Financial Capability and Financial Well-Being Challenges and Vulnerabilities of Adults Living With Acquired Brain Injury: A Pilot Survey.

Objective: To describe the financial capability (FC) and financial well-being (FWB) of adults living with acquired brain injury (ABI) from a lived experience perspective. Design: People living with ABI completed a 32-item and close others a 22-item anonymous survey using either online or print/mail-in options. Setting: Responses were collected from adults in the province of Manitoba (Canada) during August-October 2021. Participants: Respondents were adults (18+) living with ABI (n=38) or close others of ABI survivors (n=19). Adults living with ABI experienced traumatic brain injury (n=22; 58%), stroke (n=8; 21%), or other ABI mechanisms (n=8; 21%). Nineteen (50%) respondents with ABI were men, 17 (45%) were women, and 1 (2.5%) was nonbinary; 95% were more than 1-year post-ABI. Close others were spouses/partners, parents, other family, and paid caregivers. Three of the 19 close others self-reported as men and 16 as women. Interventions: n/a. Main Outcome Measures: n/a. Results: For key FC indicators, 13 (34%) people living with ABI felt their current knowledge and skills were insufficient, and 26 (70%) felt that ABI had affected their ability to make financial decisions or complete financial activities. Fourteen of the 19 close others have worried about the finance-related choices, skills, or behaviors of the person living with ABI, and 17 felt that ABI symptoms had affected the FC of the person living with ABI. For key FWB indicators, 22 (58%) adults living with ABI felt stressed or anxious about finances at least some of the time. Seventeen (45%) of the adults living with ABI reported having trouble making ends meet at least some of the time. Conclusions: Respondents reported FC limitations and FWB challenges for people living with ABI, which can be indicative of financial vulnerabilities and unmet needs. Future research should explore optimal ways to address these financial-related challenges after ABI.

Carpal Tunnel Decompression Under Wide Awake Local Anaesthesia No Tourniquet Technique (WALANT): A Cost Effective and Outcome Analysis.

Introduction Wide-awake local anaesthesia with no tourniquet (WALANT) technique is cost-effective, resource-friendly, and safe. This can be used as an alternative to hand surgery procedures in outpatient units. It can be performed in clinics or operating rooms. Methods We retrospectively evaluated the outcomes of WALANT for carpal tunnel decompression (CTD) over two years. Measured results include wound infections, relief of symptoms, paraesthesia, haematoma, Visual Analogue Scale (VAS), hospital anxiety and depression scale score (HADS) and cost-effectiveness. Results Eighteen patients underwent CTD under the WALANT technique over two years. VAS score was recorded at 3.1 ± 1.2 during the procedure and 1.67 ± 0.933 at two weeks follow-up. Persistent paraesthesia was found in only one patient at follow-up. Minimal bleeding was recorded during the procedure. No wound infections, revision surgery or post-operative haematoma formation were found. Hospital Anxiety and Depression Scale (HADS) was reported as 4.77 ± 2.1 after surgery. WALANT was also cost-effective, with an overall amount of £20. Conclusion Performing carpal tunnel decompression under WALANT in one stop upper limb clinic is a safe and cost-effective technique with no significant patient-related complications.

A Rare Case of a Child Diagnosed With Multisystem Inflammatory Syndrome After COVID-19 Presenting With Renal Infarctions and Transient Blast Cells: A Case Report and Literature Review.

Multisystem inflammatory syndrome in children (MIS-C) can develop weeks after the Coronavirus disease 2019 (COVID-19). The disease's clinical spectrum includes persistent febrile illness, features resembling Kawasaki disease, and cytokine storm symptoms. In severe cases, multisystem organ failure and death may result if not treated promptly. This report discusses a rare case of a 13-year-old girl presenting with fever and acute kidney injury (AKI) eight weeks after recovering from COVID-19 who was diagnosed with MIS-C. A 13-year-old female presented with a fever and abdominal pain following a recent COVID-19. A physical examination revealed a febrile, ill-looking child with abdominal tenderness. Pancytopenia, transaminitis, AKI, and a hyperinflammatory state were noted in the initial laboratory workup. Furthermore, blast cells were seen on the peripheral blood smear. Despite appropriate empiric antibiotic therapy for sepsis, she did not show signs of clinical improvement. An abdominal computed tomography (CT) scan revealed multiple focal areas of hypoattenuating lesions involving both kidneys, suggestive of bilateral renal infarction. Since she met the criteria of the Centers for Disease Control and Prevention (CDC) for MIS-C diagnosis, a high dose of intravenous immunoglobulin (IVIG) led to a dramatic improvement in the patient's condition and complete recovery from her illness. This case report describes a rare clinical presentation of MIS-C in a child who presented with AKI due to presumably thrombotic events and transient blast cells in blood film secondary to a severe inflammatory process. Further studies are needed to determine the prevalence of thrombotic AKI associated with MIS-C.

Alterations of Hematological Parameters, Hemoglobin and Hematocrit With Liver Enzymes, Aspartate Transaminase and Alanine Transaminase Among Patients With Chronic Kidney Disease Undergoing Hemodialysis in Aljouf Region, Saudi Arabia.

BACKGROUND: Anemia results from low kidney production of the erythropoiesis-stimulant erythropoietin. Good liver function is crucial to patients with chronic kidney disease (CKD). This study analyzed two hematological parameters (hemoglobin (Hb) and hematocrit (Ht)) and two liver enzymes, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in patients with CKD undergoing hemodialysis (HD). METHODS: Three hundred and thirty individuals participated in this study. Of them, 159 patients with CKD undergoing HD and 171 healthy individuals as a control group were recruited between January and October 2017. Blood was collected into EDTA containers for complete blood count (CBC) and into additive plain containers for ALT and AST. Relevant case history data were also taken. RESULTS: Obtained results for first and second month of Hb, Ht, AST and ALT of CKD patients undergoing HD were lower (10.2 g/dL and 8.9 for Hb; 27.2% and 24.8% for Ht; 17.8 IU/L and 15.6 IU/L for ALT; 13.9 IU/L and 12.0 IU/L for AST, respectively) (P < 0.05) compared to healthy individuals (15.1 g/dL for Hb; 44.6% for Ht; 28.3 IU/L for ALT and 23.0 IU/L for AST). Furthermore, Hb, Ht, AST and ALT levels were significantly lower (P < 0.05) in their second month compared to the first month. CONCLUSIONS: Anemia might emerge in CKD patients because of low Hb concentration and consequent low Ht. Advanced stage CKD causes decreased AST and ALT, as a result of lipid metabolism disturbances. Therefore, anemia and liver diseases are recommended to be treated in CKD patients to alleviate related complications. Renal transplantation must be performed earlier for them to avoid further complications.

Comparison of jeopardy game format versus traditional lecture format as a teaching methodology in medical education.

OBJECTIVE: To compare students` performance, satisfaction, and retention of knowledge between a `jeopardy game format` and a `didactic lecture format` in teaching viral exanthema to fifth-year medical students. METHODS: We conducted a parallel-group randomized controlled trial in the Department of Pediatrics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia from November 2008 to January 2009. We randomized fifth-year medical students into 2 groups. We taught viral exanthema to group one in lecture format, while group 2 received the same instruction in a jeopardy style game format. Both groups underwent a pretest, post-test I, and satisfaction survey. We conducted post-test II after 2 months to assess the retention of knowledge. The satisfaction survey consisted of 5 questions using a 5 point Likert scale. We used the paired sample t-test, and independent sample t-test to compare the results. RESULTS: Eighty-two students participated in the study (41 in each group). Both groups showed significant improvement in their knowledge on the post-test I compared with the pre-test scores. However, the post-test II conducted after 2 months showed that retention of knowledge was significantly better in the game format. The satisfaction survey showed that the game format was more enjoyable and fun. CONCLUSION: The game format teaching strategy has an added advantage in retaining knowledge of the subject for a longer time compared with a lecture format.

Cerebral oxygenation in awake rats during acclimation and deacclimation to hypoxia: an in vivo electron paramagnetic resonance study.

Exposure to high altitude or hypobaric hypoxia results in a series of metabolic, physiologic, and genetic changes that serve to acclimate the brain to hypoxia. Tissue Po(2) (Pto(2)) is a sensitive index of the balance between oxygen delivery and utilization and can be considered to represent the summation of such factors as cerebral blood flow, capillary density, hematocrit, arterial Po(2), and metabolic rate. As such, it can be used as a marker of the extent of acclimation. We developed a method using electron paramagnetic resonance (EPR) to measure Pto(2) in unanesthetized subjects with a chronically implanted sensor. EPR was used to measure rat cortical tissue Pto(2) in awake rats during acute hypoxia and over a time course of acclimation and deacclimation to hypobaric hypoxia. This was done to simulate the effects on brain Pto(2) of traveling to altitude for a limited period. Acute reduction of inspired O(2) to 10% caused a decline from 26.7 ± 2.2 to 13.0 ± 1.5 mmHg (mean ± SD). Addition of 10% CO(2) to animals breathing 10% O(2) returned Pto(2) to values measured while breathing 21% O(2,) indicating that hypercapnia can reverse the effects of acute hypoxia. Pto(2) in animals acclimated to 10% O(2) was similar to that measured preacclimation when breathing 21% O(2). Using a novel, individualized statistical model, it was shown that the T(1/2) of the Pto(2) response during exposure to chronic hypoxia was approximately 2 days. This indicates a capacity for rapid adaptation to hypoxia. When subjects were returned to normoxia, there was a transient hyperoxygenation, followed by a return to lower values with a T(1/2) of deacclimation of 1.5 to 3 days. These data indicate that exposure to hypoxia results in significant improvements in steady-state oxygenation for a given inspired O(2) and that both acclimation and deacclimation can occur within days.