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The positive rate of depressive symptoms was 2.26 times higher (95% CI, 1.26 to 4.05) in the female middle-aged family members of home-dwelling dementia patients compared to the control group. In addition, those who reported having symptoms almost every day in the PHQ-9 questions had significantly higher positive rates on questions about loss of interest, depression, sleep disturbance, fatigue, poor appetite, and suicidal ideation, and not on questions regarding feelings of worthlessness and psychomotor agitation, compared to the control group. [https://www.selleckchem.com/products/picropodophyllin-ppp.html this website] Conclusions Active interventions are needed to relieve depression in the family members of home-dwelling dementia patients.The coronavirus disease 2019 (COVID-19) pandemic has significantly affected all specialty practices in medicine, including the field of spinal surgery. Spinal surgery is unique in that the procedures include not only fully elective and fully emergent interventions, but also involve a separate group of semi-emergent surgeries, where delayed intervention may lead to permanent neurological deficits. link2 Here, we present an evidence-based review on the impact of the COVID-19 pandemic on spinal surgery and our current knowledge about this issue. We conducted a thorough search of the PubMed, Medline, and Google Scholar databases using the keywords, "COVID-19," "COVID-19 impact on spine surgery," "coronavirus impact on spine surgery," "COVID-19 impact on neurosurgery," "coronavirus impact on neurosurgery," "COVID-19 impact on spine surgeons," and "coronavirus impact on spine surgeons" on May 6, 2020. A total of 8,322 articles were identified in the initial search. Articles that were duplicated, those that did not pertaiand ensuring protective measures for non-infected patients, family members, fellow heath care providers, and themselves against the disease.Study design Multicenter validation study. Purpose To evaluate the inter-rater reliability of Rajasekaran's kyphosis classification through a multicenter validation study. Overview of literature The classification of kyphosis, developed by Rajasekaran, incorporates factors related to curve characteristics, including column deficiency, disc mobility, curve magnitude, and osteotomy requirements. Although the classification offers significant benefits in determining prognosis and management decisions, it has not been subjected to multicenter validation. Methods A total of 30 sets of images, including plain radiographs, computed tomography scans, and magnetic resonance imaging scans, were randomly selected from our hospital patient database. All patients had undergone deformity correction surgery for kyphosis. Twelve spine surgeons from the Asia-Pacific region (six different countries) independently evaluated and classified the deformity types and proposed their surgical recommendations. This information was thenailure to identify column deficiencies can potentially alter kyphosis management. There was excellent consensus among surgeons in the recommendation of type 2 osteotomy; however, some variation was observed in their choice for other osteotomies.Background In 12.5-56% of extremely low birth weight (ELBW) infants treated in newborn units, acute kidney injury (AKI) develops. Some of these infants may need renal replacement therapy for reasons including hyperkalemia, hypovolemia and resistant acidosis. Methods All ELBW infants who were followed in our hospital between January 2015 and December 2017 and who lived longer than 48 hours were assessed. Patients were followed for AKI and peritoneal dialysis (PD). Results AKI developed in 25 of 201 ELBW infants. PD was administered to nine patients. PD was initiated at a median of 11 days (2-22 days) for all patients due to hyperkalemia which did not respond to medical treatment. Three of the nine infants who received PD died while dialysis was ongoing. The remaining six patients completed PD successfully. In these patients, the serum potassium value returned to normal in three days, and dialysis was continued for a median of 93 hours (40-172 hours). Dialysis leakage occurred in two patients, and hyperglycemia developed in two patients. On average, diuresis started at the 25th hour (8-40th hour). Conclusions In the renal failure treatment of ELBW infants, PD is the only option which can be used for many units. It was found that in ELBW infants who had wider peritoneal surface when compared to their body weight, biochemical values recovered rapidly with PD, and diuresis started a short while later in most patients.Background Bronchiolitis is the most frequent lower airway infection leading hospitalization in children younger than 2 years. RSV is the typical common cause, followed by rhinovirus. Criteria for Pediatric Intensive Care Unit (PICU) admission are not defined by guidelines. Methods A retrospective analysis of children with severe bronchiolitis admitted from 2013 to 2016 to our PICU was performed to to identify the risk factors associated with intubation in this population. Fourteen variables were studied sex, weight, age, nationality, provenience, duration of symptoms, risk factors for bronchiolitis development, recurrence, apnea, SpO2 in air, Modified Wood's Clinical Asthma score (M-WCAS), microbiological results, medical treatment, CPAP therapy. The relationship between these variables and the need for mechanical ventilation were explored using univariate and multivariate logistic regression analysis. A ROC analysis was used to identify cut-off for the continuous variables identified as risk factors for intubation in multivariate analysis. Results We enrolled 93 patients, 19 (20.4%) were intubated. Univariate and multivariate analysis demonstrated that a M-WCAS score ≥ 7, SpO2 ≤ 75% and apnea were significantly associated to intubation in children with severe bronchiolitis. Conclusions Cut-off values of the variables identified as risk factors for intubation may represent an important tool for pediatricians to decide a prompt and appropriate intensive respiratory support.Bronchiolitis is an acute lower respiratory tract disease caused by a viral infection. It affects infants and often requires hospitalization. Treatment is based on supportive care1. Although all current guidelines do not recommend chest physiotherapy in the treatment of bronchiolitis, its role is still controversial and challenging 1,2. Two different respiratory physiotherapy techniques are known in the treatment of bronchiolitis conventional Chest Physiotherapy (cCPT), which includes vibration, percussion, postural drainage and forced expiratory maneuvers, and new Chest Physiotherapy (nCPT), based on prolonged slow expiration techniques2. While most studies have demonstrated ineffectiveness and risk of associated adverse events for cCPT1, nCPT has showed some benefits improving bronchial airway obstruction and Wang score in hospitalized infants with bronchiolitis3. Nevertheless, lack of homogeneity of the studies in literature makes the interpretation of the results less reliable. Although nCPT seems to show fair results in terms of clinical effectiveness and safety, it is rarely used in the treatment of bronchiolitis. Further research is needed in order to enhance and confirm preliminary positive results of nCPT in the management of bronchiolitis.Objective The aim of this study was to investigate the effect of short or long interpregnancy interval (IPI) with placental mediated pregnancy complications after already complicated first delivery. Methods We performed a retrospective cohort analysis of all women with singleton pregnancies who delivered their first three consecutive deliveries in one university-affiliated medical center (1994-2013). Placental mediated complications included placental abruption, small for gestational age, preeclampsia, gestational hypertension, or preterm delivery. Following first complicated delivery, IPI was compared stratified by second delivery outcome. Following two complicated deliveries, IPI was compared stratified by third delivery outcome. IPI was evaluated as continuous or categorical variable (&gt;18, 18-60, &gt;60 months). Related samples Cochrans' Q test and Mann-Whitney analysis were used as appropriate. Results Overall, 4310 women entered analysis. Of them, 18.3%, 10.5%, and 9.3% had complicated first, second, and third delivery, consecutively. Evaluated continuously, longer IPI, but not short IPI, was associated with higher rates of complicated second delivery. Stratified to categories, IPI had no effect on recurrent complications evaluated separately or as composite. link3 Conclusion Our results suggest that long IPI may increase risk for placental mediated pregnancy complications. Further studies are needed to evaluate this effect.Background Intestinal perforation is a rare but feared complication of ERCP. In this study, we identify patient and hospital factors for ERCP related intestinal perforation using a large national database. We also examine the effects of intestinal perforations on hospital outcomes. Methods Data were obtained from the National Inpatient Sample, the largest publicly available inpatient care database in the United States. ICD-9-CM procedure codes for all ERCP procedures conducted between 1998 and 2013. Our primary outcome of interest was the incidence of intestinal perforations after ERCP. Secondary outcomes of interest included hospital length of stay and inpatient mortality. Results A total of 392,336 ERCP procedures were performed over the study period, met our inclusion criteria, and were analyzed. Mean age of sample was 59 years and just over 60% were females. Low volume hospitals accounted for over 85% of ERCPs. Intestinal perforations occurred at a rate of 1.2 per 1000 ERCP procedures. Patient's age was the only patient-related factor significantly associated with perforation. (OR 1.016; 95% CI 1.009 - 1.025). For hospitals, teaching status was the only hospital related factor associated with intestinal perforation after ERCP (OR 1.56; 95% CI 1.28 -1.91). Length of stay was much longer in patients with ERCP related perforations and mortality risk was ten times higher in the same cohort. Conclusions Patients who have ERCP related perforations have longer hospital stays and have a higher mortality risk. Older patients and those who had ERCP in teaching hospitals are at a higher risk of perforation.The outbreak of Coronavirus Disease 2019 (COVID-19) worldwide had evidenced the opportunity to increase the interaction between Specialist and Primary Care Physician (PCP). COVID 19, started in December 2019 in China, has been considered a public health emergency by the Department of Health and Human Services and, at the moment, it is a pandemic disease with worldwide diffusion. The Covid 19 crisis permits to increase the role of Telemedicine as a tool for the delivery of health care services at distance and to slow down the virus diffusion. This technology is cheap and easy to use but it is limited by governmental licensing restrictions, reimbursement barriers, lesser extent of infrastructure and difficulties related to the change. During COVID 19 Epidemy, Telemedicine is safe, low cost and permits to treat urgent and routine specialist cases without human proximity and contact which would spread infection, particularly to the elderly and immunocompromised patients. In COVID 19 era, the goal of PCP is to reduce travels and visits in specialized center for liver disease patients.