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SARS-CoV-2 has rapidly spread across the globe and infected hundreds of millions of people worldwide. As our experience with this virus continues to grow, our understanding of both short-term and long-term complications of infection with SARS-CoV-2 continues to grow as well. Just as there is heterogeneity in the acute infectious phase, there is heterogeneity in the long-term complications seen following COVID-19 illness. The purpose of this review article is to present the current literature with regards to the epidemiology, pathophysiology, and proposed management algorithms for the various long-term sequelae that have been observed in each organ system following infection with SARS-CoV-2. We will also consider future directions, with regards to newer variants of the virus and their potential impact on the long-term complications observed.

Resumen: Antecedentes y objetivo: La inclinación pélvica influye en la posición relativa de los componentes de la prótesis total de cadera (PTC) la cual a su vez se puede modificar por los cambios evolutivos que aparecen en la columna lumbar. Nuestro objetivo es estudiar la variación de la posición de la pelvis y del componente acetabular en pacientes con PTC durante 5 años y las posibles complicaciones. Material y métodos: El actual estudio retrospectivo incluye 48 pacientes intervenidos de PTC entre 2008 y 2012. Se recogen los datos clínicos, complicaciones y los cambios radiológicos en relación a los ángulos sacrofemoropúbicos, inclinación acetabular en la radiografía anteroposterior de pelvis y la anteversión lateral según Woo-y-Morrey. Las mediciones se realizaron preoperatoriamente, a las 6 semanas, al año, a los dos años y a los cinco años de la intervención. Resultados: El sacrofemoropúbico disminuyó de 60,6° preoperatorio a 58,8° a los cinco años (p > 0,05), más en mujeres (de 63,3° a 59,3°) que en varones (de 58,7° a 58,3°). La inclinación acetabular aumentó de 47,3° a las seis semanas después de la PTC a 48,2° a los cinco años (p > 0,05) y la anteversión de 24,3° a 36,1° (p .05), more in females (from 63.3 to 59.3) than males (58.7 to 58.3). Acetabular abduction increased from 47.3 at six-week postoperatively to 48.2 at five years (p > .05) and acetabular anteversion varied from 24.3∘ to 36.1∘ (p < .04). There were four dislocations: one late recurrent dislocation which required cup revision. Conclusion: Despite the sacro-femoral-pubic angle tendency to decrease and anteversion tendency to increase after five years, larger studies with longer follow-up are needed to confirm the potential increasing in long term complications.

The review article includes information on data on the treatment of patients with essential hypertension and manifestations of metabolic syndrome and their effectiveness in preventing the development of long-term complications of COVID-19. The pandemic of acute respiratory syndrome caused by SARS-CoV-2 requires changes in the approach to the treatment and prevention of metabolic syndrome and essential hypertension, as the presence of these comorbidities worsens the course and prognosis of infectious disease. Some pathogenetic links have been identified that affect these pathological conditions. Emphasis is placed on the key role of a balanced and healthy diet, as a component of a healthy lifestyle, in maintaining the optimal functional state of the cardiovascular system. It is also noted that the course of infectious disease caused by SARS-CoV-2 in patients with metabolic syndrome is more severe and more often leads to complications. Since COVID-19 is recognized as a multi-organ disease with a wide range of manifestations and long-term symptoms, data on the course of this disease in patients with hypertension and metabolic syndrome were analyzed. Endothelial dysfunction is highlighted as one of the pathogenetic links that combines essential hypertension, insulin resistance and atherosclerosis, and options for its correction are considered. Standards for the treatment of essential hypertension and metabolic syndrome in view of the COVID-19 pandemic are presented. Information on the ability of statins to increase glycemia with long-term use, especially in patients with metabolic syndrome, is given. Conclusion. A number of drugs that have antioxidant, vasodilator and anti-inflammatory properties that do not cause an increase in glycemia, including quercetin, have been proposed. Its positive effect on the level of blood pressure has been revealed, which implies its use as an adjunct to antihypertensive therapy. The combination of quercetin and vitamin C is considered as an adjunct to basic therapy for COVID-19 disease and its long-term complications. Further studies are planned to determine the clinical value of quercetin supplements in therapy of essential hypertension, rehabilitation of patients after COVID-19, stabilization of dyslipidemia and insulin resistance, as well as dose adjustment and study of possible drug interactions between quercetin and antihypertensive drugs

Key words: Cardioneuroablation, Atrioventricular block, Syncope, Arrhythmia According to clinical guidelines a symptomatic atrioventricular block (AV block) is treated with a pacemaker. For young individuals such a therapy can be difficult due to possible long term complications such as infections, lead disruptions and pacemaker induced cardiomyopathy. We describe a twenty year old man with recurrent syncopes due to intermittent parasympathetic caused AV block of grade 2. The patient underwent cardioneuroablation where parasympathetic ganglia in the right atrium were ablated. After the procedure the PR interval normalized. This procedure has never been performed in Iceland before and there is a limited amount of case reports in the literature.

Objectives. The amount of patients with diabetes is increasing, and such patients experience several long-term complications. Therefore, finding a method to treat the disease and its complications is an urgent issue worldwide. In Vietnam, Phyllanthus amarus Schum. & Thonn. (PA) and Gymnema sylvestre R. Br. (GS) are common herbs used in traditional therapy including diabetes treatment. This study aimed to combine PA and GS to extend their bioactivities in antidiabetes, antioxidant, and anti-inflammatory treatments.Methods. Here, PA and GS powders were mixed at different ratios for extraction. Ethanolic extract was used to detect bioactive compounds, bioactivities, and appropriate ratios of the mixtures.Results. The optimal ratio for the PA and GS combination was 2 : 1 (g/g). The ethanolic extraction of the 2 : 1 sample at 50°C over two hours with a solid/liquid ratio of 1 : 10 achieved a high yield of 14.37%. This sample exhibited good α-glucosidase inhibition activity with a half-maximal inhibitory concentration (IC50) of 9.74 µg/mL, antioxidant activity with an IC50 of 29.87 µg/mL, and anti-inflammatory activity with an IC15 of 400 µg/mL.Conclusions. The study confirmed that combining PA and GS can have high α-glucosidase inhibition as well as antioxidant and anti-inflammatory effects.

Study Design: Fractures of the mandibular condyle are a common injury in maxillofacial trauma. Both conservative treatment (i.e., analgesic therapy and soft diet) and intermaxillary fixation (IMF) or open reduction internal fixation (ORIF) have satisfactory and functional outcomes, though severe late-onset complications have been reported. Objective: We compared the long-term complications of patients with condylar fractures treated conservatively, with IMF, or with combined ORIF and IMF. Methods: We retrospectively analyzed all patients diagnosed with unilateral or bilateral condylar fracture, isolated or combined with a fracture of the mandibular body, admitted to the Department of Maxillofacial Surgery at UZ Leuven between January 2013 and January 2020. We collected data on age, gender, side of condylar fracture, presence of associated fracture of the mandibular body, referrals, initial treatment, long-term complications and secondary treatment. Long-term complications were defined as sequelae still present 6 weeks after initial treatment. Results: Among 192 patients, 68.8% had unilateral and 31.2% bilateral condylar fractures; an associated fracture of the mandibular body was seen in 45.8%, 31% received conservative treatment, 51% IMF only, and 18% combined ORIF and IMF. Forty-eight percent of all patients suffered from 1 or more long-term complications, most frequently malocclusion (24%), reduced mouth opening (15.1%), nerve disturbances (13.5%), pain (8.9%), and facial asymmetry (2.6%). Surgery as a secondary treatment was necessary in 25% of all cases. Conclusions: The presence of bilateral condylar fractures or associated fracture of the mandibular body is a risk factor for developing long-term complications. Most patients with long-term complications were initially treated with combined ORIF and IMF, but long-term complications after initial conservative or IMF treatment were treated with secondary surgery.

Aim: Traumatic dental injuries occur frequently in children. Treatment and follow ups are important to avoid short and long term complications. The aim of this study was to investigate the prevalence of sequelae in the permanent anterior teeth following the trauma in their predecessors in the period of 2005 to 2011. Methods: This study was performed retrospectively according the data from the records of 79 children (53 boys, 26 girls), who were treated for anterior deciduous tooth trauma. Of the 79 affected children (186 teeth), 35 (91 teeth, 22 boys and13 girls) were available for the follow-up examination. Kappa coefficient was calculated for inter-examiner reliability. Descriptive statistics including percentage and mean values were also calculated. Results: Sequelae were detected on 45(49.5%) of 91 successors of the traumatized deciduous teeth and enamel hypoplasia and/or discoloration was observed in 14 (31.1%) teeth. Eruption was disturbed in 14 (31.1%). In 13 teeth (28.9%) crown and root malformation, in three teeth (6.7%) only crown and in one tooth (2.2%) only root malformation was detected. Most frequent sequela of successors were observed after the intrusive luxation of the deciduous teeth (33%). Crown-root malformations of the successor teeth were most frequently occurred after the trauma at the age of 0 to 2 (61.53%). Conclusions: Early diagnosis and treatment of primary dental injuries and routine clinical and radiological follow up would minimize the sequelae which were observed in permanent successors..

Paediatric forearm fractures are common injuries accounting for 40% of all the fractures in children. They are traditionally treated conservatively with casting. However there has been short and long term complications associated with such treatment and in recent times, closed reduction and flexible nailing has shown favourable clinical outcomes. In this prospective study, we evaluated functional outcome in closed forearm diaphyseal fractures of children and adolescents treated with titanium elastic intramedullary nails. All cases achieved bony union at an average of eight weeks and excellent functional outcome without significant complications. Nails were removed under anaesthesia after radiological union. Intramedullary nailing with elastic nails is an effective method of treatment for these unstable diaphyseal fractures of forearm in children and adolescents.

Gestational Diabetes Mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Fifty percent of GDM patients develop type 2 Diabetes in next twenty years and as well as the newborn can also be affected by diabetes in their lifetime. So the long term complications for both the mother and the child cannot be ignored. In view of maternal morbidity and mortality as well as fetal complications, early diagnosis is an utmost necessity in the present scenario. In developing country like Bangladesh, early detection and prevention is not cost effective and usually troublesome. So, there is an urgent need for a well-designed method for the detection of gestational diabetes mellitus. The purpose of this study is to predict the GDM in the first trimester. This research presents and compares some Artificial Neural Network (ANN) models on the early detection of Gestational diabetes mellitus and chooses the best neural network model among them to detect GDM early.

Objective: To compare visual outcomes and complications between manual small incision cataract surgery (MSICS) and phacoemulsification. Methods: A retrospective study was conducted in the tertiary care center. A total of 1281 cases underwent manual small incision cataract surgery and phacoemulsification from January 2014 to December 2016. The postoperative best corrected visual acuity (BCVA) along with the rates of complications were compared between both groups. Results: Five hundred and twenty-one patients (40.67%) and 760 patients (59.33%) were subjected by staff members and residents, respectively. Altogether, 689 cases (53.79%) were subjected to MSICS technique and 592 cases (46.21%) to phacoemulsification. The MSICS group had significantly harder cataract (cataract grading ≥ 4+ :31.64% vs. 7.77%; p

Menopause is defined as permanent cessation of monthly menstrual periods due to permanent depletion of ovarian follicular activity which results in reduced production of ovarian steroids. This in turn causes short term and long term complications in postmenopausal women. Hormone replacement therapy (HRT) is considered as the treatment of choice in the management of these complications. However, unscheduled bleeding following HRT is a well known complication. Diagnosis of unscheduled bleeding is confirmed after careful assessment and exclusion of secondary endometrial pathologies. This can be managed effectively by adjusting or changing the hormone profile in HRT preparations.

Aim Proper arteriovenous fistula (AVF) management is crucial to avoid AVF complications and prolong its useful life for maintenance haemodialysis (MHD). Design Retrospective cohort study. Methods Patients on MHD who underwent AVF surgery at the Wuhan Third Hospital between January 2018 and July 2018. Results A total of 144 patients were included, with 56 in the integrated group and 88 in the routine group. There were no differences between the two groups in terms of sex (p = .61), age (p = .62) and type of primary kidney disease (p > .99). At 1 year, the integrated group had significantly fewer fistula‐related complications than the routine group (3.6% versus. 23.9%, p

Gross hematuria, besides being a serious renal disorder, is quite worrisome for the patients. It merits evaluationto determine the underlying cause and initiate timely management in order to prevent long term complications as well as permanent renal damage in some cases. Anatomical abnormalities causing gross hematuria are rare and often asymptomatic, hence not diagnosed routinely. Here we present two cases of gross hematuria with underlying anatomical abnormality known as the Nut Cracker Syndrome (NCS). Keywords: Gross hematuria, Children, Non glomerular, Nut Cracker Syndrome

Diabetes, has been known to mankind for centuries, often described by its unique nature of sweet tasting urine or by the symptoms of excessive urination and thirst. Several renowned scientists have attempted to describe the symptoms, pathophysiology, diagnosis and various experimental treatment options with varying degrees of success. The current widely accepted classification focuses on etiology and pathogenesis to guide treatment and is very successful and adapted across the world. Diagnostic criteria underwent multiple changes to define glycemic targets which were more and more guided by better understanding of the disease pathogenesis. Recent research focuses on a more individualized approach to managing diabetes, better understanding and identifying individuals who are at an increased risk of complications at diagnosis itself to offer more personalized management to prevent long term complications. Early differentiation of individual based on multiple factors rather than a single parameter is the path being paved currently. BMI, Waist circumference, age at diagnosis, HbA1c, triglycerides, HDL cholesterol, GAD Antibodies, Homeostasis model assessment of Insulin Resistance (HOMA-2 IR), beta-cell dysfunction (HOMA2-Beta), and fasting and stimulated C-peptide, are core parameters in the current rationalized approach towards better long term outcomes for people with diabetes. Cluster based identification and focused treatment with individualistic targets is the way forward in Diabetes management.

Self-management in diabetic patients is vital to keep the illness under control and avert any long term complications. Effective management of diabetes is a difficult task without an adequate understanding of the existing level of knowledge, attitude, and practice related to self-management. Knowing the level of knowledge, attitude, and practice towards self-management may help to provide information for health policy-makers to design and implement effective interventions to reduce diabetes-related morbidity and mortality. To assess the level of knowledge, attitude, and practice towards self-management among patients with diabetes at Debre Tabor General Hospital chronic diseases follow up clinic. An institution-based cross-sectional study was conducted from February to March 2016. A systematic random sampling technique was employed to select 206 patients. A structured pretested interviewer-administered questionnaire was used to collect data. The data were entered and analyzed using SPSS version 20. More than half of the study participants 114 (55.3%) had poor knowledge about diabetic self-management. Poor attitude of diabetic self-management was detected among 109 (52.9%) of studied patients. Nearly two-thirds 136 (66.0%) of the study participants had poor practice towards self-management. More than half of the participants had poor knowledge and attitude towards self-management and nearly two-thirds of them had poor practice. It is better to emphasize the importance of the patient as the key person in diabetic management.

Aim. Analysis of hospital and long-term results of carotid endarterectomy (CEA) in different periods of acute cerebrovascular event (ACVE). Materials and Methods . The given study was retrospective and was conducted using the method of patients sampling. In the period from 2010 to 2019, 1113 patients with ACVE in history who were later conducted CEA, were selected. Depending on the time interval between the last ACVE and CAE, all the patients were divided into 4 groups: the 1 st group – in the acutest period of ACVE (1-3 days) (n=24; 2.2%); the 2 nd group – in the acute period of ACVE (up to 28 days) (n=493; 44.3%); the 3 rd group – in the early rehabilitation period of ACVE (up to 6 months) (n=481; 43.2%); the 4 th group – in the late rehabilitation period of ACVE (up to 2 years) (n=115; 10.3%). The long-term period was 34.8±12.5 months. Results . In the hospitalization period of observation the following complications were found: lethal outcome ((group 1 – 0%; group 2 – 0.4% (n=2); group 3 – 0.2% (n=1); group 4 – 0%; р=0.16)); myocardial infarction ((group 1 – 0%; group 2 – 0.4% (n=2); group 3 – 0%; group 4 – 0.9% (n=1); р=0.35)); ACVE/transient ischemic attack (TIA), ((group 1 – 4.2% (n=1); group 2 – 0.4% (n=2); group 3 – 0.2% (n=1); group 4 – 0%; р 1-2 =0.01; р 1-3 =0.009; р 1-4 =0.01)). By the end of hospitalization period the composite endpoint consisting of lethal outcome + myocardial infarction + ACVE/TIA made in group 1 – 4.2% (n=1), in group 2 – 1.2% (n=6), in group 3 – 0.4% (n=2), in group 4 – 2.6% (n=3), р=0.08. Complications of the long-term follow-up period were: lethal outcome from all causes ((group 1 – 25% (n=6); group 2 – 5.5% (n=27); group 3 – 7.3% (n=35); group 4 – 14% (n=16); р 1-2 =0.002; р 1-3 =0.008; р 2-4 =0.012)); lethal outcome from cardiovascular causes ((group 1 – 4.2% (n=1); group 2 – 3.6% (n=18); group 3 – 4.8% (n=23); group 4 – 5.2% (n=6); р=0.79)), myocardial infarction ((group 1 – 12.5% (n=3); group 2 – 3.6% (n=18); group 3 – 5.4% (n=26); group 4 – 6.1% (n=7); р=0.15)), ACVE/TIA ((group 1 – 16.6% (n=4); group 2 – 6.3% (n=31); group 3 – 6% (n=29); group 4 – 11.3% (n=13); р=0.05)); composite endpoint including lethal outcome + myocardial infarction + ACVE/TIA ((group 1 – 54.2% (n=13); group 2 – 15.4% (n=76); group 3 – 18.7% (n=90); group 4 – 31.3% (n=36); р 1-2 =0.0001; р 1-3 =0.0001; р 1-4 =0.005; р 2-4 =0.0006; р 3-4 =0.012)). Conclusion. Application of CEA demonstrated effectiveness and safety in the acute and early rehabilitation period of ACVE.

This study aims to propose a novel surgical technique to rehabilitate patients with long term complication of trachea-esophageal puncture and stomal stenosis. Ours is retrospective study. Ten patients with tracheo-esophageal puncture who developed long term complications and who failed conservative management were included in our study. Majority of our patients were males within the age group of 50–70 years of age. Most of our patients had received adjuvant radiotherapy (8/10). All patients had multiple change of prosthesis. Nine patients suffered from multiple complications of TEP. Most common complication was that of progressive thinning of trachea-esophageal wall. All the patients who underwent this procedure healed well without any major complications. Long term trachea-esophageal puncture may undergo significant modification in terms of position and size. This technique gives a satisfactory and viable method of excising the altered anatomy and establishes speech & swallowing in such patients who fail conservative management.

OBJECTIVE To compare the durations of surgery and anesthesia and the likelihoods of short- and long-term postoperative complications between cats positioned in sternal recumbency versus dorsal recumbency for perineal urethrostomy (PU). ANIMALS 247 client-owned cats that underwent PU between January 2004 and December 2015 at 6 veterinary teaching hospitals and 1 private veterinary referral hospital. PROCEDURES Medical records were reviewed, and signalment, presenting complaints, previous history of urethral obstruction or PU, diet fed, medications administered, indication for PU, durations of surgery and anesthesia for PU, suture type and size, suture pattern for skin closure, and short- and long-term postoperative complications were recorded. Univariable and multivariable analyses were performed to identify differences in durations of surgery and anesthesia and the likelihoods of short- and long-term complications between cats positioned in sternal recumbency and those positioned in dorsal recumbency. RESULTS Patient position was not associated with durations of surgery and anesthesia for PU, even if a concurrent cystotomy was necessary or the patient required repositioning from sternal to dorsal recumbency. Likewise, patient position was not associated with the likelihood of short- and long-term complications. CONCLUSIONS AND CLINICAL RELEVANCE The observed lack of differences in outcomes between sternal and dorsal recumbency suggested that logistic considerations and personal preference can continue to guide veterinarians when positioning cats for PU.

Fractures in the elderly are often challenging due to osteoporotic bone and co-morbidities and long term disability can occur. Surgery is the standard mode of treatment and hence a quick surgical treatment for early weight bearing and mobilization is required in order to prevent long term complications due to prolonged bed rest. All patients were documented prospectively, complete demographic details and clinical history was obtained. Clinical and radiographic evaluation was done in all the patients. Informed consent was taken and all patients were treated with DFLCP and retrograde nailing randomly. Duration of hospitalization was documented and follow up was done for 2 years. In this study, fracture union time was12-24 weeks with among the patients of the DLFP group with 75 percent have union and was 12-24weeks among the patients of the retrograde nailing group with union occurring in 80 percent of patients respectively. Significant results were obtained while comparing the mean fracture union time among the patients of the two study groups. In our study, follow up was done up to 2 years with 60% of patients followed up to 15 months in both the groups.

Long-term complications of type 1 diabetes (T1D) include microvascular complications and macrovascular disease. Despite the important advances in the treatment of T1D of the last decades, these complications still represent the leading cause of morbidity and mortality in patients with T1D. Extensive evidence indicates that structural and functional alterations of the kidney, retina, nerves and large arteries occur already in the first years after the onset of diabetes. We performed a comprehensive review of the available evidence on screening, diagnosis, prevention and treatment of vascular complications of T1D. In particular, we focused on three major challenges related to long-term complications of T1D: 1) finding of new biomarkers and diagnostic methods able to identify early signs of complications; 2) identifying specific risk factors for the development of these complications; 3) identifying and implementing new therapeutic strategies able to prevent the development and progression of vascular complications.

Background Cohort studies have reported a high prevalence of musculoskeletal, neurologic, auditory, and visual complications among Ebola virus disease (EVD) survivors. However, little is known about the host- and disease-related predictors of these symptoms and their etiological mechanisms. Methods The presence and patterns of 8 cardinal symptoms that are most commonly reported following EVD survival were assessed in the 326 EVD survivors who participated in the ongoing longitudinal Liberian EVD Survivor Study. At quarterly study visits, symptoms that developed since acute EVD were recorded and blood was collected for biomarkers of inflammation and immune activation. Results At baseline (mean 408 days from acute EVD), 75.5% of survivors reported at least 1 new cardinal symptom since surviving EVD, which in 85.8% was rated as highly interfering with life. Two or more incident symptoms were reported by 61.0% of survivors, with pairings of joint pain, headache, or fatigue the most frequent. Women were significantly more likely than men to report headache, while older age was significantly associated with musculoskeletal and visual symptoms. In analyses adjusted for multiple comparisons, no statistically significant association was found between any symptom and 26 markers of inflammation and immune activation. Symptom frequency remained largely unchanged during study follow-up. Conclusions Post-EVD complications occur in a majority of survivors and remain present more than 4 years after acute infection. An association between markers of inflammation and immune activation and individual symptoms was not found, suggesting an alternative etiology for persistent post-EVD symptomatology.

Follow-up studies of COVID-19 survivors have been performed to characterize persistence of long-term symptoms, but data are scarce on one year of follow-up. This study provides data from 48 weeks of follow-up after discharge. All patients discharged from the Department of Infectious Diseases at Aarhus University Hospital, Denmark between 1 March and 1 July 2020 were followed for 48 weeks. In total, 45 of 66 eligible patients were interviewed after 48 weeks. The median age was 57 (IQR 51–70) years, the majority were female (53%) and Caucasian (87%). Median BMI was 28.1 (IQR 24.8–32.6) kg/m2. One or more comorbidities were registered among 62% of the patients. In total, 39 out of 45 (87%) interviewed patients reported persistence of at least one symptom 48 weeks after hospitalization with COVID-19. Most frequently reported symptoms were fatigue, dyspnea, and concentration difficulties. This study provides new long-term data following COVID-19, contributing to the accumulating data of COVID-19 sequelae. Many patients suffer long-term sequelae and further research is urgently needed to gain further knowledge of the duration and therapeutic options.

Aim Robotic-assisted ventral hernia repair (rVHR) has become an attractive alternative to current laparoscopic and open procedures. The present study aims to determine short-and long-term complications following rVHR Material and Methods Patients undergoing rVHR from 01/01 2017 until 21/06 2020 were identified from the electronic medical record system. The medical case notes were reviewed and a telephone interview conducted to determine short and long-term complications. Patients with symptoms related to the repair were examined by a specialist in hernia surgery. US or CT scan was performed to determine the presence of absence of complications Results 85 patients were included. Mean age was 57.8 years, 54 were males (63.5%). Mean ASA-score was 2.12 and BMI was 30.2 kg/m2. 11 patients (13%) had diabetes, 22 (26%) were active smokers, 37 (44%) had hypertension and 7 (8%) were taking anti-coagulants. The mean hernial defect was 16.1 cm2 and the mesh size was 205.4 cm2. Mean length of stay was 0.5 days and the follow-up time was 94 weeks. Hematoma was encountered in 10 (11.8%) patients. 8 (9.4%) reported of seroma and 1 (1.2%) of a superficial wound infection complicated by skin necrosis. 5 patients (5.9%) reported of chronic pain. 2 patients (2.3%) developed recurrence. Conclusions The study demonstrates that rVHR is feasible and associated with few complications and a very low recurrence rate. Patients who had pain before surgery were likely to have less pain following the procedure. Due to the short hospital stay the procedure is suitable as an outpatient procedure.

IntroductionEpidural analgesia is the preferred method to manage pain during labor and delivery. The insertion of the epidural catheter can be complicated by unintentional dural puncture that may result in postdural puncture headache. There is limited evidence on the long-term implications of this complication. We sought to investigate if women who sustained a dural puncture have a higher risk of developing chronic headache, low back pain and visual or auditory impairment.MethodsWe conducted a 1:1 case–control study with women who delivered at our institution from January 2015 to December 2019. Cases were women who received epidural analgesia and sustained an unintentional dural puncture, and controls were women who received epidural analgesia but did not sustain such complication. We matched cases and controls for date of delivery, age, and body mass index. All women completed an online survey with validated questionnaires for diagnosis of chronic headache and chronic back pain. We used dichotomic (yes/no) questions to look for the presence of chronic visual and auditory impairment.ResultsSixty-three case–control pairs were studied. Women who sustained a dural puncture during their epidural catheter insertion had a higher risk of developing chronic headache (14.3%, vs 4.8%, p=0.057, adjusted OR (AOR): 3.67 (95% CI 1.05 to 12.82)) and chronic back pain (39.7% vs 19.1%, p=0.009, AOR: 2.67 (95% CI 1.25 to 5.72)) than women who did not sustain a dural puncture. The incidence of chronic auditory impairment was also higher in the dural puncture group (14.3% vs 1.6%, p=0.01, AOR: 9.98 (95% CI 1.21 to 82.62)).ConclusionsAn unintentional dural puncture during epidural catheter insertion in parturients is associated with increased risk of chronic headache, back pain and auditory impairment.

Background Despite the burden of disease of Respiratory syncytial virus (RSV) infection in children, there are important gaps in knowledge about the potential impact in terms of health as well as social and healthcare resources. The aim of this study was to describe the economic burden of RSV in the first two years of life in Colombia. Methods We conducted a cost-of-illness study, taking a population prevalence-based approach. A decision tree model was constructed with a time horizon of two years. We defined the following outcomes: death, RSV infection with long term complications, RSV with acute complications, RSV without complications. Inpatient and outpatient costs were collected directly from medical invoices of patients who attended a tertiary referral hospital. Results The mean cost per patient with an RSV infection was US$ 178.35 CI 95% (30.7-541.67 US$). The total cost of RSV infection in children less than 2 years in Colombia was US $ 64 443 616 per year (CI 95% US$11 092 902 - US$195 722 867). In the probabilistic sensitivity analysis, the mean cost per patient with RSV infection was only sensitive to changes in the cost of recurrent wheezing, cost of outpatient visits and cost of hospitalizations. Conclusion The infection by RSV in Colombia generates a high economic burden on the health system. Generating comprehensive data on healthcare resource use and costs associated with RSV will help to provide valuable information for the development of cost-effectiveness models, and help guide prevention strategies against RSV.

Recently, the Food and Drug Administration issued a recall for the subcutaneous implantable cardioverter-defibrillator (S-ICD) because of the possibility of lead ruptures and accelerated battery depletion.The aim of this study was to evaluate device-related complications over time in a large real-world multicenter S-ICD cohort.Patients implanted with an S-ICD from January 2015 to June 2020 were enrolled from a 19-institution European registry (Experience from the Long-term Italian S-ICD registry [ELISIR]; ClinicalTrials.gov identifier NCT0473876). Device-related complication rates over follow-up were collected. Last follow-up of patients was performed after the Boston Scientific recall issue.A total of 1254 patients (median age 52.0 [interquartile range 41.0-62.2] years; 973 (77.6%) men; 387 (30.9%) ischemic) was enrolled. Over a follow-up of 23.2 (12.8-37.8) months, complications were observed in 117 patients (9.3%) for a total of 127 device-related complications (23.6% managed conservatively and 76.4% required reintervention). Twenty-seven patients (2.2%) had unanticipated generator replacement after 3.6 (3.3-3.9) years, while 4 (0.3%) had lead rupture. Body mass index (hazard ratio [HR] 1.063 [95% confidence interval 1.028-1.100]; P.001), chronic kidney disease (HR 1.960 [1.191-3.225]; P = .008), and oral anticoagulation (HR 1.437 [1.010-2.045]; P = .043) were associated with an increase in overall complications, whereas older age (HR 0.980 [0.967-0.994]; P = .007) and procedure performed in high-volume centers (HR 0.463 [0.300-0.715]; P = .001) were protective factors.The overall complication rate over 23.2 months of follow-up in a multicenter S-ICD cohort was 9.3%. Early unanticipated device battery depletions occurred in 2.2% of patients, while lead fracture was observed in 0.3%, which is in line with the expected rates reported by Boston Scientific.

Introduction: Diabetes Mellitus is a group of metabolic disorders characterized by rise in blood glucose level. The measurement of Glycated Hemoglobin has been widely used to monitor glycemic control in patients with diabetes mellitus which is also a best marker for monitoring long term complications. As the prevalence of diabetes is increasing day by day, it is mandatory to give importance for self-management. Objectives: The objective of the present study was to compare the levels of estimated HbA1c with calculated HbA1c derived from a simple, cost effective mathematical formula by using fasting plasma glucose. Materials and Methods: The present study comprised of 66 fasting whole blood samples. All the samples were analyzed for Glycated hemoglobin and glucose, using this blood glucose level HbA1c was calculated by a formula, HbA1c = 2.6+0.03 + Blood glucose (mg/dl). Both estimated and calculated values of HbA1c were compared by dependent t-test. Results: It was observed that the mean + SD levels of Estimated HbA1c and Calculated HbA1c were 7.11+1.89 and 6.60+1.58 respectively. The p value was Conclusion: Therefore the study concluded that, there exists a significant difference between the levels of estimated HbA1c and calculated HbA1c and thus this mathematical formula cannot be used interchangeably with estimated HbA1c. Keywords: Glycated hemoglobin (HbA1c), Diabetes mellitus, Fasting plasma glucose.

Type 2 diabetes is a chronic condition associated with long term complications and premature death. It is a leading cause of non-traumatic amputations, renal failure and blindness. With advances in information technology, diabetes patient data are increasingly collated digitally, however, there is no unifi ed minimal dataset agreed nationally or internationally for data collection.

In this prospective nonrandomized multicenter trial, we analyze the incidence of early and late complications after parotidectomy in correlation to the extent of dissection.A total of 148 patients underwent a parotidectomy for a benign lesion in the superficial lobe. The number of intraoperatively dissected main facial nerve branches was photo-documented and defined the extent of tissue dissection. Early postoperative complications including sialocele were evaluated until 4 weeks after surgery. Late complications as facial nerve palsy, Frey's syndrome (FS) and the outcome of the scar and substance loss were furthermore assessed after 6 and 12 months.Early complications occurred in 22 patients (14%) and did not depend on the extent of facial nerve dissection (all P .05). However, patients with higher number of intraoperatively dissected facial nerve branches showed significantly higher palsy scores on the first postoperative day (P = .026). FS occurred with incidence of 69% and correlated significantly to the extent of dissection (P = .003). Appearance of the scar and substance loss improved significantly during the follow-up (P .001 and P ,005, respectively) without significant correlation to the extent of dissection (P .05 for both variables after 12 months).Less extensive tissue dissection resulted in better postoperative facial nerve function on the first postoperative day and in lower incidence of FS after 12 months. However, incidence of early complications did not depend on the extent of surgery. The study was registered in the German Clinical Trials Register prior to conducting the research.DRKS00008967, URL:http://apps.who.int/trialsearch/.

Introduction Pilocytic astrocytoma is the most common brain tumour in childhood but knowledge concerning its long-term outcome is sparse. The aim of the study was to investigate if children treated for low-grade pilocytic astrocytoma in the posterior fossa had complications affecting physical and psychological health, cognitive functions, learning difficulties and HRQoL. Methods A descriptive single-centre study, where 22 children and young adults out of 27 eligible patients (81%) treated for pilocytic astrocytoma, with a mean follow-up time of 12.4 years (5–19 years) participated (14 adults, two by telephone interviews and eight children). The study included a review of medical records, an interview, neurological investigation, screening tools for psychiatric symptoms (Beck Depression and Anxiety Inventories and Beck Youth Inventory Scales) and HRQoL measures (RAND-36). Results Motor complications were most common, reported in 12 patients and mainly affecting fine-motor skills. Seven patients reported cognitive difficulties affecting performance in school. Educational support was given in the period immediately after treatment but not after primary school. None had elevated levels of psychiatric symptoms and the level of HRQoL as well as their psychosocial and educational situation was in correspondence with Swedish norms. The HRQoL score for vitality (VT) almost reached statistical significance. Conclusions The long-term functional outcome for children treated for low-grade astrocytoma is favourable. However, some patients report neurological complications and learning difficulties, which are unmet in school. Therefore, there is a need to identify those who need more thorough medical and cognitive follow-up programmes including interventions in school.

Background: Otitis media is a common pediatric condition that affects most children by their second birthday and untreated cases of otitis media can possibly cause long term complications. This study aimed to evaluate the impact of implementing educational program for mothers about preventing of the recurrent otitis media. Design: Quasi- experimental design was conducted at pediatric ENT outpatient clinic at Zagazig University Hospital on a sample of 118 mothers who had children suffering from otitis media and attending the previously mentioned setting to manage their children. Tools of data collection: Data were collected by using child assessment sheet and structured interview questionnaire for mothers. Results: About one quarter of the studied children had recurrent otitis media once or twice episode per year and less than two thirds their recurrence were four episodes or more per year before program. After implementation of the educational program the children improved as the majority of children had recurrent otitis media once or twice episode per year. Conclusion: There was a positive impact of the educational program in improving mothers' knowledge as well as their reported practices about otitis media as well as on the recurrence of otitis media. Recommendations: Regular and continuous health educational programs are essential for improving the mothers' knowledge and their reported practices regarding their children having otitis media

The paper presents vascular accesses used for the purpose of haemodialysis in patients with end-stage renal disease. The recommendations of the NKF K/DOQI concern performing a first-time permanent access in the form of an autogenous fistula. Attention has been paid to accurate diagnostic imaging of blood vessels. Early and long-term complications of functioning fistulas are presented, together with the manner of their treatment. Dialysis catheters are also described as the only possibility of dialysis in patients with contraindications to the creation of fistulas. Bloodstream infections are the most common complication of dialysis with catheters. An important element of prevention is monitoring the function of catheters, which reduces the need for medical intervention. New solutions improving the functioning of vascular access have also been presented. Careful use of vascular access, as well as fistula and catheter site function monitoring, contributes to extending the lifespan of an access and reduces complications.

Emergence of nanoparticulate drug delivery systems in diabetes has facilitated improved delivery of small molecule drugs which could dramatically improve the quality of life for diabetics. Conventional dosage forms of the anti-diabetic drugs exhibit variable/less bioavailability and short half-life, demanding frequent dosing and causing increased side-effects resulting in ineffectiveness of therapy and non-compliance with the patients. Considering the chronic nature of diabetes, nanotechnology-based approaches are more promising in terms of providing site-specific delivery of drugs with higher bioavailability and reduced dosage regimen. Nanomedicines act at the cellular and molecular levels to enhance the uptake of the drug into the cells or block the efflux mechanisms thus retaining the drug inside the cell for a longer duration of time. Many studies have hinted at the possibility of administering peptide drugs like glucagon like peptides orally by encapsulation into nanoparticles. Nanoparticles also allow further modifications including their encapsulation into microparticles, polyethylene glycol (PEG)-PEGylation- or functionalization with ligands for active targeting. Nevertheless, such remarkable benefits are fraught with their long-term safety concerns, regulatory hurdles, limitations of scale-up and ineffective patent protection which have hindered their commercialization. This review summarizes the latest advances in the area of nanoformulations as applied to the delivery of anti-diabetics. STATEMENT OF SIGNIFICANCE: The present work describes the latest advancements in the area of nanoformulations for anti-diabetic therapy along with highlighting the advantages that these nanoformulations offer at molecular level for diabetes. Although several potent orally active anti-hyperglycemic agents are available, the current challenges in efficient management of diabetes include optimization of the present therapies to ensure an optimum and stable level of glucose, and also to reduce the occurrence of long term complications associated with diabetes. Nanoformulations because of their high surface area to volume ratio provide improved efficacy, targeting their delivery to the desired site of action tends to minimize adverse effects and administration of peptide drugs by oral route is also possible by encapsulating them in nanoparticles. As we reflect on the success and failures of latest research on nanoformulations for the treatment of diabetes, it is important not to dwell on lack of FDA approvals but rather define future directions that guarantee more effective anti-diabetic treatment. In proposed review we have explored the latest advancement in anti-diabetic nanotechnology based formulations.

Összefoglaló. Bevezetés: 70 éves férfi beteg kóros kövérség (BMI: 50,1) miatt 2005-ben gyomorgyűrű beültetésben részesült. 2020 decemberében hasfali phlegmone hátterében igazolt port infekció miatt más intézetben subcutan incisió, lavage történt. CT-vizsgálattal, majd gasztroszkóppal a gyomorgyűrű arrosióját, intramurális elhelyezkedését igazoltuk. A műtét során laparoszkópos technikával a gyomor corpus nagygörbületén ejtett, kb. 2 cm nagyságú nyíláson keresztül távolítottuk el a gyűrűt. A beteg szövődménymentesen került emisszióra. Megbeszélés: Mintegy 20 évvel ezelőtt a laparoszkópos állítható gyomorgyűrű (LAGB) rendkívül népszerű volt. A LAGB azonban számtalan rövid és hosszú távú szövődménnyel jár, ezért egyre inkább kikerül a bariátriai sebészet tárházából. A gyűrű arrosiója ritka, súlyos szövődmény. Eltávolításának többféle módja lehet. A gyomorgyűrű eltávolítása általában a testsúly jelentős növekedésével jár. A betegeknél konverziós bariátriai műtétet, laparoszkópos gyomor sleeve reszekciót, vagy gyomor bypass műtétet lehet végezni. Summary. Introduction: Extreme obese (BMI: 50.1) 70 year old male patient after LAGB procedure in 2005, with abdominal wall and port infection underwent subcutaneous incision drainage of the area in December 2020. CT and Gastroscopy confirmed gastric penetration and intramural position of the Band. Using laparoscopic approach with incision of 2 cm of the stomach at the gastric greater curvature the band had been removed. Patient had been discharged without any complications. Discussion: LAGB was a very popular bariatric approach at the first decade of laparoscopic bariatric surgery. The increased incidence of short and long term complications reduced worldwide the number of LAGB procedures. Band penetration is a rare but dangerous complication. Laparoscopic removal is recommended. Usually, the intervention is followed by significant weight gain which can be treated with conversion of LAGB to Sleeve Gastrectomy or LGBP procedure.