National Hospital

This study aimed to identify factors influencing long-term memory outcomes after temporal lobe epilepsy surgery, focusing on patients with well-preserved functioning versus those with severe impairments. Ninety-nine patients underwent epilepsy surgery and completed neuropsychological assessments preoperatively (T1) and two years postoperatively (T2), with follow-up 10-44 years after surgery (T3). Memory scores were categorized as severely impaired (>2 SD below the mean) or good (≥ average). At T3, 46% of patients reported surgery-related memory decline and 9% reported later decline. Objectively, verbal memory was severely impaired in 21% and good in 14%, while figural memory was severely impaired in 34% and good in 12%. Continuous seizure freedom occurred in 45%, late seizure freedom in 24%, relapse in 11%, and ongoing seizures in 20%. Seizure-free patients performed better. Among those severely impaired in verbal memory at T3, 45% had declined by T2 and 20% declined later; among good performers, 79% improved late. For figural memory, 8% declined by T2 and 65% declined later; among good performers, 27% improved after surgery and 64% improved later. Surgical side, education, and age predicted outcomes. Many years after temporal lobe epilepsy surgery, 45% of patients achieved continuous seizure freedom and 20% late seizure freedom. Only 9% reported late memory decline. Verbal memory tended to decline shortly after surgery but showed recovery over time, whereas figural memory more often declined later. These patterns suggest late mechanisms of functional recovery, compensation, and reorganization.

IntroductionRegular physical activity at a moderate-to-vigorous intensity is associated with a lower risk of recurrent cardiovascular events and mortality in individuals with coronary heart disease (CHD). Walking is a common form of physical activity; however, there is no evidence-based recommendation for the optimal step cadence (steps per minute) to achieve these intensity levels among individuals with coronary heart disease. Thus, this study aimed to establish the agreement between manually counted step cadence and step cadence assessed by waist- and wrist-worn accelerometers during treadmill walking among individuals with CHD. Next, the study aimed to establish the association between manually counted and accelerometer-assessed step cadence with cardiorespiratory intensity, followed by the development and validation of cadence thresholds for moderate- and vigorous-intensity levels.MethodsParticipants (n = 87) performed a graded treadmill test. Step cadence was counted manually and by a waist- and wrist-worn accelerometer (Actigraph GT3x). Step cadence and oxygen consumption were measured during the final minute of walking at four speeds (3–6 km·h−1). Agreement between manual and accelerometer cadence was established using Bland–Altman analyses. Step cadence thresholds for relative (%VO₂ peak) and absolute (METs) intensity were derived using generalized estimating equations in a training cohort (70%) and validated in a validation cohort (30%).ResultsAccelerometers underestimated the aggregated cadence compared with manual assessments, with a mean difference of −16 and −31 steps/min for waist- and wrist-worn accelerometers, respectively, with a higher level of agreement at higher speeds. Manually assessed cadence thresholds for moderate intensity were 99 (relative) and 92 (absolute) steps/min compared with 61 and 45 steps/min from waist-worn accelerometers. For vigorous intensity, manual and accelerometer thresholds were similar: 116 vs. 112 (relative) and 126 vs. 135 (absolute) steps/min. Both methods effectively identified valid thresholds for moderate and vigorous cardiorespiratory intensity.ConclusionStep cadence is a valid indicator of intensity in CHD populations, with manual and accelerometer methods showing comparable accuracy, despite accelerometer underestimation at lower speeds.Clinical Trial RegistrationAustralian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623000605695 (02062023).

Summary: The COVID-19 pandemic profoundly impacted healthcare systems worldwide, with India experiencing over 45 million confirmed cases and more than 534 000 deaths (WHO, 2024). This crisis significantly disrupted training programs globally, including the Ronald Reagan Institute for Emergency Medicine at George Washington University institution’s longstanding partnerships with 18 institutions across India focused on delivering education and training for emergency medicine (EM). The scale and duration of the pandemic posed unprecedented challenges to providing essential support to EM trainees, yet also underscored a critical global initiative to enhance resilience during times of crisis. As the pandemic unfolded, traditional in-person training faced severe limitations, prompting a shift to remote education. This transition allowed us to leverage online platforms for real-time didactics, case discussions, tele simulations, and remote procedural workshops, ensuring educational continuity for approximately 150 EM trainees annually. This innovative approach maintained engagement and demonstrated the scalability of distance learning to enhance education while supporting workforce development. Moreover, the pandemic amplified the importance of interprofessional collaboration and mentorship, as virtual platforms enabled connections among trainees and faculty across geographic boundaries, illustrating the resilience of educational networks in times of crisis. This experience underscored the necessity for adaptable curriculum delivery, which has led to hybrid models combining virtual and in-person training in the post-pandemic landscape, including a virtual tabletop exercise on disasters. The lessons learned from the pandemic presented a unique opportunity to innovate EM training at our partner sites in India, equipping the workforce to better respond to future healthcare challenges. By embracing adaptable training models, we can enhance educational experiences and ultimately improve emergency care delivery during times of crisis, fostering sustainable workforce capacity that strengthens healthcare systems overall.

Introduction: Invasive mechanical ventilation (IMV) in pediatric status asthmaticus has been associated with long term morbidity. Air leak syndrome (ALS), which includes pneumothorax, pneumomediastinum, or subcutaneous emphysema, is a rare but clinically challenging complication of status asthmaticus which has not been described on a large scale. Our objective was to describe ALS in patients treated with IMV for status asthmaticus and to determine the relationship between ALS and mortality and length of stay (LOS). Methods: This is a retrospective observational study of patients older than 2 years requiring IMV for status asthmaticus at a tertiary urban PICU over 15 years (2008-2023). Demographics, comorbidities, LOS, laboratory data, and interventions provided were extracted from the electronic medical record. Univariate and multivariate analyses were performed for selected variables to compare patients who did and did not develop ALS. Results: 146 patients admitted to the PICU for status asthmaticus required IMV, and 22 developed ALS. Median age of patients with ALS was 12.5 years. Patients aged 12-22 years had a higher percentage of developing ALS (p=0.016). ALS was detected in 8 patients prior to intubation, and 12 patients required intervention. There was no difference in sex, race, or location of intubation between those who did or did not develop ALS. Patients with ALS demonstrated worse lactatemia (5.8 vs 2.9, p< 0.001) and hypercarbia (91 vs 70, p< 0.001). Patients with ALS had a longer PICU and hospital LOS (PICU: 9.8 vs 4.8 days, p < 0.001, hospital:16.9 vs 8.7 days, p< 0.001). There was no difference in mortality between the two groups. Conclusions: Adolescent patients with status asthmaticus requiring IMV are at higher risk of ALS than their younger counterparts. Critically ill children with status asthmaticus and ALS have worse markers of acidosis and have longer LOS than those who do not. However, there is no association between ALS and mortality. This may suggest that presence of ALS may serve as a marker of severity of illness in status asthmaticus. These findings may guide management towards minimizing barotrauma and anticipating protracted lengths of stay. Future directions include investigating whether specific interventions for status asthmaticus can reduce incidence of ALS.

Anisometropic amblyopia is the most common cause of visual morbidity in childhood which is characterized by reduced spatial vision due to refractive error. This study was planned to determine the visual outcome after full refractive correction of anisometropic amblyopia among 5-15 years old children. The Cross sectional interventional study was conducted conducted in the Departments of Community Ophthalmology and Ophthalmology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from March 2017 to august 2019. Children (5-15 years) having myopic, hypermetropic &amp; astigmatic refractive error between two eyes will be minimum 1.0 D difference after refraction and didn’t get any treatment for this problem yet were the study population. Total 52 untreated children were included in the study. 3 children did not attend the follow up visit. The mean age of the subjects of our study was 9.47 years, range of age was 5-15 years. 44 (89.8%) patients were bilateral &amp; 5 (10.2%) were unilateral. After full correction of refractive error with spectacles alone improved anisometropic amblyopic eyes visual acuity an average of 2.3 lines in snellen’s chart. Visual acuity improved from baseline by 2 or more lines (95% CI) in 85% of the patients and by 3 or more lines in 49.3%. This improvement is statistically significant (P&lt;0.0001). Additionally, amblyopia resolved in 7 of 49 (15%) patients with residual amblyopia who continued to be treated with spectacles even after completion of follow up plan. Improvement of visual acuity continued beyond the initial 12 weeks of spectacle wearing for 37 (75.5%) of the 49 patients completing the initial 12 week visit, after completing 24 weeks, it was 26 (53.1%). The mean VA of the right eyes at baseline was 0.45 Log MAR unit. In 2nd visit shows the mean of VA is 0.34 log MAR unit and in 3rd visit mean is 0.23 log MAR unit. Total improvement in right eye was 0.22 logMAR unit. The mean VA of the left eyes at baseline was 0.51 LogMAR unit. In 2nd visit shows the mean of VA is 0.37 logMAR unit and in 3rd visit VA mean is 0.30 logMAR unit. Total improvement in right eye was 0.21 logMAR unit. Average improvement in both eyes 0.215 logMAR unit. So, results shows that refractive correction is a powerful treatment modality for young children with anisometropic amblyopia. If we can detect them earlier then we should have given these children a better vision &amp; prosperous life. J.Natl.Inst.Ophthalmol.2024;7(2): 20-27

Abstract Background Endotracheal aspirate (ETA) cultures are commonly used in tracheostomy-dependent and mechanically-ventilated children with suspected lower respiratory tract infections. Gram stains of the ETA are performed before culture incubation to assess for white blood cells and microorganisms. Samples without microorganisms on Gram stain typically have low culture yield and rarely grow clinically relevant organisms. Despite this, samples with negative Gram stains are often still processed for culture. The objective is to assess the correlation between ETA Gram stain and semi-quantitative culture results at a free-standing children’s hospital.Gram Stain and Semi-quantitative Endotracheal Aspirate Culture Results Methods This is a retrospective cohort study of ETA cultures processed at the Children’s National Hospital (CNH) Microbiology Laboratory from 01/2023 to 12/2024. ETA Gram stains and semi-quantitative culture growth (1+, 2+, 3+, or 4+) were reviewed. For cultures that grew more than one organism, the organism with the highest semi-quantitative growth category was used for the sample. Culture growth of 3+ or 4+ was considered substantial. Results A total of 2057 samples were included. 1177 (57.2%) had organisms identified on Gram stain, which corresponded with 3+ or 4+ pathogenic growth in 329 (27.9%) samples (Table 1). Of the 880 (42.8%) samples without microorganisms detected on Gram stain, 867 (98.5%) resulted in no substantial bacterial growth; 13 (1.5%) had substantial growth. Using chi-square, we found Gram stain results to be significantly associated with culture results (p&amp;lt; 0.0001). The sensitivity of a Gram stain with microorganisms for positive culture was 96.2% with an associated negative predictive value of 98.5%. Specificity of Gram stain with microorganism was 50.6% with an associated positive predictive value of 28%. Conclusion ETA Gram stain with microorganisms is strongly correlated with semi-quantitative respiratory culture results. Despite low specificity and positive predictive value, the utility of Gram stains for ETA samples lies in the sensitivity and negative predictive value of this test for determining the need for subsequent ETA culture. Disclosures Rachel Strength, MD, Dexcom: Stocks/Bonds (Public Company)|Johnson and Johnson: Stocks/Bonds (Public Company)|Merck: Stocks/Bonds (Public Company)|Thermo Fisher: Stocks/Bonds (Public Company)|Vertex Pharmaceuticals: Stocks/Bonds (Public Company) Rana F. Hamdy, MD, MPH, MSCE, FPIDS, No company, but co-inventor on a pending patent for StrepApp: co-inventor on a pending patent for StrepApp