bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum Soluble Cytotoxic T-Lymphocyte-Associated Antigen 4 in Children and Adolescents with Autoimmune Cytopenia
Authors: El-Sherif Nayera H , Hassan Mona .F , Makkeyah Sara M , Ibrahim Marwa G
Published: October 2021

Background

Autoimmune cytopenias are characterized by the production of autoantibodies against differentiated hematopoietic cells because of defects in central and/or peripheral tolerance. It includes autoimmune hemolytic anemia (AIHA), immune thrombocytopenic purpura (ITP), autoimmune proliferative syndrome (ALPS) and Evans syndrome (EV).

Aim of the Work

to compare levels of sCTLA-4 in different types of immune cytopenias and their control.

Patients and Methods

Forty seven children and adolescents who have autoimmune cytopenias were recruited and assessed for eligibility in Pediatric Hematology Clinic, Ain Shams University Children’s Hospital and forming a patients group with age range 8 – 204 months old. An age and sex matched healthy control group were recruited including forty seven healthy participants with age range 6 – 156 months old.

Results

On initial examination in our study, the prevalence of hepatosplenomegaly and lymphadenopathy among the patients group was 27.7% and 2.1% respectively. Autoimmune cytopenic patients group have statistically significant higher serum sCTLA-4 levels (range 1 – 82 ng/ml) than control group (range 0 – 9 ng/ml) (where P < 0.01 HS). On the other hand, there was no significant difference when comparing levels of sCTLA-4 between sera of ITP, AIHA and ALPS patients (P > 0.05). Serum sCTLA-4 was inversely related to the age at diagnosis and positively related to disease duration. Our results demonstrated the presence of correlations between the levels of sCTLA4 and the severity of autoimmune cytopenias (negative correlation with Hemoglobin (R= -0.315; P = 0.031), mean Hemoglobin (last year) (R= -0.471; P = 0.001) and platelet (R= -0.324; P < 0.05)) and (positive correlation between levels of sCTLA-4 and Reticulocyte count (R = 0.413; P = 0.004), Indirect Bilirubin (R = 0.427; P = 0.003) and Lactate dehydrogenase (R = 0.357; P = 0.014)). There was a significant differences in the prevalence of hepatosplenomegaly among ITP, AIHA and ALPS patients (P < 0.05) with higher prevalence among ALPS patients.

Conclusion

Soluble form of CTLA4 (sCTLA4) presents in elevated levels in the sera of children and adolescents who have autoimmune cytopenia including AIHA/Evans, ITP and ALPS compared to healthy control group that suggests sCTLA4 could play a role in the pathogenesis of immune cytopenias.
Pharmacokinetics of Factor VIII Level in Patients Hemophilia A in Relation to Clinical and Radiological Outcomes
Authors: Tantawy Azza Abdel gawad , Ragab Iman Ahmed , Khalil Mohamed Gomaa
Published: October 2021

Background

The benefit of pharmacokinetics (PK) -guided dosing is that both prophylactic and “on demand” dosing will be based on actual FVIII trough and peak levels instead of current FVIII estimates based on body weight and in-vivo recovery based dosing. Knowledge will increase with regards the relationship between FVIII level and bleeding in individual patients. The dose and frequency of factor VIII for patients on prophylaxis should only be reduced if clinically justified and impact should be monitored with regard to bleeding events, bleeding pattern and joint status.

Objective

To assess the trough and peak level of factor VIII in patients with hemophilia A on low dose prophylaxis and its impact on the clinical and radiological joint status.

Patients and Methods

A cross sectional study was performed in Ain-Shams University, Pediatrics Hospital, Hemophilia Clinic. It included 25 children and adolescents with hemophilia A on prophylactic factor VIII during the period from September 2018 to August 2019. Factor VIII used was recombinant 3rd generation with a dose of 45 IU/Kg/week rounded to the nearest 500IU. Trough level of factor VIII was done before prophylactic dose and peak level was done one hour postinfusion through chromogenic assay using STAGO-Immuno-Def VIII reagent. Clinical joint score and Functional Independence Score of Hemophilia (FISH) were done. Radiological joint scores were done using conventional x-ray, ultrasound and MRI. Cut-off level of trough levels was studied at 1% and 1%-5% of factor VIII.

Results

Patients were classified into 3 groups,4 patients (21.1%) had trough level <1%, 13 patients (68.4%) had trough level between 1%-5%, 2 patients (10.5%) had trough level > 5%. No significant difference between trough level of factor VIII and clinical joint scores and FISH scores of patients. Median score of the worst joint of patients with trough level >5% was 5 in comparison to 8 and 7 in patients with trough level 1%-5% and <1% respectively. Mean FISH of patients with trough level >5% was 9.50 ± 2.12 in comparison to 12.92 ± 5.41 and 11.00 ± 3.56 for patients with troughs 1%-5% and <1% that was respectively. Comparison between groups with different trough level of factor VIII according to X-ray scores of patients showed no significant difference

Conclusion

Low trough levels alone did not warrant intensification of the prophylaxis regimen; rather, the dose and dosing frequency should be adjusted based on individual’s bleeding pattern and many other factors as shown in our study the insignificant relation between trough levels of factor VIII and clinical and radiological outcomes.. More frequent factor VIII monitoring and incorporation into population based PK are warranted.
Comparison between Continuous positive Airway Pressure (CPAP) and High Flow Nasal Cannula (HFNC) in Management of Bronchiolitis and community acquired pneumonia in Infants and Young Children
Authors: Gawad Tarek Ahmed Abdel , Allam Ahmad Mostafa , Sayed Sarah Ali El
Published: October 2021

Background

Acute respiratory failure develops in infants with bronchiolitis and Community acquired pneumonia (CAP) because of hypoxemia, due to mismatch between ventilation and perfusion. Nasal continuous airway pressure (nCPAP) and high-flow nasal cannula (HFNC) improve the work of breathing and oxygenation .High flow nasal cannula (HFNC), also called heated humidified high flow nasal cannula (HHHFNC), is a new non-invasive ventilation therapy that seems to be well tolerated in infants with hypoxemic respiratory failure.

Aim

To compare the effectiveness and the outcome of Heated Humidified High Flow Nasal Cannula (HFNC) versus Nasal Continuous Positive Airway Pressure (NCPAP), as a primary mode of respiratory support, in patients with respiratory failure due to pneumonia or bronchiolitis at PICU regarding demographic data, length of admission, increasing of positive pressure and need of intubation.

Patients and Methods

observational study was conducted on 40 patients with acute respiratory failure due to either bronchiolitis or community acquired pneumonia (CAP), admitted to Paediatric ICU, Children Hospital, Ain Shams University, in the time period between February 2018 to July 2019. The patients, aged between 1 month to 5 years, were subjected to detailed clinical history and examination.All patients received continuous monitoring of electrocardiograph ,pulse oximetry and respiratory rate .The patients were treated either with (HFNC) Humidified high flow nasal cannula or continuous positive airway pressure (CPAP). Studied groups were compared regarding demographic data, increasing in respiratory support ,need of intubation, fate and length of admission during PICU stay.

Results

HFNC was as efficient as CPAP in lowering RR(respiratory rate) and HR(heart rate) in infants with bronchiolitis and community acquired pneumonia. Thus HFNC group was as significant as NCPAP group in treatment of bronchiolitis and CAP regarding length of admission ,increasing of positive pressure and need of iintubation in PICU .

Conclusion

This study concluded that HFNC is as efficient as nCPAP for initial respiratory support in young infants, hospitalized in a PICU for moderate to severe acute respiratory failure.
Neuroprotective effect of lacosamide on cognitive dysfunction in Streptozotocin induced Alzheimer disease
Authors: Ibrahim Fatma Sobhy , Abdel-Aziz Lobna Fouad , Elbakly Wesam Mostafa , El Gayar Nesreen Hamdy
Published: October 2021

Alzheimer disease (AD) is a chronic and progressive neurodegenerative disorder characterized by memory loss and cognition impairment. A link has been established between AD and epilepsy sharing multiple mechanisms and pathogenesis. Similar Hippocampal changes have been found between both diseases. Choosing antiepileptic drug in AD patient represent a great a challenge especially with increase seizure risk in AD patients. Lacosamide, antiepileptic drug, was reported to have a neuroprotective effect in animal models and a histone deacetylase inhibition activity. This study was designed to investigate the potential effect of chronic lacosamide treatment in Streptozotocin induced AD in male Wistar rats.

Methods

AD animal model was induced with single bilateral intracerebroventricular injection of STZ (3 mg/kg) on day one. Lacosamide (30 mg/kg orally, once daily) was administrated for 21 days.

Cognitive function assessment was done with Morris Water Maze (MWM) and Y Maze tasks. APP and MAPT mRNA level were measured.

Results

ICV-STZ caused significant prolongation in Escape latency time and reduction in time spent in target quadrant in MWM and reduction in spontaneous alteration ratio in Y Maze compared to control group. STZ induced Up-regulation in Amyloid precursor protein and Microtubule associated protein tau gene expression. Chronic Lacosamide treatment attenuated STZ induced cognitive impairment and mitigated APP and MAPT induced expression with STZ.

Conclusion

Lacosamide has a neuroprotective effect against STZ induced cognitive deficits ameliorating Aβ and Tau pathology.
Hydration therapy in oligohydraminos in Ain Shams University Maternity Hospital: Randomized Controlled Clinical Trial
Authors: Abdel-Hamaid Sherif Mohammad , Mansour Dina Yahia , Bakhat Gehad Sayed Abdel-Rahman
Published: October 2021

Background

Amniotic fluid surrounds the fetus within first gestational weeks. acts physiologically and anatomically in a protective manner preventing fetal and umbilical cord compressive forces, besides have antibacterial features keeping the fetal temperature stable, and avoiding adhesive attachment to developing fetal membrane system. Amniotic fluid volume and constituents continuously change in a dynamic manner as the gestation progresses. Sufficient amniotic fluid volume is crucial for fetal mechanophysiological well-being adding in normal musculoskeletal wellbeing besides aminiotic fluid consituents refelect physiological integrity of fetal systems particularly the renal and gastrointestinal systems.

Objective

The aim of this study is to find out if there is significant increase in amniotic fluid index after acute maternal hydration in pregnant women with oligohydraminos and to evaluate therapeutic effectiveness of two different modalities of hydration therapy.

Methods

We conducted randomized controlled open labeled clinical trial on 300 cases with oligohydraminos admitted to Ain Shams University Maternity Hospital (ASUMH) in the period from September 2019 to March 2020. These patients were classified to three groups, Patients in group A were Oral hydration group: 100 participants while Patients in group B were Intravenous hydration group: 100 participants, patients in Group 3 No hydration group: 100 participants.

Results

The demographic data analysis of the current study have shown that there was no statistical significant difference between the investigated research groups as regards the demographic characteristics (age, BMI, Parity gestational age p values 0.171,0.370,0.840,0.290 consecutively). The study results also showed that oligoydramnios recurrence frequency was highest among control group, followed by intravenous group and least in oral group, the differences were statistically nonsignificant.

Conclusion

Hydration can be considered an effective way of decreasing the chance of oligohydraminos because maternal dehydration increases the chance of the condition. Therefore both serum and oral hydration therapies are hypothesized to be effective treatment for oligohydraminos. Previous studies have supported this hypothesis. Maternal hydration may theoretically increase amniotic fluid volume may by causing fetal diuresis.
Comparison between AFI and DVP in predicting adverse neonatal respiratory outcomes in women with prolonged pregnancy undergoing induction of labour
Authors: Elkady Mohamed Ahmed , Mansour Dina Yahia , Abu zaid Hamada Farag
Published: October 2021

Background

The intrapartum management of prolonged pregnancies is aunique challenge to the obstetricians, as the perinatal outcomes areadverse after completed 40 weeks. In such cases, intrapartumasphyxia and meconium aspiration are associated with almost.

Objective

To comparison between MVP and AFI in predicting neonatal respiratory outcomes in induction of labour in prolonged pregnancies.

Patients and Methods

The study was a prospective comparative study that was conducted on 266 women with prolonged pregnancy undergoing induction of labour. The patients were recruited from Ain Shams university hospitals during the period from February 2019 to August 2019.

Results

Amniotic fluid index and MVP were evaluated in 269 women with pregnancies of 40 or more weeks and intact membranes using a 3.5-MHz linear transducer. Both measurements were obtained for each participant by the same obstetrician in one sitting. Oligohydramnios was defined as an AFI of 5 cm or less or an DVP of 1 cm or less. External cardiotocography was performed during intrapartum period in all cases. Fetal distress was diagnosed when any one of the nonreassuring fetal heart rate pattern occurred or when the Apgar score at birth was 6 or less. The results were analyzed by the chi(2) and the t tests.

Conclusion

The use of the AFI and SDVP is useful in predicting neonatal outcomes in the induction of labor in prolonged pregnancies. The SDVP measurement appears to be the more appropriate method for predicting neonatal outcomes. The same observation was found when AFI and SDVP were combined. It is also logical to recommend that only one method should be used for fetal assessment tests.
Assessment of accuracy of two dimensions ultrasonography of fetal thigh soft tissue versus Hadlock's formula in estimation of fetal weight
Authors: Elsenity Mohamed Abdel Fattah , El Sayed El Zeiny Mohamed Abdel Aziz , Shahin Marwa Radwan Abbass , El-Din Adel Shafik Salah
Published: October 2021

Objective

The current study aims to compare between mid-thigh soft tissue formula and modified mid-thigh soft tissue formula with Hadlock formula in estimation of fetal weight.

Materials and methods

Two hundred full term pregnant women attending Ain Shams Maternity Hospital in the period from April 2018 and April 2019 were included in this comparative study. Whole study group (200 women) had 2D ultrasonography using Hadlock's formula, thigh soft tissue formula and Modified thigh soft tissue formula.

Results

In our current study Hadlock's formula was better than thigh soft tissue and modified thigh soft tissue formula in estimation of fetal weight.

Conclusions

Fetal mid-thigh SST is a simple, useful, and easily applicable parameter for fetal weight estimation.
Prophylactic antibiotics in patients with artificial rupture of membranes during labor: (Randomized controlled clinical trial)
Authors: Swidan Khalid Hassan , Abuelghar Wessam Magdy , Ali Mohamed Adel , Soliman Mohamed Soliman Hussein
Published: October 2021

Background

Amniotomy, also known as artificial rupture of membranes (AROMs) and by the lay description "breaking the water," is the intentional rupture of the amniotic sac by an obstetrical provider. This procedure is common during labor management and has been performed by obstetrical providers for at least a few hundred years. Amniotomy during labor induction is associated with a faster time to delivery, most notably in nulliparous women, without an increase in cesarean delivery or maternal and neonatal morbidity. Shortening time to delivery is associated with decreased hospital costs and increased patient satisfaction, and therefore, early amniotomy, given the safety profile, should be considered when a faster delivery is of importance to patients and providers.

Objective

To determine the efficacy of prophylactic antibiotics in patient during labor on reducing maternal and neonatal morbidities.

Methods

This prospective randomized study was performed from January 2020 to July 2020, at maternity hospital of Ain Shams University. Informed consent was obtained from all participants. Candidates for this study included all patients with singleton gestations between 37 weeks and 41 weeks of gestation underwent artificial rupture of the membranes during active phase of labor. Gestational age was confirmed by a reliable last menstrual period, early sonogram. Amniotomy was confirmed by visualization of pooling fluid in the posterior vaginal fornix through the cervix after artificial rupture of membrane by sterile hook.

Results

There were no statistical significance differences between two groups regarding demographic characteristics, endometritis, cord-prolapse and abruptio placenta. Maternal septicemia was absent in both groups. Chorio-amnionitis, cesarean section rate, episiotomy infection, NICU admission, neonatal sepsis, neonatal hypoxia and intraventricular hemorrhage were significantly less frequent in prophylaxis group.

Conclusion

Using of prophylactic antibiotics with amniotomy in pregnant women during labor reduced maternal and neonatal morbidities as chorio-amnionitis, endometritis, cesarean section rate, episiotomy infection, NICU admission, neonatal sepsis, neonatal hypoxia and intraventricular hemorrhage. On the other side it had no proved protective effect against maternal septicemia, cord-prolapse and abruptio placenta.
The ‘occiput-spine angle’: a new sonographic index of fetal head deflexion during first stage of labor as predictor of course of labor and outcome
Authors: Fathy Hesham Mohammed , El-Din Ahmed Mohammed Bahaa , Mohammed Haitham Fathy , Helmy Mohammed Mahmoud Mohammed
Published: October 2021

Background

Labor is a physiologic process during which the products of conception (i.e. the fetus, membranes, umbilical cord, and placenta) are expelled outside of the uterus. Labor is achieved with changes in the biochemical connective tissue and with gradual effacement and dilatation of the uterine cervix as a result of rhythmic uterine contractions of sufficient frequency, intensity, and duration. Labor is divided into three stages that include cervical dilatation, fetal delivery and delivery of the placenta.

Objective

The aims of this study were to quantify the degree of fetal head deflection via the use of Ultrasound during the first stage of labor and to determine whether a parameter derived from ultrasound examination (the occiput-spine angle) has a relationship with the progress of labor, subsequent effect on maternal, fetal complications and rate of cesarean delivery.

Methods

This is a prospective cohort study which includes a total of 200 women with gestational age 37-42 weeks were assessed in this study in Ain shams Maternity hospital labor ward by 2 dimensional ultra sound. Examinations were performed after a verbal and written consent from the patient with the patient lying in the dorsal supine position. And exclusion of Occiput-posterior position, multigravida, Indication for cesarean, Medical disorder eg hypertension or diabetes, pre labor rupture of membranes to correlate between the Occiput- spine angle (OSA) and the outcome of labor regarding the progress of labor, incidence of cesarean section, maternal and fetal complications.

Results

This study demonstrates that the sonographic measurement of the angle formed by the fetal occiput and the spine (occiput-spine angle) is feasible and reproducible, the occiput-spine angle in the first stage of labor is positively correlated with the clinically established station and the risk of obstructed labor requiring an operative delivery ie, Occiput-spine angle have been statistically significantly lower in cases underwent operative delivery. Occiput-spine angle had a statistically significant low diagnostic performance in predicting operative delivery.

Conclusion

The occiput-spine angle in the first stage of labor correlates significantly with the risk of obstructed labor Compared with spontaneous vaginal deliveries, cases that require obstetric intervention demonstrated a smaller occiput-spine angle at a similar station, suggesting diminished flexion of the fetal head. For occiput anterior fetuses, the greater the degree of fetal head deflexion, the greater risk of operative delivery due to labor arrest.
The effect of administration of 17-OH progesterone intramascular on the latency of pregnancy in primegravida with singleton pregnancy and prelabour rupture of membrane (PPROM) (Randomized Controlled Trial)
Authors: Fattah Ihab Hassan Abdel , Allim Mohamed Mahmoud Abdel , Ahmed MortadaElsayed , Mohamed Taha Yasmeen Ahmed
Published: October 2021

Background

Preterm delivery with its associated morbidity and mortality still represents one of the major unsolved problems in Obstetrics. In PPROM, there is an increased incidence of preterm delivery which represents a life threatening situation. It has been calculated that the mean duration of PROM pregnancies is 37 weeks, so premature birth defined as delivery before 37 week of gestation, is the leading cause of perinatal mortality and short and long term fetal morbidity. Obviously, preterm deliveries represent a problem because of the severe neonatal complications that often occur afterwards. These complications are worse for the smaller newborn with earlier gestational age. These complications include respiratory distress syndrome, intraventricular hemorrhage, sepsis and necrotizing enterocolitis.

Objective

The present study aims to investigate the effect of 17-OH progesterone on primegravida and the possible change in the premature delivery rates and other pregnancy outcomes and complications regarding its use.

Methods

The current research is a randomized controlled study was conducted at Obstetric outpatient clinic of Ain Shams University Maternity Hospital and involved 80 pregnant admitted to assess the efficacy of intramuscular progesterone compared to placebo therapy in decreasing the rate of preterm birth in women with PPROM pregnancy, selected on basis being with age between 18-35 years, carrying Singleton pregnancy, at gestational age between24-34 weeks.

Results

The present study provides no evidence that 17OHP-C is beneficial in women with PROM. Although the trial turned out to be underpowered for the primary outcome, it had reasonable statistical power for the prespecified secondary outcomes, which allowed us to conclude that 17OHP-C does not prolong pregnancy or reduce perinatal morbidity after PROM. Preterm PROM is a frequently encountered obstetric diagnosis, with improved neonatal outcomes when an uninfected mother is able to continue her pregnancy for a longer duration to reach a more advanced gestational age.

Conclusion

Compared placebo with intramuscular 17-OHPC in women with prelabour rupture of membranes. Pregnancy is associated with lower percentage of preterm labour, fewer NICU admissions in 17 OHPC.
Peripheral nerve dysfunction and its correlation to interleukin-6 level in obese patients
Authors: Francis Mary Fayez , Arafa Mona Mahmoud , Amin Irene Raouf , Ahmad Manal Samier
Published: October 2021

Background

Obesity is now a worldwide health problem that predisposes to development of numerous complications, one of which is peripheral neuropathy (PN). Elevated interleukin-6 (IL-6) cytokine levels associating the chronic inflammatory state in obesity is thought to play a major role in obesity complications.

Methods

We conducted a Cross-sectional study on 30 obese patients and 10 matched healthy lean controls. All participants were subjected to full history taking, neurological examination, motor and sensory peripheral nerve conduction studies (NCS). Serum IL-6 levels were assessed using a commercially available ELISA. Laboratory investigations such as glycated haemoglobin, thyroid profile, liver and kidney function tests were done to exclude other known causes of PN.

Results

Radial, Posterior Tibial and Peroneal nerves had statistically significantly lower motor amplitudes in obese groups compared to control group. Sensory amplitudes of Median nerve showed statistically significant lower values in obese group with PN compared to control group. Conduction velocities (CV) of Ulnar nerve (motor and sensory) and sensory Median nerve showed statistically significant lower CVs in the obese group with PN compared to obese group without PN. Motor Ulnar nerve CV showed highly statistically significant higher velocities in the obese group without PN compared to control group. Posterior Tibial nerve distal motor latencies and Sensory nerve peak latencies of Median nerve had statistically significant higher values in obese group with PN compared to obese group without PN while statistically significant lower sensory peak latencies of Radial nerve were found in obese group without PN compared to control group. Regarding serum IL-6 levels, highly statistically significant higher levels were found in either obese groups when compared to the control group while no statistical significant difference was present between both obese groups and no correlation was found between serum IL-6 and NCS parameters in obese group with PN.

Conclusion

Our study revealed that despite only 6.667% of our non diabetic obese patients complained of symptoms of PN, by NCS 66.67% of patients were found to have electrophysiological evidence of PN while the remaining 33.33% of patients showed no evidence of PN and no correlation was found between serum IL-6 levels and nerve conduction parameters changes in obese patients diagnosed with PN.
A study of Madrid sonographicenthesis score Index (MASEI) versus spondyloarthritis research consortium of Canada (SPARCC) in the assessment of early enthesopathy among psoriatic skin patient
Authors: Zytoon Nehal M , Abd El Bar Nadia S , El Husseiny Mona G , El-mallah Reem M , El-Gharbawy Nermin H
Published: October 2021

Objective

To compare between Sonographic Madrid score index (MASEI) versus Spondyloarthritis research consortium of canada (SPARCC) for early assessment of enthesopathy among psoriatic skin patients.

Patients and Methods

This study included fifty psoriatic skin patients. All underwent history, laboratory investigation, clinical examination using SPARCC score, Psoriasis Area and Severity Index (PASI) and musculoskeletal ultrasound using MASEI score with power Doppler (PD) bilaterally for assessment of enthesitis.

Results

The mean age of fifty patients was 42.00 ± 10.923 years, disease duration of 11.110 ±7.402 and BMI of 29.356 ± 3.753. The mean PASI was 12.950±8.044. SPARCC score was positive in 10 out of 50 patients (20%).MASEI score was positive in 20 out of 50 patients (40%) with 10 out of 50 patients had power Doppler signals. Highly statistically significant difference between MASEI and SPARCC score( pvalue <0.001). Highly statistically significant positive correlation was observed between PASI score and MASEI(r = 0.498, p-value <0.001).

Conclusion

musculoskeletal ultrasound is useful for early detection of enthesitis and to be a sensitive tool in detecting of enthesitis and subclinical enthesitis that can be missed during routine clinical examination.
Assessment of Food Services Pre-requisite Program in a Tertiary Hospital in Egypt
Authors: MK Mahmoud , I Shehad , LS ElBagoury
Published: October 2021

Background

Hospital food service systems are one of the most complicated processes where safety in this sector is considered high priority issue due to high susceptibility of hospital population.

Objectives

Our objectives were to identify the pre-requisite program components and the degree of compliance with these components in Ain Shams University Specialized Hospital.

Methods

A team was formed, identification of the prerequisite program components was carried out and a check list for determining the compliance with the identified components was used.

Results

From our study it was found that there is a severe lack in the prerequisite program items. Only 25% of the items were achieved, and the implementation of the prerequisite items ratio was 59.4% with severe lack of temperature control in the different stages of the food flow.

Conclusions

The present study showed that the necessary founding element of any food safety program, comprising the policies, operating procedures and similar organizing documents which was deficient in the studied hospital. Similarly, implementation of the basic required sanitation aspects in food handling was almost half applied. Reconsideration of basic underlying system for food services is mandated in our hospital.
Psoriasis and imaging progression in early axial spondyloarthritis: results from a 48-month follow-up (Italian arm of SPACE study)
Authors: Lorenzin Mariagrazia , Ortolan Augusta , Vio Stefania , Cozzi Giacomo , Scapin Vanna , De Conti Giorgio , Doria Andrea , Ramonda Roberta
Published: October 2021

Objectives

To assess the influence of psoriasis on spinal/pelvic radiographic progression and MRI features in early-stage axial spondyloarthritis (axSpA).

Methods

Analysis of baseline data from the Italian SPACE cohort, including patients with chronic back pain (CBP; duration ≥3 months and ≤2 years; onset <45 years) was performed. Patients underwent a diagnostic work-up, including MRI and X-rays of the sacroiliac joints (SIJ), to establish diagnosis of axSpA (Assessment of Spondyloarthritis International Society criteria). Clinical features, disease activity and functional indices, imaging were collected at baseline and yearly during 48 months. Spinal and SIJ X-rays and MRIs were scored by two readers following Spondyloarthritis Research Consortium of Canada score, Stoke Ankylosing Spondylitis Spinal Score System modified by Creemers and modified New York criteria. Characteristics of axSpA patients with/without psoriasis were compared over time with descriptive statistics; multivariate logistic regression model was constructed to assess predictors of spinal/pelvic radiographic progression.

Results

Eighty-eight patients had axSpA (84.1% non-radiographic; 15.9% radiographic); 36.4% had psoriasis. Patients with psoriasis were older; less frequently had HLA-B27+ and radiographic sacroiliitis with unilateral/asymmetric pattern and more signs of spondylitis. Functional and disease activity indices decreased with slightly higher BASDAI and BASFI in axSpA with psoriasis. All patients showed slight spinal/pelvic radiographic progression. Patients without psoriasis showed increased sacroiliitis progression and low-grade spinal progression. More inflammatory corner lesions on cervical/thoracic MRI-spine were observed in patients with psoriasis. A significant downtrend of SPARCC SIJ/spine scores in all patients was found. Psoriasis was a predictor of increased spinal progression (odds ratio = 0.18; 95% CI: 0.04, 0.78).

Conclusions

Psoriasis was associated with distinct axSpA features, increased spinal radiographic progression and low-grade radiographic sacroiliitis.
Treatments Associated with Lower Mortality among Critically Ill COVID-19 Patients: A Retrospective Cohort Study
Authors: Zhao Xu , Gao Chan , Dai Feng , Treggiari Miriam M. , Deshpande Ranjit , Meng Lingzhong
Published: October 2021

Background

Mortality in critically ill COVID-19 patients remains high. Although randomized controlled trials must continue to definitively evaluate treatments, further hypothesis-generating efforts to identify candidate treatments are required. This study’s hypothesis was that certain treatments are associated with lower COVID-19 mortality.

Methods

This was a 1-yr retrospective cohort study involving all COVID-19 patients admitted to intensive care units in six hospitals affiliated with Yale New Haven Health System from February 13, 2020, to March 4, 2021. The exposures were any COVID-19–related pharmacologic and organ support treatments. The outcome was in-hospital mortality.

Results

This study analyzed 2,070 patients after excluding 23 patients who died within 24 h after intensive care unit admission and 3 patients who remained hospitalized on the last day of data censoring. The in-hospital mortality was 29% (593 of 2,070). Of 23 treatments analyzed, apixaban (hazard ratio, 0.42; 95% CI, 0.363 to 0.48; corrected CI, 0.336 to 0.52) and aspirin (hazard ratio, 0.72; 95% CI, 0.60 to 0.87; corrected CI, 0.54 to 0.96) were associated with lower mortality based on the multivariable analysis with multiple testing correction. Propensity score–matching analysis showed an association between apixaban treatment and lower mortality (with vs. without apixaban, 27% [96 of 360] vs. 37% [133 of 360]; hazard ratio, 0.48; 95% CI, 0.337 to 0.69) and an association between aspirin treatment and lower mortality (with vs. without aspirin, 26% [121 of 473] vs. 30% [140 of 473]; hazard ratio, 0.57; 95% CI, 0.41 to 0.78). Enoxaparin showed similar associations based on the multivariable analysis (hazard ratio, 0.82; 95% CI, 0.69 to 0.97; corrected CI, 0.61 to 1.05) and propensity score–matching analysis (with vs. without enoxaparin, 25% [87 of 347] vs. 34% [117 of 347]; hazard ratio, 0.53; 95% CI, 0.367 to 0.77).

Conclusions

Consistent with the known hypercoagulability in severe COVID-19, the use of apixaban, enoxaparin, or aspirin was independently associated with lower mortality in critically ill COVID-19 patients.

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Examining Job Satisfaction and Intent to Stay for Neonatal Nurse Practitioners
Authors: Moss Colleen Reilly
Published: October 2021

Background:

In 2017, the National Association of Neonatal Nurse Practitioners (NANNP) recommended that organizations implement formalized mentoring programs for neonatal nurse practitioners (NNPs). There is significant evidence to support that mentoring positively impacts nurse practitioners' job satisfaction and retention. However, there is a lack of evidence-based literature specific to NNP mentoring.

Purpose:

Determine the impact of participation in the NANNP formalized mentoring program on job satisfaction and retention for novice and experienced NNPs in an academic medical center in Tennessee.

Methods:

This quality improvement project utilized a secure online survey that included the Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS) and 2 intent-to-stay items prior to implementation of a 6-month mentoring program. Neonatal intensive care unit nurse practitioners completed the same electronic survey at 3 intervals after program implementation to determine the impact of the mentoring program on job satisfaction and intent to stay.

Results:

Project results identified a significant difference in MNPJSS scores for participants in a 6-month formal mentoring program using the NANNP tool kit. The MNPJSS scores moderately correlated with intent to stay at 1 year and strongly correlated with intent to stay at 3 years.

Implications for Practice:

The results of this project support the positive impact of a formalized mentoring program on job satisfaction for new graduate nurse practitioners. Recognizing the challenge to recruit and retain NNPs, organizations should explore creative solutions to develop and support formalized mentoring programs.

Implications for Research:

Further research is warranted to validate use of the NANNP tool kit in the establishment and evaluation of a formalized mentoring program.

Video abstract available at:
https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.
Developmentally Supportive Care Among Neonatal Intensive Care Unit Nurses in South Korea
Authors: Lee Han Na , Park Ji Hyeon , Cho Haeryun
Published: October 2021

Background:

The concept of developmentally supportive care in preterm infants is of considerable significance in the neonatal intensive care unit (NICU) setting with regard to preventing complications from preterm birth and promoting optimal growth and development. To provide high-quality developmentally supportive care, NICU nurses must possess high levels of knowledge, importance, perception, and competence.

Purpose:

The purpose of this study was to investigate South Korean NICU nursing staff's level of knowledge concerning developmentally supportive care, as well as the perceived importance, perception, and perceived competence regarding this concept.

Methods:

This study employed a cross-sectional descriptive design. Between June 1 and 19, 2020, 160 nurses completed a self-report questionnaire pertaining to developmentally supportive care, which covered the aspects of knowledge, perceived importance, perception (including attitudes, perceived behavioral control, subjective norms, and intentions), and perceived competence.

Results:

The levels of knowledge, attitude, and intention as a subfactor of perception, and perceived competence pertaining to developmentally supportive care were not high. There was no significant difference in the knowledge and perceived competence of skilled nurses compared with novice nurses. However, skilled nurses recognized that they could provide better developmentally supportive care than novice nurses. Perceived competence was positively correlated with perceived importance and perception.

Implications for Practice and Research:

Systematic educational programs that can enhance developmentally supportive care competence should be provided to NICU staff nurses. These must clarify the importance of developmentally supportive care and improve NICU nurses' knowledge, attitudes, self-efficacy, and intentions.
Short-term Results of Transit Bipartition to Promote Weight Loss After Laparoscopic Sleeve Gastrectomy
Authors: Reiser Markus , Christogianni Vasiliki , Nehls Fabian , Dukovska Radostina , de la Cruz Marlon , Büsing Martin
Published: October 2021

Objective:

To evaluate (1) the efficacy of transit bipartition (TB) as revisional bariatric surgery (RBS) after laparoscopic sleeve gastrectomy (LSG); (2) the impact of the length of the common channel (CC) on weight loss.

Background:

LSG in combination with TB has been shown to be highly efficacious for treating morbid obesity. The role of TB as RBS to address the problem of primary failure or weight recidivism after LSG is less well defined.

Methods:

Observational study of outcomes in 100 morbidly obese patients who received a TB following LSG. Follow-up examinations (FE) were performed at 1, 3, 6, and 12 months. Variables analyzed included BMI, percent excess weight loss (%EWL), total body weight loss (%TBWL), effect on obesity-related conditions and complications.

Results:

The mean BMI before LSG was 49.9 ± 8.5 kg/m2. A nadir of 32.7 ± 6.1 kg/m2 was reached 22.1 ± 16.9 months after LSG (%EWL 70.0 ± 14.5). The time interval between LSG and TB was 52.2 ± 26.6 months at which the BMI had increased to 37.6 ± 7.1 kg/m2 and %EWL decreased to 49.4 ± 19.7. Following TB, the BMI decreased continuously to 31.4 ± 5.7 kg/m2 after 12 months with a parallel increase in %EWL to 74.7 ± 20.3 and %TWL reaching 36.3 ± 10.5. Weight loss was significantly higher for CC length of 250 versus 300 cm after 12 months (BMI 29.4 ± 5.3/33 ± 5.3 kg/m2, P = 0.002; %EWL 79.8 ± 26.6/70.4 ± 17; P = 0.009). Improvement of comorbidities was observed in a high proportion of patients. Major early complications occurred in 3% of the patients.

Conclusion:

TB is an effective second-step procedure to address insufficient weight loss or weight recidivism after LSG. CC length of 250 versus 300 cm had a significant impact. While most improvements of obesity-related comorbidities are likely linked to weight loss, amelioration of GERD is largely mediated by accelerated gastric emptying. Major complications were observed in 3% of patients and managed without fatalities.
Changes in Vestibular Function Following Pediatric Cochlear Implantation: a Prospective Study
Authors: Dhondt Cleo , Maes Leen , Vanaudenaerde Saartje , Martens Sarie , Rombaut Lotte , Van Hecke Ruth , Valette Romain , Swinnen Freya , Dhooge Ingeborg
Published: October 2021

Objectives:

Given the close interconnection between the auditory and vestibular end organs, the increasingly broad application of (bilateral) cochlear implantation (CI) in children raises concern about its impact on the vestibular function. Unfortunately, literature on this matter is inconclusive and subject to several limitations. Therefore, this study aimed to elucidate the impact of pediatric CI on the vestibular function in a large sample of children, representative for the current CI population.

Design:

Fifty hearing-impaired children followed in the Ghent University Hospital were included in this prospective study. Twenty-seven patients underwent unilateral CI, and 23 were bilaterally implanted (9 sequentially, 14 simultaneously), adding up to 73 implanted ears. Children’s median age at first implantation was 29 (range 8 to 194) months. Vestibular assessment was scheduled on average 2.8 months (SD: 3.6) before and 4.6 (SD: 4.0) months after implantation and consisted of video Head Impulse Testing of the lateral semicircular canals, rotatory testing (0.16, 0.04, and 0.01 Hz) and cervical vestibular evoked myogenic potential (cVEMP) testing with bone conduction stimulation. Caloric testing was added in children older than 3 years of age.

Results:

Overall, group analysis in our sample of 73 CI-ears did not reveal any significant impact on the vestibular function, except for a significantly shortened ipsilateral N1 latency of the cVEMP responses (p = 0.027) after CI. Complete ipsilateral loss of function after implantation was seen in 5% (3/54) of all CI-ears on the video head impulse testing, in 0% (0/10) on the caloric test and in 2% (1/52) on the cVEMP, notably all patients deafened by a congenital cytomegalovirus infection.

Conclusions:

The impact of CI on the vestibular function in our dataset was limited. Therefore, the many advantages of simultaneous bilateral implantation may outweigh the risk for vestibular damage postoperatively. However, the impact on the vestibular function may be dependent on various factors (e.g., etiology of the hearing loss), and the clinical outcome is still difficult to predict. Vestibular assessment remains thus an important aspect in the pediatric CI population; first because the vestibular function should be considered in the decision-making process on (simultaneous or sequential bilateral) CI and second because it is essential to reveal a possible additional sensory deficit, allowing an opportunity for rehabilitation to improve the overall outcome of these children.
Single Nucleotide Variant in FAS Associates With Organ Failure and Soluble Fas Cell Surface Death Receptor in Critical Illness
Authors: Mikacenic Carmen , Bhatraju Pavan , Robinson-Cohen Cassianne , Kosamo Susanna , Fohner Alison E. , Dmyterko Victoria , Long S. Alice , Cerosaletti Karen , Calfee Carolyn S. , Matthay Michael A. , Walley Keith R. , Russell James A. , Christie Jason D. , Meyer Nuala J. , Christiani David C. , Wurfel Mark M.
Published: October 2021

OBJECTIVES:

Multiple organ failure in critically ill patients is associated with poor prognosis, but biomarkers contributory to pathogenesis are unknown. Previous studies support a role for Fas cell surface death receptor (Fas)-mediated apoptosis in organ dysfunction. Our objectives were to test for associations between soluble Fas and multiple organ failure, identify protein quantitative trait loci, and determine associations between genetic variants and multiple organ failure.

DESIGN:

Retrospective observational cohort study.

SETTING:

Four academic ICUs at U.S. hospitals.

PATIENTS:

Genetic analyses were completed in a discovery (n = 1,589) and validation set (n = 863). Fas gene expression and flow cytometry studies were completed in outpatient research participants (n = 250).

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

In discovery and validation sets of critically ill patients, we tested for associations between enrollment plasma soluble Fas concentrations and Sequential Organ Failure Assessment score on day 3. We conducted a genome-wide association study of plasma soluble Fas (discovery n = 1,042) and carried forward a single nucleotide variant in the FAS gene, rs982764, for validation (n = 863). We further tested whether the single nucleotide variant in FAS (rs982764) was associated with Sequential Organ Failure Assessment score, FAS transcriptional isoforms, and Fas cell surface expression. Higher plasma soluble Fas was associated with higher day 3 Sequential Organ Failure Assessment scores in both the discovery (β = 4.07; p < 0.001) and validation (β = 6.96; p < 0.001) sets. A single nucleotide variant in FAS (rs982764G) was associated with lower plasma soluble Fas concentrations and lower day 3 Sequential Organ Failure Assessment score in meta-analysis (–0.21; p = 0.02). Single nucleotide variant rs982764G was also associated with a lower relative expression of the transcript for soluble as opposed to transmembrane Fas and higher cell surface expression of Fas on CD4+ T cells.

CONCLUSIONS:

We found that single nucleotide variant rs982764G was associated with lower plasma soluble Fas concentrations in a discovery and validation population, and single nucleotide variant rs982764G was also associated with lower organ dysfunction on day 3. These findings support further study of the Fas pathway as a potential mediator of organ dysfunction in critically ill patients.
Q-15 Minutes Vital Sign Documentation Is a Poor Surrogate for Assessing Quality of Care After Acute Ischemic Stroke
Authors: Stone Suzanne , Zhao Huihan , Nyancho Daniel , Schneider Nathan J. , Shang Ty , Olson DaiWai M.
Published: October 2021

Objective

Documenting vital signs and National Institutes of Health Stroke Scale (NIHSS) once every 15 minutes after intravenous thrombolytic therapy for acute ischemic stroke is often used as a metric to assess the quality of care. This study explores the association between “once every 15 minutes” documentation and stroke outcomes.

Methods

This is a retrospective study of the first 2 hours of vital signs and NIHSS documentation after thrombolytic stroke therapy. Sociodemographic and clinical data, including NIHSS, temperature, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, and respiratory rate, were abstracted from the medical record. Missing documentation was examined for association with modified Rankin Scale (mRS) scores and neurologic changes.

Result

Among 84 patients with a mean age of 68.8 years, there were 2276 documented assessments from an expected 3780. There were 104 clinically significant changes in 1 or more index variables. The most commonly missed documentation occurred during interventional radiology. After controlling for admission NIHSS, there was no significant relationship between the completeness of documentation and discharge mRS score (r
2 = 0.047, P = .0561), nor between vital sign documentation and discharge mRS (r
2 = 0.003, P = .6338).

Conclusion

Frequency of documentation does not reflect the quality of care during the early phase of acute stroke treatment.