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Background: The effect of weekend admission and surgery on patient morbidity and mortality has been studied in many settings and has been shown to lead to worse outcomes. Several studies have sought to determine whether there is a weekend effect in kidney transplantation specifically, but a clear effect on outcomes and graft survival has not been established. Methods: We analyzed data from all deceased-donor organ procurements and cadaveric kidney transplants occurring during the 5-year period between Apr. 1, 2013, and Dec. 31, 2017, included in the database of the Trillium Gift of Life Network, Ontario's organ and tissue donation agency. Results: A total of 1116 deceased donor nephrectomies (DNs) and 1858 recipient procedures were performed in Ontario during the study period. The overall rate of after-hours DNs on weekdays was significantly greater than during working hours (23.1/30 d v. 15.4/30 d, p < 0.001). Donations after neurological determination of death were more frequent during weekday working hours (22.8/30 d) than after hours on weekdays (17.3/30 d, p < 0.001) or weekends (16.3/30 d, p < 0.001), whereas donations after cardiac death were significantly more frequent after hours on weekdays than during working hours (10.3/30 d v. 7.7/30 d, p = 0.021). On weekdays, mean warm ischemia time (WIT) was significantly longer after hours than during working hours (40.75 [+ or -] 12.26 min v. 38.52 [+ or -] 11.92 min, p = 0.017). Similarly, mean WIT was longer after hours than during working hours on weekends (40.23 [+ or -] 12.48 min v. 38.59 [+ or -] 11.91 min, p = 0.015). Conclusion: Kidney transplantations occurred more frequently after hours and were associated with increased WIT. Further study is needed across multiple Canadian centres to better understand the temporal patterns of kidney transplantation and implications for patients, providers, and health care systems. Contexte : Plusieurs tudes r alis es dans diff rents milieux ont r v l que la morbidit et la mortalit taient plus lev es chez la patient le quand les admissions et les chirurgies avaient lieu la fin de semaine. Certaines tudes ont voulu d terminer si un tel effet s'observe dans le cas des transplantations r nales sp cifiquement; or, aucun impact clair sur l'issue de l'intervention ou la survie du greffon n'a t confirm . M thodes : Nous avons analys les donn es relatives tous les pr l vements d'organes effectu s sur des personnes d c d es et aux greffons r naux provenant de cadavres inscrits au registre du R seau Trillium pour le don de vie, l'agence ontarienne charg e de coordonner les dons organes et de tissus, pendant la p riode de 5 ans allant du [1.sup.er] avril 2013 au 31 d cembre 2017. R sultats : En tout, 1116 n phrectomies sur des donneurs d c d s (NDD) et 1858 transplantations r nales ont t r alis es en Ontario pendant la dur e de l' tude. Le taux global de NDD a t significativement plus lev apr s les heures normales en semaine que durant les heures normales (23,1/30 j c. 15,4/30 j, p < 0,001). Les dons apr s d termination de la mort neurologique ont t plus fr quents durant les heures normales en semaine (22,8/30 j), qu'apr s les heures normales en semaine (17,3/30 j, p < 0,001) ou les fins de semaine (16,3/30 j, p < 0,001), tandis que les dons suivant la mort cardiaque ont t beaucoup plus fr quents apr s que durant les heures normales en semaine (10,3/30 j c. 7,7/30 j, p = 0,021). En semaine, la dur e moyenne de l'isch mie chaude a t significativement plus longue apr s que durant les heures normales (40,75 [+ or -] 12,26 min c. 38,52 [+ or -] 11,92 min, p = 0,017). Et de m me, les fins de semaine, la dur e moyenne de l'isch mie chaude a t plus longue apr s que durant les heures normales (40,23 [+ or -] 12,48 min c. 38,59 [+ or -] 11,91 min, p = 0,015). Conclusion : Les transplantations r nales ont plus souvent eu lieu apr s les heures normales et ont t associ es un temps d'isch mie chaude plus long. Il faudra approfondir la recherche aupr s de plusieurs centres canadiens pour mieux comprendre les modes de coordination des tapes de la transplantation r nale et leurs r percussions sur la patient le, sur le corps m dical et les syst mes de sant ., Transplantation is the gold-standard treatment for end-stage renal disease (ESRD). (1) All transplantation options--living donor, donation after cardiac death (DCD), and donation after neurologic determination of death (NDD)--are associated with [...]

: AIMS: Primary spontaneous pneumothorax (PSP) is a sudden pleural disease predominantly affecting healthy adolescents and young adults, making it a prevalent thoracic disorder within this demographic. This study evaluated the necessity of preoperative chest tube insertion for PSP patients and reassessed current clinical practices. METHODS: We conducted a retrospective analysis of medical records for individuals aged 14-30 years diagnosed with PSP who underwent video-assisted thoracoscopic surgery (VATS) at Wonju Severance Christian Hospital from January 2016 to December 2022. Patients were categorized retrospectively into two groups based on their initial treatment: Those who had a chest tube inserted and those who did not. We collected and compared clinical data, including demographics, treatment specifics, and outcomes. RESULTS: The study included 128 PSP cases. There was no difference in preoperative clinical data between the two groups, and there were no differences in operation time, number of wedge resections, and number of mechanical pleurodesis. However, the use of single-port surgery was significantly higher in the nonchest tube group (P = 0.001). The nonchest tube group had a significantly shorter hospital stay (P < 0.001), attributed to the absence of preoperative chest tube insertions. There were no significant differences in postoperative complications or recurrence rates between the groups. CONCLUSIONS: In young PSP patients, proceeding directly to VATS without prior chest tube insertion in stable individuals does not lead to serious complications or negatively affect outcomes. This approach may offer an effective alternative for PSP management. Keywords: Chest tube, pneumothorax, recurrence, video-assisted thoracoscopic surgery, Author(s): Chang Wan Kim [1]; Il Hwan Park [1]; Chun Sung Byun (corresponding author) [1] Primary spontaneous pneumothorax (PSP) is a pleural condition that abruptly impacts healthy adolescents and young [...]

* Context.--Infection-related glomerulonephritis (IRGN) usually manifests as a proliferative immune-complex glomerulonephritis. The degree of renal dysfunction at presentation can vary. Association with histologic features on kidney biopsy remains unknown. Objective.--To study the correlation between renal function in IRGN at the time of biopsy and the severity of histologic features. Design.--Culture-proven IRGN cases at our facility were included and divided based on estimated glomerular filtration rate (eGFR) 15 ml/min/1.73 [m.sup.2]. Patients' demographic and pathologic findings were obtained from electronic medical records and kidney biopsy reports. Results.--In total, 104 cases were diagnosed with IRGN on biopsy (mean age, 55.6 6 15.6 years; male, n = 79 [76%]; median eGFR, 14.5 mL/min/1.73 [m.sup.2]), and 51 of 104 showed eGFR Conclusions.--Particular attention to the extent of RBC casts on kidney biopsy is recommended in patients with IRGN because these portend worse renal dysfunction, more so in patients requiring anticoagulation (including for hemodialysis) because they are especially vulnerable to developing anticoagulant-related nephropathy., The prevalence of Staphylococcus infection-related glomerulonephritis (SAGN) has progressively increased, especially in the Western world. (1-4) Elderly patients with diabetes mellitus and other comorbidities are more prone to develop SAGN, [...]

Background and Aims: The autonomic nervous system (ANS) is cardinal for systemic homeostasis. Autonomic dysfunction is prevalent in as high as 65% of patients presenting for cardiac surgery in the Indian scenario. Pre-existing cardiac autonomic dysfunction (CAD) in surgical patients can accentuate perioperative haemodynamic fluctuations during stressful intraoperative events, predispose to adverse cardiac events, and contribute to morbidity and mortality. The prevalence and predictors of CAD in the elective neurosurgical population are unknown in the Indian scenario. The current study was conducted to bridge this knowledge gap. Methods: In this single-centre prospective observational study conducted at a tertiary care neurosciences centre, among 400 consenting adult patients of either gender, between 18 and 80 years of age, undergoing elective neurosurgery, the preoperative ANS function at the bedside was assessed as the primary outcome measure. The ANS status was evaluated using ANSiscope™-derived indices of heart rate variability. The diagnosis of CAD was made when the ANS index exceeded a threshold of 13.5. Data regarding predictors of CAD were collected from patient records as the secondary outcome measure. Statistical analysis was done using the R software. A P-value of Results: The prevalence of preoperative CAD in our study population was 79.7% (319/400 patients). None of the demographic and baseline clinical characteristics we studied predicted CAD in our study. Conclusion: We observed a significant prevalence of preoperative CAD among elective neurosurgical patients. None of the parameters we evaluated predicted CAD in our study. Keywords: Dysautonomia, neurosurgery, perioperative, prevalence, Author(s): RP Sangeetha [1]; Dhritiman Chakrabarti [1]; Kamath Sriganesh (corresponding author) [1]; Musumur Mahendranath [1]; Sathyaprabha TN [2]; Dwarakanath Srinivas [3] INTRODUCTION The autonomic nervous system (ANS) is crucial for [...]

Author(s): Sonia Bansal [1]; Dhritiman Chakrabarti [1]; Parthiban Giribabu [1]; Kamath Sriganesh (corresponding author) [1]; Dhaval Shukla [1] INTRODUCTION Few patients with coronavirus disease 2019 (COVID-19) manifest new or persistent [...]

Toxoplasmosis, caused by Toxoplasma gondii, has the unsettling ability to infect nearly every warm-blooded vertebrate. When transmitted from mother to fetus during pregnancy, it can lead to congenital toxoplasmosis in newborns, which may have severe and even fatal outcomes. Moreover, this parasite is a significant cause of reproductive issues in cattle. The aim of this literature review was to compile and synthesize information on the epidemiology and clinical features of naturally occurring Toxoplasma gondii infections in both humans and animals, as well as to assess the occurrence of oocysts in the environmental matrices in Morocco. To achieve these objectives, data were sourced from four electronic databases: PubMed, Web of Science, Scopus, and Google Scholar. A total of 32 articles published between January 1, 2000, and January 31, 2024, met the inclusion criteria. The findings indicated that the seroprevalence of T. gondii among pregnant women varied by city and appeared to be lower in drier climates. The study identified several risk factors associated with T. gondii infection among women in Morocco, including direct contact with soil, failure to wash fruits and vegetables before eating, limited education, and reliance on well water for drinking. Moreover, there is a limited amount of serological data on T. gondii in animals. In Morocco, the prevalence of this parasite can reach up to 30% in sheep, while it stands at 8.5% in cattle and goats. Leafy greens are particularly prone to hosting pathogens and are associated with foodborne outbreaks. In Morocco, the prevalence of T. gondii in leafy vegetables is around 16%, although soil analyses have not found any oocysts. This review offers a thorough epidemiological overview of T. gondii infections in Morocco, serving as a valuable resource for researchers and aiding in the development of control and prevention programs. Keywords: Toxoplasma Gondi, Humans, Animals, Environment, Morocco, Author(s): Ilham Atif[sup.1], Oulaid Touloun[sup.1] and Samia Boussaa[sup.2] Background Toxoplasma gondii (T. gondii) is an Apicomplexa protozoan first documented in 1908 by Nicolle and Manceaux at the Pasteur Institute in [...]

Introduction: A significant gap exists in the understanding and utilization of medical marijuana and its effects on a patient's quality of life. This is largely attributed to Cannabis' sp. Schedule 1 classification, which has impeded the scientific investigation of its effects on the endocannabinoid system (ECS) and quality of life. Additionally, conflicting results from previous studies highlight the need for more research to provide guidance to both patients and clinicians regarding the therapeutic potential of medical marijuana. Methods: Patients over 18 years of age who were members of the Pennsylvania Medical Marijuana Program (PAMMP) were recruited from regulated Pennsylvania medical marijuana dispensaries. Eligible patients were enrolled through informed consent, following a study design that received approval from the LECOM Institutional Review Board (IRB). Over 90 days, participants were remotely administered an electronic survey every 30 days to collect medical marijuana use patterns and assess changes in quality of life. Results: Of the 103 participants who completed the study, significant improvements were observed in physical and social functioning, emotional well-being, and energy levels within the first 30 days. Participants reported significant decreases in emotional limitations, fatigue, and pain levels. Notably, participants who used inhaled or vaped products (defined as vape cartridges and concentrates) were younger and exhibited a significantly higher increase in emotional well-being scores compared to those who used flower products (defined as dry leaf only). Participants who consumed medical marijuana for opioid use demonstrated significantly higher THC consumption compared to those seeking treatment for anxiety, chronic pain, or inflammatory bowel disease (IBD). Improvements in the first 30 days also remained constant for the remainder of the study. Discussion: This study contributed valuable insights into the effects of medical marijuana on quality of life and highlighted potential benefits associated with its use. Moreover, ongoing research aims to assess the observed sustained improvements beyond 90 days, investigating potential long-term trends. While further research is needed to explore the underlying mechanisms of action and long-term effects of medical marijuana, clinicians and patients can gain a better understanding of medical marijuana's therapeutic potential, enabling more informed decisions regarding its use in clinical settings. Keywords: THC, Cannabis, Medical Marijuana, Pennsylvania Medical Marijuana Program, Quality of life, Author(s): Mark D. Kelley; Marwah Obaid; Edward M. Miller; Marla Bowie; Zachary S. Heeter Introduction In the early 20th century, reports of cannabis' inconsistent efficacy and psychoactive effects in recreational [...]

Purpose Effective treatment options for patients with hypernatremia are limited. Free water administration (parenterally or enterally) is the mainstay of treatment but the impact of each strategy on lowering serum sodium (Na) is not known. The purpose of the study was thus to assess the effectiveness of enteral free water vs. parenteral dextrose 5% in water (D5W) in treating ICU-acquired hypernatremia. Methods An electronic medical record-based, retrospective cohort study was conducted in a 30-bed mixed medical-surgical intensive care unit (ICU) in Japan. All adult patients admitted to the ICU from August 2017 to July 2021 were reviewed. After a 2-step exclusion, patients who stayed in the ICU [greater than or equal to] 24 h and received either or both treatments for ICU-acquired hypernatremia (Na [greater than or equal to] 145 mEq/L) constituted the study cohort. The primary outcome was a change in serum Na during the 24 h before treatment each day ([DELTA]Na); the secondary outcomes were gastrointestinal complications, serum glucose levels, ICU/hospital mortality, ICU/hospital length of stay, and the duration of mechanical ventilation. Repeated measurements on each patient were addressed using a generalized estimated equation (GEE) for multiple linear regression analysis. Analysis was conducted with R version 4.0.3. Results In total, 256/6596 (131: D.sub.5W, 125: enteral free water) patients were analyzed. Median treatment lasted 6 days [3-17] for the D.sub.5W group vs 7 days [3-14] for the enteral free water group with a total median daily treatment volume of 799 [IQR 299-1221] mL vs. 400 [IQR 262-573] mL. GEE multiple linear regression analysis showed an estimated mean [DELTA]Na per liter of treatment fluid of - 2.25 [95% CI - 2.76 to - 1.74] mEq/L per liter of parenteral D.sub.5W vs. - 1.91 mEq decrease [95% CI - 2.75 to - 1.07] per liter of enteral free water. Hydrochlorothiazide was the only medication associated with a statistically significant negative [DELTA]Na by- 0.89 [- 1.57 to - 0.21] mEq/L. There were no significant inter-group differences for secondary outcomes. Conclusions These results suggest that both enteral free water and parenteral D.sub.5W are effective for treating ICU-acquired hypernatremia. Parenteral D.sub.5W was slightly more effective than enteral free water to lower serum Na levels in patients with ICU-acquired hypernatremia. Trial registration Not applicable., Author(s): Reina Suzuki [sup.1], Shigehiko Uchino [sup.1], Yusuke Sasabuchi [sup.2], Alan Kawarai Lefor [sup.3], Junji Shiotsuka [sup.1], Masamitsu Sanui [sup.1] Author Affiliations: (1) grid.410804.9, 0000000123090000, Department of Anesthesiology and Critical [...]

Background: There has been a significant increase in the incidence of recurrent, resistant, and extensive dermatophyte infections worldwide recently. This menace has spurred the need for more well-designed randomized controlled trials to optimize the treatment of dermatophyte skin infections. One of the limitations in designing such studies is the limited availability of standard and validated score, to measure the severity of dermatophyte infections. Aims: To create a severity score for the evaluation of dermatophyte infections. Materials and Methods: A Delphi consensus model was used to frame a severity scoring tool for superficial dermatophyte skin infections. Fourteen experts participated in the first round and twelve experts participated in the second round. Results: Based on the expert consensus, a final scoring system proposed was: Final Severity Score (FSS) = Sum total of Body Surface Area (BSA) in hand units for each patch multiplied by the sum of the scores for pruritis (P), lichenification (L), and actively raised borders (A) for each patch (FSS = BSA in hand units x (P + E + L + A) of patch 1 + BSA in hand units x (P + E + A) of patch 2 …etc.). For measuring hand units more accurately fractional values of 0.25 can be used (0.25 corresponding to an approximate 1/4[sup.th] of a hand unit). A score of +1 will be added in case of the following - 1) Close contact/family member affected, 2) History of at least one recurrence in the previous 6 months after a course of oral antifungals, 3) History of immunosuppression (on immunosuppressive medication or having underlying immunosuppressive disease). The scores will be valid only if the patient has not used any treatment topical or systemic, for at least 2 weeks before enrolment. Conclusion: The proposed Dermatophytosis Area and Severity Index (DeASI) score will help the physicians and researchers standardize the treatment protocol for dermatophytosis, henceforth, assessing the response to therapy. This will also help to standardize the parameters of effectiveness while designing any clinical trial. Keywords: Delphi, dermatophyte infections, severity score, Author(s): Feroze Kaliyadan [1]; Anupam Das (corresponding author) [2]; Karalikkattil T. Ashique [3]; Puravoor Jayasree [4]; Maitreyee Panda [5]; Saumya Panda [6]; Manas Chatterjee [7]; Mahdi Al Dhafiri [8]; Preethy [...]

Stunting currently affects 37% (1.1 million) of Malawian children and causing unfavorable impact for both children and their households. Identifying risk factors to stunting would go a long way in developing appropriate interventions. The objective of this study was to identify the risk factors of stunting among children aged below 60 months from Balaka, Dedza and Mzimba districts in Malawi. A matched cross-sectional case-control study was conducted among 913 (446 controls; 467 cases) children aged below 60 months from three regions of Malawi. Household demographic, anthropometric measurements, dietary intake, food security, and morbidity information were collected. Case-Control Stepwise multiple logistic regression models are used to determine risk factors of stunting. The following were identified as risk factors for stunting including; age of child (AOR= 6.3; 95% CI: 2.9, 8.9), polygamy (AOR= 8.9; 95%, CI: 3.3, 13.03), maternal education (AOR= 9.9; 95%, CI: 2.8, 20.1), access to markets (AOR= 1.3; 95%, CI: 0.2, 2.4), childhood infections (AOR= 2.11; 95%, CI: 1.4, 4.2) and presence of oedema (AOR= 2.5; 95%, CI: 1.3, 4.1). Also, lack of food any month (AOR= 1.31; 95%, CI: 1.01, 4.9), purchasing food on credit (AOR= 1.48; 95%, CI: 1.4, 1.7), begging for food (AOR= 1.55; 95%, CI: 1.2, 2.1), mothers or caregivers consuming less than 5 food groups (MDD-W) (AOR = 4.83; 95% CI: 1.9, 16.4), exclusive breastfeeding (AOR= 5.45; 95%, CI: 4.33, 7.61) children weaned on plain water (AOR= 1.6; 95%, CI: 1.6, 2.41), powdered milk (AOR= 0.63; 95%, CI: 0.4, 1.32), juices (AOR= 0.44; 95%, CI: 0.12, 0.96) and children fed on sugary food (AOR= 0.66; 95%, CI: 0.4, 0.99) were significantly related to stunting. Stunting is associated with increasing age of children, boys, polygamous households, lack of education by mothers or caregivers, inaccessible markets, childhood infections and presence of oedema, food insecurity, breastfeeding and complementary feeding among children and dietary diversity of mothers or caregivers. These results suggest that interventions against childhood stunting should be designed according to the factors that significantly affect stunting. Key words: child growth, Malawi, stunting and complementary feeding, Regression, Food Security and Health, INTRODUCTION Childhood stunting is one of the most serious health problems faced by most sub-Saharan African countries, including Malawi. Globally, Africa is the only region, where the number of stunted [...]