Background The connection between initial viral cycle threshold (Ct) values of the SARS-CoV-2 with symptoms and hospital course is not clearly studied. Methods This is a retrospective study of ...hospitalized COVID-19 patients from Jun 1st 2020 to March 30th, 2021 examining the relationship between initial viral cycle threshold (Ct) values of SARS-CoV-2 as obtained from nasopharyngeal samples. The clinical presentations and outcomes were analyzed in relation to the initial Ct values. Results The study included 202 hospitalized COVID-19 patients with a mean age (+ or - SD) of 54.75 (+ or - 15.93) and 123 (60.9%) males and 79 (39.1%) females. Of all the patients, the most frequent comorbidity was diabetes mellitus (95; 47%) and the most frequent symptoms were fever (148; 73.3%) and cough (141; 69.8%). There was no significant difference in relation to underlying conditions, clinical presentation, radiographic and laboratory data among those with low, medium and high Ct values. The mean Ct values showed no statistical change over the 10-month study period. Conclusions Initial SARS-CoV-2 Ct values did not show any association with clinical symptoms and did not predict the need for mechanical intubation or death. Keywords: SARS-CoV-2, Cycle threshold, Coronavirus disease 2019, COVID-19, Viral load
The 2019 novel corona virus and the disease it causes (COVID-19) is a public health crisis that has profoundly modified the way medical and surgical care is delivered. Countries around the globe had ...a variable initial response to the COVID-19 pandemic from imposing massive lock downs and quarantine to surrendering to herd immunity. However, healthcare bodies worldwide recognized early on that a triumph against COVID-19 could only be achieved by maintaining the infrastructure of healthcare systems and their capacity to accommodate a potentially overwhelming increase in critical patient care needs. Therefore, they reacted by restricting medical care to emergency cases and postponing elective surgical procedures in all disciplines. The priority was made for treatment of COVID-19 patients and emergency cases. Nevertheless, the battle against the COVID-19 pandemic is still ongoing. In the absence of vaccines or effective drug treatments, its timeline remains uncertain and it cannot be forecast how long healthcare systems will need to cope with it in managing inpatient and outpatient services. Accordingly, extreme measures and restriction may become a recipe for a disaster in the context of the potential adverse health implications imposed by delaying timely medical and surgical care. Therefore, restrictive measures should be substituted with a comprehensive surgical and medical care strategy. One that provides a safe balance between the prevention of COVID-19 and the delivery of essential surgical care. This article provides an overview on how to safely deliver essential surgical care in the time of COIVD-19.
This study aimed to determine the percentage infestation and population parameters of the green peach aphid Myzus persicae under laboratory conditions and evaluate the effect of aqueous extracts of ...three different plants (pot marigold: Calendula officinalis, mint: Mentha viridis and rosemary: Salvia rosmarinus) on the mortality of this aphid. Extracts of these plants were used at three concentrations (C1 = 15%, C2 = 30% and C2 = 45%). Results indicate a percentage infestation of 76.9 ± 9.4%, a mean relative growth rate of 0.062 ± 0.007 and generation time of 11.12 ± 1.42 days. All treatments reduced the numbers of aphids and statistically significantly reduced the number (α < 0.01) recorded after treatment with C1, C2 and C3 of each extract. C. officinalis extract was more effective than those of M. viridis and S. rosmarinus. The highest mortality (69.82 ± 5.23%) and efficacy (61.71 ± 4.46%) were recorded for the C3 of aqueous extract of C. officinalis, whereas the lowest mortality (38.24 ± 2.42%) and efficacy (32.41 ± 1.23%) were recorded for the C1 of extract of M. viridis. The data provided indicate that aqueous extracts of C. officinalis, M. viridis and S. rosmarinus have an insecticidal effect on M. persicae and can be integrated into a pest management strategy to reduce M. persicae abundance on pepper plants.
Abstract Purpose The commonly cited ages at presentation of many pediatric conditions have been based largely on single center or outdated epidemiologic evidence. Thus, we sought to examine the ages ...at presentation of common pediatric surgical conditions using cases from large national databases. Methods A retrospective analysis was performed on Healthcare Cost and Utilization Project databases from 1988 to 2009. Pediatric discharges were selected using matched ICD9 diagnosis and procedure codes for malrotation, intussusception, hypertrophic pyloric stenosis (HPS), incarcerated inguinal hernia (IH), and Hirschsprung disease (HD). Descriptive statistics were computed. Results A total of 63,750 discharges were identified, comprising 2744 cases of malrotation, 5831 of intussusception, 36,499 of HPS, 8564 of IH, and 10,112 of HD. About 58.2% of malrotation cases presented before age 1. Moreover, 92.8% of HPS presented between 3 and 10 weeks. For intussusception, 50.3% and 91.4% presented prior to ages 1 and 4 years, respectively. Also, 55.8% of IHD cases presented before their first birthday. For HD, 6.5% of cases presented within the neonatal period and 45.9% prior to age 1 year. Conclusion Our findings support generally cited presenting ages for HPS and intussusception. However, the ages at presentation for HD, malrotation, and IH differ from commonly cited texts.
Abstract Background For a number of pediatric and adult conditions, morbidity and mortality are increased when patients present to the hospital on a weekend compared to weekdays. The objective of ...this study was to compare pediatric surgical outcomes following weekend versus weekday procedures. Methods Using the Nationwide Inpatient Sample and the Kids’ Inpatient Database, we identified 439,457 pediatric (< 18 years old) admissions from 1988 to 2010 that required a selected index surgical procedure (abscess drainage, appendectomy, inguinal hernia repair, open fracture reduction with internal fixation, or placement/revision of ventricular shunt) on the same day of admission. Outcome metrics were compared using logistic regression models that adjusted for patient and hospital characteristics as well as procedure performed. Results Patient characteristics of those admitted on the weekend (n = 112,064) and weekday (n = 327,393) were similar, though patients admitted on the weekend were more likely to be coded as emergent (61% versus 53%). After multivariate adjustment and regression, patients undergoing a weekend procedure were more likely to die (OR 1.63, 95% CI 1.21–2.20), receive a blood transfusion despite similar rates of intraoperative hemorrhage (OR 1.15, 95% CI 1.01–1.26), and suffer from procedural complications (OR 1.40, 95% CI 1.14–1.74). Conclusion Pediatric patients undergoing common urgent surgical procedures during a weekend admission have a higher adjusted risk of death, blood transfusion, and procedural complications. While the exact etiology of these findings is not clear, the timing of surgical procedures should be considered in the context of systems-based deficiencies that may be detrimental to pediatric surgical care.
Background
The humanized monoclonal antibody galcanezumab is an anti-calcitonin-gene-related-peptide (CGRP) and frequently used for migraine prevention. However, the literature revealed limited data ...with conflicting results. This study aims to assess the safety and efficacy of galcanezumab in treating patients with episodic or chronic migraine.
Methods
We searched for randomized controlled trials till September 2022 from six databases (Cochrane library, Embase, PubMed, Web of Science, Scopus, and Clinicaltrials.gov registry). Our primary outcomes were the change in the number of monthly migraine headache days (MHDs) and adverse events. We extracted the data and analyzed it by RevMan (5.4) software.
Results
Eight studies with 4964 patients were included. Galcanezumab (≥ 120 mg) significantly reduced the MHDs for six months in migraine patients compared to placebo. The monthly risk ratio (RR) ranged from − 2.33 to − 1.62 for episodic migraine and − 2.86 to − 2.44 for chronic migraine. The response rate of ≥ 50%, ≥ 75% and 100% were higher with galcanezumab groups. The rate ranged from 1.72 to 4.19 for episodic migraine and 1.84 to 2.47 for chronic migraine. It is generally safe except for injection site safety outcomes (erythema, reaction, pruritis, and swelling), the results were significantly higher with galcanezumab groups. It appears dose independent except for injection site reaction, which showed higher with galcanezumab 120 mg only. Furthermore, any adverse events, serious adverse events (SAE) and that led to discontinuation were higher with galcanezumab 240 mg.
Conclusion
Galcanezumab is effective in patients with episodic or chronic migraine after one to six months use. It reduced MHDs and had an effective response rate. Moreover, it is generally safe except for injection site adverse events, and SAE, especially with galcanezumab 240mg.
Background There is an ongoing debate among pediatric surgeons regarding the need or lack thereof to centralize the surgical care of children to high-volume children's centers. Risk-adjusted ...comparisons of hospitals performing pediatric surgery are needed. Methods Admissions from 2006 to 2010 from two national administrative databases were analyzed. Only nontrauma pediatric patients undergoing a noncardiac surgical procedure were included. Risk-adjustment was performed with a validated International Classification of Diseases , 9th Revision code-based tool. Hospitals were grouped into metropolitan regions using the first three digits of their zip code. Poorly performing outlier hospitals were defined by an odds ratio >1 and P value <.05 for mortality compared with the center with the greatest pediatric operative volume in that same region. Results Information was obtained from 415,546 pediatric surgical admissions, and 173 hospitals in 55 regions were compared. A total of 18 poor performing hospitals (adjusted odds ratio, range 1.91–35.95) in 15 regions were identified. Mortality in poor performers ranged from 1.11% to 10.19% whereas that in the high-volume reference centers was 0.37–2.41%. A subset analysis in patients <1 year of age showed 37 poor performers in 46 regions. Median number of surgical admissions was 345 (interquartile range 152–907) for nonoutlier and 240 (interquartile range 135–566) for outlier centers ( P = .30). Conclusion The present analysis is a novel risk-adjusted assessment of the performance of hospitals delivering pediatric surgical care. By identifying the existence of multiple poor performing outlier hospitals, this study provides valuable data for discussion as health care delivery systems continue to debate optimal resource distribution and regionalization of the surgical care of children.
Background
The COVID-19 outbreak has infected people all over the world where many clinics are being constructed to diagnose and treat lingering symptoms or long COVID. Neurological and long-term ...cognitive consequences are very worrisome. Many of COVID-19’s neurological symptoms are likely the result of the body’s extensive immunological response to infection rather than the virus attacking the brain or nervous system directly. At the same time, the extent and type of COVID-19’s cognitive consequences are unknown. The goal of this study was to assess the cognitive functions of healthcare workers 2 weeks to 3 months after COVID-19 infection. Ninety-two healthcare workers participated in the study; 32 were post-COVID-19 cases, and 60 were healthy people (the comparison group). The cognitive functions of the participants were assessed using the Addenbrooke’s Cognitive Examination (ACE-III) test, which evaluated attention, memory, language, and visuospatial skills, as well as the Arabic version of the Patient Health Questionnaire Anxiety GAD-7 and Depression Assessments PHQ-9.
Results
The study revealed that there was a highly significant direct correlation between post-infection with COVID-19 and scores of both anxiety and depression and an inverse correlation in the case of attention and memory. On the other hand, there is no statistical effect of post-COVID-19 on verbal fluency, language scores, and visio-spatial abilities. Using multiple linear regression, there was a powerful significant decrease effect of post-COVID-19 on memory scores controlling both anxiety and depression degrees (Beta = − 0.745,
P
< 0.001). Also, there was a strong negative correlation post-COVID-19 on attention scores controlling both anxiety and depression degrees (Beta = − 0.745,
P
< 0.001).
Conclusions
The study showed a strong negative effect of post-COVID-19 on the attention and memory of patients. Furthermore, both anxiety and depression scores increased significantly among the post-COVID-19 patients.
Cryptorchidism is the most common congenital anomaly of the male genital tract. Cryptorchidism is associated with potentially serious consequences including reduced fertility, increases risk of ...cancer, susceptibility to torsion and traumatic injury, as well as future psychological problems related to an abnormal scrotal appearance. The mainstay of orchiopexy is to achieve an adequate tension-free and permanent scrotal fixation of the testis; one that prevents recurrent ascent. A number of suggestions have been made regarding keeping the testis in the scrotal position once it was brought down in the scrotum without tension. Several techniques for testicular fixation have been described to date; however, the optimal method remains controversial.
We herein introduce a novel scrotal orchidopexy technique. This innovative fixation technique utilizes the sub-scrotal fat as a permanent anchor for fixing the low-lying cryptorchid testicle in the scrotum through a trans-scrotal incision. Therefore, the procedure was named “the fat anchor orchiopexy”. We believe our method will give better options for scrotal fixation especially in cases of low-lying cryptorchid testes. This article provides a detailed description of this new fixation technique.
The novel coronavirus and the disease it causes COVID-19, like other viral outbreaks, have an unpredictable timeline. Therefore, a triumph in the battle against COVID-19 could only be achieved if a ...health care system's capacity to support a potentially overwhelming increase in critical patient care needs is maintained, and the viral curve is flattened. Accordingly, health care bodies around the globe called upon prioritising appropriate resource allocation as it relates to elective invasive procedures and minimising the use of essential items required to care for patients. The unpredictability COVID-19 timeline in the absence of effective drug treatments and vaccination along with the restrictive health care policies implemented suggest that patients may be deprived of access to needed surgical care, likely for many months. However, the potential undue delay in delivering essential elective surgical care may have a more detrimental impact on patients' health compared to that of COVID-19 itself. This particularly applies to the paediatric population in which infection rates have been demonstrated to be considerably lower and mortalities have not been reported yet. Therefore, the need emerges for actions to be taken that allow for the resumption of essential elective surgical procedures in this population of patients.
A comprehensive search through surgical guidance and recommendations to develop a set of evidence based recommendations that allow for the safe and timely delivery of essential paediatric surgical care during the time of COVID-19.
No compelling evidence that the paediatric population is at an increased risk of morbidity or mortality exists. Therefore, delaying essential paediatric surgical care cannot be justified as it may have a potentially negative health impact, and continuous refinements of surgical recommendations are encouraged in view of evolving circumstances.
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