The PROVENT-C19 registry: A study protocol for international multicenter SIAARTI registry on the use of prone positioning in mechanically ventilated patients with COVID-19 ARDS

Background The worldwide use of prone position (PP) for invasively ventilated patients with COVID-19 is progressively increasing from the first pandemic wave in everyday clinical practice. Among the suggested treatments for the management of ARDS patients, PP was recommended in the Surviving Sepsis Campaign COVID-19 guidelines as an adjuvant therapy for improving ventilation. In patients with severe classical ARDS, some authors reported that early application of prolonged PP sessions significantly decreases 28-day and 90-day mortality. Methods and analysis Since January 2021, the COVID19 Veneto ICU Network research group has developed and implemented nationally and internationally the "PROVENT-C19 Registry", endorsed by the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care. . .'(SIAARTI). The PROVENT-C19 Registry wishes to describe 1. The real clinical practice on the use of PP in COVID-19 patients during the pandemic at a National and International level; and 2. Potential baseline and clinical characteristics that identify subpopulations of invasively ventilated patients with COVID-19 that may improve daily from PP therapy. This web-based registry will provide relevant information on how the database research tools may improve our daily clinical practice. Conclusions This multicenter, prospective registry is the first to identify and characterize the role of PP on clinical outcome in COVID-19 patients. In recent years, data emerging from large registries have been increasingly used to provide real-world evidence on the effectiveness, quality, and safety of a clinical intervention. Indeed observation-based registries could be effective tools aimed at identifying specific clusters of patients within a large study population with widely heterogeneous clinical characteristics. Copyright

Urethral Stricture: Etiology, Pathogenesis, Diagnosis, and Management

A urethral stricture disease (USD), which is a restriction of the urethra brought on by scarring, effectively blocks the lower urinary system. By impairing the patient's capacity to pee, harming the entire urinary tract, and interfering with kidney function, this blockage can drastically diminish the patient's quality of life. Because of this, it is essential that urethral strictures, which can affect both men and women, are swiftly diagnosed and appropriately treated. Urethral stricture disease can be caused by iatrogenic injuries, due to idiopathic reasons, traumatic origin or due to inflammation. In this review we would like to throw the light on USD etiology, pathogenesis, diagnosis, and management

Dexpanthenol: New Insights on Wound Healing, a Review

Dexpanthenol, a vitamin from the B complex that is an alcoholic analogue of pantothenic acid (vitamin B5), is converted to pantothenic acid by certain enzymes and then circulated throughout the body as coenzyme-A. Pantothenic acid is rich in the liver, kidney, butter, almond and wheat bran. Dexpanthenol is administered topically as an ointment, emulsion, or solution at dosages of 2 to 5% to treat a variety of skin and mucosal conditions. Pantothenic acid is reported to act as anti-inflammatory, radical scavenger and assist in the wound healing. In this review, we want to shed some light on the dietary sources, medicinal significance, and wound healing applications of dexpanthenol

Role of magnetic resonance spectroscopy & diffusion weighted imaging in differentiation of supratentorial brain tumors

Purpose: To evaluate the role of magnetic resonance spectroscopy & diffusion weighted imaging (DWI) in differentiating between primary and secondary brain tumors. Patients & methods: This prospective study was performed for 40 patients. Diffusion weighted image (DWI) and apparent diffusion co-efficient (ADC) maps were acquired by using b-values of 0 and 1000 mm2/s. Standard mean ADC values were calculated automatically and expressed in 10−3 mm2/s in both intra-lesional and peri-lesional regions. Multi voxel MR spectroscopy was performed using a spin-echo mode sequence. The metabolites were identified including the following: N-acetylaspartate (NAA) at 2.0 ppm, creatine (Cr) at 3.0 ppm, choline (Cho) at 3.2 ppm, lipid at the range of 0.7–1.3 ppm, lactate at 1.33 ppm and myoinositol at 3.56 ppm. The ratios that were calculated include the following: Cho/NAA and Cho/Cr in both intralesional and perilesional regions. Results: Intralesional ADC values showed no difference between the metastases (0.6: 1 × 10−3 mm2/s with mean 0.86) and high grade primary tumors (0.6: 1.1 × 10−3 mm2/s with mean 0.73). Perilesional ADC value Findings in the study revealed that primary tumors have low ADC values (0.9: 1.1 × 10−3 mm2/s with mean 0.95) in their peri-lesional voxels denoting peri-lesional infiltration, while higher ADC values in metastasis (1.3–1.6 × 10−3 mm2/s mean 1.41) due to the absence of peri-lesional infiltration increase in CHO/Cr ratios (>1) in primary high grade tumors (indicating perilesional infiltration) while there was no increase in CHO/Cr ratio in cases of metastases. Low grade primary tumors showed low lactate and lipid, with increasing malignancy, and tumors showed increasing levels of lactate and lipid peaks (indicating necrosis) with remarkable difference in lipid peaks between low and high grade tumors. There was no significant difference between primary & metastatic brain tumors as regards lactate peak. Conclusion: Intra-lesional ADC values are not useful in the differentiation between primary and metastatic tumors. Perilesional ADC values can differentiate between primary & metastatic brain tumors. Intralesional MRS values (CHO/Cr ratio) were able to grade the tumor and differentiate between high and low grade tumors, while Perilesional MRS values (CHO/Cr ratio) could be able to differentiate primary tumors from metastasis

Knowledge, attitudes, and practices of Egypt’s future physicians towards antimicrobial resistance (KAP-AMR study): a multicenter cross-sectional study

International audienceAntimicrobial resistance (AMR) is a growing threat that causes over 700,000 deaths per year worldwide. The goal of the current multicenter, cross-sectional study was to identify the knowledge and practice gaps in antimicrobial stewardship among Egypt’s undergraduate medical students. Nine-hundred and sixty-three participants (375 male) from 25 medical schools responded to our self-administered questionnaire. Overall, the majority of students (96%) exhibited fair/satisfactory knowledge and attitude scores towards AMR. However, the most common misconceptions were that skipping one or two antimicrobial doses does not contribute to AMR (43%) and that antimicrobials are the drug of choice for the treatment of sore throat (38.8%). About 36% of the students thought that bacteria cause common cold and influenza. In terms of practices, about 62% of the students reported taking antibiotics when they have cough or sore throat and saving the remaining antibiotic for the next time. About 48% of the students reported that when they start feeling better, they stop the antibiotic course, and 41% stated that they often/sometimes discard the remaining leftover or share the leftover antibiotics with their friends. Interestingly, males had more frequently poorer levels of knowledge than females (p = 0.02). Moreover, students in the clinical science years (p < 0.001), living in urban areas (p= 0.02) or Cairo (p < 0.01) reported better practices than their counterparts. Educational programs about antimicrobial stewardship and the role of healthcareprofessionals in preventing AMR should be introduced early in medical curricula. Further, active educational techniques as clinical scenarios that simulate clinical settings and interactive learning workshops would be more efficient teaching methods

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally