Amita Health St. Mary's Hospital

<title>Abstract</title> <bold>Background</bold> Terminally ill patients frequently exhibit symptoms of existential distress, encompassing a diminished sense of life meaning, diminished self-efficacy, and heightened death anxiety. Although narrative nursing has demonstrated potential as a psychosocial intervention, its utilisation within a group-based palliative care framework remains under-explored. <bold>Methods</bold> A quasi-experimental pre-post study was conducted with convenience sampling. A total of fifty patients with advanced cancer were enrolled in the study, of whom forty-three completed a four-week group narrative nursing intervention. The programme encompassed weekly storytelling sessions, individual interviews, and multimedia-supported reflection. The measurement of outcomes was conducted using validated scales for life meaning, self-efficacy, and death anxiety. Paired <italic>t</italic> -tests were then conducted to statistically analyze the pre- and post-intervention data. <bold>Results</bold> A substantial enhancement in the observed outcomes was evident subsequent to the intervention. The mean scores for the construct of life meaning increased from 2.28 ± 0.65 to 2.70 ± 0.52 ( <italic>P</italic> &lt; 0.001), self-efficacy increased from 2.38 ± 0.58 to 2.88 ± 0.47 ( <italic>P</italic> &lt; 0.001), and death anxiety decreased from 2.23 ± 0.57 to 2.71 ± 0.44 ( <italic>P</italic> &lt; 0.001). The improvements demonstrated in this study were consistent across all subdomains of each measure, indicating a comprehensive psychological benefit. <bold>Conclusion</bold> The present study set out to investigate the hypothesis that structured group-based narrative nursing would significantly enhance psychological well-being among patients receiving palliative care. The findings support the integration of narrative interventions into holistic end-of-life care, particularly for improving existential outcomes.

INTRODUCCIÓN. La mayor conciencia sobre el dolor hace que, en la mayoría de los servicios de urgencias pediátricas (SUP), se hayan creado protocolos de sedoanalgesia para mejorar la calidad de atención y manejo terapéutico. El objetivo de este estudio es conocer las características de uso de la sedonanalgesia en un SUP. MATERIALES Y MÉTODOS. Se realizó estudio observacional de cohortes en pacientes &lt; 14 años atendidos en urgencias que precisaron sedoanalgesia entre los meses de marzo de 2015 y marzo de 2020. Se analizaron variables demográficas, procedimiento el que se usó esta técnica, fármacos utlizados, nivel de dolor, grado de ansiedad y tiempos de estancia en urgencias. RESULTADOS. Se analizaron 483 pacientes. El 68,5% (n = 331) eran varones. El 50% fueron menores de 5 años. El procedimiento que requirió sedoanalgesia con mayor frecuencia fue la reducción de fracturas (30,7%, n = 149). Por edad, destaca su uso en punciones lumbares en &lt; 1 año (47,36%, n = 18), reparación de heridas entre 1 y 5 años (33,05%, n = 78), y para reducción de fracturas en &gt; 5 años (48,57%, n = 102). El fármaco más empleado fue midazolam (48,1%, n = 233), mayoritariamente en combinación con fentanilo (78,5%, n = 183), siendo la vía intranasal de elección (61,8%, n = 144). Se observaron diferencias estadísticamente significativas (p &lt; 0,001) en la reducción del grado de dolor y ansiedad. La mayoría de los pacientes no presentaron efectos secundarios precoces (86,2% n = 418) ni tardíos (94%, n = 457). Finalmente, el coeficiente de correlación entre el grado de satisfacción de padres y sanitarios fue de 0,883 (p &lt; 0,001). CONCLUSIÓN. El empleo de sedoanalgesia en procedimientos diagnóstico-terapéuticos en urgencias pediátricas es eficaz en la disminución del grado de dolor y ansiedad. El escaso número de efectos secundarios permite realizarlo por pediatras, favoreciendo el alta precoz.

Prior to routine active immunization, Haemophilus influenzae was the leading cause of bacterial meningitis and other invasive bacterial disease among children. Although it is listed as one of the pathogenic causes of early-onset neonatal sepsis, it’s a relatively infrequent cause of it. The onset of a clinical syndrome along with isolation of the bacteria in the first 72 hours of life defines neonatal sepsis and often presents as bacteremia, pneumonia or meningitis. We present the case of a preterm low birth weight infant with Haemophilus influenzae sepsis. Considering the high neonatal mortality and morbidity of these infections, cultures should be reconsidered. Prompt antibiotic therapy may not be enough in positive outcome of these patients.

Subject. The stages of medication-related osteonecrosis of the jaws (MRONJ) are an important criterion for choosing treatment tactics, while laboratory diagnosis of the stages of MRONJ has not been developed. The aim of the study is to analyze the dependence of the levels of bone metabolic markers (BMM) on the stage of the disease in patients with MRONJ. Methodology. The study included 48 cancer patients with osteonecrosis of the jaws while taking osteomodifying agents (OMA) with stabilization of the underlying disease. The activity of osteosynthesis was assessed by the level of osteocalcin (OC), osteoresorption – C-terminal telopeptide (CTX) – in the blood serum before treatment. The stage of MRONJ was established according to the classification developed at the Department of Surgical Dentistry and Maxillofacial Surgery of Stavropol State Medical University (2017). The levels of BMM indicators were compared for clinically significant stages (1, 2, 3) using the Kruskal–Wallis test for p &lt; 0.05. Results. Stage 1 MRONJ was established in 17 (35.42%) patients, stage 2 – in 25 (52.08%) patients, stage 3 – in 6 (12.5%) patients. The average values of BMM indicators were: in patients with stage 1 – OK – 14.65 (10.5;17.5) ng/ml, CTX – 0.289 (0.172;0.351); with stage 2 OK – 10 (8.74;11) ng/ml, CTX – 0.137 (0.09;0.18); with stage 3 – OK – 15.5 (14;21) ng/ml, CTX – 0.476 (0.353;0.633). The average OC values were statistically significantly different in groups of patients with different stages of MRONJ (H = 14.13; p = 0.00085; p &lt; 0.05), as were the STX values (H = 22.3; p = 0.00001; p &lt; 0.05). At the same time, the average levels of both BMM in patients with stage 2 were lower than in patients with stage 1, and their highest level was recorded in stage 3 of the process. Conclusions. A significant (p &lt; 0.05) relationship was established between the levels of OC and CTX and the stage of MRONJ: the maximum values were recorded at the third stage, the minimum at the second and intermediate at the first.

Abstract Background Temperature management has been shown to be important in different diseases, and our study analyzes the research trends and future directions of temperature management in critically ill patients. Methods Literatures in our study were searched from the Web of Science core collection database (WoSCC), timeline was confined from the earliest time of the database to the latest time of literature search (October 22, 2023). R-studio and Citespace were used to perform the visualization analysis. Results A total of 529 publications from the WoSCC were analyzed. According to our research, there has been a rapid increase in publications since 2013. The largest number of articles produced by corresponding authors in the United States is as high as 161. Resuscitation had the highest number of publications among journals worldwide, with 23 publications representing 4.59% of all publications. Most of the keywords were related to cardiac arrest, critical care, hypothermia, targeted temperature management and therapeutic hypothermia. Latest burst words are neuron specific enolase, prognostication, septic shock and ambient temperature. This suggests that there may be more groundbreaking reports in these directions. Conclusions Temperature management is crucial in the clinical treatment of critically ill patients. Future studies should analyze more aspects of specific implementation in different diseases that can be controlled by temperature management target temperature, treatment timing, induction mode, induction speed, duration, rewarming mode and speed.

Aim. To assess the impact of new coronavirus infection (NCI) and COVID-19 vaccination on menstrual function in comparison with the frequency of depressive disorders during the COVID-19 pandemic among female students of a medical university.&#x0D; Materials and methods. Data for a continuous transverse (cross-sectional) study were obtained using an online survey. The questions included demographics, characteristics of menstrual function, the history of COVID-19 and vaccinations against it, and the standard CES-D (Center for Epidemiologic Studies Depression Scale) questionnaire. The survey included 1.879 female medical students. The exclusion criteria were age under 18 and over 25 years, hormonal contraceptives, pregnancy, childbirth during the last year, and vaccination after COVID-19. After applying the exclusion criteria, three study groups were formed. Group 1 included female students with a history of NCI (n=140), group 2 included students with no history of NCI, who were initially vaccinated against COVID-19 (n=647), group 3 (control group) included unvaccinated students with no history of NCI (n=55).&#x0D; Results. There were no differences in the prevalence of changes in menstrual function in female students after the NCI (49.3%) and after COVID-19 vaccination (39.6%) compared to the control group (43.6%); p=0.477. The rate of depression in the overall study cohort was 43.3%, without any significant differences between the study groups. Significant predictors of changes in menstrual function during the pandemic were marriage (odds ratio OR 2.33 [1.513.61]), depression (OR 1.72 [1.282.3]), a history of menstrual dysfunction (OR 1.5 [0.121.99]), and later menarche (OR 1.76 [1.023.04]). Multivariate analysis did not show the significance of the history of NCI and vaccination as factors of menstrual dysfunction (OR 1.61 [0.892.90] and OR 0.91 [0.591.41], respectively).&#x0D; Conclusion. During the COVID-19 pandemic, female medical students reported frequent changes in menstrual function and depressive disorders. During the pandemic, the most significant predictors of menstrual disorders in female students were depression, a history of menstrual dysfunction, and marriage. A multicenter prospective study is necessary to clarify the mechanisms of the pandemic's impact on menstrual function.

Abstract Background: Adjacent segment disc degeneration (ASDD) is one of the long-term sequelae of spinal fusion, which is more susceptible with osteoporosis. As an anti-osteoporosis drug, strontium ranelate (SR) has been reported to not only regulate bone metabolism but also cartilage matrix formation. However, it is not yet clear whether SR has a reversal or delaying effect on fusion-induced ASDD in a model of osteoporosis. Methods Fifth three-month-old female Sprague-Dawley rats that underwent L4-L5 posterolateral lumbar fusion (PLF) with spinous-process wire fixation 4 weeks after bilateral ovariectomy (OVX) surgery. Animals were subcutaneously administered vehicle (V) or SR (900 mg/kg/d) for 12 weeks post-PLF as follows: Sham + V, OVX + V, PLF + V, OVX + PLF + V, and OVX + PLF + SR. Manual palpation and X-ray were used to evaluate the state of lumbar fusion. Adjacent-segment disc was assessed by histological (VG staining and Scoring), histomorphometry (Disc Height, MVD, Calcification rate and Vascular Bud rate), immunohistochemical (Col-II, Aggrecan, MMP-13, ADAMTS-4 and Caspase-3), and mRNA analysis (Col-I, Col-II, Aggrecan, MMP-13 and ADAMTS-4). Adjacent L6 vertebrae microstructures were evaluated by microcomputed tomography. Results Manual palpation and radiographs showed clear evidence of the fused segment's immobility. After 12 weeks of PLF surgery, a fusion-induced ASDD model was established. Low bone mass caused by ovariectomy can significantly exacerbate ASDD progression. SR exerted a protective effect on adjacent segment intervertebral disc with the underlying mechanism possibly being associated with preserving bone mass to prevent spinal instability, maintaining the functional integrity of endplate vascular microstructure, and regulating matrix metabolism in the nucleus pulposus and annulus fibrosus. Conclusions Anti-osteoporosis medication SR treatments not only maintain bone mass and prevent fractures, but early intervention could also potentially delay degenerative conditions linked to osteoporosis. Taken together, our results suggested that SR might be a promising approach for the intervention of fusion-induced ASDD with osteoporosis.

It is known that the clinical course of glial tumors often shows similarities with inflammatory diseases of the brain, which made it possible to distinguish a special inflammatory type of gliomas. Chronic processes associated with the persistence of an infectious etiological factor proceed as a productive inflammation, while the etiological factor itself causes a proliferative cellular response.AIM OF THE STUDY: biopsies of 1424 glial tumors contaminated with hSV (glioblastomas (748), anaplastic astrocytomas (103), astrocytomas (248), oligodendrogliomas (126), anaplastic oligodendrogliomas (25), mixed gliomas (60), anaplastic mixed gliomas (15), ependymomas (85), anaplastic ependymomas (14)).The control groups consisted of tumors that did not express antibodiEs to hSV, in which intranuclear inclusions characteristic of hSV were not detected.Staining with hematoxylin-eosin was carried out in an automatic staining apparatus according to the generally accepted histological method. To detect hSV in tumors, an immunohistochemical study was used with antibodies to the antigen of hSV type I and II. Proliferative activity (Ki-67) was determined. Vessels were counted (CD 34). To identify inflammatory infiltration, an IhC study was performed with a set of monoclonal antibodies CD 45 (total leukocyte factor), CD 8 (T-lymphocytes). The IhC assay with p53 and bcl-2 was used to study apoptosis. To study the aggressiveness of tumor growth, the epidermal growth factor receptor (EGFR) was studied.RESULTS. It was found that glioblastomas occurring against the background of chronic inflammation have a median difference in the expression of bcl-2 and p53 in the vascular endothelium equal to 7.9 %. With an exacerbation of a chronic inflammatory process — 8.7 %. For anaplastic astrocytomas, the difference in chronic inflammation was 7.9 %, with its exacerbation — 8.2 %, for anaplastic oligodendrogliomas — 6.9 % and 7.1 %, for anaplastic oligoastrocytomas — 7.4 and 8.1 %, for anaplastic ependymomas — 7.2 % and 7.8 %, respectively. The difference between the expression of bcl-2 and p53 in tumor cells during chronic inflammation and its exacerbation for glioblastomas was 1.4 % and 1.5 %, for anaplastic astrocytomas — 0.73 % and 0.8 %, for anaplastic oligodendrogliomas — 0.7 % and 0.8 %, for anaplastic oligoastrocytomas — 0.7 % and 0.8 %, for anaplastic ependymomas — 0.6 % and 0.7 %. The difference in the expression of anti-apoptotic (bcl-2) and apoptotic (p53) factors for endothelial cells is significantly greater than for tumor cells (p&lt;0.01), which determines the primacy of vessel growth. When comparing each of the groups of high-grade glial tumors with the control group, the amount of Ki-67 expression in endothelial cells was increased by an average of 3 times in each of the groups. This was manifested by a significant increase in the number of vessels in the «hot spot», accompanied by an acceleration of tumor growth.The correlation analysis between the amount of expression of antibodies to hSV and EGFR in high-grade glial tumors showed that there is a positive correlation between the amount of expression of antibodies to hSV and EGFR.Glial tumors of low malignancy progress due to an increase in the cell population, with a twofold increase in which the appearance of a proliferating vessel is fixed, which increases the degree of aggressiveness of tumor growth.CONCLUSION. The main growth mechanism of high-grade glial tumors is that the difference in the expression of antiapoptotic (bcl-2) and apoptotic (p53) factors for endothelial cells is significantly greater than for tumor cells (p&lt;0.01), which determines the primacy of vessel growth. The main growth mechanism of low-grade glial tumors is characterized by an increase in their cell population. With an increase in the number of cells by 2 times, a proliferating vessel is formed, which increases the degree of aggressiveness of the tumor process. The aggressiveness of the disease depends on the presence of signs of exacerbation of inflammation caused by contamination of glial tumors with hSV, since EGFR activation is directly related to a high degree of tumor malignancy, aneuploidy, and a proliferative index. When planning the volume of surgical intervention during operations to remove glial tumors, the removal of the maximum number of proliferating vessels in the peritumorous zone should be taken into account as a cause provoking the onset of relapse, which will significantly increase the radicalness of the surgical intervention without reducing the quality of life of the patient.