Crypto-Stegno based model for securing medical information on IOMT platform

The integration of the Internet of Things in medical systems referred to as the Internet of Medical Things (IoMT), which supports medical events for instance real-time diagnosis, remote monitoring of patients, real-time drug prescriptions, among others. This aids the quality of services provided by the health workers thereby improve patients’ satisfaction. However, the integrity and confidentiality of medical information on the IoMT platform remain one of the contentions that causes problems in medical services. Another serious concern with achieving protection for medical records is information confidentiality for patient’s records over the IoMT environment. Therefore, this paper proposed a Crypto-Stegno model to secure medical information on the IoMT environment. The paper validates the system on healthcare information datasets and revealed extraordinary results in respect to the quality of perceptibility, extreme opposition to data loss, extreme embedding capability and security, which made the proposed system an authentic strategy for resourceful and efficient medical information on IoTM platform

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Skin biopsy in Paediatric Rheumatology: 10 years review of practice.

BACKGROUND Skin biopsy has limited but sometimes distinctly useful place in diagnosis of childhood rheumatologic disorders. For example, skin biopsy is of little value in differentiating lupus from dermatomyositis. The purpose of skin biopsy is to support diagnosis, disease monitoring (e.g.scleroderma) or treatment (e.g., skin cancer). OBJECTIVE To evaluate skin biopsy practices in a tertiary paediatric rheumatology unit in order to determine the usefulness. METHOD A retrospective review of medical records of paediatric rheumatology patients who have had skin biopsy over a 10-year period between 2008 and 2018 at Alder Hey Children Hospital. RESULTS & DISCUSSION A total of 49 skin biopsies with an average of 5 per year was performed. Patients age range from 0.75 -18 years with mean of 10 years. Sites of biopsy and main diagnoses are as shown in figure 1 & 2. Fifty nine percent had excision biopsy while 41% had punch biopsy. Majority of skin biopsies (94%) were performed to aid diagnosis. Severe HSP was the most common indi?cation for skin biopsies requested by rheumatologist. A high proportion of the biopsies (84%) were helpful in the patient care; 55% confirmed clinical suspicions, 25% excluded. CONCLUSION & PERSPECTIVES Rheumatologist are selective in the use of skin biopsy for diagnosis. When indicated, skin biopsy is often helpful in the diagnosis and monitoring of rheumatologic disorders. It must be ensured that sufficient information with clear clinico-pathologic question is provided when requesting skin biopsy to enhance positive result

Pharmacological management of low blood flow state in less than 28weeks neonate.

low blood flow state is defined as insufficient cardiac output to maintain adequate cellular metabolism at the organ level. A low blood flow state can be measured by reduced organ perfusion, such as reduced superior vena cava flow[1,2] or high resistance flow in superior mesenteric doppler scan [3]. The combination of capillary refill time of greater than 4 seconds and serum lactate greater than 4 mmol/litre has 97% sensitivity of identifying low blood flow state [4]. In the presence of the above markers of a low blood flow state, the blood pressure may be normal or high in the first 48hours of life due to high systemic resistance [5]. Therefore, high, or normal blood pressure should be interpreted with great caution. CONCLUSION The pharmacological treatment of a low blood flow state should be guided by thorough clinical assessment. The prophylaxis or stress dose hydrocortisone treatment of low flow state is gaining grounds mainly when there is evidence of adrenal insufficiency. The choice and titration of pharmacological treatment should be guided by functional echocardiography. The use of Dobutamine as first-line treatment is advised when myocardia dysfunction on echocardiography is noted. Milrinone use is reserved for extreme preterm neonates with myocardia dysfunction before patent ductus arteriosus ligation. Dopamine and noradrenaline remain the commonly used first and second-line vasopressors, respectively, to manage low blood flow states secondary to poor vasomotor resistance

Neonatal Hypoglycemia: Review of practice

The audit was to measure compliance to the Arrowe Park neonatal unit hypoglycaemia guideline which was adopted in 2017. The guideline reflected lowering the blood sugar threshold from 2.6 to 2.0mmol/litre in neonates from 34weeks to 42weeks gestation age. The study looked into the incidence of hypoglycaemia in babies with suspected sepsis and perinatal acidosis. METHODS This was a retrospective audit of babies at risk of hypoglycaemia on the postnatal ward.58 babies between 34weeks to 42weeks gestation age recruited from 1/2/2019 to 28/02/2019. The indications are- Prematurity- 34-36weeks (10), Infant of diabetic mother (4), Infant of the mother with gestational diabetes (6), Infant of mother on B-blockers (5). Others are suspected sepsis (11), and perinatal asphyxia/acidosis (11). Proforma generated based on British Association of perinatal medicine (BAPM) guideline on management of hypoglycaemia. RESULTS 1 out of 10 babies born at gestation age 34-37weeks and 1 out of 5 babies of born to diabetic mother had blood glucose 2, 0- They are asymptomatic.2 out of 11 babies with suspected sepsis had blood glucose <2. The 2 babies had a negative blood culture and C-reactive protein.2134 The 8th Congress of the European Academy of Paediatric Societies - EAPS 2020 Poster Presentation CONCLUSION The effect of dropping the blood sugar threshold from 2,6- 2mmmol/l is safe for this study and no record of neonate symptomatic at blood glucose of 2,0-2,6mmol/l. Risk of neonatal hypoglycaemia in neonates with suspected sepsis and cord Ph<7, 1 has not been noted in this audit. This study needs to be carried out with large sample size and possible multiple centres