Profuse bleeding from traumatic lateral plantar artery pseudoaneurysm after glass foot injury diagnosed by CT angiography: A case report

AbstractRetained foreign bodies and penetrating injuries to the plantar aspect of the foot are a common childhood problem. Inflammations or infections are common complications whereas vascular injury and pseudoaneurysm' formation are rare. Three cases of post -traumatic lateral plantar artery (LPA) pseudoaneurysms due to foot lacerations by glass have been reported in children. This case is a six year-old boy who presented with two episodes of bleeding after a foot laceration sustained when he stepped on glass. CT angiography showed an LPA pseudoaneurysm that was successfully managed by surgery. It should be recognized that penetrating injuries to the plantar aspect of the foot, may be associated with vascular injury and pseudoaneurysm' formation. Appropriate investigations and management is important to prevent further complications

Meckel’s diverticulum: a rare cause of intestinal perforation in a preterm newborn

Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. It is usually encountered as an incidental finding at operation or autopsy. Symptomatic cases usually present during infancy with intestinal obstruction, intestinal hemorrhage, diverticulitis, or perforation. We report on a preterm newborn who developed abdominal distension at 17 h of age and pneumoperitoneum at 30 h. At laparotomy, a  narrow-based MD with a small  perforation at the tip was encountered. Segmental resection of the ileum,  including the MD, and end-to-end anastomosis was performed. A review on perforated MD from the English medical literature is also presented. Perforated MD, although rare, should be included in the differential diagnosis of neonatal gastrointestinal perforations and acute abdomen.Keywords: acute abdomen, gastrointestinal perforation, perforated Meckel’s diverticulum, preterm newbor

Is Bowel Rest a Prerequisite for Successful Outcome in Nonoperative Management of Extrahepatic Bile Duct Blunt Injury in Children?

Extrahepatic bile duct injury resulting from blunt abdominal trauma in children is not common. Nonoperative management has become the standard of care. During a two-year period from January 2005 to December 2006, we treated 1015 pediatric traumas. Of those, 103 were blunt abdominal trauma. Only two patients had injury to the extrahepatic bile ducts. Both cases were managed nonoperatively; however, the clinical presentation required a different approach. Facilitation of bile flow by means of sphincterotomy, or putting a transampullary stent, had the most significant impact on successful outcome. Bowel rest did not influence outcome. Therefore nonoperative management of blunt extrahepatic bile duct blunt injuries in children should be based on ensuring adequate bile flow. Bowel rest does not seem to be a prerequisite for successful outcome.Index Word: Blunt abdominal trauma; extrahepatic bile duct injury; nonoperative

Determinants of COVID-19-Related Length of Hospital Stays and Long COVID in Ghana: A Cross-Sectional Analysis

Copyright: © 2022 by the authors. Objectives: There is paucity of data on determinants of length of COVID-19 admissions and long COVID, an emerging long-term sequel of COVID-19, in Ghana. Therefore, this study identified these determinants and discussed their policy implications. Method: Data of 2334 patients seen at the main COVID-19 treatment centre in Ghana were analysed in this study. Their characteristics, such as age, education level and comorbidities, were examined as explanatory variables. The dependent variables were length of COVID-19 hospitalisations and long COVID. Negative binomial and binary logistic regressions were fitted to investigate the determinants. Result: The regression analyses showed that, on average, COVID-19 patients with hypertension and diabetes mellitus spent almost 2 days longer in hospital (p = 0.00, 95% CI = 1.42–2.33) and had 4 times the odds of long COVID (95% CI = 1.61–10.85, p = 0.003) compared to those with no comorbidities. In addition, the odds of long COVID decreased with increasing patient’s education level (primary OR = 0.73, p = 0.02; secondary/vocational OR = 0.26, p = 0.02; tertiary education OR = 0.23, p = 0.12). Conclusion: The presence of hypertension and diabetes mellitus determined both length of hospitalisation and long COVID among patients with COVID-19 in Ghana. COVID-19 prevention and management policies should therefore consider these factors

A minimally invasive option for the treatment of persistent postoperative esophageal leak

Persistent postoperative leaks in esophageal surgery in children are highly morbid. They usually require technically difficult major reoperations. A less invasive approach is always desirable. During the period 2003 to 2007, we used a minimally invasive approach for the treatment of persistent postoperative esophageal leaks in two children by injection of fibrin glue into the leak site through a small catheter that was introduced through the chest tube. The procedure was successful in one case. We introduce this approach as an alternative to surgery. We found it to be a safe and viable option for the treatment of persistent postoperative esophageal leaks.Keywords: chest tube, esophageal leak, fibrin glu

Determinants of COVID-19 outcomes: A systematic review

PROSPERO registration number CRD42021237063.This article is a preprint and has not been peer-reviewed [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.Background: The current pandemic, COVID-19, caused by a novel coronavirus SARS-CoV-2, has claimed over a million lives worldwide in a year, warranting the need for more research into the wider determinants of COVID-19 outcomes to support evidence-based policies. Objective: This study aimed to investigate what factors determined the mortality and length of hospitalisation in individuals with COVID-19. Data Source: This is a systematic review with data from four electronic databases: Scopus, Google Scholar, CINAHL and Web of Science. Eligibility Criteria: Studies were included in this review if they explored determinants of COVID-19 mortality or length of hospitalisation, were written in the English Language, and had available full-text. Study appraisal and data synthesis: The authors assessed the quality of the included studies with the Newcastle□Ottawa Scale and the Agency for Healthcare Research and Quality checklist, depending on their study design. Risk of bias in the included studies was assessed with risk of bias assessment tool for non-randomised studies. A narrative synthesis of the evidence was carried out. The review methods were informed by the Joana Briggs Institute guideline for systematic reviews. Results: The review included 22 studies from nine countries, with participants totalling 239,830. The included studies’ quality was moderate to high. The identified determinants were categorised into demographic, biological, socioeconomic and lifestyle risk factors, based on the Dahlgren and Whitehead determinant of health model. Increasing age (ORs 1.04-20.6, 95%CIs 1.01-22.68) was the common demographic determinant of COVID-19 mortality while living with diabetes (ORs 0.50-3.2, 95%CIs −0.2-0.74) was one of the most common biological determinants of COVID-19 length of hospitalisation. Review limitation: Meta-analysis was not conducted because of included studies’ heterogeneity. Conclusion: COVID-19 outcomes are predicted by multiple determinants, with increasing age and living with diabetes being the most common risk factors. Population-level policies that prioritise interventions for the elderly population and the people living with diabetes may help mitigate the outbreak’s impact.The authors did not receive any funding for this study from any funding agency in the public, commercial, or not-for-profit sectors

A valid treatment option for isolated congenital microgastria

Congenital microgastria (CM) is an extremely rare anomaly of the caudal part of the foregut. Treatment of CM has not yet been standardized. We present the case of a 34-monthold girl with an isolated CM complicated by nasogastric tube-related gastric perforation. During the definitive reconstructive surgery, a scarred structure (1.5 1.5 cm) was found to follow a dilated esophagus. The scarred microstomach was resected, and a Roux-en-Y esophagojejunostomy was performed. The patient has been followed for 6 months. She tolerates a regular oral diet and has reached acceptable growth parameters. We describe the first case of CM to be treated with resection of the microstomach and with a Roux-en-Y esophagojejunostomy.Keywords: congenital microgastria, gastrectomy, Roux-en-Y esophagojejunostom

Bacillus Calmette-Guérin-related cold thigh abscess as an unusual cause of thigh swelling in infants following BCG vaccine administration: a case series

<p>Abstract</p> <p>Introduction</p> <p>Thigh swelling in an infant can be a symptom of a simple benign condition or a life-threatening condition. We observed a cluster of thigh swelling episodes in infants in which the cause was Bacillus Calmette-Guérin-related cold thigh abscess. We report this unusual case series to raise awareness about this diagnosis.</p> <p>Case presentations</p> <p>We performed a retrospective review of five infants (four boys and one girl) who presented with Bacillus Calmette-Guérin-related left thigh abscess. The swelling was noticed by the parents at a mean period of three months prior to presentation. The ages at presentation were five, five, eight and nine months for the boys, and six months for the girl. All of the patients were healthy Saudi infants, and received the Bacillus Calmette-Guérin vaccine at birth. Clinically, all of the patients were well and did not demonstrate signs of systemic infection. All patients underwent needle aspiration, with subsequent incision and drainage in four of the five cases. The cultures obtained from the abscess fluids were the key to establishing the diagnosis. Only three patients (60%) received antituberculosis drugs. Wound healing lasted for a mean period of approximately seven months. Two-year follow-up was unremarkable for all of our patients.</p> <p>Conclusions</p> <p>Technical errors continue to be significant in the development of vaccine-related complications. Bacillus Calmette-Guérin-related cold thigh abscess is an extremely rare entity.</p

Interrelationship between arterial hypertension, health service costs, therapeutic treatment and physical activity

Availability of data and materials: The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.Copyright © The Author(s) 2023. Background: Arterial hypertension is a high prevalence disease that increase healthcare costs and affects physical activity level. This study aimed to analyse the interrelationship between arterial hypertension, health service costs, therapeutic treatment, and physical activity in patients with cardiovascular diseases. Method: Cross-sectional study that evaluated 306 patients from a hospital in Presidente Prudente-Brazil. Based on their medical diagnosis, they were classified into multiple groups to access primary care and hospital-related costs variations. Then, using data from medical records and face to face interviews, they were examined on their treatment adherence and physical activity practice. Healthcare costs were accessed using medical records. Finally, the generalised linear model was used to analyse the interrelationship between treatment adherence, physical activity, health care costs and arterial hypertension. The data were analysed with Stata/MP4 16, and a p-value of less than 5% was used to determine statistical significance. Results: The group that adhered to the arterial hypertension treatments but were physically inactive presented higher costs with consultation (US$=24.1, 95$=56.60, 95%CI = 1.65; 111.5) and total primary health care costs (US$=71.60, 95%CI = 19.2; 123.9) even after adjusting for confounding variables, meanwhile those participants that adhered to the treatments and were physical active did not present difference in healthcare cost when compared to normotensive and physical active participants. Conclusion: To be adherent to hypertension treatment were related to higher health care costs meanwhile been physical activity were related to lower health care costs and the combination of both showed that be adherent and physical activity represent the same cost with health than those normotensive and active emphasizing the importance of adherence and physical activity in the hypertensive treatment.The Sao Paulo Research Foundation, FAPESP. Process 2018/07281-9 and 2019/11339-5

Framework Convention on Tobacco Control 2030 - A Program to Accelerate the Implementation of World Health Organization Framework Convention for Tobacco Control in Low- and Middle-Income Countries: A Mixed-Methods Evaluation

Data Availability: The data belongs to the WHO and cannot be made freely available. Any request for data should be directed to Trinette Lee (WHO FCTC secretariat) at [email protected] Material: A Contributorship Form detailing each author’s specific involvement with this content, as well as any supplementary data, are available online at https://academic.oup.com/ntr .Background: Framework Convention on Tobacco Control (FCTC) 2030 Program (2017-2021) was launched to accelerate World Health Organization (WHO) FCTC implementation in 15 low- and middle-income countries (LMICs). We evaluated the Program in six domains: Governance; Smoke-Free Policies; Taxation; Packaging and Health Warnings; Tobacco Advertising, Promotion, and Sponsorship (TAPS) bans; and International and Regional Cooperation. Aims and Methods: Following a mixed-methods design, we surveyed (June-September 2020) FCTC focal persons in 14 of the 15 countries, to understand the Program's financial and technical inputs and progress made in each of the six domains. The data were coded in terms of inputs (financial = 1, technical = 1, or both = 2) and progress (none = 1, some = 2, partial = 3, or strong = 4) and a correlation was computed between the inputs and progress scores for each domain. We conducted semi-structured interviews with key stakeholders in five countries. We triangulated between the survey and interview findings. Results: FCTC 2030 offered substantial financial and technical inputs, responsive to country needs, across all six domains. There was a high positive correlation between technical inputs and progress in five of the six domains, ranging from r = 0.61 for taxation (p <. 05) to r = 0.91 and for smoke-free policies (p <. 001). The interviews indicated that the Program provided timely and relevant evidence and created opportunities for influencing tobacco control debates. Conclusions: The FCTC 2030 Program might have led to variable, but significant progress in advancing FCTC implementation in the 15 countries. As expected, much of the progress was in augmenting existing structures and resources for FCTC implementation. The resulting advances are likely to lead to further progress in FCTC policy implementation. Implications: What this study adds: In many LMICs, WHO FCTC policies are not in place; and even when enshrined in law, they are poorly enforced. It is not clear how financial and technical assistance to high tobacco-burden LMICs can most effectively accelerate the implementation of WHO FCTC policies and offer value for money. Bespoke and responsive assistance, both financial and technical, to LMICs aimed at accelerating the implementation of WHO FCTC policies are likely to lead to progress in tobacco control.Independent External Evaluation of the FCTC 2030. The reference number is 2020/993019-1 received from the WHO