Post-COVID-19 pulmonary function tests in young health care workers in South Indian population – An observational study

Background: The risk of exposure to COVID-19 pandemic was substantially higher in frontline young health care workers. Due to repeated exposure while treating patients, the viral load is exponentially higher than the other population. Lungs being the earliest organ to be affected carry more risk of long-term morbidity. Thus, pulmonary function tests (PFTs) on post-COVID young health care workers provide a better view on the impact, recovery and residual effects. Aim and Objectives: The objectives of the study are as follows: (i) To assess the PFT in study group who have recovered from COVID-19 within the past 3 months; (ii) to compare their lung function with that of health care workers who have not been infected by COVID-19; and (iii) to determine obstructive, restrictive or mixed pulmonary changes if any in health care workers after 3 months of recovery. Materials and Methods: This study involving 50 young health care workers was done in the department of pulmonary medicine for a period of 4 months between January and April 2021. The study (mild COVID-19 positive) control group involved 25 participants each. PFT and diffusing capacity of lung for carbon monoxide (DLCO) were measured using computerized spirometer and single breath method. Results were analyzed using Shapiro–Wilk test, Independent sample t test, and Chi-square test. Results: A statistically significant difference was observed among the subjects of case and control group with respect to the level of FEV1 (P < 0.05), FEV1/Forced vital capacity (FVC) (P < 0.01), and FEF. FVC, Peak expiratory flow (PEF), forced expiratory time, DLCO, and peak inspiratory flow (PIF) were not statistically different between the study and control group. (P > 0.05).The 3-month post recovery values were high in males when compared to females, except for PIF, PEF and FEV1%. Conclusion: PFT and DLCO values were normal in young health care workers after 3 months of COVID-19 infection except for a decrease in FEF 25–75%.

Non-traumatic esophageal perforation: A case report on Boerhaave’s syndrome

Boerhaave’s syndrome is a potentially fatal condition characterized by spontaneous perforation of a previously healthy esophagus, due to severe vomiting or straining. It often presents with non-specific symptoms such as fever, pain, and vomiting and hence may go undiagnosed. The Makler’s triad, consisting of vomiting, chest pain, and subcutaneous emphysema, may be seen in only 50% of cases. Delayed diagnosis may result in complications such as sepsis, mediastinitis, pneumothorax, and multi-organ dysfunction. In general, patients presenting later than 48 h are conservatively managed with esophageal stenting. Surgical repair is usually reserved for those patients who present within 24 h, or are managed conservatively and develop complications. Mortality rises from 0% if treated within 24 h to about 29% if delayed more than 48 h. We present a case of Boerhaave’s syndrome in a 35-year-old male who presented with spontaneous respiratory distress and hemodynamic instability, about 36 h after the onset of vigorous vomiting. The case was managed initially with endoscopic insertion of a self-expanding metallic stent, followed later by surgical closure of the esophageal perforation. The patient, however, developed post-operative septic complications and died after a week

Wilms tumour in a two day old neonate: A rare and challenging case

Wilms tumor or nephroblastoma is the second most common renal tumor occurring in the neonatal age group next to congenital mesoblastic nephroma. The most common age group of presentation of Wilms tumor is between 3 and 4 years of age. Here, we report a case of right-sided Wilms tumor in a 2-day-old neonate. A term-born female baby presented on day 2 of birth with abdominal distension and physical examination revealed a large palpable mass in the right lumbar region crossing the midline. Imaging features were suggestive of a retroperitoneal mass of probable right renal origin. The patient was taken up for right radical nephroureterectomy and Per-operatively, there was anticipated tumor spillage. Post-operative histopathological examination was suggestive of a triphasic Wilms tumor with no anaplasia and favorable histology. The patient was diagnosed with Wilms tumor of the right kidney, COG stage III, SIOP (“International Society of Pediatric Oncology”) intermediate risk. Loss of heterozygosity testing for 1p and 16q was negative. She was started on chemotherapy with a DDA4 regimen. She completed whole abdominal radiotherapy and tolerated treatment well. The child is disease free and is under regular follow-up. This case of neonatal Wilms tumor was indeed a challenge to the pediatric surgeons and the oncologists but the final results were worth the challenge that was faced

Assessment of stress and coping mechanisms in the 1st year MBBS students from English and Vernacular medium – An experience from a new All India Institute of Medical Sciences

Background: The stress levels among the 1st year MBBS students are high due to multiple factors. In this setting, an objective assessment of stress and coping strategies among medical students may provide a foundation to adopting specific measures to help them. Aims and Objectives: The specific objectives of the study were to compare stress levels and coping strategies among medical students from different backgrounds and mediums of instructions and to ategorize the stress level of students depending on Class X, XII marks, number of attempts, and annual family income. Materials and Methods: Forty-eight 1st year MBBS students were recruited for the study. Participants were divided into two groups, that is, Group 1 – English medium schools and Group 2 – Hindi medium schools and informed consent was taken. In a preferable time slot, the participants were given two questionnaires (Zung’s SDS and Way of Coping Revised scale) and a table of personal information to fill. Results: There were significantly higher stress scores among English medium students as compared to vernacular medium. There was no correlation between Class 10th and 12th marks with the stress. Proportion of students having high stress had AFI <1 lakh and proportion having low stress had AFI more than 5 lakh. Students having more than 3 attempts in medical qualifying examination had the least stress scores. Conclusion: Stress among medical students was found to more in students from English medium schools due to the urban background of these students. High family income acts a psychological security for the students, hence the low stress among them. Students with more than 3 attempts in qualifying examination were more mature, hence the low stress score among them.

Detección clonal de cepas parentales de streptococcus agalactiae Lehmann y Neumann por amplificación aleatoria de ADN polimórfico / Clonal detection of streptococcus agalactiae Lehmann and Neumann parental strains by random amplification of polymorphic DNA

RESUMEN Streptococcus agalactiae (SGB) produce infecciones invasivas en neonatos siendo la transmisión materna la más frecuente. Estudios epidemiológicos utilizan técnicas moleculares que evalúan la diversidad genética, entre ellas la de amplificación aleatoria de ADN polimórfico (RAPD) que resulta ser accesible, sensible y utiliza cebadores arbitrarios para amplificar segmentos polimórficos de ADN mediante PCR. El objetivo fue determinar la relación clonal entre aislamientos de SGB recuperados de madres y sus respectivos recién nacidos. Se estudiaron por RAPD cuatro parejas de aislamientos de SGB obtenidos de hisopados vagino-rectales de madres y de hemocultivos de sus neonatos. Se utilizaron los cebadores OPS11, OPB17 y OPB18 para seleccionar uno con capacidad de discriminar entre cepas no relacionadas genéticamente. Se utilizó la fórmula de Hunter-Gaston que establece el índice de discriminación (D), cuando D>0,90 se considera que los aislamientos pertenecen a clones diferentes. Los perfiles de amplificación para los ocho aislamientos, empleando independientemente cada cebador, permitieron calcular un D=1 para OPS11, y D=0,84 para OPB17 y OPB18. Por lo tanto, OPS11 fue seleccionado para el estudio de la relación clonal de los aislamientos, encontrándose perfiles de amplificación similares por RAPD para cada par de cepas madre-recién nacido. Se observaron diferentes perfiles de amplificación entre los pares de cepas madre-recién nacido, lo que revela la discriminación entre cepas no relacionadas, resultados confirmados por electroforesis en campo pulsante (PFGE). Estos resultados indican transmisión vertical para cada caso estudiado y robustez del cebador OPS11. Se encontraron condiciones apropiadas del ensayo de RAPD, lo que es útil para estudios epidemiológicos.

ABSTRACT Streptococcus agalactiae (GBS) causes invasive infections in newborns, being the most frequent the maternal transmission. Epidemiological studies use molecular techniques that assess genetic diversity, including random amplification of polymorphic DNA (RAPD) that is found to be accessible, sensitive and uses arbitrary primers to amplify polymorphic segments of DNA by PCR. The objective was to determine the clonal relationship between GBS strains recovered from mothers and their respective newborns. Four pairs of GBS isolates obtained from vaginal-rectal swabs of mothers and blood cultures of their newborns were studied with RAPD. Primers OPS11, OPB17 and OPB18 were used to select one with the ability to discriminate between non-genetically related strains. The Hunter-Gaston formula that establishes the discrimination index (D) was used; when D>0.90, it is considered that the isolates belong to different clones. The amplification profiles for the eight isolates, using each primer independently, allowed to calculate a D=1 for OPS11, and D=0.84 for OPB17 and OPB18. Therefore, OPS11 was selected for the study of the clonal relationship of the isolates, and similar amplification profiles were found by RAPD for each mother-newborn pair of GBS isolates. Different amplification profiles were observed between pairs of mother-newborn strains, which reveals the discrimination between unrelated strains, confirmed by pulsating field electrophoresis (PFGE). These results indicated vertical transmission for each studied case and robustness of the OPS11 primer. Appropriate conditions of the RAPD trial were found, which is useful for epidemiological studies.

An evaluation of medication errors among staff nurses working in medicine intensive care unit of tertiary care hospital

Background: Medication errors are common problem in the hospitals leading to adverse drug event which is usually under reported by the health-care professionals; hence, the study on medication error would help to create consciousness in medical care providers and give quality care to patients and society. Aim and Objective: The aims of the study were as follows (i) To assess the types of medication error that occurs during medication use in the medicine intensive care unit (ICU) and (ii) to evaluate the adverse drug events by medication errors. Materials and Methods: The data were collected in medicine ICU Patients. Clinical data include age, gender, IP number, and diagnosis of the patient were collected. Data were analyzed on transcribed and administered medication errors. Out of 386 patients, 122 were females and 264 were males. Results: Most common age group was 41–60 year. Near seven drugs were prescribed per patient. Most common errors occurred during the drug transcribing stage (51.4%) than the administration stage (44.29%). Adverse events were more common in allergic reaction (46.15%) and musculoskeletal system (19.23%), and nervous system (11.53%). Conclusion: Medication errors are most routine problem faced in hospitals, which can significantly harm the patient. It should be recognized and their causes should be studied to minimize the recurrence and to prevent further adverse drug events.

IFTAK KSHARA SUTRA TECHNIQUE FOR THE MANAGEMENT OF INTERSPHINCTERIC PERIANAL FISTULA–IN–ANO–A CASE STUDY

An internal opening (primary opening) in the anal canal or rectum and an exterior opening (secondary opening) in the perianal skin combine to form a ?stula-in-ano, an infiammatory track. Unhealthy fibrous tissue and granulation tissue line this tract. Intersphicteric fistulas are ones that cross the internal sphincter and then have a tract to the outside of the anus leading1. The prevalence of an anal abscess-induced fistula-in-ano ranged from 26% to 38%.In men,the prevalence is 12.3 cases per 100,000 population and in women, it is 5.6 cases per 100,000 population2. Fistula-in-ano is a complicated disease, its signs and symptoms which resembles bhagandara disease described in ?yurved?. ?c?rya su?ruta mentioned this disease under aa mah?gad?s which means difficult to cure. For the management of this painful disease many treatment modalities are enumerated in ?yurved? classics and k?ra s?tra therapy is one among them which is proved to be gold standard. Though k?ra s?tra therapy is a big revolution in the field of fistula in ano, but it has some disadvantages like it is time consuming process, severe post-procedural pain, and big scar marks. In the present case report,A 24yr old male p/t c/o pain and swelling in perianal region since three months and successfully managed with IFTAK (Interception of Fistulous tract and application of Ksharsutra) technique. which showed a greatpotential in management by minimizing the duration of treatment, mild post procedural pain and minimum scar mark

Significance of Siddha Thirithoda Balancing Food Stuffs

The Siddha system of medicine is an ancient medical system, which provides ‘Holistic Health’. The word ‘Siddha’ originated from the word ‘Siddhi’ meaning achievement of perfection, eternal bliss and accomplishment. The Siddha system evolved based on ninety-six tools (96 Thattuvam) which include physical, physiological, psychological and intellectual aspects of every human being. Among the 96 tools, the five elements i.e. Pancha bootham namely Earth, Water, Fire, Air and Space are the fundamental units of everything in the human body and the cosmos. There are three vital life factors (Vaatham, Pittam, Kabham) responsible for good health. There is a relationship between these to maintain the body’s healthy. Any increase or decrease in humour causes diseases. Thirthoda sama porutkal (TSP) maintains these humour when we are using our regular diet. This article details the TSP to maintain the body healthy.

Human Body and its Relation with Planets Siddha Perspective

Siddha system is the foremost traditional system, which was introduced by ancient Siddhar’s. According to Siddhar’s, nature is man, man is nature. Man is said to be microcosm and universe is macrocosm. The universe is made up of five elements namely Earth, Water, Fire, Air, and Space. Our body is also made up of five elements (Panchaboothas), three vital humors known as Vatham (air, space), Pitham (fire), Kabam (Earth, water), seven physical constituents are Saram (nourishing fluid), Senneer (blood), Oonn (muscles), Kozhuppu (adipose tissue), Enbu (bone), Moolai (bone marrow), Sukkilam/Suronitham (sperm/ovum) respectively. The universe has stars and planets. Each planet has an influence that reflects in our bodies. Thoughts were controlled by cosmic force in the universe. Nine planets in the universe correlate with the organs in the body Sun-Heart, Moon-Brain, Mercury-Lungs, Jupiter-Liver, Saturn-Spleen, Mars-Gall Bladder. This article explains how the planets have a connection with our human body.

A Review on Chukkumthippalyadi Gulika: A Potent Herbo-Mineral Formulation in Jwara

Rasa Shastra is a branch which deals with mercury, metals, minerals, gems, herbal drugs and various principles of alchemy and metallurgy. The popular books on Kerala Ayurvedic treatment like Sahasrayoga and Chikitsamanjari describes various potent herbomineral formulations. One such Kharaleeya rasayana yoga is Chukkumthippalyadi gulika explained in Jwaraprakarana of Chikitsamanjari. This Yoga has a wide range of therapeutic utility and indicated in Tridoshaja sannipathika jwara. Jwara is the first and the most serious of all diseases so it needs to be specially attended. Ingredients in the formulation include drugs from Maharasa, Uparasa and Sadharana rasa vargikarana of Rasa dravyas which are to be used in the formulation after proper Samskaras like Sodhana and Marana. Few other controversial drugs like Gandhamarjaraveerya, and Mrigasringa are also included in the formulation. Other herbal ingredients include Sunti, Pippali, Bola, Vacha, Jeeraka, Rudraksha, Kiratatikta and Karpoora. Indication of the Yoga specifies Haret Drak Sannipathajwaram depicts its immediate action on Jwarachikitsa. Aims and Objective: The main objective of this article is to discuss the therapeutic uses of Chukkumthippalyadi gulikaand to discuss the different pharmacological properties and therapeutic uses of isolated constituent drugs of Chukkumthippalyadi gulika thus to raise an awareness of this particular formulation in the healthcare system so that they can be applied to community needs. Discussion: Most of the drug in Chukkumthippalyadi gulika is Katu, Tikta rasatmak with Ushna Veerya, Laghu, Ruksha, and Tikshna Gunatmak having Jwarghna property. Conclusion: Chukkumthippalyadi gulika is a very effective drug, it has multidimensional broad spectrum activity so this can be used in all type of Jwara.

Physico-Chemical Analysis of Panchagavya Ghritha Prepared as per Ashtanga Hridaya Reference and Comparison with Market Samples

Panchagavya Ghritha is a widely used Ayurvedic formulation mentioned in Ashtanga Hridaya Utharastana Apasmara Patishedha indicated in conditions like Apasmara (epilepsy), Jwara (pyrexia), and Kamala (jaundice). It contains 5 ingredients namely Goshakrit rasa (cow dung juice), Amladadhi (sour curd), Goksheera (cow’s milk), Gomutra (cow’s urine) and Goghritha (ghee). Authentic sources of cow products are not often obtained and found adulterated. Collection and processing of fresh raw materials are an important area in this formulation This study was conducted to find out the non conformances and quality issues in Panchagavya ghritha production in industrial level. The comparative analysis of prepared and market samples based on standard analytical parameters proposed by PLIM reveals the variation in different organoleptic characters and physico-chemical parameters. The physico-chemical parameters among prepared and different companies were statistically analysed with ANOVA test and Scheffe’s pair wise comparison, showed significant difference at 0.01 levels.

Multi Drug Resistance and Multi Antibiotics Resistance Index of Acinetobacter baumannii Isolated from Hospitals in Port Harcourt Metropolis

Acinetobacter species are aerobic gram-negative bacilli that can cause healthcare-associated infections and can survive for prolonged periods in the environment. Also on the hands of healthcare workers, infection due to Acinetobacter species is a major challenge within the health care facilities and the community in general due to their high drug resistance. The study was aimed at detecting multi drug resistance and multi antibiotics resistance index (MARI) of acinetobacter baumannii isolated from hospitals in Port Harcourt meteropolis in Rivers State, Nigeria. The cross sectional study sampled randomly; as urine and wound swab samples were collected from patients. Acinetobacter spp was isolated using standard microbiological methods. Identification of A. baumannii isolates were done using Phynotypic methods such as culture on Lead Acinetobacter medium and conventional biochemical tests. Antimicrobial susceptibility test was done by Kirby Bauer’s disk diffusion method under Clinical Laboratory Standards Institute (CLSI, 2013) guide Suspect Acinetobacter species were further identified using polymerase chain reaction (PCR) and Sanger sequence typing methods. The results of confirmatory sequence typing of isolates showed that 9 of suspect Acinetobacter spp were A. baumannii. The results of this finding showed presence of A. baumannii species resistant to conventional antibiotics. All isolates demonstrated.MDR and XDR. MARI was high. (>0.2) indicating MDR and high risk. This study established high rate of multidrug resistant Acinetobacter baumanii. There is need for improved sanitary working condition and proper patients’ management to reduce the spread of this health care associated infection as well as a Search for new therapeutic alternative and policies to control the use of antibiotics.

Review on the Ethnobotany, Phytochemical and Pharmacological Profile of Senna occidentalis L. (Fabaceae): Potential Application as Remedy in the Treatment of Dysmenorrhea

Senna occidentalis L. has been used in several traditional medicines against various diseases and this is based on its botanical, ethnopharmacology, and phytochemistry profiles. This powerful herb is recognized for its antibacterial, antifungal, antidiabetic, anticancer, antimutagenic, protective, and inflammatory hepatic activity. Multiple chemical compounds, including achrosine, aloe-emodin, emodin, anthraquinones, etc., have been isolated from this plant. The results of this bibliographic research thus presented in this review have demonstrated the ability of certain extracts from S. occidentalis L. to lower the lipid peroxide content, the activity of gamma-glutamyl transpeptidase and phospholipase A2 in exudates of the granuloma of cotton pellets, thus resulting in a reduced availability of arachidonic acid, an important precursor in the biosynthesis of prostaglandins, which are the only likely source and/or cause of dysmenorrhea. Thus, based on its phytochemical profile and its pharmacological properties, it is therefore suggested that S. occidentalis would be a potential and effective remedy in the treatment of dysmenorrhea

Knowledge, attitude, and practices of 2nd year MBBS students regarding the use of face mask to limit the spread of the new coronavirus disease

Background: The onset of the aggressive Coronavirus disease 19 (COVID-19) pandemic has necessitated masks for the health care community. For healthcare workers, proper knowledge, a good attitude and increased comfortability with masks are of great essence. Knowledge of proper use and handling of masks among health care workers and medical students is of utmost importance as they protect the wearer and those around from transmission of infection. Aim and Objectives: To assess the Knowledge, Attitude, and Practices of 2nd year MBBS Students Regarding the Use of Face Mask to Limit the Spread of the New COVID-19. Materials and Methods: After obtaining ethical approval from the Institutional Ethical Committee with an ethical approval no. of IEC/2020/2/42, a questionnaire with 14 questions was prepared to investigate the knowledge, attitude, practices, and problems faced by 2nd Year MBBS students with regards to wearing a face mask during the COVID-19 pandemic. The questionnaire was sent electronically, consent was obtained and the responses were analyzed. Results: Assessment of knowledge revealed that 87.3% of participants knew the correct way of using a mask, 87.3% knew that there are three layers in it and 83.3% knew that the middle layer acts as the filter media barrier. Only 32.4% of participants knew that a surgical mask can be used for 8 hours and 92.2% incorrectly indicated cloth masks to be as effective in protection from COVID-19 as surgical masks are. About 97.1% of participants knew the purpose of metal strips and 93.1% knew the extent to which a surgical mask must cover. The attitude was excellent with 95.1% of participants believing that surgical masks can help, 90.2% saying they knew the steps of wearing a mask, and participants wearing masks at all times when conversing with patients and in public as well. Perturbingly, only 24.5% of participants faced no issues when wearing a mask. Conclusion: Overall, respondents displayed thorough knowledge and exuded a highly positive attitude but less than a fourth of respondents faced no issues while wearing a mask. Continued educational efforts and more research into mask comfort is the need of the hour.

Isolation, Identification and Mode of action of Partially Purified Bacteriocins from Lactic Acid Bacteria in Fermented Cassava Grits

The study on the isolation, identification and mode of action of partially purified bacteriocin from lactic acid bacteria found in fermented cassava grits was carried out. Fermented cassava grits were collected from different garri processing plants and transported with cold box to the laboratory for analysis. The viable microbial count after the partially purified bacteriocin from the various lactic acid bacteria isolates were grown against the food borne bacteria (Staphylococcus aureus and Bacillus subtilis) ranged from 0.98 x 103 CFU/ml for partially purified bacteriocin from isolate 6 at 8 hrs to 9.2 x103 CFU/ml for isolate 3 at 24 hrs. Similar results were obtained against Bacillus subtilis with microbial counts that ranged from 1.02 x102 CFU/ml for isolate 3 at 8 hrs to 9.2 x 102 CFU/ml at 24 hrs. Isolates 6, 7, 10 and 11 were bactericidal to both Staphylococcus aureus and Bacillus subtilis while isolate 3 was bacteriostatic. The viable microbial count after the partially purified bacteriocin was grown against the foodborne bacteria (Escherichia coli and Salmonella typhi) ranged from 1.0 x102 CFU/ml for partially purified bacteriocin from isolate 3 at 8 hrs to 7.1 x 102 CFU/ml for partially purified bacteriocin from isolate 6 at 24 hours. The microbial count against Salmonella typhi ranged from 6.50 x 102 CFU/ml for isolate 6 at 8 hrs to 8.5 x 102 CFU/ml for isolate 7 at 24 hrs. Partially purified bacteriocins from isolates 3 and 7 were bacteriostatic while isolates 6, 10 and 11 were bactericidal to Escherichia coli and Salmonella typhi. This result showed that the partially purified bacteriocins were very efficacious in killing or inhibiting the growth of some foodborne pathogens which can be applied in biopreservation.

Perception and Practices of COVID-19 in Rural Areas of Southeastern Nigeria: A Community-based Cross-sectional Survey

Aims: Despite all efforts made globally by governments of various nations and all concerned agencies through preventative measures, quick testing, isolation, shutting down of societies and economy, the virus still succeeded in spreading through communities perhaps due to the wrong perspective, in addition to surveillance, prevention and management challenges. This study evaluated the perception and practices of covid-19 in rural areas of southeastern Nigeria. Study Design: The study adopted a community-based cross-sectional survey design that investigated awareness, perspective, surveillance challenges, prevention, management and economic impact in rural settlement areas of south-east, Nigeria. Place and duration of study: This study was be conducted in rural settlement areas of south-east Nigeria (Abia, Anambra, Ebonyi, Enugu, and Imo states). February � April, 2021. Methodology: Data was collected by the use of the questionnaire. Five hundred copies were administered per state. Results: Most participants (2464, 98.6%) heard first of COVID-19 through radio/television (1409, 56.3%), social media (539, 21.5%) and their friends/relatives (418, 16.7%); 1896 (75.8%) believed in the existence of COVID-19 infection. However, the majority in Ebonyi state (309, 61.8%) had their disbelief on the existence of COVID-19. Participants confirmed having knowledge of COVID-19 testing (2319, 92.8%) and isolation centers (2299, 92.0%), however, a major challenge was lack of (1698, 67.9%) or no awareness (550, 22.0%) of masses testing centre in their areas. A few individuals (392, 15.7%) reported having experienced one or two COVID-19 symptoms about 3 months ago. Knowledge on how to prevent contracting COVID-19 is relatively high (66.7%) among the respondents. COVID-19 induced economic burden amongst residents were mainly as a result of the imposition of lockdown to movements and businesses (1098, 43.9%), disruption of studies (959, 38.4%), increased hunger (950, 38.0%), high expenditure (894, 35.8%) and loss of job/income (816, 32.6%). Conclusion: It is concluded that the majority of the people in southeast Nigeria are aware of the possible existence of Covid-19 in their area.

Management of community acquired pneumonia (CAP) in children: Clinical practice guidelines by the Paediatric Association of Nigeria (PAN

The Paediatric Association of Nigeria first published management guideline for community-acquired pneumonia in 2015 and covered available evidence at that time. This update represents a review of available recent evidence statements regarding the management of pneumonia in children, while at the same time incorporating relevant materials from the first edition of the guideline. The guideline is developed to assist clinicians in the care of children with CAP. The recommendations provided in this guideline may not be the only approach to management, since there are considerable variations among children in the clinical course of CAP.The goal of this guideline is to reduce morbidity and mortality rate of CAP in children by providing recommendations that may be relevant in assisting clinicians to make timely diagnosis and institute appropriate antibiotic therapy of children with CAP. Summarized below are recommendations made in the new 2021 CAP guideline. As part of the recommendations, the quality of the evidence is provided and the grade of the recommendation indicated.The details of the background, methods and evidence summaries that support each of these recommendations can be found in the full text of the guideline.

Retinal changes among pre-eclamptic patients in University of Benin Teaching Hospital, Benin, Nigeria

Background: Preeclampsia is one of the hypertensive disorders in pregnancy that contributes significantly to maternal and fetal morbidity and mortality, with the impact felt more in developing countries. It is characterized by endothelial dysfunction and vasospasm of vessels which can be observed by an ocular fundal examination. The aim of this study was to determine the ocular fundus findings of women with preeclampsia. Methods: This was a cross-sectional study, carried out at the University of Benin Teaching Hospital involving a total of 220 pregnant women. The women were divided into two groups of 110 pregnant women (A&B).Their Age and Gestational age was cross-matched and retinopathy graded according to Keith and Wagner classification. Group A was made up of Preeclamptic women and Group B was made up of healthy pregnant women. Visual acuity was measured using Snellens' chart, and the fundus was examined with direct ophthalmoscope. Results: This showed that the retinal changes observed in the preeclamptic women were associated with their age (P = 0.009), gestational age (P = 0.044), blood pressure (P = 0.001), Proteinuria (P = 0.001), Severity of the disease (P = 0.001), visual acuity (P = 0.035) as well as with the visual symptoms (P = 0.001) but not statistically significant with the gravida (P = 0.799). Conclusion: Our study highlights the importance of timely ophthalmoscopy which helps to assess severity of disease (pre-eclampsia) which affects the decision of induction of delivery to predict and prevent possible complications which in turn immensely helps in judicious management of disease. Also, the study revealed that preeclamptic women who are multigravida are more likely to have retinopathy than primigravid

Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality / 대한뇌졸중학회지

Background@#and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. @*Methods@#We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). @*Results@#There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. @*Conclusions@#During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.