Comorbidities Associated With Attention-Deficit/Hyperactivity Disorder in Children and Adolescents at a Tertiary Care Setting

Studies have revealed high rates of neurodevelopmental and psychiatric comorbid conditions among individuals diagnosed with attention-deficit/hyperactivity disorder (ADHD). However, research on this topic in the Arab world has been limited. This study evaluates the medical, neurodevelopmental, and psychiatric comorbidities in children and adolescents diagnosed with ADHD in Dubai, United Arab Emirates (UAE). A total of 428 pediatric patients diagnosed with ADHD were included. Children and adolescents with ADHD had high rates of comorbid disorders. Twenty comorbid conditions were identified. More than 3 quarters of the study sample had at least 1 comorbid disorder. The most common comorbidity among children was autism spectrum disorder, and among adolescents was anxiety disorders. Comprehensive assessments are highly warranted to identify and manage associated comorbid conditions. Further research is needed in exploring the biopsychosocial factors contributing to the elevated rate of comorbidity in children and adolescents with ADHD

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Variation in postoperative outcomes of patients with intracranial tumors: insights from a prospective international cohort study during the COVID-19 pandemic

Background: This study assessed the international variation in surgical neuro-oncology practice and 30-day outcomes of patients who had surgery for an intracranial tumor during the COVID-19 pandemic. Methods: We prospectively included adults aged ≥18 years who underwent surgery for a malignant or benign intracranial tumor across 55 international hospitals from 26 countries. Each participating hospital recorded cases for 3 consecutive months from the start of the pandemic. We categorized patients’ location by World Bank income groups (high [HIC], upper-middle [UMIC], and low- and lower-middle [LLMIC]). Main outcomes were a change from routine management, SARS-CoV-2 infection, and 30-day mortality. We used a Bayesian multilevel logistic regression stratified by hospitals and adjusted for key confounders to estimate the association between income groups and mortality. Results: Among 1016 patients, the number of patients in each income group was 765 (75.3%) in HIC, 142 (14.0%) in UMIC, and 109 (10.7%) in LLMIC. The management of 200 (19.8%) patients changed from usual care, most commonly delayed surgery. Within 30 days after surgery, 14 (1.4%) patients had a COVID-19 diagnosis and 39 (3.8%) patients died. In the multivariable model, LLMIC was associated with increased mortality (odds ratio 2.83, 95% credible interval 1.37–5.74) compared to HIC. Conclusions: The first wave of the pandemic had a significant impact on surgical decision-making. While the incidence of SARS-CoV-2 infection within 30 days after surgery was low, there was a disparity in mortality between countries and this warrants further examination to identify any modifiable factors

A multifaceted approach to decrease inappropriate antibiotic use in a pediatric outpatient clinic

BACKGROUND: Inappropriate use of antimicrobial agents is the major cause for the development of resistance. Thus, it is important to include outpatient clinics in the development of antibiotic stewardship program. METHODS: We report a multifaceted approach to decrease inappropriate antibiotic use in upper respiratory tract infections (URTIs) in an outpatient pediatric clinic. The interventions included educational grand round, academic detailing, and prospective audit and feedback and peer comparison. RESULTS: During the study period, a total of 3677 outpatient clinic visits for URTIs were evaluated. Of all the included patients, 12% were <1 year of age, 42% were 1-5 years, and 46% were >5 years of age. Of the total patients, 684 (17.6%) received appropriate antibiotics, 2812 (76.4%) appropriately did not receive antibiotics, and 217 (6%) inappropriately received antibiotics. The monthly rate of prescription of inappropriate antibiotics significantly decreased from 12.3% at the beginning of the study to 3.8% at the end of the study (P < 0.0001). Antibiotic prescription among those who had rapid streptococcal antigen test (RSAT) was 40% compared with 78% among those who did not have RSAT (P < 0.0001). CONCLUSIONS: The combination of education and academic detailing is important to improve antibiotic use

Free vibration analysis of damaged beams via refined models

This paper presents the free vibration analysis of damaged beams by means of 1D (beam) advanced finite element models. The present 1D formulation stems from the Carrera Unified Formulation (CUF), and it leads to a Component-Wise (CW) modelling. By means of the CUF, any order 2D and 1D structural models can be developed in a unified and hierarchical manner, and they provide extremely accurate results with very low computational costs. The computational cost reduction in terms of total amount of DOFs ranges from 10 to 100 times less than shell and solid models, respectively. The CW provides a detailed physical description of the real structure since each component can be modelled with its material characteristics, that is, no homogenization techniques are required. Furthermore, although 1D models are exploited, the problem unknown variables can be placed on the physical surfaces of the real 3D model. No artificial surfaces or lines have to be defined to build the structural model. Global and local damages are introduced by decreasing the stiffness properties of the material in the damaged regions. The results show that the proposed 1D models can deal with damaged structures as accurately as a shell or a solid model, but with far lower computational costs. Furthermore, it is shown how the presence of damages can lead to shell-like modal shapes and torsional/bending coupling

Dynamic damage analysis of composites via a component-wise 1D approach

This paper proposes an innovative approach that is based on 1D (beam) advanced models for the damage analysis of composite structures. The present 1D formulation stems from the Carrera Unified Formulation (CUF) and it leads to a Component-Wise (CW) modelling. By means of the CUF, any-order 2D and 1D structural models can be developed in a unified and hierarchically manner and they provide extremely accurate results with very low computational costs. The computational cost reduction in terms of total amount of DOFs ranges from 10 to 100 times less then shell and solid models, respectively. The 1D CUF formulation, which is based on the use of Lagrange polynomials to describe the cross-section displacement field of the structure, is exploited in this paper. Such 1D models lead to the CW since each component of a complex structure can be modelled through a refined 1D model based on Lagrange expansions. The adoption of only 1D models to model complex structures improves the multi-dimension coupling capabilities and reduces the computational costs to a great extent. The CW can lead to a multi-scale approach for composites since each typical component of a composite structure can be modelled through the 1D CUF models and, moreover, different scale components can coexist in the same model with no need of further modelling tools. A detailed physical description of a real structure can be obtained since each component can be modelled with its own material characteristics, that is, no homogenization techniques are required. Furthermore, Although 1D models are exploited, the problem unknown variables can be placed on the physical surfaces of the real 3D model, that is, no artificial surfaces or lines have to be defined to build the structural model. In this paper, damaged composite structures are analysed by means of the CW approach. Static and dynamic responses are carried out and comparisons against classical approaches are provided to show the enhanced capabilities of the present approach in obtaining 3D-like accuracy with very low computational costs

Free vibration analysis of damaged beams via refined models

This paper presents the free vibration analysis of damaged beams by means of 1D (beam) advanced finite element models. The present 1D formulation stems from the Carrera Unified Formulation (CUF), and it leads to a Component-Wise (CW) modelling. By means of the CUF, any order 2D and 1D structural models can be developed in a unified and hierarchical manner, and they provide extremely accurate results with very low computational costs. The computational cost reduction in terms of total amount of DOFs ranges from 10 to 100 times less than shell and solid models, respectively. The CW provides a detailed physical description of the real structure since each component can be modelled with its material characteristics, that is, no homogenization techniques are required. Furthermore, although 1D models are exploited, the problem unknown variables can be placed on the physical surfaces of the real 3D model. No artificial surfaces or lines have to be defined to build the structural model. Global and local damages are introduced by decreasing the stiffness properties of the material in the damaged regions. The results show that the proposed 1D models can deal with damaged structures as accurately as a shell or a solid model, but with far lower computational costs. Furthermore, it is shown how the presence of damages can lead to shell-like modal shapes and torsional/bending coupling

EEFECTS OF DIETARY FLAVONOIDS INTAKE IN SAUDI PATIENTS WITH CORONARY HEART DISEASE.

Objectives: The aim of the study was to assess the dietary intake of flavonoids and their effect on serum lipid levels in Saudi patients with coronary heart disease (CHD). Methodology: A cross-sectional study with a sample of 50 CHD patients and 50 controls. A 24-hour recall method was used to collect data on the dietary intake of macronutrients, flavonoids, and antioxidant vitamins. A food frequency questionnaire (FFQ) was used to collect data on habitual consumption during the year preceding the interview. Baseline data collection included medical history, anthropometric measurements, physical activity, and smoking status. Results: CHD patients showed significantly less intake of fruits and vegetables compared to the controls. Serum lipids including total cholesterol (TC), triglycerides (TG), and low density lipoproteins (LDL) were found to be significantly higher in CHD patients than in the controls. The main sources of flavonoids in a typical Saudi diet are tea, fruits (apples), vegetables (onions), and chocolate. The intake of flavonoids and antioxidant vitamins was significantly lower in CHD patients compared to the controls. A negative correlation between the dietary intake of different flavonoids and serum LDL was observed in CHD patients. Significant correlation was found between the intake of flavonol and waist to hip ratio Conclusions: The findings of the study support a potential protective effect of dietary flavonoids in relation to CHD. The study showed that consuming more Flavonoids may have positive effect on lowering blood lipids.King saud universit