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1.
Pediatr Surg Int ; 40(1): 133, 2024 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-38753201

RESUMO

BACKGROUND/OBJECTIVE: Differentiation of uretero-pelvic junction obstruction (UPJO) from non-obstructive dilatation (NOD) is a major challenge. The aim of this retrospective study is to determine whether pyeloplasty prediction score (PPS) could predict the need for surgery and resolution after surgery. METHODS: Among patients with antenatally diagnosed hydronephrosis, those who were stable during post-natal follow-up were considered NOD. The UPJO group were the ones who worsened and underwent pyeloplasty based on conventional indications. All patients with UPJO underwent laparoscopic dismembered pyeloplasty. PPS was determined based on three ultrasound parameters obtained retrospectively: Society of Fetal Urology (SFU) grade of hydronephrosis, transverse anteroposterior (APD), and the absolute percentage difference of ipsilateral and contralateral renal lengths. RESULTS: Among 137 patients included (R:L = 59:73; M:F 102:35), 96 were conservatively managed (NOD), while 41 patients (29%) needed pyeloplasty (UPJO). Mean PPS was 4.2 (1.2) in the NOD group and it was significantly higher at 10.8 (1.63) in the UPJO group (p = 0.001). All patients with PPS > 8 needed a pyeloplasty, while two patients with PPS of 7 needed pyeloplasty due to drop in renal function. PPS cutoff value of >8 had a sensitivity 95%, specificity 100% and a likelihood ratio of 20. Post-pyeloplasty PPS resolution was proportional to the duration of follow-up. CONCLUSIONS: A PPS cutoff value of 8 or above is associated with the presence of significant UPJO. PPS is also useful in the assessment of hydronephrosis recovery post-pyeloplasty. The limitation of PPS: it can only be applied in the presence of contralateral normal kidney.


Assuntos
Hidronefrose , Pelve Renal , Ultrassonografia , Obstrução Ureteral , Humanos , Estudos Retrospectivos , Obstrução Ureteral/cirurgia , Obstrução Ureteral/diagnóstico por imagem , Feminino , Masculino , Hidronefrose/cirurgia , Hidronefrose/diagnóstico por imagem , Pelve Renal/cirurgia , Pelve Renal/diagnóstico por imagem , Ultrassonografia/métodos , Lactente , Procedimentos Cirúrgicos Urológicos/métodos , Recém-Nascido , Resultado do Tratamento , Laparoscopia/métodos
2.
Obes Surg ; 2024 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-38662251

RESUMO

OBJECTIVE: This study aimed to evaluate the technical variations of one-anastomosis gastric bypass (OAGB) among IFSO-APC and MENAC experts. BACKGROUND: The multitude of technical variations and patient selection challenges among metabolic and bariatric surgeons worldwide necessitates a heightened awareness of these issues. Understanding different perspectives and viewpoints can empower surgeons performing OAGB to adapt their techniques, leading to improved outcomes and reduced complications. METHODS: The scientific team of IFSO-APC, consisting of skilled bariatric and metabolic surgeons specializing in OAGB, conducted a confidential online survey. The survey aimed to assess technical variations and considerations related to OAGB within the IFSO-APC and IFSO-MENAC chapters. A total of 85 OAGB experts participated in the survey, providing their responses through a 35-question online format. The survey took place from January 1, 2024, to February 15, 2024. RESULTS: Most experts do not perform OAGB for children and adolescents younger than 18 years. Most experts create the gastric pouch over a 36-40-F bougie and prefer to create a gastrojejunostomy, at the posterior wall of the gastric pouch. An anti-reflux suture during OAGB is performed in all patients by 51.8% of experts. Most experts set a common limb length of > 4 m in revisional and conversional OAGBs to prevent nutritional complications. CONCLUSION: The ongoing debate among metabolic and bariatric surgeons regarding the technical variations and patient selection in OAGB remains a significant point of discussion. This survey demonstrated the variations in technical aspects and patient selection for OAGB among MBS surgeons in the IFSO-APC and IFSO-MENAC chapters. Standardizing the OAGB technique is crucial to ensure optimal safety and efficacy in this procedure.

3.
Front Public Health ; 12: 1325922, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38450144

RESUMO

South Asia is a demographically crucial, economically aspiring, and socio-culturally diverse region in the world. The region contributes to a large burden of surgically-treatable disease conditions. A large number of people in South Asia cannot access safe and affordable surgical, obstetric, trauma, and anesthesia (SOTA) care when in need. Yet, attention to the region in Global Surgery and Global Health is limited. Here, we assess the status of SOTA care in South Asia. We summarize the evidence on SOTA care indicators and planning. Region-wide, as well as country-specific challenges are highlighted. We also discuss potential directions-initiatives and innovations-toward addressing these challenges. Local partnerships, sustained research and advocacy efforts, and politics can be aligned with evidence-based policymaking and health planning to achieve equitable SOTA care access in the South Asian region under the South Asian Association for Regional Cooperation (SAARC).


Assuntos
Anestesia , Feminino , Humanos , Gravidez , Ásia Meridional , Povo Asiático , Planejamento em Saúde
4.
Hepatobiliary Surg Nutr ; 13(1): 89-104, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38322212

RESUMO

Background: With the rapid development of robotic surgery, especially for the abdominal surgery, robotic pancreatic surgery (RPS) has been applied increasingly around the world. However, evidence-based guidelines regarding its application, safety, and efficacy are still lacking. To harvest robust evidence and comprehensive clinical practice, this study aims to develop international guidelines on the use of RPS. Methods: World Health Organization (WHO) Handbook for Guideline Development, GRADE Grid method, Delphi vote, and the AGREE-II instrument were used to establish the Guideline Steering Group, Guideline Development Group, and Guideline Secretary Group, formulate 19 clinical questions, develop the recommendations, and draft the guidelines. Three online meetings were held on 04/12/2020, 30/11/2021, and 25/01/2022 to vote on the recommendations and get advice and suggestions from all involved experts. All the experts focusing on minimally invasive surgery from America, Europe and Oceania made great contributions to this consensus guideline. Results: After a systematic literature review 176 studies were included, 19 questions were addressed and 14 recommendations were developed through the expert assessment and comprehensive judgment of the quality and credibility of the evidence. Conclusions: The international RPS guidelines can guide current practice for surgeons, patients, medical societies, hospital administrators, and related social communities. Further randomized trials are required to determine the added value of RPS as compared to open and laparoscopic surgery.

5.
Int J Telemed Appl ; 2024: 5341988, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38327874

RESUMO

Background: There is a global shortage of healthcare professionals, especially in developing countries, leading to disparities in access to healthcare, worsened by the pandemic. Telemedicine is emerging as a solution, with growing adoption worldwide due to advancements in technology and increased awareness. Research Problem. The establishment of telemedicine depends on resources, infrastructure, and knowledge about healthcare needs. Further studies are needed to monitor and address evolving issues in telemedicine. The Overall Purpose of the Study. Rural health disparities stem from multiple factors, like limited healthcare access, workforce shortages, lifestyle choices, and lower socioeconomic status, leading to higher mortality and chronic diseases. Addressing these challenges is vital for rural community well-being. Telemedicine centers present a promising solution, bridging gaps, and improving healthcare outcomes for underserved remote populations. Methodology. Objective: This study assessed the clinicodemographic profile and clinical outcome of children presenting to the telemedicine center at the Institute of National Importance in India. Design: Prospective observational study. Setting: A single-center tertiary care level. Participants: This study included 79 children aged up to 18 years. Major Findings and Summary of Interpretations. In our study, 79 children using telemedicine found a near-equal gender distribution. 8.9% needed emergency care, with common complaints being respiratory issues, fever, abdominal pain, and vomiting. After two weeks, 83.5% showed improvement, emphasizing telemedicine's effectiveness in pediatric care. Conclusion: Our study underscores telemedicine's positive impact on pediatric healthcare, emphasizing its potential to enhance access, outcomes, and cost-efficiency. Wider telemedicine adoption can reduce morbidity and mortality, support preventive care, and streamline posttreatment services, alleviating pressure on specialized facilities. While our focus was pediatrics, the telemedicine model is adaptable to various age groups and conditions, but it should be seen as a valuable supplement to, not a total substitute for, in-person healthcare visits.

6.
Br J Surg ; 111(1)2024 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-37981863

RESUMO

BACKGROUND: Whether the benefits of the robotic platform in bariatric surgery translate into superior surgical outcomes remains unclear. The aim of this retrospective study was to establish the 'best possible' outcomes for robotic bariatric surgery and compare them with the established laparoscopic benchmarks. METHODS: Benchmark cut-offs were established for consecutive primary robotic bariatric surgery patients of 17 centres across four continents (13 expert centres and 4 learning phase centres) using the 75th percentile of the median outcome values until 90 days after surgery. The benchmark patients had no previous laparotomy, diabetes, sleep apnoea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, history of thromboembolic events, BMI greater than 50 kg/m2, or age greater than 65 years. RESULTS: A total of 9097 patients were included, who were mainly female (75.5%) and who had a mean(s.d.) age of 44.7(11.5) years and a mean(s.d.) baseline BMI of 44.6(7.7) kg/m2. In expert centres, 13.74% of the 3020 patients who underwent primary robotic Roux-en-Y gastric bypass and 5.9% of the 4078 patients who underwent primary robotic sleeve gastrectomy presented with greater than or equal to one complication within 90 postoperative days. No patient died and 1.1% of patients had adverse events related to the robotic platform. When compared with laparoscopic benchmarks, robotic Roux-en-Y gastric bypass had lower benchmark cut-offs for hospital stay, postoperative bleeding, and marginal ulceration, but the duration of the operation was 42 min longer. For most surgical outcomes, robotic sleeve gastrectomy outperformed laparoscopic sleeve gastrectomy with a comparable duration of the operation. In robotic learning phase centres, outcomes were within the established benchmarks only for low-risk robotic Roux-en-Y gastric bypass. CONCLUSION: The newly established benchmarks suggest that robotic bariatric surgery may enhance surgical safety compared with laparoscopic bariatric surgery; however, the duration of the operation for robotic Roux-en-Y gastric bypass is longer.


Assuntos
Cirurgia Bariátrica , Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Procedimentos Cirúrgicos Robóticos , Humanos , Feminino , Idoso , Adulto , Masculino , Derivação Gástrica/efeitos adversos , Obesidade Mórbida/cirurgia , Benchmarking , Estudos Retrospectivos , Cirurgia Bariátrica/efeitos adversos , Laparoscopia/efeitos adversos , Gastrectomia/efeitos adversos , Resultado do Tratamento
7.
Obes Surg ; 33(12): 3971-3980, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37889368

RESUMO

BACKGROUND: Recent advancements in artificial intelligence, such as OpenAI's ChatGPT-4, are revolutionizing various sectors, including healthcare. This study investigates the use of ChatGPT-4 in identifying suitable candidates for bariatric surgery and providing surgical recommendations to improve decision-making in obesity treatment amid the global obesity epidemic. METHODS: We devised ten patient scenarios, thoughtfully encompassing a spectrum that spans from uncomplicated cases to more complex ones. Our objective was to delve into the decision-making process regarding the recommendation of bariatric surgery. From July 29th to August 10th, 2023, we conducted a voluntary online survey involving thirty prominent bariatric surgeons, ensuring that there was no predetermined bias in the selection of a specific type of bariatric surgery. This survey was designed to collect their insights on these scenarios and gain a deeper understanding of their professional experience and background in the field of bariatric surgery. Additionally, we consulted ChatGPT-4 in two separate conversations to evaluate its alignment with expert opinions on bariatric surgery options. RESULTS: In 40% of the scenarios, disparities were identified between the two conversations with ChatGPT-4. It matched expert opinions in 30% of cases. Differences were noted in cases like gastrointestinal metaplasia and gastric adenocarcinoma, but there was alignment with conditions like endometriosis and GERD. CONCLUSION: The evaluation of ChatGPT-4's role in determining bariatric surgery suitability uncovered both potential and shortcomings. Its alignment with experts was inconsistent, and it often overlooked key factors, emphasizing human expertise's value. Its current use requires caution, and further refinement is needed for clinical application.


Assuntos
Bariatria , Obesidade Mórbida , Feminino , Humanos , Prova Pericial , Inteligência Artificial , Obesidade Mórbida/cirurgia , Obesidade
8.
Thorax ; 78(11): 1090-1096, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37487711

RESUMO

BACKGROUND: Blood eosinophil counts have been studied in patients with stable chronic obstructive pulmonary disease (COPD) and are a useful biomarker to guide inhaled corticosteroid use. Less is known about eosinophil counts during severe exacerbation. METHODS: In this retrospective study, 2645 patients admitted consecutively with COPD exacerbation across six UK hospitals were included in the study, and the clinical diagnosis was confirmed by a respiratory specialist. The relationship between admission eosinophil count, inpatient death and 1-year death was assessed. In a backward elimination, Poisson regression analysis using the log-link function with robust estimates, patients' markers of acute illness and stable-state characteristics were assessed in terms of their association with eosinopenia. RESULTS: 1369 of 2645 (52%) patients had eosinopenia at admission. Those with eosinopenia had a 2.5-fold increased risk of inpatient death compared with those without eosinopenia (12.1% vs 4.9%, RR=2.50, 95% CI 1.88 to 3.31, p<0.001). The same mortality risk with eosinopenia was seen among the subgroup with pneumonic exacerbation (n=788, 21.3% vs 8.5%, RR=2.5, 95% CI 1.67 to 2.24, p<0.001). In a regression analysis, eosinopenia was significantly associated with: older age and male sex; a higher pulse rate, temperature, neutrophil count, urea and C reactive protein level; a higher proportion of patients with chest X-ray consolidation and a reduced Glasgow Coma Score; and lower systolic and diastolic blood pressure measurements and lower oxygen saturation, albumin, platelet and previous admission counts. DISCUSSION: During severe COPD exacerbation, eosinopenia is common and associated with inpatient death and several markers of acute illness. Clinicians should be cautious about using eosinophil results obtained during severe exacerbation to guide treatment decisions regarding inhaled corticosteroid use.


Assuntos
Eosinófilos , Doença Pulmonar Obstrutiva Crônica , Humanos , Masculino , Estudos Retrospectivos , Pacientes Internados , Doença Aguda , Contagem de Leucócitos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Biomarcadores , Corticosteroides/uso terapêutico , Progressão da Doença
9.
Cureus ; 15(6): e40622, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37476108

RESUMO

BACKGROUND AND AIMS: The N95 filtering facepiece respirator (FR) is the most commonly recommended respiratory protection used in healthcare settings. However, concerns have been raised about its use because it can increase respiratory resistance and dead space. The primary objective of this study was to determine the effect of wearing N95 masks on the vital signs, i.e., oxygen saturation, pulse rate, and respiratory rate, of the participant health workers. Our secondary objective was to assess the subjective feeling of discomfort when wearing N95 masks. METHODS: The study participants were healthy healthcare workers taking care of coronavirus disease 2019 (COVID-19)-infected pediatric cases who did at least six hours of continuous shift duty in the pediatric COVID-19 ward at a tertiary care hospital in the eastern part of India. They were evaluated for vital signs at various time intervals while wearing N95 masks. Subjective discomfort at any point in time was also noted. RESULTS: We found a significant variation in the mean oxygen saturation (SpO2) and heart rate (HR) reduction across the four different points. The pair-wise comparison showed a small but significant decrease in the mean SpO2 of 98.3% (1.1) at six hours as compared with a mean SpO2 of 98.7% (0.9) at three hours. Similarly, a significant increase was noted for a mean HR of 84.7 bpm (11.2) at six hours compared with a baseline of 82.3 bpm (9.2) and 83.2 bpm (8.8) at three hours. CONCLUSION: The continuous use of an N95 mask leads to a mild increase in respiratory rate. However, heart rate and oxygen saturation vary significantly at different points in time after N95 mask use.

10.
Surg Endosc ; 37(3): 1617-1628, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36693918

RESUMO

BACKGROUND: Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgical (MBS) procedure worldwide. Despite the desired effect of SG on weight loss and remission of obesity-associated medical problems, there are some concerns regarding the need to do revisional/conversional surgeries after SG. This study aims to make an algorithmic clinical approach based on an expert-modified Delphi consensus regarding redo-surgeries after SG, to give bariatric and metabolic surgeons a guideline that might help for the best clinical decision. METHODS: Forty-six recognized bariatric and metabolic surgeons from 25 different countries participated in this Delphi consensus study in two rounds to develop a consensus on redo-surgeries after SG. An agreement/disagreement ≥ 70.0% on statements was considered to indicate a consensus. RESULTS: Consensus was reached for 62 of 72 statements and experts did not achieve consensus on 10 statements after two rounds of online voting. Most of the experts believed that multi-disciplinary team evaluation should be done in all redo-procedures after SG and there should be at least 12 months of medical and supportive management before performing redo-surgeries after SG for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD). Also, experts agreed that in case of symptomatic GERD in the presence of adequate weight loss, medical treatment for at least 1 to 2 years is an acceptable option and agreed that Roux-en Y gastric bypass is an appropriate option in this situation. There was disagreement consensus on efficacy of omentopexy in rotation and efficacy of fundoplication in the presence of a dilated fundus and GERD. CONCLUSION: Redo-surgeries after SG is still an important issue among bariatric and metabolic surgeons. The proper time and procedure selection for redo-surgery need careful considerations. Although multi-disciplinary team evaluation plays a key role to evaluate best options in these situations, an algorithmic clinical approach based on the expert's consensus as a guideline can help for the best clinical decision-making.


Assuntos
Derivação Gástrica , Refluxo Gastroesofágico , Obesidade Mórbida , Humanos , Técnica Delphi , Reoperação/métodos , Derivação Gástrica/métodos , Gastrectomia/métodos , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/cirurgia , Redução de Peso , Obesidade Mórbida/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
11.
Spectrochim Acta A Mol Biomol Spectrosc ; 287(Pt 1): 122092, 2023 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-36403540

RESUMO

In the present study, a multi-modal approach consisting of in-situ photoluminescence, Raman, and UV-Vis absorption spectroscopic studies is carried out along with chemiresistive sensing to unveil the mechanism of NH3 gas sensing by V2O5 nanoparticles in ambient air. V2O5 nanoparticles with an average size of 49 nm show a superior sensor response of 17 ± 1.5 % towards 1 ppm of NH3 gas with a response and recovery time of 96 s and 45 s, respectively. The photoluminescence and UV-Vis absorption studies in the presence of NH3 reveal electron doping to a new energy level at 1.84 eV, resulting in conduction band filling and increase in the optical band gap. The intensity of the photoluminescence spectrum shows an increase in the presence of NH3 gas as a result of this electron doping. The sensor response from the optical sensing carried out by in-situ photoluminescence study is 43 % for 40 ppm of NH3 gas. The vanadyl oxygen site is the most active in the sensing process, as evident by a selective enhancement in the intensity of V-O (vanadyl) bond vibration. This study gives an experimental evidence for the changes in optical and electronic properties of V2O5 on the adsorption of NH3 gas molecules.

13.
Discoveries (Craiova) ; 10(3): e154, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36540091

RESUMO

Tetralogy of Fallot is the most common cyanotic heart disease in children. While doing echocardiographic examination of children with Tetralogy of Fallot, we observed that many older children with this condition had congestion in their bulbar conjunctiva, easily recognizable even from some distance. This observation led us to design and perform a research study in order to find out the presence of conjunctival congestion in children with Tetralogy of Fallot. 85% of children in the ≥ 5-years of age group had conjunctival congestion without any ocular symptom. This novel clinical finding can act as an adjunct clinical sign for recognizing Tetralogy of Fallot in older children.

14.
Cureus ; 14(7): e27407, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36046302

RESUMO

A seven-year-old female child presented with sub-acute onset headache, vomiting, and aphasia with right-sided upper motor neuron (UMN) type hemiparesis and ipsilateral UMN type facial nerve weakness. Her coagulation profile and thrombotic profile were normal. MRI brain with magnetic resonance angiography (MRA) detected neurocysticercosis causing secondary vasculitis and narrowing of supraclinoid left internal carotid artery (ICA) and middle cerebral artery (MCA). The patient was given aspirin along with steroids and albendazole. She improved gradually, and her hemiparesis and facial nerve palsy improved completely by three months and aphasia by four months.

15.
Neurol India ; 70(4): 1618-1621, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36076668

RESUMO

Idiopathic intracranial hypertension (IIH) is typically described in a middle-aged female and present with symptoms of headache, transient visual obscuration, photophobia, diplopia, rarely with pulsatile tinnitus. Seizure as a sole manifestation is very rare. Here we present a case of a young non-obese female with epilepsy, and imaging revealed temporal lobe encephalocele with typical imaging features of IIH. She underwent further workup, which confirmed the diagnosis of idiopathic intracranial hypertension.


Assuntos
Epilepsia , Hipertensão Intracraniana , Pseudotumor Cerebral , Encefalocele/complicações , Encefalocele/diagnóstico por imagem , Encefalocele/cirurgia , Feminino , Cefaleia/diagnóstico , Humanos , Pessoa de Meia-Idade , Pseudotumor Cerebral/diagnóstico , Pseudotumor Cerebral/diagnóstico por imagem , Lobo Temporal
16.
Cureus ; 14(8): e27720, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36108319

RESUMO

Lathyriasis or lathyrism is a form of upper motor neuron disease caused by the dietary intake of grass pea (Lathyrus sativus). It is an irreversible crippling disease with poor outcomes. The possible pathogenesis is attributed to a toxin present in the legume, i.e., BOAA (beta-n-oxalyl amino L-alanine). Lathyrism can also be associated with vascular involvement resulting in angiolathyrism, which is mediated by a toxin ß-aminopropionitrile, and bony involvement resulting in osteolathyrism characterized by bone growth impairment. A 12-year-old male child presented to us with chronic myalgia and a gradual decline in the power in the bilateral lower limbs, both in extension and flexion, followed by an inability to walk. On examination, he had spastic paraparesis with brisk deep tendon reflexes and positive Babinski sign with sustained bilateral ankle clonus suggestive of upper motor neuron lesion. Doppler studies of the bilateral lower limb suggested deep vein thrombosis of the right posterior tibial vein. His electrophysiological studies and neuroimaging were otherwise normal. We found deep vein thrombosis and bony exostosis, which have never been reported in the existing literature. This could be a new form of angiolathyrism and osteolathyrism we are reporting here. A review of dietary history revealed consumption of grass pea over the past few years daily, following which diagnosis of neurolathyrism was considered. A review of the literature does not suggest any specific treatment for this crippling disease and the treatment largely remains supportive. The child was provided vitamin C, gabapentin, and perampanel for neuromuscular pain, and low molecular weight heparin for deep vein thrombosis. Physiotherapy was initiated and surgical excision was planned by the orthopedic team for the exostotic lesion. The diagnosis of lathyrism should strongly be suspected if there is a history of consumption of grass pea. Public health education, improvement in the socio-economic condition, and strict prohibition of the sale and consumption of grass pea can root out the problem of lathyrism.

17.
Cureus ; 14(8): e27909, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36120204

RESUMO

Neurological manifestations are common in scrub typhus in children. A 12-year-old girl presented with acute onset fever, bilateral lower limb weakness, and urinary retention. On initial investigations, scrub typhus immunoglobulin M (IgM) ELISA (enzyme-linked immunosorbent assay) was reactive. She was given an injection of doxycycline along with other supportive therapies. Her symptoms improved gradually and bilateral lower limb power came back gradually without residual weakness by the 13th day of admission.

18.
Obes Surg ; 32(8): 2512-2524, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35704259

RESUMO

PURPOSE: One anastomosis/mini gastric bypass (OAGB/MGB) is up to date the third most performed obesity and metabolic procedure worldwide, which recently has been endorsed by ASMBS. The main criticisms are the risk of bile reflux, esophageal cancer, and malnutrition. Although IFSO has recognized this procedure, guidance is needed regarding selection criteria. To give clinicians a daily support in performing the right patient selection in OAGB/MGB, the aim of this paper is to generate clinical guidelines based on an expert modified Delphi consensus. METHODS: A committee of 57 recognized bariatric surgeons from 24 countries created 69 statements. Modified Delphi consensus voting was performed in two rounds. An agreement/disagreement among ≥ 70.0% of the experts was considered to indicate a consensus. RESULTS: Consensus was achieved for 56 statements. Remarkably, ≥ 90.0% of the experts felt that OAGB/MGB is an acceptable and suitable option "in patients with Body mass index (BMI) > 70, BMI > 60, BMI > 50 kg/m2 as a one-stage procedure," "as the second stage of a two-stage bariatric surgery after Sleeve Gastrectomy for BMI > 50 kg/m2 (instead of BPD/DS)," and "in patients with weight regain after restrictive procedures. No consensus was reached on the statement that OAGB/MGB is a suitable option in case of resistant Helicobacter pylori. This is likely as there is a concern that this procedure is associated with reflux and its related long-term complications including risk of cancer in the esophagus or stomach. Also no consensus reached on OAGB/MGB as conversional surgery in patients with GERD after restrictive procedures. Consensus for disagreement was predominantly achieved "in case of intestinal metaplasia of the stomach" (74.55%), "in patients with severe Gastro Esophageal Reflux Disease (GERD)(C,D)" (75.44%), "in patients with Barrett's metaplasia" (89.29%), and "in documented insulinoma" (89.47%). CONCLUSION: Patient selection in OAGB/MGB is still a point of discussion among experts. There was consensus that OAGB/MGB is a suitable option in elderly patients, patients with low BMI (30-35 kg/m2) with associated metabolic problems, and patients with BMIs more than 50 kg/m2 as one-stage procedure. OAGB/MGB can also be a safe procedure in vegetarian and vegan patients. Although OAGB/MGB can be a suitable procedure in patients with large hiatal hernia with concurrent hiatal hernia, it should not be offered to patients with grade C or D esophagitis or Barrett's metaplasia.


Assuntos
Derivação Gástrica , Refluxo Gastroesofágico , Hérnia Hiatal , Obesidade Mórbida , Idoso , Técnica Delphi , Derivação Gástrica/métodos , Refluxo Gastroesofágico/cirurgia , Humanos , Metaplasia , Obesidade Mórbida/cirurgia , Seleção de Pacientes , Estudos Retrospectivos
19.
J Family Med Prim Care ; 11(10): 6571-6575, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36618194

RESUMO

Systemic Lupus Erythematosus (SLE) is a multisystem disorder that can affect any organ system. It can have varied presentations, and often early disease is challenging to pick up due to the absence of classical features. Pediatric systemic lupus erythematosus is rare before five years of age. We report a seventeen-month-old female child who came to us with a long-standing non-specific febrile illness. She was eventually diagnosed with childhood-onset systemic lupus erythematosus and treated with prednisolone and hydroxychloroquine with vitamin D and calcium supplements.

20.
BMJ Paediatr Open ; 5(1): e001193, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34697599

RESUMO

Background: Neonatal transmission of SARS-CoV-2 from positive mothers to their babies has been a real concern, opening the arena of research in this area. Objective: To detect the possibility of vertical transmission of SARS-CoV-2 from COVID-19-positive mothers to their neonates and the clinicopathological outcome in them. Design: A single-centre, prospective, observational study involving 47 COVID-19-positive mothers and their neonates. Setting: A tertiary care hospital in Eastern India. Participants: Neonates born to SARS-CoV-2-infected mothers. Main outcome measures: We investigated the SARS-CoV-2 positivity rate by real-time reverse transcriptase-PCR (RT-PCR) done twice (on admission and after 24 hours of admission) in neonates born to SARS-CoV-2-positive mothers, who tested RT-PCR positive for this virus in their nasopharyngeal swab. Clinical outcome was also assessed in these neonates during their hospital stay. Results: Out of 47 neonates born to SARS-CoV-2-positive mothers, four were SARS-CoV-2 positive by RT-PCR. All the neonates in our study were discharged home in stable condition after management of acute complications. None of them required readmission. Conclusion: Vertical transmission occurs in neonates born to COVID-19-positive mothers; however, the risk is small. Majority of the neonates remain asymptomatic with good clinical outcome.


Assuntos
COVID-19 , Complicações Infecciosas na Gravidez , Feminino , Humanos , Recém-Nascido , Mães , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Estudos Prospectivos , SARS-CoV-2 , Centros de Atenção Terciária
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