Controles de salud durante la pandemia e impacto clínico del COVID-19 en niños con enfermedad neuromuscular / Health checkups during the pandemic and clinical impact of COVID-19 in children with neuromuscular disease

Introducción. Los niños con enfermedad neuromuscular (ENM) requieren cuidados crónicos de salud (CCS) y podrían presentar COVID-19 grave. Objetivos. Describir CCS para niños con ENM durante la pandemia y evolución del COVID-19 en este grupo. Población y métodos. Cohorte prospectiva unicéntrica. Se incluyeron pacientes de 2-18 años, con ≥ 1 año de seguimiento previo a la pandemia. Se recolectaron variables demográficas, relativas a los CCS y al COVID-19 mediante historias clínicas y encuestas telefónicas. Resultados. Se incluyeron 226 pacientes; el 71 % varones, mediana de edad 11,3 años. Presentaban distrofias musculares (55,7 %) y atrofia muscular espinal (23 %). Comparando el primer año de pandemia con el previo, el 30 % no realizó controles médicos y el 25 % no realizó kinesioterapia. Otros disminuyeron la frecuencia. Hubo 52 casos de COVID-19. Fueron sintomáticos el 82 %: el 88,4 % leves/moderados y el 11,6 % graves. No hubo fallecidos. Conclusiones. La pandemia impactó negativamente en los CCS y los casos de COVID-19 fueron mayormente leves.

Introduction. Children with neuromuscular disease (NMD) require chronic health care (CHC) and may develop severe COVID-19. Objectives. To describe CHC for children with NMD during the pandemic and the course of COVID-19 in this group. Population and methods. Prospective, single-center cohort. Patients aged 2 to 18 years with ≥ 1 year of follow-up prior to the pandemic were included. Demographic variables in relation to CHC and COVID-19 were collected from medical records and via telephone surveys. Results. A total of 226 patients with a median age of 11.3 years were included; 71% were males. They had muscular dystrophy (55.7%) and spinal muscular atrophy (23%). When comparing the first year of the pandemic with the previous year, 30% did not have a health checkup and 25% did not receive kinesiotherapy. Others did, but with a lower frequency. A total of 52 COVID-19 cases were reported; 82% were symptomatic: 88.4% were mild/moderate and 11.6%, severe. No patient died. Conclusions. The pandemic had a negative impact on CHC, and COVID-19 cases were mostly mild.

Factores de riesgo asociados a mala adherencia en adolescentes trasplantados hepáticos en transición / Risk factors associated with poor adherence in adolescent liver transplant recipients in transition

Cada vez más pacientes trasplantados hepáticos durante la edad pediátrica alcanzan la adultez debido al aumento en las tasas de sobrevida a largo plazo, por lo que requieren continuar su atención en un centro de adultos. Este pasaje entre centros se asocia con peores resultados clínicos y mayor mala adherencia, debido al momento de vulnerabilidad que representa este momento en la atención médica y por el mismo momento vital atravesado por el paciente adolescente. La mayoría de los centros de trasplantes establecieron programas de transición para mejorar estos resultados. Para que estos programas sean efectivos, deben conocerse las barreras y los facilitadores de adherencia tanto en el paciente como en su entorno. El objetivo de este trabajo es reconocer estos factores de riesgo y su relación con mala adherencia y resultados clínicos, y realizar un seguimiento a corto plazo de los pacientes transferidos a un centro de atención de adultos. Para esto, se realizó una encuesta pre y post derivación a una cohorte de pacientes adolescentes del Hospital Garrahan. Para medir mala adherencia se utilizaron métodos objetivos y subjetivos, cada uno de los cuales correlacionó con distintos factores de riesgo, como presencia de violencia, consumo de sustancias y déficit educativo. Como conclusión, medir la mala adherencia es complejo debido a que su origen es multifactorial. Al parecer, combinar cuestionarios validados con entrevistas no estructuradas es la estrategia más efectiva para detectar mala adherencia en la consulta médica. Luego, las variables psicosociales están cobrando cada vez más relevancia y deben ser consideradas en los programas de transición de los servicios de trasplante si se quiere lograr un seguimiento a largo plazo exitoso (AU)

An increasing number of pediatric liver transplant patients reach adulthood due to the increase in long-term survival rates, and therefore require continued care in an adult center. This transition between centers is associated with worse clinical outcomes and poorer adherence, due to the vulnerability that this moment in medical care represents and the same vital moment that the adolescent patient goes through. Most transplant centers have established Transition Programs to improve these outcomes. For these programs to be effective, the barriers and facilitators of adherence in both the patient and their environment should be known. The aim of this study was to identify these risk factors and their relationship with poor adherence and clinical outcomes, and to perform a short-term follow-up of patients transferred to an adult care center. For this purpose, a pre- and post-referral survey was conducted on a cohort of adolescent patients from the Garrahan Hospital. Objective and subjective methods were used to measure poor adherence, each of which correlated with different risk factors, such as the presence of violence, substance use, and educational deficits. In conclusion, measuring poor adherence is complex because its origin is multifactorial. Combining validated questionnaires with unstructured interviews seems to be the most effective strategy for detecting poor adherence in the medical consultation. Therefore, psychosocial variables are becoming increasingly relevant and should be considered in the Transition Programs of transplantation services if a successful longterm follow-up is to be achieved (AU)

Seguimiento de niños con diagnóstico de asma grave antes y durante la pandemia por COVID-19 / Follow-up of children diagnosed with severe asthma before and during the COVID-19 pandemic

En la pandemia por COVID-19 se exploraron estrategias de atención para garantizar el seguimiento de niños con asma grave. Estudio prospectivo, observacional, comparativo. Se incluyeron pacientes del programa de asma grave de un hospital pediátrico de tercer nivel (n 74). Se evaluó el grado de control, exacerbaciones y hospitalizaciones durante un período presencial (PP), marzo 2019-2020, y uno virtual (PV), abril 2020-2021. En el PP, se incluyeron 74 pacientes vs. 68 (92 %) del PV. En el PP, el 68 % (46) de los pacientes presentaron exacerbaciones vs. el 46 % (31) de los pacientes en el PV (p 0,003). En el PP, se registraron 135 exacerbaciones totales vs. 79 en el PV (p 0,001); hubo una reducción del 41 %. En el PP, el 47 % (32) de los pacientes tuvieron exacerbaciones graves vs. el 32 % (22) de los pacientes en el PV (p 0,048). Hubo 91 exacerbaciones graves en el PP vs. 49 en el PV (p 0,029), reducción del 46 %. No hubo diferencias en las hospitalizaciones (PP 10, PV 6; p 0,9). La telemedicina fue efectiva para el seguimiento de pacientes con asma grave

During the COVID-19 pandemic, health care strategies were explored to ensure the follow-up of children with severe asthma. This was a prospective, observational, and comparative study. Patients in the severe asthma program of a tertiary care children's hospital were included (n: 74). The extent of control, exacerbations, and hospitalizations during an in-person period (IPP) (March 2019­2020) and an online period (OP) (April 2020­2021) was assessed. A total of 74 patients were enrolled in the IPP compared to 68 (92%) in the OP. During the IPP, 68% (46) of patients had exacerbations versus 46% (31) during the OP (p = 0.003). During the IPP, 135 total exacerbations were recorded compared to 79 during the OP (p = 0.001); this accounted for a 41% reduction. During the IPP, 47% (32) of patients had severe exacerbations versus 32% (22) during the OP (p = 0.048). A total of 91 severe exacerbations were recorded during the IPP compared to 49 during the OP (p = 0.029); the reduction was 46%. No differences were observed in terms of hospitalization (IPP: 10, OP: 6; p = 0,9). Telemedicine was effective for the follow-up of patients with severe asthma.

Congenital hyperinsulinism and surgical outcome in a single tertiary center in Brazil

Abstract Objective: Congenital hyperinsulinism (CHI) is a heterogeneous genetic disease characterized by increased insulin secretion and causes persistent hypoglycemia in neonates and infants due to dysregulation of insulin secretion by pancreatic β cells. Babies with severe hypoglycemia and for whom medical treatment has been ineffective usually require surgical treatment with near-total pancreatectomy. To evaluate the clinical and surgical aspects affecting survival outcomes in babies diagnosed with CHI in a single tertiary care center. Methods: Retrospective Cohort study involving a single university tertiary center for the treatment of CHI. The authors study the demographics, clinical, laboratory, and surgical outcomes of this casuistic. Results: 61 % were female, 39 % male, Birth weight: 3576 g (±313); Age of onset of symptoms: from the 2nd hour of life to 28 days; Time between diagnosis and surgery ranged between 10 and 60 days; Medical clinical treatment, all patients received glucose solution with a continuous glucose infusion and diazoxide. 81 % of the patients used corticosteroids, 77 %. thiazide, 72 % octreotide, 27 % nifedipine; Neurological sequelae during development and growth: 54 % had some degree of delay in neuropsychomotor development, 27 % obesity. Surgery was performed open in 6 and 12 minimally invasive surgery (MIS). Histopathology: 2 focal and 16 diffuse, Length of stay (days) was lower in MIS (p < 0.05). Survival was 100 %. Conclusions: CHI is a rare and difficult-to-manage tumor that must be performed in a multidisciplinary and tertiary center. Most surgical results are good and the laparoscopic approach to disease has been the best choice for patients.

Persistencia de signos y síntomas a los 6 meses posinfección por chikungunya en pacientes de un hospital público en Paraguay

Introducción: El virus chikungunya (CHIKV) causa una enfermedad con manifestaciones agudas bien documentadas, pero existen pocos datos sobre la persistencia de síntomas y secuelas a largo plazo. Objetivos: Evaluar la persistencia de signos, síntomas y factores asociados en pacientes con infección por CHIKV en un seguimiento de 6 meses posinfección. Materiales y métodos: Estudio de cohorte ambispectivo que incluyó casos confirmados de CHIKV notificados en abril de 2023 en Coronel Oviedo, Paraguay. Se realizaron entrevistas al mes, a los tres meses y a los 6 meses posinfección. Se analizaron características demográficas, comorbilidades, manifestaciones reumáticas y sintomáticas. Resultados: Ingresaron 333 participantes, completando seguimiento a 6 meses 170 pacientes. A los 6 meses persistieron: dolor de espalda (61.2%), artritis (57.1%), cefalea (54.1%), fatiga (51.2%), mialgia (49.4%), debilidad (47.6%), depresión (45.9%) y artralgia (45.9%). La persistencia de artritis (OR 7.54; p=0.008) y mialgia (OR 3.24; p=0.031) a 6 meses fue mayor en el grupo de 36-45 años. Conclusiones: Alta persistencia de síntomas musculoesqueléticos y fatiga hasta 6 meses posinfección, con tendencia decreciente, pero exacerbación de depresión. Edad entre 36-45 años asociada a mayor persistencia. Se requieren protocolos de seguimiento integral, investigar mecanismos fisiopatológicos y fortalecer prevención, dado el impacto individual y socioeconómico de la enfermedad.

Introduction: Chikungunya virus (CHIKV) causes a disease with well-documented acute manifestations, but there is limited data on the persistence of symptoms and long-term sequelae. Objectives: To evaluate the persistence of signs, symptoms, and associated factors in patients with CHIKV infection during a 6-month post-infection follow-up. Material and Methods: An ambispective cohort study that included confirmed cases of CHIKV reported in April 2023 in Coronel Oviedo, Paraguay. Interviews were conducted at 1, 3 and 6 months post-infection. Demographic characteristics, comorbidities, rheumatic, and symptomatic manifestations were analyzed. Results: 333 participants were enrolled, with 170 patients completing the 6-month follow-up. At 6 months, the following symptoms persisted: back pain (61.2%), arthritis (57.1%), headache (54.1%), fatigue (51.2%), myalgia (49.4%), weakness (47.6%), depression (45.9%), and arthralgia (45.9%). The persistence of arthritis (OR 7.54, p=0.008) and myalgia (OR 3.24, p=0.031) at 6 months was higher in the 36-45 age group. Conclusions: High persistence of musculoskeletal symptoms and fatigue up to 6 months post-infection, with a decreasing trend but exacerbation of depression. Age between 36-45 years was associated with greater persistence. Comprehensive follow-up protocols, investigation of pathophysiological mechanisms, and strengthening prevention are required, given the individual and socioeconomic impact of the disease.

Guía de práctica clínica para el tratamiento y seguimiento de personas con cáncer diferenciado de tiroides. Parte I: Vigilancia activa

Introducción: El cáncer de tiroides es una enfermedad frecuente en el mundo, con mayor prevalencia del tipo diferenciado. El diagnóstico temprano y manejo pertinente, individualizado y adaptable puede mejorar su pronóstico. Objetivo: Generar recomendaciones basadas en evidencia sobre el tratamiento y seguimiento de personas adultas con cáncer diferenciado de tiroides (CDT). Metodología: Guía de práctica clínica (GPC) a partir de revisión sistemática de literatura (RSL) y consenso de expertos clínicos. El grupo desarrollador definió el alcance y cuatro preguntas que se resolvieron a través de revisión de evidencia de GPC existentes, RSL, estudios primarios publicadas en español o inglés en diferentes fuentes de información desde 2013. Las preguntas de investigación fueron: 1. ¿Cuáles son las indicaciones de la vigilancia activa?, ¿cómo realizarla?, ¿cuándo y con que periodicidad realizarla? 2. ¿Cuál es el tratamiento y su indicación en pacientes con nódulos tiroideos sospechosos de cáncer? 3. ¿Cómo y cuándo realizar seguimiento de pacientes con CDT de acuerdo con el riesgo dinámico? 4. ¿Cuál es el manejo actual de los pacientes iodo refractarios? Se propusieron recomendaciones basadas en la evidencia, y analizadas y discutidas por el colectivo experto en sesiones asincrónicas. Se evalúo la calidad de la evidencia y las recomendaciones fueron gradadas en fuerte o condicional y a favor o en contra a partir del análisis de la calidad de la evidencia, contexto de implementación (disponibilidad e implementación) y la experticia clínica. En el presente documento se desarrollada la primera pregunta, referente a vigilancia activa. Resultados: 86 recomendaciones fueron propuestas y acordadas por el grupo desarrollador, categorizadas en tratamiento y seguimiento para resolver las preguntas planteadas. 10 de las recomendaciones corresponden a vigilancia activa y se incluyen en el presente documento. Recomendaciones claves incluyen, brindar información completa y oportuna a pacientes, conformación de equipos multidisciplinarios, análisis individualizado del paciente para la decisión de tratamiento, estadificación rutinaria de riesgo dinámico para evaluar la respuesta al tratamiento y ajustarlo, minimización de procedimientos fútiles o que aportan poco a la supervivencia y calidad de vida de los pacientes. Conclusión: Se presentan recomendaciones que esperan incidir en la estandarización de la práctica clínica cotidiana de pacientes con CDT y mejores resultados en salud.

Introduction: Thyroid cancer is a common disease in the world, with a higher prevalence of the differentiated type. Early diagnosis individualized and adaptive management can improve prognosis. Objective: Generate evidence-based recommendations on the treatment and follow-up of adults with differentiated thyroid carcinoma (DTC). Methodology: Clinical practice guideline (CPG) based on systematic literature review (RSL) and consensus of clinical experts. The development group defined the range and four questions that were resolved through a review of evidence from existing CPGs, RSLs, primary studies published in Spanish or English in various sources of information since 2013. The research questions were: 1. What are the indications for active surveillance? How to carry it out? When and how often to carry it out? 2. What is the treatment and its indication in patients with thyroid nodules suspicious for cancer? 3. How and when to follow up patients with CDT according to dynamic risk? 4. What is the current management of iodine refractory patients? Evidence-based recommendations analyzed and discussed by the expert group in asynchronous sessions were proposed. The quality of the evidence was evaluated, and the recommendations were graded as strong or conditional and in favor or against based on the analysis of the quality of the evidence, implementation context (availability and implementation) and clinical expertise. In this document, is developed the first question, referring to active surveillance. Results: 86 recommendations were proposed and agreed upon by the development group, categorized into treatment and follow-up to solve the questions raised. 10 of the recommendations correspond to active surveillance and are included in this document. Key recommendations include providing complete and timely information to patients, develop of multidisciplinary teams, individualized patient analysis for treatment decisions, routine dynamic risk staging to evaluate response to treatment and adjust it, minimization of futile procedures or that contribute little to the survival and quality of life of patients. Conclusion: Recommendations are presented that longs to influence the standardization of the daily clinical practice of patients with DTC and better health outcomes.

Orientaciones para el manejo ambulatorio de adultos que viven con VIH en Chile / Guidelines for the primary care of adult people living with HIV in Chile

El enfrentamiento de las personas que viven con VIH es amplio y requiere dedicación en múltiples dimensiones, más allá de la terapia antirretroviral. Estas recomendaciones abordan el manejo desde el diagnóstico, primera visita, seguimiento, manejo de comorbilidades infecciosas y no infecciosas, tamizaje de neoplasias, profilaxis antimicrobiana y vacunas, entre otras.

Management of people living with HIV is broad and multiple dimensions must be considered, beyond antiretroviral therapy. These recommendations include management from diagnosis, first visit, patient follow-up, infectious and non-infectious comorbidities, malignancies screening, antimicrobial and immunizations prophylaxis, among others.

Seguimiento Funcional hasta Seis Meses después de Sobrevivir a Cuidados Intensivos: Lecciones aprendidas de un Estudio Chileno Multicéntrico / Functional follow-up six months after surviving intensive care: lessons learned from a Chilean multicenter study

Introducción. Las tasas de retención en los estudios de seguimiento oscilan entre el 32 y 100%, demostrando el desafío que implica realizar estudios longitudinales de sobrevivientes de la unidad de cuidados intensivos (UCI). Objetivo. Identificar las estrategias implementadas y lecciones aprendidas en un estudio prospectivo multicéntrico de seguimiento de sobrevivientes de la UCI durante la pandemia. Métodos. Estudio post-hoc de las lecciones aprendidas mediante encuestas y entrevistas dirigidas a explorar la experiencia de los investigadores y coordinadores del estudio IMPACCT COVID-19, realizado en siete centros chilenos entre octubre 2020 y abril 2021 evaluando el síndrome post-cuidados intensivos de sobrevivientes hasta seis meses después. Resultados. Identificamos ocho lecciones: 1) selección de instrumentos de medición, 2) identificación de centros participantes, 3) aprobación del estudio, 4) financiamiento, 5) capacitación de evaluadores, 6) coordinación/aseguramiento de calidad, 7) reclutamiento y 8) seguimiento de pacientes. Incluso durante el primer año de pandemia, reclutamos 252 pacientes a una tasa de 1,4 pacientes/día con una retención del 48% a los 6 meses de seguimiento. El uso de redes académicas existentes y las estrategias de comunicación entre investigadores, coordinadores y evaluadores fueron aspectos positivos; mientras que la fidelización con evaluadores al egreso de la UCI y con pacientes durante el seguimiento son aspectos que deberían considerarse en futuros estudios. Conclusiones. Se evaluaron más de 250 pacientes en seis meses durante la pandemia, con tasas de retención post UCI acorde a la literatura. Futuros estudios debiesen optimizar los procesos de medición y de seguimiento para minimizar la pérdida de pacientes.

Background. Retention rates of follow-up studies range from 32 to 100%, demonstrating the challenge to conduct longitudinal studies of intensive care unit (ICU) survivors. Objective. To identify the strategies implemented and lessons learned in a multicenter prospective follow-up study of ICU survivors during pandemic times. Methods. Post-hoc study of lessons learned through surveys and interviews aimed at exploring the experience of the researchers and coordinators of the IMPACCT COVID-19 study. The original study was performed in seven Chilean sites between October 2020 and April 2021 evaluating the post-intensive care syndrome of survivors up to six-month follow-up. Results. We identified eight lessons: 1) selection of measurement instruments, 2) identification of participating sites, 3) Study approval, 4) funding, 5) evaluators training, 6) coordination/quality assurance, 7) recruitment, and 8) patient follow-up. Even during the first year of the pandemic, we recruited 252 patients at a rate of 1.4 patients/day with a retention rate of 48% at 6 months of follow-up. The use of existing academic networks and communication strategies between researchers, coordinators and evaluators were positive aspects; while evaluators fidelity at ICU discharge and patient engagement during follow-up are aspects should be considered. Conclusions. More than 250 patients were evaluated in six months during the pandemic, with post-ICU retention rates consistent with the literature. Future studies should optimize measurement and monitoring processes to minimize patient atrition.

Calidad asistencial y seguimiento de los pacientes operados por cáncer colorrectal en un Hospital de Paysandú, Uruguay / Quality of care and follow-up of patients operated on forcolorectal cancer at the Paysandú Hospital, Uruguay

Introducción: el cáncer colorrectal (CCR) es la segunda causa de muerte dentro de las enfermedades neoplásicas. El pronóstico individual está signado por el estadio de la enfermedad al momento del diagnóstico y la posibilidad de realizar un tratamiento curativo. Este también depende de la estratificación post quirúrgica y de la aparición de complicaciones ulteriores. El objetivo del seguimiento es diagnosticar la recidiva en un estadio potencialmente curable y detectar otros cánceres primarios. Objetivo: realizar una valoración de la calidad de la cirugía colorrectal y el seguimiento de los pacientes operados de CCR en nuestro hospital. Diseño: estudio descriptivo, observacional, retrospectivo. Material y métodos: se analizaron todos los pacientes con CCR operados en el servicio de cirugía del Hospital de Paysandú entre enero de 2017 y diciembre de 2020. Se describen diversas variables que influyen en la calidad quirúrgica y se analizan las relacionadas al seguimiento post operatorio dividiendo a los pacientes en 3 grupos, seguimiento completo, perdidos y sin datos de seguimiento. Resultados: se incluyeron 39 pacientes, con una edad media de 68 años. El 28% se diagnosticaron en estadio IV, con porcentajes bajos en estadios tempranos. Hubo 57% de cirugías de urgencia y 43% electivas. La causa más frecuente de urgencia fue la oclusión intestinal (36,6%). La tasa de dehiscencia anastomótica fue 16,6% y la de mortalidad 15,3%. Solo el 33% de los pacientes tuvieron seguimiento completo. Conclusión: existe un déficit en la atención y el seguimiento de los pacientes operados por CCR en nuestro hospital. Se impone la creación de un equipo específico en el área de coloproctología, así como un protocolo de seguimiento unificado para mejorar estos resultados. (AU)

Introduction: colorectal cancer (CRC) is the second cause of death among neoplastic diseases. The individual prognosis is determined by the stage of the disease at the time of diagnosis and the possibility of curative treatment. This also depends on the postsurgical stratification and the appearance of subsequent complications. The goal of follow-up is to diagnose recurrence at a potentially curable stage and detect other primary cancers. Objective: to carry out an evaluation of the quality of colorectal surgery and the follow-up of patients operated on for CRC in our hospital. Design: descriptive, retrospective observational study. Material and methods: all patients with CRC operated on in the surgery service of the Paysandú Hospital between January 2017 and December 2020 were analyzed. Variables that influence surgical quality are described and those related to postoperative follow-up are analyzed by dividing patients in 3 groups, complete follow-up, lost to follow-up and without follow-up data. Results: Thirty-nine patients were included, with a mean age of 68 years. Twenty-eight percent were diagnosed in stage IV, with low percentages in early stages. There were 57% emergency procedures and 43% elective proceduress. The most common cause of emergency was intestinal obstruction (36.6%). The anastomotic dehiscence rate was 16.6% and the mortality rate was 15.3%. Only 33% of patients had complete follow-up. Conclusion: there is a deficit in the care and follow-up of patients undergoing CRC surgery in our hospital. The creation of a specific team in the area of coloproctology is required, as well as a unified monitoring protocol to improve these results. (AU)

Mid-and long-term efficacy of modified Colonna arthroplasty in the treatment of unilateral dislocation type of juvenile developmental dysplasia of the hip / 中华骨科杂志

Objective:To investigate the mid-and long-term clinical efficacy of modified Colonna arthroplasty in the treatment of unilateral dislocation type developmental dysplasia of hip (DDH) in adolescents.Methods:A total of 28 adolescent DDH patients with unilateral dislocation who underwent modified Colonna capsular arthroplasty from January 2016 to January 2018 in the 920th Hospital of Joint Logistics Support Force of People's Liberation Army were retrospectively analyzed. There were 4 males and 24 females, aged 16.5±5.0 years (range, 10-25 years). The mean body mass index was 21.2±1.1 kg/m 2 (range, 18.7-24.1 kg/m 2). According to DDH classification, 10 cases were Tonnis type III and 18 cases were Tonnis type IV. The postoperative lateral center-edge angle, acetabular coverage, femoral anteversion angle and leg length discrepancy were measured. The operation time, intraoperative blood loss, visual analogue scale (VAS) of hip pain, Harris hip score (HHS) and congenital dislocation of the hip score were recorded. Results:All patients successfully completed the operation and were followed up for 72.1±5.2 months (range, 60-84 months). The operation time was 81.6±4.3 min (range, 70-90 min), the intraoperative blood loss was 177.5±12.6 ml (range, 160-200 ml), and the hospital stay was 6.8±0.7 days (range, 6-9 days). The VAS score of the hip joint was 1.8±0.6 before operation and 2.3±0.6 at the last follow-up, and the difference was not statistically significant ( t=2.845, P=0.224). The preoperative HHS score was 57.1±5.9, and it increased to 87.3±4.0 at the last follow-up, and the difference was statistically significant ( t=-22.141, P=0.001). At the last follow-up, the femoral anteversion angle was 17.0°±1.5°, which was lower than that before operation 41.6°±2.4°, with a statistically significant difference ( t=-44.868, P=0.008). The leg length discrepancy was 10.2±2.3 mm, which was lower than that before operation (26.4±6.1 mm), with a statistically significant difference ( t=-12.892, P<0.001). The lateral center-edge angle was 28° (26°, 30°), and the acetabular coverage rate was 78% (76%, 79%). The curative effect evaluation standard score of congenital dislocation of the hip was 24 (16.7, 25.7) points, including 7 excellent cases, 14 good cases, 4 fair cases, and 3 poor cases. The excellent and good rate was 75% (21/28). Conclusion:The modified Colonna arthroplasty for the treatment of unilateral dislocation DDH in adolescents has good mid-and long-term hip function recovery and radiographic improvement.

Mid-long term distal femur allograft prosthetic composite reconstruction for short proximal femur segments following tumor resection / 中华骨科杂志

Objective:To investigate the mid-to-long term therapeutic effects of allogeneic bone composite prosthesis reconstruction in patients with large bone defects after the resection of distal femoral tumors.Methods:From June 2013 to December 2018, a total of 19 patients with malignant tumors of the distal femur who underwent reconstruction with allogeneic bone composite prosthesis in the Department of Bone Tumor, Shanghai General Hospital were retrospectively collected. There were 10 males and 9 females, aged 22.3±11 years (range, 11-42 years). The mean body mass index was 19.3±3.4 kg/m 2 (range, 14-27 kg/m 2). There were 18 cases of osteosarcoma and 1 case of Ewing's sarcoma. According to Ennecking staging, there were 17 cases of stage IIB and 2 cases of stage III. The intraoperative blood loss and operation time were recorded, and the prosthesis and patient survival conditions and postoperative complications were observed. The limb function was evaluated by the Musculoskeletal Tumor Society (MSTS) 93 function score. Results:All patients successfully completed the operation. The operation time was 187.3±39.8 min (range, 110-260 min), the intraoperative blood loss was 284.9±87.0 ml (range, 200-500 ml), and the blood transfusion volume was 327±213 ml (range, 100-800 ml). The remaining length of the proximal femur was 153.7±26.6 mm (range, 93-190 mm), and the length of allogeneic bone was 84.1±24.6 mm (range, 39-134 mm). Among the 19 patients, 9 patients (47%) achieved bony union with an average healing time of 16.7±4.8 months (range, 10-25 months), and 7 patients had delayed healing with an average healing time of 18.4±4.0 months (range, 15-25 months). The remaining 10 cases were nonunion between allogeneic bone and host bone. All patients were followed up for 80.7±20.2 months (range, 56-121 months). During the follow-up, 3 cases died due to pulmonary metastasis of bone tumors, and the time of death was 57 months, 63 months, and 59 months after surgery, respectively. At the last follow-up, the patient survival rate was 84% (16/19), and the MSTS 93 function score of the 16 patients was (24.3±2.4) points (range, 21-28 points), with an excellent rate of 100% (16/16). Seven patients underwent revision surgery, 3 cases were aseptic loosening, 3 cases were prosthesis stem fracture at the junction of the allograft bone and the host bone, and 1 case was periprosthetic infection, among which the patient with periprosthetic infection had poor local soft tissue conditions due to preoperative radiotherapy, and the infection was controlled after two revision surgeries. Five cases were revised with allogeneic bone composite prosthesis, and 2 cases were revised with short-stem giant prosthesis with cortical steel plate or locking nail. After revision, the remaining length of the proximal femur was 143.4±31 mm (range, 91-175 mm), and the length of the allograft bone was 92.6±26.6 mm (range, 61-123 mm). The 7 revised patients were still in follow-up. There were no cases of pulmonary infection, nerve injury, deep vein thrombosis or other complications after surgery.Conclusion:The survival period of patients after the surgery to reconstruct large bone defects following the resection of malignant tumors at the distal end of the femur using allogeneic bone composite prosthesis is satisfactory, and the limb function is good. However, the incidence of prosthesis complications is high, which can be reconstructed through revision.

Consideration of countermeasures to promote family doctor contracting rate and first-return-visit rate in primary care institutions / 中华全科医师杂志

Based on the analysis of the existing problems and implementation dilemmas in family doctor contracting and first-return-visits faced by primary medical institutions in China, the authors propose countermeasures to provide reference for managers of primary health care institutions.

Urogenital solitary fibrous tumor: a review of 20 cases / 现代泌尿外科杂志

【Objective】 To explore the diagnosis, treatment, prognosis and long-term follow-up of urogenital solitary fibrous tumor (SFT) and to differentiate the characteristics between benign and malignant SFT. 【Methods】 Clinical data of 20 patients with urogenital SFT treated in our hospital during Jan.2004 and Aug.2021 were respectively analyzed, including the general characteristics, clinical symptoms, imaging results, treatment methods, pathological results, and long-term follow-up results. 【Results】 Of the 20 cases, 9 cases had tumor in kidney, 7 in pelvic cavity, 3 in bladder and 1 in prostate.Six patients showed non-specific clinical symptoms, including lower extremity weakness, urodynia, dysuria, frequent urination with changes in stool habits, low back pain, and abdominal wall mass with abdominal pain, and the other 14 cases were asymptomatic.The median diameter of SFT was 5.2 cm (range:1.7-15.0 cm).All patients received surgical treatment, including robotic-assisted surgery in 8 cases, open surgery in 5 cases, laparoscopic surgery in 5 cases, and transurethral resection of tumor in 2 cases.CT plain scan showed high, low and mixed density soft tissue masses, and enhanced CT showed enhanced results.Pathology results revealed frequent nuclear divisions, morphological variations and necrosis in malignant SFT, which had higher expression of Ki-67 than benign SFT.The results of the modified Demicco prognostic risk stratification model showed that all malignant SFT cases were at intermediate risk. The DFS of the SFT radical tumor resection group was slightly longer than that of the simple tumor resection group but the difference was not statistically significant (P=0.203). 【Conclusion】 Markers such as CD34, Bcl2, STAT6 and CD99 are used to diagnose SFT, while Ki-67 and tumor necrosis are used to differentiate benign and malignant SFT.The modified Demicco prognostic risk stratification model plays an important role in predicting the prognosis of SFT.Surgical resection is the most common treatment with excellent prognosis.In addition, benign SFT has much better prognosis than malignant case.

Effect of irregular follow-up during normalized prevention and control of epidemic on viral load upon BK virus reactivation and prognosis of kidney transplant recipients / 器官移植

<b>Objective</b> To evaluate the effect of irregular follow-up during normalized prevention and control of novel coronavirus pneumonia (COVID-19) epidemic on BK virus (BKV) reactivation and clinical prognosis of kidney transplant recipients. <b>Methods</b> Clinical data of 363 kidney transplant recipients were retrospectively analyzed, and they were divided into the pre-epidemic follow-up group and during-epidemic follow-up group according to the follow-up time. All patients were followed up for 1 year. The follow-up interval was compared between two groups. The infection of BKV and the correlation between the infection process of BKV and renal graft function were analyzed in two groups. <b>Results</b> A total of 1 790 preson-times were followed up before COVID-19 epidemic and 2 680 during COVID-19 epidemic. Compared with the during-epidemic follow-up group, the follow-up intervals within 3, 3-6 and 7-12 months after kidney transplantation were shorter in the pre-epidemic follow-up group, and the differences were statistically significant (all <i>P</i><0.05). Within 1 year after kidney transplantation, 35 cases（32%） were diagnosed with BKV viruria, 3 cases（3%） of BKV viremia and 1 case（1%） of BKV-associated nephropathy (BKVAN) in the pre-epidemic follow-up group, and 53（25%）, 3（1%） and 1（1%） in the during-epidemic follow-up group, with no statistical significance (all <i>P</i>>0.05). In the pre-epidemic follow-up group, the time for the initial diagnosis of BKV viruria was longer and the viral load of the first urinary BKV reactivation was smaller than those in the during-epidemic follow-up group, with statistical significance (both <i>P</i><0.05). The load of the first urinary BKV reactivation was positively correlated with the peak load of urinary BKV, and the differences between the baseline and serum creatinine levels at 1 and 3 months after BKV reactivation (all <i>P</i><0.05). <b>Conclusions</b> Irregular follow-up after kidney transplantation may lead to early BKV reactivation and higher detection value of the first viral load of urinary BKV, delay diagnosis and interventions, and lead to poor prognosis. It is urgent to establish a remote follow-up system to meet the follow-up requirements of kidney transplant recipients when public health incidents occur.

Advances in application of 21-deoxycortisol in the diagnosis and monitoring of 21-hydroxylase deficiency / 国际儿科学杂志

With the whole life involvement，21-hydroxylase deficiency（21-OHD）affects the quality of life，and the death rate of salt wasting form is high，thus the timely diagnosis and standardized treatment are needed. Traditionally，17-hydroxyprogesterone（17-OHP）is an indicator for screening，diagnosis and monitoring of 21-OHD. However，17-OHP has some limitations，such as high false-positive rate in neonatal screening，high fluctuation，and interference of puberty and menstrual cycle，etc. Therefore，attempts have been made to find better indicators to help guide clinical practice. Recently，several studies have suggested that 21-deoxycortisol（21-DF）may be a more specific marker for 21-OHD，which has the following advantages：no elevation is observed in premature infants or patients with other forms of congenital adrenal hyperplasia，and the blood sample timing doesn't affect the detection of 21-DF；21-DF is a reliable diagnostic marker of non-classical 21-OHD；adrenal gland is the only source of 21-DF. Therefore，this article reviews the limitations of 17-OHP and the relative advantages of 21-DF.

Recurrence rate of oral melanotic macule treated with Q-switched alexandrite laser versus surgical excision: a retrospective cohort study / 口腔疾病防治

Objective@#To compare the recurrence rates between 755 nm Q-switched alexandrite laser (QSAL) treatment and surgical excision of oral melanotic macules (OMM).@*Methods@#This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. A retrospective cohort study was designed to collect demographic and clinical characteristics and follow-up data from patients with OMM. Patients who received QSAL or surgical excision in the Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2019 to August 2021 were included. The one-year recurrence rate was investigated as the primary outcome. Long-term adverse reaction rates were investigated as safety indicators. Kaplan-Meier analyses were performed to analyze the recurrence-free rates between the groups.@*Results@#A total of 57 patients were enrolled in this study. 16 patients underwent surgical excision, and 41 underwent QSAL. The baseline demographic and clinical characteristics between the groups were not significantly different. No recurrence (0%) of OMM was observed in the surgical excision group, while in the QSAL group, the macule recurred in 12 patients (29.27%). The average duration of recurrence was 6.08 months after treatment. Recurrence was not found to be associated with smoking (P = 1.000), gastrointestinal polyps (P = 1.000), longitudinal melanonychia (P = 0.187), family history (P = 0.552), treatment sessions (P = 0.567) or multiple macule lesions (P = 0.497). Compared with treatment with surgical excision, the odds ratio of recurrence for treatment with QSAL was 4.41, with a 95% confidence interval of 1.27-15.24 (P = 0.020). In the surgical excision group, 3 patients (18.75%) reported depressions and scars on the lesion, while no long-term adverse reactions (0%) were reported in the QSAL group (P = 0.019).@*Conclusion@#Compared with surgical excision, the advantage of QSAL is the low long-term adverse reaction rate, while the disadvantage is the relatively high one-year recurrence rate. It is necessary to communicate the advantages and disadvantages of the two methods with OMM patients to assist in clinical decision-making.

Demographic Characteristics Associated with Missed Follow-Up Appointments among Tuberculosis Patients at Hospital Shah Alam, Selangor: A Retrospective Study from January to June 2023

Introduction@#Tuberculosis (TB) patients default their treatment during the treatment course. Therefore, this study aims to analyze the demographic characteristics of the patient who missed follow-ups and identify the reasons for missed appointments or defaulted their treatment. @*Methods@#The records of patients diagnosed with TB follow-up at the chest clinic from January to June 2023 were reviewed based on our inclusion and exclusion criteria. @*Results@#The retrospective descriptive analysis was conducted based on the data collected. Based on the study sample (n=33), the result shows that the majority of the defaulted patients were male in gender (n=22). Most of the missed appointments patients and defaulters are of Malay (39.4%) ethnicity and Malaysian nationality (66.7%). Most patients gave the transport issues as the reason for missed appointments followed by financial issues and feeling healthy. The majority of them missed follow-up in the first month after starting anti-TB.@*Conclusions@#In conclusion, missed appointments, treatment compliance and defaulted cases in TB treatment remain as one of the main challenges in the effort to end TB epidemics. Further in-depth research is required to propose effective measures to solve this issue and improve the national TB control program.

Longitudinal study on anxiety and intolerance of uncertainty among Chinese college students / 中国学校卫生

Objective@#To explore the longitudinal changes and related predictive factors of anxiety and intolerance of uncertainty (IU) among Chinese college students, so as to provide theoretical reference for promoting students mental health.@*Methods@#Intolerance of Uncertainty Scale-short Form and the 7 item Generalized Anxiety Disorder Scale were administered among 5 683 students from 22 universities in Guangdong Province from September 10 to October 17, 2021 (T1, baseline survey), and from March 15 to April 22, 2023 (T2). Using paired sample t-test to analyze the changes in anxiety and IU among college students, a linear regression model was established to explore factors that can predict anxiety, IU and their changes during T1 and T2 periods.@*Results@#During the T1 period, the average scores of anxiety and IU among college students were (3.26±3.46, 34.88±7.96), while during the T2 period, they were (4.41±4.16, 36.40±8.07). During the T2 period, the levels of anxiety and IU among college students were higher than those during the T1 period ( t=19.59, 13.67, P <0.01). The linear regression results showed that age ( B = -0.02 ), moderate ( B =-0.18) and poor ( B =-0.88) mental health status, as well as online browsing of Corona Virus Disease 2019 (COVID-19) epidemic (later called as epidemic) related information for >1-<3 hours ( B =-0.30) and ≥3 hours ( B =-0.22), all of which could negatively predict changes in anxiety during T1 to T2 periods. Living in rural areas ( B =0.11) could positively predict changes in anxiety during T1 to T2 periods ( P <0.05). Moderate ( B =-0.19) and poor ( B =-0.47) mental health status, browsing epidemic related information online for >1-<3 hours ( B =-0.32) and ≥3 hours ( B =-0.33), academic performance being moderately affected by the epidemic ( B =-0.10), and personal planning being moderately affected by the epidemic ( B =-0.13) and severely affected ( B =-0.22), all of which could negatively predict changes in IU during T1 to T2 periods ( P <0.05).@*Conclusions@#Levels of anxiety and intolerance of uncertainty increases significantly after epidemic. Mental health status of college students should need long term monitoring, and students with poor mental health should need special attention.

Establishment and application of a prospective follow-up research method for acute infectious diseases in Shanghai community residents / 上海预防医学

ObjectiveTo present the exploration and application of a prospective follow-up research method for acute infectious disease surveillance based on natural community populations， using COVID-19 infection as an example， and to provide a reference for improving the infectious disease surveillance and early warning system. MethodsA multi-stage probability proportional sampling method was employed to sample residents from all communities of 16 administrative districts in Shanghai， with households as the units. A cohort for acute infectious diseases based on natural community populations was established. The baseline survey was conducted for all cohort subjects， and COVID-19 antigen test kits were distributed. From December 21， 2022 to September 30， 2023， prospective follow-up monitoring of COVID-19 antigen and nucleic acid was carried out on the study subjects on a weekly basis. The baseline characteristics and follow-up information of the cohort subjects were described. ResultsThe cohort for acute infectious diseases included a total of 12 881 subjects， comprising 6 098 males （47.3%） and 6 783 females （52.7%）. The baseline survey revealed that 35.2% （4 540/12 881） of the subjects had a history of COVID-19 infection. During the follow-up period from December 21， 2022 to September 30， 2023， the average incidence density in the cohort was 0.61/person-year， with a higher incidence density in females （0.63/person-year） compared to males （0.59/person-year）. Individuals aged 60 and above （0.64/person-year） and those with underlying health conditions （0.67/person-year） had a higher incidence density. Healthcare workers showed a notably higher incidence density （0.84/person-year） than that in other occupational groups. As of September 30， 2023， a total of 340 subjects in the cohort experienced secondary infections， with a median interval of 170 days between the first and second infections. ConclusionThis study applies cohort study method to acute infectious disease surveillance， providing crucial data support for estimating infection rates and forecasting alerts for acute infectious diseases in the community. This method can be promoted and applied as a new approach for acute infectious disease surveillance.

Survival rate and quality of life in patients with liver cirrhosis complicated with bacterial infection / 公共卫生与预防医学

Objective To analyze the short-term survival and prognostic quality of life of patients with liver cirrhosis complicated by bacterial infection. Methods This study collected and analyzed 300 patients with liver cirrhosis complicated with infection who were hospitalized in the First Affiliated Hospital of Hebei North University, and followed up to discuss their survival and quality of life. Results In this study, the top two causes of infection were spontaneous bacterial peritonitis (60.67% of patients) and pneumonia (50.67% of patients). The second causes were urinary tract infections (15.33%), gastrointestinal infections (12.33%), and other causes. There was no statistically significant difference between male and female patients (P>0.05). In addition, the proportion of hospital infections was 71.00%, and there was no statistically significant difference between male and female patients (P>0.05). A total of 353 strains of pathogenic bacteria were isolated in this study (73.37% of patients with hospital infections). The distribution analysis of pathogenic bacteria showed that the highest proportion of ECO was 35.98%, followed by Klebsiella pneumoniae (18.98%). The distribution trend of 259 strains of pathogenic bacteria among hospital patients was consistent with that of all strains, and the difference was not statistically significant (P>0.05). Gram negative bacteria accounted for 79.60% (281/353) of all detected strains, of which Escherichia coli was mostly detected in patients with spontaneous bacterial peritonitis, Klebsiella Pneumoniae (KPN) and Pseudomonas aeruginosa (PAE) were mostly detected in patients with pneumonia, and Enterococcus (ENF) was mostly detected in patients with urinary tract infection; Among gram-negative bacteria, Staphylococcus epidermidis (SEP) and Staphylococcus aureus (SAU) are mostly found in patients with other infectious causes (blood flow infection, etc.) , and Streptococcus (STR) accounts for a high proportion in patients with Spontaneous bacterial peritonitis. In this study, 9 cases of death prognosis were detected during follow-up, and there was no statistically significant difference in the detection of death prognosis between different bacterial strains in both genders, as well as the difference in detection of death prognosis between hospital infections and out of hospital infections in both genders (P>0.05). There was no statistically significant difference in the detection of death prognosis between males and females due to different causes of infection, P>0.05. The quality of life scores of 291 surviving patients were compared between baseline and follow-up, indicating an increase in follow-up scores, especially in the dimensions of physiological function and physical pain. There was no statistically significant difference between different bacterial strains, infection causes, and hospital/non hospital infections (P>0.05) . Conclusion Spontaneous bacterial peritonitis and pneumonia are the main causes of infection that deserve special attention, and the main pathogens of infection are Gram negative bacteria. Targeted treatment and rehabilitation should be provided for patients with liver cirrhosis complicated by infection. At the same time, the proportion of hospital infections is relatively high, and attention should be paid to, prevention and control measures should be implemented as well.