COVID-19 Vaccines and Axillary Nerve Dysfunction: A Case Report.

COVID-19 resulted in a worldwide pandemic and the rapid introduction of vaccines in an attempt to mitigate it. Neuritis and neuropathy after intramuscular injection had been previously seen with influenza vaccines and appear to be a side effect of the COVID-19 vaccine as well. In the following report, we present the case of a 43-year-old female who developed axillary nerve symptoms after administration of the COVID-19 vaccine and her subsequent recovery.

Osteotomy around the knee: Assessment of quality, content and readability of online information.

BACKGROUND: As knee osteotomy surgery becomes increasingly accessible, more patients may turn to the Internet for information. This study examined the source, quality, content and readability of online information regarding osteotomy around the knee. METHODS: The first 70 websites returned by the top four search engines were identified using the key words: "knee osteotomy" and "high tibial osteotomy." The websites were categorised by type and assessed using the DISCERN score, Journal of the American Medical Association (JAMA) benchmark criteria and a novel Knee Osteotomy-Specific Score (KOSS). The presence of the Health On the Net (HON) code accreditation seal was noted. Readability of each website was assessed using eight readability formulae. The mean reading grade level (RGL) was compared to the 6th and 8th grade reading levels. The mean RGL of each category was also compared. RESULTS: Of the 45 unique websites analysed, the majority were Physician (33%) and Journal websites (31%). The mean DISCERN score was 36.7 (±8.9) which is classified as 'poor.' The mean JAMA benchmark criteria score was 2.04 (±1.5) and Physician websites were most likely to be scored zero. The mean KOSS was 15.4 (±5.7). The highest scoring website was a Commercial site but, overall, Journal category sites provided the best quality information. Websites that bore the HONcode seal obtained higher DISCERN, JAMA benchmark criteria and Knee Osteotomy - Specific Scores. The cumulative mean RGL was 13.2 (±2.2) which exceeded the 6th grade level by an average of 7.2 grade levels and the 8th grade level by an average of 5.2 grade levels. No website (0%) was written at or below either the 6th or the 8th grade reading levels. The mean Flesch Reading Ease Score of all websites was 41.13 (±14.7) which is classified as 'difficult.' Journal websites had the highest RGL. CONCLUSION: The information available online regarding osteotomy around the knee varies tremendously in quality and completeness. Physician sites predominate, but these were among the lowest scoring of all websites. Even where high quality information is available, it is set at too high a level to be easily understood. LEVEL OF EVIDENCE: Survey of materials - Internet.

Knee osteotomy: Quality tools and readability data of information on the internet.

Supplementary data for the article Osteotomy around the Knee: Assessment of Quality, Content and Readability of Online Information is provided. 45 unique websites were evaluated. The DISCERN score, JAMA (Journal of the American Medical Association) benchmark criteria and HONcode (Health On the Net) criteria are provided for reference. Readability of online information was analysed with Readability Studio Professional Edition, Version 2019 (Oleander Software Ltd.). The software assessed readability using eight different instruments: Flesch-Kincaid Reading Grade Level (FKGL), Flesch Reading Ease Score (FRES), Raygor Estimate, SMOG, Coleman- Liau, Fry, FORCAST and Gunning Fog. Data is also provided on the percentage of complex words, long words, Dale-Chall unfamiliar words, Fog words, as well as the number of 'wordy' items, overly long sentences and longest sentence length.

Are we reaping what we sow? Gender diversity in surgery: a survey of medical students.

BACKGROUND: A survey of medical students from the Royal College of Surgeons in Ireland (RCSI) at Dublin, Perdana and Penang in Malaysia was undertaken in an attempt to explore attitudes towards a career in surgery and document potential differences between male and female students' perceptions of a surgical career. METHOD: A hyperlink to an online, anonymised questionnaire was distributed to medical students in 3rd, 4th and final year at three RCSI campuses. Basic descriptive statistics were used to describe the responses to individual questions and appropriate statistical tests used to compare male and female responses to questions. RESULTS: A total of 464 completed questionnaires were analysed. Almost 40% (n=185) were male and 60% (n=279) were female. Males were significantly more influenced by remuneration than females (p<0.001) towards a choice of surgical career. Females were significantly more influenced in their choice of surgical career by part-time work (p<0.001), parental leave (p<0.001), working hours (p<0.001) and length of residency (p=0.003). During surgical attachments, females were significantly more likely to admit feeling intimidated than males (p=0.002) and males more likely to report feeling confident (p<0.001). Ninety-six per cent of students felt they would be more likely to pursue a career in which they had identified a positive role model, with female medical students three times more likely to have identified a female role model than males. CONCLUSION: According to our study, preference for a career in surgery declines with advancing years in medical school for both males and females. Medical students report high levels of feeling intimidated or ignored during their surgical placements, and enthusiasm for surgery reduces during medical school with exposure to this. These findings, along with the importance of role modelling, add further urgency to the need to address factors which make surgery less appealing to female medical graduates.

Prevalence of Malnutrition in Pediatric Hospitals in Developed and In-Transition Countries: The Impact of Hospital Practices.

Presently, undernutrition still goes undetected in pediatric hospitals despite its association with poor clinical outcomes and increased annual hospital costs, thus affecting both the patient and the health care system. The reported prevalence of undernutrition in pediatric patients seeking care or hospitalized varies considerably, ranging from 2.5 to 51%. This disparity is mostly due to the diversity of the origin of populations studied, methods used to detect and assess nutritional status, as well as the lack of consensus for defining pediatric undernutrition. The prevalence among inpatients is likely to be higher than that observed for the community at large, since malnourished children are likely to have a pre-existent disease or to develop medical complications. Meanwhile, growing evidence indicates that the nutritional status of sick children deteriorates during the course of hospitalization. Moreover, the absence of systematic nutritional screening in this environment may lead to an underestimation of this condition. The present review aims to critically discuss studies documenting the prevalence of malnutrition in pediatric hospitals in developed and in-transition countries and identifying hospital practices that may jeopardize the nutritional status of hospitalized children.

Maternal Emotional Support following the Disclosure of Child Sexual Abuse: A Qualitative Study.

Non-offending maternal (NOM) support is considered one of the most important protective factors in facilitating better victim adjustment following the disclosure of child sexual abuse (CSA). However, recent findings have led authors to conclude that NOM support has yet to be properly conceptualized and operationalized within the CSA literature. Emotional support is one dimension that has consistently emerged in studies attempting to reconceptualize NOM support but is a concept which also requires further theoretical investigation. Researchers interviewed 22 mothers of children aged 6-12 years about their experience and provision of emotional support following their child's disclosure of CSA. Data were analyzed using a method inspired by grounded theory. Mothers reported feeling initially overwhelmed and lost about how to emotionally support their child but described an improvement in their support capabilities following conjoint therapy. Furthermore, three overarching categories emerged outlining maternal emotional support strategies, each serving a specific emotional function: (a) elaborating, encouraged children to talk about their CSA experience; (b) soothing, attempted to comfort children's distress; and (c) orienting, attempted to guide children's recovery process. Authors discuss implications for offering improved and more rapid clinical services following the disclosure of CSA, and considerations for the operationalization of NOM emotional support.

Assessment of Malnutrition Risk in Canadian Pediatric Hospitals: A Multicenter Prospective Cohort Study.

OBJECTIVE: To assess the prevalence, causes, and consequences of malnutrition, as well as the evolution of nutritional status, in Canadian pediatric health care institutions. STUDY DESIGN: In this multicenter prospective cohort study, a total of 371 patients were recruited from pediatric hospitals in 5 Canadian provinces. Subjects were aged 1 month to 18 years; admitted to a medical, surgical, or oncology ward; and had a planned hospital stay of >48 hours. Data on demographics, medical condition, anthropometric measures, and dietary intake were collected. The Screening Tool Risk on Nutritional Status and Growth (STRONGkids) and Subjective Global Nutritional Assessment (SGNA) were applied at admission. Malnutrition was defined as a weight-for-age, height-for-age, body mass index-for-age, or weight-for-length/height z score <-2 SD. RESULTS: Among 307 subjects (median age, 5.3 years; median length of stay, 5 days), 19.5% were malnourished on admission. Both STRONGkids and SGNA classifications were associated with baseline nutritional status. Mean weight-for-age z score was lower at discharge compared with admission (-0.14 vs -0.09; P < .01), and nearly one-half of all patients lost weight during their hospital stay. Only one-half of the children who were malnourished or screened as high risk of malnutrition were visited by a dietitian during their stay. The percentage of patients who lost weight during hospitalization was significantly greater in the group not visited by a dietitian (76.5 vs 23.5%; P < .01). CONCLUSION: Nutritional status deterioration and malnutrition are common in hospitalized Canadian children. Screening tools, anthropometric measurements, and dietitian consultation should be used to establish adequate nutritional support.

Proteomics reveals a core molecular response of Pseudomonas putida F1 to acute chromate challenge.

BACKGROUND: Pseudomonas putida is a model organism for bioremediation because of its remarkable metabolic versatility, extensive biodegradative functions, and ubiquity in contaminated soil environments. To further the understanding of molecular pathways responding to the heavy metal chromium(VI) [Cr(VI)], the proteome of aerobically grown, Cr(VI)-stressed P. putida strain F1 was characterized within the context of two disparate nutritional environments: rich (LB) media and minimal (M9L) media containing lactate as the sole carbon source. RESULTS: Growth studies demonstrated that F1 sensitivity to Cr(VI) was impacted substantially by nutrient conditions, with a carbon-source-dependent hierarchy (lactate > glucose >> acetate) observed in minimal media. Two-dimensional HPLC-MS/MS was employed to identify differential proteome profiles generated in response to 1 mM chromate under LB and M9L growth conditions. The immediate response to Cr(VI) in LB-grown cells was up-regulation of proteins involved in inorganic ion transport, secondary metabolite biosynthesis and catabolism, and amino acid metabolism. By contrast, the chromate-responsive proteome derived under defined minimal growth conditions was characterized predominantly by up-regulated proteins related to cell envelope biogenesis, inorganic ion transport, and motility. TonB-dependent siderophore receptors involved in ferric iron acquisition and amino acid adenylation domains characterized up-regulated systems under LB-Cr(VI) conditions, while DNA repair proteins and systems scavenging sulfur from alternative sources (e.g., aliphatic sulfonates) tended to predominate the up-regulated proteome profile obtained under M9L-Cr(VI) conditions. CONCLUSIONS: Comparative analysis indicated that the core molecular response to chromate, irrespective of the nutritional conditions tested, comprised seven up-regulated proteins belonging to six different functional categories including transcription, inorganic ion transport/metabolism, and amino acid transport/metabolism. These proteins might potentially serve as indicators of chromate stress in natural microbial communities.