Measuring the Autistic Women's Experience (AWE).

We developed a Dutch questionnaire called the Autistic Women's Experience (AWE) and compared its psychometric properties to the Autism Spectrum Quotient (AQ). Whilst attenuated gender differences on the AQ have been widely replicated, this instrument may not fully capture the unique experience of autistic women. The AWE was co-developed with autistic women to include items that reflect autistic women's experience. We investigated the AWE (49 items) and compared it with the AQ (50 items) in Dutch autistic individuals (N = 153, n = 85 women) and in the general population (N = 489, n = 246 women) aged 16+. Both the AQ and AWE had excellent internal consistency and were highly and equally predictive of autism in both women and men. Whilst there was a gender difference on the AQ among non-autistic people (men > women), there was no gender difference among autistic people, confirming all earlier studies. No gender differences were detected on the AWE overall scale, yet subtle gender differences were observed on the subscales. We conclude that the AQ is valid for both genders, but the AWE provides an additional useful perspective on the characteristics of autistic women. The AWE needs further validation in independent samples using techniques that allow for testing gender biases, as well as a confirmatory factor analysis in a larger sample.

Damage control surgery of the critical Jehovah's Witness patient - a narrative review.

SUMMARY: South Africa has a high burden of trauma related injuries with haemorrhage remaining a leading treatable complication of trauma. Expedient management of haemorrhage serves to reduce patient morbidity and mortality. Damage control surgery aims to minimise haemorrhage, contain contamination, and allow restoration of physiology in an intensive care unit (ICU) before proceeding to definitive surgery. Over time, damage control surgery has found favour in non-traumarelated surgeries in unstable patients. The Jehovah's Witness (JW) religion believes that blood is sacred and strictly do not consent to blood or blood product transfusions, including in emergency settings. Thus, the management of a bleeding or bled-out JW patient proves to be a unique challenge in modern medicine. For the JW patient who is undergoing damage control surgery, the primary goal is to win time for recovery of the haemoglobin level by maintaining adequate oxygen delivery to tissues. We review the multiple methods available to optimise haemodynamic stability in a bleeding JW patient. These include techniques aimed at (i) minimising blood loss, (ii) optimising oxygen delivery (DO2), (iii) optimising oxygen consumption (VO2), and (iv) correction of coagulopathy. The management of haemorrhage in the JW patient remains challenging. It is imperative for healthcare professionals to be aware of all options available when treating these patients in order to provide optimal treatment whilst maintaining respect for their beliefs.

Visioning a food system for equitable transition towards sustainable diets.

The Global Goals to end hunger requires interpretation of problems, and change across multiple domains. We facilitated a workshop aimed at understanding how stakeholders problematise sustainable diet transition (SDT) among a previously-marginalised social group. Using the systems thinking approach, three sub-systems, access to dietary diversity, sustainable beneficiation of natural capital, and 'food choice for well-being', highlighted the main forces governing the current context, and future interventions. Moreover, when viewed as co-evolving processes within the multi-level perspective, our identified microlevel leverage points - multi-faceted literacy, youth empowerment, deliberative policy-making, promotion of sustainable diet aspirations - can be linked and developed through existing national macrolevel strategies. Thus, by reconsidering knowledge use in the pursuit sustainability, transformational SDT can streamline multiple outcomes to restructure socio-technical sectors, reconnect people to nature-based solutions and, support legitimate aspirations. The approach could be applied in countries having complex socio-political legacy and to bridge the local-global goals coherently.

Refeeding syndrome in surgical patients post initiation of artificial feeding, a prospective cohort study in a low-income country.

BACKGROUND & AIMS: South Africa's inequitable history has contributed to a malnourished population, further aggravated by high levels of violence and economic uncertainty culminating in a population suffering the sequelae of poverty. The perceived notion is that malnutrition places the South African population at greater risk for development of refeeding syndrome. This study aimed to identify the incidence of refeeding syndrome in the South African population. METHODS: All patients admitted into the surgical intensive care unit from 1 November 2019 to 30 September 2020, were screened using the National Institute for Health and Care Excellence (NICE) refeeding risk criteria. Patients started on artificial feeds with one or more risk factors were included in the study. The syndrome was confirmed using the King's College criteria and compared with the American Society for Parenteral and Enteral Nutrition (ASPEN) criteria for refeeding syndrome. RESULTS: 200 Patients were included in this study. The median age of the sample population was 41 years (IQR 30-58) with a male predominance (63%). All patients included had one or more risk factors and 62 (31%) of patients fulfilled the NICE criteria. The sensitivity of the NICE criteria was 33% and specificity was 70%. The most common risk factors identified were little or no nutritional intake for >5 days (55%) followed by a history of alcohol abuse, drugs including insulin, chemotherapy, diuretics or antacids (18%). Specificity values for all risk factors were >80% apart from little or no nutritional intake for >5 days which had a specificity of 64.2%. Sensitivity values for all risk factors were low. 84.5% of patients received artificial nutritional support in the form of enteral feeds, 9% parenteral and 6.5% both enteral and parenteral feeds. A total of 146 patients required electrolyte supplementation. Three patients fulfilled the King's College criteria and one subsequently died. In comparison, 25 patients fulfilled the ASPEN criteria and 3 demised. CONCLUSION: Due to the low sensitivity and specificity of the NICE criteria, we advise that it be used merely as a guideline to identify patients at risk of refeeding syndrome and one should remain vigilant in patients with any risk factors present. Due to the small number of patients who fulfilled the King's College criteria and significant difference in incidence when compared to the ASPEN definition, a conclusion regarding the accuracy of both diagnostic criteria could not be made. We recommend a review of the current definition and a global adoption of an agreed criteria for the estimation of the true prevalence.

Factors associated with mortality in patients with COVID-19 admitted to intensive care: a systematic review and meta-analysis.

Identification of high-risk patients admitted to intensive care with COVID-19 may inform management strategies. The objective of this meta-analysis was to determine factors associated with mortality among adults with COVID-19 admitted to intensive care by searching databases for studies published between 1 January 2020 and 6 December 2020. Observational studies of COVID-19 adults admitted to critical care were included. Studies of mixed cohorts and intensive care cohorts restricted to a specific patient sub-group were excluded. Dichotomous variables were reported with pooled OR and 95%CI, and continuous variables with pooled standardised mean difference (SMD) and 95%CI. Fifty-eight studies (44,305 patients) were included in the review. Increasing age (SMD 0.65, 95%CI 0.53-0.77); smoking (OR 1.40, 95%CI 1.03-1.90); hypertension (OR 1.54, 95%CI 1.29-1.85); diabetes (OR 1.41, 95%CI 1.22-1.63); cardiovascular disease (OR 1.91, 95%CI 1.52-2.38); respiratory disease (OR 1.75, 95%CI 1.33-2.31); renal disease (OR 2.39, 95%CI 1.68-3.40); and malignancy (OR 1.81, 95%CI 1.30-2.52) were associated with mortality. A higher sequential organ failure assessment score (SMD 0.86, 95%CI 0.63-1.10) and acute physiology and chronic health evaluation-2 score (SMD 0.89, 95%CI 0.65-1.13); a lower PaO2 :FI O2 (SMD -0.44, 95%CI -0.62 to -0.26) and the need for mechanical ventilation at admission (OR 2.53, 95%CI 1.90-3.37) were associated with mortality. Higher white cell counts (SMD 0.37, 95%CI 0.22-0.51); neutrophils (SMD 0.42, 95%CI 0.19-0.64); D-dimers (SMD 0.56, 95%CI 0.43-0.69); ferritin (SMD 0.32, 95%CI 0.19-0.45); lower platelet (SMD -0.22, 95%CI -0.35 to -0.10); and lymphocyte counts (SMD -0.37, 95%CI -0.54 to -0.19) were all associated with mortality. In conclusion, increasing age, pre-existing comorbidities, severity of illness based on validated scoring systems, and the host response to the disease were associated with mortality; while male sex and increasing BMI were not. These factors have prognostic relevance for patients admitted to intensive care with COVID-19.

[Surgically assisted rapid maxillary expansion. Effects on the nasal airways and nasal septum]. / Chirurgisch unterstützte transversale Oberkieferdistraktion. Auswirkungen auf Nasenwege und Nasenseptum.

BACKGROUND: Surgically assisted rapid maxillary expansion (SARME) is a standardized method to treat cross bites in maxillofacial surgery. Changes to the nasal airways are assumed due to the anatomic dependence between the palate and the nasal floor. PATIENTS AND METHODS: In this study 19 patients with a transverse deficit of the upper jaw underwent SARME. CT scans were performed 1 month pre- and 6 months postoperatively. Effects to the lower nasal airways, the nasal septum and the hard palate were subsequently evaluated. RESULTS: The mean distraction width of the upper jaws was 5.84 mm (SD 2.19) postoperatively. In addition to the dentoalveolar gain in width, a significant increase in the nasal floor was observed (p<0.001). The anterior part of the nasal floor was increased by 14.11%. An anterior-caudal tilt of the upper jaw was observed in the anterior part measuring 1.5 mm (SD 1.05). No significant deviation of the nasal septum occurred. CONCLUSION: SARME has a significant effect on ear, nose and throat medicine. Nasal airways enlarge significantly, while no significant deviation of the nasal septum is observed.

Proximal renal tubular acidosis in pregnancy. A case report and literature review.

Renal tubular acidosis is usually associated with chronic renal conditions and is rarely encountered in pregnancy. It may be inherited causing osteomalacia and rickets in children or acquired following autoimmune diseases or following exposure to nephrotoxic agents. It is known to worsen during pregnancy and if left untreated may cause maternal and foetal morbidity or death. We report a 28-year-old woman, gravida 3 para 2, who presented at 30 weeks gestation with lethargy, weakness and generalized myalgia. Investigation revealed severe hypokalaemia and a systemic metabolic acidosis due to proximal renal tubular acidosis. Her previous pregnancies were both complicated by foetal losses at term. Following prompt correction of her electrolyte disturbance and metabolic acidosis, she went on to deliver a healthy female infant at term. Regular evaluation up to 1 year post-partum revealed mild persistence of her hypokalaemia. At 1 year, the infant showed no signs of the disorder and is growing normally.

[CT assisted mandibular osteodistraction with reconstruction of the temporomandibular joint and two piece maxilla]. / CT-basierte Distraktion des Unterkiefers mit Gelenkrekonstruktion und Impaktation der Maxilla bei Kiefergelenkankylose.

BACKGROUND: The possibilities for computer assisted planning and its surgical conversion with stereolithographic templates are shown for complex maxillofacial surgical interventions. CASE REPORT: We describe the case of a patient with extreme micrognathia due to an ankylosis of the temporomandibular joint. In addition to the exact determination of the osteotomy lines on the mandibular angle and the segment osteotomy of the maxilla, vectors of the bidirectional osteodistraction were also predictable. CONCLUSION: In comparison with the conventional procedures, computer assisted planning achieved a much higher degree of precision and safety with reduced complication rates. The CMF module is a component of the SimPlant software which enables the precise planning of osteotomies and osteodistractions.

Optimized method for measuring aspartate aminotransferase activity with the CentrifiChem Analyzer, with automatic preincubation of serum.

We propose a routine method for the mechanized measurement of aspartate aminotransferase with the CentrifiChem Analyzer, which is based on the recommendations of both the International Federation of Clinical Chemistry and the Société Française de Biologie Clinique. A modification of the CentrifiChem pipettor permits simultaneous pipetting of two reagents, thus achieving automatic preincubation of the serum in the transfer disk. Owing to the fixed reagent volumes dispensed by the pipettor, preincubation conditions had to be modified, but the recommendations for the final reagent concentrations in the assay cuvet were observed. The totally automated method correlates very well with one involving manual pipetting to reproduce the detailed step-by-step recommendations of the International Federation of Clinical Chemistry. Intra-assay precision ranged from 3.4 to 4.9% and interassay precision from 1.7 to 7.5%. We assayed 135 sera and obtained a correlation coefficient of 0.996 (a = 1.025, b = 0.08).