are underweight and stunted, and 1 in 5 children are wasted. Methods. Using multivariate and descriptive statistical analysis, we examined the prevalence, determinants of minimum diet diversity failure (MDDF) and trends of MDDF across different regions of India among children aged 6-23 months. Dietary pattern in 8 food groups was also examined using the National Family and Health Survey (NFHS) data from 2005-06 to 2019-21. Results. Overall, MDDF in India has decreased from 87.4% (2005-06) to 77.1% (2019-21). The central region (84.6%) reported the highest prevalence of MDDF in 2019-21. Children of illiterate and rural residing mothers with no mass media exposure, children of the first birth order and children not exposed to counselling and health check-ups at Anganwadi/Integrated Child Development Services (ICDS) centres, children with low birth weight and anaemic, and who belonged to a large family had greater likelihood for MDDF. Conclusion. To tackle the high prevalence of MDDF, a holistic action is needed from the government, i.e. improved public distribution system (PDS), intensified Integrated Child Development Scheme (ICDS) programme, use of social media, and nutrition counselling through local self-governance. [ABSTRACT FROM AUTHOR]

Abstract Aberrancies in the tumor microvasculature limit the systemic delivery of anticancer agents, which impedes tumor response. Using human intravital microscopy (HIVM), we hypothesized that HIVM would be feasible in patients with peritoneal carcinomatosis (PC). During cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for PC, HIVM was performed in both tumor and non-tumor areas. The primary outcome was HIVM feasibility to measure vessel characteristics. We secondarily evaluated associations between HIVM vessel characteristics and oncologic outcomes (RECIST response to neoadjuvant therapy and disease-specific survival). Thirty patients with PC were enrolled. Nineteen patients (63.3%) received neoadjuvant therapy. HIVM was feasible in all patients. Compared to non-tumor (control) areas, PC areas had a lower density of functional vessels, higher proportion of non-functional vessels, smaller lumenal diameters, and lower blood flow velocity. Qualitative differences in these vessel characteristics were observed among patients who had partial response, stable disease, or progressive disease after receiving neoadjuvant therapy. However, no statistically significant relationships were found between HIVM vessel characteristics and oncologic outcomes. These novel findings comprise the first-in-human, real-time evidence of the microscopic differences between normal and tumor-associated vessels and form the basis for our larger, ongoing clinical trial appropriately powered to determine the clinical utility of HIVM (NCT03823144).

Inferior vena cava (IVC) injuries account for about 25%–40% of abdominal vascular injuries. Blunt vena cava injury has a lower survival rate than penetrating injury. They may present with torrential bleed. In extreme cases, ligation of the IVC may have to be done as a damage control procedure. However, it is associated with significant morbidity and mortality, especially when the suprarenal IVC is ligated. It can lead to acute kidney injury and lower limb compartment syndrome. Suprarenal IVC ligation has been done in oncological resections, as it is a chronic disease that allows collateral vessel formation. However, there is a paucity of data on the ligation of the suprarenal IVC in acute trauma. We present a case of penetrating injury to the IVC which was managed initially by suprarenal IVC ligation, followed by synthetic interposition graft placement once the patient stabilized hemodynamically. The case highlights that this approach can be viable as a damage control procedure in exsanguinating patients.

Apolipoprotein (APOE) is implicated and verified as the main risk factor for early-onset Alzheimer's disease (AD). APOE is a protein that binds to lipids and is involved in cholesterol stability. Our paper reports a case of a sporadic early-onset AD (sEOAD) patient of a 54-year-old Korean man, where a novel APOE Leu159Pro heterozygous mutation was revealed upon Whole Exome Sequence analysis. The proband's CSF showed downregulated levels of Aβ42, with unchanged Tau levels. The mutation is in the Low-Density Lipoprotein Receptor (LDLR) region of the APOE gene, which mediates the clearance of APOE lipoproteins. LDLR works as a high-affinity point for APOE. Studies suggest that APOE-LDLR interplay could have varying effects. The LDLR receptor pathway has been previously suggested as a therapeutic target to treat tauopathy. However, the APOE-LDLR interaction has also shown a significant correlation with memory retention. Leu159Pro could be an interesting mutation that could be responsible for a less damaging pattern of AD by suppressing tau-association neurodegeneration while affecting the patient's memory retention and cognitive performance.

Resumen: Antecedentes y objetivo: La ecografía pulmonar (EP) ofrece ventajas respecto a la radiografía de tórax (RT) para diagnosticar la neumonía, pero su uso no está extendido en los servicios de urgencias. El objetivo fue evaluar la utilidad y la aceptación de la EP para diagnosticar neumonía en la infancia. Pacientes: Estudio prospectivo unicéntrico, incluyendo pacientes pediátricos (0-18 años) visitados en urgencias por sospecha de neumonía. Un pediatra realizó la EP y otro diagnosticó al paciente según clínica y RT. Posteriormente, un radiólogo informó las RT. Se evaluaron la eficacia de la EP y la RT para diagnosticar neumonía considerando como estándar de referencia el diagnóstico al alta y se midió el tiempo consumido por ambas técnicas. Se evaluó la aceptación de la EP mediante un cuestionario a pediatras de urgencias. Resultados: Se incluyeron 36 pacientes, con una mediana de edad de 3 años. Se diagnosticó neumonía en 17 pacientes (47%). La EP obtuvo un AUC del 0,91 (IC 95% 0,77-0,98) (Se 82,4%, Sp 100%, VPP 100%, VPN 86,4%), la RT un AUC de 0,88 (IC 95% 0,73-0,97) (Se 76,5%, Sp 100%, VPP 100%, VPN 86,6%). La duración media de la EP fue inferior (9 ± 3,5 min) en comparación con la RT (25 ± 9,2 min), p

Abstract Background Rehabilitation pathways are crucial to reduce stroke-related disability. Motivational Interviewing (MI), as a person-centered complex intervention, aimed to empower and motivate, and could be a resource to improve rehabilitation outcomes for older stroke survivors. The IMAGINE project aims to assess the impact of MI, as a complement to standard geriatric rehabilitation, on functional improvement at 30 days after admission, compared to standard geriatric rehabilitation alone, in persons admitted to geriatric rehabilitation after a stroke. Secondary objectives include assessing the impact of MI on physical activity and performance, self-efficacy, safety, cost-utility, participants’ experiences and functional status at 3 months. Methods We will conduct a multicenter randomized clinical trial in three geriatric rehabilitation hospitals in Spain. Older adults after mild-moderate stroke without previous severe cognitive impairment or disability will be randomized into the control or intervention group (136 per group, total N = 272). The intervention group will receive 4 sessions of MI by trained nurses, including the design of a personalized rehabilitation plan agreed between stroke survivors and nurses based on stroke survivors´ goals, needs, preferences and capabilities. Main outcome will be the Functional Independence Measure (FIM). In-hospital physical activity will be measured through accelerometers and secondary outcomes using validated scales. The study includes a process evaluation and cost-utility analysis. Discussion Final results are expected by end of 2020. This study will provide relevant information on the implementation of MI as a rehabilitation reinforcement tool in older stroke survivors. A potential reduction in post-stroke disability and dependence would increase person’s health-related quality of life and well-being and reduce health and social care costs. IMAGINE has the potential to inform practice and policymakers on how to move forward towards shared decision-making and shared responsibilities in the vulnerable population of older stroke survivors. Trial registration ClinicalTrials.gov: NCT03434938 , registered on January 2018.

Abstract Background Adductor canal block (ACB) is one of the preferred methods of analgesia in total knee arthroplasty (TKA). However, conventionally its use is time-consuming, requires ultrasound guidance, a trained anaesthesia team and adherence to strict asepsis by members of the allied teams. This study was done to assess the feasibility and safety of direct adductor canal block (DACB) as a part of surgeon-administered periarticular infiltration. Materials and methods Thirty computed tomography (CT) angiography films of the patients were retrospectively reviewed. The trajectory of the needle placement for a DACB in relation to the target region of the adductor block was determined. Fourteen knees in seven cadavers, were dissected through a medial parapatellar approach to perform TKA. After administering the DACB using the technique based on CT data, dissection was carried out to ascertain the correct placement of the dye by visualising the stained areas. Results The angle of approach in the coronal plane from the entry point to the medial high point and to the adductor hiatus was 10.2° (8−14°) and 6° (3.8−11°), respectively. The angle of approach in the sagittal plane from the entry point to the medial high point and to the adductor hiatus was 7° (5−10.5°) and 29° (19−43°), respectively. In all the 14 cadaveric knees, we confirmed the correct placement of the methylene blue dye as demonstrated by the staining of the adductor canal. Conclusion The study demonstrates the feasibility of the DACB. This surgeon-driven technique is likely to reduce the cost of the procedure, reduce operating room time and also eliminate the risks of surgical-site contamination.

Alpine ecosystems are sensitive and vulnerable to climate change. In this study, we extracted three phonological parameters, viz. the start of the growing season (SOS), the end of the growing season (EOS), and the length of the growing season (LOS) from the moderate resolution imaging spectroradiometer (MODIS) normalized difference vegetation index (NDVI) dataset during 2000–2019 for alpine grasslands across the three parallel rivers region (TPRR), and also examined the spatiotemporal heterogeneity of the three phenological parameters in seasonally frozen ground regions (hereafter referred to as SFGR) in response to climate change. The results showed that the multiyear mean SOS gradually delayed from 100 to 160 days along higher elevation, EOS advanced as a whole (from 320 to 280 days), and LOS shortened (from 210 to 130 days). The multiyear mean spatial distribution of all the three parameters showed significant north-to-south differences in the TPRR. In general, the variation trends in all the phenological parameters were not significant (p > 0.05) in the past 20 years, where SOS was advanced by 0.16 days year−l, EOS delayed by 0.08 days year−l, and consequently LOS extended at a rate of 0.07 days year−l, likely due to the warming and drying climate during the study period. In addition, annual mean temperature (AMT) was negatively correlated with SOS (50.26%) and positively correlated with EOS and LOS (72.25 and 60%, respectively). As for the annual mean total precipitation (AMP), it was positively correlated with SOS and EOS (50.77 and 52.97%, respectively) and negatively correlated with LOS (52.07%). Furthermore, a higher freezing index led to a delayed SOS and an advanced EOS and a shortened LOS at the regional scale. Similar to AMT, a higher thawing index advanced the SOS, delayed the EOS, and extended the LOS. Our results confirmed the importance of climate and permafrost status on vegetation phenological processes and also contributed toward understanding the response of cold region ecosystems to global climate change.