Evaluation of dyspnea severity and sleep quality in patients with novel coronavirus

Aim Dyspnea, a common symptom of novel coronavirus, can negatively affect sleep quality. The aim of this study was to evaluate the relationship between dyspnea severity and sleep quality in patients with COVID-19. Study Design A cross-sectional design was used. Methods Using the researcher's mobile phone, data were collected via an online questionnaire from patients (n = 100) who agreed to participate in the study. The data-collection form comprised three parts: a patient descriptive information form, the Dyspnea-12 Questionnaire, and the Richards-Campbell Sleep Questionnaire (RCSQ). Results The mean age of patients was 46.39 +/- 12.61 years and 66.0% were men. Patients who were treated in the intensive care unit had bachelor's degree or more and patients with comorbid diseases had low mean scores from the RCSQ and high mean scores from the Dyspnea-12 Questionnaire (P < .001, P P = .047, P P < .001, P < .001, respectively). Patients who were not receiving oxygen therapy had higher RCSQ mean scores and lower Dyspnea-12 Questionnaire scores (P < .001, P P < .001, P < .001, respectively). There was a strong negative relationship between the total scores obtained from the RCSQ and the Dyspnea-12 Questionnaire (r = -.701, P < .001). Conclusions Sleep quality is affected by dyspnea severity in patients with COVID-19. Sleep quality and dyspnea severity are also influenced by quite different factors, and these should be addressed and eliminated by nurses as part of a holistic approach. The results of this study will help nurses, especially those providing treatment and care for patients with COVID-19, to identify the factors affecting dyspnea and sleep quality and to plan, implement and evaluate nursing interventions that will reduce their workload

Persistent headache in a postpartum patient: the investigation and management

Postdural puncture headache (PDPH) is the most common complication of obstetric regional anaesthesia and the most likely cause of headache in a woman who underwent epidural anaesthesia during delivery. Cerebral venous sinus thrombosis (CVST) is an uncommon cause of postpartum headache. Anaesthesia in obstetrics may lead to long-lasting intracranial hypotension resulting in CVST. CVST is a serious pathology with high mortality if misdiagnosed, but its correct and rapid diagnosis offers the opportunity for early treatment. Cranial magnetic resonance imaging (MRI) is an important modality in the diagnosis of both CVST and intracranial hypotension. The latter condition may be treated either by an epidural blood patch or bed rest and hydration. We report a case of a 36-year-old woman who developed CVST and multiple venous infarcts after an attempted epidural procedure during delivery. She was treated conservatively with bed rest, hydration and low-molecular-weight heparin and the patient recovered completely. Copyright 2013 BMJ Publishing Group. All rights reserved

Facies, Sequence Stratigraphy and Reservoir Heterogeneity of the Upper Wolfcampian Group (Wolfcamp A Equivalent): Glass Mountains of West Texas

The Latest Artinskian to Early Kungurian Upper Wolfcamp (Skinner Ranch) Formation is exposed in the Lenox Hills of the Glass Mountains in Brewster County, Texas. These outcrops provide geoscientists and engineers a window to examine strata equivalent to the Wolfcamp A unconventional reservoirs in the southern Delaware Basin. This study provides an outcrop-based sequence stratigraphic analysis to identify distinct chemo/litho facies within a regionally correlative framework for improved reservoir characterization of organic-rich, mudrock-dominated successions. We use modern advances in Energy-Dispersive X-Ray Fluorescence (ED-XRF) chemostratigraphy to better understand depositional constraints on reservoir quantity (spatio-temporal variations) and quality (compositional, TOC richness) within a mixed carbonate-siliciclastic system. Within the Lenox Hills, the Upper Wolfcamp Formation consists from the base up of the: 1) carbonate conglomerate-prone Decie Ranch Member,2) organic rich, mudstone-prone Poplar Tank Member, 3) mixed carbonate-siliciclastic conglomerate-prone Sullivan Peak Member, and (4) the organic poor, mudstone-prone Dugout Mountain Member. The lowermost three members of the Upper Wolfcamp Formation, especially the mudstone-prone Poplar Tank Member, were the focus of this study. Five facies were identified within the Poplar Tank Member: 1) Facies 1a (skeletal packstone/grainstone) and 1b (skeletal wackestone), Facies 2 (calcareous silty mudstone), Facies 3 (argillaceous shale/mudstone), Facies 4 (siliceous mudstone/siltstone), and Facies 5 (siliceous shale/siltstone).Within the Poplar Tank Member, the heterogeneity of the observed facies and elemental proxies throughout the lower depositional sequence of the Upper Wolfcamp Formation suggest strong depositional cyclicity. Detrital and paleo-redox proxies indicate increase in siliciclastic deposition occurred during the interpreted TST and early HST, and carbonate deposition occurring during the interpreted late TST and HST. Comparison of reservoir quality between the Upper Wolfcamp mudstone in outcrop and core studies indicate an equivalence of strata to the informal “Wolfcamp A” reservoirs in the subsurface of the Delaware Basin. Likewise, preliminary analysis of the shale/siltstone at the base of the Dugout Mountain Member indicate a correlation to the X, Y, and Z Sands of the Wolfcamp A. These findings, coupled with complete sedimentary and geochemical analysis of the type Upper Wolfcamp (Skinner Ranch) Formation provides chronostratigraphic insights for the surface to subsurface correlations. This work indicates that to make the Wolfcamp Group in outcrop coeval to the Wolfcamp Group in the subsurface, the base of the Leonard Group (Bone Springs) should be placed at the base of the Wedin Member of the overlying Cathedral Mountain Formation

Comparison outcome in management of femoral neck fracture using multiple cancellous screws with and without fibular graft

Multiple cancellous cannulated screw is preferred method in fresh cases of fracture neck of femur in young patients. Fibular strut graft is sometimes used along with multiple cancellous cannulated screws to enhance union and early restoration of function. We conducted a retrospective study to patients aged between 20-50 years old with femoral neck fracture treated with multiple cancellous screws either with or without fibular graft between the period of January 2016 to January 2018. We obtained total of six patients (five males and one female) with femoral neck fracture treated with multiple cancellous screws either with or without fibular graft. All fractures were garden type II-IV fresh femoral neck fractures. The functional outcome based on Harris hip score was excellent for all patients. The mean time of full weight bearing was 16±8 weeks in both multiple cancellous screws without fibular group and multiple cancellous screws with fibular group. The mean time of union was also 16±8 weeks in both groups. There is no complication such as non-union, avascular necrosis of femoral head and/or broken fibular graft in both the groups occurrences. Fixation with cancellous screws and fibular strut grafts for femoral neck fractures is cost effective and technically less demanding and associated with good outcomes. There is no added advantage of non-vascularized fibular grafting with multiple hip screw fixation in fresh femoral neck fractures in young adults over multiple hip screw fixation alone

Local injection of leukocyte rich platelet rich plasma produced higher radius union scoring system than local injection of pure platelet rich plasma in conservative therapy of intra-articular closed distal radius fractures

Background: Distal radius fracture often occurs both extra-articular and intra-articular, covering all ages. The use of autologous platelet rich plasma (PRP) consisting of leucocytes rich-PRP (L-PRP) and pure-PRP (P-PRP) thought can help in bone healing process. This study aimed to determine that the administration of L-PRP provides a better healing rate than P-PRP in intra-articular closed distal radius fractures after conservative treatment.Methods: This was a single-blinded experimental study with stratified randomized post-test only group design involving 51 patients with closed distal fractures undergoing closed reduction, consisting of 17 patients per study group. Group 1 received placebo, group 2 received P-PRP, and group 3 with L-PRP. Each group was then re-evaluated using x-ray at week 2, 3, and 6. RUSS score was then measured. Data was analysed using descriptive statistics and normality test, homogeneity test and inferential test were performed to determine the effect of L-PRP, P-PRP on the union rate of fracture distal radius. All obtained data was analysed using SPSS statistics 22 software.Results: Between control and P-PRP group, there was significant difference in mean RUSS with p value of 0.012. Between control and L-PRP injection group, there was a significant difference in mean RUSS with p value of 0.000. Between P-PRP and L-PRP group, there was also significant mean RUSS difference with p value of 0.003.Conclusions: There was a significant difference between the control group given placebo and the group P-PRP and L-PRP in closed fractures of the intraarticular radius after conservative therapy

Comparison between the results of proximal femur nail anti-rotation and cemented bipolar hemiarthroplasty in treatment of intertrochanteric fractures in Sanglah Hospital in 2016

Background: Hemiarthroplasty is now being considered as a primary treatment for comminuted unstable type of IT fracture in elderly on the grounds that it allows early mobilization and full weight bearing. Recently popular modality is fourth generation of intramedullary nails like the Proximal Femoral Nails. The goal of treatment is restoring mobility safely and efficiently, while minimizing the risk of medical complications and technical failure.Methods: A Forty patients, having Intertrochanteric fractures treated with PFNA or cemented BH at our institution between April 2016 and April 2017. The primary outcomes measures were postoperative complication and hip function. The secondary outcome measures were intraoperative blood loss, transfusion rate, surgical time, postoperative haemoglobin and hospital stay.Results: Seventeen patients in PFNA group and 23 patients in BH group were included for analysis. There were no significant differences between the two group regarding to the Harris Hip Score at 6 months follow up. Significant differences were found between PFNA and BH group in comparison of intraoperative blood loss (p < 0.001), length of stay (p = 0.006), surgical time (p < 0.001), postoperative transfusion (p < 0.001), and decrease of hemoglobin (p=0.001).Conclusions: These findings indicate that PFNA has obvious advantages over the BH in treatment of intertrochanteric fractures in case of surgical trauma and postoperative complication

Profile of total knee replacement patients and short term outcome in the sanglah public hospital 2018: a case reports

Total knee replacement (TKR) is considered to be among the most successful type of orthopedic surgery, with 15-year-survival-rate of implant exceeding 95%; furthermore, the improvement in quality of life is very significant. This study aims to describe the demographics, length of hospitalization and short-term outcome observed in patients undergoing TKR at Sanglah Hospital in 2018. All patients undergoing TKR at Sanglah Hospital in 2018 have been prospectively entered into our database. A total of 59 patients were recorded on 2018 for this study and 1 revision TKR patient and 2 patients with incomplete data were excluded. At baseline, 78.6% patients were female, 72.3% were Balinese and 84.1% were housewives. The mean age of patients was 63 years old. Authors also record that 44 (78.6%) patients are Overweight patients (BMI 25.00-29.99 kg/m2), 11 (19.6%) patients are at Obese Class I (30.00-34.99 kg/ m2) range, and only 1 (1.8%) patients have normal weight (18.50-24.99 kg/m2). As many as 51.8% patients had right TKR and 49.2% left TKR. The modus of patient’s length of stay is 7 days with 27 (48.2%) patients started to walk on the 4th day. VAS was recorded at level 4/10 on 92.9% patient. Drain was removed after 3 days on 42 (75%) patients. 15 patients (26.8%) had PRC transfusion due to anemia after operation

Functional outcome after total hip replacement following 30 years neglected posterior hip dislocation: a rare case report

Neglected traumatic dislocations of the hip is one of disabling condition in lower extremity which are seldom found in adults. However, in developing countries, neglected-unreduced traumatic dislocations are not uncommon. Total hip replacement (THR) still remains a recommendation for the treatment of neglected hip dislocation which occurs more than 3 months. A 45- years-old female came to the outpatient clinic complaining pain on her right hip with history of trauma 30 years before, but instead of seeking medical treatment, she went to bonesetter instead. On physical examination, there is 5 cm leg length discrepancy, and the patient walked with limping gait. Conventional x-ray confirmed persistent dislocation of the right hip. A soft tissue release procedure and femoral neck osteotomy with skeletal traction was done before, followed by delayed THR two months after. The patient’s functional status was improved, and the HHS score increased from 48 to 87. The patient had no pain or significant complaints, except for a finding of mild residual Trendelenburg gait

The potential role of BMI, plasma leptin, nesfatin-1 and ghrelin levels in the early detection of pancreatic necrosis and severe acute pancreatitis: A prospective cohort study

AbstractBackground: Early prediction of disease severity in acute pancreatitis (AP) is crucial. The aim of this study was to investigate the body-mass index (BMI), plasma leptin, nesfatin-1 and ghrelin levels as potential markers predicting peripancreatic necrosis and severity in acute pancreatitis. Methods: In the study period, 97 consecutive patients with AP were prospectively analysed. Severe AP was defined according to the Atlanta Criteria. BMI was also calculated. To measure plasma Leptin, Nesfatin-1 and Ghrelin concentrations, the blood samples were obtained from patients within 24 hours of admission. Results: Out of 97 patients, 92(70 females, 22 males) were considered eligible for analysis. Of the 92 patients, 30 patients (32.6%) were assessed as severe pancreatitis. BMI and leptin levels were significantly higher in patients with severe pancreatitis. The pooled sensitivity and specificity of BMI as a predictor for the development of pancreatic necrosis were 0.90(95%CI = 0.56–0.99) and 0.70(95%CI = 0.58–0.79), respectively; with an overall area under curve value of 0.78.The pooled sensitivity and specificity of leptin levels as a predictor for development of pancreatic necrosis were 1(95%CI = 0.69–1) and 0.73(95%CI = 0.62–0.82),respectively; with an overall area under curve value of 0.82.Nesfatin-1 and ghrelin levels showed no significant difference in patients with mild pancreatitis (6.97 ± 0.84 ng/ml and 2.3(1.0–9.9);respectively) and severe pancreatitis (6.74 ± 0.65 ng/ml and 2.0(1.9–9.9); respectively) (p = 0.1923 and 0.8531;respectively). Conclusion: BMI and plasma leptin levels both were correlated with the severity of pancreatitis. Leptin levels showed better area under the curve, sensitivity and specificity values compared to BMI in prediction of pancreatic necrosis.Nesfatin-1 and ghrelin levels were not found to be predictors of the severity of disease